issn 2193-1429 • Vol. 17 • Issue 1/2023 1/23 cosmetic dentistry beauty & science opinion The future of dentistry: What will oral care look like in 2040? case report Interdisciplinary treatment of an adult patient with worn anterior teeth meetings International Esthetic Days 2023 in Baden-Baden

editorial | Dr Sushil Koirala Editor-in-Chief Dear reader, Welcome to this year’s fi rst issue of cosmetic dentistry! After the expansion of the clinical horizons of Minimally Invasive Cosmetic Dentistry (MiCD) from cosmetic to comprehensive dentistry in 2021, MiCD education has widened in scope and has started demanding newer concepts, protocols and innovative technologies to help clinicians worldwide offer MiCD Care to their patients at MiCD Cost. Simple, fast, reliable and practical clinical protocols lay the groundwork for successful practice. In the pursuit of expanding MiCD Care globally, our team has realised that the MiCD Global Academy should now focus on MiCD clinical skills training and equipping “MiCDians” with minimally invasive smart technology. In this regard, the MiCD Global Academy has recently established the MiCD International Training and Dental Innovation Center in Nepal. The idea is to form a team of knowledge philanthropists from different fi elds of science and technology willing to work together to contribute their skills, knowledge and experiences to make MiCD Care practically useful, widely accessible and affordable to all interested dental professionals around the world. To kick off the mission, we have started collaborating with innovative minds and have already initiated a handful of projects on digital dentistry and dental artifi cial intel- ligence with a special focus on MiCD Care education and services. I personally believe that innovation and philanthropy should go hand in hand—they complement each other beautifully. Innovation requires encouragement, proper mentoring and fi nancial support, and philanthropy can provide both funds to sustain innovation and knowledge to mentor and encourage young minds. Translating an idea into reality requires proper incubation with skilled guidance. My aim with the MiCD International Training and Dental Innovation Center is to nudge young minds towards innovation in dentistry with the aim of developing start-up dental businesses that help MiCD Care reach every corner of the globe. Through this editorial, I would like to appeal for your kind support to help MiCD Care fl ourish in do-no-harm dentistry. In this issue of cosmetic dentistry, we have excellent clinical articles that support the premise of MiCD Care. I hope you will enjoy reading this issue and hopefully grow eager to share your own clinical cases, clinical research fi ndings and experiences with us so that our readers can benefi t from them. Sincerely yours, Dr Sushil Koirala Editor-in-Chief cosmetic dentistry 1 2023 03

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news | lip augmentation. They asked dentists, specialists in facial harmonisation and laypersons to evaluate the attractiveness of the lips of 16 women, grouped into eight with thin and moderately thick lips and eight with thick and full lips, before and after filling with hyaluronic acid. The researchers reported that, according to the respondents’ evaluations, participants who had thinner lips pretreatment were assessed as having significantly improved lip attractiveness after the filling procedure. However, they found that, although thicker lips were considered more attractive than thinner lips both before and after lip augmentation, they decreased in attractiveness after the filling procedure. The findings suggest that greater lip volume is not always more aesthetically pleasing. “There seems to be a limit to the amount of filler to be injected in patients who already have a certain volume in the lips before filling,” the researchers wrote in the study. In light of the findings, they suggested that dental professionals should recommend to their patients the amount of filler to be injected based on the patient’s lip volume pretreatment and other factors that significantly impact lip shape preferences, such as ethnic background and profession. “Clinicians must be aware that beauty is an ever-evolving concept subject to trends. The patient expects his doctor to be up to date with the latest scientific literature published in the field and aware of beauty trends. A good talk between the professional and the patient will awaken trust between them,” they concluded. 1a 1b 2a 2b Editorial note: The study, titled “Evaluation of the attractiveness of lips with different volumes after filling with hyaluronic acid”, was published online on 21 March 2023 in Scientific Reports. Fig. 1: Patient from the group with thinner lips before lip filling (a) and ten days after lip filling (b). Fig. 2: Patient from the group with thicker lips before lip filling (a) and ten days after lip filling (b). (Images: © De Queiroz Hernandez et al., licensed under CC BY 4.0) “[...] dental professionals should recommend to their patients the amount of filler to be injected based on the patient’s lip volume pretreatment and other factors that significantly impact lip shape preferences [...]” cosmetic dentistry 1 2023 11

opinion | microinjections of a multivitamin complex. The results are beautiful and very attractive. What about the end results? Is laser technology effective, patient-friendly and safe? How long do the results last for aesthetic procedures? The end results with the laser are very natural and very effective. These are patient-friendly, non-invasive, walk-in, walk-out procedures that require no recovery time. This makes laser aesthetic treatments more prof- itable for the dentist, as the patient turnover is higher. The only thing is that some laser aesthetic treatments have to be repeated more frequently than do treat- ments with fillers or botulinum toxin, making it more expensive for the patient. What are the benefits of laser-assisted treatments compared with using a traditional approach? When we use a laser, we’re not putting something artificial inside the body like with fillers. Instead, we work with the patient’s own collagen, stimulating natural new collagen production. Another benefit is that no recovery time is required after laser treatment. Patients can leave the clinic and immediately go to dinner with friends without concern. Was it difficult for you personally to learn how to use your laser system, such as selecting the appropriate parameters? Would you say that laser technology is suitable for beginners, experienced users or both? I went to university to obtain a degree in laser dentistry, but that’s not necessary. If you want to work with a laser, you have to learn about laser principles so that you can play with the parameters and understand all the processes: provide the right diagnosis, plan the treatment, find the optimal parameters and that is it. For each clinical case, you have to know which laser to choose: the Nd:YAG or the Er:YAG. This choice is determined by the absorption characteristics of the tissue being treated. Therefore, I think that lasers are suitable for both beginners and experienced users. Let’s look into the future. Where do you see laser aesthetic treatment in the dentist’s office in ten years’ time? Every clinic that wants to be at the top will have to use laser technology. Our patients want pain-free care, non-invasive treatments, no sutures and no recovery time. There is only one thing that will give you all this: the laser. “The best thing about the Fotona laser is that you can use only one device for so many different applications, and dental treatments and facial treatments go hand in hand nowadays.” cosmetic dentistry 1 2023 13

opinion | | To be sure of the preliminary diagnosis, the chatbot recommends that Ava’s mother take a better intra-oral photograph with Ava’s smart toothbrush when they get home. The whole family has electric toothbrushes with built-in intra-oral cameras, making it easy to monitor the health of their teeth and mouths from home. Ava and her mother walk home to join the rest of the family for dinner. When it is time to brush their teeth before bed, Ava’s mother scans Ava’s teeth with the smart toothbrush, which automatically sends the scan via the dental app. While Ava is sleeping, her mother can check the response from the app, which always gives a pre liminary diagnosis and some home care advice. The fi nal diagnosis can only be made at the clinic. If further remote assessment is needed, or if Ava’s mother has any follow-up questions, an on-call dentist or dental hygienist is always available for a remote tele-consultation via chat or voice or video call. Biohacking and dental care on subscription Ava’s mother is a biohacker and has gone one step further, having had an intra-oral sensor attached to the buccal side of one of her own mandibular molars. The sensor is a bit like an orthodontic bracket and can constantly monitor the condition of the oral cavity via various biomarkers in the saliva. This means that most dental diseases and imbalances in the oral microbiome can be detected early, allowing disease development to be discovered and reversed before requiring treat- ment. The electronic dental equipment is obviously expensive to acquire, but its cost is covered by the compulsory dental insurance package that all citizens now have. Of course, the dental care package also includes a fi xed quarterly subscription to all the oral care products that have been prescribed by the dental practitioner. Each quarter, a new pack of oral care products is provided, and the old products can be returned in the same box for sustainable recycling. Healthcare turned upside down The healthcare system long ago reoriented to care fo- cused on prevention fi rst. Anything else could no longer be justifi ed. When you look back at the system in the 2020s, you shake your head. Back then, dentistry was predominantly geared towards treatment, which made it both extremely expensive and ineffi cient. Dental staff were perpetually treating oral conditions in patients and were consequently stressed and suffering burn-out, having to take time off work frequently or leaving the profession early owing to the subsequent effects on their mental and physical health. Fortunately, in 2025, a few far-sighted health professionals, fi nancial experts and politicians reached a broad policy agreement that reshaped the fi nancing of dental care. Under the agreement, basic dental care for all citizens is funded by income tax and additional oral care is fi nanced through a combination of compulsory dental insurance and treatment fees. Central specialist clinics and local prophylaxis clinics Celina, a dentist, is resting in the staffroom wearing virtual reality glasses for engaging in a few minutes of guided mini-meditation before she sees her next patient. She is pregnant and needs a little break in which she can put her feet up and take calming deep breaths in a nature-based setting. “The clinics will communicate with each other via a cloud-based dental and medical record system, enabling data sharing and remote monitoring [...].” She is a specialist in oral–systemic medicine, having com- pleted a relatively new multidisciplinary master’s degree programme that is offered by a collaboration between dental faculties and hospitals. She works at the specialist clinic for complicated oral–systemic co-morbidities, where patients from all over the country can have complicated oral diseases treated and monitored and major recon- structions done. Patient capacity at the specialist clinic has been reached, and satellite specialist clinics are set to open in other major cities. The clinics will collaborate closely, the specialist clinic acting as a mini-hospital and providing the complicated treatments, and the local satellite clinics providing the important basic dental treatments and regular check-ups, prophylaxis and health promotion, as well as the often overlooked trust-creating social interaction between the patient and the dental staff. The clinics will communicate with each other via a cloud- based dental and medical record system, enabling data sharing and remote monitoring on the basis of extra-oral images, intra-oral scans and AI-assisted radiographs, among others. The system communicates with the common dental app, through which the entire population has access to their own dental records. cosmetic cosmetic dentistry 1 2023 15 15

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interview | “I decided to work with marketing professionals right from the outset and teamed up with WHITEVISION ( www.whitevision.de), an excellent communications agency with expertise in the fi eld of white-label brands, as it was clear to me that a start-up in a well-served location such as Friedrichshafen could only be a success if it had a clear communication and brand strategy.” What are the advantages of a solo practice? After my fi rst practice, I made the conscious decision to start up a new practice in which I could freely de- velop and design my very own concept of a dental practice. A key factor for me in the conceptual design of my boutique practice in Friedrichshafen was to de- liver particularly individual, personal and professionally demanding care for my patients. From the very begin- ning, it has been a special concern of mine and my team to engage with patients holistically, taking their personality into account too, to jointly achieve an indi- vidually optimal treatment result in a close, trusting and cooperative relationship—an opportunity supported by the practice being small. I value the freedom to be able to determine independently all aspects of my practice, whether in patient communication and treatment, re- spectful staff management, interior design or external image. Are there also trade-offs with this kind of practice? Do you see yourself in a larger structure in the long term? Being able to practise almost entirely in an autonomous manner is in itself a great opportunity, but at the same I I N O S V E T H W I , s e i r F n a i r o F r l D © cosmetic dentistry 1 2023 19

interview | I I N O S V E T H W I , s e i r F n a i r o F r l D © disciplines; for example, we do not yet have a specialist endodontic practice. Why did you integrate Guided Biofi lm Therapy (GBT) into your practice concept? From the very beginning, it was very important to me to offer my patients state-of-the-art prophylaxis. GBT is the right concept for me. On the one hand, the AIRFLOW Prophylaxis Master is a great device, and the instruments are proven to be effective and gentle on tissue and are therefore patient-friendly. On the other hand, the GBT protocol is clearly structured and can be individually adapted to all clinical indications. It is very well suited for preventive professional tooth cleaning but also for secondary prophylaxis treatment in periodontitis and peri-implantitis patients. For the GBT certifi cation, you fi rst had to invest in equipment and the further training of your staff. Was that worth it? Indeed, the costs were initially higher than for other methods, the equipment is more expensive, and I had three of my staff trained at the Swiss Dental Academy. But it has been worth it in every respect. GBT allows us to treat patients who were previously not interested in prophylaxis or who had reservations because of past bad experiences. Patients under- stand that the systematic preventive approach benefi ts them in the long term and are therefore much more accepting of an extensive treatment plan. For all these reasons, GBT prophylaxis is very well booked and fi ts in perfectly with the positioning of my practice. It also facilitates my ambition of dealing with patients and my team with empathy, mindfulness and transparency. Editorial note: This interview is an edited version of an article that was published in the 1+2/23 issue of the ZWP spezial magazine. about Dr Fries’ treatment focus is aesthetic dentistry, microscopic endodontics and guided implantology. Prophylaxis, based on EMS’s Guided Biofi lm Therapy protocol, forms an integral part of his practice concept. Complex overall restoration leading to lasting, stable and aesthetically pleasing outcomes is the primary focus of treatment. After the initial diagnosis, Dr Fries prepares a detailed treatment plan, depending on the patient’s needs and wishes, with the objective of restoring oral health, aesthetics and function. In addition, reliable backward planning with digital support such as intra-oral scanning, digital radiographs, CBCT and digital photography plays an important role in detecting any stumbling blocks early on and in supporting a predictable outcome. cosmetic dentistry 1 2023 21

user report | 4 Fig. 4: Virtual model. The patient presented with an aesthetic problem at the level of an anterior implant-supported crown. without replacing the abutment. This was due to the lack of information about the implant type and the lack of time. Case presentation A 29-year-old female patient with no significant patholog- ical history presented to my dental office in January 2023 owing to an aesthetic problem negatively affecting her smile. The extra-oral examination was without abnormal- ities, and the intra-oral examination showed good oral hygiene, healthy soft tissue, thin free gingiva and a pro- truding zirconia crown on an implant in the region of the maxillary right central incisor (Figs. 1 & 2). During the first consultation, it was established that the implant had been placed in 2020. The patient wished to have the crown aligned and the aesthetics of her smile improved before her wedding, taking place ten days after the first consultation. The patient’s former dentist had left Tunisia, and the patient had no documentation or information on the dental implant. Treatment plan Treatment After taking the preoperative photographs (Fig. 3), choosing the colour of the veneers and anaesthetising the maxillary anterior region, the incisal overlap preparation was car- ried out on the seven maxillary teeth and the zirconia crown was removed from the implant. A cylindrical diamond bur was used to separate the crown from the abutment. Subsequently, a bite registration and impres- sions were taken using the wash technique. In addition, a temporary crown was produced and placed on the abutment. In the dental laboratory, virtual models were created based on the conventional impressions (Fig. 4). The zirconia restorations were then designed in full contour, cut back for the veneering porcelain and finished by layering with CERABIEN ZR porcelain (Kuraray Noritake Dental). After obtaining the informed consent of the patient for replacement of the crown and for the placement of ve- neers for aesthetic reasons, the treatment was initiated. According to the treatment plan, seven maxillary anterior teeth (from first premolar to first premolar) would receive an incisal overlap preparation (depth of 0.1–0.3 mm) for the placement of veneers made of KATANA Zirconia UTML. For the implant, it was planned to replace the existing crown with a crown made of KATANA Zirconia UTML At try-in during the second session, we checked the insertion, the gingival margins and the contact points between the veneers and the crown on the implant. Given the superior mechanical properties of the zirconia used, the shape and thickness of the veneers were modified chairside to obtain a harmonious anterior curve and a better aesthetic rendering. After determining the colour of the resin cement, the temporary crown was put back in place. cosmetic dentistry 1 2023 23

user report | 8 9 Fig. 8: Immediate post-op photograph. Fig. 9: Treatment outcome. New smile designed according to the individual desires of the patient. The expected difficulty in bonding zirconia veneers is ex- plained by the absence of a vitreous phase, given the poor adhesion of the crystalline phase to the bonding cement. However, the desired surface modification can be achieved with a different procedure: a tribo-chemical silica coating. This was used in the present case to improve the adhesion of the zirconia veneers to the resin cement system. Indeed, it was found in an in vitro evaluation that the tribo-chemical preparation technique and the application of the MDP monomer provide an optimised adhesive interface.6 In that study, dual-beam focused ion beam technology and scan- ning electron microscopy were used to compare the resin– zirconia bonding interface with tribo-chemical preparation and MDP and the bonding interface between resin and zirconia without this preparation. The tribo-chemical process involves aero-abrasion of the zirconia surface with particles coated with silica combined with a silane primer containing MDP. The phosphate ester groups of this silane bind to the surface oxides of the zirconia, and the methacrylate group makes covalent bonds with the resin matrix of the PANAVIA Veneer LC cement.7 In the present clinical case, the KATANA Zirconia UTML veneers were abraded with silicon dioxide. As a primer, we chose CLEARFIL CERAMIC PRIMER PLUS (Kuraray Noritake Dental), because it contains the original MDP monomer developed by Kuraray Co.8 To clean the veneers before applying CLEARFIL CERAMIC PRIMER PLUS, KATANA Cleaner (Kuraray Noritake Dental) was used. The presence of saliva and residue from fittings can alter the interface with the resin cement, posing a risk of bonding failure of zirconia veneers.9 One of the most important challenges in this case was hiding the greyish colour of the implant abutment, which was visible through the zirconia crown. To hide the grey of the abutment, a resin opaquer was applied. This, combined with PANAVIA Veneer LC in white, gave us an optimal result (Fig. 9).10 Conclusion KATANA Zirconia UTML veneers have better mechanical properties compared with some other conventional veneer materials, allowing users to combine bridges, crowns and veneers without a noticeable difference in shade. It offers acceptable translucency and aes- thetics according to our observation. The technique of bonding the zirconia veneers with PANAVIA Veneer LC combined with a tribo-chemical treatment and the application of MDP to the adhesion surfaces allowed for secure bonding and effective concealment of the discoloration caused by the implant abutment. Editorial note: Please scan this QR code for the list of references. about Dr Bassem Jaidane obtained his DDM in 2010 from the University of Monastir in Tunisia. He opened his own clinic that same year, specialising in aesthetic dentistry and dental implants, as well as veneers. A general practitioner passionate about all areas of dentistry, he has advanced his knowledge in dental prosthetics, specifically concerning 3D design, ceramic layering, finishing and glazing of crowns, bridges and veneers. Dr Jaidane has therefore acquired expertise in the different types of veneers, including pressed ceramic veneers, machined veneers, layered veneers with the cutback technique and Lumineers veneers, after having carried out numerous cases, as well as veneer materials. He is a pioneer of the zirconia veneer technique. cosmetic dentistry 1 2023 25

case report | 3 5 7 9 11 4 6 8 10 12 Fig. 3: Assessment of the distance between the contact point and the bone crest. Fig. 4: Dental dam in situ. Fig. 5: Acid etching of the surfaces to be restored. Fig. 6: Situation after suction of the etching gel, rinsing and careful drying of the conditioned surfaces. Fig. 7: Application of the bonding agent to the surface of the enamel. Fig. 8: Placement of the wedge and matrix system between teeth #12 and 11. Fig. 9: Gap closure on tooth #12. Fig. 10: Simultaneous use of the two matrices (placed vertically). Fig. 11: Construction of the mesial wall of tooth #21. Fig. 12: Marked transition lines. cosmetic dentistry 1 2023 27

register at www.roots-summit.com ROOTS SUMMIT IS COMING TO ATHENS Tribune Group GmbH is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Tribune Group GmbH designates this activity for 18.5 continuing education credits. This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group GmbH and Dental Tribune International GmbH. THE GLOBAL DENTAL CE COMMUNIT Y

case report | Texturing of the surface Transition lines were drawn on the vestibular surfaces of teeth #12–21 using a pencil (Fig. 12) to provide guid- ance for the contouring.12 Lastly, the texture steps were performed (Fig. 13), creating vertical texture with a rough appearance for the demarcation of vestibular features and giving an appropriate curvature to the area of the contact point;13 as well as creating microtexture: after proper mirror polishing, restorations can be made brighter depending on how the incident light is dis- persed, absorbed and reflected on the irregular vestib- ular surface geometry (Figs. 14 & 15).14 Once the dental dam had been removed, abrasive discs were used (Sof-Lex, 3M) to optimise the mesial margins by reducing hinderances to the passage of dental floss.15 The shine and three-dimensionality of the treated surface were enhanced by polishing with a rubber cup and a diamond paste or zirconium pow- der16 (Fig. 16), all the while paying attention to the inter- dental spaces.17 To complete the polishing, a felt disc (Super-Snap Buff Disk, SHOFU) and a diamond-impregnated polishing paste (DirectDia Paste, SHOFU) were applied to the enamel, and the final polishing step was performed using silicone polishers (Dimanto, VOCO). Conventional radiographic checks were conducted to confirm that the restoration had been optimally carried out and was free of potential infiltration sites (Fig. 17). Radiographs would serve as confirmation at the DSD check. At the six-month follow-up appointment, the patient’s situation was very different to that at the initial consul- tation. There was proper closure of the interdental gaps and consequent formation of papillary tissue that harmonised the shape of the attached gingiva and of the reconstructed enamel perimeter (Figs. 18–21). In addition, the examination showed no fractures of the restoration or wear, no marginal discoloration or other staining, adequate marginal seal, adequate colour stability and translucency, very good surface structure and anatomical shape, excellent contact points, very good integrity of the teeth and no inflam- mation. Special advantages of the VOCO products used The materials used proved to be particularly useful on account of their aesthetic and functional character- istics. Futurabond U was chosen because it can be applied as a single layer with a total working time of just 35 seconds, has exceptional adhesion values, expand- ing its use to materials such as metals and ceramics, and has high moisture tolerance. Admira Fusion was used because it is universally applicable, has per- fectly harmonious translucency and opacity, enabling high-quality results that respect anatomical character- istics, and affords the flexibility to work with a single- colour or multicolour system. GrandioSO Light Flow offers 18a 18b 19 20 Figs. 18a & b: Space closure comparative check on the digital smile design before (a) and after (b). Fig. 19: Frontal image with fluorescence. Fig. 20: Aesthetic result achieved. low viscosity with exceptional fluidity, pinpoint application and outstanding aesthetic results. Results The patient was satisfied with the aesthetic accuracy in terms of restored anatomy, the gaps in the interdental space have been resolved. This result gave an im- plicit added value to the direct restoration technique: micro-invasiveness. The patient did not feel any dis- comfort during the operative steps, as no significant preparation of the teeth was needed. Discussion For the diagnostic steps, we chose a digital approach that respected dentofacial symmetry. It was necessary to carry out a smile line study with a corresponding cosmetic dentistry 1 2023 31

case report | 3a 3b Figs. 3a & b: Transillumination of the maxillary right and left central incisors using different light filters to visualise lesion depth and extent (after dental dam application and tight floss ligation). The darker areas suggest deeper lesions. Transillumination with a green filter (a). Transillumination with an orange filter (b). Note the consistent presentation between the different light filters. Transillumination suggested a slightly deeper lesion on the left central incisor. the surrounding healthy enamel.5 Alternatively, mild to moderate cases may be approached by bleaching treatment followed by resin infiltration, enamel macro- or micro-abrasion, resin or porcelain veneers, or a combination treatment. Nevertheless, deeper lesions are more challenging and often require more invasive procedures, such as complete crown coverage.4 Dental bleaching is routinely done in office or at home, both achieving similar long-term success.6 Resin infiltration is a technique that utilises a low-viscosity, polymerisable resin after the external enamel surface has been treated with 15% hydrochloric acid. A single application of 15% hydrochloric acid to enamel sur- faces can dissolve and remove 37–58 µm of super- ficial enamel, rendering the deeper fluorosis lesion more accessible by the infiltrate. This novel technique was initially introduced as a conservative approach to arresting incipient carious lesions.5 Over time, clin- ical evidence has emerged that suggests its ability to AD THE GLOBAL DENTAL CE COMMUNITY REGISTER FOR FREE DT Study Club – e-learning community www.dtstudyclub.com @DTStudyClub Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH. cosmetic dentistry 1 2023 37

case report | “A recent systematic review concluded that resin infiltration has the highest effectiveness in treating mild to moderate lesions, followed by bleaching and then micro-abrasion.” the clinician in estimating the depth of the lesion; the deeper the lesion, the greater the light blockage. For deeper lesions, a combination of various treatment means may be more appropriate. In this patient’s case, the right central incisor lesion was less extensive than the left central incisor lesion, and thus, a better out- come was anticipated. Resin infiltration was selected to treat both lesions. A dental dam with tight floss ligation was placed (Fig. 4a) to assist in isolation, prevent saliva contamination and protect the soft tissue from the hydrochloric acid. Both central incisors were polished with a non-fluoride polishing paste and a rubber cup. The resin infiltration treatment was performed according to the manu- facturer’s instructions. Icon-Etch (15% hydrochloric acid; DMG) was applied passively to the affected areas and periodically massaged for 2 minutes. The surfaces were then wiped with a cotton pellet to remove the acid gel, and the residue was rinsed off with copious water irrigation for 30 seconds. The surfaces were then thoroughly dried with a continuous stream of oil-free and water-free air. Icon-Dry (99% ethanol; DMG) was applied to and left on the surface to slowly evaporate, facilitating the elim- ination of water molecules located within the enamel porosities. Shade improvement was observed, but the process was repeated to further enhance the result. After the second Icon-Dry application, a substantial shade enhancement was observed clinically, and the TEGDMA-based Icon-Infiltrant (DMG) was applied to the etched and dried surfaces and periodically mas- saged to enhance penetration for 3 minutes. Excess material was removed with a cotton pellet and dental floss before light polymerising at a minimum intensity of 800 mW/cm2 for 40 seconds. The infiltration process was then repeated with only 1 minute of application time. Finishing cups and polishing discs were utilised to smooth the surfaces (Fig. 4b). The dental dam was removed, and the patient asked to assess her out- come. She was happy with the result and the shade modification (Fig. 5a). At the 14-month follow-up appointment, the patient expressed her great satisfaction with the result and agreed that no further treatment was needed (Fig. 5b). Conclusion Dental fluorosis is an increasingly prevalent pheno- menon. According to a Centers for Disease Control and Prevention website review paper,9 the prevalence of fluorosis in 2011/2012 has doubled from 30% in 2001/2002.10 This rapid increase in fluorosis cases, ac- companied by growing public awareness and aesthetic demands, requires dental care providers to be creative in offering the most conservative treatment modalities, such as tooth bleaching and resin infiltration. A combi- nation of home bleaching and resin infiltration was used in this case to successfully resolve anterior white spot fluorosis. The 14-month follow-up indicated both colour stability and patient satisfaction. Editorial note: This article originally appeared in Oral Health Magazine, and an edited version is provided here with permission from Newcom Media. Please scan this QR code for the list of references. about Dr Akimasa Tsujimoto is an associate professor of operative dentistry at the University of Iowa College of Dentistry and Dental Clinics in Iowa City in the US. He obtained his BDS and PhD at Nihon University in Japan and holds a tenured professorship in operative dentistry at the same university and visiting professorships at Creighton University in Omaha in Nebraska in the US and at the University of Hong Kong. Dr Ahmad Alkhazaleh is an assistant professor of restorative dentistry at the Oregon Health and Science University School of Dentistry in Portland in Oregon in the US. He obtained his BDS from the Jordan University of Science and Technology in Ar-Ramtha and MS in operative dentistry and certificate in operative dentistry from the University of Iowa College of Dentistry and Dental Clinics in Iowa City in the US. cosmetic dentistry 1 2023 39

case report | 3a 3b 3c 3d 3e 3f In daily practice, we are used to requests for functional or aesthetic improvements from adult patients with multiple associated problems and deal with these in a very precise, objective-oriented manner. The present case report describes the orthodontic and prosthetic treatment of an adult patient with worn maxillary and mandibular anterior teeth, open bite and implants replacing the mandibular first molars. Case report The 38-year-old female patient complained of her dete- riorating maxillary and mandibular incisors and associ- ated sensitivity to cold and warm food and beverages. Her medical history was non-specific. On history taking, the patient reported past and present sleep bruxism (apparent from night-time sounds reported by her hus- band), morning muscle fatigue in the masseter area, and daytime clenching and bracing of the mandible. She drank carbonated drinks on a daily basis. In the psycho- social evaluation, she reported high scores of anxiety and stress. On palpation, the bilateral anterior articular space was slightly painful (as a value of 5, reported on a scale of 1–10). There were also bilateral reciprocal articular clicks, but no functional restriction and no pain on movement or on loading of the temporomandibular joint. The retrospect, the history and the clinical examination indicated that she likely had sleep and awake bruxism.2 The clinical evaluation revealed maxillary and mandibular wear extending into the dentine. She presented with a left class II subdivision occlusion and 1.5 mm of anterior overbite and with two lithium disilicate crowns supported on implants in the positions of the mandibular first molars. The implants had been placed two years prior (Figs. 1a–f). The gingival phenotype was thin, and there was local- ised gingival recession. There was increased probing depth of 4 mm distal to the maxillary right first and left second molars. There was a probing depth of 7 mm distal to the left implant and 5 mm distal to the right implant, and both exhibited bleeding on probing. Therefore, the patient was referred to the periodontist for initial therapy and re-evaluation. As the wear facets of the anterior teeth could not be solely explained by the grinding activity,3 we considered 4a 4d 4b 4e 4c 4f cosmetic dentistry 1 2023 41

case report | 9a 9b 9c 9d 9e 9f prominent chin, 4 mm display of the maxillary incisors at rest, normal smile line, straight incisal curve, asym- metric gingival margins, maxillary occlusal plane was irregular and canted to the left (maxillary first molars had overerupted), altered dental proportions and max- illary midline deviation 0.5 mm to the right (Figs. 3a–4f). However, when determining the arc of closure, a single intermaxillary contact was found (tooth #18 with tooth #48) and anterior and posterior open bite, a bilateral Class II occlusion and an anterior shift into intercuspal position (Figs. 5a–c). “Because the occlusal scheme would have not allowed for minimally invasive prosthetic restoration, the patient was referred for orthodontics first.” Because the occlusal scheme would have not allowed for minimally invasive prosthetic restoration, the pa- tient was referred for orthodontics first. As the patient was not bothered by the facial asymmetry, and her facial and skeletal balance were satisfactory, she declined orthognathic surgery and opted for an ortho- dontic and prosthodontic solution for her deteriorating dentition. After orthodontic case analysis and interdisciplinary discussion with the prosthodontist, the following treatment objectives were established: levelling of the gingival margins of the maxillary incisors and canines, intrusion of the overerupted maxillary molars, reduction of the Class II occlusion and over- jet, levelling of the mandibular occlusal plane and uprighting of the mandibular second molars, removing the premature contacts and allowing for multiple, stable intermaxillary contacts in the registered arc of closure. 10a 10d 10b 10e 10c 10f cosmetic dentistry 1 2023 43

case report | 13a 13b 13c 13d 13e 13f After she gave her informed consent, extraction of all four third molars was performed and orthodontic treatment was initiated. Four mini-implants (MCTBIO) were placed buccally between the first and second molars and palatally between the second premolars and first molars. They were used at first for vertical an- chorage for intrusion of the maxillary first molars and then for en masse distalisation of the maxillary arch in order to reduce the Class II occlusion and overjet (Figs. 8a–f). When the orthodontic treatment entered the finishing phase, the case was discussed again with the treating prosthodontist, who validated the results. The intention of doing so was to make the case less invasive and more predictable. After bonding of fixed retention wires in order to maintain tooth position, the patient entered the prosthodontic phase. First, new implant-supported crowns were delivered for the mandibular first molars with the aim of gaining interproximal and occlusal contacts with the neighbouring teeth. A new aes- thetic and functional analysis was then performed (Figs. 9a–10f), after which a wax-up for the six maxillary and mandibular anterior teeth was done (Figs. 11a–f)—in order to restore tooth proportions and correct dental contacts and function. The wax-up was transformed into a mock-up, which was tested both aesthetically and functionally, without any modifications (Figs. 12a–13f). 14a 15a 16a 14b 15b 16b 14c 15c 16c cosmetic dentistry 1 2023 45

case report | 20d 20e 20f After the test-drive phase, because of the minimal additive requirements of the mandibular anterior teeth, composite was chosen as the restorative material. However, feldspathic ceramic restorations were chosen for the maxillary anterior teeth owing to the high aesthetic demands of the case. Minimally invasive preparations were performed, as the patient did not want colour changes, with the aim of allowing space for the restorations and having a path of insertion (Figs. 14a–c). In the same appointment, the colour of the substrate and an analogue impression were taken (Fig. 15). The restorations were received from the laboratory the following week and were then tried in and bonded using the split-dam technique (Figs. 16a–17f). The composite build-ups on the mandibular anterior teeth were done in the same appointment. After one week, the restorations were biologically, aesthetically and functionally integrated (Figs. 18a–19f). At the three-year recall, the restorations were still performing very well aesthetically and func- tionally, and the interdisciplinary treatment results remained stable (Figs. 20a–f). Conclusion By integrating orthodontics, challenging prosthodontic cases can be managed in a less invasive and more aesthetic, functional and predictable way. Good com- munication between the professionals involved and with the patient, as well as a comprehensive case analysis, is of utmost importance for the success of such cases. Editorial note: Please scan this QR code for the list of references. about Dr Elia Diana Boangar graduated from the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca in Romania in 2006 and finished her master’s degree in orthodontics in Cluj-Napoca and Bordeaux in France in 2010. Ever since, she has been exclusively practising orthodontics in Cluj-Napoca and Zalău in Romania. In 2015, she joined the Romanian Learning by Doing multidisciplinary educational platform, which advocates for solid professional and ethical principles in dentistry. Apart from her private practice, she likes to share her experience and advocate for the integration of interdisciplinarity in the protocols of complex treatment planning. She lectures nationally and internationally on the subjects of skeletal anchorage and interdisciplinary treatment of adult patients, emphasising the importance of properly sequencing orthodontic, periodontal and restorative treatment. She is an active member of the World Federation of Orthodontists, American Association of Orthodontists and European Orthodontic Society. Dr Ionut Branzan graduated from the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca in Romania in 2005. Since then, he has been working in Zalău in Romania, where he established an interdisciplinary clinic and team. Currently, he focuses on dental and implant prosthetics. He lectures extensively in Romania and abroad on the topic of aesthetics in dentistry and implant prosthodontics. He is a member of the Romanian teaching platform Learning by Doing, a project aimed at educating young dentists of different specialties. Dr Branzan has published articles concerning the clinical aspect of his work in numerous journals in Romania, Italy, Japan, China, Germany, Canada and Poland. He contributed several chapters to Incursiune în Estetica Dentară (Society of Esthetic Dentistry in Romania, 2013; available in English as Comprehensive Esthetic Dentistry, Quintessence Publishing, 2015). In 2017, he won the Award Excellence in Prosthodontics, presented by the Italian Academy of Prosthetic Dentistry, American Prosthodontic Society, Journal of Prosthetic Dentistry and Zerodonto blog. cosmetic dentistry 1 2023 47

case report | 3 4 6 8 10 12 2 5 7 9 11 Fig. 2: Patient’s facial photograph to be considered in the treatment plan. Fig. 3: Close-up view of the patient’s smile. Fig. 4: Orthodontic digital simulation using Invisalign software to show the pretreatment position (blue) and the predicted result after treatment (white). Fig. 5: Patient’s facial photograph after aligner treatment. Fig. 6: Close-up view of the patient’s smile after aligner treatment. Fig. 7: Digital planning of soft-tissue recontouring done in-house at the AORTA dental laboratory. Fig. 8: Close-up view of the surgical guide created using 3D planning, the PRO 4K printer and Zendura thermoplastics. Fig. 9: Patient’s facial photograph after soft-tissue recontouring. Fig. 10: Close-up view of the patient’s smile after soft-tissue recontouring. Fig. 11: Patient’s facial photograph after soft-tissue recontouring, direct restoration and whitening. Fig. 12: Close-up view after soft-tissue recontouring, direct restoration and whitening. cosmetic dentistry 1 2023 49

case report | 18 19 20 23 21 22 24 Fig. 18: Patient’s facial photograph to be considered in the treatment plan. Fig. 19: Close-up view of the patient’s smile. Fig. 20: Using AORTA’s simple, advanced, complex protocols to demonstrate the treatment goals. Fig. 21: Patient’s facial photograph. Fig. 22: Orthodontic digital simulation using Invisalign software to show the pre-treatment position (blue) and the predicted result after treatment (white). Fig. 23: Patient’s facial photograph after aligner treatment. Fig. 24: Close-up view of the patient’s smile after aligner treatment. cosmetic dentistry 1 2023 51

case report | 31a Restorative augmentation—introducing Virtual Interdisciplinary Smile Simulation clear aligners by simulating a restorative-only solution for comparison with the clear aligner simulation. In this third section, we will explore how clear aligner simulations with Virtual Interdisciplinary Smile Simulation (VISS; Fig. 14) can be digitally enhanced to demonstrate restorative augmentation after orthodontic treatment. This digital diagnostic and treatment planning service from AORTA digital laboratory has evolved since 2018 and is able to create a digital simulation of treatment with any aligner system, as well as of any direct or indirect restorative treatment or soft-tissue augmentation. This concept of a virtual smile simulator evolved from the notion of seeking to create patients’ emotional connec- tion to treatment through the clear aligner software. Its purpose is better smile creation by digitising the diagnosis, treatment planning and patient engagement process. This software enables the clinician to better diagnose and plan treatment using aesthetic orthodontic, prostho- dontic and facial aesthetic principles from an extra-oral, perioral and dentition perspective. When evaluating the STL files after clear aligner simulation of any aligner system, the clinician can assess whether there are hard- or soft-tissue augmentation options. From the soft-tissue perspective, if there is asymmetry of the zenith heights of the anterior gingival tissue or a need to lengthen tooth dimensions, this can be digitally simu- lated. The tooth perspective of the post-treatment STL file can digitally simulate direct or indirect restorations to optimise the golden proportions regarding tooth length– width ratio. This can provide choices for both the clinician and the patient. This digital workflow can also provide superior informed choice preand post-treatment with Now more than ever, when a patient is seen wanting a smile makeover involving veneers to straighten and whiten his or her teeth, the clinician can provide better digital visual and transparent treatment plan options. This can demonstrate what the consequences would be for restoration with veneers compared with a clear aligner solution with minor augmentation of embrasures with direct restorative solutions. The clinician can evalu- ate how much tooth preparation is required and provide more information on the risks of tooth preparation of misaligned teeth versus clear aligner treatment followed by tooth restoration with either direct or indirect resto- rations. 31b cosmetic dentistry 1 2023 53

case report | 38a 38b 39a 39b 40a 40b Figs. 38a & b: Patient’s smile before (a) and after aligner treatment (b). Figs. 39a & b: Patient’s smile after aligner treatment (a) and after veneers and soft-tissue recontouring (b). Figs. 40a & b: Patient’s smile prior to any treatment (a) compared with after clear aligner treatment, veneers and soft-tissue recontouring (b). The patient, based on the VISS simulation, decided to undergo Invisalign treatment, which lasted for ten months. Her choice of direct or indirect restoration was then rediscussed, and we decided on Philips in-chair whitening and IPS e.max veneers (Ivoclar) on the six maxillary anterior teeth and the mandibular central incisors (Figs. 35–37). Case 2 The second case using VISS demonstrates the power of visualisation of a restorative solution, clear aligner solution or both. This technique predictably engages the patient to realise that it is not necessarily a decision of one or the other but both. The patient desired veneers and presented with an anterior crossbite of teeth #11 and 21, narrow teeth #12 and 22 in relation to teeth #11 and 21, asymmetrical buccal corridors and a gummy smile tendency (Figs. 38a–41). In collaboration with the clear aligner software and VISS, we provided the patient with choice and collaboration for both a restorative and orthodontic solution. We began with clear aligners first to balance the buccal corridors, creating space equally and symmetrically around teeth #12 and 22. This treatment was orthodontically established within ten months. VISS was then engaged to facilitate soft-tissue recontouring and a restorative solution on teeth #12 and 22 only versus soft-tissue recontouring and a restorative solution for the eight maxillary anterior teeth (Figs. 42 & 43). The patient proceeded with optimal tooth colour and shape via IPS e.max veneers on the eight maxillary anterior teeth after alignment and soft-tissue recontouring of the maxillary anterior teeth (Figs. 44–46). Fig. 41: Patient’s facial photograph pre-treatment during the consultation phase, alongside a close-up view of the patient’s smile. Fig. 42: Patient’s facial photograph before aligner treatment, alongside the Invisalign software simulation. Fig. 43: Patient’s facial photograph and close-up view of the patient’s smile after clear aligner treatment had commenced, but prior to soft-tissue recontouring and veneers. 41 42 43 cosmetic dentistry 1 2023 55

case report | 48 49 50a 50c 50b 50d Fig. 48: Simulated VISS images showing the situation pretreatment and post-treatment with six veneers superimposed (purple) and the final result. Fig. 49: Simulated VISS images showing the situation pretreatment, after aligner treatment and after direct restoration too (purple). Figs. 50a–d: The result after veneers, soft-tissue recontouring and whitening. Case 3 The final case was a patient in her late teens wanting to improve her smile. Owing to social media exposure, she wanted veneers, but was apprehensive of the risks. VISS enables optimal informed consent based on demonstra- tion of what a veneer option can achieve and how versus a clear aligner solution with direct restoration enhancement. The patient chose what made her feel comfortable by visu- alising the risks without pressure or bias. She could make a self-assessed decision based on how both options made her feel and rationalise the result (Figs. 47a–49). As the clinician, I achieved ideal informed consent, as both options were viable, predictable and acceptable. My responsibility was to present the visual aids with the risks, pros and cons to allow the patient to determine the path best for her. We proceeded with six months of Invisalign to align and improve her smile. Once orthodontic treatment had been completed, we performed tooth whitening and augmented teeth #12 and 22 (Figs. 50a–d). Conclusion As these cases indicate, clear aligner and digital treatment planning can provide the clinician and patient with compre- hensive and minimally invasive alternatives to camouflage and address the patient’s aesthetic concerns effectively and predictably. VISS provides better smile creation by digitising the diagnosis, treatment planning and patient engagement process. It could not be done without digitising the dental practice and patient experience with intra-oral scanners and the dental laboratory, whether in-house or external, and using cutting-edge 3D printers like PRO 4K. Editorial note: This article was first published in aligners—international magazine of aligner orthodontics, vol. 2, issue 1/2023. about Dr John Hagiliassis graduated from the University of Melbourne in Australia with a BDS in 1998. His passion for cosmetic dentistry saw him complete a graduate diploma in aesthetic orthodontics at the Postgraduate School of Dentistry in Double Bay, New South Wales, in Australia in 2017. He founded an inner city-based dental clinic in 2007, which appeared on the BRW Fast 100 list of businesses in Australia for 2011 and 2012. He regularly speaks and mentors at the Postgraduate School of Dentistry, SmileStyler, Ivoclar, 3DMEDiTech, Angel Aligners, Smile Academy, Dental Axess and the Dental Hygienists Association of Australia and is a key opinion leader for Philips and DentalMonitoring. Dr Hagiliassis absolutely loves technology and finding ways to incorporate it into his practice’s workflow to enhance the patient experience. He has been the largest provider of Philips Zoom! whitening treatment in Australasia since 2012 and one of the largest Invisalign providers in Australasia since 2014. He has treated over 5,000 clear aligners cases to date using five different systems and has been a Black Diamond Invisalign provider since 2014. Dr Hagiliassis also founded the non-profit Australasian Clear Aligner Society in 2018 and an education and digital dental laboratory called AORTA (Aesthetic Orthodontic and Restorative Training Academy) in 2017. contact Dr John Hagiliassis john@aortaaustralia.com.au www.aortaaustralia.com.au cosmetic dentistry 1 2023 57

opinion | What impact can the output or fabrication of dental prostheses have on sustainability? Initially casting re- quired investing, melting and significant finishing and was heavily reliant on materials and time. Milling provides an accurate and predictable workflow but has limitations on design and sustainability. How does additive manufacturing (AM) or 3D printing fit into the equation? There are a multitude of AM pro- cesses that provide accurate and efficient prostheses in plastic (resins), metals and ceramics (zirconia and lithium disilicate). These approaches can create any geometry and typically offer superior accuracy and improved sustainability. Additionally, recent research has quantified that the AM workflow is more sustainable than conven- tional fabrication pathways. A further advantage is that prostheses made digitally offer impressive physical properties. The possibility of bypassing digital design by using indirect onlay restorations has also been explored. This would be a novel approach that could save an enor- mous amount of time, money and resources. And this is just the beginning, since artificial intelligence is already having an impact on diagnosis and treatment planning, and virtual and augmented reality are being used for education and training. Another factor to be considered is the developing metaverse. However, digital dentistry comes with a significant caveat: the user must have an excellent understanding of its applications and limitations in a clinical setting. After all, digital dentistry provides another set of tools in the dentist’s toolbox. Clinicians must know which tool to use and when. For example, there was a recent report of a clinical full-arch implant case which included a bone reduction guide and a guide for implant placement. Both were acquired through a fully digital workflow. Unfortunately, during the surgical session, neither guide fitted well, and the clinician had to detour to a free-hand approach. Kudos to the clinician for realising the errors, but what an unnecessary environmental impact and waste of time and money! I have heard similar stories where the implant surgical guides did not fit intra-orally owing to the patient’s limited mouth opening—another unfortunate situation in which digital dentistry was improperly used. The last scenario I will highlight concerns a clinician who bought a 3D resin printer to complement his intra-oral scanner. In this case, all patients received a diagnostic scan and printed models for educational and marketing reasons. Is this an appropriate use of digital dentistry? How does this reflect sustainability? What happens to those models when the patients have no use for them? Are they recyclable? This scenario reminds me of that meme where a gas- powered generator is being used to charge an electric vehicle. “Digital dentistry provides another set of tools in the dentist’s toolbox.” If we collectively strive for dentistry to have improved sustainability, we must consider the entire picture. Here are a few recommendations for implementing digital dentistry as related to sustainability: – consider the clinical workflow and assess how sustainability can be improved without compromising the standard of care; – understand and follow the fundamentals and principles of digital dentistry. It is merely a set of tools to improve the workflow; – be curious and explore new technologies; – be critical. For example, consider whether a fully guided case is essential; – consider a hybrid or fused workflow, combining the best aspects of analogue and digital, until there is a strong grasp on predictable digital workflows; and – exercise the Rs: recognise, reduce, recycle, repurpose, rethink and rejoice! Digital dentistry is a strong technological tool that can help dentistry become more sustainable. However, dental professionals have to ask the right questions, perform due diligence and make appropriate decisions that benefit patients and the planet. about Dr Les Kalman is an educator and medical device researcher focusing on additive manufacturing and software. He is a fellow of the Academy of Osseointegration, American College of Dentists and Academy for Dental Facial Esthetics and a diplomate of the International Congress of Oral Implantologists. He is the recipient of an Alumni of Distinction Award from the Schulich School of Medicine and Dentistry at Western University in London in Ontario in Canada and a CES Innovation Awards honouree. cosmetic dentistry 1 2023 59

meetings | m o c . k c o t s r e t t u h S / m o c . l e x p w a R © i The wait is over: passionate endodontists can now sign up for ROOTS SUMMIT 2024, which will be held from 9 to 12 May 2024 in Greece. Registration for ROOTS SUMMIT 2024 now open By Franziska Beier, Dental Tribune International The ROOTS SUMMIT organisers are pleased to announce that online registration for the endodontic meeting is now open. This highlight event will be held from 9 to 12 May 2024 at the Eugenides Foundation in Athens. Attendees can expect the great experiences that ROOTS SUMMIT participants always enjoy in addition to the same high level of clinical practice that members of the online endodontic study group have relied on for over 20 years. Speakers from nine countries and par ticipants from 50 countries are expected to attend. The organisers are offering an early bird discount until the end of the year. Speakers will include Dr Mitsuhiro Tsukiboshi from Japan, Prof. Matthias Zehnder from Switzerland, Dr Josiane Almeida from Brazil, Dr Ruth Pérez Alfayate from Spain and Dr Antonis Chaniotis from Greece. In addition to the lecture programme, attendees will have the opportunity to participate in hands-on work- shops, connect with industry professionals and learn about new equipment, procedures and protocols in endodontics. Two large lecture halls and two exhibition fl oors assure enough space for education, showcasing and socialising. The organisers are inviting endodontists, dental pro- fessionals in other fi elds, dental students and industry representatives to attend next year’s meeting. Those quick to decide can take advantage of the super- discounted fl ash sale (€595), valid until midnight (CET) on 15 July. The early bird discount (€695) will run until 31 December. The standard registration fee thereafter will be €795. A student rate (€595) will be offered per- manently. Hands-on courses will be charged separately, and the rates for these will announced later. ROOTS SUMMIT originally started as a mailing list of a large group of endodontic enthusiasts in the 1990s. Since setting up a private Facebook group, ROOTS, in 2012, the group has increased its membership from just under 1,000 to almost 29,000, including many global endodontic experts. Its members represent more than 100 countries. ROOTS SUMMIT 2024 will be taking place in the landmark building complex of the Eugenides Foundation, which has been hosting educational events for over 60 years. More information on the registration, programme and speakers can be found on the ROOTS SUMMIT website (www.roots-summit.com). News will also be posted regularly on the event’s Facebook page. cosmetic dentistry 1 2023 61

meetings | 3 Fig. 1: The International Esthetic Days will take place from 21 to 23 September in Baden-Baden in Germany. Fig. 2: According to the organisers, participants can expect presentations of the highest level. Fig. 3: The event will be an opportunity for the dental community to meet and exchange experiences. Fig. 4: During the meeting, participants will be able to learn more about new product innovations. Fig. 5: In addition to an engaging scientific programme, the organisers have created a fun social and entertainment programme. Fig. 6: The modern venue will provide all the technological support for a first-class event in a beautiful setting. Please scan the QR code for further details about the event. (Italy), Dr Andreas Benecke (Germany), Dr Armand Bedrossian (US), Dr Barbara Sobczak (Poland), Björn Roland (Germany), Dr Daniel Neves (Brazil), Dr David Norré (Belgium), Dr Eirik Salvesen (Norway), Dr Eric van Dooren (Belgium), Dr Fernando Franch (Spain), Dr Florin Cofar (Romania), Dr Gabor Tepper (Austria), Prof. Irena Sailer (Switzerland), Dr Kay Vietor (Germany), Dr Krzysztof Chmielewski (Poland), Dr Laurence Adriaens (Spain), Dr Maja Chmielewska (Poland), Dr Martin Gollner (Germany), Dr Rebecca Komischke (Germany), Dr Romain Doliveux (France), Prof. Ronald Jung (Switzerland), Dr Sepehr Zarrine (France), Prof. Tim Joda (Switzerland) and Vincent Fehmer (Switzerland). Even more speakers are still signing up! Where and when will the event take place? All this will be happening from 21 to 23 September at the Kongresshaus in the unique destination of Baden-Baden in Germany. This famous spa town in south-western Germany has been attracting visitors for centuries, particularly for its therapeutic waters, elegant architecture, cultural events and picturesque setting in the Black Forest. The language of the congress will be English, and there will be simultaneous interpretation into German. Where can you register and find further information? Any dental professional interested in attending the event can now register and book accommodation at www.estheticdays.com and benefit from the early bird rate—valid until the end of June. The ticket for “The Night” is not included in the reg- istration fee. We encourage you to secure your spot for “The Night” during registration, but you will be able to pur- chase your ticket on-site if spots remain. Participants may purchase a maximum of two tickets for “The Night”. Using the official International Esthetic Days event app, you can create your own personalised agenda, browse the programme, receive the latest event-related news alerts, interact with other participants, ask questions at Q & A sessions, and much more. 4 5 6

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 infor- mation. 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 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 under- lining. 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 programme you are using help you do this formatting au- tomatically. Similarly, should you need to make a list, or add footnotes or endnotes, please let the word processing pro- gramme 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 ar- ticle 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 require images in TIF or JPEG for- mat. · These images must be no smaller than Questions? 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!). Magda Wojtkiewicz (Managing Editor) m.wojtkiewicz@dental-tribune.com cosmetic dentistry 1 2023 65

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