cosmetic dentistry international No. 1, 2016
Cover
/ Editorial
/ Content
/ An innovative adhesive luting protocol
/ Between BOPT and BTA: A case report on shaping the gingival contour around tooth-supported restorations by means of provisional resin crowns
/ Utilising smile design software and CAD/CAM for creating a mock-up and final restorations
/ Conservative smile design for the general dentist
/ Interview: We will be able to treat pretty much everything in the future
/ Light and the biological clock
/ What do our teeth betray about us?—Part II
/ Eleven tips for success in your dental clinic - Part I: SWOT analysis and loyal patients
/ News
/ Meetings
/ Submission guidelines
/ Imprint
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[1] =>
Vol. 10 • Issue 1/2016
issn 2193-1429
cosmetic
dentistry
beauty & science
1
2016
trends & applications
An innovative adhesive luting protocol
case report
Between BOPT and BTA:
Shaping the gingival contour
practice management
Eleven tips for success
in your dental clinic
[2] =>
B 1 G UAR AN TEE D W HI TEN I NG
THE ONLY WHITENING SYSTEM IN
THE WORLD TO GUARANTEE RESULTS
OVER 2 0 0 , 0 0 0 TR E ATM E NT S
WITH 9 8 % SUC CE SS R ATE
TO VITA SHADE B 1
Contact us to arrange a skype meeting.
Distributors Wanted
Email:
international@enlightensmiles.com
[3] =>
cosmetic dentistry editorial
|
Dear Reader,
It is interesting to note the trends in cosmetic dentistry training these days. Cosmetic dentists are
spending time and money learning various smile design techniques and protocols. In recent years,
the use of computer-guided digital devices (hardware and software) in smile design has become quite
popular and many clinicians are already trained in different kinds of digital smile design protocols.
Dr Sushil Koirala
If we carefully analyse digital smile design techniques or protocols, it can be established that they
generally follow three steps: photography, digital analysis (calculation) and digital wax-up (drawing,
cut and paste). After these clinical steps, dentists have two choices for achieving the final trial smile.
The first and most popular one is a laboratory-fabricated acrylic or composite restoration and the
other one is CAD/CAM fabricated. For the manual approach, the laboratory technician has to manually wax up the digital design. Even though digital smile design uses computer-guided techniques
and protocols, the entire design process is not that as fast as many clinicians may think. This is
because the dentist needs to develop specific computer graphic skills, be involved in digital communication with the laboratory, as well as pursue emotional counselling and marketing tactics.
Several months ago, I asked some of my close Asian, American and European friends who have
completed various digital smile design courses about the use of digital smile design protocols in their
daily practice. It was surprising to learn that none of these popular cosmetic dentists regularly use
digital smile design in their practice. They frankly informed me that such techniques are timeconsuming and computer design is not as easy as the day-to-day restorations that they do. I was
also told that they use digital smile design protocols only when they need to present clinical cases
for conferences or seminars.
I was quite pleased with their candid comments, as I rarely use digital smile design myself, because
I do not want to give stock smiles to my patients based on universal design formulas. I apply art more
than science when designing new smiles for my patients. I respect my patients’ personal desires and
needs and guide them in achieving natural and realistic smiles with low biological cost. I have never
sold cosmetic dentistry using the emotional counselling tactics of digital smile design, because
I firmly believe that exploiting emotions to sell cosmetic dentistry actually constitutes emotional
blackmailing of patients.
Keeping all of the above in mind, I have recently developed a simple “Quick Smile Design” concept,
which is not new but a logical modification of the age-old direct composite mock-up technique.
The beauty of this simple technique is that it is fast, realistic and predictable. You do not need to
open your computer and spend time using Photoshop. Your patients will instantly be able to give
their comments about the aesthetics and level of comfort of your smile design. You do not need to
acquire computer graphic skills. Moreover, this technique indirectly enhances the dentist’s direct
cosmetic restoration skills. I hope you will have the opportunity to learn about it in the upcoming
issue of the cosmetic dentistry magazine.
In this issue, we have also selected some articles on smile design and cosmetic restorations.
I hope you will enjoy reading them.
Sincerely,
Dr Sushil Koirala
Editor-in-Chief
cosmetic
dentistry
1
2016
03
[4] =>
| content
| editorial
| opinion
03 Dear Reader
32 What do our teeth betray about us?—Part II
Dr Sushil Koirala, Editor-in-Chief
Dr Stanislav Cícha
| trends & applications
| practice management
06 An innovative adhesive luting protocol
36 Eleven tips for success in your dental clinic—Part I
Prof. Claus-Peter Ernst
Dr Anna Maria Yiannikos
| case report
40 news
10 Between BOPT and BTA: A case report on shaping
the gingival contour
| meetings
Dr Feng Liu
16 Utilising smile design software and CAD/CAM
for creating a mock-up and final restorations
44 Roots Summit 2016
Premier global forum for endodontics takes
place in Dubai
Aki Lindén
46 Where innovation comes to life
20 Conservative smile design for the general dentist
Nobel Biocare Global Symposium
Dr Rami Chayah
48 International Events
| feature
issn 2193-1429
| about the publisher
24 “We will be able to treat pretty much
everything in the future”
Interview with Dr Graham Gardner, EAS President
49 submission guidelines
50 imprint
Vol. 10 • Issue 1/2016
cosmetic
dentistry
beauty & science
1
2016
trends & applications
An innovative adhesive luting protocol
case report
Between BOPT and BTA:
Shaping the gingival contour
practice management
Eleven tips for success
in your dental clinic
28 Light and the biological clock
Antonín Fuksa
Cover image courtesy of Enlighten.
04 cosmetic
dentistry
1 2016
[5] =>
[6] =>
| trends & applications luting protocol
An innovative adhesive
luting protocol
All-ceramic anterior crowns (IPS e.max Press lithium
disilicate) placed with Monobond Etch & Prime
Author: Prof. Claus-Peter Ernst, Germany
Fig. 1
Fig. 2
Fig. 1: Unattractive, old porcelainfused-to-metal restorations on teeth
#11 and 21 in a 20-year-old patient.
Fig. 2: Close-up photograph of the
functionally intact anterior crowns
showing unattractive PFM work due to
the metal framework showing through.
Fig. 3: Incisal view of the
existing crowns.
Fig. 4: The self-conditioning ceramic
primer Monobond Etch & Prime
is scrubbed in for 20 seconds.
Fig. 5: Additional reaction time of
Monobond Etch & Prime of 40 seconds.
Fig. 6: Apical view of the IPS e.max
Press lithium disilicate crown
after Monobond Etch & Prime
had been rinsed off.
Fig. 4
Anterior crowns come in many different variations,
from purely functional to highly aesthetic, depending on the requirements and means of the patient,
the skill of the dental technician, availability of
materials, and preparation and cementation procedures used. Many anterior crowns considered to
be aesthetic in the past no longer meet the demands
of today’s patients. The example detailed in this
article is a case in point.
When she presented to our practice, the 20-yearold high school graduate wished to have the crowns
on her two central incisors replaced (Fig. 1). At the
age of 14, she had sustained anterior tooth trauma
that apparently damaged the mesio-incisal part of
the incisal edges of both teeth. The dentist she had
consulted at that time restored her teeth with porcelain-fused-to-metal (PFM) crowns. Even though
Fig. 5
06 cosmetic
dentistry
1 2016
Fig. 3
the extent of the trauma can no longer be assessed,
today’s alternative—in light of the patient’s young
age in particular—would most probably have been
a direct composite restoration.
Figure 2 shows the two central incisors in detail
from the labial aspect and Figure 3 shows an incisal
view. The crowns did not exhibit any functional
defects. As a result, the main treatment aim was to
improve the aesthetic appearance of the anterior
teeth as requested. Subsequently, the patient was
informed about the treatment procedure, in particular about any possible additional preparation
requiring the removal of tooth structure, as well as
the cost involved.
The treatment was begun at a separate appointment. The restorations were fabricated by the dental
Fig. 6
[7] =>
luting protocol trends & applications
laboratory of Hildegard Hofmann (Mainz,
Germany). Pressed all-ceramic IPS e.max
lithium disilicate (Ivoclar Vivadent) crowns
were selected for this case, since they are the
first choice for this type of indication. This
has been confirmed by numerous clinical
studies, including the recently published
German S3 Clinical Practice Guideline on
ceramic restorations.
The teeth were anaesthetised at the placement
appointment. The crowns were removed and the
bonding surfaces were carefully cleaned with ultrasound and a fluoride-free cleaning paste. Since the
new Variolink Esthetic DC (Ivoclar Vivadent) had
been chosen as the luting material, the crowns were
tried in with the corresponding try-in pastes. An immediate match to the adjacent and the mandibular
anterior teeth was achieved with the Neutral shade.
No adjustments were necessary with regard to a
lighter (Light) or darker (Warm) shade of the luting
composite. We attributed this excellent match to
the dental technician having selected the shade
at the chairside. The extra expense of this step far
outweighs the inconvenience of having to make
numerous adjustments or new restorations because of a shade mismatch.
Conditioning of the crown
Saliva and residue of the try-in paste were removed (Ivoclean, Ivoclar Vivadent) from the crowns
before they were conditioned. It is advisable to
fabricate a “handle” to allow the inner crown
surfaces to be conditioned without having to
touch the crown with the fingers. In this case, the
crowns were attached to a brush holder with a
light-curing provisional composite. This handle
also allowed the crowns to be placed with ease
during the luting procedure. As an alternative, an
OptraStick (Ivoclar Vivadent) could have been used.
Hydrofluoric acid etching of glass-based ceramics
and subsequent silanisation has been an accepted
conditioning method for decades. The newest
studies confirm its effectiveness. It even generates
a strong bond on state-of-the-art ceramic materials such as hybrid ceramics. An acid concentration
of 5 per cent has been established, which represents
Fig. 9
Fig. 7
a reasonable compromise according to the latest
research.
The new Monobond Etch & Prime (Ivoclar Vivadent), which was introduced at the 2015 International Dental Show, is a conditioning material based
on ammonium polyfluoride. The product is actively
scrubbed on the bonding surface (Fig. 4) for 20 seconds, thereby removing any contamination with
saliva or silicone. After another 40 seconds (Fig. 5),
the ammonium polyfluoride reacts with the ceramic
surface and produces a rough etching pattern. Even
though this pattern is not as pronounced as that of
conventional 20 seconds etching with 5 per cent
hydrofluoric acid, the bonding results achieved in
both cases are comparable. The enlarged surface
created in this way helps to activate the ceramic
bonding surface.
The restoration is subsequently rinsed to remove
the ammonium polyfluoride and its reaction products. The reaction of the silane and the activated
glass-ceramic then begins. A thin layer of chemically bonded silane remains on the ceramic after its
distribution with blown air. This product, therefore,
combines the steps of hydrofluoric acid etching and
silanisation and it even appears to render cleaning
with Ivoclean superfluous. The currently available
in vitro data justifies using this new product with
due care to replace the hydrofluoric acid etching
and silanising method. Even though it has not been
shown to improve the bonding values in relation to
the established references, no negative effects on
the adhesive bond have been found to date either.
Moreover, since the adhesive bond to glass-ceramics
is considered to be the most unproblematic interface in the bonding process of indirect restorations,
no clinical irregularities are to be expected.
|
Fig. 8
Fig. 7: Conditioning of the prepared
teeth for the adhesive cementation
of the restorations under cotton
roll isolation. Retraction cords were
placed in the sulcus to prevent any
contamination with sulcular fluids.
Fig. 8: Incisal view
of the prepared teeth.
Fig. 9: Application of Adhese
Universal adhesive
with the pen applicator.
Fig. 10: Light polymerisation
of the adhesive after careful
distribution with blown air.
Fig. 11: The polymerised adhesive
layer on teeth #11 and 21.
Fig. 10
Fig. 11
cosmetic
dentistry
1
2016
07
[8] =>
| trends & applications luting protocol
Fig. 12
Fig. 13
Fig. 12: The IPS e.max Press lithium
disilicate crowns, cemented with
Variolink Esthetic DC, at the follow-up
examination after four weeks.
Fig. 13: Incisal view of the crowns
at the follow-up examination
after four weeks.
Fig. 14: Frontal view of the anterior
teeth. A significant aesthetic
improvement over the initial
situation was achieved.
In the case presented, the crowns could even
have been placed by conventional or self-adhesive
means. The loss of retention would have been as
unlikely as the occurrence of a ceramic fracture
due to inadequate adhesive support. Figure 6 shows
one of the two crowns after Monobond Etch &
Prime had been rinsed off and the surface dried with
blown air.
Cementation of the crowns
Variolink Esthetic DC was used for the adhesive
cementation of the crowns. As this luting system is
a full adhesive, sufficient moisture control must be
ensured. Owing to the equi-gingival preparation
margin, the healthy condition of the gingiva and
the excellent cooperation of the patient, the placement of a rubber dam was not essential. Therefore,
cotton roll isolation was used to seat the crowns.
Two retraction cords (Ultradent Products) were
placed to prevent any contamination with sulcular
fluids (Figs. 7 & 8).
Fig. 15
Fig. 15: Photograph of the
satisfied patient.
The bonding surfaces were cleaned with a fluoride-free prophy paste. Next, Adhese Universal adhesive (Ivoclar Vivadent) was applied from the pen
applicator (Fig. 9). The remaining thin enamel margin was not etched, in order to prevent any gingival
bleeding. Adhese Universal was scrubbed into the
conditioned tooth surface for >20 seconds as stated
in the directions for use. According to the manufacturer, this time should not be reduced, as it is
not sufficient to simply paint the adhesive on to
the tooth surface. Next, the adhesive was dried with
blown air until an immobile, glossy film was left.
The adhesive was then light cured for 10 seconds
(Fig. 10).
Since the universally compatible adhesive forms
a considerably thinner film than does Heliobond
(Ivoclar Vivadent), for example, it can be light cured
without encountering any subsequent problems of
fit or bite elevation. The polymerised adhesive layer
on teeth #11 and 21 is visible in Figure 11. Figures 12
and 13 show the adhesively cemented IPS e.max
lithium disilicate crowns at the final follow-up
appointment, four weeks after the treatment. The
gingiva was free from any irritation and the crowns
08 cosmetic
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Fig. 14
blended in smoothly with the surrounding teeth.
The tremendous improvement in the appearance
of the anterior teeth achieved with the all-ceramic
restorations on teeth #11 and 21 is visible in the
close-up photograph shown in Figure 14. For the
first time in many years, the patient dared to smile
again (Fig. 15).
Conclusion
It takes quite a bit of courage to use innovative
products and procedures, such as those described in
this article. Adequate clinical data is not yet available, let alone the much-needed long-term studies.
Nonetheless, a start must be made somewhere. For
those dental practitioners who would like to be rid
of hydrofluoric acid sooner rather than later, the
described self-conditioning glass-ceramic primer
may offer a viable option.
Since the etching time has a significant influence
on the strength of the ceramic when hydrofluoric
acid is used to condition ceramic restorations, the
specifications of the manufacturer must be strictly
observed. IPS e.max Press lithium disilicate should
be etched for 20 seconds if 5 per cent hydrofluoric
acid is used. Other conventional glass-ceramics require 60 seconds of etching. DeguDent (DENTSPLY)
recommends that its material CELTRA be etched for
30 seconds. The reaction time of Monobond Etch &
Prime is 60 seconds on all types of ceramics. Thus, it
offers a first step in the direction of error prevention.
It remains to be seen whether external studies can
confirm the effectiveness of the product in establishing an adhesive bond on ceramics other than
those from Ivoclar Vivadent._
contact
Prof. Claus-Peter Ernst
works at the Johannes
Gutenberg University of Mainz
Medical Center’s policlinic
for restorative dentistry
in Mainz in Germany.
He can be contacted at
ernst@uni-mainz.de.
[9] =>
[10] =>
| case report shaping the gingival contour
Between BOPT and BTA:
A case report on shaping the gingival
contour around tooth-supported restorations
by means of provisional resin crowns
Author: Dr Feng Liu, China
Fig. 1
Fig. 2
Fig. 1: Frontal view of the patient’s
smile before treatment.
Fig. 2: Pre-op photograph showing
the occlusal relationship
of the anterior teeth.
Fig. 3: Pre-op photograph of the
maxillary anterior teeth.
Fig. 4: Pre-op photograph of the
maxillary anterior dental arch.
Fig. 5: The inclined axis of the
tooth would have resulted in an
unfavourable aesthetic outcome.
Fig. 6: The labial side of the
restorations would be shifted labially.
Fig. 7: The probing depth of the
gingival sulcus around the maxillary
left central incisor was 3 mm.
Fig. 8: The probing depth of the
gingival sulcus around the maxillary
right central incisor was 1 mm.
Fig. 9: Frontal view of the pre-op model.
Fig. 4
Shaping the soft-tissue contour around implants
with provisional resin crowns after implant placement
has become a frequently used technique in implant
dentistry.1 For most implant-supported restorations,
there is a 3 to 4 mm transmucosal attachment surrounding both the implant and the restoration.2
Therefore, adjusting the soft-tissue contour by modifying the emergence profile of the provisional crowns
to optimise the aesthetic outcome has become a regular practice in implant dentistry.3
In consideration of the health of periodontal tissue
around natural teeth, the location of the crown margin is preferably placed supragingivally or flush with
the gingival margin so that the contour of the restoration will not influence the gingival contour.4, 5 However, in the case of covering the original colour of the
abutment tooth, forming the ferrule, and/or improving retention and resistance form, the crown margin
can be placed subgingivally.6 Because the sulcular
depth around a healthy natural tooth is around 1 mm,
Fig. 5
10 cosmetic
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Fig. 3
the cervical margin of the crown is usually located
0.5 mm below the free gingival margin.7, 8 Thus, unlike an implant-supported crown, a tooth-supported
crown can hardly influence the gingival contour.
However, when the sulcular depth of the abutment
is sufficiently deep, as with a thick gingival biotype,
it is possible to sculpt the gingival contour around
the abutment teeth using provisional resin crowns.
The treatment process will be demonstrated in this
article through a typical case with a seven-year retrospective review.
Case report
A 48-year-old female patient whose general health
condition was good, was referred to the Peking University Hospital of Stomatology in Beijing in China in
2008. The patient’s main concern was the restoration
of her maxillary anterior teeth that had been compromised by severe dental caries and treated with root
Fig. 6
[11] =>
shaping the gingival contour case report
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
canal therapy. The patient had no discomfort and desired not only restoration of the defective anterior
teeth but also an aesthetic outcome. However, financial limitations meant not all of her dental problems
could be addressed.
The dental examination revealed that tooth #22
was missing and tooth #23 had shifted mesially.
In addition, there were visible defects on teeth #21, 11
and 12. The roots of teeth #21 and 12 were apparently
palatally inclined and so were the crowns. Tooth #11
was slightly inclined to the palatal side and so was
the crown. During examination of the occlusion,
a deep overbite and a large overjet of the anterior
teeth became evident. In addition, the contour of the
patient’s gingival line was inharmonious. The angle
of her mouth was asymmetrical when she smiled
(Figs. 1–4).
Treatment plan
For patients with malocclusion and misalignment
of teeth, the restorative procedures should be performed once the primary orthodontic treatment has
been completed. However, considering the length of
treatment and her financial limitations, the patient refused orthodontic treatment and only accepted the
restorative treatment. Since the patient’s inharmonious gingival line may have interfered with the
final aesthetic outcome, certain methods to improve
the gingival contour were considered before tooth
preparation.
|
Fig. 10: The gingival contour
was marked on the model.
Fig. 11: The gingival contour
was modified on the model.
Fig. 12: The diagnostic wax-up showing
the upward-shifted gingival contour.
Fig. 13: Occlusal view
of the diagnostic model.
Fig. 14: The diagnostic wax-up
showing the labially shifted restorations.
Figs. 15 & 16: The tooth preparation
was guided by the silicone index.
Fig. 17: The completed
tooth preparation.
Fig. 18: The provisional restorations
replicated from the diagnostic wax-up.
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
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| case report shaping the gingival contour
Fig. 19
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 19: The provisional restorations
placed in the mouth.
Figs. 20 & 21: The gingiva was
covered by the labial side
of the provisional restorations.
Fig. 22: The gingiva was covered
by the labial side of provisional
restorations (diagrammatic sketch).
Fig. 23: The provisional restorations
appeared just as if they had
erupted from the gingival sulcus
(diagrammatic sketch).
Fig. 24: Two weeks after placement
of the provisional restorations,
the gingival contour had begun
preliminary remodelling and the
margin of the abutment teeth
had been exposed.
Fig. 25: Gold alloy cast post and core.
Figs. 26 & 27: The second
provisional restorations with advanced
gingival contour remodelling.
Fig. 25
Crown lengthening has been widely used for improving the contour of the gingival line.9–11 However,
even if the contour of the gingival line could be
modified through periodontal surgery from the
vertical direction, the palatally inclined maxillary
anterior teeth would cause the inclination of the
teeth’s long axes in the sagittal direction. Therefore,
the ideal aesthetic outcome would be difficult to
achieve (Fig. 5). In this case, the restoration’s entire
labial face needed to be shifted labially so that the
height of the gingival contour could be improved
(Fig. 6). Therefore, a more suitable treatment option
was considered.
During further examination, we found that the patient had a thick gingival biotype with a 3 mm deep
gingival sulcus around the maxillary right lateral incisor and maxillary left central incisor and 1 mm deep
around the maxillary right central incisor (Figs. 7 & 8).
In implant dentistry, when the soft tissue around the
implant is of a thick biotype, modifying the contour of
the soft tissue by shaping the transmucosal soft tissue
with a provisional resin crown of a certain shape has
been proved to be an effective method for improving
the aesthetic outcome.12–15 However, for restoring
defective natural teeth, there is insufficient clinical
evidence to prove whether provisional resin crowns
Fig. 26
12 cosmetic
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are capable of shaping the gingival contour. Such
a treatment protocol was deemed worth attempting
in the current case.
Diagnostic wax-up
In order to preview the expected outcome and guide
the treatment, a diagnostic wax-up was prepared.
On the model, the incisal edges of both central incisors were located on the palatal side of the red line
(wet–dry border) of the lower lip; hence, the position
of the incisal edges was to be shifted 2 mm to the
labial side. Furthermore, in order to improve the patient’s deep overbite and large overjet, we decided to
shift the incisal edges of the maxillary central incisors
by 2 mm in the vertical direction, where the lip–teeth
relationship could still tolerate changes palatally.
According to the varied gingival sulcular depth, in
order to protect the connective epithelium of the gingival sulcus, the top of the gingival line of the maxillary right lateral incisor, maxillary right central incisor
and maxillary left central incisor would be shifted in
the apical direction by 2.5 mm, 0.7 mm and 2.5 mm,
respectively. The entire restoration would be inclined
to the labial side by 1.5 to 2 mm so that the palatally
inclined roots would not interfere with the aesthetic
outcome (Figs. 9–14).
Fig. 27
[13] =>
shaping the gingival contour case report
Fig. 28
Fig. 29
Fig. 30
Fig. 31
Fig. 32
Fig. 33
Tooth preparation
and provisional restoration
According to the diagnostic wax-up, two silicone
indices were fabricated. One of the indices was cut in
the labiolingual direction to guide the preparation of
the abutment teeth. The margin of the prostheses was
designed to be placed 0.5 mm subgingivally (Figs. 15–
17). The provisional restorations would be fabricated
according to the other silicone index, in which the
improvement of the aesthetic outcome could be observed clearly. However, the shape of the provisional
restorations was not designed to emulate the erupted
natural teeth, but for the cervical part of the restorations to cover the labial gingiva. After a long period
of remodelling and reshaping, the form of erupted
natural teeth would be established (Figs. 22 & 23).
The impressions for the post and cores were taken at
the same time. Because the restorations were labially
inclined, a gold alloy post and cores was chosen.
Shaping the gingival contour
The patient attended a follow-up two weeks after
placement of the provisional restorations. At that
time, the intra-oral examination showed recession of
the gingiva and exposure of the shoulders on the labial
Fig. 34
side of both tooth #21 and tooth #12 (Fig. 24). The
margins of tooth #11 could also be observed and the
gingiva was healthy. At this appointment, the post and
cores were placed and further tooth preparation was
carried out to shift the margins in the apical direction.
The new provisional restorations were fabricated to
increase the convexity of the cervical part in order
to enhance the effect of the gingival contour shaping.
In accordance with the patient’s wishes, the incisal
edges of the crowns were extended slightly by about
1 mm (Figs. 25–27).
After another two weeks, the patient returned to
our clinic and examination found that the gingival
contour had changed noticeably and the reconstruction of the transmucosal gingival contour was almost
complete. The gingiva around the restorations was
healthy (Fig. 28). The transgingival parts of the restorations were modified and the incisal edges were
shortened in keeping with the patient’s wishes.
Two weeks after the new provisional crowns had
been placed, the patient returned to our clinic for further treatment. At that time, the patient expressed her
satisfaction with both the gingival contour and the
position of the incisal edges (Fig. 29). Once the provisional crowns had been removed, the gingival contour
|
Fig. 28: Two weeks after placement
of the second provisional restorations
with advanced modification.
Fig. 29: Four weeks after placement
of the second provisional restorations.
The gingival contour and the shape
of the crowns were satisfactory.
Fig. 30: Once the second provisional
restorations had been removed,
the ideal gingival contour
could be observed.
Fig. 31: The gingival collars
of the abutment teeth.
Fig. 32: Regular shoulders did not
form around teeth #12 and 11.
Fig. 33: The restorations showing
remarkable transgingival convexity.
Fig. 34: The transgingival contour of
the restoration was closely matched
to the gingival collars on the model.
Fig. 35: Restoration showing
remarkable transgingival convexity.
Fig. 36: The transgingival contour of
the restoration was closely matched
to the gingival collars on the model.
Fig. 35
Fig. 36
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| case report shaping the gingival contour
Fig. 37
Fig. 38
Fig. 39
Fig. 40
Fig. 41
Fig. 42
Fig. 37: The final restoration seated
on the maxillary anterior dental arch.
Fig. 38: Left lateral view of the
patient’s smile after placement
of the restoration.
Fig. 39: Right lateral view of the
patient’s smile after placement
of the restoration.
Fig. 40: One-week post-op
photograph of the maxillary
anterior teeth.
Fig. 41: Frontal view of the patient’s
smile after treatment.
Fig. 42: One-week post-op
photograph of the left lateral view
of the patient’s smile.
around the abutment teeth was similar to the softtissue collar around dental implants. The final impression was taken in order to fabricate the master model,
which would replicate the gingival contour accurately
(Figs. 30–32). The final all-ceramic restorations were
fabricated according to the master model.
Completing the final restorations
Once the final restorations had been completed, the
clear transgingival contours of the crowns could be
seen and were consistent with the shape of the gingival collars around the abutment teeth on the master
model (Figs. 33–35). During the try-in procedure, the
marginal fit, the shape and the contact points, the
consistency of the transgingival contours of the restorations and gingival collars around the abutment
teeth were examined carefully. The transgingival contours of the restorations should maintain the shape of
the gingiva, but not increase the pressure, allowing
the gingiva to remain healthy and maintaining the
contour in the long term (Figs. 36–39).
Revisits
The one-week follow-up after placement of the final
restorations found that the gingiva was healthy and
stable around the crowns. When compared with the
preoperative intra-oral photographs, the aesthetic outcome was a significant improvement (Figs. 1, 3, 40–43).
The patient unfortunately did not attend the remainder of the follow-ups until seven years after placement of the final restoration. At this appointment, the
examination revealed an undesirable oral health status,
with a Debirs Index (+) and Dental Calculus Index (++).
The gingiva was mildly reddened and swollen. However,
the health of the gingiva around teeth #21, 11 and 12
14 cosmetic
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was better than around any other teeth. Around teeth
#21 and 12, the gingiva was healthy and the gingival
contour was stable without noticeable gingival recession. Around tooth #11, slight gingival recession was
found with slight reddening and swelling of the gingiva. However, the aesthetic outcome of the modified
gingival contour had been maintained (Figs. 44–47).
Discussion
Shaping the transmucosal contour around implants
using provisional crowns has been frequently used in
implant dentistry. By using an individualised transfer
coping, the collar-like soft-tissue contour around an
implant can be replicated on the working model accurately.3, 16, 17 In this manner, the contour of the final
restoration will fit the exact contour of the soft tissue,
thus assuring the long-term stability of the shape and
position of the soft tissue around the implant.
In this case, the treatment protocol was drawn
from the experience of the restorative process of
implant-supported crowns. Taking advantage of the
relatively deep gingival sulcus and thick biotype, the
gingival contours around the abutment teeth were
modified by the provisional restorations; therefore,
the gingival contour was reshaped in 3-D and the ideal
aesthetic outcome was achieved.
Throughout the relatively long-term follow-up period,
the gingiva around the maxillary right lateral incisor
and left central incisor with their larger transgingival
depth and convexity was quite stable. The stability
of the gingiva around these two teeth was greater
than around the maxillary right central incisor with its
relatively shallow transgingival depth and smaller
convexity. In addition, the gingiva was healthy, proving
the effectiveness of the treatment protocol applied.
[15] =>
shaping the gingival contour case report
Fig. 43
Fig. 44
Fig. 45
Fig. 46
Fig. 47a
Fig. 47b
In this case, the treatment protocol lay between the
concept of the biologically oriented preparation technique (BOPT) and biological tissue adaptation (BTA),
both of which have gained gradual acceptance. The
BOPT approach suggests modification of the gingival
contour by provisional restorations. Once the ideal
gingival contour has been achieved, the gingival
contour is replicated to the final restorations precisely.
The BOPT approach suggests finishing the tooth
preparation without a defined shoulder so that the
gingival margin can be modified freely. In the present
case, the maxillary right lateral incisor and maxillary
left central incisor were prepared without a defined
shoulder, thus fulfilling BOPT’s requirements for tooth
preparation.18 However, for BOPT, the convexity of
the final restoration should be similar to that of the
natural teeth and could play a role in remodelling
the cemento-enamel junction. For the present case,
the convexity of the final restorations was greater
than that of the natural teeth and in that manner the
current treatment protocol differed from BOPT.
The BTA protocol suggests cutting and modifying
the gingiva in order to achieve an ideal gingival contour, and thereafter fabricating provisional restorations with a larger cervical convexity to remodel the
gingiva. Once the gingival contour is stable and meets
the requirement, the final restoration with the same
transgingival contour is placed to maintain the gingival contour.19
According to the BTA approach, cutting part of
the gingiva directly may damage the biologic width;
thus, the gingiva is stimulated to regrow. However, the
larger labial cervical convexity of the provisional or
final restoration will interfere with the regeneration
of gingiva in the vertical direction. The gingiva will
only be able to regenerate along the contour of the
restorations, and thus a gingival sulcus with a sealing
function will develop and the gingival contour will be
consistent with the shape of the restorations.19
In the BTA approach, the gingival–alveolar relationships are defined as 3-D biologic widths and the
relationship between the gingival contour and restorations is deemed to be a stable relationship.19 In
the present case, the treatment protocol differed from
BTA; however, the outcome of the final restorations
was similar.
Both BOPT and BTA are creative aesthetic gingival
treatment concepts that have been established in
recent years. The protocol applied in the current
study lay somewhere between these two approaches.
After seven years of follow-up, the maxillary right
lateral incisor and maxillary left central incisor
demonstrated better final aesthetic outcomes compared with the maxillary right central incisor, for
which the restorative procedure was close to conventional restoration. Such a result encourages some
consideration._
|
Fig. 43: One-week post-op
photograph of the right lateral view
of the patient’s smile.
Fig. 44: The gingiva around teeth
#21, 11 and 12 was healthier than
the gingiva around any other teeth.
The photograph was taken seven
years after restorative treatment.
Figs. 45 & 46: The seven-year
follow-up showed that the gingiva
of the anterior maxillary teeth
was healthy.
Figs. 47a & b: When comparing
the seven-year post-op photograph
(left) to the immediate post-op
photograph (right), the gingival
contour and position around teeth #21
and 12 were evidently stable.
Editorial note: A complete list of references is available from
the publisher.
about
Dr Feng Liu
is a Clinic Professor and Vice
Director of Clinical Division of
Peking University School and
Hospital of Stomatology. He is
also the director of the Clinical
Division Esthetic Dentistry
Training Center.
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| case Ireport
smile design
CAD/CAM
Utilising smile design software
and CAD/CAM for creating
a mock-up and final restorations
Author: Aki Lindén, Finland
Fig. 2
Fig. 7
Summary
Treatment plan
Patient
Patient photos and smile design software were
used for treatment planning and creating a digital
mock-up. A digital impression was captured with an
intraoral scanner. A digital mock-up design was
used in CAD software for designing
a wax-up. After preparations, a digital impression was taken again; the
final veneers were designed with
CAD software and created with a
milling unit.
A 32-year-old woman with hypoplastic pitted
amelogenesis imperfecta.
Introduction
Treatment planning and smile
designing have been performed
with traditional techniques for years
in aesthetic dentistry. In recent
years, various software programmes
have emerged to offer useful new
tools for digital designing. When
compared to traditional techniques, the main advantages of digital designing lie in speed, flexibility
and improved communication between the patient and the treatment
team.
Fig. 1
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Digital
smile designing
During the first
patient visit, preoperative face photos were
taken with a Canon
EOS 6D camera (Fig. 1).
Two photos were taken
of the patient—one
face photo of a smile
(Fig. 2) and one retractor image (Fig. 3).
The photos were
both carefully taken
from the same angle
using a camera stand.
The distal distance
between the maxillary
central incisors was
measured with a calliper for the calibration of the image.
Fig. 3
Fig. 4
Fig. 5
Fig. 6
The appropriate shade for the new teeth was also determined (BL3—Fig. 4, the third colour from the left).
Next, the patient’s smile photo
was imported into a smile design
software programme. The patient’s
facial proportions were analysed—
including the smile line, central line
and papillary line (Fig. 5)
The different treatment possibilities
were explained to the patient visually
with help of the software’s silhouette tool (Fig. 6). The patient
was able to take part in the
treatment planning process by
visually expressing their expectations of the
final result (Fig. 7). Ultimately, the decision was
made to treat eight anterior maxillary teeth instead
of the initially planned six, as the patient’s wide
smile revealed more teeth than average. The more
comprehensive treatment was also better in line
with the patient’s expectation of the result (Fig. 8).
To finalise the design, the patient’s retractor
image was superimposed on top of the
smile image, which enabled viewing
and modifying the gingival
area (Fig. 9).
Creating wax-up
Fig. 8
A digital impression of
the patient’s pre-op dentition was taken using an
CAD/CAM
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Fig. 9
Fig. 10
Fig. 12
Fig. 11
Fig. 13
intraoral scanner (Figs. 10 & 11). Both the upper
and lower arches were scanned and the digital impressions were immediately available for wax-up
designing.
The smile design silhouette was exported from
the smile design software to the CAD software for
wax-up designing (Fig. 12). The silhouette was adjusted on top of the digital impression and used as
a guideline for creating veneer designs in the software. The tools in the CAD software were used to
design and finalise the digital wax-up (Fig. 13).
Next, the digital wax-up was 3-D printed for
mock-up creation. A silicone key was prepared
from the 3-D printed model. Using the silicon key
and the 3M ESPE Protemp 4 Temporisation Material,
a mock-up was created into the patient’s mouth
(Fig. 14), with its fit and functionality checked. At this
point, the patient had the
opportunity to experience
the design of her new teeth
and understand the altered
feel and look (Fig. 15).
Preparations and
temporary veneers
Fig. 14
Fig. 15
Fig. 16
Fig. 17
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After confirming the
proper fit, the patient’s teeth
were prepared (Figs. 16 & 17)
and the preparations were
scanned, again using an intraoral scanner. Next, temporary veneers were created
with the same silicon key
and 3D ESPE Protemp 4
Temporisation Material. The
temporary veneers were tried
on the patient and fixed by
spot-etching.
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Creating final restorations
Once the temporary veneers had been successfully fitted, the final veneers were created from
IPS e.max CAD blocks using a milling unit. The
restorations were finished by layering ceramics
(e.max Ceram) to the labial and incisal parts for
maximum aesthetics (Fig. 18).
To conclude a successful treatment process, the
final restorations were cemented. A photo of the
end result was also taken (Figs. 19 & 20).
Fig. 19
Conclusion
Digital smile designing significantly improves
the communication between the patient and the
entire treatment team. More predictable results
make patients more confident, as they can trust
that the outcome will be in accordance with their
expectations. Patients are also pleased to be actively
involved in their own treatment and that they are
able to take part in the design process right from
the start. As a result, patient case acceptance is
improved.
Digital smile designing provides several benefits
compared to the traditional way of smile designing
with different wax-ups—it is easier, more comfortable for the patient and more time-efficient._
Acknowledgment: The author would like to thank Dr Katja
Narva, DDS, PhD, Specialist in Prosthodontics.
Utilised equipment and software: Planmeca Romexis
Smile Design software, Planmeca PlanCAD Premium software, Planmeca PlanScan intraoral scanner, Planmeca
PlanMill 50 milling unit.
Fig. 20
about
Fig. 18
Aki Lindén, CDT has an
extensive history in aesthetic
dentistry and fixed prosthetics,
as he has worked in his
own dental laboratory
in Helsinki for over 20 years.
Lindén is a recognised Opinion
Leader for Ivoclar Vivadent in
Finland, for which he regularly
serves as an instructor and lecturer. Mr. Lindén is also
a member of several aesthetic dentistry societies,
such as the Scandinavian Academy of Esthetic
Dentistry (SAED), the American Academy of
Cosmetic Dentistry (AACD), and the Society
for Color and Appearance in Dentistry (SCAD).
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| case report Inman Aligner appliance
Conservative smile design
for the general dentist
Author: Dr Rami Chayah, Lebanon
Fig. 1
Fig. 2
Fig. 1: Inman Aligner appliance.
Fig. 2: Illustration of the Inman Aligner
showing the appliance components.
Fig. 3: Inman Aligner appliance
in the mouth.
Case 1
Fig. 4: Frontal view with the teeth
in occlusion before treatment.
Fig. 5: Frontal view with slightly open
bite showing the status of the teeth
before treatment.
Fig. 6: Frontal view with the teeth in
occlusion after alignment and bleaching.
Fig. 7: Close up frontal view of
the maxillary teeth after ABB.
Fig. 8: Right side view of
the maxillary teeth before ABB.
Fig. 9: Right side view of
the maxillary teeth after ABB.
Fig. 4
Fig. 3
Abstract
thodontic treatment may accept short-term removable
alignment techniques such as the Inman Aligner system.
This article discusses the advantages of short-term
anterior tooth alignment using the Inman Aligner system, particularly for general dentists. The article will give
a brief description of the Inman Aligner appliance and its
use in short-term orthodontics, and it will answer three
major questions the general dentist should ask himself
or herself during the treatment planning process. In support of this treatment modality, three case scenarios
general dentists see daily will be given as examples.
Introduction
General dentists face the daily challenge of performing instant veneers for patients with misaligned anterior
teeth who refuse orthodontic treatment, many of whom
regard fixed orthodontic treatment as too long a commitment for achieving their desired aesthetic results. In
today’s fast-paced life, some patients are not prepared
to wait or to go through long treatments.1, 2 One of the
greatest benefits of short-term anterior alignment is
that many people who would refuse comprehensive or-
Fig. 5
20 cosmetic
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The Inman Aligner is a simple removable appliance,
a modification of the removable spring retainer. It uses
super-elastic coil springs to apply highly efficient light
and consistent forces on both the labial and lingual
surfaces of the anterior teeth (Figs. 1 & 2). The appliance is fabricated on a cast on which, based on a
surgical model, the anterior teeth needing correction
have been removed and reset in the ideal position in
wax on the working cast.3 When the patient wears the
appliance, the built-in forces generated by the spring
coils will correct the misaligned anterior teeth (Fig. 3).
What distinguishes the Inman Aligner appliance
from other short-term orthodontic systems such as
Invisalign (Align Technology) and Six Month Smiles is
its low cost, low risk and short learning curve for general practitioners. Only one appliance is used from the
start to the end of the treatment. Sometimes, several
clear aligners may be used to de-rotate resistant canines. The system is well received by patients because
Fig. 6
[21] =>
Inman Aligner appliance case report
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
it is fast and relatively cheap. It also accommodates
today’s active lifestyle. Usually, most cases take from
six to 16 weeks. Patients can take the appliance out
during meals or work meetings.
As with any other treatment techniques, the Inman
Aligner has its limitations. Hence, case selection is
imperative, as the Inman Aligner is not suitable for
posterior orthodontic treatment or Class II or III treatment. Only certain types of movements are possible
and some patients will still need conventional orthodontic treatment or indirect restorations. Certain
criteria should be met before treatment proceeds.
At consultation, other orthodontic alternatives should
be offered. The dentist must quote for the long-term
retention maintenance and should look for any skeletal discrepancies. Compromises must be signed off.
Treatment concept and case presentation
Dentists need to consider three questions about
treatment during the treatment planning process.
The first question: can the patient’s teeth be fixed
Fig. 13
without orthodontic treatment in a very short period?
In order for the general dentist to answer this question, he or she should first establish whether the
patient does not wish to pursue orthodontic treatment because of the time commitment and cost.
Would he or she also refuse short-term anterior tooth
alignment? Would the occlusion be improved even
though a Class I molar or Class I canine relationship
may not be achieved? Patients may prefer shortterm alignment techniques because of the shorter
treatment time and the lower cost.
Case 1
The first case presented is a good example of a
scenario relevant to the question above. The patient
was a young woman at college who presented at my
office requesting a full smile makeover of 20 veneers;
she desired a “Hollywood smile” as expressed in her
own words. Her complaint was the retracted maxillary right and left central incisors, the incisal edge
wear on the maxillary central incisors and mandibular
anterior teeth, the pointy shape of the maxillary and
|
Fig. 10: Left side view of
the maxillary teeth before ABB.
Fig. 11: Left side view of
the maxillary teeth after
alignment and bleaching.
Fig. 12: Full face before treatment.
Fig. 13: Full face after treatment.
Fig. 14: Frontal view showing
the patient’s natural smile
before treatment.
Fig. 15: Frontal view showing the
patient’s natural smile after treatment.
Fig. 16: Full face showing the
patient’s natural smile
before treatment.
Fig. 17: Full face showing the
patient’s natural smile after treatment.
Fig. 18: Occlusal view showing the
maxillary arch before treatment.
Fig. 19: Occlusal view showing the
maxillary arch after treatment.
Fig. 14
Fig. 15
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[22] =>
| case report Inman Aligner appliance
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Case 2
Fig. 20: Frontal view showing
the overlapping central incisors
before treatment.
Fig. 21: Side view showing the
overlapping central incisors
before alignment.
Fig. 22: Frontal view showing
the teeth after alignment.
mandibular canines, and the yellow colour of her
teeth overall (Figs. 4 & 5). It could be argued that
it would be highly unethical to prepare the sound
enamel, transforming her ten maxillary teeth into
stumps, for the rest of her life, especially at this young
age. After long discussion and explanation of the
disadvantages of the shortcut route of preparing her
teeth for ceramic veneers, this option was excluded.
Several other options were available and discussed
with her, but because she wanted a smile enhancement
in a short period of time, conventional fixed orthodontic treatment was also excluded. After checking
her bite, it was observed that there was insufficient
interocclusal space to shift the maxillary central
incisors forwards without opening the bite. However,
the patient accepted use of the Inman Aligner system
owing to its short treatment time and flexibility regarding being able to take the appliance off during
the day while eating.
The treatment plan was to follow the ABB protocol
(alignment, bleaching and bonding). This concept
still constitutes a smile makeover but in a very conservative manner. Taking into consideration her age
and her sound enamel tissue, this was agreed to be
the most progressive means of carrying out her smile
enhancement. First, her maxillary teeth were aligned
using the Inman Aligner with an expander for nine
weeks. Two extra-clear aligners were used in the last
two weeks of treatment to de-rotate the maxillary
left lateral. Once the maxillary teeth had been aligned
and in the last two weeks of treatment, the teeth
were bleached with custom-fitted super-sealed trays
(Fig. 6). Now that the teeth had been straightened
and whitened, the patient became more aware of the
differential wear on the incisal edges of her anterior
maxillary and mandibular teeth. Incisal edge bonding
using composite was completed using a simple direct
technique. The patient was very happy with the final
result (Figs. 7–19).
Case 2
Fig. 20
Fig. 21
Fig. 22
Fig. 23
Fig. 24a
Fig. 24b
22 cosmetic
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1 2016
The second question to be considered regarding
treatment: would some of the teeth be aggressively
prepared or end up with root canal treatment if
treated with restorative dentistry without alignment
and would the overall outcome be better with alignment rather than without? This question addresses
the ethical dilemma general dentists face every day.
We often have cases with overlapping anterior central incisors in our office.
The patient presented in this case was bothered
by the look of his overlapping maxillary central incisors (Figs. 20 & 21). His mandibular teeth were also
crowded, but for some reason, his concern was only
with his maxillary teeth. He had started to hide his
smile in front of his friends, feeling embarrassed to
show his maxillary teeth. After the full orthodontic examination and discussion about all of the treatment
options, including comprehensive orthodontic treatment, the patient chose the removable Inman Aligner
system owing to its flexibility in that the wearer is able
to remove the appliance for several hours a day and
because of its short treatment time. The maxillary left
central incisor would have been aggressively prepared
Fig. 20
[23] =>
Inman Aligner appliance case report
had it been treated restoratively.7–9 By using a simple
anterior alignment technique, the treatment took
only eight weeks to straighten the teeth and a great
deal of sound enamel tissue was preserved by conservatively resolving the unattractive appearance of
the maxillary teeth (Figs. 22 & 23).
short-term tooth alignment alone or in conjunction
with restorative dentistry when treating patients.
Hopefully, these three questions and cases will
prompt readers in thinking through the process of
this treatment modality._
|
Fig. 23: Side view showing
the teeth after alignment.
Figs. 24a & b: Side views showing
the moderately crowded and
worn teeth before treatment.
Case 3
The third question to be considered: will the teeth require restorative work anyway, even after alignment?
Fig. 20
The case presented serves to demonstrate the necessity of aligning the teeth even before placing ceramic veneers.10–13 The patient in this case exhibited
moderate misalignment with major anterior edge wear
due to occlusal trauma. In addition, the teeth were
darkened through years of stains being absorbed
through the worn dentine of the incisal edges (Fig. 25).
The patient initially requested instant veneers to resolve his smile problem, but after mocking up the design directly in his mouth, he was discouraged from
pursuing this option owing the amount of tissue that
would be lost. The aggressive preparation of the tissue
was explained to him using the occlusal image of
his maxillary teeth. After an extensive orthodontic
examination and discussion of the options, the patient
refused fixed orthodontic treatment, as well as clear
aligners. He refused the first option because he did
not want anything fixed in his mouth, and he refused
the second option because of the proposed time involved. The Inman Aligner system was introduced to
the patient, and he quickly accepted this option owing
to the short treatment time and removability.
The treatment plan was to align the teeth first and
then to reassess the restorative work needed (Fig. 26).
The appliance was used for 12 weeks and only worn
for 16 to 18 hours a day. During the last three weeks
of alignment, the patient began to bleach his teeth.
By week 12, the teeth were straight and white (Fig. 27).
At this point, a direct mock-up was done to show the
patient the smile design that could be achieved with
composite. He felt that the teeth were still flat and
wanted a fuller smile. Because we had aligned the
teeth, only minimal preparation was needed as evident
from the wax-up and the decision was made to fabricate ceramic veneers instead (Fig. 28). This case shows
that for complex situations and considering patients’
high aesthetic demands, pre-alignment is essential
to produce minimally invasive veneers with minimal
enamel loss. This clinical approach guarantees that the
strength of bonding to the enamel is much greater.
Conclusion
The goal of this article is to encourage general
dentists to reflect on the importance of considering
Fig. 25
Fig. 26
Fig. 27
Fig. 28
Disclosure: Dr Chayah is the trainer for Inman Aligner
Training in the Middle East. He provides hands-on full-day
certificate courses to general practitioners.
Acknowledgement: I wish to thank Dr Tif Qureshi, the
founder and Director of Inman Aligner Training in London,
for his mentoring and sharing the last case in this article.
Editorial note: A complete list of references is available from
the publisher.
Case 3
Fig. 25: Occlusal view showing
the tooth misalignment.
Fig. 26: Occlusal view showing
the result of treatment.
Fig. 27: Maxillary teeth after
alignment to reassess
the restorative work needed.
Fig. 28: Natural-looking thin maxillary
veneers owing to aligning
the teeth first.
contact
Dr Rami Chayah
runs a cosmetic dental practice
in Lebanon with an emphasis
on minimally invasive dentistry.
He seeks to share his passion
for photographic and video
production and believes that
through his personalised dental
approach, he can demonstrate
a more positive way of practising dentistry, helping
other dentists to view the dental
domain in a different way.
You can reach Dr Chayah through his social media
links: www.facebook.com/ramichayah and
http://instagram.com/ramichayah
www.inmanalignertraining.com
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[24] =>
| feature interview
“We will be able to treat
pretty much everything
in the future”
An interview with Dr Graham Gardner, UK, President of the European Aligner Society
The European Aligner Society is an international
organisation established in 2013 that aims to promote education and research in aligner therapy.
Trained in South Africa and with 22 years of clinical
experience, Dr Graham Gardner has been running
his own private practices in the UK since 2008.
In an interview with Dental Tribune International,
the EAS President shares his ideas and views about
the importance of aligners in orthodontics and
about the EAS, which he believes will become the
society for aligner therapy.
DTI: Dr Gardner, you have been working with
aligners for more than a decade now. What
convinced you initially of this treatment method
and what are the main advantages in your
experience?
Dr Graham Gardner
Dr Graham Gardner: From the beginning of my
career in the early 1990s, a time when ceramic
brackets and lingual braces became available, I was
certainly aware of the fact that aesthetic appliances
were going to be the future of orthodontics.
In 2001, I was fortunate to attend a certification
course for Invisalign, which was truly a watershed
moment in my orthodontic career because I saw
the value and potential of aligner therapy for both
dental professionals and patients. In my opinion,
aligner therapy opened the door for a huge cohort
of patients who would not have considered orthodontic therapy in the past mainly owing to aesthetic
concerns. In addition to aesthetic benefits, aligners
are far more comfortable than fixed appliances, as
they are removable and hence facilitate oral hygiene
during therapy.
They also move the teeth more gently with less
pressure, which is favourable with regard to patient
comfort and from a biological perspective too.
24 cosmetic
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1 2016
Today, I treat over 75 per cent of patients with
Invisalign in my practices.
In recent years, clear aligners have become a
favourable treatment alternative to fixed appliances, and the global orthodontic supplies
market is expected to reach about US$3.9 billion
(€3.6 billion) by 2020. In your professional
opinion, how will this market develop in the near
future?
Over the past decade, aligners have become
mainstream orthodontics and I definitely see this
trend continuing and expanding.
With the technological advancements, including
3-D and CAD/CAM, that allow the clinician to diag-
[25] =>
feature interview
|
“...the advancements we are now
seeing in Europe will match those in
America and Asia...”
nose, plan the treatment and confirm biomechanics
in a far more in-depth way than ever before, orthodontics is now catching up with the high-tech world
we live in—it is twenty-first-century orthodontics.
When aligners were first introduced to the market, there were some limitations and we could only
treat mild malocclusions. However, aligner therapy
has come of age and is now a genuine appliance
system with which we can treat the majority of
malocclusions.
At the moment, however, aligner therapy is still a
fairly expensive form of orthodontics. Thus, I hope
that improvements in materials and 3-D printing
will render manufacture and the product itself
more cost-effective. For example, 3-D printers
could allow individual practices to print their own
aligners in the future.
Overall, with technological advancements and increasing patient acceptance, we will be able to treat
pretty much everything in the future in my view.
How have developments in the European and
the overseas market differed?
Dentistry as a profession is very conservative and
dentists in the US, for example, are perhaps a bit
more progressive. However, with regard to aligners,
I no longer really see a great difference between
Europe and America. The movement is global and
I suspect the advancements we are now seeing in
Europe will match those in America and Asia, where
cosmetic
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[26] =>
| feature interview
aligner therapy is also very popular. There are always
regional differences, also partly related to legal
restrictions, but the trend towards aligner therapy
is a global phenomenon.
and grant annual awards for excellence in aligner
therapy.
How does the EAS address the current trends in
orthodontics?
With the help of our sponsors, the EAS will grow
and become an international umbrella organisation
to help promote education and research and development for aligner therapy.
Aligner therapy has seen huge advancements
over the past decade, with an increasing number of
manufacturers offering different systems today.
The EAS is a fairly young organisation and hosted
its first congress on 13 and 14 February in
Vienna. What was the idea behind this event?
“...aligner therapy opened the door for a huge
cohort of patients who would not have considered
orthodontic therapy in the past...”
The EAS’s primary objective is education because,
obviously, education underpins every profession
and without it we simply stagnate. Therefore, we
decided that our first event should be a congress
held in the heart of Europe offering a broad spectrum of informative lectures and a showcase of
different systems and products. At the first congress
in Vienna, internationally distinguished speakers
shared their views and expertise about aligner
therapy. Moreover, the event offered manufacturers an independent forum for exhibiting their
solutions.
Thus, the main motivation behind the foundation
of the EAS was to establish a neutral body—an international society that is independent of any aligner
company and open to all dentists using aligners for
orthodontic treatment.
The work of the EAS is characterised by three cornerstones. The first is education, namely arranging
conferences and regional meetings and introducing
clinical online forums, through which members
can interact and share experiences and ideas. The
second column of the EAS’s philosophy is communication. We aim to be a neutral organisation that
patients can turn to for comprehensive information
about aligner therapy and that members can consult for guidelines. Research is our third column,
which is currently lagging behind. Eventually, we
hope to have our own aligner journal or magazine
26 cosmetic
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1 2016
Can dental professionals look forward to another
EAS congress next year?
Based on the success of the inaugural event over
the past weekend, we definitely want the congress
to become a regular event in the calendar. While we
are planning to hold the EAS congress every two
years, we will be organising smaller regional forums
on a continuous basis throughout every year.
Thank you very much for the interview.
[27] =>
www.DTStudyClub.com
Y education everywhere
and anytime
Y live and interactive webinars
Y more than 500 archived courses
Y a focused discussion forum
Y free membership
Y no travel costs
Y no time away from the practice
Y interaction with colleagues and
experts across the globe
Y a growing database of
scientific articles and case reports
Y ADA CERP-recognized
credit administration
Register for
FREE!
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof 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.
[28] =>
Light and the
biological clock
© Viktorija Reuta
| feature wellbeing
Author: Antonín Fuksa, Czech Republic
Introduction
Temporal rhythms can be found throughout
the whole natural world. The circadian (from Latin
circa—around, diem—day) have been discussed in
the magazine Svetlo (Czech lighting journal) several
times in a past few years. The expression ‘circadian’
was introduced in the 1950s by Franz Halberg, one
of the founders of chronobiology, the science of
temporal order in the living realm. From Czech chronobiologists, Prof Helena Illnerová and her team are
the most well-known for the discovery of melatonin
secretion variation in rats, which depends on light
exposure changes over the four seasons, as well as for
the discovery of photosensitivity in the biological
clock in suprachiasmatic nuclei in hypothalamus.1,2
Fig. 1: Daily rhythms
of the human body.
Fig. 2: C1,2—possible shapes of
relative sensitivity of Circadian sensor,
smel—the 2015 Melanopic action
spectrum and V( ) – the spectral
luminous efficiency function.
Fig. 1
In the autonomous nervous system of mammals,
the central biological clock is found under the crossing of optical nerves in the suprachiasmatic nuclei
(SCN), which controls hormone levels in blood, body
temperature, sleep and alertness, to name just a few.
Melatonin is the hormone governing sleep and body
regeneration, while cortisone is the hormone connected with activity, stress and motion. Examples of
levels observed, courtesy of Philips Lighting, are
shown in Fig. 1.3 The patterns of the curves vary
slightly each day.
The central biological clock is synchronised by
light, but food intake also matters. In young hu-
mans, this clock has a circa of 24 hours when
running free of light synchronisation, which is the
origin of the term 'circadian'. Individual organs
have their local clock synchronised with the SCN
‘master’ clock. Light is the strongest synchronizing agent (Zeitgeber). A dose of several lux of
suitable spectral distribution for several minutes
can already cause level of melatonin in blood to
decrease.
Effects of light on living organisms
Prof. Fritz Hollwich, an author of an ophthalmology
textbook and inventor of many procedures in ophthalmology, has studied these effects closely. In his
inaugural dissertation from 1948, he distinguishes
the visual and energetic (non-visual) function of
the eye. He found that patients suffering blindness
due to cataracts had different levels of certain hormones and other markers in the blood, compared to
the normally sighted population. When the patients
regained their sight after an operation, the levels
returned to normal. He also found that some distributions of light, lack of light or excess light or its
invariance have adverse effects on organisms. In the
last few years, a novel photoreceptor—intrinsic photosensitive retinal ganglion cells (ipRGCs) is often
discussed. These had already been found in mice back
in 1991 and in humans as late as 2007. ipRGCs contain melanopsin photo pigment, which maximum
sensitivity is reported between 450–482 nm (rarely
Fig. 2
28 cosmetic
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[29] =>
feature wellbeing
also between 420 nm and 491 nm). These cells project
the synchronisation event to the central biological
clock, they also play a part in the pupil reflex and they
may also contribute to the visual sensation. They are
spread all over the retina, but are more numerous in
its lower part.
They are called the circadian sensor or blue-sky
sensor for their high sensitivity to blue and spatial
distribution on the retina. The latest research5 shows
that the synchronisation signal is also assisted by the
cones, and the exposition time also plays an important part. The effects of two narrowband lights with
wavelengths of 460 nm and 555 nm were compared:
their initial effect on melatonin decrease was almost
the same, however, in the case of the green light,
the effect ceased after about 90 minutes, while the
blue light effect persisted. C1( ) hence shows the
long-term sensitivity while the C2( ) takes the shortterm effects into account. Two effects are observed:
melatonin level decrease and phase-shift of the
central biological clock.
Figueiro and Hubalek described the construction
of a circadian dosimeter (Daysimeter, LuxBlick).6,7
It is a small instrument that is worn like spectacles.
Two photodiodes are used as sensors, one corrected
by a filter to V( ) and the second to C( ). Measured
values are stored along with timestamps in intervals
of tens of seconds. Analysis of the data can show
whether the user gets a sufficient dose of the light
affecting the nervous system and whether or not he/
she is disturbed by light at night. Critical points can
be localised in time so a remedy may be suggested.
Data from additional sensors like an accelerometer or
a thermometer can make interpretation of the light
data easier.
Decreasing of the melatonin level in the morning
and keeping it low during the day is naturally beneficial as it starts a number of processes that lead to
higher alertness, activity and concentration. Light
sources of higher chromatic temperature can provide spectrum rich in the circadian-efficient band.
According to the Kruithoff curve, we can expect the
users to require higher levels of light in their place of
work, which can be also aided by local luminaries.
Higher illuminance and higher chromatic temperature can have tangible economic outputs in the
workplace thanks to a better quality of workmanship8, lowering stress4, better use of work time or
lowering sick leave. Melatonin is a hormone of sleep
and regeneration of the organisms. It scavenges free
radicals and kills cancer cells in the body. So it is most
beneficial to let it do its job undisturbed during the
night. The means for lowering disturbing night light
include a more sophisticated design of street lamps,
curtains, window blinds, shutters or red night light.
|
White LEDs are mostly blue LEDs with a phosphor
that converts part of the blue light into wideband
yellow, which then mixes with blue, making white.
This introduces a risk of disturbing the darkness at
night by LED streetlights. Blue light gets far more
scattered in the atmosphere than the longer wavelengths, so disturbing scattered light should also be
considered. According to the International Dark-Sky
Association (IDA), LEDs with a low chromatic temperature (2,600 K) are suitable for street lighting.9
However, even in this case, the portion of circadianefficient light is three to four times higher than in the
more commonly used high-pressure sodium lamps
(see Table 1, page 30).
Calculation and measurement
Circadian values were introduced in parallel with
photometric values by Gall and Lapuente.10 Function
V( ) is replaced with C( ) and index c is used with
the values. In this way, we can consider ‘circadian
illuminance’ for example. Circadian illuminance can
be measured with a luxmeter corrected to circadian
efficiency C( ). For coarse relative measurements,
a Lee 120 gel filter can be used. Another option is
calculation from the spectrum or establishing a
factor for converting ‘photopic lumens’ to ‘circadian
lumens’ for a given light source. A factor of circadian
efficiency acv (Zircadianer Wirkungsfaktor in German) is introduced.10 This is calculated for light of
relative spectral distribution of power according to
Equation 1.
780
acv {X(λ )} =
K m ∫ X(λ )C(λ )dλ
380
780
K m ∫ X(λ )V (λ )dλ
380
780
∫X
D65
(λ )V (λ )dλ
acv λis)}a= 100
factor for converting
photometric
Ac {X(
acv {X(
λ )} ≈ 106, 25avalues
cv {X( λ )}
X
(
λ
)C(
λ
)d
λ
into circadian∫values
for a given light source. It can
D65
380
780
380
be used to compare different lights or light sources
from the perspective of their effect on our nervous
system.
The shape of the curve C( ) and the area under
it are not exactly known yet. This is why another
factor can be introduced to allow a comparison of
the results calculated with the presently known
shape of C( ), and those based on an updated C( )
in future. The factor can be defined in different
ways, for example the equality of areas under C( )
and under V( ) or by the equality of luminous
and circadian flux for CIE A incandescent bulb
model.10 The option proposed here for discussion
is Circadian Activation Index Ac (CAI). Its value is
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[30] =>
780
| feature wellbeing
acv {X(λ )} =
K m ∫ X(λ )C(λ )dλ
K
380
780
∫ X(λ )V (λ )dλ
definedm= 100 for CIE D65 illuminant. Ac is calculated
according to Equation 2.
780
380
∫X
D65
(λ )V (λ )dλ
∫X
D65
(λ )C(λ )dλ
380
Ac {X(λ )} = 100 780
380
acv {X(λ )} ≈ 106, 25acv {X(λ )}
Ac makes it easy to compare the impact of different lights on the nervous system. It has a value
of 100 for the reference D65 daylight. Values for
some common light sources and black body temperatures are tabulated in Table 1. Besides the daily
rhythms, physiological rhythms of high/low tide,
weekly rhythms, lunar and annual rhythms are
known.
Table 1: Examples of Ac values.
Lack of light during winter contributes to sleepiness and the need for longer sleep, but also to seasonal affective disorder (SAD), known as the winter
blues. This can be treated by bright light therapy
(phototherapy); 10,000 lux at eye level for 30 minutes
is a proven efficient dose.11 For personal application,
sunshine simulators are used. In contrast to industrial sun simulators, these are luminaries for illumi-
Light source
Specification
Ac (–)
Daylight
D65
100
Black body
2,700 K
4,000 K
5,000 K
6,500 K
8,000 K
20,000 K
100,000 K
36
64
82
100
116
156
181
Fluorescent
Warm white 827
Cool white 840
Daylight 950
Cool daylight 965
Blue
2,700 K
4,000 K
5,000 K
6,500 K
TL-D Blue
27
55
83
95 to 105
740
Incandescent
General
Halogen
2,800 K
2,900 K
36
40
Warm white
Cool white
(daylight)
Blue
Green
Red
2,850 K
6,800 K
450 nm
520 nm
630 nm
36
90
875
52
0,4
High pressure
Low pressure
4,200 K
6,500 K
8 to 13
0,2
69
100
LED
Arc lamp
Sodium
Sodium
Metal halide 942
Metal halide 965
30 cosmetic
dentistry
1 2016
nating the eyes and face. Desk or wall luminaries with
fluorescent lamps are well known (usually providing
10,000 lux at the diffuser). Portable battery-powered
luminaries with white or blue LEDs are also available
on the market. Less known are light visors with
embedded LEDs for illuminating the eyes. These aids
can ease the start of a new day, but for a permanent
effect, lighting with sufficient circadian effect is
needed all day long.
Appendix
This article was first published in Czech Republic
in Svetlo magazine in 2010.12 Since then, a new
technical rule DIN SPEC 5031-100 has been published,13 specifying a new shape of ipRGCs sensitivity curve, now called smel( ) peaking at 490 nm,
see Fig 2. A new term ‘melanopic’ is now preferred
for non-image forming effects of light. A melanopic
conversion factor mV, mel, D65 has been defined to
compare various lights with D65 daylight (Ac /100
equivalent).
Dental surgery is one of the most visually demanding tasks involving high contrasts. With melanopic
effects of light in mind, DentaSun ‘above-the-chair’
dental luminaires have been developed by NASLI.
Better light ergonomics, improved sight performance and minimalised eye fatigue are achieved by
an advanced approach in lighting based on nonvisual effects, along with a lower perceived contrast
and an emphasis on light uniformity.
Electric light has been known to alleviate SAD
since the 1980s. Nowadays, full spectrum light
is used to treat general depression and to restore
sleep/wake cycle to improve all kinds of conditions including dementia or Alzheimer disease.
NASLI phototherapeutic luminaires are used in
bright light therapy, dawn/dusk simulation, wake
therapy and programmable all-day phototherapy.
Chronobiological methods of treatment received
statutory healthcare funding in 2015 in the Czech
Republic._
Editorial note: A complete list of references is available from
the publisher.
about
Antonín Fuksa graduated (MSc) in 2000 at the
Czech Technical University in Prague, Faculty of
Electrical Engineering in the field of study Measurement
and instrumentation. He currently works as a developer
of intelligent luminaires, smart lighting systems and
chronobiological phototherapy devices in NASLI.
[31] =>
[32] =>
| opinion significance of teeth
What do our teeth
betray about us?—Part II
Author: Dr Stanislav Cícha, Czech Republic
FIRST PREMOLARS
How would we like to display
ourselves on the outside
our ego, our desires
Realization of our plans
Our desires
in the emotional area
Expressing of our wishes to
the nearest surroundings
Fig. 1
In the first part of this article series, I described
the significance of individual teeth in terms of
emotional and health status, considering specifically the canines. In the second part, I will focus
on the premolars and molars. The first premolars
represent our desires and our own self, simply
described with the words “I want” (Fig. 1). The maxillary right first premolar reflects how we would like
to appear on the outside and the left one represents
our emotional desires.
SECOND PREMOLARS
Our development in the outer
world, our plans, children
our creative ego, our children,
our hobbies
Realization of our plans,
particularly in our profession
Utilization of hereditary
mother´s energy
Fig. 3
32 cosmetic
dentistry
Our natural talents, karma
1 2016
Fig. 2
The maxillary first premolars are among the
most frequently treated teeth, with interventions
ranging from fillings to endodontic treatment,
crowns and extractions (Fig. 2). This does not come
as a surprise, since every day we are confronted
with notions perpetuated by the media regarding
how we should look and what we should buy
to reach this ideal. Instead of fulfilling our true
emotional desires, we are urged to follow the
crowd.
The mandibular right first premolar reflects the
ability to realise our goals and the left premolar
shows our ability to convey our feelings and wishes
in our environment. With the first premolars, there
arises the question of orthodontic extractions.
The author of the book Quand les dents se mettent
à parler (When the teeth talk), Dr Michèle Caffin,
mentions that extractions of first premolars weaken
the sense of self, and children with extracted premolars tend to submit easily to authority figures
despite not wanting to do so. I cannot confirm nor
refute this, as I have only had a few patients who
have undergone this treatment and was not able to
observe them over a longer period.
The second premolars can be characterised by the
sentence “I want to create” or the term “our creative
[33] =>
significance of teeth opinion
Fig. 4
ego” (Fig. 3). The maxillary right second premolar
represents our development in the outside world,
our children and our hobbies, and the left second
premolar our natural abilities. The mandibular
right second premolar, similar to the adjacent first
premolar, reflects the ability to realise our goals,
particularly in our professions. After the reconstruction of anodontia using an inlay bridge, an
indecisive young female patient successfully finished school to the great joy of her parents (Fig. 4).
In contrast, Figures 5 & 6 are photographs of
patients who always used to come second place in
their career progression.
The mandibular left second premolar indicates
the assimilation of the maternal energy in our lives.
Lingual inclination, the persistence of primary
tooth #75 and its reinclusion point to the situation
in which a child does not want to or cannot mature
into an adult. Behind this is often the dominant
influence of the mother, similar to the case of retrusion of tooth #22, which we learnt about in the
first part of this article series.
Fortunately, mothers generally do not know
about these effects. Thus, after successful orthodontic treatment initiated by them and the subsequent realignment of the permanent second premolar, they are very surprised by the transformation
of their once-obedient child with a self-conscious
personality.
The first molars (Fig. 7) are closely associated with
the status that we desire both in society and in our
families. Fulfilling ideals to improve our position in
society is linked to the maxillary and mandibular
right first molars, and they reflect our professional
lives and our successes in this regard. The patient
shown in Figure 8 had to leave her beloved profession owing to family circumstances. She had to
move and stay at home. After having endodontic
treatment performed on teeth #15 and 16, she presented with a large periapical lesion on tooth #16
several years later (Fig. 9). She probably has still not
accepted her new situation.
Fig. 5
|
Fig. 6
The maxillary left first molar reflects the expression of our feelings. As this is often suppressed in
our modern society, this tooth is treated very often.
FIRST MOLARS
The place which we want to
achieve in the society
position which we want
to achieve
Our job, profession
The effort to express
our own feelings
Our desire to be loved
Fig. 7
The mandibular left first molar reflects our desire
to be loved. This tooth is restored often and from
very early on, a sad finding in this context. As an
example, Figures 10a–e shows a female patient who
Fig. 8
Fig. 9
cosmetic
dentistry
1
2016
33
[34] =>
| opinion significance of teeth
Fig. 10a
Fig. 10b
Fig. 10c
Fig. 10d
Fig. 10e
broke this tooth after a failed relationship. A radiographic examination revealed that all of the other
teeth remained intact.
The left second molars can show how harmonious the relationships with our family members are.
I had a juvenile patient who was struggling to cope
with an ongoing love triangle in his family. Endodontic treatment was indicated for his maxillary
left second molar, yet the entire dentition showed
hardly any tooth decay (Fig. 12). His brother, who
did not have to deal with such a situation, did not
have any dental problems. In this context, I would
like to emphasise that teeth reflect life circumstances according to the subjective perception of
the person concerned.
The second molars reflect our relationships with
the world around us and in particular with our closest relatives (Fig. 11). Both right second molars reveal, through their status and alignment, ordinary
circumstances of daily life. Long-term recurring
situations, often considered trivial in our contexts,
that annoy us but that we are not able to change
may manifest in these teeth.
SECOND MOLARS
Outer circumstances
of daily life
our relationships with the surrounding world,
how do the near people respond to us
Outer circumstances
of daily life
Relationships with
the nearest people
Fig. 11
34 cosmetic
dentistry
Relationships with
the nearest people
1 2016
Fig. 12
[35] =>
significance of teeth opinion
|
THIRD MOLARS
The effort to contract the
material and spiritual world
expression of individual energy
The ability to share our feelings
with the surroundings
The fears of rejection of
both spiritual and material world
Physical energy
Fig. 13
As dentists, third molars are usually of marginal
interest to us, except for surgeons and endodontists, who can show off with perfectly filled
root canals of bizarre shapes in these teeth. From
a holistic perspective, however, third molars express the individual energy of a person (Fig. 13).
The maxillary right third molar corresponds to our
efforts to contact the material and spiritual worlds.
The maxillary left third molar represents the fear
of rejection by both these worlds. The mandibular
right third molar is a barometer of our physical
energy.
If one looks at the characteristics of all third
molars, one will discover the typical adolescent
problems a young person faces at the time of
eruption of these teeth. For example, I repeatedly
see complicated eruptions of mandibular third
molars in students during the examination period,
when they are weaker both mentally and physically. I adopt a very conservative approach towards radical and preventive extractions of the
third molars because I consider them to play an
important part in the energy balance of the whole
organism.
In order to learn much more about this topic,
I recommend that you read a book by French dentist
Dr Michèle Caffin, Quand les dents se mettent
à parler (When the teeth talk). I wish you many
interesting discoveries in observing the manifestations of the professional and emotional lives of
your patients in their teeth._
Fig. 14
Fig. 14: Czech edition of a book by
Dr Michèle Caffin, Quand les dents se
mettent à parler (When the teeth talk).
contact
Dr Stanislav Cícha
is working as a dentist in Prag
in the Czech Republic.
He can be contacted at
mojezubysro@gmail.com.
Editorial note: This is the second of a two-part article
which first appeared in Cosmetic Dentistry 2/15. A complete list of references is available from the publisher.
cosmetic
dentistry
1
2016
35
[36] =>
| practice management SWOT analysis
Eleven tips for success
in your dental clinic
Part I: SWOT analysis and loyal patients
Author: Dr Anna Maria Yiannikos, Germany & Cyprus
During this journey towards business growth and
educational development with this new series on tips
for success in your dental clinic, I am going to explore
various factors of our success and professional development as dental practitioners. I will share with you
the knowledge I have gained within the past 24 years
of managing and evolving my clinic, so you can be one
step ahead and avoid the mistakes I made, starting
with the first tip: know yourself, which entails acknowledging your mistakes. It is an extremely useful
and sometimes painful process.
How can we really learn the areas in which we need
to improve ourselves (clinics) and in which we are advanced? The answer is through the use of an essential
36 cosmetic
dentistry
1 2016
tool we ought to use every six to 12 months, SWOT
analysis. With this tool, we will be able to discover
and recognise our strengths and weaknesses as both
dentists and individuals, as well as identify opportunities for and threats to our clinics. Let us analyse this
a little bit further.
Strengths
· What do you consider as strengths, as your competitive advantages in your dental clinic?
· Do you offer a large variety of services that fulfil
your patients’ needs?
· Can your patients find you and book an appointment easily with your clinic?
[37] =>
SWOT analysis practice management
|
Opportunities
What are current social, financial or other trends
that you could benefit from? For example, the demand for invisible braces for adults could be useful for
an orthodontist to explore. The general dentist could
consider including an aesthetic treatment based on
the latest trends, such as whitening or restoration
with white aesthetic material.
Threats
Is there anything happening in your environment
that could be detrimental to your clinic? For example, a larger and newer clinic is to be opened in the
neighbourhood or an existing competitor clinic is
installing better technological equipment than that
in your clinic. Other threats include political and
environmental ones, such as an unstable political
situation.
As a conclusion, it is evident that performing a
SWOT analysis for your dental clinic will allow you to
be proactive in your marketing strategies, since you
will have the information necessary to develop effective strategies for the promotion of your clinic.
The second tip of this article is realising the importance of having patients who are not just satisfied but
loyal. In order to understand the significance of this,
let us explore the major difference between these two
categories.
Satisfied patient
© Rawpixel.com
· Is your clinic characterised by high-technology
and do your patients appreciate this?
· Is your dental clinic in a convenient location, allowing your patients to find you and reach you with
ease?
Weaknesses
· What are the areas that need improvement at your
dental clinic?
· Are your payment options inflexible?
· Do patients have to wait for more than 5 minutes
for their appointment in the waiting area? Is the
clinic decoration old and out of fashion? Should
you change it?
A satisfied patient is one who comes to the clinic for
treatment and is not unhappy with the treatment or
the service provided, but when a friend, a relative or a
colleague proposes that he or she visit another dentist
would do so. Such a patient too would not refer the
clinic to others or tell others about your good treatment.
Loyal patient
A loyal patient, however, is one who will spread
through word of mouth what a wonderful dentist you
are, and what a brilliant scientist, advising others to
visit your clinic and promoting your well-being. This
is a patient who comes to your clinic regularly, is appreciative of your treatment and demonstrates this.
It is important to understand that we do not deliver
a service in isolation, but as part of a culture, the culture of our clinics through the experience that our
patients receive. They do not expect us to be the best
just in our health care industry. We have to be the best,
period. Our patients will not compare us only with
cosmetic
dentistry
1
2016
37
[38] =>
| practice management SWOT analysis
© shutteratakan
other dentists but with all the services they receive
and have experienced, such as in a hotel or a restaurant. Our competitors are anyone with whom our
patients can compare us. People have expectations
regarding how they should and want to be treated
and these become the standard by which they judge
their experiences.
When nothing in particular about an experience
stands out, this indicates that one was merely satisfied. It takes something memorable to turn an ordinary experience into something special. Dissatisfaction comes from something bad that one experienced
and remembers; loyalty is created through memorable things that happened that one did not expect.
If our treatment is not memorable, why would patients continue coming to us?
Another essential question is how do we establish
the areas in which we are lacking and in which we
should improve our clinics to increase the group of
loyal patients? The answer of course is nothing but
obvious: by asking. We can obtain patients’ opinions
through satisfaction surveys.
Several studies have highlighted the growing impact of patient satisfaction on the business success of
dental clinics. In a more recent study, those patients
surveyed cited being unhappy with their dentist as
being their main reason for changing dentists.
38 cosmetic
dentistry
1 2016
Our goal is to discover what the most important
factors for patients are in order to foster their loyalty,
as well as determine the areas in which we are underperforming in order to improve ourselves and the
treatment we offer our patients.
The two tips provided in this article are a good start
for all dentists in order to begin the improvement and
evolution of our clinics, as well as ourselves. In the
next part, I will offer two new tips that will reveal opportunities and potential of your dental clinic. Until
then, remember that you are not only the dentist in
your clinic, but also the manager and the leader._
Editorial note: This article is the first one from the two parts
series. Part II will appear in Cosmetic Dentistry 2/2016.
contact
Dr Anna Maria Yiannikos
Adjunct Faculty Member
of AALZ at RWTH Aachen
University
Campus, Germany
DDS, LSO, MSc, MBA
dba@yiannikosdental.com
www.dbamastership.com
[39] =>
Dubai Clinical Masters Program
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in Esthetic and Restorative Dentistry
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(Based on your schedule, you can register for this program one session at a time.)
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this course is created
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Tribune Group GmbH is an 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.
100
C.E.
CREDITS
Certificates will be
awarded upon completion
Tribune Group GmbH 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 province board of dentistry or AGD
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[40] =>
news
international markets
SHOFU: “We see the fastest growth coming from China”
SHOFU Dental Asia-Pacific attended the UAE International Dental Conference and Arab Dental Exhibition (AEEDC) in Dubai this year to introduce its
new abrasive and restorative materials to professionals in the Middle East. The global
dental materials and equipment
manufacturer has been eyeing the
region for a long time, but ongoing
market restrictions remain a challenge. However, SHOFU is also targeting countries in Asia Pacific that
promise stronger growth.
SHOFU was founded in 1922 in Kyoto at the time when
growing national debt and political uproar endangered Japan’s strong economy. The company initially produced high-quality porcelain teeth for the local
While trade show attendees from the
Middle East expressed great interest
in SHOFU’s materials and digital dental cameras, the company feels that
the market conditions do not facilitate foreign investment. “Our meetings were good—although the fair SHOFU Dental Asia-Pacific’s booth at AEEDC Dubai 2016.
could have been stronger. We met
dentists and dental students from the UAE, Kuwait, market, but soon added abrasives, silicone polishIran and Iraq. This is a big market, especially for ers, composites and amalgam fillings to its portfolio.
Asian companies, but the market needs to open The 1970s saw the opening of new manufacturing
more to ease import and export,” stated Patrick facilities in Japan and sales offices in the US and
Loke, Managing Director of SHOFU Dental Asia- Germany, while Asia Pacific remained relatively unPacific during AEEDC. Given the company’s his- touched despite SHOFU’s geographical proximity.
tory, SHOFU is continuing its careful assessment
of business opportunities before possibly opening SHOFU finally established a new subsidiary in Singaa production facility or sales office in the Middle pore in 1980. Since then, SHOFU Dental Asia-Pacific
East.
has reached a number of milestones in the region.
In 1985, SHOFU began operating in China with the
establishment of a worldwide sales network and
opened a production facility and sales office
20 years later. Back then, the country had only
50,000 dentists and fewer than
200 dental clinics to serve its 1.3 billion
people—about 440,000 dental professionals would have been needed to
provide adequate oral health care according to Western standards.
In the last decade, the Chinese government has invested substantially in
dental training facilities and schools.
The result was an increase in dental
clinics that led to double-digit growth
in relatively new market segments,
such as dental implants.
Loke is very pleased with SHOFU’s sales
in China. “We see the fastest growth
coming from China. For the most part, China is now
a fully developed country with huge opportunities
to conduct business. We have experienced a double-digit increase in Chinese sales and the nation
remains our most important market in the region,”
he said during AEEDC. “Other countries in the
South-East Asian region are also developed but
growth is slower. However, India is coming up.
Shofu will start operating in India soon. There is
growing awareness regarding dental health there.”
Invisible braces market to grow rapidly over next five years
According to a recently published report, the global
invisible braces market is expected to grow at a
12.16 per cent compound annual growth rate from
2016 to 2021. The report analyses the development
of the ceramic, lingual and clear aligners segment
in ten major countries and further shows that the
process will be mainly driven by technological innovations and increasing demand for invisible braces
among the adult population with aesthetic concerns about fixed orthodontic appliances.
Over the past decade, improved technological advancements, particularly digital technologies, and
40 cosmetic
dentistry
1 2016
increasing awareness of aesthetic alternatives to
conventional braces have led to growing demand
for orthodontic treatment with aligners.
In addition, rising disposable income has resulted
in increasing per capita health care expenditure,
which has further led to a growing focus on health
care, thereby increasing the demand for invisible
braces specifically among the adult population.
While the market has witnessed a strong foothold
in North America and Europe, rapid growth in the
demand for invisible braces is expected to be fueled
by the emerging markets in Asia Pacific and Latin
America through India and Brazil, whereas rising
dental tourism in Mexico and Thailand will continue
to contribute towards the invisible braces market.
Among the leading companies operating in the
market are Align Technology, Ormco, DENTSPLY
International, 3M and ClearCorrect.
The 152-page report titled Global invisible braces
market: Trends, opportunities and forecasts
(2016–2021) was published on 1 February. It can be
purchased at www.rnrmarketresearch.com.
© StephenVanHorn
orthodontics
[41] =>
© faysal
cosmetic procedures
AACD survey indicates digital push in cosmetic dentistry
The field of cosmetic dentistry is showing persistent
growth potential, a survey conducted by the American Academy of Cosmetic Dentistry (AACD) has
found. The majority of respondents believed that
cosmetic procedures will generate the same
amount of revenue or more in the coming year, with
the greatest expectation being that dental implants
will continue to see the most positive growth.
“Some of the most notable findings from the survey are
those that relate to larger trends in the dental industry,”
remarked AACD President Dr Joyce Bassett. This particularly applies to the ongoing trend towards digitalization in dentistry. Bassett said, “The digital push is
definitely something being felt in the area of cosmetics
– more than 50 per cent of respondents said they either
currently use chairside CAD/CAM or are considering
purchasing a chairside CAD/CAM system.”
In the survey, 93 per cent of dental professionals
believed that the continued demand for cosmetic
dentistry is primarily driven by referrals from
friends and family who have had a positive experience. Other factors included increasing information about cosmetic dentistry online (75 per cent),
better marketing of dental practices (63 per cent),
and media coverage of cosmetic dentistry (56 per
cent).
Concerning the most frequently performed cosmetic procedures, crowns and bridgework, bonding, veneers, and whitening made up the bulk of
interventions. At 32 per cent, the most popular
treatment in practices was tooth whitening.
According to the practitioners surveyed, patients
requested cosmetic treatment mainly to improve
physical attractiveness and self-esteem (86 per
cent); to fix a previously failed cosmetic treatment
(51 per cent); for upcoming events, such as a wedding (48 per cent); for restorative or health reasons,
such as an accident or injury (46 per cent); and to
look and feel younger (45 per cent).
The survey was conducted between September
and November 2015. It included 360 dental professionals, of whom 89 per cent described themselves
as either general dentists (60 per cent) or cosmetic dentists (29 per cent). Among the respondents,
74 per cent were AACD members.
The academy has conducted the biennial survey on
the state of the industry since 2005. The full report,
titled Cosmetic Dentistry: State of the Industry,
Survey 2015, is available at www.aacd.com.
colour assessment
Study evaluates accuracy of digital v. conventional shade measurement
even make-up. In order to compensate for these
variables, the shade determination was performed
in natural daylight, but away from windows and with
no direct light. Lipstick or other factors that may
match for each tooth and with each method. The
colour tabs chosen were then evaluated pairwise.
The study found that the reliability of the computerbased systems was higher than that of
the conventional visual system. The TRIOS
measurement system achieved the greatest
agreement for colour chroma and hue, whereas SpectroShade demonstrated the highest
agreement for colour value. However, no significant differences were found between the
TRIOS tool and the colour tab system and between SpectroShade and the colour tab system.
© Pavel Ilyukhin
Matching the shade of the natural dentition is of
great importance for achieving a good aesthetic
result in prosthetic reconstructions, especially in
the anterior region. Although various computerbased shade determination systems have
been developed in recent years, the use of
this new technology has not been widely
evaluated in clinical settings. A study has
now compared the reliability of two digital
shade measurement solutions with the
conventional method for colour assessment, the human eye.
In the study, researchers from the University of Copenhagen in Denmark and the Saints
Cyril and Methodius University in Skopje
compared 3Shape’s TRIOS shade measurement tool, MHT’s SpectroShade spectrophotometric computer-based system and VITA
Zahnfabrik’s VITA Toothguide 3D-MASTER, a conventional colour tab system.
affect colour assessment were removed, and patients with brightly coloured clothing were covered
with a neutral cloth.
According to the researchers, the results
support the use of computer-based scanning
and shade measurement systems for dentistry. They concluded that further development
of such systems for clinical use could be valuable for
material selection and restoration design, particularly in aesthetic and restorative dentistry.
According to the researchers, reliable visual shade
selection by the human eye can be inconsistent
owing to the complexity of tooth colour and external
factors, such as room lighting, patient clothing and
Shade determination was tested on 87 teeth in
29 patients between the ages of 22 and 62. In order
to validate the various methods, two dentists selected the colour tab they considered to be the best
The study titled Effectiveness of shade measurements using a scanning and computer software
system: A pilot study was published on 25 April 2015
in the International Journal of Oral and Dental Health.
cosmetic
dentistry
1
2016
41
[42] =>
news
teeth whitening
Enlighten: “The most important feature of a
whitening system is predictability”
Enlighten is widely acknowledged as the most effective teeth whitening system in the world. With
over 200,000 VITA shade B1 Guaranteed procedures, Enlighten has a 98 per cent success rate,
irrespective of starting shade. Enlighten is a combination of home whitening followed by in office.
There are no lights or lasers, the system comes with
impression materials, bleaching labwork, desensitisers and toothpastes.
“Our users understand that the most important
feature of a whitening system is predictability and
wow results”, said Dr Payman Langroudi, Clinical
Director “There is nothing worse or more damaging
to a practice than underwhelming whitening results, we really think we have a breakthrough”
continued Langroudi “We are looking for the top 5
to 10 per cent of dentists in each country, to become
Enlighten Centres of Excellence.”
Enlighten partners with dentists and provides both
clinical and marketing training to all the team.
Enlighten trained dentists do four times as much
whitening as a result. There is no need to change
diet or habits like smoking, and results last indefinitely with very simple maintenance. “When a patient asks how white their teeth will go, the dentist
can confidently predict a minimum B1 shade. When
they ask how long it will last, the dentist can confidently say forever”, says Langroudi.
The company is pursuing an aggressive international expansion from its London base with a combination of joint venture and distributor partnership
models.
Enlighten Smiles Limited
1st Floor
172 Arlington Road
Camden
London, UK
international@enlightensmiles.com
expansion of production
VOCO to give its headquarters in Cuxhaven a boost
Left: With the cutting of the first sod, Manfred Thomas
Plaumann, Ines Plaumann-Sauerbier and Olaf Sauerbier
(VOCO management, from left) marked the start of the
construction project to expand production at the dental
company based in Cuxhaven (Photo © www.voco.com).
‘We deliberately opted for a two-storey design
for this extension project in order to make optimal
use of the company site’, explained the VOCO
management.
Global family company
More room for further growth: Given its ever-growing market presence and the resulting order situation, VOCO has long needed to expand its production capacity. And this process has been initiated:
With the cutting of the first sod, the management of
the family company marked the start of construction work on the 5th building phase.
With this expansion VOCO is not just reacting to
the need for more space. The project is also a
clear statement of the company's commitment
to strengthening the headquarters in Cuxhaven.
A step which ‘in the medium term will, of course,
result in the creation of more jobs in the region’, explained Manfred Thomas Plaumann, Ines PlaumannSauerbier and Olaf Sauerbier (VOCO management).
The central company site is home to all areas of
the company, from R&D, administration and sales
to production.
42 cosmetic
dentistry
1 2016
Plans to expand production have been in discussion
for around a year with the Bremerhaven planning
company Müller und Peters. The Cuxhaven company Lüdke Hoch- und Tiefbau in conjunction
with Schröder from Bremervörde have been commissioned to perform this work. The investment
volume is in excess of 10 million euros.
Today this family company is one of the leading
brands in the dental industry and operates around
the world with great success. Some 340 people
work at the headquarters in Cuxhaven and, in addition, there are more than 50 dental consultants
in Germany as well as 370 country-specific sales
representatives around the world.
Creation of long-term capacities
This project is the fifth construction phase. In 1997
and 2005 the production hall area, which was developed back in 1992, was almost doubled both
times. Construction of the striking main building
together with the laboratory building was completed in 2013. The current complex is to be expanded
to include a two-storey new building boasting an
effective floor area in excess of 9,000 m². The total
effective floor area, including the administration and
research areas, will amount to around 39,000 m²
upon completion of this stage. And, of course, we
have already taken future growth into account:
Following the inauguration of the impressive new
main building with its exclusive training centre and
the state-of-the-art research and development
building in autumn 2013, the expansion of our
production facilities is the next step to paving the
way for further growth. Completion of the new
production area is planned for spring 2017.
VOCO GmbH
Anton-Flettner-Straße 1-3
27472 Cuxhaven
Germany
www.voco.com
[43] =>
The Dental Tribune International
C.E. Magazines
www.dental-tribune.com
I would like to subscribe to
CAD/CAM
cone beam
cosmetic dentistry*
DT Study Club (France)***
gums*
€ 44/magazine (4 issues/year;
incl. shipping and VAT for customers
in Germany) and € 46/magazine
(4 issues/year; incl. shipping for customers
outside Germany).** Your subscription will
be renewed automatically every year until
a written cancellation is sent to
Dental Tribune International GmbH,
Holbeinstr. 29, 04229 Leipzig, Germany,
six weeks prior to the renewal date.
implants
laser
ortho
prevention*
roots
4 issues per year | * 2 issues per year
*** €56/magazine (4 issues/year; incl. shipping and VAT)
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[44] =>
Dubai © Rus S
| meetings Roots Summit
Roots Summit 2016
Premier global forum for endodontics
takes place in Dubai
This year’s ROOTS SUMMIT, which has drawn dental
professionals to various locations all over the world in
the past decade, will take place from Nov. 30 to Dec. 3
at the Crowne Plaza Dubai hotel in the United Arab
Emirates. Aimed at updating participants about the
latest in endodontic treatment, an unparalleled series
of lectures and workshops will be held by global opinion leaders in the field.
Although the meeting will focus exclusively on the
latest techniques and technologies in endodontics,
the organisers have strongly encouraged not only
dentists specialising in the field to attend but all who
have an interest in endodontics, including general dentists and manufacturers and suppliers of endodontic
products. Overall, about 700 attendees are expected.
Over the past 15 years, the ROOTS SUMMIT has
grown significantly. The community originally started
as a mailing list of a large group of endodontic enthusiasts in the 1990s. After the establishment of a
dedicated Facebook group three years ago, membership increased from 1,000 to more than 20,000.
Today, the group is composed of members from over
100 countries.
Previous ROOTS SUMMITS have been held in Canada, the US, Mexico, Spain, the Netherlands, Brazil
and last year in India. These meetings have been
known for the strength of their scientific programs
and their relevancy to clinical practice. The lectures,
workshops and hands-on courses scheduled for
44 cosmetic
dentistry
1 2016
this year’s meeting will be no exception. More than
15 distinguished experts are presenting during the
conference.
For the summit in Dubai, the organisers have partnered with Dental Tribune International (DTI) and the
Dubai-based Centre for Advanced Professional Practices (CAPP) for the first time. With its international
network, composed of the leading publishers in dentistry, DTI reaches more than 650,000 dental professionals in 90 countries through its print, online and
educational channels, as well as a number of special
events.
Over the past decade, CAPP has been able to establish first-class standards for continuing dental
education programs not only in the UAE but also
across the Middle East. Since 2012, CAPP has been
affiliated with DTI as a strong local partner in the
Middle East.
Based on the successes of previous ROOTS
SUMMITS, the organisers anticipate a large turnout
for this year’s meeting. Various sponsorship opportunities are available, including booth space, as well
as sponsorships of workshops, hands-on courses,
meeting bags and social events.
Online registration for the ROOTS SUMMIT is now
open at www.roots-summit.com. Dental professionals are also invited to join the ROOTS Facebook group
and like the ROOTS SUMMIT 2016 Facebook page._
[45] =>
[46] =>
| meetings Nobel Biocare Global Symposium
Where innovation
comes to life
New York © inigocia
World-class speakers, hands-on instruction, master
classes, forums and social networking opportunities,
all in the heart of one of the greatest cities in the
world. Between June 23 and 26 this year, the fabled
Waldorf Astoria in Manhattan will be hosting the
Nobel Biocare Global Symposium under the banner
“Where innovation comes to life.”
Four days of learning
The symposium’s four-day program will be based on
three main themes: refining and enhancing treatment,
digital dentistry and achieving clinical excellence in
challenging situations. Each theme has a complete
schedule of its own, including lectures, master classes
and practical sessions. Should attendees choose to follow only one theme, the symposium schedule allows
them to be a part of every related session.
If, on the other hand, delegates would like to pick
and choose between the different themes and attend
individual sessions of special interest in several (or all)
of the themes, Nobel Biocare gives them the opportunity to design their own learning program.
In addition to a theme-related agenda intertwined
with independent study opportunities, the company
is arranging a compelling array of forums, including
an innovation assembly and a full-day compromised
patient forum. Other forums will cover the company’s
Partnering for Life program, through which Nobel
Biocare helps dental professionals achieve their goals,
the All-on-4 treatment concept and the dental laboratory workflow. A new generation of dental professionals will also have their own platform at the event’s
NEXT GEN forum.
Getting to know each other
After a busy first day of lectures, master classes and
hands-on sessions, a welcome cocktail on June 23
46 cosmetic
dentistry
1 2016
will provide the perfect opportunity to unwind and
network with colleagues from around the world.
Attendees will be able to raise a glass, enjoy some
food and see a display of innovative Nobel Biocare
products in the beautiful, historical setting of the
Waldorf Astoria.
On the evening of June 24, Nobel Biocare will be
hosting the symposium’s reception off-site at an
exciting venue, yet to be revealed. It is set to be an
evening to remember with an inspiring blend of
diversion and education.
By popular demand
The Scientific Chairmen for the Nobel Biocare
Global Symposium are Drs Peter Wöhrle (USA) and
Bertil Friberg (Sweden). They recently announced
that—for the first time at a Nobel Biocare dental
event—registered attendees will be able to have a
direct impact on the program by voting for various
topics and speakers on the event’s website. The
results will be revealed a few weeks before the
symposium.
With world-class lecturers and thousands of
dental professionals from around the world exploring
the future of dental implants together, the 2016
Nobel Biocare Global Symposium promises to be an
incomparable experience for everyone involved.
Registration for the symposium is open at:
www.nobelbiocare.com/global-symposium-2016_
contact
Nobel Biocare
Balsberg
Balz-Zimmermann-Str. 7
8302 Kloten
Switzerland
[47] =>
PRINT
L
DIGITA N
O
I
T
A
C
U
ED
EVENTS
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.
[48] =>
| meetings events
International Events
2016
11th CAD/CAM &
Digital Dentistry International Conference
6–7 May 2015
Dubai, UAE
www.cappmea.com
IMAGINA Dental
5th Digital Technologies &
Aesthetic Dentistry Congress
7–9 April 2016
Monaco
www.imaginadental.org
International Osteology Symposium
21–23 April 2016
Monaco
www.osteology.org
ABSOLUTE ESTHETICS
13th International Congress
of Esthetic Dentistry
12–14 May 2016
Bucharest, Romania
www.sser.ro
3rd MIS Global Conference:
360° IMPLANTOLOGY
26–29 May2016
Barcelona, Spain
www.mis-implants.com
EAED 30th Annual Meeting
2–4 June 2016
Copenhagen, Denmark
www.eaed.org
Nobel Biocare Global Symposium
23–26 June 2016
New York, USA
www.nobelbiocare.com/global-symposium-2016
AAED 41st Annual Meeting
3–5 August 2016
Dana Point, California, USA
www.estheticacademy.org
Monaco © karamysh
AACD Annual Congress
27–30 April 2016
Toronto, Canada
www.aacd.com
48 cosmetic
dentistry
1 2016
ROYAL ESTHETICS
13th ESCD Annual Meeting
22–24 September 2016
Krakow, Poland
www.royalesthetics.eu
© 06photo
Dental Digital Marketing Conference
29–30 April 2016
Dallas, USA
www.dentalmarketingconference.com
FDI Annual World Dental Congress
7–10 September 2016
Poznan, Poland
www.fdi2016poznan.org
[49] =>
submission guidelines about the publisher
submission guidelines:
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|
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Article lengths can vary greatly—from 1,500 to 5,500 words—
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the article as long or as short as necessary.
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(The larger the starting image is in terms of bytes, the more leeWe can run an unusually long article in multiple parts, but this way the designer has for resizing the image in order to fill up more
usually entails a topic for which each part can stand alone be- space should there be room available.)
cause it contains so much information.
Also, please remember that images must not be embedded into
In short, we do not want to limit you in terms of article length, the body of the article submitted. Images must be submitted
so please use the word count above as a general guideline and if separately to the textual submission.
you have specific questions, please do not hesitate to contact us.
You may submit images via e-mail, via our FTP server or post
Text formatting
a CD containing your images directly to us (please contact us
We also ask that you forego any special formatting beyond the for the mailing address, as this will depend upon the country
use of italics and boldface. If you would like to emphasise certain from which you will be mailing).
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ning or a larger font size). Boldface is reserved for article headers. Please also send us a head shot of yourself that is in accordance
Please do not use underlining.
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with your article.
Please use single spacing and make sure that the text is left justified. Please do not centre text on the page. Do not indent para- Abstracts
graphs, rather place a blank line between paragraphs. Please do An abstract of your article is not required.
not add tab stops.
Author or contact information
Should you require a special layout, please let the word processing The author’s contact information and a head shot of the author
programme you are using help you do this formatting automati are included at the end of every article. Please note the exact
cally. Similarly, should you need to make a list, or add footnotes information you would like to appear in this section and foror endnotes, please let the word processing programme do it for mat it according to the requirements stated above. A short
you automatically. There are menus in every programme that will biographical sketch may precede the contact information
enable you to do so. The fact is that no matter how carefully done, if you provide us with the necessary information (60 words
errors can creep in when you try to number footnotes yourself.
or less).
Any formatting contrary to stated above will require us to remove
such formatting before layout, which is very time-consuming.
Please consider this when formatting your document.
Questions?
Magda Wojtkiewicz (Managing Editor)
m.wojtkiewicz@dental-tribune.com
cosmetic
dentistry
1
2016
49
[50] =>
| about the publisher imprint
cosmetic
dentistry
beauty & science
asia pacific edition
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
Editor-in-Chief
Dr Sushil Koirala
skoirala@vedicsmile.com
Co-Editor-in-Chief
Dr So Ran Kwon
soran-kwon@uiowa.edu
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Designer
Franziska Dachsel
Copy Editors
Sabrina Raaff
Hans Motschmann
International Administration
Chief Financial Officer
Dan Wunderlich
Business Development Manager
Claudia Salwiczek
Event Manager
Lars Hoffmann
Event Services
Esther Wodarski
Marketing Services
Nadine Dehmel
Sales Services
Nicole Andrä
Executive Producer
Gernot Meyer
International Media Sales
Matthias Diessner (Key Accounts)
m.diessner@dental-tribune.com
Melissa Brown (International)
m.brown@dental-tribune.com
Peter Witteczek (Asia Pacific)
p.witteczek@dental-tribune.com
Weridiana Mageswki (Latin America)
w.mageswki@dental-tribune.com
Hélène Carpentier (Europe)
h.carpentier@dental-tribune.com
Barbora Solarova (Eastern Europe)
b.solarova@dental-tribune.com
International Offices
Dental Tribune International
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
info@dental-tribune.com
www.dental-tribune.com
Dental Tribune Asia Pacific Ltd.
Room A, 20/F, Harvard Commercial Building,
105–111 Thomson Road, Wanchai, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
Tribune America, LLC
116 West 23rd Street, Ste. 500,
New York, NY 10011, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
Advisory Board
Dr Michael Miller, USA
Dr Seok-Hoon Ko, Korea
Editorial Board
Dr Anthony Au, Australia
Dr Bao Baicheng, China
Dr Helena Lee, Singapore
Dr Hisashi Hisamitsu, Japan
Dr Jiraporn Charudilaka, Thailand
Dr Mostaque H. Sattar, Bangladesh
Dr Ratnadeep Patil, India
Dr Suhit Raj Adhikari, Nepal
Dr Takashi Nakamura, Japan
Dr Vijayaratnam Vijayakumaran, Sri Lanka
cosmetic
dentistry
beauty & science
is the official publication of:
Printed by
Löhnert Druck
Handelsstraße 12
04420 Markranstädt, Germany
www.cd-magazine.info
Copyright Regulations
cosmeticdentistry beauty & science is published by Dental Tribune International (DTI) and appears in 2016 with two issues. The magazine and all articles
and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and liable to prosecution.
This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply. Legal venue is Leipzig, Germany.
50 cosmetic
dentistry
1 2016
[51] =>
Nobel Biocare Global Symposium
June 23–26, 2016 – New York
Where innovation comes to life
Register
now
nobelbiocare.com/global-symposium-2016
An experience beyond the ordinary
Design your own learning experience
The Nobel Biocare Global Symposium 2016 program will
offer unparalleled clinical and scientific education, as well
as in-depth hands-on training. Held at the Waldorf Astoria
in New York, it’s a unique opportunity to experience how
innovation can come to life in your daily work.
Choose from numerous lectures, forums, master classes
and hands-on sessions – from over 150 of the best speakers
and presenters in the world. This must-attend event will
cover a vast variety of techniques and treatment solutions,
from diagnosis to treatment completion. Don’t miss this
opportunity. Sign up now and we’ll see you in New York!
Read more about the Symposium
© Nobel Biocare Services AG, 2016. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. Disclaimer: Some products may not be regulatory cleared/released for
sale in all markets. Please contact the local Nobel Biocare sales office for current product assortment and availability.
[52] =>
of
True evolution
Ta
k
cu e a
rre dv
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of tag
fe e
rs
!*
Now also
as a Flow!
X
C
EL
L E NT
E
NO
RS
E
M
O
MON
L
S
S
I
C
O
I
B
I
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I T
Y
C
A
C O
M P A T
I B
THE FIRST CERAMIC FOR
DIRECT FILLINGS
Admira Fusion
• The worldwide first purely ceramic-based restorative material
• Lowest polymerisation shrinkage (1.25 % by volume) and particularly
low level of shrinkage stress**
• Inert, so highly biocompatible and extremely resistant to discolouration
• Meeting highest demands in anterior and posterior regions
• Excellent handling, simple high-lustre polishing procedure coupled with
high surface hardness guarantee first-class long-term results
• Compatible with all conventional bonding agents
* Find all current offers on www.voco.com or contact your local VOCO dental consultant.
**in comparison to all conventional restorative composites
VOCO GmbH · Anton-Flettner-Straße 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.com
VOCO_CosmDent-Int_0116_AdmiraFusionFlow_210x297.indd 1
09.03.2016 15:09:35
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[page] => 32
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[page] => 36
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/ Utilising smile design software and CAD/CAM for creating a mock-up and final restorations
/ Conservative smile design for the general dentist
/ Interview: We will be able to treat pretty much everything in the future
/ Light and the biological clock
/ What do our teeth betray about us?—Part II
/ Eleven tips for success in your dental clinic - Part I: SWOT analysis and loyal patients
/ News
/ Meetings
/ Submission guidelines
/ Imprint
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