News / Opinion: Sugar - sugar...honey - money / Interview with Curaden CEO Ueli Breitschmid: “The future of dentistry is digital and focused on prevention” / Career opportunities and work–life balance in dentistry / Causes and treatment of breath odour / Optimum results achieved with minimally invasive methods / Interview with Dr Sigal Jacobson: “Predictable cosmetic dentistry with Uveneers” / A contemporary endodontic approach using bioceramic cement
News
01 - 08 viewOpinion: Sugar - sugar...honey - money
04 - 04 viewInterview with Curaden CEO Ueli Breitschmid: “The future of dentistry is digital and focused on prevention”
06 - 06 viewCareer opportunities and work–life balance in dentistry
09 - 10 viewCauses and treatment of breath odour
14 - 15 viewOptimum results achieved with minimally invasive methods
17 - 18 viewInterview with Dr Sigal Jacobson: “Predictable cosmetic dentistry with Uveneers”
20 - 20 viewA contemporary endodontic approach using bioceramic cement
22 - 23 viewArray
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DTAP0516_01-02_Title 04.05.16 14:16 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
Published in Hong Kong
www.dental-tribune.asia
Vol. 14, No. 5
INTERVIEW
CAREER PATHWAYS
RESTORATIVE DENTISTRY
Curaden CEO Ueli Breitschmid
about new ways in dentistry and
optimal preventive care as key to
good oral health.
Working in dentistry is both exciting and difficult, as there are
numerous options and opportunities to consider.
Dr Yao Lv from China demonstrating how an optimal restoration
can be achieved with IPS Empress
Direct from Ivoclar Vivadent.
” Page 6
” Page 9
” Page 17
AD
IDEM Singapore more
than meets expectations
By DTI
SINGAPORE: A record number of
8,173 visitors from 72 countries
attended this year’s International
Dental Exhibition and Meeting
(IDEM) in Singapore, organiser
Koelnmesse reported last week.
The figures are a slight increase
from the last show in 2014, which
saw 7,800 visitors attending.
Medical Devices Manufacturers
Association (ABIMO).
“Being geographically further
away from the Asia-Pacific region,
it is important for us to update our
new technologies and the needs of
the industry, as we see Singapore as
a key target for the dental industry,”
Laísa França, ABIMO Trade Promotion Coordinator, said. “We hope to
This year’s edition has been the largest in numbers of visitors and exhibitors since
the first meeting was held in 2000.
With 512 dental manufacturers
and dealers, there were also more
participants in the trade exhibition
this time, including a new national
pavilion organised by the Brazilian
be able to participate in the next
edition of IDEM Singapore in 2018.”
The show saw a number of worldpremière product launches by lead-
ing dental suppliers that included
new implant systems, dental disinfection lines and digital practice
management solutions. Many of
these products were available to
dentists in the Asia-Pacific region
for the first time. For the second
time, IDEM was held over three
floors of the Suntec Singapore Convention and Exhibition Centre from
8 to 10 April. Owing to the rise in industry participants, the exhibition
space was extended to 18,000 m2
this year. The scientific programme
brought back regulars, like the New
Dentist Forum, but also featured
new educational formats, such as
the Digital Dentistry Forum, aimed
at advising attendees on ways to integrate digital dentistry and of the
benefits of CAD/CAM, 3-D printing
and CBCT scans, among others.
“The IDEM Singapore 2016 show
statistics proved once again that we
are Asia Pacific’s most anticipated
event on the dental calendar, providing all visitors with knowledge
and insights into the industry.
We will strive to continue to be the
preferred platform for the dental
industry to grow in this region,”
said Michael Dreyer, Koelnmesse
vice president for Asia Pacific.
“IDEM Singapore 2016 was a very
successful event for the industry, as
well for the Singapore Dental Associ-
ation (SDA),” commented SDA President Dr Kuan Chee Keong. “We encourage professionalism and continuous learning through events such as
IDEM Singapore. Through our partnership and efforts, we hope to ensure more participation from industry leaders in Asia and worldwide.”
For IDEM 2018, Koelnmesse is
already in talks with the Inter-
national Academy of Periodontology regarding a forum focusing on
periodontology. Further collaboration with specialist organisations is
under consideration. The next edition will be held from 13 to 15 April,
again at Suntec. It will be the tenth
time that the show is held in
Singapore. Moreover, it will mark
20 years of collaboration between
Koelnmesse and the SDA.
AD
Distinguished by innovation
Healthy teeth produce a radiant smile. We strive to achieve this goal on a daily basis. It inspires
us to search for innovative, economic and esthetic solutions for direct filling procedures and
the fabrication of indirect, fixed or removable restorations, so that you have quality products
at your disposal to help people regain a beautiful smile.
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
[2] =>
DTAP0516_01-02_Title 04.05.16 14:16 Seite 2
ASIA PACIFIC NEWS
02
Dental Tribune Asia Pacific Edition | 5/2016
Henry Schein gains interest in
J. Morita subsidiary
One Piece is composed of eight
dental dealers throughout Japan,
which serve approximately 6,000
dental clinics and had aggregate
sales of approximately US$125 million in the 2015 fiscal year. Henry
Schein expects the transaction to
be neutral to financial results. The
financial terms of the transaction
were not disclosed.
By DTI
KYOTO, Japan/MELVILLE, USA:
Henry Schein announced that
it has entered into a definitive
transaction to acquire a 50 per
cent interest in the One Piece
Corporation, a subsidiary of
J. Morita, one of the world’s largest manufacturers and distributors of dental equipment and
supplies.
Henry Schein first entered the
Japanese market in October 2014,
with an investment in Iwase Dental
Supply, a full-service provider of
dental consumables, implants and
equipment. Kenichiro Iwase, the
Managing Director of Iwase Dental
Supply, will assume the leadership of Henry Schein’s expanded
presence in Japan.
Sleep-disordered breathing
often undiagnosed in Asians
By DTI
SINGAPORE: Aiming to determine
the prevalence of sleep-disordered
breathing (SDB) across different
Asian ethnicities in Singapore, a
new study has found that about
one-third of the participants suf-
fered from SDB. The study further
established that over 90 per cent
of the SDB group had never been
diagnosed with or treated for the
condition before.
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Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany
In the study, SDB incidence was
evaluated in 242 participants aged
AD
Published by DT Asia Pacific Ltd.
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21 to 79 with a home-based Embletta PDS digital recording device
(ResMed). Moderate-to-severe SDB,
which was defined as an apnoea–
hypopnoea index (AHI) score of
≥ 15 events/hour, was used to estimate prevalence.
The results showed that moderate-to-severe SDB and sleep apnoea
syndrome were present in 30.5 per
cent and 18.1 per cent of the participants, respectively. Of those with
an AHI score of ≥ 15, 91 per cent had
not previously been diagnosed for
the condition.
Moreover, the analyses found
that moderate-to-severe SDB varied across the different ethnicities. SBD was diagnosed in 32.1
per cent of the Chinese, 33.8 per
cent of the Malay and 16.5 per
cent of the Indian study participants.
Based on the results, the researchers concluded that new
strategies need to be implemented
in order to optimise diagnosis and
recognise ethnic differences in the
frequency of the condition. If left
untreated, the chronic sleep deprivation that comes with SDB and
sleep apnoea can lead to serious
health problems, including diabetes, high blood pressure, heart
disease, stroke and weight gain.
The study, titled “Prevalence of
sleep-disordered breathing in a
multiethnic Asian population in
Singapore: A community-based
study”, was published online ahead
of print on 29 February in the
Respirology Journal.
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[3] =>
DTAP0516_03_News 04.05.16 14:16 Seite 1
WORLD NEWS
Dental Tribune Asia Pacific Edition | 5/2016
03
Planmeca ProModel technology part
of first Nordic facial tissue transplant
By DTI
HELSINKI, Finland: Finnish dental
manufacturer Planmeca’s ProModel technology has supported
the first facial tissue transplant
procedure in the history of the
Nordic countries. The service,
which designs and creates patient-specific surgical guides and
skull models from CBCT/CT images, helped surgeons to significantly reduce operating time for
the demanding procedure, which
was performed at Töölö Hospital in the Hospital District of
Helsinki and Uusimaa (HUS).
surgeons in advance. Following
this, the components were designed and manufactured at
Planmeca’s headquarters and
transported to the hospital, where
they were taken directly to the
operating room.
the world, entailed transplanting
the patient’s upper and lower jaws,
lips and nose, as well as segments of
the skin, midfacial and tongue muscles, and the nerves of these muscles.
The extremely rare procedure,
which was only the 35th of its kind in
AD
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In addition to a decrease in
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compared with conventional
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Törnwall explained: “Based on
literature, we know that it can
take 3 to 4 hours to trim bones.
In this particular operation, it
took Patrik [Lassus] and myself
under 10 minutes to place the
transplant. This led to a drastic
reduction in the duration of the
surgery, while also significantly
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placement.”
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“Surgeons and us engineers both
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kind of collaboration,” said Jani
Horelli, CAD/CAM Design Manager at Planmeca. “The field continues to advance at a fast rate
and it is very interesting to witness this evolution first hand.
I am proud to be part of a highly
skilled Finnish community of
specialists. It feels meaningful
to take part in improving the lives
of people, who have encountered serious illnesses and disabilities.”
Both HUS and Planmeca began
planning for the operation already years before the surgery
was carried out and this consisted
of modelling donor tissue and
determining how it matched the
recipient, as well as simulating
the operation together with the
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“Planmeca’s role has been essential to our work for years—we
have been able to utilise computer simulations to create saw
guides, which allow us to saw at
a specific orientation and to an
exact depth, as well as remove
facial structures, which we know
match the donor, at a precise angle,” said Törnwall, acknowledging
the benefits of the company’s
3-D services.
The surgery itself took 21 hours and
included a team of 11 surgeons, 20
nurses and other medical experts.
The first face transplant in the world
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[4] =>
DTAP0516_04_Alani 04.05.16 14:25 Seite 1
OPINION
04
Dental Tribune Asia Pacific Edition | 5/2016
Sugar, sugar…honey, money
By Aws Alani, UK
The sugar tax is finally upon us here
in the UK, but are corner shops or
supermarkets for that matter likely to
worry about this potentially threatening change to their flagship product line? The tax targets all drinks and
equates to a tax of 24 pence per litre
on those with the most sugar content. This could potentially equate to
an increase in the price to the consumer, but bearing in mind that soft
drinks are more accessible and cost
less in the UK than water in many
Third World countries, it is doubtful
that things will change markedly.
try was worth £15.7 billion, with
over 14.8 billion litres in overall
consumption, which represents
a steady and exponential growth
that is likely to continue. One interesting observation is the slow
demise of the 330 ml can—it being
replaced by the 500 ml plastic
bottle. The larger bottle may represent better value for money, but
is less likely to represent better
health value, especially since a resealable bottle is more likely to be
sipped over hours than a can once
opened.
restaurants may not be as ironic as
I first thought!
masked by other ills while slowly
swelling corporate turnovers?
Erosive tooth wear seems to
have been forgotten amongst
overweight toddlers needing earto-ear clearances. From bulimics
who like to taste but do not like
their waist to the energy drink
crew who prefer machismo gothic
graphic designs, the younger generation is likely to experience
more dissolution of tooth tissue.
At the other end of the spectrum,
obese patients are more likely to
Society is forever changing and
food is now at the centre of how we
relate and connect with each other.
From Instagram posts of freshly
cooked home meals to wedding
“...food is an emotive
issue...”
cake bliss after inordinate tastings,
it seems to be important to everyone. As a result, food is an emotive
issue that affects oral and general
health in ways that may not be
readily apparent to our patients.
I have an old friend in Florida, who
I visited last year. He is a specialist
in periodontology and runs a successful, swish, modern referral
practice. As a matter of routine, he
tells patients they need to stop
carbohydrate intake post-surgery.
Once patients understand that this
improves outcomes owing to decreased plaque build-up on the
wound edges, they are receptive
to this brief change in their diet.
He also advocates periodontal medicine while identifying stress as a
risk factor for periodontitis.
There is the argument that taxing tobacco has had an effect on the
uptake of smoking and the consequent addiction, but the evidence
for this is relatively sparse and
weak. Although a worthy initiative,
taxing drinks may result in a
greater squeeze on those who can
afford it the least and I doubt
whether little Jimmy will stop his
tearful tantrums for penny sweets
as a result of a celebrity chef’s
campaign as our sugar saviour.
As a child of the eighties, these
celebrity-led campaigns remind
me of rock bands who decided that
African poverty should be on the
agenda, but this does not seem to
be as important to them now. It
would appear that it is easier to tax
sugar than to provide funding for
dentistry; unfortunately, there is
unlikely to be a symbiotic decrease
in caries as a result.
One could argue that sugar pollutes much in the same way that
inefficient power stations do. The
societal repercussions need to be
managed by all, with no or little
comeback for the fizz producers.
As carbonated drinks are so popular, these juggernaut companies
are powerful and, as a result, denting their progress with a tax is unlikely to truly positively affect the
general health of the population.
In 2014, the UK soft drinks indus-
Overconsumption of sugar
causes an inordinate amount of
health problems. Indeed, Type II
diabetes and obesity are leading
causes of death and disability in the
US, the birthplace of the canned,
develop diabetes, which in turn
makes them more susceptible to
periodontal disease.
Society’s gluttonous overconsumption is manufacturing pa-
Research by Prof. Iain Chapple in
Birmingham investigating the effect of diet on periodontal disease
confirms that one is what one eats
and the gingivae follow suit. Purely
“Society’s gluttonous
overconsumption is manufacturing
pathology unheard of 50 years ago.”
likely red, refreshment. These lifethreatening conditions are in
addition to our experiences of
sugar-laden drink devastation. In
contrast, but just as worrying, the
emerging evidence shows that
low-/no-calorie drinks (49 per cent
of drink consumption in 2014) actually fuel hunger and trick one’s
stomach into thinking that calories
are on the way, only to be disappointed, resulting in further foodseeking behaviour. The ordering of
diet beverages in all-you-can-eat
thology unheard of 50 years ago.
Lest we forget the ageing population among the tabloid’s sugar mania of the young—polypharmacy is
likely to increase caries owing to
a variety of co-morbidities, such as
a dry mouth or heavily sugar-supplemented medication. I have seen
restorations seemingly intact for
generations in hospital notes only
to sprout caries at the cavity margin within months of a new medicine being prescribed. Is there a pill
for every ill or do pills allow ills to be
health effects of smoking and the
related exacerbation of periodontal disease, only for it to become
important when teeth are all but
held in by the last tenuous Sharpey
fibre. Owing to their own lack of
awareness or lack of engagement
with a toothbrush, they can request
taxing sugar may not impact on
its consumption. Patients need to
be motivated to take ownership of
their health and relate this with
foresight to repercussions in the
future. It is this lack of responsibility and potential blame shifting
by patients that not only results
in poorer health, but also makes
providing National Health Service
care for all increasingly impossible
if prevention is the best cure. This
commonly occurs when patients
claim to be unaware of the oral
some sort of compensation or pursue a litigious course likely to involve an expensive implant-based
restoration. What may escape the
lawyers and the patient is that
previous periodontal disease is a
significant risk factor for implant
failure, and so the cycle is likely to
continue. Patients are responsible
for their own health and the lack of
recognition of this cannot be the
fault of the clinician.
Successful dental care requires
collective effort between the patient and the dentist. Health care is
a partnership in which both sides
have different responsibilities and
active roles, but if the clinician provides a service for ailments that the
patient could have prevented, the
question of self-governance arises.
Patients have a right to health care,
but they also have responsibilities
derived from the principle of autonomy. The patient’s physical and
mental integrity should always be
upheld and respected. In contrast,
autonomy identifies the human
capacity to self-govern and choose
the most appropriate pathway to
protect that integrity.
As such, capable patients exert
some control over lifestyle choices
that influence their well-being.
Unfortunately, regardless of the
imminent extra tax on the already
dirt-cheap confectionery, the innate responsibility held by the
patient to self-govern will always
trump our advice, treatment, knowledge or collective experience.
Aws Alani is
a Consultant in
Restorative Dentistry at Kings
College Hospital
in London, UK,
and a lead clinician for the
management of
congenital abnormalities. He can be contacted at
awsalani@hotmail.com.
[5] =>
DTAP0516_05_Brexit 04.05.16 14:17 Seite 1
Dental Tribune Asia Pacific Edition | 5/2016
WORLD NEWS
05
Survey sees majority of British
dentists rejecting Brexit
More than half would vote against the United Kingdom leaving the EU
By DTI
LONDON, UK: Were it up to dentists, the UK would remain a
member of the European Union
after the national referendum
in June. According to an online
survey conducted among Dental
Tribune Online readers between
February and March this year,
a slight majority of dental professionals would vote for staying in the EU rather than leaving
it.
After analysing the results of the
poll, Dental Tribune found that
more than 55 per cent of dentists
who participated in the survey intended voting against Britain leaving the EU, while 44 per cent were
in favour of a Brexit.
Less than 1 per cent were still
undecided on the issue, but perceived an overall more negative
future should Britain decide to
split from the Union.
Similar responses were given by
the participants when asked
whether a Brexit would have positive or negative consequences
for the country. A larger share of
dentists, however, replied “I do not
know” to this question.
The overall majority of respondents to the survey said they will
definitely vote in the referendum.
Only one in ten did not intend to
participate in it.
The poll was conducted among
16,000 recipients of the Dental
Tribune UK & Ireland weekly
newsletter, with almost half of all
replies from dentists in southern
England, particularly London,
which made up almost 20 per cent
of the survey respondents. There
was less participation by dentists
from the northern regions, with
slightly less than 30 per cent taking
part in the poll. Only one in ten
respondents were from the Midlands.
Dentists from Scotland, Wales
and Northern Ireland, who made
up 12 per cent of the participants in
the poll, were split, with almost the
same number voting for the Brexit
as voting against it.
Almost one-third of those who
responded to the survey said they
were in private practice, while onequarter said they were employed in
the National Health Service. Forty
per cent worked in practices that
offered both NHS and private dental care services.
Regarding the age of the respondents, more than half were be-
tween 30 and 50 years old, followed
by a large group aged 50 to 60.
Britons have to decide on
23 June whether they want the UK
to remain a member of the EU.
Mirroring the results of the Dental
Tribune survey, the latest national
polls indicate that the slight majority of the population will vote
to stay in the UK.
However, 10 per cent of eligible
voters have still not decided
which way to vote. Prominent
political and economic figures
have argued that a decision to
leave the EU will have widespread
negative consequences for the
UK.
AD
[6] =>
DTAP0516_06_Curaden 04.05.16 14:17 Seite 1
WORLD NEWS
06
Dental Tribune Asia Pacific Edition | 5/2016
“The future of dentistry is digital and
focused on prevention”
An interview with Curaden CEO Ueli Breitschmid
Swiss dental company Curaden is
one of the few businesses in the
industry that adopt a holistic approach to dentistry. The company
combines high-quality dental products, pioneering training systems
and prophylaxis concepts for longterm oral health. In this interview,
CEO Ueli Breitschmid talks about
new ways and knowledge in dentistry and optimal preventive care
as key to good oral health, as well as
prevention programmes that both
promote patients’ health and offer
practices financial success.
Dental Tribune: Mr Breitschmid,
Curaden aims to offer more than
just dental care products. You advocate comprehensive training in the
field of dental prevention. Why is
this issue so important?
Ueli Breitschmid: Curaden is the
only company that, in addition to
manufacturing products, provides
patients with the necessary knowledge and skills, in cooperation with
trained instructors, to take control
of their oral health themselves. We
have developed our knowledge and
products with the aim of teeth remaining healthy for a lifetime. Our
corporate philosophy combines the
innovative CURAPROX products,
our dental educational system iTOP
and the practical Prevention-One
plan. Our goal is to reduce the prevalence of gingivitis, periodontitis and
tooth loss. Therefore, we support
comprehensive soft-tissue prophylaxis. Finally, gingival problems are
still the most common cause of poor
oral health. We support prophylaxis
to this end with our great interdental toothbrushes, our iTOP seminars
and other services.
In any oral health discussion, it
is always important to look at the
combination of a high-quality
product and the trained application thereof. The product alone
without a trained user changes
little or nothing. Therefore, 80 per
cent of people in developed countries have gingival diseases; because nobody has shown them
proper oral hygiene. Only a welltrained person can motivate and
instruct someone else.
How can control and continued
motivation be achieved?
Patients and dentists should follow a regular schedule concerning
both treatment and training. Today’s
approach of one or two dental visits
annually is no longer appropriate.
Going to the dentist or the dental
hygienist should not be an annual
event, but more frequent. Just think
how often we enjoy a beauty treatment or a pleasant massage. White
and well-kept teeth are part of the
modern concept of body awareness,
much like a trip to the fitness centre.
So, does this mean that most oral
health problems can be solved
through regular prophylaxis?
Dental prophylaxis is only one
aspect of oral health. It seems much
more important to consider dental
training. For years, leading dentists
and dental companies have been
in favour of a change in dental education. Preventive dental therapy
should hold at least the same
position as restorative dentistry.
now better understood. Slowly but
surely, dentists will be recognised
for their role in medicine. They are
the gatekeepers of health, because
the mouth represents the basis of
almost all chronic diseases. In time,
dentists will measure blood pressure and take saliva samples or
blood samples. It will become possible to decrease the prevalence of
chronic diseases, including cancer,
Alzheimer’s disease, cardiovascu-
control of individual prophylaxis
for long-term dental health. This
approach includes regular training, the proper tools and a good
dose of motivation. First, we begin
with the dental professionals, who
pass their new knowledge and
skills directly to patients. All our
iTOP seminars are supervised by
independent dentists and dental
hygienists who have completed the
training themselves.
day seminars for both beginners
and advanced participants, as well
as for prospective iTOP trainers. Our
recall seminars enhance knowledge and provide additional motivation. iTOP also teaches communication strategies. Communication
with the patient and with-in the
team too are key to dental health.
A further advantage of iTOP is the
global coverage of our educational
programme. Whether in Europe,
Asia or North America, dental staff
can benefit from the comprehensive solutions of our iTOP training.
I would like to recommend our
iTOP workshop on 23 June in Basel
in Switzerland to all dental hygienists. This is being held as part of the
2016 International Symposium on
Dental Hygiene. We have invited
top speakers from Ireland, South
Africa, Canada and Switzerland to
talk about their experiences with
iTOP in their respective fields and
how it has helped them to achieve
sustainable oral health in their
patients.
Ueli Breitschmid
“There are always new ways
to brush teeth and gaps properly.”
Every dentist knows how little is
taught in dental schools about
prevention. There are long-established and financially attractive
prevention concepts for the entire
office staff, including PreventionOne. Today’s digital solutions offer
a painless and quick prophylactic
therapy. The future of dentistry is
digital and focused on prevention,
and the dentist of the future as a
preventive physician is responsible
for patients’ overall health.
So you envision dentists and doctors
working more closely?
Dentistry and medicine will certainly continue to move closer together, as the interaction between
the oral tissue and other organs is
lar disease and diabetes, through
better oral health. At the same time,
medicine of the future will be able
to detect signs of gingivitis or periodontitis.
Mr Breitschmid, you focus on holistic
oral health prevention rather than
restoration. What concepts does
Curaden offer in this regard?
We focus on optimal prophylaxis
for patients and dental professionals. Individually trained oral
prevention (iTOP) is our internationally well-known educational
system. For this purpose, we have
been working together with established dentist Dr Jiri Sedelmayer.
He has revolutionised the approach to teaching, motivation and
iTOP addresses one of the major
issues in every dental practice: how
to motivate and instruct patients
to brush perfectly, with good outcomes. Through iTOP, we offer
individual training with regular
monitoring and correction of the
learnt prophylaxis techniques.
We use the latest technologies and
modern cleaning techniques; in
short, the right mechanical plaque
control. Of course, the seminars are
open to those dental staff with
years of experience too. There are
always new ways to brush teeth and
gaps properly.
How long is the iTOP programme?
The iTOP programme is structured consecutively. We offer multi-
With iTOP for students, Curaden
is targeting students and young
dentists. Why does Curaden place
so much importance on the early
training of students?
First, students should maintain
their teeth for perfect oral health;
only then can they treat their patients. The dentist and patient
should always have the regular care
of their own teeth with good toothbrushes, toothpaste and interdental brushes in common. This allows
the aspiring dentist to become familiar with how the damage to be
repaired arose. Early on, we convey
the principle of touch to teach—
the proof is in the pudding.
How can dental professionals better
apply your iTOP concept for the benefit of the patient and practice?
We offer them a financially attractive service package for the
long-term dental health of their
patients, called Prevention-One.
Prevention-One is our innovative
treatment approach to prophylaxis services. The plan includes
regular dental cleaning and dental procedures, as well as our
CURAPROX products. We believe
strongly that Prevention-One represents the future of dentistry.
No matter the product, whether
Prevention-One or CURAPROX, we
strive to be accessible to patients. In
2015, we founded the first Curaden
clinic, in the heart of London. The
practice offers top facilities and,
of course, all the products and
concepts of Curaden.
Thank you very much for the interview.
[7] =>
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[8] =>
DTAP0516_08_Biomin 04.05.16 14:18 Seite 1
WORLD NEWS
08
Dental Tribune Asia Pacific Edition | 5/2016
Poor root fillings result of stress and
financial pressure in dentistry
By DTI
GOTHENBURG, Sweden: A new survey
has linked the quality of root fillings to
the level of stress dentists experience
in performing the procedure and the
fee charged. Some dentists reported
that “good enough” was often a more
realistic goal than optimal quality in
light of the complexity of root fillings
and insufficient time allocated owing
to the associated treatment tariff,
among other reasons.
According to the study, which was
conducted as part of a doctoral thesis
at the Sahlgrenska Academy, only half
of all root fillings that are performed in
the Swedish public dental service are
of good quality. Moreover, more than
one-third of root fillings show signs
of apical periodontitis, which can lead
to acute symptoms, such as pain and
swelling, and may even spread and become life-threatening in some cases.
Aiming to investigate the reasons
dentists accept technically poor root
fillings, Lisbeth Dahlström, a senior
dental officer and researcher
at the Sahlgrenska Academy,
conducted group interviews
with 33 dentists from the
Swedish public dental service.
they were very concerned
about their patients, the
researcher said.
In order to improve the
quality of root fillings,
Dahlström suggested
measures such as increased opportunity for
continuing education,
time for discussion and
exchange of experiences
at the workplace, as well as
investment in equipment
that enhances treatment,
shortens the time needed
and improves visibility.
The results showed that
treatment was often associated with negative feelings,
such as stress and frustration,
and it was common for treatment to be performed with
a sense of a loss of control
owing to the perceived technical difficulty. Another cause
of dentists accepting poorer
root fillings was that allotted
time for treatment according
to the fee charged was insufficient, participants reported.
Each year, approximately 250,000 root fillings
are done in Sweden and
it has been estimated that
“The dentist then finds
A survey among Swedish dentists has established the potential for improving the quality of root fillings
there are at least 2.5 milthey are facing a dilemma,
and thus reducing persistent inflammation associated with inadequate treatment.
lion root-filled teeth afto ‘go back’ to the treatment,
fected by periapical periodontitis.
to optimize quality, or to offer care
Regarding quality, the dentists inwas a more realistic goal than opwithin the framework of the comterviewed reported uncertainty as to
timal quality. However, despite the
Dahlström defended her thesis,
what constitutes reasonably acceptdifficulties experienced, the survey
pensation and, thus, risk accepting an
titled “On root-filling quality in
able quality. According to Dahlström,
also showed that the dentists wanted
incomplete root filling,” Dahlström
general dental practice”, on 4 March.
they often stated that “good enough”
to provide good treatment and that
explained.
Promising oral health IPS e.max Smile
care tech launched
Award finalists
By DTI
LONDON, UK: With the BioMin calcium fluoro-phosphosilicate, dental researchers from Queen Mary
University of London have developed a material that has the potential to significantly reduce dental decay and solve tooth sensitivity when
UK through wholesalers for the
time being, BioMin Technologies
CEO Richard Whatley said. A launch
in high-street stores, however, is
anticipated for the end of this
year. For users who do not want to
brush with a fluoride toothpaste,
a fluoride-free version is currently
in development. Whatley further
sional and the general public,” he
said.
In 2013, the promising invention received the Armourers and
Brasiers’ Venture Prize, an annual
award given to breakthrough innovations in materials science from
the UK. A bioactive glass, it has been
developed to adhere to tooth structure through a special polymer,
from where it slowly dissolves ions
that form fluorapatite, a mineral
also found in shark teeth, over an
8–12-hour period to make teeth
more resistant to acids from food.
According to BioMin founder
and Queen Mary Director of Research Prof. Robert Hill, the process
has been proven to be more effective than the use of fluorides in
conventional toothpastes or professional prophylaxis materials,
which are washed away and lose
their effect more quickly.
From left to right: BioMin clinical advisor and QMUL senior lecturer Dr David Gillam
posing with Prof. Robert Hill and Richard Whatley.
used as an ingredient in common
oral hygiene brands. On Wednesday,
the first commercial product was
presented to the public in the form
of a remineralising toothpaste
during a press launch at the Royal
London Hospital Dental Institute.
The BioMinF will only be available to dental professionals in the
added that his company is in talks
about licensing the product for use
in other dental products, including
polishing pastes, varnishes and restorative dental materials.
In addition, the fluorapatite
formed from brushing with BioMinF toothpaste has shown to effectively reduce dentine hypersensitivity by sealing open dentinal
tubules in in vitro studies at Queen
Mary.
“Our aim is for the BioMin brand
to become synonymous with the
treatment of tooth sensitivity in
the eyes of both the dental profes-
The team now intends to conduct long-term studies on the effects of the material over the course
of the next two years.
By DTI
SCHAAN, Liechtenstein: A panel
of experts has chosen the nine
finalists for Ivoclar Vivadent’s
IPS e.max Smile Award 2016. The
winners will be announced at
the award ceremony on 10 June
in Madrid in Spain, on the eve
of Ivoclar’s third International
Expert Symposium. Held for the
first time this year, the competition recognises extraordinary
aesthetic and dental restoration
cases that use the company’s allceramic system.
For the award, hundreds of
teams, each consisting of a dentist and dental technician, submitted their case presentations,
accompanied by written and
photographic documentation,
Ivoclar stated. “Choosing the winners was rather difficult, as all the
cases showed beautiful parts and
details,” said Gonzalo Zubiri, a
member of the international panel of experts who evaluated the
submissions.
the experts chose nine finalists
for the three competition areas:
Asia Pacific: Dr Jineel Ham and
HaSeong Yoo (Korea), Dr Baijun
Sun and Benhui Du (China),
and Dr Tetsuya Uchiyama and
Michiro Manaka (Japan).
Europe, the Middle East and
Africa: Dr Anna Giorgadze and
Ilias Psarris (Greece), Prof. Petra
Gierthmühlen and Udo Plaster
(Germany), and Dr Ferran Llansana and Juan Sampol Reus
(Spain).
North America and Latin America: Dr Gabriela Pappaterra and
Libardo García Tolosa (Colombia), Lucio Armando Quevado
Hernández and Ramon Sanchez
Hernández (Mexico), and Dr Luis
Sanchez and Alic Alen (US).
“It was fun and very interesting
to see the different workflows
and concepts behind the cases,”
fellow panel member Oliver Brix
remarked.
The finalists’ projects will be
presented and the first, second
and third place winners announced at the awards ceremony
in Madrid on 10 June. In addition,
the winning cases will be introduced to the broader public
through social media, at trade
shows and other events, and in
professional journals, the company said.
As aesthetic perception varies
between continents and regions,
More information can be found
at www.ipsemax.com.
[9] =>
DTAP0516_09-10_Bellmann 04.05.16 16:17 Seite 1
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 5/2016
09
Career opportunities and
work–life balance in dentistry
By Dr Christine Bellmann
Dentistry is among the most rewarding professions and has a
much broader scope of practice
than ever before. Young dental professionals who have finished their
studies and received their diplomas
will have to individually decide on
their career pathways. This choice is
both exciting and difficult, as there
are numerous options and opportunities to consider.
The transition from dental student to young working dental professional requires extensive adjustment. At university, students
are told how to work, what to learn
and what goals they need to fulfil.
During practical work on patients,
they are supervised by experienced dentists.
As a working professional, it is
now up to each individual to assess
patients on his or her own and to
judge their needs and treat them
accordingly. It is not just dental
skills that are put to the test, however, as there are also other important skills that a working professional will need to have. These may
be skills that are not taught at dental school, such as communicating
with the patient, co-workers and assistants, as well as financial aspects
and legal issues in the dental clinic.
Acting correctly and appropriately is
a substantial challenge, and may be
overwhelming for some individuals.
Being aware of those requirements
is the first step to a successful transition.
Every graduate dental student
has to decide where and how to
embark on their professional careers. The majority of young dental professionals lay the foundation of their careers in private
or public dental clinics, but some
also remain at university to engage
in research or teaching careers.
Whichever way is chosen at this
stage, it does not need to be the final
decision. Paths can be changed and
new ones explored, but the decision should be thought through,
as the initial years in any profession
form and influence one’s future
career path.
ning, as well as in case of illness.
Smaller teams can have the advan-
tage of being forced to take more
responsibility, from which great
knowledge can be gained in living
the concept of “learning by doing”.
Working in a clinic that has a
certain specialisation will help
a young graduate if he or she
wishes to specialise in the same
field, as knowledge can be gained
during the daily workflow and, in
combination with a postgraduate
course, it can make the perfect
choice. Choosing the right clinic
can be challenging and sometimes
the best choice is to go with one’s
intuition.
AD
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Working in a dental office outside of university provides multiple options and opportunities.
Dental practices come in every
size and shape. There are small
clinics and very large practices.
Some have a specialisation or
orientation; others are general
dentistry practices. Each model
has, for every individual, certain
advantages and disadvantages,
depending on one’s expectations
and goals. A larger clinic, with
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[10] =>
DTAP0516_09-10_Bellmann 04.05.16 16:17 Seite 2
Dental Tribune Asia Pacific Edition | 5/2016
Purpose of
specialisation
Many young dentists want to
specialise in one of the many fields
of dentistry. Once the decision has
been made on the area in which to
specialise, they should take their
time to work out what is the right
path of specialisation for them.
What is their goal after specialisation? What is the specialisation
AD
to be used for: to work in a private
dental clinic or establish their own
clinic; or to enter into research and
education at a university? And
what is the goal for the practice?
There are many programmes on
the market, and it is not always the
best decision to choose the most
expensive, most time-consuming
one or the one that is the furthest
away from home.
Since there are courses and postgraduate education programmes
all around the world, many young
dentists leave their home countries
to gain experience and specialisation abroad. That can be an amazing
experience and much can be gained
from it. However, it is not the right
choice for everyone, as it can hold
more challenges and risks than
might initially be expected. Studying or working abroad needs to be
thought through and well planned,
otherwise it can very easily end in
a major disappointment. At first,
working abroad may seem to be
a great opportunity and exciting,
and it certainly can be, but it may
not turn out that way. An accurate
assessment of the goals and the desired outcome of a life in a different
country needs to be conducted.
Others may decide to open their
own dental clinic or take over an
existing one. Running one’s own
business is a great opportunity to
work in a comfortable work environment because it is self-created. Aligning a dental office to individual expectations and having a financially
successful and well-run clinic can be
challenging. Like any other business,
strategies and standard operating
procedures in various fields need to
be established. It is not only the clinical abilities of the dentist that are
important. Equally important are
economic factors, such as analysis of
the local conditions, human resource
management, marketing strategies
and legal guidelines.
With so many exciting opportunities in the dental field and the
numerous options for how and
where to work, it is easy to lose track
of other important things in life.
Time with family and friends or
time for leisure activities is very important. Finding a healthy balance
between fulfilling career goals and
having rewarding downtime is the
key to a happy and healthy life. It
makes sense to take the time to
reflect on the past and think about
future expectations of life and, perhaps, write those down to keep them
in mind. During these decisionmaking processes, of all the possible
choices that have to be made, the
most important factor that should
be considered is one’s private life
and what one wants in life.
Dr Christine
Bellmann is the
Director of Dental
Gateway, a global
dental consulting
agency. She can
be contacted at
bellmann@dentalgate-way.com.
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DTAP0516_14-15_Gomez 04.05.16 14:20 Seite 1
TRENDS & APPLICATIONS
14
Dental Tribune Asia Pacific Edition | 5/2016
Causes and treatment of breath odour
By Dr Paola Gomez-Pereira, UK
1
2
Fig. 1: Classification of oral malodour (modified from Scully and Greenman).—Fig. 2a: Tongue with a slight coating.—Fig. 2b: Filiform and fungiform papillae histology of the human tongue
(https://www.med.umich.edu/histology/giLiver/oralCavity.htm).—Fig. 2c: Sketch of papillae with biofilm between releases of VOCs to the oral cavity.
Breath odour is the presence of
odorous volatile organic compounds
in the breath of individuals.It is a widespread problem, as it affects a high
percentage of the adult population;
30 per cent of the global population
suffers from chronic oral malodour and
74 per cent considers it an issue.1 Breath
odour has strong social implications
for the sufferer and it significantly
affects normal social interactions.
generally assessed by organoleptic
score, which is determined by a
trained odour judge, who measures
the strength of target odours and expresses the value according to a predefined scale from 0 (no odour) to 5
(strong malodour).
Breath odour can have physiological or pathological causes of intraor extra-oral origin (Fig. 1). Physiological odour includes morning
breath, which is transient and related to low salivary flow during
the night. Other lifestyle factors can
influence it too, such as smoking, as
well as the consumption of alcohol
or odoriferous foods and drinks
(garlic, onion and cabbage, among
others). These are fairly common
reasons for concern in the adult population, but can easily be rectified
by modification of beverages and
foods consumed, toothbrushing,
mouthrinses and tongue cleaning.
The tongue has a very complex
and rough surface structure covered with flexible papillae (Fig. 2b).
Those papillae vary in shape, size
and distribution pattern and give
the tongue a surface with numerous
crypts and fissures.7, 8 This constitutes a perfect microbial niche for
anaerobic bacteria to thrive and
form thick biofilms largely undisturbed. Bacteria can degrade a complex mixture of amino acids and
proteins from numerous origins
(diet, debris, cells) with their complex enzymatic machinery. Partic-
A niche for bacterial
biofilms
ularly the degradation of amino
acids, such as cysteine and methionine, produces VSCs with a very high
odour power.9 The bacterial density
on the tongue surface has been
related to the degree of breath
odour.10–12 For example, individuals
with noticeable breath odour (above
2.5 in the 5-point organoleptic scale)
have more than 1 × 108 bacterial
colony-forming units per cm2 of
the tongue, while individuals with
lower organoleptic scores harbour
lower bacterial numbers (approximately 1 × 107).12 Therefore, in order
to reduce breath odour in patients,
the tongue bacterial density must
be reduced and kept at low levels.
Treatment of oral
malodour
There are numerous over-thecounter products for oral malodour
and these can be divided into chemical and mechanical treatments.
Chemical treatments are mostly
mouthrinses specifically developed
for oral malodour, containing a
combination of antimicrobials and
metal ions. Commonly used antimicrobials are chlorhexidine and
cetylpyridinium chloride (CPC),
which have a strong effect in killing
bacteria. Metal ions, such as zinc,
bind to sulphur compounds and
form insoluble complexes (zinc
sulphide) that are not volatile and
are therefore non-odoriferous.10, 13–16
Another category of mouthrinses
for malodour contains chlorine
dioxide, which neutralises the sulphur gases and oxidises VSCs, while
the chlorite anions act as an antibacterial compound.17
While mouthrinses have the
potential to be very effective owing
to their antibacterial and oral malodour-masking properties, they
rarely provide a long-lasting result.
They are effective for a few hours,
but they have little effect on the
Pathological malodour, however,
is more challenging to treat. Extraoral breath odour can arise from
respiratory, gastrointestinal or
metabolic issues, which cannot be
addressed by oral hygiene, as these
do not originate from the mouth.2–4
Most cases, however, originate from
the oral cavity. Breath odour from
intra-oral causes arises from volatile
sulphur and organic compounds
(VSCs and VOCs, respectively)
formed as a result of the degradation of organic substrates by anaerobic bacteria on the dorsum of
the tongue, particularly at the back
of it.5, 6 It can also result from gingivitis and periodontitis, and their
combination with tongue bacteria.
However, in individuals with good
oral hygiene and gingival health,
the main cause is the bacteria on
the tongue (Fig. 2a).4 Breath odour is
Clinical studies have shown that
the use of mechanical methods reduces the tongue coating.10–21 However, the effect on malodour is very
short lived,19 which is probably due
to the reduction of the bacterial nutrients present in the tongue coating rather than the reduction of the
bacterial density itself.22 The limited
amount of bacterial removal from
the tongue’s complex surface is due
to the difficulty in reaching the
biofilm between the tongue papillae. Moreover, as the tongue tissue
is very flexible, the use of tongue
scrapers could flatten the papillae,
trapping the bacterial biofilm underneath and not removing it.
Combined approach
for all-day fresh
breath
The use of mouthrinses in combination with mechanical intervention could help the active ingredients penetrate deeper into
the biofilm than when used alone,
while simultaneously reducing the
tongue coating and bacterial density. The combined approach of
chemical and mechanical intervention could have a synergistic effect
on oral malodour to deliver full-day
3a
3c
tongue bacterial density.18, 10 A possible cause of this limited effect on
the tongue is that the active components of mouthrinses cannot
reach the odour-producing bacteria. Biofilms that produce volatile
gases are mostly located deep between the tongue papillae (Fig. 2c),
where mixing and diffusion of active ingredients are difficult owing
to the small papillary spaces, the
viscosity of salivary molecules and
the low permeability of biofilms.
Guidelines for the treatment of oral
malodour by dental professionals
emphasise the need for tongue
cleaning using scrapers or brushes.
3b
3d
3e
Figs. 3a–e: Philips Sonicare TongueCare+ brush head, BreathRx, and sketch of MicroBristles and BreathRx cleaning between tongue papillae covered with biofilm.
[15] =>
DTAP0516_14-15_Gomez 04.05.16 14:20 Seite 2
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 5/2016
15
VSCs, such as hydrogen sulphide
and methanethiol, are toxic to periodontal tissue even when present
in very low concentrations, so it
has been hypothesised that they
can contribute to the progression
of gingival diseases.26 Therefore,
maintaining a good tongue cleaning
routine could have far-reaching
implications.
4a
Conflict of interest: Dr Paola GomezPereira is a senior scientist at Philips in
Cambridge in the UK.
4b
Fig. 4a: Average and 95 per cent confidence interval of the organoleptic score at baseline, and 1 hour, 3 hours and 6 hours after
each treatment.—Fig. 4b: Total anaerobes at baseline, and 1 hour and 6 hours after treatment. Source: www.iopscience.iop.org
Editorial note: A list of references is available from the publisher.
Dr Paola GomezPereira can be
contac ted at
paola.gomezpereira@philips.com.
AD
fresh breath, as has been shown in
recent studies.23, 20 In a recent clinical
investigation, we showed that the
combined use of a newly designed
sonic tongue brush with an antimicrobial spray delivered a significantly superior reduction in breath
odour than did the individual treatments.
Philips Oral Healthcare has recently developed and launched a
new sonic powered tongue brush
and antibacterial spray combination, Sonicare TongueCare+. The
brush has been designed to penetrate between the tongue papillae
and to provide thorough mechanical biofilm removal. Bristle dimensions and stiffness parameters were
optimised based on analysis of the
human tongue. The brush head
consists of 240 flexible elastomer
MicroBristles mounted on to a
Sonicare power toothbrush handle,
with 31,000 vibrations per minute
to help break up any tongue coating
and sweep away debris and bacteria
(Fig. 3).
TongueCare+ brush is used in
combination with the BreathRx antimicrobial tongue spray (Philips),
which contains antimicrobial
agents, such as CPC and zinc. In the
first proof of principle clinical investigation of this technology, it was
shown that the organoleptic score
and the tongue bacterial density can
be significantly reduced with a
single use of TongueCare+ with
BreathRx, measured up to 6 hours
(Figs. 4a & b). This combined treatment reduces breath odour significantly more than using TongueCare+ alone or BreathRx alone, supporting the idea that a combined
approach is likely more effective.
Moreover, TongueCare+ has been
shown to significantly decrease the
tongue bacterial density, which is
kept low for up to at least 6 hours,
indicating that the root cause of
breath odour is addressed with this
approach. This, this combination
provides a more effective and longlasting treatment option for people
suffering from breath odour.
Possible oral health
implications
Overall, it is of key importance to
integrate tongue cleaning into the
oral hygiene routine in order to have
fresh breath all day. Additionally, it
has been suggested that the tongue
can act as a reservoir of periodontal pathogens for the rest of the
mouth,24, 25 which could colonise
other areas and have an impact on
oral health in general. Moreover,
several studies have shown that
38 Asia Pacific
Dental Congress
th
17-19 June, 2016
Hong Kong Convention and Exhibition Centre
Advancing Dentistry with Modern Science and Technology
On behalf of the Asia Pacific Dental Federation and the Hong
Kong Dental Association, we would like to invite you to attend
the 38th Asia Pacific Dental Congress (APDC 2016) to be held
at Hong Kong Convention and Exhibition Centre from 17-19
June 2016.
Theme ‘Advancing Dentistry with Modern Science and
Technology’, APDC 2016 will be an excellent platform to meet
and dissect challenges in the field with leading experts from
around the world.
INVITED SPEAKERS
· Dr Chris Chang
· Dr Stanley Malamed
· Dr Hiroshi Ogawa
· Dr Frankie So
· And many more…
ABSTRACT TOPICS INCLUDE
· Endodontics
· Geriatric Dentistry
· Implantology
· Infection Control
· Neuroscience / TMD
· And many more…
IMPORTANT DATES
Abstract Submission Deadline: 29 February 2016
Early Bird Registration Deadline: 1 April 2016
APDC 2016 SECRETARIAT
· Professor Monty Duggal
· Professor Hsu Ming-Lun
· Professor Mariano Sanz
· Professor Adrian Yap
KEYNOTE & PLENARY LECTURE TOPICS
· Innovations in Dental Traumatology. Tradition Versus
a Bright New Future
· Is the Mandibular Block Passé?
· Emergency Medicine - Sudden Cardiac Arrest and AEDs?
· Prevention of Peri Implant Disease for Implant Success
· The Implications of Population Aging to General
Dental Practice
· Guided Surgery: Application in Complex
Edentulous Cases and Use of a New Digital
Workflow for Partial and Single Cases
· Simplified Mechanics for Challenging
Cases, Part I & II
· Improve Population Oral Health by Targeting NCDCommon
Risk Factors
· “Oh My Aching Jaw”: Detection and Management of
TMD in Primary Care
· Bone Biomechanics of Implant Dentistry
ABSTRACT SUBMISSION
APDC 2016 is now accepting abstracts. Submit your abstract
now and let your voice be heard!
Visit www.apdc2016.org for more information.
www.apdc2016.org
Registration & Accommodation:
for your queries and requirements about registration and
accommodation;
-RSá0ÞNARáaOBANOÛLU á2EGISTRATIONáANDá!CCOMMODATIONá
Manager
E-mail: pcobanoglu@kenes.com
Scientific Information:
for your queries about scientific programme;
Ms. Selen Akün, Scientific Programme Coordinator
E-mail: sakun@kenes.com
Sponsorship & Exhibition Requirements:
for your queries about sponsorship & exhibition opportunities
and application process;
Mr. Veysel Güzel, Project Manager
E-mail: vguzel@kenes.com
General Details for all other queries;
Mr. Veysel Güzel, Project Manager
E-mail: mailto:vguzel@kenes.com
-Sá-ARALá"ALIMOÛLU á0ROJECTá-ANAGER
E-Mail: mbalimoglu@kenes.com
[16] =>
Shofu_280x400_DTAP516.pdf 1
06.05.16 10:40
[17] =>
DTAP0516_17-18_Lv 04.05.16 14:21 Seite 1
Dental Tribune Asia Pacific Edition | 5/2016
TRENDS & APPLICATIONS
17
Optimum results achieved with
minimally invasive methods
Aesthetic restoration of maxillary central incisors
Dr Yao Lv, People’s Republic of China
Impressive developments of composite materials have been introduced to the market in recent
years. Nano-hybrid composites
such as IPS Empress Direct (Ivoclar
Vivadent) have enabled dentists
to offer their patients adhesive
restorations that meet the requirements for functional and aesthetic
excellence. A well-considered layering technique and accurate shade
selection contribute towards an
optimal outcome.
A natural tooth is composed
of different layers of tissue and
reproducing these is important
in the restoration of anterior
teeth in particular. In order to
obtain a natural-looking vibrant
restoration, the natural tooth
has to be replicated in fine detail.
In addition to the anatomy, the
optical characteristics of the natural tooth structure should be
reflected in each composite layer.
These properties include brightness, saturation, hue, translu-
technique (IPS Empress Direct).
A lingual silicone key would help
in establishing the correct tooth
shape.
1
2
Fig. 1: Crown facture of the maxillary central incisors caused by trauma.—Fig. 2: Shade selection with the help of a polarising filter.
cency, opalescence and fluorescence.
mould the restoration to impart
a natural shape.
IPS Empress Direct is a welldesigned composite system consisting of 32 shades, five levels of
translucency and seven characterisation shades. With this versatile
range, the product meets all conceivable requirements for an aesthetic composite. Additionally,
the material features exceptionally low sensitivity to ambient
light, giving the dentist sufficient
time to layer the composite and
Clinical case
The case presented here demonstrates how an optimal restoration can be achieved with IPS Empress Direct. A 37-year-old female
patient presented to our practice
with both maxillary central incisors fractured to approximately
one-third of the mesial area. The
patient requested fast and minimally invasive restoration of the
broken teeth. She did not want
healthy tooth structure to be removed, which meant that crown
restorations were not an option.
A detailed clinical examination
showed that the pulp of tooth #21
was exposed; however, the periodontal tissue was undamaged
(Fig. 1). After discussing the treatment choices with the patient, we
decided on performing endodontic treatment on the affected teeth
and then reconstructing teeth #21
and #11 using a composite layering
A polarising filter assisted in
evaluating the internal and external colour distribution of the natural teeth (Fig. 2). Based on the values we measured and the natural
tooth colour, we selected the appropriate shades for the restoration, namely A2 and A3 for the dentine, A2 for the enamel, Trans 30,
Trans Opal and suitable characterisation shades. In the reconstruction of the translucent enamel
area, Trans 30 was mainly applied,
and Trans Opal was mostly applied to imitate the structural features of the incisal ridge. In order
to achieve a high bond strength,
I continued with the total-etch
technique using Tetric N-Bond
(Ivoclar Vivadent).
I recommend using the OptraSculpt modelling instrument
AD
[18] =>
DTAP0516_17-18_Lv 04.05.16 14:21 Seite 2
TRENDS & APPLICATIONS
18
Dental Tribune Asia Pacific Edition | 5/2016
3
4
5
6
7
8
9
10
11
12
13
14
Fig. 3: Prepared teeth with wave-shaped bevels.—Fig. 4: Phosphoric acid was applied to the bonding surface.—Fig. 5: The lingual walls were reconstructed with IPS Empress Direct A3 Enamel and Tetric N-Flow.—
Fig. 6: The dentine was built up with IPS Empress Direct A3 Dentin and A2 Dentin.—Fig. 7: The enamel was built up with A2 Enamel, Trans 30 and Trans Opal.—Fig. 8: Outer contours and surface structures were created
with a diamond bur.—Fig. 9: Finishing and polishing were achieved with the Astropol and Astrobrush polishing sets.—Fig. 10: Optimal result two weeks after placement of the restoration.—Fig. 11: Even six months
after placement, the restoration appeared exceptionally lifelike.—Fig. 12: Viewed from the lateral side, the texture of the restored teeth looked vibrant.—Fig. 13: The patient smiling with confidence.—Fig. 14:
The restorations examined with a polarising filter showed optimal results.
(Ivoclar Vivadent) to shape fillings
more easily. The OptraSculpt Pad
(Ivoclar Vivadent) is particularly
handy when contouring anterior
restorations.
AD
The South African Society of
Endodontics & Aesthetic Dentistry
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Gianluca Gambarini (Italy)
James L Guttman (USA)
Markus Haapasalo (Canada)
Sergio Kuttler (USA)
Martin Levin (USA)
Tara Mc Mahon (Ireland)
Francesco Mangani (Italy)
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A rubber dam was then applied
to provide absolute isolation and
adequately expose the tooth surfaces to be restored. With a minimally invasive technique, waveshaped bevels were prepared on
the teeth. This preparation design
generally results in an increase in
bond strength and enhances the intrinsic vibrancy of the restoration
(Fig. 3). Once the teeth had been
prepared, 37 % phosphoric acid was
applied. The bonding surfaces were
etched for 20 seconds (Fig. 4).
The adjacent teeth were covered
with PTFE tape to prevent the
phosphoric acid from coming into
contact with them during the etching procedure. Subsequently, Tetric
N-Bond was applied to the enamel
surface and allowed to react for
10 seconds. As a result, the adhesive
was able to penetrate the enamel
evenly. Excess adhesive was then
dispersed with compressed air.
The resulting thin adhesive film was
light cured for 10 seconds using the
high power mode (1,200 mW/cm2)
of the curing light (Bluephase N,
Ivoclar Vivadent).
The layering procedure began
by building up the lingual contours with the help of the silicone
key. In the first step, IPS Empress
Direct A3 Enamel was applied, followed by Tetric N-Flow (Fig. 5). It
should be noted that Tetric N-Flow
is particularly suitable for reconstructing the lingual anatomy.
Once the lingual walls had been
rebuilt, the dentine and enamel areas were layered with IPS Empress
Direct A3 Dentin, A2 Dentin, A2
Enamel, Trans 30 and Trans Opal.
It is recommended that one work
from the inside out (from the dentine towards the enamel) in order
to facilitate the layering procedure. After light curing the composite material, I contoured the
restorations to give them a natural
shape and created a textured
enamel surface using a diamond
bur.
The resulting restorations demonstrated a lifelike and vibrant appearance and faithfully reflected
the optical properties of the natural teeth (Figs. 6–8). I finally polished the restoration to a naturallooking gloss using the Astropol
and Astrobrush polishing sets
(Ivoclar Vivadent; Fig. 9). Two
weeks later, tooth #21 showed
an undesirable change in shape.
We therefore decided to remodify
the restoration. The retreatment
resulted in a restoration that met
both my own and the patient’s
expectations (Fig. 10). Six months
after the placement, no imperfections or changes in shade or
shape, neither from the frontal
nor from the lateral view, were
noted (Figs. 11–13). Even when evaluated with a polarising filter, the
restoration met all the requirements (Fig. 14).
The case described here shows
that healthy tooth structure can
be protected and preserved by
using minimally invasive techniques and products, satisfying
both the preferences of the patient and the requirements of the
dentist. In this manner, superior
restorative outcomes can be accomplished.
Dr Yao Lv is a
dentist at the
Department of
Stomatology of
the People’s Hospital of Yixing in
Jiangsu in the
People’s Republic of China. He
can be contacted
at drlvyao@vip.163.com.
[19] =>
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7 days of intensive live training with the Masters in Dubai (UAE)
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Learn from the Masters of Esthetic and Restorative Dentistry:
Online access to our
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Registration information:
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Curriculum fee: €6,350
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email: request@tribunecme.com
(Based on your schedule, you can register for this program one session at a time.)
Collaborate
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University
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this course is created
in collaboration with
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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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[20] =>
DTAP0516_20_Jacobson 04.05.16 14:22 Seite 1
TRENDS & APPLICATIONS
20
Dental Tribune Asia Pacific Edition | 5/2016
“Predictable cosmetic dentistry
with Uveneers”
An interview with Dr Sigal Jacobson, Australia
By DTI
and because it was so successful,
my husband and I took it to engineers in Australia. After two
years of developing and perfecting the system, we finally came
out with the Uveneers. I was surprised at how well it was received
by dentists. Apparently, it addressed not only my problem but
also those of other dental professionals.
Recognising a gap in the market,
a few years ago, Australian dentist
Dr Sigal Jacobson developed a
unique, minimally invasive template system that was designed to
create beautiful direct composite
veneers with predictable shapes and
symmetry in only one visit. Now
exclusively distributed by dental
manufacturer Ultradent worldwide,
the Uveneer system was recently
on display at IDEM 2016 in Singapore. At the show, Dental Tribune
had the opportunity to speak to her
about the development of the product and what makes it unique.
How did the collaboration with
Ultradent arise?
As soon as we had the first
samples ready, we went to the
Chicago Dental Society Midwinter
Meeting. There, we literally had
the worst booth, but we pulled
through. We were very busy and
after the positive feedback, we
began to search for distributors
and markets and to sell Uveneers
worldwide over the Internet.
Dental Tribune: Dr Jacobson, could
you please tell us the incentive behind the development of Uveneers?
Dr Sigal Jacobson: During my
20 or so years as a dentist, I developed a strong love for cosmetic
work. Minimally invasive dentistry
was something I wanted to follow,
especially the use of composites.
Much of the temporary work I did
with the material lasted for many
years, which showed how good
composites had become.
I was still struggling, however,
to do cosmetic dentistry with
composites because it was very
time-consuming and an artistic
challenge overall. While I took
many courses to learn how to place
composite veneers, the time factor
remained an issue. That is why
I looked into the market to find out
what else could help me to make
treatment quicker.
Later at the Greater New York
Dental Meeting, we were approached by Dr Dan Fischer, the
CEO of Ultradent, who had a
close look at the system. Shortly
thereafter, Ultradent became the
exclusive distributor of Uveneers
worldwide. Owing to the company’s overall minimally invasive dentistry approach regarding
products, Uveneers are a very good
fit for Ultradent.
Dr Sigal Jacobson
While everything is templates
nowadays, we did not have templates for composite veneers and
so I started to work on this idea.
I was surprised that no one had
done it before, because it is so simple: just place a template, press
and cure. I first used it in my clinic
What are the main advantages of
the system?
First of all, it allows one to
perform predictable dentistry.
Cosmetic dentistry is all about
predictability and it is important
that one can predict the outcome
before making the composite veneers. One can actually see the
outcome without having to bond
and etch. This saves a great deal
of time.
Furthermore, it is very affordable, so dentists can increase their
profits starting from the first case
while being able to help patients in
a very short amount of time.
In addition, Uveneers are suitable for not only direct composite
veneers but also temporaries and
mock-ups to show the patient
the expected outcome. There are
so many other uses for Uveneers.
They are also autoclavable, so one
can use the templates many times
over.
As I dentist, I wanted to do something for other dentists. We like
something that is reusable and
that is quick, simple and not too
expensive. We gave users a onemonth money-back guarantee.
While we sold thousands, not a
single one came back.
This is the first generation of
this product. What is in store for
Uveneers in the future?
We intend coming out with
other developments around the
product, but for the moment, I
want dentists to acquire the first
one. The second generation will
definitely be a surprise.
Thank you very much for the interview.
AD
SINO Dental
09. - 12. 06. 2016
Booth: F25
German Pavillion
Light-curing micro-hybrid composite
• applicable for various indications
• attributes which ensure aesthetic results
• excellent physical properties
• high filler content
• packable consistency
(also available as Composan LCM flow)
Glass ionomer luting cement
• high level of adhesion
• highly biocompatible, low acidity
• continuous fluoride release
• precision due to micro- fine film thickness
• translucency for an aesthetic result
Temporary eugenol-free luting cement
• temporary attachment of crowns, bridges and inlays
• safe adhesion but easy to remove by cooling
• contains calcium hydroxide for pulp protection
Visit www.promedica.de to see all our products
Dental Material GmbH
24537 Neumünster / Germany
Tel.
+49 43 21 / 5 41 73
Fax
+49 43 21 / 5 19 08
eMail
info@promedica.de
Internet www.promedica.de
[21] =>
[22] =>
DTAP0516_22-23_Pereira 04.05.16 14:23 Seite 1
TRENDS & APPLICATIONS
22
Dental Tribune Asia Pacific Edition | 5/2016
A contemporary endodontic approach
using bioceramic cement
By Prof. Leandro Pereira, Brazil
Endodontics is the specialty in dentistry concerned with preventing or
treating pathologies of pulpal and
periapical origins. The ultimate goal
is to resolve the endodontic disease
and allow the affected tooth to reestablish its aesthetics and function
through a complementary restorative treatment.
Obturation of the root canal system is an important step in any
endodontic treatment. Its function
is to fill and seal the canals to prevent their recontamination. With
the evolution in knowledge of the
intra-canal microbiology and the
impact of new canal modelling instruments with continuous or alternating rotation, we know that it
is not possible to eliminate completely the micro-organisms inside
the endodontic microanatomy.
However, we also know that this
is not necessary for success and
that the significant reduction in
the levels of intra-canal infection,
in most cases, is sufficient to
achieve success.1 Thus, at the time
of obturation, it is necessary to
create an inter-canal environment
that is unfavourable to the population growth of the remaining
bacteria.
Another function of obturation
is to prevent or hinder the growth
of residual bacteria that were not
eliminated during the cleaning
and disinfection process. In order
to achieve the desired objectives,
obturation cements must have
certain essential properties in order to be used clinically. In addition
to insolubility in the organic tissue
Thus, in order to gain the benefit
of this material’s biocompatibility,
a new class of obturation endodontic cement was created, known as
silicate-based cements. This designation is derived from the components that make up MTA and
are present in these cements (tricalcium silicate, dicalcium silicate,
calcium oxide and tricalcium aluminate).
fluids, these include the capacity
to fill, seal and attain dimensional
stability; producing a film thickness of no more than 50 µm; good
drainage; radiopacity; not producing chromatic alterations; a suitable working time, allowing setting, easy manipulation and easy
removal if necessary; promoting
cementogenesis; biocompatibility; and non-irritating to the periapical tissue.2
With the development of new
materials and rehabilitative concepts in the field of adhesive dentistry, the search for two further
characteristics has become in-
creasingly important in the development of new endodontic cements. One of these is the absence
of eugenol, which interferes with
the strength of the bond of the
resin system.3 The second characteristic is bioactivity, which is the
capacity of a material to be integrated with the tissues and structures of the organism with which
it is in contact.
The bioactivity of mineral trioxide aggregate (MTA) is known as
biomineralisation and was first
described by Reyes-Carmona et al.
in 2009.4 In one in vitrostudy, using
scanning electron microscopy im-
ages, the authors observed the
integration of MTA with dentine
through deposition of numerous
apatite groups on the dental collagen fibrils throughout the dentinal tubule surface in contact with
the MTA. Another very interesting
finding is that the authors observed that the more contact time
the material had with the dentine,
the more extensive the mineralisation was. This may be responsible
for the superior adaptation of this
material to dentine.5, 6
However, the low drainage capacity of MTA does not allow for
its use as an obturation cement.
1
2
3
4
5
6
The clinical case described in
this article demonstrates the use
of MTA-FILLAPEX (Angelus) with
gutta-percha cones for endodontic
obturation in a case of endodontic
treatment performed in a single
session. A 56-year-old female patient presented to the office complaining about spontaneous pulsing pain in the left mandibular region that did not respond to analgesics or anti-inflammatories. All
of the teeth in this quadrant tested
negative to apical palpation, as well
as to vertical and lateral percussion. Thermal tests of tooth #37
showed an exacerbated, long-duration positive response to both cold
and heat. The other teeth in the
quadrant showed a slight, shortduration positive response to cold
and a negative response to heat.
According to the classification of
the American Association of Endodontists, tooth #36 had a pulpal
and periapical diagnosis of irreversible inflammatory pulpitis
with a normal periapex (Figs. 1 & 2).
Endodontic treatment was indicated and conducted under an operative microscope, with a magnification varying between 2.5× and
Fig. 1:Initial radiograph.—Fig. 2:Initial clinical condition.—Fig. 3:Clinical aspect after removal of the provisional restoration.—Fig. 4:Access to the pulp chamber and location of the canals.—Fig. 5:Models and disinfected
canals.—Fig. 6: Canals obturated with gutta-percha and MTA-FILLAPEX.
[23] =>
DTAP0516_22-23_Pereira 04.05.16 14:23 Seite 2
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 5/2016
7
8
Fig. 7: Final radiograph.—Fig. 8: Control radiograph after 17 months.
12.5×. Access to the pulp chamber
was achieved with a #1013 spherical
diamond bit, followed by a #3082
conical-truck diamond bit (Figs. 3
& 4). The finishing was done with
a conical-truck ultrasonic diamond
tip (E7D, Helse). After the canals had
been located, a #10 K-type-file was
slowly introduced to two-thirds of
the initial radiographic length of
the tooth. This was followed by a
#25.06 reciprocating instrument
(RECIPROC, VDW) with apical progression in sequences of three
movements of around 1 mm in amplitude in the apical direction. With
each sequence of three movements
with the reciprocating instrument,
irrigation was performed with 5 ml
of 2.5 % sodium hypochlorite, and
a #10 K-type-file was taken to twothirds of the radiographic length
of the tooth. This procedure was
repeated until the R25 instruments reached this pre-established
length.
The next step was to establish the
true working length with a foramen locator. Along the working
length, the diameter of the region
was verified through introduction
of manual K-type-files of different
diameters until one of them was
observed to adapt to the lateral
walls of the canals. In the mesial
canals, we used the #30 instrument, while in the distal canal, we
used the #40. In this way and using
the same initial operative sequence of preparation, modelling
and irrigation, the mesial canals
were prepared for the RECIPROC 40
instrument, and the distal canal
was prepared for the RECIPROC 50
instrument.
After modelling of the canals, the
system of canals was dried and
filled with 17 % EDTA-T, and an
Irrisonic ultrasonic tip (Helse) was
used to passively activate the substance for three cycles of 15 seconds
with renewal of the substance
for each cycle. After the ultrasonic
passive activation, the canals were
again irrigated with 5 ml of 2.5 %
sodium hypochlorite (Fig. 5). The
main gutta-percha cones were
tested and adjusted. The system of
canals was then dried with aspiration micro-cannulas connected to
a vacuum pump.
The MTA-FILLAPEX cement was
prepared and introduced into the
canals using the main gutta-percha
cones (Fig. 6). The excess from the
cones was removed using a heat
transfer system (Touch’n Heat,
Kerr) and cold compressed vertically. The pulp chamber was sealed
with photopolymerisable composite resin, and the patient was sent to
23
her dentist, who would perform the
definitive restoration of the dental
element (Fig. 7).
Editorial note: A list of references is
available from the publisher.
After 17 months, the patient attend a control consultation, and endodontic success was evident on
the radiograph (Fig. 8), owing to the
absence of signs and symptoms,
physiological functioning of the
tooth, normality of the periapex
and reabsorption of the surplus
MTA-FILLAPEX.
A pioneer in
piezoelectric endodontic microsurgery, Leandro
Pereira is a professor at the
endodontics department of the
São Leopoldo
Mandic dental
school in São Paulo in Brazil.
AD
[24] =>
PRINT
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in more than 90 countries.
)
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[page] => 01
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[title] => Opinion: Sugar - sugar...honey - money
[page] => 04
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[2] => Array
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[title] => Interview with Curaden CEO Ueli Breitschmid: “The future of dentistry is digital and focused on prevention”
[page] => 06
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[3] => Array
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[title] => Career opportunities and work–life balance in dentistry
[page] => 09
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[page] => 14
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[5] => Array
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[title] => Optimum results achieved with minimally invasive methods
[page] => 17
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[title] => Interview with Dr Sigal Jacobson: “Predictable cosmetic dentistry with Uveneers”
[page] => 20
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[toc_html] =>
Table of contents
-
News
01 - 08
view
-
Opinion: Sugar - sugar...honey - money
04 - 04
view
-
Interview with Curaden CEO Ueli Breitschmid: “The future of dentistry is digital and focused on prevention”
06 - 06
view
-
Career opportunities and work–life balance in dentistry
09 - 10
view
-
Causes and treatment of breath odour
14 - 15
view
-
Optimum results achieved with minimally invasive methods
17 - 18
view
-
Interview with Dr Sigal Jacobson: “Predictable cosmetic dentistry with Uveneers”
20 - 20
view
-
A contemporary endodontic approach using bioceramic cement
22 - 23
view
[toc_titles] => News
/ Opinion: Sugar - sugar...honey - money
/ Interview with Curaden CEO Ueli Breitschmid: “The future of dentistry is digital and focused on prevention”
/ Career opportunities and work–life balance in dentistry
/ Causes and treatment of breath odour
/ Optimum results achieved with minimally invasive methods
/ Interview with Dr Sigal Jacobson: “Predictable cosmetic dentistry with Uveneers”
/ A contemporary endodontic approach using bioceramic cement
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