| content editorial Dear readers Magda Wojtkiewicz opinion Dental technicians: The missing link Dr Ali Nankali page 10 interview “Dental technology advances dentistry” An interview with Dr Ryan C. Lewis case report Fully digital workflow with a twist Dr Marco Tudts & Bob Bosman Elst Full-mouth restoration with Zolid FX—a successful concept for sophisticated prostheses Joachim Maier page 16 Incorporating an inclusive approach to oral rehabilitation Dr Ara Nazarian Implant-retained overdenture on a very thin bone ridge Drs Nicola Alberto Valente, Murali Srinivasan & Nicole Kalberer feature The art of ultra-aesthetic dentistry Nasser Shademan 03 06 08 10 16 22 28 32 page 42 interview “There are obvious advantages to leveraging the skills of a robotic system” 34 An interview with Dr Alon Mozes news Living in digital age: Can smartphones be detrimental to oral health? 36 Iveta Ramonaite COVID-19 and dental education: Will dental schools admit new students in 2021? 38 Iveta Ramonaite Cover image courtesy of Dental Pro Content/Shutterstock.com issn 1616-7390 • Vol. 12 • Issue 1/2021 1/21 CAD/CAM international magazine of dental laboratories opinion Dental technicians: The missing link case report Full-mouth restoration with Zolid FX feature The art of ultra- aesthetic dentistry 04 CAD/CAM 1 2021 industry Full-mouth rehabilitation with three different types of KATANA Zirconia Dr Davide Cortellini & Angelo Canale Aesthetics for all intends and purposes Axel Reichert events Capitalising on digitisation with the right strategy about the publisher submission guidelines international imprint 40 44 46 48 50

| opinion Dental technicians: The missing link Dr Ali Nankali, UK 1 Fig. 1: Dr Ali Nankali believes that dental technicians have received insufficient support during the pandemic, from both the government and the members of the dental team. (Image: © Ali Nankali) If you ask a dental patient to which member of the den- tal team we should give our thanks, many of them would say to dentists and dental nurses. What do you think is the correct answer? I assume we all agree that dentists cannot provide an appropriate health care service without their team. Members of the dental team who are regis- tered with the General Dental Council (GDC) are clinical dental technicians, dental hygienists, dental nurses, den- tal technicians, dental therapists, dentists and orthodon- tic therapists. Unfortunately, it seems to me that some members of this team have not been treated equally during the COVID-19 pandemic. In this article, I want to talk about dental technicians as an integral part of the dental team. 2 3 Fig. 2: Chad Cluff. (Image: © Queen Mary University of London) Fig. 3: Adel Houmani. (Image: © Ali Nankali) 06 CAD/CAM 1 2021

| interview “Dental technology advances dentistry” By Iveta Ramonaite, Dental Tribune International i s w e L n a y R © Dr Ryan C. Lewis, a prosthodontist and owner of Longmont Prosthodontics. With its transformative power, digital dentistry is slowly taking over dental practices and laboratories all around the world. In this interview, prosthodontist Dr Ryan C. Lewis talks about how digital dentistry can help improve work- flow efficiency and highlights some of the latest advance- ments in digital dentistry. Dr Lewis, digital technologies are being taken up in dental practices worldwide. In your opinion, is it still possible to imagine dentistry without them? Dental technology advances dentistry by increasing com- munication, efficiency and accuracy. The most important technologies that I currently utilise are CAD/CAM milling, intra-oral scanning, digital implant planning, 3D printing and photography. We initially integrate digital technology with CAD/CAM milling abutments and digitally design restorations. If we compare this to UCLA casting abutments and hand wax- ing porcelain-fused-to-metal restorations, we do not only 08 CAD/CAM 1 2021 save significantly on our gold costs, but we are also able to increase the efficiency of fabricating the restorations. If we then consider intra-oral scanning and the ability to digitally submit cases to the laboratory, plus the savings in impression material, shipping costs, time to ship, and cases getting lost or delayed in shipping, it is easy to appreciate the benefits that digital dentistry offers. All of my implant cases are now digitally planned. After using digital planning and fully guided surgery, my surgeon no longer wants to place implants the traditional way. It provides peace of mind knowing that the implant will be positioned ideally, the referring doctor will be happy with the work and the patient will have the desired outcome. 3D printing has changed the way that we produce sur- gical guides. 3D printers have become so accurate and inexpensive that any dentist can now afford to have them in his or her office and print surgical guides as well as casts for diagnostic purposes or aligners at a relatively low cost. Additionally, photography has become essential when communicating with my dental technicians. The accuracy and quality of my restorations would suffer significantly without it. “3D printing has changed the way that we produce surgical guides.” What are some of the latest, most notable advances in digital dentistry? Digital implant treatment planning, intra-oral scanning and 3D printing. With digital implant treatment planning, we can significantly improve the accuracy of our implant position. We now can integrate facial scans and intra- oral scans without full-arch digital wax-ups. This ensures that we are accurately planning our new tooth positions. Because our digital diagnostic wax-ups are so accu- rate, we can also plan our full-arch implant positions with confidence. This allows us to place implants immediately at the time of extraction in cases where we would have previously recommended extraction of teeth and healing first.

| case report Fully digital workflow with a twist Dr Marco Tudts & Bob Bosman Elst, Belgium 1 2 Fig. 1: Smile before the treatment. Fig. 2: Mock-up (GC Temp PRINT, GC) in the mouth. A 61-year-old male patient presented suffering from severe tooth wear, which can be classified as attrition, abrasion or erosion depending on its cause. The entire smile line had been lost and even became negative (Fig. 1). The patient was an extrovert, and hence a new nice smile would impact his social life positively. The destructive wear of his teeth had already caused several endodontic treatments and temporomandib- ular joint dysfunction caused by the loss of the verti- cal dimension and resulting in tense and tired muscles. Severe tooth wear had caused morphological change of occlusal tooth, decrease of vertical dimension, pulp pathology, occlusal disharmony and changed mastica- tory function. In this condition, more complex therapies are needed, such as endodontics, periodontics and full coronal coverage. A digital impression was taken, and the master model was printed. A digital wax-up/mock-up was made in exocad DentalCAD (exocad) using the Smile Creator module. A standard length of 10.8 mm and width of 8.4 mm was used, as described by Mauro Fradeani. This set-up was a really nice starting point for this patient’s biotype. The idea was to verify the integration because the vertical dimension had to be increased by several millimetres and the patient wanted to rejuve- nate his smile inconspicuously, as naturally as possible, in addition to all the comfort of a balanced occlusion. 3a 3b 4 Fig. 3a: Printed temporary restorations relined with G-ænial Universal Injectable (GC). Fig. 3b: Temporary restorations in the mouth after relining with G-ænial Universal Injectable. Fig. 4: Smile with the provisional restorations in zirconia, characterised with GC Initial IQ Lustre Pastes NF (GC). 10 CAD/CAM 1 2021

| case report 7 9a 8 9b Fig. 7: Creation of the neck. Fig. 8: After application of the dentine material, the horizontal line was checked with the putty key. Fig. 9a: Mamelons and cervical surfaces: 50% FD-91 + 50% DA2 (green), A1 (dark pink), 50% A1 + 50% E58 (blue). Fig. 9b: The enamel blocker (50% A1 + 50% E58; blue) was also used on the cervical part. The vertical dimension was increased by 8 mm. To ensure that this would be comfortable for the patient, three months were taken to revise the situation. The patient suffered no headaches, muscle stress or any other problems. Hence, the first phase of the aes- thetic adaptation was begun. Minor gingivectomy with bone correction was carried out first. An impression was taken, and long-term provisional restorations were manufactured in full zirconia. Those were characterised with GC Initial IQ Lustre Pastes NF (GC) and cemented temporarily (Fig. 4). A recall was planned for three months later. This period also allowed the soft and hard tissue to heal properly after the periodontal surgery. At that point, definitive work could begin; however, owing to a skiing accident, the definitive impression 10 11 Fig. 10: Central incisor with GC Initial IQ Lustre Pastes NF CL-F. Fig. 11: Colour firing with GC Initial IQ Lustre Pastes NF CL-F. 12 CAD/CAM 1 2021

| case report 15 16 Fig. 15: Prepared teeth before luting. Fig. 16: Final result in intercuspal position. For the four anterior teeth, a 0.6 mm cut-back was done and the incisal height was decreased by 0.4 mm. To maintain control of the horizontal line, a palatal putty index of the provisional restorations was made for use as a key during the ceramic build-up (Figs. 5a & b). The zirconia substructure was slightly adapted and went into the furnace for a regeneration firing. There- after, the workflow continued with the wash firing. After application of the GC Initial IQ Lustre Pastes NF (Fig. 6a), the Initial CL-F (Clear Fluorescence) powder was sprinkled on top of the wet paste (Figs. 6b & c). This gave the opportunity to sandblast after the wash firing without damaging the colour. Moreover, it ensured that the colours would not slip down. Zirconia does not absorb heat well, and the heat must be carefully adjusted to avoid chipping. The problem of chipping is also a consequence of poor adjustment of the heating program. The larger the volume of zirco- nia, the slower the heating up and cooling down should take place. In this case, the heating temperature was dropped by 30 °C per minute, and the cooling down should have a similar rate. To keep it simple: the time to heat up should be more or less the same as the cooling down. The part until the CL-F was the first layer. For the neck, IN-42 (Terracotta; 40%) was used with A2 (60%), and then the main colour was A2 (Fig. 7). After apply- ing DA2 to the full contour (Dentin A2), the horizontal 17 18 Fig. 17: Night guard to protect the restorations and periodontal tissue. Fig. 18: Final result, portrait. The patient was satisfied with the aesthetics and function of his new smile. 14 CAD/CAM 1 2021

| case report Full-mouth restoration with Zolid FX— a successful concept for sophisticated prostheses Joachim Maier, Germany 1 2 Figs. 1 & 2: Pronounced abrasion due to bruxism, resulting in significant loss of the vertical dimension. Case description The patient case outlined here describes the challenges that prostheses have to meet under high stress. The pa- tient presented to the practice with pronounced abrasion and asked to have his natural dental appearance restored. Full-mouth restorations have their own challenges, and this was particularly so for this patient, who tended to re- lieve his daytime stress by grinding his teeth at night. After completion of pretreatment and splint therapy, the patient presented to us with the status shown in Figures 1 and 2. Goal definition Our task was to fabricate prostheses which, in addition to their natural aesthetics, could withstand high mechani- 3 4 Figs. 3 & 4: The occlusal design was created, and the contacts placed on unveneered zirconia. These should not be positioned directly on the veneer interface. 16 CAD/CAM 1 2021

| case report 10 12 11 13 Figs. 10 & 11: If required, the fissures can be recontoured with a pointed carbide cutter. Fig. 12: After sintering, diamond silicone polishers are recommended for refining the zirconia surface. For example, the Zolid Sinter-State Polishing Kit (Amann Girrbach) is well suited here. Fig. 13: Stone and diamond polishers from EVE-Diacera HP Set for zirconia. of natural teeth. Unveneered, smooth-polished zirco- nia would exhibit less loss of height over the years and would result in uneven abrasion of the teeth, having unforeseeable consequences. Our standard solution is thinly veneered zirconia if only a few teeth are to be restored, for example in the case of isolated gaps. 14 15 Figs. 14 & 15: Silicone brushes with diamond grains do not change the shape of the surface, but smooth it. Contact with the workpiece should be made at a slight angle so that the bristles can deflect better and do not kink. 18 CAD/CAM 1 2021

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

| case report Incorporating an inclusive approach to oral rehabilitation Dr Ara Nazarian, USA 1 2 Fig. 1: Pre-op retracted frontal view. Fig. 2: CBCT scan using the CS 8100 3D (Carestream Dental). Introduction goals are to perform the necessary treatment efficiently, effectively and predictably within their comfort zone. Today, we are starting to see a large increase in patients needing full-mouth extractions, whether it is due to decay, periodontal disease or infection. Also, as people mature and age, their periodontium is exposed to many more variables that may contribute to the loss of their teeth. For these patients, the greatest concerns are the avail- ability of various treatment options within their budgets, the duration of the surgical and prosthetic process, and whether they will be able to function as they did when they had healthy teeth. For dental providers, the most common 3 Fig. 3: CS 3D imaging of the proposed treatment. 22 CAD/CAM 1 2021 Clinical case In this particular case example, the patient was referred to me by her dentist. According to her previous dental provider, she had undergone quite a bit of dental work in the maxillary arch with a combination of porcelain veneers and bridgework several years prior, but had neglected to maintain regular hygiene appointments and oral home care. When she did finally return to her dentist with a con- cern about the spacing and mobility of her maxillary and mandibular teeth, he referred her to me for comprehensive treatment with an all-inclusive approach under intravenous sedation. When the patient presented to my practice for an initial evaluation, all the necessary diagnostic information was obtained, including a medical history, a smile question- naire, digital photographs and all the necessary radio- graphs. Upon clinical examination, it was very apparent that this patient had generalised advanced periodontal disease (Fig. 1). In fact, most of her teeth had Class II–III mobility with accompanying extensive cervical decay. Upon reviewing the diagnostic information, it was under- stood that all the teeth in both the maxillary and mandib- ular arches needed to be removed. Because of this, the patient was very interested in dental implants. In order to determine whether this patient was a good candidate,

| case report 8 9 Fig. 8: Engage dental implant. Fig. 9: Implants placed for the maxillary overdenture. The patient was appropriately sedated using intravenous medications, and local anaesthetic was administered to both arches. Starting with the maxillary teeth, atraumatic extractions were accomplished using the Physics Forceps (GoldenDent), which implements a modified Class I lever movement (Fig. 6). Once the teeth had been extracted, a full-thickness flap was reflected on both the facial and pal- atal aspects of the ridge using the Reflector (GoldenDent) so that the surgical guide would fully seat without any inter- ference from underlying tissue. Once positioned, sites for the three retention pins were prepared on the facial portion of the guide with the AEU-7000 surgical motor (Aseptico) and corresponding handpiece. Once the surgical guide had been fully secured (Fig. 7), initiation of the drilling se- quence using the Guided Surgical System Instrumentation Kit (OCO Biomedical) at a speed of 800–1,200 rpm with copious amounts of sterile saline was begun, followed by the insertion of four 3.25 × 12.00 mm Engage dental implants (OCO Biomedical) at a speed of 20 rpm until increased torque was necessary (Fig. 8). At that point, the ratchet wrench was connected and the implants torqued to final depths, reaching a torque level of about 40–50 Ncm. Using the Degranulation and Shaping Bur Kit (GoldenDent), any irregular areas of the ridge as well as unwanted remnant tissue was removed. Extended healing caps were placed into the dental implants (Fig. 9), followed by a cortical mineralised/demineralised bone grafting material (OCO Biomedical) in areas around the implants and within the sockets. Primary closure was achieved with 4/0 chromic gut sutures (Salvin Dental Specialties). In the mandibular arch, any remaining teeth were extracted using the Physics Forceps (Fig. 10) followed by full-thickness flap retraction using the Reflector. The CBCT-based surgi- cal guide was positioned and secured in the same fashion as the maxillary guide (Fig. 11). Using the OCO Biomedical guided kit, the osteotomies were performed, followed by the placement of seven Engage dental implants. Since a fixed provisional restoration was planned, an objec- tive reading, in addition to a high insertion torque, was pre- ferred. Using the Penguin RFA (Aseptico), a baseline implant stability quotient (ISQ) reading was taken, and all values av- eraged over 70 Ncm, an indication for adequate immediate loading. Since the ISQ values were favourable, slim stock abutments were tightened to 25 Ncm into the Engage den- tal implants (Fig. 12). The access openings were filled with Teflon tape, followed by TempoSIL (COLTENE). The mandib- ular immediate denture, which had already been relieved in the areas of the dental implants, was tried in to verify a pas- sive fit. Once confirmed, a plastic cap spacer was placed on each abutment to avoid the restoration locking on during the relining procedure with REBASE II FAST hard reline ma- terial (Tokuyama Dental). Within 2–3 minutes, the material polymerised, so the immediate denture was removed and shaped like a fixed bridge (Fig. 13) using the Torque Plus laboratory handpiece (Aseptico) and an acrylic bur (Komet). 10 11 12 Fig. 10: Extraction using the Physics Forceps. Fig. 11: Mandibular surgical guide. Fig. 12: Implants, abutments and grafting material placed. 24 CAD/CAM 1 2021

1a 2b 4a 1b 3a 4b 2a 3b 4c Fig. 1a: Occlusal view before the treatment showing a very thin ridge. Fig. 1b: Frontal view of the ill-fitting mandibular denture. Fig. 2a: Frontal view of the initial clinical situation. Fig. 2b: Preoperative radiograph. Fig. 3a: A flap was raised to obtain a clear view of the underlying bone. Fig. 3b: Preparation of the four implant sites. Fig. 4a: Placement of the four implants. Fig. 4b: The flap was closed with a 4/0 polyamide continuous suture. Fig. 4c: Radiograph taken immediately after surgery. Implant-retained overdenture on a very thin bone ridge Drs Nicola Alberto Valente, Murali Srinivasan & Nicole Kalberer, Switzerland Initial situation A healthy 60-year-old female patient with no medical his- tory presented at our clinic with a non-fitting full mandib- ular denture. Her chief complaints at this point included the lack of retention of her mandibular denture and poor aesthetics, coupled with difficulty in chewing and embar- rassment at social events. The treatment plan comprised the rehabilitation of jaw function and aesthetics with a new set of dentures, including a conventional maxil- lary complete denture (CD) and a mandibular implant- supported overdenture (IOD) retained by four implants. For standard implants, the ridge would have had to be reduced by a vertical osteotomy in order to gain thickness and to reach the wider portion of basal bone. However, this would cause both a loss of height and a reduction in vestibule depth, which would be unfavourable for the rendition of the prosthesis (Figs. 1 & 2). After evaluating the patient’s motivation, the decision was made to use the new Straumann® Mini Implants (2.4 mm diameter) with the integrated Optiloc® retention system for a new denture supported by four implants. The implants were planned for placement in the regions 34, 32, 42 and 44. Due to the very limited width of the ridge, open flap sur- gery was planned in order to place the implants safely under direct vision. Surgical procedure After a careful crestal incision, keeping the edge of the blade always in contact with the thin bone ridge, a cen- tral release incision was performed. The flap was raised 28 CAD/CAM 1 2021

| case report 8a 9a 8b 9b Fig. 8a: Final bite registration was performed. Fig. 8b: Photographs of the patient’s natural dentition helped in preparing the final teeth set-up. Figs. 9a & b: The final set-up was checked during try-in. (PVS) impression material (Figs. 5 & 6). The preparation of the master models and corresponding wax rims and all subsequent laboratory works were carried out in the Swiss-based dental laboratory Zahnmanufaktur Zimmer- mann und Mäder in Bern using the Optiloc® analogues and standard techniques (Fig. 7a). The next clinical steps included verification of the upper and lower lip support (ensuring aesthetic teeth exposure), checking the occlu- sal planes, defining the vertical dimension of occlusion, and final bite registration (Figs. 7b–d). Communication with the dental laboratory using photo- graphs of the patient’s natural dentition was a key fac- tor for successfully preparing the final teeth set-up (Figs. 8a & b). During try-in, the final set-up was checked for lip support, occlusal planes, teeth exposure and occlusal contacts (Figs. 9a & b). Moreover, the patient was able to suggest modifications and give her consent before the final prostheses were prepared. To prevent fractures and ensure the longevity of the mandibular IOD, a polyether ether ketone (PEEK) reinforcement was in- corporated in the final prosthesis (Fig. 10). The new conventional maxillary CD and mandibular IOD on the Optiloc® retention system was then finalised in the dental laboratory, placing the Optiloc® housings and process- ing inserts on all Optiloc® model analogues and following the usual manufacturing procedures. The dental labo- ratory delivered the completed maxillary CD and man- dibular IOD (Figs. 11a & b). During the final consultation, the appropriate retention inserts (low force) Optiloc® were selected and inserted into the housings using the Optiloc® retention insert placement tool (Figs. 12 & 13). The completed conventional maxillary CD and mandibu- lar IOD were then inserted into the patient’s mouth, and 10 11a 11b Fig. 10: A PEEK reinforcement was incorporated in the final prosthesis. Figs. 11a & b: The dental laboratory delivered the completed maxillary CD and man- dibular IOD. 30 CAD/CAM 1 2021

| feature The art of ultra-aesthetic dentistry Nasser Shademan, Malaysia 32 CAD/CAM 1 2021

| interview “There are obvious advantages to leveraging the skills of a robotic system” By Brendan Day, Dental Tribune International path tended more toward engineering and computer sci- ence, and I quickly became really interested in computer graphics and special effects. I began my career at Sportvision, the company that devel- oped the yellow line you see during American football games on TV, and while there, I developed a baseball pitch tracker. It was great fun at Sportvision, but I wanted to make my way back to Miami and work on the medical side of things. I went back to the University of Miami for my PhD, which is where I connected with Mako Surgical, a very successful startup that was doing robotic surgery in the orthopedic area. You worked at Mako Surgical as a software engineer, correct? Yes, along with Juan Salcedo, the co-founder of Neocis, who was a design engineer at Mako. Working there gave us an in- depth understanding of robotic surgery, and we were looking to break into an interesting market. That was when I turned my attention back to dentistry. I started to investigate oppor- tunities in the dental world and found that dental implants really stood out not only as a prime market opportunity but also, more importantly, as an excellent clinical match for the style of robotic surgery we wanted to develop at Neocis. It’s just been announced that NYU Dentistry will be the third American dental school to integrate Yomi into its curriculum. What kind of benefits does Yomi specifically offer dental students? The world of dentistry is becoming more and more digitally focused. You have preoperative digital technologies like CBCT scanners and intra-oral scanners, whereas in a post- operative sense, there are devices like CAD/CAM milling machines that take the digital files and create prostheses from them. But there’s still a large gap when it comes to the surgical portion of dental procedures, a gap that needs to be addressed in order to fully digitise dental workflows. This is where the Yomi platform comes in—it gives stu- dents an opportunity to conduct implant surgery in a dig- ital way. And if students are able to access that kind of technology, it is going to give them a huge leg up, given that it’s the direction in which the industry is headed. Dr Alon Mozes, co-founder and CEO of Neocis. (Image: © Neocis) As digital technologies become increasingly enmeshed in the everyday workflow of dental practices, dental educa- tion is changing to reflect their growing influence. One ex- ample of this is the recent announcement by the New York University College of Dentistry (NYU Dentistry) that it would be implementing Yomi, a robot-assisted surgical device de- veloped by the health care startup Neocis, into its dental implant procedures. Dental Tribune International recently spoke with Dr Alon Mozes, CEO and co-founder of Neocis, about the path toward Yomi’s creation and the benefits this system offers both dental students and practicing clinicians. Dr Mozes, thank you for taking the time to chat. How did the idea for Yomi initially come about? Your father is an experienced endodontist. Did this instill a desire in you to work in a dentistry-related capacity? Funnily enough, I actually spent one afternoon when I was in high school at my father’s private practice while he was performing a procedure and drilling into a pa- tient’s mouth. It wasn’t a great experience, and I decided then and there that I didn’t ever want my occupation to involve being stuck inside a dental office. So, my career 34 CAD/CAM 1 2021

| news A recent study found that ultra-Orthodox Jews who use kosher phones that do not have internet access showed less anxiety, had a better night’s sleep and experienced less bruxism and facial muscle pain compared with secular people who are often dependant on their mobile phones. Living in digital age: Can smartphones be detrimental to oral health? By Iveta Ramonaite, Dental Tribune International Since digital technology is so deeply rooted in our society, it would be hard to imagine a world without the internet. Whereas smartphones used to be a commodity, they have now become a necessity for most people, offering limitless opportunities and opening the door to the rest of the world. Ironically, when overused, smartphones can also socially isolate people. A new study has also found that excessive use of smartphones and social media may cause certain health problems, including bruxism and facial muscle pain. The internet allows us to access the most hidden cor- ners of the world, experience new cultures and stay con- nected with family and friends. During the pandemic, the internet was also instrumental in helping us maintain our oral health, as many dental practices offered tele dentistry to patients who needed urgent care. It also helped den- tal professionals stay up-to-date with the latest tech- nology and advancements by offering online education opportunities. But what if not everyone is in favour of internet free- dom and the dangers that come with it? Some religious groups, for example Haredi Jews, shun the use of the internet. In this, Haredi Jews are following the advice of 36 CAD/CAM 1 2021

| news Since dental students had to suspend their clinical training during the pandemic, some dental schools around the world have announced that they will not be taking in new students in 2021. COVID-19 and dental education: Will dental schools admit new students in 2021? By Iveta Ramonaite, Dental Tribune International Since the COVID-19 pandemic has severely restricted access to clinical practice, students around the world have been adversely affected by the far-reaching consequences the pandemic has had on dental education. To make the most of the current situation, numerous schools have instituted video and virtual platforms in order to familiarise students with standard clinical procedures. However, the knowledge gained through online learning is limited, and some students are now being asked to repeat the 2020–2021 academic year in order to complete the necessary clinical training. To this end, some dental schools have announced that they will not be admitting new students in 2021. Owing to the high risk of the virus spreading through aero- sol transmission in clinical practice, dentistry has been severely affected by the pandemic. This has manifested itself in a lack of the in-person training for dental students which is crucial for the successful completion of their edu- cation. Students have also been burdened by various fears and worries caused by factors such as the necessity to adapt to the updated infection control protocols and the need to rise to academic challenges. The gravity of this situation is clearly evident in Scotland. Since final year dental students have been unable to graduate owing to a lack of practical clinical experience, Universities Scotland, the representative body of Scotland’s 19 higher education institutions, has announced that dental schools will not be accepting new students in September 2021. Mairi Gougeon, Scotland’s public health minister, was quoted as saying that the decision was difficult but necessary. “The quality and calibre of dental treatment in Scotland is outstanding and it needs to be protected by taking the 38 CAD/CAM 1 2021

| industry Full-mouth rehabilitation with three different types of KATANA Zirconia By Kuraray Noritake Dental 1 Fig. 1: Three different KATANA Zirconia varieties. A female patient came to Studio Cortellini in Riccione in Italy in order to improve not just her ability to chew but also the overall aesthetic appearance of her teeth. A clinical examination revealed the presence of several erosive lesions that contributed to her chewing prob- lems and had caused a decrease in enamel thickness. This reduction in enamel, combined with a number of discoloured composite restorations, negatively affected the aesthetics of her smile. New types of cubic and tetragonal multilayered zir- conia, available in Kuraray Noritake Dental’s KATANA Zirconia range, made it possible to plan a number of extremely conservative crowns for all different areas of the patient’s mouth. Dr Davide Cortellini, owner of Studio Cortellini, car- ried out conservative preparations without the need for anaesthesia. In the maxillary arch, the aesthetic zone was prepared for full veneers, while the mandib- ular anterior teeth were treated for conventional lithium disilicate veneers without any interproximal separa- tion. Digital impressions were taken using an intra-oral scanner; Angelo Canale, owner of Canale dental laboratory in Rimini in Italy, designed the zirconia res- torations using CAD software. The restorations were then milled and aesthetically characterised by the dental ceramist Angela Giordano of the Canale dental laboratory. 40 CAD/CAM 1 2021

| industry Full-mouth rehabilitation with three different types of KATANA Zirconia: A case report Dr Davide Cortellini & Angelo Canale, Italy nology. They differ with regard to their optical and me- chanical properties, which makes it possible to choose an ideal material for every clinical situation. Case presentation The patient came to the clinic to improve her masticatory ability and aesthetics. The physical examination revealed the presence of several endogenous erosive lesions that made mastication difficult, in addition to partly affecting the aesthet- ics owing to a decrease in enamel thickness and the presence of dyschromic composite restorations (Figs. 1a & 2c). The possibility of using the new types of both tetragonal and cubic multilayer zirconia made it possible for us to plan the complete covering of all the teeth with ex- tremely conservative crowns with thicknesses of between 0.5 mm and 1.0 mm in the axial and occlusal areas and up to 0.2 mm at the margin. Very conservative vertical preparation of the enamel was carried out without anaesthesia. In the maxillary arch, the anterior teeth were prepared for full-veneer crowns, while 1a 1b 1c Figs. 1a–c: Initial situation, extra-oral view. Dental zirconia is no longer just the opaque frame- work material introduced two decades ago. Nowadays, it offers the high strength needed for long-span bridges, dentine-like translucency and the strength perfect for thin-walled posterior crowns, and enamel-like optical properties for beautiful anterior restorations—depending on its composition and structure. Kuraray Noritake Dental offers three types of dental zirconia with a multilayered structure created using patented powder colouring tech- 2a 3a 2b 2c 3b 3c 3d 3e Figs. 2a–c: Initial situation, intra-oral view. Figs. 3a–e: Vertical preparations. Knife edge (a). No finishing line (b–e). 42 CAD/CAM 1 2021

| industry 1 2 5 3 4 Fig. 1: Zolid Gen-X is available in all common heights on the market (12, 14, 16, 18, 20, 22, 25 mm). Fig. 2: Zolid Gen-X 16 mm. Fig. 3: Zolid Gen-X 22 mm with proportionally increased polychromatic shade content. Fig. 4: Zolid Gen-X 25 mm with extended monochromatic gingival component. Fig. 5: Visualisation of the shade distribution of a nested restoration made of Zolid Gen-X with the Ceramill Match 2 CAM software. Fig. 6: Optimally aligned restorations with a high gingival component (“REAX” bridge) to achieve the correct VITA shade while observing the asymmetrical shade distribution. 6 Aesthetics for all intends and purposes Optimising outcomes in implant restorations Axel Reichert, Austria Industrial multilayer pre-shaded zirconium-oxide blanks have established a strong positive trend in the dental market for quite some time now and form part of the established state-of-the-art across a wide variety of facets in terms of integrated colour design. They ensure simple, fast and highly accurate reproducibility of co- lour and translucency in everyday laboratory work. For the user to be able to assess which underlying “ optics” are hidden in the blank, nesting concepts are often necessary. However, these must first be imparted to the user so that the desired tooth shade prevails after sin- tering. If additional pronounced gingival sections are to be added, which of course cannot meaningfully be ac- counted for in terms of shade in a tooth-coloured blank, then a simple “symmetrical” or evenly distributed shade gradient is often no longer sufficient for this purpose. In these cases, users can choose the aesthetic and high- strength Zolid Gen-X zirconia with integrated shade gradient from Amann Girrbach (Fig. 1). Zolid Gen-X is available in 16 VITA shades, two Bleach shades and all common heights on the market. To ensure that the shade gradient of the tooth section is optimally matched with regard to the height of the res- 44 CAD/CAM 1 2021

| event Capitalising on digitisation with the right strategy By Amann Girrbach Digitisation can bring dental technicians and dentists closer together. How new opportunities arising from this interdisciplinary approach can be used best is the topic of Amann Girrbach’s AG.Live CON virtual congress, which will be held from 20 to 24 April. The event will kick off with a top-class panel discus- sion in which independent experts such as Profs. Daniel Edelhoff, Florian Beuer and Andreas Moritz will discuss the issues governing current patient care: What is the significance of digitisation for dentistry? Is it possible to sustainably narrow the communica- tion gap between dentists and dental technicians and unite both parties in a common, efficient treatment approach? Will all dentists in future be required to offer direct restorations? The individual problems and approaches to solutions will be dealt with in greater depth in a wide-ranging programme of specialist presentations. However, theory is only one part of the equation. During the event, Amann Girrbach will present numerous new product developments at a virtual exhibition, including the AG.Live platform, which offers networking opportunities for dentists and dental laboratories and thus facilitates effort- less interdisciplinary teamwork. These networking oppor- tunities also support collaboration in direct restorations, which are increasingly being requested by patients. Using AG.Live, the dentist can always consult a dental technician, whose expertise remains indispensable for high-quality restorations. With its new intra-oral scanner and its AG.Live platform, Amann Girrbach offers dentists an easy intro- duction to direct restorations and allows them to provide patients with same-day dentistry of laboratory quality. Dental technicians and dentists can register free of charge for the digital congress at show.aglivecon.digital. The website provides information on the congress pro- gramme. At the virtual exhibition, participants can contact Amann Girrbach’s specialists directly. 46 CAD/CAM 1 2021

m o c . k c o t s r e t t u h S / s l i e x p 2 3 © | submission guidelines How to send us your work Please note that all the textual compo- nents of your submission must be com- bined into one MS Word document. Please do not submit multiple files for each of these items: the complete article; · · all the image (tables, charts, photo- · · graphs, etc.) captions; the complete list of sources consulted and the author or contact information (bi- ographical sketch, mailing address, e-mail address, etc.). In addition, images must not be embed- ded into the MS Word document. All im- ages must be submitted separately, and details about such submission follow be- low under image requirements. Text length Article lengths can vary greatly—from 1,500 to 5,500 words—depending on the subject matter. Our approach is that if you need more or fewer words to do the topic justice, then please make the article as long or as short as necessary. We can run an unusually long article in multiple parts, but this usually entails a topic for which each part can stand alone because it contains so much in- formation. In short, we do not want to limit you in terms of article length, so please use the word count above as a general guideline and if you have specific questions, please do not hesitate to contact us. Text formatting Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent paragraphs, rather place a blank line be- tween paragraphs. Please do not add tab stops. Should you require a special layout, please let the word processing pro- gramme you are using help you do this formatting automatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word process- ing programme do it for you automatically. There are menus in every programme that will enable you to do so. The fact is that no matter how carefully done, errors can creep in when you try to number footnotes yourself. Any formatting contrary to stated above will require us to remove such formatting before layout, which is very time-consum- ing. Please consider this when formatting your document. Image requirements Please number images consecutively throughout the article by using a new number for each image. If it is imperative that certain images are grouped together, then use lowercase letters to designate these in a group (for example, 2a, 2b, 2c). Please place image references in your article wherever they are appropriate, whether in the middle or at the end of a sentence. If you do not directly refer to the image, place the reference at the end of the sentence to which it relates enclosed within brackets and before the period. In addition, please note: We also ask that you forego any special formatting beyond the use of italics and boldface. If you would like to emphasise certain words within the text, please only use italics (do not use underlining or a larger font size). Boldface is reserved for article headers. Please do not use un- derlining. · We require images in TIF or JPEG for- · · mat. These images must be no smaller than 6 x 6 cm in size at 300 DPI. These image files must be no smaller than 80 KB in size (or they will print the size of a postage stamp!). Larger image files are always better, and those approximately the size of 1 MB are best. Thus, do not size large image files down to meet our requirements but send us the largest files available. (The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more space should there be room available.) Also, please remember that images must not be embedded into the body of the article submitted. Images must be submitted separately to the textual sub- mission. You may submit images via e-mail, via our FTP server or post a CD contain- ing your images directly to us (please contact us for the mailing address, as this will depend upon the country from which you will be mailing). Please also send us a head shot of your- self that is in accordance with the re- quirements stated above so that it can be printed with your article. Abstracts An abstract of your article is not re- quired. Author or contact information The author’s contact information and a head shot of the author are included at the end of every article. Please note the exact information you would like to ap- pear in this section and format it accord- ing to the requirements stated above. A short biographical sketch may precede the contact information if you provide us with the necessary information (60 words or less). Questions? Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com 48 CAD/CAM 1 2021

| international imprint international magazine of dental laboratories Imprint Publisher and Chief Executive Officer Torsten R. Oemus t.oemus@dental-tribune.com Managing Editor Magda Wojtkiewicz m.wojtkiewicz@dental-tribune.com Designer Franziska Schmid Copy Editors Sabrina Raaff Ann-Katrin Paulick Contributors Angelo Canale Dr Davide Cortellini Bob Bosman Elst Dr Nicole Kalberer Dr Ryan C. Lewis Joachim Maier Dr Alon Mozes Dr Ali Nankali Dr Ara Nazarian Dipl.-Ing. Axel Reichert Nasser Shademan Dr Murali Srinivasan Dr Marco Tudts Dr Nicola Alberto Valente International Administration International Headquarters Chief Financial Officer Dan Wunderlich Chief Content Officer Claudia Duschek Clinical Editors Nathalie Schüller Magda Wojtkiewicz Editors Franziska Beier Jeremy Booth Brendan Day Monique Mehler Iveta Ramonaite Executive Producer Gernot Meyer Advertising Disposition Marius Mezger Art Director Alexander Jahn Dental Tribune International GmbH Holbeinstr. 29, 04229 Leipzig, Germany Tel.: +49 341 48474-302 Fax: +49 341 48474-173 General requests: info@dental-tribune.com Sales requests: mediasales@dental-tribune.com www.dental-tribune.com Printed by Löhnert Druck Handelsstraße 12 04420 Markranstädt, Germany Copyright Regulations All rights reserved. © 2021 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH is expressly prohibited. Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune International GmbH. 50 CAD/CAM 1 2021

THE INTERDISCIPLINARY CO N F E R E N C E FOR THE DENTAL INDUSTRY THE VIRTUAL E X P O WITH INNOVATIVE PRODUCT NOVELTIES n i c i a n s and dentist s h c t e ntal e d r o F #dentistryunified DIGITAL DENTAL CONFERENCE + EXPO 20-24 APRIL 2021 show.aglivecon.digital PANEL DISCUSSION & PRESENTATIONS Be part of this congress and learn how digitization can be used simply, intelligently and integratively! PRESENTATION HIGHLIGHTS PROF. DR. MED. DENT. DANIEL EDELHOFF LMU University Clinic of Munich Polyclinic for Dental Prosthetics / Director UNIV.-PROF. DR. MED. DENT. FLORIAN BEUER MME Charité University Clinic of Berlin, Department of Prosthodontics, Geriatric Dentistry and Cranio- mandibular Disorders PROF. DDR. ANDREAS MORITZ University Clinic of Dentistry Vienna Managing Director, Medical Director, Head of the Clinic CE credits are available for individual presentations. bit.ly/AGLiveConTeaser expo.aglivecon.digital DIGITAL DENTAL INNOVATIONS Discover the new dimension of unified dentistry! Where competencies are pooled with the aid of digital technologies and where interdisciplinary teamwork can be accomplished simply and efficiently in the full meaning of optimal patient care. LAB DENTIST PATIENT 3REGISTER NOW: show.aglivecon.digital Amann Girrbach AG Tel +43 5523 62333-105 www.amanngirrbach.com