DT UK No. 6+7, 2015

News / Business / Bisphosphonates: A threat or an option? / Interview: “Tongue sanitisation is often inconvenient” / Portable micro-motor: Adventurous and unrestricted? / Endo Tribune United Kingdom Edition No. 6+7 - 2015

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DTUK0615_01_Title 27.11.15 12:01 Seite 1

DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
www.dental-tribune.co.uk

Published in London

Vol. 9, No. 6 + 7

CURADEN DENTAL CLINIC

BISPHOSPHONATES

ENDO TRIBUNE

Dental Tribune paid an exclusive
visit to the first UK-based practice
of the international franchise in
London.

Theoretical reasoning and experimental data suggest that local
application of the drugs is safe
and effective.

Read the latest news and clinical
developments from the field of
endodontics in our specialty section included in this issue.

” Page 4

” Page 13

” Page 17

Large national gap identiﬁed
Private dental fees vary signiﬁcantly throughout Britain, according to report

Cancer toolkit
launched
By DTI

By DTI
DUBLIN, Ireland: Private fees for
dental services have seen another 30 per cent increase in the
last few months. A new survey
conducted by Irish health care
website WhatClinic.com has now
found that patients in some parts
of the UK have to pay up to twice
as much for check-ups and other
dental services than do patients
in the rest of the country.

LONDON, UK: Cancer Research UK
has launched a new oral cancer
toolkit in partnership with the
British Dental Association and the
British Dental Health Foundation.
It is aimed at helping dental professionals and general medical practitioners identify the disease earlier.
In addition to images of signs and
symptoms of the condition, the
free toolkit outlines how health
professionals should refer patients
for further testing. By completing
the toolkit, professionals are eligible for continuing professional
development credits, the organisations said.

Among all areas surveyed, Milton Keynes stood out as the most
expensive, with dental check-ups
costing an average of £62 compared with only £31 charged by
dentists in Birmingham, for example.
Other cities with high average
fees in the same category were
London (£53), Glasgow (£50) and
Cardiff (£45). However, in Cambridge (£32), Manchester (£34)
and Southampton (£35), patients
pay the least for a dental checkup.

The nationwide survey was
conducted among 13,000 private
dentists across Britain.

The national average for a
dental check-up is £46, according
to Whatclinic.com. However, over
80 per cent of all of the cities and
towns surveyed charge less than
that, the results indicate.

In addition to basic services
like dental general check-ups, it
compared average prices for four
different speciality treatments,
such as root canal therapy and
implants.

Patients in some parts of the UK have to pay up to twice as much than do patients in the rest of the country.

For such treatments, patients in
cities like London and Cambridge
generally pay the most, while the
rest of the country showed no distinguishable geographic pattern
regarding the fees charged.
For example, root canal therapy costs the least north of the
border in Glasgow and Edin-

burgh, as well as in Manchester
and Belfast, where dentists also
use to charge the least amount for
implant treatment and tooth
whitening procedures.
Fees for both of these treatments were also found to be at the
lower end in Liverpool, Newcastle
upon Tyne and Glasgow

Despite measures like Mouth
Cancer Action Month, oral cancer
in the UK continues to rise. New
figures released by Cancer Research UK in November indicate
that cases have almost doubled,
with 7,300 people diagnosed in
2012 compared with 4,500 in 2002.
Currently, up to 2,000 people die
from the disease per year.
According to a 2015 study conducted by King’s College London researchers, insufficient knowledge
and training among dentists was
identified as a significant factor in
lack of oral cancer awareness.
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DTUK0615_02_News 23.03.16 17:39 Seite 1

UK NEWS

Dental Tribune United Kingdom Edition | 6+7/2015

Professional footballers score
low in oral health survey
According to the paper published
in the latest edition of the British
Journal of Sports Medicine, over onethird of players who underwent oral
health examinations were found to
have dental decay and every second
player exhibited signs of tooth
wear. Periodontal disease was less
prevalent, with one in 20 suffering
from severe or moderate forms of
the condition.

A significant percentage of England’s footballers are affected by dental diseases.

By DTI
LONDON, UK: The previous season
saw Premier League revenues soar to
a new record of more than £3.5 billion.
It seems that little of this money is

spent on dental care, however, as a
new study by researchers at UCL Eastman Dental Institute has revealed
that many players throughout England’s three top-tier divisions present
with various forms of oral disease.

The study involved 184 players
from the Premier League (including record champion Manchester
United), as well as Championship
and League One. The researchers
examined the teeth and gingivae
of 90 per cent of members of each
senior squad and asked the players
how they think oral disease affects
their quality of life and overall performance. The majority of players
surveyed regarded dental or gingival problems as having little influence on their overall performance
on the pitch. One on five players,
however, responded that oral
health-related pain has affected
their quality of life.
“Oral health is an area where
many athletes have greater prob-

lems than the general population
so it has been a massive achievement for so many professional
football clubs to collaborate with
each other to help us understand
the scale of this problem better,”
commented West Ham United’s
Head of Medical and Sports Science
Stijn Vandenbroucke, whose club
participated in the study. “Being
part of this study has also helped us
as a club to implement tailored interventions to treat and prevent
further problems.”
West Ham regularly conducts
preventive interventions with a
dentist in the off- and pre-season.
“We are pleased that clubs such as
West Ham are already embracing
the findings and building on their
existing interventions by placing
oral health care at the forefront
of their medical agenda,” Dr Ian
Needleman, Professor of Restorative
Dentistry and Evidence-Informed
Healthcare at UCL Eastman Dental
Institute, said. “We hope that other
teams follow their lead and introduce robust oral health screening
and promotion as a routine element
of their programmes.”

IMPRINT
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Torsten OEMUS
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Dr Howard Glazer, Cariology, USA

Paediatric dentistry expert
scoops Scottish Health Award
By DTI
EDINBURGH, UK: Since its first
publication in 1997, Paediatric
Dentistry by Prof. Richard Welbury has become the standard
textbook for all dentists working

with children in the UK and Ireland. For this and other contributions to the field, the former
paediatric dentistry professor from
Glasgow received the first ever
Scottish Health Award in the category “dentist”.

Welbury beat fellow nominees
Drew Gibson of Bearsden Dental
Care and Roger Levie from Hamilton in Lanarkshire in the new
category, which was announced
this year. “I didn’t even know I had
been nominated until I got the call

saying I was a finalist,” he told the
Daily Record newspaper.
Organised annually in partnership with NHS Scotland and the
Scottish government, the Scottish
Health Awards have been held since
2010. They recognise individuals
in categories such as “innovation”
and “healthier lifestyle”. Sixteen
professionals were acknowledged
with this year’s awards, which were
celebrated at the Corn Exchange in
Edinburgh on 4 November.
In addition to his achievements as
an author, Welbury was recognised
for his work on guidelines on protection of children against abuse.
He recently retired from his position
of Professor of Paediatric Dentistry
at Glasgow Dental Hospital that he
held since 2001. Prior to that, he
worked as a regional consultant and
senior clinical lecturer at Newcastle
University, his alma mater.
Welbury has served as president
of both the British Society of Paediatric Dentistry and the European
Academy of Paediatric Dentistry.

Prof. Richard Welbury accepting his award.

In July, he chaired the 25th Congress of the International Association of Paediatric Dentistry, which
was held in Glasgow.

Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany

Published by DTI.
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responsibility for the validity of product claims,
or for typographical errors. The publishers also do
not assume responsibility for product names or
claims, or statements made by advertisers. Opinions
expressed by authors are their
own and may not reflect those
of Dental Tribune International.
Scan this code to subscribe
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DTUK0615_04_News 27.11.15 12:18 Seite 1

UK NEWS

04

Dental Tribune United Kingdom Edition | 6+7/2015

n
A new dental destination
Dental Tribune paid an exclusive visit to the new Curaden Dental Clinicc in London
Curaden Dental Clinic that recently
opened in Mayfair is seeking to do
exactly that. Conveniently located
right in the heart of the city, only a
5-minute walk from Oxford Street,
it is ready to take the city by storm
with a holistic prophylaxis approach called “Prevention-One”.

Clinic manager Patricia Adam.

By DTI
LONDON, UK: Maintaining a dental
practice on the high street can be

a complex endeavour, particularly
in the capital, where setting one’s
practice apart from the rest is often
key to long-term success. The new

The brainchild of Ueli Breitschmid,
founder and CEO of Swiss preventative product specialist Curaden,
and Zurich dentist Rolf Kufus, this
practice branding concept involves
not only a comprehensive product
range, including toothpaste and
-brushes under the well-known
CURAPROX brand, but also tailored
teaching programmes developed
to help dentists better communicate the importance of oral health
prevention to patients.
“There is a great deal of talk about
prevention nowadays and how

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The clinic opened in October.

important it is, but the reality is
that teeth are often extracted unnecessarily and replaced with an
implant, for example,” said clinic
manager Patricia Adam. “With Prevention-One, in contrast, patients
are intended to be healthier and
happier with their smiles.”
Adam knows exactly what she is
talking about. As a trained dental
hygienist, she learnt all about the
unique concept when working at
Kufus’s dental practice in Switzerland for several years. While the
offer to develop and manage the
first Curaden-branded practice in
the UK initially came as a surprise
for the native German, she soon
adapted to the idea, despite the
challenges that came with moving
to another country and transforming an existing
dental practice
that did not meet
the requirements
for the new clinic.

seen many former patients returning and starting to recommend the
practice to their family, friends and
colleagues.
“We have also seen many patients presenting for a second
opinion on their dental problems,”
she said.
All staff members, from the
receptionists to the practitioners,
undergo Curaden’s iTop training
on a regular basis, a three-level
programme on the demonstration
and explanation of prophylaxis as
more than just fluoridation. In the
long run, the concept is intended to
change the role of the dental practice, moving away from restoration
towards prevention, while ensuring
the practice remains profitable.

“We certainly
had to deal with a
lot of regulations
during the last
few months, but
we are happy that
it all came together in the end,”
she explained.
Practice interior.

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According to
Adam, it took almost a year to bring
the site up to standard, culminating in a much-anticipated public
opening in October, during which
old and new patients had the first
look at the now sleek and modern
premises, defined by a simple but
atmospheric colour scheme.
“A highlight of the CURAPROX
product range is the new white and
black toothpaste and we wanted
to see that contrast reflected in
the practice interior,” Adam said.
“At the same time, we wanted to
maintain a bit of Curaden’s heritage; therefore, we also incorporated the company’s characteristic
blue, as well as the Swiss cross, here
and there.”

www.hagerwerken.de
Tel. +49 (203) 99269-0  Fax +49 (203) 299283

In order to accommodate the
busy lifestyles of most Londoners,
the clinic is open until late and on
certain Saturdays. According to
Adam, the last few weeks have

“Therefore, it is important that
every member of the staff be able
to explain the principles and
products of our philosophy to the
patient,” Adam emphasised.
The clinic offers the complete
spectrum of dental treatment,
ranging from check-ups to implant
therapy. A separate whitening room
is to be established in the months
to come, although whitening procedures, according to Adam, are already part of the clinic’s extensive
offering.
Located at 73 New Bond Street
in London, the Curaden Dental
Clinic is open Monday to Friday
from 9:30 to 18:00 (except Thursdays, from 10:30 to 19:00) and on
the first Saturday of the month.
More information is available at
www.curaden.clinic and via e-mail
(newbondstreet@curaden.clinic)
or telephone (+44 20 7499 9806).

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DTUK0615_06-07_Noumbissi 27.11.15 14:10 Seite 1

WORLD NEWS

Dental Tribune United Kingdom Edition | 6+7/2015

“Consumers are pushing dentists
toward metal-free implantology”
An interview with Dr Sammy Noumbissi, founder of the International Academy of Ceramic Implantology
structure and could not survive the
demands of the oral environment.
Then came the use of polycrystals
and in the early 2000s yttria-stabilized zirconia bioceramic emerged
as the material of choice for metalfree intrabony implantation in dental implantology.

A great deal of progress has been made
in terms of materials, techniques and
design of dental implants since the beginnings of modern implantology over
50 years ago. While titanium and titanium alloys have always been in use,
the search for metal-free implantable
materials began in the late 1960s and
early 1970s, and during the last decade,
zirconia has emerged as the most
reliable implantable bioceramic. The
International Academy of Ceramic
Implantology (IAOCI) is an organisation entirely dedicated to ceramic
and metal-free alternatives to metal
implants. It was founded in 2011 by
Dr Sammy Noumbissi, with whom
Dental Tribune had the opportunity
to speak about the mission and vision
of the IAOCI, as well as the state of
ceramic implantology today.

in the host bone and surrounding
tissue as a result of the breakdown
and corrosion of metal alloys in the

In the late 1960s, pioneers in
ceramic implantology and notably
Professor Sami Sandhaus began the

How did you become involved in research on ceramic dental implants?
My interest in ceramic implants
came about in two ways. First, on
a personal level, when I discovered
that the metal fillings and implant
I had in my own mouth were determined to be the source of some
of the health problems I had experienced. Second, on a professional
level, where a few of the patients
to whom I had provided metal
implants returned for check-ups or
more implants, and upon reviewing
their medical and dental history,
it was also determined that the implants were at least in part responsible for the health problems they
were experiencing. I then began to
actively look for alternatives and at

“…reports of titanium and titanium alloy
intolerance have increased and are increasingly
being investigated and demonstrated
in the scientiﬁc dental literature.”
presence of body fluids and the oral
environment in particular. Such
facts have been established and
widely recognized in orthopedics.

search for modern non-metal implantable ceramic materials. However, many of the early ceramic implants were monocrystalline in their

the scientific literature, including
case reports in both medical orthopedics and dental implantology. It
was clear that bioceramics in the last

Dental Tribune: Dr Noumbissi, could
you please provide some background
information on the development of
ceramic implants?
Dr. Sammy Noumbissi: The use of
dental implants to replace teeth has
increased very rapidly in the last
15 or more years. With this increase
in dental implant procedures, the
number of manufacturers has increased too. Also, we have witnessed
the introduction of various alloys of
titanium over time.
Now, just like with any pharmaceutical or medical product, the
increase in demand and changes in
production methods come with
problems and challenges. Although
initially anecdotal, reports of titanium and titanium alloy intolerance
have increased and are increasingly
being investigated and demonstrated in the scientific dental literature. Based on the body of research
available today, this intolerance of
implant alloys can in great part be
attributed to the release of metal ions

Dr Sammy Noumbissi presenting clinical cases at the recent Annual World Dental Congress in Bangkok.

Dr Sammy Noumbissi

two decades had established themselves in both medicine and implant
dentistry as the most bio-inert implantable material available. In 2011,
two colleagues and I decided to create the IAOCI.
What is the primary aim of the IAOCI?
Associations and academies exist
around various types of trades and
industries. The common purpose
of such groups is to organise and
create a supportive environment for
those involved in the respective area.
The IAOCI was created with the same
spirit, not only to organize metalfree implantology but also to provide the profession as a whole with
quality and high-level continuing
implant education on bioceramics
as implantable materials. The IAOCI
is also a resource for the public seeking practitioners who have experience with ceramic implants.
In your opinion, what are the dangers
of metal implants?
Metal and most particularly
titanium implants have been very
successful. Their use has grown
exponentially and with that manufacturers have multiplied, as well
as manufacturing protocols. As a
result, we have observed a steady increase in the alloy elements mixed
with titanium during the manufacturing process. The problems begin
when the metal implant highly alloyed or not, once placed is subjected
to functional stresses, galvanism,
body fluids and the harsh oral environment. The combination of
mechanical, chemical and electrical
events induces cracks and pitting of
the metal, as well as breach in the
oxide layer, and the implant undergoes corrosion attack. The corrosion
attack, which is essentially an oxidation process, leads to the release
of metal ions that studies have
shown to be found in the surrounding bone, lymphatics, spleen, liver
and in some cases crossing the
blood–brain barrier.
What alternatives to metal dental
implants are currently available on
the market?

[7] =>

DTUK0615_06-07_Noumbissi 27.11.15 14:10 Seite 2

WORLD NEWS

Dental Tribune United Kingdom Edition | 6+7/2015

Today, the well-researched and
proven alternative material to metal
for dental implants is zirconium
dioxide, also known as zirconia. This
is also a well-proven fact in medical
orthopedics. Zirconia is the crystal
phase of zirconium and as such it
is not a metal. There are different
manufacturing protocols for zirconia
for dental implantation and they all
lead to a variety of polycrystal bioceramics, such as zirconia-toughened
alumina, hot isostatic-pressed zirconia and yttria-stabilized zirconia.
The common and most important
properties of these bioceramics
are inertness in the bone and oral
environment, structural stability,
absence of electrical activity, extremely low plaque retention and
superior aesthetics.

in today’s world research and application of discoveries are moving
at lightning speed compared with
20 years ago. Therefore, once one
has an environment in which much
of the time and energy is spent
tracking, learning and sharing innovative techniques and materials, members have a forum where
they can obtain the information,
training and skills to deliver the
best of care to their patients in
an evidence-based and organized
manner.

As a matter of fact, our membership has doubled in the last two years
and when prospective or new members are asked why they want to join
or joined the academy, the most
common response is that they are
seeking a forum where they can obtain structured information and
training.
Another frequent reason is that
dentists have had patients challenge
or inform them on the use and occasionally the existence of ceramic

07
implants. Through technology and
the ease of access to information, the
public obtains information faster
than we busy clinicians.
The IAOCI will be hosting its Fifth
Annual Winter Congress in Montego
Bay, Jamaica. What can people expect
from the event?
The theme in 2016 will be the last
decade in ceramic implantology.
We will have 14 speakers from seven
different countries who will share
their experiences with a variety of

ceramic implant systems over the
last ten years. One of our guest
speakers has over 15 years of documented experience with zirconia
implants. We will also have workshops on different implant systems,
ceramic regenerative products and
revolutionary soft-tissue- and hardtissue-enhancing protocols proven
to optimize implant integration and
long-term stability.
Thank you very much for the interview.
AD

Is the success rate of metal-free implants comparable with that of titanium implants?
In the early days, there were challenges. The materials were monocrystalline with very highly polished
and glassy surfaces, which made the
early implants prone to fracture,
poor attachment of bone-forming
cells and low bone–implant contact.
The manufacturing protocols, design, surface modification techniques and technologies of zirconia
implants have evolved to a point
where bone integration is ensured
and comparable results are obtained.
Are ceramic alternatives the future
of dental implantology?
Every industry projection one
sees about implants signals good
news for the future. Implants are
now and will continue to be widely
accepted by patients and the profession. Both groups agree that this
is state-of-the-art treatment. However, owing to technology, the public
is much more informed about
health issues and therapies. We are
in a similar situation today to that
of Invisalign braces a few years back,
in that consumers are pushing
dentists toward metal-free implantology for the most part. In five years’
time, I believe that the number of
ceramic implants being placed will
double.
Bio-inert materials are the future
of any type of implantable device.
I believe bioceramics have taken
hold and will be around for a long
time because there has been a strong
shift toward providing health care
with the minimum risk and invasiveness over the last few years,
as well as in a way that is more integrated, natural and biological.
Furthermore, manufacturers have
rapidly evolved and adapted the material and implant designs to clinical
needs and demands. We now have
a wide variety of implant designs,
surface microstructures, components
and prosthetic connections, making
ceramic implants applicable to an
extensive range of tooth replacement situations.
Dentists may have concerns about
the reliability of ceramic implants.
How does your organization address
this?
Even within specialties, there is a
need for organized groups because

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MONACO
21 – 23 APRIL 2016

WWW.OSTEOLOGY-MONACO.ORG

Poster Presentation

Speakers / Moderators

Poster abstracts can be submitted
at www.osteology-monaco.org

Antoun Hadi I Araújo Maurício I Aroca Soﬁa I Becker Jürgen I Benic Goran I Beschnidt
Marcus S. I Bonnet Franck I Bornstein Michael I Bosshardt Dieter I Buser Daniel I Cairo
Francesco I Carvalho da Silva Robert I Chappuis Vivianne I Chen Stephen I Chiapasco
Matteo I Cortellini Pierpaolo I Cosyn Jan I Dagnelid Marcus I Dahlin Christer I De Sanctis
Massimo I Derks Jan I Fickl Stefan I Fontana Filippo I Giannobile William V. I Giesenhagen
Bernhard I Gruber Reinhard I Grunder Ueli I Haas Robert I Hämmerle Christoph I Happe
Arndt I Hermann Frederic I Holst Stefan I Jepsen Karin I Jung Ronald E. I Kasaj Adrian
Kielhorn Jan I Kim David I Koo Ki-Tae I Lang Niklaus P. I Malet Jacques I McClain Pamela K.
Merli Mauro I Neukam Friedrich W. I Nevins Marc I Nevins Myron I Nisand David
Rebele Stephan I Renouard Franck I Rocchietta Isabella I Roccuzzo Mario I Rothamel
Daniel I Russe Philippe I Salvi Giovanni I Sanz Mariano I Scheyer Todd I Schlee Markus
Schlegel Karl Andreas I Schmelzeisen Rainer I Schwarz Frank I Sculean Anton I Simion
Massimo I Thoma Daniel I Urban Istvan I Van de Velde Tommie I Wagner Wilfried I Weyer
Nils I Wise Roger I Zabalegui Ion I Zucchelli Giovanni I Zuhr Otto

Language
English
Clinical Forum 1 with simultaneous
translation into French, German, Italian
and Russian

Venue
Grimaldi Forum, Monaco

Organisation
Osteology Foundation
Landenbergstrasse 35
6002 Lucerne | Switzerland
phone +41 41 368 44 44
infoosteology.org

Scientiﬁc Chairmen
Friedrich W. Neukam, Germany
Myron Nevins, USA

[8] =>

DTUK0615_08_Business 27.11.15 12:23 Seite 1

BUSINESS

08

Dental Tribune United Kingdom Edition | 6+7/2015

Planmeca moves its UK base to Coventry
Global dental equipment manufacturer opens new head ofﬁce inside Ricoh Arena
By DTI

ble of hosting courses for up to
40 delegates, O’Higgins said.

COVENTRY & BIRMINGHAM,
UK: For almost a decade, the
Ricoh Arena has been unsuccessfully waiting for Premiere
league football to return to
Coventry. Besides being the
home of one of Europe’s most
progressive rugby teams, the
complex was extended in recent years to host a number
of different events including
concerts and exhibitions. In
October, a new attraction
was added, as global dental
equipment manufacturer
Planmeca opened its new
headquarters for the UK and
Showroom with Planmeca dental unit.
Ireland inside the complex as
part of a new marketing camwhich success can be built upon.
paign to heighten awareness of its
This new facility offers the perfect
brand throughout markets in the
environment to discover our range
British Isles.
of digital imaging solutions, world
class CAD/CAM system and our
With Planmeca’s Senior Vice
range of highly innovative digital
President Tuomas Lokki from Findental units,” Lokki said.
land attending as a special guest,
the company’s representatives,
According to Planmeca UK Manpartners and associates celebrated
aging Director Karl O’Higgins, to
the opening together during the
whom Dental Tribune had the opBDIA Dental Showcase.
portunity to speak in Birmingham,
the new facilities will offer im“This is a new era for Planmeca
proved logistics for distribution
UK and our new home is one of the
and training. A new customer exmost important foundations from

“Planmeca hasn’t exploited
its opportunities across the
UK and Ireland for many
years,” he commented on the
opening, “With the new office we wanted to emulate
our global headquarters in
Helsinki but with a size that is
appropriate to the market.”

The showroom will also
includes Planmeca’s range
of digital dental units, which
Karl O’Higgins.
are all combined through
the comprehensive and
modular Romexis software. It can
“Our team put in a lot of hard
be quickly transformed into a small
work and hours into the new office,
conference and event facility capawhether it be building a sophisti-

Nobel Biocare event series reaches ﬁnal point with London meeting
in view of its transition into the
Danaher group. He said that Nobel
Biocare will continue to provide
innovation in the future. “There is
definitely more to come,” Laube
promised.

tients better and in turn improving
the quality of life of more patients.”
US health conglomerate Danaher
acquired the Swiss Implant specialist at the end of last year. Following
the transition, Nobel Biocare introduced a number of new products in
the UK market this year, including
new complete posterior solutions

Nobel Biocare CEO Richard Laube.

LONDON, UK: Celebrating the
50-year anniversary of the first
successful osseointegrated implant
ever placed in a patient, experts
from all around the globe recently
gathered in East London for the
Nobel Biocare Team Conference. In
addition to the achievements of the
last decades, they discussed future
concepts and prospects in the field
of dental implantology.
Held in The Brewery, the former
site of the Whitbread brewery, the

Plans to relocate the company’s
UK headquarters to Coventry took
shape earlier this year. Prior to that,
Planmeca had operated from its
former headquarters in Stevenage
in Hertfordshire. At the end of last
year, the company parted with its

perience centre will feature
a dedicated CAD/CAM training zone alongside a full
range of 3-D imaging machines showcasing the latest
in the field.

Something to celebrate

By DTI

cated digital dental unit or putting
an AD system into the ceiling. The
final result has clearly exceeded our
expectations,” O’Higgins added.

event was the latest in a series of international expert
symposia that Nobel Biocare has held in cities
around the world this year,
including Los Angeles,
Up to 400 attended the two-day event.
Hong Kong and Monaco.
According to UK marketing
“Being a part of such a big dental
manager for Nobel Biocare Glenn
platform in the UK, we are already
Rhodes, up to 400 professionals
starting to see the benefits of
from the UK and abroad attended
that cross-working,” Rhodes added.
the symposium in London, which
“There is a lot of potential here with
also saw an appearance by Nobel
new opportunities to deliver more
Biocare CEO Richard Laube who
solutions to more professionals, to
acknowledged the achievements of
help our customers treat more pahis company this year, particularly

with the NobelParallel Conical Connect (CC) and the NobelActive Wide
Platform (WP) implant systems.
“The Angulated Screw Channel
(ASC) abutment and Omnigrip
tooling is also flying off the shelves,
because it offers enhanced access

consumables business, Plandent,
which was acquired by Henry
Schein UK.

for posterior restorations, as well as
fantastic restorative possibilities in
the aesthetic zone,” Rhodes said.
Attendees of the conference were
able to experience and discuss
these and the company’s other
latest innovations, such as new
additions to the wide-platform
NobelActive and the All-on-4 treatment concept with zygomatic implants, in London.
The two-day event also offered a number of lectures,
master classes and workshops on a wide range of
topics, including peri-implantitis and immediate implant placement. Overall, the
meeting gathered 26 leading
speakers for the conference,
according to Scientific cochair Prof. Daniel van Steenberghe from Belgium, who
also invited attendees to participate in the Foundation for
Oral Rehabilitation, an independent, international initiative, founded in 2013 and
endowed by Nobel Biocare.
“The energy from the recent conference shows that the
profession is really behind Nobel
Biocare and the solutions we offer.
With this and so much more to offer the profession, we will continue
striving for excellence and look forward to what we will achieve in the
future,” Rhodes concluded.

[9] =>

[10] =>

DTUK0615_10_Business 27.11.15 12:24 Seite 1

BUSINESS

Dental Tribune United Kingdom Edition | 6+7/2015

BDIA sees launch of new home
whitening solution by Philips
By DTI

irritation of soft tissue. After
30 minutes, the varnish can then
simply be dry brushed or wiped
off by the patient, according to
Philips.

BIRMINGHAM, UK: Unlicensed
tooth whitening is putting the
health of an increasing numbers
of patients in the UK at risk, according to reports. With its new
Zoom! QuickPro home whitening
solution, Philips intends to offer
not only a safe alternative to these
potentially harmful products but
also one that makes tooth whitening easier and faster at the same
time.
Introduced to the UK market
for the first time today at the
BDIA Dental Showcase in Birmingham, the solution saves valuable chair time by quickly sealing

Company representatives told
members of the press this morning that studies have shown that
Philips Zoom! QuickPro 6 % can
whiten teeth by up to four shades
in as little as four days.

a 6 % hydrogen peroxide whitening varnish on the teeth instead

of using custom-made trays,
thereby reducing leakage and

Recommended especially for
practices with limited space or
staff to carry out whitening procedures, or that have previously
not focused on home whitening,
it can be used as a stand-alone
product, after chairside treat-

3D White Whitestrips available
to customers in Britain
By DTI
BIRMINGHAM & WEYBRIDGE, UK:
Simultaneously to launches in
eastern and western European
countries, Oral-B has put its
whitening solution 3D Whitestrips
on the UK market. The product was
officially introduced to dentists at
the recent BDIA Dental Showcase
in Birmingham and is exclusively
distributed by health care products
provider Henry Schein.
Requiring only one consultation
by a dentist, the whitening process with 3D White Whitestrips can
be entirely performed by patients
at home. According to the manufacturer, the solution provides
visible results that can last for up
to 12 months after only 14 days of
treatment.

Conforming to European legislation, Whitestrips are thin, flexible polyethylene strips coated
with 5.25 % hydrogen peroxide
that adapt to the shape of the
teeth and are easy to apply, the
company said, providing consumers with a secure and effective
solution to improve their appearance.

sold since the product was first
launched to the market 14 years

ago. In addition to the UK, Germany, Spain and Portugal, the

ment or to improve the results of
previous whitening efforts.
“Many patients who used to
buy over-the-counter whitening
products still want to whiten with
the convenience of a home-use
kit. Philips Zoom! QuickPro provides an affordable but professional whitening solution with
that convenience,” commented
tooth whitening expert Dr Zaki
Kanaan. “For dentists who do not
major on whitening procedures,
Zoom QuickPro is simple to provide, requiring little professional
time, and is profitable to the practice.”
Zoom! QuickPro will be available to dentists throughout the
UK as of now. In addition to the
extension to the Philips Zoom!
line of tooth whitening products,
the company is introducing new
variations and brush heads to its
Sonicare electric toothbrush
range.

solution is expected to be introduced to more markets in Europe
in a larger roll-out starting in 2017.
In addition to Whitestrips, the
3D White product range consists
of toothpaste, toothbrushes, floss
and mouth rinses.

“3D White is committed to pioneering new whitening technology
and Whitestrips represents our
most advanced whitening solution
yet,” remarked P&G Oral Care
Global Marketing Director Stephen
Squire.
3D Whitestrips have been available to dentists in the US for over
a decade. According to Oral-B,
over 30 million kits have been

BDIA Dental Showcase attendees watching a Whitestrips presentation.

New interdental cleaning product
from TePe an “easy” pick
By DTI
BIRMINGHAM, UK: TePe’s wide assortment of interdental cleaning
products has an option for everybody. For those patients who
find it difficult to floss or who are
new to interdental cleaning aids,
the company has recently introduced a convenient solution with
the EasyPick. The new device is
now available in markets in the
UK and Ireland.

A large replica of the EasyPick on display at the recent BDIA Dental Showcase in Birmingham.

Developed and manufactured
in Sweden in close collaboration
with dental experts, the EasyPick

has a firm and pliable core coated
with silicone, which not only feels
comfortable on the gingivae but
also cleans effectively, even in the
posterior area, the company said.
According to TePe, this optimal
balance between flexibility and
stability is what makes it unique
in comparison with other interdental devices available on the
market.
“It is easy to use and so flexible
you can even access molar sites.
Good at cleaning out interdental
spaces. Very good grip handle,”

Grantham dental hygienist Helen
Raitt commented.
Dental patient Jane Bewick
said of the interdental device:
“Very easy to insert, even into
the smallest gaps. They look good,
are durable and easy to grip.”
Owing to its conical head, the
EasyPick is suitable for the cleaning of medium or large interdental spaces. TePe announced
that it can be used as stand-alone
or to complement other interdental cleaning devices. A free
pocket case comes with each pack
for use on the go.
The company offers an instructional video on the internet at
www.tepe-easypick.com.

[11] =>

[12] =>

DTUK0615_12_Business 27.11.15 12:48 Seite 1

BUSINESS

Dental Tribune United Kingdom Edition | 6+7/2015

KaVo extends
digital support

Software of Excellence
and Zesty partner

By DTI

AMERSHAM, UK: In order to help
customers in their transition to
digital dentistry, KaVo UK has announced that it has formed a specialist Imaging and Digital Solutions
Team. Available since mid-October,
it was set up to provide fast specialist on-site and remote imaging
support to users throughout the
UK.
The Imaging and Digital Solutions Team consists of three specialists in CBCT, dental implant
planning software and computerguided surgery, including Barry
Chandler, who joined the company
from the IDT Dental Group. IDT
experts David Balchin and Simon
Du Plooy will also work alongside
KaVo’s current imaging specialist,
Alberto Neves, to offer their expertise in the use of a digital workflow
and its seamless integration into
the practice, the company said,
ensuring the correct products are
selected and return on investment
for customers is maximised.

Customers may contact the new
team through the KaVo website or
via e-mail at info@kavo.co.uk.

LONDON, UK: Since 2013, patients in
the UK have been able to find dental
care providers and book appointments
via the Zesty website. A new partnership with Britain’s largest practice
software provider, Software of Excellence (SOE), is aimed at extending
the service to a wider population.
According to Zesty CEO James Balmain, the strategic move will enable
new patients across the UK to easily
find and compare providers and book
dentist appointments on their mobile
devices. Zesty will work with SOE to allow patients to search for dentists and
book their appointments at the best
dental practices, all in less than 60 seconds. “Our aim is to make finding an
available dentist appointment as easy
as booking a flight, hotel or restaurant
online,” Balmain explained.

Alberto Neves (left) presenting with the
KaVo Imaging Solutions Team.

From left to right: James Balmain and Ben Flewett.

has announced plans to extend its
platform outside the UK to other markets in western Europe.
“We’ve seen tremendous growth,
but to gain mass-market appeal, we
need to widen the scope of services
patients can search for on our site,”
Balmain said. “SOE are the right partner to help us with this ambition. It has
built a fantastic technology platform
and shares our vision to operate flexible, robust and secure solutions to
healthcare professionals.”

Originally launched as an appointment website for dental care providers only, Zesty now includes other
health services, such as physiotherapy and chiropractic. The company

SEO UK Managing Director Ben
Flewett commented that his company decided to partner with Zesty, as it
offers an exceptional solution that
makes booking appointments in dental practices easy to do and confirm.
According to its own figures, over
50 per cent of dental practices in the
UK use SOE’s EXACT practice management software. The company is part
of Henry Schein, which acquired the
software provider in a £29 million
transaction in 2007.

[13] =>

DTUK0615_13_Aspen 27.11.15 12:25 Seite 1

Dental Tribune United Kingdom Edition | 6+7/2015

TRENDS & APPLICATIONS

Bisphosphonates: A threat or an option?
Prof. Per Aspenberg, Sweden
phosphonates seem not to confer
this risk, and improve implant fixation by their net anabolic effect.
Local bisphosphonate treatment
could become an important tool
in dentistry and maxillofacial
surgery.

Most dentists will be familiar with
bisphosphonates mainly as a cause
of osteonecrosis of the jaw (ONJ).
ONJ is a complication of systemic
treatment. In contrast, locally applied bisphosphonates have been
proven efficacious for improving the
fixation of dental implants. Theoretical reasoning, experimental data,
and small clinical trials suggest that
local application of bisphosphonates is safe and effective in periodontology and implant surgery.

Editorial note: A list of references is
available from the publisher.
Conflict of interest declaration: The
author has shares in AddBIO.

Dr Per Aspenberg
is Professor of
Orthopaedic Surgery at Linköping
University in Sweden with two decades of experience in research
and clinical trials
on the use of
bisphosphonates to treat orthopaedic
conditions. He can be contacted at per.
aspenberg@liu.se.

Bisphosphonates have positive
effects on many conditions in bone
and few and rare side-effects. Their
efficacy in osteoporosis is well
known, and there is evidence for improved implant fixation in an
increasing number of applications.
In dentistry, however, bisphosphonates are often regarded negatively,
owing to the small risk of ONJ.
ONJ is indeed a problem. However, there is theoretical and clinical
evidence to suggest that the risk of
ONJ can be avoided by local treatment. Local bisphosphonate treatment has shown beneficial effects
without complications in randomised blinded clinical trials in
periodontology and dental implant
surgery.1 How can this be? Here is an
explanation:
Bisphosphonates either bind to
bone mineral or are quickly excreted. Normally, they do not enter
cells and are therefore not toxic.
Only osteoclasts can resorb bone,
and when they do so, the dissolved
bone material passes through the
cell. Therefore, bisphosphonates
can reach the intracellular space of
osteoclasts. Once inside the osteoclast, they will inactivate the cell
and thus reduce bone resorption.
When bone is infected, the bone
surrounding the infection will be
quickly resorbed. The infected bone
will therefore become surrounded
by richly vascularised soft tissue
that demarcates the infected area.
Thus, a good resorption capability
is important for preventing the
spread of bony infection. This protection mechanism can be impaired if resorption is reduced by
any potent anti-resorptive, leading
to the spread of infection and established osteomyelitis. In dentistry,
this kind of osteomyelitis is called
osteonecrosis. Thus, from a pathophysiological perspective, ONJ is
a somewhat misleading term. The
already well-known anti-osteoclastic
effects of bisphosphonates are sufficient to explain ONJ without suppositions about other, less known,
mechanisms.2 Moreover, the theory fits with the observation that
non-bisphosphonate anti-resorptives are associated with ONJ too.
When implants are inserted into bone, numerous studies have
shown that—especially in cancellous bone—bisphosphonates re-

duce the resorptive response to
the trauma without impairing the
bone formation response, therefore having a net anabolic effect.
This explains why both local and
systemic bisphosphonates have
been shown to improve the early
fixation of knee and hip replacements in randomised blinded clinical trials.3

Because bisphosphonates bind
strongly to bone, local treatment
will stay local. Bisphosphonates
applied to a bone surface will stay
there more or less forever, and thus
not impair the resistance to infection anywhere else. In an animal
model of dental implants (at sites
compromised by local wounding),
the author’s group showed that
systemic bisphosphonate treatment induced osteomyelitis (ONJ),
whereas implants with a bisphosphonate coating improved implant
fixation without problems in spite
of the compromised insertion site.4
Moreover, if an implant site in humans were infected, only the bone
about one millimetre away from
the implant surface would contain
bisphosphonate and could be removed if necessary.
In a randomised blinded controlled trial of dental implants
coated with a protein layer loaded
with bisphosphonates, improved
fixation was demonstrated.5 The
resonance frequency was 6.9 ISQ
units higher for the coated implants compared with the controls
(p = 0.0001; Cohen’s d = 1.3). Radiographs showed less marginal
resorption both at two months
(p = 0.012) and at six months
(p = 0.012). The patients were followed for five years without complications.
To conclude, systemic antiresorptives may impair protection
against osteomyelitis, thereby increasing the risk of ONJ in patients
with other risk factors. Local bis-

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[14] =>

DTUK0615_14_Georgi 27.11.15 12:25 Seite 1

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 6+7/2015

“Tongue sanitisation is often inconvenient”
An interview with Matthias Georgi, developer of the TS1 Tongue Sanitizer
Visitors to the BDIA Dental Showcase
were among the first dental professionals to try out the TS1 Tongue
Sanitizer before its official market
launch in the UK. Dental Tribune had the
opportunity to speak with developer
and company director Matthias Georgi
in Birmingham at the show about the

product and how it can improve an
often neglected clinical problem.
Dental Tribune: Could you describe, in
short, the functionality of the product?
Matthias Georgi: The TS1 was developed for use in professional care and
exclusively for use in dental practices.

It is simply attached to the saliva ejector of the suction unit. It is important
to note that the cap at the end of the
saliva ejector has to be removable in
order to be compatible with the TS1.
The backside of the TS1 with knobs and
a depression in the middle allows for
easy application and rubbing in of the

tongue gel, which is already widely
used at dental practices. With this
process, the biofilm on the tongue is
broken up and the gel is evenly distributed over the tongue. Next, the TS1 is
turned over to suction the residue and
remove it permanently via gentle serpentine movement of the laminar side.
Since the biofilm is removed mechanically, the device is very effective even

www.idem-singapore.com
Matthias Georgi

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Suntec Singapore Convention & Exhibition Centre

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IDEM Singapore 2016’s conference theme is built upon the common goal of all dentists – both general and specialist:
Striving for Clinical Excellence. Look forward to world-class clinicians, researchers and educators discussing
contemporary issues in the field of dentistry.
Robert Edwab, USA
Treating Medical
Emergencies in the
Dental Office

Elif Keser, Turkey
PiezocisionTM for Rapid
Orthodontic Therapy:
A Multi-disciplinary Team
Approach

Walter Dias, Germany
Clinical Excellence in Aesthetic
Restorations - Hybrid and Indirect
Techniques Using Smart Composites

Ian Meyers, Australia
Full Day Symposium:
Towards the PostAmalgam Era

Hien Ngo, Kuwait
Chairperson of the Full
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the Post-Amalgam Era

Shinya Murakami, Japan
Cell to Cell Communcation:
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Periodontal Regeneration:
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idem-reg@koelnmesse.com.sg

without the tongue gel. Owing to its
flavour, however, the gel intensifies the
feeling of freshness for the patient.
What are the short- and long-term advantages of the system?
Owing to the gag reflex, among
other things, tongue sanitisation using
common techniques and materials is
often inconvenient for both the hygienist and the patient. With the TS1,
the result of the tongue sanitisation
is immediately visible. Its design, incorporating soft synthetic elements,
allows gentle, pressure-free, mild
cleaning of the tongue without irritating or traumatising the papillae on the
surface. The direct advantage of using
the TS1 is that, compared with common
methods of cleaning, like using a polishing brush and a tongue scraper, the
device removes most of the contamination before finishing the cleaning process. Similar to toothbrushing during
and after a professional tooth cleaning,
it is important that the patient continue the tongue cleaning at home for
a long-term effect. For this, a toothbrush
and basic tongue scraper will suffice.
Is there any research that confirms the
effectiveness of the TS1?
Similar to tooth cleaning, the medical relevance of tongue cleaning has
been the subject of debate, without
any concrete results. Hence, we are
currently working with key opinion
leaders on studies that will compare
our device and tongue scrapers in
terms of acceptance and efficacy.
Furthermore, we conducted widescale user tests during development
with a group of German hygienists,
who are still supporting and advising
us in the process. In the UK, we recently
started initial tests involving local
hygienists, for which we have gained
support from the British Society of
Dental Hygiene and Therapy. Practical
relevance is very important to us.
When will the device be available in
Britain and is it available for testing?
The official launch is planned for
December 2015. We are currently in
talks with several potential partners
to manage distribution. Until then, we
are offering test samples, which can be
ordered at any time. We would like to
use the show to raise awareness of the
product among dental professionals
in the UK and as preparation for the
market launch. Since we introduced the
TS1 in Germany last month, feedback
on the device has been overwhelming.
Thank you very much for the interview.

[15] =>

LONDON’S TOP 10
ATTRACTIONS

1. BRITISH
MUSEUM
The world-famous British
Museum exhibits the works
of man from prehistoric to
modern times, from around
the world. Highlights include
the Rosetta Stone, the
Parthenon sculptures and
the mummies in the Ancient
Egypt collection. Entry is
free but special exhibitions
require tickets.

6. SCIENCE
MUSEUM
From the future of space
travel to asking that difﬁcult
question: “who am I?”, the
Science Museum makes
your brain perform Olympicstandard mental gymnastics.
See, touch and experience
the major scientiﬁc advances
of the last 300 years; and
don’t forget the awesome
Imax cinema. Entry is free
but some exhibitions require
tickets.

2. NATIONAL 3. NATURAL
HISTORY
GALLERY
The crowning glory of
MUSEUM
Trafalgar Square, London’s

4.TATE
MODERN
Sitting grandly on the
banks of the Thames is Tate
Modern, Britain’s national
museum of modern and
contemporary art. Its unique
shape is due to it previously
being a power station. The
gallery’s restaurants offer
fabulous views across the
city. Entry is free but special
exhibitions require tickets.

5.THE
LONDON
EYE

National Gallery is a vast
space ﬁlled with Western
European paintings from the
13th to the 19th centuries.
In this iconic art gallery you
can ﬁnd works by masters
such as Van Gogh, da Vinci,
Botticelli, Constable, Renoir,
Titian and Stubbs. Entry is
free but special exhibitions
require tickets

As well as the permanent
(and permanently
fascinating!) dinosaur
exhibition, the Natural History
Museum boasts a collection
of the biggest, tallest and
rarest animals in the world.
See a life-sized blue whale,
a 40-million-year-old spider,
and the beautiful Central
Hall. Entry is free but special
exhibitions require tickets.

7. VICTORIA
& ALBERT
MUSEUM

8. TOWER OF 9. ROYAL
10. MADAME
LONDON
MUSEUMS
TUSSAUDS
Take a tour with one of the
Madame Tussauds, you’ll
GREENWICH Atcome
Yeoman Warders around
face-to-face with some

The V&A celebrates art and
design with 3,000 years’
worth of amazing artefacts
from around the world. A real
treasure trove of goodies,
you never know what you’ll
discover next: furniture,
paintings, sculpture, metal
work and textiles; the list
goes on and on… Entry is
free but special exhibitions
require you to purchase
tickets.

the Tower of London, one
of the world’s most famous
buildings. Discover its
900-year history as a royal
palace, prison and place
of execution, arsenal, jewel
house and zoo! Gaze up
at the White Tower, tiptoe
through a medieval king’s
bedchamber and marvel at
the Crown Jewels.

Visit the National Maritime
Museum - the world’s
largest maritime museum,
see the historic Queen’s
House, stand astride the
Prime Meridian at Royal
Observatory Greenwich
and explore the famous
Cutty Sark: all part of the
Royal Museums Greenwich.
Some are free to enter; some
charges apply.

The London Eye is a major
feature of London’s skyline.
It boasts some of London’s
best views from its 32
capsules, each weighing 10
tonnes and holding up to 25
people. Climb aboard for
a breathtaking experience,
with an unforgettable perspective of more than 55
of London’s most famous
landmarks – all in just 30
minutes!

of the world’s most famous
faces. From Shakespeare
to Lady Gaga you’ll meet
inﬂuential ﬁgures from
showbiz, sport, politics and
even royalty. Strike a pose
with Usain Bolt, get close to
One Direction or receive a
once-in-a-lifetime audience
with Her Majesty the Queen.

[16] =>

DTUK0615_16_Sellmann 27.11.15 12:26 Seite 1

TRENDS & APPLICATIONS

Dental Tribune
United Kingdom Edition | 6+7/2015
Trib

The device can be recharged
more than 500 times, yielding a
service life of many years. Twenty
years ago, I bought the predecessor
of the Portable II and it was only
recently that I had to replace it with
the newer model.

Portable micro-motor:
Adventurous and unrestricted?
By
ByDr
DrHans
HansH.
H.Sellmann,
Sellmann,Germany
Germany
Fig. 1: The Bravo Portable II provides mobility in every situation.

Recently, I read in a highly regarded
dental publication of the dentist
drilling, treating and providing
aid out in the middle of the de-

sert, just next to the off-road vehicle, with the nearest hospital
probably hundreds of kilometres
away.

Men love adventures. Full of
excitement, we enjoy watching
others survive life-threatening adventures in the jeep of that well-

known cigarette brand bearing the
humped animal on its packaging.
Owing to mobile medical technology, treatment at a good level can
even be provided in such contexts.

Poznan, Poland
7-10 September 2016

Annual
World
Dental
Congress

Face the world with a smile!

I recently needed something
similar. A long-term patient (glioblastoma, radiotherapy, palliative
care, mucositis) presented with
a pressure sore and requested
a home visit, since he was not able
to walk. This posed no problems
for me, since our joint practice has
looked after patients in two old age

The manufacturer provides a
comprehensive instruction manual with its motor, which is compatible with any standard handpiece. The manual states that the
Portable II needs to be charged with
the charging unit for only 6 hours
to be fully charged. Of course, the
motor runs as well counter-clockwise as clockwise. Rotations can be
preselected from 1,600 to 25,000
with a standard contra-angle handpiece (blue ring). Owing to its low
weight of 300 g and a clip to attach
it to a belt, the device can be carried
everywhere.
Face every treatment situation
with confidence, whether it be a
home visit, in an old age home, at
a correctional facility or even in
the wilderness.
The elderly patients at the nursing home will thank you for being
able to resolve their pressure spots
on-site instead of taking their
prostheses to your practice. Just
make sure that you always keep
your Bravo Portable in sight, and
if it goes missing, have a look in
your son’s workshop. The small
portable micro-motor is also suitable for filigreed craft-work, so it is
popular with non-dentists too.

“...it is remarkable how the
dimensions of batteries have
decreased while their running
time has increased.”
homes for years. In the homes,
there are infirmaries where the
mostly bed-ridden patients receive
special care. Our agreement with
management is that we see the patient at the respective home if any
dental problems arise. If we determine that more complex diagnostic and therapeutic measures are
necessary, the patient is brought to
our practice by ambulance. Often,
seniors are already edentulous, and
sometimes only the usual problems with tooth #28 occur.
In these situations, a useful
mobile device we employ is the
cordless Bravo Portable II (Hager
& Werken), a small and portable
micro-motor. Similar to mobile
phones, it is remarkable how the
dimensions of batteries have decreased while their running time
has increased. Inside the Bravo
Portable II, a nickel–metal hydride
battery with a voltage of 15 V provides a running time of 8 hours. With
this, you can make all of the old age
home residents fit and happy again
without having to recharge once.

Available since April
The Bravo Marathon Portable III
features a number of improvements. It is more powerful and has
a higher torque. Equipped with
a state-of-the-art battery, it offers
an infinitely variable 4,000 to
35,000 rpm. Running time extends
to 12 hours with the battery only requiring 5 hours to be fully charged.

Fig. 2:The new Bravo Marathon Portable III
saves space when clipped to a belt.

[17] =>

DTUK0615_17-20_ETWebber 27.11.15 12:27 Seite 1

ENDO TRIBUNE

The World’s Endodontic Newspaper · United Kingdom Edition
www.dental-tribune.co.uk

Published in London

Vol. 9, No. 6+7

WAVEONE GOLD

INTERVIEW

SINGLE-USE INSTRUMENTS

Dr Julian Webber explains why
shaping canals with confidence
is now a clinical reality for all.

Patric Charest about the EyeZoom
and the benefits it offers compared with conventional loupes.

The One Shape Procedure Pack
from Micro-Mega: A unique solution for root canal shaping.

” Page 17–20

” Page 21

” Page 22–23

Shaping canals with conﬁdence:
WaveOne GOLD single-ﬁle reciprocating system
By Dr Julian Webber, UK

1a

1b

2

Fig. 1a: WaveOne GOLD ﬁle series, Small, Primary, Medium and Large.—Fig. 1b:
WaveOne GOLD ﬁles have variable and reducing tapers, producing a more conservatively shaped canal compared with their WaveOne predecessor.—Fig. 2: The
cross-section of WaveOne GOLD is a parallelogram with an 85-degree active cutting
edge with alternate one and two point contact.—Fig. 3a: WaveOne GOLD tip and
proﬁle.—Fig. 3b: WaveOne GOLD ogival tip design.

The mechanical and biological objectives of shaping root canals were
beautifully described by Herbert
Schilder in 1974.1 As relevant today,
in the era of automated canal preparation techniques, as they were in the
days of hand preparation techniques,
these objectives provide the rationale
for the designs, tapers and tip sizes of
modern-day endodontic instruments.
Shaping the root canal facilitates
3-D irrigation and cleaning of the root
canal system of all pulp tissue, bacteria and their related by-products.2
Importantly, shaping the root canal
provides the resistance form and facilitates filling the root canal system.1,3

From hand to rotary
When manually shaping canals
with multiple sequences of stainless-steel files and Gates Glidden
Drills, root canal preparation tech-

4

niques, old and new, have many deficiencies and iatrogenic problems,
such as blocking, ledging, transportation and perforation, are common.4 The use of nickel-titanium
(NiTi) files in continuous rotation
driven by a dedicated endodontic
motor capable of speed and torque
control maintains the original
pathway of the canal while limiting
the amount of apically extruded
debris.5,6 However, while the advantages of continuously rotating NiTi
files are many, all commercially
available file systems are influenced
by cyclic fatigue and torque, especially in longer, narrower and more
curved canals.
Cyclic fatigue, caused by the
structural alteration and work hardening of the metal, is induced by repeated tensile–compressive stress,
especially when preparing canals

3b

3a

exhibiting curvature.7 Torsional
failure caused by using too much
apical force occurs more frequently
than flexural fatigue.8 Specifically,
taper lock results when an excessive length of a file’s active portion
binds in the canal during rotation.
Undesirable taper lock promotes
torsional failure and file breakage.
When the canal diameter is narrower than the diameter of the
rotating file, the latter has limited
ability to progress deeper into the
canal, binds and then potentially
unwinds and/or breaks.9

5

From rotary
to reciprocation
While the majority of commercially available NiTi systems are
mechanically driven in continuous
rotation, reciprocation—defined
as any repetitive up and down or
forward and reverse movement—
has been used to drive endodontic
instruments since 1958. Early attempts at reciprocation utilised
alternating, but equal, forward and
reverse angles of either 90 degrees

or, more recently, smaller angles of
30 degrees. As such none of these
instruments ever complete a full
rotation. Although these reciprocating systems offer an alternative to
manual preparation, multiple-file
sequences, apical transportation,
reduced cutting efficiency, inward
pressure and limited debris removal
remain issues.5,10 However, with a
novel reciprocating movement of
unequal bidirectional angles that
complete a full forward rotation of
360 degrees after four 90-degree
cutting cycles of reciprocation, just

6

Fig. 4: The WaveOne GOLD ﬁle engages 150 degrees CCW and 30 degrees CW, turning 360 degrees after three cycles of reciprocation.—Fig. 5: The new X-Smart iQ motor operated by the DENTSPLY iOS app downloaded
on to an iPad mini 2 is a full digital solution with a cordless Bluetooth 8:1 reducing handpiece.

[18] =>

DTUK0615_17-20_ETWebber 27.11.15 12:27 Seite 2

ENDO NEWS

Endo Tribune United Kingdom Edition | 6+7/2015

Fig. 6: Summary of the WaveOne GOLD shaping technique: 80 per cent of cases start and ﬁnish with the Primary ﬁle. At completion of shaping, gauging with hand ﬁles or inspecting ﬂutes for debris conﬁrms whether
either the Medium or the Large ﬁle is needed.—Fig. 7a: WaveOne GOLD procedural ﬂow chart where a #10 hand ﬁle is able to establish length: conﬁrm patency and verify the glide path. ProGlider will expand any
conﬁrmed, veriﬁed and reproducible glide path prior to the shaping procedure with the Primary ﬁle. (Rx: radiograph; AL: apex locator; IRI: irrigate, recapitulate and irrigate again).—Fig. 7b: WaveOne GOLD procedural
ﬂow chart for more restrictive canals: use a #10 hand ﬁle in any region of the canal to create a glide path. ProGlider will expand any conﬁrmed, veriﬁed and reproducible glide path.—Fig. 7c:WaveOne GOLD procedural
ﬂow chart when the Primary ﬁle does not progress: use the Small ﬁle in one or more passes to working length and then use the Primary ﬁle to working length to optimise the shape.—Fig. 8: A ProGlider progressing
apically expands the glide path.—Fig. 9: WaveOne GOLD Primary progressing apically through the expanded glide path.—Fig. 10: WaveOne GOLD Primary at full working length.—Fig. 11: WaveOne GOLD Primary
loaded with debris, especially in the apical extent of the ﬁle, indicating that full shape has been achieved.

one single file can start and fully
complete the preparation of a canal
to a perfect shape.11 A single-file technique in conjunction with a novel
reciprocating movement has been
clearly shown to reduce both cyclic
fatigue and torsional failure, preventing broken instruments.12
In 2008, the concept of the
“single-file technique” was adopted
by DENTSPLY International as a
project in collaboration with eight
international clinicians to produce
a more optimal, dedicated, safe,
unique reciprocating single file
and to identify the most suitable
unequal bidirectional angles with
a motor system to generate this
movement. The outcome was the
launch of RECIPROC (VDW) in 2010
and WaveOne (DENTSPLY Maillefer)
in 2011. Both systems were marketed
as simple, efficient and predictable
automated methods to shape canals
and embraced by many general dental practitioners looking to move
into automated canal shaping after
years of unsuccessful attempts with
manual techniques and valued both
in terms of time and cost savings.
WaveOne and RECIPROC file systems (reciprocating files) demonstrate considerably improved mechanical properties, superior to rotary
files. While the cyclic fatigue properties of RECIPROC are superior to
WaveOne, the resistance to torsional
failure of WaveOne is superior to
RECIPROC.13,14 Overall, reciprocating
files are more resistant to fracture than
are continuously rotating files,15 extrude less debris than do conventional
multiple-file rotary systems16 and eliminate bacteria from root canal systems as efficiently as rotary systems.17
The shaping ability of reciprocating
files is as good as and in many cases
better than rotary files.18 Finally, it can
be clearly stated that reciprocating
files do not induce dentine cracks.19
WaveOne and RECIPROC were
designed as true single-use instru-

ments that cannot be sterilised and
re-used. The ISO colour-coded ABS
ring on the handle expands if sterilised and the file will not fit into its
handpiece. Single use is based on
sound scientific facts and common
sense, as elimination of repeated use
decreases the possibility of fracture
due to both fatigue and torsional
failure.20 The inability to consistently clean and sterilise used instruments eliminates any concerns
about cross-contamination,21 and
disposal after single-patient use
eliminates the cost of disinfecting,
cleaning and sterilising, reducing
costs overall.22 However, it should be
understood and fully appreciated
that a single reciprocating file performs the same task that would typically require three or more rotary
NiTi files to accomplish. Logic dictates that single use is by far the best
solution to reducing the incidence
of file breakage with all its ethical,
emotional and malpractice ramifications.

Advanced metallurgy
WaveOne GOLD instruments are
manufactured utilising a new
DENTSPLY proprietary thermal
process, producing a super-elastic
NiTi file. The gold process is a postmanufacturing procedure in which
the ground NiTi files are heattreated and slowly cooled. From
a technical perspective, the heat
treatment modifies the transformation temperatures (austenitic start
and austenitic finish), and this has a
positive effect on the instrument
properties.24,25 While this process
gives the file its distinctive gold
finish, more importantly, it considerably improves its strength and
flexibility far in excess of its predecessor. DENTSPLY internal testing
has shown the following: the cyclic
fatigue resistance of WaveOne
GOLD Primary is 50 per cent greater

than that of WaveOne Primary
(which itself was twice as great as
most standard rotary file systems),
and the flexibility of WaveOne
GOLD Primary is 80 per cent greater
than that of WaveOne Primary.26

Design features
There are four tip sizes in the
WaveOne GOLD single-file reciprocating system: Small (20.07, yellow),
Primary (25.07, red), Medium (35.06,
green) and Large (45.05, white)
(Fig. 1a), available in 21, 25 and 31 mm
lengths. The various tip sizes and
tapers afford the clinician the ability
to clinically prepare a wider range of
apical diameters and endodontic
anatomy commonly encountered
in daily practice.27 Canal preparations that have sufficiently tapered
resistance form are ideal for irrigant
exchange and removal of debris,28

New developments
With today’s increased focus on
minimally invasive endodontics,23 the
conclusions from the literature and
taking into account feedback from
clinicians using WaveOne since its introduction in 2011, four of the original
opinion leaders involved in the initial
development of the file, Drs Clifford
Ruddle (US), Sergio Kuttler (US),
Wilhelm Pertot (France) and Julian
Webber (UK), worked in collaboration
with the research and development
team at DENTSPLY in Ballaigues,
Switzerland, to further improve the
cutting efficiency and mechanical
properties of the file and give a new
level of confidence to the many clinicians still wary of automated techniques for shaping canals.
The result is the recent launch of
WaveOne GOLD, a new generation of
reciprocating files offering simplicity, safety and single use in shaping
canals.

Fig. 12: WaveOne GOLD obturating solutions with matching paper points, guttapercha points and Thermaﬁl.
• Always initiate shaping procedures with WaveOne GOLD Primary.
• Irrigate abundantly and frequently with sodium hypochlorite after removing
any given WaveOne GOLD file from a canal.
• Remove the WaveOne GOLD file when it does not easily progress. Clean
and inspect the cutting flutes for wear and/or distortion and then irrigate,
recapitulate with a #10 hand file and re-irrigate.
• Owing to the unique WaveOne GOLD post-manufacturing process,
the files may appear to be slightly curved. This is not a defect and it is not
necessary to straighten the file before use. Place the tip of the file in the canal
entrance and start the motor. The file will follow the glide path conforming
to the natural curvature. The advantage is that a slightly curved file can be
more easily placed into canals of posterior teeth where access is restricted.
Table I: WaveOne GOLD tips.

thus promoting 3-D disinfection
and filling of the root canal system.
WaveOne GOLD has active cutting
lengths of 16 mm, shortened 11 mm
handles for improved posterior
access and the same expanding ISO
colour-coded ABS ring as WaveOne,
maintaining the philosophy of
single use. Variable and reducing tapers ensure a more conservatively
shaped canal with greater preservation of tooth structure at D16,
the coronal extent of the preparation (Fig. 1b). While the concepts of
“minimally invasive endodontics”
lack documented and meaningful
studies,29 any shaping objective that
removes less of the existing tooth
structure while optimising efficient
3-D irrigation and obturation is a
positive step in an effort to preserve
the integrity of the natural tooth.
The cross-section of WaveOne
GOLD is a parallelogram with two
85-degree cutting edges in contact
with the canal wall, alternating with
a patented DENTSPLY off-centred
cross-section where only one cutting edge is in contact with the canal
wall (Fig. 2). Decreasing the contact
area between the file and the canal
wall reduces binding (taper lock)
and, in conjunction with a constant
helical angle of 24 degrees along
the active length of the instrument,
ensures little or no screwing in. The
additional space around the instrument also ensures additional space
for improved debris removal. The
tip of WaveOne GOLD (Figs. 3a & b) is
ogival, roundly tapered and semiactive, modified to reduce the mass
of the centre of the tip and improve
its penetration into any secured
canal with a confirmed, smooth and
reproducible glide path.
Collectively, these design features
result in a reciprocating movement
that is very smooth, eliminating the
need to push on the file, and thereby
promoting safety and considerably
improving cutting efficiency. This

[19] =>

1 Year Clinical Masters Program
TM

in Endodontics
12 days of intensive live training with the Masters in Rome (IT), Milan (IT), Athens (GR)

Participants will master techniques that are repeatable, predictable
and have the ability to create different but always excellent results.
Learn from the Masters of Endodontics:

Registration information:
12 days of live training with the Masters
in Rome (IT), Milan (IT), Athens (GR) + self study

Curriculum fee: €9,900
(Based on your schedule, you can register for this program one session at a time.)

Collaborate
on your cases

Sapienza University
of Rome

and access hours of
premium video training
and live webinars

you will receive
a certiﬁcate from the
Sapienza University

Tribune Group GmbH is the ADA CERP provider. ADA CERP is a service
of the American Dental Association to assist dental professionals in
identifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it
imply acceptance of credit hours by boards of dentistry.

Details on www.TribuneCME.com
contact us at tel.: +49-341-484-74134
email: request@tribunecme.com

100 C.E.

CREDITS

Tribune Group GmbH i is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
program provider are accepted by AGD for Fellowship, Mastership, and membership
maintenance credit. Approval does not imply acceptance by a state or provincial board of
dentistry or AGD endorsement.

[20] =>

DTUK0615_17-20_ETWebber 27.11.15 12:28 Seite 3

ENDO NEWS

13a

13b

Endo Tribune United Kingdom Edition | 6+7/2015

• Expand this glide path to at least
0.15 mm using a manual or mechanical glide path file.
• Carry the Primary file to the full
working length (Fig. 10) in one or
more passes. Upon reaching working length, remove the file to avoid
over-enlarging the apical foramen.
Inspect the apical flutes; if they are
loaded with dentinal debris, then
the shape is finished (Fig. 11).*
• If the Primary file does not progress,
use the Small file (020.07 yellow) in
one or more passes to working
length and then use the Primary file
to working length to optimise the
shape.
• When the shape is confirmed, proceed with 3-D disinfection protocols.

13c

Obturation solutions

14a

14b

14c

15a

15b

15c

Obturation of the root canal system is the final step of the endodontic procedure. The WaveOne GOLD
system includes matching paper
points, gutta-percha points and
Thermafil obturators (Fig. 12). The
new nanotechnology-engineered
gutta-percha points with their extended heat flow are ideal for all
warm vertical compaction (WVC)
techniques (Figs. 13a–c, 14a–c & 15a–c).
WaveOne GOLD shapes can also be
effectively obturated with GuttaCore (DENTSPLY), the cross-linked
gutta-percha core obturator.

Conclusion

Figs. 13a–c & 14a–c: The series of pre- and post-op radiographs of tooth #26 demonstrates the ability of WaveOne GOLD to shape considerable curvatures in canals that
are long, curved and narrow, following the apical anatomy. All canals were obturated with WVC.—Figs. 15a–c: The series of pre- and post-op radiographs of tooth #46
demonstrates the ability of WaveOne GOLD to shape considerable curvatures in canals that are long, curved and narrow, following the apical anatomy. All canals were
obturated with WVC. (Images courtesy of Prof. Sergio Kuttler)

reduces shaping time by a further
19 per cent in canals when compared
with WaveOne.26

Reciprocating
movement
WaveOne GOLD files are designed
with a reverse cutting helix, engage
and cut dentine in a 150-degree
counter-clockwise (CCW) direction
and then, before the instrument has
a chance to taper lock, disengages
30 degrees in a clockwise (CW) direction. The net file movement is
a cutting cycle of 120 degrees and
therefore after three cycles the file
will have made a reverse rotation of
360 degrees (Fig. 4).
The X-Smart iQ (Fig. 5) launched
in conjunction with WaveOne GOLD
is an endodontic motor and cordless
8 : 1 handpiece designed for reciprocation and continuous motion.
The handpiece is Bluetooth controlled by a DENTSPLY Apple iOS
iQ app downloaded on to an iPad
mini 2 (Apple). As a complete digital
solution, it is designed for all stages
of the endodontic procedure, including patient management, file
selection, torque control training
and patient education. The X-Smart
iQ also offers electronic apex locator
functionality. Currently available
DENTSPLY reciprocating file motors
and their respective handpieces,
the X-Smart Plus motor (Rest of the
World) and ProMark and e3 Torque
Control motors (North America),
can be used without modification

when using the complete range of
WaveOne GOLD files. All reciprocating file motors are preprogrammed
to produce the reverse bidirectional
movement, but the CCW/CW angles,
torque and speed settings cannot be
altered. These motors can, of course,
be used for continuous rotation
when the clinician is able to adjust
the speed and torque, as desired.

Shaping technique (Fig. 6)
The WaveOne GOLD Primary
(025.07) is always used first to initiate the shaping procedure. It will
create optimal shape in approximately 80 per cent of canals as a
true single-file technique and is used
in canals that have a confirmed,
smooth and reproducible glide
path. An expanded glide path is a
perfect set-up for the safe apical progression of any mechanically driven
endodontic file.30
The WaveOne GOLD Small (020.07)
file should be thought of as a bridge
file, as the resulting shape is considered too small to allow disinfection
and filling of the root canal system.
When the Primary file will not passively advance through the glide
path, which has been verified to
length, the Small file is used to transition and expand the shape. The
Primary file is then re-utilised to reach
the full working length. Although a
two-file sequence is the exception,
this method must be considered a
safer and more efficient option compared with most other commercially
available rotary shaping techniques.

After the Primary file reaches
length, the flutes are inspected and if
full of debris would indicate shaping
is finished. If the Primary file is loose
at length with no dentinal debris
on the apical flutes, shaping continues with WaveOne GOLD Medium
and/or WaveOne GOLD Large until
the apical flutes are loaded. Apical
gauging with ISO #25 or 35 hand
files, respectively, will also confirm
whether the apical foramen diameter is larger and that a Medium or
Large file is required.
WaveOne GOLD files are used in a
brushing action to reduce resistance
and more effectively instrument
canals that exhibit irregular crosssections. Brushing eliminates coronal
interferences, creates lateral space,
and promotes the inward advancement of the file. Further, a brushing
action reduces the contact between
the file and dentine, mitigates undesirable taper lock, and allows the
instrument to run more freely. In
order to avoid transportation, never
brush at length. The files are used with
a gentle inward ‘stroking’ motion of
short 2 to 3 mm amplitude, to passively advance the file along a smooth,
reproducible glide path.
Reduced shaping time with
WaveOne GOLD means there is more
time available to focus on active irrigation methods. In order to enhance
irrigation and improve effectiveness
activation with sonic and ultrasonic
irrigation is now well accepted.31
Dynamic irrigation in the apical
one-third of highly curved canals

has been shown to significantly
improve disinfection.32
The stages of the shaping procedure can be summarised as follows
(Figs. 7a–c):
• Establish straight-line coronal and
radicular access with emphasis on
flaring, flattening and finishing the
internal axial walls.32
• In the presence of a viscous chelator, use a #10 hand file to verify
a glide path to length. In more restrictive canals, use a #10 hand file
in any region of the canal to create
a glide path.
• Expand this glide path to at least
0.15 mm using either a manual
or a dedicated mechanical file,
such as the ProGlider or PathFile
(DENTSPLY) (Fig. 8).
• Initiate the shaping procedure with
the Primary file in the presence of
sodium hypochlorite (Fig. 9).
• Use gentle inward pressure and let
the Primary file passively progress
through any region of the canal
that has a confirmed glide path.
After shaping 2 to 3 mm of any given
canal, remove and clean the Primary
file, irrigate, recapitulate with a
#10 hand file and re-irrigate.
• Continue with the Primary file, in
two to three passes, to pre-enlarge
the coronal two-thirds of the canal.
• In more restrictive canals, use a #10
hand file in the presence of a viscous
chelator and negotiate to the terminus of the canal. Gently work this file
until it is completely loose at length.
• Establish working length, confirm
patency and verify the glide path.

WaveOne GOLD is a safe, efficient
and simple system for preparing
canals. Sophisticated metallurgy and
design result in improved flexibility
and cyclic fatigue life with less binding and torsional stress on the file
during work. The fear of instrument
breakage should be eliminated for
many clinicians by using WaveOne
GOLD. Root canal preparation with
WaveOne GOLD is very cost-effective,
since 80 per cent of cases can be
completed with the single Primary
instrument. Single use eliminates
the need to spend valuable time and
unnecessary expense in sterilising
procedures, with further benefits in
cost savings. Faster preparation time
allows the clinician to focus on the
most important aspect of clinical
endodontics, disinfection, thus fulfilling the mechanical and biological
objectives of shaping canals.
WaveOne GOLD has set a new
standard and shaping canals with
confidence is now a clinical reality
for all.
* If the Primary file is loose at length with
no dentinal debris on the apical flutes,
continue shaping with the Medium or
Large file.
Editorial note: The author has a commercial interest in WaveOne and WaveOne
GOLD file systems. A list of references is
available from the publisher.

Dr Julian Webber
has been a practising endodontics in London
for over 35 years.
He can be contacted at jw@
julianwebber.com.

[21] =>

DTUK0615_21_Charest 27.11.15 12:29 Seite 1

ENDO NEWS

Endo Tribune United Kingdom Edition | 6+7/2015

21

“Greater power in the
focus area”
An interview with Patric Charest, Orascoptic
Back in January, dental loupes manufacturer Orascoptic introduced its
adjustable magnification loupe
EyeZoom to dental professionals in
the UK. At the recent BDIA Dental
Showcase in Birmingham, Dental
Tribune had the opportunity to speak
with International Sales Manager
Patric Charest, USA, about the device
and the benefits it offers compared
with conventional loupes.
Dental Tribune: Mr Charest, EyeZoom
promises significant advantages
over conventional loupes. What features make it stand out from the
competition?
Patric Charest: With conventional loupes, the field of view is
usually very small. There are clinical procedures, however, for which
the operator would like to have
greater magnification without sacrificing on what he or she can see.
This system allows the operator to
do that. The EyeZoom is the only
loupe that has two prisms inside
and provides three to four times
the magnification while working.
Ergonomics plays a part, since
EyeZoom allows clinicians to see
better while being able to move
back and forth. Many clinicians
work from the 12 to 9 o’clock position and they typically move closer
when approaching the treatment
area. They need a loupe that allows
them to see the arch clearly and
maintain good posture while moving between positions.
The device has been on the market
for a couple of months. How has it
been received by the market here?
Like in the US, there are many
clinicians who like to work with
a wider field of view. It has been
well received and our customers
here are really enjoying it so far.
If the operator wants to increase
the power while performing endodontic treatment, he or she can
literally twist the loupe and the
field will not become narrower.
This is the only loupe in the world
that can do that. The operator gains
greater power in the focus area,
unlike with conventional loupes,
which have to be taken off during
the procedure.
In addition, most customers
like that it is lightweight and comfortable. The frame weighs only
96 grams and was designed in Italy.
It is perfectly balanced for a comfortable fit.

the dentist having to buy three
separate loupes. Many clinicians
find value in that.

As a company, we focus on high
quality and want our loupes to be
the best on the market. The quality
of the EyeZoom is really exquisite;
it has already received a number of
awards. It has been a really successful
product in both the US and the UK.
Thank you very much for the interview.

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The price for conventional loupes
ranges between £1,600 and £3,000.
Where does the EyeZoom fall?
Normally, the dentist pays more
for a wider field of view from edge
to edge. The EyeZoom is located
at the higher end, but offers three
magnifications in one instead of

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[22] =>

DTUK0615_22-23_Mahon 27.11.15 12:29 Seite 1

TRENDS & APPLICATIONS

Endo Tribune United Kingdom Edition | 6+7/2015

The One Shape Procedure Pack
A unique solution for root canal shaping
Dr Tara Mc Mahon, Belgium

Fig. 1: One Shape Procedure Pack.—Fig. 2: Pre-op radiograph of tooth #17.—Fig. 3: Opening of the pulp chamber (P: palatal canal; DB: distobuccal canal; MB: mesiobuccal canal).—Fig. 4: Elimination of overhangs
with ENDOFLARE (P: palatal canal; DB: distobuccal canal; MB: mesiobuccal canal).—Fig. 5: After the passage of ENDOFLARE, access to the distobuccal canal is straightened (P: palatal canal; DB: distobuccal canal;
MB1: ﬁrst mesiobuccal canal; MB1: second mesiobuccal canal).—Fig. 6: Exploration ﬁle, #10 MMC, in the distobuccal canal.—Fig. 7: One G.—Fig. 8: Radiograph of One G in the second mesiobuccal canal.

The objective of endodontic treatment is the elimination of pulp
debris or the bacterial biofilm and
its toxins from the root canal system in order to prevent or eliminate any periapical lesion.1 For this
purpose, root canal shaping is an
essential, necessary and complex
step. Essential because it allows
indispensable irrigation, necessary
to achieve 3-D obturation of the
endodontic root canal system2 and
complex because of the infinite
complexity of the root canal anatomy.3
Over the past several years, the
definition of an endodontically
successful root canal treatment
has changed considerably. In 1986,
success was based on the complete
disappearance of the periapical lesion.4 In 2004, the concept evolved
and the terms “recovered tooth”,
“tooth on the way to recovery”
and “diseased tooth”5 were used.
In 2011, the terminology of
“functional tooth” versus “nonfunctional tooth” was finally in-

troduced.6 Despite this, the concepts for root canal shaping established by Schilder in 1974 remain
unchanged,7 namely with respect
to the initial root canal anatomy
and position of the apical foramen, as well as conservation of
root canal patency and obtainment
of a sufficient taper to guarantee
the penetration of the irrigating
solutions to the apex.
Practitioners are familiar with
these concepts and try to implement them in the best possible
way. However, endodontic treatment remains an area that poses
great difficulties for dental surgeons, and time constraints can
often lead to inadequate treatments. Thus, general practitioners
desire a simple, efficient and rapid
solution that allows reproducible
treatments. The introduction of
rotary nickel-titanium (NiTi) instruments in endodontics in the
late 1980s has revolutionised the
discipline. The material’s extreme
elasticity imparts great flexibility

to instruments with greater diameters and tapers than those of
hand files. Stainless-steel hand
files are more rigid and can lead
to the creation of an apical ledge,
canal transportation, a crack in
the apical foramen or even instrument fracture.8, 9
Although NiTi instruments allow reliable and reproducible
results, they present a higher risk
of fracture than do stainless-steel
files, particularly those used in
continuous rotation, which is due
to cyclic fatigue or higher torsional stress. Instrument fractures
caused by cyclic fatigue occur
without prior deformation visible
to the naked eye. They are therefore impossible to foresee with
certainty.10
Too often does this elevated risk
of instrument fracture result in
general practitioners abandoning
endodontics altogether. However,
respecting several simple principles, such as using the speed

and torque recommended by the
instrument manufacturer, preenlarging the root canal, using
vertical up-and-down movements,
as well as cleaning and performing
visual control of the instrument
after each passage, makes the
practitioner’s work less stressful
and more relaxed.
The introduction of single-use
instruments not only eliminates
the risk of cross-contamination,
but also considerably reduces the
risk of instrument fracture due
to cyclic fatigue and simplifies
the operating procedure. MICROMEGA has designed the One Shape
Procedure Pack, which contains
an ENDOFLARE file, a #10 MMC
file, a One G file, a #15 MMC file and
a One Shape file (Fig. 1). It simplifies
the operating procedure, removes
the need for instrument maintenance and makes stock management easier. All of the necessary
instruments for the endodontic
treatment are single-use files supplied in sterile packaging.

Operating procedure
Each endodontic treatment requires a preoperative radiograph
taken with a radiograph film
holder (Fig. 2). Once a dental dam
has been placed and the access
cavity has been prepared, the
root canal entrances are localised
and the pulp chamber is irrigated with sodium hypochlorite
(Fig. 3).
The first step of the root canal
preparation is the enlargement
of the canal entrances. As the
first instrument in the One Shape
Procedure Pack, ENDOFLARE (with
a diameter of 0.25 and a 0.12 taper)
is used with up-and-down movements and pressure on the canal
walls in the first 3–4 mm of the
root canal to enlarge the canal
orifices. In this case, ENDOFLARE
eliminates the dentinal overhang at the entrance to the distal
root canal (Fig. 4) and lays open
the second mesiobuccal canal
(Fig. 5).

Fig. 9: Photograph of One G in the second mesiobuccal canal (P: palatal canal; DB: distobuccal canal; MB1: ﬁrst mesiobuccal canal; MB1: second mesiobuccal canal).—Fig. 10: One Shape.—Fig. 11: Passage of
One Shape in the canal: two-thirds of the WL, 3 mm short of the WL, and WL.—Fig. 12: Radiograph of One Shape in the second mesiobuccal canal.—Fig. 13: Photograph of One Shape in the second mesiobuccal canal.—
Fig. 14: Radiograph with the master cone.—Fig. 15: Post-op radiograph.—Fig. 16: Post-op radiograph of tooth #17.

[23] =>

DTUK0615_22-23_Mahon 27.11.15 12:29 Seite 2

TRENDS & APPLICATIONS

Endo Tribune United Kingdom Edition | 6+7/2015

17a

17b

23
torque of 2.5 Ncm. Root canal
shaping is performed in three
steps with progression of One
Shape to two-thirds of the WL,
3 mm short of the WL, and the
WL (Fig. 11). Between each passage,
the root canal is abundantly irrigated with sodium hypochlorite
and patency is checked with a #10
file. The instrument’s spires must
be systematically cleaned and
visually inspected.

17c

Figs. 17a–e: Pre-op photograph (a). Radiograph of One G in the second mesiobuccal
canal (b). Radiograph of One Shape in the
second mesiobuccal canal (c). Radiograph
with the master cone (d). Post-op radiograph (e).”

17d

The exploration file (#10 MMC)
serves to evaluate the root canal’s
complexity. It is introduced into
the root canal without axial constraints in the coronal zone, owing
to the previous action of ENDOFLARE. Any coronal interference
that might hinder the file’s passage must be eliminated to make
the treatment as safe as possible
(Fig. 6).
The second step of the root canal
preparation is the exploration of
the root canal and the creation
of a glide path. This step entails the
pre-enlargement of the root canal
and facilitates the passage of the
following rotary shaping instrument. Root canal exploration and
glide path development are performed with stainless-steel hand
files or rotary NiTi files.8 It has
been shown that the use of a
highly flexible instrument with an
asymmetrical cross-section reduces the risk of canal transportation.9 In addition, this kind of
cross-section combined with a
variable helical pitch diminishes
screwing effects.11
The second rotary instrument
in the One Shape Procedure Pack is
One G (Fig. 7). This NiTi instrument
with a diameter of 0.14 and a

Stress-free, relaxed working: Since
the instruments are single-use only,
the risk of instrument fracture due
to cyclic fatigue is considerably reduced and there is no risk of crosscontamination.
Short learning curve: All of the rotary
instruments are used in continuous
rotation.
Rapidity of the root canal preparation:
The gain in time during root canal
shaping allows for a more thorough
final irrigation.
Simplification of the operating procedure: A single instrument is used for
glide path creation, and one instrument for root canal shaping.
Gain in time for the dental assistant:
Simpler and quicker preparation of
the working materials, since no
cleaning and no sterilization of the
instruments are required after the
treatment. Thus, there is more time
to assist the practitioner during
treatment.
Optimised organisation in the dental
office: Stock management is easier
and less storage space is required.

better upward transport of the
debris and limit screwing effects.
Owing to its characteristics, One
Shape causes less extrusion of debris and irrigating solution in the
apical zone than other single-file
systems available on the market.14

17e

0.03 taper has an asymmetrical
cross-section. Its three cutting
edges are situated on three different radiuses to the root canal axis.
One G also has a variable helical
pitch and thus variable helical
angles. The narrower the angle,
the more active the rotating instrument, and the wider the angle,
the greater the efficiency of the
instrument’s traction.8 All of these
features provide One G with a high
flexibility and great efficiency.
Clinically, if the root canal is
patent, One G is taken to the working length (WL) previously determined with the #10 MMC file and
an apex locator. However, if the root
canal is not patent, One G penetrates
with vertical up-and-down movements on the canal axis down to the
length attained by the #10 MMC
file. This allows the elimination
of constraints in the cervical and
middle thirds of the root canal. The
#10 file is then pre-curved in order
to check the canal patency. The
WL is determined and transferred
to One G, which is then taken to
the WL at a speed of 250–400 rpm
and a maximum torque of 1.2 Ncm
(Figs. 8 & 9). After the creation of the
glide path with One G, the #15 MMC
file must penetrate down to the WL
without constraints. The root canal
is now ready for shaping.

capacity to negotiate curves.13 The
instrument’s tip is inactive and
allows for a smooth progression
in the root canal. The helical pitch
and angle are variable along the
instrument and thus guarantee

The instrument progresses with
an up-and-down movement of
low amplitude and without excessive pressure. One Shape is used in
continuous rotation with a speed
of 350–450 rpm and a maximum

Editorial note: A list of references is
available from the publisher.

Dr Tara Mc Mahon
is a working as
a dentist in an
endodontic practice in Brussels,
Belgium.

PRINT
L
DIGITA N
TIO
EDUCA
EVENTS

The third rotary instrument
is One Shape (Fig. 10). This NiTi
instrument with a diameter of
0.25 and a 0.06 taper has a variable
cross-section. The apical 2 mm of
its active blade with a global length
of 16 mm has a triple-helix crosssection with three cutting edges
situated on three different radiuses to the canal axis. The following 7.5 mm constitutes a transitional zone that terminates in a
double-helix section of 6.5 mm in
the coronal part of the file.12
The cutting effect of the two cutting angles in the coronal zone is
more important and allows more
efficient elimination of the debris,
whereas the three cutting angles
in the apical zone provide the
instrument with a better centring
ability, a higher resistance totorsional constraints and a better

One Shape performs the root
canal preparation quicker than
other single-file system.15 This
gain in time must be used for the
indispensable final irrigation.

The DTI publishing group is composed of the world’s leading
dental trade publishers that reach more than 650,000 dentists
in more than 90 countries.

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[cover] => DT UK No. 6+7, 2015

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