Healthy Practices. Healthy Smiles. CHALLENGE ACCEPTED. Nobody thought a bulk ﬁll ﬂowable was possible. Until we invented Sureﬁl® SDR ﬂow+ Material. Today, we redeﬁne restorative materials again with Sureﬁl one™ Restorative, transforming how dentists manage challenging clinical situations • Self-adhesive—no separate adhesive step needed • Unlimited depth of cure—no layering of composite materials, making it faster than a traditional composite restoration, especially in compromised cases. Sureﬁl one™ Restorative. Progress where you need it most. For more information visit DentsplySirona.com Sureﬁl one™ Self-Adhesive Composite Hybrid
4 INDUSTRY Dental Tribune Middle East & Africa Edition | 3/2021 How PIEZOSURGERY has redeﬁ ned bone surgery 20 years of PIEZOSURGERY technology By mectron s.p.a. Twenty years ago, the International Dental Show (IDS) saw the premier of the PIEZOSURGERY unit, a fi rst for pi- ezoelectric bone surgery. Since then, mectron has not only succeeded in revolutionising clinical reality with PIEZOSURGERY, but also benefi tted practioners and patients worldwide with two decades of ease of use and minimal invasiveness. "When I started developing piezo- electric bone surgery more than 20 years ago, I never expected that Pi- ezosurgery would redefi ne all bone surgery," says Prof. Tomaso Vercel- lotti, the inventor of PIEZOSURGERY, today, 20 years after the fi rst system was launched. Yet the success story of the original PIEZOSURGERY method was already underway in 1997, when the peri- odontist Vercellotti, in partnership with the company mectron, began working on the idea of ultrasonic bone surgery. Even then it was clear to them: an essential success factor for oral surgical treatment is reduc- ing its invasiveness to a minimum, ensuring that the surrounding soft tissue is spared, therefore enabling rapid healing. Vercellotti and mec- tron saw a solution for this in the use of modulated ultrasonic vibra- THE EVOLUTION OF PROPHYLAXIS COMBI touch AIRPOLISHING AND ULTRASOUND IN ONE UNIT easy switch from supra to subgingival air-polishing by a simple click subgingival perio air-polishing tip – flexible, soft and anatomically adjustable to the periodontal pocket more than 40 inserts for scaling, perio, endo and prosthetics SOFT MODE: the ultra-gentle scaling for sensitive patients V I S I T O U R B O OT H C AT A E E D C D U BA I , J U N E J U LY, www.mectron.com AD tions. Shortly afterwards, mectron succeeded in building the fi rst pro- totype and carrying out the fi rst ex- traction treatments. PIEZOSURGERY: A new para- digm in bone surgery In 2001 the time had come: The world's fi rst PIEZOSURGERY device was presented at IDS. In 2005, the fi rst implant bed preparation using PIEZOSURGERY was successfully completed. Vercellotti: "2005 was also the year in which a grand mas- ter of periodontology from Harvard University defi ned PIEZOSURGERY as a new paradigm. Making us very happy, of course." And indeed, piezo- electric bone surgery became a clini- cal reality worldwide over the follow- ing years. This success is based not only on the exceptional intraopera- tive control PIEZOSURGERY offers its users, but also the reduction in the surgical trauma to the surrounding tissue, enabling faster healing than after more invasive cutting surgical procedures. In 2011, the 4th generation of PIEZO- SURGERY equipment was launched. Other groundbreaking milestones include in 2015, when the world's narrowest osteotomy instrument, OT12S, was introduced. With a width of only 0.25 mm, it is suitable for all osteotomy techniques where stand- ard bone saws have access diffi cul- ties. In 2019, the REX PiezoImplant was launched on the market as the fi rst implant with a minimally in- vasive implant bed prepared exclu- sively with PIEZOSURGERY. The in- novative REX PiezoImplant wedge implants are suitable for use in the narrow ridge of the jawbone. This is because their unusual shape means that the bone does not have to be augmented before the implant is placed. 30,000 customers in over 80 countries have already been won over Today, more than 250 scientifi c and clinical studies have proven the posi- tive effects of using the PIEZOSUR- GERY method. The more than 90 different instruments for the PIEZO- SURGERY equipment are exclusively produced in Italy and distributed worldwide in more than 80 coun- tries. More than 30,000 customers have so far been convinced of the advantages of piezoelectric bone sur- gery. Vercellotti: "The commitment of all those involved in improving PI- EZOSURGERY year on year has been rewarded with the confi dence of an extraordinary number of surgeons and, above all, with the satisfaction of the patients treated."
3M™ Imprint™ 4 VPS Impression Material Stress less over everyday impressions. Say “YES” to the VPS impression material with the shortest intra-oral setting time. Move through your day with speed, control and precision. Speed. Reduced chair time and stress for patients—Imprint 4 material has the shortest intra-oral setting time among leading VPS fast-setting impression materials. Control. Long working time for you. Due to the unique chemistry, the setting time doesn’t start until the END of the working time. That means you’ll have a sufficient amount of time to load and seat the tray—no stressful race against the clock. Precision. Super hydrophilicity. Imprint 4 material is super-hydrophilic, displacing moisture right from the start in the unset state—which helps prevent detail-disrupting voids. To learn more how our NEW Imprint 4 VPS Impression Material can Impress you with the results simply scan the QR Code and we’ll be in touch with you! Email: email@example.com
extraPro HIGH-TECH, HIGH-PERFORMANCE SOLUTIONS SOLUTIONS FOR SPECIFIC multiPro VERSATILE SOLUTIONS easyPro ESSENTIAL SOLUTIONS Gluten Gluten Lactose Lactose FREE FREE alginates Matter, technology, science. The origin of Zhermack solutions. Zhermack alginates satisfy the most stringent quality standards in terms of both the raw materials used and the solutions proposed. A vast range with distinctive characteristics to satisfy the diverse demands of daily clinical practice. Chromatic and non-chromatic solutions with different setting times (normal, fast and extra-fast), surface detail reproduction down to 5 microns and dimensional stability for up to 5 days. First, the impression www.zhermack.com Some products may not be available in all countries. For further information on product availability, please contact your local representative.
14 GENERAL DENTISTRY Dental Tribune Middle East & Africa Edition | 3/2021 A CEREC Zirconia single crown – Tooth 16 in 82 minutes Primemill case study By Dr Todd Ehrlich, USA Case description A 58-year-old male patient came into our practice with a large cari- ous lesion on the distal surface of tooth 16. The tooth was previously restored with a CEREC onlay in 2003 with a ceramic. It was doing well, but the caries was large enough that a new restoration was indicated for the entire tooth. The large buccal abfraction was also a concern for the patient, so he wanted that covered as well. While waiting for the an- aesthetic, much of the digital work could already be completed. With the CEREC Primescan and the CEREC Primemill it is now possible to com- plete two workflow steps simultane- ously. After scanning and creating the model, the margin was marked and approved, and the proposal was completed. The CEREC software analyzed adjacent teeth to find the best anatomical shape that fit the patient. The milling strategies were calculated, and the proposal was displayed as it would be milled. The design for the molar was sent to the CEREC Primemill where the CEREC Zirconia block and the milling burs were ready to make a crown come to life. The entire time for milling was 4:22 minutes. Zirconia can be milled in Super Fast mode, resulting in sub- 5-minute milling which reduces the overall process by approximately 10-15 minutes. Because the CEREC Primemill and the CEREC SpeedFire are seamlessly connected, the sin- tering cycle is automated and made very efficient. Standard sintering times can be as short as 18 minutes depending on materials and pro- posal design. The manufactured res- toration was easily cemented with a Before: Large carious lesion on the distal surface of tooth 16, with 16-year-old onlay Final result Workﬂow 1 After: Highly aesthetic full-surface zirconia crown resin-modified glass ionomer. Total treatment time was 1:22 hours, in- cluding preparation of the tooth and fabricating the restoration. Discussion The CEREC chairside system has always been known for its speed in delivering a restoration. In this particular case of a single unit, it re- quires usually just seconds of time to image the preparation. After im- aging, the biogeneric proposal takes about 15 seconds. The clinician may do minor adjustments and changes of occlusion at his or her discretion. Finally, at the point of cementation, the clinical procedure is fast because CEREC supports you in producing predictable outcomes with regards to the anatomy, interproximal con- tact, and occlusion. The advancing technologies in zirconias are bring- ing out better aesthetics with every generation. The design of the resto- ration enabled the restoration to fit interproximally and occlusally with- out any adjustment. Workﬂow 2 Workﬂow 3 Workﬂow 4 Workﬂow 5 Workﬂow 6 Workﬂow 7 Find out more by scanning the QR code. About the author Dr Todd Ehrlich Dr Ehrlich elevates his patient care by the digital components of his practice and years of experience of hand-making his own ceramics. Although having a small practice outside of Austin, Texas, he utilizes the technologies to their fullest and reaps the beneﬁts from them, espe- cially CEREC and Galileos. Dr. Ehrlich has lectured extensively on CAD/CAM tech- nologies and has developed one of the premiere training programs for CEREC. He is a Master CEREC Trainer for Sirona and Patterson Dental. He was a beta tester for CEREC’s Omnicam and was a beta tester for Ivoclar-Vivadent’s Emax CAD. He was also an Administrator on Dental Town’s website. He has a passion for skiing and was a professional ski instructor for seven years. Although he doesn’t get to ski like he used to, he hits the slopes in Utah, Colorado, and New Mexico whenever he can. Fly- ﬁshing comes in a close second.
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18 NEWS Dental Tribune Middle East & Africa Edition | 3/2021 World Oral Health Day Dentsply Sirona proves its commitment to healthy smiles with more than 1 million participants in its Clinical Education courses By Dentsply Sirona On March 20, an important topic is in the spotlight worldwide: World Oral Health Day, which this year is themed “Be proud of your mouth.” The day aims to raise awareness of oral health as a key factor in liv- ing a longer, healthier life. Dent- sply Sirona, as the world’s largest manufacturer of professional dental products and technologies, wants to demonstrate on this day that it is focusing its energies on innovative product solutions and clinical edu- cation for dental professionals. The goal of these efforts is to empower dental professionals to give pa- tients a healthy smile. 7,300, 80, and 1 million – these figures represent Dentsply Sirona’s comprehensive commitment to clinical education for dental professionals. Last year, almost 7,300 courses (mainly online) were held in 80 countries with a to- tal of more than one million partici- pants. Using educational technology, Dentsply Sirona more than doubled the number of dental professionals participating in clinical education as compared to those in 2019. In addi- tion, the on-demand CE library has grown to more than 180 courses as dentists are using this format more and more. “ Dentsply Sirona is com- mitted to empowering dental pro- fessionals through innovation and education. These continuing educa- tion courses support dentists and team members in their daily work to provide the best possible care to their patients,” said Dr. Terri Dolan, Vice President Chief Clinical Officer at Dentsply Sirona. “In addition to appreciating information about infection prevention and the safe delivery of dental care, feedback indicates a strong commitment to timely AD Dentsply Sirona Imaging Solutions Axeos. Experience the difference. A new generation of progressive imaging is here – experience the difference with Axeos. • 2D/3D hybrid device equipped with new technology and a broad Field of View (FoV) range, from a focused FoV (Ø5 x 5.5 cm) for endodontic cases up to a large FoV (Ø17 x 13 cm) that covers complete dentition, including both TMJs • Seamless connectivity and individualized treatment workflow with Sidexis 4 Software • Patient Positioning and Image Assistant (PIA) for increased patient comfort and image accuracy Because every patient deserves a healthy, happy smile and every practice team deserves the tools to make this a reality. It’s time to elevate and expand your treatment offer. It’s time for Axeos. For more information on Axeos please contact your local dealer, Dentsply Sirona sales representative or visit dentsplysirona.com/axeos THE DENTAL SOLUTIONS COMPANYTM Find out more by scanning the QR code. enhancing their knowledge and skills using cutting-edge technology as they care for their patients.” Aligner treatment with a com- pletely digital workflow Around the globe dentists and team members participated in clinical education on endodontics, implant and restorative dentistry and digital technologies. We have also seen an increased interest in clinical educa- tion in orthodontic treatment for patients who want to have their teeth corrected with clear aligners. SureSmile brings precision, ease of use, control and flexibility to the clinician and delivers comfort and predictable outcomes to their pa- tients. With over 20 years of dedi- cated research in Orthodontics, the clinical expertise and technical skills of SureSmile technicians in the SureSmile Digital Lab as well as in-practice support, Dentsply Si- rona can support clinicians through all phases of aligner treatments. SureSmile is integrated into the workflows of other Dentsply Sirona digital products, intraoral scanners and imaging devices. The company’s digital products complement each other and work together seamlessly. “I specialize in aesthetic dentistry in my digitally equipped practice,” said Dr. Shivi Gupta, a dentist from San Diego, California, and a key opinion leader that works with Dentsply Si- rona. “SureSmile is a very attractive concept for me because the digital workflow with my CBCT and Prime- scan for digital impression is really simple. Since it is constantly being advanced by Dentsply Sirona, it is only natural for me to continue my education even in spite of the condi- tions of the COVID-19 pandemic so that I can keep offering my patients the best possible dental treatment.” Axeos - an award-winning den- tal X-ray solution Axeos, the latest top-of-the-line, versatile 2D/3D imaging solution by Dentsply Sirona, offers both a comfortable experience for patients and dentists and at the same time a growth engine for practices across various workflows. The exceptional image quality and a seamless experi- ence that connects technology and practice team together aid in what matters most – providing the best possible care to patients. From a fo- cused Field of View (Ø5 x 5.5 cm) for endodontic cases up to a large FoV (Ø17 x 13 cm) that covers complete dentition, including both tempo- romandibular joints, Axeos offers a broad range of treatments. Axeos offers three core benefits for any practice: clinical confidence, smart connectivity with integrated solutions and treatment planning, and an exceptional user and patient experience. “Dentsply Sirona con- tinues to lead the dental industry through its commitment to inno- vation, clinical education, and as a reliable partner to dentists, dental hygienists and dental team mem- bers, as well as dental technicians,” Dr. Terri Dolan summed up. Due to different approval and regis- tration times, not all technologies and products are immediately available in all countries.
OU PAPAPA HELP KEEP HELP KEEP YOUR PATIENTS ON A JOURNEY TO HEALTHY GUMS PARODONTAX® TOOTHPASTE IS CLINICALLY PROVEN TO REDUCE PLAQUE, BLEEDING GUMS AND INFLAMMATION 4X greater plaque removal *1 48% greater reduction in bleeding gums*1 Recommend parodontax® toothpaste to help patients maintain their optimal gum health between dental visits. *Compared to a regular toothpaste following a professional clean and 24 weeks’ twice-daily brushing. * Compared to a regular toothpaste and professional clean and 24 weeks’ twice-daily brushing. Reference: 1. PM-BH-PAD-20-00018
Scan and connect digitally. Or treat it in a single visit. Either way, it‘s prime. Enjoy the scan. With the connectivity options of Primescan. Find out more on dentsplysirona.com/primescan
22 RESTORATIVE Dental Tribune Middle East & Africa Edition | 3/2021 The material of the future for all kind of indications Resin-based blocks beyond your imagination By Dr Nicolas Guitierrez, Spain Introduction Implant prosthetics and dental pros- thetics differ considerably, with the absence of periodontal ligament in the implant/prosthesis complex. This situation causes mechanical problems to the implants, especially to the implant prosthetic material, due the lack of stress absorption re- sulting from the normal impact dur- ing chewing1, 2. Among the problems we face in daily practice is the un- screwing and fracturing of veneer- ing material of the implant crown and fracturing of implant/abutment components. It is very important to consider that resin based blocks give us the miss- ing part from ceramic materials to solve the problem of anterior expo- sure. It is also necessary to consider the importance of reliable bonding union between the resin block and the abutment component of the implant, because the right transmis- sion of occlusal load depends on the reliability of this bonding interface. One of the biggest advantages of BRILLIANT Crios blocks is the com- bination with ONE COAT 7 UNIVER- SAL, the best bonding system for the resin based blocks according to the scientifi c literature3, 4 and also tested in my own practice over the last fi ve years of use. Another very important feature is the size and distribution of ceramic fi llers. We have learned from the past that bigger size fi llers are better for the strength but, at the same time, are more prone to detach from the surface creating craters iniciating the material degradation. A homo- geneous fi ller size and distribution is much better for the material’s wear, luster, aesthetics and strength over long term. Case 1 During daily practice, it is very com- mon to face situations where the implant has to be placed lingually due to normal resorption (Fig. 1) of the buccal plate after the extraction. But, at the same time, it is not neces- sary to perform bone grafting proce- dures. The result of this scenario is to increase the stress on the implant- bone complex when we use rigid materials like conventional ceramics (Fig. 2). For this daily practice situa- tion, the combination of rigid and resilient materials against the an- tagonist, allows the stress to the im- plant-bone complex to be reduced (Figs. 3 & 4). Oblique loads have been reported to increase stress values in peripheral bone and prosthetic components also generating high stress in the crown, implant, abutment, and corti- cal bone. The Young’s modulus, also known as elastic modulus, is one of the important factors determining a material’s behaviour5. Case 2 Another common situation is a full- mouth restoration over implant. It is well known that the big issue is chip- ping and delimitation of the ceram- ics, due to the high forces applied in the patient with dental implants. In regards to this problem, the combi- nation of rigid materials to support the connectors and resilient mate- rials to absorb the shock and, at the same time, allow easy fi xation, make the use of resin based blocks the logi- cal choice for this kind of restoration. (Figs. 6–8) Case 3 In this case, a patient presented with extremely atrophic bone in the mandible, with four short implants placed between the dental nerve ÿPage 24 Fig. 1: Implant placed lingually due to the normal re- sorption of the buccal plate Fig. 2: The design of the crown has to be with a pseu- do pontic, increasing the oblique load on the crown Fig. 3: Hybrid implant crown made with zirconia mes- ostructure and BRILLIANT Crios cemented adhesively on top ready to be screwed in mouth Fig. 4: Implant crown after one week of placement Fig. 5: Implant crown after placement Fig. 6: Zirconia thimble framework and BRILLIANT Crios bridges for extra oral bonding Fig. 7: Zirconia bridges ready to be screwed Fig. 8: Upper and lower bridges in the mouth Fig. 9: Panoramic view of the ﬁ nished case Fig. 10a: Patient with extremely atrophic bone in the mandible with four short implants placed between the dental nerve foramen Fig. 10b: Patient with extremely atrophic bone in the mandible with four short implants placed between the dental nerve foramen Fig. 11: Telescopic bar with retentions for the second- ary structure Fig. 12: Debonding of prefabricated tooth is very common on overdentures Fig. 13: PEEK thimble structure Fig. 14: Secondary metal structure Fig. 15 and 16: Telescopic prosthesis with BRILLIANT Crios restorations. Occlusal and bottom view
Enduring gloss – made brilliant made brilliant BRILLIANT Crios Reinforced composite bloc for permanent restoration Ò High ﬂexural strength – resistant restorations Ò Tooth-like modulus of elasticity – shock absorbing Ò Wear resistant and gentle to the antagonist firstname.lastname@example.org | www.coltene.com 1 2 2 0 . 1 9 5 6 0 0
24 ◊Page 23 RESTORATIVE Dental Tribune Middle East & Africa Edition | 3/2021 Fig. 17: BRILLIANT Crios restorations used for removable tel- escopic implant prosthesis Fig. 18: Final case in the mouth of the patient. Wearing a complete denture on top and telescopic BRILLIANT Crios on the lower jaw foramen (Figs. 10a & b). After some time, patients wearing this kind of restoration with prefabricated teeth, their muscle activity increase con- siderably, which very often leads to fracture or debonding of the prefab- ricated teeth (Fig. 12). A combination of a rigid metal structure over the tel- escopic bar and a thimble structure made of PEEK (Figs. 13 & 14) works as base for the ﬁ nal restorations. These were milled out of a BRILLIANT Crios disc either as single tooth units or bridges and cemented on the thim- ble structure (Fig. 15–17). Using BRIL- LIANT Crios instead of prefabricated teeth, we can increase the strength of the restoration, have good aesthetics and keep the weight low for this kind of prosthesis. References 1. Magne P, Silva M, Oderich E, Boff LL, Enciso R. Damping behavior of implantsupported restorations. Clinical Oral Implants Research. 2013;24(2):143–8. 2. Liebig J. Energy Dissipation and Damping Behavior of Com- monly Used CAD / CAM Materials. 2018;35392. 3. Reymus M, Roos M, Eichberger M, Edelhoff D, Hickel R, Stawarczyk B. Bonding to new CAD/CAM resin composites: inﬂ uence of air abrasion and conditioning agents as pretreat- ment strategy. Clinical Oral Investi- gations. 2019;23(2):529–38. 4. Emsermann I, Eggmann F, Krastl G, Weiger R, Amato J. Inﬂ uence of Pre- treatment Methods on the Adhe- sion of Composite and Polymer In- ﬁ ltrated Ceramic CAD-CAM Blocks. The journal of adhesive dentistry. 2019;21(5):1–11. 5. Kaleli N, Sarac D, Külünk S, Öztürk Ö. Effect of different restorative crown and customized abutment materials on stress distribution in single implants and peripheral bone: A three-dimensional ﬁ nite element analysis study. Journal of Prosthetic Dentistry [Internet]. 2017;1–9. Availa- ble from: http://dx.doi.org/10.1016/j. prosdent.2017.03.008 For more information, contact Dr. Nicolás Gutiérrez Robledo DOA Dental Clinic Calle Alcala 199 28028 Madrid, Spain https://www.doadental.com Interview: “The future is certainly looking bright” By Claudia Duschek & Jeremy Booth, Dental Tribune International This year, Planmeca is celebrating 50 years of contributions to modern dental practice. Many of our readers will know Heikki Kyöstilä, chair- man and CEO of the Finnish dental manufac- turer. Kyöstilä has been credited with putting Finland on the global dental map, and he has remained humble and customer-focused even as Planmeca set sales records and grew into a household name in dentistry. Dental Tribune International spoke with Kyöstilä to ﬁ nd out more about Planmeca’s achievements and about the man who founded one of the largest dental manufacturers in the world. Mr Kyöstilä, you founded Planmeca in 1971 as a small-scale business; however, you quickly adopted a global approach. What L A U N C H I N G O P T I O N S W I T H O R W I T H O U T L E N S E S AD The dentist must use an extra protection! NURSE PATIENT PATIENT DOCTOR PATIENT PHYSIOTHERAPIST PATIENT NUTRITIONIST PATIENT DENTIST PATIENT e c a F o r P GREATER PROTECTION WITH VISUAL PERFORMANCE e i v o m e h t h c t a w email@example.com +5516 99184-6684 was the rationale behind the founding of the company and what have been the greatest obstacles so far during its development? Back in the 1960s, when I was working as a sales representative for a Finnish dental supply company, almost all dental products sold in Finland were imported. I realised that—espe- cially when it came to patient chairs—the de- sign and ergonomics of these products could easily be improved. That is why I decided to set up my own business. I thought, “Why not start manufacturing products of our own?” The beginning was ﬁ nancially tough, since Finnish banks did not easily grant loans to start-up companies. I had to sell my sailing boat—my only possession, back then—in order to raise an initial capital of 5,000 Finn- ish marks, which is roughly the equivalent of €7,000 today. However, having realised that the Finnish den- tal market simply was not big enough to build upon, I immediately aimed for the internation- al market. Today, there are only around 4,000 dental professionals in Finland, whereas the number is close to 2 million globally. Luckily, I had the opportunity to take part in the Interna- tional Dental Show in Munich in 1971. I exhibit- ed my ﬁ rst products at the fair—an ergonomic dental stool and an instrument cabinet. One of the biggest challenges in the begin- ning was simply putting Finland on the map and getting the word out about Finnish dental products. It was not only our company that was unknown but also our country of origin. Many of our customers had no idea where we were located; however, little by little, we began to gain a foothold in the industry. What have been the greatest milestones in the history of Planmeca? Businesswise, I would say that the achieve- ment that I am personally the proudest of is that of having secured the largest individual sales deals in the history of dentistry. Planmeca entered the US market in 1983 with the sale of 10,000 patient chairs, and we delivered over 1,000 dental units to Saudi Arabian dental institutions in 2012. In terms of technological innovations, one of our most signiﬁ cant mile- stones was the development of the Planmeca Dimaxis all-in-one software concept in the 1990s. It really was a groundbreaking and bold innovation at the time and was launched long before the term “software ecosystem” became a buzzword. The Dimaxis concept paved the way for many new ideas that would further improve the daily dental workﬂ ow. I am also extremely proud of our algorithm expertise. We have already managed to lower patient doses considerably and cancel from 3D images the effects of patient movement. We continue to work tirelessly to keep introducing new innovative algorithms that will further improve image quality and help to provide the best basis for diagnosis. Today, Planmeca is one of the world’s larg- est privately-owned dental manufactur- ers. Have you ever been tempted to sell the business or to consider consolidation with a larger dental group? Quite frankly, no. Naturally, we have received many offers over the years, but selling a com- pany that is the result of the life’s work of so many people is not a decision one would take lightly. We also want to preserve our independ- ence—the independence to change our course, if needed, to make fast decisions and product modiﬁ cations based on the feedback that we receive from customers, and to invest in new companies and product development. Planmeca rapidly expanded its interna- tional business as early as the 1980s with the establishment of subsidiaries in the US, Italy and Sweden; and yet your headquarters has remained in Helsinki. How has being located in Finland contributed to the success of the company and how important has invest- ment in the national economy been for you? I have always believed in Finnish know-how and education. Despite our global success, I wanted to keep the company’s production lo- cated in Finland in order to preserve the agility, low hierarchy and entrepreneurial spirit that has deﬁ ned the company from its early days. When everything is in close proximity, it is so much easier to make fast decisions and prod- uct modiﬁ cations. Also, Finnish design is rec- ognised around the world, and this has always been one of our key competitive advantages. For me, above all else, ﬁ nancial success means that I am able to secure the workplaces of my staff and create new career opportunities for young people in Finland. What is a typical working day for Heikki Kyöstilä? Before the pandemic, I used to spend around 100 days every year travelling for business— meeting our customers and partners around the world. Meeting them in person has always been the spice of my working career. Naturally, those meetings are now taking place online. Every day is different in this fast-paced compa- ny and industry. I really like to take the time to talk to my staff, to visit our production facilities and to stay up to date with whatever is going on in each department—whether it be product development, design, marketing, production or human resources. ÿPage 26
30 NEWS Dental Tribune Middle East & Africa Edition | 3/2021 Children with immune deﬁciencies more likely to develop periodontal disease By Iveta Ramonaite, Dental Tribune Interna- tional LONDON, UK: Primary immunodeficiency (PID) is characterised by a missing or poorly functioning part of the body’s immune sys- tem. Inherent from birth or acquired later in life, the disorder inhibits the body’s ability to fight all types of infections. New research has also found that, since children with PID have no natural defence against the oral microbiota that cause periodontal disease, they are more susceptible to developing gingivitis than sys- temically healthy children. According to a report published in the Journal of Translational Immunology, 4,758 patients had been entered into the UK Primary Im- mune Deficiency registry by August 2017. As detailed in an editorial published in Frontiers in Immunology last year, the worldwide in- cidence of people with PID is one in 10,000, and the disorder is more prevalent in children. Although the incidence rate is comparatively low, researchers have identified more than 300 diseases associated with PID to date, which is why its complications vary greatly, depend- ing on the type of the disorder the patient has. Since children with PID are more prone to de- veloping frequent, severe infections that com- promise their overall health, more research needs to be done to improve understanding of the diagnosis, symptoms and treatment of the disease. Primary immunodeficiency and oral health In a recent study, researchers assessed the link between neutrophil-related PIDs and the pres- ence of periodontal and other oral diseases, as well as the response of children with PID to periodontal treatment. AD “The motivation came from seeing some very young children with advanced periodontal disease and poor response to treatment. Some of them ended up with dentures from a very young age, hence the need to better under- stand the mechanisms of the disease,” lead au- thor Dr Luigi Nibali, professor of periodontics at King’s College London, told Dental Tribune International (DTI). The study was carried out at Great Ormond Street Hospital and the Royal London Hospi- tal by researchers from King’s College London and Queen Mary University of London and included 24 children aged 4–16 with PIDs and 24 age-matched children without PIDs. All children underwent a dental clinical examina- tion which included measuring periodontal pocket depths, clinical attachment loss and bleeding on probing. The researchers found that a certain level of dental caries in the mouth, which usually does not pose a threat to systemic health, leads to gingivitis in children with PIDS. “The prevalence of oral conditions and peri- odontal diseases has been known to increase in children affected by PIDs as they seem par- ticularly susceptible due to the crucial defen- sive role of neutrophils against periodonto- pathogenic bacteria,” said co-author Dr Hiten Halai, a clinical lecturer in periodontics at King’s College London, in a press release. “Furthermore, their response to periodontal treatment is highly variable, and the presence of periodontitis often leads to early tooth loss. However, most published papers on this so far consisted of case reports, with a lack of good evidence,” he added. The study also found that children with PIDS had increased chances of suffering from oral ulcers. When asked to elaborate on the find- ing, Nibali told DTI that little is known on why children with PIDs often develop oral ulcers but that it might be related to their immune response and explained that it was a coinci- dental finding. He also noted that although the findings are not novel, the study offers strong evidence on the topic. Therefore, he thinks it is crucial that future studies delve deeper into understand- ing the link between PIDs and periodontal disease and oral mucosal lesions. This, in turn, could improve the prevention and manage- ment of the disease and improve the quality of life of children with PIDs, he believes. Fi- nally, Nibali thinks that further research could also help find ways to relieve the systemic in- flammatory burden resulting from inflamed gingival tissues in children with PID. “The study shows that children with PIDs have a more severe response to dental caries, which can potentially lead to advanced periodontal disease. However, if the PID is controlled and good oral hygiene and interceptive treatment are achieved early on, the high susceptibility does not necessarily result in tooth loss,” Ni- bali concluded. The researcher team is planning to continue working on understanding the genetic–micro- bial basis of problems related to the periodon- tal health of children with PIDs. The study, titled “Periodontal status in chil- dren with primary immunodeficiencies”, was published online on 3 April 2021 in the Journal of Periodontal Research, ahead of inclusion in an issue.
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