issn 2193-4673 • Vol. 2 • Issue 3/2021 3/21 digital international magazine of digital dentistry interview “Digital dentistry will set you apart” case report Immediate loading of post-extraction implant in an area of high-aesthetic value education Digital impression taking in modern dentistry

editorial | Dr Scott D. Ganz Editor-in-Chief The Summer Olympic Games 2021 Despite the ongoing saga of COVID-19 and a postpone- ment from 2020, the Summer Olympic Games were held in Tokyo in Japan. What a wonder to watch these special athletes taking part in their chosen sport at the highest level of competition from over 200 countries around the globe. The incredible precision required of these athletes is a direct result of the many months and years of train- ing required to refine their skills. Many of these excep- tional people have participated in more than one Olympic Games, trying their best to be at peak performance at exactly the right time to excel when it counts, striving for a gold, silver or bronze medal. These athletes perform under extreme pressure against the best of the best, very little separating first place from second or third place. Consider these examples. Caeleb Dressel won the men’s 50 m freestyle swimming final, which was decided by less than one half of a second, and the difference between second and third was 0.02 seconds! The men’s 4 × 100 m swimming medley relay race ended with times of 3:26.78 for first place and 3:27.51 for second place, a difference of 0.27 seconds! The final women’s 100 m sprint results were also decided by a very small margin. The first-place time turned in by Elaine Thompson-Herah was 10.61 sec - onds, a new Olympic record! Second place was only 0.13 seconds later at 10.74 seconds, and the separa- tion between second and third was 0.02 seconds at 10.76 seconds! In women’s gymnastics, Sunisa Lee narrowly won the all-around competition by posting a score of 57.433, winning by less than 0.2 points over Rebeca Andrade, followed by Angelina Melnikova and Vladislava Urazova, both within 0.5 points of the lead. Regardless of the event, there is little room for error. Dentistry too leaves very little room for error. We often deal with digital measurements that are within Olympic tolerances. Intra-oral scanners have demonstrated ex- cellent accuracy, measured in microns, for conventional crown and bridge dentistry as well as for dental implant reconstruction with the implementation of scanning abutments. Dental laboratories digitise stone casts and impressions with desktop optical scanners which demon- strate excellent accuracy when utilised with advanced CAD/CAM software, milling devices and 3D printers. It has been our mission within the pages of digital magazine to provide our readership with state-of-the-art concepts that demonstrate how technology can be incorporated into the modern practice of dentistry. As technology continues to evolve, the accuracy and consistency of the digital workflow will aid in reducing complications, remakes and chair time while increasing efficiency and patient outcomes. Dentistry will forever be challenged to achieve gold medals in all categories. Enjoy this current issue of digital magazine! Dr Scott D. Ganz Editor-in-Chief 03 3 2021

d e v r e s e r s t h g i r l l A . a n o r i S y p s t n e D l 1 2 0 2 © 6 0 1 2 - X S U - 4 4 9 1 7 6 2 3 . ™ r o ® s l o b m y s e h t g n i s u t o n y b s k r a m e d a r t s t i o t t h g i r y n a e v i a w t o n s e o d a n o r i S y p s t n e D l Digital Implant Workflow Streamlined collaboration for your treatment team From data capturing, planning and guided surgery to the final restorative solutions, with the Digital Implant Workflow from Dentsply Sirona you have all the support you need to save time, deliver predictable results and provide your patients with the best possible care. www.dentsplysirona.com Follow Dentsply Sirona dentsplysirona.com

practice management | thing, because they actively seek out problems and solve them. Interview questions. (Box 1) Individuals who lack hunger are not simply lazy. In fact, people who lack hunger can often accomplish tasks reasonably. The primary characteristic of those who lack hunger is a lack of passion and inability to see the big picture. These individuals might get work done when told, but rarely if ever seek out problems on their own and are the kind to quit when the going gets tough. Smarts Being smart is the most misunderstood of the three characteristics. In the context of the ideal team player, it refers to being people-smart. Smart people pick up on social cues that others do not, more easily empathise with others, and are more capa- ble of understanding the needs of others and acting ac- cordingly. Smart individuals build stronger relationships with teammates because they understand intricacies in conversation that less people-smart individuals do not. Generally speaking, smart people are a pleasure to be around and are well liked by their peers. Those who are not smart tend to be awkward and/or destructive in building relationships. These individuals have more difficulty communicating with others, and they generally have trouble understanding the needs and wants of their co-workers outside of day-to-day respon- sibilities in the workplace. Ultimately, these team players tend to cause personal, people, problems at the office due to their general inability to pick up on the repercus- sions of their behaviour. Humility The third—and arguably most important—of the three characteristics is obvious yet critical. Humble people build their team members up by sharing in successes and taking responsibility when appropriate for failures. Having humility means lacking an excessive ego and not concerning oneself with status, and humble individuals are quick to praise and slow to seek praise. Success is collective. Lacking humility, on the contrary, means broadcasting personal achievements and downplaying the contribu- tions of others. Those who are not humble tend to take on responsibilities with the primary purpose of boosting their own self-esteem, and they lack an awareness of the efforts of their team. It can be especially dangerous when an individual lacks humility and acts on personal greed while putting on a facade of caring about the team’s success. Hungry What is the hardest you have ever worked on something in your life? What do you like to do when you are not working? Did you work hard when you were a teenager? What hours do you generally work? Smart How would you describe your personality? What do you do that others in your personal life might find annoying? What kinds of people annoy you the most, and how do you deal with them? Can you give me an example of how you have demonstrated empathy to a teammate? Humble Tell me about the most important accomplishments of your career What was the most embarrassing moment in your career? Or the biggest failure? How did you handle that embarrassment or failure? What is your greatest weakness? How do you handle apologies—either giving or accepting them? Tell me about someone who is better than you in an area that really matters to you. Great interview questions Of course, these characteristics are not simply black and white, individuals clearly showing capability or otherwise. There are many nuances, and Lencioni explains in con- siderable detail how to identify the places between these “...what makes an ideal team player and an ideal team, and how does the practice manager keep the right people?” 07 3 2021

practice management | – the dental therapist demanding 50% of all fees col- lected before agreeing to join a practice; – the client who has lost three senior team players, all of whom were headhunted by rival businesses; – the micro-corporate who advertised for associates in three locations and has so far had just two CVs submit- ted, despite registering with three agencies; – the owner who is worried that her 60% UK National Health Service fulfilment target cannot be achieved because her associate is abroad visiting unwell fam- ily, cannot get back and will have to self-isolate when back; – multiple examples of team members taking maternity leave, leaving the profession for similarly paid jobs with less onerous working conditions, and following part- ners and spouses who have changed their career pathways; – dental nurses choosing to leave full-time employment with one employer and sign on with locum agencies. Unlike previous years, it is not going to be so easy to replace team members by zipping off to recruitment fairs in continental Europe—Brexit has put paid to that. Furthermore, I recently noted a thread on LinkedIn sug- gesting that 5,000 dental nurses in the UK have dereg- istered during the pandemic, representing a loss of almost 10% of the UK nursing workforce—and they are not being replaced. The available supply of nurses, hygien- ists, therapists and associates in the UK is, quite simply, drying up. That means that the cost of hiring will increase; wages are going to go up. It has never been more important, therefore, to start with retention; what do you have to do to keep the good people you already have? I predict that this will become the most serious challenge that we will face in the next 12 months. Remuneration across the board will have to rise, and it is essential to pass those increases in variable and fixed costs on to patients in the form of price rises— otherwise your profit margins will be eroded. This means that we are going to have to come up with some language to explain to patients why prices are going to go up again. However, it is not just about the money, and I would like to conclude by sharing with you my eight attributes of a confident team and workplace: 1. Conditions: The general terms and conditions of work and employment contracts are well defined. 2. Culture: The team share core values and a vision of how they want to serve their community. They publish promises and expectations around behaviours and always observe politeness. “It has never been more important, therefore, to start with retention; what do you have to do to keep the good people you already have?” 3. Communing: The team meet socially (when permitted) for special occasions and to visit dental workshops, trade shows and conferences. 4. Communication: The team gather for daily huddles, weekly reflections, monthly management, quarterly training and annual business planning. 5. Career: There are pathways to progress for those who are hungry for more. 6. Compensation: Remuneration is above average and may include a performance-related element, and there are attractive employee benefits. 7. Corporate social responsibility: The business has an active corporate social responsibility programme, in- cluding people and ethics, environment and sustain- ability, and community and charity. 8. Celebration: Everyone feels appreciated for what they do, people are recognised for doing things right, regular personal progress interviews take place, and patient reviews and testimonials are shared. Do not for a minute think that any of this is easy—quite the opposite—but an ideal team will fly higher and for longer and will make your role as practice manager a joy. In the concluding part of this series, I will be looking at extreme self-care, making sure that the best possible version of you can turn up for work (and arrive home again!). about Chris Barrow has been active as a consultant, trainer and coach to the UK dental profession for over 24 years. His main professional focus now is through his Extreme Business company, providing coaching and mentorship to independent dentistry around the world via face-to-face meetings, a workshop programme and an online learning platform. 09 3 2021

Soft tissue augmentation NovoMatrix™ Reconstructive Tissue Matrix – the next generation material NovoMatrix™ Reconstructive Tissue Matrix is an acellular dermal matrix derived from porcine tissue intended for soft tissue appli ca tions. The proprietary LifeCell™ tissue processing is designed to maintain the biomechanical integrity of the tissue, which is critical to support tissue regeneration. Indications Localized gingival augmentation to increase keratinized tissue (KT) around teeth and implants Alveolar ridge reconstruction for prosthetic treatment Guided tissue regeneration procedures in recession defects for root coverage Product features Consistent thickness (1 mm) Pre-hydrated Controlled source www.biohorizonscamlog.com 0 2 0 2 / 6 0 3 0 7 7 . J . X Before use, physicians should review all risk information, which can be found in the Instructions for Use attached to the packaging of each NovoMatix™ Reconstructive Tissue Matrix graft. NovoMatrix™ is a trademark of LifeCell™ Corporation, an Allergan affi liate. ©BioHorizons. All rights reserved. Not all products are available in all countries.

practice management | resulting from downtime and lost production may be far bigger burdens. According to an IBM -commissioned report, the average cost of recovering from a breach is US$380 per patient, that is US$760,000 for a 2,000- patient practice. Cyberattacks happen very regularly. In fact, over the course of the last few years, the frequency has increased exponentially. Just how frequent are they? One occurs every 39 seconds to be exact. By the time you have finished reading the next few paragraphs, another cyber- attack will have been executed. The big questions are these: – What can you do to prevent such attacks? – How does your practice function during the recovery process? And the bigger—and immensely tougher—question is, what do you tell your patients? Light at the end of this tunnel Believe it or not, there is some good news that can come from a situation like this. The best news? It was com- pletely preventable. In this case, a properly configured secure network would have decreased by tenfold the likelihood of this incident happening. Having the proper security measures in place to thwart would-be attackers takes care of the vast majority of attacks. “Cyberattacks happen very regularly. In fact, over the course of the last few years, the frequency has increased exponentially.” morning at 2:00 a.m. and the attack was made at 11:00 p.m. on Sunday night. Everything that was saved during that 2:00 a.m. backup would be stored in the off- site backup location, and this process would ensure total recovery of everything up to that point. You’re not off the hook While multiple types of IT failure may create an environ- ment which results in significant disruption that impacts your office routine, the responsibility and downtime are yours. It’s your name on the practice. The patients are your patients. It’s your duty to own whatever mistakes occurred. While it’s a bitter pill to swallow, accepting responsibility for the disruptive issues and being 100% transparent with your patients are imperative. Not only does this allow your patients to be clued of what has happened, but it also helps you maintain the credibility you’ve worked so hard to build up to this point. On the off-chance that an attack was successful de- spite your existing defence system, an off-site, monitored backup or disaster recovery system would have allowed for the restoration of all of your data based on a snapshot taken just before the attack occurred. Let’s say your last backup was successfully completed on a Sunday One of the most effective ways to rebuild the patient practice trust is by communicating your plan to correct the issue which caused the situation. Your first correc- tive step should be to find a more reliable and effec- tive IT vendor that has expertise in working with dental practices. 13 3 2021

practice management | The normal antivirus applications designed for home use that you’re likely accustomed to are unacceptable options for use in protecting your practice. Choosing one of these options is basically like arming your practice with Swiss cheese—there are just too many holes. Staff training Having the peace of mind that your employees—the people who are using your network on a daily basis— are properly educated in keeping your systems safe is invaluable. Cybersecurity training should be given annually at a minimum, but the ideal time frame is quarterly. Keeping up with new threats, trends and techniques goes a long way towards helping protect your practice. Two big pieces of advice I always give to the practices I assist are: 1. Don’t get click happy; slow down when browsing any- thing online and do not click without reading. 2. Don’t open e-mail attachments unless you are 100% certain of whom the sender is and are expecting an attachment from this person or company. Secure firewalls Having a firewall is your first line of defence against Internet malice. However, don’t be fooled; your practice needs much more than just a firewall, but a firewall is as important as antivirus/anti-malware protection. A prac- tice without a firewall would be like playing chess with- out pawns acting as the initial barrier, blocking access to your royalty. You may be thinking, managing each of those big-ticket solutions sounds great, but how can I accomplish all of them? That’s a perfect question to ask, and the answer has several components. But it starts by understanding the importance of this short and simple quip, not all IT is created equal. Just like in the dental profession, specialties exist in IT. One company that’s great at solving problems may not have a security focus or may not have experience in that field at all. In many cases, general IT companies are far less equipped to protect your practice than a dentistry- specific IT company. Even then, just because a company identifies as a dentistry-specific IT vendor, it doesn’t automatically mean it is expert in the secu- rity field. Identifying a dentistry-specific IT vendor that is a known expert in practice security is essential. Such vendors are like a rare four-leaf clover, and you’re lucky when you find one. “Don’t open e-mail attachments unless you are 100% certain of whom the sender is and are expecting an attachment from this person or company.” the expertise and quality they provide. Protecting your practice means protecting your patients. Patients who have placed their undivided trust in you deserve the best protection possible. Being proactive rather than reactive in protecting your practice and patient data can save you more than just the thousands of dollars in recovery costs and fines. Doing so will also save you unneeded stress, headache and—maybe most importantly—your reputation. Having premier IT support should not be looked at as an expense, but rather as an investment and even as insur- ance to an extent. Find an IT partner who sees itself as an extension of your practice, not just a vendor who sees you as just another number on its bottom line. When it comes to finding the IT vendor that is the best fit for your practice, always keep in mind these words, spoken by the brilliant Benjamin Franklin, “An ounce of prevention is worth a pound of cure.” Editorial note: This article originally appeared in Shift Magazine (autumn 2019), and an edited version is provided here with permission from Sprig Oral Health Technologies. about Tom Terronez is a hands-on leader in the dental technology industry and is committed to helping practices reach their efficiency and IT security potential. Since founding tech companies Medix Dental IT and Terrostar Interactive Media in the early 2000s, he has become a nationally respected and increasingly sought-after expert in his field. While their fees may be more than those of the run- of-the-mill local general IT company, there’s a reason: His mission to help practices mitigate risk, protect patients and maximise overall success has enabled dentists all over the US to embrace a new type of technology partner. 15 3 2021

My boutique one-surgery practice idea was born purely out of my passion to provide better outcomes for my patients utilising the right tools. Dental companies like Dentsply Sirona have also inspired me with their state-of-the-art digital technology tools which help deliver such outcomes. My theme for the practice is based around the concept of wellness dentistry for better oral health, using smart digital technology with a focus on patient education. The key focus areas are developed to include treatments such as CEREC same-visit crowns, clear aligner therapy, SMART (Safe Mercury Amalgam Removal Technique) protocol and smile design, using all the principles I learned at the Kois Center. For my practice, I have purchased the CEREC Primescan, the CEREC Primemill and the CEREC SpeedFire. I am ex- cited about the new Primescan because it enables more accurate and faster full-arch scans for diagnostics and dig- ital impressions for Kois Deprogrammer construction and other removable appliances. I am able to track wear of teeth over consecutive years and give it a metric judgement rather than a visual observation based on vague memory recall. I also have the ability to scan the deeper subgingival margins for CEREC crowns which was more difficult with the prede- cessor Omnicam. I am looking forward to using SiroLaser Blue for smooth no-touch cutting efficiency for gingivec- tomies and for exposing crown margins. The feature I like most about the Primemill is how it reduces the time taken to grind e.max crowns and the milling of zirconia crowns to under 5 minutes! And it has a whole new bur system. The brand new 0.5 mm bur tool for achieving detailed fissure anatomy on the occlusal surface of crowns also helps the crowns look more like a natural tooth. It is impressive to see how CEREC technology has evolved in the past 30 years. Does digitalisation play a major role in dentistry in New Zealand? And how important is the topic of digitalisation in dentistry for you, personally, and in your practice? With the current exchange rates, I feel the level of financial investment required to enter the digital space and the steep learning curve hinder many of us. For this reason alone, the uptake may not be as high in New Zealand as compared with other parts of the world. When it comes to CEREC awareness, though, about 90% of New Zealand dentists know about it and would probably plan to have it at some stage of their careers as the technology keeps improving. Actually, many dental practices and especially laboratories in New Zealand are currently investing in intra-oral scanners. How did your work and dentistry change with COVID-19 in relation to patient care and the role of digitalisa- tion in dentistry? Does digitalisation now play an even greater role? Yes, digitalisation does play an even greater role now than ever before. The pandemic has definitely brought about an urgency for reducing the physical touch points at my prac- tice. Using cloud-based dental software means no more paper is required for medical and dental history forms because it can be done through a secure portal online. Sidexis 4 enables us to discuss the radiographs, photographs, treatment plan, estimates and invoices on the chair monitor with the patient at the treatment centre. We no longer have the need to print estimates or invoices but can e-mail them when requested. Having the foot control tog- gle to change settings on the Sinius treatment centre helps for a hands-free approach. Digitalised auto purging of the treatment centre also ensures a systematic robotic process to help eliminate any human error for chair cross-infection protocols. Primescan, Primemill and SpeedFire ensure we can remain independent of national and worldwide courier delay issues, and they also reduce touch points. In addi- tion, our IQAir filtration units and ducted ventilation system give us peace of mind that we are doing everything we possibly can to keep our patients and ourselves safe in the unpredictable times of COVID-19. Dr Ginal Bilimoria (Image: © Dentsply Sirona) What are your special interests and focus topics in dentistry? My special interest is on patient education, and one of my focus topics in dentistry is the breaking down of barriers so that our patients feel more engaged, involved and excited about their dental visit and treatment. I have found that patients who are educated about their oral health value and appreciate the treatment we have to offer. I am keen to research what patients are really trying to say when they explain their dental symptoms and perceived needs. It is important to educate our patients that dentistry is custom- ised and health based and not an itemised commodity. Patients need to become advocates for their own dental health so they can make better decisions about it in order to improve their dental outcome and experience. Do you have any special professional or personal goals? Dentistry is my main hobby. My goal is to realise my passion- ate vision in the context of my start-up practice. I want to cre- ate a practice with a wellness atmosphere for myself as the provider and for my patients. Being close to home and my children is important to me. To be able to afford cutting-edge technology will require a phased approach and support from patients that share the same values for their smile goals. Editorial note: The winners of this year’s award will be announced during a virtual award ceremony on 12 November 2021. 17 3 2021

interview | From a dentist’s perspective, digital dentistry will set you apart from others—the ability to simulate images and show patients how treatment can benefit them can, ultimately, lead to a greater sense of trust. Digital impressions provide a much better experience for our patients, and no longer do they have to suffer the use of physical impression materials which can be uncomfort- able and cause gagging. Along with the improvement in efficiency and ease of use, the majority of dentists that embark on a digital workflow enjoy the advantages of intra-oral scanners. 3 What is the attitude of other dental professionals at your practice when it comes to integrating digital den- tistry? Are there any generational differences? I think it’s fair to say that the younger dentists in my practice are generally extremely tech-savvy and adopt digital tech- nologies very readily. For the older dentists, it did sometimes take them a little bit of time to familiarise themselves with tools such as intra-oral scanning, but once they were com- fortable with them, it created a major transformation in what they could offer patients, and they haven’t looked back since. What role does digital technology play in your prac- tice’s everyday workflows? We take pride in being a state-of-the-art practice and in delivering the best treatment that we possibly can for our patients. Part of what we offer, then, lies in having the best products and the most technologically advanced equip- ment, and this is where 3Shape really offers us benefits. A large part of digital dentistry for me involves using 3Shape’s workflows. This means using 3Shape TRIOS MOVE, for example, to conduct intra-oral scans of the patients, which can then be placed in a virtual articulator to sim- ulate jaw movements. I can then communicate with our in-house dental laboratory by using these 3Shape scans to plan cases more accurately and, ultimately, successfully. When everyone can see the same digital scans, it allows for better communication and planning. “A large part of digital dentistry for me involves using 3Shape’s workfl ows.” Dr Ho’s practice offers state-of-the-art digital dentistry services. Which other 3Shape products does your practice use and for what purposes? As I mentioned, I use the 3Shape TRIOS MOVE but I also employ the TRIOS Patient Specific Motion tool to bet- ter understand how my patients function with their teeth. Just recently, I had a patient referred with significant tem- poromandibular jaw problems after recent restorations. To investigate the underlying problem, I manually checked occlusion but was unable to see exactly what the issue was. With the TRIOS Patient Specific Motion tool, I could actually see quite clearly where the interferences in the bite were, and thanks to the increased accuracy of this technol- ogy, I was able to alleviate the problem by careful removal of the iatrogenic interferences. The Smile Design app is another handy tool from 3Shape that I use quite frequently. It allows me to show patients what their smiles will look like after treatment, and it’s so quick and easy to use that, when I demonstrate it in front of a patient, he or she can instantly grasp how to use it and can then play around with it and compare the before and after mock-ups. TRIOS Patient Monitoring has been another useful tool with the ability to show patients the difference between scans taken over a period of time. We can demonstrate tooth wear, gingival recession and even the effect of augmen- tation with soft- or hard-tissue grafts. 19 3 2021

case report | 3a 4a 5a 6a 3b 4b 5b 6b Figs. 3a & b: Extensive patient data was obtained using the facebow and transfer to the Artex CR. Figs. 4a & b: The virtual articulator is filled with CADIAX data. Figs. 5a & b: 2D and 3D images, combined with the design, are the perfect base for recreating the patient situation. Figs. 6a & b: Beautiful surface results after manual surface treatment. 21 3 2021

case report | 10a 10b Figs. 10a & b: Highly aesthetic and functional result. data, in combination with the Artex CR (Amann Girrbach) and the CADIAX data, is necessary to reproduce the jaw movements with the virtual articulator (Figs. 3a & b). in these complex cases, I want as little post-processing as possible (Figs. 8a & b). During the design, I concentrate on a few key points, which I finally check with the virtual articulator. The most important points are the occlusal supporting surfaces, such as the posterior tooth areas, which are important for support during intercuspation and stabilisation of the vertical dimension. They protect the joints from compres- sion and the anterior teeth from overloading. Based on this information, I consider the natural waxing- up technique and sequential functional occlusion to be particularly suitable. With the virtual articulator, I control all the jaw movements in all directions (Fig. 4). The ca- nines are important because they protect the posterior teeth from overloading. The guiding angle of the canine should be coordinated with the craniomandibular system and should not affect the posterior teeth. The anterior teeth are important for speech, for function with the lips and, of course, for aesthetics—a natural smile. To recre- ate the original patient situation, I use 2D and 3D images for excellent orientation (Figs. 5a & b). With the Ceramill Motion 2 (Amann Girrbach), I obtain satisfactory milling results, but if I want to achieve more surface structure with higher aesthetic results, I treat the surfaces manually. I select my tools carefully because it is essential to avoid of the chipping, cracking and contami- nation of the zirconia during this procedure (Figs. 6a & b). The manual surface treatment produces beautiful small details and morphologies for a natural appearance. These include perikymata and transverse ridges, which are needed for anterior teeth morphologies. After sintering, I obtain the perfect basis for the finish (Figs. 7a & b). The occlusal contacts are polished by hand before glazing. For a natural shine, I finally set the last accents with staining and glazing. From my point of view, the greatest advantage of Zolid FX Multilayer is that I can produce the digitally designed form precisely. Especially Finally, I would like to have canine guidance with no dis- turbing contacts in laterotrusion and protrusion. These movements are reproduced correctly in the same way as I designed them in virtual Artex CR (Figs. 9a & b). The coordinated workflow from the manual articulator to the virtual articulator is simply ingenious and facilitates my daily work. This only works successfully if the manufacturer coordinates both the articulator and the CAD/CAM system, which has been done successfully for these products. Function is a major part of my daily laboratory life, and I am very thankful that the virtual implementation of func- tion in combination with efficient materials makes my work much easier. From my point of view, zirconia, especially Zolid FX Multilayer, is ideal, as it combines high aesthetics with strength (Figs. 10a & b). Zirconia also has disadvan- tages; for example, if the crown is incorrectly stressed, this can lead to periodontitis or problems with preparation or the condyles. Therefore, our job as dental technicians requires that we consider occlusion and function. I would like to thank my clients who provide me with exciting work every day. about Atsushi Hasegawa gained his licence to practise as a dental technician in 1996 and completed postgraduate studies at Kanagawa Dental University in Yokosuka in Japan in 1998. He then worked for 11 years in a dental laboratory in Tokyo in Japan, where he acquired specific knowledge and skills in the field of occlusal concepts. In 2008, he opened his own laboratory, Organ Dental Lab, in Chigasaki in Japan. Today, Hasegawa transfers his knowledge through lectures in Japan and worldwide. He can be reached through his website, www.organdental.jp. 23 3 2021

case report | 25 3 2021 3 4 Fig. 3: Nesting of the zirconia crowns, upper view. Fig. 4: Nesting of the zirconia crowns, lateral view. Fig. 5: Milling bur path in the zirconia disc. Fig. 6: Digital wax-up of the crowns. Fig. 7: Digital models of the maxillary and mandibular arches. most often wish to regain their original smiles, which have been gradually altered by time and life events. The healthcare professional must then demonstrate techni- cal and medical ingenuity to restore the initial situation by restoring the original shape, colour and position of the oral structures. In this article, we will inverse time to describe a clinical case backwards and show that therapeutic success is achieved when the end result becomes a new begin- ning for the patient. Case report Figure 1 shows a clinical situation in which the patient will be able to smile literally and figuratively. The teeth have a harmonious shape, position and shade, despite minor defects such as cervical lesions of the mandib- ular incisors. There is also good periodontal health, there being no plaque or gingivitis. What the reader is far from suspecting is that this final situation cor- responds to the placement of four crowns on teeth #12–22. Figure 2 shows us close up the quality of the resto- rations and the care taken by the dental technician in the production of these crowns. Indeed, the anatomy is “Patients most often wish to regain their original smiles, which have been gradually altered by time and life events.” 5 6 7

case report | 11 12 Fig. 11: Initial situation. Fig. 12: Close-up of the initial situation. tooth itself. We will go back in time to understand this phenomenon. Taken 1 hour earlier, Figure 10 shows a real patchwork of tooth shades. There was translucency of the incisal edge, cervical saturation, cracks, missing restorations and a complex coronary fracture of tooth #11. All these elements caused the teeth to react by building reaction- ary dentine over time, and that was the source of the several shade differences. Captured at the same time as Figure 10, Figures 11 and 12 show the initial situation of this patient, who came for a consultation to rehabilitate his maxillary incisors. The diagnosis revealed nocturnal bruxism as the origin of several areas of crown destruction: wear of the incisal edge, abfraction, missing restorations, cracks and a complex coronary fracture. It is easy to understand why the choice of material was zirconia. It is also easy to understand the motivations of this patient to recover his lost smile. This degradation over time is inevitable, but in this patient, it was particularly fast and aggressive. Reversing the course of time was therefore obvious in restoring the dental health of this patient. Conclusion “...modern dentistry has initiated a digital transition in which new tools and new techniques are emerging.” was destroyed in the past and give a new future to the smiles of our patients. Digital dentistry therefore move with the times and does not create any damage, which could be summed up with this palindrome sentence: “Live on time; emit no evil”. Disclosure The author did not report any disclosures. Acknowledgement The author wishes to thank certified dental technician Christophe Pacaud and his team at ACL Dentaire laboratory in France for their skilful work. One does not have to own a time machine or a time turnstile like in the blockbuster movie Tenet to reverse the effects of time. Dentists have access to technol- ogy sophisticated enough to correct the deleterious effects of time and allow patients to regain their for- mer smiles. about Far from science fiction, modern dentistry has initiated a digital transition in which new tools and new tech- niques are emerging. All our patients dream of regaining the smile of their 20s: healthy and beautiful teeth. With current digital tools, it is now possible to restore what Dr Yassine Harichane graduated from the former Paris Descartes University in France and conducted a number of research projects there. He is the author of numerous publications and a member of the cosmetic dentistry study group at the University of Paris. He can be contacted at yassine.harichane@gmail.com. 27 3 2021

case report | 4 5 Taking into consideration the patient’s expectations and the clinical and radiographic findings, the placement of a post-extraction dental implant was planned. (diameter: 3.75 mm; length: 12.00 mm) using computer- guided flapless surgery and a screwed, immediately loaded temporary crown in order to minimise the patient’s aesthetic discomfort and enable immediate soft-tissue conditioning. Treatment planning The SAC Assessment Tool was used to assess the complexity and potential risk associated with this case. Since the protocol to be used would include immediate loading and other modifiers, this case was defined as advanced and complex (Fig. 3). The treatment plan included the insertion of one Straumann BLX Roxolid SLActive post-extraction implant An intra-oral impression of the initial clinical situation was taken using the Virtuo Vivo scanner (Fig. 4). The CBCT DI- COM files were imported into the coDiagnostiX planning software and were created through segmentation to elim- inate CBCT data artefacts and obtain a 3D conversion of the bone tissue (Fig. 5). The PLY file obtained from the ini- tial scan with the scanner imported the information con- cerning soft tissue and dental surfaces. Moreover, another STL file was created during the prosthetic planning. 6 7 8 29 3 2021

case report | 15 17 16 18 VeloDrill for the implant bed preparation with abundant irrigation with saline solution (Figs. 13 & 14). The surgery was carried out by flapless procedures, follow- ing the standard phases of computer-guided surgery. The im- plant was placed using a specific mounter through the sleeve in an accurately chosen position (Figs. 15 & 16). We obtained optimal primary stability and ISQ and were thus able to pro- ceed with the immediate loading (Fig. 17). The follow-up ra- diograph showed the excellent precision obtained in implant 19 21 20 22 31 3 2021

case report | 25 28 26 27 29 30 31 temporary crown, making sure that no contacts occurred in centric and protrusive movements (Figs. 23 & 24). The CAD was milled in Temp Multilayer PMMA (Straumann) and glued on to a Variobase abutment with RelyX Unicem 2 cement (3M; Fig. 25). The temporary crown was screwed to 15 Ncm (Fig. 26). The temporary restoration was imme- diately adapted from an aesthetic and functional point of view and did not require any changes thanks to the accu- rate digital planning (Fig. 27). Owing to global pandemic situation, a second provisional restoration was adapted six months after the surgery. The patient attended a follow-up visit for the final prosthetic procedures. After removal of the temporary restoration, optimal peri-implant soft tissue was observed (Fig. 28). The definitive prosthesis was prepared in a digital work- flow using Virtuo Vivo and CARES Visual. The scanner captured the 3D position of the implant with the aid of a scan body screwed into the BLX implant (Fig. 29). The definitive crown made of layered zirconia and a Variobase abutment for crown, regular base (diameter: 4.5 mm; transgingival height: 1.5 mm) was delivered, and a control radiograph was taken (Fig. 30). As requested by the patient, the new prosthesis was in harmony with the sur- rounding teeth and had a natural appearance (Fig. 31). Treatment outcomes The fully digital workflow reduces chair time and speeds up patient turnover, guaranteeing immediate provisional- isation, reduced patient discomfort and immediate soft- tissue conditioning. The accurate analysis of the case and treatment planning using all the digital tools at our disposal allowed us to reduce the possibility of mistakes and have a very predictable clinical outcome. The Straumann BLX system is the perfect solution for the positioning and imme- diate loading of the implant itself, thanks to its anatomical design, TorcFit connection, surface and material. Acknowledgement We would like to thank the Magma Center dental laboratory (Castellammare di Stabia NA) for helping with the digital planning and the prosthetic restoration. Reference 1. Kühl S, Payer M, Zitzmann NU, Lambrecht JT, Filippi A. Technical accuracy of printed surgical templates for guided implant surgery with the coDiagnostiXTM software. Clin Implant Dent Relat Res. 2015 Jan; 17 Suppl 1:e177–82. doi: 10.1111/cid.12152. about Dr Vincenzo Santomauro graduated in dentistry and dental prosthodontics from the University of Naples Federico II in Italy in 2002. He has attended many postgraduate implantology courses both in Italy and abroad. He has been a member of the International Team for Implantology since 2007 and a speaker for the association since 2012, ITI Fellow since 2020. He has written a number of scientific publications focusing particularly on digital implant prosthetics and has attended many national conferences as a rapporteur. He has recently improved his knowledge of the digital implant prosthetic flow, specialising in the use of guided surgery and the intra-oral scanner for digital impression taking. He works as a freelancer in Battipaglia and Salerno in Italy. 33 3 2021

3 Fig. 3: Dental professionals who would like to join the tour have to register online on the Ivoclar Vivadent website in advance. (All images: © Ivoclar Vivadent) A roaming showcase with a strong focus on education From September 2021 to early 2022, dental professionals across Europe will have the opportunity to learn first-hand from some of the most experienced experts in the dental field, reconnect with their peers and explore Ivoclar Vivadent’s innovative workflows. With at least three sessions for each two-day event, the tour will have a strong education compo- nent—something that “has been and will remain a priority for Ivoclar Vivadent to support our customers,” Frank confirmed. The Live Experience Tour is Ivoclar Vivadent’s platform for unveiling its latest products, software and services this year. “The new products will be launched within the matching workflow, as we believe that products need to be optimised within a dedicated workflow to enable our customers to achieve the highest aesthetics and efficiency,” Frank said. At each tour stop, product presentations will be complemented by interactive educational sessions and products for custom- ers to test, such as milling machines, scanners and printers. “While products remain at the core of our workflows, we are taking the bigger picture into account, linking them to the other important factors in the work of our customers,” Frank clarified. “Ivoclar Vivadent has always considered itself as a vital link between the dental practice and the laboratory. The presentations and educational sessions therefore are also aimed at fostering collaboration between the two entities.” Among other topics, the following will be in focus: – direct filling therapy with the Tetric line of four coordi- nated composites and 3s PowerCure, an innovative blue phase curing light system for intra-oral polymerisation; – CAD/CAM chairside treatment with the recently launched PrograScan intra-oral scanners and Programat CS6 fur- nace, supporting fast crystallisation of IPS e.max CAD; – the combination of pressing and printing with the re- cently launched Programat furnaces and PrograPrint PR5 3D printer; and Frank further revealed that one highlight of the tour will be the global launch of two new products—one for dentists in the adhesion product portfolio and the other for dental laboratories in the zirconia restoration range. Tour participants will learn about a number of updates, in- cluding the latest version of IvoSmile with CAD integration, for which they will receive an annual licence. The right locations for a safe experience and intimate atmosphere In order to safeguard the health and safety of its customers, Ivoclar Vivadent has worked closely with local experts at each location. The company has also chosen its tour stop locations wisely to provide enough space for a pleasant and relaxing atmosphere that will allow excellent network- ing opportunities. Frank summarised: “The Live Experience Tour is the chance to meet in person again, not only with the wider Ivoclar Vivadent team, including product developers and sales representatives, but also with other dental profes- sionals for business and informal conversation while enjoy- ing great food and drinks in unique locations. Most impor- tantly, each tour stop will be a chance for our customers to share their feedback and wishes with Ivoclar Vivadent as we strive to constantly improve our products and services for the benefit of the user. We can’t wait to catch up with our customers all over Europe.” The number of participants per event is limited and in- advance registration is mandatory. However, at least three time slots per city will be offered. While safety protocols will be adapted to local regulations, wearing of face masks will be required in all indoor areas and all participants will be asked to provide a SARS-CoV-2- negative test. – the Ivotion denture system, which offers a complete digital manufacturing process, allowing laboratories to create top-quality removable dentures. More information about the different tour stops and the respective programmes, as well as the registration form, can be found at www.ivoclarvivadent.com/live-experience. 35 3 2021

case report | 5 6 Fig. 5: Surgical guides and provisional restorations. Fig. 6: Touareg-OS dental implants. To further develop the treatment plan, diagnostic model impressions were taken using Silginat polyvinylsiloxane im- pression material (Kettenbach), poured up and forwarded to the dental laboratory. These models were then mounted on an articulator (Stratos 100, Ivoclar Vivadent) for further analysis in order to meet the patient’s aesthetic and func- tional needs. heightened the risk of damage to anatomical structures and lengthened the duration of the surgery. I personally feel that surgical guides give clinicians more confidence in accurately placing implants in every case, whether gen- eral practitioners or specialists. Precision surgery reduces stress, decreases liability and leads to a better outcome for the patient. Financing options using a third-party payment option (LendingClub) were discussed with the patient. This dis- cussion was a very important part of facilitating accep- tance of her care, since it made the cost of treatment more feasible. A 3D virtual treatment plan was further developed from our planning with the CS 3D imaging software, integrating it with the photographs and models. A virtual online integra- tive meeting with the dental laboratory allowed for a com- prehensive review of the assembled digital and clinical in- formation to formulate an optimal treatment plan that would fulfil the necessary requirements for aesthetics, form and function. Within a short amount of time, the dental labora- tory had fabricated all the necessary guides for position- ing, levelling, drilling and implant placement, in addition to the PMMA provisional restorations and back-up dentures (Fig. 5). It is my belief that surgical guides in implant dentistry in- crease the predictability of treatment outcomes as well as make the clinician extremely efficient. In the past, implant placement routinely took place freehand, but this approach The implants that would be utilised for this case were Touareg-OS dental implants (Adin Dental Implant Systems; Fig. 6). The Touareg-S and Touareg-OS spiral implants are tapered with a spiral tap that condenses the bone during placement for immediate stability. There are two large vari- able threads and a tapered design for accurate implant placement, self-drilling, improved aesthetics and better load distribution. In addition, Touareg-OS implants fea- ture the company’s biocompatible and osteoconductive OsseoFix implant surface. This has proved to achieve the desired roughness levels for optimal osseointegration, at- tain the highest implant surface purity levels and increase the success rate of bone-to-implant contact. Once the virtual plan had been orchestrated and fully con- firmed, the next appointment was for the planned surgery with all the necessary components for the guided surgical approach. The patient was appropriately sedated with in- travenous medications, and local anaesthesia was admin- istered in both arches. The tissue was then reflected using the Reflector instrument (GoldenDent) so that the bone lev- elling surgical guide would be fully seated and fixed with its respective retention screws (Fig. 7). After the positioning of 7 8 Fig. 7: Maxillary bone levelling foundation guide. Fig. 8: Guided surgery dental implant kits. 37 3 2021

case report | 15 16 Fig. 15: Maxillary and mandibular provisional restorations. Fig. 16: Post-op panoramic radiograph. 800 rpm with copious amounts of sterile saline, sequen- tial drill preparation was initiated. Once the osteotomies were complete, the drivers in the guided kit (Adin Dental Implant Systems; Fig. 10) were used to place the dental implants with precise timing so that the flat portion of the internal hex was positioned ideally for receiving the multi- unit abutments. A baseline implant stability quotient (ISQ) reading was taken of these implants utilising the Penguin RFA unit (Aseptico). Since the initial readings were all above 70 ISQ, and the quality of bone after levelling was good, multi-unit abut- ments (Adin Dental Implant Systems) were tightened into the Touareg-OS dental implants to 30 Ncm, followed by temporary cylinders to 15 Ncm. Any residual areas around the implants or in the sockets were grafted with a mineralised and demineralised cortical bone grafting material (GoldenDent) to optimise the area for regeneration. The prefabricated immediate provisional arch restorations with pre-drilled access openings were inspected before being tried in. The maxillary provisional restoration was tried in to verify a passive fit over the temporary abutments. Once fit had been confirmed, trimmed dental dam pieces were placed to avoid the restoration (Fig. 11) from locking on during the relining procedure with REBASE III FAST set hard reline material (Tokuyama Dental). After the material had polymerised, the immediate provisional restoration was removed and any access material was removed with the Torque Plus laboratory handpiece (Aseptico) and an acrylic bur (Komet). The same procedures were accomplished in the mandibular arch (Figs. 12–14). Once trimmed and pol- ished, the provisional restorations were seated and tight- ened with a torque wrench at 15 Ncm (Fig. 15). The access openings were filled in three-quarters of the way with Teflon tape, followed by Cavit filling material (3M ESPE). A postop- erative panoramic radiograph was taken immediately after the surgery (Fig. 16). A few days later, the patient returned for her postoperative appointment with very little discomfort, swelling or bruising. She was very pleased with her new maxillary and mandibu- lar fixed provisional restorations. The occlusion was further checked and adjusted to confirm that there were no inter- ferences in lateral or protrusive movements. The next step in her treatment would consist of full-arch impressions for the definitive restorations approximately four to five months postoperatively. Conclusion Having the ability to take a patient from start to finish in a fewer number of appointments within your practice allows you to position yourself as a provider that can fulfil your patient’s surgical and restorative needs. With the proper training and appropriate materials, a dental provider may provide extraction, grafting and implant placement within one appointment at one location. Not only does this allow you to reduce the number of visits for the patient, but this type of service also helps minimize the cost to the patient, since he or she is not seeing multiple dental providers. Most importantly, this enables the dental provider full control of the surgical and prosthetic outcome. Depending on the patient’s desires, the clinical conditions of the oral environment and the skills of the provider, a dentist may choose to extract teeth, level bone and graft with guided dental implant placement within his or her dental practice. about Dr Ara Nazarian maintains a private practice in Troy in Michigan in the US with an emphasis on comprehensive and restorative care. He is a diplomate of the International Congress of Oral Implantologists. He has conducted lectures and hands-on workshops on aesthetic materials, grafting and dental implants throughout the US, Europe, New Zealand and Australia. 39 3 2021

case report | 3 4c 5a 5d 4a 4d 4b 4e Fig. 3: After impression taking, the fractured crown was sent to the laboratory technician to copy the shape and colour. Figs. 4a–e: Partial tooth extraction with Socket Shield approach: bisection of the root, extraction of the palatal parts and contouring of the buccal shield. tally at gingival level. The pulp sensitivity test of the fractured tooth with CO2 snow was negative, the peri-coronal tissue was irritated, but showed absence of active purulent infec- tions. Hard and soft tissue showed no signs of bone loss or recession, in comparison of the soft tissue and bone sup- port of the two maxillary quadrants there was no difference from one quadrant to the other. Radiologically the root rem- nant showed no alterations or signs of fracture (Figs. 1a & b). Oral hygiene was good. Tooth conservation was assessed to be feasible but seemed rather unpredictable due to the lack of enough dentine to predictably support a crown in the long term. Another alternative was to extract the root and to retreat the adjacent teeth with a fixed bridge. After a discus- sion of the treatment options and the respective risks and benefits, the patient agreed to substitute the tooth by an implant. The crown of the fractured tooth was temporarily positioned in place with the help of flowable composite. An intra-oral scan of both maxillary and mandibular jaw (TRIOS, 3Shape) to produce the guide template was taken. For planning of the implant position a CBCT scan was done (Planmeca Promax 3D Plus) paying special attention to the 5b 6a 5c 6b Figs. 5a–d: Fully guided placement of the implant into the exact 3D prosthodontic position, in distance to the root shield. Care was given to not change the position of the buccal root shield. Figs. 6a & b: The interim restoration had been designed based on the intra-oral scan. It could be screwed onto the implant immediately after the surgery to close the extraction wound and preserve the soft tissue. 41 3 2021

case report | 11a 12 11b 13 Figs. 11a & b: After seating the final prosthesis, slightly chipped adjacent crowns were repaired with composite. Fig. 12: Final situation the day the crown was delivered. Fig. 13: Follow-up 6 months later. fore, a scan body had been screwed in immediately after implant placement to register the 3D position of the implant and scanned digitally (Figs. 7a & b). The interim restoration was designed in the office after importing the STL file into a professional software (Exocad dentalCAD) and after half an hour the provisional was manufactured with a milling machine (Ceramill Motion 2 5X, Amann Girrbach). Afterwards the wound was microsurgically sutured (Cytoplast 6/0 PTFE) to fix the flap in position. The interim restoration was cemented onto a Ti-base (CONELOG Tita- nium base CAD/CAM crown, CAMLOG) with a resin cement (SpeedCEM plus, Ivoclar Vivadent). This provisional cus- tomised healing abutment placed immediately after the im- plant placement covered exactly the extractions wound and helped in maintaining the soft-tissue contours. A control radiograph confirmed the right position of the implant, the position stability of the shield and the correct distance from the tooth shield to the implant (Figs. 8a & b). After 2.5 months of healing, an optimal soft-tissue emergence profile was obtained (Fig. 9) and final restoration was delivered after 10 weeks (Figs. 10–12). Six months after insertion of the final restoration the crown is perfectly integrated (Fig. 13). Conclusion Shield Technique is still difficult to perform and very tech- nique sensitive, with an apically tapered implant geared to high primary stability like PROGRESSIVE-LINE, the dentist has good control of the implant position and can reach a rather favourable cost-benefit ratio when using this tech- nique. With this case it is also shown that the implant used is a reliable option for immediacy cases with fully-guided options, taking advantage of a fully digital workflow. Editorial note: This article was first published in implants— international magazine of oral implantology, Vol. 22, Issue 2/2021. A list of references is available from the publisher. about Dr Ramón Gómez Meda holds a degree in dentistry from the University of Santiago de Compostela. In addition, he holds a Master’s degree in Occlusion and Temporomandibular Dysfunction and has completed a Postgraduate course in Periodontics and Implantology. Since 2001, he has been leading a private practice in Ponferrada This case illustrates an experimental technique for preserv- ing a buccal root segment in conjunction with immediate implant placement and provisionalisation. The Socket Shield Technique shows to be a valuable technique to minimise buccal contour changes after tooth extraction, leading to increased volume stability of the mucosa adjacent to the inserted implant. Even if the clinical application of the Socket in Spain. Dr Meda is an international lecturer on Periodontics, Implantology, Aesthetics and multidisciplinary treatments. contact Dr Ramón Gómez Meda MEDA Dental Education, Ponferrada, León, Spain ramon@dentalmeda.com, https://medaformacion.com 43 3 2021

3a 3b Primescan picked up everything, including the metal on the partial denture (Figs. 2a-d). The double buccal bite ensured that we were able to obtain a stable model (Figs. 3a & b). The depth of scan was impressive, right into the implants (Fig. 4). We placed the Atlantis IO FLO scan bodies and took our scans (Figs. 5–8). Again, the detail was extraordinary—the scanner even captured the clasps. We sent the case to Atlantis for fabrication of the abut- ments. They were able to parallel everything and sent me the plan (Fig. 9). I approved the plan and they sent me the abutments and the core file for the bridge. I was able to send the core file via connect to the laboratory. At this point, I had not taken a single physical impression or touched a model, but had received the abutments and a definitive fixed partial denture was being manufactured. 6 4 8 5 7 case report | 45 3 2021

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case report | 5 6 Fig. 5: Proposal for the definitive restoration displayed as it would be milled. Figs. 6 & 7: Milling process. The entire milling time was 4.22 minutes. was displayed as it would be milled (Figs. 3–5). The de- sign for the molar was sent to CEREC Primemill, where the CEREC Zirconia block (Dentsply Sirona) and the mill- ing burs were ready to make a crown come to life. The entire time for milling was 4.22 minutes (Figs. 6 & 7). Zirconia can be milled in super-fast mode, resulting in milling that takes less than 5 minutes, reducing the overall process by approximately 10–15 minutes. Because CEREC Primemill and CEREC SpeedFire (Dentsply Sirona) are seamlessly connected, the sintering cycle is automated and made very efficient. Standard sintering times can be as short as 18 minutes, depending on materials and proposal design. The manufactured restoration was easily ce- mented with a resin-modified glass ionomer (Figs. 8 & 9). 7 because CEREC supports you in producing predictable outcomes with regard to the anatomy, interproximal con- tact and occlusion. The advancing technologies in zirconia are bringing out better aesthetics with every generation. The design of the restoration enabled the restoration to fit interproximally and occlusally without any adjustment. 8 9 Fig. 8: Final result: highly aesthetic complete zirconia crown. Fig. 9: Buccal view of the definitive restoration. The total treatment time was 1.22 hours, including prepara- tion of the tooth and fabrication of the restoration. about Conclusion The CEREC chairside system has always been known for its speed in delivering a restoration. In this particular case of a single unit, it requires usually just seconds to image the preparation. After imaging, 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 Dr Todd Ehrlich has practised in the area of Austin in Texas in the US since 1998. He attended the University of Texas Health Science Center at San Antonio School of Dentistry, where he graduated magna cum laude. Dr Ehrlich is a consultant and lecturer on the state-of-the-art technology in dentistry. His training courses are well known in the dental CAD/CAM world. 49 3 2021

industry news | “There is great potential in the use of innovative materials and the integration of additional functionalities in dental prostheses”— Prof. Frank Brückner, Fraunhofer IWS Fraunhofer IWS says that additive manufacturing could shorten lead times in the production of orthodontic distractors and enable an individualised fi t for the patient. The institute pointed to orthodontics, stating that additive manufacturing could enable treatment time to be reduced and brackets to be individualised for patients. The produc- tion of dental prostheses could also be made faster and more efficient, both in terms of treatment costs and resources, by using additive manufacturing technologies, it said. “Additive technologies offer interesting opportunities, particularly for manufacturers in the medical technology sector,” Fraunhofer IWS explained. It commented that 3D printing allows individual solutions to be tailored to the patient and that additive technologies could help to inte- grate new and improved properties and functionalities into components. “This is usually not only more cost-effective than conventional processes but also allows to provide novel therapies and treatment approaches,” it added. owing not only to the seamless workflows that they offer in the practice but also to their ability to better con- trol the risk of infection. In an editorial published by Dental Tribune International, Zamanian said that the COVID-19 pandemic had already influenced the market for dental 3D-printing technologies. “[Sales] of 3D printers are in- creasing rapidly now that the pandemic is getting closer to being stabilised. In addition, digital technologies, such as 3D printers and intra-oral scanners, offer better con- trol of contamination risk, and this has already started to drive sales and will continue to do so in the near future,” he wrote. The ATeM High-Performance Center was founded in 2021 and aims to incorporate additive manufacturing as an established tool in the field of medical technology. Dentists are showing high interest in intra-oral scanners and 3D printing for dental applications, and both of these fields are expected to show double-digit growth in the next five years. Dr Kamran Zamanian, a market researcher in specialist dental applications and founding partner of iData Research, commented in June that the technologies are increasingly attractive to dentists The project is a collaboration between the Fraunhofer Institute for Material and Beam Technology IWS in Dresden, the Fraunhofer Institute for Machine Tools and Forming Technology IWU in Chemnitz in Germany, and the Faculty of Mechanical Engineering and the Center for Advanced Manufacturing Technologies at Wroclaw University of Science and Technology in Wroclaw in Poland. The Additive Technologies for Medicine and Health project wants to digitise the production of dental prostheses in order to make it faster, cheaper and more effi cient. 51 3 2021

industry news | m o c . k c o t s r e t t u h S / o y e W n a i r a M © cross-contamination and achieve high-quality treatment outcomes. Going digital can be beneficial during treat- ment when using virtual indirect bonding for accurate orthodontic bracket positioning as well as when making in-house aligners. The result is an improved treatment outcome, with reduced time and laboratory fees. Why did you choose orthodontics as your specialty, and why is working digitally in this field important? I chose orthodontics because I think it’s a unique dental specialty. It is challenging, as no one case is like another, and fulfilling, as one watches patients smile happily with more self-confidence at the end of treatment. The extended treatment time, compared with other den- tal specialties, also allows for a strong bond between me and my patients. If you compare working as an orthodontist now with the situation when you started your career, what do you regard as the greatest developments that have taken place? Oh, there have been many changes. First off, I now use an intra-oral scanner for my dental impressions, so it is less messy and more comfortable for my patients. A great amount of time has been saved and much frustration has been avoided, as my staff members no longer have to pour, trim or store dental models. Digital analysis of dental models nowadays is far more accu- rate than the old manual method, since one can magnify “Digital analysis of dental models nowadays is far more accurate than the old manual method.” the teeth virtually on a computer screen to examine and measure. I use special software that combines patients’ digital models, photographs and radiographs to help me customise my treatment plans and to allow for patient involvement during decision-making. about Dr Dalia El-Bokle, BDS, MSc, PhD, received her certifi cate of orthodontic training from Augusta University in the US and is a diplomate of the American Board of Orthodontics. She was formerly professor of orthodontics at Cairo University in Egypt and runs a private practice in Giza in Egypt. She is a member of the Egyptian Orthodontic Society, American Association of Orthodontists and World Federation of Orthodontists. 53 3 2021

industry news | model providing me with a complete view of the mouth. In the virtual model created by the Model Maker feature, I can see the jaws using different view options and adjust them to make sure that everything is aligned and centred. Additionally, before finalising, I am able to download and print a PDF document with the images of the model, giving me the necessary tools to plan my cases. How has the Aadva IOS 100 benefited your daily workflow compared with your conventional work- flow? The Aadva IOS 100 has allowed me to enjoy a greater work–life balance. I have been able to reduce my work week to less than four days, allowing me to spend more time with my family. We don’t have to store gypsum mod- els (with a few exceptions), and our administrative work- load is reduced because when we do in vivo scans, we now have different options for sharing the cases with the lab. Also, we can keep patients’ information synchronised with our patient management software. With the Aadva IOS 100, I am able to scan a full arch in less than 3 minutes. But the combination of features I found in it are what attracted me the most. As mentioned before, I have worked with the Aadva IOS 100 since 2018 and have already scanned over 500 patients, scanning an average of ten patients per day. I see Aadva IOS 100 as a reliable entry-level scanner with an attractive price tag. From which features of the Aadva IOS 100 have you benefited the most? How and why? The overall performance of the newly created workflow lends great support in the daily clinical routine. The big- gest benefit is the PDF creator in the case of the treat- ment planning and marketing. Planning has become very simple with model analysis and creation of tooth motion. right side view left side view Scale 1:1 cm inch front view upper jaw lower jaw 5 Fig. 5: Example of PDF document for treatment planning. Do you like the handpiece? The Aadva IOS 100 has one of the lightest and smallest handpieces on the market, which makes it easy to use. However, in some cases, we have noticed that the head of the handpiece is a bit wide for patients with small mouths (such as children). To work around this, we are able to combine conventional impressions with the in vivo bite scan. 6a 6b Figs. 6a & b: Lightweight, ergonomic Aadva IOS 100 handpiece for easy handling. 55 3 2021

FOR DIGITAL TEAMPLAYERS. The new dimension of united dentistry in laboratory and practice. PATIENT CASE SHARING CONNECTION KIT PRODUCTION KIT HIGH-SPEED ZIRCONIA KIT Intraoral scanner, software and AG.Live Patient Case Sharing for Same Day Dentistry Up to 3-pontic bridges directly in the practice within one session Sintering zirconia in just 20 minutes with 16 perfectly matched VITA shades 20 min HIGH- S P E D E G N I R E T N SI www.ceramill-drs.com 22-25 September 2021 Hall 3.2 | Booth A010–B011 2021 Amann Girrbach AG Tel +43 5523 62333-105 www.amanngirrbach.com . i g n e b e m i t e h t r o f s t e k r a m d e t c e e s n l i l y e v i s u l c x e e b a l l i a v A l l r. e a e d h c a b r r i G n n a m A e b i s n o p s e r e h t t c a t n o c e s a e p y n a m r e G e d i s t u o s e i t r a p d e t s e r e t n l I

manufacturer news | BioHorizons Camlog The next generation soft-tissue augmentation material When choosing a biomaterial, there is a strong demand in clinical practice for predictable outcomes. For over 20 years, LifeCell, a leading global medical technology company, has developed innovative products for use in a wide range of applications. BioHorizons Camlog expands its soft-tissue portfolio to bring NovoMatrix, an innovative soft-tissue augmentation material. NovoMatrix is an acellular extracellular dermal matrix consisting of tissue-engineered porcine material. It is a breakthrough in xenogeneic processing ensuring a structurally intact, undamaged scaffold that supports cell and microvascular ingrowth. The proprietary tissue processing allows for rapid revascularisation, cell repopulation and minimal inflammation. NovoMatrix comes pre-hydrated and ready to use and offers a true alternative to autogenous soft-tissue grafts and current products on the market. The NovoMatrix indications include guided tissue regeneration procedures in recession defects for root coverage, localised gingival augmentation to increase keratinised tissue (KT) around implants and natural teeth, and alveolar ridge reconstruction for prosthetic treatment. www.biohorizonscamlog.com MIS Implant Technologies New 16 mm drill kit for conical connection implant procedures As part of the company’s continuing effort to offer As part of the company’s continuing effort to offer comprehensive solutions for guided surgery comprehensive solutions for guided surgery procedures in all clinical scenarios, this spring, procedures in all clinical scenarios, this spring, MIS released their new MGUIDE kit for 16 mm MIS released their new MGUIDE kit for 16 mm conical connection drills used in implant place conical connection drills used in implant place- ment procedures. The new kit has already been ment procedures. The new kit has already been implemented in MSOFT, the MIS software used for implemented in MSOFT, the MIS software used for guided procedure planning, and is offered through an guided procedure planning, and is offered through an automatic update. This new offering extends the exist automatic update. This new offering extends the exist- ing solution for this range of implant lengths that were ing solution for this range of implant lengths that were not previously available. The kit includes all drills for not previously available. The kit includes all drills for a complete procedure, as well as the addition of a a complete procedure, as well as the addition of a marking drill which is intended for extraction sites. marking drill which is intended for extraction sites. Orit Kario, MIS Digital Solutions Product Manager, Orit Kario, MIS Digital Solutions Product Manager, highlights the marking drill, explaining that highlights the marking drill, explaining that “it was designed for this specific kit and enables drilling within sock- ets, providing an added value in immediate placement proce- dures within extraction sites. The drill’s design allows to drill in through the socket wall. In addi- tion, the same kit may be used for both standard and narrow sleeve drills. www.mis-implants.com 61 3 2021

© MIS Implants Technologies Ltd. All rights reserved. © MIS Implants Technologies Ltd. All rights reserved. IT'S SIMPLE IT'S SIMPLE TO FIND YOUR TO FIND YOUR ZEN ZENZEN ZEN ® PEACE OF MIND WITH PERSONALIZED DIGITAL DENTISTRY. MAKE IT SIMPLE The MGUIDE system features user friendly software to ensure accurate planning and an open design template that allows for a greater field-of-view and irrigation for easier implant placement. Learn more about the MGUIDE and MIS at: www.mis-implants.com

How to send us your work submission guidelines | m o c . k c o t s r e t t u h S / s l i e x p 2 3 © Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: the complete article; · · all the image (tables, charts, photo- · · graphs, etc.) captions; the complete list of sources consulted and the author or contact information (bi- ographical sketch, mailing address, e-mail address, etc.). In addition, images must not be embed- ded into the MS Word document. All im- ages must be submitted separately, and details about such submission follow be- low under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much in- formation. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing pro- gramme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word process- ing programme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such formatting before layout, which is very time-consum- ing. Please consider this when formatting your document. Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our requirements but send us the largest files available. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) Also, please remember that images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail or share the files in our cloud storage (please contact us for the link). Please also send us a head shot of your- self that is in accordance with the re- quirements stated above so that it can be printed with your article. Image requirements Abstracts Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to ap- pear in this section and format it accord- ing to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary information (60 words or less). We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to emphasise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use un- derlining. · We require images in TIF or JPEG for- · · mat. These images must be no smaller than 6 x 6 cm in size at 300 DPI. These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Questions? Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com 65 3 2021

3Shape TRIOS A digital experience that feels just right. “ For me, going digital has been a magical ride. Dentist, Hellerup, Denmark Your digital experience should make you smile. So we’ve partnered with more than 20,000 labs and made it easy for you to find the one you want. Just pick a lab, take an impression, and send it off. It’s fast, easy, and hygienic.1 Plus TRIOS® scanners fit perfectly in your hand and make scanning a pleasure. Patients will prefer comfortable digital impressions, too.2 And the TRIOS Care service agreement for this proven product includes unlimited technical support, and much more. Explore more at 3Shape.com 1. A Look at Infection Prevention in Dental Settings (Barenghil, et al. 2019). 2. 80% of studies (4 of 5) show patients choose digital impressions over conventional (Chandran et al. 2019).