Solutions for better, safer, faster dental care Dentsply and Sirona have joined forces to become the world’s largest provider of professional dental solutions. Our trusted brands have empow- ered dental professionals to provide better, safer and faster care in all fields of dentistry for over 100 years. However, as advanced as dentistry is today, together we are committed to making it even better. Everything we do is about helping you deliver the best possible dental care, for the benefit of your patients and practice. Find out more on dentsplysirona.com
Filtek ™ Universal Restorative What if a composite could make your busy days easier?
6 INTERVIEW Dental Tribune Middle East & Africa Edition | 6/2019 Printing the future Interview with Rik Jacobs about the rise of 3D printing in dentistry By 3D Systems The 21st century has not turned out exactly as predicted by the science fi ction writers of the past. There aren no fl ying cars fi lling the skies or robots walking the streets, but there are devices in our homes, like Amazon’s Alexa, which listen for our voices and carry out our commands. Companies like Boston Dynamics have taken impressive steps towards creating eerily lifelike robots and the US Navy is even testing incred- ibly precise laser weapons onboard its ships. 3D printing is also seeing a massive expansion in its applica- tions, from the inspiring printing of functioning human organs to the more sinister ability to download and create working fi re-arms. But where does dentistry fi t into this? Dentistry is currently undergoing a fundamental move towards digital workfl ows, with digital scanning, design, compatible materials and 3D printing all set to become essential parts of providing oral healthcare in the future. 3D printing especially has the capacity to largely democratise the production process of many den- tal appliances, and dentistry is one of the areas best suited to take advan- tage of the advances the technology allows for. The largest 3D printing operation in the world is carried out for Align Technology Ltd, well known in the dental industry as the creator of the Invisalign clear aligner, who utilise 3D Systems' 3D printers to print over 359,000 unique retainers every day. 3D Systems, a company co-founded by the inventor of the 3D printing process, Chuck Hull, in 1986 has clearly recognised the potential of the dental industry and recently released the NextDent5100. I spoke with Rik Jacobs, vice-president of 3D Systems’ dental business, to get his views on the past, present and future of the technology. Rik didn’t study dentistry, instead opting to study international mar- keting management. He became active in the dental sales and mar- keting sphere around 20 years ago where he sold polymers and mono- mers, materials which he also sold for the hearing aid market. Explaining this, Rik said, “I wasn’t at the forefront in the hearing aid market in those days. That market transformed from analogue into digital over a period of two or three years between 2007 and 2009, and I learned my lesson. When digital technology came to dental I wanted to be at the forefront, so I went back to school in 2009 and learnt eve- rything I could about 3D printing.” Rik was privy to how quickly digital technologies came to dominate one market and didn’t want to miss out on the next. This affected his ap- proach to the dental market, and in 2012 he co-founded NextDent, which focused on reformulating existing polymers into printable, biocom- patible materials which would pass regulations. Creating printable and biocompat- ible materials was essential for the progression of 3D printing, and the concept attracted interest from big players in the market. NextDent was acquired by 3D Systems in January 2017. As Rik explained however, there wasn’t always a belief in the uses of 3D printing for dental applications. He elaborated, “People still had some hesitations and questions about the durability of the materials even fi ve years ago; they weren’t sure that you could print crowns or dentures that would stay in a patient’s mouth for very long. Back then a few things still needed to happen to make 3D printing viable in dentistry; soft- ware companies needed to develop software design solutions, materials needed to be proven and more ad- vanced 3D printers needed to be de- veloped. I was convinced it could be done but people were very cautious, so it was only in 2018, when we were able to combine all these factors, that there was a real tipping point for 3D printing.” Digitalisation in the dental profes- sion and industry is an oftdiscussed topic that most agree will come to defi ne dentistry in the near future. Every dentist will be able to fi nd a personal use for some piece of digital technology, but the same isn’t neces- sarily true of a 3D printer. 3D printing’s relationship to the digital dental revolution is impor- tant however, and I asked Rik about what role the technology plays. He said, “Most dentists will fi nd a use for an intraoral scanner as a more accurate and convenient alternative to analogue impression materials, but what gets done with that scan af- terwards is important. If the patient needs a denture the dentist can send the scan to a lab so that a denture could be designed and printed, or with a 3D printer the dentist could print the denture themselves in their practice. Completely new business models are coming into the market with this technology. A one-surgery practice probably won’t have much use for a 3D printer, for example, but An example of a 3D printed dental splint. Rik Jacobs, vice-president of 3D Systems' dental business. even the smallest of practices will benefi t from outsourcing to a lab with a printer because of the higher speeds, accuracy and lower cost.” Rik explained that 3D Systems primarily sell their printers and materials to labs, but that dental practices inter- ested in keeping some of their pro- duction in-house are increasingly purchasing 3D printers. As complicated pieces of equipment, learning to use 3D printers to their fullest can require a fairly signifi cant amount of training. Rik explained, “3D printing can sound a little too good to be true, but we’re sometimes faced with people that think they can start using their printer without any training and expect great results; if you put rubbish into the printer, you’ll get rubbish out. That’s some- thing I’m always explaining and em- phasising.” 3D printing is sure to play an impor- tant part in the digital future of den- tistry, and as materials become more and more advanced the applications of the technology will only grow. But printers in labs and in practice are already changing dental workfl ows, with labs able to provide faster, more reliable and very precise end prod- ucts with incredible effi ciency. The future may not end up being characterised by a deluge of sci-fi ro- bots and lasers, but there’s no doubt that 3D printing will play an incred- ibly important role in the increas- ingly digital profession of dentistry. Rik Jacobs, The Netherlands Rik Jacobs is a founder and the former CEO of NextDent B.V. The company was founded in 2012 in the Netherlands as an independent subsidiary of Vertex Global Holding to complement the dental mate- rials portfolio of its afﬁ liate Vertex-Dental B.V., which has a 77-year track record in developing and producing traditional denture materials and products. Within four years, NextDent became the lead- ing developer and manufacturer of bio- compatible dental 3D printing materials. In January 2017, Vertex Global Holding merged with 3D Systems, a company that provides comprehensive Additive Manu- facturing products and services, includ- ing 3D printers speciﬁ cally designed for dental applications, print materials, on- demand parts services and digital design tools. Upon this merger, Rik became the VP, General Manager of the Dental busi- ness. He holds a degree in International Marketing Management from NHL Uni- versity of Applied Science.
ZirCAD MT Multi The most esthetic high-strength, multi-translucent1 zirconia All ceramic, all you need. 1 Composed of different material classes www.ivoclarvivadent.com Ivoclar Vivadent AG Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60
10 INDUSTRY Dental Tribune Middle East & Africa Edition | 6/2019 COMBI touch The all in one in prophylaxis By Mectron S.P.A. The COMBI touch combines ultra- sound and air-polishing in one unit to provide a complete prophylaxis treatment from removal of supra- gingival and subgingival calculus to gentle removal of stain and biofi lm and even implant cleaning. Thanks to the ergonomic touch pan- el, allows to control every function as fast and intuitive as never before and at the same time clean and disinfect the device in literally no time. The ultrasound unit, thanks to its “SOFT-MODE” function, allows for ultra-gentle scaling, which reduces the insert's oscillation amplitude, rendering its motion compatible with even the most sensitive of pa- tients. While also guaranteeing op- timal performance with prosthetics and extractions treatments thanks to the “pulse mode” function trans- forming the ultrasound oscillation to a new profi le. The air-polishing unit allows for the use of different types of powder (supra- or subgingival), depending on the desired treatment type. The greatest advantage is the ability to manage the use of both powders on the same patient with a simple click. Furthermore, it is not necessary to change the air-polishing handpiece. Instead, simply insert any one of the 3 available spray nozzles with differ- ent orientation (120°, PERIO and the optional 90°), COMBI touch technol- ogy made it possible for the operator to decontaminate the oral cavity in an effective manner, with the ad- vantage of being able to work in an ergonomic fashion, easily reaching all necessary sites. The greatest advantage for the op- erator, therefore, is that the technol- ogy provides a complete set of tools for effective, fast and minimally invasive Non Surgical Periodontal Therapy, even in periodontal pock- ets deeper than 5 mm, thanks to the dedicated subgingival perio tips simply attached to the PERIO noz- zle. Soft, fl exible, and anatomically adjustable to the periodontal pocket, this tip gentle removes bacterial bio- fi lms from the periodontal and peri- implant pockets. This new combined technique al- lows the operator to obtain an excel- lent clinical result, with an advantage in the timing of the procedure much appreciated by patients. Device maintenance is fast and sim- ple, thanks to containers that can be removed without having to switch off the device, and an exclusive an- ti-clogging system for the powder. What's more, it can either be hooked up to the offi ce’s regular water sys- tem or used with a 500ml external bottle. For more information contact: mectron S.P.A. Via Loreto, 15/A 16042 Carasco (GE) – Italy Tel: +39 0185 35361 Fax: +39 0185 351374 E-mail: firstname.lastname@example.org Web: www.mectron.com COMBI touch Flow variations The ﬂ ow variant of the universal composite BRILLIANT EverGlow makes ﬁ lling extremely simple By COLTENE Undercuts, sharp angles or cervi- cal bevels present particular chal- lenges when placing conventional composites. Therefore clinicians will benefi t substantially from an inno- vative dental material with an opti- mal thixotropic property and allows effortless positioning. The fl owable consistency is particularly suited for treating areas with diffi cult access and saves valuable treatment time. Rapid, voidless fi llings To complete the classical presenta- tion form, the Swiss dental special- ist COLTENE additionally offers its BRILLIANT EverGlow submicron universal composite in a fl owable variant. The low viscosity fi lling ma- terial combines convenient appli- cation with high stability. Among other things, BRILLIANT EverGlow Flow is ideally suited for fi lling ar- eas with diffi cult access as well as for sealing fi ssures. Due to its fl ow properties, the restorative material fully comes into its own when fi lling cavity linings. The fl ow variant can be applied directly from the syringe to the bonded surface which saves material and time. The composite, which fl ows under pressure, can then be comfortably brought into the required position until curing. BRILLIANT EverGlow Flow The exceptionally smooth consist- ency of BRILLIANT EverGlow high performance composite has already captivated many clinicans. Owing to its sophisticated composition of special fi llers, the pliable material can be applied easily into all classes of cavities without sticking to the in- strument. Not only that, it has long gloss stability and excellent polish- ability. BRILLIANT EverGlow Flow, a user-friendly and highly aesthetic fl owable, rounds off the programme. Depending on the indication, den- tists can in future choose a suitable variant from the extended product range. BRILLIANT EverGlow Flow The versatile fi lling material is avail- able from dental wholesalers in a 2g syringe. Next to six universal shades, the fl owable variant is also available in a translucent enamel shade and an opaque material in shade A2. As usual, the assortment includes shades in the sophisticated "Duo Shade" system which cover two classical VITA shades in one, ranging from A1/B1 to A4/C4. For further information, please contact: Coltène/Whaledent AG Feldwiesenstrasse 20 9450 Altstätten SG Switzerland
Enduring gloss – made brilliant BRILLIANT EverGlow® Universal Submicron Hybrid Composite Ò Outstanding polishability and gloss retention Ò Brilliant single-shade restorations Ò Ideal handling through a smooth consistency Ò Good wettability on the tooth surface email@example.com | P +41 71 757 54 40 . 9 1 0 1 6 8 0 5 0 0
12 INDUSTRY Dental Tribune Middle East & Africa Edition | 6/2019 Tight contacts are just the beginning – Dr Laura Beresford Pratt PROPER EXECUTION OF EACH STEP OF THE CLASS II PROCEDURE IS ESSENTIAL FOR SUCCESS. By addressing the most vulnerable interface and delivering esthetic results eﬃciently, you can be more conﬁdent that the result will positively impact patient experience and the bottom line of your business. DENTAL PROFESSIONALS’ PRIMARY CONCERNS WHEN PERFORMING POSTERIOR RESTORATIONS1 : 82% CLINICAL LONGEVITY 81% MARGINAL INTEGRITY 53% ADAPTION 40% ESTHETICS 30% TIME CONSUMPTION 0 0 1 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 17% PROFITABILITY THE MOST VULNERABLE INTERFACE Studies show that the #1 reason for composite failures is recurrent caries. Dentsply Sirona products work together to protect the ﬂoor of the proximal box, the most vulnerable interface.2 Protect it with the power of three proven products. 1. ISOLATE the restorative ﬁeld with a tight gingival seal - 2. CREATE a strong bond with an adhesive that gives you the ﬁrst step in protecting the high bond strength and low ﬁlm most vulnerable interface. thickness. Palodent® V3 Sectional Matrix System Prime&Bond universal™ Universal Adhesive 3. MAINTAIN marginal integrity while also achieving excellent cavity adaptation. SDR® Plus Posterior Bulk Fill Flowable Base EFFICIENT ESTHETICS Achieve eﬃcient esthetics with a simpliﬁed shade selection process, and ﬁnishing in a single step. Eﬃcient esthetics is where artistry and eﬃciency meet. Deliver smooth, contoured surfaces and simpliﬁed shade matching for your Class II restorations. FINISHING AND POLISHING make up 14% of total chair time for a Class II procedure.3 RESTORATIONS THAT LAST Clinicians can increase the longevity of Class II restorations with proper ﬁnishing technique.4 APPEARANCES MATTER More than 80% of patients are reportedly aware of color diﬀerences between restored and adjacent natural teeth.5 SIMPLIFY shading and preferred handling, for lifelike results in less time. FINISH and improve your likelihood of success while saving time. ceram.x® SphereTEC™ one Universal Nano-Ceramic Restorative CHAMELEON EFFECT SURFACE IRREGULARITIES Helps dentist more accurately match the tooth shade, oﬀsetting variables in shade selection including extrinsic staining, lighting, and shade availability. By reducing surface irregularities with proper ﬁnishing, you can avoid things like staining, plaque retention, gingival irritation and recurrent caries. Plaque Accumulation Gingival Irritation Staining SOURCES 1 Dental Products Report April 2015 posterior composite survey. 2 Durable Bonds at the Adhesive/Dentin Interface. Braz Dent Sci. 2012; 15(1): 4-18 3 DENTSPLY Caulk procedure timing breakdown study. Data on ﬁle. 4 Christensen, G J. (2014). Simplifying your Class II Composite Finishing Technique. Clinicians Report, Colum 7 Issue 4 5 Joiner A. Tooth colour: a review of literature. JDent. 2004; 32 (Suppl. 1): 3-12 AD Young dentist, Laura Beresford Pratt explains why once she’d tried the Palodent® V3 sectional matrix system, she couldn’t go back to using any other sectional matrix. Then she explored the rest of the Dentsply Sirona Class II Solution. By Dentsply Sirona I perform Class II restorations every day as part of my private practice in Hailsham, East Sussex, so I require materials that enable me to deliver long-lasting and aesthetic restora- tions to my patients. Key to that is fi nding a matrix that can give me reliable contact points even for deep cavities. Keeping in contact Class II restorations are something my colleagues and I deal with every day. Working as an associate in a fully private, amalgam-free practice, our challenge was to fi nd a compos- ite-based restorative solution which would reduce the existing level of postoperative sensitivity amongst our patients. The design and meth- odology of Dentsply Sirona’s Pal- odent® V3 sectional matrix system makes creating predictable, tight contact points and a natural tooth shape much more achievable. The matrix band is shaped to fi t snugly around the tooth and is thin so that good contact is easier to achieve. It is then held fi rmly in place by the wedges and the ring. Using the Palodent® V3 System I am able to perform composite restora- tions in really deep cavities and I now use it for all my Class II restorations that require a matrix. Moisture-defying adhesive The second product in the Class II So- lution that I had experience with was Prime&Bond® universal, Dentsply Sirona’s universal adhesive. I was particularly fascinated by a video showing how the adhesive mixes with water in over-wet conditions so that it forms a gap-free adhesive layer. Since adopting Prime&Bond active my patients have reported very little sensitivity. An eﬃ cient and versatile bulk fi ll I also now use SDR® Plus which is the Dentsply Sirona Class II solution bulk fi ll. It is a good, versatile mate- rial which is easy to use and makes me more effi cient with its 4mm depth of cure. I fi nd that the surface fi nish of SDR fl ow+ is so smooth that I can use it on its own for paediatric fi llings. It fl ows and adapts to the cav- ity well and has even proved to be an excellent alternative to amalgam in a deep box if I use it with the Pal- odent® V3. A great surface fi nish And fi nally, I use Ceram.x® SphereTEC universal as my capping composite which gives a great sur- face fi nish to all my Class II restora- tions. I fi nd the handling very easy as it is a lot less sticky than the previ- ous composite I used, which means I have far better control. The compos- ite adapts well to the cavity and gives great aesthetic results with minimal polishing required. The power of choice As an associate in my practice, I felt it was important to ask my prac- tice principal for the materials that would enable me to give the best restorative solutions to my patients. I am fortunate that she has given me the freedom to choose. My restorative failure rate is low which I believe is partly due to the quality of the materials I am using. What gives all of these products from the Dentsply Sirona Class II Solution an extra edge is that they are de- signed to work together. Along with the added effi ciency that the Class II Solution has made possible, it means that I can fi t in more treatments, which is a win for both me and my practice. Find out more by scanning the QR code.
14 LASER DENTISTRY Dental Tribune Middle East & Africa Edition | 6/2019 Diverse applications of lasers in dentistry Recent literature By Dr Igor Cernavin, Australia When considering whether to work with la- sers and in which field they could be applied, recent studies provide many application op- tions and issues for practitioners to consider. The following presents some of the newest research on possible areas of application and further investigation. Petrov et al. used a femtosecond laser with a high repetition rate, which is probably the future of lasers for hard-tissue removal to achieve fast and more precise ablation in dentine and enamel.1 They concluded that the ultra-fast femtosecond laser used in their work holds the promise of a significant drilling ability without collateral thermome- chanical effects. It achieved high processing efficiency, overcame disadvantages of other laser systems reported, and can be used to develop an instrument for cavity prepa- ration based on fast and precise ablation. Their further aim is to exceed the speed of conventional drilling instruments and thus to reduce the treatment time, which in turn will bring comfort to the patient. Levine published an article on how to choose the right laser for one’s practice, which read- ers may find of interest.2 Hashimoto et al. investigated fluoridated hydroxyapatite for application as an im- plant coating for titanium bone substitute materials for dental implants.3 They con- cluded that fluoridated hydroxyapatite coatings are suitable for real-world implan- tation applications. single-centre, Giannelli et al. carried out a double-blind, randomised, split-mouth clinical trial investigating the efficacy of and patient-reported outcomes after one year of treatment of severe periodontitis with a laser and light-emitting diode (LED) proce- dure adjunctive to scaling and root planing.4 Their study confirmed the efficacy of com- bined phototherapy and scaling and root planning, which had emerged from previ- ous clinical trials, extending its field of appli- cation to severe periodontitis.4 Belcheva et al. carried out a study whose aim was to evaluate the positive effects of the carbon dioxide laser (10,600nm) with acidu- lated phosphate fluoride gel on enamel acid resistance.5 Their conclusion was that this combination was more effective in protect- ing the enamel surface and resisting dem- ineralisation than was carbon dioxide laser irradiation or fluoride alone.5 Campos et al. published a double-blind study on immediate laser-induced haemo- stasis in anticoagulated rats subjected to oral soft-tissue surgery.6 There has been much controversy about the management of pa- tients on oral anticoagulants requiring oral surgical procedures. The haemostatic prop- erties of high-power lasers were perceived to be potentially helpful during oral soft- tissue surgeries in anticoagulated patients. The authors concluded that laser-induced haemostasis is an alternative for intra- and postoperative bleeding control in patients on anticoagulation therapy.6 As oncological treatment can result in chang- es in the oral cavity, Carvalho et al. drafted a guide, based on a systematic review, directed at the team of health professionals involved in the oral care of oncological patients.7 The review concentrated on randomised clinical trials involving paediatric and adult onco- logical patients, focusing on the prevention and treatment of oral complications.7 The studies included in the review emphasise the provision of Low Level Laser Therapy, among other interventions, to minimise the severity of oral problems in such patients.7 Tani et al. carried out an in vitro study that compared photo-biomodulation potential- ity using red (635 ± 5nm) or near-infrared (808 ± 10nm) diode lasers and vio- let-blue (405 ± 5 nm) LED operating in a continuous wave with a 0.4J/cm energy density, on hu- man osteoblast and mesenchymal stromal cell viability, proliferation, adhesion and osteogenic differentiation.8 They concluded that the 635nm laser had a potential effec- tive option for promoting/improving bone regeneration.8 Ghouth et al. carried out a systematic review of the evidence on the use of laser Doppler flowmetry in the assessment of the pulpal status of permanent teeth compared with other sensibility and/or vitality tests. They AD PRINT EVENTS EDUCATION SERVICES DIGITAL Dental Tribune International The World's Dental Marketplace concluded that, despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, this data is based on studies with a high level of bias and serious shortfalls in study design.9 More research is needed to study the effect of different laser Doppler flowmetry’s pa- rameters on its diagnostic accuracy and the true cut-off ratios by which a tooth could be diagnosed as having a normal pulp.9 Kaur et al. compared soft-tissue wound healing using diode lasers (810nm) versus the conventional scalpel approach as an uncovering technique during second- stage surgery for implants.10 They found that it can minimise surgical trauma, reduce the amount of anaesthetic required, improve visibility during surgery owing to the ab- sence of bleeding and eliminate postopera- tive discomfort.10 Efficiency in debonding porcelain laminate veneers was studied by Al-Balkhi et al. using several laser parameters and two different application modes of the Er:YAG laser (con- tact and non-contact mode).11 Their finding was that the Er:YAG laser is an effective tool in debonding porcelain laminate veneers. The non-contact application mode was more efficient in reducing debonding time than the contact application mode, but re- sulted in a higher change in pulp tempera- ture.11 Kellesarian et al. carried out a comprehen- sive review to assess the effectiveness of erbium lasers in the removal of all-ceramic fixed dental prostheses and found that the benefits of lasers over mechanical instru- mentation for crown removal encompassed efficient restoration retrievability without restoration or tooth surface damage and a relatively easier and more time-effective procedure with no prerequisite for anaes- thetic agents.12 It is, however, imperative for clinicians to be well trained and exhibit ad- equate knowledge regarding recommended power settings and laser-safety parameters with reference to interactions between light and different tissues and ceramics.12 www.dental-tribune.com ÿPage 16 AD Medifil IX forte Glasionomer Füllungsmaterial Glas Ionomer restorative material Matériau verre ionomère pour restaurations Material de obturación de ionómero de vidrio 50 Capsules Glass ionomer filling material Variable mixing time for adjustment of consistency Modulation is possible right after insertion Perfect marginal adaption High compressive strength & abrasion resistance Easy activation without the need of an activator Perfect for smaller cavities & difficult to reach areas Temporary crown & bridge material Less than 5 min. processing time Strong functional load Perfect long-term aesthetics Excellent biocompatibility Light-curing nano-ceram composite Universal for all cavity classes Nano-reinforced ceramic particles Special resin matrix Significantly less free monomers Exceptional aesthetics Comfortable handling, easy modelling Also available as a flowable version Kaltpolymerisierendes provisorisches Kronen- und Brückenmaterial, Paste-Paste-System Material provisório polimerizável a frio para coroas e pontes, sistema pasta-pasta 50 ml cartridge / mixing tips Made in Germany 0482 Visit www.promedica.de to see all our products Dental Material GmbH 24537 Neumünster / Germany +49 43 21 / 5 41 73 Tel. +49 43 21 / 5 19 08 Fax Email firstname.lastname@example.org Internet www.promedica.de
From British Academy of Restorative Dentistry DUBAI 2020-2022 Prof. Paul Tipton, UK Specialist in Prosthodontics President, British Academy of Restorative Dentistry Dr. Hugo Grancho Pinto Portugal Specialist in Periodontics Academic Clinical Lecturer - University of Manchester Prof. Edward Lynch, UK The University of Warick, Coventry PhD, Lond, MA, BDentSc, TCD, FDSRCSEd, FIADFE, FDSRCSLond, FASDA, FACD Prof. James Prichard, UK BDS (ULond), MSc(ULond), LDSRCS (Eng), MFGDP (UK) FIADFE (USA), F BARD (UK), MFDTEd Dr. Rami Haidar, UK BDS MFDS RCS (UK), Oral & Maxillofacial Surgery Specialist, Aesthetics Training Consultant Dr. Adam Toft, UK BSc (Hons), BDS (Hons), MFGDP (UK), MMedSci (Rest Dent), Dip Aesth (BARD) FBARD PGCertEd (Sheﬃeld) Prof. Adam Nulty, UK BChD MJDF RCS Eng PGCert MSc (Dist.) MAcadMEd Dr. Matthew Holyoak, UK BDS, Dip Rest Dent (RCS Eng), MSc (Rest Dent) Dr. Ashish Rayarel, UK BDS MFGDP(UK) MSc (Aesthetic and Restor- ative Dentistry) Mr. Gary Jenkinson, UK RDT, MBA, DipCDT, RCS Group 6 Registration Open Patway to UK Masters 210 CME & Daily Hands-On Certificate | 4 Modules | 15 Days Module 1 | 01-03 October 2020 | Prof. Paul Tipton & Dr. Adam Toft & Dr. Ashish Rayarel Treatment Planning in Advanced Restorative Dentistry | The Principles of Occlusion in Advanced Restorative Dentistry Tooth Preparation in Advanced Restorative Dentistry Module 2 | 11-14 November 2020 | Prof. Paul Tipton & Dr. Matthew Holyoak & Dr. Adam Toft & Dr. Ashish Rayarel Minimally Invasive Veneer Preparations | Master the Art of Composites Part 1 - Adhesion Composites & Anterior Composite Restorations Master the Art of Composites Part 2 - Composite Veneers | Master the Art Composites Part 3 - Posterior Composites Module 3 | February 2021 | Prof. Paul Tipton & Prof. James Prichard & Dr. Adam Toft & Dr. Ashish Rayarel Enhance Your Expertise in Endo Part 1 | Enhance Your Expertise in Endo Part 2 | Occlusal Examination Emax & Zirconia Anterior & Posterior Restorations Module 4 | May 2021 | Prof. Paul Tipton & Dr. Hugo Grancho Pinto & Dr. Adam Toft & Dr. Ashish Rayarel Bridge Design | Aesthetic Perio Connective Tissue Grafting | Aesthetic Perio Crown Lengthening | Modern Post and Core Techniques Diploma | 4 Modules | 15 Days Module 5 | September 2021 | Prof. Paul Tipton & Dr. Adam Toft & Dr. Ashish Rayeral Bridge Preparation Techniques | Articulator selection in Restorative Dentistry | Porcelain Inlays & Onlays | Veneer Cementation Techniques Practical Module 6 | November 2021 | Prof. Paul Tipton & Mr. Gary Jenkinson & Dr. Adam Toft & Dr. Ashish Rayeral Smile Design, Composite Veneers, Anterior Tooth Anatomy & Lab Communications (Part 1& 2) | TMD, It's Diagnosis and Treatment | Adhesive Bridge Preparation Techniques Module 7 | February 2022 | Prof. Edward Lynch & Prof. Adam Nulty & Dr. Adam Toft & Dr. Ashish Rayeral Tooth Whitening, Silver Diamine Fluoride and an Update on Adhesive Dentistry – Minimal Invasive Dentistry | Same Day Crowns Finishing and Polishing and Clinical Applications of Lasers in Dentistry – Minimal Invasive Dentistry | Restoration of Dental Implants | Digital Dentistry & Photography Module 8 | May 2022 | Prof. Paul Tipton & Dr. Rami Haidar & Dr. Adam Toft & Dr. Ashish Rayeral Occlusion 3 Seminar, Treatment of the Worn Dentition, Vertical Dimension and Facial Aesthetics Botox & Dermal Fillers – A Dental Facial Aesthetics Part 1 & 2 +971 528 423659 | email@example.com www.cappmea.com/capptipton
16 ◊Page 14 LASER DENTISTRY Dental Tribune Middle East & Africa Edition | 6/2019 The effect of Er:YAG (Smart 2940D Plus, DEKA) and Er,Cr:YSGG (Waterlase iPlus, BIOLASE) lasers on the shear bond strength between orthodontic brackets and dental porcelain in com- parison with conventional acid etching with 9% hy- drofluoric acid (Ultradent Products) was investigated by Mirhashemi et al.13 They concluded that with the la- ser groups the failures were mostly adhesive, while they were mostly cohesive with the controls.13 They found that the Er:YAG laser with the specifications they used was not a suitable alternative to hydrofluoric acid etch- AD VITA AKZENT® Plus – Optimizes everything. Effortlessly. Stain glazing, masking and glazing – regardless of the CTE. Now available! VITA AKZENT® Plus FLUOGLAZE LT SPRAY for a natural, homogeneous flourescence without with VITA AKZENT ® Plus • POWDER: for unlimited ﬂ exibility and cost-effectiveness • PASTE: ready-to-use pastes with uniform consistency and homogeneous pigmentation • SPRAY: ready-to-use, easy-to-apply glaze and ﬁ nishing agent stains www.vita-zahnfabrik.com facebook.com/vita.zahnfabrik ing.13 In the case of the Er,Cr:YSGG laser, although the conditioning outcome met the bond strength re- quirement for orthodontic brackets (6–8MPa) they concluded that the bond strength must be further im- proved by fine-tuning the irradia- tion parameters. Yassaei et al. assessed the efficacy of an Er:YAG laser and pastes contain- ing casein phosphopeptide-amor- phous calcium phosphate (CPP- ACP) with and without fluoride and their combination for prevention of white spot lesions in the enamel.14 They found that the Er:YAG laser was able to decrease demineralisa- tion.14 It further proved to be a po- tential alternative to preventative dentistry and was more effective when combined with CPP-ACP prod- ucts.14 This would be useful especial- ly for orthodontics. Sarmadi et al. evaluated patients’ experiences of two excavation methods, the Er:YAG laser and ro- tary bur, and the time required with these methods, as well as objective assessments of quality and durabil- ity of restorations over a two-year period.15 Their conclusions were that the Er:YAG laser technique was more time-consuming than the ro- tary bur, but despite this, the laser technique caused less discomfort and was preferred as an excavation method by patients.15 Li et al. carried out a meta-analysis to systematically evaluate the applica- tions of Er:YAG lasers for the remov- al of caries and cavity preparation in children.16 They concluded that the time required for Er:YAG laser treat- ment was longer than that for the conventional mechanical method, but there was less pain associated with the Er:YAG laser treatment.16 There were no significant differ- ences in the complete retention rate, marginal discoloration and margin- al adaptation when compared with the conventional method.16 Pinheiro et al. assessed the utility of dental acid etchants containing 37% phosphoric acid and methylene blue dye as a sensitising agent for photodynamic therapy to reduce Streptococcus mutans in dentinal caries.17 They concluded that this treatment can be used as a photo- sensitising agent for photodynamic therapy to reduce the S. mutans bur- den in dentinal caries. Laser dentistry offers many applica- tion options and numerous research approaches that might be interest- ing to investigate or to stay up-to- date with for practitioners. This consideration of recent literature has shown that there is still much potential for the increased use and application of lasers in the different fields of dentistry. About the Author Dr Igor Cernavin Prosthodontist Honorary Senior Fellow at the University of Melbourne School of Medicine, Dentistry and Health Sciences Director and Co-Founder of the Asia Paciﬁc Institute of Dental Education and Research (AIDER) Australian representative of WFLD Private practice 274 Main Rd East St Albans VIC 3021, Australia
18 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2019 Preoperative digital planning RAW workﬂow: A professional’s approach to planning monolithic restorations on single-tooth implants By Florin Cofar, DDS, Romania, and Dr Eric van Dooren, Belgium Digital planning and preparation provides a high level of reliability in implant-prosthetic procedures. Pre- liminary virtual simulation of the surgical intervention can provide the necessary confidence and cer- tainty to carry out the actual surgery with peace of mind. Two dental pro- fessionals describe their procedure. Every workflow begins with an in- formation gathering exercise. If a digital workflow is followed, the in- formation consists of data that can be processed by the software being used. Our prosthetics team employs a photo-video protocol to examine the esthetic-functional relationship between the smile, dental situation and face of the patient. In addition to conventional photographic docu- mentation and video sequences, we use digital volume tomography (DVT) and intraoral scans in the as- sessment of implant prosthetics cases. By merging all the informa- tion gathered we obtain what we call a “digital clone”. These amalgamated data sets enable us to plan all steps in a virtual treatment suite as if we were working on a clone of the patient. Be- low we present our procedure, using the example of an implant prosthet- ic single-tooth restoration. Creating a digital clone The process begins by obtaining a high-quality portrait photograph, a DVT and an STL file (Figs 1 to 3). In the case presented here, tooth 12 can no longer be preserved and needs to be replaced with an implant prosthetic restoration. Designing the prosthetic restoration forms the first stage of the implant planning sequence. In the present case, the shape of the ex- isting tooth should be maintained. If an analogue workflow is followed, the premise for the implant is the extraction of the tooth. This scenario also forms the first step in the digital procedure described here - however, the tooth is “only” extracted virtual- ly. We can extract the tooth digitally to design e.g. the future alveolar cav- ity (emergence profile) and generate an optimized emergence profile. An alveolar model is required for: 1) designing the drill template (navi- gated implant insertion) and 2) fabricating a temporary restora- tion / abutment prior to the surgical intervention. We only ever use copies of the data files. Theoriginal data sets remain untouched. Several methods can be employed to perform the virtual tooth extraction. In our opinion, the most effective approach is to use the “Provisional Pontic” CAD process and to design the alveolar cavity to have an optimum shape. You should always work on two levels when ex- ecuting this step. The working scan represents the first level. The original scan with the tooth represents the second level in this scenario. Implant prosthetic planning The implant crown is designed (vir- tual wax-up). In the present case, the tooth being replaced serves as the template. The crown reflects the po- sition and proportions of the origi- nal tooth. A copy of the scan file is again used as working file on which the virtual tooth extraction is per- formed. This allows us to go back to the original data and compare it with the working file. We define the ideal implant placement position and design the peri-implant soft tissue contours on the screen to provide an adequate emergence profile (Fig. 4). We then prepare a drill template for safe transfer of the implant posi- tion to the oral cavity. Even though most dentists are familiar with this procedure, we will briefly address the fundamentals: Basically, three data sets are required for preparing a drill template: 1) a scan showing the digitally ex- tracted tooth, 2) a data file of the DVT, and 3) a scan showing the CAD design of the tooth being treated; in the pre- sent case, this means the original scan with the existing tooth. At the next step, we simulate the sur- gical procedure on the screen. The implant is inserted digitally and then a template of the procedure is ex- ported. The conditions of the alveolar bone can be assessed to determine the bone’s fitness for the planned procedure. If necessary, the alveolar bone may be adjusted, for instance by planning a bone transplant. Al- ternatively, a compromise may be made and it may be preferable to opt for a cemented restoration or a change in the design instead. We take all the major decisions at the virtual implant insertion stage. The details can then be transferred to the clinical situation by means of the drill tem- plate. The position of the implant is established with the help of the wax- up (3 to 4 mm deeper). The implant angle and position should be select- ed so that the available bone struc- ture can be used to optimum effect, without deviating too much from the specifications of the prosthetic restoration. In this case, the aim is to provide a screw-retained restoration. We are still using our “digital clone” to plan these steps. Once the pre- paratory steps have been completed, the drill template is printed (Fig. 5). In addition, the STL file of the implant model including the optimized al- veolar cavity design and digital scan body (Fig. 6) are prepared to design the temporary restoration. Fig. 2. DVT data set in the software program Fig. 1. Portrait image prior to the intervention Fig. 3. Surface scan of the preoperative situation Fig. 4. Virtual extraction of the tooth in need of treat- ment Fig. 5. DVT data set in the software program Fig. 6. Surface scan of the preoperative situation the temporary Designing restoration The virtual implant model (Fig. 6) is imported into the construction soft- ware to design the abutment and/or temporary restoration. The crown- abutment interface should be placed in an optimum position in the previ- ously prepared alveolar cavity. The Ti base has been defined at the time when the implant depth was deter- mined during the implant planning step. In the present case, the implant has a depth of 3 to 4 mm. The opti- mum length of the Ti base is there- fore 1.5 mm. Fig. 7. Printed drill template (Mguide, MIS) Fig. 8. Immediate temporary restoration Fig. 9. Atraumatic tooth extraction Fig. 10. Implant insertion (NP implant, MIS) with drill template The temporary restoration is placed on a Ti base with free rotation to pre- vent potential problems caused by the implant index position. Whether a screw-retained or ce- mented restoration is chosen is at the discretion of the dentist. We tend to prefer screw-retained resto- rations. However, the ultimate deci- ÿPage 20 Fig. 11. Drill template and implant after insertion Fig. 12. Temporary restoration after the surgical intervention
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20 ◊Page 18 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2019 formed at the time of the tempo- rary restoration. In the present case, the thickness of the gingival tissue should be additionally increased. For the fi nal restoration, a Ti base of the same length as the one for the temporary restoration is used. This time, however, the base features an anti-rotation lock. A large selection of materials is available for the fi nal restoration. We normally use hybrid restorations for the restoration of single implants. Here, the restora- tion consists of a monolithic zirco- nium oxide abutment (Zenostar) and a monolithic multi-shaded all- ceramic crown (IPS e.max ZirCAD MT Multi). The restoration is char- acterized with stains and completed without any shape modifi cations (Figs 14 to 16). Conclusion Errors can be avoided by planning the intervention on a “digital clone” and preparing any auxiliary and therapeutic devices ahead of the actual surgical procedure. If this ap- proach is used, suboptimal implant placement – both prosthetically and surgically – can be detected and corrected in advance. In addition, necessary augmentative measures are already evident at the planning stage and can be prepared accord- ingly. This way, “surprises” during the intervention on the patient can be avoided as far as possible. This brings a high level of reliability and certainty to the treatment process. Florin Cofar, DDS S.C. DENTCOF s.r.l. Simion Barnutiu Nr 62 etj. 5 300302 Timisoara Romania Florin.firstname.lastname@example.org Dr Eric van Dooren Tandartsenpraktijk van Dooren Tavernierkaai 2, 8e verdieping 2000 Antwerp Belgium AD Fig. 13. Clinical situation with scan body Fig. 14. Implant prosthetic restoration Fig. 15. Close-up of the ﬁ nal situation Fig. 16. Portrait image after completion of the restoration sion about which restoration to use can only be made at the point when the surgical inter- vention is planned. Whether the prosthetic restoration is made in one piece or as a hybrid crown is also at the discretion of the dentist. Hybrid restorations are normally preferred in esthetically demanding situations and onepiece restorations in the posterior region. AD 5 YEARS WARRANTY WARRANTY Surgical phase All the items required for the surgical intervention have been prepared and are now ready for use: This includes the printed drill template (Fig. 7) and the temporary implant restoration (Fig. 8). Tooth 12 is now extracted atraumatically in the “real world” (Fig. 9). Immediately afterwards, the fi t of the drill template is checked in the oral cavity and the implant is inserted ac- cording to the drill protocol (Fig. 10). This is followed by the augmentative measures planned in advance and fi - nally, the temporary crown is screwed on (Figs 11 and 12). Prosthetic restoration After a healing phase of at least eight weeks, the tem- porary restoration is removed and the design is copied. This is the fi rst time in the entire procedure that the actual scan body is used (Fig. 13). The scan body assists in recording the position of the implant. This position corresponds to the originally planned position and also refl ects the implant index position. This method ensures the accuracy of the restoration procedure. The transgingival areas have already been The most reliable turbine on the market 60 years of know-how and passion is the secret 60 years of know-how and passion is the secret that leads Bien-Air Dental today to offer exceptionally that leads Bien-Air Dental today to offer exceptionally reliable products. Discover all our expertise and reliable products. Discover all our expertise and attention to detail in the new TORNADO X turbine. attention to detail in the new TORNADO X turbine. WWW.BIENAIR.COM Bien-Air Dental SA Länggasse 60 Case postale 2500 Bienne 6 Switzerland Tél. +41 (0)32 344 64 64 email@example.com www.bienair.com
22 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2019 The new frontier restorative dentistry Federico Ferraris Adhesthetics Theca Kit By Hu-Friedy The Adhesthetics Theca kit is com- prised of four unique instruments designed by Dr. Federico Ferraris in collaboration with Hu-Friedy. It is a unique set of instruments created for use during the clinical phases of both direct and indirect restorative dentistry to help clinicians achieve positive results through clinical ex- cellence. The Main Shaper, the Fine Shaper, the 3D Shaper and the Direct Caliper are all made using XTS technology, a dark Aluminum Titanium Nitride (AlTiN) coating that offers superb contrast in comparison to composite materials and tooth structure. The coating is also incredibly slick, resisting the adhesion of sticky com- posite materials. The smooth handle is not only ergonomic and light- weight, but each instrument has its own distinct set of colour cones, making instrument identifi cation simple. The set of four instruments includes an IMS Cassette, which pre- vents the instruments from being damaged during transportation and sterilization protocols. TNFF1/2 FF1 Manipulation of composite on buc- cal surfaces during direct anterior restorations, Class IV and V cases, di- rect veneers restorations and general esthetic restorations. The tip’s lance shape and fl exibility allow for it to adapt to restorative material and is also effective in removing excess material from the vestibular region by using its edge (Fig. 7). Its fl exibility allows for restorative materials to be manipulated with a delicate touch. It is sturdier than a standard brush however less rigid than a standard spatula. FF2 Application of medium-great quan- tity of material directly on the tooth or as a material carrier. Its round shape and rigidity allow for the ma- nipulation of restorative materials in wide cavities. It is also effective when placing material on wide surfaces (Fig. 8). Dimensions of working part: length 11,5 mm; width 2,5 mm and thickness 0,4mm. Fig. 7 Fig. 12 Fig. 17 aligned against the preparation bevel, allows for the thickness of den- tinal material and residual buccal enamel to be determined. The FF7 can be used to assess an enamel thickness of 0.5mm (the uni- versal thickness in the third medium of the crown), while the FF8 can be used to assess a thickness of 0.9mm (which is preferred in incisal areas, or times when the thickness of the nat- ural enamel is of critical importance). The shape of the dentin in the incisal direction in addition to the thickness to the margin can be determined with this instrument. Fig. 8 Fig. 14 Fig. 23 TNFF3/4 Fine Shaper /Cord Packer Modelling of restorative materials on anterior and posterior teeth as well as the placement of retraction cord. A distinctive characteristic of this spatula (FF3 straight and FF4 an- gled) is its fl exibility. Its thin design allows for precise modelling (Fig. 9, 12). It is particularly useful for deep cavi- ties. It is also helpful during proce- dures where high magnifi cation is used because its length allows for easier access to these deep regions while not interfering with the clini- cian’s fi eld of vision. Retraction cord can be placed precisely with the thin instrument tip (Fig. 14). TNFF5/6 3D Shaper FF5 Anatomical modelling of restora- tions of posterior cusps (Fig. 17) or of anatomical dentinal or superfi - cial elements on anterior teeth. The unique teardrop shape of this point makes it excellent for sculpting ma- terials in both posterior and anterior cases. FF6 Sculpting thin sulcus as well as fi n- ishing of the margins and thin mod- ellings on posterior and anterior direct restorations. Application of fl uid material in deep cavities (Fig. 23), positioning of fl owable materials in occlusal sulcus, coating low viscos- ity materials, removal of excesses of high viscosity cementation material and control of margins after cemen- tation (Fig. 27) point makes it excel- lent for sculpting materials in both posterior and anterior cases. Fig. 27 TNFF7/8 Direct Caliper Measuring thickness of enamel mar- gin in direct restorations on anterior teeth, measuring thicknesses of di- rect and indirect restorations during various clinical phases (Fig. 29), cre- ating defi nition of dentinal curving (Fig. 30). Its distinctive curved shape allows the tip to easily reach areas in both the anterior and posterior arch. Fine details can be created in restorative materials due to the tip’s thin design. This instrument is a restorative probe with a fl at head (not rounded, as most periodontal probes) with grooves at 0.5mm increments. The tip is angled at 45° which when Fig. 9 Fig. 29 Fig. 30 To learn more about Federico Fer- raris’ Adhesthetic Theca Kit visit www.hu-friedy.eu or contact our lo- cal distributors. Follow us on @HuFriedyEU @hu_friedy_europe @hu_friedy_europe Align Technology showcases its digital dentistry solutions at DLS4 Bahrain By Align Technology, Inc. Align Technology, Inc. (NASDAQ: ALGN), a global medical device com- pany engaged in the design, manu- facture and marketing of the Invis- align system, the most advanced clear aligner system in the world, and iTero intraoral scanners and ser- vices for orthodontic and restorative dentistry, will highlight its digital so- lutions that have helped transform the lives of millions of patients at the fourth International Dental Confer- ence & Exhibition (DLS4). The event will take place at Art Rotana Hotel, Amwaj Islands in Bahrain, from Nov. 14 to 16, 2019. One of the highlights of the event will be an Invisalign seminar, hosted by Dr. Mario Greco, the visiting profes- sor at the University of Ferrara, who will discuss in detail the advantages of clear aligners versus conventional appliances. The seminar is open to all delegates of DLS4, and will be held on November 15 from 1 to 3pm. Dr. Greco will also lead a plenary lecture on November 15 from 10.30 to 11.30 am on ‘the Effective Affi nities for Aligner Digital Orthodontics.” In addition to the lecture and the workshop, Align Technology’s exhi- bition stand will showcase its digital dentistry solutions, including the Invisalign clear aligner system that helps straighten teeth of teenagers and adults without the need for a brace. Invisalign`s Mandibular Advance- ment feature combines the benefi ts of the most advanced clear aligner system in the world with features for moving lower jaw forward while simultaneously aligning the teeth. Invisalign treatment with mandibu- lar advancement offers convenient and barely visible treatment in com- parison to functional appliances. The treatment is done without the need for elastics typically used to treat teen Class II patients. Mawlid Chaoui, Align Technology general manager for Middle East and Africa, said: “DLS4 Bahrain is a truly global event that brings together den- tal experts and medical professionals to discuss evolving trends as well as the challenges faced. We are extend- ing our support to the event as a Dia- mond Sponsor in addition to hosting Dr. Mario Greco at the event to present the advances we have made in digital dentistry. Today, our Invisalign clear aligner systems and iTero Element scanner are a popular choice among practitioners and we aim to leverage our participation to strengthen doctor awareness about our innovative prod- ucts and solutions.” Invisalign clear aligners help move teeth without the use of braces, mini-screws or mini-implants. Invis- align aligners are removable, easy to clean and made of a proprietary ma- terial called SmartTrack, developed specially for Align, which differenti- ates the Invisalign system from tra- ditional braces as well as alternative clear aligner offerings.
28 ◊Page 27 INTERVIEW Dental Tribune Middle East & Africa Edition | 6/2019 milestones are really important. Of course, Dentsply Sirona will want to partner together, especially with our teams that are located in Dubai. Even though it’s global, we can help to promote those events together. We want to celebrate and recognise what those advancements have done, how technology has really been able to provide final restorations that help to make patients’ lives better. Truly, it’s very different to what it was 20 years ago and we’re looking for that same type of technology to expand into the digital dentures field as well, so that you’ve got everything, crown and bridge, digital denture, but I think those are really important events and we would be proud and honoured to be a part of promoting and supporting those types of global congresses. For us, it is important as well to make sure that we continue to wrap people into the process of continuing the workflow around digital between the laboratory and the dentist. It’s an exciting time and we are proud to be partnered along with you to do that. We create modelling that shows all the efficiency time-savings that a laboratory will have, but also from the material side, so we run it all together like a business model and then educate the laboratory on that. If you can produce traditionally say eight dentures in a day, now with this Carbon and Dentsply Sirona technology, you can produce almost 32 dentures in a day. When you put the investment of the equipment together with the material, your sav- ings per denture are much lower, and you can return the case faster to the dentist, with equivalent proper- ties that you’re getting today. So you have to think about the whole story and that is why we are trying to help them. Since most Lab’s focus is on the craft of making the devices, we try to help support them on the busi- ness model and profitability. There’s going to value and reason for both milling and printing. We still believe that there’s places where milling is really important, and there’s places where printing is really valuable and we’re trying to make sure that we can guide a laboratory so that they can choose the right thing. I don’t think there will ever be a time where printing will totally take over milling, but there are times when it’s important, so having both processes is really valuable. Thank you very much for your time and the interview.
www.idem-singapore.com 24 - 26 April 2020 Suntec Singapore THE LEADING DENTAL EXHIBITION AND CONFERENCE IN ASIA PACIFIC INTRODUCING THE IDEM 2020 MAIN CONFERENCE SPEAKERS SDA Masterclass SDSDSDSDS AAAAA MMMMMMMMMMMMMMMasasasa teteteeeetet rcrcrcrcrcccccccccccccccrccccccccclalalalallllalalalaaaaaaaalallalallallaallllallallaalallaallalalallaaaaaaaaaaassssss SDA Masterclass AAAAAAA Shimon Friedman Shimon Friedman Mark Wolff Thuan Dao TTThTThThTThThTThThThThThThhThThThThhThThThThThhThThhhThThTThThThThThTThThTThThTTTThThhThhTTTTTTTThhThThThThhThThThThTThThThThThhThhThhhhThThThTThThThThTThThThThTThThThhThThhhhhThThTThThTTThThThhhThhhhThThhhhhThTThTThThTTThhhhhhhhThTTThTTTTThhhhhhhhTThTTThThThhTTThhThhThThTTTThTThhhhhhhhhhhhhTThTThThTThThhThThhhThTTTThhhhhThhThThThThTTTTThhhTTTThTThhThhhhThThThTThThTTThhhhThTTTTTTTThThhhhhhhThhTTTThThhThhhhhhhTTThThhhhhhhhhhhThThTTTThTTThhhThTTThhhhhTTTTTTTTThhhTTTTThTTThhhhTTTThhhhTTTTTThhhhhTTTTThhhhTTTTThhThTThhhuuuuuuuuuuauauauaauauauaauauaaaauuuuuuuuauuuuauauauaauaauuuuuuuuuuuuauauaauaauauauaaauuuuuuuuuuuuaauuuauauuuuuuuauaauauuuuuuuuuuuuuuuuauuuuauuuuuuuuuuuuuuuuuuuuuuuuauuuuaauuuuauuauuuauauuau nnnnnnnnnnnnnnnnnnnnnnn nnnn nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn DaDaDaDaDaaDDaDaaDDaaaaaaaDaDDaDaaDaDDDaaaaDDaaaaDaaaaaaaaaaaaDaDaaaaaaaaaaaaaaDDaaaaaaaaaaaaDDaaaaaaDDaaaaaaaaaDDaaaaaaaaaDaaaaaaaaaDDaaaaaaaaaaaDaaaaaaaaaDDaaaaaaaaaaaaaDaaaaaaaaaaaDaDDaaaDaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaoooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo Brian B. Nový Axel Spahr AAAAAAAxAxAxAxAxAxAAAAAAAAxxAAAAAAxAAAxAAAAAxAAAAAAAAAAAAAxxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAxAAAAAAAAxxAxA elelelellllll SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSppapapapappppppapppapapapapaapapappapappppppapaappapappappapaapapapapappappppppappapapaaaapappappapppppaaaapapapapppappppppppapapapapppapapapappapppaapaaappppappppaaaappappppppapppppaaappppappappapappappppapapppappppppappppaapppppappppppppppappappappppaaaapppppppppppappppppaappppppppppppappaappppppppppppppppppppppappaapppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp hrhrhhrhrhrhhhhrrhrhhrhrhrhrhhhhhrhhrhrhhhrrhrhrhrhhhrrhrhhrhhrhhrhhhrhrrhhrhrhrhhhhhrhrrrrrrhhhhhhhrrhhrrhhhhrrrhhhhrrrhhhhhhrrrhhhhrrhhhhhhhhrrrhhrrrrrrrr Thuan Dao Thuan Dao ThThThThThThThhThuuuuauuauauauauaaauaauaaaaaaaaaauuauaaaaauuauauaaaaauauaaauuuaaauaauaaaauaaaaauaaaaaaaaauaaaaauaaaaaaauauaaaaaaaaaaaaaaaaannnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn DaDaDaDaDaDaDaDaDaDaDaDaaDaDaDDaDDDDaDaaDaDaDDDaaDaDaaDDaDaDDaDaDDaaDDDaDaDaaDaDDaDDaaaaaDDDDaaaoooooooooooooooooooooo Axel Spahr Axel Spahr AAAAAAAAAxAxAxAAxAxxxxAAAAAxxAAAAAAxAAAAAAAxxAAAAAAAAAAxxAAAAAxAAAxAAxAAAAAxAAAAAAxAAAAAAAAAxAxxAAAAAAAxxAAAAAAAAAAxxAAAAxxeeleleeleleleellllellellllellllllllllelelellllllelellllllellllelelllelleleeeeeeelllelelleleeeleeeeeleleleeeeelleleeeeeellleleeeeleelleeeeeelleeeelleleelelleleleeeeeeleeeleeeeell SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSpapapappapapapapapaaaaapaaaaaaaaapapapappappapaaaapaaaaaaaapappapaapaaaaaaaaapapapapaaapaaaapapappaaaaaappapappaaaaaapappaaaapappaappaaaapaaappaaaaaaapapaapapapapapaaappaaaaapapaaapapaapaaaapppppppppppp hhrhrrhrhrhrhrhrhhhhrhrhrhrhrhrhrhrhrhrhrhrhrhhrhhhhhhhhrrhrhrhrhrhrhrhhrhrhrhrhrrhhrhhhhrhhrhhrhrrhrhrhhrhrhrhrhrhhhhrhhrhhrhrhhhrhrhrhrrrhhhhhrrrhhhhrhrhhhrhrrhrhrrhrhhhhhhhrrhrhrhrhrhrhrhhhhrhrrhrrhhrhhhhrhhhhrrr Fadi Yassmin Axel Spahr Mohamed Hassanien Mitsuhiro Tsukiboshi Peet Van Der Vyer Roberto Turrini Peet Van Der Vyer Peet van der Vyver Peet Van Der Vyer Dental Hygienist and Therapist Forum The 2020 dental hygienist and therapist forum will focus on issues such as dealing with fear of dental visits, the periodontal probe and more. Special Care Dentistry Symposium Highlighting the treatment needs of patients with special needs, this full day forum is one of the first in Asia to focus on this niche topic in dentistry. W E N Trade Exhibition Discover the latest products and services in the dental industry and meet over 500 exhibitors at IDEM. Hands-On Workshops Hone your skills and learn new techniques at the limited attendance, hands-on workshops. SECURE YOUR PASSES ONLINE FOR IDEM 2020 Registration Connect with us Endorsed by Supported by Held in Organised by Koelnmesse Pte Ltd Ms. Isabel Shankar T: +65 6500 6700 E: firstname.lastname@example.org +65 9622 9782 IDEM Singapore IDEM Singapore idem.sg @IDEMSingapore Singapore Dental Association
30 INTERVIEW Dental Tribune Middle East & Africa Edition | 6/2019 "... the beginning of leading network of dental clinics in the UAE..." Interview with Mr Álvaro Martínez-Arroyo López, Asisa Internacional Salud General Manager and General Manager and Director of True Smile Works Dental Network LLC By Kinga Mollov, DTMEA True Smile Works Dental Network clinic offers the expertise of interna- tional, modern and dynamic dental services to the UAE residents while concentrating on providing quality, integrity and world-class premium standards across dental care in the region. Could you please explain the vi- sion behind True Works Dental Network Clinics? True Smile Works is a joint venture between Faisal Holding and the Asisa Group, one of Europe’s largest medi- cal corporations. True Smile Works Dental Network was launched to pro- vide the expertise of an international dental services company to the UAE residents while concentrating on quality, integrity and world-class standards. Our mission is to develop long-term relationships with our pa- tients and to ensure distinguished services through personalized, hon- est, ethical and informed care. The objective of our team of quali- fi ed dentists is to take care of our patients’ oral health and provide specialty services. smile makeovers, Teeth Whitening • Prosthodontics – Dental Crowns & Bridges • Endodontics (Root canals treat- ment) • Children Dentistry, Orthodontics (Braces) • Periodontics – gum disease treat- ments, Dental Hygiene/cleaning; • Laser Dentistry • Oral Surgery – Dental Implants, wisdom tooth extractions • Sedation Dentistry True Works Dental Clinics are the ﬁ rst international dental network which sets its presence in UAE. Could you elaborate more? As you may know, ASISA Group is one of the leading Spanish private health care establishments, interna- tional expansion of the company led by ASISA Dental units and ASISA In- ternational allows us to develop pro- jects in new countries and offer high quality service and treatment. We distinguish UAE as a strategic business location for the regional growth, and an essential market where we recognized the opportu- nities to develop and establish our presence. Which specialized treatments are provided by the clinic? We are specialized in the following: • General Dentistry • Cosmetic Dentistry – Veneers, We have embarked on a joint ven- ture with Faisal Holding and estab- lished TRUE SMILE WORKS Dental Network. A network of dental clinics in the UAE that will provide the ex- pertise of an international dental ser- vices to the UAE residents following the successful model of Asisa Dental, the international dental network of Asisa Group. With more than 40 clin- ics in 5 countries and over 20 years of patient satisfaction. Which doctors have been selected to work at the clinics as advertised - providing international standard treatments. • Dr Veronica Ramirez Montes – Gen- eral Dentist – Restorative Dentistry, Oral Rehabilitation & Cosmetic Dentistry; Doctor of Dental Surgery/ Chile/Spain. • Dr Layal Ksaybi – General Dentist – Cosmetic Dentist; Doctor of Dental Medicine/Canada • Dr Fernando Arroyo Meneses – General Dentist, Oral Surgeon, Implantogist; Doctor of Dental Sur- gery/Spain • Dr Ihab Attieh – General Dentist – Endodontist; Doctor of Dental sur- gery/Lebanon • Dr Muge Kasim Dilmen – Specialist Orthodontist; Doctor of Dental Sur- gery, Phd/Turkey How else do you set yourself apart from other international dental clinics? One of our parent companies ASISA Group, is founded and managed by doctors. Our model is the same one we have been applying in Europe for decades: a combination of fi rst- Mr Álvaro Martínez-Arroyo López, Asisa Internacional Salud General Manager and Gen- eral Manager and Director of True Smile Works Dental Network LLC class professionals working in clinics equipped with the latest technol- ogy and using the most advanced medical techniques. We focus on the patient and the constant pursuit of excellence whilst concentrating on customer’s satisfaction and well- being. Additionally, our customers have a big advantage being part of our clin- ic. We are not only the dental clinic, we are the network of more than 40 clinics, which means our patients can have access to international pro- fessionals available in Spain, Italy, Portugal and Brazil. How many clinics do you plan to open across UAE and how many in Dubai? Our fi rst Dental Clinic at Marsa Plaza, Dubai Festival City, is the beginning of the leading network of dental clin- ics in the UAE that we hope to be- come in a few years’ time. In a span of four years, we are plan- ning to open up to 11 clinics through- out the UAE.
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32 NEWS Dental Tribune Middle East & Africa Edition | 6/2019 Dentsply Sirona presents the new generation 5 of CAD/CAM software with OraCheck By Dentsply Sirona The possibilities offered by Primes- can, Omnicam and CEREC are notice- ably increasing with the new gen- eration 5 software updates: Dentsply Sirona announced today that it has signed an agreement to acquire Ora- Check. The new OraCheck 5.0 will en- able Dentsply Sirona to offer patient monitoring before, during and after treatment. Additionally, the updat- ed Connect Software 5.1 now offers more digitally feasible treatment options, especially for orthodontics and implant dentistry. CEREC SW 5.1 brings the performance upgrade of CEREC generation 5 also to existing CEREC Omnicam units. All software updates will be available in October. The acquisition of OraCheck and ap- plicable updates of its software will enable Dentsply Sirona to provide dentists with a valuable tool for pa- tient analysis. OraCheck offers ad- vanced software and supplements conventional assessment with valu- able three-dimensional information developed for dental professionals to register and illustrate changes in the patient's mouth over time. It is a key tool to analyze and follow-up exami- nation. A comparison of the most re- cently scanned image with an image that was taken at a previous point in time facilitates precise assessment of any changes. The new generation of OraCheck is available for all scan- ners and carts running with the new Software Generation 5 with of CEREC SW, Connect SW and CEREC Ortho 2.1. Common start for OraCheck and new Software Generation 5 Dentsply Sirona is also launching the latest updates of CEREC SW and Con- nect SW as part of the new Software Generation 5. All software updates represent a new design and an up- graded, more user-friendly and in- telligent interface. Generation 5 SW runs on all Primescan and Omnicam systems and requires Windows 10. Depending on the hardware model, AD X-Smart IQ® Handpiece with Propex IQ® Apex Locator Increase your IQ X-Smart IQ® HandpFece Endo IQ® App Propex IQ® Apex Locator A motor offering complete freedom of movement Control all your IQ devices through the integrated Endo IQ® app Attractive and ergonomic design • Future proof. FFrmware can be upgraded • A slFm, well-balanced and cordless • Enhances the functFonalFty of your vFa an app update. handpFece IQ devFces • Guarantees relFable monFtorFng of • Easy access and excellent vFsFbFlFty • Enables apFcal-reverse and shapFng target file progressFon • QuFckly swFtch from recFprocatFng to contFnuous motFon features (only wFth app) • LFghtweFght, ultra portable, weFghFng only • Supports all FPad® sFzes Fn landscape mode 80 grams dentsplysirona.com/iq an upgrade might be required. "We are fulfi lling an explicit request from customers and providing added val- ue for dentists," explained Dr. Alex- ander Völcker, Group Vice President CAD/CAM & Orthodontics at Dent- sply Sirona. "We're realizing our idea that any dental workfl ow should start with an intraoral scan." OraCheck: more possibilities for dentists In conjunction with a digital optical impression system, OraCheck is de- signed to visualize three-dimension- al change on virtual optical scans on the computer. The changes could include movement, tilting as well as geometric changes to the surface. Depending on the clinical situation as interpreted by the dental profes- sional, these changes could be a hint for abrasion, swelling, recession, plaque build-up and change of tooth position. Connect Software 5.1: expanded options The updated Connect SW 5.1 enables a guided scan with Omnicam and more accurate results when scan- ning the whole jaw compared to software generation 4. It now offers expanded scan options for aligners, splints, individual impression trays as well as improvements of scan quality for Primescan and Omnicam. For new customers, the Connect Software 5.1 is supplied with every intraoral scanner. CEREC Software 5.1: improved scanning accuracy The updated CEREC Software 5.1 for fabricating chairside restorations has undergone numerous enhance- ments. The calculation of the 3D model and the quality of the pre-pro- posals for the restorations benefi t from the precise scans of the Omni- cam in combination with the CEREC SW 5.1. Automatic artifact removal and artifi cial intelligence-based al- gorithms – already introduced with CEREC 5.0 – will fi nd their way into the previous generation CEREC AC. The ability to export STL fi les is al- ways part of the software now. "With Primescan, we took a huge step towards speed, accuracy and ease of use," said Völcker. "With this new software generation, we have taken a further step in digital work- fl ows: the indications have become more extensive, and clinical success can also be ensured in the long-term through monitoring.” Due to different approval and regis- tration times, not all technologies and products are immediately available in all countries. Find out more by scanning the QR code.
Mastership Programme Lasers in Dentistry Certiﬁcation Course From Aachen Dental Laser Center & RWTH International Academy - RWTH Aachen University & CAPP Prof. Dr. med. dent. Norbert Gutknecht DDS, MS, PhD Germany Dr. Dimitris Strakas DDS, MSc, PhD Greece Dr. Miguel Rodrigues Martins DDS, MSc, PhD Portugal Priv.-Doz. Dr. rer. medic. Rene Franzen Germany DUBAI AACHEN Group 8 Registration Open Pathway to German Masters 84 CME & Daily Hands-on One-year clinical specialisation course for selected wavelengths Module 1 | 25-28 November 2020 (4 days) | Laser Safety, Laser Devices and Diode Lasers Laser Safety Ofﬁcer course | e-learning | Laser technique (Diode lasers) | High power Diode lasers (clinics) | Scientiﬁc background and clinical indications | Skill training every day of every clinical indication | Patient treatments (demonstrations) Hands on: Pigmentation on soft tissue, gingivectomy and gingivoplasty, frenectomy, ﬁbroma removal, crown lengthening, depigmentation, endodontic procedure- canal irradiation performed on sheep heads | Patient treatments (demonstrations) Module 2 | 23-26 March 2021 (4 days) | Module Erbium Lasers Erbium Lasers (clinics) | Laser technique (Erbium lasers) | Er:YAG and Er,Cr:YSGG | Scientiﬁc background and clinical indications | Skill training every day of every clinical indication | Patient treatments (demonstrations) Hands on: Preparation in enamel and dentine, generation of a retentive surface, canal decontamination, apicectomy, soft-tissue cut with short pulses, soft-tissue cut with long pulses, open curettage, crown lengthening and bone preparation performed on sheep heads. | Patient treatments (demonstrations) Module 3 | 12-15 December 2021 (4 days) | Combined Wavelengths Therapy Concepts & Mastership Exams Laser therapy concepts with the use of 2 diﬀerent wavelengths | Written multiple-choice exam | Oral Exam (presentation of 5 patient treatments cases with diode or Erbium lasers) | Graduation Ceremony, after successful completion of an examination at RWTH Aachen University | 600 hours total workload | Over the complete course duration: case documentation & discussions The programme targets dentists who would like to specialise in certain wavelengths. Over the course of one year, participants are taught fundamental physical and technical knowledge, and how to recognise primary, secondary, and tertiary indications on 12 attendance days split into 3 modules held over 3 educational blocks. This programme concludes with an ofﬁcial certiﬁcate of RWTH Aachen University, and is oﬀered in collaboration with the RWTH Aachen International Academy, the post graduate education wing of the University.. +971 528423659 | email@example.com www.cappmea.com/laser
34 NEWS Dental Tribune Middle East & Africa Edition | 6/2019 200 days, 100 countries: Primescan users experience digital impressions in a completely new way Primescan user Dr. Carlos Repullo particularly appreciates the accu- racy and speed of the scans. Primescan meets Dr. Mike Skram- stad's requirements for accuracy, ease of use, speed, integration, and deployment. Dr. Verena Freier, Primescan user from day one, is particularly im- pressed by the touch screen op- eration. Digital impressions made with Primescan: simple, fast and very accurate. By Dentsply Sirona It is standard practice to review feedback after a product has fi rst been launched: Primescan, Dentsply Sirona’s new intraoral scanner, was introduced about 200 days ago. It provides dentists in more than 100 countries with a completely new experience of taking digital im- pressions. The feedback after the fi rst months in practice shows that Primescan was able to meet and even exceed the high expectations of demanding users. With Primescan, Dentsply Sirona presented the latest generation of intraoral scanners at the be- ginning of February in Frankfurt (Germany): It enables users to take a digital impression with very high accuracy. This has been substantiated by a study at the University of Zurich1. Since the launch of this new intraoral scanner users in more than 100 countries have been using Pri- mescan in their practices and reporting on their experiences. For dentist Dr. Carlos Repullo from Sevilla, Spain, the perfect end result for the patient has AD HEROES don’t wear capes, they WEAR WHITE COATS MASTER OF SCIENCE IN: Endodontics | Orthodontics | Pediatric Dentistry Periodontology | Prosthodontics All graduates are recognized as specialists upon graduation in the UAE* Extensive clinical training over the 3-year program Postgraduate students practice at the ﬁrst and largest dental hospital in Dubai, the Dubai Dental Hospital Opportunities to participate in overseas scientiﬁc presentations International academic faculty Admissions open to all nationalities Eligibility for the Royal College of Surgeons of Edinburgh and for the Royal College of Surgeons in Ireland Specialty Membership examinations Accredited by Ministry of Education *Non-UAE Nationals will have to meet the licensure requirements 800 - MBRU 76878) firstname.lastname@example.org mbru.ac.ae @MBRUniversity top priority. For several years now, he has relied on the sup- port of digital procedures such as CAD/CAM. From his point of view, the technol- ogy of intraoral scanners has developed enormously – this is especially true for Prime- scan. "The accuracy of the scan is remarkable. This also applies to the whole jaw scan, which can be taken in a very short time. This is exactly the quality that we need in practices. The handling must be simple, fast and safe, the function must be stable. The new intraoral scanner offers all this. Primescan does have a small 'disadvantage': "If the restoration does not fi t now, I can no longer blame the technology." Primescan meets very high quality standards For quite some time, Dr. Mike Skramstad, den- tist from Orono, Minnesota (USA), has been observing the development of intraoral scan- ners in the dental market. For a long time, no system was able to fully meet his high require- ments in terms of accuracy, user-friendliness, speed, integration capability and possible ap- plications. He also took a close look at Primes- can in his practice. 200 days after the new in- traoral scanner’s launch, he is now more than satisfi ed: "With the introduction of Dentsply Sirona's Primescan, things have changed con- siderably. Scanning is very easy and more ac- curate than with the CEREC Omnicam. What impresses me most about Primescan is the outstanding software performance, which has been further enhanced by artifi cial intel- ligence. I'm excited about the many dental applications that allow me to work with Pri- mescan." Dr. Verena Freier, a dentist from Bad-Soden in Germany, sees an improvement in the ac- curacy of Primescan, especially for whole jaw scans. " With the new intraoral scanner Pri- mescan, which also works with CEREC, I am bringing the treatment of my patients to a very high level. If the results were really good before, for me they are now even better. And everything is easy and relaxed - I don't re- ally want to put the scanner out of my hand anymore. I particularly like the operation via a touch surface. Since patient satisfaction is very important to me, I am especially pleased that patients ask specifi cally for this impres- sion method and talk about it once they have experienced it themselves.” Primescan improves workﬂ ow with dental laboratories In addition to accurate and fast digital impres- sion taking, another advantage of Primescan is that it is designed for different digital work- Frankie Acosta is particularly pleased with the optimized pro- cesses and the high quality of the impression. Dr. Alexander Völcker, Group Vice President at Dentsply Sirona CAD/CAM & Orthodontics, sees promising prospects for digital impressions in dental and ortho- dontic practices. fl ows – in practice with CEREC as well as in col- laboration with the dental laboratory or other partners. Using the new Connect software, a digital 3D model can be transferred directly to the laboratory of choice for further processing. Frankie Acosta, a dental technician from Mur- rieta, California (USA), is particularly pleased with the optimized processes and the high quality of the impression. "As a dental laboratory that has been working with digital impressions for around ten years, we are delighted that it is now even easier for dentists to take impressions with an intraoral scanner. The accuracy with which Primescan works convinces us in our daily work. This also enables us to deliver work at a high level. The automatic download from the Inbox of the Connect Case Center is a real time saver". "With Primescan, we are providing our cus- tomers with a technology that decisively improves digital impression taking in many points," says Dr. Alexander Völcker, Group Vice President CAD/CAM and Orthodontics at Dentsply Sirona. "With a completely new tech- nology, the high-frequency contrast analysis, Primescan enables our customers to achieve very high accuracy in every digital impression. This offers possibilities for using it in many indications. The positive feedback from users all over the world encourages us to drive the development in this area." Unless stated otherwise, all statements in this press release refer to a comparison of Dentsply Sirona products. References 1. Ender et al, Ac- curacy of com- plete- and partial- arch impressions ofactual intraoral scanning systems in-vitro, Int J Com- put Dent 2019; 22(1);11-19 Find out more by scanning the QR code.
Optimal X-ray diagnostics is the ba- sis for almost all indications. With the three different Orthophos mod- els with varying features, every user – whether general or specialized dentist – can use the latest X-ray technology for the specifi c needs of his or her practice. In the future, im- ages created with the Orthophos S 3D and Orthophos SL 3D devices can also be used to plan treatment with SureSmile aligners. In conjunction with an optical scan, they were vali- dated for use in the SureSmile Align- er and SureSmile Ortho software. At the cutting edge of hygiene Dentsply Sirona World focused ex- tensively on this topic again this year with its own hygiene track, including presentations by Linda Harvey, Dr. Mia Geisinger, and Katrina Sanders. When it comes to hygiene, Dent- sply Sirona offers a comprehensive product range that greatly simplifi es treatment for patients and hygiene assistants. For example, the Nupro Freedom cordless prophylaxis hand- piece allows uncomplicated and thorough tooth polishing with easy intraoral access and no annoying cables. The ultrasonic scaling system of the Cavitron 300 series is the lat- est member of the Cavitron system family. The exclusive Steri-Mate 360 rotating handpiece allows easy handling without stopping, adjust- ing, and laboriously turning the ultrasonic probe during scaling treatment. The new digital operat- ing system generates less heat and requires less water for improved pa- tient comfort. This year's highlights: Jerry Seinfeld and Zac Brown Band The fi rst-class entertainment pro- gram has made Dentsply Sirona World an industry event that con- tinues to thrill dental experts and dentists. This year, Dentsply Sirona surprised the participants with two special highlights. On the fi rst even- ing, the world-renowned standup comedian, actor, screenwriter, pro- ducer, and author Jerry Seinfeld wel- comed the audience to the evening event in the Mandala Bay Resort and Casino. After an intensive day of ad- vanced training, another highlight awaited the participants on Friday 35 evening: Multiple Grammy Award- winning Zac Brown Band rocked the stage in a private concert. As Dentsply Sirona World has ended, planning for the next one begins: Next year the successful congress will take place in Las Vegas again, this time at the Caesars Forum, October 1-3. You can fi nd more information on Dentsply Sirona World at: www.dentsplysironaworld.com. Due to different approval and reg- istration times, not all technologies and products are immediately avail- able in all countries. AD Our new Turbine Generation Power is not a Matter of Size More power, smaller heads and less weight – The turbines of the premium class lie ideally balanced in your hand. No matter if you choose T1 Boost, T1 mini or T1 Control: all turbines offer high power, give you full control at all times and are working very quietly. Due to its small head, T1 mini allows for outstanding sight, T1 Boost offers maximum power at a whisper tone and T1 Control works continuously and at low noise due to its patented speed break. dentsplysirona.com/turbines Dental Tribune Middle East & Africa Edition | 6/2019 ◊Page 1 NEWS Dentsply Sirona World in Las Vegas is an absolute highlight of the den- tal industry, and this year was sold out weeks before the event. The successful concept also impressed thousands of participants – with a unique mix of clinical training units, presentations by more than 100 renowned dental experts, an inspir- ing exchange between colleagues, and a fi rst-class entertainment pro- gramme. One of the absolute highlights was the live treatments, which were streamed into the auditorium. For instance, Dr. Tarun Agarwal per- formed a full arch restoration using the Smartfi x concept with the new Astra Tech Implant EV, Dr. Erin Elliot presented a treatment for obstruc- tive sleep apnea, Dr. Meena Barsoum shared an orthodontic session with SureSmile with the audience. The live treatments were frequently used as an opportunity for discus- sions about the topics that practi- tioners deal with in their practice routines. "It is precisely these inter- actions that are crucial to us," said Don Casey, Chief Executive Offi cer of Dentsply Sirona. "We consistently direct our innovations to what our customers need in practices and labs. This is why we focus on entire workfl ows and solutions that inte- grate seamlessly with one another. Underlying these solutions is our commitment to R&D, into which we are investing more than 150 million US dollars this year alone. Over the past several years we invested close to one billion dollars – more than any other company in the dental in- dustry.” Specialist training: Personal and intensive The advanced training programme offered a broad overview with more than 100 intensive workshops on a comprehensive range of topics and lectures in twelve different areas, such as implant dentistry, labora- tory and hygiene, and presentations of new products and solutions by Dentsply Sirona. On the podium, dentists such as Dr. Karyn M. Halp- ern, Dr. Todd Ehrlich, Dr. Sameer Puri, Jasmin Haley, Dr. Tarun Agarw- al, and Shannon Pace Brinker, as well as many other well-known names of the industry, spoke about trends and developments. For Dentsply Sirona it is certain: Con- tinuous, professional clinical educa- tion is a factor to success for prac- tices and laboratories. In addition, innovative product solutions and a close relationship with customers are part of the common goal which is bringing healthy smiles to more people through happy and healthy practices. Astra Tech Implant System: The development continues Dentsply Sirona World proved again this year to be an excellent platform for getting fi rst hand knowledge of new products and solutions. The new Astra Tech Implant EV is a fur- ther development of the Astra Tech Implant System, one of the best- documented implant systems on the market. The modifi ed implant design brings signifi cant improve- ments: The apical implant thread ensures that the desired primary stability can be achieved. Addition- ally, the handling for inserting the implant has been simplifi ed. This innovation will be available starting October 2019 in the North American market and from the beginning of 2020 in Europe. Digital, validated and successful workﬂ ows
38 EVENTS Dental Tribune Middle East & Africa Edition | 6/2019 11th Dental Facial Cosmetic Conference & Exhibition Highlights Impressions from teh 11th Dental Facial Cosmetic Conference & Exhibition which took place in Dubai on 08-09 November 2019 at InterContinental Hotel, DFC.
Dental Tribune Middle East & Africa Edition | 6/2019 EVENTS 39
» What drives me? Best results. And Primescan is my answer. « Dr. Verena Freier, Dentist Primescan Engineered for superior performance. Innovation requires commitment to ambition: Primescan sets new standards in dental technology, making scanning more accurate, faster and easier than ever. It is engineered to enable all kind of treatments, from single tooth to full arch. Primescan produces highly accurate images and allows for fast scanning consolidating 50.000 images per second. The new patented “High Frequency Contrast Analysis” delivers perfect sharpness and an outstanding accuracy. With Primescan, intraoral scanning delivers excellent results like never before. Enjoy the scan. Learn more at: dentsplysirona.com/primescan
N L Y A L S O N F E S SI O O R T A L P N E D PUBLISHED IN DUBAI www.dental-tribune.me November-December 2019 | No. 6, Vol. 9 Better technology and referral relationships —Are they related? By Dr Gary Glassman, CA Advancements in technology have made it easier for dental profession- als to deliver successful endodontic treatment. Nevertheless, endodon- tics continues to be a specialty that is best handled by trained experts. It is appropriate for a general dentist to perform endodontic treatment on a patient when he or she is properly trained to perform the said proce- dure, has the appropriate equip- ment and possesses the requisite skill set for the treatment. However, if there is any doubt that the clinician can perform the procedure to the same standard of practice as an en- dodontic specialist, the case should be referred out. The American As- sociation of Endodontists offers its case difficulty assessment form and guidelines to help general practition- ers with case selection. Rapid advancements in endodontic technology have permitted dental professionals to enjoy higher success rates. Patients can retain their teeth for as long as possible, reducing the need for retreatment and/or extrac- tion, and thereby limiting the high costs they once faced. The dental operating microscope is a prime example. As it enables clini- cians to visualise the anatomy of the pulp chamber, they can locate the canal anatomy more proficiently and offer minimally invasive treat- ment by keeping access openings as small as practical while maintaining the structural integrity of the tooth. In addition, practitioners are able to maintain a more ergonomically fa- vourable position, thereby reducing stress on their back and neck. Ultrasonic instruments with spe- cially designed endodontic tips allow clinicians to uncover calcified canals, remove pulp stones, refine access preparations, and remove posts and cores. They aid in the debridement of the root canal system during irri- gation protocols in a controlled and predictably safe manner. Cone beam computed tomography (CBCT) offers unprecedented accu- racy and acuity. We can visualise the tooth in 3D; it is like a road map to the anatomy of the root canal system. In addition, the resolution of the CBCT is higher than that of traditional ra- diography, allowing the detection of periradicular pathology, which may have otherwise gone undetected. The type, location and extent of in- ternal/external resorption can now be definitively diagnosed and the relationship of normal anatomical structures can be assessed with ease. Dental service organisations offer specialists like endodontists an op- portunity to connect with general dentists and their patients, who may require advanced care. An open dialogue between endodontists and their general dentist colleagues will help ensure that patients receive the best possible treatment. Plus, the ac- cessibility of the patients through their general dentist’s office is often more practical and convenient, both for the patients and the practitioners. Communication and continuing ed- ucation are key components of the relationship between endodontists and general dentists, noting that a true partnership between practition- ers ultimately leads to better patient care. Dr Gary Glassman Endodontic Surgery https://www.rootcanals.ca AD FREE WORKSHOPS AT THE BOOTH Discover our products on Swiss Pavilion, Hall 8, Booth 8F06 ADAPTIVE. EASY. SAFE. EFFICIENT. www.fkg.ch/xpendo EXPAND YOUR MIND
Dental Tribune Middle East & Africa Edition | 6/2019 ENDO TRIBUNE A4 E=mc3: Endodontics is equal to the third power of many changes By Dr Kenneth S. Serota, USA Revolutionary protocols and materi- als science demonstrate the evolving sophistication of modern era root canal therapy. The technological ad- vances of the past three decades have enabled greater debridement and disinfection of the labyrinthine root canal space. Iterations of apex loca- tors, enhanced magnifi cation and illumination, new fi le designs and metallurgy provide for bio-minimal- ism and diminished fracture poten- tial. The development of bio-active adherent sealers has enhanced the biologic potential of root fi lling. How- ever, the sum of these innovations has not as yet produced a substantive increase in treatment outcome per- centages. For years, clinicians have accepted on faith the purported mar- keting claims of company-supported in vitro testing. Fortunately, scientifi c determination of the metrics of suc- cess of productneutral studies has replaced the possibility of experi- mental bias. The most profound change in en- dodontics is the recognition that root canal therapy is a restoratively driven discipline. Bio-smart materi- als used in the root and crown do not require egregious removal of tooth structure as dictated by classical pro- tocols. Clinicians blinded by the op- tics of the “artistry” of radiographic results are recognizing that this does not represent the totality of the bio- logic requirements of success. The “look” academically disenfran- chised the clinician from the un- derstanding of the biomechanical dynamics of dentine and its impact on the potential for fracture. The ex- AD EdgeEndo When you want... PERFORMANCE, STRENGTH, FLEXIBILITY AND VALUE HEAT-TREATED FIREWIRE™ NiTi • EdgeOne Fire™ is designed to shape canals in a reciprocating motion similar to WaveOne® Gold • EdgeOne Fire™ can be used with the same motor and hand piece setting as WaveOne® Gold. • EdgeOne Fire™ features our heat-treated Fire-Wire™ • Excellent flexibility, capable of 90° curves. • No bounce back to preserve canal anatomy. Differences in cyclic fatigue lifespan: WaveOne® Gold vs EdgeOne Fire.TM Background: Aim of this study is to investigate the cyclic fatigue resistance of the Gold treated WaveOne® Gold and the Firewire treated EdgeOne FireTM instruments. Conclusions: Firewire instruments resulted to be about two times more resistant to cyclic fatigue when compared with identical instruments made with Gold treatment. See latest research: https://web.edgeendo.com/differences-in- cyclic-fatigue-lifespan-waveone-gold-vs-edgeone-fire/ To learn more about EdgeEndo and the offering, please access the website www.edgeendo.com Made in the USA l a t n e D a s l u T y l p s t n e D f o k r a m e d a r t d e r e t s i g e r a s i l ® d o G e n O e v a W 3 1 - 9 0 6 e : ) 7 ( 1 1 ; 9 1 0 2 . t n e D p x E n i l C J cessive removal of tooth structure to enable treatment needs was coun- terintuitive to long term success and is fortunately a protocol of the past. As well, the overlooked impact of both light and heavy parafunc- tional loading on endodontically treated teeth is now recognized as the most important tipping point in the confi guration of the restoration required. The rigid restorative mandate of posts and cores had the propensity to cause catastrophic failure. Fortu- nately, reduced taper, new irrigation products have reduced the retention of greater volumes of tooth structure and the costs of new equipment. Overprepared tooth structure is not necessary in the adhesion era. The dogma of the protocol of clean- ing shaping, irrigation and “mono- bloc obturation” is axiomatic folly. The pendulum swings of new equipment and treatments are not necessarily best practices. The pri- mary disease vector of pulpal and peri-radicular is biofi lms and to date, the mechanism for their removal remains elusive. The work of Kishen and Shrestha on biofi lm disruption by nanoparticles shows the greatest hope for elimination of recrudescent disease as a consequence of biofi lm resistance intractability. The ebbs and fl ows of endodontic growth, even if measured in dollops, has always have been part of the ten- ets of interdisciplinary dental thera- peutics. The recognition that endo- dontics is an equal member at the table of disciplines is now assured as it has chosen to extend its involve- ment beyond the orifi ce. Endodon- tics is a foundational component of the state of oral health. Its outreach is now extended to a point commen- surate with its potential. Dr Kenneth Serota graduated with a DDS from the Univer- sity of Toronto Faculty of Dentistry in Can- ada in 1973 and received his Certiﬁ cate in Endodontics and Master of Medical Sci- ences from the Harvard–Forsyth Dental Center in Boston in Massachusetts in the US. Active in online education since 1998, he is the founder of the ROOTS endodon- tic forum and the NEXUS interdisciplinary forum. Dr Serota is an adjunct clinical in- structor in the University of Toronto post- doctoral endodontics department.
N L Y A L S O N F E S SI O O R T A L P N E D PUBLISHED IN DUBAI www.dental-tribune.me November-December | No. 6, Vol. 9 Dental Lab Technicians: Aesthetics at Its Best Highlights Impressions from the event with Umit Pak for dental technicians, part of Dental Facial Cosmetic Conference & Exhibition, which took place in Dubai on 08-09 November 2019 at InterContinental Hotel, DFC.
B2 LAB TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2019 Precisely controlling shade saturation with VITA AKZENT Plus CHROMA STAINS By VITA In the case of reconstructions that have an intermediate shade in whole or in part, near-natural reproduc- tion of the tooth shade is typically demanding. The chroma of the res- toration must be adjusted selectively or completely to consistently match the tooth shade. With the new VITA AKZENT Plus CHROMA STAINS (VITA Zahnfabrik, Bad Säckingen, Germany), the shade saturation of ceramic restorations can be con- trolled in a targeted manner. Dental Technician Renato Carretti (Zurich, Switzerland) uses an anterior crown to show how the shade effect can be systematically inﬂuenced with the new stains. Patient case Tooth 12 of a retired woman had been repeatedly restored with composite. Due to the size of the defect, chip- ping and fractures of the direct res- toration occurred again and again. After careful consideration, the pa- tient decided to have the tooth fully crowned. This was no easy task. Due to the aging process, the neighboring natural teeth in the aesthetic zone showed an individual play of shade and light that had to be reproduced ceramically. For the demanding single-tooth reconstruction, it was to be anatomically reduced from the vestibular side, and multichromatic zirconia and the multifaceted ve- neering ceramics VITA VM 9 were to be used. In the ﬁrst session, the tooth was prepared, scanned and provi- sionally restored. The determined basic tooth shade was between A2 and A3. conia was designed, milled and sin- tered in the CAD/CAM workﬂow. The vestibular reduction was cervi- cally layered with VITA VM 9 BASE DENTINE A3, and the body area was layered with A2. Due to the high translucency of the natural residual dentition, NEUTRAL and a very thin layer of WINDOW were used on the incisal edge. For a translucent depth effect, the ﬂanks were accentu- ated with bluish translucent EFFECT ENAMEL 9. This was followed by the ﬁrst dentin ﬁring. The restora- tion was still too bright on tryin. The cervical area was then characterized with a three-to-one mixture of BASE DENTINE A3 and EFFECT CHROMA 3 (light yellow). A translucent effect on both ﬂanks was achieved with EF- FECT STAINS 11 (blue). Vestibular individualisation The crown framework made of zir- Play of shade with VITA AKZENT Plus In order to replicate the multifaceted shade nuances in the incisal edge and in the body area of the crown, VITA AKZENT Plus CHROMA STAINS was used on a selective basis. “The CHROMA STAINS are very intense and also visible in a thin layer. This is fantastic, especially with monolithic restorations,” says Carretti, describ- ing the beneﬁts of the stains, which allow a targeted control of chroma staining. The mesial and distal in- cisal area, as well as the body area, were characterized with CHROMA STAINS A, and the middle incisal area with the more intense B. After visual intraoral comparison in the patient, all characterizations were ﬁxed with a stain ﬁring. Result and conclusion After a follow up clinical try-in, all participants were satisﬁed with the result. After the completion of the crown with ﬁne diamond and sand- paper, the glaze ﬁring could be car- ried out. For a natural effect, the gloss was ﬁnally reduced with a polishing brush and pumice, without reduc- ing the shade effect. The controllable chroma of the VITA AKZENT Plus CHROMA STAINS enabled a play of shades that matched the natural re- sidual dentition. The restoration met the high expectations of the patient. VITA® and other VITA products men- tioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany. Fig. 1: Initial Situation: Condition of tooth 12 after full crown preparation, intraoral scan and provisional restoration. Fig. 2: For the raw and stain try-ins, the temporary was removed. DT Renato Carretti Zurich, Switzerland Fig. 3: The raw ﬁring try-in after the ﬁrst dentin ﬁring still shows a crown that is much too bright. Fig. 4: The play of shade at the incisal edge and the body area was reproduced with VITA AKZENT Plus CHROMA STAINS A and B. Fig. 5: After the stain ﬁring, all participants were satisﬁed with the result. Fig. 6: Result: The crown was polished and ﬁnally integrated. The restoration harmonized with the remaining tooth substance.
N L Y A L S O N F E S SI O O R T A L P N E D PUBLISHED IN DUBAI www.dental-tribune.me November-December | No. 6, Vol. 9 Full-arch implant rehabilitation By Dr David García Baeza, Spain An implant-supported restoration is a good alternative to conventional complete prostheses for patients with edentulism. This treatment has been performed successfully in recent years and constitutes a high- value clinical reality. Oral implantology has undergone great advances in recent years, as it allows lost teeth to be replaced with a high degree of satisfaction on the functional and aesthetic level. A par- tial or total loss of teeth affects not only facial aesthetics but also vital functions, like chewing and phona- tion. A prosthodontic rehabilitation with a high success rate can be ob- tained for this type of patient. The prosthetic options for rehabilitating an edentulous patient with dental implants are divided into two cat- egories: fixed and removable resto- rations.1 A hybrid prosthesis consists of a cast metal framework covered by acrylic, which supports artificial fixed teeth. The original design of the hybrid prosthesis (fixed-removable) was developed by Swedish research- ers using the two-stage endosseous implant system developed by Per- Ingvar Brånemark. The prosthesis consisted of a gold alloy framework attached to the copings of the im- plants, and on this framework con- ventional acrylic resin denture teeth were secured with acrylic resin.2 The factors that determine the type of implant-supported restoration for a completely edentulous patient are the amount of space from the bone to the occlusal plane (pros- thetic space) and the lip support. The prosthetic space needed for a hybrid prosthesis is a minimum of 11mm and a maximum of 15mm, with lip support given by the bone structures. When a space of 10mm or less is available and there is lip support, a porcelain-to-metal res- toration is suggested. When there is more than 15 mm of prosthetic space and absence of lip support, a type of implant-supported overdenture res- toration is recommended, which will give the lip support not provided by the bony structures of the patient.1 Cox and Zarb described the treat- ment of severely resorbed complete- ly edentulous maxillae with a hybrid prosthesis using a metallic structure with acrylic and artificial teeth, with prosthetic spaces larger than 15mm.3 An incorrect adaptation between metal structures and implants can cause bone loss and failure of os- seointegration, which is clinically decisive. It is generally accepted in the literature that the passive fit of a prosthesis is required for mainte- nance and long-term success of an implant treatment. In addition, the literature has implied that incorrect adaptation of metal structures is a decisive and significant factor, caus- ing mechanical and biological com- plications. The loosening of both the prosthesis and the abutment screws and even the fracture of various sys- tem components have been attrib- uted to the lack of adjustment and adaptation of the prosthesis. In this article, the clinical case of a pa- tient with a completely edentulous maxilla and advanced periodontal disease in the mandible is presented. The patient’s mandible was rehabili- tated with a hybrid prosthesis on six implants. The implant-supported prosthetic treatment that was per- formed to restore the patient’s aes- thetics and functionality, thereby improving his quality of life, is de- scribed step by step, as is the prepa- ration process of the prosthesis. Case presentation A 68-year-old patient presented to our facility with a complete maxil- lary mucosa-supported denture, with which he was relatively com- fortable. He had all of his original teeth on the lower arch, but with very advanced periodontal disease, which had caused him a loss of sup- port of more than 80 per cent. These teeth presented with Class II and III mobility, which made it very diffi- cult to chew (Figs. 1 & 2). The proposed treatment plan for the patient was to extract the mandibu- lar teeth and rehabilitate the lower arch using implants and a fixed pros- thesis to maintain the same feeling as with his natural teeth. In addition, it was decided to replace the com- plete denture of the upper arch. Normally, when teeth are extracted from a complete arch and an im- mediate restoration is placed, it cre- ates a problem of adaptation for the patient, especially in the mandibular area. To help the patient during this period of healing and osseointegra- tion of the implants, it is recom- mended to place two provisional implants. Once the extractions had healed, six Aadva tapered implants (GC Tech. Europe) of 4mm in diameter and 10mm in length were placed in the position of the molars, first premo- lars and central incisors (Figs. 3a & b). The bone quality and quantity were good, and once the expected osse- ointegration time had passed, transi- tional abutments were placed. In this case, two abutment diameters were used, narrower (SR Abutment of 3.8 x 2.0mm, GC Tech.Europe) for the in- cisal and premolar areas, where there was less inserted gingival tissue, and wider (SR Abutment of 4.3 x 2.0 mm) in the posterior area (Figs. 4 & 5). Before beginning with the prosthetic phase, there was a waiting period for the tissue to mature. For this, an impression was taken with closed- tray copings, which is very simple, but does not give a very exact model (Figs. 6 & 7). This was subsequently used to make a rigid impression tray that was made of metal and was se- cured with plaster to only one of the implants (Fig. 8). Fig. 1: Frontal view of the initial patient situation. Fig. 2: Intraoral view of the initial situation. Figs. 3a & b: After extractions: a) Frontal and b) occlusal view. Figs. 4a & b: Healing abutments: a) Frontal and b) occlusal view. Fig. 5: SR Abutments at gingival level. Fig. 6: Impression taking with closed-tray copings. Fig. 7: Preliminary impression. Fig. 8: Rigid metal tray impression taking: Fixing with plaster. Fig. 9: First step of ﬁnal impression taking. Fig. 10: Final impression. Fig. 11: Master model. Once the rigid impression tray was placed in the mouth, open-tray cop- ings were then used and they were splinted to the structure with a spe- cial plaster mixture; once this had hardened, everything was registered with a polyvinylsiloxane impression (Figs. 9 & 10). This technique yields a very reliable master cast, ensuring a very good structure fit (Fig. 11). Once the final model with the differ- ent analogues was ready, the plan- ÿPage C2
C2 ◊Page C1 IMPLANT TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2019 Fig. 12: Lateral radiograph taken with lead foil on the old denture for radiographic evaluation. Fig. 13: Fox plane test. Fig. 14: Panadent articulator phase. Fig. 15: Wax test conﬁrming smile parameters. Figs. 16a–c: Wax try-in: a) Left, b) right and c) frontal view. Fig. 17: Models in ﬁnal position. Figs. 18a: Models in the articulator. Figs. 18b: Models in the articulator. Figs. 18c: Models in the articulator. Figs. 19a: Final wax test. Fig. 20: Aadva software: Structural design. Figs. 19b: Final wax test. ning started. First, the old complete maxillary denture was analysed. In this type of case, it is very useful to perform a lateral analysis, thus photographs and radiographs were taken. A step that differentiates our technique from other dentists’ is that a narrow lead foil strip is placed on the maxillary and mandibular central incisors. This provides extra information to see the relationship between the position of the anterior teeth and the bone (Fig. 12). With the lateral radiographs, the situation of the transitional abut- ments can be visualised, which is very important, as all the manipula- tion based on the different tests that need to be done will be carried out far from the head of the implant. Once the fulcrum points and the in- clination of the maxillary incisors for lip support had been analysed, the new upper arch was designed in or- der to give the patient a new occlusal plane and a new incisal position. The Fox plane helped us to obtain the correct plane and then we used the Kois Bow for the cranial-maxillary reference (Fig. 13). Once the models had been placed in the articulator and the parameters taken from the patient, the labora- tory technician began to make a set of test teeth from wax for both the upper and lower arches so that the correct fit could be assessed, includ- ing the patient’s occlusion and aes- thetics (Figs. 14 & 15). As Figures 16 to 19 show, the upper arch was narrower than the lower one because those teeth were lost much earlier, which meant that, for correct functioning of the complete maxillary prosthesis while chewing, the posterior areas were to be placed at a crossbite. That way, the axis of force when chewing food would fall on the alveolar process and not dis- place the prosthesis. Once confirmed that everything worked properly, the next step was constructing the metal structure that would be closely linked to the wax tooth design (Figs. 20 & 21). This was once again checked with the teeth in position to give a last confir- mation before the final manufactur- ing. At that time, confirmation of the modifications made could be carried out again by using the lead foil strip, as well as confirmation of the occlu- sion, in case there was any variation (Fig. 22). Subsequently, the final prostheses were made. The maxillary one was made as wide as possible in the pos- terior area so that it would be as sta- ble as possible, and the mandibular one was placed on implants. Confir- mation and small adjustments had to be performed in the mouth to counterbalance the small misalign- ments that normally occur in manu- facturing (Figs. 23–25). Discussion The treatment of a completely eden- tulous patient with an oral restora- tion on implants begins by discuss- ing treatment expectations, followed by an accurate clinical evaluation. Thus, a detailed intraoral and ex- traoral examination are performed following a work plan to help in the diagnosis. This includes studying pa- tient photographs and radiographs, which have evolved remarkably in recent times, using models on a semi-adjustable articulator and fol- lowing the protocol for the design of a proper prosthetic restoration on implants, choosing from overden- tures, or hybrid or fixed prostheses. The choice will depend on what the dentist plans using a multifunctional guide—tomographic/surgical/pros- thetic—for implant placement and a suitable type of oral restoration. Rehabilitation with implant-sup- ported hybrid prostheses is a fixed treatment in completely edentulous jaws where the prosthetic space is 11mm or 15mm,3 but where the need for lip support for prosthetic restora- tion is not a determining factor.4 An implant-supported hybrid prosthe- sis can be a questionable alternative treatment when a fixed restoration of porcelain and metal does not meet the patient’s requirements for aes- thetics, good phonetics, proper oral hygiene and oral comfort.5,6 Bidra and Agar proposed a classifica- tion system for edentulous patients for using implant-supported fixed prostheses, classifying them into four classes according to the follow- ing factors: 1. amount of tissue loss; 2. position of the anterior teeth in re- lation to the location of the residual ridge; 3. lip support; 4. smile line; and 5.need for prosthetic material for gin- gival colouring (pink acrylic).4 Class I includes patients who require gingiva-coloured prosthetic mate- rial such as pink acrylic to obtain aes- thetic tooth proportions and op- timal prosthetic contouring to attain adequate lip support. Class II patients require pink acrylic only to obtain aesthetic tooth proportions and for prosthetic contouring. Lip support is not a consideration, since the differ- ence in lip projection with or without any prosthesis is generally insignifi- cant. Class III contains patients who do not require gin giva-coloured prosthetic material. Class IV is as- signed to patients who may or may not require pink acrylic, depending on the result obtained after surgical intervention.4 Following this classifi- cation, the patient in this report was determined as Class II. The fabrication of hybrid dentures in patients with adequate interoc- clusal space provides the dentist with several advantages regarding the aesthetic appearance, including replacement and decrease of soft- tissue support owing to the bulki- ness of the metal substructure and in the height of crowns compared with a metal-supported porcelain pros- thesis. In addition to these aesthetic advantages, hybrid prostheses work Fig. 21: Anterior view, ﬁnal test. Fig. 22: Lead foil test for the new design. ÿPage C3
Dental Tribune Middle East & Africa Edition | 6/2019 ◊Page C2 IMPLANT TRIBUNE C3 as shock absorbers, reducing load forces on implants.7 The success rate of implant-support- ed hybrid prosthetic treatments is high, as demonstrated by a system- atic review published in 2014, which included 18 studies for evaluation. In a period of five to ten years, high sur- vival rates of 93.3–100 per cent for the prostheses and of 87.9–100 per cent for the implants were found.8 In a retrospective study evaluating the main complications after reha- bilitation with an implant-support- ed hybrid prosthesis, it was observed that the main complication was mu- cositis, which affected 24 per cent of the cases, followed by problems with the prosthetic screws in 13.7 per cent of the cases, including thread wear or loss, and the same percentage was found for fracture of the prosthetic teeth or prosthesis detachment. These problems were related to an incorrect record of vertical dimen- sion, inadequate occlusion or a lack of passive fit of the metallic struc- ture. Another problem encountered concerned the access to the entrance holes of the prosthetic screws (7.8 per cent).9 Conclusion A lower jaw hybrid restoration is a good option for the rehabilitation of an edentulous mandible, and it should be included in the treatment options when evaluating a patient, as it improves aesthetics, function- ality and proprioception. It is fur- thermore easy to clean, requires less prosthetic maintenance, and can be removed at any time and repaired at a very low cost. Editorial note: This article was originally published in implants-international magazine of oral implantology, Issue 4/2018. Dr David García Baeza CIMA private dental practice Laguna Grande 4 28034 Madrid, Spain email@example.com Figs. 23a & b: Final restorations: a) Lateral and b) frontal view. Fig. 24: Final smile. Fig. 25: Final restoration. Delivering innovation, digital solutions and versatility—the Astra Tech Implant System evolution continues… By Dentsply Sirona Implants Dentsply Sirona Implants contin- ues to deliver innovation, digital solutions and versatility in implant dentistry. With the latest product de- velopments, the Astra Tech Implant System continues to evolve, based on customer needs and the latest digital technology. With a comprehensive product and solutions portfolio for all phases of implant dentistry, Dentsply Sirona Implants continually strives to in- crease the application of implant therapy, based on science and with- out compromising safety and effi- cacy. “The implant solutions that we develop are based on the needs of our customers, as well as centered around our well-documented and clinically proven implant systems. We’re all about providing long-term functional and aesthetic solutions for the many different situations that happen in clinics and laborato- ries every day all over the world. And we help dental professionals deliver the absolute best care for their pa- tients,” says Gene Dorff, Group Vice President at Dentsply Sirona Im- plants. Azento for single tooth replacement Azento is the latest innovation in the Dentsply Sirona Implants’ implant solutions portfolio, helping implant dentistry professionals with one of their most common indications— single tooth replacement—in im- plant therapy. Each patient treated with Azento gets a custom treatment plan, in- cluding surgical guide, instruments, drills, a case-specific Astra Tech Im- plant System or Xive implant, an At- lantis custom healing abutment and an optional temporary restoration. Fig. 1: Azento is a digital implant workﬂow solution that streamlines the implant planning, purchasing and delivery for single tooth replacement. This digital implant workflow solu- tion streamlines the implant plan- ning, purchasing and delivery of products. For the clinician, this cus- tom implant solution increases con- venience, seamlessly and efficiently connects with qualified laboratories, and enables consistent, excellent re- sults for patients. Introducing Astra Tech Implant EV The Astra Tech Implant System just got even better—with the new Astra Tech Implant EV. As one of the most well-documented implant systems in the market today—documented in over 1,000 publications in peer- reviewed journals—it continues to evolve and provide great clinical benefits. In fact, the revised implant design change comes with significant ad- vantages—with a deeper implant thread design apically, it is easier to reach preferred primary stability and the handling experience is en- hanced for easy installation. Dr. Mark Ludlow, Division Direc- tor of Implant Prosthodontics and Associate Professor at the College of Dental Medicine at the Medical University of South Carolina, agrees: “You still have all the wonderful properties of TX and EV, but with this new implant, you get better han- dling that helps hit that primary sta- bility—it literally just sinks into the osteotomy.” With this new change in design prop- erties also comes the new name— Astra Tech Implant EV. The new im- plant line will be available starting in the North American market in Octo- ber 2019 and in the European market in early 2020. Fig. 2: The Astra Tech Implant EV has a deeper implant thread design apically, making it easier to reach preferred prima- ry stability and enhances the handling experience for easy installation. Latest clinical data on Astra Tech Implant System The Astra Tech Implant System Os- seoSpeed implants show excellent long-term clinical results, as de- scribed in the article by Windael et. al.** Patients in this study received a total of 105 immediately loaded im- plants in the edentulous mandible. Minimal bone loss, 100% implant survival and 100% prosthetic surviv- al rates were reported at the 10-year follow-up. Using short implant is a solution for patients with limited bone that are unwilling or unable to undergo bone grafting. In a recently pub- ÿPage C4
N L Y A L S O N F E S SI O O R T A L P N E D PUBLISHED IN DUBAI www.dental-tribune.me November-December | No. 6, Vol. 9 Three-dimensional “technologies are going to become the standard of care” Interview with Dr Sean K. Carlson By Nathalie Schüller, DTI Dr Sean K. Carlson is Associate Pro- fessor of Orthodontics at the Univer- sity of the Pacific’s Arthur A. Dugoni School of Dentistry in San Francisco and maintains a private practice in Mill Valley, both in California in the US. Carlson is also a senior investi- gator in the Craniofacial Research Instrumentation Laboratory at the dental school. He lectures nationally on a variety of clinical and theoreti- cal subjects, with a focus on 3-D im- aging in orthodontics. His primary focus is on using computer technol- ogy to improve the way we study, teach and practise orthodontics. During the Spring Meeting of the European Aligner Society, which took place in Venice in Italy from 29 to 31 March, Carlson shared some of his thoughts on making the change to 3-D technology in orthodontics, the use of clear aligners and treating sleep apnoea. Why did you choose to specialise in orthodontics? Did your need for creativity have anything to do with your choice? Of course! Orthodontics is incred- ibly creative, and I think, depending on the type of orthodontist you be- come, you can express that creativ- ity in ways that are difficult in other careers. I’ve always liked the idea of healthcare; I am very altruistic in nature and like to help people, so all fitted very well in choosing ortho- dontics. It is a very clean profession in healthcare: your patients are not AD truly sick, but you are helping them with your engineering skills and spatial relationships, which always interested me, so it all came perfectly into place with my personality traits and I’ve never found anything more interesting. What do you mean when you say that depending on the type of or- thodontics you practise you can express your creativity better? I think there are both creative and non-creative orthodontists. Some people follow the rules, follow what was done before and never think for themselves and, in doing so, just repeat what’s been done. That’s fine but is not going to push the specialty forward. If you are going to be crea- tive, your job is to find the next level, find the horizon, and not everybody wants to do that because it is chal- lenging. You spoke about altruism being important to you. How can we ap- ply it in orthodontics? Giving back is essential and I think you should do it at every opportu- nity you can, but I think value in delivering service is important. Doc- tors tend to think that caring is about providing free treatment. That’s not fair. Human relationships are about exchange. If you are expected to give with nothing in return, people won’t value what they are receiving. I have no problem with the cost of something; if it has value to you, I think the cost is worth it. That does not mean you should ignore people that are less fortunate, so I love pro- grammes that help patients who can’t afford the treatments. Dr Melissa Shotell in her presen- tation stated that only 20 per cent of dentists use CAD/CAM tech- nology and Dr Adriano Marotta Araujo that only 10 to 20 per cent use aligners. Three-dimensional technology is at the core of your treatments, possibly your teach- ing and research too. Why do you think so many dentists do not use these amazing technologies, and how could we change that? There are two major reasons people don’t use them: cost and experience or the lack thereof. They either don’t want to pay for it, which brings us back to our discussion about service with orthodontics. Even if the tech- nology is great, such as a 3-D CAD/ CAM camera or a CBCT device, if you think it is overpriced, you will find any excuse not to use it. So, the chal- lenge with these new types of tech- nologies is that people don’t under- stand the value until they have paid the cost to own them. Once you get into new technologies and you real- ise you can’t live without them, then the price does not matter, but getting people to that point is very hard. The other reason is the learning curve of these new technologies. Whether it’s using CAD/CAM to produce crowns using 3-D milling machines or using impression-free imaging or CBCT, learning how to use them is difficult; you need practice and it’s hard work. Many dentists and orthodontists are very comfortable; we have a very good life, so why make it hard? I think we just use the excuse to avoid pushing through the pain, and it stifles our progress. But there are always going to be doctors who understand that pushing through that pain ceiling to become better is a constant pursuit in daily practice. And if you do that, you adopt these new technologies very quickly and end up being on the leading edge of technology. These technologies are going to be- come the standard of care; there is no question about it. It is just going to take a generation or two to hap- pen. Since you teach as well, you’d be able to say whether I’m correct in surmising that the next generation does not plan to have a practice without 3-D technologies, right? There is no question that my stu- dents understand these types of technologies ten times better than a seasoned orthodontist who is 50 years old and has a really hard time adapting to new technologies be- cause he or she, like the rest of us, is really comfortable and doesn’t want to feel pain. The young doctors un- derstand this and are very eager. The challenge for them is cost because they are fearful of not being able to afford things. I think that the young students who understand that this technology is necessary will thrive, but the students who are focused on the cost issue will end up stall- ing their practice growth and be five years behind the ones who use it. So, a lot is about fear. The main answer to your question is that people are scared and that is just human na- ture; we don’t like change, whether it is where you live, or in your rela- tionships or career. Anything that’s unknown is scary and hard. By na- ture, human beings don’t like pain, so that’s what’s keeping people be- hind. There are nowadays many com- panies on the market, and com- petition will drive the price down, don’t you think? Yes, that is one answer but not the ÿPage D2
D3 ORTHO TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2019 Treatment of a moderate to severe Class II malocclusion using Invisalign® treatment with mandibular advancement—a case report Intraoral view of Invisalign treatment with mandibular advancement INITIAL RECORS By Dr Donna Galante, USA Introduction Minimizing the use of elastics in Class II treatments not only address- es a patient compliance concern, it also addresses a treatment effi ciency concern. The vertical force com- ponent of Class II elastics tends to extrude teeth, which redirects man- dibular growth in a vertical direction and makes the A-P correction less ef- fi cient. Avoiding clockwise rotation of the mandible (i.e., downward and backward) helps to keep mandibular growth along a horizontal trajectory in order to maximize the sagittal change. Case Report Patient information: • 14 years old • Male • Chief concern: overbite and crowd- ing Orthodontic diagnosis: • Right side: Class II molar and canine (moderate) • Left side: Class II molar and canine (severe) • Overbite: severe deep bite • Upper arch: moderate crowding, with retroclined incisors • Lower arch: moderate crowding Invisalign treatment with mandibu- lar advancement utilize integrated precision wings to advance the man- Horizontal mandibular development (green arrow) has a greater amount of sagittal change than mandibular devel- opment which contains a vertical compo- nent (blue arrow) dible without the use of interarch elastics. The precision wings in the lower aligners position the mandible forward by sliding against the preci- sion wings in the upper aligners. At the same time, the active portions of the aligners straighten the teeth and coordinate the arches to remove interarch interferences and stabilize the sagittal changes. This approach maximizes the horizontal compo- nent of the mandibular advance- ment and minimizes unwanted ver- tical changes. KEY CEPHALOMETRIC VALUES Measurement (deg) SNA SNB ANB U1-SN L1-MP Interincisal angle FMA Initial 83.1 73.3 9.9 82.8 84.9 138.4 35.5 Norm 82 80 2.0 103 90 135 25 Std Dev 2.0 2.0 1.5 6.0 4.5 6.0 2.0 Treatment plan: How the precision wings (in blue) appear in the ClinCheck set-up. 3 month progress records (weekly aligner changes) 6 month progress records (weekly aligner changes) – Class I molar and canine relationship was achieved, but the transverse and posterior vertical dimensions still needed correction. End of mandibular advancement phase (12 months, U: 23 + 26; L: 23 + 26; weekly aligner changes) Final after an additional aligners phase of U:25 + L:25 aligners, changed weekly (10 months total) ÿPage D4
N L Y A L S O N F E S SI O O R T A L P N E D PUBLISHED IN DUBAI www.dental-tribune.me November-December | No. 6, Vol. 9 Dental Hygienist Seminar Highlights Impressions from Dental Hygienist Seminar and hands-on courses for dental hygienists, part of Dental Facial Cosmetic Conference & Exhibition, which took place in Dubai on 08-09 November 2019 at InterContinental Hotel, DFC.
E2 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2019 Ozone therapy in dentistry: notably effective in accelerating pre- and postoperative healing By DTI Over the last few decades, the use of ozone in dentistry has been estab- lished as an effective, minimally in- vasive therapeutic modality with an increasing number of applications. Sixty years after Dr Joachim Hänsler patented his OZONOSAN, the first medical ozone water generator with an exact dosage output, family- owned company Dr. J. Hänsler has become a leader in ozone technol- ogy with applications in medical and dental hygiene. We interviewed Managing Director Dr Renate Viebahn-Hänsler, who is also a board member of the European Commit- tee of the International Ozone As- sociation, and Yvonne Hoffmann, Managing Director of Hoffmann Dental Manufaktur, which took over the global sales and distribution of the OZONOSAN dental water unit in 2017. What is ozone used for in dentistry? Dr Renate Viebahn-Hänsler: The use of ozone in dentistry extends back to the 1930s, which is when sci- entists first discovered its properties and started to use it for a number of applications, such as wound cleans- ing, mouth rinsing and disinfecting. Ozone is also notably effective in accelerating pre- and postoperative healing of the oral mucosa. Nowa- days, ozone therapy in dentistry is mainly used in clinics for holistic dentistry, but owing to its disinfect- ant properties, ozonised water could be of great help after dental implant surgery and should be introduced in periodontal treatment, as well as any form of oral or dental surgery, in the future. How did you become aware of ozone’s potential? Viebahn-Hänsler: I have been in the medical ozone business for over 30 years. In this time, a significant amount of research on the topic has been conducted, including much research specifically related to den- tistry. Those who are interested can find these publications listed on our website, www.ozonosan.de. Yvonne Hoffmann: In 2014, Hoff- mann Dental took over Proxidentis Dentale Biomaterialien, a producer of natural oral health products, in- cluding ozone oil for periodontal treatment. After learning about ozone oil, it was only a small step towards developing ozone water rinses. What are the differences in appli- cation between ozone as a gas mix- ture and ozone dissolved in water? Viebahn-Hänsler: Gaseous ozone cannot possibly act as a disinfectant. Owing to its polar molecular struc- ture, ozone has great solubility in a polar solvent like water. As hydro- gen bonds stabilise ozone, ozone’s half-life in water by far exceeds that of its gaseous version. As such, we recommend ozone water or oil for disinfecting wounds, not an ozone– oxygen gas mixture. Moreover, the gas mixture cannot be used safely in dentistry owing its toxicity to the respiratory epithelium. Ozone water, however, can be used as a mouth- wash to rinse wounds and periodon- tal pockets. Owing to its pronounced disinfectant and healing effects, ozone is a perfect alternative to tooth cleaning with sugar alcohols or sodi- um bicarbonate. Ozone water must be generated on- site. Is training necessary? Viebahn-Hänsler: Our ozone water generator is subject to the Medical Device Act and requires instruction and training by a medical device consultant. Nonetheless, its handling is very simple. conventional periodontal treat- ment? Hoffmann: Rinsing with ozone wa- ter followed by the application of ozone oil is a great complement to conventional periodontal treatment or professional dental cleaning. Viebahn-Hänsler: Ozone water does not distinguish between aerobic and anaerobic bacteria. It destroys the cell membrane and ultimately the DNA/RNA of bacteria and viruses that come into direct contact with the ozone molecules. Additionally, ozone water improves healing pro- cesses by activating the cellular me- tabolism. How does ozone inhibit anaerobic periodonto-pathogenic bacteria? What advantages does it have over Hoffmann: Ozone oil works differ- ently in that it only kills anaerobic bacteria, which are the bacteria spe- Dr Renate Viebahn-Hänsler Yvonne Hoffmann cifically linked to periodontal dis- ease. Because of its density, ozone oil easily adheres to interdental spaces and periodontal pockets, where it is retained for longer than ozone water. Unlike chlorhexidine, ozone water and ozone oil in excessive amounts cannot possibly lead to altered taste or tooth discoloration. They do not provoke any allergies, have no known side-effects and are a safe, ef- fective way to reduce the postopera- tive use of antibiotics and cortisone. What are the beneﬁts of ozone be- yond dentistry? Is it used elsewhere? Viebahn-Hänsler: Medical ozone is used for wound disinfection and treating chronic inflammatory dis- eases. Other therapeutic applica- tions are auto-haemotherapy, in which the patient’s blood is exposed to ozone and then reinjected, or rec- tal insufflation. Hoffmann: Ozone is also used in wa- ter purification in municipal water- works to destroy bacteria and para- sites such as Cryptosporidium and Giardia. Unnoticed by most of us, it is also used in public swimming pools to reduce the total chlorine level needed to improve the water quality. Editorial note: This article was originally published in prevention-international maga- zine for oral health, Issue 1/2018.
E4 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2019 Oral microbiota, intestinal microbiota and inﬂammatory bowel disease By Prof. Denis Bourgeois, France Intestinal microbiota There exists a close relationship between the human host and the intestinal microbiota—a mixed community of microorganisms that protect the intestine from being colonised by exogenous pathogens. In a healthy individual, the host and microbiota coexist in mutual harmony, allowing both to function properly.1 The balance of the intesti- nal microbial ecosystem can be dis- rupted by a number of factors, such as antibiotics, vaccinations, certain foods and stress. An intestinal bac- terial disorder primarily manifests in terms of quantitative changes in bacterial location, causing excessive bacterial growth in the intestine. This can damage the intestinal mucosal barrier, thereby releasing entero- toxins as a means to increase intes- tinal epithelial permeability so that bacteria and products can enter the intestinal lamellae, causing an im- mune dysregulation of the mucous membranes and inducing inflam- matory bowel disease (IBD). Changes in intestinal microbes are associated with the development of IBD. IBD comprises a group of idiopathic diseases characterised by chronic inflammation of the bowel. This inflammation may affect any part of the gastrointestinal tract. IBD represents a group of two principal intestinal disorders: Crohn’s disease (CD) and ulcerative colitis. These two disorders have distinct clinical and pathological features, yet they do overlap. The pathogenesis of CD is most no- tably associated with a deterioration of the immune system, which be- comes incapable of destroying bac- teria, viruses and other potentially harmful foreign organisms, as well as the intestinal microbiota. There is currently good evidence that the intestinal flora or microbiota plays a key role in the development of IBD. Recent studies have shown that certain strains of intestinal bacteria are responsible for ulceration and chronic inflammation in IBD. Ulcera- tive colitis, as opposed to what was initially believed, is not an autoim- mune disease, but rather an infec- tious disease elated to an imbalance in the intestinal microbiota.2 According to He et al., the CD micro- biota is grouped into two distinct meta-communities, which would in- dicate subject variation in the struc- ture of the microbiome.3 Specific functional changes in the CD meta- community show increased levels of pro-inflammatory hexa-acylated lipopolysaccharides and a reduced potential to synthesise short-chain fatty acids. Moreover, disruption of ecological networks in CD is associ- ated with reduced growth rates of many bacterial species. The authors concluded that the microbiota of CD patients can be layered into two dis- tinct meta-communities, in which the most seriously disrupted meta- community exhibits functional po- tentials that substantially deviate from those of a healthy individual, with a possible implication for the pathogenesis of CD. Various explanations have been advanced, such as the hygiene hy- pothesis, which blames the frequent use of antibiotics and microbicidal compounds; the partial elimination of enteric microflora after suffer- ing from infectious acute gastroen- teritis; certain food components, AD REGISTER FOR FREE! DT Study Club – e-learning platform Join the largest educational network in dentistry! www.DTStudyClub.com Tribune Group GmbH is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of 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. Tribune Group GmbH designates this activity for one continuing education credit. Prof. Denis Bourgeois for example refined sugars used in developed countries, which could promote the growth of certain types of bacterial species; and even certain types of toothpaste. Oral microbiome Individuals’ oral microbiomes are highly specific at the species level, although overall, the human oral microbiome is largely homogenous. If the symbiotic balance between the host and the microbiota of the oral cavity is disrupted, the microbiota may become harmful. Distinctions in microbial composition have been found between carious and caries- free microbiomes, as well as perio- dontally diseased and periodontally healthy microbiomes. Although caries and periodontitis are clearly bacterial diseases, they are not infec- tious diseases in the classical sense, since they result from a number of factors: commensal microbiota, host susceptibility and environmental factors, such as diet and smoking. The literature on interdental ap- plied to carious lesions is extremely limited. However, it has been estab- lished that the effective presence of the red complex, particularly Por- phyromonas gingivalis, a pathogen of heart disease and other systemic diseases, is a strong indicator of the need to develop new methods to disrupt interdental biofilm through daily oral hygiene. Indeed, it has been shown that low levels of P. gingivalis (< 0.01% of the total load) were able to induce changes in the composi- tion of the biofilm.4 Likewise, the presence of Candidas albicans in sig- nificant quantities in the interdental spaces is cause for concern. Under- standing the impact of such bacteria and yeasts in the interdental spaces within an oral environment, includ- ing, of course, the salivary environ- ment—which have the potential to spread at any time of their lives with- in the digestive tract—is a priority. The relationship between the two Though there is still much to be learnt about the interaction between the oral and intestinal microbiota, numerous recent studies have shed some light on it. By examining the oral health of patients with dyspep- sia who were candidates for diag- nostic upper gastrointestinal endos- copies, Zaheda et al. found a direct relationship between Helicobacter pylori, a bacterium known to irri- tate the stomach lining and induce chronic gastritis, as well as poor peri- odontal health.5 This observation is supported by existing literature on the subject, which suggests that den- tal plaque may harbour H. pylori and cause recurrences of gastric infec- tion. A 2017 study by Hujoel and Ling- ström traced an overview of the historical role of nutrition in the de- velopment and prevention of dental caries, gingival bleeding and peri- odontal disease.6 Given how much recommendations on nutrition have changed over time—the World Health Organization has only since 2015 recommended the restriction of sugar intake, for example—it is in- teresting to see that the current evi- dence suggested a low-carbohydrate diet high in non-vegetable fats, mi- cronutrients (e.g. vitamin C and B12) and protein was correlated with peri- odontal health. However, the ability to absorb these nutrients can be in- fluenced by gastrointestinal health. As the Canadian Society of Intestinal Research has reported, the improper functioning of the gastrointestinal tract can reduce nutrient absorption, leading to vitamin and mineral defi- ciencies that may cause oral lesions and tongue inflammation. Editorial note: A list of references can be obtained from the publisher. This article was originally published in prevention-international maga- zine for oral health, Issue 1/2018.
THE COMPACT MAKES ABIG CHANGE To help any user of air driven handpieces c o n v e r t t o e l e c t r i c a n d e n j o y t h e f u l l b e n e ﬁ t s o f i t s h i g h f u n c t i o n a l i t y. A b i g c h a n g e i n t r e a t m e n t e n v i r o n m e n t i s brou ght with only a minor addition to the current equipment in your off ice. E L ECT R IC M IC ROMOTO R U P G R A D I NG SYS T EM *NLZ E with Endo Function
E6 HYGIENE TRIBUNE Dental Tribune Middle East & Africa Edition | 6/2019 A shift in bioﬁlm management By Dr Klaus-Dieter Bastendorf, Swit- zerland Centuries ago, dentistry identified mineral deposits, such as tartar or calculus, as the main cause of den- tal disease. Further research then recognised bacterial infections in the roots and the periodontium as the cause of periodontitis. So, what was the logical conclusion? Calculus (tartar) was removed completely. Today, we know that calculus has a porous surface that provides a niche environment for bacteria and endo- toxins. Endotoxins are not absorbed into the calculus, so it can be easily removed. However, extensive removal of cal- culus is contraindicated and coun- terproductive. When I started out as a dentist over 40 years ago, prophylaxis was still in its infancy. At my university, there was minimal literature on everyday oral hygiene. An eye-opening mo- ment for me was during a visit to see Prof. Jan Lindhe in Gothenburg. There, we studied cases of periodon- titis that caused almost everyone to cry out: full dentures! We then saw images of the same patients ten years later—they still had their natu- ral teeth, solely thanks to prophy- laxis. The thing that made me opt for prophylaxis in dentistry was the birth of my first daughter. I would never have been able to forgive my- self if she developed a dental disease. This private passion for preventive dentistry and the vision of Prof. Ax- elsson and Prof. Lindhe have stayed with me to this day. Although my children and grandchildren’s teeth are healthy, I do see a lot of un- healthy teeth in people in my own generation. 40 years ago, there was a limited un- derstanding of biofilm, individual diagnostics and individual prophy- laxis. We removed calculus twice a year, but only introduced individual diagnostics and treatment in 1994. Today, we know the value of prophy- laxis. One major reason is that we have a greater understanding of the causes of the most prevalent dental illnesses. The trigger for cavities, gin- givitis, periodontitis, peri-implant mucositis and peri-implantitis is al- ways biofilm and not calculus. How- ever, the amount of biofilm is not the determining factor, rather, it is the biofilm’s ecological make-up, type and balance. Biofilm is a microbial, “organised” collection of microorganisms. The microorganisms are embedded in a matrix of extracellular polymer substances that the microorgan- isms produce themselves. Microor- ganisms in biofilm show a different phenotype regarding growth rate and gene expression compared to suspended living cells. Dental plaque is a kind of biofilm and since biofilm forms an adhesive layer, special at- tention is required to destroy and/or remove it. Classic... Currently, there are two technologies available for the manual destruction of oral biofilm, everyday manual biofilm management and profes- sional manual biofilm management. In professional manual biofilm man- agement, we have a range of tools available, including manual debride- ment with handheld instruments and classic surface polishing, as well as debridement with sonic and ultra- sound instruments, such as air pol- ishing systems. Most dental practices still clean the surface of the teeth with manual tools. In initial therapy, after the use of Piezon, we sometimes still use manual tools, though never for maintenance therapy. The correct use of these manual tools is techni- cally challenging and requires a good tactile feel and extensive training. The treatment itself is very time- consuming and tiring for the prac- titioner, but indispensable for deep pockets of periodontitis that are not being treated surgically. The pro- cedure often leads to oversensitive roots and aesthetically displeasing and noticeable recessions. Manual tools are not well received by pa- tients either and often cause dental practitioners’ hand and arm liga- ments to tire. These reasons have led to the need for new tools to be used at regular intervals. ...Or modern? Axelsson and Lindhe have begun to use ultrasound tools in their maintenance therapy. This technol- ogy broke through in the 1980s as bulky ultrasound tips were replaced with fine tips based on periodontal probes. I can still remember the in- troduction of gentler piezo-ceramic ultrasound devices—a real scientific and technological innovation. Only this ultrasound technology al- lowed linear, low-pain movements. A consensus paper on this topic, published during the EuroPerio 2012 Congress in Vienna, can be summa- rised as follows: – Piezo-ceramic technologies have proven effective for manually re- moving build-up – They can be used universally (both sub- and supragingival) to remove mineralised build-up and bacterial biofilm – They are gentle on soft tissue – They allow for shorter treatment times – They cause less pain for the patient – They can be used after a short train- ing period Today, we know even more. Pow- der jet devices can be used to clean sub- and supragingival biofilm and staining more efficiently and quick- ly. Low-abrasion powder based on glycine or erythritol and new sub- gingival nozzles perform exception- ally well. The literature on powder and water jet technology with low- abrasion powders in biofilm man- agement, compared with manual and ultrasound tools, highlights the benefits of this new technology. Furthermore, air polishing with low- abrasion powder removes more bac- teria than manual and ultrasound tools. Many studies have shown that air polishing can remove supragingi- val build-up and stains much more effectively than classic polishing methods. This applies to soft tissue, hard tissue or restorative materials. Therefore, subgingival air polishing with low-abrasion powder is gentle enough and therefore suitable for use on all dental tissue. A short guide to powder The most commonly used powders are sodium bicarbonate, glycine and erythritol. Sodium bicarbonate is a white, crystalline powder with a range of applications in food and medicine and it breaks down at tem- peratures above 56 degrees Celsius. In wet conditions, sodium bicarbo- nate, a hydrogen carbonate anion, can neutralise acids. This property explains its central role as the most important blood buffer, since it can regulate the acid-alkali balance in the human body. Glycine is the simplest stable amino acid that can be made by the hu- man body, where it acts as a radical catcher and neurotransmitter. Gly- cine is found in almost all foods that contain protein as it is a common building block of almost all types of protein. Glycine is also found in col- lagen, an important component of tendons, bone, skin and teeth. Gly- cine is an approved dietary supple- ment with no maximum dose as it supports various bodily functions. In the food industry, it is often used as a flavour enhancer or humec- tant. Studies from 2008 onwards have shown that air polishing with glycine powder does not irritate the gingivae. Now, we come to erythritol. Since 2012, we have almost exclusively used this white, crystalline powder with a pleasantly sweet taste. Eryth- ritol is found in small amounts in nature, for example, in honey, wine grapes, melons and mushrooms and it is produced by the fermen- tation of natural sugar. Due to its sweet taste, erythritol is used as a sweetener to replace sugar. It has al- most no calories when absorbed by the human body and is suitable for diabetics. Oral bacteria are also not able to metabolise erythritol, so it is tooth-friendly and not cariogenic. Various studies have shown that only glycine and erythritol powders do not change the surface structure of composite fillings, while erythritol powder showed no changes on glass ionomer surfaces. Guided Biofilm Therapy–GBT GBT perfectly combines air polishing devices and low-abrasion powders. Developed in collaboration with uni- versities and dental practices, GBT is a concept designed for contemporary prophylaxis. Based on decades of sci entific knowledge and evidence, GBT is the next step in prophylaxis. The eight steps that comprise GBT can be adapted to suit the treatment and patient, including patients in initial therapy to patients in maintenance therapy, healthy patients, patients with dental caries (especially in the initial stadium), patients with gin- givi- tis, patients with periodontitis, patients with perimucositis and pa- tients with peri-implantitis. quality-orientated The GBT concept ensures a sys- tematic, ap- proach, from greeting the patient to collecting diagnostic data, everyday oral hygiene advice, professional teeth cleaning, the dentist’s final diagnosis and check-ups and chem- ically-supported plaque removal, as well as recalls. Alongside the dyeing of the supragingival biofilm, the pro- cess of professional teeth cleaning has changed considerably. The mod- ern approach begins with sub- and supragingival biofilm removal using air-polishing technology with Air- Flow Plus Powder®. This erythritol-based powder guar- antees a targeted, gentle, risk-ori- entated removal of the biofilm to support the initial diagnosis. This is followed by the targeted and mini- mally invasive removal of mineral- ised build-up with Piezon No Pain®. This approach has many addi tional benefits, including short treatment Guided Biofilm Therapy (GBT) is a new individual clinical treatment protocol. Decades of experience and research are reflected in a clear eight- step solution: diagnosis, disclosing, motivation, AIRFLOW®, PERIOFLOW®, PIEZON®, control and recall. Only GBT gives the practice team the skills, motivation, training and products for the most professional dental cleaning of patients. EMS offers a new brochure for more information, available at ems-dental.com times and maximum comfort for both the technician and the patient. Finally, we can carry out profession- al biofilm management effectively, gently, safely, quickly and without pain. Going forward, it is especially im- portant to use the correct devices and tools, such as GBT. Currently, there are a few new products on the powder market. However, in addi- tion to the powders’ properties and scientific evidence that these pow- ders are biocompatible and do not cause damage, it has become more and more important for powders to be compatible with dental devices. This is a strength exhibited by Swit- zerland-based EMS, who have not only significantly contributed to the development of GBT, but have also provided suitable devices and tools (AIRFLOW® PROPYHXLAXIS MAS- TER, AIR-FLOW® POWDER PLUS, AIR- FLOW® handpiece, PERIO-FLOW® handpiece, PERIO-FLOW® nozzle, Pi- ezon No Pain®). The scientific knowledge and tech- nological progress for a paradigm change in professional prophylaxis has now been established. Now comes the time to integrate these de- velopments into our everyday prac- tice for the well- being of our patients and ourselves. Editorial note: This article was originally published in prevention-international maga- zine for oral health, Issue 1/2017.
HELP PATIENTS STOP THE CLOCK ON GINGIVITIS NOW GINGIVITIS TOOTH LOSS HALITOSIS GINGIVAL RECESSION Parodontax helps stop the clock on gingivitis Parodontax helps stop the clock on gingivitis and gets your patients back to healthy gums. CHSAU/CHPDX/0001/19 - Production Date: January 2019 With twice daily brushing Please read the label before use We Value your Feedback +973 16500404 - Gulf & Near East countries firstname.lastname@example.org www.gsk.com