DT Nordic No. 4, 2016

Nordic News / World News / “Dentists can have much better conversations with patients” / Going green: The bottom-line benefi ts of green dental offi ce design / Digitally designed - meticulously implemented / “In the not-so-distant-future - half of all treatments will be done with aligners” / The mock-up: A clinician’s everyday tool for aesthetic dentistry / today Swedental - Stockholm - 16–18 November 2016

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DENTALTRIBUNE
The World’s Dental Newspaper · Nordic Edition
www.dental-tribune.com

PATIENT PROFILING

Vol. 2, No. 4

THE MOCK-UP

Esben Toftdahl Nielsen on how
the PI Dental solution uses data
intelligence to improve patients’
dental experiences.

Easily performed in daily practice,
the dental mock-up is a reversible
technique with benefits for both
patients and practitioners.

” Page 6

today SWEDENTAL

Published in Scandinavia

Read all about Scandinavia’s
largest dental show in our today
specialty section included in this
issue.

” Page 13

” Page 17

Dental
fear
Bruxism and implant failure heritable
© pathdoc/Shutterstock.com

By DTI

MALMÖ, Sweden: Affecting up to
a billion people worldwide, bruxism is a common disorder that can
cause severe damage to the dentition and dental restorations. In addition, the findings of a new study
from Malmö University suggest
that excessive tooth grinding or
jaw clenching may be linked to a
higher implant failure risk. In the
study, implant failure rates were
three times higher in bruxers
than in patients without the
parafunctional habit.
Aiming to investigate the association between bruxism and
the risk of dental implant failure,
the researchers analysed data on
3,549 implants that were placed in
994 patients. Of these, 56 patients
(with 185 implants in total) suffered from bruxism. Overall, 179
implants were reported as failures
among both groups.

A study from Malmö University has found that implant failure was more common in patients with bruxism.

Comparing implant failure in
patients with bruxism to patients
without the condition, the Swedish researchers found that the
failure rates were 13 per cent

and 4.6 per cent, respectively.
Thus, the risk of losing an implant
was almost three times higher in
the bruxer group in the current
study.

The analysis further showed
that bruxism was more common
in men and failure rates were
higher for short and wide im” Page 2

By DTI
MORGANTOWN, USA: Psychologists
in the US have found that, in addition to environmental factors, genetic influences play an important
role in the development of dental
fear and anxiety. The study, which
included 1,370 participants (aged
11–74), of whom 827 were female,
demonstrated that fear of pain, a
problem related to, but separate
from dental fear, is heritable.
The researchers found that some
of the genes that influence fear of
pain likely influence dental fear
too. They believe that the new
findings could have important
implications for improving future
dental treatment, as a better understanding of dental anxiety
could lead to the development of
interventions aimed at reducing
distress that is a barrier to seeking
dental care.
AD

Oral cancer therapy
By DTI
COPENHAGEN, Denmark/LUGANO,
Switzerland: Compliance is a
major issue in medical therapy
in general. Non-adherence may
impact the efficacy of treatment
and survival, with high costs for

the patient and health care system.
In a new study, conducted by
the European Society for Medical
Oncology (ESMO), 111 patients (median age of 70) underwent a neuropsychological test and completed

a questionnaire one month after
they had started their first exclusive oral therapy. Global cognitive
impairment was observed in 50 per
cent of the participants. According
to the researchers, the overall adherence rate was 90 per cent. However, working memory disorders
and depression were significantly
associated with and appeared as
predictors of non-adherence.

The findings indicate that oncologists need to take cognitive
functions before initiation of oral
anti-cancer therapy into account
too, in order to identify patients
who are more likely to fail in
self-management of oral anti-cancer therapy. “I believe the current
concept of adherence is too narrow
i.e. physicians expect patients to
take their medication as prescribed
and non-adherence is considered a
form of disobedience,” said Dr Bettina Ryll, Chair of the ESMO Patient
Advocates Working Group.
The findings of the study were
first presented at the ESMO 2016
Congress, which took place from
7 to 11 October in Copenhagen.

Essential Dental Media

Dental Tribune International

The World’s Largest News
and Educational Network
in Dentistry
www.dental-tribune.com

[2] =>

NORDIC NEWS

Dental Tribune Nordic Edition | 4/2016

Study investigates process
of tooth loss and replacement
UPPSALA, Sweden: By investigating
the jawbone of a 424 million-yearold fossil fish, researchers from
Uppsala University in Sweden and
the European Synchrotron Radiation Facility (ESRF) in Grenoble in
France have aimed to gain insights
into the process of tooth replacement. Their findings will help
scientists better understand the
underlying cellular mechanisms
of tooth growth and resorption.
The jaw investigated in the
study originated from a fossil of
the Andreolepis fish, which was
found in Gotland in Sweden. Less
than a centimetre in length, the
microstructure of the bone is perfectly preserved and contains a
record of its growth history. According to the researchers, the fish

ONLINE EDITOR:
Claudia DUSCHEK

CFO/COO:
Dan WUNDERLICH
MEDIA SALES MANAGERS:
Matthias DIESSNER
Peter WITTECZEK
Maria KAISER
Melissa BROWN
Weridiana MAGESWKI
Hélène CARPENTIER
Antje KAHNT
INTERNATIONAL PR & PROJECT MANAGER:
Marc CHALUPSKY

A 3-D image of the jaw’s tooth replacement sequence. Replacement teeth (in gold) sitting on a stack of resorption surfaces,
evidencing that this tooth site was replaced four times. In contrast, the tooth-like odontodes (in red) and the gap-filling
odontodes (in pink) never experienced basal resorption.

bone of attachment, the old resorption surface remained as a faint
buried scar within the bone tissue,”
Chen explained. “I found up to four

This is the first time that an
early fossil dentition has been analysed in such detail, the research
team stated. The results suggest
that new replacement teeth developed alongside the old ones,
rather than underneath them like
in humans. Moreover, the mechanism seems to be most similar to
the process of tooth replacement
seen today in primitive bony fish
such as gar (Lepisosteus) and bichir
(Polypterus).

“The amount of biological information we get from the scans
is simply astonishing. We can
follow the process of growth and
resorption right down to cellular
level, almost like in a living animal,” stated Prof. Per Ahlberg,
one of the leaders of the project.
“As we apply this technique to
more early vertebrates, we will
come to understand their life
processes much better—and no
doubt we will be in for some major
surprises.”

MARKETING & SALES SERVICES:
Nicole ANDRAE
ACCOUNTING:
Karen HAMATSCHEK
BUSINESS DEVELOPMENT:
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AD PRODUCTION:
Marius MEZGER
DESIGNER:
Franziska DACHSEL
INTERNATIONAL EDITORIAL BOARD:
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
Dr George Freedman, Esthetics, Canada
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

The study, titled “The stem
osteichthyan Andreolepis and the
origin of tooth replacement”, was
published online on 17 October in
the Nature journal.
© Uppsala University

plants. Other risk factors associated with higher implant failure
rates were smoking, Type 1 diabetes, medication for high cholesterol and hypothyroidism, anti-

CLINICAL EDITOR:
Magda WOJTKIEWICZ

PRESIDENT/CEO:
Torsten OEMUS

While until recently it was
only possible to see internal structures by physically cutting thin
sections from the fossil and viewing them under the microscope,
the researchers applied a different
technique, synchrotron microtomography, in the current study.
At the ESRF, they produced tomographic scans that captured the
same level of microscopic detail,
but in 3-D and without damaging
the specimen. Virtually dissecting
the scan data on the computer
screen, lead author Donglei Chen
spent several years producing a
3-D map of the jaw’s entire sequence of tooth addition and loss.

“ Page 1

GROUP EDITOR:
Daniel ZIMMERMANN

COPY EDITORS:
Sabrina RAAFF, Hans MOTSCHMANN

The jaw investigated in the study originated from a fossil of the Andreolepis fish.

“Every time a tooth was shed,
the resorption process created a
hollow where it had been attached.
When the succeeding replacement
tooth was cemented in place by

MANAGING EDITOR DT NORDIC EDITION:
Kristin HÜBNER
k.huebner@dental-tribune.com

EDITOR:
Anne FAULMANN

of these buried resorption surfaces
under each tooth, stacked on top
of each other like plates in a cupboard. This shows that the teeth
were replaced again and again during the life of the fish.”

represents the earliest known example of tooth shedding by basal
resorption.

PUBLISHER:
Torsten OEMUS

By DTI

IMPRINT

Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany

Published by DT Asia Pacific Ltd.
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Donglei Chen spent several years producing a 3-D map of the jaw’s entire sequence of tooth addition and loss.

depressant drugs and protonpump inhibitors.
The researchers concluded that
bruxism could be associated with
an increased risk of dental implant
failure. However, in investigating

the underlying causes, other risk
factors, including implant length,
implant diameter, implant surface,
habits such as smoking, and intake
of certain medication, have to be
taken into consideration as well,
the researchers emphasised.

The study, titled “Bruxism
and dental implant failures: A
multilevel mixed effects parametric survival analysis approach”,
was published in the November
issue of the Journal of Oral Rehabilitation.

All rights reserved. Dental Tribune makes every effort
to report clinical information and manufacturer’s
product news accurately, but cannot assume responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume
responsibility for product names or claims, or statements made by advertisers.
Opinions expressed by authors
are their own and may not
reflect those of Dental Tribune
International. Scan this code
to subscribe our weekly Dental
Tribune Nordic e-newsletter.

[3] =>

NORDIC NEWS

Dental Tribune Nordic Edition | 4/2016

03

By DTI
COPENHAGEN, Denmark: In a new
report, titled Modernisering af
omsorgstandplejen, the Danish
Health Authority has called for
significant changes in municipal
oral care for disabled and elderly
citizens. The working group responsible for the report recommended that dental care for people
living in sheltered housing units
and care homes be improved.
Moreover, it urged municipalities
to find ways to better inform eligible patients and their relatives
about existing services.
In Denmark, statutory municipal dental care services are offered to people whose self-care is
so limited that they need help performing basic daily functions or
any self-care. Services for patients
who are have trouble accessing
general adult dental care include
financial and practical help for
transport to and from specialty
clinics, among others.
It is estimated that the target
group for municipal dental care
is up to 63,000 Danes. However,
according to figures in the report,
only 25,000 of the eligible persons received this service in 2015.
Therefore, the report recommends
that means of informing citizens
of existing offers, as well as referral mechanisms, be expanded
in the future.
As the target groups for municipal dental care and specialty
dentistry often overlap, the report further suggests that both
care programmes be amalgamated into one common dental
service. According to the authors,
this would likely make better use
of resources, strengthen dental
care staff competencies and simplify administration for municipalities.
“We are very pleased with the
new and concrete recommendations regarding how the special
oral care programme may work
better. The Danish Dental Association has been looking forward to
this for years,” remarked Danish
Dental Association President Dr
Freddie Sloth-Lisbjerg concerning
the release of the report earlier
this month.
The working group that
drafted the report was multidisciplinary and included representatives from Kommunernes
Landsforening (the local government association), the Danish
Association of Dental Hygienists,
the Danish Dental Association
and Landsforeningen af Kliniske
Tandteknikere (the national association of clinical dental technicians).

“The experiences in the report
demonstrate just what a good result
one can achieve when one involves
professionals from the fields of

nursing and dental care,” SlothLisbjerg said. The full report can
be accessed at the Kommunernes
Landsforening website, www.kl.dk.

© ESB Professional/Shutterstock.com

Improved oral care for
special needs patients

The Danish Health Authority recently released a new report targeting oral care for
people with special needs. The report’s recommendations mainly focus on strengthening prevention, treatment, referral and organisation of municipal oral care.
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[4] =>

WORLD NEWS

Dental Tribune Nordic Edition | 4/2016

Plaque-identifying toothpaste could
reduce risk of heart disease and stroke
© Ruslan Guzov/Shutterstock.com

By DTI
BOCA RATON, Fla., USA: Health
experts worldwide agree that
oral health and inflammatory
diseases, such as cardiovascular
disease and stroke, are correlated.
A recently published study has
shown that users of a toothpaste
that identifies plaque buildup on
teeth also exhibited lower levels of
a heart disease marker, suggesting
that the toothpaste resulted in
statistically significant reductions
in dental plaque and inflammation throughout the body.
In the study, 61 healthy individuals (aged 19–44) were randomly divided into two groups.
While one group (31) used the
plaque-identifying toothpaste for
60 days, the second group (30)
used a placebo toothpaste for the
same duration. To assess dental
plaque, all participants utilized a
fluorescein mouthrinse and intraoral photographs were taken
under black light imaging.
An analysis showed that the
plaque-identifying toothpaste re-

25 per cent in individuals using
the placebo toothpaste.
Plaque HD, the toothpaste
used in this study, was introduced
at the beginning of 2016. It incorporates Targetol Technology,
which contains all-natural, plantbased disclosing agents, and
colors any plaque and thus helps
users remove up to four times
more plaque than standard toothpastes do.
The researchers concluded
that the observed reduction supports the hypothesis that Plaque
HD could reduce the risk of cardiovascular disease. However, a
large-scale randomised trial of
sufficient size and duration is
needed to verify the results, they
stated.

Brushing one’s teeth with a special plaque-identifying toothpaste could help prevent cardiovascular disease.

duced the mean plaque score by
49 per cent compared with a 24
per cent reduction in the placebo
group. In addition, laboratory

tests in a pre-specified subgroup
of 38 participants found that the
plaque-identifying toothpaste reduced levels of high-sensitivity

C-reactive protein (hs-CRP), a sensitive marker for future heart attacks and strokes, by 29 per cent,
while hs-CRP levels increased by

The study, titled “Randomized
trial of plaque identifying toothpaste: Dental plaque and inflammation,” was published online on
19 October in the American Journal
of Medicine ahead of print. It was
conducted at Florida Atlantic University in the US.

New review: Oral health education by
itself is ineffective in preventing caries
© Anna Hoychuk/Shutterstock.com

By DTI
MELBOURNE, Australia: Evaluating
the effectiveness of oral health
promotion strategies for preventing dental caries and periodontal disease among children, researchers from the Cochrane
Public Health Group have found
that oral health education alone,
such as classroom lessons, videos,
comics and brochures, was ineffective.

Generally, the findings of this
review will have global implications in the area of models of
oral health care delivery and
oral health promotion, research,
policy and practice, Hegde concluded.

From analysis of the results
of 38 international studies, the
Cochrane researchers found that
oral health education as a standalone measure, had no significant
impact on caries in permanent or
primary teeth and surfaces. Nonetheless, some of the studies reported improvements in gingival
health, oral hygiene behaviours
and oral cleanliness, the review
showed.
“There is a general perception
that oral health education will
change oral health risk behaviours and promote good oral
health practices,” commented Dr
Shalika Hegde, a research fellow
at Dental Health Services Victoria
in Melbourne and part of the
Cochrane Public Health Group,

Another most promising intervention approach for reducing caries in children—although
additional research is needed—
appears to be improving access
to fluoride in its various forms
and reducing sugar consumption,
Hegde told Dental Tribune.

International researchers from the Cochrane Public Health Group have aimed to determine which promotion strategies are
most effective and equitable in preventing poor oral health.

on the findings in an article
on DrBicuspid.com. “However,
this thinking is fundamentally
flawed, as knowledge gained alone
will not lead to sustained changes
in oral health,” Hegde emphasised.

When coupled with other
measures, such as supervised
toothbrushing with fluoridated
toothpaste, oral health promotion
interventions were generally
found to be effective in reducing
caries in children’s primary teeth.

Moreover, oral health education
provided in an educational setting, combined with professional
preventative oral care in a dental
clinic, was effective in reducing
caries in children’s permanent
teeth, the researchers found.

The review, which was the first
of its kind at an international
level, included data on 119,789
children in 21 countries from
studies conducted between January 1996 and April 2014. All of the
studies reviewed focused on community-based oral health promotion interventions for preventing
caries and periodontal disease
among children from birth to
18 years of age.
The review, titled “Communitybased population-level interventions for promoting child oral
health”, was published online on
15 September in the Cochrane Database of Systematic Reviews.

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06

BUSINESS

Dental Tribune Nordic Edition | 4/2016

“Dentists can have much better
conversations with patients”
An Interview with Cope it CEO Esben Toftdahl Nielsen, Denmark

The PI Dental mental X-ray screen—the key patient profile screen.

“The patient profile covers two dimensions:
needs and desires, and treatment barriers.”
Cope it CEO Esben Toftdahl Nielsen

By Kristin Hübner, DTI
Aiming to help patients suffering
from dental anxiety, Danish start-up
Cope it introduced a digital anxiety
treatment tool in June 2014. The
solution consists of clinic software
and an accompanying mobile app.
Practices using the system ask their
patients to answer a dental anxiety
scale test on a tablet device prior
to the visit. Through the test, they
determine what situations trigger
the patient’s anxiety most. The
information collected is then used
by the dentist to evaluate the pa-

tient’s current level of dental fear.
This, according to the developers,
enables clinicians to respond more
effectively to the special needs of
these patients.

patients with dental anxiety towards a broader approach of using
data intelligence for generally
improving patients’ dental experiences too.

In the last two years, much
has happened, Cope it CEO Esben
Toftdahl Nielsen told Dental Tribune
in an interview. In 2015, the digital
tool was named Product of the
Year by the organisers of Danish
dental exhibition SCANDEFA in
Copenhagen. This year, the company redirected its focus from
giving practitioners insights into

Dental Tribune: The Cope it clinic
software is aimed at helping patients with dental anxiety. What
has the feedback from patients and
practitioners been?
Esben Toftdahl Nielsen: It has
been well received by both dentists and patients. The information
acquired through the solution has
proved invaluable for dentists, as

before the patient even sets foot in
the surgery room, the practitioner
has a very good idea of his or
her core needs and how his or her
treatment can be personalised.
Furthermore, we have seen that
patients who are just slightly anxious have felt that their dentist
better understands them because
of the advanced mental profile of
the patient obtained via the software. This results in better care for
patients, as well as increased treatment uptake.
How did the company develop, and
what has your experience as young
entrepreneurs been?
We launched the solution in
Denmark in 2014. Since then,
we have expanded to the UK,
Hungary and Australia in collaboration with great partners. In
the rest of the world, we provide
the solution along with an online
training course.
Our key challenge as a start-up
company has been to gain access
to prospective customers. Dentists have full schedules and focus
their attention on their patients—
as they should. Our job has been to
make our offering appealing to
dentists. We do so in collaboration
with our partners in the industry,
as well as via our blog—which has
a growing audience.

Feelings and thoughts are assessed in order to gain in-depth insight into the patient.

Furthermore, we changed the
name of the software to “PI Dental”
just a few months ago. It stands
for “Patient insight—for dental
clinics”. Our purpose was to create

a stronger link to the dental community with a solution with a
dentistry-related name.
You also expanded the use of the
tool to gain more general patient
insight.
The adjustment to our offering
was driven by customer demand.
Quite quickly, our customers asked
us whether we could make patient
profiles that did not only focus
on identifying patients with dental anxiety, that is they desired
a more comprehensive dental assessment of the patient, thereby
making the solution even more
useful. This is now a core part of
PI Dental as well. The patient profile covers two dimensions: needs
and desires, and treatment barriers.
With this information, dentists can
have much better conversations
with patients.
Your company actively uses social
media to keep customers and clients
up to date. Why do you think that is
important today?
As mentioned earlier, dentists
have a tight treatment schedule
and spend the majority of their
time with patients. For that reason,
we communicate our message to
dentists via several channels and,
among those, online channels
are a great means of communication today. We focus mainly on
our blog, www.copeit.com/blog-uk,
which provides the latest insights
into our work.
Thank you very much for the interview.

[7] =>

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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
endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.

[8] =>

SCIENCE & PRACTICE

Dental Tribune Nordic Edition | 4/2016

Going green: The bottom-line benefits
of green dental office design
By James Kuester, US
There is much talk these days about
climate change and how we need
to go green. Besides being better
for the environment, a building
designed according to green principles has several benefits: it is
healthier for you, your patients and
your staff. Moreover, a green building lowers one’s utility and operating costs and boosts the sales value
of the building. Lastly, adopting
green practices provides an enhanced marketing opportunity for
the dental office to attract and retain patients. Keeping these advantages in mind, let us look at some of
the things one needs to consider
when making the decision to build
an eco-friendly practice.
There are five aspects that we
will examine as we explore designing a green dental office: site
selection, alternatives to building
new, ways to design to reduce
both energy and water usage, ecofriendly materials, and Leadership in Energy and Environmental
Design certification.

Site selection
What are some of the things
one needs to consider when selecting a site for a new dental office?
First, one should look for a site
where the building can have an
east–west orientation. One should
also look for a brownfield site,
a site that has already had development on it, versus a greenfield,
which is one where there has
never been any development or
building on the site. One should
look for a site that is in a higher
density area and close to existing
utilities and access. Lastly, one
should look for a site that is transportation friendly.

ergy to heat, cool and illuminate,
thus reducing utility costs. Additionally, a smaller, more efficiently designed space increases
the productivity of the dental
staff and this helps reduce labour
costs.

Locating the new dental office
in a higher density area helps increase the likelihood that it will
be pedestrian friendly and thus
encourage patients and staff to
walk to the office. Look at whether
there are sidewalks to the building
site and whether they are tied
into municipal sidewalks. Having
a sidewalk in front of the building
that does not connect to a larger
network of walkways does nothing to encourage walking, especially if patients have to cross multiple lanes of busy traffic or a large
expanse of a busy parking lot.
Additionally, one should look
to locate the dental office near ex-

cies and dry-cleaners, helps reduce
carbon emissions by reducing car
usage.

Alternatives to
building new
Rather than building a new
dental office, one could consider
renovating an existing structure.
Renovating can significantly reduce the carbon footprint of the
new dental office by making use of
the existing shell of the building.
This prevents the loss of all of
the embodied energy contained
within that building shell and
prevents the consumption of all
of the additional energy needed
to build a new one. Renovating
avoids the destruction of the existing ecosystem, as the site has
already been developed. Typically,
few, if any, trees need to be removed during renovation of an
existing building and the natural
rainwater run-off of the site has
already been altered.
When renovating an existing
building, however, it is important
that one have the indoor air quality checked. Existing buildings
can often contain carcinogens
such as asbestos in old pipe coverings, flooring and adhesives.
While the removal or remediation
of these items may add to the cost
of renovation, the cost of doing
so rarely exceeds the cost of new
construction.

An east–west orientation has
been found to be the best situation on a site for a building to take
maximum advantage of natural
wind flow in order to provide good
natural ventilation in the space.
Siting a building as such places
its longest axis parallel with the
movement of the sun to make
maximum use of sunlight for
natural lighting, as well as energy production, as photovoltaics
are utilised in energy production
(Fig. 1).
A brownfield site limits the
destruction of the existing, undisturbed vegetation and ecosystem
compared with that of a greenfield
or virgin site that has never seen
development. Also, even if building on a brownfield site, if there
are existing trees, one should try
to limit the number of trees removed during construction, as
mature trees help provide natural
cooling for the building.

isting public transportation stops.
Within 0.4 km is considered ideal
for encouraging patients and staff
to make use of public transportation. A location near a commuter
parking lot can help encourage
patients to cluster their appointments at the beginning or end
of their workday, before or after
heading off on public transit to
get to and from work. Locating the
office near existing bicycle lanes
and providing safe, secure parking for patients’ bicycles can help
promote cycling to appointments
(Fig. 2). Lastly, locating the office
near other businesses that patients and staff frequently visit,
such as supermarkets, pharma-

Reducing both energy
and water usage

Having decided to design a
new dental office, what are ways
one can design to reduce energy
and water usage in the new space?
One of the best things to do right
at the start is to design an office
that is as small and efficient as
possible. A smaller space contains
less embodied energy, since less
materials are used to construct it.
A smaller space requires less en-

One should make as much use
of natural light in the design of the
office as possible. Going back to
the discussion on site selection,
finding a site that offers plenty of
natural light that can be incorporated into the design of the office
helps to reduce energy costs by
reducing the need for artificial
lighting and electricity. Research
by the Interdepartmental Neuroscience program at Northwestern
University in Chicago has found
that humans respond better to
natural lighting, experiencing it
to be more soothing.1 In a dental
office, where patient anxiety is
typically already high, anything
that can be done to help make the
space more calming and reduce
stress is good (Fig. 3).
One should make as much
use of natural ventilation in the
design of the office. In this regard,
the east–west orientation becomes important, as it will help
maximise the amount of natural
airflow through the building.
Install operable windows so that
they can be opened to take advantage of natural breezes and
airflow. Again, research has shown
people prefer natural ventilation
over air-conditioned air. One
should design the building to
make maximum use of shade.2
Large overhangs on the roof and
awnings and other building features can be used to create shade.
These factors help to reduce cooling costs.
Window tinting can help reduce energy costs. It can reduce
solar heat gain by as much as
54 per cent and can block up to
99.9 per cent of ultraviolet radiation.3 Ultraviolet light is damaging
to finishes and fixtures, and protecting them from the ultraviolet
light will help extend their life
and increase their return on investment.
One should design to make
use of LED (light-emitting diode)
or compact fluorescent lighting
throughout the new office. The
former use only about 20 per
cent of the electricity of an incandescent bulb and the latter use
about 30 per cent of the energy.
An incandescent or compact
fluorescent lamp shines indiscriminately, wasting a significant
amount of its light inside the fixture. 4 An LED lamp is monodirectional and shines light only on the

[9] =>

Dental Tribune Nordic Edition | 4/2016

location where one wants it. Thus,
there is no wasted light.

compact enough to fit under counters and inside cabinets.

Installing motion sensors in
rooms so lights are only on when
someone is present also helps
reduce energy usage. While these
may not be practical in areas such
as waiting rooms or operatories,
in other less trafficked areas, such
as restrooms, storage rooms or
staff lounges, they can work well.
Also, installing a programmable
thermostat so the building is not
being overly heated or cooled during off-hours helps reduce energy
consumption and costs.

One way to design to reduce
water usage is by installing motionsensing faucets and dual-flush
toilets. Both deliver the right
amount of water to do the job and
eliminate or at least reduce water
waste.

Whether building new or renovating, the building must be insulated properly for the climate
zone of its location. Having adequate insulation can save up to
20 per cent on heating and cooling
costs, especially when combined
with proper seals on windows and
doors.5
Every new building and even
some renovated ones need new
roof systems. Designing the roof
to be light or white in colour is
more energy-efficient than a dark
one, as these colours reflect the
solar energy away from the building rather than absorbing it,
which would cause the building
to become a heat island. If possible, one should consider installing a living roof system. These
systems help reduce rainwater
run-off, reduce cooling costs for
the building, and when visible
from the ground, attract and
retain patients, as people find
them appealing. One could also
consider installing photovoltaics.
Today’s solar panels are much
more efficient and affordable
than the panels of the 1970s and
1980s, with integrated photovoltaics possible (Fig. 4).
Rather than installing a
hot-water tank in the new office,
one should design for in-line
hot-water systems. These systems
provide hot water on demand,
thus eliminating the need to heat
and keep hot a large tank of water.
Today’s systems are small and

SCIENCE & PRACTICE

is a program by the US Green
Building Council (USGBC) that
has become a global standard for
certifying that buildings are designed and built to reduce energy
and water usage, as well as their
carbon footprint. A 2008 study
by the CoStar Group found that
LEED buildings command rent
premiums of US$11.33 per square
foot over their non-LEED peers
and have 4.1 per cent higher occupancy. Additionally, LEED certified buildings command a US$171
per square foot premium over
non-certified ones at the time of
sale.6

Eco-friendly materials
Making environmentally sound
material and finish choices during
the design of the office can help
reduce the new office’s carbon
footprint. Dental practices contain a high number of cabinets
and counter-tops and these need
to be able to provide a high level
of sanitation and infection control, especially in operatories, laboratories and sterilisation areas.
In these areas, quartz provides
an eco-friendly option. Quartz is
non-absorbing and the most sanitary material choice next to stainless steel. Quartz will not promote
the growth of bacteria or mould.
One should look for a source that
is within 800 km of one’s location
to avoid or reduce high transportation costs.
3

Away from areas of high sanitation needs, one can consider
other materials, such as reclaimed
wood, concrete or terrazzo, as a
counter-top material. Reclaimed
barn wood is very popular right
now in counters, counter-tops and
floors. These materials offer a
wide range of design options, are
attractive and can readily be recycled at the end of their useful life.
On the floor, one can look to
eliminate unnecessary material
by leaving the floor as stained or
polished concrete, if possible. This
gives a great aesthetic, but is probably not a good choice in operatories and other areas of high sanitation control, as concrete tends
to be porous. Furthermore, it can
promote lower back and leg pain if
one stands on it for long periods.
In these areas consider a sheet
vinyl that has a high degree of recycled content, can be recycled at

the end of its life and is installed
using welded seams. The reason
for the welded seams is to eliminate cracks that are difficult to
keep clean and where bacteria can
hide.
On the walls, one can consider
using only a zero volatile organic
compound paint. While vinyl wallcoverings have been popular in
health care for many years, it is
one more material that requires
energy to produce and adds to the
carbon footprint of the office.
When choosing a vinyl wallcovering, one should select one that has
a high recycled content and is recyclable at the end of its useful life
and with zero emissions of volatile
organic compounds in the case of
both it and its adhesion method.
Lastly, the upholstery throughout the office should be designed

to be green. While in a dental office the upholstery needs to aid in
infection control, there are plenty
of fabric options available that
have a high degree of recycled
content, are recyclable at the end
of their useful life, have a high
wear factor for use in commercial
settings, and are bleach cleanable
to reduce the spread of infection.
Whenever and wherever possible, one should reuse materials
such as doors, door frames, cabinets, cabinet and door hardware,
and lighting. This reduces the
amount of material going into
landfills and reduces the total
carbon footprint of the new office.
Especially when remodelling, one
can breathe new life into existing
fixtures to give the office a clean,
fresh appearance without having
to buy everything new.
When looking to build or
remodel, one should search for
a contractor who is on board
with the project’s energy-reducing
goals, one who is willing to commit the time to segregating waste
materials and diverting them
to the proper recycling centres.
Many carpet, wallcovering and restroom fixture companies are
willing to take old materials back
and recycle them into their new
ones. While this takes extra effort
on the part of the contractor,
doing so helps reduce the project’s
total carbon footprint.

Leadership in Energy
and Environmental
Design

Now that you have decided
to build a green dental office,
consider having the project LEED
certified. Leadership in Energy
and Environmental Design (LEED)

Designing and building a
green or environmentally friendly
dental office is not more difficult
than designing and building a
conventional one, but it requires a
bit more planning and thought up
front to ensure the choices made
during the design process and
contractor selection promote the
goal of reducing the building’s
environmental impact. The selection of the office’s location, its orientation on the building site and
the design of all of its various component parts all contribute to how
much energy and water will be
saved during the building’s useful
life. These choices affect the dayto-day operating costs of the practice too. Slowing down up front
and taking care in the choices
made can help promote both a
healthier bottom line for the practice and a healthier environment
to work and live in.
One does not necessarily have
to wait to build or renovate to attain operating cost improvements
and help the environment. There
are things that can be done immediately, such as installing a
programmable thermostat so the
building temperature is always
the right temperature for the occupancy at the time. There are a
wide variety of LED lamps available now that can be used in almost
any existing fixture, so replacing
all of the bulbs in the office with
LEDs will have an immediate impact on energy use. One can have
the existing heating, ventilation
and air conditioning system inspected to make certain it is operating at its peak efficiency and
make sure all windows and doors
are properly sealed. These few
steps can have a dramatic impact
on reducing energy usage and on
the dental practice’s bottom line.

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

In 2002, James
Kuester founded
Küster Design,
which specialises in a full
range of interior design services for dental
offices. As a LEED Green Associate,
Kuester is experienced in applying design principles that reduce energy costs
and carbon footprints. He can be contacted at james@kusterdesign.com.

[10] =>

TRENDS & APPLICATIONS

Dental Tribune Nordic Edition | 4/2016

Digitally designed, meticulously implemented
Maxillary and mandibular all-ceramic restorations after loss of occlusal vertical dimension
By Prof. Petra Gierthmühlen & Udo Plaster, Germany

The problem of worn and eroded
teeth is becoming more prevalent.
The pathological loss of tooth
substance can result from erosion
(acid-related tooth damage), attrition
(tooth-to-tooth wear) or abrasion
(mechanical processes). In most
cases, a number of factors contribute to the clinical situation. Once
the causes have been established,
suitable therapeutic measures
can be planned. In modern dentistry, the removal of considerable
amounts of tooth structure for the
preparation of a restoration is regarded very critically. A more appropriate solution is to find a minimally
invasive or non-invasive means of
restoring the teeth using adhesively
bonded restorations. This type of
approach is described on the basis
of the following case study.

Preoperative situation

Fig. 1: Substantial loss of tooth structure, particularly in the anterior region.—Fig. 2: A digital wax-up served as the basis for the creation of the PMMA mock-ups.—Figs. 3a & b: Try-in
of the mock-up in the mouth.—Figs. 4 & 5: Comparison of the aesthetic analysis of the initial and target situations.—Figs. 6a & b: Defect-oriented preparation in both of the jaws.

fillings. All of the teeth showed
severe signs of erosion (Fig. 1). Substantial loss of tooth structure was
evident in the anterior teeth in particular. The analysis of the smile
line established that the length-towidth ratio had been negatively affected. In the relaxed smiling position, the teeth were hardly visible.
In addition, the discrepancy between the smile line and the midline was very pronounced.

When the patient consulted
our practice, he complained about
restricted masticatory function
and tooth hypersensitivity. In addition, he was dissatisfied with the
appearance of his teeth. The dental
examination revealed large carious lesions and various defective

The patient showed considerable loss of occlusal vertical
dimension. A functional disorder
(e.g. craniomandibular dysfunction)
was not diagnosed. The aim of the
extensive treatment was to reconstruct the proportions, function
and aesthetics of the teeth. Therefore, the occlusion was to be rede-

fined and the vertical dimension
adjusted.

Creation of the mock-up
In order to obtain a sound
basis for the treatment planning
process, the Face Hunter scanner
(Zirkonzahn) was used to produce
a digitalised image of the patient’s
face. The 3-D view of the preoperative situation offers an advantage
over conventional photographs
in that it enables the envisaged
situation to be examined from different aspects, thereby providing
a realistic overall picture.
A digital wax-up with a heightened occlusal plane was created
with the PlaneSystem (Zirkonzahn). In this step, the tooth posi-

tions, lengths, sizes and shapes
were determined on the basis of
functional and aesthetic criteria.
The Digital Articulator module
was used to check the static and
dynamic occlusion. The digitally
calculated movement paths correlated with the guiding surfaces
of the teeth. In the process, the
extra-oral aesthetic parameters
were checked too. The segments
designed with the Zirkonzahn
software were used to construct
a PMMA mock-up by means of
CAD/CAM fabrication methods.
The mock-up was tried in and
deemed to be satisfactory in terms
of its function and aesthetics (Fig. 2).
The patient accepted the new situation and the raised vertical
dimension (Figs. 3a & b). Therefore,
the mock-up served as a template

for the remainder of the treatment
process (Figs. 4 & 5). First, the digital design was used in the creation
of the provisional restorations.

Tooth preparation
and provisionalisation
The restorative procedure involved the entire dental arch in
both jaws. The defective restorations were replaced and the teeth
were prepared according to defectoriented principles (Figs. 6a & b).
A minimally invasive approach
was taken to prepare the maxillary
anterior teeth for the crowns, the
mandibular anterior teeth for the
veneers, and the molars for the
crowns and onlays. The digitally
designed final situation was super-

Figs. 7a & b: Transfer of the situation by means of conventional impressions.—Fig. 8: The digital design of the mock-up for the provisional restorations.—Fig. 9: The patient quickly became accustomed to the CAD/CAMfabricated provisionals.—Fig. 10: Construction of the permanent restorations with the help of the initial facial scan and the mock-up.—Fig. 11: The individual restorations were machined in wax, pressed with lithium
disilicate glass-ceramic and subsequently finished.—Fig. 12: The maxillary anterior teeth were cut back and then veneered. The veneers, the onlays and crowns for the molars were manufactured in monolithic form.

[11] =>

imposed on the prepared teeth to
demonstrate the minimally invasive and additive character of the
procedure. Conventional impressions were taken of the situation
and sent to the dental laboratory
(Figs. 7a & b). Models were fabricated
and digitised with a laboratory
scanner (S600 ARTI, Zirkonzahn).
The preparation shade was determined in the laboratory in order to
properly establish the individual
tooth shades. This is particularly
important when all-ceramics are
used, since the preparation shade
considerably influences the optical
properties of these materials.
The provisional restorations
were fabricated using CAD/CAM
technology. The crowns, veneers
and onlays were adjusted to the
prepared situation in the digital
mock-up and then milled to full
contour using a tooth-coloured
PMMA material (Fig. 8). The fit of
the restorations was checked on
the model. The provisionals were
then polished and cemented in
place with a temporary luting
composite. The functional and aesthetic factors were checked in the
mouth. During the following eight
weeks, the patient was able to test
the new situation and the raised
vertical dimension (Fig. 9). At this
stage, it was still possible to modify
the restorations without any difficulty. However, the patient had
accustomed himself to the new
vertical dimension very quickly
and without any complications.

Fabrication of the
all-ceramic restorations
The permanent restorations
were fabricated with the help of
the mock-up data. On the basis of
the initial facial scan, the crowns,
onlays and veneers were constructed in accordance with the
mock-up (Fig. 10). Up to this part of
the procedure, all the work had
been done using digital means,
without a conventional wax-up.
This changed when the individual
ceramic restorations, especially
the veneers, were produced, since
their aesthetic design required
considerable manual skill.

Prof. Petra
Gierthmühlen
is Director of
the Department
of Prosthodontics at the Düsseldorf Universit y Hospital
in Germany. She can be contacted
at petra.gierthmuehlen@med.uniduesseldorf.de.

Udo Plaster is
a master dental
technician and
runs his own
dental laboratory in Nuremberg in Germany.
He can be contacted at info@plasterdental.de.

TRENDS & APPLICATIONS

Dental Tribune Nordic Edition | 4/2016

14a

14b

15a

15b

Fig. 13: Preparation for the adhesive cementation.—Figs. 14a–15b: Photographic documentation of the result: the function and
aesthetics of the teeth completely fulfilled the requirements of the patient.—Fig. 16: The happy patient.

In the present case, the plan
was to obtain the desired functional and aesthetic results with
the press technique. For this
purpose, the computer designedrestorations were machined in wax
in a five-axis milling unit (M5 Heavy
Metal Milling Unit, Zirkonzahn)
and subsequently pressed with
the IPS e.max lithium disilicate
glass-ceramic (Ivoclar Vivadent;
Fig. 11). The maxillary anterior restorations were cut back and then
imparted with lifelike characteristics and play of colour. The crowns
pressed with low-translucency
ingots in Shade A1 were reduced
and then the incisal areas were
built up with veneering ceramic
(IPS e.max Ceram, Ivoclar Vivadent).
The pressed monolithic veneers
for the mandibular anterior teeth,
as well as the onlays and the crowns
for the posterior teeth, showed
adequate aesthetics (mediumtranslucency ingots in Shade A1).
These monolithic restorations were
polished to a high gloss and then
individualised with stains (IPS
e.max Shades/Essence and Glaze,
Ivoclar Vivadent). On the model,
the all-ceramic restorations looked
very natural in terms of their
colour and shape (Fig. 12).

tional and reliable solution for restoring the dentition.

Conclusion
Digital technology—in the form
of a face scanner, for example—is
of immense help in the treatment
planning process. The minimally
invasive approach used in this
case is easy to implement with
the help of CAD/CAM fabrication

methods. The creation of a virtual
wax-up, a CAD/CAM mock-up,
provisionals and wax models for
pressing the lithium disilicate
restorations all contributed to
achieving a predictable, aesthetic,
cost-effective and efficient result.
The intra-oral photographs taken
three months after the treatment
show the stable occlusion and the
excellent condition of the periodontal tissue.

This case report was the winning
entry in the Europe, Middle East
and Africa category of the IPS
e.max Smile Award 2016. It was
first published in the REFLECT
magazine, 3/2016.
AD

The Dental Tribune
International Magazines
www.dental-tribune.com

Adhesive cementation
In preparation for their placement, the inner surfaces of the individual ceramic restorations were
conditioned and etched with a
4.9% hydrofluoric acid (IPS Ceramic
Etching Gel, Ivoclar Vivadent) for
20 seconds. The clean, prepared
teeth were conditioned with the
Syntac classic system (Ivoclar
Vivadent), which comprises a
primer, an adhesive and Heliobond.
The lithium disilicate glass-ceramic restorations were adhesively
bonded with a dual-curing luting
composite (Variolink Esthetic DC,
Ivoclar Vivadent) in accordance
with the manufacturer’s instructions (Fig. 13). The restorations
showed excellent marginal adaptation after their adhesive cementation. The transitions to the natural
tooth structure were virtually invisible. In terms of their shape and
function, the restorations fully
corresponded to the result realised
with the help of the provisional restorations (Figs. 14a–16). The permanent restorations were fabricated
using CAD/CAM technology and
the press technique. The thin,
defect-oriented individual restorations provided an aesthetic, func-

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TRENDS & APPLICATIONS

Dental Tribune Nordic Edition | 4/2016

“In the not-so-distant-future, half of all
treatments will be done with aligners”
An interview with Dr Sam Daher, Canada
I personally like about this
treatment modality is that
the aligners do not apply a
great deal of force, maybe
10, 20 or 30 grams. Research has shown that this
is the optimal amount of
force; strong forces are not
actually needed. Also, the
clinical achievement is really in the hands of the orthodontist. There is very
little downside to this as far
as I am concerned.

Vancouver orthodontist Dr
Sam Daher is one of the
world’s leading experts in
clear aligner treatment. Having performed more than
4,000 treatments with Invisalign, he currently runs two
practices entirely specialised
in this treatment modality in
addition to his other four
clinics. At the recent British
Orthodontic Conference (BOC)
in Brighton in the UK, where
he presented a paper on
open-bite treatment with
clear aligners, Dental Tribune
had the opportunity to
speak with him about the
benefits of digital technology,
the future of clear aligners
in general and his business
model.

Dental Tribune: Dr Daher,
this is the first time you have
spoken at the BOC. How was
your presentation received?
Dr Sam Daher: I have
never been to the BOC, but
I have spoken in London
many times before. I can recall my first talk to a UK audience a couple of years ago.
Back then, the interest in
Invisalign was not what it is
today, perhaps owing to a
lack of faith in the system.
Today, far more experience
has been gleaned and we
have seen much better results with it, so there is generally more interest from Dr Sam Daher
specialists. The attendance
ClinCheck and digital scanning
of my lecture here in Brighton was
have advanced clear aligner treatamazing. There is clearly much inment. What impact have they had
terest and far greater acceptance
on digital technology in the field?
than before. Also, the questions
posed were far more genuine.
I have been using scanners for
six years and have not taken one
Your presentation here in Brighton
conventional impression since
focused on open-bite treatment
with clear aligners. Could you summarise some of your key points for
our readers?
One of the main advantages
of clear aligners is that with them
we can control the vertical dimension. One of the worst things we
can do in open-bite treatment is to
allow the posterior teeth to push
through. With clear aligners, we
do not only prevent the posterior
teeth from extruding, but actually intrude them a little, when
then. The first thing one notices
needed, allowing us to control the
when one starts using scanners
vertical dimension and close the
is that aligners adapt so much
anterior open bite at a much faster
better to the teeth because the
rate than with any other fixed apscan is far more accurate. Second,
pliance as a matter of fact. Thus,
it allows for an improved pawhat I aim for is to intrude the
tient experience. Using polyvinyl
posterior teeth when there is alsiloxane material is always a
ready an anterior open bite. With
hassle and a discomfort for
both an anterior and posterior
the patient if the material gets
open bite, we create a mandible
into the mouth. Using scanners
that simply autorotates and that
saves a great deal of time and
will help close the anterior open
is more comfortable for the pabite.
tient.

defined by a combination of technology improving quite nicely
and patients requesting it as an
aesthetic treatment modality, for
example. I am sure that in the notso-distant future half of all treatments will be done with aligners.
Where would you personally like
to see aligner treatment heading
in the future?
I think aligner suppliers need
to provide auxiliaries as part of
their systems too. At present, we

“The aligner market
has actually advanced
quite a bit and this
development is based
on science, technology
and experience.”
There are certain shortfalls. For example, patient
compliance and sometimes teeth do not move as
one intended, but that happens with fixed braces too.
Furthermore, with ClinCheck,
which provides 3-D treatment
planning, I am able to plan different approaches and then decide for
myself. If I am still not certain, I can
show the patient what each treatment outcome will look like and

What was obvious here in Brighton
is that orthodontics is at a crossroads. What role will clear aligners
play in the future, in your opinion?
I believe—and I said that already five years ago—that in ten to
20 years, a much larger portion of

“Treatment with aligners is not necessarily
difficult, but it is a bit different...”
then let him or her decide. This way,
it becomes an educational tool that
can enhance patient compliance.
Aligner treatment is not without its
critics. Is there any justification for
this, in your opinion?
The aligner market has actually advanced quite a bit and
this development is based on science, technology and experience.
Aligners are custom made and that
alone should be enough to elicit a
positive response to aligners. What

our patients will be treated with
aligners as opposed to fixed braces.
Braces have allowed us to understand the biomechanics very well
and aligners just take that same
knowledge and apply it to invisible
aligners.
The future role of clear aligners is also determined by patients
asking for this treatment. Dentists
not yet using aligners have had to
learn this treatment modality and
quickly. Thus, its role is definitely

obtain aligners from one company, but have to go elsewhere to
obtain the elastics and miniscrews etc. In a few years, companies will hopefully offer a comprehensive package to allow dentists
to plan much ahead of time.
Another area where clinicians
could benefit is being able to
use different materials for the
start and the end of treatment—
just like in conventional orthodontic treatment where we use
NiTi at the start of treatment
and stainless steel at the end.
However, there is a great deal of
improvement in this regard already.
You run two practices entirely focused on aligner treatment. What
advice would you give a clinician
who would like to switch to that
business model?
It is important to first acquire
the necessary clinical skills and
become really comfortable using
aligners. Treatment with aligners
is not necessarily difficult, but
it is a bit different, so it is necessary to become acquainted with it.
The way to attain confidence is to
treat enough patients—my guess
is 1,000 or so. Once the clinician
has become comfortable working
with aligners, he or she can start
thinking about switching.
Thank you very much for the interview.

[13] =>

TRENDS & APPLICATIONS

Dental Tribune Nordic Edition | 4/2016

The mock-up: A clinician’s everyday
tool for aesthetic dentistry
By Dr Yassine Harichane, France

Fig. 1: Cartridge with self-curing composite (Structur 3).—Fig. 2: Pre-op situation, portrait.—Fig. 3: Pre-op situation, smile.

For a wax-up, also known as a diagnostic wax model, laboratory wax
is used to create an aesthetic concept model based on the patient’s
plaster model. However, its aesthetic and functional use is limited.
From an aesthetic perspective,
even though the wax does not reproduce the tooth shade perfectly,
it facilitates visualisation of the
shape and position of the teeth
in the concept model. As far as
function is concerned, even when
a high-performance articulator is
used, it is still difficult to replicate
the full range of masticatory movements.
The mock-up, essentially a preview produced from composite, is
a technique all too rarely employed by dentists, but that proves
exceptionally practical in a wide
variety of situations in routine
clinical practice. It offers a preview of the intended aesthetic
result and as such plays a decisive
role in treatment planning.1–3 The
mock-up phase follows validation
of the wax-up. In this phase, the
concept model is adapted directly
in the mouth after validation on
the plaster model. 4, 5 This facilitates transfer of the wax-up data
from the patient model directly
to the mouth.6, 7 The trial fitting in
the mouth offers the opportunity
to verify the concept model from
an aesthetic, functional and psychological perspective. This last
aspect is of particular signifi-

cance, considering that it imparts
an important principle of patient
acceptance, namely being able to
first try out a solution and then
make an educated final decision.
In this way, the patient plays an
active role in the decision-making
process, which considerably improves communication.8

any corrections, a duplicate of the
mock-up is sent to the laboratory.
The dental technician now has
at his or her disposal additional
information, with which he or
she can achieve a predictable aesthetic result.

It is important to note that
communication with the dental
technician too is optimised in the

Mock-ups are suitable for
treatment in the anterior region
requiring corrections to the shape

Treatment plan

a wax-up based on the patient’s
tooth model. Of course, he or she
needs to inform the dental technician in the laboratory of what he
or she expects in terms of shape
and position, but not yet the
shade. The first step is for the dentist to validate the wax-up on the
model; this allows him or her to
make any necessary corrections
directly in the practice using suitable materials. In such cases, it is
always worth asking the dental

“The mock-up, essentially a preview
produced from composite, is a technique
all too rarely employed by dentists”
process, which promotes smooth
cooperation between the practice
and the laboratory. It is only
possible to implement minimal
corrections directly on a wax-up,
whereas the dentist is free to make
aesthetic changes to the mock-up
by adding or removing materials
generally available in the dental
practice.9 In addition, the mock-up
can be used to check the occlusion
in the mouth in order to validate
the accuracy of the wax-up. After

of teeth through the addition of
material and, to a lesser extent,
adaptation of the position of the
teeth. The main indications are
thus loss of substance on vital
teeth, missing individual teeth,
diastema or other congenital
aesthetic defects that permit a
bio-aesthetic approach.10
Once a diagnosis has been
established and the type of treatment selected, the dentist orders

technician to send additional wax
with which any corrections requiring addition of material can
be performed. The wax-up is then
shown to the briefed patient (it is
a 3-D simulation of the concept
design)—and the limitations (the
tooth shade cannot be replicated
in a wax-up) mentioned—and it
is compared with the plaster
model without wax-up in order to
demonstrate the improvements
objectively. Once the patient has

Fig. 4: Pre-op situation, intra-oral in occlusion.—Fig. 5: Pre-op situation, intra-oral in non-occlusion.—Fig. 6: Wax-up without preparation of the teeth.

accepted the wax-up and any necessary corrections have been
made, the wax model is transferred from the plaster model
to the patient’s mouth in order
to simulate the treatment intraorally. These steps are described in
the “Step by step” section.
The mock-up is shown to the
patient in order to determine
the optimal tooth length and the
general proportions of the new
smile. It is still possible to make
corrections at this stage. After
any corrections, the dentist and
patient approve the mock-up and
an impression is taken, which is
then sent to the laboratory, where
it serves as a reference for the
final production of the concept
model.

Materials
Mock-ups are easy to produce
in routine clinical practice as long
as there is sufficient material available and the user masters the
necessary skills in advance. In
this article, I describe a technique
in which a self-curing composite
(Structur 3, VOCO; Fig. 1), which is
usually employed in the production of temporary crowns, bridges,
inlays and onlays, is deployed in
the scope of an off-label use. In contrast to laboratory wax, which is
used for wax-ups, the visual properties of this material allow reproduction of the natural tooth shade

[14] =>

TRENDS & APPLICATIONS

Dental Tribune Nordic Edition | 4/2016

Fig. 7: Silicone wax-up impression.—Fig. 8: Verification of the accuracy of the wax-up impression.—Fig. 9: Filling of the impression with self-curing composite (Structur 3).—Fig. 10: Insertion of the impression
with self-curing composite.—Fig. 11: Occlusal view of the mock-up after removal of the impression and all excess material.—Fig. 12: Filling of a bubble in the mock-up with flowable composite (Grandio Flow).—
Fig. 13: Curing of the flowable composite.

(within a sufficiently large range of
A1 to A3.5, including the Shades B, C
and Bleach Light). The mechanical
resistance of the material makes
it possible to simulate the occlusion of the mock-up in the mouth.
Self-curing composites are similar
to conventional light-curing composites. As a result, the composite
can be adhered to the mock-up in
order to compensate for defects or
change the shape (tooth elongation, curvature of vestibular tooth
surface, incisal cut-back, etc.). The
retention occurs mechanically,
that is no cement is required. In
contrast to a temporary crown, the
mock-up is ultimately destroyed
upon removal.

mouth as a guide for the implementation of the mock-up.
The guide is tried in the mouth
and any necessary corrections
made with a scalpel. The shade of
the self-curing composite (in this
case, Shade A1) is now selected in
accordance with the patient’s expectations and the tooth shade of
the natural teeth.
The impression is filled with
the composite (Fig. 9) and inserted
into the mouth (Fig. 10). The impression is removed, at the earliest, 1.5 minutes after mixing
(Fig. 11). However, final processing
can only be performed after

with composite. The data is sent
to the laboratory as photographs
(portrait, smile and intra-oral;
Figs. 15 & 16), along with an impression of the mock-up and the analysis of the smile. The dental technician in the laboratory then has
the necessary and sufficient information at his or her disposal
to produce the actual prosthetic
restoration in accordance with the
patient’s and dentist’s wishes.12
At the end of the treatment
session, the question remains as
to what to do with the mock-up.
The dentist has the choice of two
possibilities. One option involves
removing the mock-up and per-

point, it must be reiterated that
the material is suitable for situations of this type, as it was developed for the production of temporary crowns. 4 It is up to the dentist
to decide how long the mock-up
can remain in the patient’s mouth,
and it goes without saying that
special attention must be paid to
exceptional oral hygiene. From the
perspective of the psychological
period for visual acclimatisation
and functional aspects, one week
appears to be a practical period. 4, 5

Discussion
The mock-up technique offers
a whole range of advantages. The

wearing it to test it extensively
from an aesthetic, functional and
psychological perspective. Patient
compliance increases, as he or
she can follow the treatment plan
more calmly and is better informed.
In addition to improved patient communication, communication with the dental technician
is facilitated. Owing to the impression and photographs of the
mock-up in the mouth, the dental
laboratory has at its disposal a
wealth of invaluable information,
which was not systemically provided in the past.12 The dental
technician is then able to test the

Fig. 14: Surface of the mock-up at tooth #21 after filling of the defect.—Fig. 15: Post-op situation, portrait.—Fig. 16: Post-op situation, occlusion check.

Step by step
The clinical case presented here
to illustrate the workflow was a
consultation for aesthetic reasons.
The patient wanted to improve his
smile considerably without resorting to invasive techniques (I restrict
myself here to the implementation
of a mock-up in the maxilla). The
first step involves taking a number
of photographs in order to analyse
the initial clinical situation with
the patient (Figs. 2–5).11 A plaster
model serves as the basis for production of the wax-up (Fig. 6). An
impression is taken of the wax-up
(Figs. 7 & 8), which is used in the

4 minutes. The shape is adjusted
either by means of contouring in
conjunction with water cooling, as
in the case of conventional composites, or by filling defects with a
flowable composite (Grandio Flow,
VOCO; Figs. 12–14). Finally, the
structure and dynamics of the
occlusion are verified.
Once all adaptations have
been completed, the mock-up is
presented to the patient for his or
her aesthetic approval regarding
shape, position and tooth shade.
If necessary, further adaptations
can be effected in the same way,
that is via contouring or filling

mitting the patient to leave the
practice with the restored initial
clinical situation. No invasive or
irreversible interventions have
been performed and the patient
is happy to have tried out his or
her future smile without having to
sacrifice any tissue or be anaesthetised. The other option is to allow
the patient to leave with the
mock-up still inserted. This allows
him or her to show off his or her
new smile to his or her nearest and
dearest and to verify its acceptance in social situations. Furthermore, this enables the patient to
test the articulation and masticatory loads in daily life. At this

quick, cost-effective method allows the patient to assess the desired result in his or her mouth.13
Until now, patients went along
with dentists’ decisions without
being actively involved in the
treatment plan, and this occasionally resulted in unexpected
outcomes and possible conflicts.
A waiting period with temporary
restorations makes it possible to
assess the required result, but is
not indicated in clinical cases with
conservative or non-invasive approaches. In future, the patient
will be able to try out his or her
new smile in order to become used
to it quickly and even go home

wax-up not only from a functional perspective (structural and
dynamic occlusion, position of
the free margin for articulation,
lip support, etc.), but also from
an aesthetic perspective (tooth
shade, shape and volume of the
teeth, smile symmetry, smile
alignment with regard to facial
aesthetics, etc.). The user friendliness of the material means this
technique is suitable for use in
routine clinical practice.
For the dentist, this technique
is just as easy to perform as the
production of temporary crowns.
There is no need for a rubber dam,

[15] =>

as the mock-up is produced under
the same conditions as for a temporary crown. In addition, this
non-invasive technique does not
require preparation, retention,
bonding or anaesthesia. The patient will certainly appreciate
this tissue-preserving approach.
As such, the patient will perceive
the treatment as more of an adventure.6
Of course, however, mock-ups
are not without their restrictions.
Their indication is restricted to
prosthetic restorations in the anterior region, with severe malformations representing a contraindication, as the teeth may be
positioned outside of the shape of
the wax-up. The technique is also
not indicated in cases in which
enameloplasty is required (too
long or too severely curved tooth).
As production of a mock-up
requires a certain degree of dexterity, it should be initially practised on a plaster model before
work is performed directly in the
patient’s mouth. The therapeutic
treatment of a patient may require a longer period; even though
the mock-up phase can be very
informative and useful for patient
communication, it remains an
additional, facultative phase. Furthermore, dentists who do not use
self-curing composites for temporary restorations could view procurement of these materials as an
additional cost factor. However, it
is worth weighing up the fact that
the mock-up could considerably
improve patient acceptance in an
extensive treatment and thus the
investment could indeed be worth
it. Nothing is more frustrating
for a dentist than investing time
and effort in the development of
a long, complex treatment plan
only for it to be rejected by the
patient because it fails to meet his
or her expectations.

Final remarks
The mock-up constitutes a
simple, reversible technique that
can be easily performed in routine clinical practice. As a preview
made of composite, it allows validation of the planned prosthetic
restoration in the mouth from an
aesthetic, functional and psychological perspective. This opens up
a whole new dimension to the patient, as he or she is able to try out
his or her future smile and is thus
better able to imagine the end result. Patient compliance increases
and the dentist–patient relationship benefits.

Dr Yassine
Harichane
graduated from
the Faculty of
Odontology at
Paris Descartes
University and
now works in
research. He is a member of the Cosmetic Dentistry Study Group and can
be contacted at yassine.harichane@
gmail.com.

TRENDS & APPLICATIONS

Dental Tribune Nordic Edition | 4/2016

“Patient compliance increases, as he
or she can follow the treatment plan
more calmly and is better informed.”
From the dental laboratory’s
perspective, this method pro-

vides the dental technician with
additional information, which

allows him or her to tailor his or
her work precisely to the patient’s

and dentist’s expectations. The
improved communication reinforces the cooperation between
the dentist, patient and dental
technician.

Note: This article was originally published in the Dental Tribune Study
Club France magazine, 03/2015.
It is published here with the kind
permission of the author and OEMUS
MEDIA. A list of references is available from the publisher.
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[17] =>

Model-free crowns

Dental products in focus

Learn about a family-owned dental laboratory
from Denmark that made the digital leap and
is now beating the competition.

With a comprehensive offering of the latest
products in dentistry, there will be much for
visitors to Swedental 2016 to see and do.

» Seite 02

» Seite 06

What’s on in Stockholm

Swedental • Stockholm, 16–18 November 2016

Discover what beautiful and trendy Stockholm has to offer for some relaxing time off
this week in the “What’s on” section of today.

» Seite 07

Swedental 2016 welcomes dental professionals to Stockholm
Discover the future of dentistry at Stockholmsmässan
 From 16 to 18 November, the
Swedish capital once again welcomes
dental professionals to Scandinavia’s
largest dental show. The event is
being held in conjunction with the
Swedish Dental Association’s Annual
Dental Congress under the theme
“Movement: The mouth and the
world—The roads ahead”. Visitors are
invited to discover the latest trends in
dentistry at Stockholmsmässan, the
largest exhibition and convention
centre in the Nordic countries.

Moreover, the Swedish Dental
Association will be launching a
new programme to address the oral
health of the elderly, titled “Munnen
är allas ansvar! [The mouth is everyone’s responsibility!]”. Emil Broberg,
third vice chairman of Sweden’s
municipalities and county councils,
and Dr Hans Göransson, Chairman
of the Swedish Dental Association,
will be introducing the new programme at the event on Thursday at
11:45.

For the first time, the meeting
will be held from Wednesday to Friday instead of Thursday to Saturday.
Both the exhibition and the congress
will run from 09:00 to 17:00 throughout the event. Up to 200 dealers from
the region and elsewhere will be participating in the industry exhibition,
showcasing their latest novelties and
product highlights.

On Wednesday and Thursday
evening, attendees will be able to
mingle with friends and colleagues at
the After Dent party, held from 17:00
to 19:00. On both days, Swedish pianist Ellinor Asp will be providing the
musical backdrop for a relaxing end
to the day.

sultant and author of several books
on the subject, will seek to answer
the question of how dentists can approach and better communicate with
foreign patients who have come to
the Nordic countries owing to the recent refugee crisis.

All information about the
meeting, parallel scientific sessions
and social events is available at
www.swedental.org and via the newly launched Stockholmsmässan app,
which is available for both Apple and
Android phones. 

Apart from the industry exhibition, creative works by dental professionals will be on display (to the right
of Hall A). Aiming to capture the
creativity that exists in dentistry, the

Swedish Dental Association invited
dental professionals to participate in
an art exhibition during the event.
Highlights of the scientific programme include the FluORO session,
which will discuss the oral health ef-

fects of fluoride, as well as its potential association with various diseases
and its toxicology. Also of interest
and importance will be the lecture
“Kulturkrockar i tandvården (Cultural
clashes in dentistry)”, in which Anna
Melle, a culture and integration con-

“Medical & dental work could benefit from considerable restructuring”
Megaklinikka founder and COO Heikki Pilvinen on sustaining competitive advantage in dentistry
 With a dentistry degree from the
University of Helsinki and a Master
of Business Administration from the
Helsinki School of Economics and
Business (now Aalto University School
of Business), Heikki Pilvinen has always been half-dentist, half-entrepreneur. With the launch of the first Megaklinikka in Helsinki in 2010, Pilvinen
introduced a new dentistry delivery
model in Finland. The clinic provides
a completely new service concept that
streamlines the dental appointment
and treatment process and offers
patients all basic dental care in one
sitting and at affordable prices. Just
recently, the first Swedish branch of
Megaklinikka opened in Stockholm.
In this interview, Pilvinen talks about
new care models in dentistry.
today international: Have you always
been passionate about adopting new
ideas and technologies?

Heikki Pilvinen: Yes, most definitely. I have always loved to solve
problems and have used information
technology to make things easier and
more reliable and to have an edge on
the competition.
How are new technologies affecting
dentistry right now?
We are in the midst of a huge
change through digitalisation. We
now have business and service possibilities that we could not even
have dreamt about ten years ago.
The Megaklinikka concept would
not have been possible just 20 years
ago because fewer people had mobile
phones then. The whole world has
experienced enormous structural
changes, in conjunction with massive digital input to support these
and to just do things faster and better
and to enhance the quality of services.

We saw this in industry in the
1980s, in banking in the 1990s and
lately in agriculture. Efficiency, availability and quality have dramatically
increased in all areas of our life, but
for one, the delivery process of medical services. We have seen huge leaps
in technology, but the delivery system of medical and dental care has
not changed in 300 years.
This is why the cost of medical
services to society is so unbearably
high that we cannot continue like
this. We have to reorganise ourselves
and the way we work. According to
research findings by Aalto University
(2015), the existing way of working
has an inherent wastage of 32 per
cent of overall work time.

Heikki Pilvinen



How will digital technology be implemented in daily practice in the
future?

We are moving towards larger
entities, mega-clinics and even gigaclinics! The most demanding specialty
work will remain in smaller units,
and geriatric, psychiatric and child
care would remain similar. However,
80 per cent of the medical and dental
work could benefit a great deal from
considerable restructuring.
Thank you very much for the interview. 
At the annual Swedish dental congress in Stockholm, Heikki Pilvinen
will be presenting at the “Ledarskap—en spännande utmaning
för tandläkare (Leadership—An
exciting challenge for dentists)”
session, which takes place on
Friday, 18 November, from 13:30 to
15:00 in Hall A5.

[18] =>

news

Moving to model-free crowns
How a family-owned dental laboratory from Denmark increased its market share by going digital

Schmidt Dentalkeramik in Horsens in Denmark adopted CAD/CAM
technology about ten years ago. Ejner
Schmidt, the father, always wanted to
stay ahead of the game and embrace
new technology. However, when his
son came to him with the radical idea
of model-free crowns, trouble erupted.
The family laboratory was renowned
for its craftsmanship and service. The
idea of giving up control of their artistry by going all-digital—and, even
worse, creating a product for half the
price—was abhorrent to the father.
Sune Schmidt, the son, was insistent. He felt the family’s laboratory

years. In a short interview, he recounts how it all started.

 Like a Hollywood film, the upstart
son passionately argues with his father over the need for the family business to make the digital leap. And
true to the script, the son’s vision and
hard-headedness eventually earn the
grudging respect of his father. Best
of all, the story has a happy-ending.
The move to model-free has changed
the fortunes of the family business.

What motivated you to go model-free
at your laboratory?
Sune Schmidt: Over the years,
I had seen our laboratory’s molar and
premolar business disappearing to
low-cost laboratories abroad. Danish
laboratories just could not compete
on pricing. That motivated me. I spent
eight months testing systems, specifically milling machines. We had previously outsourced our milling. However, to realise our vision of producing
inexpensive model-free crowns, milling then needed to be done in-house.



Sune Schmidt of Schmidt Dentalkeramik.

was not taking advantage of what
their CAD/CAM system could do. The
machines just produced the same
product they always did. Since making the change, Schmidt Dentalkeramik has shipped thousands of model-free crowns over the past few

What made model-free crowns possible for you?
First, we needed to find an open
CAD system. That way we could
select whatever milling machine we
needed. Having the freedom to choose
was important. Second, we needed to
be certain we could rely on the accuracy of the digital impressions from
the dentist. In theory, with our open



Aesthetic and functional results without a model.

“...the opportunity not only to compete,
but also to beat the competition.”

Live
MOUTH SMART
Join us

for World Oral
Health Day 2017!

CAD/CAM software (Dental System,
3Shape), we could accept scans from
all intra-oral scanners; however, after
completing the testing, we ended up
working only with 3Shape TRIOS
intra-oral scans. We felt that they
produced the best impressions.
Was it easy for technicians to learn
to work model-free?
It was very easy for us to learn to
use the software (I think it might be
due to our age), whereas my father
felt it was more difficult. However, initially it was still tough for our laboratory to adapt to model-free crowns.
You have to remember that we are
a family business. Traditionally, my
father and I check every crown by
hand we sent out. We still do it. To
suddenly have a finished crown with
no means of controlling it—I still

cringe a little when we send an order
to a new customer.
How has it changed your business?
Like most laboratories, we saw
our business disappearing to lowcost laboratories abroad. Model-free
crowns have given us the opportunity not only to compete, but also to
beat the competition. Going model-free has made our workflow more
effective, cutting down on man hours,
speeding up turnaround time and,
importantly, increasing our market
share. It has separated us from the
pack. This is basically the first time in
history that one is able to produce
a crown so quickly and cheaply in
Denmark. In the beginning, my father
thought I was crazy, but now he is
just very proud of what his laboratory has accomplished. 

“...my father thought I was crazy,
but now he is just very proud of what
his laboratory has accomplished.”

about the publisher

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Publisher
Torsten Oemus

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ENGLISH
Good oral hygiene habits, avoiding risk factors and having a regular dental check-up from early in life
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Kristin Hübner
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today will appear at The Annual Dental Congress and
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The magazine and all articles and illustrations therein are
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[19] =>

news

CURAPROX: One can always learn more
 Leading Swiss oral care company Curaden, through its brand
CURAPROX, combines high-quality,
professionally recommended oral
care products, pioneering training
systems and prophylaxis concepts for
long-term oral health. At this year’s
Swedental trade fair in Stockholm,
CURAPROX Sweden will be presenting toothbrushes that are gentle
yet effective, first-in-class interdental
brushes, single brushes, non-staining
chlorhexidine mouthrinses and gels,
as well as enzymatic toothpastes that
are free of sodium lauryl sulphate and
help to inhibit the formation of dental
plaque. Also on display will be the
revolutionary Black Is White toothpaste and the Black Is White Hydrosonic electrical toothbrush.

CURAL surgical wire that supports
long, soft bristles, making them very
versatile and extremely effective,
even in tight interdental spaces. The
range of innovative products includes
the SLS-free Enzycal mild toothpaste
with 1,450 ppm fluoride. The product
contains special enzymes that boost
natural saliva protection, reduce mouth
ulcers, promote re-calcification and protect against dry mouth. In addition,
the CURASEPT ADS mouthrinses and
gels offer the full benefits of chlorhex-

idine for care of patients with implants, periodontitis or fixed tooth replacements, but without staining.
Dr Anna Olsson, who has been a
practising dentist for about 28 years,
runs her own clinic specialising
in prosthetics and implantology in
Åstorp in Sweden. She has been using
CURAPROX for almost two years
and recommends the products to her
patients. “The toothbrushes are very
smooth and gentle, and they last

much longer than other brands. One’s
teeth feel very clean after brushing
and the interdental brushes particularly feel very hygienic,” she said.
When asked about the advantages of
prevention as opposed to restoration,
Olsson supported the Curaden philosophy of promoting good oral health to
patients: “Preventive dentistry is the
most important part, the best investment a person can make both in terms
of health and financially. I think dentists are quite well trained in preven-

tive dental care in Sweden, and the
general health care system expends a
great deal of resources on dental care
for children and the youth. However,
we might need to teach our children
and young people to take greater responsibility for themselves. One can
always learn more.” 
CURAPROX, Switzerland
www.curaprox.com
BOOTH A17:40
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The largest dental event in Latin America!

#ciosp60years

Transforming the History
of Dentistry

“CURAPROX products have become very popular in Sweden thanks
to our focus on quality, functionality
and design. For example, the new
whitening toothpaste, Black Is White,
is a great success. It provides safe and
effective whitening with activated
carbon and uses hydroxyapatite and
fluoride to remineralise the tooth
enamel. Dentists have confirmed that
their patients love the black colour
of the toothpaste and the feeling
of cleanness,” stated Olle Nilsson,
Sales Manager at CURAPROX Sweden.
“We have received great feedback
from dentists, dental hygienists and
pharmacists, who recommend our
products to consumers.”
In addition to the well-known
CS toothbrushes with their CUREN
filaments for efficient cleaning of
tooth surfaces, visitors to Swedental
can view the complete range of interdental brushes at the CURAPROX
booth. The CPS prime interdental
brushes are the most atraumatic and
smallest on the market and can be
used by healthy persons too as a
more effective alternative to dental
floss. CURAPROX manufactures interdental brushes with a very thin

Information:
Exhibit Inquiry:
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@apcdcentral

Support:

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International Media:

[20] =>

exhibitors list

Booth

Company

Booth

Company

3D Verkstan
3M Svenska AB
A Child’s Smile
Actavis
Acteon Group
ADA WORLD INTERNATIONAL
Almasoft AB
Apex Italia
APL
ApoEx AB
Astro Sweden
Bendent AB
Bigman AB
BioGaia
Biolase/SciVision Nordic
BPR Swiss
Brilliant Dental of Scandinavia
BrilliantSmile
Brotech
CADstar GMBH
Carl Martin GmbH
CCS Healthcare
CelinDental
Cenger Scandinavia AB
Chemisch-Pharmazeutische Fabrik

A07:48
A08:30
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A23:28
A15:20
A24:55
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A23:13
A13:11
A06:40
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A12:11
A21:57
A23:41
A24:51
A18:51
A05:49
A20:50
A14:20
A17:28
A18:48
A10:40
A21:49

Elysee Dental AB
Euro-Park
Exactodent Sweden AB
FDI World Dental Federation
Fimet OY
Flavio Medicos
Folktandvården Sverige
Forstec Dental AB
FSD, Föreningen Svensk Dentalhandel
Försäkringskassan
Gama Dental AB
Garrison Dental Solutions
GC NORDIC AB
Gingi Produkter AB
GlaxoSmithKline Healthcare AB
Götene Specialinredningar AB
HADI DENT INSTRUMENTS CO.
Hager & Werken GmbH & Co. KG
Harry Holms AB
Hear Nordic AB
Hejco
Heraeus Kulzer Nordic AB
Hultén & Co AB
Humble Brush AB
Hådéns Dental Original Products HB

A06:44
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A22:50
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A16:50
A07:49
A20:49

Officeline AB
A15:48
Opus Systemer AS
A11:30
Oraldyne Munhygien AB
A24:31
Orkla Care AB
A23:40
Ortopro AB
A07:09
Pastelli
A08:03
Periacryl
A25:23
Pharmex As
A25:35
Philips Sonicare
A09:11
Plackers Scandinavia AB
A09:40
Plagg & Design i Mölndal AB
A10:50
Plandent AB
A10:30, A11:28, A11:30
PPH Cerkamed Wojciech Pawlowski
A19:51
Praktikertjänst AB
A10:20
Praxis
A21:31
Privattandläkarna
A16:49
Procter & Gamble Sverige AB / Oral-B
A06:31
Protera Dental
A09:48
Proxident AB
A22:40
Quintessence Publishing Co Ltd
A24:32
ResMed Sweden AB
A17:35
Restodont
A22:49
Rini Ergoteknik AB
A23:15
Röntgenutbildarna Stockholm AB
A18:38
Sableline
A10:19, A23:18, A25:21
Salli Systems
A20:11
Scanex Medical Systems AB
A21:28
SE-BRA Scandinavia AB
A10:11
SHOFU Dental GmbH
A09:41
Smila Workwear
A12:52
Smile Tandvård
A16:40
Solident Sweden AB
A16:48
Straumann AB
A09:20
Sun Dental Labs AB
A05:41
Sunstar Sverige AB
A20:40
Support Design AB
A18:49
Swede Dental AB
A08:50
Sweden Recycling AB
A17:48
Swedish Care System AB
A21:30
Svensk Dentalservice
A18:20, A20:20
Svensk Dentalåtervinning AB
A22:30
Svenska Tandsköterskeförbundet
A21:53
Sveriges Tandhygienistförening
A21:40
Sveriges Tandläkarförbund
A13:20
Sveriges Tandteknikerförbund
A21:20, A22:29
Syster Jane
A24:36
Tandfakta JS AB
A22:58
Tanja Unlimited AB
A22:30
TeethRus Sweden AB
A20:39
TePe Nordic AB
A15:40
TEV, Riksföreningen Tandläkare-Egen Verksamhet
A13:20
Tidningskungen.se
A25:40
Tieto
A15:29
Tingstad Prowear
A23:25
Tjänstetandläkarna
A13:20
Toshio Surgico
A26:10
TrendRehab
A23:20
TrollDental
A09:09
TS Dental
A18:30
UMEC EARfoon AB
A24:30
Unident AB
A17:30
Unilever Sverige AB
A17:37
Unionen
A20:52
W&H Nordic AB
A09:30
Wear Work AB
A24:41
WENDELIN MEDIA
A24:57
Westside Resources
A24:28
Victus Medical Group
A16:13
VOCO
A06:02
Yirro-plus® & Medical-D
A23:44
Zeedent
A17:11
Zhermack S.p.A.
A23:38
Zirkonzahn
A23:31
Åhgrens Dental AB
A21:55
Åhrén Dental Consult
A15:28

© Stockholmsmässan.se

Company

ClearPath aligners
Colgate-Palmolive AB
Coltène
Combimed AB
Curaprox
D.V.I.
DAB Dental AB
Danderyds Snickeri AB
Dentabiz AB
Dentakon
Dental Zone
Dental Direkt GmbH
Dental Technology
Dentaldoktorn
DentalEye AB
Dentalmagazinet i Sverige AB
Dentalmind AB
Dentalringen AB
Dentatus AB
Denthouse AB
DentMan, Sten Lagerstedt AB
Dentsply Sirona
Directa AB
Don Marc Spain SL
Dynamostol
Dürr Dental AG
Edenta
Ekulf AB
Elos Medtech AB

04

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A08:52
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A16:11
A14:11
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A21:48
A22:20
A12:50

Swedental 2016

ICT Europe GmbH
Implantat Maraton
Inform A/S
Inkassogram
Ivoclar Vivadent AB
Johnson & Johnson AB
Johnson & Johnson Consumer Nordic
KaVo Scandinavia AB
KBSPK Industries
Keystone Dental AB
Klardent AB
Klinik Support Sverige AB
Koine’ Italia
LM Dental AB
Meda Otc AB
MEDIDENT ITALIA
MeridentOptergo AB
Milmedtek AB
MIS
Mode Medikal San. ve Tic.Ltd.Sti.
Multify AB
Mun- och halscancerförbundet
Mun-H-Center
Museinämnden, Svenska Tandläkare-Sällskapet
Neoss AB
Nobel Biocare AB
Nordenta AB
Nordisk Väntrums-TV AB
Normedico AB

A22:52
A10:54
A12:19
A26:08
A07:02
A15:35
A15:35
A06:20, A06:21
A24:33
A11:48
A12:51
A22:41
A21:39
A11:28
A07:38
A21:11
A22:11
A09:07
A25:20
A24:21
A18:52
A24:22
A22:54
A20:19
A07:40
A06:30
A07:10
A24:38
A05:45

Booth

The exhibitors list is subject to change. Last update was 21 October, 2016.

[21] =>

You’re invited to New York City!
Register and Reserve
your seat today!

12 CE
Credits

Innovative Solutions
for Contemporary Implant Dentistry
December 8th & 9th, 2016

In cooperation with Columbia University &
ICOI Dental Implant Symposium
December 10th, 2016
Guest Speakers
Prof. Dr. Hakan Akıncıbay - Turkey
Nurit Bittner, DDS - USA, New York
Dr. Diego Capri - Italy
Prof. Dr. Thomas Fortin - France
Dr. Constantin Ionescu - Sweden
Dr. Marco Josch - Germany
Dr. Maciej Marcinowski - Poland

Dr. Gregory Oxford - USA, Florida
Mariano Polack, DDS, MS - USA, Maryland
Prof. Dr. Michael Rosin - Germany
Dennis Tarnow, DDS - USA, New York
Robert E. Walinchus, DMD - USA, Pennsylvania
Associate Prof. Dr. Zekai Yaman - Turkey

RSVP
info.europe@keystonedental.com or +39 045 8230294

[22] =>

business

G-CEM LinkForce—The only luting cement a dentist needs
Optimal strength and aesthetics for all indications and substrates
dual-cure feature of G-CEM LinkForce
is outstanding too, ensuring efficient
polymerisation in both light-cure and
self-cure modes, the latter being crucial, as with many indirect restorations only a small percentage of the
light can pass through. Finally, G-CEM
LinkForce is highly polishable and
the use of ultra-fine homogeneously
dispersed fillers in high concentration
delivers remarkable wear resistance,
even on occlusal margins.

n Which cement works best for which
indication and which substrate? With
the different types of restorations and
the wide choice of substrates available, GC understands why dentists
may be uncertain of which luting
agent to choose. They want products
that make their work easier, allow
them to work in a standardised way
and offer predictable results at all
times. That is the thinking behind
G-CEM LinkForce, GC’s new dual-cure
adhesive resin luting cement. G-CEM
LinkForce is the universal solution to
all adhesive challenges, featuring the
optimal strength and aesthetics for all
indications and all substrates, with no
compromises.
The development of CAD/CAM
and the evolution of adhesive dentistry have revolutionised the type of
indirect restorations that are performed: from very retentive crowns
and bridges to less invasive solutions,
such as inlays, onlays, overlays and
veneers that need to be bonded instead of cemented. Parallel to this

trend has come a procession of new
substrates, such as zirconia, lithium
disilicate and hybrid ceramics. One
consequence of this revolution is the
difficulty for dentists of making sense

of the multiple treatment options now
available. Mastering all of the cementation procedures to cover all indications is very challenging, so it is no
surprise that most dentists would

INSPIRATION, BUYING
AND NETWORKING
MUCH TO LOOK BACK ON - MORE TO LOOK FORWARD TO

want a universal solution with a
standardised procedure that eliminates the complexity, performs at the
highest level and produces predictable results.
G-CEM LinkForce is that solution.
Together with G-Premio BOND and
G-Multi Primer, it forms a universal
adhesive system that ensures a strong
bond to all substrates for all indications, with no compromises:
• G-Premio BOND bonds with no compromises to all preparations.
• G-CEM LinkForce provides a strong
link for all indications.
• G-Multi Primer ensures a stable adhesion to all restorations.
GC’s new adhesive luting cement
offers many dentist-friendly features,
beginning with the mixing. After selecting from the four available shades

50
YEARS
SCANDEFA

G-Premio BOND is a one-bottle
solution that bonds perfectly to all
preparations, even core build-ups and
metal abutments. It can be used for
self-etch, selective etch and total etch
with virtually no postoperative sensitivity. Furthermore, G-Premio BOND
is easy to apply and produces a very
thin layer of 3 µm that can be light
cured without interfering with the
final adaptation of the restoration.
G-Multi Primer is the only primer
a dentist needs. It uses three different
functional monomers to ensure adhesion to all substrates. GC further
ensures the long-term stability of the
adhesion by including silane in the
primer rather than in the bonding
agent.
With the combination of G-CEM
LinkForce, G-Premio BOND and G-Multi
Primer, predictable cementation of all
indirect restorations is guaranteed—
even on non-retentive preparations
such as inlays and onlays. The same
is true for veneers, with the added
advantages of easy positioning, light
curing and excess removal, multiple
shades with their try-in pastes to
cover all aesthetic needs, and optimal
fluorescence. The system is ideal for
post luting too, owing to its low vis-

2017

“...the use of ultra-fine homogeneously
dispersed fillers in high concentration
delivers remarkable wear resistance,
even on occlusal margins.”
SCANDEFA invites you to exclusively meet the Scandinavian dental market
and sales partners in wonderful Copenhagen.
Why exhibit at SCANDEFA?
SCANDEFA is a leading, professional branding and
sales platform for the dental industry.

Who visits SCANDEFA?
In 2016 over 8,000 dentists, dental hygienists, dental
assistants and dental technicians visited SCANDEFA.

In 2017 we are pleased to present SCANDEFA with
two fair days and a more flexible course programme
at the Annual Meeting. In addition to sales, branding and customer care, the fair format gives you
the opportunity for networking, staff care, professional inspiration and competence development.
SCANDEFA is organised by Bella Center Copenhagen and held in collaboration with the Annual
Meeting organised by the Danish Dental Association (tandlaegeforeningen.dk).

For further statistical information please see
scandefa.dk

How to exhibit
Please book online at scandefa.dk or contact
Sales & Relation Manager Mia Clement Rosenvinge
mro@bellacenter.dk/+45 32 47 21 33.

Where to stay during SCANDEFA?
Two busy fair days require a lot of energy, and therefore a good night’s sleep and a delicious breakfast are
a must. We offer all of our exhibitors a special price
for our three hotels, AC Hotel Bella Sky Copenhagen
– Scandinavia’s largest design hotel, Hotel Crowne
Plaza – one of the leading sustainable hotels in
Denmark and 5 Copenhagen Marriott Hotel.

We also offer easy shuttle service transport between
the airport, Hotel Crowne Plaza and AC Hotel Bella
Sky Copenhagen.

SCANDINAVIAN DENTAL FAIR
27 - 28 APRIL 2017

scandefa.dk

(Translucent, A2, Opaque and Bleach),
dentists will appreciate the easy automix mode to dispense directly into the
restoration or with an endodontic tip
into the root canal. Seating and adaptation are central to a perfect cementation procedure, and the optimum
wettability and viscosity of G-CEM
LinkForce thus play a critical role, ensuring that the luting paste is well
spread. The exceptional film thickness of just 4 µm further guarantees
the adaptation of the prosthesis to the
abutment.
Removal of excess is very easy
when tack cured for 1–2 seconds. The

cosity and excellent wettability, its
ability to etch dentine in deep canals,
and perfect polymerisation of both
the bonding and the paste in dark
canals.
G-CEM LinkForce is the universal,
durable solution to all adhesive challenges, providing optimum strength
and aesthetics in one system for all
indications and all substrates. 7

GC NORDIC
www.gceurope.com
Booth A08:20

[23] =>

events

What’s on in Stockholm
Stockholm, 16–18 November
Ketil Thorgersen, Mats Skimmelå
and Ari Haraldsson have been performing together since 2008, playing
in various jazz locations in Sweden.
Their repertoire includes classical
jazz tunes and Norwegian fjord
jazz, as well as a number of songs
by Lars Jansson and Lars Gullin, and
of course, the band’s own compositions. Perfect for grabbing a beer or
a glass of wine and unwinding after
a busy exhibition day. Admission is
free.

Christmas market
in the Old Town

Moki Cherry “Utan” ca. 1967 © Moderna Museet

Moment—Moki Cherry
Date: 16–18 November
Opening times: 10:00–18:00 Wednesday & Thursday | 10:00–20:00 Friday
Venue: Moderna Museet, Skeppsholmen
www.modernamuseet.se
With a mixture of original works,
music and stage photos, the museum
of modern art in Stockholm is honouring Swedish artist Moki Cherry
(1943–2009). Her artistic practice
was inspired by experiments such
as counter-urbanisation, subsistence
farming and children’s projects. Visitors can follow Cherry’s journey between life, art, pop, jazz and politics
through her colourful and vibrant
art. The exhibition includes works
made from 1967 to 2007, but highlights particularly her 1970s creations.
The museum is located on
Skeppsholmen, an island in central
Stockholm that can be accessed by
foot, bus and boat. For the last, take
the Djurgården ferry from Slussen
and enjoy a 5-minute panoramic ride
before entering Moki Cherry’s eclectic world.

Autechre
Date: 16 November
Start time: 21:00
Venue: Kägelbanan, Södra Teatern,

Autechre © The Windish Agency

Mosebacke Torg 1–3
www.sodrateatern.com
One of electronic music’s most
exciting and critically acclaimed acts,
British duo Autechre will be performing on Wednesday night at Kägelbanan. However, those of you interested in the spectacular gold and red
velvet setting of the Södra Teatern,
Stockholm’s oldest active theatre,
constructed in 1856, will be disappointed: The concert will be performed
in total darkness in order to convey
the “classically pitch-dark mind-warping audio affair” that is an Autechre
live experience. Presenting their latest album, elseq 1–5—a 4 hour-long
electronic music feast in five pieces—
Manchester natives Sean Booth and
Rob Brown will be supported by
Russell Haswell and Andy Maddocks
in Stockholm.

After-work jazz with
Jam Station
Date: 17 November
Time: 17:30–20:00
Venue: Hotel Birger Jarl, Tulegatan 8
www.birgerjarl.se
Bring the day to a relaxing end
with live music and a tasty menu
at Hotel Birger Jarl. Today, Stockholm-based jazz quartet Jam Station
will feed your senses with its musical
after-work selection. Magnus Nordén,

Date: 19 & 20 November
Opening times: 11:00–18:00
Venue: Stortorget, Old Town of Stockholm
www.stortorgetsjulmarknad.com
Visitors extending their stay to
the weekend should make sure to
experience the medieval charme and
Swedish delicacies sold at the Old
Town Christmas Market that opens
on Saturday. Held for the first time
in 1523, the market is the oldest
one in Sweden and one of the oldest

Stockholm Christmas market © Scanrail1/Shutterstock.com

Christmas markets in Europe. During
the four weeks before Christmas,
select vendors sell local specialities,
such as smoked sausages and reindeer meat, candy floss and glögg
(mulled wine), as well as a range of

Swedish handicrafts and decorative
arts of high-quality workmanship.
Put on some warm winter clothing to
brave the crisp November temperatures and immerse yourself in the
magic of a Nordic Christmas. 
AD

[24] =>

Made to fit

all your adhesive challenges.

Designed to last
Visit the
GC booth
on Swedental
A08:20

G-CEM
LinkForce™
from GC
Dual-cure

One system, three base elements

that’s all it takes to create strong adhesion in all situations

G-Premio BOND
bonds with
no compromises to
ALL preparations

GC Nordic AB
Box 70396
107 24 Stockholm
Tel. 08-506 361 85
info@nordic.gceurope.com
http://www.gceurope.com/local/nordic
https://www.facebook.com/gcnordic

G-CEM LinkForce
provides a
strong link in
ALL indications

adhesive luting cement
for all indications,
all substrates

G-Multi Primer
ensures a stable
adhesion to
ALL restorations

GC EUROPE N.V.
Head Office
Researchpark
Haasrode-Leuven 1240
Interleuvenlaan 33
B-3001 Leuven
Tel. +32.16.74.10.00
Fax. +32.16.40.48.32
info@gceurope.com
http://www.gceurope.com

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[cover] => DT Nordic No. 4, 2016

[toc] => Array ( [0] => Array ( [title] => Nordic News [page] => 01 ) [1] => Array ( [title] => World News [page] => 04 ) [2] => Array ( [title] => “Dentists can have much better conversations with patients” [page] => 06 ) [3] => Array ( [title] => Going green: The bottom-line benefi ts of green dental offi ce design [page] => 08 ) [4] => Array ( [title] => Digitally designed - meticulously implemented [page] => 10 ) [5] => Array ( [title] => “In the not-so-distant-future - half of all treatments will be done with aligners” [page] => 12 ) [6] => Array ( [title] => The mock-up: A clinician’s everyday tool for aesthetic dentistry [page] => 13 ) [7] => Array ( [title] => today Swedental - Stockholm - 16–18 November 2016 [page] => 17 ) ) [toc_html] =>

Table of contents

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