SHOW PREVIEW news “IDS will light the way for the whole dental industry” An interview with Mark Stephen Pace, chairman of the Association of the German Dental Industry, ahead of IDS 2021 by Christian Ehrensberger. For me, the first priority is to as- sess the situation and be proactive. Patients come into the dental practice with a greater awareness of health and its various dimensions. Many pa- tients now understand that oral health and general health are closely linked and that strengthening perio- dontal health is also a protective fac- tor against severe progression of COVID-19. While this has been relia- bly proved in studies, reduction of other oral inflammation—for example of the dental pulp—through treat- ment is also a likely advantage for general health. Presumably, this is also a positive component in the de- fence against COVID-19. We can take advantage of this in- creased awareness in patients by dis- cussing the subject with them and us- ing it to create awareness of the importance of recall appointments, as well as the value of high-quality den- tistry. What does this mean for IDS visi- tors? As a trade fair visitor, I would look around to see how I can offer pa- tients the best possible dental treat- ment using state-of-the-art technol- ogy. This begins with periodontal prophylaxis—virtually nowhere else can you find such a large selection of manual instruments, sonic and ultra- sonic instruments, and powder– water jets. At the same time, informa- tion will be available regarding adju- vant measures such as the adminis- tration of chlorhexidine and laser treatments. At the trade fair, dentists and dental assistants will also find products that can provide maximum protection of or relief for their ten- dons, ligaments and joints. Similarly, with regard to oral in- flammation, IDS 2021 offers attendees the opportunity to test and compare proven and innovative procedures and products. To mention just one in- teresting detail: during diagnosis of ir- reversible pulpitis using analysis of in- flammatory markers, it can emerge that the tooth can still be retained vi- tally through pulp capping with bioac- tive or bactericidal material. This ap- proach would probably be employed more often with wider availability of the analytic test procedure. At previous IDSs, the focus has com- monly been on digital technology. Where is the development of digital technology headed? dustry forward the most—perhaps self-regenerating teeth? Digital technologies have, in gen- eral, maintained their momentum over the course of the pandemic, and the dental industry remains a leader in this regard. In attending this year’s IDS, both dentists and dental techni- IDS always offers surprises as far as innovation is concerned. Self-generating teeth are unfortu- nately still the domain of sharks, but innovative concepts for single-tooth restoration of implants using digitally  CAD/CAM fabrication will be a focal topic of IDS 2021. (Images: Koelnmesse/Harald Fleissner) cians are likely to have the following two questions in mind: 1. What can be digitised in my dental practice or laboratory so that I can offer patients added value at a fair and considered price? 2. What areas can utilise combined analogue and digital procedures as an alternative to complete dig- itisation? For example, a com- plete denture can either be com- pletely 3D-printed or be set up conventionally on a printed or milled denture base with artifi- cial alveoli and retained using an adhesive in the final stage. You have already discussed various fields of innovation. What innovation at IDS 2021 will help to take the in- supported backward planning, how- ever, is something I can very much picture. Innovations that can be im- plemented immediately in the dental practice and laboratory will also be present at IDS 2021. The biggest innovation for me, though, is a new sense of together- ness. I experienced this already at the European press conference in the run-up to IDS 2021, and at the event itself, we are coming together again. We will be talking to each other and actively looking for com- petition to ensure that we can se- cure the best deals. Personally, I’m curious to see what interests den- tists and dental technicians most, and I wish everyone a safe and ex- citing IDS 2021. 7 Mark Stephen Pace, chairman of the Association of the German Dental Industry. (Image: DENTAURUM/Andreas Fabry) sung SDS, using eGuard smartphone app. the associated We must, of course, acknowledge that we cannot prevent unexpected developments related to the COVID-19 incidence rate in the broader popula- tion. Anything that occurs under the present conditions over the next few weeks will see us go as far as hu- manly possible to find a solution for the trade fair. IDS 2021 will be a safe place, not least because visitors from industry and trade, and dentists, den- tal technicians and their teams deal professionally with hygiene and in- fection control on a daily basis—and thus will also do so at IDS. What do you see as the major topics that are shaping dentistry? We have all certainly endured some difficult months, but are now re- alising that it’s going to be different in the future—things are looking up. We must, however, also reorientate ourselves and adjust to these new conditions. n From 22 to 25 September, Cologne will once more become the place to be for dental professionals when the 39th edition of IDS takes place. Mark Stephen Pace, chairman of the Asso- ciation of the German Dental Indus- try, discussed his optimism ahead of the event and the innovations that he sees as drivers of the dental in- dustry’s future. Mr Pace, IDS 2021 is just around the corner. Are you worried that another COVID-19 wave will still prevent the trade fair from taking place? I think we have two options. Ei- ther we assume that IDS cannot take place under any circumstances and slide into depression, or we accept the challenge and ask ourselves: what do we have to do to ensure IDS 2021 will be a success for all involved and lead our industry into a new nor- mal? I have unequivocally decided in favour of this second option. With IDS only a few weeks away, we can sense the promise of a new beginning. IDS will light the way for the whole dental industry! What steps have you taken to make IDS 2021 a success? We have created safe conditions in the trade fair halls. The #B-SAFE- 4business concept has been specifi- cally developed for this purpose and gives us great flexibility. If, for exam- ple, the minimum social distancing requirements are decreased or in- creased the day before the trade fair begins owing to the COVID-19 inci- dence rate at the time, we can react immediately to the situation. Visitor management will then also change accordingly. This will be conducted via our indoor positioning system, developed in conjunction with Sam-  Proven and innovative products, both small and large, aid in daily dental routines—and will be available at IDS 2021. (Image: Koelnmesse/Thomas Klerx) 2 39th International Dental Show 2021

SHOW PREVIEW news EU wakes up to new medical device regulations What will change under the EU’s new medical device regulations? n After a three-year transition pe- riod and a delay of 12 months owing to the SARS-CoV-2 pandemic, new regulations for medical devices for human use in the European Union went into force on 26 May. The new and stricter rules mainly apply to those who manufacture, import and sell medical devices; however, den- tal professionals should be aware that distributors must keep a regis- ter of any complaints or reports re- ceived from health professionals and patients relating to devices and forward these complaints to the de- vice manufacturer or importer. Commonly referred to as the MDR (Medical Device Regulation), Council Regulation (EU) 2017/745 came into effect on 25 May 2017 with a grace period of three years. The MDR repealed Council Directive 93/42/EEC, known as the Medical Device Directive (MDD), and Council Directive 90/385/EEC, which regu- lated active implantable medical devices in the EU. An additional di- rective—Council Regulation (EU) 2017/746, known as the In Vitro Di- agnostic Regulation (IVDR)—came into effect in tandem with the MDR and is set to regulate in vitro diagnos- tic medical devices when a five-year m o c . k c o t s r e t t u h S / t o b m y s i © transition period expires in May 2022. The European Commission, in April last year, announced a 12- month delay of the application of the MDR. A statement from the commission explained that the decision was made so that member states, health institutions and commercial opera- tors in the medical devices industry could prioritise efforts to combat the pandemic. “Shortages or delays in getting key medical devices certi- fied and on the market are not an option right now,” commented Mar- garitis Schinas, vice president for promoting our European way of life, in the media release. Indeed, the MDR is denser and more complex than its predecessor and transpos- ing the directive has been a mam- moth task for all stakeholders. Compared with the repealed MDD, the MDR changes device scope and the way that medical de- vices are classified. For example, the legislation includes new rules for de- vices that use hazardous substances and for software applications. Some devices have been reclassified under the MDR, and the directive regulates certain devices that were previously exempt from medical device regula- tions. The MDR also brings changes to the oversight process. Under the new directive, only notified bodies that are designated under the MDR can verify medical devices as being fit for use in the EU. Notified bodies that were designated under the MDD must be newly designated un- der the MDR. According to a white paper published by the Brussels- based European business law firm contrast and the Association of Den- tal Dealers in Europe—seen by Den- tal Tribune International—the public health situation in Europe has ham- pered efforts to designate enough notified bodies. Since some notified bodies that were designated under the MDD may not receive designa- tion under the MDR, it is expected that some medical device manufac- turers will need to change notified bodies. Other examples of the various changes brought by the MDR in- clude a redefined economic operator concept, which differentiates be- tween manufacturer, authorised rep- resentative, importer and distribu- tor. All economic operators must conform to the directive and the re- sponsibilities of these stakeholders are expected to increase. The MDR also brings heightened post-market surveillance to the med- ical devices market, and EU member states are required to adopt penal- ties for any infringements of its re- quirements. Unique identifiers must be placed on medical devices so that they can be registered on a new Eu- ropean database. Named EUDAMED, the database will record the registra- tion of devices, the accredited noti- fied bodies, and also certificates and reports of incidents relating to the safety and clinical performance of devices. that they receive Distributors will be required to keep a record of any complaints or reports from health professionals and immedi- ately forward them to the manufac- turer and/or importer of the device in question. Distributors of medical devices must also keep a register of non-conforming devices and devices that were recalled or withdrawn from sale. The full text of the MDR is avail- able at https://eur-lex.europa.eu/eli/ reg/2017/745/oj. 7 IDSconnect: The new digital event platform of IDS Koelnmesse has stepped up its game to make IDS a successful event—online and offline. n In 2021, IDS is going hybrid, which means that more participants than ever before will attend the largest trade show in the dental industry from the comfort of their homes and not in person, owing to COVID-19 travel restrictions. To provide a digital enhancement to the classic physical event, the free platform IDSconnect intends to maintain IDS’s extensive international reach together with a successful on-site trade fair experience. At a trade fair or in day-to-day commercial business, a company’s success is based on three essential building blocks: inspiration, interaction and business. IDSconnect provides innovative opportunities for you to reduce the live from Cologne or streaming from locations through- out the world. The IDS Main Stage is the central platform for the official event programme of IDS 2021. This is where to find insight and motivation in the many presentations and official side events. Let yourself be inspired by the visionary programme. The area Exhibitors and Products represents the exhibition hall. From there, users have access to the booths of the various exhibitors in so-called Show - rooms in which relevant information about the exhibi- tor’s company, products and services will be provided. On the Product Stage, exhibitors will present product e s s e m n e o K © l effects of any current deficit in these crucial elements. Extensive features enable you to reach more potential customers easily, to experience trends and lectures on demand, and to establish valuable contacts—from any- where in the world. The experience starts in the Lobby, where users find an overview of all the features as well as initial recom- mendations for relevant contacts, exhibitors and upcom- ing scheduled trade fair items. Features include top experts on stage presenting on industry-relevant topics innovations and highlights live to the audience. Alter- natively, these can be watched later on demand. At a Virtual Café, visitors, exhibitors, top decision makers, purchasers, industry experts and media repre- sentatives can come together to chat and network. In terms of networking, the Discovery Graph ensures networking with new contacts and achieving a direct exchange of ideas via the communication centre. More information about IDSconnect can be accessed at https://www.english.ids-cologne.de/fair/idsconnect/. 7 4 39th International Dental Show 2021 Around 830 exhibitors from 56 countries to attend IDS 2021 High number of international companies underscores importance of global industry platform. n The International Dental Show (IDS) will be opening its doors for the 39th time from 22 to 25 September. Owing to the ongoing global SARS- CoV-2 pandemic, which led the or- ganisers to postpone the event from March to September, this year’s edi- tion will be taking place under extraordinary circumstances. Al- though a considerable number of companies will not be exhibiting at IDS, about 830 companies have al- ready confirmed their participation. According to the latest figures by Koelnmesse, 74% of exhibitors come from abroad, including from France, Great Britain, Italy, South Korea, Switzerland and the US. Companies from Brazil, Bulgaria, China, France, Italy, South Korea, Russia and the US will have country-specific pavil- ions. In a recent press release, Koeln- messe stated that the high level of in- ternational participation underlines once again the outstanding signifi- cance of IDS as the most important global dental industry platform. Overall, the organisers predict that IDS will play a key role in the successful restart of the market. Throughout 2020, dental companies around the globe reported the finan- cial effects of government-imposed lockdowns and radical public health measures, including the partial or complete closure of dental practices. As revealed by the fourth-quarter re- sults for 2020 and this year’s first- quarter results, the industry is slowly but steadily recovering from the cri- sis. In order to protect and ensure the health and safety of exhibitors and visitors alike, rigorous protective measures in line with the official re- quirements have been taken into account in the allocation of the exhi- bition floor. IDS 2021 will be staged in Halls 2, 3, 10 and 11, which are connected via a simple circular route. Visitors will be able to enter the fair through four entrances, which will allow for an even distribution of at- tendees across the exhibition halls. To meet social distancing rules, the existing restaurant and resting areas in the halls have been expanded and a new food area has been installed in Hall 4.1. In addition, the organisers are extending the physical event in Co- logne through the digital platform IDSconnect. This strategic move to make IDS 2021 a hybrid event will benefit both dental professionals and companies and, in particular, those who will not be able to travel to Co- logne in September, as it includes a number of innovative features that will allow users to discover new prod- ucts and connect with colleagues and partners online. More information about IDS can be found on the https:// www.english.ids-cologne.de/. 7

SHOW PREVIEW news For patients looking for high-quality dentistry, IDS provides the answers An overview of the state-of-the-art technology on exhibit at IDS 2021 by Christian Ehrensberger. (2) compatibility; (3) preservation of as much natural tooth structure as possible; (4) natural aesthetics; and (5) favourable price. IDS 2021 allows a comparison of current filling mate­ rials in line with these criteria. At the same time, the trends to­ wards speeding up and simplifying the clinical procedures are continu­ ing. The team can now work more quickly with many of the numerous self­adhesive composites. A compari­ son of the achievable adhesion val­ ues and marginal impermeabilities with the corresponding values of classic three­step etch and rinse sys­ tems as a reference shows how far their indication now extends. Bulk fill composites can be ap­ plied in cavities in layers that are 4–5 mm thick, thus avoiding a time­ consuming incremental technique. Flowable bulk fill composites are then overlaid with an occlusal filling material, and with specialist prod­ ucts, a change in consistency can be induced by sonic activation. For example, these are flowable when placed and become mouldable later. With this procedure, as with the high­viscosity bulk fill composites, a covering layer may be omitted. The existing range of composites is further enriched by dual­polymer­ ising and permanent composite rela­ tives. Able to be used without reten­ tive preparation and without etching, bonding or other conditioning, these materials allow for a tooth­coloured restoration and can be placed in the cavity quickly. However, a different technique is required. improvement of nickel–titanium al­ loys for files has reached a level where innovative clinical concepts allowing for the conservation of tooth structure are now possible. At the same time, digitally supported endo­ dontic backward planning is becom­ ing established and, with it, new forms of collaborative working. For example, the dental practitioner can have specialists perform the digital planning (including files, obturation and an endodontic drilling template for the access cavity), but perform the subsequent treatment himself or her­ self. Backward planning in implantol­ ogy is already part of the standard repertoire, and new digital interfaces that allow for a truly integrated digi­ tal workflow will be presented at IDS 2021. Furthermore, the benefits of the use of artificial intelligence (AI) are already becoming tangible. It is hoped that AI will provide ever greater assistance in the evaluation of radiographic images and other visual representations. Attendees will also be able to ex­ perience innovation in orthodontics. The classic means of checking for oc­ clusal contact is now supplemented by digitally supported variants, and special bruxism splints can even pro­ vide immediate biofeedback and thus, ultimately, help prevent damage. The sheer range of proven and in­ novative products, enabling patients to be treated using state­of­the­art technology, that will be on display at IDS 2021 is unique. Visitors to the trade fair will also develop a keen 5 At IDS 2021, new interfaces will turn various well­functioning partial workflows into a fluid, fully digital procedure from A to Z. (Image: Koelnmesse/IDS Cologne/Harald Fleissner) Digital processes: Strong in specialist disciplines In endodontics, the trend is in­ creasingly towards conserving more natural tooth structure. The gradual sense of how patients with their clearly increased interest in health in general and dental health in particu­ lar can best be persuaded to visit the dental practice. 7 1 2 3  The whole range of filling treatments at the world’s leading dental trade fair: Some of the goal­oriented and attractive solutions for dental practices from Silfradent, Polydentia and GC that will be on display at IDS 2021. (Images: Koelnmesse/IDS Cologne/Harald Fleissner [1 & 2]/Thomas Klerx [3]) n The development of dental prac­ tices is in a much better position than one and a half years ago, and the COVID­19 pandemic is even show­ ing positive signs. The 2021 IDS in Cologne will provide a view into where we are headed. Oral health: A key theme and an opportunity for the dental practice Broad segments of the population are becoming increasingly interested in health, nutrition, physical activity, sport, medicine and more. This has resulted in a particularly strong focus on dentistry, since many patients are becoming aware of the significance of the oral cavity for their general health, including preventing the se­ vere progression of COVID­19. This is boosting patients’ confi­ dence in their dental team, in their expert consultation skills and in their ability to perform prophylactic treat­ ment. Among other things, hygiene standards are contributing to this. This is a classic core competence of the dental practice—though there are still things that can be improved. Based on current studies, optimising the holding technique for suction and a demand­oriented design of the suc­ tion system will further improve existing hygiene standards. Impor­ tant decisions are made in particular when founding, taking over or ex­ panding a dental practice. IDS 2021 4 A way to control the viscosity of a bulk fill composite from flowable to mouldable: thermo­viscous material for the entire Class I, II and V indication range (VisCalor bulk, VOCO). (Image: Koeln­ messe/IDS Cologne/Thomas Klerx) 6 39th International Dental Show 2021 will provide an overview of suction systems and suction tips, and visitors will be able to experience first­hand how the responsible design of their dental treatment facilities can pro­ vide the ideal hygienic conditions for the use of the entire range of instru­ ments. This includes, in particular, high­speed turbines and powder–wa­ ter jets used in prophylaxis. Filling treatments will become more customised, quicker and easier In the future, patients in all areas are likely to attach greater impor­ tance to extremely high­quality res­ torations. For example, they will want restorations that are hygienic as well as increasingly highly aes­ thetic. Direct restorations have been an outstanding and innovative field for years. Since they represent the bread and butter of the vast majority of practices, even minor advances in procedures and materials have a clearly positive impact. The dental team works with a number of proven materials, includ­ ing composites, compomers, glass ionomer cements and amalgam, still. Recently, composite hybrids have been added to this mix. The field of dental materials is becoming more differentiated, and so in a given clin­ ical situation, a decision can be made in favour of different options. Pa­ tients come to the dental practice with specific wishes and set their preferences accordingly. In general, this list of preferences can be as­ sumed to be (1) long­term stability;

SHOW PREVIEW news Top three trends influencing US dental bone grafting industry in 2021 US dental bone graft substitutes market size expected to reach $390 million in 2021. competitive pressures, the medium- and long-term growth trends remain positive. Major drivers of sales include growth in the related dental implant market, increases in supporting scien- tific literature, and innovations in den- tal regenerative products. Like the dental implant market, the DBGS and related biomaterial markets will make a strong recovery from the pandemic- induced market shock and continue a modest growth trend over the forecast period. 7 Editorial note: A list of references can be ob- tained from the publisher. About the authors  The number of implants being placed with bone graft substitutes is increasing, and a growing body of evidence suggests that most dental implant procedures could benefit from a bone graft. (All images: iData Research) n Dental bone grafting has become an important and common step in the dental implant procedure. Advance- ments in allograft, xenograft and syn- thetic bone graft materials have posi- tioned them as suitable alternatives to traditional autologous bone grafts, and this has created a thriving mar- ket for dental biomaterials. Although demand declined significantly in 2020 owing to the rippling economic effects of the COVID-19 pandemic, it is expected to recover quickly alongs- ide the overall demand for dental im- plants. trends Notable accelerating growth in this market include the in- creasing number of dental implant procedures performed. There is also a growing body of evidence suggesting that most (if not all) dental implant procedures could benefit from a bone graft.1 Although the dental bone graft substitute (DBGS) market faces some minor headwinds in commoditisation effects and short-term pandemic- related constraints, the long-term out- look and secular growth trends re- main positive. Trend 1: Growth in implant market; stronger scientific support The percentage of dental implants placed with DBGS in the US is forecast to grow from 58% in 2020 to over 60% in 2027, according to iData Research’s new report on the US DBGS market. Because the two markets are closely related, the same growth trends that drive the demand for dental implants will also contribute to growth in sales of dental biomaterials. These trends in- clude an aging population that is more prone to ailments like edentulism, a growing number of dentists trained in implant dentistry, improved consumer accessibility owing to industry consol- idation, and stronger value proposi- tions offered by shrewd pricing strate- gies. In addition, there is growing clini- cal research suggesting that bone graft substitutes perform as well as au- tologous grafts with regard to bone for- mation, eliminating the need for costly and uncomfortable secondary graft- ing procedures.2 This level of rigorous scientific documentation lends cre- dence to manufacturers’ own clinical trials and reinforces the value proposi- tion of DBGS materials in implant den- tistry. Trend 2: Slowing innovation and bundling of DBGS Innovations in bone grafting prod- ucts are most often driven by advance- ments in the much larger orthopaedic market, before trickling down into dental applications. In recent years, in- novation has slowed in both the ortho- paedic and dental biomaterial mar- kets, particularly with regard to bone graft substitutes, leaving little room for price growth and product differen- tiation. Furthermore, parts of the mar- ket are heavily fractured owing to hundreds of competitors offering simi- lar products, which exerts downward pressure on prices and market value. Put together, the two effects of commoditisation and bund- ling present a moderately bul- lish case for the DBGS market Leading manufacturers have in- stead turned to leveraging their strong positions in the marketplace by em- ploying bundling strategies to mutu- ally reinforce demand for both dental implants and biomaterials. Because demand for dental biomaterials is largely driven by specialists, who typically order large volumes of dental implants in bulk, companies with strong brand recognition across the dental supply the Straumann Group, Zimmer Biomet and BioHorizons, have capitalised on this imbalance by bundling DBGS and implant products. industry, like Put together, the two effects of commoditisation and bundling pres- ent a moderately bullish case for the DBGS market. Although competition and commoditisation can threaten stalled growth, strong players in the DBGS and adjacent markets will be re- warded if they are able to continue providing value to end users by offer- ing attractive pricing strategies. The DBGS overall sales value is expected to have shrunk by nearly 21% in 2020 owing to the pandemic-induced eco- nomic downturn, followed by a sharp rebound of around 22% in 2021. Trend 3: Innovation oppor- tunities in barrier membranes and regenerative materials While innovation in DBGS has slowed, there is no evidence of this for dental barrier membranes and dental growth factors. Over the next six years, both markets are projected to grow at an annualised rate of over 6%, following a sharp decline in 2020 and a complete recovery in 2021. In the barrier membrane supply chain, market leader Osteogenics Biomedical has been consistently re- leasing new products with promising novel features. In 2019, the company released the RPM reinforced PTFE mesh, which was designed to work like a traditional titanium mesh but with a porous design that provides the added benefits of easier trimming and adaptation. In 2020, Osteogenics an- nounced a distribution partnership with DBGS giant Geistlich Pharma, adding the mesh to Geistlich’s expan- sive biomaterial portfolio. This move combines the brand recognition of two strong players in their respective mar- kets to reinforce demand. Currently, manufacturing of den- tal growth factors is led by four major players: Medtronic, Lynch Biologics, the Straumann Group and ACE Surgical. Each of these companies’ re- generative products is indicated for a slightly different use, though they all generally originated as innovative products for orthopaedic applications. Dental growth factor production is still in its early stages of the industry life cycle, and the entire market stands to benefit from new product develop- ments in the orthopaedic market. Fur- thermore, blood derivative growth fac- tors such as platelet-rich fibrin (PRF) are seeing a rise in popularity. Nota- bly, BioHorizons acquired Intra-Lock in 2018, stating in a press release that it was “excited to add the IntraSpin system to [its] portfolio since [PRF] is increasingly used in grafting procedures.”3 Although it is not yet clear that blood derivative growth fac- tors are ready for prime time, an en- dorsement of PRF products by a major player is a good indication of the mar- ket trend. The impact of COVID-19 on dental bone graft substitutes The COVID-19 pandemic and sub- sequent forced business closures ground all dental implant procedures to a halt in early 2020. As dental clin- ics across the US began to reopen in the latter half of 2020, dentists re- ported a large volume of pent-up de- mand for implant (and therefore bone grafting) procedures, which is a prom- ising indicator for a strong recovery.4 Industry leaders remain confident in their respective companies’ funda- mentals and expect to recover pre- pandemic sales by the end of 2021 or early in 2022 before resuming pre- vious growth targets. Demand is forecast to grow Demand for dental biomaterials will continue to grow alongside the dental implant market for the foresee- able future in the US as well as in 21 other countries, as analysed by iData Research. Although some seg- ments may be negatively impacted by slowed innovations and increased Dr Kamran Zamanian is CEO and founding partner of iData Research. He has spent over 20 years wor- king in the market research industry with a dedication to the study of dental implants, dental bone graf- ting substitutes, prosthetics, as well as other dental devices used in the health of patients all over the globe. William Guo is a research analyst at iData Research. He has been invol- ved in the global research of dental implant and bone graft substitute markets, publishing the reports on the US market. About iData Research For 16 years, iData Research has been a strong advocate for data-dri- ven decision-making within the global medical device, dental, and pharmaceutical industries. By pro- viding custom research and consul- ting solutions, iData empowers its clients to trust the source of data and make important strategic deci- sions with confidence. More infor- mation: https://idataresearch.com 8 39th International Dental Show 2021

SHOW PREVIEW industry Newest digital tools from Amann Girrbach are patient oriented and enhance teamwork Connection Kit server is the entry- level option, and it consists of the Ceramill Map DRS intra-oral scan- ner and appropriate scanning soft- ware, as well as the connection to AG.Live. Any order data, including all the required information, can therefore be shared seamlessly and in real time, as the practice and the laboratory are digitally linked via AG.Live. This permits same-day den- tistry for simple restorations, includ- ing those using zirconia, owing to its use of the Ceramill DRS High-Speed Zirconia Kit. This is further supple- mented by the Ceramill DRS Pro- duction Kit, which allows fabrica- tion to be performed directly in the practice by the dentist. Here, the laboratory can assist the practice in terms of design, expertise, service and advice. In total, this results in access to three Ceramill team workfl ows, de- pending on the kit equipment and the team constellation. Owing to the modular design of Amann Girrbach’s solutions, it is possible to begin working with the Ceramill DRS Con- nection Kit and to upgrade at a later time to the Ceramill DRS Production Kit. In addition, the Cera mill DRS system is fully integrated and all components are compatible with one another and originate from a single source. Thus, Amann Girrbach is able to take full responsibility for service, support and the fi nal resto- ration. Availability of the individual kits can be requested from respec- tive dental dealerships. With an expanding portfolio of digitised solutions such as AG.Live and DRS, Amann Girrbach supports dental practices and laboratories on their journey to a patient-oriented digital future. In addition to a num- ber of innovations to its proven CAD/CAM products and materials, the company will focus on solutions for interdisciplinary cooperation be- tween dental laboratories and den- tal practices at its IDS booth (#A010/ B011 in Hall 3.2).   The Ceramill Direct Restoration System (DRS) joins dental technicians and practitioners together in an interdisciplinary and future-oriented team and enables easy entry into same-day denture fabrication (Same Day Dentistry).  Digitisation in the dental indus- try is unstoppable—it heralds change and, at the same time, offers unlimi- ted potential. Digital technology brings about enormous advantages, such as the simplifi cation of pro- cess steps, reproducibility and a high degree of predictability. Making these advantages tangi- ble for dental professionals is pre- cisely the mission that Amann Girrbach has set itself. Now, after fi ve years of development, the com- pany has launched AG.Live, its largest digitisation offensive to date. AG.Live is a web-based portal for collaboration between laboratories and dentists, and it strives for per- fection across the exhaustive digital services that it offers. For example, the platform is a central tool for digital case management, a net- working, infrastructure and mate- rial management tool, and a support and knowledge database that will gradually replace the company’s previous customer portal, C3. The AG.Live platform also net- works machines and materials in the laboratory, thereby simplifying processes and increasing quality and reproducibility. The greatest ad- vancement that the platform offers, however, is that it links together the growing global network of dental professionals who are operating dig- itally. This link bridges the interdis- ciplinary gap between dentists and dental technicians and facilitates fu- ture-oriented cooperation. Harness- ing this network of new and opti- mised partnerships, dental parti - cipants can focus on their strengths and better position themselves on the market. The interface of the Ceramill Direct Restoration System (DRS), with which Amann Girrbach ex- tends the digital Ceramill CAD/CAM workfl ow to the dentist, is also pro- vided by AG.Live. The Ceramill DRS  The digital platform AG.Live paves the way for smooth interdisciplinary collaboration. IDS 2021: exocad announces its largest ever presence at trade show  Exocad, an Align Technology company, has announced its ex- panded presence at the Internatio- nal Dental Show (IDS) 2021. exocad will showcase its newest software releases and innovations for dental technicians and dentists at Booth A020 in Hall 3.2, where it will have 360 m² of exhibition space and a multitude of demo stations. IDS is one of the most important dates on exocad’s calendar. The international trade show is held biennially in Cologne and offers additional opportunities additional opportunities the company to connect the company to connect with new partners and with new partners and deepen deepen relationships. long-standing long-standing for for “Proximity to den- tal technicians and clinicians is key for us at exocad, and for that reason we are de- lighted to fi nally re- lighted to fi nally re- connect in person. It was connect in person. It was always clear for always clear for us that we’d par- us that we’d par- ticipate in IDS, but noticing how keen our users and partners are for trade shows, we’ve decided to ex- tend our presence at this year’s 10 39th International Dental Show 2021 event,” said Tillmann Steinbrecher, exocad CEO. “At IDS 2021, we will showcase our wide spectrum of innovative solutions for labs and practices, inviting them to discover these at our interactive demo sta- tions.” Participants can experience exocad’s variety of software solutions, including DentalCAD, Chairside CAD and exoplan, and meet exocad’s own experts as well as the renowned dental trailblazers Waldo Zarco Nosti and Dr Gulshan Murgai. Exocad will present a new booth design at IDS 2021, refl ecting the company’s continued innovation and growth. For those who will not be able to attend IDS 2021, the trade show will offer a virtual experience that will feature many exocad high- lights. On-site participants can find exocad at booth A020 in Hall 3.2, and additional information is avail- able at exocad.com/ids. 

SHOW PREVIEW practice & science Glass hybrids versus composite Efficacy and cost-effectiveness in a multicentre clinical study. n Through the Minamata Convention on Mercury in 2013, the countries of the EU committed themselves to com- pletely or largely eliminating mer- cury-containing industrial products such as dental amalgam from the sup- ply and disposal cycle by 2030.1 In 2020, the EU came to the conclusion through an expert opinion that not only the planned phase-down but even a complete phase-out of dental amalgam is possible. Accordingly, dental amalgam is becoming a mate- rial of the past. In Germany and many other countries, however, this de- velopment had already been apparent for some time without the Minamata agreement. Modern tooth-coloured restorative materials such as compo- sites or glass ionomers enable metal- free restoration of tooth structure de- fects with better aesthetics and less substance loss during preparation.2 While composites have advanta- geous physical properties, such as high flexural strength, their use is technically demanding. Although the dental industry has been able to signifi- cantly reduce the complexity of the treatment steps required for placing a composite filling in recent years, even modern one-step adhesive systems in combination with bulk fill compos- ites—which often have to be applied in at least two increments, depending on the cavity dimensions and material— still require step-by-step application and adequate drying. In addition, com- posites exhibit an increased risk of secondary caries, especially at the gin- givo-cervical margins, compared with amalgam, and the time-saving materi- als mentioned may be particularly problematic in this respect. Glass ionomers, however, were long considered to be temporary mate- rials with a limited longevity of use in the posterior region. This was largely due to the physical properties of these materials, which exhibited low flex- ural strength and limited abrasion re- sistance. Aiming to eliminate these disadvantages, advanced high-viscos- ity glass ionomers covered with a light-polymerised resin coating have been introduced.3 In 2015, a newer class of restora- tive materials was launched, the glass hybrids. These materials are fluoroalu- Parameters Countries Croatia Italy Serbia Turkey Age (years) 26.5 (7.4) 44.6 (15.8) 31.7 (11.4) 30.6 (11.2) Sex (f/m) 44/16 16/16 16/12 40/20 Glass hybrid cost (US$) Composite cost (US$) Survival time glass hybrid (months) Survival time com- posite (months) 92.7 (7.4) 146.1 (12.9) 44.0 (3.3) 66.2 (11.9) 126.42 (16.3) 146.2 (19.3) 61.0 (3.5) 128.6 (3.8) 35.1 (3.4) 35.3 (2.3) 34.1 (6.2) 35.0 (3.0) 34.3 (5.1) 35.0 (4.0) 34.9 (4.6) 35.8 (1.0) Table 1: Patient characteristics, costs and mean (standard deviation) survival times. 12 39th International Dental Show 2021 A considerable range of materials, including glass hybrids and composites, are available for the restoration of posterior dental cavities resulting  from dental caries. (Image: Stasique/Shutterstock.com) increase minosilicate glasses reinforced with a second, smaller and more reactive sil- icate particle and acrylic acid mole- cules with higher molecular weight, which can the matrix cross-linking and, consequently, the mechanical properties of the mate- rial.4, 5 A nano-filled resin coat is used to cover the restorations and is sup- posed to increase the resistance of the material to mechanical forces5, 6 and al- lows greater surface stability and aes- thetics. Even if the resin coat is subject to certain wear in the masticatory load-bearing area, it can still be reap- plied, and thus, above all, the problem of abrasion stability can be largely eliminated.5 Glass hybrids also have several advantages over composites: 1. They are self-conditioning and self-adhesive; thus, the application of an adhesive system is not neces- sary. 2. They are applied in one increment, that is, truly in bulk—regardless of the cavity dimension—among other things because reliable polymerisa- tion occurs in all layers and inde- pendent of light polymerisation steps. 3. They are also moderately tolerant of moisture. In a recently published study, a modern glass hybrid material was tested for the first time against an es- tablished composite material for the restoration of two-surface, occlusal– proximal restorations in molars, that is, in the load-bearing area. This was a randomised controlled clinical trial in which patients with two molars in need of restoration were randomly as- signed to receive the glass hybrid ma- terial in one molar and the composite material in the other molar; the mate- rials were then compared in the same patient.7 The special feature of this study was the large number of pa- tients. Moreover, it took place in four different countries—Croatia, Serbia, Italy and Turkey. In all four countries, patients were treated in university hospitals. Patients had to be at least 18 years old and demonstrate tooth sensitivity to the vitality test. A total of 180 patients, each with a pair of mo- lars to be restored (i.e. 360 molars), were included. The teeth were first cleaned, local anaesthesia was applied, the molar to be restored with composite (Tetric Evo- Of the 180 patients, significantly more were treated in Croatia and Tur- key than in Italy and Serbia. In Italy, the patients were older than in the other three countries. A total of 32 pa- tients could not be followed up during the three-year study, and 21 patients (27 molars) required follow-up treat- ment owing to complications. The two materials showed limited differences in complication-free time. Broken down by country, the survival time of glass hybrids tended to be longer than that of composites in Croatia and Italy and tended to be shorter in Serbia and Turkey. Overall, however, the differ- ences were minimal and not statisti- cally significant. The results were completely dif- ferent for the costs (Table 1). In Croa- tia, Serbia and Turkey, composite was initially significantly more expensive than glass hybrid. In these three coun- tries, the use of glass hybrid also saved money over the entire study period. When looking at the cost-effectiveness difference, it became clear that any ef- fectiveness advantage of composite was minimal, but the cost difference was relatively large. Overall, each ad- ditional month without complications for the composite compared with the glass hybrid group cost US$270. How- ever, with slight variations in this value in the different centres, this ex- act pattern was also confirmed in the four different countries. The results of this study are rele- vant on many levels. It is a large ran- domised controlled clinical trial con- ducted in four different countries. The high methodological quality and randomised design confer high inter- nal validity, and thus the study re- sults are presumably robust. Based on the fact that the study results were similar across the four centres in very different patients, the exter- nal validity, that is, the generalisabil- ity of the study results, can also be assumed to be high. In addition, a high methodological standard was implemented: the investigators were blinded (as far as this was possible as glass hybrid restorations and com- posite will have been identifiable for the investigator in individual cases) and calibrated before the examina- tions, and established examination criteria were applied. The considera- tion of multiple end points, such as complication-free time and cost-effec- tiveness, should also be emphasised. This study is one of the first to compare the two existing amalgam alternatives, composite and glass hy- brid, in such a design and for a cru- cial indication—restorations in the load-bearing region (Fig. 1).2 The results are relevant, among other things, because even in this difficult indication, glass hybrids performed overall on a par with com- posites (with minor differences be- tween countries). It is also relevant that glass hybrids were significantly more favourable than composites in almost all the centres when it came to costs—both initially and in the long term. The latter in particular should be emphasised, as long-term cost-ef- fectiveness can be significantly influ- posterior Ceram, Ivoclar Vivadent) was isolated using a dental dam, and the molar to be restored with a glass hybrid (EQUIA Forte, GC) was isolated using cotton rolls, and then the cavity preparation was performed. Segment matrices (Palodent Plus, Dentsply Sirona) were used to shape the proximal contacts. A two-step self-etching adhesive system (AdheSE, Ivoclar Vivadent) was ap- plied in the composite group accord- ing to the manufacturer’s instructions. Cavities in the glass hybrid group were conditioned with 20% poly- acrylic acid (CAVITY CONDITIONER, GC) prior to placing the restoration. Both materials were then applied ac- cording to the manufacturers’ instruc- tions, and the glass hybrid was subse- quently coated with a nano-filled resin coat (EQUIA Coat, GC). Patients were followed up for a to- tal of three years; the planned fol- low-up duration was five years. Each patient was examined by two blinded, independent and calibrated investiga- tors using the FDI World Dental Feder- ation criteria.7 Statistical methods were used to determine the mean time to complication for both groups. Fur- thermore, the costs for the initial and subsequent treatments within the study period, for example for restora- tive, endodontic or surgical complica- tions, were determined. For this pur- pose, fee items from the fee schedules for dentists of the various countries were used. It should be mentioned that these fee schedules are applied very differently in the four countries and that the costs in the analysis were determined from a university setting perspective instead of that of a private practice. To allow comparability across the four countries, costs were harmo- nised using the 2018 purchasing power parities8 and expressed in US dollars per tooth. Cost and efficacy dif- ferences, that is, the difference in US dollars per gain or loss in compli- cation-free time (in months), were finally calculated, and stratified analy- ses were performed for each country in addition to the main analysis.

m o c . k c o t s r e t t u h S / s r e b A r e t n e u G © l SHOW PREVIEW travel When in Cologne, get out and about  Cologne is one of Germany’s most diverse, historic and rowdy cities—fa- mous in equal measure for its archi- tecture, night life, art and gastro- nomy. Read on for selected tips on fi nding your feet, fi nding something to eat, and fi nding some of the many surprises that the city has to offer. Cologne is an old city, having been founded by the Romans nearly 2,000 years ago. Since then, it has given us many different things, in- cluding the world’s tallest cathedral, a type of perfume marketed for men, and a long list of infl uential and nota- ble residents. Nowadays, the largest city on the Rhine has come into its own as a stronghold of the German carnival tradition and a bastion of contemporary European culture. You painter. You may prefer to simply take a selfi e in front of the cathe- dral’s superlative facade and then head off. Rest assured—Cologne has much more to offer! Just south of the cathedral is the Heinzelmännchen fountain (a nod to the city’s love of folklore) and the 900-year-old city hall. A short ride west will bring you to the expansive, park-like Melaten cemetery, home to the remains of many notable resi- dents—including Johann Maria Fa- rina, who invented eau de cologne, and Alfred Nourney, Cologne’s own Titanic survivor. To get to know the city from a different perspective, take a city tour, the themes of which are so di- verse that there is literally some-  Cologne Crane Houses near the Rhine.  The museum Ludwig for modern art in front of the Cologne Cathedral. will not regret juggling your time at IDS to allow for an excursion into the heart of the city. A taste of what Cologne has to offer may leave you with a thirst for more. Cologne by day Most visitors will head to the ca- thedral. It is Germany’s most visited landmark, after all, and an important site of pilgrimage in Europe. Keep an eye out for the Shrine of the Three Kings and the bold stained-glass win- dows in the south transept—they con- sist of 11,500 identically sized pieces of coloured glass and were installed in 2007 by Gerhard Richter, arguably Germany’s most celebrated living thing for everyone. A Segway tour will take you through, and beyond, the inner city, whereas a guided brewery tour will help you to dis- cover the hidden, hoppy lanes of the historic city centre. You can explore the social fabric of Cologne by tak- ing a “Love stories of Cologne” tour, or an LGBQT tour. What role has mustard played in the history of Co- logne? What is carnival really all about? And are people in Cologne ac- tually obsessed with chocolate? Vis- iting one of the city’s many specialty museums may answer these ques- tions, while posing many others— visit tripadvisor.com for more infor- mation on these activities. 14 39th International Dental Show 2021 Visitors to IDS should consider taking a break every once in a while, and what better way to do so than by enjoying a piece of cake and a cup of hot coffee? The multicultural Ehren- feld district (north-west of the inner city) offers a relaxed and interesting atmosphere, and a number of good cafes. Visit the cosy and slightly hid- den Kaffeebud Ehrenfeld to fi nd out what a “third wave” coffee is, or sam- ple a creamy latte and authentic New York-style cheesecake at Cafe- cafe Ehrenfeld (cafecafe.de), where the breakfast menu is also to be rec- ommended. If you are longing for a holiday feel and fi nd yourself in the southern part of the inner city, Sabor ’ermoso has surfboards hanging on the walls, little Spanish delicacies and an excel- lent cappuccino—perfect to unwind after a busy day of dental business. Cologne by night As the sun goes down, Cologne reawakens in a different light, and so it is easy to enjoy the city once the trade fair halls close. Keep an eye out for the Büdchen (kiosks), which are found on many street corners. Locals will stop by one of them for drink before heading to their favourite Kölsch-serving bar, so why not join them? The trendy bar Zum scheuen Reh is located next to the Köln West train station and is perfect for start- ing the evening: get to know some Cologne locals while enjoying a couple of long drinks—non-alcoholic drinks are also plentiful—and the live music on offer in the bar’s outdoor area (www.zum-scheuen-reh.de). Afterwards, you can hit Bumann & SOHN, which is close to the Ehren- feld train station. It is here that beer garden atmosphere meets urban in- dustrial vibes, and this is where the dynamic, alternative fl air of this dis- trict can be felt best (www.bumann- undsohn.de). Coming early pays off! The next destination is STAPEL. BAR, which is located within walking distance from Bumann & SOHN at the heart of the Helios district. At STAPEL. BAR, you can buy freshly brewed Gaffel Kölsch from the barrel and experience a colourful music pro- gramme, including DJs, live acts and local artists (www.stapel.bar). Are you intrigued by the original steel dartboard? Then this is also the place for a casual round of darts. If you are in the mood for dancing, you can spend the rest of the night in the northern part of Cologne, between Ehrenfeld and Nippes at the Odonien nightclub, to be exact. Apart from concerts, plays, fl ea markets and open-air fi lm showings, you can dance to predominantly electronic club music in the midst of obscure metal sculptures and impressive fi re- works. Arts and culture Cologne has a great deal to offer as far as arts and culture are con- cerned. Collections of famous canoni- cal artworks can be found in the cel- ebrated Museum Ludwig—this might be your thing. However, the museum’s current temporary exhibition, “In Situ: Photo Stories on Migration”, of- fers a window into local history. The personal photographs on show document the period between 1955 and 1989 (when the social make-up of Cologne was forever altered by an infl ux of migrant workers) and may change the way that you see and understand the city today (museum- ludwig.de). Speaking of understanding Co- logne, how has this carnival-obsessed city negotiated social distancing and the cancellation and scaling down of two successive carnival seasons? The exhibition “Alaaf auf Abstand. Bilder einer anderen Session” is taking place online and in public spaces across the city, and is therefore also a must for virtual visitors to IDS. Or- ganised by Kölnisches Stadtmuseum, it features photographs and digital media that investigate the hidden dynamics of a pandemic carnival season. A virtual tour of the show, fol- lowed by a real-life scavenger hunt through the inner city, is highly rec- ommended (alaaf-auf-abstand.de). Cologne is also home to the Käthe Kollwitz Museum Köln, which spe- cialises in exhibiting work by and re- lating to the pioneering female artist (1867–1945), who is nowadays associ- ated with the expressionist move- ment. A new exhibition—“Der Aus- druck der Augen vergrübelt und fern”—presents a variety of Kollwitz’s portraits of friends, family members and political fi gures across a range of media (kollwitz.de). There are many, many more mu- seums of note—the Museum für An- gewandte Kunst Köln, the Wallraf - Richartz Museum, the Museum für Ostasiatische Kunst Köln, just to name a few. Film buffs should pay a visit to the Filmforum NRW, and one of many other highlights of the city for cineastes is the ODEON, a cosy, retro-style movie theatre that shows art-house productions. Food and drinks Whether you are interested in music, art or history, Cologne and its attractions are best explored on a full stomach. For quite some time now, an unoffi cial institution of the city has been the falafel. Usually, it is freshly made with coriander or parsley (ei- ther Lebanese or Syrian style) and fried to perfection. In Cologne, these spicy chickpea balls taste like no- where else in Germany and are pref- erably eaten with a giant spoonful of tahini. Try it yourself: take a stroll down Venloer Street in Ehrenfeld and see how long you can resist the smell of the various oriental bistros and ca- fes. Arguably, the best falafel can be found at the traditional Habibi (habibi- koeln.de), in doughnut shape at Ve- gan Food Revolution (vegan-food-rev- olution.de) or at Beirut restaurant, while enjoying a beautiful view over the Rhine (beirut-restaurant.de). If your tastes are more carnivo- rous, however, then you should pay Karl Hermann’s a visit. Also located on Venloer Street, here you will fi nd high-quality burgers with freshly minced and succulently grilled meat patties—free from antibiotics—in a fl uffy brioche bun (karlhermanns. de). If you still have some room left afterwards, you can hit Frittenwerk Köln for some delicious homemade fries (frittenwerk.com/koeln). Enjoy fries made from regular or sweet potatoes with chive-and-cheese top- ping. Whatever you choose, make sure to also try the lemon aioli and the homemade guacamole. Natu- rally, humans are not like goats, and these large amounts of salt need to be counteracted somehow, which is why a visit to one of the Kölsch-serv- ing traditional restaurants is a ne- cessity. Enjoy a chilled Kölsch beer like a true local at Bierhaus en d’r (bierhaus-salzgass.de) or Salzgass Weinhaus Vogel (weinhaus-vogel. de), where not only simple, authen- tic Cologne food is served, but also the spirit of the city can be experi- enced. Enjoy!   Chickpea-falafel-balls with white sauce and pita-bread.

Personal assistant of every dental team in diagnostics and treatment planning Messenger With the support of AI you will never miss out even on the smallest details during the complex treatment GP report Visit us at IDS USA Pavilion, hall 10.2, booth R 047 Task manager