cosmetic dentistry international No. 4, 2013
Cover
/ Editorial
/ Content
/ Bio-aesthetics: giving a new face to smile enhancements
/ Interview: “Aesthetic dentistry in itself means nothing”
/ Improving aesthetics in CAD/CAM dentistry – anatomic shell technique (AST)
/ Interdisciplinary treatment of a patient with 11 missing permanent teeth: A biomimetic approach
/ Reconstruction of a horizontal ridge defect using the bone lamina technique
/ Stem cells in implant dentistry
/ Dublin conference discussed future concepts in dental implant rehabilitation
/ KATANAZirconia ML Disc
/ International Events
/ Submission guidelines
/ Imprint
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[1] =>
CDE0413_01_Title
CDE0413_01_Title 05.12.13 17:23 Seite 1
issn 2193-1429
Vol. 7 • Issue 4/2013
cosmetic
dentistry
_ beauty & science
4
2013
| special
Bio-aesthetics: giving a new
face to smile enhancements
| case report
Interdisciplinary treatment:
A biomimetic approach
| feature
“Aesthetic dentistry in itself means nothing”
An interview with Pascal Magne
[2] =>
CDE0413_01_Title
[3] =>
CDE0413_01_Title
CDE0413_03_Editorial 05.12.13 17:24 Seite 1
editorial _ cosmetic dentistry
I
Dear Reader,
_Modern science and technology are making tremendous advances and changes in all
aspects of dentistry. The rapid integration of technology has dramatically improved the way
we collect and acquire information, and has greatly facilitated successful diagnosis and
treatment planning.
Since beauty is subjective, successful cosmetic dentistry requires skills beyond the ability
to diagnose and treat functional or pathological irregularities. Besides entailing attention to
function and pathology, cosmetic treatment requires mastery of the art of understanding
different types of personalities with different expectations for treatment. Proper communication appropriate to each type will not only enhance the doctor–patient relationship, but
also provide greater acceptance of treatment planning.
Dr So Ran Kwon
Co-Editor-in-Chief
According to Chu and colleagues, patient expectations fall into three categories: Hollywood, “Alfred E. Neuman” and the naturalist. The first type desires very white and straight
restorations, and is generally very concerned and vocal. The second type tends to rely on the
clinician’s expertise and follow his or her recommendations. The naturalist is often the most
difficult to treat because of the expectation that all the restorations should look natural and
blend in perfectly with rest of the dentition.
In this issue of cosmetic dentistry, we have included beautifully illustrated and documented articles that provide the solutions to improving aesthetics in CAD/CAM dentistry and
present the concept of bio-aesthetics, giving a new face to smile enhancement. Emphasis has
also been placed on interdisciplinary treatment planning using a biomimetic approach. I hope
you will enjoy this edition and apply your new knowledge to your daily practice successfully.
Yours faithfully,
Dr So Ran Kwon
Co-Editor-in-Chief
President, Korean Bleaching Society
Seoul, Korea
cosmetic
I 03
dentistry 4
_ 2013
[4] =>
CDE0413_01_Title
CDE0413_04_Content 05.12.13 17:25 Seite 1
I content _ cosmetic dentistry
I editorial
03
30
Dear Reader
| Dr Arndt Happe, Germany
| Dr So Ran Kwon, Co-Editor-in-Chief
I research
I special
06
Bio-aesthetics:
giving a new face to smile enhancements
| Dr Didier Dietschi, Switzerland
I feature
14
32
Stem cells in implant dentistry
| Dr André Antonio Pelegrine, Brazil
I meetings
36
Dublin conference discussed
future concepts in dental implant rehabilitation
40
International Events
“Aesthetic dentistry in itself means nothing”
| An interview with Dr Pascal Magne, USA
I industry news
I technique
18
Reconstruction of a horizontal ridge defect
using the bone lamina technique
Improving aesthetics in CAD/CAM dentistry
– anatomic shell technique (AST)
38
| Dr Paulo Kano, Brazil, Dr Eric Van Dooren, Belgium,
KATANA Zirconia ML Disc
High-performance zirconia with integrated colour shift
| Kuraray
Dr Cristiano Xavier, Brazil, Dr Jonathan L. Ferencz, USA,
Emerson Lacerda, Brazil & Dr Nelson RFA Silva, Brazil
I about the publisher
issn 2193-1429
41
42
I case report
22
Interdisciplinary treatment of a patient with
11 missing permanent teeth: A biomimetic approach
| submission guidelines
| imprint
Vol. 7 • Issue 4/2013
cosmetic
dentistry _ beauty & science
4
2013
| special
Bio-aesthetics: giving a new
face to smile enhancements
| case report
Interdisciplinary treatment:
A biomimetic approach
| Drs Magdalena Jaszczak-Małkowska, Joanna Witanowska &
Małgorzata Zadurska, Poland
| feature
“Aesthetic dentistry in itself means nothing”
An interview with Pascal Magne
Cover image courtesy of luminaimages
n
hick
of t
5%
)
3
(
yer
15%
l La yer 1 ( %)
me
Ena tion La r 2 (15
si
ye
Tran tion La %)
si
35
Tran ayer (
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d
o
B
04 I cosmetic
dentistry
4_ 2013
ess
)
[5] =>
CDE0413_01_Title
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30.10.2013 15:46:14
[6] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 1
I special _ composites
Bio-aesthetics:
giving a new face to smile enhancements
Author_ Dr Didier Dietschi, Switzerland
Bio-aesthetics is the quintessence of biology, biomechanics
and aesthetics and aims to more conservative,
ethical solutions to a myriad of aesthetic deficiencies.
difying existing tooth anatomy or assuming the
replacement of decayed tissues; this constitutes
an unparalleled advantage of “free-hand bonding” also due to its relative simplicity. This rationale has been the foundation of a new concept
named “bio-aesthetics”, giving priority to additive, minimally or microinvasive procedures to
preserve tooth biology and biomechanics.
_Introduction
A more attractive smile, improved dental aesthetics and durable results have been for long
intimately linked to ceramic restorations such
as veneers and crowns and remain strongly anchored in patients and dental professional minds.
Modern composite resin technology has however challenged this assumption 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.1–3 Moreover, composite restorations allow for minimally invasive
preparations or no preparation at all when mo-
06 I cosmetic
dentistry
4_ 2013
While resin composites are universally considered the “standard of care” material for the filling
of small to medium class III, IV and V cavities, they
can be used today in many more indications such
as the correction of small to moderate aesthetic
and functional deficiencies.2, 3 ...+ Recent developments in composite optical properties and physical properties have also significantly contributed
to simplifying their application and improving
treatment outcome and predictability.4–6 The aim
of this short article is then to demonstrate the
potential and multiple applications of composite
as a modern aesthetic restorative material in the
context of bio-aesthetic treatment approach.
[7] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 2
special _ composites
I
Fig. 1a
Fig. 1b
Fig. 1c
Fig. 1d
_Revisiting smile rehabilitation
concepts: Bio-aesthetics
This rationale has been the foundation of a new
Choosing the right restorative approach (di- concept named “bio-aesthetics”, giving priority
rect or indirect, composite or ceramics) has been
debated over decades and finally, the decision to additive, minimally or microinvasive procedures
largely depends on the practitioner’s own edu- to preserve tooth biology and biomechanics.
cation background and experience with each
of the aforementioned options. Only “extreme”
Figs. 1a & b_Pre-operative views of
a young patient presenting relatively
large diastemas distally to lateral
incisors. The case is complicated
by improper occlusal relationship
with lower canines which reduce
the space available for restorations.
Figs. 1c–e_Post-operative views
showing an improved smile
configuration using “no-prep” direct
composite restoration (inspiro,
Edelweiss DR). This treatment
illustrates the “bio-aesthetic”
philosophy which truly represents
a breakthrough in modern
restorative dentistry.
Fig. 1e
cosmetic
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dentistry 4
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[8] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 3
I special _ composites
Fig. 2a
Fig. 2b
Fig. 2c
Fig. 2d
Figs. 2a & b_Pre-operative smile
of a young patient presenting
post-orthodontic enamel
hypocalcifications and
asymmetrical shorter, incisors.
Fig. 2c_A free-hand mock-up
was made to assess the ideal length
for an optimal smile configuration.
Fig. 2d_Post-treatment view
showing better smile balance and
harmony, following micro-abrasion
(to remove white spots)
and direct bonding (inspire).
Parameters
Direct option
Indirect option
veneer to crown
age of the patient
younger
older
size of the decay
smaller
larger
tooth vitality
vital
non-vital
tooth colour
normal
non-treatable
discolouration*
facial anatomy
normal
altered
number of restoration
unrelated
unrelated
*using chemical treatments (vital & non-vital bleaching or microabrasion)
Table I_Treatment decision process.
Table II_Modern progressive
treatment concept and
various types of procedures.
08 I cosmetic
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4_ 2013
Types of procedures
Typical procedures
Non restorative
_Aesthetic chemical treatments
(bleaching, micro-abrasion)
_Direct bonding
Minimally invasive
_Direct bonding
_Ultra-thin Veneers
_Modern inlay and onlay techniques
Micro-invasive
_Classical veneers, inlay and onlay
Macro-invasive
_Crowns and bridges
Tab. I
Tab. II
[9] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 4
special _ composites
I
conditions such as minor aesthetic form
and colour corrections or extensive decays in non-vital teeth, lead to evident
solutions (direct and respectively indirect
restorations), while the majority of other
cases lie in a “gray zone” which actually
makes a pertinent choice more intricate.
A simple yet effective approach to this
dilemma relies on a sound bio-mechanical
analysis of the teeth potentially involved
in the treatment status, combined to the
usual functional and aesthetic analysis.
Then, having as a prime objective the respect of tooth biology and conservation
guides clinician to a logical decisional tree,
such as presented in table I.
The “Bio-aesthetic” philosophy actually give priority to chemical color improvements (vital bleaching, non-vital bleaching,
micro-abrasion), associated to direct composite
restorations and bonded ceramic restorations
for more extensive decays, limiting the use of
traditional full crowns to existing restoration
Fig. 3a
replacement and a few conditions of extreme
tooth “fragilization” (weakening). The progressive treatment concept presented in table II
then summarizes the modern vision of aesthetic
restorative dentistry.
Fig. 3a_Pre-operative views of
a young patient showing enamel
hypocalcifications and
asymmetrical tooth forms.
Figs. 3b & c_Shade selection
is performed using a special
dual-laminate shade guide which
grants colour predictability (inspiro).
Figs. 3d & e_A partial mock-up
(teeth #11 and #12) is made
to assess the impact of planned
restorations on the smile configuration.
Fig. 3b
Fig. 3c
Fig. 3d
Fig. 3e
cosmetic
I 09
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[10] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 5
I special _ composites
Fig. 3f
Fig. 3g
Fig. 3h
Fig. 3i
Fig. 3j
Fig. 3k
Figs. 3f & g_Rubber dam is placed to provide an optimal working environment. The full smile (premolar to premolar) is visible to facilitate procedures
and especially to keep control of the smile line configuration.
Fig. 3h_A conservative preparation of the white spots is made to provide a minimum space for color correction (1–1.5 mm).
Fig. 3i_A first layer of dentin shade is placed to cover residual discoloured area and provide a correct chroma (body i2, inspiro).
Fig. 3j_The second layer is placed with an achromatic enamel providing proper translucency and opalescence (skin white, inspiro).
Fig. 3k_Further form correction are made with the same enamel shade (no dentin is needed as layers are not thicker than 1–1.25 mm).
10 I cosmetic
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[11] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 6
special _ composites
I
Fig. 3l_Detailed view of the
corrected central and lateral incisors,
using minimally invasive approach
with direct composite.
Fig. 3m_Post-operative view
showing a more harmonious smile
configuration and uniform
tooth colour.
Fig. 3n_Two years view showing
no alteration of these partial
composite restorations.
Figs. 3o & p_Anatomical details
of the restoration micro-morphology
and surface smoothness which
proved stable over 2 years of clinical
function (inspiro, Edelweiss DR).
Fig. 3l
Fig. 3m
Fig. 3n
Fig. 3o
Fig. 3p
cosmetic
I 11
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[12] =>
CDE0413_01_Title
CDE0413_06-12_Dietschi 05.12.13 17:26 Seite 7
I special _ composites
So far, the over-simplification (mono-incremental) as well as
over-complexity (multi-incremental) of shading systems has
tremendously limited the benefit of direct composite restorations.
_New shading approach:
the natural layering concept
To achieve perfect direct restorations has
been for long and hypothetical aim due to the
imperfect optical properties of many composite
resins systems. So far, the over-simplification
(mono-incremental) as well as over-complexity
(multi-incremental) of shading systems has
tremendously limited the benefit of direct composite restorations. Even today, the complexity
of some systems is often associated to shading
concepts mimicking ceramic systems (which are
applied in totally different layer thicknesses) or
the influence of over-meticulous clinicians who
compensated deficient composite optical properties with intricate layering concepts. 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) has then been
a landmark in developing better direct tooth
coloured materials.4, 7–8 The ‘natural layering
concept’ is then a simple and effective approach
to creating highly aesthetic direct restorations
which has become a reference in the field of
composite restorations.9–12_
5. Magne P, So WS. Optical integration of incisoproximal restorations using the natural layering
concept. Quintessence Int. 2008;39:633-43
6. Dietschi D. Optimizing smile composition and
esthetics with resin composites and other conservative esthetic procedures. Eur J Esthet Dent.
2008;3:14-29.
7. Cook WD, McAree DC. Optical properties of esthetic restorative materials and natural dentition.
J Biomat Mat Res 1985;19:469-488.
8. Dietschi D, Ardu S, Krejci I. Exploring the layering
concepts for anterior teeth. In Roulet JF and
Degrange M, Editors: Adhesion – The silent revolution in Dentistry. Berlin, Quintessence Publishing,
2000:235-251.
9. Ubassy G. Shape and color: the key to successful
ceramic restorations. Quintessenz Verlag, Berlin;
1993.
10. Dietschi D. Free-hand composite resin restorations:
a key to anterior aesthetics. Pract Periodont &
Aesthetic Dent 1995;7:15-25.
11. Dietschi D. Free-hand bonding in esthetic treatment of anterior teeth: creating the illusion.
J Esthet Dent 1997;9:156-164.
12. Dietschi D. Layering concepts in anterior composite
restorations. J Adhesive Dent 2001;3:71-80.
_References
_about the author
1. Macedo G, Raj V, Ritter AV. Longevity of anterior
composite restorations. J Esthet Restor Dent
2006;18:310-311.
2. Peumans M, Van Meerbeek B, Lambrechts P,
Vanherle G. The 5-year clinical performance of
direct composite additions to correct tooth form
and position. II. Marginal qualities. Clin Oral Investig.
1997;1:19-26.
3. Peumans M, Van Meerbeek B, Lambrechts P,
Vanherle G. The 5-year clinical performance of
direct composite additions to correct tooth form
and position. I. Esthetic qualities. Clin Oral Investig.
1997;1:12-8.
4. Dietschi D, Ardu S, Krejci I. A new shading concept
based on natural tooth color applied to direct
composite restorations. Quintessence Int. 2006;
37:91-102.
12 I cosmetic
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4_ 2013
cosmetic
dentistry
Didier Dietschi, DMD, PhD,
Privat-Docent. Senior lecturer,
Department of Cariology &
Endodontics, School of
Dentistry, University of Geneva,
Switzerland. Adjunct Professor,
Department of Comprehensive
Care, Case Western University,
Cleveland, Ohio. Private practice & Education
Center – The Geneva Smile Center, Switzerland.
The Geneva Smile Center
2 Quai Gustave Ador
1207 Geneva
Switzerland
[13] =>
CDE0413_01_Title
1 Year Clinical Masters Program
in Aesthetic and Restorative Dentistry
13 days of intensive live training with the Masters
in Santorini (GR), Geneva (CH), Pesaro (IT)
Three on location sessions with live patient treatment,
hands on practice plus online learning and online
mentoring under the Masters’ supervision.
Learn from the Masters of Aesthetic and Restorative Dentistry:
Registration information:
13 days of live training with the Masters
in Santorini, Geneva, Pesaro + self study
Curriculum fee: € 9,900
contact us at tel.: +49-341-48474-302 / email: request@tribunecme
(€ 900 when registering, € 3,000 prior to each session)
Collaborate
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ADA CERP
C.E. CREDITS
Tribune America LLC is the ADA CERP provider. ADA CERP is a service of the American Dental Association to assist dental professionals
in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors,
nor does it imply acceptance of credit hours by boards of dentistry.
[14] =>
CDE0413_01_Title
CDE0413_14-16_Magne 05.12.13 17:28 Seite 1
I feature _ interview
“Aesthetic
dentistry in itself
means nothing”
An interview with Dr Pascal Magne, USA
_Success in aesthetic dentistry depends
on biology, function and mechanics; aesthetic dentistry cannot exist independently.
cosmetic dentistry had the opportunity to
speak with Dr Pascal Magne, a specialist in aesthetic dentistry, lecturer, author of many clinical
and research articles and the well-known book
Bonded Porcelain Restorations, and associate
professor at the University of Southern California in Los Angeles, where he holds the Don and
Sybil Harrington Foundation Chair in Esthetic
Dentistry, about the latest trends in modern
restorative dentistry at the 12th Annual Scientific
Conference of the Polish Academy of Esthetic
Dentistry and Art Oral, which was held in June
2013 in Sopot, Poland.
Dr Pascal Magne
_cosmetic dentistry: Dr Magne, you created
an impressive training programme on aesthetic
restorative dentistry and have become one of
the most reputable lecturers on this topic. What
is the philosophy underlying your success?
Dr Pascal Magne: I believe that success needs
to be defined first. Success at work, success in
life, personal success? Often, professional success has been obtained by sacrifice of a personal
nature. Can it then still be considered success?
I strongly believe in what I call “balanced success”, meaning that the most important values,
such as spirituality and family, are preserved.
I also believe in mentorship.
My advice to young colleagues is to choose
one mentor (or several), a kind of dental parent.
I know it is not easy to find such a person but
14 I cosmetic
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4_ 2013
it is worth the search. I have been blessed in my
career to have three mentors, my clinical mentor,
Prof. Urs Belser (University of Geneva); my research mentor, Prof. William Douglas (University
of Minnesota); and my dental technique mentor,
my brother Michel (university of „life“).
Of course, none of this would have been
possible without my mentor above all, my Lord
Jesus, and I pray to receive his inspiration every
day. One of my favourite quotes is Proverbs 16: 9:
“In his heart a man plans his course, but the Lord
determines his steps.”
_What are current concepts in aesthetic
restorative dentistry? In which direction is aesthetic dentistry developing?
Aesthetic dentistry in itself means nothing;
it is contingent on biology, function and mechanics. Aesthetic dentistry is the cherry on the
cake for those who follow sound biomimetic
concepts in restorative dentistry. Above all,
as described by Rev. W. John Murray in his book
The Realm of Reality, “the aesthetic is itself
nothing more than a beautiful symbol of the
spiritual, without which spiritual, the aesthetic
is a shadow without substance”.1
I like to remind my patients that they can
always have internal beauty, the beauty of the
heart, which surpasses physical aesthetics. That
said, if we look at your question from a more
technical perspective, the answer lies in the
biomimetic approach to restorative sciences,
which in turn is dependent on adhesive dentistry
[15] =>
CDE0413_01_Title
CDE0413_14-16_Magne 05.12.13 17:28 Seite 2
feature _ interview
and minimally invasive approaches—no post, no
crown dentistry.
Restorative dentistry is likely to evolve in a
manner similar to technological advancements
in general. If you have a smartphone, you know
what I mean. CAD/CAM and technology will be
used increasingly, and I hope for the best, meaning just as an additional tool in our armamentarium and not as an excuse to treat more patients.
I
when they start their practice. Today, we can
no longer ignore that adhesive dentistry is this
daily bread.
_Is it possible to reproduce the original stiffness of a tooth? How can this be achieved?
Absolutely! Much research, starting in the
early 1980s, has demonstrated that adhesive
forces obtained solely on enamel can restore
I believe we will stop using posts, crowns
and metal alloys, and stop performing intentional endodontics eventually—this has already
happened for many of us who believe in the
biomimetic approach.
My hope is that technology will make better
treatment accessible to more patients, with a reduced need for root-canal treatment and crown
lengthening. I see an increase in the diagnosis of
diet-related problems and improved differential
diagnosis between wear- and erosion-related
lesions. Such cases will force us to strive for the
solution that will preserve as much of the tooth
as possible (keep the pulp alive using non-retentive preparation) that is no-post no-crown
restorative dentistry. In summary I would say for
the future less is more (minimally invasive). We
will learn to think differently, think biomimetically, think bonding.
Technically, good bonding implies some
cardinal rules: good isolation (very important;
ideally a rubber dam) and knowledge of your
materials, products, and procedures. A checklist
is the best aid—this is similar to pilots going
through a checklist before flying an airplane!
Dentists need to have a look at sound, unbiased literature before choosing products.
Manufacturers do not always sell the best product but rather the most convenient one. Many
new products today have been developed in response to the pressure of the market; for example, one company starts a new trend and then all
the other companies follow with competing products even if this trend does not yield the best performance. It is business driven. It happens a lot.
I would say that dentists need to undergo
training and gain as much experience as possible
because we know that the operator factor is
even more critical than the choice of product and
technique. This is why as an academic I want
my students to have as much experience as
possible with the materials and techniques
that are going to represent their daily bread
the original stiffness of a tooth. Various degrees of stiffness are obtained with a combination of dental adhesives, composite resins
and ceramics that simulate dentine and enamel,
respectively.
Fig. 1_Partial bonded restorations
teeth 13 to 23 (porcelain by
Michel Magne, Oral Design
Beverly Hills, on teeth 12–22).
(Image courtesy of European Journal
of Esthetic Dentistry)
_One of the objectives of your courses is to explain a new biomimetic approach to restorative
dentistry. What is this concept about?
I can respond in two words: mimicking nature. As said earlier, it implies first respecting
biological parameters, such as pulp vitality—
once lost, the pulp will not come back and
we know that a non-vital tooth has a poor
prognosis—then emulating mechanical function as intended by nature. This will ultimately
form an aesthetic and pleasing whole with
the tooth because dental materials that are
able to simulate the mechanical properties of
dentine and enamel are also available in tooth
colours.
This is the fundamental difference between
a filling (old alloy restorations) that only fills
a cavity like an obturator and one that rehabilitates the biomechanics of the tooth.
Biomimetic research is changing dentistry
using apparently weak materials synergistically
to simulate enamel and dentine. After all, enamel
is extremely brittle (more brittle than glass)
cosmetic
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[16] =>
CDE0413_01_Title
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I feature _ interview
and dentine absolutely not wear resistant; yet,
together (bonded) they can make a tooth that
can withstand stress and function for a lifetime.
How do you explain that? That is synergy! What
I call the “dental trinity” (enamel, dentine and
dentino-enamel junction) should be the model
and we can realistically approach this model today with the structured use of porcelain/ceramics, composite resin, and enamel and dentine
bonding agents. Adhesive dentistry is the cornerstone of this process. Even endodontically
treated teeth can benefit from this approach
because the remaining enamel and dentine can
be preserved.
Adhesive dentistry today is capable of producing continuity between the ceramic/polymer
and the tooth, and above all allows us to save
It is a growing trend, and it will grow not
only as a restorative tool but also as a diagnostic
tool through the inclusion of various modules,
such as wear/erosion monitoring, caries detection, etc. I strongly believe in CAD/CAM but
only as a tool, not a philosophy of work. That
means that the operator still needs to have his
or her own core values, treatment planning
strategies, etc. that are totally independent of
the tools that are used to reach the treatment
objective.
_You have lectured all over the world. What do
you think dental education today should entail?
What should its main objective be?
I believe that an effective educator should be
imbued with passion and knowledge, and must
infect others with this passion and knowledge.
His or her teaching must be based not only
on science, but also on common sense and experience. The educator must not hide anything,
especially not his or her failures.
When listening to such a teacher, dentists
taking the course should feel empowered with
new abilities to provide their patients with
durable treatments that are better adapted and
more conservative.
Fig. 2_Partial bonded restorations
teeth 13 to 23
(porcelain by Michel Magne,
Oral Design Beverly Hills,
on teeth 12-22) in black and white.
(Image courtesy of European Journal
of Esthetic Dentistry)
a great deal of intact tooth structure (adhesion
replacing retention and resistance form). It
would be foolish to ignore bonding techniques
today and remove precious enamel and dentine
instead. In summary, it is not about aesthetics
but about tooth-conserving dentistry.
I believe biomimetic research will allow us to
develop better solutions for tooth replacement.
Currently, dental implants are not biomimetic
per se because of the lack of periodontal ligament, extreme stiffness, etc. (they are only indirectly biomimetic because they do not require
the neighbouring teeth to be altered). We are
looking at ways to make them more biomimetic
through the use of materials that are more compliant2 and even adhesive techniques—bonding
to implant abutments can be very useful.3
_What is your view of the role of CAD/CAM
techniques in modern aesthetic restorative
dentistry? Is this the future or just a temporary
trend?
16 I cosmetic
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4_ 2013
Ideally, this kind of teacher should be a model
in his or her personal life too. This is the difference between just having success and being
a successful human being. I am not saying that
I am a successful human being but I strive to be.
Albert Einstein once said, “I want to know God’s
thoughts; the rest are details.”
The main objective of dental education
should be to establish very strong core values;
values that will not age, that will be timeless.
We know that ten years from now, most of the
materials and tools that we use today will have
been supplanted by new ones.
So I always ask my colleagues, “What is it that
you would like to be remembered for when you
retire?”. This question usually calls for a deep
reflection about one’s values.
Deep respect for God’s creation, including
teeth, and trying to emulate it—this is the kind
of value that I want to pursue.
_Thank you very much for the interview; it
was very inspiring.
Editorial note: A complete list of references is available
from the publisher.
[17] =>
CDE0413_01_Title
October 9-14, 2014 | San Antonio, Texas, USA
Education: October 9-12 | Exhibition: October 9-11
Education
Exhibition
Connections
Participate in challenging
CE courses that fit into your
schedule and budget
Research and purchase
dental products and services
at a discount
Mingle with colleagues
from across the world
To learn more, visit ADA.org/meeting.
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CDE0413_18-21_Silva 05.12.13 17:30 Seite 1
I technique _ improving aesthetics
Improving aesthetics
in CAD/CAM dentistry
– anatomic shell
technique (AST)
Authors_ Dr Paulo Kano, Brazil, Dr Eric Van Dooren, Belgium, Dr Cristiano Xavier, Brazil, Dr Jonathan L. Ferencz, USA,
Emerson Lacerda, Brazil & Dr Nelson RFA Silva, Brazil
Figs. 1a–d_The images show the
frontal view of the clinical situation.
Note the inadequate restoration on
tooth 21 and the dark aspect of both
tooth 11 and tooth 21 (a & b). Frontal
view before and after the temporary
restoration was fabricated for
tooth 21 (c & d). The temporary
crown was made with a lighter shade
to create a more suitable substrate for
the aesthetic evaluation after composite
resin shells had been placed.
Note the dark substrate of tooth 11.
_Abstract
_Introduction
Challenges in aesthetic dentistry frequently involve achieving natural and lifelike surface textures
and ensuring the predictability of the final aesthetic
results.
Lack of predictability regarding the final aesthetic outcome of CAD/CAM restorations is one of
the major concerns among dental professionals,
particularly in complex cases involving reconstruction using multiple units. Unfortunately, there is
limited literature available on this topic. This article
presents a technique in which light-cured flowable
composite resin shells are used as temporary
veneers prior to the final restoration to predict and
preview the aesthetic and morphological outcomes
using CAD/CAM technology. A clinical case is used
to describe and illustrate the
clinical steps.1
This article presents the anatomic shell technique (AST), which uses flowable composite resin
shells as temporary veneers to guide the fabrication of the final restorations and to predict
the aesthetic and morphological outcomes using
CAD/CAM technology.
Fig. 1a
Fig. 1b
Fig. 1c
Fig. 1d
18 I cosmetic
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4_ 2013
One of the challenges in
aesthetic dentistry is achieving natural and lifelike surface textures.2 Surface texture directly influences the
colour, value and saturation
and the zones of light reflection and absorption. An anterior restoration that does not
exhibit a surface texture and
lustre that is comparable to
the adjacent natural teeth
will immediately appear to be
out of place, particularly when
the surface of the surrounding
dentition is complex or heavily
textured. The natural tooth
surface is composed of horizontal and vertical concavities
[19] =>
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technique _ improving aesthetics
Fig. 2a
and convexities that vary in complexity and intensity from tooth to tooth. The ability to observe and
replicate the surface texture and lustre to create an
anterior restoration that is indistinguishable from
adjacent natural teeth typically requires a highly
skilled laboratory technician. However, if one could
mimic the surface texture of adjacent natural tooth
surfaces and use a milling machine to reproduce it,
one could provide a very good aesthetic restoration
without the need for a highly skilled laboratory
technician. The goal of this article is to describe
a novel approach that attempts to reproduce the
complexities and nuances observed in the surface
texture and lustre of natural teeth utilising the
AST technique for CAD/CAM restorations.
I
Fig. 2b
At this point, it was decided to address the
patient’s aesthetic goals with porcelain veneers.
To achieve a rapid aesthetic transformation, the
treatment plan involved using digital dental technology together with a novel concept in which composite resin temporary veneers (composite resin
shells) were utilised prior to the placement of the
final restorations to predict the final aesthetic
outcome and to provide lifelike texture.
_Materials
IPS Empress CAD Multi (leucite-reinforced glassceramic blocks; Ivoclar Vivadent) in shade A2 was
selected for the final restorations. No impressions
Figs. 2a & b_Image of the Hajto
model showing the surface texture
of the anterior teeth (a).
Image of composite shells under
polarised light. Note the opalescence
of the composite shells when
the photograph was taken
under polarised light (b).
Figs. 3a–f_Anatomic resin shell
being positioned (a), polished (b) and
luted (c) without etching and utilising
a flowable composite. The texture
obtained mimics the original texture
of the Hajto model shown
in Figure 2 (d–f).
_Case description
The treatment described
involved a 43-year-old patient seen at the clinic with
the chief complaint of dark
staining of his teeth from antibiotic therapy (particularly
tooth 21; Figs. 1a–d). The patient stated that his appearance affected his ability to
socialise and smile. The patient expressed an interest in
having his teeth treated to improve both his appearance
and his occlusion.
The clinical examination
revealed a very dark root due
to endodontic treatment, with
compromised remaining coronal structure. The endodontic treatment was accepted
and a fibre post was cemented using a dual-cure resin
cement (Multilink Automix,
Ivoclar Vivadent) according
to the manufacturer’s instructions, followed by temporisation. Tooth 11 also exhibited
an abfraction lesion.
Fig. 3a
Fig. 3b
Fig. 3c
Fig. 3d
Fig. 3e
Fig. 3f
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I technique _ improving aesthetics
After determining the ideal shapes and sizes
from the digital smile design database, Hajto models3 were selected based on the previously determined tooth dimensions of the patient. Hajto models are replicas of the ideal natural anterior dentition
of males and females, with examples of different
tooth shapes, sizes and surface textures. Subsequently, a silicone index (Virtual, Ivoclar Vivadent)
was produced from the labial surface of the anterior
teeth of the Hajto model that best matched the
patient (Figs. 2a & b).
Fig. 4
_Composite resin shells
A light-cured flowable composite resin (Tetric
EvoFlow Ivoclar Vivadent) was then carefully placed
into the index to produce very thin composite
shells that duplicated the shape of the model teeth.
After complete polymerisation, the composite shells
were gently placed intra-orally on the labial surfaces of the teeth and adjusted to obtain the best
possible fit (Fig. 3a).
Fig. 5
Fig. 4_Initial photographs
with composite shells temporarily
cemented in place. The shade
difference of tooth 11 is due
to the dark substrate showing
through the composite veneer.
Fig. 5_CEREC Optispray powder
was applied in the patient’s mouth to
coat the teeth fitted with the polished
anatomic composite resin shells.
Figs. 6a–e_A digital impression
was taken after tooth preparation.
The image shows the procedure
for tooth 22 (a). The digital image
acquired after preparation was
or diagnostic casts were used during the treatment
planning and clinical procedures. The entire aesthetic treatment plan relied upon imaging (including photographs), prefabricated Hajto models3 and
dental digital technology (CEREC AC with Bluecam,
Sirona—CEREC Software 4.0).
_Description of the anatomic
shell technique
The digital smile design protocol4–8 was used
to determine the aesthetic needs of the patient.
The patient, with the dentist’s assistance, selected
the shapes of the teeth that best suited him using
digital photographs of natural smiles from a computer smile library.
Once the best anatomic resin shell position was
obtained, the shells were polished and luted without acid etching using flowable composite (Tetric
EvoFlow, Ivoclar Vivadent) (Fig. 3d–f).
The clinician together with the patient evaluated the aesthetic outcome with the polished
composite shells in place (Fig. 3d–f). Digital photographs were taken to analyse the symmetry between the teeth and the patient’s face. Following
the digital imaging analyses, small adjustments
were performed at the interproximal embrasures.
After completion of the aesthetic modifications
and polishing steps, the patient approved the
aesthetic design (Fig. 4).
_Digital imaging
In order to facilitate the digital image capturing
process, CEREC Optispray powder (Sirona; Fig. 5)
was applied in the patient’s mouth to coat the teeth
restored with the composite resin shells. An intraoral scanner (CEREC Bluecam) was then used to
create a 3-D digital model of the full mouth with
the temporary composite resin shells.
Fig. 6a
Fig. 6b
Fig. 6c
Fig. 6d
20 I cosmetic
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Fig. 6e
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technique _ improving aesthetics
Fig. 7a
In this procedure, the composite shells help to
predict the shape and the final aesthetic outcome
of the milling process. They also serve as a guide
to establish the amount of reduction necessary during tooth preparation. After the scanning process,
the teeth were prepared using the composite resin
shells as a reference to determine the amount of
tooth reduction.
A digital impression was taken (CEREC Bluecam)
after the preparations had been completed. The digital image acquired after preparation was merged
and correlated with the digital image taken with
the anatomic composite shell in place to generate
the proper shape of the permanent veneers to be
fabricated (Figs. 6a–e). The milling process was then
initiated using a CEREC III milling unit equipped
with CEREC Software 4.0.
After the milling process, the veneers were removed from the milling unit and visually inspected
for potential flaws. The veneers were then tried-in,
polished with 0.6 µ diamond paste and subsequently placed with Variolink Veneer Medium Value 0
(Ivoclar Vivadent) using the adhesive technique according to the manufacturer’s instructions (Figs. 7a–c).
In order to mask the dark shade of the tooth substrate, a staining agent (IPS Empress Universal
Stains, Ivoclar Vivadent) was applied internally to
each veneer prior to cementation.
Fig. 7b
ness of the final restorations and the straighter incisal edges of the two central incisors (Figs. 7a–c)
compared with the composite shells (Figs. 3d–f).
These differences were attributed to a software
limitation, as no other anatomical/morphological
modification was performed after the milling process
had been completed. However, the final outcome
using monochromatic blocks was acceptable and the
clinical sequence presented here using AST shows
a very simple and innovative way to predict the final
outcome of an aesthetic treatment and suggests
that CAD/CAM technology is a very attractive concept when one understands the materials science,
machine capability and the limitations involved._
Editorial note: A complete list of references is available
from the publisher.
_about the authors
I
Fig. 7c
merged and correlated with the
digital image taken with the anatomic
composite shell (b) in place to
generate the proper shape (c & d)
of the permanent veneers
to be fabricated (e).
Figs. 7a–c_Photograph of
the completed clinical case (a).
The final texture produced by
the milling machine (b & c) and
the quality of the aesthetic result
are satisfactory despite the use
of a monochromatic ceramic block.
The texture matches that of the
buccal surface of the Hajto model
(Fig. 2a) that was selected
for this clinical case.
cosmetic
dentistry
Nelson RFA Silva, DDS, MSc, PhD
(Federal University of Minas Gerais, Belo Horizonte),
is an assistant professor at the New York University
College of Dentistry.
Tel.: +55 31 8949 2405
nrfa.silva@gmail.com
Paulo Kano, DDS, is enrolled for an MSc
and is in private practice in São Paulo in Brazil.
_Conclusion
The concept of chairside CAD/CAM restoration
differs from conventional dentistry in that the
restoration is typically luted or bonded in place
on the same day, whereas conventional dental prostheses of larger size, such as crowns, involve the
placement of temporaries for several weeks while
a dental laboratory produces the restoration.1 As the
CAD/CAM restoration is bonded on the same day, the
principles applied in predicting the final outcomes
present unique challenges compared with conventional clinical procedures for any aesthetic treatment. The clinical case described here presented
some limitations, as can be seen in the slight bulki-
Eric Van Dooren, DDS,
is a visiting professor at the University of Liège
and is in private practice in Belgium.
Cristiano Xavier, DDS, is a professional
photographer in Belo Horizonte in Brazil.
Jonathan L. Ferencz, DDS, is a clinical professor
at the New York University College of Dentistry
in the USA and in private practice in New York.
Emerson Lacerda, CDT,
works in a laboratory in São Paulo.
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CDE0413_22-28_Jaszczak 05.12.13 17:34 Seite 1
I case report _ biomimetic approach
Interdisciplinary treatment
of a patient with 11 missing
permanent teeth:
A biomimetic approach
Author_ Drs Magdalena Jaszczak-Małkowska, Joanna Witanowska & Małgorzata Zadurska, Poland
Fig. 1a
Fig. 1b
Figs. 1a & b_Situation before
orthodontic treatment.
Fig. 2_A pre-op panoramic
radiograph.
Fig. 2
_The current level of technology and specialisation in all areas of life allow us to assess correctly our capabilities and limitations in the treatment
of our patients. We are no longer trying to improve
Fig. 3a
nature, but we are doing everything to imitate it
as perfectly as possible, drawing from its best
solutions. This is the essence of biomimetics. It has
already been applied in many fields of science
Fig. 3c
Fig. 3b
Figs. 3a–c_Teeth contacts
before treatment.
Figs. 4a & b_The maxillary and
mandibular arches before treatment.
22 I cosmetic
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4_ 2013
Fig. 4a
Fig. 4b
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case report _ biomimetic approach
and technology, including
medicine and dentistry.
By applying the biomimetic approach to the
treatment of our patients,
we can achieve satisfying
results aesthetically and
functionally. The aim of
the biomimetic approach
is to respect nature and
effect as little irreversible
change as possible. It is
very important for young
adult patients, whose
entire lives lie before
them, and has a great influence on their treatment planning, especially
in patients with multiple
agenesis Undoubtedly,
this is a therapeutic challenge and requires extensive knowledge, experience and close collaboration between different
specialists in dentistry.
_Case description
A 19-year-old female sought treatment at
the Department of Orthodontics at the Medical
University of Warsaw because of her congenitally
missing permanent teeth (Figs. 1a & b). During
an interview, she reported that her brother and
mother also had several missing teeth. Clinical
examination revealed a persistent primary maxillary right second molar, the absence of all
I
Fig. 5a
Fig. 5b
Fig. 5c
Fig. 5d
maxillary premolars, two mandibular second
premolars and one mandibular incisor. A panoramic radiograph confirmed the absence of the
seven permanent teeth above and all third molars
(Fig. 2).
Figs. 5a–d_Occlusal contacts
after orthodontic treatment,
showing the rounded shape
of the maxillary incisors.
_Occlusal analysis
Figs. 6a & b_Plaster models
without (a) and with
the diagnostic wax-up (b).
Fig. 7_A panoramic radiograph
after implantation.
Figs. 8a–c_Delayed implantation
of the implant in region 14.
The midline of the maxillary arch did not coincide with the facial midline. The midline of the
mandibular arch could not be assessed owing
to the presence of three mandibular incisors. The
lateral crossbite on the right side was present
Fig. 6a
Fig. 6b
Fig. 7
Fig. 8a
Fig. 8b
Fig. 8c
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I case report _ biomimetic approach
Fig. 9a
Fig. 9b
Figs. 9a & b_Reshaping
of the two maxillary central incisors
(before and after).
Fig. 10_The prepared feldspathic
veneers for the two maxillary
lateral incisors.
Figs. 11a & b_The maxillary lateral
incisors before and immediately
after placing the veneers,
with visible gingival irritation.
Figs. 12a & b_The veneers
one week after cementation,
showing perfect gingival integration.
from the lateral incisor to the last tooth in the arch.
Transverse and vertical relationships were normal
(Figs. 3a–c, 4a & b). During lateral excursions, there
Fig. 10
was no canine guidance on both sides and traumatic occlusion was present at the second molars.
During protrusion, the incisal guidance was maintained.
The incisal edges of the maxillary lateral incisors
were rounded, and midline diastemas were present
in the maxillary and mandibular arches.
Fig. 11b
Fig. 12a
Fig. 12b
dentistry
4_ 2013
Combined orthodontic, prosthodontic, and implant treatment was planned, aimed at restoring
aesthetics and function with the maximum preservation of hard tissue, while replacing the missing teeth and reshaping the maxillary lateral incisors. It was planned to close the diastemas between the teeth, restore the midline in both arches
and canine guidance, and gain the space necessary for one premolar on each side of the maxilla
and the second premolars in the mandible. The
missing teeth were to be replaced with crowns
supported by implants, while the shape of incisors was to be changed with veneers and direct
composite.
_Orthodontic treatment
Fig. 11a
24 I cosmetic
_Treatment plan
The first stage of treatment included the orthodontic treatment to correct the lateral crossbite,
close spaces in the anterior segment and restore
coincidence between the midline of the maxillary
arch and the facial midline. The treatment plan
also included restoring the coincidence between
the maxillary midline and the line between two
mandibular incisors on the left side. Therefore, two
incisors were left on the right side, whereas on the
left side the canine was moved to the position of
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case report _ biomimetic approach
I
Figs. 13a–d_The maxillary lateral
incisors without and with veneers,
showing perfect white
and red aesthetics.
Figs. 14a–d_Gingival shaping with
the healing screw and temporary
crown (a & b), zirconia abutment
and final restoration (c & d).
Fig. 13b
Fig. 13a
Fig. 13c
Fig. 13d
Fig. 14b
Fig. 14a
the missing lateral incisor. Normal intercuspation
and canine guidance were achieved on both sides.
In the mandibular arch on the left side, the left
canine assumed the function of the lateral incisor
and the left premolar that of the canine. During
orthodontic treatment, the persistent primary tooth
was retained, to provide additional anchorage and
to maintain the width of the alveolar process.
_Implant-prosthodontic treatment
After orthodontic treatment had been completed, a new occlusal analysis was performed
to evaluate the aesthetics and to establish the
implant-prosthodontic rehabilitation necessary.
Photographs were taken at different angles and diagnostic casts were mounted in an Artex partially
adjustable articulator (AmannGirrbach) using the
facebow registration and the centric relation registration techniques by Dawson.
Fig. 14c
Fig. 14d
and traumatic occlusion were seen in articulation
(centric relation = maximum intercuspation).
No subjective or objective temporomandibular
joint problems were registered. Spaces were closed
and tooth contacts were restored in the maxillary
and mandibular anterior segments. The space
necessary to restore missing teeth 24, 25 and 45
was established by orthodontic treatment. In order
to restore missing tooth 14, the space was maintained by retaining the persistent primary molar
(Figs. 5a–d).
_White and red aesthetics
About 1 mm of the incisal edges was visible with
lips in the rest position. During smiling, normal
exposure of the maxillary teeth was present and
the incisal line did not follow the curvature of the
lower lip. In order to maintain the canine guidance,
elongation of the maxillary incisors was not possible. The anterior gingival margin line was normal.
_Analysis of occlusion and articulation
_Treatment plan re-evaluation
Normal occlusion was present, and incisal and
canine guidance was restored (disclusion of posterior teeth during protrusion and laterotrusion).
Normal occlusal contacts and intercuspation were
present. In centric relation, no premature contacts
Fig. 15a
In order to establish the treatment plan and
to analyse aesthetics in the anterior segment, the
diagnostic wax-up and mock-up were created,
which enable an assessment of the proportions
Figs. 15a–c_Teeth contacts
after prosthodontic treatment.
Fig. 15c
Fig. 15b
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Fig. 16a
between the maxillary lateral
incisors and canines to maintain the normal proportions
between the central and
lateral incisors. The patient
is still using permanent and
removable retainers The
persistent primary tooth 55
was scheduled for extraction.
Restoration of all the missing
premolars was planned using
implant-supported ceramic
crowns.
Fig. 16b
_Implant treatment
Fig. 17a
Fig. 17b
Fig. 18
Fig. 19a
Figs. 16a & b_The maxillary
and mandibular arches
after prosthodontic treatment.
Figs. 17a & b_The modified zirconia
crown on a standard abutment—the
visible subgingival part of the crown
was not covered with the ceramic.
Fig. 18_The modified crown
screwed on to implant 14.
Figs. 19a & b_Post-op situation.
Fig. 20_Harmonous smile
after treatment.
26 I cosmetic
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4_ 2013
Fig. 19b
and appearance of the final restoration in the
patient’s mouth (Figs. 6 a & b). It was decided to recontour the mesial angles of the maxillary central
incisors with composite and to apply two ceramic
feldspathic veneers sintered on a refractory mass
to the lateral incisors. Because the patient did
not agree to the recontouring of the maxillary
canines, it was decided not to close the gaps
Fig. 20
CBCT was performed to
evaluate the anatomical and
surgical conditions, and to
plan the surgical treatment.
Owing to sufficient height
and width of the alveolar
process at the implant sites,
guided bone regeneration
was not required. TSIII implants (OSSTEM; 4 mm ×
10 mm S, 3.5 mm × 10 mm M)
were used in regions 14
and 24, and TSII implants
(OSSTEM; 3.5 mm × 10 mm M,
3.5 mm × 10 mm M) were used
in regions 35 and 45. However, delayed implantation in
region 14 was performed four
weeks after the extraction of
tooth 55 (Figs. 7 & 8a–c).
_Prosthodontic treatment
Recontouring of the central incisors was performed using the direct method with GRADIA
DIRECT composite (GC Europe) and a two-component adhesive system, CLEARFIL SE BOND (Kuraray
Noritake). Mesial angles were recontoured using
the standard Hawe celluloid matrix system
(Kerr). The composite surface
was prepared and polished
using Sof-Lex discs (3M ESPE;
Figs. 9a & b). The contours of
the veneers for teeth 12 and
22 were checked again using
a mock-up, and then minor
adjustments were performed.
Using a specially trimmed silicone mock-up, the amount
of space for the planned
ceramic reconstructions was
determined and the prepa-
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case report _ biomimetic approach
ration of teeth was abandoned. After cleaning the
teeth with pumice and introducing Ultrapak #00
retraction cord (Ultradent) into the gingival
sulcus, two-layer single-phase impressions were
taken using polyvinyl siloxane impression material
(Bisico).
Once the final restorations had been received
from the laboratory (Fig. 10), their integrity, match
to the abutments and colour were checked using
a Variolink Try-in paste
(Ivoclar Vivadent). The
abutment surfaces were
isolated with a rubber dam
and cleaned with pumice,
then rinsed thoroughly
with water and etched
with 37 % phosphoric acid
for 45 seconds. They were
then rinsed with water for
the same period. Subsequently, Variolink Veneer
light-curing adhesive composite was applied. Meanwhile, the inner surfaces
of the veneers were etched
with 7 % hydrofluoric
acid for 1 minute, rinsed
with water and then the
veneers were placed in the
I
Fig. 21a
Fig. 21b
Fig. 21c
Fig. 21d
Fig. 22a
Fig. 22b
ultrasonic bath for 2 minutes. Silane (Monobond
Plus, Ivoclar Vivadent) was applied to the etched
surface of the veneers, which were then dried, and
the bonding agent (Heliobond, Ivoclar Vivadent)
was applied. Variolink Veneer in shade HV+1 was
applied to the veneers’ surface and the veneers
were placed on the abutments. Excess material
was initially removed and precured for 10 seconds.
The restoration edges were smeared with glycerine
Figs. 21a–d_Upper incisors after
finishing prosthodontic treatment
and the two years follow-up.
Figs. 22a & b_Bite after finishing
treatment and after two years,
stable functional and aesthetic result.
Figs. 23a–d_Bite after finishing
treatment and after two years,
stable functional and aesthetic result.
Fig. 23a
Fig. 23b
Fig. 23c
Fig. 23d
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CDE0413_01_Title
CDE0413_22-28_Jaszczak 05.12.13 17:34 Seite 7
I case report _ biomimetic approach
I mentioned at the beginning, apart from other
crucial issues, it is important to preserve the patient’s own tissue as far as possible, which translates into the longevity and stability of the restorations. The case presented demonstrates that.
We achieved satisfactory long-term aesthetic and
functional results with minimum intervention.
After two years, there is perfect bone stability
around the implants (Fig. 21a–d) and excellent
gingival integration with the prostheses on both
the implants and the natural teeth (Figs. 22a & b,
23a–d, 24)._
Fig. 24
Fig. 24_Pantomographic X-ray
two years after implants loading,
perfect bone stability.
gel to prevent oxygen access and the formation
of an oxygen inhibition layer on the composite
bond. Curing was continued with an 800 mW/cm2
polymerisation lamp for 60 seconds on each surface. Excess composite was removed with a #12
scalpel blade, and the veneers were polished with
strips and rubber polishing burs for composites.
Finally, the veneers were checked during occlusion and articulation using 14 µm articulating paper. Corrections were made using a 45 µm smooth
diamond-coated bur on a 1: 5 speed-increasing
handpiece on a micromotor. The final polishing
was performed using rubber burs for composites
(Figs. 11a & b). After a week, gingival integration
with the veneers had been achieved (Figs. 12a & b,
13 a–d).
After a period of healing, the emergence profile
of the implant restorations was reshaped using
crowns on temporary abutments (Figs. 14a & b).
After obtaining a satisfactory effect for implants
24, 35 and 45, permanent zirconia crowns on standard zirconia abutments were fabricated (Figs. 14c
& d, 15a–c, 16a & b). Owing to the thick layer of soft
tissue, a modified screw-retained zirconia crown
on a zirconia abutment was placed on implant 14
(Figs. 17a & b). The emergence profile was reshaped
using a crown bonded to the standard zirconia
abutment and the crown was veneered with
feldspathic ceramics only at the supragingival
zone, owing to the unavailability of individually
shaped zirconia abutments for the OSSTEM system
(Fig. 18).
_about the authors
cosmetic
dentistry
Dr Magdalena JaszczakMałkowska (DMD) graduated
from the Medical University
of Warsaw in Poland in 1996.
Until 1998, she was a
collaborator with the Institute
of Genetics and Animal
Breeding of the Polish
Academy of Sciences. In 2008, she obtained
a certificate in Prosthodontics. She has worked
in a private practice specialising in aesthetic
and prosthodontic dentistry since 2000.
ESTEDENTICA
ul. Dobra 27/A, 00-344 Warsaw, Poland
m.jaszczak@estedentica.pl
Dr Joanna Witanowska
(DMD) graduated
from the Medical University
of Warsaw. She is a specialist
in orthodontics and a research
fellow at the Department of
Orthodontics at the University.
She is completing
a doctoral thesis in Orthodontics.
ul. Nowogrodzka 59, 02-005 Warsaw, Poland
jwitanowska@gmail.com
_Conclusion
Working with patients missing so many permanent teeth is extremely difficult and sometimes
marked with compromise. Achieving a satisfactory
result both functionally and aesthetically is possible only through the close co-operation of specialists from various fields of dentistry and meticulous
planning from the commencement of treatment
to the final aesthetic stage (Figs. 19a & b, 20). As
28 I cosmetic
dentistry
4_ 2013
Dr Małgorzata Zadurska (DMD, PhD) graduated
from the Poznan University of Medical Sciences
in Poland. She is a specialist in orthodontics
and paediatric dentistry, and Associate Professor
at and head of the Department of Orthodontics
at the Medical University of Warsaw.
Nowogrodzka 59, 02-005 Warsaw, Poland
[29] =>
CDE0413_01_Title
P R O F E S S I O N A L
M E D I C A L
C O U T U R E
EXPERIENCE OUR ENTIRE COLLECTION ONLINE
WWW.CROIXTURE.COM
[30] =>
CDE0413_01_Title
CDE0413_30-31_Happe 05.12.13 17:36 Seite 1
I case report _ bone regeneration
Reconstruction of a
horizontal ridge defect using
the bone lamina technique
Author_ Dr Arndt Happe, Germany
Fig. 1_Localised horizontal ridge
defect. The treatment plan
was to place a single implant
to replace the lateral incisor.
Fig. 2_A CBCT scan of the defect.
The residual ridge width was 5.6 mm.
Fig. 3_Once a full thickness flap had
been reflected, the buccal plate was
reconstructed using OsteoBiol Soft
Cortical Lamina. The lamina was
secured using titanium pins.
Fig. 4_The defect was filled
with OsteoBiol mp3.
Fig. 5_The lamina was shaped
such that it could be folded over the
coronal aspect of the filler material.
A titanium pin was used to
secure the lamina here too.
Fig. 6_The lamina itself was covered
with a collagen membrane to allow
for rapid soft-tissue integration.
30 I cosmetic
dentistry
4_ 2013
Fig. 1
Fig. 2
_In the case presented, the treatment plan
was to place a single implant in the aesthetically demanding anterior maxillary region in the
place of the left lateral incisor. A moderate horizontal ridge defect was present and the residual
bone width was 5.6 mm. A staged approach
employing a guided bone regeneration technique
with a porcine partially demineralised cortical
lamina (OsteoBiol Soft Cortical Lamina, Tecnoss
Dental) was chosen. A porcine bone substitute
(OsteoBiol mp3, Tecnoss Dental) was used as
a filler material.
Fig. 3
Fig. 4
Fig. 5
Fig. 6
[31] =>
CDE0413_01_Title
CDE0413_30-31_Happe 05.12.13 17:36 Seite 2
case report _ bone regeneration
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
After the augmentation procedure, the lamina
was covered with a collagen membrane to allow
for rapid soft-tissue integration. The augmentation surgery was completed with meticulous
flap closure using microsurgical techniques.
Finally, an all-ceramic crown was seated on the
zirconia abutment.
After a healing period of six months, an implant of 3.8 mm in diameter and 11 mm in length
was placed according to the restorative planning.
_contact
The images of the final result demonstrate
clearly that an aesthetically pleasing outcome
was achieved by employing the bone augmentation technique described._
I
Fig. 7_Meticulous, tension-free
soft-tissue closure is crucial
for successful regeneration.
Fig. 8_The clinical situation
after six months of healing.
Fig. 9_A CBCT scan showing
the regenerated area. The ridge
width was increased to 10.3 mm.
A new cortical plate and cancellous
compartment are visible.
Fig. 10_Upon reflection of a full
thickness flap, the regenerated
tissue is visible. The tissue has
a good blood supply and remnants
of the lamina are present.
Fig. 11_It was possible to place
an implant of 3.8 mm in diameter in
the correct 3-D position as planned.
Fig. 12_The regenerated ridge
before restorative treatment.
Fig. 13_The final situation
six months after seating the
all-ceramic restoration.
Fig. 14_A periapical radiograph
six months after restorative treatment.
cosmetic
dentistry
Dr Arndt Happe
Schützenstr. 2
48143 Münster
Germany
www.dr-happe.de
Fig. 13
Fig. 14
cosmetic
I 31
dentistry 4
_ 2013
[32] =>
CDE0413_01_Title
CDE0413_32-35_Pelegrine 05.12.13 17:37 Seite 1
I research _ science & practice
Stem cells in
implant dentistry
Author_ Dr André Antonio Pelegrine, Brazil
damage. In order to achieve this, quiescent cells
(dormant cells) in the tissue become proliferative, or
stem cells are activated and differentiate into the
appropriate cell type needed to repair the damaged
tissue. Research into stem cells seeks to understand
tissue maintenance and repair in adulthood and
the derivation of the significant number of cell types
from human embryos.
Fig. 1_A stem cell following
either self-replication
or a differentiation pathway.
Fig. 2_Different tissues originated
from mesenchymal stem cells.
Fig. 3_The diversity of cell types
present in the bone marrow.
Fig. 4a_Point of needle puncture
for access to the bone marrow space
in the iliac bone.
Fig. 4b_The needle inside
the bone marrow.
Fig. 5a_A bone graft being
harvested from the chin (mentum).
Fig. 5b_A bone graft being harvested
from the angle of the mandible
(ramus).
Fig. 5c_A bone graft being harvested
from the angle of the skull (calvaria).
Fig. 5d_A bone graft being
harvested from the angle of the leg
(tibia or fibula).
Fig. 5e_A bone graft from
the pelvic bone (iliac).
Fig. 6_A critical bony defect created
in the skull (calvaria) of a rabbit.
Fig. 7_A primary culture of adult
mesenchymal stem cells from the
bone marrow after 21 days of culture.
Fig. 8a_A CT image of a rabbit’s skull
after bone-sparing grafting without
stem cells (blue arrow). Note
that the bony defect remains.
Fig. 8b_A CT image of a rabbit’s
skull after bone-sparing grafting with
stem cells. Note that the bony defect
has almost been resolved.
Fig. 9_A bone block from
a musculoskeletal tissue bank
32 I cosmetic
dentistry
4_ 2013
_The human body contains over 200 different
types of cells, which are organised into tissues
and organs that perform all the tasks required to
maintain the viability of the system, including reproduction. In healthy adult tissues, the cell population size is the result of a fine balance between cell
proliferation, differentiation, and death. Following
tissue injury, cell proliferation begins to repair the
It has long been observed that tissues can differentiate into a wide variety of cells, and in the case
of blood, skin and the gastric lining the differentiated cells possess a short half-life and are incapable
of renewing themselves. This has led to the idea
that some tissues may be maintained by stem cells,
which are defined as cells with enormous renewal
capacity (self-replication) and the ability to generate daughter cells with the capacity of differentiation. Such cells, also known as adult stem cells,
will only produce the appropriate cell lines for the
tissues in which they reside (Fig. 1).
Fig. 2
Fig. 3
Fig. 4a
Fig. 4b
Fig. 1
[33] =>
CDE0413_01_Title
CDE0413_32-35_Pelegrine 05.12.13 17:37 Seite 2
research _ science & practice
I
Fig. 5a
Fig. 5b
Fig. 5c
Fig. 5d
Fig. 5e
Fig. 6
Not only can stem cells be isolated from both
adult and embryo tissues; they can also be kept
in cultures as undifferentiated cells. Embryo stem
cells have the ability to produce all the differentiated cells of an adult. Their potential can therefore
be extended beyond the conventional mesodermal
lineage to include differentiation into liver, kidney,
muscle, skin, cardiac, and nerve cells (Fig. 2).
The recognition of stem cell potential unearthed a new age in medicine: the age of regenerative medicine. It has made it possible to consider
the regeneration of damaged tissue or an organ
that would otherwise be lost. Because the use of
embryo stem cells raises ethical issues for obvious
reasons, most scientific studies focus on the applications of adult stem cells. Adult stem cells are
not considered as versatile as embryo stem cells
because they are widely regarded as multipotent,
that is, capable of giving rise to certain types of
specific cells/tissues only, whereas the embryo
stem cells can differentiate into any types of
cells/tissues. Advances in scientific research have
determined that some tissues have greater diffi-
combined with a bone marrow
concentrate.
Fig. 10a_A histological image
of the site grafted with bank bone
combined with bone marrow.
Note the presence of considerable
amounts of mineralised tissue.
Fig. 10b_A histological image
of the site grafted with bank bone
not combined with bone marrow.
Note the presence of low amounts
of mineralised tissue.
Fig. 7
Fig. 8a
Fig. 8b
Fig. 9
Fig. 10a
Fig. 10b
cosmetic
I 33
dentistry 4
_ 2013
[34] =>
CDE0413_01_Title
CDE0413_32-35_Pelegrine 05.12.13 17:37 Seite 3
I research _ science & practice
Fig. 11a
Fig. 11b
Fig. 11c
Fig. 11d
Fig. 11e
Fig. 11f
Fig. 11a_Bone marrow.
Fig. 11b_Bone marrow transfer
into a conic tube in a sterile
environment (laminar flow).
Fig. 11c_Bone marrow
homogenisation in a buffer
solution (laminar flow).
Fig. 11d_Bone marrow combined
with Ficoll (to aid cell separation).
Fig. 11e_Pipette collection
of the interface containing
the mononuclear cells
(where the stem cells are present).
Fig. 11f_Second centrifuge spin.
culty regenerating, such as the nervous tissue,
whereas bone and blood, for instance, are considered more suitable for stem cell therapy.
In dentistry, pulp from primary teeth has been
thoroughly investigated as a potential source of
stem cells with promising results. However, the
regeneration of an entire tooth, known as third
dentition, is a highly complex process, which despite some promising results with animals remains
very far from clinical applicability. The opposite has
been observed in the area of jawbone regeneration,
where there is a higher level of scientific evidence
for its clinical applications. Currently, adult stem
cells have been harvested from bone marrow and
fat, among other tissues.
Bone marrow is haematopoietic, that is, capable of producing all the blood cells. Since the 1950s,
when Nobel Prize winner Dr E. Donnall Thomas
demonstrated the viability of bone marrow transplants in patients with leukaemia, many lives
have been saved using this approach for a variety
of immunological and haematopoietic illnesses.
However, the bone marrow contains more than
just haematopoietic stem cells (which give rise
to red and white blood cells, as well as platelets,
for example); it is also home to mesenchymal
stem cells (which will become bone, muscle and fat
tissues, for instance; Fig. 3).
Bone marrow harvesting is carried out under
local anaesthesia using an aspiration needle
through the iliac (pelvic) bone. Other than requiring a competent doctor to perform such a task, it is
34 I cosmetic
dentistry
4_ 2013
not regarded as an excessively invasive or complex
procedure. It is also not associated with high levels of discomfort either intra or post-operatively
(Figs. 4a & b).
Bone reconstruction is a challenge in dentistry
(also in orthopaedics and oncology) because rebuilding bony defects caused by trauma, infections, tumours or dental extractions requires bone
grafting. The lack of bone in the jaws may impede
the placement of dental implants, thus adversely
affecting patients’ quality of life. In order to remedy bone scarcity, a bone graft is conventionally
harvested from the chin region or the angle of
the mandible. If the amount required is too large,
bone from the skull, legs or pelvis may be used.
Unlike the process for harvesting bone marrow, the
process involved in obtaining larger bone grafts
is often associated with high levels of discomfort and, occasionally, inevitable post-operative
sequelae (Figs. 5a–e).
The problems related to bone grafting have encouraged the use of bone substitutes (synthetic
materials and bone from human or bovine donors,
for example). However, such materials show inferior results compared with autologous bone grafts
(from the patient himself/herself), since they lack
autologous proteins. Therefore, in critical bony
defects, that is, those requiring specific therapy
to recover their original contour, a novel concept
to avoid autologous grafting, involving the use of
bone-sparing material combined with stem cells
from the same patient, has been gaining ground
as a more modern philosophy of treatment. Con-
[35] =>
CDE0413_01_Title
CDE0413_32-35_Pelegrine 05.12.13 17:37 Seite 4
research _ science & practice
I
Fig. 11g_The pellet containing
the bone marrow mononuclear cells
after the second centrifuge spin.
Fig. 11h_A bovine bone graft
combined with a bone marrow
stem cell concentrate.
All images courtesy of Células
Tronco em Implantodontia.2
Fig. 11g
Fig. 11h
sequently, to the detriment of traditional bone
grafting (with all its inherent problems), this novel
method of combining stem cells with mineralised
materials uses a viable graft with cells from the patient himself/herself without the need for surgical
bone harvesting.
cells for bone reconstruction (Fig. 9). It is clear that
the level of mineralised tissue is significantly
higher in those areas where stem cells were applied
(Figs. 10a & b).
Until recently, no studies had compared the
different methods available for using bone marrow
stem cells for bone reconstruction. In the following
paragraphs, I shall summarise a study conducted
by our research team, which entailed the creation
of critical bony defects in rabbits and subsequently
applying each of the four main stem cell methods
used globally in order to compare their effectiveness in terms of bone healing:1
_fresh bone marrow (without any kind of processing);
_a bone marrow stem cell concentrate;
_a bone marrow stem cell culture; and
_a fat stem cell culture (Figs. 6 & 7).
In a fifth group of animals, no cell therapy
method (control group) was used. The best bone
regeneration results were found in the groups in
which a bone marrow stem cell concentrate and
a bone marrow stem cell culture were used, and
the control group showed the worst results. Consequently, it was suggested that stem cells from
bone marrow would be more suitable than those
from fat tissue for bone reconstruction and that
a simple stem cell concentrate method (which
takes a few hours) would achieve similar results to
those obtained using complex cell culture procedures (which take on average three to four weeks;
Figs. 8a & b).
Similar studies performed in humans have
corroborated the finding that bone marrow stem
cells improve the repair of bony defects caused
by trauma, dental extractions or tumours. The
histological images below illustrate the potential
of bone-sparing materials combined with stem
Evidently, although bone marrow stem cell
techniques for bone reconstruction are very close
to routine clinical use, much caution must be
exercised before indicating such a procedure. This
procedure requires an appropriately trained surgical and laboratory team, as well as the availability
of the necessary resources (Figs. 11a–h, taken during laboratory manipulation of marrow stem cells
at São Leopoldo Mandic dental school in Brazil)._
André Antonio Pelegrine, Antonio Carlos Aloise, Allan
Zimmermann et al., Repair of critical-size bone defects
using bone marrow stromal cells: A histomorphometric
study in rabbit calvaria. Part I: Use of fresh bone marrow or bone marrow mononuclear fraction, Clinical Oral
Implants Research, 00 (2013): 1–6.
2 André Antonio Pelegrine, Antonio Carlos Aloise & Carlos
Eduardo Sorgi da Costa, Células Tronco em Implantodontia (São Paulo: Napoleão, 2013).
1
_about the author
cosmetic
dentistry
Dr André Antonio Pelegrine
is a specialist dental surgeon
in periodontology and implant
dentistry (CFO) with an MSc
in Implant Dentistry (UNISA),
and a PhD in clinical
medicine (University of
Campinas). He completed
postdoctoral research in transplant surgery
(Federal University of São Paulo). He is an associate
lecturer in implant dentistry at São Leopoldo
Mandic dental school and coordinator of the
perio-prosthodontic-implant dentistry team
at the University of Campinas in Brazil. He can be
contacted at pelegrineandre@gmail.com.
cosmetic
I 35
dentistry 4
_ 2013
[36] =>
CDE0413_01_Title
CDE0413_36-37_EAO 05.12.13 17:39 Seite 1
I meetings _ EAO
Dublin conference discussed
future concepts in dental
implant rehabilitation
cussed when the Convention Centre Dublin
opened its doors last October for the 22nd Annual
Scientific Meeting of the European Association
for Osseointegration (EAO).
According to the organiser, over 2,000 dental
professionals participated the three-day event,
which was held in the Irish capital for the second
time. In addition to current issues in the field,
like peri-implantitis and the challenges linked to
the treatment of an increasing elderly population,
the congress reflected on new developments
and methods, such as computer-assisted implant
rehabilitation and tissue regeneration.
Moreover, a number of sessions focused on risk
factors, treatment planning and the possibilities
of virtual learning techniques.
_Dental rehabilitation using implants has
seen significant advancements in the last decade.
Trends for the future of the specialty were dis-
36 I cosmetic
dentistry
4_ 2013
Up to 70 experts from Europe and around the
globe were speaking at the meeting. The latest
research were presented in the form of short oral
[37] =>
CDE0413_01_Title
CDE0413_36-37_EAO 05.12.13 17:39 Seite 2
meetings _ EAO
sessions and poster presentations took place
between the scientific sessions.
New products for treatment outcomes that are
more predictable and an improved workflow in
dental practices and laboratories were presented
at the industry exhibition, which was supported by
87 sponsors this year. Among others, MIS and Henry
Schein presented their latest tools for a complete
digital workflow. Furthermore, Danish dental solutions provider 3Shape had its recently launched
TRIOS intra-oral scanning system on display. New
and improved implant systems were presented by
Implant Direct and a number of other companies.
In 1995, the EAO held one of its earliest meetings in Dublin. Since then, the prestigious event
has taken place at 17 locations in 15 countries
throughout Europe. Last year’s anniversary meeting in Copenhagen saw more than 2,500 professionals participating, the number expected for the
2013 edition in Ireland. In addition to the Royal
College of Surgeons in Ireland and the Oral Surgery Society of Ireland, the meeting has received
support from the Irish Society of Periodontology
and the Prosthodontic Society of Ireland.
I
“In 1995, implant treatment was provided by
a fairly small number of specialists and access
for patients was limited,” commented Dr Brian
O’Connell, congress chairman and Professor of
Restorative Dentistry at Trinity College Dublin’s
dental school and hospital.
“Now implant treatment is available in every
part of the country and is provided by a wide
range of practitioners. As a result, awareness has
really grown among the population. (…)Europe
has a generally ageing population, who may have
the greatest demand and need for dental implant
treatment in the future. Evidence suggests that
the majority remain healthy and active for much
longer than we may have believed. We need to
learn much more about the specific requirements
of the older population and be aware of the risks
as well. Often assumptions about older people are
inaccurate. Although they may less demanding
about their needs, they frequently respond well
to implant treatment.”
Next year’s EAO annual congress will be held
from 16 to 19 October in Rome. For details please
visit EAO website._
All photos courtesy of EAO.
cosmetic
I 37
dentistry 4
_ 2013
[38] =>
CDE0413_01_Title
CDE0413_38_Kuraray 05.12.13 17:39 Seite 1
I industry news _ Kuraray
KATANAZirconia ML Disc
High-performance zirconia with integrated colour shift
kn
thic
ess
f
%o )
5
3
%
r(
aye r 1 (15 )
L
l
%
ye
me
Ena tion La r 2 (15
i
s
ye
Tran tion La %)
si
35
Tran Layer (
y
Bod
)
_KATANA Zirconia ML Discs are the
world’s first polychrome zirconia
with integrated colour shift
KATANA Zirconia ML Discs are highperformance zirconia blanks manufactured
on an industrial scale and with consistently
high quality. They can be used easily in everyday milling process for laboratories with
milling machines. A natural-looking restoration can be achieved immediately in one
step, yielding a remarkable result with a
natural gradient. The shortened manufacturing process makes the discs economical
and avoids possible complaints.
The KATANA range is completed by the
white KATANA Zirconia HT (High Translucent)
Disc, which offers additional possibilities for
individual staining and veneering.
_The KATANA Zirconia ML (Multi-Layered)
Disc consists of four pre-coloured layers showing smooth enamel, dentine and cervical colour
shifts. They represent natural tooth colours
and allow dentists to achieve a natural-looking
restoration.
_KATANA Zirconia ML yields impressive
results immediately
The sintering process can be started immediately after milling without the usual working
steps like dipping or painting and drying, significantly reducing the steps in the production
process. After polishing or glazing, impressive
restorations can be achieved under standard
conditions.
_Reproducibility of colours for crowns,
bridges and frames by integrated
colour gradation
The reliability of KATANA, Noritake’s highperformance zirconia material, has been proven
scientifically.1 Reproducibility has been further
developed and with KATANA Zirconia ML we have
succeeded in making predictable and aesthetic
results as easy to achieve as possible.
38 I cosmetic
dentistry
4_ 2013
The CERABIEN ZR Stain can be used for the
KATANA Zirconia range. Conventional glazing and
polishing techniques can be used as well.
Technical details:
_Pre-sintered disc with collar
_Flexural strength: 1,050–1,100 MPa
_Fracture toughness: 5 MPa√m
_Diameter: 98.5 mm_
1
B.D. Flinn et al., Accelerated aging characteristics of
three yttria-stabilized tetragonal zirconia polycrystalline dental materials, Journal of Prosthetic Dentistry,
108/4 (2012): 223–30.
_contact
Kuraray Europe GmbH
BU Medical Products
Philipp-Reis-Str. 4
65795 Hattersheim/Main, Germany
Tel.: +49 69 305 35833
dental@kuraray.eu
www.kuraray-dental.eu
cosmetic
dentistry
[39] =>
CDE0413_01_Title
2013 - 2014
ALL EVENTS ACCREDITED BY
UPCOMING EVENTS
MIDDLE
EAST
Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider. ADA CERP is a service
of the American Dental Association to assist dental professionals in identifying quality providers of continuing
dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply
acceptance of credit hours by boards of dentistry.
5th DENTAL - FACIAL COSMETIC INTERNATIONAL CONFERENCE
Joint Meeting with
American Academy of Implant Dentistry, 2nd Global Conference
JUMEIRAH BEACH HOTEL
08-09 NOVEMBER 2013
DUBAI, UAE
www.cappmea.com/aesthetic2013
DENTAL TECHNICIAN FORUM part of IDEM SINGAPORE 2014
in cooperation with Koelnmesse
SUNTEC INTERNATIONAL CONVENTION & EXHIBITION CENTRE
05-06 APRIL 2014
SINGAPORE
www.idem-singapore.com
CAD/CAM & DIGITAL DENTISTRY INTERNATIONAL CONFERENCE
9th EDITION
09-10 MAY 2014
DUBAI, UAE
www.cappmea.com/cadcam9
4
4
4 th IRAQI DENTAL REUNION ANNUAL CONFERENCE
Breaking New Opportunities in cooperation with
The 5th International Healthcare Exhibition & Conference Serving Iraq
MAY 2014
ERBIL IRAQ
36 th ASIA PACIFIC DENTAL CONGRESS 2014
Event Supporter
17, 18, 19 JUNE 2013
DUBAI, UAE
www.apdentalcongress.org
T: +971 4 3616174 | F: +971 4 3686883 | M: +971 50 2793711 | E: info@cappmea.
f
fo@cappmea.
com | www.cappmea.com
M: +971 55 1128581 | E: deyanov@capp-asia.com | www.capp-asia.com
[40] =>
CDE0413_01_Title
CDE0413_40_Events 05.12.13 17:40 Seite 1
I meetings _ events
International Events
2014
IMAGINA Dental
3rd 3-D & CAD/CAM Digital Dentistry Congress
13–15 February 2014
Monaco
www.imaginadental.org
9th CAD/CAM & Digital Dentistry
International Conference
9 & 10 May 2014
Dubai, UAE
www.cappmea.com
SSER Annual Meeting
15–17 May 2014
Bucharest, Romania
www.sser.ro
EAED 28th Annual Meeting
29–31 May 2014
Athens, Greece
www.eaed.org
PASE Annual Meeting
12–14 June 2014
Warsaw, Poland
www.pase.org.pl
APDC 36th Asia Pacific Dental Congress
17–19 June 2014
Dubai, UAE
www.apdentalcongress.org
IACA 2014 Annual Meeting
24–26 July 2014
Bahamas
www.theiaca.com
AAED 39th Annual Meeting
5–8 August 2014
Santa Barbara, CA, USA
www.estheticacademy.org
FDI Annual World Dental Congress
11–14 September 2014,
New Delhi, India
www.fdi2014.org.in
ESCD 11th Annual Meeting
9–11 October 2014
Rome, Italy
www.escdonline.eu
155th ADA Annual Session
9–12 October 2014
San Antonio, USA
www.ada.org
EAO 2014
16–19 October 2014
Rome, Italy
www.eao.org
BACD Annual Conference
6–8 November 2014
Liverpool, UK
www.bacd.com
40 I cosmetic
dentistry
4_ 2013
[41] =>
CDE0413_01_Title
CDE0413_41_Submission 05.12.13 17:40 Seite 1
about the publisher _ submission guidelines
submission guidelines:
Please note that all the textual components of your submission
must be combined into one MS Word document. Please do not
submit multiple files for each of these items:
_the complete article;
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_the complete list of sources consulted; and
_the author or contact information (biographical sketch, mailing
address, e-mail address, etc.).
I
Image requirements
Please number images consecutively throughout the article
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Please place image references in your article wherever they
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If you do not directly refer to the image, place the reference
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In addition, please note:
In addition, images must not be embedded into the MS Word
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about such submission follow below under image requirements.
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Article lengths can vary greatly—from 1,500 to 5,500 words—
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In short, we do not want to limit you in terms of article length,
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you have specific questions, please do not hesitate to contact us.
Text formatting
We also ask that you forego any special formatting beyond the
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_We require images in TIF or JPEG format.
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_These image files must be no smaller than 80 KB in size (or they
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Larger image files are always better, and those approximately
the size of 1 MB are best. Thus, do not size large image files down
to meet our requirements but send us the largest files available.
(The larger the starting image is in terms of bytes, the more leeway the designer has for resizing the image in order to fill up more
space should there be room available.)
Also, please remember that images must not be embedded into
the body of the article submitted. Images must be submitted
separately to the textual submission.
You may submit images via e-mail, via our FTP server or post
a CD containing your images directly to us (please contact us
for the mailing address, as this will depend upon the country from
which you will be mailing).
Please also send us a head shot of yourself that is in accordance
with the requirements stated above so that it can be printed with
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enable you to do so. The fact is that no matter how carefully done,
errors can creep in when you try to number footnotes yourself.
Author or contact information
The author’s contact information and a head shot of the author
are included at the end of every article. Please note the exact
information you would like to appear in this section and format it according to the requirements stated above. A short
biographical sketch may precede the contact information
if you provide us with the necessary information (60 words
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Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com
cosmetic
I 41
dentistry 4
_ 2013
[42] =>
CDE0413_01_Title
CDE0413_42_Impressum 05.12.13 17:40 Seite 1
I about the publisher _ imprint
cosmetic
dentistry
_ beauty & science
asia pacific edition
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
International Media Sales
Matthias Diessner
m.diessner@dental-tribune.com
Editor-in-Chief
Dr Sushil Koirala
skoirala@vedicsmile.com
Europe
Melissa Brown
m.brown@dental-tribune.com
Co-Editor-in-Chief
Dr So Ran Kwon
soran-kwon@uiowa.edu
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
Designer
Franziska Dachsel
f.dachsel@dental-tribune.com
Copy Editors
Sabrina Raaff
Hans Motschmann
International Administration
Marketing & Sales
Esther Wodarski
e.wodarski@dental-tribune.com
Executive Vice President
Finance
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Asia Pacific
Peter Witteczek
p.witteczek@dental-tribune.com
The Americas
Jan M. Agostaro
j.agostaro@dental-tribune.com
International Offices
Europe
Dental Tribune International GmbH
Contact: Esther Wodarski
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
Advisory Board
Dr Michael Miller, USA
Dr Seok-Hoon Ko, Korea
Editorial Board
Dr Anthony Au, Australia
Dr Bao Baicheng, China
Dr Helena Lee, Singapore
Dr Hisashi Hisamitsu, Japan
Dr Jiraporn Charudilaka, Thailand
Dr Mostaque H. Sattar, Bangladesh
Dr Ratnadeep Patil, India
Dr Suhit Raj Adhikari, Nepal
Dr Takashi Nakamura, Japan
Dr Vijayaratnam Vijayakumaran, Sri Lanka
cosmetic
dentistry _ beauty & science
is the official publication of:
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
Contact: Anna Wlodarczyk
116 West 23rd Street, Suite 500
NY 10011, New York, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
www.dental-tribune.com
Copyright Regulations
_cosmetic dentistry_ beauty & science is published by Dental Tribune Asia Pacific Ltd. and will appear in 2013 with four issues. 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
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
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.
42 I cosmetic
dentistry
4_ 2013
[43] =>
CDE0413_01_Title
CDE_Abo_A4_CDE_Abo_A4 13.09.13 15:43 Seite 1
cosmetic
dentistry _ beauty & science
You can also subscribe via
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Subscribe now!
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[44] =>
CDE0413_01_Title
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05/11/13 13:06
)
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/ Interdisciplinary treatment of a patient with 11 missing permanent teeth: A biomimetic approach
/ Reconstruction of a horizontal ridge defect using the bone lamina technique
/ Stem cells in implant dentistry
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/ KATANAZirconia ML Disc
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