DT Canada No. 1, 2016

Irish fun is on tap at the 2016 Pacific Dental Conference / Cosmetic meeting reimagined for Toronto / Pediatric dentists heading to the River Walk / Industry / Implant Tribune Cananda Edition

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Table of contents

Pa
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DENTAL TRIBUNE
The World’s Dental Newspaper · Canada Edition

March 2016 — Vol. 10, No. 1

www.dental-tribune.com

10 facts about dental implants

GAME CHANGER IN HYGIENE INSTRUMENTS

Editor in Chief Dr. Sebastian
Saba comments on the
word ‘simple’ in marketing:
‘Prosthetic dentistry is not
simple. And patients rarely
have simple problems.’

Company reports that its
manufacturing process
gives surfaces of scalers
and curettes a metallurgic
composition that ends the
need for sharpening.

” page A2

” page A10

Implant Tribune
gingival grafting
Dr. Preety Desai documents
novel approach: A singlestage augmentation graft
for root coverage.
” page B1

Irish fun is on tap
at the 2016 Pacific
Dental Conference

FROM THE Editor In Chief A2
• 10 facts about dental implants

EVENTS A4–A6
• Cosmetic meeting reimagined for
Toronto
• Journées Dentaires Internationales
du Québec (JDIQ) features deep
lineup of courses
• Pediatric dentists heading to the
River Walk

Vancouver-based event is packed full with C.E.,
a sold-out exhibit hall and lively social events

ore than 150 open sessions and hands-on courses, six sessions of live
dentistry, lively social events and an exhibit floor with more than 300
companies in 600 booths will be available to attendees of the Pacific
Dental Conference. The event runs from Thursday, March 17, through
Saturday, March 19.
The annual gathering in Vancouver, British Columbia, in recent years has been attracting more than 12,500 dental professionals, making it one of the largest dental conferences in North America.
Held in the Vancouver Convention Centre, on the Vancouver Harbour waterfront, the
meeting can claim one of the most magnificent settings for a dental conference, with
backdrops that include the busy harbor, an expansive Vancouver skyline and the snowcovered peaks towering above North Vancouver.

Live dentistry on the exhibit floor

Publications Mail Agreement No. 42225022

The exhibit floor will be open from 8:30 a.m. to
5:30 p.m. on Thursday and Friday, March 17 and 18,
with live dentistry sessions running throughout
both days, sponsored by Sinclair Dental and Adec.
On Thursday:
• At 9 a.m., Bernard Jin, DMD, presents “Immediate anterior implant solutions with ridge augmentations using innovative PRF applications” with
commentary by Dr. Mark Kwon, cosponsored by
Hiossen Implant Canada.
• At 11:30 a.m., Ho-Young Chung, DDS, presents
“Immediate implant denture solution with extractions, PRF, immediate implant placement and immediate loading” with commentary by Dr. Mark
Kwon, cosponsored by Hiossen Implant Canada.
• At 2 p.m., Alan Lowe, DMD, Dip Ortho, PhD,
FRCD(C), presents “Clinical techniques for sleep apnea therapy with oral appliances” cosponsored by
Aurum Group.
On Friday:
• At 8:30 a.m., Peter Walford, DDS, FCARDP, presents “Can’t place implants? Take a look at the
inlay/flange bridge and what it can do.”
• At 11 a.m., Sonia Lezly, DDS, Dipi Perio, FCDS(BC),
FRCD(C), presents “Immediate implant placement
and transitional restoration — 5 key steps for success,” cosponsored by BioHorizons Canada.
• At 1:30 p.m., David Chong, DDS, and Brandon
Kang, DDS, DMD, MD, present “Lateral and crestal
” See PDC, page A2

Industry

Pacific Dental
Conference
March 17–19,
Vancouver
‘The Drop’ is one of many works of art in and
around the Vancouver Convention Centre,
the scenic host site of the annual Pacific
Dental Conference in British Columbia.
Opening day this year is St. Patrick’s Day.
Photo/Robert Selleck, Dental Tribune

a8–a17

• SciCan SALUS: Rack-and-sleeve
system eliminates sterilization
paper and pouches
• Keystone adds first Canadiandedicated regional manager
• Game changer: American Eagle
Instruments XP Technology
• Designs For Vision: Headlight
transfers across loupes, frames
• Obturation system compacts and
seals all canals — including lateral
• From VOCO: Infection and climatecontrol packaging
• Isolite Systems delivers dentalisolation technology
• LVI Core I three-day course enables
dentist and team to learn together
• Elbow your way to better health
• Single-bottle adhesive self-cures
with no light activation

[2] =>

FROM THE EDITOR IN CHIEF

Dental Tribune Canada Edition | March 2016

10 facts about dental implants DENTAL TRIBUNE
The World’s Dental Newspaper · Canada Edition

By Sebastian Saba DDS, Cert. Pros.,
FADI, FICD, Editor in Chief

Dental implant marketing often emphasizes “simplicity,” underplaying an
inherent complexity in the product, procedure — and patient. Prosthetic dentistry is not simple. And patients rarely
have simple problems. Potential complications can be far from simple to correct.
To ease your learning curve with implant dentistry, following are some core
variables that can be managed based on
proven research.

1
2

Implant surface design: Choose implants that have micro-topography
and bioactive surfaces that enhance bone contact and have
macro-topography (overall shape) that
better stabilizes bone profiles with little
or no crestal bone loss.

Abutment connections: Internal connections have simplified
abutment insertion. And if the
abutment-implant margin is kept
shy of the implant outer surface, a connective tissue zone will develop. The result is improved bone preservation at the
crest. Abutments should be torqued to
position and have specifically designed
abutment screws that support long-term
stability.

Provisionalization phase: Once
thought optional, today this step
is a critical diagnostic and management tool used to verify osseointegration, occlusion, esthetics, softtissue management, hygiene, prosthetic
design and abutment selection.

Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com

Prosthetic options — screw
vs. cement: Some companies emphasize a “simpler”
and familiar cement-only
option. But irretrievability — presence of subgingival cement — can
be problematic. Plan your design to
minimize complications.

President/Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Kristine Colker k.colker@dental-tribune.com
Editor in Chief
Dr. Sebastian Saba feedback@dental-tribune.com
Managing Editor
Robert Selleck r.selleck@dental-tribune.com

Earlier
osseointegration
Photo/Dr. Sebastian Saba
and restorative phases: Improved implant surfaces
and shapes support primary
stability in bone and enhanced osseoComputer-guided implant therintegration. Early loading is becoming
apy: You can’t deny the value of
more feasible — choose cases carefully.
3-D software that helps measure and locate vital structures
such as the mandibular nerve, sinus cavSoft- and hard-tissue manageities and nasal floor. But most practices
ment: Timely placement of
still rely primarily on conventional radiprovisionals can influence the
ography.
support and contour of tissue.
Advancements in bone grafting and tissue preservation help preserve soft tisLong-term studies: Imsue, maintain anatomical bone contour
plant companies provide
and improve gingival esthetics.
education, solid research
and ongoing support to
customers (you). Incorporating up-toEnhanced marketing: Implant
date knowledge into the clinical varidentistry is aggressively promotables you’re managing on a daily basis
ed. However, costs remain high
will enable you to achieve a predictable
for average-income patients. It’s
approach in your decision-making with
critical that benefits a patient realizes far
dental implants.
outlast any corresponding debt.

6
7
8

Te c h n o l o g i c a l
improvements:
Zirconia ceramics and CAD/CAM
have created an explosion
in design, customization
and improved esthetics.
Zirconium is doing for esthetics what titanium did
for osseointegration.

Sebastian Saba, DDS, Cert. Pros.,
FADI, FICD, is a graduate of the
Goldman School of Dental
Medicine, Boston University. He has

Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com
Managing Editor
Sierra Rendon s.rendon@dental-tribune.com
Product/Account Manager
Will Kenyon w.kenyon@dental-tribune.com
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Product/Account Manager
Maria Kaiser m.kaiser@dental-tribune.com
BUSINESS DEVELOPMENT MANAGER
Travis Gittens t.gittens@dental-tribune.com
Education Director
Christiane Ferret c.ferret@dtstudyclub.com
Accounting Coordinator
Nirmala Singh n.singh@dental-tribune.com
Tribune America, LLC
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2016 Tribune America LLC
All rights reserved.
Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you find a factual error or content that requires clarification, please
contact Managing Editor Robert Selleck at r.selleck@
dental-tribune.com.

Montreal limited to prosthetic and

Tribune America cannot assume responsibility for the
validity of product claims or for typographical errors.
The publisher also does not assume responsibility for
product names or statements made by advertisers.
Opinions expressed by authors are their own and may
not reflect those of Tribune America.

implant dentistry.

Editorial Board

published extensively on the topics
of prosthetic and implant dentistry
and has a private practice in

Dr. Joel Berg
Dr. L. Stephen Buchanan
Dr. Arnaldo Castellucci
Dr. Gorden Christensen
Dr. Rella Christensen
Dr. William Dickerson
Hugh Doherty
Dr. James Doundoulakis
Dr. David Garber
Dr. Fay Goldstep
Dr. Howard Glazer
Dr. Harold Heymann
Dr. Karl Leinfelder
Dr. Roger Levin
Dr. Carl E. Misch
Dr. Dan Nathanson
Dr. Chester Redhead
Dr. Irwin Smigel
Dr. Jon Suzuki
Dr. Dennis Tartakow
Dr. Dan Ward

Tell us what you think!
Always a top draw at the Pacific Dental Conference, this year’s live-dentistry stage in the exhibit hall features three live-patient demonstrations on each of the two days that the exhibit hall is open. Pictured is a 2014 session. Photo/Provided by Pacific Dental Conference

“ PDC, page A1
sinus surgery,” cosponsored by Hiossen
Implant Canada.
The live dentistry stage, located in the
exhibit hall, is open to all attendees. The
start times are subject to change, so it’s
worth confirming through the PDC app
or the latest Conference at a Glance to access the most current schedule. To get the
PDC 2016 Mobile App, point your mobile
device’s browser to http://m.pdconf.com.

.
.

If you have last year’s app, it’s worth removing it from your device because the
PDC 2016 app is new — designed specifically for this year’s conference.
With the first day of the conference falling on St. Patrick’s Day, meeting organizers have planned a “Celtic Celebration”
with a mixture of Canadian and Irish
fun. The evening starts with a wine and
beer tasting event. Beers will be provided
by Parallel 49 Brewing, one of Canada’s
fastest-growing breweries, based in East

Vancouver. The wines are being assembled by “Wine Whisperer” David Lancelot, sourcing the selection from some of
Canada’s most talented winemakers. During the samplings, which also will feature buffet stations, live Celtic music will
be provided by Tiller’s Folly, who, as the
evening progresses, will segue to tunes
geared toward filling the dance floor.
Tickets for the evening are $50.
(Source: Pacific Dental Conference)

Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Dental Tribune? Let us
know by emailing feedback@dentaltribune.com. We look forward to hearing from you!
If you would like to make any change
to your subscription (name, address or
to opt out) please send us an email at
database@dental-tribune.com and be
sure to include which publication you
are referring to. Also, please note that
subscription changes can take up to six
weeks to process.

[3] =>

[4] =>

EVENTS

Dental Tribune Canada Edition | March 2016

Cosmetic meeting reimagined for Toronto
American Academy of Cosmetic Dentistry’s annual scientific session will be from April 28–30
Dental professionals from across the
globe will be able to see the latest in dental products and services at the American
Academy of Cosmetic Dentistry’s annual
scientific session, AACD 2016, which will
be held in Toronto from April 28–30.
AACD 2016 is considered by many to
be cosmetic dentistry’s premier education event, with its hands-on workshops,
lectures and social events catering specifically to professionals involved with cosmetic dentistry.
The AACD exhibit hall will be open all
three days, featuring breakfasts, lunches
and several cocktail receptions.
More than 1,500 dental professionals

are expected to attend the event, which
will take place at the Metro Toronto Convention Center in downtown Toronto.
While the exhibit hall is open to attendees
of AACD 2016, those who aren’t attending
the meeting can still purchase products
and services with daily passes.
Jeff Roach, director of strategic partnerships at AACD, said, “Our attendees look
forward to the amazing products and
services our exhibitors offer, and with
several cocktail receptions and other activities planned, we anticipate plenty of
foot traffic.”
A new meeting structure is in place to
deliver this year’s educational offerings.

The conference will feature separate
themes on each of the three days: design,
implementation and realization.
Organizers describe the themes as being
a scaffolding on which the entire conference will be structured. The three themes
are designed as a sequential and cumulative process, with each day building on
knowledge gained the previous day.
Billed as AACD Triple Plays, some of the
themes will track as rapid-fire morning
and afternoon sessions delivered by topname speakers. Thursday’s rapid-fire sessions will focuses on treatment planning.
Friday’s “implementation” theme includes rapid-fire sessions on orthodontic

and surgical options. The “revitalization”
theme on Saturday features rapid-fire sessions on restorative implementation.
In addition to the rapid-fire offerings, all
of the courses at AACD 2016 are designed
with the intent to elevate clinical skills of
the entire dental team. The AACD event
also will include a lineup of accreditation
courses for attendees who seek to differentiate themselves at a level of excellence
achieved by only the most dedicated and
passionate dental professionals.
For more information and to register,
you can visit www.aacdconference.com.
(Source: AACD)

JDIQ features
deep lineup
of courses
The Journées Dentaires Internationales
du Québec, the annual meeting of the Ordre des Dentists du Québec, will be held
in Montréal from Friday, May 27, through
Tuesday, May 31.
The meeting typically attracts more
than 12,000 delegates from around the
world. Organizers describe the event as
being the “world’s most highly attended
bilingual convention.” The JDIQ offers a
scientific program with more than 125
lectures and workshops presented in both
English and French.
Featured speakers for this 46th edition
of the meeting include Drs. Véronique
Benhamou, Philippe Martineau, Marina
Braniste, Matthieu Schmittbuhl, Gordon J. Christensen, Marie-Andrée Houle,
Samer Abi Nader, Maude Albert and Nadia
Rizkallah.
Session topics include cone-beam computed tomography, endodontics, lasers,
dental photography, dentures, composites, challenging implant cases, advanced
local anesthesia, dento-alveolar surgery,
conservative dentistry, sleep apnea and
embezzlement protection for practices.
More than 225 exhibitors will span 500
booths in the exhibit hall, which will be
open on Monday and Tuesday, May 30
and 31. A continental breakfast will be
available to early risers on both days, and
a wine and cheese reception will close out
each of the two days.
Many of the workshop courses have already sold out. Prospective attendees are
encouraged to register as soon as possible
at www.odq.qc.ca/convention.
You can download the free mobile app,
JDIQ 2016, to your smart phone or tablet
via the App Store or Google Play. Or you
can access the app via the QR codes on the
meeting website.
The meeting organizers look forward to
seeing attendees in Montreal at the end of
May, with their usual promise of beautiful summer weather.
(Source: JDIQ)

[5] =>

[6] =>

EVENTS

Dental Tribune Canada Edition | March 2016

Pediatric dentists heading to the River Walk
American Academy of Pediatric Dentistry scientific session will be from May 26–29 in San Antonio
The American
Academy of
Pediatric Dentistry
annual session
will be from May
26–29 at the
Henry B. Gonzalez
Convention
Center on San
Antonio’s highly
popular River
Walk. Photo/Stuart
Dee, provided by the
San Antonio
Convention &
Visitors Bureau

The fun and history of Alamo City
combine with top speakers and highvalue C.E. at the American Academy of
Pediatric Dentistry (AAPD) 2016 annual
session. The event will be held from May
26–29 at the Henry B. Gonzalez Convention Center in San Antonio, Texas.
Online registration is open via www.
aapd.org, with the cutoff for advanced
registration set for April 4. You can use
AAPD’s online itinerary planner to find
details on the scientific program, social
events and other events in San Antonio.

Barbecue, hoedown, carnival rides
The welcome reception on Friday, May 27,
will feature a family-friendly fiesta San
Antonio style, with barbecue, southern
hoedown and carnival rides for the kids.
The keynote speaker on Friday, May
27, will be Erik Wahl, an internationally
recognized graffiti artist known for his
high-energy, inspirational live performances. The best-selling author of the business book “UNThink” uses his on-stage
painting as a visual metaphor to communicate his core message: encouraging
organizations to achieve greater profitability through innovations and superior
levels of performance.
Because attendees must register for the
meeting prior to making meeting-block
hotel reservations, attendees are encouraged to register early. There are a number
of hotels in the AAPD block, including
the Marriott Rivercenter (headquarters
hotel), the Marriott Riverwalk, the Grand
Hyatt San Antonio, the Hilton Palacio
del Rio, the Residence Inn Alamo Plaza
and the Westin Riverwalk. As you can
tell from the hotel names, the convention center and hotels string the city’s
famed River Walk and its many restaurants, bars, shopping and entertainment
venues.
A wide variety of other popular destinations are just blocks away in the heart of
downtown San Antonio. All of the meeting’s scientific sessions will take place at
the Henry B. Gonzalez Convention Center.

Preconference course on esthetic
restorations
The preconference course “Esthetic Pediatric Restorative Dentistry” will be presented by Kevin J. Donly, DDS, MS; William F. Waggoner, DDS, MS; Theodore P.
Croll, DDS, MS; and Nasser Barghi, DDS
on Thursday, May 26. The course will offer the most current esthetic pediatric
restorative dentistry techniques with
data available to support restorative
regimens. Indications and contraindications will be presented. You can learn
more about this course and the complete
scientific program with the AAPD 2016
Online Itinerary Planner.
(Source: AAPD)

Tell us what you think!
Do you have general comments or criticism? Is
there a particular topic you would like to see articles about? Let us know by emailing feedback@
dental-tribune.com.

[7] =>

.

.

[8] =>

INDUSTRY

Rack-and-sleeve
system eliminates
sterilization paper
and pouches
worth of sterilization
SciCan has recently introduced
paper. Another benefit
SALUS, which it refers to as “the
PDC
is the reduction in the
world’s first paperless, rack-andBOOTH
amount of waste being
sleeve, hygiene sterility mainten1029
generated by your practice.
ance container.”
With SALUS, instruments are
According to the company,
kept safe and are easily transportSALUS eliminates the costly and
able using a secure rack-and-sleeve techtime-consuming use of sterilization
nology.
paper and pouches. This enables clinThe rack has handles designed to hold
icians to save hours that otherwise would
instruments in place. There is also a safebe spent wrapping hundreds of dollars

Keystone adds first Canadiandedicated regional manager
Ad

Dental Tribune Canada Edition | March 2016

The SALUS hygiene sterility
maintenance container from
SciCan eliminates the need for
sterilization paper and pouches.
It can save hours and dollars
spent wrapping instruments in
sterilization paper.
Photos Provided by SciCan

With the SALUS, instruments are transportable —
using a secure, rack-and-sleeve design.

Rack portion
of the SALUS.

Sleeve portion
of the SALUS.

ty knob that locks the container for safe
and secure transportation. Additionally,
a tamper-evident latch is activated when
the container is processed through a
steam sterilizer.
The transparent container enables in-

stant identification of instruments and
chemical indicators, according to the
company. Visit SciCan in booth No. 1029
at the Pacific Dental Conference.

Keystone Industries, one of the leaders
in manufacturing dental products for
both domestic and international markets, recently named the organization’s
first Canadian-dedicated regional manager to help lead Keystone’s expanding

sales group.
Megan Shank is serving as the company’s regional manager for the Canadian customer base.

(Source: SciCan)

” See KEYSTONE, page A11

[9] =>

[10] =>

INDUSTRY

A10

Dental Tribune Canada Edition | March 2016

Game changer: American Eagle
Instruments XP Technology
PDC
BOOTH
NO. 1645

XP Technology is a
metallurgical
advancement that
eliminates the task
of sharpening.
Photo/Provided by
American Eagle
Instruments

By American Eagle Instruments Staff

Do you ever feel like practice efficiency
and quality care can’t coexist? Are you
frustrated by time spent on tasks that
should be solved by technological advancements?
Here’s some good news: Times have
changed, and hand-instrument technology has advanced, making it possible to
deliver higher quality patient care within
an efficient practice. Recently named “The
Practice Game Changer of 2015” by readers of RDH Magazine, American Eagle
Instruments has developed XP Technol-

ogy, a metallurgical advancement that
eliminates the task of sharpening, which
is viewed by many as tedious and is often
imperfect. Clinicians chose XP Technology
by writing in the product or service they
felt has made the biggest impact on their
practice, a testament to the positive effect
XP Technology sharpen-free instruments
have had for thousands of clinicians.
A proprietary manufacturing process,
XP Technology is behind the market’s only
line of sharpen-free scalers and curettes.
The process enhances metallurgic composition of the instrument’s surface, giving it properties of a much more durable
material. It is not a coating that will flake
or peel off over time, but an embedded
surface akin to a stained piece of wood,
unable to flake or be removed. Because
XP Technology’s durability renders it
sharpen-free, the instruments are manufactured with thinner working ends for
greater access to calculus and previously
inaccessible pockets. Working ends retain
the factory blade angulation that assures
proper calculus removal and eliminates
the risk of burnished calculus.
A sharpen-free metal brings another,
less-quantifiable benefit. Metallurgic durability of this magnitude allows a modified scaling technique. For the first time
ever, clinicians have a hand instrument
made with an alloy that is harder than the
calculus being removed. Calculus removal
with XP Technology is accomplished with
a much lighter grasp and shaving stroke vs.
the heavy lateral pressure and “popping
off” of calculus used with stainless-steel
instruments. Hygienists describe XP Technology in action as “melting” calculus off
the tooth surface. According to the company, it is a smooth, painless technique
that can reduce physical stress for clinicians and promote improved ergonomics and hand health, both big concerns for
most clinicians during their careers.
The return on investment with XP Technology is not only evident for the practice,
but for the patient as well. The practice
wins when team members are spending
time with patients rather than wasting
time sharpening instruments. That extra
patient-contact time can lead to accepted
treatment and better overall patient
health. Patients win when clinicians use
the modified scaling technique, experiencing comfortable appointments that make
them want to return.
American Eagle Instruments understands that these are medical devices that
require a precise fabrication process to
achieve a consistent, reliable product. AEI
is an American manufacturer based in
Missoula, Mont. It takes 36 steps to fabricate an XP Technology instrument, and
each step takes place within the factory
under strict quality control standards.
This attention to detail has helped AEI
earn a reputation for creating some of the
world’s most precise and long-lasting instruments, according to the company.
You can check out XP Technology in
booth No. 1645 at the Pacific Dental Conference, and you also can visit www.am-eagle.
com to see why XP Technology scalers and
curettes belong in your practice — and in
your hands.
Then you can change your game, too.

[11] =>

INDUSTRY

Dental Tribune Canada Edition | March 2016

A11

Headlight transfers across
loupes, frames

The LED DayLite WireLess headlight can integrate with various
platforms, including your existing loupes, safety
eyewear, lightweight headbands and future loupes or
eyewear purchases. Photo/Provided by Designs For Vision

Designs for Vision’s new LED DayLite®
WireLess™ not only frees you from being tethered to a battery pack, but the
simple modular design also uncouples
the “WireLess” light from a specific
frame or single pair of loupes. Prior
technology married a cordless light to
one pair of loupes via a cumbersome integration of the batteries and electronics into the frame. The compact design
of the DayLite WireLess is independent
of any frame/loupes.
The patent-pending design of the LED
DayLite WireLess is a new concept: a selfcontained headlight that can integrate
with various platforms, including your
existing loupes, safety eyewear, lightweight headbands and future loupes or
eyewear purchases.
The LED DayLite WireLess is not limited to just one pair of loupes or built

into a single, specific eyeglass frame.
The LED DayLite WireLess can be transferred from one platform to another, expanding your “WireLess” illumination
possibilities across all of your eyewear
options.

1.4 ounces
The LED DayLite WireLess weighs only
1.4 ounces and, when attached to a pair
of loupes, the combined weight is half
the weight of integrated cordless lights/
loupes.
The LED DayLite WireLess produces
more than 40,000 lux at high intensity
and 27,000 lux at medium intensity.
The spot size of the LED DayLite WireLess will illuminate the entire oral cavity. The function of the headlight is controlled via capacitive touch.
The LED DayLite WireLess is powered

by a compact, rechargeable lithium-ion
power pod. It comes with three power
pods. The charging cradle enables
you to independently recharge
two power pods at the same
PDC
time and it clearly displays the
BOOTH
progress of each charge cycle.
1309
Designs for Vision has been
The Micro Series is fully customshowing the Micro Series togethized and uses the proprietary lens
er for the first time this winter. The
coatings for the greatest light transmisMicro 3.5EF Scopes use a revolutionary
sion.
optical design that reduces the size of
You can “See the Visible Difference®”
the prismatic telescope by 50 percent
yourself by visiting the Designs for Viand reduces the weight by 40 percent,
sion booth, No. 1309/1311 at The Pacific
while providing an expanded-field fullDental Conference in Vancouver, British
oral-cavity view at 3.5x magnification.
Columbia. Or arrange a visit in your ofThe new Micro 2.5x Scopes are 23 perfice by telephoning (800) 345-4009 or
cent smaller and 36 percent lighter than
emailing info@dvimail.com.
traditional 2.5x telescopes, and enlarge
the entire oral cavity at true 2.5x magni(Source: Designs For Vision)
fication.

Obturation system compacts and
seals all canals — including lateral
EvoFill Duo offers fast
heating and controlled
gutta-percha
extrusion with
precise 3-D fills.

By DiaDent Staff

and compact the root canal filling material. A new,
PDC
LED-light-guided condenser provides users a clear
view inside the oral cavity. Color-coded pen tips
BOOTH
are available in five sizes, including XF, F, FM, M
The purpose of obturating a root canal is to fill
1529
and ML. Its quick heating tip reaches a highest level
the space three-dimensionally to eliminate any
of temperature of 2,50o C within one second to save
gateways through which bacteria might enter. Thanks
treatment time. Three levels of temperature and two heatto DiaDent, dentists may now have a bulletproof way to
ing-time settings give users full control of any procedure.
seal root canals and help ensure treatment success. StudEvoFill is a motorized, cordless obturation system that
ies indicate that using the warm compaction technique
extrudes warm gutta-percha to backfill unfilled portions
increases the chances that no voids will be left behind in
of the canal. The motorized mechanism helps prevent
the obturation process.
users from experiencing hand fatigue. EvoFill uses hyThe EvoFillTM Duo obturation system, a new technology,
gienic, one-time-use gutta-percha cartridges to deliver
was showcased in February at the Chicago Dental Society
fast, precise and direct injection of softened gutta-percha
Midwinter Meeting. While countless methods and techinto the root canal. The tips can be bent to the desired
niques are available for root canal procedures, perhaps
shape and angle using the multipurpose wrench provided.
none is as easy, intuitive and time-saving as DiaDent’s
The clear GP window displays the amount of gutta-percha
complete obturation system, according to the company.
available in the cartridge. With the new disposable fastWith an innovative electric motor that prevents hand faloading gutta-percha cartridge, there is no messy, tedious
tigue, EvoFill Duo offers fast heating and controlled guttacleanup, according to the company. EvoFill has three varipercha extrusion with precise 3-D fills and reliable results.
able temperature settings to provide precise control of obBoth units can be fully charged within 90 minutes.
TM
turation flow. The preheating function quickly softens the
EvoPack is a cordless, warm, vertical-compaction degutta-percha when device temperature is low.
vice. It effectively and tightly compacts and seals all canDetailed instructional and introductory videos can be
als, including lateral canals. After a canal has been shaped
viewed on DiaDent’s website at www.diadent.com. A broand cleaned, a master cone is selected for a snug fit and
chure and demo unit also can be requested. Purchase
tug back. EvoPack is then used to cut, soften, downpack

“ KEYSTONE, page A8
“Megan has all the right tools to build
upon existing relationships and create
new ones with Canadian customers,”
said Keystone Industries Vice President
of Sales Mike Prozzillo. “We are confident Megan will take control of a large
and important region that has become
a much more vital part of our business.”
Shank’s dental career started at

Apavia, a company from Ohio that
manufactures dental water filtration
systems in both the U.S. and international markets. Shank has eight years
of sales experience and, as the first
Canadian-dedicated liaison, is focusing
on expanding relationships with new
dental-practice and dental-lab partners.
Her goal is to provide effective and efficient information to keep customers
on the cutting edge of dental innova-

Photo/Provided
by DiaDent

EvoFill Duo
from
your
trusted dental
dealers, such as
Henry Schein,
Patterson,
Benco Dental,
Ultimate Dental, etc. DiaDent
will be exhibiting
at the following
shows in 2016: Pacific
Dental Conference in
Vancouver, British Columbia,
March 17–18, booth No. 1529; AAE
meeting in San Francisco, April 6–8,
booth No. 807; and California Dental Association Meeting in Anaheim, May 12–14, nooth No. 1284. For additional
product details, you also can call (877) 342-3368.

tions, and Keystone Industries is excited
to see the organization’s dental business
grow throughout markets across the expanse of Canada.

About Keystone Industries
Keystone Industries, a privately held
company founded in 1908, has earned a
strong reputation for producing innovative, high-tech dental products in both
the operatory and laboratory realms.

According to the company, the organization’s dedication is driven by the
need to provide customers with the finest quality materials while developing
products that meet and surpass customer expectations. The company has continued to pursue this same mission as
it has moved forward with expansions
around the globe.
(Source: Keystone Industries)

[12] =>

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[13] =>

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[14] =>

A14

From VOCO:
Infection and
climate-control
packaging
Air-tight, individually sealed
foil saves time and money
By VOCO Staff

VOCO, a Germany-based global leader in the manufacturing of dental restorative materials, offers the
next level of quality control with the introduction of
its new ISO-pak packaging.
For use with all of VOCO’s composites (Grandio,
GrandioSO, x-tra fil) and VOCO’s new nano-ORMOCER
Admira Fusion, the new ISO-pak comes as an airtight, individually sealed foil that includes the prod-

INDUSTRY

VOCO’S ISO-pak is designed to
maximize the infection-control efforts
of each office, saving the offices time
and money by making the disinfection
of each single-unit-dose capsule
obsolete. Photos/Provided by VOCO

uct name, expiration date, shade, cure time, storage
information and lot number imprinted on each individual unit.
The ISO-pak will maximize the infection-control
efforts of each office, saving the offices time and
money by making the disinfection of each singleunit-dose capsule obsolete.
An added ISO-pak benefit is humidity control. All
encapsulated composites and ORMOCERS on the market have the tendency to get stickier with increased
levels of humidity or stiffer in low humidity levels.
The new ISO-pak is an air-tight packaging solution
that will provide the clinician the same consistency
of VOCO restoratives for each use whether they are
located in the dry winter arctic air of Canada or in the

Dental Tribune Canada Edition | March 2016

PDC
BOOTH
No. 1335
moist humid air in the tropics of Florida.
VOCO’s new ISO-pak offers added value to its customers without any additional costs passed on.
According to the company, VOCO is proud to continue to be an industry leader and innovator when it
comes to product solutions and product value — as
experienced by both dentists and their patients.
For more information on VOCO’s new ISO-pak packaging and VOCO products, you can visit the VOCO
websites at www.voco.com and www.vocoamerica.
com.
Additionally, you can earn C.E. credit online
through www.vocolearning.com. To learn more about
ISO-pak and other products, contact VOCO America at
(888) 658-2584 or infousa@voco.com.

Dental isolation technique unlike any other
By Isolite Systems Staff

Dental isolation is one of the most
common and ongoing challenges in
dentistry. The mouth is a difficult
environment in which to work. It is
wet and dark, the tongue is in the
way, and there is the added humidity of breath, which all make dentistry more difficult.
Proper dental isolation and moisture control are two often overlooked factors that can affect the
longevity of dental work — especially with today’s advanced techniques and materials.
Leading dental isolation methods
Above, Isolite mouthpieces are now available in six patient-friendly sizes. Below, the Isovac and the Isodry. Photos/Provided by Isolite Systems
have long been the rubber dam — or
manual suction and retraction with
PDC
Isolite Systems
the aid of cotton rolls and dry angles. Both of these
BOOTH
provides
three
methods are time and labor intensive, and not particuNo. 1729
state-of-the-ar t
larly pleasant for the patient.
product solutions
Enter Isolite Systems. Its dental isolation systems defor every practice,
liver an isolated, humidity- and moisture-free workevery operatory:
ing field as dry as the rubber dam but with significant
Isolite, illuminated
advantages, including better visibility, greater access,
dental
isolation
improved patient safety and a leap forward in comfort.
system; Isodry, a
Plus, it allows dentists to work in two quadrants at a
non -i l lu m i n ate d
time.
dental
isolation;
The key to the technology is the “Isolation Mouthand the new Isopiece.” Compatible with Isolite’s full line of products,
vac, dental isolathe mouthpiece is the heart of the system. It is specifiction adapter.
ally designed and engineered around the anatomy and
Using the Isolamorphology of the mouth to accommodate every pation Mouthpieces,
tient, from children to the elderly.
all three dental isoThe single-use Isolation Mouthpieces are now availlation products isoable in six sizes and position in seconds to provide
the majority of dental procedures where oral control
late upper and lower quadrants simultaneously while
complete, comfortable tongue and cheek retraction
and dental isolation in the working field is desired. It
providing continuous hands-free suction. This allows
while also shielding the airway to prevent inadvertent
has been favorably reviewed by leading independent
a positive experience where the patient no longer
foreign body aspiration.
evaluators and is recommended for procedures where
has the sensation of drowning in saliva/water during
Constructed out of a polymeric material that is softgood isolation is critical to quality dental outcomes.
a procedure, and the practitioner can precisely coner than gingival tissue, the mouthpieces provide sigFind Isolite in booth No. 1729 at the Pacific Dental
trol the amount of suction/humidity in the patient’s
nificant safety advantages, and their ease-of-use can
Conference and see the Isolite in action. You can visit
mouth.
boost your practice’s efficiency, results and patient
the company online at www.isolitesystem.com.
Isolite Systems’ dental isolation is recommended for
satisfaction.

[15] =>

[16] =>

INDUSTRY

A16

Dental Tribune Canada Edition | March 2016

LVI Core I three-day course enables
dentist and team to learn together
By Mark Duncan, DDS, FAGD, LVIF, DICOI,
FICCMO, Clinical Director, LVI

As a patient, I expect the best care I can
find. As a doctor, I want to deliver the best
care possible. That takes us to the power of
continuing education, and as doctors we
are faced with many choices in continuing education.
As a way to introduce you to the Las
Vegas Institute for Advanced Dental Studies, or LVI, I want to outline what LVI is
about and what void it fills in your practice. The alumni who have completed programs at LVI were given an independent
survey, and unlike the typical surveys,
99.7 percent said they love practicing
dentistry, and of those surveyed, 92 percent said they enjoy their profession more
since they started their training at LVI.
That alone is reason enough to go to LVI
and find out more.

Functional dentistry: Power of
physiologic-based occlusion
While the programs at LVI cover the
breadth of dentistry, the most powerful
Ad

and life-changing program is generally
reported as Core I, “Advanced Functional
Dentistry: The Power of Physiologic-Based
Occlusion.”
This program is a three-day course that
is designed for doctors and their teams to
learn together about the power of getting
their patients’ physiology on their side. In
this program, doctors can learn how to
start the process of taking control of their
practice and start to enjoy the full benefits of owning their practice and providing high-quality dentistry.

Las Vegas Institute for Advanced Dental Studies offers Core I, a three-day course for dentists
and their teams. Photo/Provided by Las Vegas Institute for Advanced Dental Studies

Comprehensive care
Whether he or she works in a solo practice
or in a group setting, every doctor can
start the process of creating comprehensive care experiences for patients.
We will discuss why some cases that
doctors are asked by their patients to
do are actually dangerous cases to restore cosmetically. We will discover the
developmental science behind how unattractive smiles evolve and what cases
may need the help of auxiliary health
care professionals to get the patient feeling better.

The impact of musculoskeletal signs
and symptoms will be explored and how
the supporting soft tissue is the most important diagnostic tool you have — not
simply the gingiva, but the entire soft-tissue support of the structures not just in
the mouth but also in the rest of the body.
A successful restorative practice doesn’t
need to be built on insurance reimbursement schedules.
An independent business should stand
not on the whims and distractions of a fee
schedule but rather on the ideal benefits

of comprehensive care balanced by the
patients’ needs and desires. Dentistry is
a challenging and thankless business, but
it doesn’t have to be. Through complete
and comprehensive diagnosis, there is an
amazing world of thank-yous and hugs
and tears that our patients bring to us, but
only when we can change their lives. The
Core I program at LVI is the first step on
that journey.
That’s why when you call, we will answer
the phone, “LVI, where lives are changing
daily!”

[17] =>

INDUSTRY

Dental Tribune Canada Edition | March 2016

A17

Elbow your way to better health

entists, hygienists and dental assistants face
on a daily basis all of the top conditions
needed to develop musculoskeletal disorders.
Dental work requires precision and control in movement — so static positions can result in fatigue in the
muscles of the neck, the back and the shoulders. After
a few years or even months, the muscle fatigue may
cause ailments, pain or even more severe conditions,
such as tendinitis, bursitis, neck pain, disk herniation
and others.
If I work with my arms close to my body, can I avoid
muscle tension?
Even when your arms seem relaxed along your body,
the shoulder and upper back muscles have to be contracted to keep the stability required for the precise
work of your hands. These muscle contractions can
reduce the blood flow up to 90 percent, which causes
fatigue to accumulate and weaken your muscles and
articulations.

Do I have to always be on the supports to get the benefit?
It is not possible to be on the supports 100 percent of
the time. The studies demonstrated that with 50 percent of the time on the support, bloodstream is sufficient to prevent and diminish tension. After a short
learning curve, the majority of users are on the supports 80 to 90 percent of the time.
Why invest in a dental stool?
Dental professionals can easily spend eight to 12 hours
a day on a stool. In fact, it is the piece of equipment you
use the most and, generally, it is also the most neglected. You pay attention to your patient comfort, so what
about your comfort and that of your employees?
The investment is modest and quickly profitable
compared to costs created by medical treatments
or leave from work. Do you have to plan long procedures early in the week because your body can’t do it on
Thursdays?

Michelle Fontaine, RDH, demonstrates the ergonomic improvement in her work position enabled in part by her use of Posiflex
free motion elbow supports. Photos/Posiflex Design

ition does not provide lumbar support or a safe position.
Many speakers and authors favor a higher position of the
patient chair with the patient lying flat. The arms stay close
to the body and the forearms are flexed.
To learn more on ergonomics in the dental clinic, visit
www.posiflexdesign.com. The source for some of the statistics in this article is “Prevention of Work-Related Musculoskeletal Disorders in Dental Clinics,” by Rose-Ange Proteau.
It is available free at www.asstsas.qc.ca.

How should the patient chair be adjusted to keep the
practitioner in good posture?
Eyes-to-task distance is the key for good posture. When
the patient chair is placed low it forces you to bend your
neck, even with loupes, creating tensions. Furthermore,
because of lack of leg room, the operator must straddle
the chair or, worse, sit on the tip of the seat. This pos-

Why use mobile elbow supports?
The Posiflex mobile elbow support system was developed to diminish the charge to the upper body in
order to favor a good bloodstream. A scientific study
demonstrated that using the Posiflex system contributes to achieving a more secure and
comfortable work posture while signifiFactors contributing to development of musculoskeletal disorders:
cantly reducing muscle contractions in
the shoulders, neck and upper body. This
unique concept follows body movements.
The elbow rests offer an appropriate support of the arms while preserving the
freedom of movement.
Precision work requires concentration
and effort. We forget ourselves when we
are concentrated on a task. The elbow supports enable practitioners to keep a good
posture as they keep you in line.
Repetition.
Tempo.
Force.

(Source: Posiflex Design)

Awkward movements
and posture.

Inadequate rest.

PDC
BOOTH
No. 1335

Single-bottle adhesive selfcures with no light activation
By VOCO Staff

VOCO recently introduced Futurabond M+, a universal single-bottle adhesive. Futurabond M+ versatility enables it to be used in self-, selective- or total-etch
mode without any additional primers on virtually all
substrates. Futurabond M+ achieves total-etch bond
strength levels with all light-, self- and dual-cure resinbased composites, cements and core buildup materials.
With a dual-cured activator, Futurabond M+ will selfcure without any light activation, which, according to

the company, offers a big advantage for endodontic applications such as post cementation where it avoids the
pooling effect, a problem with light-cured adhesives.
Futurabond M+ also adheres well to metal, zirconia and
ceramic, making extra primers unnecessary.
Futurabond M+ needs only one coat and takes 35
seconds from start to finish. Its low film thickness of
9 microns makes bonding margins invisible (no “halo”
effect) and prevents pooling problems. It does not need
to be refrigerated. Benefits include its indication as a
desensitizer for use under amalgam restorations or on
hypersensitive tooth necks as a protective varnish for

Futurabond M+ achieves total-etch bond strength levels with
all light-, self- and dual-cure resin-based composites, cements
and core buildup materials. Photos/Provided by VOCO

glass ionomers and an intraoral repair of ceramic restorations.
For more information on Futurabond M+ you can visit
the VOCO website at www.voco.com.

Temporary luting material delivers natural translucent appearance

VOCO’s Bifix Temp offers 90 seconds of
working time and sets in four minutes.

.
.

VOCO’s Bifix Temp offers high esthetics with a simple application that provides users with visually pleasing results.
The translucent and tooth-like universal shade
blends with highly esthetic temporaries, does
not shine through and promotes natural appearance of temporary restorations. Thanks
to Bifix Temp’s low film thickness, temporaries
can be cemented to fit without adjustment.
As a composite-based dual-cure material, Bifix Temp offers

90 seconds of working time and sets in four minutes. The
light-cure mode offers the user control and easy removal of
excess material via a “tack-cure” technique that activates an
initial elastic gel phase. Any unwanted residues are easy to
locate and remove as Bifix Temp’s universal shade stands out
well against the gingiva.
Bifix Temp comes in an auto-mix syringe with very short
tips, making application precise and economical. To learn
more, you can visit www.voco.com.

[18] =>

[19] =>

IMPLANT TRIBUNE
The World’s Dental Implant Newspaper · Canada Edition

March 2016 — Vol. 4, No. 1

www.dental-tribune.com

Clinical

Novel approach to gingival grafting: Singlestage augmentation graft for root coverage
By Preety Desai, DDS,
Dip Periodontics

he existence and preservation
of attached keratinized gingiva
around natural teeth and dental implants plays an important role in periodontal1 and peri-implant
health.46,47 This article describes a novel
surgical technique that addresses multiple adjacent Miller Class II and III recession defects5 in a predictable one-staged
surgical procedure. The goals of treatment
are to improve esthetic outcomes and gain
clinical attachment and keratinized tissue
levels in addition to possible root coverage.
A combination of traditional periodontal plastic procedures is used, following
sound, evidence-based techniques. To date,
more than 100 surgical cases have been
completed. Surgical steps and rationale for
this new technique are detailed here, and
representative cases are shown (Figs. 1–12).

Introduction
As many epidemiological reports suggest,
gingival recession affects the majority of
the adult population.2,3 Gingival recession
is defined as the apical migration of the
soft-tissue margin around teeth leading to
exposure of the cementoenamel junction
(CEJ) and the dentinal root surface4 and
is classically categorized by Miller.5,6 The
philosophy for increasing the zone of keratinized tissue for teeth is for attachment
stability, facilitation of plaque control and
to prevent further gingival recession from
frenal/muscle pulls.6,7
Periodontal plastic procedure articles
in the literature evidentially demonstrate
very predictable and esthetic root coverage in the majority of Miller Class I and
II single- or adjacent-tooth sites with and
without the adjunct of a subcutaneous
connective tissue graft (SCTG).3,7 This holds
true irrespective of surgical technique(s)
used, i.e., pedicles, tunnels, coronally positioned flaps (CPF), guided-tissue regeneration (GTR), etc., provided that biologic
principles for obtaining root coverage
are satisfied, i.e., interproximal papillary
height and interseptal bone height.
Additionally, the results of long-term
clinical retrospective studies in private
practice demonstrate that not only is there
effective root coverage but mean root
coverage tends to improve over time after
initial surgery.8 In acellular dermal matrix
and GTR studies over the short and long
term, neither showed a statistically significant increase in root coverage compared
with the use of autogenous tissues.9,10 More

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 1: Case 1, lower-right sextant presurgery. Fig. 2: Case 1, lower-right sextant pre-op X-ray. Fig. 3: Case 1, post-op. Fig. 4: Case 2, upper
left sextant pre-op. Fig. 5: Case 2, surgery — flap elevation. Photos/Provided by Dr. Preety Desai

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 6: Case 2, surgery — coronally positioned flap. Fig. 7: Case 2, upper-left sextant — four weeks post-op. Fig. 8: Case 2, upper-left
sextant — six weeks post-op. Fig. 9: Case 3, upper-left sextant pre-op. Fig. 10: Case 3, upper-left sextant post-op.

recently, the literature also shows clinical cases of inexplicable root resorption
in SCTG cases performed in a traditional
manner.47,48 In contrast, the presence of
multiple recessed sites in a posterior sextant that have advanced recession beyond
Miller Class I/II, presents a clinical conundrum that has not been addressed until recently in the literature of periodontics3,11,12
and clinical periodontal practice. Nevertheless, the goal of periodontal therapy
should be to address the needs and wishes
of each patient, and treatment options
should be made available to each patient
accordingly.13
Recession in multiple adjacent teeth
can occur for a variety of reasons: the patient’s iatrogenic habits; history and/or
treatment of chronic periodontal disease
by traditional flap therapy; anatomy/malpositioned teeth in the alveolar ridge corridor compromising attachment apparatus; muscle/frenal attachment levels at or
beyond the mucogingival junction (MGJ);
secondary parafunctional habits; and the
obvious long-standing results of a history
of chronic untreated periodontal disease.
A two-staged surgical procedure — free
gingival graft (FGG) plus surgical repositioning coronally positioned flap (CPF)12,14
— can aid individual sites in some Miller
II/III recessed areas. These surgical sites
that have experienced two surgeries are
prone to double the postoperative surgical
shrinkage, fibrotic scar tissues and morbidity.30 Patients also report discontent
with this two-surgery treatment option
because of increased costs, healing time,
work absences and scheduling issues. In
difficult economic times, the dental profession must streamline treatment options for patients but still continue to deliver excellent surgical skills and subsequent
clinical benefit. No treatment options are

available in posterior sextants with multiple recessed Miller Class II/III sites that
have a lack of adequate keratinized and
attached gingiva regardless of if the adjacent papillae is affected. As such, an effort
has been made to fill this void with a corrective surgical procedure able to stabilize progressive recession with the added
benefit of some root coverage in Miller III
recessions.11

Inclusion criteria
for single-stage CPF/FGG
Patients eligible for the one-stage CPF/FGG
procedure included those with:
1) No health issues as a contraindication
for periodontal surgery.
2) Presence of at least two to three adjacent teeth with Miller Class II/III facial
recession with a frenal/ligamental attachment deemed to be playing a role in creating a stable gingival margin.
3) Chief complaint of impaired esthetics
associated with the recession.
4) Absence of anatomical defects, caries
or restorations needed in the site.
5) No periodontal surgical treatment of
the involved sites during the previous 24
months.
6) Adequate oral hygiene.
7) Non smokers.

Procedure
Patients chosen exhibit posterior sextants
of recession with interproximal bone loss
(Miller II or III) and encroachment of gingival recession on the MGJ, commonly
with frenal pulls and muscle attachments,
which may or may not have played a role
in the etiology of attachment loss but will
play a role on the success and stability of
surgical treatment to resolve progressive
recession.15,49
A modified one-staged FGG + CPF12,14 sur-

gical approach is suggested: Implementing
Sumner’s full-thickness envelope16 and
Sorrentino and Tarnow’s17 semilunar procedure augmented with a traditional
FGG18 apical to the coronally positioned
semilunar flap is suggested. This combination procedure proposes to inhibit the
coronal reattachment of the musculature
and freni, which can play havoc with graft
stability in the long term, 49 in addition to
increasing the zone of keratinized and attached tissues. Results showed that most
Class III recessed cases even showed some
root coverage in addition to an ample gain
in keratinized and attached tissues.11,12
The first incision was performed by the
Er,Cr:YSGG laser (with appropriate softtissue settings due to its known properties
of hemostasis). The T4 laser tip incises precisely at the MGJ in a contact/non-contact
manner depending on the extent of fibrous and ligamentous frenal attachment
to make a split-thickness-incision release
of all musculature/fibres prior to reaching
the periosteum. All elastomeric fibres are
thus incised and denatured at the MGJ.
This allows the mucosa to apically relax,
laying passively, extending the vestibular
region without causing any tension on the
future graft’s recipient surgical site. Rarely
was vestibular suturing needed for hemostasis in the region unlike with a traditional blade incision. Resorbable 4-0 gut
sutures are used in the vestibule for this
purpose.
Dentinal root preparation is done in a
conservative manner if the anatomy is
deemed to be inhibitory to coronal-flap
positioning and stability (i.e., in root abrasion, horizontal grooving, caries cases, etc.).
The root surfaces are traditionally modified with root planing to remove calculus,
” See GRAFTING, page B2

[20] =>

XXXXX
CLINICAL

“ GRAFTING, Page B1
plaque, debris and to
create a flat/convex
architecture; and they
Fig. 11a
Fig. 11b
Fig. 12
are etched with the
hard-tissue
setting
Fig. 11a,b: Case 4, pre-op surgery. Fig. 12: Case 4, postop surgery.
with the Er,Cr:YSGG at
the coronal gingival
weeks following surgery and were premargins prior to suturing of the coronal
scribed 0.12 percent chlorhexidine mouthflap.
wash three to four times per day during
The second incision is the release of the
the three weeks after the procedure.
coronally attached keratinized tissues incised as an envelope flap19 from the sulcus
Results
in a full-thickness manner20 with microsurgical blades — without the use of vertiAll patients demonstrated surgical results
cal incisions on the facial aspect and split
that had an improved and stable zone of
thickness in the papillary regions. The flap
attached and keratinized tissues with no
is coronally positioned with vertical matevidence of muscle or frenal reattachment
tress interrupted sutures using 6-0 noncompromising the zone of KT. Most often,
resorbable monofilament microsurgical
there was evidence of partial root coversutures. Once the coronally placed flap is
age in Class III Miller recessions. The typsecure, then the soft-tissue laser setting of
ical white “scar line” evidenced at the MGJ
the Er,Cr:YSGG allows gingivoplasty/gindiscussed in Sorrentino and Tarnow’s17 origivectomy via microplastiying of the marginal paper is rarely seen in this one-staged
ginal tissue outline and adaptation of the
procedure. Patients also found the procedmarginal papillary regions of the gingival
ure no more arduous than any other perimargins.
odontal plastic procedure and, more often
An ideal scalloping in the manner of a
then not, the treatment was more comfort“paintbrush” stroke of the laser tip allows
able than expected using the Er,Cr:YSGG
the coronal architecture of the free gingilaser for the initial incision.
val margin (FGM) adjacent to the teeth to
The author has done this procedure in
adapt the marginal tissues precisely. This
more than 100 cases with no untoward
gingivoplasty allows the whole site to have
results and with great patient satisfaction.
a more finessed marginal gingival adaptaDiscussion
tion and contoured appearance against the
dentition. The whole coronally positioned
In recession studies available to review,
tissue is still attached with its mesial and
Miller I and II recessions are the majority
distal blood supplies intact and is now
found in the literature. In one such study,21
fixed with interproximal sutures, gaining
coronally advanced flaps were used for
blood supply from the split-thickness papmultiple teeth in the esthetic zone for root
illae and the alveolar bone beneath it. The
coverage and were noted to be stable at one
coronally positioned tissue is immobile
year’s time with a statistically significant
and well adapted interproximally to have
increase in the amounts of KT. Yet in anthe best chance of blood vessel anastomoother study by Gurgan, 49 after five years,
ses, but at the apical aspect it lays passively
50 percent of these cases receded to the
on the periosteal bed.
presurgical levels as surmised by using
The donor FGG is then placed apical to
alveolar connective tissue as donor as opthe coronally positioned flap onto the
posed to gingival tissue as donor.
periosteum and alveolar bone, which has
Research papers looking at both animal
been cleared of any elastomeric fibres and
and human subjects demonstrate that alsutured with resorbable interrupted 6-0
tered gingival circulation and vitality, as
sutures, which engages the periosteum
determined by fluorescein angiography,
and the apical aspect of the CPF, binding
show that more vascularity is associated
the coronal aspect of the donor FGG down.
with greater graft survival.23 Hwang and
This creates immobility and no dead space
Wang24 also indicated that a positive asso— to ensure the best blood supply.
ciation exists between weighted flap thickThe Er:YSGG laser is used at appropriate
ness and mean and complete root coversettings to actually “weld” and plasty the
age.
donor FGG with paintbrush strokes to the
Langer and Langer’s25 technique used
CPF at the junction of the new augmented
partial-thickness flap elevation to enhance
KT/AT. This creates a more esthetic result
revascularization of the graft, which was
and strengthens tissue junction.
then stabilized on the recipient site using
Pressure on the whole surgical site aids
periosteal sutures. Raetszke,19 however,
in hemostasis and immobility if needed
advocated the use of the split-thickness
prior to pack placement, avoiding any dead
envelope in isolated areas only, reporting
space or blood clots that may hinder a
difficulty in obtaining sufficient tissue
healthy blood supply for vascularity of the
for use in more extensive areas of recesnewly placed graft and tissue. Surgical glue
sion. Surgically, though, the elevation of
is used if necessary for additional stabilizaa partial-thickness flap can be arduous to
tion, minding any subtissue leakage, which
perform, particularly in patients with a
will impede healing. Thus, the whole site
thin gingival biotype. A partial-thickness
is tension free, with an increased vestibuflap also reduces the KT tissue thickness;
lar depth and an increased zone of AT/KT
and mucosal flaps less than 1-mm thick
without frenal/muscle hindrance, in addihave been correlated with a reduction in
tion to the potential of root coverage.
the percentage of root coverage in defects
Traditional postoperative instructions
treated using coronally advanced flaps.22,27
are provided, and analgesics and antiBecause bilaminar vascularity is reinflammatories are prescribed. Patients
quired only to provide blood supply to a
are followed at one- (pak removal), threeSCTG, a full-thickness CPF was used in this
(suture removal) and six-week intervals for
procedure.
follow-up, as with traditional periodontal
Any chance of fenestration or dehiscense
plastic procedures. Patients were asked
over the roots26 remaining after a fullto refrain from any mechanical hygiene
thickness CPF is compensated for by the
techniques in the treated area for the three
FGG placed over these denuded sites, and

Implant Tribune Canada Edition | March 2016

historically that has proven
to not be an issue28,29 when
grafts were placed straight
onto the alveolar bone. No
issues were observed due to
coronally positioning a fullthickness flap vs. a partialthickness flap,26,29 and yet,
the benefit of maintaining
the full buccal lingual thickness of KT remains a huge asset.20 Also, the elevation of
a full- or partial-thickness flap did not appear to influence the amount of KT or the
percentage of root coverage achieved postsurgically.20
Literature comparing the CPF vs. semilunar flaps showed that both designs
were effective in obtaining and maintaining a coronal displacement of the gingival margin. The CPF resulted in clinical
improvements significantly better than semilunar flaps for percentage of root coverage, frequency of complete root coverage
and gain in clinical attachment level.27
A recent review50 points out that aberrant frenal pulls are a contraindication to
the traditional CPF/SCTG. Aberrant freni
cannot be corrected at the time of surgery
because incisions would compromise the
blood supply available to the graft. When
indicated, a frenectomy is scheduled
four to six weeks prior to grafting.15,50 The
beauty of the single-stage laser CPF/FGG
is that all aberrant frenal attachments are
dealt with immediately in order not to
compromise graft stability, microvasculatature from the recipient bed and graft
longevity — and thus future recession of
the new donor tissue.
In another paper, Harris10 treated 266
defects with connective tissue grafts associated with a coronally advanced or a
double-papilla flap and reported that the
average results of deep recessions (≥ 5 mm)
were less favorable (87 percent vs. 95 percent), when connective tissue grafts were
associated with a coronally advanced flap.
Although these results were for Miller I
and II recessions and showed better results
then seen in the Miller III laser CPF/FGG
procedure, they confirm limitations when
recessions reach 5 mm.30
In the traditional SCTG + CPF without
vertical releasing incisions, results in Miller III root coverage ranged from 1 to 3
mm (mean 1 ± 1.5); and Miller IV recessions
ranged from 2 to 10 mm (mean 1.86 ± 0.14).
The number of Class III and IV recessions
were fewer than Class I and II recessions.
Nevertheless, the authors noted that these
type III/IV clinical situations can be improved with this procedure.12
It has also been shown that when CPF
plus CTG versus CPF procedures for root
coverage were compared, the two surgical
procedures resulted in similar degree of
root coverage, but the CPFs alone reverted
to presurgical positions of the MGJ.31 In
addition, other long-term papers evaluating CPF with CTG all show that an apical
rebound of the MGJ occurs, resulting in
unstable root coverage and increased recession.31,45,52 These findings may be explained by Ainamo et al.,51 who reported
that the MGJ will regain its original apical
position over time, resulting in unstable
root coverage – with a brand new MGJ reestablished by adding keratinized FGG
apically.
In a study comparing CPF techniques
with and without the use of vertical releasing incisions, both were shown to be
effective in reducing recession depth, but
” See GRAFTING, page B4

IMPLANT TRIBUNE
Publisher & Chairman
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Eric Seid e.seid@dental-tribune.com
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Dr. Sebastian Saba feedback@dental-tribune.com
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Kristine Colker k.colker@dental-tribune.com
Managing Editor Implant Tribune Canada
Robert Selleck, r.selleck@dental-tribune.com
Managing Editor Implant Tribune U.S.
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Managing Editor
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Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you find a
factual error or content that requires clarification,
please contact Managing Editor Robert Selleck at
r.selleck@dental-tribune.com.
Tribune America cannot assume responsibility for
the validity of product claims or for typographical
errors. The publisher also does not assume responsibility for product names or statements made by
advertisers. Opinions expressed by authors are their
own and may not reflect those of Tribune America.

Editorial Board
Dr. Pankaj Singh
Dr. Bernard Touati
Dr. Jack T. Krauser
Dr. Andre Saadoun
Dr. Gary Henkel
Dr. Doug Deporter
Dr. Michael Norton
Dr. Ken Serota
Dr. Axel Zoellner
Dr. Glen Liddelow
Dr. Marius Steigmann

Corrections
Implant Tribune strives to maintain the
utmost accuracy in its news and clinical
reports. If you find a factual error or
content that requires clarification, report
the details to managing editor Robert
Selleck, r.selleck@dental-tribune.com.

Tell us what you think!
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are referring to.

[21] =>

[22] =>

B4
“ GRAFTING, Page B2
the envelope type of CAF was associated
with an increased probability of achieving
complete root coverage — and with a better postoperative course.
Keloid formation along the vertical releasing incisions was responsible for a
poor esthetic outcome along with a longer
healing period and a more uncomfortable postoperative course.32 Complete root
coverage has been shown to be more likely
in Miller I and II type recessions, when
marginal tissue recessions are shallower:
66 percent for an average attachment level
of 3.81 mm, compared with 50 percent and
33.3 percent for mean attachment levels of
5.23 and 5.5 mm, respectively.33,34 Glise and
Monnet-Corti also reported that percentage of root coverage was inversely proportional to width and height of initial recession dimensions.35 Thus, even though the
literature indicates that Miller III and IV re-

Ad

XXXXX
CLINICAL

cessions have little probability of 100 percent root coverage, increasing the KT and
AT can increase the longevity of a patient’s
dentition. Even if only some slight root
coverage (based on individual anatomy
and physiology) is possible, this may be a
significant improvement for the patient
esthetically; and it also increases the chances of additional root coverage as a result of
creeping attachment for the patient.36
The Er,Cr:YSGG laser is used here for the
first time in surgical grafting procedures
because it achieves a precision not possible
with a surgical blade. Erbium lasers also
have the unique ability to vaporize watercontaining tissue because of its wavelength and provide a hemostatic effect to
cauterize blood vessels.
What is clearly observed is that the
Er:YSGG laser enables the operator to take
a “microsurgical approach” — to finesse
the marginal-tissue adaptation at the coronal edges along with “laser welding” the

Implant Tribune Canada Edition | March 2016

FGG-donor portion to the CPF portion of
the surgical site and control the hemostasis without additional suturing. Pini
Prato37 showed that the gingival marginal
position at the end of plastic surgery allowed for complete root coverage in Class I
and Class II gingival recession defects, and
applying this philosophy of treatment to
the laser CPF/FGG will only enhance any
probability of root coverage in Miller III/IV
recession defects.
The elevation of a full- vs. partialthickness flap does not appear to influence
either the amount of keratinized tissue or
the percentage of root coverage achieved
post-surgically.20 In fact, the thicker coronal tissue, allows an increase in blood
supply, surgical anchorage and less tissue
trauma with better potential root coverage.38 Pedicle and envelope flaps are successful if the grafted tissues remain vital
on the exposed dental avascular root surface, and soft-tissue healing is critically

controlled by this vascularity.28,29 Most reaffirming was Romanos et al.43 showing
that the lateral bridging flap technique,
designed similar to this paper’s CPF, exhibited the most stable location of the repositioned MGJ, which was 2-3 mm coronally over five to eight years, with stable root
coverage and gingival margins.
Of further interest is that treatment
success is more predictable, with limited
interproximal bone loss and undamaged
interproximal soft tissue.5,39
Gurgan commented that tooth location,
vestibular depth, and muscular and frenum insertions may affect wound stability
once a flap is advanced.50
Fombellida analyzed the significance of
the “vascular supply” as a critical factor on
the prediction of root coverage success; a
positive balance between the vascularized
and nonvascularized areas of the surgical
field yields better results in terms of root
coverage, even in those less favorable cases,
such as Miller Class III recessions.40

Conclusions
Clinicians all too often are faced with the
request: “Can you not do something to
cover these teeth?” Many times the concern is not related to sensitivity but rather
that of esthetics, after recession has increased over a period of time for a patient
on a stable maintenance schedule. Once
the periodontal health was assessed to be
stable, the remaining compromised zone
of KT/AT and the location of the muscle/
frenal attachment often appeared to play
a role in progressive recession. Thus, the
single-staged laser CPF/FGG was developed
and completed in more than 100 patients
— and was reported to be a comfortable
procedure with an esthetic improvement.
Additionally, there have even been documented areas of root coverage in Miller III
and IV situations and, over the years, some
“creeping attachment” has been documented.36
Additional investigation through a prospective clinical study with volumetric
methodology44 needs to be done to assess
the statistical significance of increases in
KT and root-coverage results of this new
procedure — or with the adjunct of tissue
engineering and biological adjuncts, such
as enamel matrix derivative, PRP (platelet
rich plasma) or PRF (platelet rich fibrin).41
The CAF procedure is effective in the
treatment of gingival recessions. However,
recession relapse and reduction of KT occurred during follow-up periods without
any FGG adjunct.42 The baseline width of
KT is a predictive factor for recession reduction when using the CAF technique.
Thus the new single-staged laser CPF/FGG
is an effective and predictable method to
increase the zone of KT and AT width. The
technique can also anecdotally be shown
to increase root coverage in Miller III and
IV cases and fulfills the need of the patient,
while at the same time reducing the number of appointments and patient costs.
A list of references is available from the
publisher on request.
Preety Desai, BSc, DDS, Dip
Periodontics, has been in fulltime specialty periodontal practice in Kamloops, British Columbia, since 1997. She has no
financial interests in, and has received no materialistic or financial benefit from, corporations
with respect to this article. She can be contacted by
email at kamloopsperiodontics@gmail.com.

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[cover] => DT Canada No. 1, 2016

[toc] => Array ( [0] => Array ( [title] => Irish fun is on tap at the 2016 Pacific Dental Conference [page] => 01 ) [1] => Array ( [title] => Cosmetic meeting reimagined for Toronto [page] => 04 ) [2] => Array ( [title] => Pediatric dentists heading to the River Walk [page] => 06 ) [3] => Array ( [title] => Industry [page] => 08 ) [4] => Array ( [title] => Implant Tribune Cananda Edition [page] => 19 ) ) [toc_html] =>

Table of contents

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Irish fun is on tap at the 2016 Pacific Dental Conference / Cosmetic meeting reimagined for Toronto / Pediatric dentists heading to the River Walk / Industry / Implant Tribune Cananda Edition

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