DT Middle East and Africa No. 3, 2014

News / Quest for the Perfect Restoration / CAD/CAM Conference Dubai grows as fast as Digital Dental Technology / Passive micro-volume management of sodium hypochlorite in endodontic treatment / The power of cross coding: How hygienists can support their patients’ overall body health / Clinical Tips: Demi™ Ultra and C.U.R.E™ Technology: (Curing Uniformity & Reduced Energy) what this brings versus competition? / The European University College hosts its official graduation ceremony / Lab Tribune / CAD/CAM | Digital Tribune / “The edentulous patient is an amputee - an oral invalid - to whom we should pay total respect and rehabilitation ambitions”. Per-Ingvar Brånemark / Hygiene Tribune / Ortho Tribune / Education Tribune / Implant Tribune / Endo Tribune / Industry News / 9th CAD/CAM & Digital Dentistry International Conference

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Printed in Dubai

May-June 2014 | No. 2, Vol. 3

SIGNATURE
9th CAD/CAM EVENT
& Digital DentistrymCME
International Conference

CEREC Desert Fest
The power of cross coding:
BOOK YOUR CALENDAR
12-13 September 2014
How hygienists can support
The Palace Hotel, Dubai09-10 MAY 2014 their patients’ overall body
15% discount for
JUMEIRAH BEACH HOTEL,health
DUBAI
ORGANIZED BY

DTMEA club members

>Page 3

E: events@cappmea.com

aesthetic dentistry
Joint Meeting with

ORGANIZED BY

CO-ORGANIZERS

M: +971502793711

>Page 6

NOVEMBER
14-15, 2014
6th Dental-Facial
Cosmetic
JUMEIRAH BEACH HOTEL
International Conference
DUBAI, UAE
3rd AAID Global Conference

14-15 November
M: +9715027937112014
www.cappmea.com
Jumeirah Beach Hotel, Dubai

E: events@cappmea.com

www.cappmea.com/cadcam9

CAD/CAM
Conference Dubai
grows as fast as Digital
Dental Technology
much anticipated event will
have 27 International Speakers, 24 Presentations, 12 Sponsors and 19 Industrial Players,
bringing the latest in the field
of Dentistry.

Conference is co-organized by
Emirates Dental Society, Saudi
Dental Society, Lebanese Dental Association and Centre For
Advanced Professional Practices - spearheaded by Dr. Dobrina Mollova, DDS, experienced
provider of Continual Medical
Education for the last 10 years
in the Middle East and Asia.

This year’s annual CAD/CAM &
Digital Dentistry International

The event enjoys accreditation
from ADA CERP, DHA, HAAD

Dr. Munir Silwadi during the Hands-On Course in Dubai

By Dental Tribune MEA

D

UBAI, UAE: Jumeirah
Beach Hotel will once
again become the venue
hosting the regions dental elite
for the 9th CAD/CAM & Digital
Dentistry International Conference on 09-10 May 2014. The

and SCHS, including cutting
edge presentations and an impressive lineup of lectures to
be provided by opinion leading
Dental Professionals such as:
Prof. Dr. Dr. h.c. Georg Meyer,
Germany; Dr. Andreas Kurbad, Germany; Dr. Lida Swann,
USA; Lee Culp, CDT, USA; Dr.
Andrea Mastrorosa Agnini, Italy; Dr. Alessandro Agnini, Italy;
Prof. Alfred Hans Resch, Germany; Dr. Ulrich Wegmann,

Germany; Dr. Maria Hardman,
UK and Dr. Ziad Salameh DDS,
MSc, PhD, Lebanon.
The two day Scientific Session is complimented by eight
hands-on courses, pre- and
post-conference,
including:
Indirect Veneers; Laser: Unconventional Management for
Soft & Hard Tissue; Mastering

> Page 32

Quest for the Perfect First Dental Technician Forum
highlights current developments in
Restoration
dental labs

By Dr. Munir Silwadi, UAE

A
Dr. Munir Silwadi, Chairman
at the 8th CAD/CAM & Digital
Dentistry Int’l Conf. in Dubai

BU DHABI, UAE:
CAD/CAM generated
dental
restorations
were introduced nearly
30 years ago. It is beyond doubt
that this introduction represents
an extremely important milestone in our endeavor to reach
the perfect restoration. Restoring damaged or missing teeth
has always been a tough challenge all the way since ancient
Egyptians untill our present
time.
Though our restorations of-

> Page 15

By Dr. Dobrina Mollova, DDS

S

INGAPORE: Dental technicians are a very important part of the dental team.
As an extension of IDEM’s educational offering, the first Dental
Technician Forum organised by
the Centre for Advanced Professional Practices in Dubai and
Koelnmesse saw over 220 dental
technicians from 18 countries
come to Singapore to develop
the knowledge and skills they
need to keep pace with the rapid
advances and innovations in
dental technology. An exhibition
sponsored by VITA, Sirona and
SHERA, among other companies, created excellent network-

Vanik Kaufmann-Jinoian, MDT, Switzerland

ing opportunities and had the
latest developments, systems
and technologies on display.
Moderated by key opinion leaders from around the globe, the

two-day event saw participants
sharing and discussing cuttingedge knowledge and the newest
clinical approaches in prostho-

> Page 2

NEWS

ORTHO TRIBUNE

HYGIENE TRIBUNE IMPLANT TRIBUNE ENDO TRIBUNE

Page 25

Page 28

Page 21

Page 42

Page 30

Scientists from Norway develop scaffolding to ...
Dental photography made
simple by Shofu

Aesthetics and function:
Orthodontic – surgical...
“The Middle East region is
right up there in terms...”

Keeping Hygienists in par
with Continuing...
Maintenance of dental implants for the hygienist

Page 36

Case Report Maxillary
Implant

Page 37

Stem cells in implant
dentistry

Page 40

Visual information and imaging technology in...
“Continuous Education is a
top priority for us, first...

[2] =>

2 news

Dental Tribune Middle East & Africa Edition | May - June 2014

< Page 1
dontics, aesthetics in implantology, and CAD/CAM technologies, among others. “Things in
the dental lab are changing in a
rapid manner. Digital technology and workflows allow us to be
more economical and creative
with new materials and produce
excellent aesthetics,” said Swiss
master dental technician Vanik
Kaufmann-Jinoian, who presented a lecture on minimally
invasive restorations with CAD/
CAM.
The four table clinic presentations, which ran concurrently,
were among the most appealing and enjoyable sessions for

“New educational format presented
at IDEM Singapore a success”
all participants. Among other
things, new hybrid materials
and their benefits were presented. Participants were also given
the opportunity to ask questions
on real cases that were printed
live with help of 3-D scanners
and milling machines. By analysing different cases, brothers
Drs Andrea Mastrorosa Agnini
and Alessandro Agnini from Italy gave the audience a surprising insight into the operational
techniques that they have developed over time with their increasing knowledge of new ma-

terials. With new technologies
replacing traditional materials
and techniques, they said that
achieving good clinical results
has become more systematic
and time effective.
A ceramist and professional
photographer, Naoki Aiba demonstrated the capture of shade
view photographs in order to
communicate shade accurately.
Tips for calibrating and coding a shade guide were also
given. Hue and value analysis
with shade view photographs

utilising Adobe Photoshop for
ceramic fabrication generated
a great deal of interest and discussion during the session.
Rik Jacobs’ presentation on the
latest developments concerning 3-D printers, software, biocompatible materials and workflow management drew a large
crowd of not only participants
but also industry representatives. The ensuing discussion
lasted over an hour with debates
sparked about the suitability
of alginate impression materials for scanning, the accuracy
of models milled by the inLab
MC XL (Sirona Dental Systems),

the shade availability of crown
and bridge materials, as well as
which zirconia blocks are recommended for good aesthetics.

Group Editor

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Dental Tribune
Middle East & Africa
Edition Editorial Board

Dr. Aisha Sultan Alsuwaidi, UAE
Dr. Nabeel Humood Alsabeeha, UAE
Dr. Mohammad Al-Obaida, KSA
Dr. Meshari F. Alotaibi, KSA
Dr. Jasim M. Al-Saeedi, Oman
Dr.Mohammed Sultan Al-Darwish
Prof. Khaled Balto, KSA
Dr. Dobrina Mollova, UAE
Dr. Munir Silwadi, UAE
Dr. Khaled Abouseada, KSA
Dr. Rabih Abi Nader, UAE
Dr. George Sanoop, UAE
Retty M. Mathew, UAE
Rodny Abdallah, Lebanon
Victoria Wilson, UK
Partners

Emirates Dental Society
Saudi Dental Society
Lebanese Dental Society
Qatar Dental Society
Oman Dental Society
Director of mCME
Dr. Dobrina Mollova
mollova@dental-tribune.me
+971 50 42 43072
Business Partner | BDM

Tzvetan Deyanov
deyanov@dental-tribune.me
+971 55 11 28 581

[3] =>

CEREC

Desert Fest

Panel
Show

The Palace Hotel Downtown
12-13 September 2014
Dubai, UAE
www.cappmea.com/cerecfest

Desert
Night

Clinic
Presentations

[4] =>

industry

4

[5] =>

news

Dental Tribune Middle East & Africa Edition | May - June 2014

World oral health report:
Almost 100 per cent
of adults suffer from
dental caries
A white paper on world oral health was presented in London last
week. (Photo courtesy of FDI World Dental Federation)

ONDON, UK: In celebration of World Oral Health
Day, representatives of the
FDI World Dental Federation
presented the latest findings
on oral health on 20 March at
a press conference held in collaboration with the British Dental Association in London. The
report identifies the main obstacles to achieving universal oral
health and includes recommendations to improve oral health
worldwide.

Among other aspects, the report,
titled “Oral health worldwide: A
report by FDI World Dental Federation”, highlights that nearly
100 per cent of adults and between 60 and 90 per cent of children worldwide have dental caries, which results in millions of
lost school and work hours. For
instance, in the US, an estimated 2.4 million days of work and
1.6 million days of school are
missed owing to oral disease. In
the Philippines, toothache is the
primary reason for school absenteeism. The FDI stated that
about 97 per cent of Philippine
6-year-olds have dental caries.
In addition, the report states that
only 60 per cent of the world’s
population have access to oral
care, creating enormous disparities between different populations. According to the FDI, people of a lower socio-economic
status visit the dentist less often
and have fewer fillings, more
missing teeth, higher tobacco
consumption, higher rates of
caries and untreated decay, and
higher rates of periodontitis
compared with those of a high
socio-economic status.
In order to increase access to
oral care, the training of the
oral health work-force needs to
be strengthened and expanded
to improve the quality of and
increase the number of oral
health professionals. Moreover,
emphasis needs to be put on the
equal geographical distribution
of oral health personnel, especially within developing countries, where the dentist-to-population ratio is approximately
1:150,000 compared with about
1:2,000 in most industrialised
countries.
The FDI further highlighted
that a solely curative approach
to tackling the burden of oral
health is neither realistic nor
sustainable. The organisation
asserts that the prevention of
oral diseases and promotion of
oral health must be at the core
of national policies and programmes. In this respect, global

and national surveillance should
be strengthened to identify risk
factors and oral health needs as
a basis for developing appropriate approaches and measures,
the FDI stated.

ORTHOPANTOMOGRAPH ® is a registered trademark of Instrumentarium Dental, PaloDEx Group Oy.

By Dental Tribune International

The event also saw the launch
of The Tooth Thief, an illustrated book for children that includes oral health tips. The book
emphasises the importance of
good oral health to children to
instil good oral care habits from
a young age. The foreword was

written by Yaya Touré, Manchester City Football Club player and
three times African Footballer
of the Year, who was this year’s
World Oral Health Day ambassador.
The book is available from the

Apple iBooks Store and Amazon,
and can be downloaded from
the World Oral Health Day website, www.worldoralhealthday.
com. The complete white paper
can be accessed free on the website as well.

The One
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With a legacy of innovation and experience
spanning over 50 years, we’ve mastered
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DentalTribune_add_210x297mm_jan_2014.indd 1

1/14/2014 8:37:03 AM

[6] =>

6 mcme

Dental Tribune Middle East & Africa Edition | May - June 2014

Passive micro-volume management of
sodium hypochlorite in endodontic treatment
mCME articles in Dental Tribune have been approved by:
HAAD as having educational content for 2 CME Credit Hours
DHA awarded this program for 2 CPD Credit Points

By Les Kalman, B.Sc (Hon),
DDS

he passive utilization
and
micro-volume
management of sodium
hypochlorite
as an endodontic irrigant has
been illustrated with a laboratory demonstration and several clinical cases. By limiting the volume and pressure
of sodium hypochlorite, the
injurious effects can be minimized while still benefiting
from the ideal disinfecting
characteristics. Further studies are required to understand
the behavior of fluids, especially sodium hypochlorite,
within the context of permeability, fluid mechanics and
multiphase fluid flow through
porous media.
Introduction

Endodontic treatment addresses the removal of the
tooth’s internal pulp and microorganisms, 1 primarily due
to infection and necrosis. Once
proper diagnosis and prognosis has been established,
the patient has the option of
maintaining the tooth’s form
and function while the vitality becomes lost. Current endodontic treatment consists of
utilizing rotary files to remove
the pulpal tissue and shape
the internal dentin chamber
of the tooth. Chemicals, in the
form of gels and liquids, are
then implemented to disinfect the canal(s) and eliminate
bacteria.2 The chemicals are
then dried and the canal space
filled with either gutta-percha
or resin to create a hermetic
seal.
The chemicals employed to
clean and disinfect the intracanal space are vast and include file lubricants such as
Prolube (DENTSPLY) and irrigants such as QMix (DENTSPLY). During clinical endodontics, the canal is filled with
a cocktail of chemicals, as file
lubricants and irrigants become a mixture.
Chlorhexidine
gluconate
(CHX) is an uncommonly used
irrigant3 with several desirable properties. It provides
antimicrobial activity against
certain aerobic and anaerobic bacteria, exhibits no significant changes in bacterial
resistance in the oral micro-

bial environment and has no
injurious effect to the skin or
mucosa.4 In fact, CHX has a
role as an oral rinse at the 0.12
percent concentration.4
Sodium hypochlorite (NaOCl)
still remains the most commonly used chemical,2,3 because of its availability, cost
and effectiveness.2,5 Sodium
hypochlorite
is
effective
against broad-spectrum bacteria and has the ability to dissolve both vital and necrotic
tissue.6 However, this irrigant
is equally damaging to the patient and has a history of injurious effects.5 Typically the
NaOCl is delivered into the canal space with a syringe dose
of 2-10 ml that is expelled
under pressure. The ability of NaOCl to escape either
through poorly sealed isolation or other means can cause
serious injury to the patient.5
Injury from NaOCl is well established in the literature3,5,6
and has been attributed to
three main errors: poor handling, injection beyond the
apical foramen and allergy.6
Poor handling injury can result in operator and/or patient
injury to the eye and/or skin.6
Injection beyond the apical
foramen can result in the following:6
•
immediate and severe
pain
•
edema to adjacent tissue
•
edema to the lip, infraorbital region and side of
face
•
intense bleeding from
within the canal space
skin and mucosa bleeding
•
•
intestinal bleeding
•
paraesthesia
•
secondary infection.
Allergy from NaOCl is rare
but has been reported and
may result in severe pain, a
burning sensation, edema and
transient paraesthesia.6
Methodology
Although there is no universally accepted irrigation protocol regarding endodontic
treatment,3 it is the duty of
clinicians to apply evidencebased dentistry within clinical parameters to provide
their patients with the highest
standard of care with minimal
morbidity. The use of NaOCl
has numerous beneficial factors that maximize treatment

success; however, it is the application of the liquid that can
cause injury.
Micro-volume management
of NaOCl has been proposed.
The concept is based on the
premise that endodontic instruments
have
irregular
surfaces, crucial for dentinal
preparation, and that liquids exhibit surface tension
characteristics.7 By placing
an instrument into a suitable
container, the NaOCl will be

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.

CAPP designates this activity
for 2 CE credits.

The operator has control of
the minimized liquid while
benefitting from its effectiveness.
The micro-volume management of sodium hypochlorite
has been applied to numerous
clinical cases. Post-operative
obturation radiographs of
completed clinical cases have
been presented (Figs. 5–9).
Discussion

duces liquids, then the successful removal of those liquids is key to clinical success.
Concepts of multiphase fluid
flow through porous media,
and capillaries, 10 permeability of porous media11 and surface tension fluid mechanics7
must be recognized to validate
and further advance canal irrigation.
Micro-volume management
of NaOCl has been suggested
as a delivery modality to maxi-

Fig. 1 DENTSPLY Vortex rotary file with sodium
hypochlorite. (Photos/Provided by Les Kalman,
B.Sc (Hon), DDS)

Fig. 2 DENTSPLY Profile rotary file with dyed sodium
hypochlorite.

Fig. 3 Micro-volume delivery of sodium hypochlorite with rotary file.

Fig. 4 Sodium hypochlorite in block with rotary file.

carried within the surface texture of the instrument (Figs. 1,
2). As the operator inserts the
instrument into the canal (Fig.
3), the NaOCl is carried with
it. Upon instrument movement, the NaOCl is released
into the canal space (Fig. 4).
Surface tension and permeability of porous media (dentin)
will also increase the ability of
the liquid to percolate into the
canal.7 This approach is radically different than current
philosophies, as the NaOCl
is introduced into the canal space in a micro-volume
amount without any pressure.

The canal system inside a tooth
is very complex. Although
there is the presence of one or
more canals, there also exist
numerous micro tunnels, ribbons and sheets throughout
the canal network.8 The canals are also housed within a
porous dentinal structure, for
which the permeability has
been distinguished.9 Although
the elimination of the pulp is a
relatively predictable clinical
procedure, the introduction
of liquids into this complex
micro-network porous development further complicates
matters. If the clinician intro-

mize its bactericidal effects yet
minimize its injurious effects.
Surface tension fluid mechanics and permeability7,10,11 suggest that the NaOCl can be
carried within the surface irregularities of endodontic instrumentation and deposited
into the canal space and percolate within the complex network of the canal. The passive
management of the irrigant in
micro-volume would greatly
reduce complications due
to poor handling. CHX has

> Page 7

[7] =>

mcme

Dental Tribune Middle East & Africa Edition | May - June 2014

< Page 6

Fig. 5 Radiograph of endodontic treatment on #47.

Fig. 6 Radiograph of endodontic treatment on #26.

been suggested as the larger
volume, positive pressure irrigant that may be delivered
into the canal space. CHX has
favorable antibacterial characteristics but minimal injurious effects, if mismanagement
of the irrigant has occurred.
If positive pressure delivery
of CHX is required, the operator should regulate the
pressure and avoid the risk
of injection beyond the apex.
The use of EDTA (ethylenedi- Fig. 8 Radiograph of endodontic treatment on #36.
aminetetraacetic acid) could
be employed after NaOCl, to
minimize the formation of
precipitates.2
The application of micro-volume management of NaOCl
suggests that the canal space
can be effectively cleaned in
a conservative manner. Application of this principle has
been applied to clinical cases
with little to no post-endodontic sensitivity. Obturation has
been completed with ThermaSeal and Thermafil (DENTSPLY). Even though there is

Fig. 7 Radiograph of endodontic treatment on #16.

ments in microscopic capillaries. Journal of Petroleum
Technology.
1956;8:(9):211–
214.
11. Crotti MA. Motion of Fluids in Oil and Gas Reservoirs.
Mosby:New York,1978;8–14.

About the Author
Fig. 9 Radiograph of endodontic treatment on #16.

morbidity while maximizing
clinical endodontic success
seems promising for both clinician and patient.

“NaOCl has several advantages
for its role as an endodontic
References
irrigant, but its use must be
Dang E. Comparison of soexercised with caution in order 1.dium
hypochlorite and chlorhexidine
gluconate: qualto prevent injury.”
ity of current evidence. The

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evidence of sealer extrusion,
the absence of post-operative
symptoms and pathology suggests adequate volume for sufficient disinfection.
Further laboratory studies are
required to understand permeability, fluid mechanics and
multiphase fluid flow through
porous media and their relation to the micro-management of NaOCl. Additional
clinical investigations should
be implemented to assess and
validate the efficiency and efficacy of micro-volume management of sodium hypochlorite on endodontic therapy.
Conclusions
Introduction of lubricants and
irrigants into the canal complex is crucial for endodontic
success. The action of fluids
in the canal complex must be
understood within the context
of permeability, fluid mechanics and multiphase fluid flow
through porous media.
NaOCl has several advantages
for its role as an endodontic irrigant, but its use must be exercised with caution in order
to prevent injury. Application
of NaOCl as a passive, microvolume liquid has been illustrated.
Further consideration is required to validate the theory.
The potential to minimize

Journal of Young Investigators: An Undergraduate, PeerReviewed Science Journal
2008:23(1):1–9.
2. Basrani BR, Manek S, Rana
SNS, Fillery E. and Manzur
A. Interaction between sodium hypochlorite and chlorhexidine gluconate. J Endod
2007;33: 966–969.
3. Dutner J, Mines P, and Anderson A. Irrigation trends
among American Association
of Endodontists members: a
webbased survey. J Endod:
2011;-: 1–4.
4. 3M ESPE: Peridex™ Chlorhexidine Gluconate (0.12%)
Oral Rinse Fact Sheet: 2009.
5. Clarkson RM, and Moule
AJ. Sodium hypochlorite and
its use as an endodontic irrigant. Australian Dental Journal 1998;43:(4).
6. Hülsmann H. & Hahn W.
Complications during root
canal irrigation-literature review and case reports. International Endodontic Journal:
2000;33:186–193.
7. Trefethen L. Surface tension in fluid mechanics. Encyclopaedia Britannica. (12ed.)
Wiley:Chicago,1969;1–7.
8. West JD, Roane JB and Goering AC. Cleaning & shaping of the root canal system.
In Cohen S. and Burns RC.
Pathways of the Pulp. (6th ed.)
Mosby:St. Louis,1994;179–218.
9. Trowbridge HO. and Kim S.
Pulp development, structure
& function. In Cohen S. and
Burns RC. Pathways of the
Pulp. (6th ed.) Mosby:St. Louis,1994;296–336.
10. Templeton CC. and Rushing SS. Jr. Oil-water displace-

Les Kalman, B.Sc (Hon), DDS,
graduated from the University
of Western Ontario with a doctor of dental surgery degree
in 1999. He then completed
a GPR at the London Health
Sciences Centre. He has been
involved in general dentistry
within private practice since
2000.
He has served as the chief of
dentistry at the Strathroy-Middlesex General hospital. In
2011, he transitioned to fulltime academics as an assistant professor at the Schulich
School of Medicine and Dentistry. Kalman’s research focuses on clinical innovations,
including the Virtual Facebow
app. Kalman is also the director of the Dental Outreach
Community Services (DOCS)
program, which provides free
dentistry within the community. Kalman has authored
articles ranging from pediatric impression to immediate
implant surgery in both Canadian and American journals.
He has been a product evaluator for several companies,
including GC America and Clinician’s Choice. Kalman is the
co-owner of Research Driven,
a company that deals with
intelectual property development. Kalman is a member
of the American Society for
Forensic Odontology, International Team for Implantology,
Academy of Osseointegration,
American Academy of Implant
Dentistry and the International Congress of Oral Implantology.
He has been recognized as
an academic associate fellow
(AAID) and diplomate (ICOI).
He can be contacted at lkalman@uwo.ca.

[8] =>

8 mcme

Dental Tribune Middle East & Africa Edition | May - June 2014

The power of cross coding:
How hygienists can support their patients’
overall body health
mCME articles in Dental Tribune have been approved by:
HAAD as having educational content for 2 CME Credit Hours
DHA awarded this program for 2 CPD Credit Points

By Marianne Harper

ave you lost the excitement? Are you
content with what
you
might
now
perceive as the same-old,
same-old every day? Day after day you may be performing hygiene procedures over
and over again, all the while
knowing you are helping your
patients but perhaps you simply don’t feel as though you are
truly making a significant dif-

ference in their overall health.
If you feel that level of frustration, or even if you don’t, but
you are interested in advancing your career, then read on to
discover some ways in which
you can make a significant difference in the health of your
patients.
As you are aware, dentistry
is becoming recognized as a
medical discipline. We in the
dental field are in a unique
position to support our patients’ overall body health. Our

patients who maintain their
regular recare schedules are
quite probably seen by us more
frequently than they are seen
by their primary care providers. “Around 39 percent of
adults see their physicians in a
year while 64 percent see their
dentists, which means we see
25 percent more patients than
they do.”1
Hygienists can be key players in
this opportunity. By thoroughly
questioning their new patients
and by providing and reviewing

CAPP designates this activity
for 2 CE credits.

medical history forms that are
updated with the most current
medical questions, hygienists
can begin an evaluation of their
patients’ medical state. In addition, our established patients
may have had a change in their
medical history since their last
appointment, so a recare update
form is an efficient way to inquire about their health. If your
practice is not familiar with recare update forms, please check
my website to obtain a copy.
Again, thorough questioning of
all new and established patients
is an essential component to
getting the full picture of your
patients’ health.
What is discovered from these
questions can be a strong determining factor in how each
patient is handled. Patient questioning should always be followed by dental exams, X-rays,
blood pressure checks and clinical observations. For those patients who may have a systemic
disorder, your practice should
become proactive by referring
the patient back to his or her
primary care provider.
However, because dentistry has
evolved over the last decade,
there are more ways that the
dental practice can help make
these determinations. With the
frequency of patients’ visits and
the availability of numerous
cutting edge diagnostic tools,
we have the unique opportunity
to administer different types of
disease testing that, in the past,
were performed only by medical practices.
If you are unfamiliar with the
types of medical testing that are
available for dental practices to
perform, then the following information can make a big difference in the quality of your practice’s treatment, and it may help
to make a significant change in
how you perceive your career.

Fig. 1 Photocopy of example CMS-1500 health insurance claim for treatment of sleep apnea, considered
a medically necessary dental procedure that qualifies for coverage through health insurance. Many
other dental procedures and tests also might qualify. But you need to know the diagnosis and
procedure codes — and other nuances of the process.

First of all, periodontal diseases
and caries are bacterial infections, but the majority of dental
practices diagnose these conditions through the use of periodontal probes and explorers.
Have you considered that medical practices would never begin
treatment without determining
if they are treating bacteria or a
virus? In dentistry, we need to
differentiate between aspirin
sensitivity, blood dyscrasias,

other diseases, fungus, yeast
or a cyst; so bacteriologic tests
should be performed.2 Microscopic tests, DNA tests, or bacteriologic tests should be performed if periodontal infections
are apparent.
Tests that can be performed in a
dental practice:
•
HgA1c for blood sugar
•
C-reactive protein (CRP)
for inflammation
•
BANA for bacterial pathogens or their byproducts
•
DNA for the presence of
specific pathogens or for
patient susceptibility to periodontal disease
• TOPAS for inflammatory
markers
•
Oral HPV testing
•
Diabetes testing with a glucometer — finger stick or
blood sample taken from a
periodontal pocket
• Oral cancer screening (e.g.
ViziLite)
• HIV testing
Screening for cardiovascu•
lar disease (e.g. HeartScore
System)
Saliva biomarker test —
•
measures three specific biomarkers that play a role in
cancer development in the
oral cavity
As you can see, these tests cover
many possible systemic conditions. Your practice will have to
determine which staff members
are allowed to administer these
tests, because your state makes
regulations controlling this. Hygienists may be allowed and, if
so, this may make a difference
in your career. Even if hygienists are not allowed per your
state’s regulations regulations,
your encouragement in the
practice to add these tests to the
practice’s procedure mix will
be invaluable to the practice.
In addition, hygienists need to
realize the importance of their
observations and questioning of
the patients in helping to move
these patients to better overall
health. This puts a new slant on
the same-old, same-old.
Power of cross coding
There is, however, another area
in which hygienists can make
a significant difference in their
practices. Dental-medical cross

> Page 9

[9] =>

mcme

Dental Tribune Middle East & Africa Edition | May - June 2014

< Page 8
coding is a cutting edge insurance system whereby dental
practices can file a patient’s
medically necessary dental
procedures with their medical
plans. Implementing cross coding creates greater case acceptance resulting in increased patient affordability and practice
profitability. Hygienists can play
a key role in the implementation of cross coding. Hygienists
can be the communicators for
cross coding in their practices
by alerting the practice of patients whom they believe are
medically compromised. Such
patients are excellent candidates for cross-coded claims.
As an example, hygienists can
inquire about conditions that
might indicate that a patient has
sleep apnea (Fig. 1). For those
practices that treat sleep apnea,
the practice would then need
to refer the patient for a sleep
study before commencing treatment. If the practice does not
treat sleep apnea, this referral
would at least get the ball rolling for treatment by another
provider.
Hygienists can also be the
champions for cross coding by
encouraging that their practices implement a cross-coding
system. In most practices, the
business office staff will need to

play a significant role, but the
hygienists can spearhead the
process.
There are significant differences between dental and medical
claims. The biggest difference is
that, at present, medical insurance is diagnosis driven while
dental insurance is not as of
yet. Medical insurance uses diagnosis codes to explain why
a procedure was performed.
Without at least one appropriate diagnosis code, a claim will
not be paid. The diagnosis codes
are titled ICD-9-CM. The procedure codes are titled CPT codes.
At present, there are growing
numbers of dentally related diagnosis codes, which are very
helpful when cross coding.
However, it is not so easy to use
the CPT codes because there
are so few dental CPT codes.
This is the area that makes cross
coding more difficult. The medical claim form is a bit different
than the dental claim form. It is
titled the CMS-1500 form and is
printed in red ink (Fig. 2).
The form provides spaces for at
least four diagnosis codes and
six procedure codes. There are
also other codes within these
code systems that are used to
give further diagnostic information or to provide information on why a procedure might

have been modified by a specific circumstance. As you can
see, cross coding is not an easy
system to implement. The answer to easing the difficulty with
cross coding is to take a good
course on the topic. You also can
check out my website, www.
artofpracticemanagement.com,
to see the different tools available to help dental practices implement cross coding.
As mentioned already, the patient’s benefit from cross coding is that medically necessary
dental procedure can be made
more affordable. It is possible to
file the tests already mentioned
with a patient’s medical insurance plan. There are diagnosis
and procedure codes that apply
to these tests, but those are too
involved for the scope of this article to provide all of the codes
needed. There is no guarantee
that these tests would be covered by the plan. According to
the Centers for Medicare and
Medicaid Services, “the existence of a code does not, of itself, determine coverage or
noncoverage.”3 It is certainly
worth the effort of a phone call
to determine coverage. I always
advise practices that cross code
and receive negative responses
to encourage their patients to
complain to their employers. Insurance contracts are between

the insurance company and
the employer, so dental practices have little power to make
any plan changes. However, the
more that complaints are issued, the more likely that medical insurance carriers will begin
to see the necessity for including these types of procedures in
their plans.
The full scope of cross coding
is much more extensive than
just these tests. Dental practices
should be cross coding for the
following:
•
Trauma procedures
•
Oral surgical procedures
•
TMD procedures
•
Sleep apnea procedures
•
Medically necessary endodontic procedures
•
Medically necessary implant and periodontal procedures
Exams, radiographs and di•
agnostic procedures for any
medically necessary dental
procedure

Fig. 2 Blank, original CMS-1500 form, which is printed in red ink, provides spaces for at least four
diagnosis codes and six procedure codes. Codes within these code systems provide further diagnostic
information or details on why a procedure might have been modified. The complexity serves as fair
warning that cross coding is not an easy system to implement.

Between implementing disease
testing and cross coding, a hygienist will significantly make
positive changes to his or her
career. These hygienists will
not only help patients obtain optimal health, but they can also
help make procedures more
affordable. Patients will be able
to see their dental practice truly
cares about their health and will
have more confidence in the
practice. This is a true win-win
situation. The dental practice
will value the contributions of
these hygienists, and hygienists
will rarely face each day with
that “same-old, same-old” feeling.

References
1. Dentists can help patients
at risk of fatal heart attack,
available
at
www.drbicuspid.com/redirect/redirect.
sp?itemid=303206&wf=33ing,
accessed July 7, 2012.
2. Zaromb A, Chamberlain D,
Schoor R, et al. Periodontitis as
a manifestation of chronic benign neutropenia. J Periodontol.
2006;77:1921–1926.
3. Common Procedure Coding
System (HCPCS) Level II coding
procedures. Centers for Medicare and Medicaid Services
website. Available at: www.cms.
hhs.gov/MedHCPCSGenInfoHealthcare/Downloads/LevelIICoding Procedures113005.pdf
Accessed Oct 24, 2006.

About the Author
Marianne Harper is the CEO of
The Art of Practice Management.
Her areas of expertise include
revenue and collection systems,
business office systems and the
training of dental practices in
dental/medical cross coding.
Harper is a consultant, trainer,
lecturer and author. Her published works include “CrossWalking — A Guide Through the Cross
Walk of Dental to Medical Coding” and her “Abra-Code-Dabra”
series on medical cross coding
for sleep apnea, TMD and trauma
procedures. She also is the author
of many articles published in dental journals.
Contact her at:
The Art of Practice Management, 2217 Fox Horn Road, New
Bern, N.C., 28562, or by email at
a.p.m.1@suddenlink.net.

[10] =>

10 clinical

Dental Tribune Middle East & Africa Edition | May - June 2014

Clinical Tips: Demi™ Ultra and C.U.R.E™ Technology:
(Curing Uniformity & Reduced Energy) what this brings
versus competition?
By Kerr

.U.R.E.™ Technology
1. COLLIMATION: collimated light is light with
rays are parallel, and therefore
wil spread slowly as it propagates. The word is related to
«collinear» and implies light
that does not disperse with
distance. A better collimation
translates in more curing power and a less sensitivity to tip
positioning.

2. DEPTH OF CURE: according
to the JADA, %37 of all composite restorations are insufficiently cured (Fan et al, 2002).
Demi Ultra, compared to other
lights, guarantees, in addition
to an optimal curing uniformity, the best depth of cure.

Thanks to its proprietary C.U.R.E
technology, Demi Ultra is able
to maintain low temperatures
avoiding any tissue damage.

C.U.R.E.™ Technology

The photopolymerization process of dimethacrylate-based
dental resins is a reaction triggered by free radicals, which
are generated by irradiation of a

1. TIP TEMPERATURE: an increase of °5.5C can cause irreversible damages to pulp.

Universal curing? Seems to be
a compromise.
Light and quality of cure.

light-sensitive initiator and open
the double bond of methacrylate
groups (C=C), generating a
chain reaction.

Collimation Comparison1
1 Collimation as measured by the angle of beam divergence.

The depth of cure can settle by
playing on light intensity (or irradiance), wavelength and concentration and/or type of light
initiators.
Curing Lights with violet LED to
cure alternative photoinitiators
provide non-uniform beam irraSource: Dental Advisor, R. Yapp, May 2013!

LED Ultracapacitor Curing Light System

DON’T CHANGE BATTERIES, CHANGE CURING LIGHTS!

*Used 3 second safety delay between multiple
cures

The Kerr Demi™ Ultra LED Ultracapacitor Curing Light System represents the latest technological advancement in
dental curing from the Kerr Demi brand. It is the first curing light to free dentists from both batteries and cords, while
offering the unmatched performance and reliability of a Demetron curing light.
The Demi Ultra is powered by the revolutionary U40-™ Ultracapacitor – exclusive technology that re-energizes to full
power in just 40 seconds, for incomparable convenience. Proprietary C.U.R.E. Technology™ allows the Demi Ultra to
rapidly deliver a uniform depth of cure with industry leading low temperatures, and the Easy Suite feature set combines
simple and intuitive operation with worry-free cleaning.
A new after sales service gives you the peace of mind to know your investment and budget are protected from the
hassles of unexpected repair expenses.
Demi Ultra is a quantum leap in curing light technology!

NO BATTERY, NO CORD, NO EQUAL

√ REVOLUTIONARY U40-™ ULTRACAPACITOR
√ PROPRIETARY C.U.R.E.™ TECHNOLOGY
√ EASY SUITE FEATURE SET
√ AFTER SALES SERVICE
As the angle decreased from perpendicular,
there’s a significant drop in intensity! which
results in a slight decrease in depth of cure.
Demi Ultra, thanks to its °60C angle makes
easy the access to the posterior area and the
curing phase more confortable for the patient.

Order information:
Demi™ Ultra LED Ultracapacitor Curing Light System
Item nr 35664
Contains: 1 x handpiece, 1 x 8 mm light attachment, 1 x charging dock with radiometer, 1 x power supply,
1 x protective light shield, 1 x hardness disk kit, 1 x -5pack disposable barrier bag, 1 x IFU
Accessories
Item nr 35665
Item nr 35666
Item nr 35667
Item nr 35668
Item nr 35815
Item nr 35837
Item nr 21042
Item nr PEDEMIULTRA100

Demi Ultra LED Light Attachment 8mm
Demi Ultra Charging dock with built-in radiometer
Demi Ultra Handpiece
Demi Ultra Light Shield
Demi Ultra Power Supply
Disposable Hardness Disk Kit (pack of 1)
Optics Maintenance Kit
-Demi Ultra Barrier Bag (pack of 100)

diance that leads to non-uniform
cure. The power is distributed
inefficiently and additional energy is needed to cure in depth.
This unnecessary energy increases the heat and the risk of
pulpal damages.
A non–uniform beam also penalized the irradiance when increasing the tip distance as can
be seen in the graph.
In dental composites, the most
commonly used photoinitiator system is a combination of
camphorquinone and tertiary
amines (CQ/Amine). Other
materials are blends of CQ and
other photoinitiators.

> Page 11

[11] =>

news 11

Dental Tribune Middle East & Africa Edition | May - June 2014

The European University College hosts
its official graduation ceremony

By European University College

he European University
College (EUC), held its
official graduation ceremony on February 22nd at the
Fairmont the Palm Jumeirah
in Dubai.
43 dental specialists were
graduated during the event
and earned their Master Degree certificates in Orthodontics and Pediatric Dentistry, Diploma in Advanced Education
in General Dentistry, and High
Diploma in Oral Implantology.
A total of 35 guests of honor attended the ceremony including; Dr. Aisha Sultan, President
of the Emirates Dental Association and Head of the Dental
Department at the UAE Ministry of Health, Dr. Amer Sharif, Managing Director of the
Education division of DHCC,
Dr. Leila Al Habashi, Head of
Pediatric Dentistry Unit at the
Dubai Health Authority, Dr.
Khadija Al Maqboul, Head of
Pediatric Dentistry Unit at the
Abu Dhabi Health Authority,
and Dr. Hasna Al Saeed, Head
of the Orthodontics Unit at the
at the Dubai Health Authority.
The EUC is the first postgradu-

ate dental institution to offer
international training programs in the UAE and MENA
Region. EUC’s international
and “Western-trained” faculty
come from reputed Universities and Research Centers
based in the USA, Sweden,
England, France, and the UAE.
Staff selection criteria is based
upon their prowess as teachers, clinicians, and researchers
are all well known worldwide.
Since the launch of the EUC,
the university has run an extensive range of postgraduate
programs across a wide range
of dental specialties. These
high quality educational programs include the latest research and use innovative approaches to learning. There
are currently international residents from Asia, Europe and
the Middle East. The students
have to meet rigorous theoretical, clinical and research
requirements in order to meet
the international educational
requirements and patient care
standards.
Professor Donald Ferguson,
Dean of the EUC, expressed:
“I am very proud and happy

< Page 10
Moreover recent works reports
that single diode blue LED light
achieve similar degrees of polymerization than broadband
(multiple diode) LED and halogen lights, just increasing the
curing time when curing clear
and white composite shades.

As the irradiance decreases with
the increase of the distance between tip and restoration, the
position of the light guide should
be perpendicular to the tooth
and positioned on the proximity of the tooth surface being restored.

Light guide tip positioning!

Intensity and depth of cure decreases as the position of the
light moves from the perpendicular.

The adequate positioning of the
light guide tip/attachment can
significantly affect the energy
received by the RBC, and thereby the quality of its polymerization.
The light should be stabilized
during the irradiation procedure.

It will be necessary to increase
the cure time and/or cure from
multiple directions if optimum
positioning cannot be obtained.

to see young professionals
achieve the goals of academic
and clinical education, and
successfully present and defend a Master degree thesis,
and assemble records that
thoughtfully explain the forensics of patient care. They be-

have ethically, act responsibly
and eye the world with standards of excellence.”
The EUC has been instrumental in enhancing the clinical
capacity of its graduates. The
university offers state-of-the-

art services, latest trends and
treatment philosophies, and
uniquely handles highly complicated dental cases within
the UAE.

[12] =>

12 lab tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Revolutionary aligner appliance expanding in
the Middle East
By Inman Aligner

he Inman Aligner is
a highly effective and
unique evolution of the
traditional spring retainer that
moves upper and lower anterior teeth predictably, safely
and quickly. This makes it a
revolutionary appliance, often
described as the “missing-link”
between cosmetic dentistry
and orthodontics. With a proven track record throughout the
UK the Inman Aligner is now
becoming highly recognized in
the Middle East.
One appliance
What is unique with the Inman
Aligner is that it can be used to
align teeth either as a standalone treatment or before aesthetic or restorative treatment.
In contrary to other treatments
only one appliance will be
used. The Inman uses superelastic Nickel-Titanium open

coil springs to move upper and
lower anterior teeth with light
but consistent forces, enabling
correction of anterior crowding, rotations and some types of
spacing.
Fast and predictable result
Most cases are completed within 6-16 weeks depending on the
complexity of the case. The system is removable and very fast,
and patients who were previously put off by brackets and
months of treatment can now
achieve alignment in 6 to 16
weeks, with a brace that can be
worn for as little as 16 hours a
day. As an Inman Aligner Certified dentist you will understand how to provide a realistic
guide of what to expect for each
case. For suitable cases, the Inman Aligner is almost always
much faster than alternative
orthodontic techniques. Treatment is backed up with a full
and comprehensive free sup-

port forum with many trainers
helping to treatment plan cases
safely and predictably.
The lecturer - Tif Qureshi
The first dentist in the world
to use the Inman Aligner as a
major tool for cosmetic dentistry is Dr Tif Qureshi. Dr
Qureshi qualified from Kings
College London in 1992 and
he is the Past President of the
British Academy of Cosmetic
Dentistry. Dr Qureshi has a
special interest in simple orthodontics using removable
appliances and was the first
dentist in the UK to pioneer the
Inman Aligner. To this date Dr
Qureshi has completed over
1000 cases using Aligners as
a stand alone treatment and
to align teeth before cosmetic
dentistry and functional dentistry - At the coming APDC Exhibition in Dubai the 17-19th of
June Dr Qureshi will be having
a lecture on the subject “Simple

Before Inman Aligner

After Inman Aligner, with retainer

After Inman Aligner

Aesthetic Orthodontics for the
General Dentist”.

next hands-on course in Dubai
on 20th of June. The course is a
one day course at the SAS Royal
Hotel located on Sheik Zayed
Road. Participating dentists
will benefit from Dr Qureshis
acknowledged experience of
Inman treatments and learn
how to grow their business
with this revolutionary aligner.

Certification course
Apart from lecturing nationally
and internationally, Dr Qureshi
is a trainer on Inman Aligner
certification courses worldwide. He will be training at the

“The Dental market is truly
flourishing in Lebanon and
in the Middle East”
By Rodny Abdallah

odny Abdallah: Please
share with our readers a
short biography including
your education and Laboratory
experience.
Alain Sakr: My Name is Alain
Sakr, I am a Certified Dental
Technician, graduated from The
Universite Antonine at Baabda
in 1991. I started my experience
as an intern at Claude Thoume
dental lab during the summer of
the same year. Then I started to
run my own dental lab until the
present date.
How important is the choice of
working for your colleagues and
being the President of the Lebanese Dental Laboratories Association?
Recently, I have been elected by
my colleagues to run the dental
laboratory order for the coming
three years, my main role and
target will be to develop the order’s vision towards a better future.
Compared to when you first
started in the dental lab field,
how has dentistry in dental lab
developed through the years?
The field of Dentistry has passed
a long way since I first started
my career. This profession has
made a huge upgrade from being a totally manual labour or
hand work to an almost fully
computerised and mechanical
dentistry due to the involvement
of scanners, milling devices and
3D printers.
What do you think about the den-

tal lab market in Lebanon and
the Middle East?
The Dental market is truly flourishing in Lebanon and in the
Middle East, we could notice
that people are more aware of
the importance of a healthy oral
hygiene and the role of aesthetic
dentistry is at a high demand.
How important is the involvement of digital dentistry in the
daily work of dental laboratories?
Digital dentistry has impacted
the dental laboratory field heavily in a positive way. It is helping
in improving the skills and products used in our labs, especially
in the aesthetic department. A
new demand is being noticed as
well in the role of a hybrid dental
technicians skills.
What are the plans of OPDL in
the coming years? As you have
been elected for the coming three
years.
My plans as elected president
for the coming three years are to
make sure that OPDL will continue to make decisions that will
further develop our order and
could be beneficial for all our
colleagues. One of my targets is
to push our profession to higher
standards and elaborate future
workshops with the contribution of opinion leaders in our
field worldwide.
How important is the role of the
dental technician in the dental
team?
The dental technician has an important role in the dental team
as he insures the fabrication and

Alain Sakr, CDT

the refining of the devices that
shall be used in the dental cavity
as well as the role of the dentists.
They both contribute in creating
a good team as one hand does
not clap alone.
How important is the dental media in the lab field or the association?
These days, the dental media is
playing an important role in the
development of our industry by
sharing all news and updates to
a large and wide range of people and highlighting on all new
technologys and materials before we could see them in the
dental events.
OPDL dental events have been
well established over the years,
what can you tell us about LDLS
2014?
LDLS 2014 (Lebanese Dental
Laboratories Show 2014) is truly
shaping up to be a remarkable

> Page 15

[13] =>

[14] =>

14 lab tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

One step further with CAD/CAM
but, once familiar with the systems involved, all will benefit
from the improved and efficient
workflow.

By Dr Steven Soo, Singapore

AD/CAM methods for
conventional dental and
implant-borne prostheses
have gained popularity for a variety of reasons. Despite many
advantages in terms of cost and
convenience, the uptake of this
relatively new technology is
slow, hinting at a reluctance to
try something new.
Many, if not most, clinicians still
choose to have fixed implantborne multi-unit prostheses fabricated by traditional methods
of casting and veneering precious metal alloys. However, the
associated high technical and
material costs may be prohibitive to the group of patients who
need this treatment modality the
most. To this end, more costeffective alloys, including base
metal alloys, have been cast and
veneered with a variety of toothcoloured materials with good
success. CAD/CAM takes this
one step further. In fact, materials such as zirconia, which has
revolutionised dental prostheses, would not be in use were it
not for CAD/CAM.
There has been much discus-

CAD/CAM solutions, such as Planmeca’s PlanCAD Easy, are becoming more widely accepted in
dental practice. (Photo courtesy of Planmeca)

sion around the problem of
achieving passivity of fit, the
lack of which, it has been postulated, can contribute to mechanical and biological complications. The multiple steps and
materials used in impression
taking, casting a working model,
producing a wax pattern, casting
in metal alloy then veneering in
tooth-coloured material all lead
to a certain degree of misfit.

CAD/CAM can help to address
this common problem. The use
of digital dentistry is more common than clinicians might think,
as the laboratory processes involved have already been widely
implemented and dental technicians can take the credit for driving the use of the technology forwards. The next step is to adopt
digital technology to replace
some of the clinical steps in fab-

ricating a prosthesis, namely the
impression stage, which leads to
production of a working cast.
These steps can introduce cumulative inaccuracies, as well
as consume a variety of materials that are then discarded. In
addition, there are time-savings
to be made, perhaps not in the
initial stages of learning and
integrating new technology,

My presentation at the Dental
Tribune Study Club Symposium highlighted some of the
advantages and disadvantages
of CAD/CAM. My goal was to
enable clinicians to see how it
might become more widely accepted in their daily practice
and remove some of their reservations. The next generation
of dentists will hopefully come
to view traditional methods of
manufacturing dental prostheses in the same way as we now
view fixed partial dentures as a
way to replace missing teeth before implants.
Having received his dental degree from the University of Liverpool in the UK, Dr Steven Soo
now works as a dental specialist in prosthodontics at Specialist Dental Group in Singapore.
During IDEM, he presented a
lecture on the benefits of CAD/
CAM technology for dental implant and restorative procedures
at the Dental Tribune Study Club
Symposium on Level 6 at Suntec
City.

Straumann
abutments now
available to
3Shape software
users
By Dental Tribune International

OPENHAGEN,
Denmark/BASEL,
Switzerland: Global implant
manufacturer Straumann and
CAD/CAM software provider
3Shape have been working together to integrate Straumann
CARES libraries into 3Shape’s
software. Yesterday, the new
software function was made
available to 3Shape software
users, enabling them to design
and order customised zirconia
or titanium abutments with
Straumann original implant
connections.
Using the new software capabilities, dental technicians who
use the 3Shape Dental System
software can design abutments
and a range of customised prosthetics, including cobalt–chromium alloy, zirconium dioxide,
and various full contour materials. These can be ordered
with an original Straumann
connection.
“Many laboratories are steadfast users of both the 3Shape

Dental System and Straumann
abutments. Now, they can design highly aesthetic and functional customised abutments
and send them directly for
manufacturing at Straumann—
thereby introducing a wider
range of choices for dentists
and their patients,” explained
Flemming Thorup, President
and CEO of 3Shape.
“In addition, 3Shape customers
are now able to connect with
Straumann dentists and, thus
expand their business opportunities,” Frank Hemm, Executive Vice-President of Customer
Solutions and Education at
Straumann, added.
3Shape users who wish to benefit from this opportunity may
contact Straumann for information on obtaining the libraries. However, availability will
depend on the specific system
configurations, the companies
stated.

[15] =>

lab tribune 15

Dental Tribune Middle East & Africa Edition | May - June 2014

Visit us at
www.promedica.de

high quality glass ionomer cements
first class composites

Glass ionomer luting cement
• highly biocompatible, low acidity
• micro-fine film thickness
• excellent adhesion
• no temperature rise during setting

innovative compomers
modern bonding systems
materials for long-term prophylaxis

Light-curing nano-ceram composite
• highly esthetic and biocompatible
• universal for all cavity classes
• comfortable handling, easy modellation
• also available as flowable version

temporary solutions
bleaching products …
All our products convince by
excellent physical properties

Dental desensitising varnish
• treatment of hypersensitive dentine
• fast desensitisation
• fluoride release
• easy and fast application

perfect aesthetical results

PROMEDICA Dental Material GmbH

phone: +49 43 21/5 41 73 · fax +49 43 21/5 19 08 · Internet: www.promedica.de · eMail: info@promedica.de

< Page 12
event, this year we are involving esteemed speakers as well
as fellow dental dealers who are
eager to display the latest products in the dental field for 2014.
What are the challenges facing
the dental lab order today?
OPDL is an established order

due to the solidarity of my fellow
peers and colleagues. It’s main
challenge is to involve securing the rights of our colleagues
and perform strict laws for those
who would try to practice our
profession illegally.
What are your recommendations

< Page 1
fer our patients a large cascade
of benefits, they do not come
without disadvantages. Often
than not, part of the remaining
healthy tooth structure must be
sacrificed to accommodate and
retain the restoration. Regardless of the method of fabrication, whether direct or indirect,
dental materials used usually
exhibit dimensional as well as
structural changes through the
process leading to an array of
problems.
It is paramount for perfect results to standardize procedures
as well as different steps taken
to fabricate a restoration. Manual fabrication involves numerous errors that are nothing but
part of the human nature. The
human eyes and hands are not
predictable when measuring
and evaluating dimensions, angles, spaces, and all other calculations needed to achieve a
satisfactory result. Computers
are, beyond doubt, far superior
to humans in determining such

printers are getting so precise
to the extent that results can
exhibit preciseness of few if not
single micron tolerances. Utilizing the very well advanced CAD
software, we are able to come
up with almost perfect restoration designs. CAM software are
following suit. What we see on
the screen is often what we got
out of the milling unit or the 3D
printer. It is the obligation of
every one of us to join this fast
moving industry. We owe it to
our patients as well as to ourselves to get acquainted with
and put in use all available technology to offer the best possible
treatment.
I believe that Digital and CAD/
CAM generated restorations are
taking over in setting the standards of dental restorations. They
are precise, predictable and
much easier to produce. We are,
beyond doubt, getting closer to
our goal. The perfect restoration seems to be just around the
corner.

“The human eyes and hands are not predictable
when measuring and evaluating dimensions, angles,
spaces, and all other calculations needed to achieve a
satisfactory result.”
critical parameters.
Rapid developments in the field
of CAD/CAM systems in the last
decade are bringing us ever
closer to our goal. Nowadays,
digital workflow can be implemented with great confidence.
Scanners, milling units, and 3D

Contact Information
Dr. Munir Silwadi BDS,
MRCDSO, DUSS, FADI, FICD
CEO, Dr Munir Silwadi
Dental Centers
msilwadi@eim.ae

to the fresh dental lab graduates?
I would like to tell all fresh
graduates to enrol immediately
after their graduation in our
dental laboratory order to ensure a better future and uphold
the right to practice as dental
laboratory specialist legally and

together we will be more powerful through solidarity. I would
advise them as well to be honest
individuals in their community.
President Sakr, truly an honour to interview you here today,
would you like to share more top-

ics to the Dental Tribune readers
in the MEA region?
I would like to thank you for giving me the opportunity to share
with your readers all the discussed topics and keep reading
the Dental Tribune.

[16] =>

16 cad/cam | digital tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Predictability in Implant Planning with
3D Imaging - Clinical Case Report
By Norberto Velázquez, DDS

reenville, NC, Dr. Velázquez graduated from
dental school in 2002
and attended a general practice
residence (GPR) in Oklahoma
City, Oklahoma from June of
2002 until June 2003. Shortly after finishing the GPR residence,
Dr. Velázquez moved to Greenville, NC and worked in Kinston
for the J.H. Rose Dental Clinic
as the Dental Director for four
years. Dr. Velázquez has advanced education in implantology and enjoys working on cosmetic procedures, oral surgery,
crown and bridge (prosthetics),
implants, and dentures. He just
finished another intensive implant course.
The case presented represents
a typical instance where an implant is required in the area of
the first or second premolar. A
three-dimensional scan is used
to accurately locate the exact
position of important anatomic
structures or landmarks. The
3D scan and software allow
moving, slicing, and viewing
the anatomy from any direc-

tion. A critical step is the ability to mark the position of the
nerve (marked in red in the
images below) — this becomes
especially helpful when virtual
implants are used.
A first look might indicate that
the implant on this image (1)
could interfere with the inferior
alveolar nerve and mental foramen. This is not the case. This
image (2) is a disto-facial view
of the 3D scan showing appropriate clearance between the
implant, inferior nerve, and the
mental foramen — as indicated
by the mint circle. In addition,
the Invivo5 software provides a
visual indication of such clearance by coloring green the implant model in the lower left of
the screen.
The arch section of the software shows axial, sagittal, and
coronal slices. Multiple views
(3) provide a more comprehensive understanding of the anatomical features of the patient.
After surgery, a follow up with a
post-operative image (4), either
2D or 3D, can be done based on
case necessity.

Dr. Velázquez’s Conclusion
The GXDP-700 system offers
several functionalities that benefit my patients. The advantage
of the extra dimension to both
implant patients for me, and
orthodontic patients for my
wife, is incalculable. This machine has become a basic part
of the diagnostic process for implants — like my explorer and
mirror. It allows me to see the
location of important anatomical structures and landmarks
so I can avoid additional or unnecessary invasive procedures.
With the scan, I can inform patients of my implant treatment
plan, and show them how the
surgery will proceed. They
gain confidence in my knowledge of their dental anatomy
even before surgery begins.
Before 3D, a surprise could pop
up during surgery. Then, the
patient would be disappointed
that he or she was not going to
get an implant immediately,
but needed an additional procedure first, such as grafting.
My patients understand that I

have implemented this technology for the sake of their dental
health.
For a dentist, the opportunity
for improved diagnostic capabilities is always a benefit to
the patient. While they are not
always directly aware of all the
advantages, the information
that I obtain from these pans
and scans is beneficial for their
care. I witness these benefits
every day, in increased patient
communication and more successful treatment outcomes.

Contact Information
KaVo Dental GmbH
Alexia Valera
9th Floor Rotana Arjaan Tower
Dubai Media City, UAE
Tel. +971 4 4332186
Mob. +971 56 1757141
E-Mail alexia.valera@kavo.com
www.kavo.com/MEA

Understanding the
Advantages of 3D
Dental Imaging
By KaVo

ith the advent of any
new technology, it’s
important for dental
professionals to consider not
only cost and risks, but also the
benefits of switching. In the
case of 3D dental imaging, the
advantages are clear, granting
practitioners and patients alike
a better clinical experience.

NEW from Gendex!
The new 3-in-1 Imaging Solution: Pan. Ceph. 3D
The new GXDP-700 Series gives clinicians dependable image capture of a wide
variety of radiographs, from 2D Panoramics to Cephalometrics to 3D. These images
are valuable for diagnosis and treatment planning of caries, root investigation,
orthodontics, implants, and other surgical procedures. The new GXDP-700 Series
provides:

P Flexibility

Capture the images necessary for the procedures you perform

Intraoral X-ray Systems
Digital Intraoral Sensors

P Repeatability

Acquire high-quality images, easily and consistently

P Upgradability

Advanced imaging to accommodate additional treatment offerings

Learn more about the GXDP-700 and the full line of
Gendex imaging solutions at: www.gendex-dental.com
KaVo Dental GmbH
Arjaan Tower 9th Floor
Dubai Media City, UAE
PO Box 71569
Phone +971 4 433 21 86
Fax +971 4 457 93 73
Email: info.mea@kavo.com
www.kavo.com/mea

P Cone Beam 3D Imaging Systems
P Panoramic X-ray Systems

Become a fan
facebook.com/KaVoGlobal
Follow us
youtube.com/user/KaVoDentalGmbH

Intraoral Cameras
Imaging Software

A dental 3D scan allows clinicians to view dental anatomy
from different angles. A 3D
scan can help gain a better view
of bone structures, such as adjacent root positions, in order to
locate canals and root fractures,
as well as provide the ability to
more accurately measure anatomical structures. These scans
also support a wide range of
diagnosis and treatment planning, making them extremely
flexible. Further, they increase
the possibility of treatment success, granting practitioners
greater predictability and confidence in preparing for extractions, performing root evaluations, and placing implants.
3D dental imaging also delivers
the power of repeatability, providing fast and accurate imaging that’s consistent—and thus,
reliable. Using a 3D dental scanner equips dental professionals
with a comprehensive view,
letting them see specific conditions in the region of interest to
determine whether a treatment
is necessary. Because details
show up so clearly, patients can
be more confident in a dentist’s
decision. In addition, the use of
dental imaging technology often creates a more comfortable
and engaging dental visit for the
patient.
The Gendex GXDP-700 Series
features the pinnacle of 3D
dental imaging technology, allowing dentists to plan for more
predictable treatment outcomes
by taking advantage of power-

ful 3D software analysis and
simulation tools. Plus, dental
practitioners can control the exposure and the size of scanned
areas using the system’s flexible field-of-view (FOV) to meet
individual patient and clinical
needs. As a practice grows to offer additional imaging capabilities, the GXDP-700 imaging solution can be upgraded within
your own timeline and budget.
X-ray imaging, including dental 3D (CBCT), provides a fast,
non-invasive way of answering
a number of clinical questions.
Dental CBCT images provide
three-dimensional (3D) information, rather than the twodimensional (2D) information
provided by a conventional Xray image. This may help with
the diagnosis, treatment planning and evaluation of certain conditions. Dental CBCT
should be performed only when
necessary to provide clinical
information that cannot be
provided using other imaging
modalities. Concerns about radiation exposure are greater for
younger patients because they
are more sensitive to radiation.

Contact Information
For more information about the
use, benefits, and risks of CBCT,
visit: www.kavo.com/MEA
Or email us: info.mea@kavo.com

[17] =>

Dental Tribune Middle East & Africa Edition | May - June 2014

cad/cam | digital tribune 17

Restoration is becoming Easier and Affordable
for all Dental Practices
By Norberto Velázquez, DDS

S Solutions is the title
name for the new CAD
CAM system from
Carestream
Dental
that was launched in the Middle
East at AEEDC last February.
The system consists of an intraoral scanner, CBCT impression
scanning system, restoration
design software, and chair side
milling machine. All of the
parts are separate creating an
open Web-based system that
enables dentists to use the complete product family or choose
any of the products as a standalone unit. The benefit that this
offers is an easy sharing of restoration cases between dentists
and laboratories.
The important thing about any
system is not having to be tied
into using every individual
product, software or consumable that is incorporated in that
system. Although this may be
beneficial if you feel there is
security in working with one
single supplier you may on the
other hand prefer the features
of another supplier’s product
that you want to use instead of
the one that is provided.
At Carestream Dental we have
seen many Dentists choose the
CS 3500 Scanner to capture images for their digital restoration
work. They have preferred the
elegant slim and easy to use
design of the scanner which
makes it simpler and more reliable to capture detailed scans
of the patient’s teeth that can
then be e-mailed to their laboratory for completion.
The CS 3500 scans patients’
teeth directly to acquire true
colour, 2D and 3D images.
With an average precision of
30 µm, the CS 3500 scans to a
depth ranging from -2 to +13
mm and offers high-angulation
scanning of up to 45 degrees. It
features a light guidance system that enables dental professionals to focus more on patients’ mouths while capturing
data by limiting the time practitioners need to watch a monitor
during scans. The CS 3500 also
has an internal heater that prevents the mirror from fogging
during digital impression acquisitions. To further streamline the scanning process, the
scanner does not require a trolley or the use of powder, saving
practitioners time and making
the experience more pleasant
for patients.
Here is what Leading dentists
have had to say about their experiencing using the CS 3500.
Dr. Carsten Stockleben
Hannover, Germany
http://www.stockleben.com/
“With the CS 3500, it’s easy. You
just say ‘I want my scanner,’
put it in, and start. It’s small,
it’s light, it can be connected
to any computer via USB, so I

don’t have to have a big trolley
with a computer and a monitor
that have to be driven around
the operatories. You don’t need
powder, you don’t have to mess
around in the patient’s mouth,
keep it dry, put the powder in,
and so on. It makes it much
easier. It’s got a guiding system
and that allows me to concentrate and to take the impression
or the scan in the mouth, and
that’s fantastic.”
Dr. Dan Delrose
North Rive Dental
Ellenton, FL, USA
www.northriverdental.com

“By using the CS 3500 intraoral
scanner, we eliminate many of
the problems that come with
using impression materials and
pouring casts—all you have to
do is scan the tooth and send
the data to your restoration
software or the lab. But probably the most important feature
of the whole scanner is something so simple—that it’s not
connected to a trolley. It’s not
connected to a tower or a workstation. You’re going to be able
to take this light, ergonomic
scanner and plug it right into
your workstation in the operatory, quickly and easily.”

Digital restoration and all the
benefits it can bring to everyday dentistry, is now available
for all dentists to use. The next
step is to learn about the technology and to visit the exhibitions and congresses where you
can see what is on offer.
Carestream Dental will be exhibiting in Dubai at:

• CAD/CAM & Digital Dentistry International Conference on
9-10 May 2014
• Dental Facial & Cosmetic
International Conference on
14–15 November 2014
• AEEDC 17-19 February 2015
But if you need to talk to someone now then please do not hesitate to contact me on:
Ernesto.jaconelli@carestream.
com

The waiT
is over

CS 8100 3D
3D imaging is now available for everyone
Many have waited for a redefined 2D/3D multi-functional system that was more relevant to their everyday work, that was
plug-and-play and that was a strong yet affordable investment for their practice. With the CS 8100 3D, that wait is over.
• Versatile programs and views (from 8 cm x 9 cm to 4 cm x 4 cm)
• New 4T CMOS sensor for detailed images with up to 75 μm resolution
• Intuitive patient placement, fast acquisition and low dose
• The new standard of care, now even more affordable

LET’S REDEFINE EXPERTISE
The CS 8100 3D is just one way we redefine imaging.
Discover more at carestreamdental.com
© Carestream Health, Inc. 2014.

[18] =>

18 cad/cam | digital tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Isolite wins
2014
Scandefa
Award in
Copenhagen

VITA SUPRINITY ® – Glass Ceramic. Revolutionized.
The new zirconia-reinforced high-performance glass ceramic.

dependable

By Dental Tribune International

C

b
relia

OPENHAGEN,
Denmark: Reporting on this
year’s Scandefa, the organisers announced that over
10,000 visitors and about 200
exhibitors mainly from Denmark, Sweden and Germany
attended the Scandinavian
dental trade show from 2 to
5 April. At the opening of the
show, dental equipment provider Unident was given the 2014
Scandefa Award for the Isolite
oral isolation system.

high-strength

le

Isolite is a single-use isolation
mouthpiece that retracts and
protects the patient’s cheeks
and tongue, increasing patient
safety. It obstructs the entrance
to the throat, which not only
adds to patient comfort, but
also allows the dentist to monitor the patient’s airway.

+ZrO2

“Using Isolite, practitioners can
achieve optimal control of the
oral environment and make the
treatment more comfortable for
the patient at the same time,”
Marinette Larsson, Chief Marketing Officer at Unident, told
Dental Tribune ONLINE in Copenhagen.

3448 E

Li2O

SiO2

VITA SUPRINITY material belongs to the new generation

features a particularly homogeneous structure that ensures

of CAD/CAM glass ceramics. Now for the first time this in-

simple processing and reproducible results. And what's

novative, high-performance material is reinforced with zirco-

more, VITA SUPRINITY offers the benefit of a very wide

nia. This results in a high-strength material and processing

range of indications. For more information visit:

safety coupled with an extraordinary degree of reliability. It

www.vita-suprinity.com

3448E 210x297 neu .indd 1

The mouthpiece, which is
available in five different sizes, was developed by Isolite
Systems, a US medical device
manufacturer that specialises
in dentistry. Unident is the exclusive supplier of the system in
Scandinavia. Founded in 1992,
the company today has offices
in Stockholm in Sweden, in
Horten in Norway, and Copenhagen in Denmark.

facebook.com/vita.zahnfabrik

The next Scandefa will be held
from 15 to 17 April 2015. The
annual Scandefa Award recognises the most innovative
dental products on the Danish
market.
14.06.13 07:46

[19] =>

NEWS 19

Dental Tribune Middle East & Africa Edition | May - June 2014

“The edentulous patient is an amputee, an oral invalid,
to whom we should pay total respect and rehabilitation
ambitions”. Per-Ingvar Brånemark
By Safa Tahmasebi DDS MS

s a professor of surgery
and research, P-I Brånemark is considered the
father of modern dental Implantology (Figure 1) . In the early
50’s he discovered the process
of osseointegration, which later
was referred to as the direct
structural and functional connection between living bone
and the surface of a load-bearing artificial implant. (Figure 2)
This discovery was a result of a
series of vital microscopic experiments on blood in mobile
tissues, bone and bone marrow
by placing titanium optic chambers in rabbit’s tibia. Later it was
discovered it was extremely difficult to remove these chambers
for further use after a period of
healing. (Figure 3)
Since then Brånemark and his
team conducted numerous research aimed at Orthopedics,
joint replacements, plastic surgery and tumor defects. In 1965
Brånemark treated the first human patient Gösta Larsson with
titanium dental implants who
was missing teeth as a result of
jaw deformities. Larsson passed
away in 2006 and used his implants for more than 40 years.
(Figure 4 - page 34)
The initial reaction of skepticism and doubt was overcome
in 1982 in North America at the
Toronto conference on osseintegration. Here the biology, clinical research and applications of
osseointegration were presented to the world and since then
for 32 yeas millions of people
have been able to benefit from
the life changing contributions
of osseointegration.
Today the rehabilitation of patients with oral, Maxillofacial
and orthopedic impairments
has been accepted and adopted
by the international community and through a worldwide
collaboration and ongoing research and advancements we
have gained enormous knowledge for treating our patients.
These advancements have
allowed the clinicians to apply load-bearing implants with
teeth the day of the surgery and
this has had a remarkable impact into the quality of the patient’s lives.
In 1989 Professor Brånemark
founded the first The Brånemark Osseointegration Center
(BOC) in Gothenburg, Sweden
(www.branemark.com). BOC’s
principal task was to offer management for patients with severe oral, maxillo-facial and
orthopedic disablements. There
are only 10 such clinics in the
world and in the June of 2013
due to its excellence in dental
implant treatment the Dubai
BOC was founded by Dr Cotsa
Nicolopoulos and Dr. Petros

Yuvanoglu at the Dubai Healthcare City and named SameDay
Dental Implants (www.Samedayme.com). This demonstrates
a milestone of progress for the
health system in Dubai being
able to host a BOC in the Middle East.
“With dental implants & new
teeth all in one day my life
changed thanks to SAME DAY
DENTAL IMPLANTS. I can now

Figure 2. (Scanning electron micrograph showing a bone cell attaching to titanium)
Figure 1. Professor Per-Ingvar
Brånemark

Figure 3. (Titanium optic chamber
fixed to the rabbit’s tibia and fibula)

> Page 34

[20] =>

NEW: Philips Sonicare FlexCare Platinum
For outstanding cleaning, even deep between the teeth

Philips has the right sonic toothbrush for every cleaning
need. The latest innovation is called Philips Sonicare
FlexCare Platinum. Its innovative pressure sensor gives
immediate feedback in a simple manner if too much
pressure on the brush head minimizes the vibrations.
This makes the Philips Sonicare FlexCare Platinum ideal

for those of your patients who are worried about
using too much pressure when cleaning with an
electronic toothbrush. Nine individual settings and
intensity levels thereby make adaptation to the
individual cleaning requirements possible.

Pressure sensor
This innovative sensor gives simple and
intuitive feedback if the brush head is
pressed down too hard.

3 cleaning settings
• Clean – ensures optimal plaque removal (standard)
• White – removes discoloration of the tooth surface
in 2 minutes, and the front teeth are whitened and
polished in a further 30 seconds.
• GumCare – combines 2 minutes in the Clean setting
with 1 minute of gentle gum massage for healthy gums.

3 intensity levels
Maximum comfort with the 3 adjustable intensity
levels: low (for sensitive areas), medium and high.
Each of the 3 intensity levels can be combined with
each of the 3 cleaning settings.

Philips Sonicare InterCare brush head
Extra long filaments reach deep into the spaces
between teeth and ensure an excellent plaque
removal there compared to a manual toothbrush.
For better tooth and gum health.

UV-Sanitizer
With the UV light technology from Philips, up to
99% of the bacteria and viruses1 on the brush head
are rendered harmless – in only 10 minutes.

Lithium-ion rechargeable battery
With 3-week working life

1

E. coli, S. mutans and HSVI, HA

Removes up to 6x more plaque
in the spaces between the teeth in
comparison to a manual toothbrush.

[21] =>

Hygiene tribune 21

Dental Tribune Middle East & Africa Edition | May - June 2014

Keeping Hygienists in par with Continuing
Education initiatives
By Victoria Wilson,
Dental Hygiene Therapist, UK

t is our aim of the Dental Hygiene Tribune MEA to keep
you, our valuable members
and readers, on par with continuing education initiatives
across the region. We will
target and focus on the most
up-to-date treatment methods
available, the emerging scientific research and the current
best practice techniques used
in dental hygiene.

Victoria Wilson,
Dental Hygiene Therapist

Hygienists or Dental Care Pro-

Maintenance of
dental implants
for the hygienist
By Biberach/Riss

mplant dentistry has become more and more prominent in our everyday practice as patients are keen to
have implant-borne prostheses
than a conventional bridge work
or removable dentures. One
of the most important factors
for long term success of dental
implants is the maintenance of
healthy peri-implant tissues.
Hygienist are now seeing more
of their patients with dental
implant and this is only going
to increase in the future as implant therapy become cheaper.
The role of the hygienist has
increased in many ways with
regards to dental implants. It is
important for a hygienist to be
able to diagnose peri-implantitis
and to have the knowledge to
treat simple to moderate periimplantitis and to monitor the
health of dental implants in the

fessionals (DCPs) are ideally
positioned to provide comprehensive support to dentists
and patients - starting from
pre- and post- restorative work
through to periodontal treatment, maintenance and longterm continuing care. In order
to do this effectively, DCPs need
to be continually updating and
developing their knowledge
and clinical skills, as well as being aware of the new technologies on the market.
I welcome the opportunity to
bring my enthusiasm for Den-

How do you know when an implant has problems?

When probing peri-implant tis-

I am dedicated to liaising and
representing the Continuing
Medical Education (CME) team
for Dental Hygiene Tribune
members to ensure that your
interests are being met. With
your support, I look forward to
developing new programmes
for this publication to further

By Victoria Wilson

y defining Continuing
Professional
Development (CPD) and outlining the need for it for dental
professionals through a series
of publications from Governing bodies, it can be seen that
with proper planning, goal assessment and verifiable CPD
activities one can not only
meet government regulations
for CPD but gain insight and
skill-set for further professional and personal development.
Method
Review an analysis of CPD
for dental professionals from
online publications related to
bodies in the UK, US, Canada,
and the Middle East.
Results
CPD can be obtained through
a wide range of activities. A
structured approach when
undertaking the CPD projects
of choice, in line with key targeted learning objectives, is
key to achieving a noteworthy
and credible progression in job
performance.
Conclusion
Not only is a minimal amount

of CPD required in most countries by law, it can be determined that CPD will not only
enhance one’s performance
and the overall operations of
the facility/clinic, but will result in valuable public awareness for the safety and regulated practices of dental facilities
in general.
Introduction
What is CME - CPD?
Continuing Medical Education
(CME), otherwise referred as
Continuing Professional Development (CPD), is the way
in which professionals can
enhance their knowledge and
skills related through a structured approach.
CPD for dental professionals
is an obligation in many countries. A mandatory amount of
course-related points must be
fulfilled in the form of: lectures, seminars, courses, individual study, peer review,
clinical audit or E-learning
activities. These hours can be
recorded on a personal CPD
record providing the courses
are designed to advance professional development as a
dental professional and is relevant to one’s practice. (1)
Why is CPD in Dentistry so
Important?
Education and qualifications
are only the first step towards
obtaining a professional career. CPD is an obligation to
one’s profession - not only for

I would appreciate hearing
your preferences for CME topics and any other suggestions
that you would like to offer.

Contact Information
Ms. Victoria Wilson, Dental
Hygiene Therapist, UK
wilson@dental-tribune.me
www.dental-tribune.me

the personal benefits for individuals and clinics, but also
for the overall perception and
confidence that the public has
in the dental industry.
Dentistry is constantly evolving through new methods and
technologies to better meet the
needs of patients. CPD will ensure that dental professionals
continue to be at the forefront
of this knowledge. It is important for patient comfort, wellbeing and safety.
It is also required by law for
all registrants working under
the local medical authority to
undertake a minimum amount
of CPD points in order to maintain the license of the practice.
If this minimum is not met by
all of the professionals, the license cannot be renewed.
Verifying CPD points
In some countries, such as
the UAE, the Governing body
acts to verify the CPD provider. Submission of papers for a
CPD event must be approved
by Dubai Health Authority
(DHA), Dubai Health Care City
(DHCC) or Health Authority
Abu Dhabi (HAAD) prior to an
event.
In other countries, such as the
UK, parts of US and Canada,
verifying the CPD provider is
determined by the judgment
of the registrant. It is a common requirement to have to
keep documentary evidence
in these countries for up to 5
years post CPD cycle. (4,5)
There will generally be documentary evidence that the
CPD has been undertaken
with concise educational aims
and objectives and clear an-

Figure 1: Cumulative Interceptive Supportive Therapy (CIST)
Protocol.

> Page 26

encourage collaboration and
clinical excellence in the Hygiene field.

Why CME (Continuing Medical Education)
or CPD (Continuing Professional Development)
is Important to Dental Professionals

long term as part of the patients
regular maintenance.

It is essential to be methodical
when monitoring the peri-implant tissues at review appointments to spot the early signs of
peri-implantitis. The clinical
markers that are used to assess
the presence and severity of inflammation around the implant
are:
•
plaque and calculus accumulation;
•
inflammation of the periimplant tissues;
•
increase in peri-implant
probing depths;
•
bleeding on probing;
•
suppuration from the periimplant pocket;
•
implant mobility;
•
radiographic changes.

tal Hygiene Tribune to Dental
Hygienists in the Middle East
and offer an earnest commitment to meeting the need for
high quality training and ongoing support in our commendable profession.

Table 1 – Dubai Health Authority (DHA) CPD Requirements (2)

> Page 25

[22] =>

[23] =>

100

Mean percentage surface
microhardness recovery

60

P<0.001

45
30
15
0
Pronamel
(1450ppm NaF)

A leading
toothpaste
(1450ppm NaF)

Placebo
(oppm F)

Pronamel is proven to reharden acid-softened enamel and
provide ongoing protection from the effects of Acid Wear:

3

Low abrasivity

3

Neutral pH (7.1)

3

SLS*-free

1 um

[24] =>

New Philips Zoom WhiteSpeed
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Packed in procedural order, you get everything you need for each treatment, including
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Each treatment comes with a Patient Post Care and Maintenance kit that includes the
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potassium nitrate for sensitivity relief along with Amorphous Calcium Phosphate (ACP)
that helps create healthier smiles through advanced
enamel protection. To ensure a more comfortable experience all around, instruct
patients to use it for 10-30 minutes after treatment.

New Philips Zoom WhiteSpeed Whitening LED Accelerator
The advanced Philips blue LED technology provides approximately 50,000 hours of
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energy efﬁcient. The light also emits 100% greater light intensity* with no compromise
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ergonomic, your patients and your treatment will be better than ever.

New support for your practice
Philips Zoom is funding a worldwide public relations campaign to drive patients to
dental professionals, and new programs to help you quickly
and easily integrate Zoom into your practice.

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[25] =>

hygiene tribune 25

Dental Tribune Middle East & Africa Edition | May - June 2014
< Page 21
ticipated outcomes and quality
control.
Dubai Health Care City
(DHCC)
Dental Hygienists, require 24
Continuing Educational Units
(CEU) equivalent to CPD every
year.
General CPD
General CPD included activities that do not satisfy all of the
verifiable CPD criteria. These
activities may be recorded as
part of the total CPD hours but
not verifiable as they do not
require a certificate. However
these course should still help
to further career development.
Audits of CPD
Audits of CPD activities can be
carried out by authorities at
any time. These inspections
are ways of investigating the
effectiveness of a course. It is
thus advisable to file all submitted CPD certificates for a
period up to 5 years.
Quality of CPD
It is advisable to make a Professional Development Plan
(PDP), including overall goals,
to ensure the quality of your
CPD is achieved. One should
personally review the PDP
regularly and assess that these
goals are achieved.
A PDP will allow one to approach CPD in a structured
way by identifying learning
needs and prioritising the subject matter relevant to practice

Table 2 – Health Authority Abu Dhabi (HAAD) CPD Requirements (3)

ie: patients and practice environment should be considered
when tailoring a specific personal PDP.
It is important to review the
PDP plan within the CPD cycle to ensure that all CPD activities remain in line with the
professional development that
has been targeted. Topics of
CPD could include, Medical
Emergencies, Disinfection and
Decontamination, Radiography, Legal and Ethical Issues,
Complaint Handling and Oral
Cancer.
Points for Consideration Prior to Undertaking CPD
When deciding what CPD activities to undertake, practitioners should first consider
if the activity relates to the
objectives of their personal
CPD plan. One should assess
the stated aims, objectives and
outcomes of the activity and
evaluate them against the criteria for CPD.
•

Activities should address
contemporary clinical and
professional issues.

•

•
•
•

Scientific and clinical activities should reflect accepted dental practice or
be based on critical appraisal of scientific literature.
Activity content should be
evidence-based without
exaggerated claims.
Activities should have scientific integrity and independence.
Clinical content should
reflect best practice care
and evidence based treatment that is supported by
scientific and biomedical
research. (4)

Conclusions
After review, it has been concluded that in order to make
CPD most effective to dental
professionals:
1. CPD must achieve outcomes
that support practice in accordance with local Standards
and Regulations.
2. Proper planning and reflection with a PDP for CPD requirements is advisable.
3. All CPD should be verified
or come from a strong reliable
publication source in order to

Table 3 – UK Standards for CDP

Table 4 - Example of Professional Development Plan

emphasise the importance of
high quality CPD
4. Annual CPD declarations
should be introduced as a requirement of on-going registration.
References
1. General Dental Councils,
Continuing Professional Development for Dental Professionals,
Protection Patients, regulating
the dental team.
2. Policy on Continuing Professional Development (CPD) Requirements, Health Regulation
Department, Dubai Health Authority, July 2010.

3. Continuing Professional Education Health Authority - Abu
Dhabi.
4. Continuing Professional Development, dental Board of Australia, February 2011.
5. Continuing Professional Development, dental Board of Australia, February 2011.

Contact Information
Ms. Victoria Wilson, Dental
Hygiene Therapist, UK
wilson@dental-tribune.me
www.dental-tribune.me

Scientists from Norway develop
scaffolding to repair severe teeth and
jawbone defects
By Dental Tribune International

SLO, Norway: Dental researchers at the University of Oslo have developed
a new artificial scaffolding that
aids bone regeneration. Within
a few years, they hope to market
their invention to help patients
with serious teeth and jaw damage caused by severe periodontitis, mandibular cancer, infection or trauma.
According to the researchers,
the artificial scaffolding could
be used in particular for cases
in which the gap between two
bone fragments is too wide, or
when large parts of the bone
have been damaged through
surgical removal or radiotherapy. The scaffolding helps the
body repair such serious defects,
the researchers explained.
“With the new method, it is sufficient to insert a small piece
of synthetic bone-stimulating
material into the bone. The artificial scaffolding is as strong as
real bone and yet porous enough

for bone tissue and blood vessels to grow into it and work
as a reinforcement for the new
bone,” said Prof. Ståle Petter
Lyngstadaas, Dean of Research
at the Department of Biomaterials at the university’s Institute of
Clinical Dentistry.
The scaffolding can be produced like cinder blocks and
cut into individual shapes to fit
into specific bone defects. It is
manufactured from a mixture
of water and ceramic powder,
which is poured through foam
rubber that was designed to
look like trabecular bone. The
ceramic powder consists of
medical-grade titanium dioxide
monodisperse
nanoparticles,
which are also widely used as
an additive in sweets, toothpaste
and baked goods. Once the mixture has solidified, it is heated to
a temperature that causes the
foam rubber to dissolve into water vapour and carbon dioxide
and the nanoparticles to ligate
into one solid structure. It has
an open porosity of 90 per cent,
containing mostly empty space

that can be filled with new bone
and blood vessels, which current materials do not provide.
While current materials are degraded gradually, the new scaffolding remains an integral part
of the repaired bone, working
as reinforcement, Lyngstadaas
explained.

Since the scaffolding has shown
positive results in preliminary
animal studies, the researchers
are currently planning to undertake clinical trials on patients
with periodontitis and damaged
mandibular bone. They also
hope that orthopaedists will
show interest in the new method.

The new material was developed in collaboration with Corticalis, a Norwegian company that
specialises in innovative biomaterials. In order to market their
invention, the researchers are
currently looking for an industry
partner.

In addition, the generation process could
be accelerated by the
insertion of bone progenitor cells or bone
marrow
containing
stem cells.
Conventionally, damaged bone is repaired
by removing tissue
from healthy bones,
such as the mandible
or hip, for implantation. Patients often
experience discomfort
and complications after the surgery. This
can be avoided by using the scaffolding.

Bone cells and blood vessels can grow into the scaffolding. The pace of this
process can be accelerated by adding the patient’s own bone progenitor cells.
(Photo courtesy of the University of Oslo)

[26] =>

ED BY

26 hygiene tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

< Page 21

Figs. 2a-f: Cross over flossing technique.

Fig. 4a: Subgingival inflammation due excess cement.

Fig. 5: Plastic Scalers.

Fig. 6a: 8 mm pocketing UR2.

provoke an acute peri-implantitis which can cause soreness,
swelling, bleeding on probing
and eventual bone loss (Figs. 3
& 4).

Fig. 3a: Excess cement on implant
surface.

Fig. 3b: Severe bone loss due to
excess cement forced in to the
tissues.

sues it is essential that a light
force is used (0.25 Ncm) to avoid
trauma to the tissues. There is a
parallel attachment of the junctional epithelium around the
implant surface, therefore there
is less resistance when probing
around the implant. This will result in deeper peri-implant probing depths compared to probing
around natural teeth. Peri-implant probing depths of implants
placed in sites excluding the aesthetic zone range between 2-4
mm under healthy conditions.
In the aesthetic zone where
the implant is usually placed
deeper, the probing depths are
greater than the normal range.
It is important to note that most
implant systems show evidence
of a small amount of marginal
bone loss within the first year
of function. Smoking has been
shown to be a risk factor to affect the long-term prognosis of
dental implants therefore it is essential to assess the health of the
peri-implant tissues regularly in
smokers.

•
•

What to do if there is bone loss?
If there is on-going bone loss it is
important to ascertain the cause.
The causes of bone loss are:

Fig. 4b: Note the excess cement on
the implant crown.

Occlusal overload;
Bacterial induced inflammation.

Any occlusal overloading needs
to be corrected by the implant
dentist.
Plaque induced inflammation is
initially treated non-surgically
but depends on the initial clinical presentation. This involves
the removal of dental plaque
with or without the use of locally
delivered or systemic adjuncts.
Lesions with probing depth of
5 mm or more and bone loss of
greater than 2 mm would need
surgical intervention as recommended by the International
Team for Implantology (ITI)
consensus report Figure1.
A common cause of plaque induced peri-implantitis is excess
cement which has been forced
into the tissue when the crown is
cemented. If the excess cement
is not thoroughly removed by
the implant dentist, this will induce inflammation of the tissue
and possible bone loss.
How to maintain dental implants?
It is important that good oral

Fig. 4c: A healthy gingival cuff
around an implant.

hygiene is performed to maintain healthy peri-implant tissues. The use of toothbrushes,
either manual or electric, helps
to reduce the amount of plaque
biofilm. Floss, including superfloss and interdental brushes is
essential for access interproximally. It is very important that
oral hygiene for the patient is
not made too complicated thereby prolonging the time required
by using too many oral hygiene
aids. In the aesthetic zone, a
cross over flossing technique
can be used (Figs. 2a-f).
A poor flossing technique or no
flossing at all can lead to subgingival inflammation of the periimplant tissues. It is essential
that if a cement retained crown
is placed that all the cement is
removed as subgingival irritants such as excess cement can

In premolar and molar areas the
use of floss or intedental brushes
can be easier for the patient in
the case of single unit implant,
and in fixed bridgework.
Calculus formation on dental
implants is very similar to that
found on teeth, the only difference is that the abutment and
the porcelain are very highly
polished, therefore the calculus is not as tenacious as on a
natural tooth. When removing
supragingival calculus from the
implant crowns, it is very important not to use stainless steel
scalers as this will damage the
titanium surfaces. Therefore it
is recommended that one uses a
material that is softer than titanium either gold plated or reinforced plastic instruments (Fig.
5). It is very important that an
ultrasonic is never used on an
implant as this will heat up the
implant and could kill the bone
that helps integrate the implant.
When pocketing has been noted
then using the CIST protocol
will help treat the majority of
peri-implantitis cases. Below
is an example of an UR2 with
8 mm pocketing, the site was
treated non-surgically with local
delivery antimicrobials and with
the patient using chorhexidine
gel with the largest interdental
brush (Figs. 6a-c). At the 2 week
review the pocketing associated
with the UR2 has reduced to 5
mm with simple non-surgical
therapy any further intervention
will need to be reviewed by the
implant dentist.

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Fig. 6b: After subgingival currettage of the pocket the patient was
shown how to use a large interdental brush with chlorhexidine
gel twice a day.

Fig. 6c: Patient reviewed at 2
weeks. The inflamed tissue have
reduced exposing the crown
margin.

Fig. 6d: U2 pocketing has reduced 5 mm.

Conclusion
Good oral hygiene performed
by the patient has a significant
affect on the stability of the
marginal bone around dental
implants. Therefore regular hygienist appointments are necessary to ensure that your patients
are maintaining a high standard
of oral hygiene around their
dental implants.

[27] =>

ortho tribune 27

Dental Tribune Middle East & Africa Edition | May - June 2014

Complex dental problems and the
contribution of adjunctive orthodontics
By Professor Athanasios E. Athanasiou, DSDM

he goal of contemporary dentistry is the
maintenance of natural dentition under
biologically, functionally and
esthetically optimal conditions,
for the longest possible period.
An increasing number of adult

ment is tooth movement carried out to facilitate other dental procedures necessary to
control disease and to restore
function. It may be an alternative adjunct to general dentistry by providing (a) rehabilitation following tooth migration
due to pre-existing periodontal disease; (b) pre-prosthetic
orthodontics; (c) treatment of
periodontal defects; and (d) orthodontics as an alternative to
prosthodontics (2).

Orthodontics and periodontics
It has been documented that
orthodontic treatment in patients with severe periodontal destruction is no longer a
contraindication (3). On the
contrary such treatment might
even enhance the possibilities
of saving and restoring a deteriorating dentition. During the
orthodontic movement it is the
entire periodontal unit (bone,
periodontal ligament, and soft

tissues), which moves with the
tooth (4). This all-embracing
movement has been shown to
be beneficial when orthodontic uprighting of tipped molars
is undertaken since the crestal
bone exhibits predictable and
considerable changes (5) (Figure 1). Forced eruption has also
been reported to decrease the
depth of isolated vertical infrabony defects and to expose
tooth structure, thus allowing
the prosthetic management of

subgingival fractures, caries
and lateral root perforations (6)
(Figure 2).
Orthodontics and missing teeth
In cases where lateral incisors
are congenitally missing and
other malocclusion co-exist, in
most instances the treatment
of choice is the orthodontic
movement of the canines to-

> Page 33

(A)

Figure 1. Extraction of the lower
first molars has resulted several
years later to a mesial tipping of
the second and third molars (A).
When orthodontic uprighting of
tipped molars was undertaken the
crestal bone exhibited considerable
changes (B).

The Proof is in the Numbers

people present a variety of complex dental problems, which
concern more than one clinical
discipline or specialty. These
include caries, periodontal
diseases, dental trauma, edentulous sites, malocclusions, or
their combination.

Reduced Treatment Time*

(B)

Fewer Patient Visits*

This article outlines existing
orthodontic therapeutic possibilities for adjunctive dental
work and emphasizes the importance of teamwork among
the general dentist, the orthodontic specialist, and other
dental specialists.
Principles of treatment planning for complex dental problems
The need to formulate problem-oriented treatment plans,
which address patients’ chief
complaint for complex cases
necessitates consensus among
the parties involved namely the
general dentist, the specialist
and the patient. Diagnosis must
utilize patient’s data, derived
from records interpreted by
the clinician using strict scientific criteria. On the other
hand, treatment planning constitutes an intellectual process
where subjective elements are
often involved. It is the path
that the well-educated and experienced clinician follows in
order to maximize the benefits
for the patient, which must be
contrasted to the cost and risk
involved when certain procedures are adopted (1). An essential requirement for successful
interaction is that both general
practitioner and specialist are
in agreement regarding the advantages and limitations of the
treatment chosen.
Adjunctive orthodontics

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* Weber II, Dennis J., Koroluk, Lorne D., Phillips, Ceib, Nguyen, Tung, Proffit, William R.,
“Clinical Effectiveness and Efficiency of Customized vs. Conventional Preadjusted Bracket
Systems”, Journal of Clinical Orthodontics, Volume XLVII, No. 4 (2013): 261-266.

Adjunctive orthodontic treatInsignia-Ad-2014-A4Size.indd 1

3/6/14 12:45 PM

[28] =>

28 ortho tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Aesthetics and function:
Orthodontic – surgical collaboration as a key to success
By Drs Martin Jaroch &
Friedrich Bunz, Germany

ral surgery is an important cornerstone in
orthodontic treatment
of malocclusions. Tooth movement is only possible to a limited
extent and always depends on
the misalignment of the maxilla
and mandible in relation to each
other, as well as on deformities
of the jaw in relation to the other
facial bones.
Abnormalities may be congenital or acquired and may affect
patients in childhood already.
If so, the focus of orthodontic
treatment is not primarily in
the aesthetic correction, but is
guided by functional and prophylactic concerns. Efficient occlusion and restoration of masticatory function are decisive
factors for tooth preservation
and prevention of secondary
disorders (Figs. 1a–c). Without
a doubt, aesthetic improvement, as well as the associated
self-consciousness, is the main
concern of most patients, which
can be pursued through surgical correction.
Causes of malocclusion
Generally, patients visit an
orthodontic practice only after
symptoms or significant abnormalities have already presented. Clinically, this results in late
mixed dentition or permanent
dentition, which can complicate an accurate mapping of the
reasons for this malocclusion.
In the literature, the causes of
malocclusion and the aetiological structure of the symptoms of
malocclusion in orthodontic patients are controversial issues.
No explicit information on the
percentage of patients with acquired or congenital malocclusions can be found in a study by
Schopf (1981) on the exogenous
factors that are involved in the
development of malocclusion.
However, from the assessment
of individual patients’ symptoms, all symptoms of malocclusion could be associated
with exogenous aetiological
factors only in 48% of patients.
Brodmann and Saekel (2001)
concluded from Schopf’s report
that only 20% of the anomalies
were hereditary and thus could
not be affected by prophylactic
interventions. Accordingly, 80%
of malocclusions could be resolved through prevention and
better oral hygiene. This idea
is contrary to the results of the
German Oral Health Study. In
this study, a decrease in childhood caries was observed. However, clinically these results
were not associated with a lower
rate of and need for orthodontic
treatment. The study at the University of Greifswald, Germany,
found that 20.3% of the symptoms were genetically determined, 44.3% were exogenous
and 35.3% were not precisely
defined. Based on these results,
the assumption that 80% of
malocclusions can be resolved
by prevention and better oral
hygiene is very questionable

Fig. 2a-b: Significant changes between the initial assessment of latero-gnathia in 2007 (a) and the beginning of
combined orthodontic?surgical treatment in 2011 (b;
19-year-old patient).

Fig. 3a: Side view of a
19-year-old patient: laterognathia is visible in the
lower lip area.

Fig. 6a: View of the casts in
the articulator after successful
simulation of surgery.

Fig. 1a-c: Deep bite, prognathism
and latero-gnathia: according to
clinical evaluation, they can be
resolved only through interdisciplinary treatment.

is possible to draw conclusions
about the growth’s behaviour.
If the jaw continues to change
by abnormal bursts of growth,
it is advisable to postpone surgical therapy until the cessation of
growth.

(Hensel, DGKFO opinion, 2001).
The varying findings and remarks illustrate the difficulty of
clear classification of malocclusion. Nonetheless, the demands
of the patient have priority and
he expects a symptom-based
therapy with stable treatment
results. This means that in malocclusion cases that cannot be
resolved by functional orthodontics solely, orthodontic–surgical planning can be done before any treatment is attempted
by pure dentoalveolar compensatory intervention. Compensatory dentoalveolar procedures
could prevent a surgical operation. At the same time, patients
may run the risk of protracted
treatment without any longlasting benefit. The decision
for or against orthopaedic surgery requires interdisciplinary
agreement and reliable treatment goals must be defined in
advance (Figs. 2a & b).
Target group for orthopaedic
surgery
Nowadays, adults make up
the majority of patients in the
orthodontic practice. They are
generally motivated by high
socio-cultural demands and
the desire for perfect teeth. In
adults who have an obvious discrepancy between their maxilla
and mandible, it must be clarified whether the deformities
are dentoalveolar or skeletal.
Owing to the limitations of conventional orthodontic treatment, skeletal discrepancies
can rarely be entirely resolved.
In those cases, combined orthodontic–surgical treatment is
necessary. During growth, it is
mostly possible to treat malocclusions successfully without
surgery by purely orthodontic
treatment using removable appliances or brackets.
Children and young people for
whom functional orthodontic
treatment has not led to the desired result are treated surgically after the growth period. Early
surgery always carries the risk

Fig. 3b: Frontal view:
latero-gnathia to the right
and the resulting deviation is clearly visible.

Surgical technique

Fig. 4a-c: Orthodontic, prepared
pre-op diagnostic radiology (orthopantomograph, cephalometric
radiograph and antero-posterior
projection) of the now 20-year-old
patient.

of unexpected growth pattern
or unilateral abnormal hyperplasia and can affect the results
of the operation.
Selection of patients
Combined
orthodontic–surgical treatment requires not
only strong and focused interdisciplinary collaboration, but
also absolute acceptance of the
treatment plan by patients and
parents. The treatment is timeconsuming and post-operative
corrections cannot be excluded.
A detailed medical preoperative discussion should inform
patients about the risks of combined treatment and the consequences of untreated malocclusions. Malocclusions can cause
numerous side-effects, such as
back pain and chronic headaches (Figs. 3a & b). In markedly
dolichofacial face types, malocclusions can lead to a pharyngeal constriction, which can
manifest as obstructive sleep
apnoea syndrome (Hochban et
al. 1997).
In adult patients, it is normally
useful to determine the amount
of malocclusion and force bite
using a flat-plane bite splint.
The splint is worn for six to
eight weeks, and guarantees the
identification of the physiological condylar position. Pursuing
orthodontic correction depends
on the intended post-operative
situation. Therefore, such correction is only dentoalveolar
and does not transfer bite forces

Fig. 5a-e: Pre-op clinical situation
after orthodontic preparatory
work.

(Figs. 4a–c & 5a–e). The most favourable position of the maxilla
and mandible is assessed on the
basis of simulated cast surgery
in which the amount of shift is
determined. Using these casts,
a splint can be fabricated and
placed during surgery to fix the
determined physiological condylar position preoperatively
(Figs. 6a–c).
Teenagers
with
mandibular asymmetry that cannot
be clearly classified should
be treated with special care.
Should clinical records be available only from the age of 16—
whether as a result of erroneous
dental records or simply owing
to late initial assessment in a
specialised practice—accurate
early diagnosis of potential unilateral hyperplasia with further
growth tendency is essential.
According to the German Society of Oral and Maxillofacial
Surgery guidelines, a nuclear
medicine diagnostic is necessary—in addition to inspection,
palpation and radiography—to
determine the risk of an abnormal growth in time. Through
increased uptake in the affected
region during scintigraphy, it

The choice of technique for the
osteotomy depends on various
factors. In displacement osteotomy, surgical access to the
bone is created, which is split at
fixed points. Correction of the
bone and bone healing in the
new fixed position is accomplished using simulated cast
surgery and a fabricated splint.
Following surgical modification
of the jaw area, it is important to
consider the correct position of
the jaw and optimal occlusion.
This crucial step has to be performed by the orthodontist as
accurately as possible because
repositioning and the degree of
displacement of the jaw depend
on achievable occlusion. Furthermore, teeth have an influence on access to the surgical
field and wisdom teeth must be
removed before osteotomy in
certain cases.
Osteotomy can be done on both
jaws or can be limited to the
maxilla or mandible. However,
in many cases it is functional to
perform bimaxillary osteotomy
and to shift both jaws. Today,
generally the entire tooth-bearing portions of the jaw are shifted. Segmental osteotomy has
not been proven to be very successful in the past and corrections of malocclusions are left to
the orthodontic treatment partners. In this field of treatment,
the Obwegeser–Dal Pont surgical technique is recommended.
This procedure describes an
intra-oral stepped osteotomy at
the mandibular ramus (Figs.
7a & b). Since Bell and Epker
described the possibility of bimaxillary surgery as the “down
fracture” technique in 1975, it
has been popular and today you
can find it mostly as a combi-

> Page 29

[29] =>

ortho tribune 29

Dental Tribune Middle East & Africa Edition | May - June 2014
< Page 28

Fig. 6b, 6c: Intra-op fixation
of the splint for correction of
latero-gnathia after osteotomy.

nation of Obwegeser–Dal Pont
and Le Fort I osteotomy. The
bimaxillary approach seems
reasonable, since the maxilla
and mandible influence each
other during growth. However,
it is frequently only possible to
obtain a very good and risk-free
result by using Obwegeser–Dal
Pont surgery. Fixation in split
osteotomy of the mandible is
usually realised by using minimally invasive plate osteosynthesis. In modified techniques
of Obwegeser–Dal Pont surgery,
a displaced ramus is fixed using
osteosynthesis screws only (Hochban 1997; Figs. 8a & b). This
modification avoids the complicated surgical removal of osteosynthesis plates.
Operation risk
Any surgical procedure can lead
to unexpected complications,

Fig. 7a, 7b: Illustration of
Obwegeser? Dal Pont osteotomy
of the 20-year-old patient: split
osteotomy of the intra-oral
ramus is clearly visible.

which must always be considered according to the risk–benefit principle. Today, the need
for osteotomy remains controversial because a jaw deformity
is not a serious illness like a tumour, abscess or bone fracture,
which is necessarily treated by
surgery. Since deformities are
often aesthetic corrections and
can be classified as elective
procedures, operation safety is
a chief concern. Isolated osteotomies of the mandible, which
present a significantly lower
surgery risk, should be the first
choice for orthodontic–surgical
interventions.
The most significant risk of osteotomy of the mandible is a
probability of about 5% of damaging the sensory nerve, called
the inferior alveolar nerve. This
can cause sensibility problems
of the lower lip and chin area

(Figs. 9a–c). Additional serious
risks are not expected using Obwegeser–Dal Pont surgery and
post-operative bleeding can be
controlled very safely.
Interdisciplinary collaboration
The literature review of work
done in the 1970s makes clear
that today’s conscientious collaboration between surgeons
and orthodontists is not a matter of course. Over the years,
orthognathic surgery was considered to be the last option for
treating orthodontic cases that
could not be resolved using
standard treatment techniques.
Therefore, operations were carried out based on tolerance of
dentoalveolar
compensation
and likely made further corrective surgery more probable.
Today, in almost all cases of

malocclusion,
orthodontic
treatment is preceded by surgical treatment. Nowadays,
the planning of the operation
based on simulated cast surgery
and the creation of a splint is a
very safe method by which to
achieve predictable and stable
long-term results (Figs. 10a &
b). Individual dentoalveolar
discrepancies in occlusion can
be corrected preoperatively or
post-operatively by orthodontic
treatment. Therefore, interdisciplinary collaboration is
always a benefit for the patient
and treatment team.

About the Author
Dr Martin Jaroch
Dr Friedrich Bunz
Aesthetic and Function Dr
Bunz—Dr Jaroch & Partner Professional Practice of Orthodontics
Teggingerstr. 5
78315 Radolfzell, Germany

Science in Every Smile

IT IS TIME TO SEE THE

FUTURE NOW!

Fig. 8a, 8b: Intraoperative
view of osteosynthesis screws
inserted during surgery of the
20-year-old patient.

Invisalign uses 3D CAD/CAM
technology to visualize the
treatment and a step-by-step
simulated results.

Fig. 9a: Post-op X-ray diagnostics (orthopantomograph,
cephalometric radiograph).

INVISALIGN® CERTIFICATION

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Fig. 10a: Pre-op view.

Post-op view. Significant improvement in lateral occlusion
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[30] =>

30 ortho tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

“The Middle East region is right up there in
terms of Global Orthodontic standards”
It is critical to understand that
publishing our work is our obligation to our specialty. We cannot do more, we should not dare
to do less!

By Dr. Khaled Abouseada, KSA

t was a pleasure to interview Dr. Nikhilesh Vaid
who could be ranked as
one of the key doctors to enrich
and strengthen our orthodontic section in Dental Tribune,
bringing it to new heights
by displaying a wide screening of Dr. Nanda’s vast crucial
achievements. The focal objective was encapsulating the
accumulated information I
received from him into an easily digestible manner providing
a platform for all the diverse
ideas, updates, ethics and principles of orthodontic practices
and researches Dr. Nikhilesh
conveyed. Working with the
philosophy of placing an attractively remarkable plan to shine
light on distinguished professional orthodontists to paint the
path forward for our sciencerelated readers. Dr. Vaid is an
innovative leader in the field of
Orthodontics and has demonstrated excellent judgment and
played a major role in improving the practice in India, targeting unique researches and
development efforts as well as
leading growth initiatives.
Dr. Khaled Abouseada: Compared to when you started practicing, how has Orthodontics
developed through the past
years? What are the driving factors behind this development?
Dr. Nikhilesh Vaid: To be very
honest I have not been an orthodontist for that long, to see
a decade-by-decade shift in the
procedures that I have practiced. In the last 12 years from
when I did start out, the major thrust has been the incorporation of technology in all
spheres: Diagnosis, Research,
Planning, Mechanics and Appliances. A lot of purists feel the
skill levels of the contemporary
Orthodontist are becoming redundant because of technology;
I would like to think otherwise.
The skills required are changing and change is the only
thing constant with any science. Fundamental principles
will still govern Orthodontic
care delivery, but incorporation of technology will increase
the quality of life of both the orthodontist and the orthodontic
patient. Today Micro implants
are the main stay of anchorage
control, I only use Self Ligating brackets, because of chair
side efficiency. Lingual Orthodontics, Aligners, Stereolithigraphic 3D Surgical Planning
are the main stay of our teaching and practice protocols. The
thrust towards this is driven by
improved precision in these appliances due to CAD CAM and
Robotics.
Back to years of study and residency in India, how can you describe those days?
My residency years in Mysore,

What are your future expectations in Orthodontics?

Dr. Nikhilesh Vaid

India at the JSS Dental College
& Hospital were literally, to borrow a line from a famous song,
the “best days of my life”. Orthodontic training in India is very
regimented and even today the
accent is mainly on enhancing
dexterity skills, which I think
are non negotiable as far as any
Orthodontic training is concerned. The programme at JSS
was very “cerebral” and “clinical”, in the sense, we were encouraged to think, very often,
out of the box. This has influenced us to be receptive to new
advances, without the dogma of
a particular school of thought.
The bonding and the camaraderie amongst colleagues as
well as the discipline that kept
us on our toes, were actually
lessons that have molded me to
assume greater responsibilities
in life.
Do any of your teachers stand
out who encouraged you to pursue this career? What would you
tell them now?
Well the soul of any teaching
programme is the Programme
Director or a Guide in a Masters
Programme, whatever the nomenclature is in any part of the
world. The biggest influence
in my life has been my Professor, Prof E. T. Roy, who has
mentored me as an Orthodontist in my years in my Masters
programme. He is a strict disciplinarian, and was responsible
for influencing my life beyond
Orthodontics as well. Its important to inspire your residents to
be complete professionals, Orthodontics is only a part of what
we do. The spirit to serve my
profession and professional organization is something that he
has inculcated in me. Dr Ashok
Simha, Dr Ravi Gupta, Dr Ravi
Sable, Dr Shailesh Deshmukh
and Dr Sripad Nagarsekhar
have taught me Othodontics at
different stages of my life as an
undergraduate and graduate
student. My colleagues dur-

ing my Masters programme,
and later, most importantly Dr
Meghna Vandekar, Dr Gurkeerat Singh and Dr Jacob John
are also responsible for what I
am today. I would like to thank
each of these individuals for
touching my life and promise
to make them proud with everything I attempt to do.
What can you tell us about your
experience as the president elect
of the Indian Orthodontic society and Editor in Chief of the
Asian Pacific Orthodontic Society?
I have just been elected President Elect of the Indian Orthodontic Society, which is
amongst the largest Orthodontic Societies globally. We have
an obligation to contribute to
the knowledge bank of global
Orthodontics, and encourage
scientific content of the highest
caliber. I will be President in
the Golden Jubilee year (50th
Year) of the IOS, which will
be a time for us to rejoice and
commemorate our past, but at
the same time, plan to propel
ourselves with policies that
will enhance our member’s
lives with the changing global
trends in Orthodontics. I was
appointed Editor of the APOS
Trends in 2011 and the Chief
Editor in 2013. Today the Journal is indexed by multiple indexing agencies. I have an excellent young and enthusiastic
team which is committed to the
cause of achieving excellence
in documentation of scientific
data from the Asian Pacific region that is available to orthodontists across the globe at no
cost. I have to compliment the
Past APOS President Dr Loh Kai
Woh, for his vision, Dr Kazuo
Tanne, President APOS and Dr
Bryce Lee, Secretary General
APOS, for their support as well
as American Orthodontics for
being the corporate sponsor of
this endeavor for 2013-14.

What golden advice could you
provide to orthodontic residences to consider in shaping
their future careers as Orthodontists?
I don’t know if I’m qualified
enough to advice, but I am
greatly influenced by a quote
of our times, “The illiterate of
the 21st century will not be the
ones who cannot read or write
but the ones who cannot unlearn and relearn new things.”
Science today is progressing at
a pace where the global knowledge bank doubles in just a few
years. We have to have open
minds and the willingness to
be students all our lives. If we
can attune our mindsets to this
aspect, success in every sphere
of life will follow.
As having a lot of scientific
publications in the field of orthodontics, can you tell us how
can we come to a statistically
significant scientific conclusion
that needs to be published and
the benefit of being published?
I believe documentation of every form of scientific data is
paramount. That is creating
database, which is critical to
any form of research and future
reference. As long as any form
of information serves to enhance the knowledge bank of
orthodontics and follows guidelines and procedures of research that are contemporary,
it needs to be considered for
publication. Statistically insignificant information also can
give information that is of clinical relevance. It’s important to
understand that phenomenon.
With respect to the benefits of
publication, I would not dwell
on the fact that we need it for
career enhancement. It is our
contribution to our profession. If Andrews did not publish the “six keys of occlusion”,
or Angle, the “classification of
malocclusion”, would we have
evolved to where we are today?

I envision a tomorrow, where
Orthodontic care will be available in every corner of the
world, provided by a specialist
Orthodontist. From a health
care perspective, the scope of
orthodontics should also include interdisciplinary and
adjunctive therapies. Collaboration with Sleep Medicine,
Plastic Surgery, ENT Specialists and other Dental Specialists will be the tomorrow of
Orthodontics. Aesthetic Orthodontics using CAD CAM and
Robotics will be a regular feature of our appliances, as well
as our Diagnostic and finishing protocols. Diagnostic Aids
will become 3 Dimensional for
a fact. Research in Genetics,
Bone Biology and Molecular
Genetics will play a significant
role in the way we approach the
growing patient in the next decade. It is an exciting time to be
witnessing this change in Orthodontics.
Regarding our Middle-East region, as you are an active contributor in many events in the
area, what can you say about
the Orthodontic mark in the
area?
I think the Middle East region
is right up there in terms of
Global Orthodontic standards.
I have travelled to lecture in
UAE, Jordan, Lebanon and
Oman, and was impressed with
the quality of work and enthusiasm in the region.
Conclusion
My main purpose will always
revolve around focusing and
bringing Professors of the
highest level into focus thus
enhance quality, ensuring this
top quality and therefore creating the ultimate satisfaction
for our readers. I hope that our
crew have gained the trust of
our readers by always respecting them, providing the best
service possible and improving our material are our main
components of value. Receiving feedback is always welcome whether positive, negative, thankful or harsh replies,
which will always keep us on
the right track and guide us
to our next steps. Continuous
improvement of this section is
our definite preference and its
growth is our distinct mission,
which we hope would be envisaged to meet your needs.

Contact Information
Dr. Khaled Abouseada
Consultant Orthodontist
khaledseada@yahoo.com

[31] =>

Dental Tribune Middle East & Africa Edition | May - June 2014

education tribune 31

The 2nd International Students’
Dental Conference 2014
By University of Sharjah Dental
Students Association

A

pril 9-10, 2014, saw
over 700 students from
ten countries gather
together at the University of Sharjah College of
Dental Medicine for the 2nd
International Students’ Dental
Conference. The conference
was opened by His Highness
Crown Prince Sheikh Sultan
bin Mohammed bin Sultan Al
Qasimi who toured all the exhibits from eight companies
such as Listerine/J&J, Crest/
Oral B and GlaxoSmithKline,
asking many questions along
the way, before he oversaw the
opening ceremonies.
The conference was a huge
success for the students of the
University of Sharjah Dental
Students Association, who cre-

drew lots of interest and resulted in lively and sometimes passionate discussion.

all over the world to the University of Sharjah” said studentdoctor Rawand.

Additionally, a number of participation workshops on topics
ranging from layering of anterior resin composite, to TMJ,
lasers, rotary endodontics, implants, veneers and a suturing
clinic gave participants some
outstanding hands-on experiences.

Social events such as a desert
safari, go karting, and a dinner
cruise in Dubai were added attractions for the international
students which also included
large contingents of students
from the Kingdom of Saudi
Arabia, Sudan and Malaysia as
well as students from all the local schools.

All-in-all, the conference was a
culmination of very hard work
from the Executive Committee
of the Student Association and
the Organizing Committee.
Dean of the College, Professor Richard J. Simonsen noted
in his strong praise of the students that he has never seen a
more active and giving group
of young people in his over 40
years in dental education.

“It is quite remarkable that a group of 20-year
old young students (mainly ladies by the way!)
could pull this off” - Prof. Richard Simonsen,
Dean of the University of Sharjah College of
Dental Medicine
ated, planned, organized and
executed the whole conference
of exhibits, poster presentations, oral research presentations and debates. The two debates focusing on the treatment
options of endodontics versus
implants, and the other debate
on where to draw the line between prevention and restoration in cases of incipient caries,

The main organizer, Rawand
Naji, the President of the USDSA was very pleased with
the program and participation
from countries as far afield as
Russia and Poland. “Next year
we hope to consolidate this
conference into a regular annual highlight on the dental
calendar and eventually to attract many more students from

The President of the USDSA
was ably supported by the rest
of her Board of student-doctors,
Mays Faris, Jumana Lisa Irbaye, Abeer Sha’al, Shorouk
Mahmoud, Sally Masoud Manla, Sara Anbari, Deema Raslan
and
Mohammed
Hussein
Haider, all from the secondyear dental program at UoS.
“It is quite remarkable that
a group of 20-year old young
students (mainly ladies by the
way!) could pull this off with
such success while still studying hard for upcoming final exams,” said Dean Simonsen.

(Photo courtesy of Prof. Richard Simonsen, Dean of the
University of Sharjah College of Dental Medicine)

(Photo courtesy of Dr Shehreyar Chaudry)

Faculty support was provided
by Dr Karim Salah and Dr
Eman Mustafa, and huge support was provided by former
USDSA Presidents, Faraj Edher
and Hiba Abdulhadi, who were
the first to give the credit to the
student association leadership,
and all the many other students
who helped out with the execution of this remarkable conference.
(Photo courtesy of Dr Al-Moatasen Khougeer)

Still lots to see and discover at IDEM
By Dental Tribune International

S

INGAPORE: In the presence of Singapore’s Health
Minister Gan Kim Yong
and senior representatives of
Koelnmesse, the Singapore
Dental Association, and FDI
World Dental Federation, the
eighth edition of IDEM Singapore was officially opened
on 04 April 2014 at the Suntec
Singapore International Convention and Exhibition Centre.
The Minister, who graced the
traditional Opening Ceremony
outside the Exhibition Hall on
Level 4 as Guest of Honour,
congratulated the organisers
of the show that, in his words,
“has evolved to be a ‘must-attend’ event for all dental healthcare professionals and related
industries in the Asia-Pacific
region.”
Praise was also given by Singapore Dental Association’s President Dr Kuan Chee Keong, who

“...has evolved to be a ‘must-attend’ event for
all dental healthcare professionals and related
industries in the Asia-Pacific region.”
said that the ongoing support of
Gan’s Ministry and other sponsors is a testament that IDEM
has firmly consolidated its status as the focal event for the
Asia Pacific dental community.
“Besides the opportunity to interact with friends and dental
professionals from around the
world, IDEM also offers the opportunity to share knowledge,
ideas and practical applications
in dentistry,” he said.

is being held over the weekend at the recently renovated
Suntec convention centre. Reflecting greater interest from
industry players in the Asia
Pacific region, national pavilions from China and Japan are

IDEM 2014 is poised to be the
largest dental show ever to be
held in Singapore since it was
launched in 2000. According
to Koelnmesse’s Vice President
of Asia Pacific, Michael Dreyer,
30 per cent more dental manufacturers and distributors have
signed up for the event, which

being staged for the first time
along with group presentations
from established markets like
Germany, Italy and the US. In
total, over 500 exhibitors are
presenting their latest products
and solutions for dentistry at
Levels 4 and 6.

Attendance figures are also
expected to increase by 12 per
cent, with many new visitors
coming from nearby countries
like Cambodia, Myanmar and
Taiwan. “Not just a place where
East meets West, IDEM Singapore is also increasingly being
considered a gathering point
for different parts of the East to
meet one another,“ Dreyer said.

“...IDEM also offers the opportunity
to share knowledge, ideas and practical
applications in dentistry”
Aside from the trade fair bustle,
clinical presentations as part of
the scientific programme will
continue today at Level 4 with
lectures and workshop focussing on fields like prosthodontics and orthodontics. A special
presentation by US dentist Dr
Barry Freydberg on 05 April

2014 at 4.30 p.m. focused on the
detection and prevention of oral
cancer, which is among the few
types of cancer which are currently on the rise worldwide. At
the Dental Tribune Study Club
Symposium at booth 6P-22, Singapore’s own prosthodontic expert, Dr Stephen Soo of Specialist Dental Group, will provide
insight into CAD/CAM and how
its use can benefit workflow in
dental practices.
New concepts and methods for
dental labs will be discussed at
the Dental Technicians Forum,
one of the new educational
formats specifically targeting
other members of the dental
profession. In addition to these
presentations, lectures for dental hygienist/therapists were
also held throughout the days.

[32] =>

32 education tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Dentistry – your dream profession
cilities and our in-house clinic,
strives to both challenge and
support its students. We want
our graduates to be among the
acknowledged leaders of their
profession. The dental faculty
of the University includes many
highly respected scientists who
take great pleasure in being a
part of a new, innovative project in basic dental studies that
is of particular benefit to society – led by our Chancellor, Professor Dr. Dr. Dieter Müssig and
our Dean, Professor Dr. Dr. hc.
Andrej Kielbassa.

In addition to instruction in
medical and dental subjects,
the President of the University,
Honorary Consul M.B. WagnerPischel, is dedicated not only to
the achievement of excellence
in research, instruction and innovation, but also to the holistic
education of the young people,
ensuring that they receive a
solid grounding in the arts,
literature, science journalism
and music, as well as training in
empathy. The aim is to promote
the well-rounded development
of the young people, and equip

them with positive approaches
for their subsequent career that
enhance their communicative intelligence. Dental health
and personal care and hygiene
play a key role in how people
are perceived today. Beauty
and mindfulness are reflected
more than anywhere else in
oral and dental health. A good
dentist can be compared to an
artist, as she requires an exceptional understanding of form
and colour as well as spatial
visualisation skills. When combined with the state of the art in

Marga B. Wagner-Pischel

By Danube Private University

t Danube Private University, students undergo a six-year course
in dental medicine,
and on completion of the course
are awarded the internationally recognized degree Dr. med.
dent. This elite course of study
at the leading edge of medical
and dental science, utilising
state-of-the-art medical and
dental equipment, practical famedical and dental knowledge,
the result is uncompromising
excellence in patient treatment.
For President Wagner-Pischel,
a life spent in the exercise of a
profession about which one is
passionate is an important and
meaningful life commitment
as well as a significant contribution to the welfare of society
as a whole.
“Our students at Danube Private University have excellent
life and education opportunities. We offer them a top dentistry course equipped with
state of the art technology that
focuses on students’ needs and
values them above all else,
while upholding the finest traditional humanistic values.
Danube Private University emphasises not only medical and
dental science, but also human
interaction among students and

instructors as well as responsibility to both patients and society,” explains M.B. WagnerPischel, President of Danube
Private University.
To date, the student body of
Danube Private University is
made up mostly of the children
of dentists and doctors from
German-speaking
Europe.
Young people from all over the
world are interested in studying at Danube Private University. In response, we are offering
a preparatory course of study
for students outside of Germanspeaking Europe.

Contact Information
http://www.danube-privateuniversity.at/studien.php?id=130
&PHPSESSID=um7ngso5ounere
80c0ldcu3ae7

< Page 1
Composite Veneers and Masking Discoloration; About Red
& White Aesthetics; Direct Veneers Diastema Closure; Virtual Articulator and CAD/CAM
Designing Workshop.
The second day of the conference will feature the new Dental Hygiene Seminar focused
entirely on the Dental Hygienist providing the latest in Periodontal Instrumentation and
Oral Prevention and Management of Dentine Hypersensitivity.
Additional to the knowledge
delegates will exchange, all attendees will benefit from the

networking opportunities in
the cozy atmosphere provided by Jumeirah Beach Hotel
where you can meet your colleagues from across the globe
while lunching at Dubai’s best
restaurant.
All Dentists, Dental Technicians and Dental Hygienists
are welcome to get the most
updated scientific exchange
and view the latest technology,
trends and developments in
CAD/CAM & Digital Dentistry.
The future is here and all are
welcome to join.

[33] =>

education tribune 33

Dental Tribune Middle East & Africa Edition | May - June 2014
< Page 27

(A)

(B)

(C)
Figure 2. Subgingival horizontal fracture of the upper left central incisor (A) was managed
by orthodontic forced eruption,
which resulted to the exposure of
tooth structure (B), thus allowing
the prosthetic management (C),
(Melsen, 1982).

(A)

(B)

(C)
Figure 3. Young adult with lower
second premolars congenitally
missing (A). Following extraction
of lower second deciduous molars
orthodontic treatment resulted to
the closure of the space (B) and (C).

laterals, which they replace
(7). Furthermore, periodontal health is greatly improved
as compared to that of cases,
which have been rehabilitated
by means of prosthodontics (8).
The orthodontic closure of the
space might be indicated when
a premolar or even a molar are
missing as long as certain indications exist concerning the
whole occlusion or malocclusion (9) (Figure 3).

“Failure to provide appropriate treatment of occlusal
trauma in patients with chronic periodontitis may
result in progressive bone loss”

Orthodontics, restorative dentistry and oral health

In cases of extreme anterior
overbite, direct trauma to the
gingiva from the incisal edges
of the mandibular incisors may
result in palatal recession of
the maxillary incisors (Figure
5). Similarly, in severe Class II,
division 2 malocclusions with
linguoversion of the maxillary
incisors, functional trauma can
cause marginal recession of the
labial gingiva of the mandibular incisors. This recession,
although not the result of periodontitis, can result to a significant loss of attachment.

When teeth have been lost
early, those remaining distal to
the edentulous space, usually
present with a mesial tipping,
displacement and rotation. Individuals with an abnormal
mesio-distal inclination or
displacement of the posterior
teeth were found to have a positive association between mesial inclination and periodontal
destruction. Once periodontal
health is established, occlusal
therapy can be used to reduce
mobility, to regain bone lost
owing to traumatic occlusal
forces, and to treat a variety
of clinical problems related
to occlusal instability and restorative needs (7). Failure to
provide appropriate treatment
of occlusal trauma in patients
with chronic periodontitis
may result in progressive bone
loss, adverse change in prognosis thus resulting in tooth
loss. Uprighting these teeth
by orthodontic means before
the conventional restoration of
the edentulous areas may corroborate to their periodontal
treatment and maintenance in
the dental arch. When premolars will be replaced adequate
space is necessary not only at
the mesio-distal but also at the
bucco-lingual direction. Teeth
with a negative prognosis can
be used to maintain or improve
the volume and structure of the
alveolar bone at the site where
they are located. The forced
eruption of a tooth, which is
planned to be extracted, alters
the architecture of the soft periodontal tissues and improves
the quality of the available bone
(Figure 4). Therefore, the final
prosthetic work is associated
with a better overall result due
to the increase in the gingival
height produced by this method
(8).

(A)
(A)

(B)
Figure 4. Maxillary incisor with
negative prognosis due to significant bone loss (A). Following orthodontic forced eruption of the tooth,
which is planned to be extracted,
improved the quality of the available bone (B). (Papadopoulou,
2013)

ward the midline, while at the
same time their cusp tip are
esthetically reshaped in order
to make them resemble to the

Subsequent absence from the
dental arch of impacted permanent teeth is not an indication
for their prosthetic replacement but rather a sign for the
start of their orthodontic traction, placement and alignment
into their natural position in
the dentition (9).

Clinical observation suggests
that when crowding causes
overlapping of adjacent teeth,
the interproximal space may
be minimal, root proximity
may occur, and the quality and
amount of bony support maybe
compromised (Diedrich, 2000).
This is a poor environment for
tissue health. The removal of

plaque and subgingival calculus in the inaccessible proximal
space may fail despite careful
application of prophylaxis procedures. Orthodontic intervention can improve the anatomic
and functional environment
and may limit the recession.
Conclusions
Provision of adjunctive orthodontic treatment should be
characterized by the following
preconditions: (a) Knowledge of
the clinical boundaries of general dentistry and of any other
dental specialty involved in
maintaining natural dentition
under biologically, functionally, and esthetically optimal
conditions; (b) establishment
of two-way, structured, and
continuous
communication
between general dentists and
orthodontists concerning the
contribution of specialised care
to the oral rehabilitation; (c)
assessment of the cost-benefit
relationship concerning treatment fees and duration, cooperation, inconvenience, discomfort, pain and difficulty;
and (d) diagnosis and treatment planning relying on strict
evidence-based criteria.

References
1. Proffit WR. Special considerations in comprehensive treatment for adults. In: Proffit WR,
Fields HW, eds. Contemporary
Orthodontics. St. Louis: Mosby,
2000:644-73.
2. Mavreas D, Athanasiou AE.
Orthodontics and its interactions with other dental disciplines. Prog Orthod 2009;10:7281.
3. Re S, Corrente G, Abundo
R, Cardaropoli D. Orthodontic treatment in periodontally
compromised patients: 12-year
report. Int J Periodontics Restorative Dent 2000;20:31-9.
Editorial note:
Full list of references is available from the author.

About the Author
Dr. Athanasios E. Athanasiou is
Professor and Program Director
of Orthodontics, Dubai School
of Dental Medicine, United Arab
Emirates and Professor of Orthodontics Aristotle University of
Thessaloniki, Greece.
He is former President of the
World Federation of Orthodontists and the European Federation of Orthodontics.

(B)
Figure 5. Adult patient with significant loss of posterior occlusal support, extreme anterior overbite, and
direct trauma to the gingiva from
the incisal edges of the mandibular
incisors (A). Following orthodontic treatment and comprehensive
restorative therapy patient’s occlusion and health have been significantly improved (B).

04-4248777 ‫ أو‬800-DENTAL (800-336825) ‫ﻟﻼﺳﺘﻔﺴﺎر وﺣﺠﺰ اﻟﻤﻮاﻋﻴﺪ ﻳﺮﺟﻰ اﻻﺗﺼﺎل ﻋﻠﻰ ارﻗﺎم‬
For more information or to make an appointment call us on 800-DENTAL (800-336825) or 04-4248777

‫ارﺑﻌﺎء‬

are

www.dsdm.ac.ae

[34] =>

34 news

Dental Tribune Middle East & Africa Edition | May - June 2014

< Page 19
bite into my food without pain &
with confidence”. Said P.V Shah
an elderly man who received
his oral rehabilitation in Dubai
by Oral Maxillofacial Surgeon
Dr. Costa Nicolopoulos at SameDay Dental Implants. Since 1991
Doctor Nicolopolous has been
practicing as a full time Maxillofacial & Oral Surgery specialist concentrating on immediate
loading of dental implants. (Figure 5)
“Less is more, that is our ambition when it comes to dimensions and numbers of anchoring elements” says Per-Ingvar
Brånemark. In ordinance with
the founding father of modern
implants we can now install
a full set of teeth on only four
implants thanks to the new ad-

vancements in implantology.
This total rehabilitation technique for the edentulous patient
known as the All-on-4® treatment concept, is a well documented surgical and prosthetic
medical procedure.
Clinics like The SameDay Dental Implants Clinic utilize this
treatment protocol allowing
patients to have their implants
and teeth placed all in the same
day as opposed to the conventional technique where dental
implants are loaded with teeth
usually two or three months
later. (Figure 6)

Figure 5. (Dr. Costa Nicolopoulos BDS, FFD MFOS)

Every year all the BOC clinics
from around the globe are invited to the Annual Brånemark Osseointegration Center meeting

Figure 4. (Per-Ingvar Brånemark and Gösta Larsson in 2005)

Figure 6. (Full mouth rehabilitation on twelve implants at SameDay Dental implants)

FDI 2014 · New Delhi · India
Greater Noida (UP)

Annual World Dental Congress

11-14 September 2014
Deadline for
early bird registration
31 May 2014

Figure 7. (Professor Per-Ingvar
Brånemark and Dr. Costa Nicolopoulos at ABOC meeting 2014 Gothenburg Sweden)

Figure 8. (Professor Per-Ingvar Brånemark Lecturing 2009)

in Gothenburg Sweden to pay
respects and tribute to the man
who started it all. (Figure 7)
“It is the works of Professor
Brånemark sixty years ago that
allows us to change our patients
lives on a daily basis”, said Dr.
Costas Nicolopoulos at the
ABOC annual meeting 2014 in
February. Here SameDay Dental Implants Clinic was given
the Leading Dentists of the
World award as a special member at the ABOC meeting 2014.

A billion smiles welcome the world of dentistry
www.fdi2014.org.in
www.fdiworldental.org

While new advancements in
the medical and dental world
impact our patient’s lives, one
must not forget that the basis of
this invention lies within a man
who saw a future while living in
the past. (Figure 8)

[35] =>

[36] =>

36 implant tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Case Report Maxillary Implant

Initial Presentation
Periapical X-Ray

later, implant placement on #3
(Eu.#16) using the bone added
osteotome sinus floor elevation
technique.‡

By Stavros Mastronikolas
D.D.S., M.Sc. Periodontist
(Dubai, UAE)

xtraction, site preservation and delayed placement of maxillary implant using the bone added
osteotome sinus floor elevation
technique.
Initial Presentation
Pt is a 28 y.o. female, medically
healthy, denies taking any medications, reports a heavy smoker, NKDA’s. A cone-beam computerized tomographic scan
was acquired pre-operatively.
A prophylaxis was completed
and oral hygiene instructions
were given. Surgical treatment
plan consisted: a) extraction,
site preservation on #3 (Eu.#16)
and distal crown lengthening
on #17 (Eu.#2), b) three months

Extraction and Site Preservation
Pt was pre-medicated, one day
pre-operatively, with 4mg Medrol (1 week dose pack) and
875+125mg Augmentin, two
times daily for 9 days. Atraumatic tooth extraction on #3
(Eu.#16) was performed using a piezotome. The deficient
alveolar socket on #3 (Eu.#16)
was carefully enucleated, soft
tissues were manipulated and
0.7cc DFDBA (Demineralized
Freeze Dried Bone Allograft)
and (15x30mm) X-Sm Fascia
Lata membrane were placed.
DFDBA vs FDBA was placed on
the extraction site to facilitate
greater new bone formation.*
DFDBA was hydrated with
physiologic saline. Fascia Lata
membrane was allowed to be
soaked into saline for 10-15
minutes. Allograft ID stickers
are always kept for traceability
purposes.
Primary closure was achieved
with minimal tension. Post op
instructions were given. Sutures were removed 2 weeks
after the site preservation was
performed.

Implant Placement
Three months later, pt was premedicated 1 day pre-operatively with 875+125 mg Augmentin,
two times daily for 9 days and
an implant (5x11.5mm) was
placed flapless. An internal sinus technique was performed
using osteotome instruments
and 0.25cc FDBA (Freeze Dried
Bone Allograft). The technique
employed a specific set of osteotome instruments to tent
the sinus membrane with bone

CT-Scan/Coronal

Extraction and Site Preservation

Two weeks post-op

Implant Placement

Periapical X-Ray

C.T/Scan and Restoration
CT-Scan/Coronal

CT-Scan/Axial

graft material placed through
the osteotomy site. Implant survival expected to be high since
preexisting bone height between the sinus floor and crest
was more than 5mm.‡ Fixture
stability>45N/cm allowed for a
healing abutment to be placed
(Stage I). Post op instructions
and sinus precautions were
given.
C.T/Scan and Restoration
Three months later a maxillary C.T/Scan was prescribed
to verify the amount of floor elevation achieved. Soon after an
implant supported crown was
fabricated and delivered. Pt
was placed on a 6-month periodontal and restorative recall.
Results
Pre-treatment the alveolar
dimensions of the first maxillary molar were 12mm widthx
8mm height and 3 months post
fixture placement the ridge dimensions were 9mm width x
7,5mm height. Verified with
the cone-beam computerized
tomographic scan a 4mm internal sinus lift was achieved
using FDBA (Freeze Dried
Bone Allograft) and osteotome
instruments.
Conclusions
Ridge dimensions can be preserved on extracted molar
teeth with deficient alveolar
architecture. Successful site
preservation can favor placing
fixtures flapless decreasing
patients’ morbidity and chair
time. Internal sinus lift with
the bone added osteotome sinus floor elevation technique
is a successful procedure. The
FDBA placed into the maxillary

sinus cavity appears to surround circumferentially the
implant having intimate contact with it.
Acknowledgments
The author wants to thank Lifenet Health for providing the
allograft materials used in this
case report. Furthermore special thanks to Dr. Paul Rosen
(www.psrperioimplant.com)
for his review for this case report.
References
‡ Rosen PS, Summers R, et al.
The bone added osteotome sinus floor elevation technique:
Multi-center
retrospective
report of consecutively treated patients. Int J Oral Maxillofac Implants 1999;14:853858.
* Wood R, Mealey, B. Histologic comparison of healing after tooth extraction
with ridge preservation using mineralized versus demineralized
freeze-dried
bone allograft. J Periodontol
2012;83:329-336.

About the Author
Periodontist Dr. Stavros Mastronikolas received his dental
degree at University of Illinois
at Chicago. He completed his
advanced training in periodontology and implantology at University of Maryland at Baltimore.
He is a Diplomate of the American Board of Periodontology. At
the moment Dr. Mastronikolas is
working full time as a Periodontist and Implant Surgeon at Drs
Nicolas and Asp (Dubai, UAE).
Email: dr.mperio@gmail.com

[37] =>

Dental Tribune Middle East & Africa Edition | May - June 2014

implant tribune 37

Stem cells in implant dentistry
By Dr. André Antonio Pelegrine,
Brazil

he 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 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

Fig. 1: A stem cell following either selfreplication or a differentiation pathway.
(All images are from: A. A. Pelegrine, A.
C. Aloise & C. E. Sorgi da Costa, Células
Tronco em Implantodontia; São Paulo:
Napoleão, 2013).

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.

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.
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 renew-

ing 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).

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).

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

Not only can stem cells be

The recognition of stem cell

> Page 38

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38 implant tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

< Page 37

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.

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 difficulty 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 not regarded
as an excessively invasive or
complex procedure. It is also
not associated with high levels

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 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.

> Page 39

[39] =>

implant tribune 39

Dental Tribune Middle East & Africa Edition | May - June 2014
< Page 38
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

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.

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.

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. Consequently, 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.
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 (with•
out 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 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).

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).

About The Author

References
[1] 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).

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.

[40] =>

40 endo tribune

Dental Tribune Middle East & Africa Edition | May - June 2014

Visual information and imaging
technology in endodontics
By Prof. Hideaki Suda &
Dr Toshihiko Yoshioka, Japan

n addition to intra-oral and
panoramic radiographs,
various visual techniques
are available for endodontic treatment today. Above all,
information obtained through
the dental microscope has become essential.
“See better, do better” is a slogan in modern endodontics.
The dental microscope is a wonderful tool for problem-solving
in endodontics, for instance for
the removal of broken instruments and root-filling materials, finding missed canals,
perforation repair, diagnosis of
tooth fractures, evaluation of
marginal integrity of restorations, precise manipulation in
periradicular surgery and deep
dental caries, and confirmation
of root-canal cleanliness. Yoshioka et al. (2002), for example,
reported that the rate of detection of root-canal orifices under a microscope was significantly higher than the number

Fig. 1a

detected with the naked eye.
It was also found that surgical
loupes were relatively ineffective compared with the microscope.
In addition, computed tomography (CT) is becoming increasingly popular among endodontists, particularly in the
assessment of difficult cases
and for problem-solving in endodontic treatment. Higher use
(34.2 per cent) of CBCT was
demonstrated by a recent webbased survey of active members of the American Associa-

Fig. 1b

Fig. 2

tion of Endodontists in the US
and Canada (Dailey et al. 2010).
Owing to its high radiation dosage, however, careful consideration is needed before taking
CT images. Consequently, a
project team from the Japanese
Association for Dental Science
presented a report in 2010 on
the use of CT in dentistry, and
a joint position statement by the
American Association of Endodontists and American Academy of Oral and Maxillofacial
Radiology was issued in February 2011. The combined use of
the dental microscope and CT

for apicectomy was approved as
an advanced dental technology
by the Ministry of Health, Labor and Welfare in Japan in
2007, and seven Japanese dental hospitals have been using
the technology since 1 February 2013.
Optical coherence tomography (OCT) is a highresolution
imaging technique that allows
micro-metre-scale imaging of
biological tissues over small
distances. It was introduced
in 1991 and uses infrared light
waves that are reflected from

the
internal
microstructure
within the biological tissues
(Shemesh et al.
2008). There
have been reports on its use
for intra-canal
imaging, diagnosis of vertical
root fracture
(Yoshioka et al.
2013) and perforations. Since
OCT is non-invasive and free of
radiation, this technology may
be very useful for endodontic
diagnosis and treatment (Figs.
1a–2).

Contact Information
Prof. Hideaki Suda is a professor
of Pulp Biology and Endodontics
at the Tokyo Medical & Dental
University’s Graduate School.
During the APEC congress in
Seoul, he will be presenting a
paper titled “Visual information
and imaging technology in endodontics”.

“Continuous Education is a top
priority for us, first proof is our new
Training Centers”
By Dental Tribune Middle East
& Africa

UBAI, UAE: After the
inauguration of the
FKG Dentaire Training Centre in November 2013,
Dental Tribune Middle East &
Africa catches up with Alexandre Mulhauser, Middle East
& Africa Director to get an update on the decision to set up in
Dubai as the regional hub. We
visited Alexandre Mulhauser at
the Training Centre in JLT in
Dubai.
DTMEA: Can you introduce us
FKG Dentaire?
Alexandre Mulhauser: Founded in 1931 in the heart of the
watch valley, FKG Dentaire
is a Swiss company internationally renowned for its high
quality products for dentists,
Endodontists and laboratories.
This Swiss High Tech company
is led by two visionaries Jean
Claude Rouiller (Chairman)
and his son Thierry Rouiller
(CEO) who have a mission to
always push Endo forward for
the benefit of both the dentists
and patients. This is possible
thanks to the creation of one of
the most modern Endo factories and the close collaboration

Alexandre Mulhauser, Middle East and Africa Director

between the Research & Development, Sales team, Marketing
and a team of General Practitioners and Endodontists globally.
FKG inaugurated its Regional
Office and Training Centre
around 6 months ago in Dubai.
What were the reasons for this
set up?
I joined the FKG team almost
four years ago to build up a new
strategy which to develop FKG
Dentaire in the Middle East and
Africa Region. When I started

this new challenge the FKG
Dentaire name was known but
the distribution network in the
ME-A region was not working
properly and the sales were
below average sales in other
regions. We are pleased to see
that in a few years we were
able to level up from the few
countries where we were represented to over 30 countries
today and continue to increase
monthly. It has been possible
thanks to a new positioning, a
complete reorganization of the
distribution channels, selec-

tion and training of
serious Distributors
that share our vision
of quality and service
to customers. It has
been a success also
thanks to the reactivity and flexibility
of the structure and
a fluidity of information together with
fast decision processes with our CEO, Thierry Rouiller. Even
with all the effort
and dedication, we
believed being in the
core of this market
and tighten the links
with our customers will be the key
of success. The decision was finalized in December
2012 and already in June 2013
the subsidiary was created and
we moved to Dubai.
Has the decision been good to
choose UAE as your regional
hub?
Companies that open a regional HQ in the ME-A Region usually open it either in Egypt, Jordan, Lebanon or United Arab
Emirates. Due to the number of
meetings we have around the
region, installing the ME-A of-

fice less than 45 minutes road of
two major airports (Dubai and
Abu Dhabi) was the best choice
to manage efficiently our travels. We decided to create the
first MEA Endo Training Center owned by an Endo manufacturer and fully equipped
with microscopes. The UAE
training center receives groups
from Middle East, Africa but
also now India and is open to
all other countries. Dentists
who would like to come for a
training do not have time to
lose in connections between
airports and these two hubs
and their great number of connections are very useful for us
to organize trainings. In addition, many love to enjoy Dubai
and the other Emirates while
coming for the training. In all
cases the decision was the perfect choice.
What are the plans for 2014 and
the Training Centre?
FKG Dentaire is already collaborating with international
Speakers (Dr. Gilberto Debelian, Dr. Martin Trope, Dr.
Bertrand Khayat and others).
We are currently finalizing a
team of highly skilled clini-

> Page 41

[41] =>

Dental Tribune Middle East & Africa Edition | May - June 2014

endo tribune 41

< Page 40
cians based in the ME-A Region
passionate by FKG Instruments
and ready to share their experience and knowledge. Dentists
are eager to test our technologies and we may increase the
number of trainings in the UAE
Office and around the ME-A
Region. Regarding the training center, thanks to the growing number of top products in
the FKG Dentaire range, along
with partnerships with other
companies we plan to also diversify the subjects. This might
be linked with the organization
of trainings with partners managing high level Continuous
Education Programs. Depending of your level, your points
of interests or the skills you
want to improve you will have
a portfolio of dates and subjects
to choose in. Following the success of the last months we also
plan to increase the size of the
FKG UAE training center to answer to the demand.
The FKG Dentaire ME-A team
is growing and we plan to focus
on emerging markets where
FKG has had a very small presence until now but with high
demand from dentists that have
had the opportunity to try our
range during international
conferences or that could read
evidence based articles about
Race. FKG ME-A Division is
currently opening Pakistan
and now also in charge of India,
a great and exciting new challenge for us. On the product

side, 2013 has been a great year
for FKG Dentaire and we are
accelerating in 2014 and 2015.
We have developed a new generation of Endo Motor called
Rooter together with dentists,
Endodontists and a French
partner. These motors are the
first wireless motors to come
with a detachable and sterilizable LED Light. Rooter is extremely well balanced for the
comfort of the Dentists and the
programmable speed ranges
from 250 to 1200 RPM to fit with
all of rotary files needed by clinicians. Rooter should be available in the coming weeks in our
distribution network throughout the ME-A region.
We are currently launching
FKG Dentaire BT-Race (a new
single use and sterile 3 files
sequence with a revolutionary
tip) and TotalFill BC Sealer, a
user friendly Hydrophilic Bioceramic filler that has already a
lot of articles stating its fantastic results. The TotalFill range
is completed with TotalFill
RRM putty (Bioceramic Root
Repair Material).
The FKG Dentaire team has
been working hard on the different states of the Nickel Titanium, clinical tests results
are beyond expectation so a lot
of great things are ahead with
the launch of a new product in
the near future. It will be a new
breakthrough in Endo.

How does FKG separate itself
from its competitors?
The Swiss Venture Club awarded FKG ‘Western Switzerland
Company of the Year 2012’, a
reward for the company’s dynamism, high product quality,
and its continuing innovation.
Race files is a real revolution
in the Endodontic world, these
files are opposite to most of the
products on the market and it
does not screw thanks to an alternating cutting edge design.
This allows the dentist to be
more confident using a precise
file he controls. It also features
the SMD (SafetyMemoDisk),
a patented daisy on all the instruments which is the only
user friendly system allowing
the clinicians to know exactly
how many times a file has been
used and help to monitor the
file stress to reduce risk of file
separation.
FKG Dentaire has developed a
sequence of scouting files years
before any company on the
market, the ScoutRace 10.02 is
still todays smallest rotary file
and now a new generation of
tips is available with six blades
(Available on BT-Race). It is
able to drill and follow the way
in the canals without stressing the root unlike big tapered
files. FKG Dentaire is not ruled
and led by marketing and sales
figures but by passion of precision, quality and pride of happiness of dentists and patients.

How important is Continual
Medical Education for FKG and
its clients?
Continuous Education is a top
priority for us, first proof is our
Training Centers in UAE, Switzerland and Norway, the second is the organization of trainings with CME providers such
as CAPP and partnerships with
private and public hospitals
and clinics asking us to train
their teams all throughout the
year. We have also recently announce the start a partnership
with the Dental College in Lebanon. Prof Roger Rebeiz and his
team will use FKG Dentaire
MEA Training Center in Dubai
for its Educational Program.
Where do you see FKG in a year
from now?
In the hands of all dentists and
Endodontist wishing to share
our vision of conservative and
biological Endo.
What are some of the regional
events you are attending with
FKG?
In United Arab Emirates we are
present in most of the important conferences in the region
(Dental Facial Cosmetic Int’l
Conference, AEEDC, APDC,
and even the CAD/CAM & Digital Dentistry Int’l Conference
through our distributor Dubai
Medical Equipment) and we
have been really active at the

Pan Arab Endo Conference
in Lebanon this year bringing Dr. Gavin Williams, a very
experienced South African
Endodontist and Prof Roger
Rebeiz, Lebanon who provide
live retreatment with FKG Files
D-Race and iRace. We are also
represented in most of the congress and shows in the region
with our distributors and partners.
You are a member of MEMA Association, can you tell us about
it?
MEMA (Middle East Managers
Association) has been created
few years ago in Lebanon. Today it gathers over 70 Middle
East Managers of Top Dental
companies. The goal of this association is to grow the dental
market through the network
and expertise of this team of
skilled professionals. I believe
all Dental Industry Middle East
Managers that are not already
part of MEMA should join; it is
a very respectful and friendly
environment with great perspectives.

Contact Information
FKG Dentaire JLT
Jumeirah Business Center 1
Cluster G, Office 2008,
PO Box 450280
Jumeirah Lake Towers
Dubai,United Arab Emirates
T: +971 445 222 40

Rooter, light up your work

LED
Ergonomic
and light

250 – 1200 rpm

Auto-reverse
disengage mode
10 presetable
torque/speed
programmes

FKG Dentaire SA
www.fkg.ch

[42] =>

42 industry news

Dental Tribune Middle East & Africa Edition | May - June 2014

The Pinnacle of Precision:
The KaVo CAD/CAM Systems Everest & Arctica
By Biberach/Riss

blocks in one cycle. Moreover,
the Everest CAM2 software
allows optional, manual tool
changes enabling the finest
cutting of fissures, for example.
The new software increases
flexibility in the choice of materials, while at the same time
expanding the system’s range
of indications.

ith the ARCTICA and
Everest systems, KaVo
offers dental and practice labs in the CAD/CAM field
practice-oriented,
economic
solutions for high-quality restorations.
The KaVo ARCTICA CAD/CAM
system is optimally attuned
to the daily requirements in
small labs and practice labs.
It provides dental technicians
and dentists with high-quality
results. For maximum flexibility, the ARCTICA system has
open interfaces allowing, for
example, the upload of various
intraoral scanner data (which
are available in the market)
into the KaVo multiCAD soft-

KaVo Arctica CAD/CAM System

ware. Thus, the system offers
a high degree of future and
investment safety and, with its
optimized individual components consisting of a scanner,
CAD software, a 5-pivot cutting
machine and materials such
as zirconium soft, titanium,
glass ceramics and synthetics
in block form, provides a wide
range of applications, indica-

KaVo Everest CAD/CAM System

tions and materials.
With the introduction of the
new Everest CAM2 software
in mid 2013, the proven Everest CAD/CAM system - present
in the market for more than
10 years - has repeatedly set
new standards. For mid-size
to large dental labs in particular, the Everest Engine offers

numerous advantages such as
overnight production, in which
up to 60 units may be cut within
one cycle, and the processing of
the most varied materials such
as titanium, CAMselect (NEM)
and Zirkon Soft in circular
form. A new clamping bridge
offers the ability to easily and
quickly process 8 ARCTICA
synthetic and glass ceramic

With CAM2, KaVo Everest has
now become even more economical, faster and more accurate.

Contact Information
For more information visit:
www.kavo.com/MEA
Or email us:
info.mea@kavo.com

Dental photogra- GC announces changes at
phy made simple executive management level
by Shofu
By Dental Tribune International

By Dental Tribune International

INGAPORE: For almost
a century, Shofu Dental
has been an international household name for dental clinical and lab materials.
However, the company has also
been manufacturing and selling equipment for digital dentistry and photography, if only
in its home market in Japan.
With the introduction of the
new EyeSpecial C-II (on display
at IDEM 2014), Shofu is now
bringing a new digital camera
to Singapore, exclusively developed for use in dentistry.
Made completely in-house in
cooperation with experts in
photography and cosmetic dentistry, the camera was conceptualised to be useful for a wide
range of dental applications including intra-oral photography,
shade selection and detailed
image taking of anterior teeth.
It comes with eight pre-set dental modes which, according
to Shofu Dental’s Asia-Pacific
Managing Director Patrick
Loke, are combined with a
built-in proprietary flashmatic
system and a number of image
processing functions like colour-correction and auto-cropping to simplify the process of
dental photography significantly. He added that the camera is
extremely lightweight and features a large LCD touchscreen
display, making it possible for
the user to operate it with one
hand, leaving the other hand
free for holding the mirror or
cheek retractor.
“This camera is so simple and

predictable that it provides a
fool-proof solution for dentists,
enabling even those without
any in-depth knowledge of
dental photography to take accurate photos every time. The
entire dental team, even in
multi-specialty practices, will
benefit from it,” Loke told Dental Tribune ONLINE on Thursday.
Prior to its premiere here at
IDEM, the camera has been
showcased at large dental
meetings in the US and China.
But it is here, in Singapore, that
the EyeSpecial C-II will be presented to a large community of
Asian dental professionals for
the first time. “We believe that
IDEM is the most suitable event
in which to launch the EyeSpecial C-II as it will give this
unique product regional exposure,” explained Loke.
He said that further development into shade taking and restorative simulating functions
is anticipated for the camera in
the future.
Visitors to IDEM Singapore
2014 will be able to get handson with the EyeSpecial C-II at
Shofu’s booth 4A-10 on Level
4. In addition to the camera,
the company also has a number of products for restorative
dentistry on display, including
the universal direct aesthetic
restorative Beautifil Injectable
and Beautisealant, a product
for sealing deep grooves and
fissures without the need for a
conventional phosphoric acid
etchant.

EUVEN, Belgium: Dental materials manufacturer GC has announced
that it has adapted organisational structures at its European headquarters to accommodate its new orthodontic
business. On 1 April, Eckhard
Maedel assumed the role of
President of GC Orthodontics
Europe and GC Tech.Europe,
while Michele Puttini was
named new President of GC
Europe.
Maedel has served as President of GC Europe for the past
two years, and will now help
strengthen the growth of the
new business entities in relation to their operations and revenues.
Last September, GC Corpora-

Eckhard Maedel (left), new President of GC Orthodontics
Europe and GC Tech.Europe, and Michele Puttini, new
President of GC Europe. (Photos courtesy of GC Europe)

tion announced the foundation
of GC Orthodontics Europe,
which currently aims to sell the
company’s orthodontic product
portfolio to customers in Europe and the Middle East. GC
Tech.Europe offers a variety
of possibilities and solutions in
implant therapy to dental professionals.

Puttini will retain his responsibilities as General Manager of
Sales and Marketing in Europe
for the time being, and will
contribute his expertise in international management in the
dental industry to develop GC
Europe’s business further.

Doctor smile educates Saudi
supplier on dental lasers
By Dental Tribune International

EDDAH, Saudi Arabia:
Italian dental laser manufacturer LAMBDA has announced that it is aiming to
strengthen its position in the
Middle East. At the beginning
of the year, the company’s sales
manager met with Saudi sales
representatives to instruct
them in the use of doctor smile
lasers, a line of products made
by LAMBDA.
Doctor smile’s Export Sales
Manager Alessandro Boschi

and the board of directors of
Medical & Pharmaceutical Services Bashir Shakib Al Jabri, a
supplier of dental products in
Saudi Arabia and the Gulf region, met to define the support
strategy for laser users in terms
of educational opportunities
and services across the Saudi
territory.
Boschi trained the Saudi company’s sales team by providing
in-depth information on the lasers and outlining the relevant
marketing strategies.

In addition, doctor smile erbium and diode dental lasers
were installed at the Faculty
of Dentistry at King Abdulaziz
University, which was established in 1985 in response to
the need for qualified Saudi
dentists to maintain the dental
health services in the country.
The company works in close
collaboration with the faculty
in establishing higher education fellowships for all doctors
interested in learning more
about advanced laser dentistry.

[43] =>

[44] =>

[45] =>

9th CAD/CAM & Digital Dentistry International Conference
09-10 MAY 2014 . Jumeirah beach hotel, dubai, uae

9 CAD/CAM & Digital Dentistry
International Conference
th

09-10 May 2014

ORGANIZED BY

CO-ORGANIZERS

Jumeirah Beach Hotel, Dubai, UAE
Dubai, UAE

www.cappmea.com/cadcam9

Dear Friends
and Colleagues

elcome to yet another
edition of the 9th CAD/
CAM & Digital Dentistry International Conference.
We live in an exciting era of medical and technological breakthroughs. Having witnessed a
number of great advancements
in the dental industry we need
to keep abreast with these latest
developments in order to serve
our patients at the best level
which they deserve.
This year’s conference will
cover several subjects related

to Digital Dentistry enlightening all delegates with experiences from over 25 international
Key Opinion Leaders who have
gathered in Dubai to share with
us the latest research and developments. Participants will also
have the unique chance to see
the latest equipment which will
be showcased at the product display made available by the top of
the dental industry. We sincerely
hope that this meeting will let
participants immerse themselves in plenty of knowledge
exchange and share opportunities with one another.
On behalf of Emirates Dental
Society, I would also like to take
this opportunity to invite all of
you to join us for the 36th Asia
Pacic Dental Congress which
will take place on 17-19 June
2014 in Dubai, UAE. The event
will be held under the patronage of H. H. Sheikh Hamdan Bin
Rashid Al Maktoum, Deputy Ruler of Dubai, Minister of Finance
and President of Dubai Health
Authority. We look forward to
seeing you there.
Dr. Aisha Sultan
President Emirates Dental Society
President of the Conference

Welcome to yet
another edition
after year. By now, all of us;
organizers, sponsors, as well
as speakers are a very well
known symbol of quality at
the international level. It is
our mutual cooperation that
brought us to this level of professionalism. All of us put the
interest of our participants as
our top priority.

ear Friends and Colleagues, Welcome to
the CAD/CAM & Digital Dentistry International
Conference, 9th Edition.
As you all know, the 8th edition was held in May in Dubai
and the 2nd Asia-Pacic edition
was held in October 2013 in
Singapore. As you may expect,
both events enjoyed the same
success that we are all used to.
We are very much thrilled
by the grounds that our conferences are covering year

Though the dental CAD/CAM
industry has reached quite
a very high level of development and became a major
trusted player in Dentistry, it
continues to improve on a fast
pace. Statistics tell us that by
the year of 2050, more that
50% of dental services will be
done through CAD/CAM technology. This serves only to
highlight the importance in
keeping up with this fast moving technology through such
highly specialized conferences.
We will continue this unsurpassed cooperation to bring to
our audience the most recent
updates of technology in the
CAD/CAM eld with few “surprises” as well.

Dr. Munir Silwadi
BDS, MRCDSO, DUSS, FADI, FICD
Conference Chairman & Scientic Advisor

Show Edition

WELCOMING
Dr. Aisha Sultan
President Emirates Dental
Society
President of the Conference
Dr. Munir Silwadi
Conference Chairman &
Scientic Advisor

> Page 1

FINAL PROGRAM
Speaker Highlights
Scientific Conference
Dental Hygienist Day
Hands-On Courses

> Page 2

GAME PLAN
See the industry

> Page 3

PLANMECA
Planmeca’s open CAD/CAM
solutions
Your ideal combination

> Page 4

OFFICIAL
MEDIA
PARTNER

[46] =>

2 f i na l progr a m

9th CAD/CAM & Digital Dentistry International Conference
09-10 MAY 2014 . Jumeirah beach hotel, dubai, uae

[47] =>

9th CAD/CAM & Digital Dentistry International Conference
09-10 MAY 2014 . Jumeirah beach hotel, dubai, uae

platinum sponsor

main product

silver sponsor

main product

crystal sponsor

main product

gold sponsor

main product

official sponsor

official sponsor

ga m e pl a n 3

gold sponsor

main product

official sponsor

gold sponsor

main product

official sponsor

main product

main product

main product

main product

other industry players

other industry players

other industry players

other industry players

main product

main product

main product

main product

main product

other industry players

other industry players

other industry players

other industry players

other industry players

main product

main product

main product

main product

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other industry players

other industry players

other industry players

other industry players

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other industry players

other industry players

other industry players

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main product

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main product

main product

official sponsor

Instructions:
1. Exchange Business Cards with Company - Ask for Stamp in return
2. Find out the Main Product
3. Complete the Gameplan with products & stamps
4. Submit your contact details to the reception

[48] =>

Planmeca’s open CAD/CAM solutions

Your ideal combination
Scan.

• Open solutions for efficient digital dentistry
• Seamless workflow with one easy-to-use software
• Perfectly fitting prosthetic works
• Flexible and advanced same-day dentistry

Planmeca PlanScan®
Planmeca PlanScan® Lab

Design.

Planmeca PlanCAD® Easy
Planmeca PlanCAD® Premium

Manufacture.

Planmeca PlanMill® 40
Planmeca PlanMill® 50
PlanEasyMill™

Find more info and your local dealer
www.planmeca.com

Planmeca Oy Asentajankatu 6, 00880 Helsinki, Finland
Tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com

Crystal sponsor at
CAD/CAM & Digital Dentistry International Conference
Jumeirah Beach Hotel, Dubai 09-10 May 2014

[49] =>

Tel: +971 4 361 6174 / email: info@cappmea.com

[50] =>

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[cover] => DT Middle East and Africa No. 3, 2014

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => Quest for the Perfect Restoration [page] => 01 ) [2] => Array ( [title] => CAD/CAM Conference Dubai grows as fast as Digital Dental Technology [page] => 01 ) [3] => Array ( [title] => Passive micro-volume management of sodium hypochlorite in endodontic treatment [page] => 06 ) [4] => Array ( [title] => The power of cross coding: How hygienists can support their patients’ overall body health [page] => 08 ) [5] => Array ( [title] => Clinical Tips: Demi™ Ultra and C.U.R.E™ Technology: (Curing Uniformity & Reduced Energy) what this brings versus competition? [page] => 10 ) [6] => Array ( [title] => The European University College hosts its official graduation ceremony [page] => 11 ) [7] => Array ( [title] => Lab Tribune [page] => 12 ) [8] => Array ( [title] => CAD/CAM | Digital Tribune [page] => 16 ) [9] => Array ( [title] => “The edentulous patient is an amputee - an oral invalid - to whom we should pay total respect and rehabilitation ambitions”. Per-Ingvar Brånemark [page] => 19 ) [10] => Array ( [title] => Hygiene Tribune [page] => 21 ) [11] => Array ( [title] => Ortho Tribune [page] => 27 ) [12] => Array ( [title] => Education Tribune [page] => 31 ) [13] => Array ( [title] => Implant Tribune [page] => 36 ) [14] => Array ( [title] => Endo Tribune [page] => 40 ) [15] => Array ( [title] => Industry News [page] => 42 ) [16] => Array ( [title] => 9th CAD/CAM & Digital Dentistry International Conference [page] => 45 ) ) [toc_html] =>

Table of contents

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