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| content page 10 page 28 page 54 editorial per·ma·nent /'pərmənənt/ adjective 1. lasting or intended to last or remain unchanged indefi nitely Dr Scott D. Ganz practice management The COVID-19 practice manager 2021: Four steps to confi dence Chris Barrow case report Digital approach in the anterior area: Management of surgical and prosthetic cases Dr Roberto Molinari 03 06 10 An in-offi ce-fabricated implant surgical guide corrected using CBCT 22 Drs Sean W. Meitner & Gregori M. Kurtzman The use of new technologies and digital implant solutions in a one-stage surgical procedure Dr Michał Nawrocki 28 Bimaxillary prosthetic reconstruction with implant-supported overdentures 32 Dr Said Sánchez Full-mouth restoration with Zolid FX— a successful concept for sophisticated prostheses Joachim Maier 40 trends & applications Zygomatic dynamic navigation: New challenges and possibilities Drs Fernando Duarte, Carina Ramos, João Neves Silva & Luis Pinheiro 46 news COVID-19 and dental education: Will dental schools admit new students in 2021? Iveta Ramonaite Study fi nds differences in accuracy of intra-oral scanners Franziska Beier event Amann Girrbach presents attractive gateways to the future at virtual congress industry news 3Shape and Ivoclar Vivadent intensify collaborative efforts manufacturer news about the publisher submission guidelines international imprint Cover image courtesy of Straumann (www.straumann.com) issn 2193-4673 • Vol. 2 • Issue 1/2021 1/21 digital international magazine of digital dentistry case report Digital approach in the anterior area trends & applications Zygomatic dynamic navigation news Study finds differences in intra-oral scanners 04 1 2021 50 52 53 54 55 56 58

| practice management The COVID-19 practice manager 2021: Four steps to confi dence Chris Barrow, UK Introduction It was American politician Adlai Stevenson (1835–1914) who observed that “it’s hard to lead a cavalry charge when you think you look funny on a horse”. I have spo- ken to many practice managers in the last 12 months who have shared with me their sense of imposter syn- drome, as team members, clinicians, owners and family members have looked to them for guidance in the ever- changing pandemic landscape. In this four-part series, I am going to suggest a step-by-step approach to over- coming any feelings you may harbour that you are not good enough and, I hope, provide you with a framework on which to grow your self-confidence. I will be talking about the following in steps: 1. Leadership—why you do not have to be a Marvel super- hero to be a good leader; 2. Management—a checklist of all the systems you need in place to reduce your stress levels (and remain compliant); 3. Teamwork—the psychology of teams and how to create environments in which morale improves; 4. Extreme self-care—making sure that the best possible version of you turns up for work (and arrives home again). Leadership Let us begin our journey atop that horse, the cavalry regiment waiting for you to give the orders and you (just maybe) wondering how the devil you ended up there. “C’est magnifique, mais ce n’est pas la guerre: c’est de la folie.” [It is magnificent, but it is not war: it is madness.] Thus spoke Pierre François Joseph Bosquet, distinguished French army general, as he watched Lord Cardigan lead the British light cavalry to their doom at the ill-fated Charge of the Light Brigade on 25 October 1854, during the Crimean War. One hundred and eigh- teen men were killed, 127 wounded and 60 taken pris- oner after the carnage created by the misinterpretation of an order. The good news is that you are unlikely to ex- perience such devastation in a dental practice, but there has never been a time when so many orders have been flying around in the heat of battle (nor so many people asking questions)—and there are plenty of times when everybody is looking at you. Let me define “everybody” a little more specifically. When you are a practice manager, you have a leadership re- sponsibility to multiple communities. These may be your employer, patients, team, self-employed clinicians, refer- ring general dental practitioners, suppliers, lenders, local community or family. They are all looking to you for guid- ance, and you dare not have a bad day, because your emotion is contagious. As soon as the UK lockdown started, the first impor- tant message to my practice managers was to keep communicating with all these communities. The qual- ity and the quantity of that communication have clearly differentiated the winners and losers in the pandemic period. “Whether it is silence or noise, good or bad, people will not forget how you showed up.” My second message was that people will remember the things you did and the way that you did them. Whether it is silence or noise, good or bad, people will not forget how you showed up. My third message was to keep your message confident— no matter how difficult things become. I define leadership as the combination of the following attributes: – communicating a clear vision: knowing where we are going, why we are going there and how we intend to do it; – listening regularly to feedback on how your people are feeling; – being an example of the standards of performance and behaviour that you expect from those around you— people will follow your lead and that is a constant burden that the leader must bear; 06 1 2021

| practice management 2 What resources are available to me to help me to understand what makes people tick? Frankly, the list is endless, and a few moments on any search engine will reveal countless resources to assist with your leadership role. The best teacher is, of course, your own personal experience of dealing with people over many years of interaction. For the beginners, I strongly recommend any reading on simple psychology. One of the most revealing lessons I have learned on understanding the behaviour of other peo- ple is the Karpman Drama Triangle. Dr Stephen Karpman conducted research in the 1960s into three modes of behaviour adopted by those who are emotionally charged (and what to do or say in response). There is never a week that passes without my discussing this with managers. To read more, go to https://karpmandramatriangle.com (a rather dated website) or take a look at The Karpman Drama Triangle Explained: A Guide for Coaches, Managers, Trainers, Therapists—and Everybody Else by Chris West. How do I delegate when I do not trust the people that I am delegating to? This is, perhaps, one of the greatest challenges the practice manager faces, and it is all too easy (especially in a pandemic landscape) for the practice manager to argue that it is easier just to do it himself or herself. That, of course, is no use as a long-term solution. Business author Harry Beckwith 08 1 2021 suggests that “there is no performance without account- ability and no accountability without measurement”. To delegate, follow the simple rules: 1. Be specific about what you want to be done. 2. Be specific about who you want to do it. 3. Agree on a deadline. 4. Agree on how you want to be informed of completion. 5. Walk away and do not micromanage. To begin, people will make mistakes. Then you will train them. If the mistakes are repeated, you have the wrong person. If you have the right person, the mistakes will not reoccur. Finding the sweet spot between abdication and micromanagement is a skill of a true leader. Finally, let us deal with the Chimp. The Chimp Paradox is the 2012 groundbreaking book by psychiatrist and sports performance coach Dr Steve Peters. The Chimp in ques- tion is the limbic (emotional) brain. The paradox is that the Chimp can be our best friend or our worst enemy. The book is about dealing with what happens when the Chimp whispers in our ear that we are not good enough, that our plans will fail, that we are the imposter; when we start comparing our inside with everybody else’s outside. My Chimp attacks me every September, when we begin marketing our coaching programmes for the following year. My team will tell you that I repeat the same behaviour every year, fantasising that I will have no clients and I will be out of work—being revealed as the imposter coach. My business coach Rachel Turner will also confirm that we have the same coaching session every year, during which she asks me to grab pen and paper and make a list of the top ten reasons that the Chimp is wrong—you might say, the top ten reasons that you look just great up there on that horse. I keep my list with me at all times— and refer to it when I feel those moments of uncertainty. Leaders are quiet and confident, firm and fair, inspiring and vulnerable, above all else, that beacon of light I referred to in my manifesto. You are a leader. about Chris Barrow has been active as a consultant, trainer and coach to the UK dental profession for over 24 years. His main professional focus now is through his Extreme Business company, providing coaching and mentorship to independent dentistry around the world via face-to-face meetings, a workshop programme and an online learning platform.

| case report Digital approach in the anterior area: Management of surgical and prosthetic cases Dr Roberto Molinari, Italy As is already known, to achieve an optimal result in aes- thetic cases, it is necessary for a certain harmony between the soft tissue and prosthetic devices; this means that the interdental papillae, the gingival margin, the dental axes and the dominance of the central incisors must be well balanced (Fig. 1). The digital management of aesthetic cases in which it is essential to perform a surgical procedure in the anterior area, such as the insertion of an implant, requires greater at- tention to detail, especially if the patient has a gummy smile. In order to keep the position and thickness of the gin- gival margin and papillae stable, it is recommended to perform a connective tissue graft in the vestibular area of the implant. The insertion of the connective tissue graft in this area is essential from an aesthetic point of view and in order to maintain the long-term health of the implant. The most commonly used method is to extract the con- nective tissue for the graft from the palate or maxillary tuberosity. This type of conventional approach presents some risks, such as the following: 1. bleeding from the donor area; 2. necrosis of the connective tissue graft; 3. neurological damage; 4. aesthetic damage; and 5. pain, swelling and paraesthesia. 1 Fig. 1: Ideal anterior aesthetic composition. Introduction In this article, I would like to propose a new approach to digital dentistry regarding new surgical and prosthetic work processes on the subject of complex aesthetic re- habilitation in the anterior area, with particular reference to gummy smile patients. More precisely, I would like to introduce the digital process that I apply when I need to preserve the original morphology of the soft tissue (gingival margin and papillae) in the anterior areas, a pro- tocol that involves the use of a customisable collagen matrix and provisional devices created by a digital method. 2a 2b Fig. 2a: Initial extra-oral situation. Fig. 2b: Initial intra-oral situation. 10 1 2021

| case report 7 Fig. 7: Mock-up of the future restoration and its aesthetic impact on the patient’s face. and gingival margin), as a temporary solution, I removed the root of the lost tooth with a bur and I made a pontic, modifying the crown with some composite on the cervi- cal third. I then bonded the avulsed tooth to the adjacent teeth using a metal wire and flow resin (Fig. 4). Case analysis and treatment plan In all cases in which aesthetics is involved, I always carry out an aesthetic analysis of the smile following the Digital Smile Design concept in order to optimise the harmony between the patient’s teeth and face (Fig. 5). In this case, in order to test the aesthetic potential of the project, I created a mock-up of the intended final result. In order to reduce treatment time, I used a digital method of pro- totyping a resin model with the new morphology and creating a silicone index to carry out testing directly in the patient’s mouth (Figs. 6a–e). After simulating the patient’s new smile and verifying its harmony and proportion - 8 Fig. 8: Definitive treatment plan overview. 12 1 2021

| case report 11 12b 12a 12c Fig. 11: Digital impression necessary to create the second provisional crown screwed into the implant. Fig. 12a: First incision. Fig. 12b: Full-thickness flap detachment by 3 mm. Fig. 13: Implant placement. 1. I etched teeth #13–23 in order to bond the previously tested mock-up using the adhesive technique. This de- cision was decisive, as it allowed me to virtually design a provisional crown for area #21 with an adequate cervical shape by copying it with the scanner and then mirroring the new tooth #11 morphology with the CEREC design software (Dentsply Sirona; Figs. 9a–d). 2. I performed bone regeneration of socket #21 using Geistlich Bio-Oss and Geistlich Mucograft (Geistlich Pharma). In this phase, the previously milled provisional crown was bonded to the adjacent teeth with a metal wire and flow resin after etching and applying the ad- hesive on their palatal surfaces. An adequate compres- sion of the provisional crown protected the biomaterial 14a 14c 14b 14d Fig. 14a: Customisation of the collagen matrix with a zirconia bur. Fig. 14b: Customised collagen matrix. Fig. 14c: Collagen matrix positioning. Fig. 14d: Collagen matrix insertion. 14 1 2021

| case report 18a 19 18b 20 Fig. 18a: Soft-tissue digital impression gingival mask. Fig. 18b: Biogeneric copy of the mock-up and the screwed-in provisional crown. Fig. 19: Prepared teeth. Fig. 20: Definitive digital impression of the prepared teeth. and thus an impairment of the final aesthetics. There- fore, an intra-sulcular vestibular incision was performed by creating a small mucosa pocket obtained through a further partial-thickness incision of the soft tissue in cor- respondence with the buccal portion of the edentulous area (Figs. 12a & b). 3. Placement of the implant. The implant was positioned centrally with a palatal inclination in order to prevent the screw access hole from affecting the incisal edge of the provisional crown or its vestibular surface (Fig. 13). 4. Customisation of a Geistlich Fibro-Gide matrix (Geistlich). Fibro-Gide is a porous, resorbable and volu- metrically stable collagen matrix of porcine origin, spe- cifically designed for the regeneration of soft tissue in order to avoid removal of autologous connective tissue. This matrix promotes angiogenesis, the formation of new connective tissue and the stability of the collagen network in submerged healing. In an aesthetic case like this, however, the matrix must be customised and adapted to the recipient site. It would then be very sta- ble and maintain its volume in the healing phase, and it would not be oversized, avoiding traction of the flap and/or excessive volume of the soft tissue after healing. As it is a particularly resistant matrix, I always find it dif- ficult to shape it with a scalpel blade. Instead, I suggest the use of a zirconia bur at low speed. In this way, over- heating and denaturation of the collagen will be avoided and the structural characteristics will be maintained (Figs. 14a–d). 5. Placement of the collagen matrix and suturing. The collagen matrix was placed in the previously created mucosa pocket. The soft tissue must be hermetically sutured over the matrix so that it is completely submerged (Fig. 15). 6. Taking of final digital impressions to fabricate the immediate provisional crown. Once the previously cut impression had been achieved, along with the comple- tion of the 3D position of the implant, the emergence profile was drawn (baseline) on the gingival mask. Subsequently, on selection of the anatomical portion of tooth #11 (copy line), crown #21 was automatically created thanks to the design software. The restoration of tooth #21 milled in PMMA was cemented to the TBase and then screwed into the implant at 20 Ncm. The real advantage of this technique is that the provi- sional crown would not have to be relined with acrylic resin in the patient’s mouth, avoiding the risk of con- taminating the collagen matrix. The provisional crown properly designed thanks to a personalised emergence profile would favour the conditioning of the soft tissue by supporting it and, furthermore, by sealing the mar- gins of the surgical gap. This would protect the under- lying collagen matrix, ensuring a successful final result (Figs. 16a–d). 16 1 2021

| case report 23a Figs. 23a & b: Polished restorations. 3. Taking of final impressions of the prepared teeth. With a scan post positioned on the implant, the prepared maxillary arch was scanned with the intra-oral scanner, capturing every single anatomical detail not only of the prepared teeth but also of the teeth not involved in the preparation. This operation is necessary to match the virtual models, a prerequisite in order to obtain definitive prosthetic devices with the same shape as the mock-up (Fig. 20). 4. Development of the master models and digital de- sign. Once the impression phase had been completed, we would rely on the software in order to design the definitive prosthetic teeth. To begin with, it is necessary to draw the baseline on the soft-tissue profile, highlighting the area within which the software will detect and create a prosthetic crown with a proper emergence profile that will support the previously conditioned papillae and gin- gival margin. Subsequently, the baseline for each of the prepared teeth must be drawn, highlighting the finishing line preparation. In the following step, the copy line will be drawn, selecting the same teeth from the master model created by copying the mock-up. With this information, the software will create the final virtual prosthetic teeth. 23b 18 1 2021 The digital tools that the software makes available are an excellent aid in perfecting the shape of the prosthetic teeth (Figs. 21a–e). 5. Choice of material and milling of prosthetic teeth. The choice of material is another important key point. A den- tist who decides to take the digital path must have a good knowledge of the chemical and physical characteristics of materials on the market because they are directly linked to the aesthetic and functional result that will be obtained. If it is clear to us how natural teeth react to light, consider- ing aspects such as fluorescence, opalescence and trans- lucency, then our goal will be to select the most suitable CAD/CAM block. In general, my first choice is feldspathic ceramics, as they allow me to obtain results that are closest to the aesthetic characteristics of natural teeth. However, in the case that it is necessary to mill prosthetic restorations to a very thin thickness (0.2–0.3 mm), it is nec- essary to choose a hybrid ceramic containing a variable percentage of resin, which gives greater elasticity and thus avoids fractures during milling and obtains accurate margins. In addition to chroma and value, it is important to con- sider translucency when choosing the material to create prosthetic restorations for the anterior area. The multi- coloured blocks, or so-called multilayer blocks, have a stratification that goes from opaque to translucent. In the design phase, it is recommended to allocate the trans- lucent area to the incisal edge of the anterior teeth. In this case, having the need to make very thin veneers, I se- lected a hybrid ceramic. As mentioned, it is a more elastic material than feldspathic ceramic and offers the advan- tage of being available in industrially drilled CAD/CAM blocks for the production of screw-retained crowns on implants. More specifically in the case described in this article, I milled five multicoloured hybrid ceramic veneers, a multicoloured hybrid ceramic crown for implant #21 and a single-colour hybrid ceramic abutment to mask the grey titanium of the TBase (Fig. 22). 6. Finalisation of the prosthetic teeth. This point is very important, as it will define the final appearance of the prosthetic teeth. In my opinion, we erroneously rely too much on products such as glazes or stains to perform the surface characterisation. The goal we should aim for at this step should not be the creation of mirrors that reflect light evenly, but the creation of a surface texture capable of reflecting light in a different way that gives the prosthetic teeth a more natural appearance. The mi- cro- and macro-texture of each tooth should be sculpted by inserting all the micro-defects that are typical of nat- ural teeth and that help us to camouflage the prosthe- ses. When I use ceramic materials, I do not use stains or glazes, but after sculpting the texture, I just polish them with a series of polishers in order to enhance the anatomy of each individual tooth.

| case report 25a Figs. 25a–c: Final outcome. 25b – isolation of the operative site by dental dam (I will not discuss the importance of the dental dam here, as we clinicians know that adhesive cementation must be performed under isolation of the operating site); – conservative preparation; and – evaluation of the final colour. devices by mitigating the possible discoloration of a de- vitalised tooth or highly chromatic dentine, or to slightly modify the value of the ceramic. These products are sold with the respective full-colour test glycerines, through which it is possible to select the most suitable cement colour for the case (Figs. 24a–e). Conclusion I hope that reading this article will be an incentive to see your work differently. Over the years, my vision has led me to change my approach and my work process con- tinuously and to look at what I am doing with a critical eye, in order to improve. After so many years of navigat- ing the digital sea, I must admit that today, compared with 20 years ago, procedures have been simplified and what was considered pioneering at the time is now part of the accepted clinical protocols. Technological innovations and the development of increasingly high-performing materials have allowed me to reduce therapy times and discomfort for my patients and, moreover, to increase my profit margin (Figs. 25a–c). 25c about I believe it is essential to emphasise how important con- servative preparation of the teeth involved in the treat- ment is: leaving enamel on the surfaces of the prepared teeth will allow for greater adhesion than would be ob- tained on dentine. For this reason, I advise you to start the preparation already from the mock-up, creating the guide grooves of 0.5 mm deep with a calibrated bur that allows conservation of the enamel. We must not forget that the dentine must be hybridised immediately if it is uncovered because in this way, by engaging the newly uncovered collagen fibres, the strength of the adhesive bond will also be increased on this tissue. Delay in these cases would lead to deterioration of the fibres, consequently lowering strength of the adhesive bond. Equally decisive for the final aesthetic result is the third point. Today, there are coloured cements on the market that allow us to modulate the final colour of prosthetic Dr Roberto Molinari obtained his diploma in dental technology in 1986 and his degree in dentistry and dental prosthetics with honours from the University of Bologna in Italy in 1993. After having trained with the most notable experts in modern dentistry, he specialised in periodontics, implantology and aesthetic prosthetics. He holds courses for dentists on the correct use of CAD/CAM techniques for natural teeth and implants. He is an active member of the board of PEERS (the Platform for Exchange of Experience, Research and Science, founded by Dentsply Sirona) and a founder member of the Accademia Italiana di Odontostomatologia Digitale (Italian academy of digital odonto- stomatology). He is an international key opinion leader for Dentsply Sirona and Zeiss on CAD/CAM and micro-dentistry, respectively. He lives in Mantua in Italy, where he runs his own dental clinic. He can be contacted at r.molinari@sanitasservizi.it. 20 1 2021

| case report An in-office-fabricated implant surgical guide corrected using CBCT Drs Sean W. Meitner & Gregori M. Kurtzman, USA 1a 1b 2 Figs. 1a & b: Pretreatment radiograph demonstrating significant bone loss associated with the mandibular right central incisor, lateral incisor and canine. Fig. 2: A 3/32 in. drill was used to make a pilot hole in the edentulous area of the cast where implants were planned and guide posts inserted. Introduction Geometry of the bone present can make implant place- ment challenging. This can be especially true in the ante- rior, where the angle of the ridge requires a different trajec- tory than that of the prosthetic axis that will be used during restoration.1 Both the maxillary and mandibular ridge tip to the facial aspect, requiring implant placement that is not vertical in position. This can become more complicated in a site that is either edentulous or undergoing significant periodontal changes to the bone present, as the facial as- pect is lost first, shifting the trajectory of the available bone present. Periapical and panoramic radiographs only provide a 2D view of the 3D anatomy practitioners operate within. There- fore, information regarding the inclination of the triangle of bone is not available. Attempts at a flapless approach sur- gically in those cases can lead to perforation of the lin- gual plate or dehiscence on the facial aspect of the ridge. This implant placement requires a flapped approach to fully view the facial plate to aid in osteotomy preparation during implant placement.2, 3 Even under those circumstances, the surgeon must centre the drills in the space for the im- plant to be properly positioned in the mesiodistal orienta- tion.4 This becomes more complex, with greater potential error, when placing two implants adjacent to each other 3a 3b Figs. 3a & b: Guide sleeves were placed over the guide posts with the retentive cleats at the lingual aspect. 22 1 2021

| case report 6 7a 7b Fig. 6: Guide Right Bending Tool and stylus. Figs. 7a & b: A 1 mm offset post was bent to 9° for the central incisor site (a) and a 1 mm offset post was bent to 15° for the canine site (b). nique and application with regard to adjacent implants to be placed, each requiring a different orientation with regard to the osseous anatomy, is presented. informed that, owing to the amount of bone loss, extraction of the three teeth was the recommended treatment that could be performed on those teeth. Clinical case A 76-year-old male patient presented with mobility and pain in the right mandible. Review of the medical history of the patient informed that he had controlled diabetes and high blood pressure, for which he was on medication with regular supervision by his physician. Examination noted that the mandibular right central incisor and lateral incisor had Grade II mobility and that the right canine presented with Grade III mobility. Periapical radiographs were taken to access the conditions present (Figs. 1a & b). A large area of bone loss was noted around the entire root of the canine, which had no osseous support. The lateral incisor presented with 90% bone loss and the central incisor 75% bone loss. The patient was Treatment options to replace the teeth, which included a removable partial denture or placement of two implants and restoration with a three-unit fixed prosthesis, were dis- cussed. The patient decided on the implant-retained fixed prosthesis as the treatment he wished to proceed with. Review of the steps necessary to follow this treatment option were discussed and the patient was informed that osseous grafting would be necessary at the time of ex- traction and, after a healing period, implants would be placed. The implants would then require a healing period to osseointegrate before restoration could be initiated. During the healing periods, the patient would wear a provisional partial denture. The patient was scheduled for surgery. The patient presented, and informed consent forms were reviewed and signed by him. Local anaesthetic (4% art- 8a 8b 9 Figs. 8a & b: Corrected 1.0 mm offset guide posts with 3.9 mm upper parts for alignment of 4.0 mm guide sleeves placed into the post holes on the cast. Fig. 9: Guide sleeves were placed on the upper removable parts of the corrected guide posts. 24 1 2021

| case report 13 14a 14b Fig. 13: Densah osseodensification drills used through the Guide Right surgical guide to create the osteotomies for the implants to be placed. Figs. 14a & b: Periapical radiographs of the implant placement (a) and healing abutments placed (b). aspect (Figs. 3a & b). Triad gel (Dentsply Sirona) was placed over the retentive cleats on the sleeves and over the lubri- cated surfaces of the adjacent teeth on the cast and light- polymerised to create the diagnostic guide (Figs. 4a & b). A CBCT scan was taken with the diagnostic guide worn intra-orally. The data was imported into CS 3D implant planning software (Carestream Dental), and the position of the two sleeves were analysed with regard to orientation to the underlying ridge and its angulation. A virtual implant was placed at each site in the software. It was determined that, based on the trajectory of the guide sleeves, that both implant sites were angled to the facial aspect. This would create lingual perforation when the osteotomies were prepared, and a correction would be necessary with the surgical guide that would be fabricated. Additionally, both planned implants would need to be shifted and angled lingually to allow the definitive resto- ration to have lingual access openings for the abutment 15a 15b Figs. 15a & b: Radiograph of the definitive restoration (a) and the definitive restoration displaying the lingual access openings (b). 26 1 2021 screws. Analysis determined that the implant at the central incisor would need to be angled 9° to the lingual aspect and offset to the facial aspect at the crest by 1 mm and the canine angled 15° to the lingual aspect and offset to the facial aspect by 1 mm (Figs. 5a–c). The corrections to the guide posts would be made using the Guide Right Bending Tool (DePlaque; Fig. 6) and the appropriate offset guide posts. As planned in the virtual software, for the central incisor site, a 1 mm offset post (DePlaque) was bent using the bending tool previously mentioned to achieve the desired 9° correction to the pilot hole in the cast (Fig. 7a). This was repeated for the canine site using a 1 mm offset post which was bent to 15° (Fig. 7b). The corrected offset guide posts were inserted into the cast at the appropriate pilot holes, and 3.9 mm upper removable parts were placed over the top portion of the offset guide posts (Figs. 8a & b). Guide sleeves (4 mm) were placed over the upper removable parts with the cleats at the lingual aspect and oriented to maximise resin reten- tion to them (Figs. 9 & 10) Triad gel was flowed over the cleats and adjacent lubricated portions of the cast and light- polymerised to create the corrected surgical guide (Fig. 11). The surgical stent was soaked in povidone-iodine prior to use surgically. Chlorhexidine may be used as an alter- native liquid to disinfect the guide. Local anaesthetic was administered, and the surgical guide verified for fit and stability intra-orally (Figs. 12a & b). A crestal incision was made with a scalpel, and a full-thickness flap was reflected to expose the crest. The Guide Right surgical guide with 4 mm guide sleeves was inserted. The osteotomies were initiated with a 2.2 mm drill in a 2.3 mm insert and com- pleted with Densah osseodensification burs (Versah), start- ing at 2.5 mm and continuing to 3.5 mm in diameter to a depth of 11.5 mm at both sites through the surgical guide (Fig. 13). A 3.5 × 11.5 mm implant was placed into the cen- tral incisor site and a 4.0 × 11.5 mm implant was inserted into the canine site (AnyRidge, MegaGen). A post-insertion

| case report The use of new technologies and digital implant solutions in a one-stage surgical procedure Dr Michał Nawrocki, Poland 1 2 Fig. 1: Situation before treatment, which led to the decision to extract tooth #11. Fig. 2: CBCT scan: the root of the tooth was visibly fractured, and there was clear external resorption of the root from the vestibular side. The aim of this article is to present a case of single- tooth prosthetic restoration in the aesthetic zone step by step. The patient was referred to our clinic with a fractured root of tooth #11 (Fig. 1). The cone beam computed tomography (CBCT) analysis confirmed the fracture and revealed external resorption of the root 3 Fig. 3: Buccal scan: information on the positioning of the maxilla relative to the mandible. This is absolutely necessary for designing a crown. 28 1 2021

| case report 9 10 Fig. 9: Visible granulation tissue at the resorption and fracture area of tooth #11. Fig. 10: Removal of the granulation tissue with an Er:YAG laser. from the vestibular side (Fig. 2). The tooth had to be ex- tracted, and it was decided to follow immediate implant placement with a temporary aesthetic implant resto- ration. The immediate implant placement was planned with short-term non-occlusal loading. With the use of the CEREC Omnicam scanner (Dentsply Sirona), scans were taken of both the maxillary and the mandibular full arches along with a buccal scan (Fig. 3). The scans, together with the DICOM files, were up- loaded to the Simplant software (Dentsply Sirona; Figs. 4 & 5). The optimal position was planned for an Ankylos C/X B 14 implant (Dentsply Sirona) in line with the 3A–2B rule.1 Using the Simplant software, a Simplant Guide, along with a patient-specific Atlantis CustomBase Solution (with a titanium nitride abutment surface; Dentsply Sirona) and digital files, were ordered using Atlantis Core File (Dentsply Sirona). 11 13 12 14 Fig. 11: Clean socket after atraumatic extraction of tooth #11. Fig. 12: Tooth-supported Simplant Guide. Fig. 13: The guide fitted flawlessly on the patient’s teeth. Fig. 14: A sequence of implant drills with specific guide sleeves were used. 30 1 2021

| case report Bimaxillary prosthetic reconstruction with implant-supported overdentures using novel materials and digital technology Dr Said Sánchez, Mexico 1 4 2 5 3 6 Figs. 1–3: Baseline situation, extra-oral aspect. Figs. 4–6: Baseline situation, intra-oral view. Introduction The prosthetic rehabilitation of the fully edentulous pa- tient with implant-supported overdentures has many 7 Fig. 7: Baseline situation, panoramic aspect obtained by CBCT. 32 1 2021 advantages in comparison with conventional tissue- supported dentures in terms of retention, stability and masticatory efficiency, resulting in high patient satis- faction. Nevertheless, a proper diagnosis identifying the aetiology of edentulism, appropriate treatment plan- ning according to the patient’s profile, and the incor- poration of novel technologies and materials in com- bination with evidence-based concepts are critical for obtaining highly successful results for the benefit of our patients. This clinical report describes the surgical and prosthetic management in the rehabilitation of a fully edentulous pa- tient, using narrow-diameter Roxolid implants (Straumann), allowing us to exploit the alveolar bone available and thereby avoid augmentation procedures. We applied the Novaloc retention system (Straumann) to restore the edentulous mandible in combination with advanced digi- tal technology. Together, this allowed us to perform accu- rate full-mouth implant restorations with highly aesthetic and functional results.

| case report 15 17 19 21 16 18 20 22 Fig. 15: Panoramic radiograph after the eight-week post-op healing period. Fig. 16: Occlusal view of the five uncovered maxillary implants. Fig. 17: Occlusal view of the four uncovered mandibular implants. Fig. 18: 3D digitisation of the patient’s face in the natural head position with maxillary and mandibular baseplates and wax rims with the correct intermaxillary parameters. Fig. 19: Facial data integrated into the virtual articulator with final virtual design of the restorations. Fig. 20: Facial data integrated into the virtual articulator with final virtual design of the maxillary restoration. Fig. 21: Facial data integrated into the virtual articulator with final virtual design of the maxillary restoration. Fig. 22: Facial data integrated into the virtual articulator with final virtual design of the maxillary and mandibular restorations. 34 1 2021

| case report 28 30 32 34 29 31 33 35 Figs. 28–31: Final virtual design in the CAD software of the maxillary overdenture before the CAM procedure. Fig. 32: Maxillary overdenture base material milled in reinforced PEEK. The customised ceramic denture teeth were milled in lithium disilicate glass ceramic and finally were bonded to the reinforced denture base structure. Fig. 33: Final characterisation with pink veneering composite. Figs. 34 & 35: Final telescopic maxillary complete overdenture customised with pink veneering composite. 36 1 2021

| case report 41 43 42 44 Fig. 41: Intra-oral occlusal view of Novaloc abutments screwed in and torqued to 35 Ncm. Fig. 42: Intra-oral direct pick-up procedure. Titanium matrix housings in situ. Fig. 43: Intra-oral direct pick-up procedure. Block-out rings placed over the abutments to prevent excess dual-polymerising resin processing material below the matrix housings. Fig. 44: Intra-oral direct pick-up procedure. After adequate passive seating of the definitive prosthesis had been checked, the final pick-up was performed with finger pressure using dual-polymerising self-adhesive resin material. Prosthetic procedure The first step was to accurately transfer the implant 3D position to the laboratory through conventional impres- sions with the open-tray technique using polyvinylsilox- ane and customised trays. Cast models with implant an- alogues were obtained, scanned and digitised. From this point, a completely digital workflow for the production of the definitive restorations was employed. Posteriorly, the craniomandibular jaw relation was registered using a specific system (PlaneSystem by Udo Plaster, Zirkon- zahn), which is based on the patient’s natural head posi- tion and the ala-tragal line allowing an accurate transfer of this information to the physical and virtual articulator. Eventually, the patient’s facial 3D recording was taken using an optical face scanner with a bite plate for image merging and 3D patient analysis (Fig. 18). The application of a 3D face scanner is an important tool that provides the clinician and laboratory with valuable patient information and better communication with the patient. 45 46 Figs. 45 & 46: Final intra-oral aspect of the bimaxillary implant rehabilitation after six months. 38 1 2021

| case report Full-mouth restoration with Zolid FX— a successful concept for sophisticated prostheses Joachim Maier, Germany 1 2 Figs. 1 & 2: Pronounced abrasion due to bruxism, resulting in significant loss of the vertical dimension. Case description The patient case outlined here describes the challenges that prostheses have to meet under high stress. The pa- tient presented to the practice with pronounced abrasion and asked to have his natural dental appearance restored. Full-mouth restorations have their own challenges, and this was particularly so for this patient, who tended to re- lieve his daytime stress by grinding his teeth at night. After completion of pretreatment and splint therapy, the patient presented to us with the status shown in Figures 1 and 2. Goal definition Our task was to fabricate prostheses which, in addition to their natural aesthetics, could withstand high mechani- 3 4 Figs. 3 & 4: The occlusal design was created, and the contacts placed on unveneered zirconia. These should not be positioned directly on the veneer interface. 40 1 2021

| case report 10 12 11 13 Figs. 10 & 11: If required, the fissures can be recontoured with a pointed carbide cutter. Fig. 12: After sintering, diamond silicone polishers are recommended for refining the zirconia surface. For example, the Zolid Sinter-State Polishing Kit (Amann Girrbach) is well suited here. Fig. 13: Stone and diamond polishers from EVE-Diacera HP Set for zirconia. of natural teeth. Unveneered, smooth-polished zirco- nia would exhibit less loss of height over the years and would result in uneven abrasion of the teeth, having unforeseeable consequences. Our standard solution is thinly veneered zirconia if only a few teeth are to be restored, for example in the case of isolated gaps. 14 15 Figs. 14 & 15: Silicone brushes with diamond grains do not change the shape of the surface, but smooth it. Contact with the workpiece should be made at a slight angle so that the bristles can deflect better and do not kink. 42 1 2021

| case report 19 20 Figs. 19 & 20: The combination of areas with monolithic zirconia and areas with buccal veneering combines the entirely different advantages of two ceramics. again slightly at the raised areas with mostly smoother surfaces. It is important that these structures are not applied to bridges in tensile stress areas, to prevent any possible initial formation of cracks. Finally, the fissures are reworked if necessary. Figures 10 and 11 demon- strate this final processing step before cleaning, infil- tration and sintering. The small contact and guide sur- faces on zirconia must be polished to a high gloss after sintering and grinding to prevent mutual abrasion and early failure of the restoration. The analysis of an inter- nal study by our laboratory showed that polishing with a diamond polisher or the finest diamond grinder largely removes the deep surface damage caused by a Rotring diamond bur. The success of this approach has been confirmed by Coldea et al.2: if final sintered Y-TZP is pro- cessed with coarse abrasives, subsequent polishing is absolutely necessary. It is recommended to grind or polish gradually with increasingly finer grinders or pol- ishers. The surfaces are smoothed with suitable dia- mond silicone polishers, that is, the spikes are removed without causing any further surface damage. This can be facilitated quite easily, for example, with the polishing sets in Figures 12 and 13. In contrast to veneering ceramics or lithium disilicate, our polished zirconia samples have very low roughness depths. The smooth surface of final sintered zirconia that can be achieved by polishing also has advantages in abrasion behaviour compared with veneering ceramics. Preis et al. came to this conclusion in a comparison of the abrasion behaviour of zirconia and veneering ce- ramics on natural enamel.3 Abrasion caused by zirconia was considerably less than that of veneering ceramics. Owing to the veneering ceramics, the antagonist exhib- ited a roughened surface and partially also cracks and fractures in the enamel. The contact surfaces with zirco- nia were polished.3 In an in vitro study, Sripetchdanond and Leevailoj showed that monolithic zirconia had a lower wear depth on human enamel than glass- ceramic and human enamel did.4 The best result of our laboratory test regarding the lowest roughness depth was obtained with an epoxy resin-bonded, diamond- 21 22 Figs. 21 & 22: New teeth with abrasion facets and cracks that suit bruxism patients. Stability, function and inconspicuous integration of the restorations were the objectives of our work. 44 1 2021

| trends & applications Zygomatic dynamic navigation: New challenges and possibilities Drs Fernando Duarte, Carina Ramos, João Neves Silva & Luis Pinheiro, Portugal surgical interventions and has varying implant success rates, high potential for donor site morbidity and increased surgi- cal costs.2, 3 A major breakthrough came when Brånemark first used custom-designed, longer implants inserted into the zygomatic bone in support of a craniofacial prosthesis in the 1980s.4 When used in the treatment of maxillary at- rophy,5, 6 zygomatic implants present a graftless alternative. Zygomatic implant concept The zygomatic implant design and placement protocols have been extensively described.6–17 In short, the implant, ranging from 30.0 mm to 62.5 mm, is introduced into the second premolar area, traversing the maxillary sinus, and is anchored in the zygomatic bone. In addition to two zygomatic implants, two to four conventional implants are required in the anterior maxilla to support the prosthesis.18, 19 Zygomatic implants have shown good clinical success rates in clinical studies, most often close to 100% success in follow-up periods of up to five years.20–23 Sinuscopy performed in patients with zygomatic implants has shown absence of infection or inflammation in the surrounding mucosa.24 Furthermore, placement of multiple (two to four) zygomatic implants in the same zygomatic bone has been reported to be a clinically successful treatment and to have similar com- plications to those experienced with the original technique.25–29 Immediate function, a well-documented concept associated with the immediate loading of implants upon insertion,30–33 has shown high success rates, provided that there is high 1 Fig. 1: StealthStation S8 system (Medtronic) equipment. Introduction The presence of sufficient bone volume is one of the most important criteria for successful osseointegration of implants,1 wherefore restoration of atrophied edentulous maxillae poses a great dilemma for the surgeon and re- storative dentist. Sinus bone grafting to build new bone for implant anchorage in atrophied jaws entails multiple 2a 2c 2b Figs. 2a–c: Pre-op evaluation: dental occlusion (a); dental panoramic tomograph (b); and appearance of the contour of the lips and orbicularis oris muscle of the mouth (c). 46 1 2021

| trends & applications 5 6a 6b Fig. 5: The navigation instrument. Figs. 6a & b: Placement of the first-quadrant zygomatic implant with the help of the navigation instrument. can be identified relative to a tomography- or magnetic resonance-based model, fluoroscopic images or digitised landmarks of the anatomy.43, 44 For the software to display the instrument’s location in re- lation to the patient’s images, the software must create a map between the points on the patient and the points on the images. This process is called registration. Upon com- pletion of registration, whenever the operator touches a point on the patient using a special tracked instrument, the computer will use the map to identify the corresponding point on the images. This identification is called navigation. A navigated point is identified on the system screen in vari- ous patient image planes and other anatomical renderings. The surgical navigation system offers both optical and electromagnetic tracking capabilities, integration with ex- 7b ternal devices like microscopes and ultrasonic devices, a broad array of instrument offerings, and core software ap- plications for neurosurgery, spine procedures and maxillo- facial surgery.43, 44 During navigation, the system identifies the location of the tip and the trajectory of the tracked in- strument in images and models that the user has selected for viewing. The surgeon may also create and store one or more surgical plane trajectories prior to surgery and sim- ulate the progression along these trajectories. In surgery, the software can show the actual position at the tip of the instrument and its trajectory, relating them to the preoper- ative plane.43, 44 To maintain accuracy, the StealthStation S8 system uses dynamic referencing to constantly track the position of the anatomy during registration and navigation. Two devices are required for dynamic referencing: a patient frame of reference and a locator. The patient’s frame of reference is rigidly positioned in relation to anatomy. The locator, which is a camera for optical tracking or a transmitter and an in- strument interface for electromagnetic tracking, finds the patient’s frame of reference and reports the position of the frame to the navigation software. As the frame of reference remains in a rigid and fixed posi- tion in relation to the anatomy, any movement of the anat- omy or of the locator results in corresponding movement of the frame of reference in the locator’s field of view. This allows the locator to detect any movement of the anatomy by identifying the position of the frame of reference, which moves simultaneously with the anatomy. The system can then display the instrument or implant location relative to the patient’s frame of reference while maintaining accurate navigation. Without dynamic referencing, any movement of the locator after registration would be invalid, as the po- sition of the frame of reference would be changed in the navigation field. Dynamic referencing allows the flexibility to reposition the locator at any time. The system consists of a platform, clinical software, surgical instruments and a ref- erence system (including patient and instrument trackers; Fig. 1). 3D images of the patient can be displayed by soft- ware from various perspectives (axial, sagittal, coronal and oblique planes).43, 44 Clinical case Figs. 7a & b: Placement of the second-quadrant zygomatic implant with the help of the navigation instrument. Fig. 8: Intra-op aspect of implant place- ment. Fig. 9: 3D intra-op images provided by the navigation system. A 56-year-old male patient attended the oral-maxillofacial surgery consultation at Clitrofa medical centre in Trofa in Portugal to perform an implant-supported rehabilitation of the upper jaw. The clinical evaluation revealed a partially 7a 7a 8 9 48 1 2021

| news Since dental students had to suspend their clinical training during the pandemic, some dental schools around the world have announced that they will not be taking in new students in 2021. COVID-19 and dental education: Will dental schools admit new students in 2021? By Iveta Ramonaite, Dental Tribune International Since the COVID-19 pandemic has severely restricted access to clinical practice, students around the world have been adversely affected by the far-reaching consequences the pandemic has had on dental education. To make the most of the current situation, numerous schools have instituted video and virtual platforms in order to familiarise students with standard clinical procedures. However, the knowledge gained through online learning is limited, and some students are now being asked to repeat the 2020–2021 academic year in order to complete the necessary clinical training. To this end, some dental schools have announced that they will not be admitting new students in 2021. Owing to the high risk of the virus spreading through aero- sol transmission in clinical practice, dentistry has been severely affected by the pandemic. This has manifested itself in a lack of the in-person training for dental students which is crucial for the successful completion of their edu- cation. Students have also been burdened by various fears and worries caused by factors such as the necessity to adapt to the updated infection control protocols and the need to rise to academic challenges. The gravity of this situation is clearly evident in Scotland. Since final year dental students have been unable to graduate owing to a lack of practical clinical experience, Universities Scotland, the representative body of Scotland’s 19 higher education institutions, has announced that dental schools will not be accepting new students in September 2021. Mairi Gougeon, Scotland’s public health minister, was quoted as saying that the decision was difficult but necessary. “The quality and calibre of dental treatment in Scotland is outstanding and it needs to be protected by taking the 50 1 2021

Study fi nds differences in accuracy of intra-oral scanners By Franziska Beier, Dental Tribune International | news m o c . e b o d a . k c o t s – b e g _ y l i l o t a n a © A comparison of ten intra-oral scanners from different manufacturers found differences in their accuracy. Even though intra-oral scanners have been around for more than three decades and their use in dental practice is increasing, few investigations have evaluated the 3D ac- curacy of digital implant scans. As discrepancies between implant components must be minimal, researchers from Seoul National University School of Dentistry have evalu- ated the trueness of ten intra-oral scanners in determining the positions of simulated implant scan bodies. The lowest deviation was found at the cylinder next to the reference origin, while the highest deviation was ob- served at the contralateral side for all tested scanners. CEREC Primescan and TRIOS 3 had the highest trueness, followed by the i500, TRIOS 2 and the iTero Element— although the difference was not statistically significant. The DWIO and PlanScan showed the lowest accuracy in partially edentulous mandibular digital implant scans. The researchers tested the null hypotheses that there would be no significant difference in 3D accuracy among the intra-oral scanners and that the scan body position would have no effect on the trueness. They evaluated the performance of the CEREC Omnicam and CEREC Primescan (Dentsply Sirona), CS 3600 (Carestream Dental), DWIO (Dental Wings), i500 (Schütz Dental), iTero Element (Align Technology), PlanScan (Planmeca), TRIOS 2 and TRIOS 3 (3Shape), and True Definition (3M) in acquiring the accurate positions of six cylinders simulating implant scan bodies in a partially edentulous model. Digital scans from each intra-oral scanner were compared with the reference data set obtained by means of a coordinate measuring machine. Deviation from the actual positions of the six cylinders along the x, y and z axes and the overall 3D deviation of the digital scan were calculated. The second null hypothesis—that scan body position would have no effect on trueness—was also rejected, as digital scans deviated with distance from the refer- ence origin. The further the scan was from the origin, the greater the deviation was. This result is in accordance with previous studies confirming the reduced trueness of digital implant scans owing to accumulation of errors during image stitching. The research group noted that a limitation of the study was that the digital impressions were collected in an in vitro model, which may differ from in vivo scenarios in which the outcome could be influenced by factors such as patient movement and presence of soft tissue and moisture. The study authors concluded: “It would be recommended to use an (intra-oral scanner) that is capable of producing accurate complete-arch scans, especially for fabrication of long-span prostheses or appliances.” Contrary to the first null hypothesis, the researchers found that the type of intra-oral scanner and the posi- tion of the simulated cylindrical scan bodies influenced the degree and direction of the deviations in accuracy. The study, titled “Trueness of ten intraoral scanners in de- termining the positions of simulated implant scan b odies”, was published on 28 January 2021 in Scientific Reports. 52 1 2021

| industry news 3Shape and Ivoclar Vivadent intensify collaborative efforts By 3Shape 3D scanner developer 3Shape and smart product sys- tems manufacturer Ivoclar Vivadent are scaling up their collaborative efforts. Their common goal is to develop the best possible oral health solutions for the health and wellbeing of patients. One, a compact five-axis milling machine designed for IPS e.max; and – integration of the Ivotion Denture System and the pat- ented workflows from Ivoclar Vivadent in 3Shape’s Dental System 2020. Both companies strive to offer highly efficient and fully integrated digital workflows. The scanning and CAD software solutions from 3Shape are coordinated with the PrograMill and PrograPrint CAM machines from Ivoclar Vivadent. This efficient combination, together with superior dental materials, ensures results that promote good oral health. The two companies are collaborating in the following areas: – patient consultation with IvoSmile, augmented reality software that provides the patient with a preview of the treatment result in real-time 3D; – a fully integrated chairside solution featuring PrograScan One intra-oral scanners and PrograMill Diego Gabathuler, CEO of Ivoclar Vivadent, is excited about his company’s collaboration with 3Shape: “Ivoclar Vivadent and 3Shape together offer competitive end- to-end solutions not only for dental offices, but also for laboratories and orthodontic practices.” 3Shape CEO Jakob Just-Bomholt added: “The success story of 3Shape and Ivoclar Vivadent continues. We be- lieve that these offerings will enhance the overall patient experience, and give dentists and technicians all the benefits of 3Shape’s and Ivoclar’s powerful products. We look forward to seeing the creative minds of both companies coming up with more solutions and work- flows that will further enhance dental treatment pro- cedures.” 54 1 2021

m o c . k c o t s r e t t u h S / s l i e x p 2 3 © | submission guidelines How to send us your work Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: the complete article; · · all the image (tables, charts, photo- · · graphs, etc.) captions; the complete list of sources consulted and the author or contact information (bi- ographical sketch, mailing address, e-mail address, etc.). In addition, images must not be embed- ded into the MS Word document. All im- ages must be submitted separately, and details about such submission follow be- low under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much in- formation. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing pro- gramme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word process- ing programme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such formatting before layout, which is very time-consum- ing. Please consider this when formatting your document. Image requirements Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to emphasise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use un- derlining. · We require images in TIF or JPEG for- · · mat. These images must be no smaller than 6 x 6 cm in size at 300 DPI. These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our requirements but send us the largest files available. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) Also, please remember that images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail, via our FTP server or post a CD contain- ing your images directly to us (please contact us for the mailing address, as this will depend upon the country from which you will be mailing). Please also send us a head shot of your- self that is in accordance with the re- quirements stated above so that it can be printed with your article. Abstracts An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to ap- pear in this section and format it accord- ing to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary information (60 words or less). Questions? Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com 56 1 2021

| international imprint Imprint Publisher and Chief Executive Officer Torsten R. Oemus t.oemus@dental-tribune.com Editor-in-Chief Dr Scott D. Ganz Managing Editor Magda Wojtkiewicz m.wojtkiewicz@dental-tribune.com Designer Franziska Schmid Copy Editors Sabrina Raaff Ann-Katrin Paulick Editorial Board Prof. Gerwin Arnetzl (Austria) Dr Christian Brenes (USA) Dr Ansgar Cheng (Singapore) Dr Scott D. Ganz (USA) Hans Geiselhöringer (Germany) Lars Hansson (USA) Uli Hauschild (Italy) Dr Stefan Holst (Germany) Prof. Albert Mehl (Switzerland) International Administration International Headquarters Dental Tribune International GmbH Holbeinstr. 29, 04229 Leipzig, Germany Tel.: +49 341 48474-302 Fax: +49 341 48474-173 General requests: info@dental-tribune.com Sales requests: mediasales@dental-tribune.com www.dental-tribune.com Printed by Löhnert Druck Handelsstraße 12 04420 Markranstädt, Germany Chief Financial Officer Dan Wunderlich Chief Content Officer Claudia Duschek Clinical Editors Nathalie Schüller Magda Wojtkiewicz Editors Franziska Beier Jeremy Booth Brendan Day Monique Mehler Iveta Ramonaite Executive Producer Gernot Meyer Advertising Disposition Marius Mezger Art Director Alexander Jahn Copyright Regulations All rights reserved. © 2021 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH is expressly prohibited. Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune International GmbH. 58 1 2021

TRIOS 4 Smiles are in your hands 3Shape TRIOS 4 takes care of all your intraoral scanning needs so you can take care of what you do best – delivering a great patient experience and treatment outcomes. ULTIMATE PATIENT COMMUNICATION Vivid colors and details Patient excitement apps High-resolution scan data enables clear visualization of treatment need Bring dental conditions and treatment possibilities to life for optimal engagement and case acceptance Contact your reseller regarding availability of 3Shape products in your region. TRIOS 4 – skilled hands made stronger www.3shape.com/en/scanners/trios-4