cosmetic dentistry international
Cover
/ Editorial
/ Content
/ Orthodontic surgery and aesthetics
/ Fixed prosthodontic management of a mutilated dentition: A team approach
/ Replacement of a faulty posterior restoration
/ Simplified digital impression-taking
/ The new NobelProcera system for clinical success: The next level of CAD/CAM dentistry
/ Aesthetics with all-ceramics and tooth whitening
/ Learning and applying the Natural Layering Concept
/ Amaris Gingiva— A beautiful smile - naturally
/ IDS flourishes despite economic trouble
/ Events
/ Submissions
/ Imprint
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[page] => 03
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[page] => 04
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[page] => 12
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[page] => 26
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[page] => 44
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/ Editorial
/ Content
/ Orthodontic surgery and aesthetics
/ Fixed prosthodontic management of a mutilated dentition: A team approach
/ Replacement of a faulty posterior restoration
/ Simplified digital impression-taking
/ The new NobelProcera system for clinical success: The next level of CAD/CAM dentistry
/ Aesthetics with all-ceramics and tooth whitening
/ Learning and applying the Natural Layering Concept
/ Amaris Gingiva— A beautiful smile - naturally
/ IDS flourishes despite economic trouble
/ Events
/ Submissions
/ Imprint
[pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/53871-d0cbb4a7/epaper.pdf
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[1] =>
CDE0209_01_Titel
CDE0209_01_Titel
29.04.2009
16:59 Uhr
Seite 1
issn 1616-7390
Vol. 3 • Issue 2/2009
cosmetic
dentistry
_ beauty & science
2
2009
_special
Orthodontic surgery and aesthetics
_industry report
Simplified digital impression-taking
_meetings
IDS review
[2] =>
CDE0209_01_Titel
BEAUTY – COMPOSE IT!
Highly aesthetic restorative
r Two simple steps
r Layers like in nature
r Brilliant results
r Now available in Gingiva shades
Please visit us at
#UKC2CEKƂE&GPVCN%QPITGUU
*QPI-QPI5VCPF##
VOCO GmbH · P.O. Box 767 · 27457 Cuxhaven · Germany · Tel. +49 (4721) 719-0 · Fax +49 (4721) 719-140 · www.voco.com
[3] =>
CDE0209_01_Titel
editorial _ cosmetic dentistry
I
Dear Reader,
_I sincerely appreciate the enthusiastic support of our authors for the second
edition of cosmetic dentistry . Since we began, we have striven to fulfil the needs of
our valued readers, by providing innovative and informative articles on clinical techniques and new dental technologies. So far, we have received very positive and
encouraging feedback from many supporters. We are certainly grateful to have established a well-suited and efficient team in such a short time.
Dr So-Ran Kwon
Co-Editor-in-Chief
Cosmetic and implant dentistry have without a doubt become of central interest,
attracting the interest of many dentists worldwide. At many important academic
seminars or conventions, the main theme is directly or indirectly related to these two
specialities. This trend is expected to be even more pronounced in the future. Dental
education, from undergraduate programmes to graduate programmes and continuing
education courses, exhibits a continual shift towards cosmetic and implant dentistry.
The number of patients in need of cosmetic and implant procedures is steadily
increasing. I have personally witnessed this boom in Europe, Asia and the US during my
international lectures and have been informed of it through regular feedback from
dentists and dental hygienists. If we are to satisfy our patients’ needs, additional skills
and knowledge are essential.
In this edition, you will find solutions for quality and cosmetic restorations on natural teeth and implants. Our industry reports introduce innovative materials and
devices that will make your clinical work not only more precise, but also much easier.
I am confident that the more knowledge we have on cosmetic dentistry, the greater our
success in our dental practices will be.
I hope you will enjoy this edition of cosmetic dentistry, and look forward to receiving your valuable feedback!
Sincerely yours,
Dr So-Ran Kwon
Co-Editor-in-Chief
President Korean Bleaching Society
Seoul, Korea
cosmetic
dentistry 2
I 03
_ 2009
[4] =>
CDE0209_01_Titel
I content _ cosmetic dentistry
page 06
I editorial
03
page 12
32
Dear Reader
page 22
Aesthetics with all-ceramics
and tooth whitening
_ Marcus Striegel
_ So-Ran Kwon, Co-Editor-in-Chief
36
_ Didier Dietschi
I special
06
Orthodontic surgery and aesthetics
_ Nezar Watted et al.
I industry news
44
I case study
12
Learning and applying the
Natural Layering Concept
Fixed prosthodontic management
of a mutilated dentition: A team approach
_ Helena Lee & Ansgar Cheng
Amaris Gingiva—
A beautiful smile, naturally
I meetings
46
IDS flourishes despite economic trouble
_ Daniel Zimmermann
I clinical technique
18
48
Cosmetic events
Replacement of a faulty posterior restoration
_ Sushil Koirala
I about the publisher
49
50
I industry report
22
_submissions
_ imprint
Simplified digital impression-taking
_ Helmut Götte
26
The new NobelProcera system for
clinical success: The next level
of CAD/CAM dentistry
_ Hans Geiselhöringer & Stefan Holst
page 26
04 I cosmetic
dentistry
2_ 2009
Cover image courtesy of coltène whaledent.
page 32
page 46
[5] =>
CDE0209_01_Titel
[6] =>
CDE0209_01_Titel
I special _ orthodontics
Orthodontic surgery
and aesthetics
Author_ Prof Nezar Watted, Prof Josip Bill, Dr Ori Blanc & Dr Benjamin Schlomi, Germany & Israel
Fig. 1_Diagrammatic representation
of the osterotomy lines on the
outer (continuous line) and the inner
compacta (dashed line) of the
mandible; 4 = inner saw cut above
the N. mandibularis.
Figs. 2a & b_Lateral view of the
25-year-old male patient, showing
lower facial retrusion diagonally
forward. The frontal view shows the
right-sided deviation due to the laterognathia. The upper-lip vermillion is
relatively weakly developed (b).
_Orthodontic treatment generally follows aesthetic, functional, and prophylactic objectives, where
individual aspects of isolated cases are accorded varying importance as they arise. Increasing aesthetic
expectations and awareness of modern dental treatment options disseminated by the media have resulted
in increased interest and greater willingness of adults to
consider orthodontic treatment. Aesthetic orthodontics is thus primarily adult orthodontics.
A peculiarity of orthodontic treatment in adults
compared with paediatric or adolescent orthodontics is
the age-associated involution of the connective tissues
that leads to a reduction in cell density, thickening of the
fibre bundles, delayed fibroblast proliferation, and
reduced vascularisation. These are the causes of slower
dental movement and delayed tissue and bone reactions. Absent sutural growth, the age of the periodontium, specific periodontal diagnoses, and tissue atrophy
also make treatment in adults particularly challenging.
Fig. 1
As a rule, aesthetically oriented adult orthodontics
therefore has an interdisciplinary inclination. Occlusion,
function and aesthetics are considered to be equivalent
parameters in modern orthodontics and particularly
here in combined orthodontic-maxillofacial surgical
treatment.32,33 This was achieved through optimisation
of diagnostic tools and further development and increasing experience in orthopaedic surgery.4
Nowadays, treatment of adult patients with dental
malposition and mastication impairment is one of the
standard tasks of the orthodontist. If the discrepancies
in spatial allocations of the upper and lower dentition
are particularly pronounced and where the cause is
primarily skeletal and not only dentoalveolar, conventional orthodontic therapy is limited and combined
orthodontic-surgical therapy is indicated for remodelling of the jaw bases.
Treatment for a skeletal dysgnathia (Class III) using
combined orthodontic-maxillofacial surgical correction is discussed in this article.
_Chronological development of
maxillofacial surgery of the mandible
Fig. 2a
Fig. 2b
06 I cosmetic
dentistry
2_ 2009
The first orthodontic-maxillofacial surgical procedure on the mandible described in the literature was
that of the American surgeon Hullihen in 1848.13 This
procedure was a segmental osteotomy of the anterior
[7] =>
CDE0209_01_Titel
special _ orthodontics
mandible (a posterior shift [retrusion] of a protruding
mandibular alveolar process, following a burn injury).
Towards the end of the 19th century, the method
of orthodontic-maxillofacial surgical correction of
dysgnathias by surgical retrusion or protrusion of the
mandible was revisited. Jaboulay14 described resection
of the Processus condylaris and Blair4, osteotomy on
the Corpus mandibulae. The continuity resection in
the horizontal branch by Blair was the first surgical
prognathism procedure. The patient first visited the
dentist Whipple in St. Louis in 1891 and was then
I
referred to the then most renowned orthodontist
Dr Edward Hartley Angle2, who ultimately recommended the surgical procedure mentioned above.
Six years later, the procedure in this osteotomy
on the Corpus mandibulae was also published by the
Hamburg surgeon Floris.11 Parallel with this development in the US, Von Auffenberg3 in Europe conceived
a step-by-step osteotomy for correcting a mandibular
retrusion, which was performed by Von Eiselberg
in 1901.
Figs. 3a–e_Clinical situation before the
start of treatment.
Fig. 4_The cephalometric X-ray shows
the disharmonious arrangement in the
vertical axis. The lower face shows an
approx. 60 per cent enlargement in
relation to the upper face.
Fig. 3a
Fig. 3d
Fig. 3b
Fig. 3e
Fig. 3c
Fig. 4
Fig. 5
cosmetic
dentistry 2
I 07
_ 2009
[8] =>
CDE0209_01_Titel
I special _ orthodontics
Fig. 5_Orthopantomographic image
before the start of orthodontic treatment. An apical lucency at tooth 31.
Pronounced maxillary-antrum expansion between teeth 25 and 27. Orthodontic closure of the gap is difficult.
Figs. 6a–c_Situation after orthodontic
preparation for the surgical procedure.
Figs. 7a–e_Occlusion at the end of
treatment; there is a neutral stable
occlusion with physiological anterior
bite in the sagittal and vertical axes
and a correct midline (a–c). Monitoring
images of the upper and lower jaws.
A ceramic bridge was made in the
lower jaw (d & e).
Fig. 6a
Fig. 6b
Fig. 6c
Fig. 7a
Fig. 7b
Fig. 7c
Fig. 7d
Fig. 7e
_contact cosmetic
dentistry
Prof Nezar Watted
Wolfgangstraße 12
97980 Bad Mergentheim
Germany
E-mail:
nezar.watted@gmx.net
08 I cosmetic
dentistry
2_ 2009
The era of orthodontic surgery in Europe began only
after World War I. The experience gained there led to a
substantial extension of the indications for orthodontic-maxillofacial surgical procedures, as well as to the
transferral of this surgical technique to the area of elective procedures.5,6,16–18,24 In the early 1920s, Bruhn and
Lindemann set transversal osteotomy of the Ramus
mandibulae as the standard method at the time for the
surgical correction of mandibular prognathism. This
method, which continued to have many adherents well
into the 1960s, is today known as the Bruhn–Lindemann
procedure.1,6,25,45
In 1935, Wassmund, who saw its drawbacks in a possible dislocation of the proximal segment by the muscles inserted there, described a modification of the
Bruhn–Lindemann surgical technique.26 In the early
1950s, a new era in orthodontic surgery of the mandible
was begun with Kazanjian’s resumption12,15,23 of the
technique of transverse, oblique severing of the ascending ramus, first performed by Perthes in 1922.22
Shuchard modified this method in 1954 by enlarging
the bony insertion surface, and in 1955 Obwegeser
introduced sagittal splitting at the horizontal ramus of
the mandible. He shifted the buccal osteotomy line
[9] =>
CDE0209_01_Titel
special _ orthodontics
I
obliquely from the last molar to the posterior margin of
the jaw angle.19–21 In 1959, Dal Pont moved this buccal
osteotomy line from the last molar to the inferior margin of the mandible.8,9 Since then, this method of sagittal split at the mandible has been called sagittal split
according to Obwegeser–Dal Pont (Fig. 1). Epker10 developed the incomplete sagittal splitinto a routine method.
_Clinical case presentation
History and diagnosis
A 25-year-old patient presented on his own initiative. He complained of functional (impairment of mastication and jaw joint pain) and aesthetic impairment
(sunken face with facial asymmetry). He had undergone
orthodontic treatment between the ages of 8 and 15
and reported pain in the area of the anterior mandible.
The lateral image showed a retrusive lower face
inclined forward with mid-facial hypoplasia—regio
infraorbitale—a flat upper lip and an elongated lower
face compared with the mid-face—47%:53% instead
of 50%:50%29 (Table I; Fig. 2a). Owing to the negative
sagittal overjet, there was a positive lower lip step. The
frontal image shows mandibular deviation (laterognathia) to the right, which can be traced to growth
asymmetry in the jaw (Fig. 2b). In addition, there was a
Class III dysgnathia angle with conspicuous mandibular midline deviation to the right, frontal and right lateral crossbite, anterior mandibular labial tilt, and a steep
anterior mandible. Tooth 26 had been missing for some
time (Figs. 3a–e). FRS analysis (Table I & II) clearly shows
the strongly sagittal and relatively weak vertical dysgnathia both in the soft-tissue profile and in the skeletal
region. The parameters indicated a mesiobasal jaw relationship and a growth pattern with an anterior course:
the vertical grouping of the soft-tissue profile showed a
disharmony between the mid-face and the lower face
(G’-Sn:Sn-Me’; 47%:53%). This was relatively weakly
expressed in the bony structures (N-Sna:Sna-Me;
44%:56%). In the region of the lower face there was also
mild disharmony (Sn-Stm:Stm-Me’; 31%:69%). Complementary assessment of the mandible showed that the
area from the subnasal-labral inferius to the soft-tissue
chin (Li-Me’), which should have been 1:0.9, was shifted
in favour of the Li-Me’ part (0.9:1; Fig. 4).The panoramic
image showed a lucency of teeth 31 and 41. A root canal
procedure followed by root apex resection was thus
performed (Fig. 5).
_Therapeutic objectives and treatment
planning
The objectives of this combined orthodonticmaxillofacial surgical treatment were:
1. the establishment of neutral, stable, and functional
occlusion with physiological condylar positioning;
Fig. 8a
Fig. 8b
Fig. 8c
Fig. 8d
2. the optimisation of the facial aesthetics;
3. the optimisation of the dental aesthetics, considering
the periodontal situation;
4. the assurance of the stability of the results achieved;
5. meeting the patient’s expectations.
Figs. 8a–d_The extra-oral treatment
results. The sagittal, vertical and transverse were corrected (a & b). Change in
the oral profile: left pre-op, right post-op
(c & d).
The improvement of the facial aesthetics not only in
the sagittal axis in the region of the lower face (the
mandibular region), but also in the region of the mid-face
(hypoplasia) and in the transverse axis should be noted as
specific treatment objectives. The change in the region of
the mid-face was intended to affect the upper lip and the
upper-lip vermillion. These treatment objectives were
achieved by two procedures:
1. a dorsal extension of the mandible with lateral sweep
to the left for correction of the sagittal and transverse
defects, as well as occlusion and the soft-tissue profile;
2. bone augmentation in the mid-face for harmonisation
of the face. It would not have been possible to achieve
cosmetic
dentistry 2
I 09
_ 2009
[10] =>
CDE0209_01_Titel
I special _ orthodontics
Fig. 9
Fig. 10
Fig. 9_The cephalometric image after
conclusion of treatment shows a
harmonious ratio between the skeletal
structures, as well in the sagittal axis
and the vertical axis, and harmonisation
in the soft-tissue profile between the
upper and lower face.
Fig. 10_Orthopantomogram after conclusion of the orthodontic treatment and
before the prosthetic care.
Table 1_Proportions of soft-tissue
structures before and after treatment.
Table 2_Proportions of skeletal structures before and after treatment.
the desired treatment objectives with respect to function and aesthetics using orthodontic procedures
alone.27
Therapeutic procedure
Correction of the pronounced dysgnathia was done
in six phases:28,30–33
1. Splint therapy: a flat bite guard splint was installed for
six weeks in order to determine the physiological
condylar position or centrics before the final treatment planning. By doing this, the forced bite could be
demonstrated to its full extent.
2. Orthodontics for forming and adjusting the dental
arches relative to each other and decompensation of
the skeletal dysgnathia (Figs. 6a–c).
Parameter
Mean
Before treatment
After treatment
G’-Sn/G’-Me’
50 %
47 %
50 %
Sn-Me’/G’-Me’
50 %
53 %
50 %
Sn-Stm/Stm-Me’
33 % : 67 %
31 % : 69 %
33 % : 67 %
Sn-Li/Li-Me’
1 : 0.9
0.9 : 1
1:1
Parameter
Mean
Before treatment
After treatment
SNA
82°
90°
90°
SNB
80°
93°
90°
ANB
2°
- 3° ( indl. 4,5°)
0° ( indl. 4,5°)
WITS-Wert
± 1 mm
- 8 mm
- 3 mm
ML-SNL
32°
20°
20°
NL-SNL
9°
4°
4°
ML-NL
23°
16°
16°
Gonion-<
130°
120°
120°
SN-Pg
81°
93°
90.5°
PFH/AFH
63 %
74 %
76 %
N-Sna /N-Me
45 %
44 %
44 %
Sna-Me/N-Me
55 %
56 %
56 %
Table 1
Table 2
10 I cosmetic
dentistry
2_ 2009
3. Splint therapy for determining the condylar position.
This was performed in the 4 to 6 weeks prior to the
surgical procedure. The objective was registration of
the jaw joint in a physiological position (centrics).
4. Oral surgery for correction of the skeletal dysgnathia:
after model operation, determination of the transposition path and production of the splint in the target
occlusion, the surgical mandibular translocation
using sagittal split according to Obwegeser–Dal Pont
was done. Augmentation in the mid-facial region was
done using autologous bone.
5. Orthodontics for fine adjustment of occlusion.
6. Retention: 3-3 retainers were cemented in the
mandible.
Mandibular and maxillary plates were used as the
retention appliance. Prosthetic care was provided after
six months.
_Results
Figures 7a–e show the situation after the conclusion
of treatment and after extraction of tooth 31 and subsequent prosthetic treatment, neutral occlusion, and
correct midline with physiological sagittal and vertical
bite. The extra-oral images show a harmonious profile in
the vertical as well as in the sagittal axis (Figs. 8a & b). The
oral profile is harmonious. The upper-lip vermillion is
distinctly visible in comparison to the original situation
(Figs. 8c & d).
The FRS shows the changes in the parameters that
arose as the result of the displacement of the mandible.
There is harmonisation in the vertical arrangement
of the bony and soft-tissue profile. The disharmony in
the lower third of the face has been corrected (Fig. 9;
Tables 1 & 2).
The OPG shows the positioning screws in both jaw
angles and the fixation screws of the augmented bone in
the mid-face (Fig. 10)._
Editorial note: A complete list of references is available from the publisher.
[11] =>
CDE0209_01_Titel
2009
Greater New York Dental Meeting
85th
Annual Session
The
Largest Dental
Convention/
Exhibition/Congress
in the United States
NO
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[12] =>
CDE0209_01_Titel
I case study _ prosthodontic management
Fixed prosthodontic
management of a mutilated
dentition: A team approach
Authors_Dr Helena Lee & Dr Ansgar Cheng, Singapore
Fig. 1_Pre-treatment intra-oral
frontal view, presenting with attrition,
loss of posterior support, reduced
VDO and compromised aesthetics.
Fig. 1
_Abstract
_Successful full mouth fixed rehabilitation
of a mutilated dentition is always a prosthodontic and surgical challenge. Accurate diagnosis,
proper treatment planning, prudent choice of
prosthodontic materials and meticulous treatment execution are essential for a successful
treatment outcome over a long period. The treatment of a partially edentulous oral cavity using a
combination of immediate-loading and delayedloading implant-supported porcelain-fused-tometal and full-ceramic restorations is presented
in this report.
_Introduction
Prudent clinical judgement and careful balancing of the risks and benefits of various treat-
12 I cosmetic
dentistry
2_ 2009
ment options are essential for a predictable longterm treatment outcome for prosthodontic treatment.1 It is known that loss of the vertical dimension of occlusion (VDO) may pose significant
clinical difficulties in prosthodontic treatment.2
The clinical procedures for the re-establishment of
a new therapeutic vertical dimension of occlusion
is seldom taught in undergraduate dental curricula. VDO is defined as the superior–inferior measurement between two points when the occluding
elements are in contact.3 Various methods have
been proposed for the clinical assessment of the
VDO.4 Loss of the tooth structure does not necessarily equate to loss of the VDO,5 as the VDO may
be maintained as a result of compensatory dental
eruption.6 When the clinical loss of the VDO is
small, accurate diagnosis can be difficult.7 In this
case study, the management objective was to
determine whether there was any need for the re-
[13] =>
CDE0209_01_Titel
case study _ prosthodontic management
establishment of the VDO in the case of small loss
and whether the proposed change in the VDO was
clinically acceptable. When the loss of the VDO is
small, any change in the VDO should be based on
the amount of interocclusal space required to
restore the dentition to proper form and function.
A significant alteration of the VDO should be
approached with care, and unnecessary, excessive
changes of the VDO should be avoided. In general,
a significant change of the VDO should be monitored over an extended period.8
Improvements in macroscopic implant morphology and surface treatments have led to the
reduction of healing time and the concept of immediate loading of implants.9–18 Early implant
loading is a successful protocol in selected
cases.19–24 Providing that sufficient bone volume
is available, flapless surgical implant placement is
predictable25, 26 and patients experience minimal
post-surgical discomfort.27
Fig. 2
Fig. 3
Fig. 4
Fig. 5
matisation of the maxillary sinus occurs after
extraction of molars. In addition, the posterior
maxilla has poorer bone quality, mainly Type IV
bone.28
Placement of implants in grafted bone sites
has a high success rate of osseointegation.29–32
Several authors have reported an approximate
92 per cent success rate of implants after sinus
augmentation.33 However, immediate implant
loading under such conditions is generally
avoided. The low failure rate may be attributed to
the placement of implants of greater lengths in
grafted bone sites.29, 30, 34
This case study describes the team approach
management of a mutilated dentition, using
different types of conventional and implantsupported fixed restorations with immediateloading and delayed-loading protocol.
_Clinical report
The posterior maxilla presents a unique challenge to implant placement when minimal bone
height remains inferior to the sinus floor. Pneu-
I
A 38-year-old patient presented with multiple
missing teeth. The patient desired the restoration
Fig. 2_Pre-treatment intra-oral
occlusal view of the maxilla, showing
dental attrition and inadequately
restored molars. The orthodontic
arch wire was broken.
Fig. 3_Pre-treatment intra-oral
occlusal view of the mandible, showing dental attrition and inadequately
restored teeth. A few of the orthodontic brackets were de-bonded
from the mandibular incisors.
Fig. 4_Pre-treatment orthopantomogram X-ray, showing adequate
endodontic fillings, over-eruption of
maxillary molars, inadequate
occlusal support and inadequately
restored teeth. Posterior mandible
bone bed was diagnosed as Type 2B.
Fig. 5_Completed tooth preparations
for full coverage restorations at the
approximated treatment VDO. Note
the equi-gingival preparation
margins. Implants were placed
immediately upon completion of
crown preparations.
cosmetic
dentistry 2
I 13
_ 2009
[14] =>
CDE0209_01_Titel
I case study _ prosthodontic management
Fig. 6_Completed anterior fullceramic crown restorations. Occlusal
support was gained by definitive
restorations on all the natural teeth
and mandibular implant-supported
prostheses to maintain the newly
established VDO.
Fig. 7_Panoramic radiograph after
insertion of the crowns. Additional
implants were placed in the maxillary
posterior areas.
Fig. 8_Occlusal view of completed
definitive maxillary restorations with
porcelain occlusal surfaces.
Fig. 9_Occlusal view of completed
definitive mandibular restorations
with porcelain occlusal surfaces.
of function and aesthetics. He was undergoing
orthodontic treatment. He presented clinically
with moderate dental attrition, defective
restorations, loss of posterior support, discolouration, mild loss of the VDO and compromised
aesthetics (Figs. 1–3). The pre-treatment radiograph showed adequate endodontic obturation, missing mandibular posterior teeth, overeruption of maxillary posterior teeth and attrition of the incisors. The dentition was free from
active dental caries and periodontal probing was
within normal limits. The maxillary left molar
region bone bed was determined to be inadequate
for the placement of dental implants. The
mandibular posterior bone bed was diagnosed as
Type 2B with sufficient bone density for early
implant-loading prosthodontic treatment (Fig. 4).
The overall fixed prosthodontic treatment
plan included placement of endosseous implants in the mandibular posterior area for
prosthodontic rehabilitation, using the early implant-loading protocol; placement of fixed
restorations in the maxilla and mandible; sinus
lift with bone augmentation on the patient’s left
Fig. 6
Fig. 7
Fig. 8
Fig. 9
14 I cosmetic
dentistry
2_ 2009
side; and simultaneous bilateral placement
of implants in the maxillary posterior area,
using the conventional two-stage protocol. This
was followed by the placement of implantsupported prostheses in the maxilla after a healing
period of six months.
Maxillary and mandibular diagnostic casts
were made of Type IV dental stone (Silky-Rock,
Whip Mix). The casts were mounted on a semiadjustable articulator (Hanau, Wide-vue, Teledyne Waterpik). Diagnostic wax-up was carried
out to restore the anterior teeth to proper form.
The resulting diagnostic wax-up indicated that
an increase of 1.0 mm in vertical dimension at
the incisal pin level was required to restore the
patient’s anterior teeth to proper form. Such
level of change of the VDO had no practical need
for prolonged provisionalisation before definitive prosthodontic treatment. The patient’s maxillary right second and third molars required a
reduction of 2.5 mm gingivo-incisal height, in
order to re-establish a proper occlusal plane. All
the natural teeth in the maxillary and mandibular arches required full coverage restorations.
[15] =>
CDE0209_01_Titel
case study _ prosthodontic management
I
Fig. 10_Post-treatment intra-oral
frontal view.
Fig. 10
The maxillary right second molar was restored
with an amalgam post-and-core foundation
prior to full coverage restoration preparation. An
adequate pre-existing composite resin core retained by a prefabricated post with sufficient
ferrule was noted in the mandibular left second
premolar.
tray loaded with putty material (Aquasil Putty,
DENTSPLY DeTrey) was seated over the entire
dental arch to make the definitive mandibular
impression. The maxillary definitive impression
was made in the usual manner. A centric relation
record was made with a vinyl polysiloxane material (Regisil PB, DENTSPLY DeTrey).
On the day of teeth preparation, all teeth were
prepared to receive full crown restorations. In
order to establish anterior guidance,35 the treatment indicated that the restoration of the anterior teeth should be completed before or at the
same time as the implant-supported restorations. The anterior teeth were prepared in the
usual manner for complete coverage crown
restorations. Margins of the tooth preparations
were kept supra-gingival, and no gingival displacement procedures on the prepared teeth
were necessary.
The development of the definitive crown
restorations was carried out as usual on the
definitive casts. Except for the maxillary right
molars, all maxillary and mandibular crowns
supported by natural teeth were restored with
Cercon (DeguDent) full-ceramic crowns. Prefabricated abutments (NobelReplace, Nobel Biocare)
were custom milled with a six-degree taper in
the dental laboratory to facilitate the development of the restorations. Splinted, cementretained, implant-supported mandibular restorations with porcelain occlusal surfaces were
made of porcelain fused to metal material.
Upon completion of the crown preparations,
six endosseous implants (NobelReplace, Nobel
Biocare) were placed by the periodontist in the
posterior mandible using a flapless surgical
protocol. All implants were placed with 45 Ncm
insertion torque (Fig. 5). No surgical template
was used during the surgical phase; the prosthodontist was present during the implant surgery
to ensure implant placement was prosthodontically acceptable.
On the day of restoration delivery, the
mandibular implant abutments were torqued
down to 32 Ncm. The abutment screw holes
were sealed with gutta-percha (Mynol, Block
Drug Company). All the definitive crowns were
cemented in resin-modified glass-ionomer
luting agent (RelyX Unicem, ESPE). The insertion
of crowns was followed by implant placement in
the maxillary arch.
Pick-up type implant impression copings
(NobelReplace, Nobel Biocare) were attached to
the newly placed mandibular implants. Highviscosity vinyl polysiloxane material (Aquasil
Ultra Heavy, DENTSPLY DeTrey) was carefully
injected onto all tooth preparations and the
implant impression copings. A stock polystyrene
In the presence of the prosthodontist, three
endosseous implants (NobelReplace, Nobel
Biocare) were placed by the periodontist in the
right maxilla, using a flapless surgical protocol.
The implants were inserted with 45 Ncm insertion torque. The implants were placed in the left
maxilla with a simultaneous sinus lift (Figs. 6 & 7).
cosmetic
dentistry 2
I 15
_ 2009
[16] =>
CDE0209_01_Titel
I case study _ prosthodontic management
The sinus space was augmented with a xenograft
material (Bioss, Geistlich Pharma).
beneficial for individuals with thin gingival
biotypes.
After a six-month healing period, the left maxillary implants were exposed. A definitive maxillary impression was made as usual. The fabrication of the definitive porcelain-fused-to-metal
implant-supported restorations was carried out
in the usual manner on the definitive casts.
Splinted, cement-retained, porcelain-fused-tometal restorations with porcelain occlusal surfaces
were prescribed for the implant-supported
maxillary posterior crowns. The maxillary implantsupported restorations were inserted in the same
manner described earlier using resin-modified
glass-ionomer luting agent (RelyX Unicem, ESPE;
Figs. 8 & 9).
Porcelain-fused-to-metal restorations were
used in the posterior teeth because of the welldocumented long-term clinical track record of
this restoration. In order to maximise the aesthetic outcome, porcelain occlusal surfaces were
prescribed.
_Discussion
Various newer implant clinical protocols and
conventional two-stage delayed-loading implant
protocols have a high level of clinical predictability. In this report, a flapless implant procedure,
single-stage implant placement, sinus lift augmentation, and early implant-loading and delayed
implant-loading techniques were applied.
_Conclusion
The clinical management of an aesthetically
demanding, complex functional prosthodontic
rehabilitation is a clinical challenge. Various
restorative materials were used for this treatment. A combination of full-ceramic restorations
and porcelain-fused-to-metal restorations with
porcelain occlusal surfaces enhances the overall
aesthetic outcome, as well as functional predictability. Various surgical and implant-loading
protocols were used, to ensure optimal results._
Editorial note: A complete list of references is
available from the publisher.
_author info
The treatment required a small increase in the
VDO. It was therefore necessary to make impressions that registered all tooth preparations simultaneously.
The patient desired a high level of aesthetics;
full-ceramic restorations were chosen for the
anterior teeth. As the minimum core thickness for
this full-ceramic system is 0.4 mm, this enabled
conservation of tooth structure while achieving
excellent aesthetics.
Traditional porcelain-fused-to-metal anterior
crown restorations require the placement of labial
crown margins within the gingival sulcus, in order
to mask the transition between the root surface
and the porcelain-fused-to-metal restoration.
By prescribing full-ceramic restorations, intrasulcular placement of crown margins on the labial
surface becomes less important from an aesthetic
standpoint.
In this report, the cervical tooth structure of
the anterior teeth was free of caries, teeth preparation margins were made at the gingival
level and gingival retraction procedures were
eliminated. As gingival retraction cord packing
was not required, mechanical trauma to the
gingival tissues was reduced and significantly
less clinical time was required. This is particularly
16 I cosmetic
dentistry
2_ 2009
cosmetic
dentistry
Dr Helena Lee
obtained her dental training
at the National University
of Singapore and her
periodontics specialty
training from the University
of London-Eastman Dental
Institute, UK. She is
a consultant periodontist
with Specialist Dental Group™ in Singapore.
Dr Lee can be reached at
drlee@specialistdentalgroup.com.
Dr Ansgar Cheng
obtained his dental training
from the University of Hong
Kong, his prosthodontics
specialty training from
Northwestern University,
USA, and his Certificate
in Maxillofacial Prosthodontics from UCLA, USA.
He is a Consultant Prosthodontist with Specialist
Dental Group™ in Singapore.
Specialist Dental Group™
www.specialistdentalgroup.com
[17] =>
CDE0209_01_Titel
(XURSHULR
-XQH 6WRFNKROP6ZHGHQ
The event of the year in
Periodontology and Implant Dentistry
&ORVHWRDEVWUDFWVVXEPLWWHG
7KHEHVWVSHDNHUVDUHFRPLQJ
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[18] =>
CDE0209_01_Titel
I clinical technique _ restoration replacement
Replacement of a
faulty posterior
restoration
Author_ Dr Sushil Koirala, Nepal
_A 21-year-old male patient presented complaining of sensitivity and mild pain when chewing
on tooth #36. During examination, an under filled
tooth with poor marginal seal and marginal discoloration was visible. The peri-apical radiograph indicated secondary caries.
After careful removal of the faulty composite
restoration, the cavity was treated with the fluoridereleasing bonding system Fl-Bond II and restored
with Beautifil Flow as a base and Beautifil fluoridereleasing materials (all SHOFU). Effect colours were
used on the occlusal surface to mimic the adjacent
tooth.
The main challenges in this case were the removal
of the faulty composite restoration with minimal intervention of the healthy tooth structure and the
mimicking of the occlusal anatomy and proper
shade._
Fig. 1_Poorly restored composite
restoration on tooth 36.
Fig. 2_Cavity after careful removal
of faulty restoration with diamond
point #340s.
_contact cosmetic
dentistry
Dr Sushil Koirala, VISA
president, can be reached
at skoirala@wlink.com.np.
Fig. 1
18 I cosmetic
dentistry
2_ 2009
Fig. 2
[19] =>
CDE0209_01_Titel
clinical technique _ restoration replacement
Fig. 3
Fig. 5
Fig. 7
I
Fig. 4
Fig. 3_Isolation of tooth 36 with
rubber dam.
Fig. 4_Application of self-etching
primer on the entire cavity.
Fig. 6
Fig. 5_Uniform application of
bonding agent and subsequent
light-curing.
Fig. 6_Application of a thin layer of
flowable resin on the cavity floor.
Fig. 8
Fig. 7_Application of flowable
opaque (#UO) to mask the
discolouration.
Fig. 8_Build-up of the dentin layer,
obtaining occlusal anatomy.
cosmetic
dentistry 2
I 19
_ 2009
[20] =>
CDE0209_01_Titel
I clinical technique _ restoration replacement
Fig. 9_Build-up of the enamel layer
and carving of the pits and fissures
to achieve natural anatomy.
Fig. 10_Application of dark brown
stain on the pits and fissures
to match adjacent tooth 7,
and light-curing.
Fig. 9
Fig. 10
Fig. 11_Checking the occlusal
contact with articulating paper.
Fig. 12_Reduction of the high points
with Dura White Stone #FL2.
Fig. 11
Fig. 12
Fig. 13_Note the restored anatomy
comparable to natural adjacent tooth.
Fig. 14_Restoration after finishing
and polishing.
Fig. 13
Fig. 14
20 I cosmetic
dentistry
2_ 2009
[21] =>
CDE0209_01_Titel
A CLINICAL GUIDE TO
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Available now for $ 50 (+shipping).
To order please contact books@dental-tribune.com
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[22] =>
CDE0209_01_Titel
I industry report _ digital impression-taking
Simplified digital
impression-taking
Author_ Dr Helmut Götte, Germany
Fig. 1_CEREC Bluecam Intra-oral
Scanner.
(Image: Götte)
Fig. 2_Quadrant scan with preparations, created from automatically
joined individual images to
yield a 3-D preview.
(Image: Götte)
Fig. 1
_As the only system in the world that uses the
principle of triangulation for intra-oral measurements, the CEREC system is setting higher standards in CAD/DAM technology with CEREC AC and
the CEREC Bluecam camera. Never before have
intra-oral scans been made as fast, sharp, or accurately in 3-D. Whole-jaw images broaden the indication spectrum and, with virtual models, allow
the dental office and the dental laboratory to work
together impression-free.
The advantages of an improved intra-oral
image-capturing system do not stop at producing
larger restorations chairside. The simplified inclusion of the adjacent teeth and the opposing jaw
makes it possible to improve the occlusal and functional design, and the more exact measurement of
the preparation enables an increase in the information content of the image. Furthermore, intraorally recorded 3-D data sets of gnathic situations
offer new diagnostic possibilities.
The acquisition unit of the CEREC 3D system—
called CEREC AC (acquisition center)—has been
equipped with a new camera (Bluecam). CEREC AC
replaces the previous CEREC 3 acquisition unit;
however, the new software still supports the
CEREC 3 camera. CEREC AC is compatible with both
milling units—CEREC 3 milling unit and CEREC MC
XL (extra large).
The heart of CEREC AC is the Bluecam camera.
Instead of infrared light, Bluecam emits shortwave blue light produced by diodes. In addition,
the lens configuration is new: aspherical lenses
bundle the light beam and orient it parallel to the
image sensor (CCD). The light sensitivity has been
increased, the image capture time shortened by 50
per cent, and the image sequence accelerated. The
Fig. 2
22 I cosmetic
dentistry
2_ 2009
[23] =>
CDE0209_01_Titel
industry report _ digital impression-taking
projection matrix still employs the tried-andtested light-stripe grid.
_Faster, sharper, blur-free
As a result, the new Bluecam offers higher image accuracy in the clinical situation: the measurement depth has been increased by 20 per cent
and the focus depth deepened to 14 mm. The
sharpness of individual images has been heightened, and marginal blurring eliminated. Blur control (automatic capture), the sensitivity of which
can be pre-selected, checks the intended image,
and the camera automatically takes the image only
when it is certain there is no blurring. In quadrants
and across the dental arch, any number of pictures
can be taken as an overlapping sequence.
The 3-D image catalogue manages the individual images on the screen. The software assesses
their usefulness, marks and rejects useless scans,
and joins the images to form a complete row of
teeth (matching) and a virtual cast modelled on the
natural example. Images acquired at the beginning
of the sequence, the quality of which may have
been lessened owing to the presence of rubber dam
or cotton rolls, are automatically exchanged for a
suitable image pair as soon as this is found. In this
way, inadequate images are quickly replaced. In
vitro studies in the laboratory at the University of
Zurich in Switzerland have shown that the image
accuracy deviates from the reference measurement of a master laboratory scanner by only
19 µm—this is equivalent to one-third of the diameter of a human hair. This means Bluecam’s accuracy is similar to that of stationary laser scanners.
Such precision increases the marginal fitting
accuracy of the restoration; thus, less excess
occurs during adhesive luting, which in turn takes
less time to remove.
I
Because of the image depth and focus depth, it
is not necessary to keep an exactly determined
distance from the preparation; the camera’s prism
window can be placed directly on the tooth, which
makes image acquisition easier, particularly in the
distal region. The Autocapture function, responsible for actually taking the image, engages automatically upon ensuring that the image is in focus.
Hence, there is no need to operate a footswitch,
which requires eye–foot coordination. This means
that an entire quadrant can be scanned in 30 seconds. The blur control makes the image sequence
and menu operation accurate and simple; thus,
this phase can be delegated to the dental assistant.
If the acquisition unit has a wireless or WLAN connection to the milling unit, the system can operate
without power with no data loss for up to six minutes, thanks to its own optional, uninterrupted
power supply—ideal for changing location during
the milling/grinding phase.
_Up to four-unit bridges chairside
Bluecam takes about 30 seconds to scan a complete quadrant and is suitable for scanning stone
casts. In addition, bite records with static and dynamic occlusion are digitised and prepared for
functional articulation of the restoration. After selecting bridge tooth databank, the preparation for
a four-unit bridge can be scanned with Bluecam.
This enables the construction and chairside manufacture of long-term, provisional compositeresin restorations employing the CEREC milling
unit, which broadens CEREC’s indication spectrum
considerably.
As when constructing crowns with CEREC 3D,
fissure axes and cusps of the adjacent teeth are
analysed—if desired, the antagonists’ morphology
is also analysed—and incorporated into the
Fig. 3_Crown restoration: adjusting
the counterbite for occlusal surface
design, region 24.
(Image: Götte)
Fig. 4_Completing the crown’s
occlusal surface.
(Image: Götte)
Fig. 3
Fig. 4
cosmetic
dentistry 2
I 23
_ 2009
[24] =>
CDE0209_01_Titel
I industry report _ digital impression-taking
Fig. 5
Fig. 6
Fig. 5_Crown 24 after adhesive
insertion.
(Image: Götte)
Fig. 6_CEREC AC showing Bluecam
and Quadrant Scan.
(Image: Sirona)
occlusal surface calculation. The software adjusts
the occlusal contact points and sliding planes of
the crown construction to the occlusal surface of
the antagonist. The wall thickness of the projected
ceramic framework is checked beforehand, as are
the insertion paths of the abutment crowns. After
designing the restoration, the data set can be
transmitted to the milling unit or the practice’s
laboratory, or sent via LAN or wireless LAN to the
dental laboratory. In the rapid milling mode of the
CEREC MC XL milling unit, a four-unit bridge can
be produced in about 20 minutes. Composite resin
blocks by VITA (CAD-Temp) and Merz (artBloc Temp)
can be used to fabricate the provisional restoration. The milling preview shows the size of the block
required and the positioning of the restoration in
the material—ideal when using ceramic blocks
with integrated, density-determined enamel/
dentine colour progression (VITA TriLuxe, Ivoclar
Multishade).
smallest possible initiation into the CEREC system,
which can be expanded upon to any extent desired.
Every inLab laboratory can make use of this option
to accept work from impression-free practices and
manufacture all-ceramic crowns and bridges
using CAD/CAM technology.
With the milling unit CEREC MC XL, the new
CEREC 3D software and CEREC Connect, CEREC AC
sets a new standard in restorative dental treatment. The system’s ease of operation allows a constant and time-saving workflow in the dental
office. The progressive technology also offers new
opportunities for highly efficient cooperation with
the dental laboratory. In addition, the modular
nature of the CEREC system, its consistent development, and its total compatibility with all system
components, including the labside system inLab,
ensure complete treatment flexibility and sustainable investment security._
_The virtual cast, online
_author info
Using the CEREC Connect system, the digital
data of the optical impression, even of the whole
jaw, can be sent from CEREC AC to the dental laboratory. This enables the cast-free manufacture of
the restoration. In the future, it will be possible to
manufacture a physical cast using these data from
a portal, for dental laboratory use. In this manner,
all single-tooth restorations could be manufactured, such as inlays, onlays, partial crowns, veneers, crowns and temporaries. For crown-andbridge frameworks of up to four units, any dental
laboratory lacking a CEREC milling unit will in
the future be able to access the Internet portal
infiniDent to have a cast manufactured, which will
serve as the starting point from which the laboratory itself can manufacture the framework. Thus,
CEREC AC and CEREC Connect together offer the
24 I cosmetic
dentistry
2_ 2009
cosmetic
dentistry
Dr Helmut Götte
studied dentistry at the
University of Munich were
he graduated in 1993.
Today, Dr Götte runs a
fully digitalised, paperless dental office in
Bickenbach, Germany.
He has been using CEREC
since 1996 and is a
member of German Society of Computerized
Dentistry.
Dr Götte can be reached at
helmut.goette@goette-online.de
[25] =>
CDE0209_01_Titel
[26] =>
CDE0209_01_Titel
I industry report _ CAD/CAM
The new NobelProcera
system for clinical success:
The next level of
CAD/CAM dentistry
Authors_ Hans Geiselhöringer & Dr Stefan Holst, Germany
Fig. 1
Fig. 1_Modern materials combined
with CAD/CAM technology present
solutions for all clinical indications.
26 I cosmetic
dentistry
2_ 2009
_Introduction
_While implant dentistry has broadened the
range of treatment options available for patients,
CAD/CAM technology is changing the restorative
quality and concepts of the future. Advantages related to material and manufacturing will promote
the continued preference of CAD/CAM systems to
conventional casting techniques. The advantages
new technologies offer include standardised
quality guaranteed by industrial fabrication
methods, excellent precision of fit, and outstanding biocompatibility, combined with adequate
mechanical strength and provisions for aesthetic
design. While there are many CAD/CAM systems
on the market, only very few actually provide a
broad range of products for different indications.
The NobelProcera system advances digital dentistry to the next level in that it provides the ability to manufacture high-quality conventional
restorations and implant-retained restorations
from various materials.
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I
Fig. 2_The working principle of
a conoscopic laser scanner. The significant difference to conventionally
used non-contact triangulation
scanners is the co-linearity of the
laser beam.
Fig. 2
Fig. 3a
Fig. 3a_Schematic illustration of the
conoscopic holography (left) and triangulation working principle (right).
The impact of advanced materials and manufacturing techniques on dentistry is significant.
Owing to their many advantages, CAD/CAM technology and industrial fabrication of prosthetic
components will replace several conventional
laboratory fabrication processes in the future. Today, almost any clinical situation from conventional tooth-supported to implant-retained
superstructures can be manufactured. This broad
versatility and a guarantee of the highest quality
material and precision of fit ensure reliable and
safe solutions for any clinical indication irrespective of the type of finishing (Fig. 1). Moreover,
industrialised fabrication methods reduce costintensive manual labour and provide cost-efficiency in the dental laboratory and practice.
Fig. 3b
The CAD/CAM system is able to minimise
material incompatibilities, corrosive phenomena
due to dissimilar metal alloys, interfaces between
cast and machined components, and inadequate
precision of fit.
This influences both the long-term success of a
restoration and the aesthetic outcome. However, the predominant criteria for success are adequate treatment planning
and the precise transfer of the intraFig. 4 oral situation into a digital data set.
Fig. 3b_General set-up of triangulation scanners prevents scanning of
deep cavities due to shadowing effects
(left). Co-linearity of the beam in
conoscopic holography (right) allows
for scanning of deep cavities
(e.g. impressions).
Fig. 4_The new NobelProcera scanner (Nobel Biocare) based on conoscopic holography provides high
accuracy for both impression-scanning and conventional cast-scanning.
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Fig. 5a
Fig. 5b
Fig. 5c
Fig. 5d
Fig. 5a_CAD/CAM technology allows
virtual design of single- and multipleunit frameworks (a NobelProcera
software, Nobel Biocare).
Figs. 5b–d_Advanced software systems provide an additional margin of
safety for the technician and the
patient, as cross-sectional views
allow for assessment of the correct
framework dimension. As the
connector area is the most critical
aspect of long-term clinical success,
special software features (NobelProcera software, Nobel Biocare)
help to design the connector
appropriately.
_Conoscopic holography: The next level of applications. In conoscopic holography—
in non-contact digitisation in dentistry unlike triangulation—the measurement is not
Currently the majority of scanners utilised in
dentistry apply the triangulation principle. The
configuration consists of two sensors (one a digital sensor and the other a camera or light-projector) observing the object. The triangulation
sensor projects light onto the object, which is
reflected back to a detector that is at an angle to
the emitted light. The position of the illuminated
pixel creates a triangle (light, object, detector)
that allows the calculation of the distance from
the sensor to the object. Owing to the working
principle, this technique is adequate for scanning conventional dental casts predominantly.
Although initial attempts to scan cavities were
made, the general set-up has distinct limitations
(shadowing effect). A variation of triangulation
is structured light (projected fringes) projected
onto the object. A camera, offset slightly from
the pattern projector, looks at the shape of the
light and uses a triangulation technique to
calculate the distance of every point on the line.
An innovative technology introduced with
the new NobelProcera non-contact scanner is
conoscopic holography. The most significant
difference to triangulation is the co-linearity of
the laser beam: the light is emitted and reflected
in the same axis, allowing for a whole new range
28 I cosmetic
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2_ 2009
based on the geometry of the sensor and the
system. Conoscopic holography creates a special
fringe pattern and signals proportional to the
distance from the object, and obtains a large
amount of quality data reflected back from the
surface, increasing measurement capability and
precision. The scanner can digitise any convex
(positive) or concave (negative) geometry that
the laser beam is capable of ‘seeing’ with coverage of up to 240º (180º + 60º undercuts). This setup combined with the co-linearity also allows
for the scanning of impressions, eliminating a
potential step for inaccuracies, such as model
fabrication (Figs. 2–4).
_Ease of use and additional safety
features with improved design software
In order to ensure efficient workflow, the
digitisation and manufacture of components
is needed, as well as a user-friendly software
interface and intuitive handling.
Current scientific findings and clinical experience underscore the need for adequate material manufacture and framework design to
minimise clinical failures, such as the chipping of
veneering ceramics or fracture of frameworks.
The most important request—especially when
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I
Fig. 6
working with zirconia substructures—is that the
framework is anatomically designed and no
manual post-processing adjustments are
needed. Previously, double-scans were performed to achieve this goal. However, with new
software design tools, these time-consuming
and cost-intensive steps are unnecessary, as
‘anatomic tooth-libraries’ support the user in
optimal restoration and framework design. Automatic cutback functions increase the ease of
use and provide an additional margin of safety
by ensuring homogenous veneering material
thickness.
An equally important aspect to consider is the
design and dimension of the connector crosssection for fixed dental prostheses. Long-term
clinical success is ensured only if minimum connector dimensions are respected. Newly developed software tools support the user in virtual
design of the frameworks and provide immediate feedback on cross-sectional area, connector
height and width, as well as coping thickness
(Figs. 5a–d).
_Versatility for patients’ demands
and expectations: Material selection
A wide range of materials can be used in
CAD/CAM manufacturing. Important aspects to
consider include long-term stability in the oral
cavity, biocompatibility, and post-processing
options (for example, the type of veneering material).
Advancements in ceramic materials research
have led to the development of high-strength,
non-silica-based ceramics that have beneficial
properties, including biocompatibility, aesthetics and long-term function. Aluminium oxide
(Al2O3) and zirconium oxide (ZrO2) ceramics are
the most common materials for copings, FPD
frameworks, and implant abutments. It is often
wrongly assumed that CAD/CAM technology is
only applicable to zirconium ceramics. Actually,
CAD/CAM technology can be applied to a variety
of materials. Aluminium oxide ceramics are the
material of choice in aesthetically demanding
areas, for example the anterior dentition, owing
to their beneficial light optical properties.
Fig. 6_In order to maximise aesthetic
outcome, shaded zirconia abutments
(NobelProcera Abutment Shaded
zirconia, Nobel Biocare) can be
combined with alumina or zirconia
copings.
In addition, the clinical applicability of Al2O3
in single-tooth and short-anterior FPD has been
clinically proven, and Al2O3 surpasses zirconium
in terms of long-term clinical success and aesthetic outcome. In contrast, for large-span and
posterior restorations, yttria-stabilised zirconium dioxide (Y-TZP) is the material of choice.
The material fracture strength properties of
Y-TZP allow its application in any area of the oral
cavity where strength and stability are more
important than aesthetics. Additionally, the
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material properties of zirconium make it a reliable
alternative to cast alloys for implant-retained
superstructures, including implant abutments
and multi-unit implant-retained bridge frameworks. The availability of shaded zirconia is yet
another step towards extensive and highly
aesthetic solutions for the patient (Fig. 6).
Alternative materials are titanium and nonprecious alloys, such as cobalt-chrome (CoCr). If
centrally manufactured, these materials ensure
excellent precision and long-term function in
the oral cavity (Figs. 7a & b).
Additionally they may be applied whenever
space requirements or expected biomechanical
forces prohibit the use of ceramic materials or as
long-term provisional restorations. With the
new NobelProcera software, deciding on the
appropriate material needs merely a click of a
button.
_Clinical versatility through solutions
for natural teeth and implants
A basic requirement of a modern CAD/CAM
system is providing solutions for natural teeth
and implants. In the future, implant-retained
restorations for missing teeth will become the
predominant form of restoration. The clinical
Fig. 7a
Fig. 7b
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I
Figs. 7a & b_Industrial fabrication
provides consistent product quality
irrespective of material ordered,
owing to material-specific milling
and sintering strategies impossible in
small units (Nobel Biocare production
facility Tokyo, Japan).
Fig. 8_Screenshot of the design tool
for implant-retained frameworks
(NobelProcera software, Nobel
Biocare). Cost-efficient workflow and
high precision make this approach a
very promising one for the future.
Fig. 8
success rates, the high predictability and a reduction of costs, as well as the implementation
of implantology in dental school curricula will
lead to more frequent and earlier implant placement when a tooth is deemed non-restorable.
The abutment design and material to restore
implant-retained single-tooth or implantretained FPD restorations must fulfil some basic
requirements. Today, multiple abutment types
are available. Various studies have demonstrated the successful application of ceramic
and titanium abutments in terms of acceptable
soft-tissue and marginal bone stability.
A study examining different abutment materials and their influence on soft-tissue barriers
surrounding dental implants found that the type
of material used affected both the height and the
quality of the tissue. Titanium and ceramic abutments permitted the formation of a mucosal
attachment, while gold-alloy and metalceramic abutments led to soft-tissue recession
and crestal bone resorption. Similar findings
were observed through in vitro studies that validated the finding of reduced plaque and bacterial adhesion on titanium or zirconia abutments.
An indispensable factor of the long-term
clinical success of implant-retained superstructures is the precision of fit. Depending on the
complexity of a restoration, poor fit can have a
significant impact on function and stability in
the oral environment. When it comes to reproducible precision, CAD/CAM technology clearly
outperforms conventional framework manufacturing techniques. New generation software
tools eliminate the need for time-consuming
framework design on the master cast. Instead, a
scan of the implant position can easily be
matched to a scan of a wax-up, followed by a
virtual framework design in the CAD tool. Adjusting the design and dimensions according to
the anticipated final contour of the definitive
restoration is done in a few minutes instead of
several hours with conventional fabrication protocols (Fig. 8).
Eliminating time-consuming and cost-intensive fabrication steps in the laboratory is not
only beneficial for economic considerations, but
also leads to an overall increase in precision and
component quality through industrial manufacturing processes._
Editorial note: A complete list of references is
available from the authors.
_contact info
cosmetic
dentistry
Hans Geiselhöringer
Dental Technician
Dental X Hans Geiselhöringer GmbH & Co. KG
Lachnerstraße 2
80639 Munich, Germany
Dr Stefan Holst
University Clinic Erlangen
Dental Clinic 2 – Department of Prosthodontics
Glueckstraße 11
91054 Erlangen, Germany
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I industry report _ all-ceramics & tooth whitening
Aesthetics with
all-ceramics and
tooth whitening
Author_ Dr Marcus Striegel, Germany
_Many dentists continue to have reservations
about bleaching and are hesitant to include tooth
whitening in the range of services they offer to
their patients. At the same time, increasing
numbers of patients are more aware of their teeth
and tooth colour. Many people feel upset about
their teeth not meeting their expectations of an
ideal aesthetic appearance.
A smile that is marred by a dark anterior tooth
can be restored to its natural beauty by means of
a minimally invasive bleaching treatment in the
Fig. 1a
Fig. 1b
32 I cosmetic
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dental practice—a treatment that is cost-effective and will leave most patients completely
satisfied.
Surveys have shown that over 90 per cent of
patients are highly satisfied with the results
achieved by whitening discoloured or yellowish
teeth with bleaching materials applied under the
supervision of a dental professional. However, it
is essential to have a thorough understanding of
the aetiology of the discolouration and to adhere
strictly to the indication guidelines regarding
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the risks and limitations of bleaching, to ensure
that the treatment provides safe and predictable
results in practice.
_Case presentation
A young female patient presented with a request for a lighter tooth shade. Teeth 12, 11 and 21
had previously been restored with ceramic
crowns. In the course of the patient’s consultation, the need for replacing the existing crowns
was discussed.
It is often advisable to commence the bleaching treatment in one jaw only, to demonstrate the
outcome of the whitening process to the patient
and align the treatment to the patient’s expectations. This simple step soon raised the patient’s
enthusiasm for the treatment.
_How can I access the ‘world of bleaching’?
Tooth whitening, using a deep-drawn tray and
appropriate gels in the practice or at home, is an
established bleaching method, even if this option
is not quite as spectacular for the patient as
bleaching with laser or UV-light. Deep-drawn
trays are produced in a relatively straightforward
procedure using thermoformable material on a
stone model. It is worthwhile equipping the practice with a basic thermoforming unit, if you have
not already done so. Various concentrations of
carbamide peroxide preparations are available on
I
the market. Higher concentrations provide faster
results, but they involve the increased risk of
reversible side effects, such as a burning sensation
of the gums and hypersensitivities. It is important
to provide the patient with clear guidance on how
to apply the whitening gel.
According to the treatment plan, the upper jaw
was first bleached using VivaStyle gel (Ivoclar
Vivadent) containing 16 % carbamide peroxide
and a tray. The patient wore the tray for one hour
a day over a three-week period. In the course of
the subsequent recall visit, she decided to extend
the treatment to the lower jaw. Figures 2a and b
show the teeth at the end of the bleaching treatment. Compared with the shade of the crowns on
teeth 12, 11 and 21, the bleaching effect is clearly
noticeable.
Normally, the degree of brightness achieved
during the bleaching process will slightly decrease upon completion of the treatment. It is
therefore necessary to wait at least two weeks
before initiating any further treatments. In the
present case, the existing crowns were replaced
two months after completion of the whitening
procedure.
Figs. 1a & b_Initial situation: tooth
shade of the existing restoration
(A3.5).
Figs. 2a & b_Tooth shade after the
application of VivaStyle 16 % for
three weeks. The shade of the natural
teeth is clearly lighter than the shade
of the existing restorations.
Figs. 3a–c_Prepared teeth and oral
situation after cementation.
Fig. 4_Final situation.
Figures 3a to c show the prepared teeth. The
original dentine shade contrasts with the shade of
the adjacent bleached teeth. In this case, we did
not have to forgo the aesthetic advantages of
glass-ceramic materials, as special opaque ingots
Fig. 2a
Fig. 2b
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that are capable of masking the shade of the tooth
preparation are now available. We decided to restore the teeth of our patient with IPS e.max Press
(Ivoclar Vivadent) in combination with the
veneering ceramic IPS e.max Ceram (Ivoclar
Vivadent). This ceramic not only offers a variety of
aesthetic possibilities, but can also be cemented
using a conventional technique because of its
high flexural strength. Whenever possible, we
prefer using an adhesive cementation technique
in conjunction with an aesthetic dual-curing luting composite. Variolink II (Ivoclar Vivadent) is a
proven adhesive composite that has been used for
many years in dental practice. The possibility of
enhancing the shade effect of the final restoration by selecting an appropriate cement shade
can be advantageous in some cases.
Fig. 3a
The result speaks for itself: the crowns harmoniously blend into the anterior region and complement the outcome of the treatment in terms of
shade and shape.
_Conclusion
The whitening of discoloured tooth structure
can be effectively integrated into a practice concept that helps patients to overcome their initial
fear of dental treatment. As this type of treatment should always be performed under the
supervision of a dental professional, patients are
given a detailed consultation to establish their
requirements prior to commencing the treatment. In the process, patients are made more
aware of the range of prophylactic measures
and high-quality dental treatments available to
them. The combination of all-ceramic restoration and bleaching can form an aesthetic
treatment strategy to enhance the smile of
patients in a straightforward fashion with a high
success rate._
Fig. 3b
Fig. 3c
_author info
cosmetic
dentistry
Dr Marcus Striegel
Ludwigsplatz 1a
90403 Nürnberg
Germany
E-mail:
striegel@praxis-striegel.de
Fig. 4
34 I cosmetic
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[35] =>
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FDI Annual World Dental Congress
2 -5 September 2009
Singapore
congress@fdiworldental.org
www.fdiworldental.org
[36] =>
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I industry report _ natural layering concept
Learning and
applying the
Natural Layering
Concept
Author_ Prof Didier Dietschi, Switzerland
Right_Dentine samples of the Miris 2
system, developed according to the
NLC. Dentine samples all have the same
hue but different chroma levels.
Below_Enamel samples and effect
shades of the Miris 2 system. There are
three tints (white, neutral and ivory) with
different translucency levels and high
opalescence that allow for an optimal
imitation of natural enamel optical
effects and behaviour (a). Two different
white effect masses plus light, opalescent blue and gold shades allow the
replication of specific colour effects,
such as localised opalescence,
enamel hypocalcification and dentine
sclerosis (b).
a
36 I cosmetic
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_Composite resins nowadays occupy
a paramount position among restorative
materials because they offer excellent aesthetic potential and acceptable longevity,
with a much lower cost than equivalent
ceramic restorations for the treatment of
both anterior and posterior teeth.9,11–13 In
addition, composite restorations allow for
minimally invasive preparations or no
preparation at all when replacing decayed
or missing tissues. This approach is part of
a new concept termed bio-aesthetics that gives
priority to non-restorative or additive procedures,
such as bleaching, micro-abrasion, enamel recontouring, direct composite resins, bonded
bridges, and implants, in the case of missing dental
units or cases that are more complex. These many
procedures definitely
merit further attention
because they offer
tremendous improvements in practicability,
efficiency and predictability.2,8,10,11,14,15,17 All
together, bio-aesthetics undoubtedly moves
aesthetic and restorative dentistry to a new
b
level; one that can be
described as comprehensive and conservative
smile design.
For quite some time, the creation of perfect direct
restorations has been an elusive goal because of the
imperfect optical properties of composite resins and
perfectible clinical procedures. The attempt to mimic
the shades and layering techniques developed for
ceramic restorations led to complicated application
methods, controllable only by highly skilled practitioners. For years, this has limited the number of
patients who could benefit from the tremendous
advantage of free-hand bonding. The use of the
natural tooth as a model and the identification of
respective dentine and enamel optical characteristics (tristimulus L*a*b* colour measurements and
contrast ratio) have been essential in developing
better direct tooth-coloured materials.1,3,4
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The Natural Layering Concept (NLC) is
a simple and effective approach to the
creation of highly aesthetic direct restorations. The concept is increasingly referred
to in the field of composite restorations;
thus, the aim of this article is to familiarise
the practitioner with the features and
clinical aspects of this new technique.
Fig. 1a
_A new array of indications for
free-hand bonding
Besides classical indications, such as
the filling of Class III, IV and V cavities,
many other aesthetic or functional problems can be addressed by simple direct
composite restorations. The indications
are as follows:
I
Fig. 1a_Pre-op view of a 50-year-old
patient with natural arrangement
of teeth following bilateral incisor
aplasia.
Figs. 1b & c_Lateral views demonstrate the numerous aesthetic
deficiencies, such as incorrect space
distribution, tooth form proportions,
axis and abrasion.
Figs. 1d & e_Post-op view of reconstructed smile following bleaching
and the use of additive procedures.
Fig. 1f_The 4.5 years post-op
view shows the good behaviour of
these restorations and illustrates the
potential of conservative adhesive
dentistry to resolve relatively
complex aesthetic cases.
Fig. 1b
1) Congenital aesthetic deficiencies
Owing to the early preoccupation of
patients with these aesthetic anomalies,
a conservative aesthetic correction of
these conditions is increasingly mandated (Figs. 1a–f):
Fig. 1c
Fig. 1d
Fig. 1e
Fig. 1f
_displasia/discolorations;
_hypoplasia;
_unsual tooth forms or dimensions;
and
_diastemas.
2) Post-orthodontic conditions
Lateral incisor aplasia or incorrigible
canine impactions are frequent findings,
approached often with an orthodontic solution. Unfortunately, different anatomical, functional and aesthetic anomalies
may result from such an orthodontic
approach. Patients’ increasing concern
for aesthetics obliges the dental team to
correct these deficiencies (Figs. 2a–h):
_unusual crown dimensions (larger
or smaller);
_unusual root diameter (larger or
smaller);
_unusual shape of the crown;
_difference in colour (mainly for cuspids); and
_difference in gingival contour or
level.
3) Acquired and other aesthetic deficiencies
Many other aesthetic deficiencies in
fairly intact dentitions also require
conservative correction (Figs. 3a–e):
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Figs. 2a–c_Smile of a 30-year-old
patient showing aged and unaesthetic composite reconstructions
of canines, following lateral
incisor aplasia.
Fig. 2d_A rubber dam is in place
from premolar to premolar to allow
for a full smile view and comprehensive correction of the six front teeth.
Figs. 2e–h_The post-op views show
the final conservative smile rehabilitation, using direct bonding to
re-establish better tooth proportions
and forms (enlargement of central
incisors, reshaping of lateral incisors
and premolars).
Fig. 2a
Fig. 2b
Fig. 2c
Fig. 2d
Fig. 2e
Fig. 2f
Fig. 2g
Fig. 2h
_discolourations (i.e. traumatised non-vital
tooth);
_diastemas;
_abrasion, abfraction and erosion lesions;
_tooth fractures;
_caries; and
_functional deficiencies.
All aforementioned conditions are potential indications for conservative additive treatments, according to pre-existing tissue loss and functional status.
_A new shading concept
The use of the natural tooth as a model was a
logical development of direct restorative materials
38 I cosmetic
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that led to the simplified shading and layering
concept, the NLC. It is based on the identification of
true dentine and enamel optical characteristics
using tristimulus L*a*b* colour and contrast ratio
measurements.1,3,4
Dentine replacement
The aforementioned measurements led to the
following recommendations regarding the optical
characteristics of an ideal material aimed at replacing dentine:
_single hue;
_single opacity; and
_large chroma scale (beyond the four chroma
levels of the VITA system)
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Fig. 3a
Fig. 3b
Fig. 3c
Fig. 3d
I
Fig. 3a_Young adult presenting
hypoplasia of numerous front teeth.
Some lesions were previously
restored with an incorrect direct
composite technique.
Figs. 3b & c_Teeth were bleached
before initiation of a new restorative
phase. The previous composite
material was first removed to expose
underlying sound tissue.
Figs. 3d & e_Better tooth shape and
colour integration could be achieved
through a simplified and improved
direct restorative technique (NLC)
and Miris 2.
Fig. 3e
Actually, variations in a* and b* dentine values between ‘A’ and ‘B’ VITA shades seemed not to justify
the use of distinct dentine colours, at least for a
direct composite restorative system. Likewise, the
variations of the contrast ratio (opacity–translucency) within a single shade group did not support
the use of different dentine opacities (i.e. translucent,
regular or opaque dentine). However, the concept of
a large chroma scale covering all variations of
natural dentitions plus some specific conditions like
sclerotic dentine (as found underneath decays,
fillings or cervical lesions) proved justified.
Enamel replacement
Concerning enamel, differences in tissue lightness and translucency proved generally to vary
with tooth age. This confirmed the clinical concept
of three specific enamel types:16
_Young enamel: White tint, high opalescence,
lower translucency;
_Adult enamel: Neutral tint, lower opalescence,
intermediate translucency; and
_Old enamel: Yellow tint, higher translucency.
These findings have logically fashioned the concept of an optimal restorative material. Dentine
shades should be available in one single hue (VITA
‘A’ or Universal dentine shade) with a sufficient
range of chroma (covering at least the existing VITA
shade range) and presenting opacity similar to that
of natural dentine. Enamel shades should present
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_Clinical application of the Natural
Layering Concept
Composites can be applied by following different incremental techniques for aesthetic or practical reasons and better management of polymerisation stresses. The classical approach is the centrifugal technique, indicated for Class III, small Class IV,
and limited form corrections (Figs. 4a—c). It implies
the placement in depth of one or two dentine layers (in Class III cavities, 01 with oblique position),6
followed by the enamel, covering the entire surface.
Fig. 4a
Fig. 4b
Figs. 4a–c_The centrifugal technique: Post-preparation (a). The first
layer is the dentine increment, placed
in the depth of the preparation (b).
The second layer is the enamel
increment, creating the restoration
surface (c).
Fig. 4d–g_The bucco-lingual tech-
nique: for optimal 3-D control of complex build-ups: Post-preparation (d).
The first layer is an enamel
increment, placed into the silicone
index (e). The second increment is
the dentine, placed buccally onto the
previous enamel layer (f).
The third layer is composed of additional enamel increments, creating
the restoration surface (g).
Figs. 5a–c_The maturation of
tissues influences incisal edge
anatomy. Young tooth configuration:
The dentine core that has a low
chroma is fully covered with a white,
opalescent enamel (a). Adult tooth
configuration: The dentine core with
medium chroma is usually covered
with a more neutral, opalescent
enamel. Dentine extends close to, or
is even exposed at, the incisal edge
(b). Old tooth configuration: The dentine core with higher chroma is covered with a thinner, more yellow and
translucent opalescent enamel. Dentine extends to the incisal edge (c).
various tints and opacity levels, tentatively replicating all variations found in nature. Well-known
brand names include Miris and Miris 2 (Coltène
Whaledent), Ceram-X duo (Dentsply) and Enamel
HFO (Micerium).
The influence of the Natural Layering Concept
on shade recording
The quality of the final restoration depends on
correct shade evaluation. According to the NLC,
there are only two basic steps involved: The selection of the dentine chroma in the cervical area,
where enamel is the thinnest, using samples of the
composite material; and the selection of the enamel
tint, often performed by simple visual observation.
With the special Miris and Miris 2 shading
systems, each combination of dentine and enamel
shades can be evaluated and compared to reference
teeth, so that the risk of incorrect shade selection
and aesthetic outcome is minimised. In specific and
less frequent cases, a third step might be involved
in the form of a visual or photographic mapping of
the tooth special optical effects (such as white
hypocalcification, high opalescence areas or areas
with a higher chroma). In this situation, the application of effect materials, such as white, blue or
orange-gold (i.e. Miris Effects, Coltène Whaledent),
may be recommended.
Fig. 4d
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Fig. 4c
Fig. 4e
Another commonly used incremental approach
is the bucco-lingual technique (Figs. 4d—g).5–7 It makes
use of a silicone key made from either a free-hand
mock-up (simple cases) or wax-up (advanced
cases). The first layer of enamel is placed directly on
the silicone key, so that it provides the lingual profile, width and position of the incisal edge of the
future restoration in one step. Thereafter, dentine
and effect materials (when needed) can be applied
in a precise 3-D configuration. This provides the
conditions for an optimal aesthetic result, as well as
translucency, opalescence and halo effects.
The effect of tooth ageing on dentine and
enamel optical properties
Special attention has to be paid to the morphological changes that affect the incisal edge
structure due to tissue ageing and functional wear.
Actually, in addition to the increase in dentine
chroma and enamel translucency, the progressive
thinning of the enamel layer and exposure of dentine at the incisal edge necessitates an adaptation
of the layering technique (Figs. 5a–c).7
_A new learning experience at the
Geneva Smile Center
The Geneva Smile Center (GSC) strives for
excellence in teaching comprehensive and conservative smile design and tooth-coloured posterior
Fig. 4f
Fig. 4g
[41] =>
CDE0209_01_Titel
industry report _ natural layering concept
Fig. 5a
restorations (Figs. 6a–c). The three programmes
offered thus far cover adhesive, aesthetic anterior
and posterior direct and indirect restorations. The
anterior programme consists of two courses run
over three days (advanced and master levels), while
the comprehensive posterior programme is run over
three days.
All courses include well-balanced theoretical
and hands-on components, which provide participants with the necessary scientific evidence to
support clinical decisions and procedures and with
ample time to practise the different procedures,
leading to expertise in a developing field of dentistry. Dentists are spoilt today with a vast choice of
procedures and products; therefore, it is essential
to analyse the results of clinical studies and
identify those options that guarantee long-term
success. Translating complex and abundant in vitro
and in vivo research data into clinical essentials has
become one of the major assets of the education
programme amongst the GSC programmes, next to
the unsurpassed quality of practical teaching.
Fig. 5c
Fig. 5b
restorations and easier application of all kinds of
adhesive procedures. Magnification lenses are also
available for trial. These tools are of great help in the
context of such courses, even though microscopes
are not mandatory for routine treatments in
restorative dentistry. There is also a great emphasis
placed on individualised teaching, and the
programmes at the GSC provide plenty of time to
interact directly with course instructors. This is the
reason that courses are organised for small groups
with a maximum of 20 participants.
It is likely that the present economical situation
or ‘crisis’ will also affect our profession. If it could
ever have a ‘positive’ effect for us, this might be in
the form of patients becoming more discriminative
in their search for aesthetic treatments. We can
I
Figs. 6a–c_Education infrastructure
at the GSC. Lecture room (a) and
workshop room with dedicated
microscopes and audiovisual network (b & c). The participants follow
demonstrations and other presentations on their individual screens.
Another important aspect of these programmes
is the focus on precision. The use of Zeiss microscopes, installed at each working station, helps
participants to work with better vision and optimal
precision, which is the key to success in aesthetic
Fig. 6a
Fig. 6b
Fig. 6c
cosmetic
dentistry 2
I 41
_ 2009
[42] =>
CDE0209_01_Titel
I industry report _ natural layering concept
therefore expect that patients and dentists will
better understand the tremendous advantage of
non-invasive techniques, which can not only fulfil
many of our aesthetic needs, but will also contribute to better preserving patient dental capital.
The vision at the GSC is to share knowledge and
25 years of clinical expertise with colleagues from
around the world and to improve and facilitate
their existing operation protocols, as well as instrument and product selection, and ultimately to help
them achieve the highest level of aesthetics and
precision in restorative dentistry.
_Conclusion
Traditional restorative objectives have not
changed over time; rather, the implementation of
restoratives has been based on the aesthetic demands of an increasing number of patients. Composite resins, which require a strictly conservative
approach, have thus become the materials of
choice for young patients and less privileged people. The contemporary practitioner is ultimately
challenged to replace the missing tissues or eventually modify their configuration, by applying an
artificial material to the patient’s teeth, which has
to simulate the appearance of natural tissues. The
NLC has enabled this objective to be achieved in a
predictable way, by incorporating newly acquired
knowledge about natural tissue optical properties
into contemporary composite systems. This advance can be regarded as a milestone in operative
dentistry, as it will contribute tremendously to
direct composite application, helping a larger number of our patients to receive aesthetic restorations
that are more conservative.
Further information, including studies for Miris 2,
is available at www.coltenewhaledent.com.
For online education possibilities please visit
www.globalinstituteonline.com._
cosmetic
dentistry
_author info
Prof Didier Dietschi is in private practice and teaches at the GSC
in Switzerland. He is a senior lecturer in the Department of Cariology and Endodontics in the School of Dentistry at the University of
Geneva in Switzerland and an Adjunct Professor in the Department
of Comprehensive Dentistry at Case Western University in Cleveland (Ohio, USA).
Prof Didier Dietschi
The Geneva Smile Center
2 Quai Gustave Ador
1207 Geneva, Switzerland
42 I cosmetic
dentistry
2_ 2009
Tel.: +41 22 700 91 26
Fax: +41 22 700 78 57
E-mail: ddietschi@genevasmilecenter.ch
Editorial note: A complete list of references is
available from the publisher
Dr Didier Dietschi lecture events 2009–2010
2009
08–09 May
Patricia, Bulgaria
15–16 May
Coltène Whaledent, Altstätten,
Switzerland
28–30 May
EAED, Gleneagles, Scotland
12–13 June
International Comprehensive Care
Symposium, Cleveland, OH, USA
24–27 June
SBOE, Brazil
24–26 September
Dentart seminars/UDA Poltava, Ukraine
16–17 October
Coltène Whaledent, London, UK
24 October
CIDAE, Brussels, Belgium
02–03 November
Coltène Whaledent, Buenos Aires,
Argentina
04–05 November
Coltène Whaledent, Santiago, Chile
08–11 November
IDEA San Francisco, CA, USA
2010
16 January
Arbeitskreis Kempten, Kempten,
Germany
23 January
BSOS, Leeds, UK
03–06 February
Geneva Smile Center, Geneva,
Switzerland
12–13 February
Coltène Whaledent, Altstätten,
Switzerland
18–20 February
Geneva Smile Center, Geneva,
Switzerland
04–10 March
CEO seminars — Gold Coast Australia
12–16 March
NZACD New Zealand
25–27 March
Geneva Smile Center, Geneva,
Switzerland
15–21 April
Geneva Smile Center, Geneva,
Switzerland
23– 24 April
Coltène Whaledent (Dr L. Baratiori),
Florianopolis, Brazil
14–16 May
AAAD Kuala Lumpur, Malaysia
27–29 May
EAED, London, UK
10–12 June
Geneva Smile Center, Geneva,
Switzerland
25–26 June
Coltène Whaledent, Altstätten,
Switzerland
03 September
Arbeitskreis Kempten, Kempten,
Germany
24–25 September
Coltène Whaledent, Altstätten,
Switzerland
14–16 October
Geneva Smile Center, Geneva,
Switzerland
04–06 November
Geneva Smile Center, Geneva,
Switzerland
12–13 November
Coltène Whaledent, Montreux,
Switzerland
03 December
FGDP, Glasgow, UK
For more information and to register
for Dr Dietschi’s programmes, please visit
www.edudentinternational.com
[43] =>
CDE0209_01_Titel
[44] =>
CDE0209_01_Titel
I industry news _ VOCO
Amaris Gingiva—
A beautiful smile, naturally
to beyond the cervical boundary. This new material
permits the reconstruction of the ‘red–white’ boundary
with a predictable result.
_Suitable for multiple indications
Amaris Gingiva is also suitable for other indications.
Reconstruction with gingiva-shaded composite thus
represents an important extension of therapeutic
measures following muco-gingival surgery. In addition,
the ‘black holes’ induced by the loss of interdental
papillae as a consequence of periodontitis or gingival
recession can be quickly and easily treated with Amaris
Gingiva to provide an aesthetic restoration. Amaris
Gingiva can also be used to extend the lifespan of in situ
crowns with visible and exposed edges caused by
natural gingival shrinkage significantly.
_Outstanding material and handling
properties
_contact cosmetic
dentistry
VOCO GmbH
c/o Dr Olaf Krems
P.O. Box 767
27457 Cuxhaven
Germany
www.voco.com
44 I cosmetic
dentistry
2_ 2009
_For the highest standards in aesthetic dentistry,
Amaris Gingiva is the only restorative that permits
chairside gingival shade matching. This new gingivashaded, composite-based restoration system facilitates
individual shade matching using a combination of a
base shade and three mixable opaque shades in white,
light and dark. The result is a representation of the
gingiva that appears natural. Through this technique,
supported by proven Amaris expertise, extensively
exposed cervical areas caused by gingival recession and
wedge-shaped defects in the cervical area can be controlled in the future, both functionally and aesthetically.
Amaris Gingiva extends the high standard
of performance of modern composites
In addition to its material properties, Amaris Gingiva
has impressive handling properties. It can be moulded
extremely well and polished to a high gloss. Also, owing
to the new non-drip, non-run NDT syringe from VOCO,
applying the material is just as economical as it is
hygienic. Amaris Gingiva has outstanding translucency
and shade stability, exhibiting a very low shrinkage with
a high filler content of 80 w/w % as a modern composite. It provides long-lasting, aesthetic restorations
because of its low abrasion values, as well as its high
compressive and transverse strength._
[45] =>
CDE0209_01_Titel
Dental Tribune International GmbH | Contact: Nadine Parczyk
Holbeinstraße 29 | 04229 Leipzig | Germany
Tel.: +49 341 484 74 330 | Fax: +49 341 484 74 173
n.parczyk@dental-tribune.com | www.dental-tribune.com
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Date/Signature
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[46] =>
CDE0209_01_Titel
I meetings _ IDS 2009
46 I cosmetic
dentistry
2_ 2009
[47] =>
CDE0209_01_Titel
meetings _ IDS 2009
I
IDS flourishes
despite economic
trouble
Author_ Daniel Zimmermann, Germany
Photographs_ Koelnmesse
_The world’s largest dental show has defied the
economic gloom. According to a preliminary report
released by the organiser Koelnmesse at the end of
March, the number of visitors this year increased by
6.9 per cent to over 100,000. The number of exhibitors also rose by 4.5 per cent to 1,820. International companies held a 65 per cent share, an increase of 10 per cent compared with the previous
show in 2007.
The results confirm a slight decline in the German
domestic market, which is significant for the local
dental industry. Sales have dropped by 2.6 per cent
to €1.58 billion compared with 2007; this is attributed mainly to financial constraints in the dental
and dental technology sectors in the last quarter of
2008. Although dental physicians are the group of
medical specialists who are the most willing to invest in the establishment of clinics, according to the
latest results of the Institute of German Dental
Physicians (IDZ), the overall investment trend
has fallen significantly.
least consistent, overseas sales for 2009. The export
quota of the companies traditionally operating as
‘global players’ is 57 per cent.
“It is good news that in spite of the turbulence in
the financial market, the dental industry and the
health economy can, overall, sustain as solid markets,” Dr Rickert said during a press conference in
Cologne. “IDS has confirmed its status as the international leading trade show in dentistry. We are
certain that the show’s outcome will give positive
signals for the global dental market and
international health markets
as well,” he added._
However, a survey conducted by the
Association of German Dental Manufacturers (VDDI) found that export
business expectations for 2009 are
positive overall in spite of varying
business development in individual regions. VDDI Chairman, Dr
Martin Rickert said that 83 per
cent of the member companies
surveyed expect a rise in, or at
cosmetic
dentistry 2
I 47
_ 2009
[48] =>
CDE0209_01_Titel
I meetings _ events
Cosmetic events
2009
EAED Spring Meeting
Where:
Gleneagles, Scotland
Date:
28–30 May 2009
Tel.:
+39 02 295 236 27
E-mail:
info@eaed.org
Web site: www.eaed.org
2nd International Meeting by Dental
Tribune Italian Edition
Where:
Salerno, Italy
Date:
5–7 June 2009
Tel.:
+39 39 39 34 00 44
E-mail:
cosmeticmeeting@tueor.com
IACA Annual Meeting
Where:
San Francisco, CA, USA
Date:
30 July–1 August 2009
Tel.:
+1 866 669 4222
E-mail:
info@theIACA.com
Web site: www.theiaca.com
AAED 34th Annual Meeting &
IFED 6th World Congress
Where:
Las Vegas, NV, USA
Date:
2–5 August 2009
Tel.:
+1 312 981 6770
E-mail:
meetings@estheticacademy.org
Web site: www.estheticacademy.org
FDI Annual World Dental Congress
Where:
Singapore, Singapore
Date:
2–5 September 2009
Tel.:
+33 450 4050 50
E-mail:
congress@fdiworldental.org
Web site: www.fdiworldental.org
ACE 2009 Symposium on Esthetic Dentistry
Where:
Scottsdale, AZ, USA
Date:
11–14 November 2009
Tel.:
+1 80 07 01 62 23
E-mail:
contact@ACEsthetics.com
Web site: www.acesthetics.com
SAAAD Aesthetic Dental Conference
Where:
Kathmandu, Nepal
Date:
21–22 November 2009
Tel.:
+977 142 425 64
E-mail:
skoirala@wlink.com.np
Greater New York Dental Meeting
Where:
New York, NY, USA
Date:
27 November–2 December 2009
Tel.:
+1 212 398 6922
Web site: www.gnydm.org
2010
EAED Spring Meeting
Where:
London, UK
Date:
27–29 May 2010
Tel.:
+39 02 295 236 27
E-mail:
info@eaed.org
Web site: www.eaed.org
AAED 35th Annual Meeting
Where:
Kapalua, HI, USA
Date:
3–6 August 2010
E-mail:
meetings@estheticacademy.org
Web site: www.estheticacademy.org
48 I cosmetic
dentistry
2_ 2009
[49] =>
CDE0209_01_Titel
I about the publisher _ submissions I
submissions:
formatting requirements
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c.salwiczek@dental-tribune.com
cosmetic
dentistry 2
I 49
_ 2009
[50] =>
CDE0209_01_Titel
I about the publisher _ imprint
cosmetic
dentistry
_ beauty & science
asia pacific edition
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
Editor-in-Chief
Dr Sushil Koirala
skoirala@wlink.com.np
Co-Editor-in-Chief
Dr So-Ran Kwon
smileksr@hotmail.com
Managing Editor
Claudia Salwiczek
c.salwiczek@dental-tribune.com
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Bernhard Moldenhauer
b.moldenhauer@dental-tribune.com
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Gernot Meyer
g.meyer@dental-tribune.com
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n.ostermann@dental-tribune.com
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President/CEO
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Finance
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a.kahnt@dental-tribune.com
Advisory Board
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Dr Seok-Hoon Ko, Korea
Editorial Board
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International Offices
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Dental Tribune International GmbH
Contact: Nadine Parczyk
Holbeinstr. 29
04229 Leipzig, Germany
Tel.: +49 341 484 74 302
Fax: +49 341 484 74 173
www.dti-publishing.com
Dr Anthony Au, Australia
Dr Bao Baicheng, China
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Dr Sim Tang Eng, Malaysia
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Dr Takashi Nakamura, Japan
Dr Vijayaratnam Vijayakumaran, Sri Lanka
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New York, NY 10001, USA
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cosmetic dentistry_Copyright Regulations
_cosmetic dentistry asia pacific edition is published by Dental Tribune Asia Pacific Ltd. and will appear in 2009 with one issue every quarter. The magazine
and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and liable
to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
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check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
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by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
50 I cosmetic
dentistry
2_ 2009
[51] =>
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[52] =>
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DENTAL TRIBUNE
The World’s Dental Newspaper
The first worldwide online newspaper aimed
at dental professionals and the dental industry
is now online!
online
now!
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