N L Y A L S O N F E S SI O O R T A L P N E D PUBLISH ED IN DUBAI www.dental-tribune.me November-December 2020 | No. 6, Vol. 10 ENDO TRIBUNE Palliative care successful for endodontic emergencies during lockdown LAB TRIBUNE Interview: “Dental laboratories will be left in an extremely vulnerable position” IMPLANT TRIBUNE CBCT bone-densitometry for pre-surgical decision-making ORTHO TRIBUNE Orthodontists should see their patients through the eyes of a periodontist HYGIENE TRIBUNE The dental hygienist in times of COVID-19 ÿA1-2 ÿB1-4 ÿC1-4 ÿD1-4 ÿE1-4 CAPP November Dental Livestream attendance: 30,546 dental professionals from 149 countries By Dental Tribune MEA | CAPPmea DUBAI, UAE: CAPP November Den- tal Livestream, a month full of con- tinuing dental education, featured CAPP’s two annual conferences, sub- specialty seminars and 25 multidis- ciplinary dental hands-on training courses. A total of 30,547 internation- al dental professionals registered and attended the various dental CE programmes between 05th – 28th November 2020. The highlights of the month were the two annual dental conferences which gathered virtually 20,910 unique dental pro- fessionals from 149 countries. The 15th CAD/CAM & Digital Dentistry and the 12th Dental Facial Cosmetic international conferences lasted a total of 8 days and were accessible on complimentary basis due to the ongoing COVID-19 global pandemic. Additionally, 9,636 dental profes- sionals attended the various courses and seminars made available during November 2020. Centre for Advanced Professional Practices (CAPP) was founded in 2005 in Dubai, UAE by Dr Dobrina Mollova with the purpose of deliv- ering excellence in CE in dentistry in the Middle East, Africa, Asia and beyond. CAPP is an American Dental Association Continuing Education Recognition Programme recognised provider. In 2020, despite the effects of the COVID-19 global pandemic, CAPP was committed to continue organis- ÿPage 2 #whdentalwerk video.wh.com Now at your dealer or wh.com Respects your needs. Respects your needs. Today and tomorrow. Today and tomorrow. The new W&H Implantmed Needs and requirements can change. So can the W&H Implantmed: The wireless foot control, LED+ motor and W&H Osstell ISQ module are all The wireless foot control, LED+ motor and W&H Osstell ISQ module are all available as optional accessories. Upgrade at any time – for today and tomorrow! available as optional accessories. Upgrade at any time – for today and tomorrow! AD Register your product & benefit wh.com
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10 INDUSTRY Dental Tribune Middle East & Africa Edition | 6/2020 HuFriedyGroup introduces Harmony Ergonomic Scaler designed with TrueFit Technology Innovative new scaler scientiﬁ cally proven to relieve pressure in the hand By HuFriedyGroup HuFriedyGroup, the dental divi- sion of Cantel Medical Corp., and a global leader in infection prevention, dental instrument manufacturing, and instrument reprocessing work- fl ows for the dental market, today introduced the new line of Harmony Ergonomic Scalers and Curettes de- signed with TrueFit Technology. This latest addition to the best-in-class instrument portfolio from HuFrie- dyGroup is a truly ergonomic scaling solution backed by scientifi c innova- tion. “We set out with the goal of develop- ing a new scaler that would provide scientifi cally proven ergonomic benefi t for clinicians, improving their experience and that of the pa- tient as well,” said Stacie Barth, Vice President, Global Strategic Business Unit, HuFriedyGroup. “Our rigor- ous, data-supported design process is a novel approach for the industry, and the results speak for themselves. More than ever, clinicians and dental hygienists need to feel comfortable with their instruments, and the new Harmony Scaler is designed pre- cisely to improve their daily working experience.” HuFriedyGroup developed the Har- mony Scaler using TrueFit Technol- ogy to provide true ergonomic ben- efi ts driven by scientifi c evidence. This advanced, sensor-based testing system measures pinch force in the fi nger and pressure applied to the tooth when scaling. With over 2.8 million data points recorded, Hu- FriedyGroup researchers and engi- neers utilised TrueFit Technology to develop a scaler handle with optimal proportions and ideal width that provides a secure and nimble grasp. HuFriedyGroup relied on a broad, globe-spanning group of hygienists to participate in testing and develop- ment as part of an iterative design process. To ensure a scientifi c per- spective and accurate representation of the data collected, HuFriedyGroup worked with a world-renowned third-party analytics fi rm to review and analyse the resulting 2,878,320 data points. The result was pure harmony, a han- dle that reduces pinch force up to 65% compared to other leading scal- er designs. This reduces the amount of pressure a clinician needs to apply when using the instrument, which may alleviate hand fatigue and in- jury risk due to repetitive motion. With up to 37% less pressure against the tooth surface during scaling compared to other leading scaler handle designs, Harmony Ergonom- ic Scalers and Curettes can increase patient comfort and reduce clini- cian fatigue. Furthermore, Harmony Harmony Ergonomic Scaler features EverEdge 2.0 Working Ends, which are 72% sharper than the next leading competitor, which also con- tributes to creating a more comfort- able experience for both clinician and patient. The durable metal handle, which features a recessed double-helix tex- ture, is designed for optimal tactile sensitivity and to reduce tactile fa- tigue. The comfortable silicone grip, which has been extended by 30%, provides a secure and nimble grasp with a geometric pattern specifi cally designed for stable grip in any direc- tion. Clinicians can comfortably ma- noeuvre and roll the scaler due to the round shape of the handle and the smooth transition to the functional shank. With 30 unique working end op- tions, including Sickles, Universals, and Graceys, the Harmony Scaler is immediately available for purchase from authorized HuFriedyGroup representatives or dental distribu- tors. For more information, dental profession- als should contact their HuFriedyGroup representative or visit https://www.hu- friedy.eu/en/harmony-scaler . Life-like aesthetics powered by Beautiﬁ l IILS By SHOFU Beautifi l IILS bioactive composite of- fers a smart solution for your direct resin restorations with its life-like aesthetics, sculptable, non-tacky con- sistency and exceptional durability. Smart Benefi ts for your Practice: • • Predictable aesthetics for seam- less restorations Optimal light diffusion for a perfect shade match without requiring complicated stratifi - cation • • • • • Non-sticky consistency enables easy adaptation and shaping of restorations Unique S-PRG fi llers impart bio- active properties – anti-plaque & anti-caries benefi ts for great- er longevity Effortless polish to a lasting natural lustre Robust polymer- fi ller complex ensures remarkable mechani- cal properties and durability Low volumetric shrinkage – 0.85% For further information, please contact: SHOFU DENTAL ASIA-PACIFIC PTE LTD 10 Science Park Road, #03-12 The Alpha Singapore Science Park II Singapore 117684 Tel: (65) 6377 2722 Fax: (65) 6377 1121 E-mail: firstname.lastname@example.org Web: www.shofu.com.sg For more information, please visit: https://www.shofu.com.sg/product/ beautiﬁ l-ii-ls/
12 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2020 Simpliﬁed protocol for adjacent Class II direct resin restorations By Dr Anand Narvekar, India Introduction Bioactive direct composite resin ma- terials like the next generation high strength injectables and low shrink- age packable composites, when used with advanced matrix systems, provide clinicians with an opportu- nity to adopt a minimally invasive patient-centric treatment approach while preserving sound tooth struc- ture. Material selection is an impor- tant step in treatment planning for posterior restorations. The use of bioactive composites under strict isolation with rubber dam helps to achieve aesthetics and function with long-term clinical success while min- imising the risk of secondary caries. Clinicians often find it challenging to restore multiple posterior teeth with direct resin in an efficient and predictable manner. The key to suc- cess lies in achieving a well-sealed restoration with good contact and contours. Therefore, restoration of interproximal areas on posterior teeth requires stringent preopera- tive evaluation of tooth & defect size, location of contact & tightness, adja- cent tooth position & contours and gingival location. This article aims to provide a simple and predictable protocol when dealing with adjacent Class II direct resin restorations in routine clinical practice. Before & After - adjacent Class II restorations Patient Case A 21-year-old female visited the den- tal office with a chief complaint of food lodgment and pain in tooth #46 when consuming sweet or cold food. Radiographic examination with IOPA reveled old composite restoration in tooth #46 and distal decay on #45 without involving the marginal ridge. Upon clinical exami- nation, Class II cavities on tooth #46 & #45 were identified (Fig. 1). The most suitable treatment approach in this situation was direct restorations with bioactive composite resins. Restorative Approach Prior to caries removal, proper quad- rant isolation was done with place- ment of rubber dam and pre-wedg- ing with Garrison small FXBL wedge. Tip: Pre-wedging creates momen- tary tooth separation to help achieve a more accurate proximal seal with ideal contact after placement of the final restoration and the teeth return to their original position. In addition, it helps to protect the rubber dam when removing the caries in the cer- vical area. Caries removal was completed with a blue stripped high speed small round bur followed by slow speed round carbide bur. Caries detection dye was applied to ensure complete removal of active decay. Old com- posite was removed from occlusal and buccal pit area of tooth #46. For tooth #45, decay was initially removed without touching the oc- clusal surface, however as the mar- ginal ridge area was left with very thin structure, the proximal box was later extended to the occlusal surface (C-shaped preparation) to avoid ex- cessive stress that could lead to resto- ration failure (Fig. 2). After cavity preparation and caries removal Smooth enamel margins were achieved with Super Fine Diamond Bur (yellow band) and proximal walls were finished with Super-Snap disk violet, to ensure optimal bond- ing to the enamel, avoid detachment of unsupported enamel and poten- tial micro leakage. Etching & Bonding The wedge was removed & selective etching technique was used with 35% phosphoric acid solution followed by abundant rinsing with water. It is important, to avoid overdrying the dentin with strong airflow as a complete- ly dried surface will cause collapse of colla- gen affecting the pen- etration of adhesive monomers resulting in a weaker bond. To achieve reliable adhesion, my personal preference is to use a sixth generation bonding system (Shofu FL-Bond II) combined with selective etching as the outcome is predict- able compared to current seventh generation and universal adhesive systems in the market. Even if you etch dentin, the primer is able to wet the surface without collapsing collagen and facilitate effective pen- etration into the demineralised area. To maintain a humid dentinal sub- strate, a generous amount of primer should be applied and left undis- turbed for 10 seconds and air dried for 5 seconds to ensure the solvent evaporates and mild acid primes the dentin. The bonding agent should be carefully applied as an even layer on the entire restorative surface and light-cured for 10 seconds or longer in case of deep cavities. Matricing Garrison Composi-Tight 3D Fusion Matrix Ring Tall Orange (FX500) was selected according to the height of the cavity, in this instance we se- lected FX150 band for the premolar and FX175 for the molar. Both bands should be placed simultaneously and secured with suitable wedges. The wedges should be placed and ÿPage 15 Fig. 1. MO Class II cavity along with old composite restoration on tooth #46 and distal decay on tooth #45. Fig. 2. Pre-wedging with removal of active decay on teeth #45, 46. Fig. 3. Garrison FX150 band for the premolar and FX175 for the molar was placed with the Garrison 3D Fusion Blue Wedge and the Garrison 3D Fusion Orange Ring (FX500) . Fig. 4. Tooth #45 was restored ﬁrst with Beautiﬁl Injectable XSL shade A2 followed by Beautiful II LS shade A2 in snow-plow technique. Fig. 5. Band from premolar was removed and molar band burnished with light to medium pressure on the adjacent premolar tooth to ensure proper contour and contact. Fig. 6. Spreading of Beautiﬁl Injectable XSL (Self-leveling composite resin) shade A2. Fig. 7. Converting Class II to Class I with Beautiﬁl II LS shade A2. Fig. 8. Composite build-up with a combination of Beautiﬁl Injectable XSL and Beautiﬁl II LS, leaving 1.5 mm.
Dental Tribune Middle East & Africa Edition | 6/2020 ◊Page 14 RESTORATIVE 13 Fig. 9. Final occlusal morphology was achieved with build-up of each cusp using Beautiﬁl Injectable X shade A2. Fig. 10. Buccal pit on tooth #46 was directly ﬁlled with Beautiﬁl Inject- able X shade A2. Fig. 11. Graphical representation of restorative technique with incre- mental layering. Fig. 12. IOPA before treatment and post-op showing natural contour and seal achieved with a perfect contact. Fig. 13. After treatment - immediate post-op. Fig. 14. Post-op after 7 days - Final Invisible Restorations. inserted from the buccal side at an angle by holding the bands with a finger to avoid the bands from be- ing displaced from its ideal location. Always good to double check the fit and seating of the bands, specially in the proximal box to ensure com- plete seal when placing the compos- ite resin material (Fig. 3). Tip: When restoring adjacent teeth, place both matrix bands at once to avoid over contour of the 1st restora- tion and difficult placement of sec- ond matrix band due to tight contact. Composite resin layering technique To minimise the effects of polymeri- sation shrinkage, composite resin layering can be performed using different techniques: horizontal, oblique or three-sites. In this clini- cal case, we used a combination of these techniques with soft-start curing (i.e. incremental light-curing programmes), which starts at a low intensity of 100 to 250 mW/cm², al- lowing better composite resin adap- tation at the cavity margins before increasing to a standard intensity. Tooth #45 was restored first to help increase visibility during restoration of tooth #46. As the cavity on the premolar was a shallow proximal box, horizontal incremental layering was used with Shofu range of Bioac- tive composites, Beautifil Injectable XSL, shade A2 (Self-leveling compos- ite resin) injected in small quantity followed by Beautifil II LS, shade A2 (packable composite) in snow-plow technique. In the final increment the marginal ridge and distal pit area were carved to achieve a more natu- ral occlusal morphology (Fig. 4). The sectional matrix on premolar and ring were removed carefully with the help of artery forceps with- out dislodging the matrix band placed on molar. The band was bur- nished with light to medium pres- sure on the adjacent premolar tooth to ensure proper contour and con- tact (Fig. 5). To restore the Class II cavity of tooth #46, a combination of vertical, hori- zontal and oblique layering tech- nique was adopted. A thin layer of Beautifil Injectable XSL (Self-leveling composite resin) shade A2 was first injected and spread in the proximal box area and light cured to ensure a complete seal (Fig. 6). Followed by the proximal wall and marginal ridge build-up with Beauti- fil II LS shade A2 to convert the origi- nal Class II into a Class I cavity. Once the proximal wall and contact was achieved the matrix band and ring were removed (Fig. 7). The Class I cavity build-up was com- pleted using a combination of Beau- tifil Injectable XSL and Beautifil II LS packable composite, leaving 1.5 mm space for final occlusal anatomy (Fig. 8). Final occlusal morphology was achieved using Beautifil Injectable X shade A2 with build-up of each cusp (oblique layering technique) and pe- ripheral grooves as reference. (Fig. 9). Buccal pit on tooth same tooth was directly filled with Beautifil Inject- able X – Universal Restorative, shade A2. Tip: The ideal consistency Beautifil Injectable X enables you to inject and shape at the same time for added convenience (Fig. 10). Brown resin stains were used on the occlusal surface to mimic the adja- cent teeth. High points were checked with 40 micron articulating paper and removed with a small round dia- mond bur while following the tooth anatomy. Finishing and polishing of composite resin, even though often neglected, with posterior restora- tions remains essential to increase longevity of the restoration. Finishing & polishing protocol Finishing and margination of the occlusal surface with Dura-Green Stone, polishing with SHOFU On- eGloss Midi-Points and super pol- ishing with SuperBuff impregnated disk to achieve a high gloss for the extra enamel like lustre (Fig. 11). incremental Restorative outcome The following graphical represen- tation of the restorative technique used with layering and the before / after images of the IOPA radiographs further illustrate the simplified protocol used to re- store adjacent Class II cavities, where natural contour and seal has been achieved with a perfect contact (Figs. 11, 12). Conclusion Restoration of adjacent posterior teeth with good contour and ideal contacts is essential to ensure pre- dictable outcomes (Figs. 13, 14). Simplifying the restorative process with the following helps to increase efficiency and save chair time. Pre- wedging to separate the teeth during restoration and achieve good proxi- mal contact, placement of both ma- trix bands at one time on adjacent teeth, build-up of each tooth one at a time, transforming Class II to Class I makes layering and creating natural occlusal morphology easier which minimises numerous adjustments in the finishing stage. The use of Beautifil injectable X – Self-leveling composites in combination with Beautifil II LS packable composites helps to achieve a better marginal seal while minimising the intrinsic shrinking effect. Once the resto- ration has been shaped and high points checked, finishing and polish- ing should be performed to enhance the aesthetics and long-term prog- nosis of the restorations. Acknowledgment Author wishes to thank Garrison Dental Solutions and Shofu Dental Asia-Pacific for material support. References 1. Ferraris F. Adhesion, layering, and finishing of resin composite resto- rations for class II cavity prepara- tions. Eur J Esthet Dent. 2007 Sum- mer;2(2):210-21. 2. Jordan RE, Suzuki M. Posterior composite restorations. Where and how they work best. J Am Dent Assoc 1991;122:30–37 3. Van Meerbeek B, Peumans M, Ver- schueren M, et al. Clinical status of ten dentin adhesive systems. J Dent Res 1994;73: 1690–1702. 4. Van Meerbeek B, Peumans M, Gladys S, Braem M, Lambrechts P, Vanherle G. Three-year clinical effec- tiveness of four total-etch dentinal adhesive systems in cervical lesions. Quintessence Int 1996; 27:775–784. 5. Fortin D, Swift EJ, Denehy GE, Rein- hardt JW. Bond strength and micro- leakage of current dentine adhesives. Dent Mater 1994;10:253–258. 6. Kanca J. Improving bond strength through acid etching of dentin and bonding to wet dentin surfaces. J Am Dent Assoc 1992;123:35–43. 7. Tjan AHL, Bergh BH, Lidner C. Effect of various incremental techniques on the marginal adaptation of Class II composite restorations. J Prosth Dent 1992;67:62–66. 8. Feilzer AJ, Dooren LH, de Gee AJ, Davidson CL. Influence of light in- tensity on polymerisation shrinkage and integrity of restoration-cavity interface. Eur J Oral Sci 1995;105:322– 326 9. An In-Vitro Comparison of Mi- cro Leakage Between Two Posterior Composites Restored with Different Layering Techniques Using Two Dif- ferent LED Modes Nikhil Relhan , K C Ponnappa , Ashima Relhan , Anurag Jain , Priyanka Gupta 10. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Frankenberger R. Influence of c-fac- tor and layering technique on micro- tensile bond strength to dentin. Dent Mater 2004;20:579–585. 11. Roeder LB, Tate WH, Powers JM. Ef- fects of finishing and polishing pro- cedures on the sur- face roughness of packable composites. Oper Dent 2000; 25:534–543. About the author Dr. Anand Narvekar, India Dr. Narvekar graduated in 1996 from Pune India, has immersed himself in the ﬁeld of dentistry with a special focus on aesthetic dentistry. His special interest lies in treating complex full-mouth re- habilitation and smile design cases. His keen eye for aesthetics extends beyond dentistry as well as a globally acclaimed photographer with his photographs pub- lished in industry-wide publications. He is a fellow, advocator and trainer for MiCD (Minimally Invasive Cosmetic Dentistry) Global Academy, a key opinion leader for a number of companies, and conducts workshops for articulators, photography and direct resin restorations. AD PRINT EVENTS EDUCATION DIGITAL SERVICES Dental Tribune International The World's Dental Marketplace www.dental-tribune.com
+971528423659 email@example.com www.cappmea.com/implant Dr Charlotte Stilwell ITI President Elect, Specialist in Prosthodontic Surgery UK Prof Giovanni Salvi University of Berne Switzerland Prof Bilal Al-Nawas University of Mainz Germany Prof Urs Brägger University of Berne Switzerland Dr Vladimir Kokovic Dr Krzysztof Chmielewski Prof Hani A. Salam Dr Salma Al Jahdhami University of Sharjah UAE DDS, MSc Poland McGill University Canada BDS, MFD, RCSI, OMSB, FFD(OSOM), RSCI Oman ITI Implant Privilege Mastership 20 OR 30 IMPLANTS LIVE PATIENT AND LAB WORK INCLUDED TREATMENT (40%) OVER 200 CME AVAILABLE PERSONAL MENTOR FOR THE CLINICAL DAYS THEORY I 6 MODULES I 20 DAYS CLINICAL I 8 MODULES I 16 DAYS THEORY FOUNDATION 1 I 04 – 08 OCT 2021 I BASICS OF IMPLANTOLOGY Programme Outline: Introduction and Treatment Planning Part 1, Introduction and Treatment Planning Part 2, Evolution of Dental Implants, Anatomic Structures relevant to Implantology and Webinar on Dental Photography THEORY FOUNDATION 2 I DATES TO BE ANNOUNCED I SURGICAL INTERVENTION Programme Outline: Surgical Intervention Part 1, Surgical Intervention Part 2, Surgical Intervention Part 3 & Loading Protocols THEORY FOUNDATION 3 I DATES TO BE ANNOUNCED I PROSTHETIC REHABILITATION Programme Outline: Prosthetic Rehabilitation: Material Science, Prosthetic Rehabilitation: Partial Edentulous, Prosthetic Rehabilitation: Removable Dentures Part 1 and Prosthetic Rehabilitation: Removable Dentures Part 2 THEORY INTERMEDIATE 4 I DATES TO BE ANNOUNCED I SURGICAL INTERVENTION ADVANCED Programme Outline: Implant placement: Aesthetic Zone, Principles of Guided Bone Regeneration, Live Surgeries, Sinus Augmentation: Window Technique THEORY INTERMEDIATE 5 I DATES TO BE ANNOUNCED I ADVANCED PROSTHETIC INTERVENTION Programme Outline: Advanced Aesthetic Rehabilitation Part 1, Advanced Aesthetic Rehabilitation Part 2 THEORY INTERMEDIATE 6 I DATES TO BE ANNOUNCED I MANAGEMENT OF BIOLOGICAL & MECHANICAL COMPLICATIONS Programme Outline: Biological Complication Management, Technical Complication Management, Assessment of Intermediate Modules CLINICAL MODULES | LIVE PATIENT TREATMENT IN UNIVERSITY COLLEGE IN UAE | 16 DAYS Dates to be ananounced ORGANISED BY AWARDED BY MATERIAL & EQUIPMENT SPONSORS MARKETING PARTNER
16 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2020 Clinical conduct for restoration of non-carious cervical lesions – Case report By Dr. Raphael Monte Alto, Dra. Madelaine Torres da Silva, Dra. Amanda Vaz dos Reis, Dr. Gustavo Oliveira dos Santos, Portugal Non-carious cervical lesions (NCCL) are characterised by loss of dental structure near the cementoenamel junction, which may extend to the coronary and radicular portion, and by an association with dentin hypersensitivity and gingival reces- sion. NCCLs are not related to caries and their etiology is multifactorial, including both endogenous and ex- ogenous factors related to the pro- cesses of biocorrosion, tension and friction. NCCLs mainly affect the ves- tibular surface of the molars and pre- molars and are frequently observed in clinical practice. This report aims to describe the case of a 45-year-old male patient identified as ALMM and treated in the integrated clinic of the Faculty of Dentistry of Uni- versidade Federal Fluminense with a main complaint of dental wear. Clinical examination revealed NCCL and gingival recession in elements 11, 12, 13, 14, 15, 16, 33, 34 and 35, with no complaint of dentin hypersensitivi- ty. Rehabilitation treatment through NCCL restorations using composite resin was proposed, starting with an- terior teeth; then, rehabilitation with removable partial dentures was per- formed. The patient will be followed up and there will be a thorough in- vestigation to control the etiological factors involved, thus enabling treat- ment success. This case was realised at UFF (Univer- sidade Federal Fluminense). For further information, please contact: Coltène/Whaledent AG Feldwiesenstrasse 20 9450 Altstätten SG Switzerland Fig. 1. Initial appearance of NCCL (frontal view). Fig. 2. Initial appearance of NCCL (proximal view). Fig. 3. Absolute isolation performed. Fig. 4. Long diamond tip FF bevel on cervical enamel. Fig. 5. Long diamond tip FF bevel on cervical enamel. Fig. 6. Long diamond tip FF bevel on cervical enamel. Fig. 7. Long diamond tip FF bevel on cervical enamel. Fig. 8. Prophylaxis with pumice and water. Fig. 9. Selective enamel acid etching (acid application for 30 seconds). Fig. 10. Rinse with water for at least 30 seconds. Fig. 11. Appearance of the enamel after acid etching. ÿPage 20
18 ◊Page 18 RESTORATIVE Dental Tribune Middle East & Africa Edition | 6/2020 Fig. 12. Active application of ONE COAT 7 UNIVERSAL adhesive on dentin and enamel. Fig. 13. Active application of ONE COAT 7 UNIVERSAL adhesive on dentin and enamel. Fig. 14. Active application of ONE COAT 7 UNIVERSAL adhesive on dentin and enamel. Fig. 15. Photopolymerization of the adhesive. Fig. 16. Measuring the depth of the lesion. Lesions up to 2 mm deep can be restored with a single increment. Fig. 17. Composite resin is selected (BRILLANT EverGlow – COLTENE) Fig. 18. Application of composite resin. Fig. 19. Application of composite resin. Fig. 20. Application of composite resin. Fig. 21. Application of composite resin. Fig. 22. Removal of excess material using No. 12 scalpel blade. Fig. 23. Appearance after removal of absolute isolation. Fig. 24. Polishing of the cervical margin using ﬂame tips. (DIATECH System – COLTENE). Fig. 25. Initial ﬁnish with lilac spiral (DIATECH Shapeguard – COLTENE). Fig. 26. Initial ﬁnish with lilac spiral (DIATECH Shapeguard – COLTENE). Fig. 27. Final polishing with blue spiral (DIATECH Shapeguard COLTENE). Fig. 28. Final polishing with blue spiral (DIATECH Shapeguard COLTENE). Fig. 29. End Result.
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22 NEWS Dental Tribune Middle East & Africa Edition | 6/2020 Beneﬁts of a fully integrated digital workﬂow – clinical focus How digital impressions will help you rebuild: As we all try to ﬁnd ways to bounce back from COVID-19, could digital dental impressions be just the boost your practice needs? By Dentsply Sirona As dental professionals across the country plan a tentative path out of lockdown, many are looking for new ways to deliver dental care. New guidelines have forced practices to oper- ate in a different way, but forward-thinking dentists are seeing these adjustments as an op- portunity to bring about change for the better. Key, amongst the long list of priorities in this new COVID-19 era, is keeping chair time to a minimum, so anything that achieves this and makes procedures more efficient, is extremely valuable. Digital impressions do both, and also deliver a substantial amount of business-build- ing potential. So, what’s not to like? More efficient, more hygienic, more comfortable Digital impressions can be taken with a Prime- scan intraoral scanner in a matter of seconds. Simply use the sleek scanner wand, which comes with a choice of removable sleeves (au- toclave, wipe-down and single-use), to sweep AD i n t e l l i g e n t s o l u t i o n s The advantage of with Interchangeable Articulators Accurate r a n s f e r t DENTIST LAB. workflow Enable interchangeability of stone models between articulators of the same brand (when calibrated) providing convenience in handling and clinical communication x laboratory and digital equipment. Many of the articulators on the market are not calibrated. In this way, stone models mounted on a given SAA cannot be transferred to another SAA with guaranteed accuracy, even though they are from the same brand. Bio-Art developed a standardization kit consisting of tools used to calibrate the articulators (models A7Fix and A7Plus). Using this resource is essential for the professional who has more than one articulator, as well as for use between dentists and dental technicians without the need to keep the models always in the same articulator. The calibration allows the interchanging of the models previously mounted on calibrated articulator plates. The gauging device (calibration column) must be used periodically to check the accuracy between the articulators. Extracted article from the book: Logical - A clinical approach to occlusion around the mouth, capturing outstanding quality, digital scans in less time than it would take to prepare for and take a traditional im- pression. The digital impression is saved as a high defini- tion, 3D image within the CAD/CAM software, whilst the patient is in the chair for consider- ably less time than for conventional impres- sions, and the whole experience is far more comfortable. Access all areas Once captured, digital impressions open up ac- cess to a range of efficient, income-generating workflows that are much easier to achieve than using traditional methods. For instance, you can offer patients clear align- er treatment through digitally enabled services such as SureSmile Aligner treatment. Clear aligner treatments such as this have soared in popularity recently and offering this service will help keep your patients loyal and ensure you are responding positively to patients’ de- mands. Add a chairside milling unit to your workflow and you have opened the door to a whole new world of digital design and manufacture. Dentsply Sirona’s CEREC single visit restorative workflow creates fast, efficient single-tooth restorations, reducing the risk of cross-contam- ination and giving patients the safest, most comfortable experience possible, all achieved in a single visit. Additionally, it opens up new revenue streams, whilst containing costs with- in the practice. Labs get digital Even if you don’t want to move straight into a full digital workflow in your practice, digital impressions can still open up opportunities with other providers; one of the most impor- tant being your dental laboratory. More and more labs are now adopting digital processes and are able to receive digital impressions from dentists. The digital technologies also improve communication between clinician and techni- cian, which is achieved via instant, efficient and secure software. In a pre-COVID world, digital impressions were slowly gaining in popularity. Now, with the need to reduce patients’ time in practice and with infection control stakes much higher, in- traoral scanners are becoming an essential tool for dentists who want to not only survive, but also thrive in the new world of dentistry. And what’s even more exciting is the range of op- portunities that are at your command once you’ve made that first step. Find out more by scanning the QR code. 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26 NEWS Dental Tribune Middle East & Africa Edition | 6/2020 Mental health in the dental profession during the COVID-19 pandemic By Monique Mehler, Dental Tribune International Even though millions of people suffer from anxiety and depres- sion, according to the World Health Organization, psychiatric disorders often remain under-recognised and underdiagnosed. The persisting stigma around mental health issues exacerbates the problem, since those suffering feel shame and guilt on top of their existing condition and may therefore fail to seek the appropriate help. Because of the chronic stress associated with their profession, dentists are especially prone to occupational burn-out and depression, as studies have shown. Now, with the spread of SARS-CoV-2, there is an even greater physical and psy- chological burden among dental professionals. The profession of dentistry has long been claimed to have a high suicide rate owing to a range of physical and mental stressors. A feature article by orthodontist Dr Randy Lang from 2007 sums up statistics which he collected from several studies that indi- cate that dental professionals are indeed at higher risk of stress- related mental and physical illnesses. For example, Lang stated that “dentists suffer psycho-neurotic disorders at a rate of 2.5 times greater than physicians” and “coronary disease and high blood pressure are over 25 per cent more prevalent among den- tists than in the general population”. In a more recent investigation, a feature article by Vice Media reported on the signiﬁcant occupationally linked pressure in the form of “money trouble, physical and emotional stress, iso- lation, and the unfavourable public perception of dentists in general”. Consequences of the coronavirus pandemic In addition to the pre-existing stressors of their jobs, dental pro- fessionals have been particularly burdened by the challenges arising from SARS-CoV-2. Dentistry has been reported to be one of the most high-risk occupations regarding infection potential, since the virus is airborne and dentists work in very close prox- imity to their patients. Furthermore, practices have been forced to close during lockdowns in many countries, adding immense ﬁnancial pressure and leading to the retrenchment of staff in some cases. In a recently published paper, Dr Andrea Vergara Buenaventura and her research team from the Universidad Cientiﬁcadel Sur in Lima in Peru have provided a comprehensive review of the consequences of past epidemics for mental health and have as- sessed possible aspects that might be associated with mental implications for dentists owing to the COVID-19 pandemic. In an interview with Dental Tribune International, Vergara Bue- naventura shared that the idea for the article came up during a video call with colleagues who all shared similar worries and fears. “In the beginning, when we started with the literature review, we only had few references on COVID-19 and mental health and much less about mental health in dentists. We just found data about past epidemics, but it was precisely the same; the same feelings were reported,” she explained. Surveys con- ducted in India and Israel, for example, conﬁrm the psycho- logical distress being experienced by dental professionals in response to the COVID-19 pandemic. Despite the challenges, Vergara Buenaventura is hopeful that this pandemic “will strengthen us as individuals and as a sys- tem”. “In my country, Peru, this pandemic has brought out the weaknesses of the Peruvian health system and has shown that dentists have to be part of the healthcare system. Dentists must be prepared to play a more critical role and to ﬁght against emerging life-threatening diseases,” she concluded. The challenges so far Dr Sujata Basawaraj runs a private practice in Lewisville in Texas in the US and has ﬁrst-hand experience of the challenges posed by SARS-CoV-2. “Mentally, working during a pandemic has been very stressful and tiring owing to the number of additional tasks that go into creating a safe environment for myself, employees and patients in my practice. We have to treat every patient with the possibility that he or she may have contracted SARS-CoV-2,” she explained to Dental Tribune International. She continued: “I feel like a level of com- munication that was imperative for dentists has been removed owing to the new gear we need to wear. It isn’t as easy to talk to patients, but at the end of the day, I believe that everyone’s safety should come ﬁrst.” AD Basawaraj went on to say that, as medical profession- als, she and her colleagues are responsible for taking care of their patients’ health, which is something they have always been accountable for. She added: “I hope that people will continue to, or start to if they do not already, follow safety and social distancing guidelines as well as be patient with us doctors as we work to pro- vide care during the pandemic.” Despite the difﬁculties she has encountered, Basa- waraj remains positive and takes care of her mental health as well as possible: “At the moment, spending time with my family, cooking, going on walks in the park while wearing a mask and social distancing (...) have been my way of relieving some of the stress that comes from working during this pandemic. (...) All we can do at this point is hope for the best.” Creating a healthier work environment A study by researchers from London has investigated mental healthcare for medical staff and afﬁliated health-care workers during the COVID-19 pandemic and how they can be supported. The authors report that “rapid access to counselling, psychiatry and con- tingency for time off work” is important, but “preven- tion and mitigation is far more important than cure”. Experts from several universities across the US have published a review paper in which they report that psychological ﬂexibility and self-care are fundamen- tal aspects of psychological health in general. Also, ex- ercising regularly has a positive inﬂuence on overall well-being, according to researchers from Italy who speciﬁcally looked at how activity levels among the population changed during the pandemic. Owing to physical isolation and distancing, feelings of loneli- ness and anxiety may arise, and these should be ad- dressed. It is key to reach out to family and friends in a safe manner, for example by keeping in touch via the phone or video calls. In the pursuit of psychological health, it should be re- alised that the COVID-19 pandemic is unprecedented and each individual experiences and responds very differently. For these reasons, going at one’s own pace and taking care of oneself as well as possible are abso- lutely crucial. Many dental associations offer resources, support and advice for dental professionals who are affected by work and personal stress. For instance, the British Dental Association gives its members access to 24-hour counselling and emotional support via Health As- sured’s helpline, and the American Dental Association offers COVID-19 mental health resources on its website. Another helpful tool is a platform called Conﬁdental, which aims to provide emotional ﬁrst aid for UK den- tists in distress.
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