DT Asia Pacific No. 12, 2016

Asia-Pacific News / World News / Business / Proving effective oral instructions in a clinical setting / Nothing compares to ROOTS / Pedonomics: lasers in paediatric dentistry / Enhanced gingival aesthetics

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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia
© Claudia Duschek/DTI

ANTIBIOTICS

A short interview with Dr Paul
Sambrook, Australia, about what
dental professionals can do to
combat the growing issue of resistance.

Vol. 14, No. 12

ROOTS SUMMIT

Stephen Jones & Drs David E.
Jaramillo and Freddy Belliard review this year’s most important
event in endodontics.

” Page 3

GINGIVAL AESTHETICS

Dr Jiro Abe & Kyoko Kokubo,
Japan, explain how to optimise
conventional dentures with an
innovative veneering material.

” Page 8

” Page 14

(866) 999-2635

First dental vaccine may help combating
chronic periodontitis soon
By DTI
MELBOURNE, Australia: After researching the development of a
vaccine for chronic periodontitis
for the past 15 years, a team of scientists from the Oral Health CRC
at the University of Melbourne has
published their latest findings.

trials could potentially begin on
periodontitis patients in 2018.
“Periodontitis is widespread
and destructive. We hold high
hopes for this vaccine to improve
the quality of life of millions of
people,” said Prof. Eric Reynolds,
CEO of the Oral Health CRC.

Flow cytometry is used to measure changing levels of oral bacteria.

The results thus far show promising prospects that the vaccine
may reduce the need for surgery
and antibiotics for patients with
severe periodontal disease. According to the researchers, clinical

Developed in collaboration with
Australian biopharmaceutical company CSL Limited, the vaccine
targets enzymes produced by the
bacterium Porphyromonas gingivalis, one of the main periodontal

pathogens, triggering an immune
response. According to the researchers, this response produces
antibodies that neutralise the
pathogen’s destructive toxins.

The results of the study were
published in the NPJ Vaccines journal on 1 December in an ar ticle, titled “A therapeutic Porphyromonas

gingivalis gingipain vaccine induces neutralising IgG1 antibodies
that protect against experimental
periodontitis”.

IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1
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Currently, periodontitis is
treated by manually removing
toxic plaque that builds up between the tooth and the gingivae,
which sometimes involves surgery and antibiotic regimes. Although these measures are helpful, in many cases the bacterium
re-establishes itself in the dental
plaque, which causes a microbiological imbalance, so the disease
continues, Reynolds said.
Epidemiological surveys indicate that moderate to severe forms
of periodontitis affect about one
in three adults worldwide. Left untreated, the condition can result in
the destruction of gingival tissue
and ultimately in tooth loss.
Several studies have further
linked the disease to an increased
risk of various health conditions,
including cardiovascular diseases,
certain cancers, preterm birth and
dementia. If implemented in clinical practise, an effective vaccine
for chronic periodontitis could
therefore help combat the global
burden of these widespread diseases as well.

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[2] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 12/2016

Barriers to cleft lip and palate
surgery persist in Vietnam
LOS ANGELES, USA: Charitable organisations perform more than
80 per cent of cleft lip and cleft
palate surgeries in Vietnam, a
new study by US researchers has
found. According to the scientists,
this reflects the complex and persistent barriers to surgical care in
low- to middle-income countries
(LMICs) and shows that charitable
missions remain a critical source
of access to surgical care for these
states.

tions about their perceptions of
the barriers to surgical and medical care for their child’s condition.
Facing structural, financial and
cultural barriers to cleft lip and

gery, the children’s average age
was 3.25 years. By comparison, in
developed countries, the recommended age for cleft lip and palate
repair surgery is between 3 and
18 months of age.

understood in order to design
more effective programmes for
both missions-based and locally
sustainable surgical care in LMICs.
On the basis of their findings, they
proposed a new surgical LMIC

By DTI

PUBLISHER:
Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT AP & UK:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
CLINICAL EDITOR:
Magda WOJTKIEWICZ
ONLINE EDITOR:
Claudia DUSCHEK
EDITOR:
Anne FAULMANN
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Antje KAHNT

Cleft lip and palate are the
most common craniofacial birth
defects, occurring in between one
in 500 to one in 2,500 infants
worldwide. “The defect not only
results in physical obstacles to
feeding and language development, but patients are often subjected to significant social stigma,”
the researchers stated.
They surveyed approximately
450 Vietnamese families seeking
cleft lip and/or palate repair surgery for their affected child. Some
of the children had already undergone surgery for their condition
previously (54 per cent) and 46 per
cent of them were seeking surgical
care for the first time. The families
were seen at four medical missions sponsored by the international charity Operation Smile.
Parents were asked in-depth ques-

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For their child affected by cleft lip and/or palate, more than 80 per cent of Vietnamese families surveyed in a study sought
surgical care in a charitable mission—although 73 per cent of them had health insurance.

palate surgery, patients in LMICs
rely on charitable care outside
the centralised health care system, the study report pointed out.
“As a result, surgical treatment of
cleft lip and palate is delayed beyond the standard optimal window compared to more developed
countries,” the researchers wrote.
At the time of initial cleft sur-

FREE

– education everywhere
and anytime

Nearly three-quarters of the
families had health insurance
coverage. Nevertheless, 83 per
cent had their surgery performed
by a charitable organisation outside of the national health care
system. While most parents had
a local hospital that was more
accessible than the charitable mission was, many said that they
could not obtain cleft treatment
there, mainly owing to cost. About
40 per cent stated that, without
the charitable mission, they would
not have had access to any surgical or medical treatment for their
child’s condition.

model that accounts for the unique
barriers and specific challenges to
accessing surgery in resource-poor
countries—especially for conditions
that require multiple operations,
such as cleft lip and palate.
Improving access to surgical
care has become a major global
health priority, the researchers
said. However, the current knowledge gap on providing surgery in
LMICs—including the need for
specialised facilities, physicians
and follow-up care—has only begun
to be studied. Thus, even in countries with near-universal health

– live and interactive webinars

– a focused discussion forum

– no travel costs
– no time away from the practice
– interaction with colleagues and
experts across the globe
– a growing database of
scientific articles and case reports
– ADA CERP-recognized
credit administration

“...patients are often
subjected to significant
social stigma...”

www.DTStudyClub.com

Dental Tribune Study Club

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

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

Published by DT Asia Pacific Ltd.
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The survey found a wide range
of structural, financial and cultural barriers to cleft care. Structural barriers included lack of
trained medical staff, equipment
and medicine. Financial barriers
were identified as not only the
cost of the surgery, but also
the cost of travel to obtain care.
Cultural barriers included family
members’ opinions and permission, as well as lack of trust in the
medical system and staff.
According to the researchers,
these barriers need to be better

insurance, charitable missions remain a critical source of access to
surgical care, they concluded.
The study, titled “Barriers to
reconstructive surgery in lowand middle-income countries: A
cross-sectional study of 453 cleft
lip and cleft palate patients in
Vietnam”, was conducted by scientists from the University of Southern California in Los Angeles. It
was published in the November
issue of Plastic and Reconstructive
Surgery, the journal of the American Society of Plastic Surgeons.

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© 2016, Dental Tribune International GmbH

DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition

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 AP e-newsletter.

[3] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 12/2016

“Antibiotic resistance is
a serious health issue”
By Brendan Day, DTI
The use of antibiotics is essential
in modern medical treatments,
yet frequent misuse has reduced
their effectiveness. This year’s
World Antibiotic Awareness Week
(WAAW), held from 14 to 20 November, sought to increase public understanding of the issue.
Dental Tribune spoke with Dr Paul
Sambrook, Chairman of the Dental Therapeutics Committee of
the Australian Dental Association
(ADA), about WAAW’s purpose
and what dental professionals can
do to combat antimicrobial resistance.

Dr Geraldine Moses, from whom
they can seek expert advice
on prescribing. We also provide
members with a copy of the dental and oral therapeutic guide-

How can dental professionals help
minimise the risk of increasing
antimicrobial resistance?
The first response to dental
problems must always be accurate assessment by a dentist who
can deal with the cause, not just
the symptoms. That is our message to patients.

lines, which provide reliable and
independent therapeutic information to assist in making the
best decisions for patients in a
dental setting.

We urge dental professionals
to use the opportunity to educate
their patients about how to address dental problems they have

pre- and post-treatment and where
antibiotics do or do not fit in their
particular case.
To ensure that dental professionals are prescribing antibiotics in line with best practice,
ADA members can use services such as PharmaAdvice and
the afore-mentioned therapeutic
guidelines.
Thank you very much for the interview.
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Dental Tribune: What is the primary
goal of WAAW?
Dr Paul Sambrook: The aim of
the WAAW is to increase awareness of global antibiotic resistance and to encourage best practices among the general public,
prescribers and policymakers
to avoid the further emergence
and spread of antibiotic resistance.

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How widespread of a problem is
misuse or overuse of antibiotics in
Australia?
Dentists prescribe less than
3 per cent of all antibiotics prescribed in Australia. However, information from NPS MedicineWise states that Australia has one
of the highest prescription rates
globally, with around 29 million
prescriptions issued each year—
more than one per person on
average.

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Antibiotic resistance is a serious health issue already present in our community. Without
antibiotics, infections that were
once easily treated may once
again kill.

The ADA has been doing its
part to address the problem of
antibiotic resistance by advising members through informational articles in its regular
publications and website. ADA
members have access to a highly
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How did the ADA encourage involvement during WAAW?
The continuing theme of
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for this year’s WAAW is highly relevant for dentistry. People with
dental problems sometimes think
that popping a painkiller or seeing their doctor for antibiotics
is the best response rather than
having a proper examination by
their dentist.

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[4] =>

WORLD NEWS

Dental Tribune Asia Pacific Edition | 12/2016

Foreign studies show e-cigarettes
harmful to oral health
By DTI
ROCHESTER, USA/QUEBEC CITY,
Canada: In the Western world,
electronic cigarettes continue to
grow in popularity among young
AD

adults and current and former
smokers because they are often
perceived as a healthier alternative to conventional cigarettes.
However, two recent studies conducted by scientists in the US and

Canada have found that regular
exposure to e-cigarette vapours
causes damage to the gingival
tissue, which may lead to infection, inflammation and periodontal disease.

Both studies investigated the
effect of e-cigarettes on oral health
on cellular and molecular levels
through in vitro experiments. The
team of Prof. Mahmoud Rouabhia
from the Faculty of Dentistry at

Université Laval in Quebec City
exposed gingival epithelial cells to
e-cigarette vapour, finding that a
large number of these cells died
within a few days. “Mouth epithelium is the body’s first line of defense against microbial infection,”
Rouabhia explained. “This epithelium protects us against several
microorganisms living in our
mouths.”
To simulate what happens in
a person’s mouth while inhaling,
the Canadian researchers placed
human epithelial cells into a
small chamber containing a salivalike liquid. E-cigarette vapor was
pumped into the chamber at a rate
of two 5-second “inhalations” per
minute for 15 minutes a day. Observations under the microscope
showed that the percentage of dead
or dying cells, which is about 2 per
cent in unexposed cell cultures,
rose to 18, 40 and 53 per cent after
one, two and three days of exposure to e-cigarette vapour, respectively.
“Contrary to what one might
think, e-cigarette vapour isn’t just
water,” Rouabhia stated. “Although
it doesn’t contain tar compounds
like regular cigarette smoke, it
exposes mouth tissues and the
respiratory tract to compounds
produced by heating the vegetable glycerine, propylene glycol,
and nicotine aromas in e-cigarette
liquid.”
The cumulative effects of this
cell damage have not yet been documented, but they are worrying,
according to Rouabhia. “Damage to
the defensive barrier in the mouth
can increase the risk of infection,
inflammation, and gum disease.
Over the longer term, it may also
increase the risk of cancer. This is
what we will be investigating in the
future,” he concluded.
Researchers at the University of
Rochester Medical Center in the
US came to similar conclusions.
Dr Irfan Rahman, Professor of Environmental Medicine at the university’s School of Medicine and
Dentistry, and his colleagues exposed cell cultures of human gingival epithelial cells and periodontal
ligament fibroblasts to e-cigarette
vapours. “We showed that when
the vapours from an e-cigarette
are burned, it causes cells to release
inflammatory proteins, which in
turn aggravate stress within cells,
resulting in damage that could lead
to various oral diseases,” he explained.
Most e-cigarettes feature a battery, a heating device and a cartridge to hold liquid, which typically contains nicotine, flavourings
and other chemicals. The US researchers found that the flavouring
chemicals negatively affect gingival cells too. “We learned that
the flavourings—some more than
others—made the damage to the
cells even worse,” said study author
Fawad Javed, a postdoctoral resident at Eastman Institute for Oral
Health, part of the university’s
medical centre.

[5] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 12/2016

By DTI
BANGALORE, India: European dental manufacturers W&H Dentalwerk and Planmeca have joined
forces on the dental market in
India. Comprising a shared office
centre in Bangalore and a specialised customer service network,
the collaboration between the two
companies is aimed at exploiting
synergies in offering a comprehensive and unique product portfolio to dental professionals in the
country.
According to the companies,
Bangalore was chosen in order to
create a strong base for sustainable growth in the high-potential
Indian market. Equipped with a
state-of-the-art showroom and

facilities for local customer support and service, the office centre,
which began operating in November, will be an important contact
point for Indian customers.
“With the local presence of our
sales and service team we can establish a direct link to the Indian
customers. This is an important
basis to build up a good reputation
and create confidence of our Indian
users with the W&H and Planmeca
products we sell,” said Raghavan
Radhakrishnan, General Manager
of W&H India and Planmeca India.
In addition to the institutional
sector, particular focus will be directed towards the private sector,
as the demand for innovative,
high-tech solutions for efficient

W&H and Planmeca approach the
Indian market together
patient care is currently growing
in India. “This is a terrific new
dawn for Planmeca in India,” commented Planmeca Vice President
of Sales Jouko Nykänen. “We are
extremely excited about the country’s growing dental market and
will utilise this new kind of grassroots partnership and partner
support model to provide increasingly better customer experiences
in India,” he added.
Commenting on the cooperation, W&H Managing Director
Peter Malata remarked: “The collaboration with Planmeca, also
a family-run enterprise with advanced technology, allows for
synergies of two strong brands.
The purpose of establishing a subsidiary in India is to be able to learn

Raghavan Radhakrishnan, General Manager of the office centre in Bangalore,
(left) and W&H Managing Director Peter Malata.

first-hand the needs of dentistry in
India. The sharing of office space
and infrastructure by Planmeca

and W&H will allow us to offer
perfect solutions for dental clinics
in India. This is what we strive for.”

GC celebrates 95 anniversary at
fourth International Dental Symposium
th

By DTI

well as hands-on courses, was attended by 6,951 participants.

TOKYO, Japan: On 12 and 13 November, Japanese dental manufacturer GC Corporation hosted
the fourth International Dental
Symposium in Tokyo to commemorate the 95th anniversary of
the company’s establishment and
the 60th anniversary of the GC
Membership Society. The two-day
event, which included scientific
sessions for dentists, dental technicians and dental hygienists, as

Held under the theme “Advanced technology and knowledge will change the dental practice—Dentistry that supports and
improves people’s lives”, the symposium comprised 23 sessions,
which were presented by 85 prominent researchers and clinicians
from various fields of dentistry.
The scientific programme was
complemented by four international sessions with lectures by

14 distinguished speakers, including Dr Javier Tapia Guadix (Spain),
Dr Gianfranco Politano (Italy),
Dr David Garcia Baeza (Spain),
Dr Sreenivas Koka (US), Prof. Bart
Van Meerbeek (Belgium) and Prof.
Mark A. Latta (US).
At the opening ceremony, FDI
World Dental Federation President
Dr Patrick Hescot, Prof. Jukka
H. Meurman, President of the
International Association for Dental Research (IADR), and immediate past President of the IADR

Prof. Marc Heft delivered congratulatory speeches.

tal Symposium Lab Work Award,
a contest for dental technicians.

In conjunction with the scientific programme, a dental show
was held on an underground level
of the Tokyo International Forum.
Featuring product experience
booths and various seminars, the
show was crowded with visitors
throughout the weekend.

Next year, GC will once again
celebrate both anniversaries with
the MI World Symposium, which
is to be held in Tokyo at the JP
Tower Hall and Conference centre
on 5 February 2017. The focus
of the event will be future applications of MI Paste Plus, the
company’s water-based, sugar-free
dental topical crème containing
RECALDENT and fluoride, in clinical dentistry.

At the event, the company
presented the GC Membership
Society’s fourth International Den-

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[6] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2016

Proving effective oral instructions
in a clinical setting

Naturally, dental professionals
agree that, despite clinical evidence
that supports the importance of
interdental biofilm management,
effective daily cleaning of interdental spaces remains a challenge
among their patients. Removal of
interproximal plaque is considered
important for the maintenance of
gingival health, prevention of periodontal diseases and the reduction
of caries, as well as the prevention
of systemic diseases. However, dentistry still argues whether today’s
interdental cleaning tools are sufficient to interrupt biofilm devel-

terdental brushes were found to be
more effective in removing plaque
compared with brushing alone or
the combined use of toothbrushing
and dental floss.

patient ability and motivation. “Interdental cleaning does not readily become an established part of
daily oral hygiene,” said Bourgeois
throughout his presentation. Dam-

According to Prof. Denis Bourgeois, toothbrushing alone is not enough to prevent interdental plaque. Individually trained
oral prophylaxis is key to success.

Establishing the accessibility
and widths of the interdental spaces
should therefore be part of the routine examination of all patients. Its
goal is to identify the distribution
of interdental brush accessibility
site by site and to choose the largest
diameter that can pass between the
teeth without causing discomfort

age to the interdental papilla and
abrasive trauma to the dental surface result from a lack of motivation
and training. Furthermore, bleeding
may stop patients from using interdental brushes even though bleeding will stop after several uses if an
interdental brush of the correct diameter is used. Oral and periodontal
© DTI

Prof. Denis Bourgeois spoke about the role of interdental biofilm management in his presentation in Poland.

opment. Professionals debate on
which tools to use and how to use
them correctly, as uncertainty has
remained about how to maintain
clean interdental spaces.
As Bourgeois concluded in his
presentation, the majority of studies have reported a positive significant difference in the plaque index
when using an interdental brush
compared with floss. In general, in-

nique and regular training can reduce the risk of bleeding and oral
bacteria,” said Bourgeois. “From a
clinical point of view, the oral
prophylactic goal of achieving thor© DTI

Despite advances in good oral health
care, many patients and dental professionals remain uncertain about
oral physiopathology and the concept of disruption of interdental biofilm. Although patients may have
bought more oral care products and
become more interested in their
dental hygiene, many still do not
know how to use them correctly. A
previous article published in Dental
Tribune Asia-Pacific 11/2016 introduced to the outstanding research
done by Prof. Denis Bourgeois, Dean
of the University of Lyon’s dental
faculty in France. In his presentation
at the FDI Annual World Dental
Congress in Poznań in Poland, he
presented scientific evidence that
interdental brushes, in particular
CURAPROX CPS interdental brushes,
are efficient tools to interrupt the
interdental biofilm. However, questions remain about the level of individual training that the dental staff
should provide for their patients.

or trauma. An interdental brush
that is sized correctly for each interdental space is easy to handle and
atraumatic, yet effective.

Individual instruction
important for good
interdental health
One major problem with interdental cleaning has always been

diseases are not only due to sugar
consumption or heredity, but result
from a lack of proper dental hygiene.
“The reason for oral and periodontal diseases is not a lack of antiseptics, a lack of fluoride or a lack of
massage of the gingivae. Antiseptics
continue to be used, but mouthwash does not stop bleeding. Only
the right technique of cleaning interdentally, repetition of this tech-

ough cleaning with minimal damage, due to the misuse of interdental
brushes, is important. It is necessary
to emphasise individual instruction
and selection of oral hygiene means
with a view to attaining a high level
of cleanliness with little or no harm
to either soft or hard tissue.”
Oral prophylaxis should therefore be taught individually and not
in lectures. By correcting and repeating the right cleaning technique,
prevention of oral and systemic
disease can be achieved. Currently,
Bourgeois offers prophylaxis training courses for dental students. In
these, they are taught the correct
use of oral hygiene tools such as
interdental brushes, cleaning techniques, and the importance of motivation and repetition. As observed
by the course presenter, 95 per cent
of the dental students continue to
use interdental brushes after two
years of completing the training. “Interdental cleaning needs to become
an established part of daily oral hygiene for the reduction of interproximal plaque, the control of gingivitis
and improvement of patient motivation. If you use a toothbrush twice
a day, you have to use interdental
brushes once a day. If not, you will
risk your health,” Bourgeois said.

A probe as key to
successful interdental
cleaning
As an effective and predictable
tool to objectively measure the
size of the interdental spaces, interdental probes are now increasingly

used by some dental hygienists to
help choose the right access diameter defined by the thickness of the
wire core. A study by Bourgeois et
al., titled “A colorimetric interdental
probe as a standard method to evaluate interdental efficiency of interdental brush,” emphasised the need
for choosing the right diameter
so that the interdental brush can
easily fit the interdental space.
Apart from the individual anatomy,
interproximal spaces can change
with age, periodontal health or dental treatment. While under-sizing
of the interdental brush will affect
its efficiency, oversizing might influence acceptability, comfort and
could cause gingival trauma.
Essentially, Bourgeois and his
colleagues suggested that the use of
a colorimetric probe and interdental
brushes is more beneficial to both
the patient and the practitioner
than merely choosing interdental
brushes based on the reference technique of trial and error alone. By
using the IAP CURAPROX calibrating
colorimetric probe, a conical professional instrument with a rounded
tip, dental professionals were able to
measure the interdental space and
choose the most suitable interdental
brush for their patients. The study
found that the brushes chosen had
a diameter larger than that indicated
by the probe in 23.54 per cent of
cases and a diameter smaller than
the probe value in 33.41 per cent of
cases. According to the study, the
colorimetric interdental probe can
be considered as a newly developed
in-clinic professional procedure that
will make interdental cleaning easier and more predictable and help
improve patient motivation.
By measuring the interproximal space correctly, Bourgeois and
his team concluded that the latest
generation of interdental brushes
was able to access 94 per cent of interdental spaces. Over 80 per cent of
the sites required a small-diameter
interdental brush (0.6 to 0.7 mm) of
the Curaprox CPS Prime Series, and
differences occurred between anterior and posterior sites. Participants
were able to use the interdental
brush easily following instructions.
As a result, most interdental sites
can be cleaned using interdental
brushes, but accessibility of interdental spaces would need to be established in the dental practice with
the use of the CURAPROX IAP Probe.
More information can be found at
www.curaprox.com.

Prof. Denis Bourgeois is working as a
professor in the Faculty of Dentistry
at the University of Lyon (11 Rue
Guillaume Paradin, 69372 Lyon Cedex
08), France, and can be contacted by
phone at +33 478778684 or by e-mail
at denis.bourgeois@univ-lyon1.fr.

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TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2016

Nothing compares to ROOTS
© Claudia Duschek/DTI

By DTI
ROOTS SUMMITs have been held
since the late 1990s. Over the
past two decades, Stephen Jones,
Drs. David E. Jaramillo and Freddy
Belliard have been part of the
meeting that regularly attracts endodontists from all over the world.
At the 2016 event, which was organized in close collaboration with
Dental Tribune International, the
publisher sat down with the three
endodontic experts to learn more
about the mission of the ROOTS
community.
Dental Tribune International: How
did each of you become involved in
the ROOTS SUMMIT?
Stephen Jones: Late in 1999,
I received a promotion in endodontic product management as a
sales representative at SybronEndo.
However, I had no knowledge of
rotary instruments. When I was
researching for information on
the Internet, I came across the
ROOTS group. I became a fan
right away, because it brought my

From left: Scientific chairman Dr. David E. Jaramillo, co-chairman Dr. Freddy Belliard and co-chairman Stephen Jones at the
2016 ROOTS SUMMIT in Dubai.

Facebook in 2012—a move that
some people resisted at first—the
group became much bigger, how-

because people had the opportunity to see each other’s faces and
literally communicate at eye level.
© Claudia Duschek/DTI

Almost 20 international companies exhibited their latest endodontic products.

knowledge of the procedures up to
speed very quickly. I soon noticed
that there is nothing comparable
to the ROOTS community, especially with regards to an open discussion among specialists from
many different areas.

Jones: In addition to an exponential increase in memberships
from about 1,000 to 23,000 as of
today, the move to Facebook improved the tone of the discussions,

Jaramillo: The technology that
is available to endodontist has
developed rapidly from the time
of the first meetings to today.
Over the whole period, participants have always been eager
to learn more about the latest
developments and the ROOTS
SUMMIT has always recognized

What are the main characteristics
of the group?
Jones: The ROOTS community
is a group of individuals who have
a sincere and passionate interest
in the profession of endodontics
and are constantly searching
for knowledge and the improvement of the practice for better
outcomes. Moreover, the ROOTS
SUMMIT is completely independent. Although a number of companies have supported our meetings, there is no commercial or
political influence from any manufacturer or society whatsoever.
ROOTS is purely about learning endodontics—a practitioners’ forum
for practitioners. The content we
provide is only shaped by members of the group itself and is not
guided from any external party.
Belliard: Even though it might
sound a little bit like a cliché, for
me, ROOTS is a family. The over
23,000 members engage at different levels, with some who are very
active in sharing their cases while

Jaramillo: ROOTS people are
very enthusiastic and aim to improve their own, and the skills
of others, in endodontics for the
benefit of the patient. One of its
unique features is its international diversity. Despite this, almost everybody knows each other.
That distinguishes it from other
endodontic meetings.
Has the 2016 ROOTS SUMMIT met
your expectations?
Jones: We chose Dubai specifically for the fact that daily, there
are more than 200 direct flights
from various cities around the
globe to this location. The number
of countries that we achieved to
draw this year is overwhelming.
Hundreds of participants, including some of the key opinion leaders of the endodontic profession,
from over 45 countries registered
for the event. Thus, this year’s
meeting has completely met our
expectations.
Belliard: It met our expectations not only in the quantity
and quality of people who came,
but also from the organizational
point of view. Dental Tribune
International was a massive help
in managing the logistics and promotions related to the meeting.
Without its organizational team
we would not have drawn such a
variety of people.
Jaramillo: With regards to the
scientific program of this year’s
program, we received very positive feedback from the participants, which shows that we picked
the right speakers to take the audience through the different topics,
step-by-step.
When will the next ROOTS SUMMIT
take place?
Jones: Although we haven’t
agreed on a definite date yet, the
next meeting will be held in 2018
in Germany’s capital, Berlin.
Thank you very much for the interview.
© Claudia Duschek/DTI

Dr. Freddy Belliard: In 1999,
I had just graduated from my endodontic Masters’ program in Mexico City and I was looking for an
endodontic forum on the Internet.
Although it was only a small group
at the time, this unique forum, to
which a couple of friends from the
Dominican Republic drew my attention, convinced me right away.

ever, it became easier to communicate thanks to the high quantity
of visual information.

new treatment options and techniques in its program, which has
always combined scientific evidence with clinical tips for dental
practices.

others are just observing. However, it is a unique platform for
education among specialists.

Dr. David E. Jaramillo: It started
several years ago when Freddy
invited me to participate in this
community. I have been a very active member ever since.
What has changed since then?
Belliard: In the early phases
of ROOTS, not many people had
full-time Internet access. After we
decided to take the community to

From left: Carlos Aznar Portoles, Roberto Cristescu, Nicola Grande, Ana Arias, David E. Jaramillo, Freddy Belliard, Ahmed Abdel Rahman Hashem, Stephen Jones,
Gary Glassman, Sergio Rosler, Gianluca Plotino, Piotr Wujec, Walter Vargas Obando, Imran Cassim and Bojidar Kafelov.

[9] =>

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Tribune Group GmbH is an ADA CERP provider. ADA CERP is a service of
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[10] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2016

Pedonomics: lasers in paediatric dentistry
By Dr Imneet Madan, UAE
We live in an era in which time is
the basis for many decisions: what
saves time is what gets chosen. Introducing better technology helps
to work with time economics in
paediatric dentistry. The recent
term coined for this perspective
of expanded thinking is “Pedonomics”. Pedonomics refers to the
impact of the changing world of
paediatric dentistry in the dental
practice.1

Marketing protocols help us
to see a larger number of patients
per day, but to have these patients

ments when it comes to completing the laser requirements of any
practice.

tissue procedures. The first laser
specifically for dental use was a
neodymium-doped yttrium alu-

Lasers allow the dental practice to balance well between business and dentistry. Offices that
in-corporate lasers in their practice have a unique psychological
and promotional advantage over
those who fail short to offer such
services. Lasers are definitely the
foundation of creating a referralbased practice.16

Time economics goes hand in
hand with pedonomics. The selective niches of dentistry are expanding far more today than in
the past years. Few reasons that
account for the need of this level
of advanced healthcare are:2

Lasers as game
changers
Lasers are introduced as excellent instruments in everyday
dentistry. However, the idea of
dentistry is generally connected to
discomfort and pain in children’s
minds. Any treatment trend that
can help our practice to remove
this connection by the use of contemporary technologies can increase patient referrals and treatment acceptance.
Although the hand piece does
remove the dental decay, it may
also cause abrasion of the tooth
structure and a significant amount
of discomfort that may not be
taken very well by the children. In
addition, the vibration and noise
of the drill could be unpleasant to
young ears, thereby lasers can
prove a better tool as they do overcome all these fears of drill dentistry.3 Additional benefits must
far supersede the costs and invest-

Benefits that add to the practice are always important, but
how actually does one convince
oneself to accept the resulting
expenses for the practice. Usually,
lasers are considered high investments and any high investment
must prove reasonable enough to
be accommodated in the practice.
Return on investments with lasers
can be easily pre-calculated. In
general, laser treatments can cost
35 to 40 per cent more than the
usual appliance, this calculation
done for a return period of two
to three years can yield on the
investment.

1. Some parents who have their
children later in life are referred
to as drone parents. These parents self-educate a lot via social
networks and extensive internet research. With less inherent
trust in healthcare providers,
they generally form a strong
opinion about the dental care
of their children and are most
demanding of their paediatric
dentist.
2. This category of parents are
often techno-savvy and are
quite updated with latest technologies. They appreciate a “no
pain, no drill, no memory” dentistry.
3. Caries rate in dentistry is everincreasing, with a heightened
frequency of cariogenic diet and
a decline in caries prevention.
4. There are more and more general dentists that would “do the
job” and only if it is mismanaged, would they refer the child
to the specialist. Increased availability of advanced technology
can put an end to this trial
practice.

Lasers and profits
in dentistry

Patients’ perception
of laser dentistry

accept the proposed treatments
better, it is advisable to introduce
to them tools that can truly help.
As applicable in any field, an experience that exceeds the expectations will motivate the patients
to keep appointments, accept recommended care and hence allow
to build up positive clientele.

Generally, the treatment approach in paediatric dentistry is
much different from adults. With
Lasers bringing the additional
benefits of no contact, no pressure, no drill, no anaesthesia and
thereby a less negative perception
of dentistry, higher success rates
are likely to be seen. This is certainly because of an increased
degree of satisfaction of the patients.

Laser indications
in dentistry
Medicine began to integrate
lasers in the mid-1970s for soft

Laser Filling

Conventional Filling

One Surface

785

577

Two Surface

895

706

Three Surface

976

784

More than three surface

1,082

847

Table 1: Number of patients treated with laser vs. conventional approach.

Other procedures
1

Laser Cosmodent

Cosmodent

2250

1800

Laser Frenectomy

Frenectomy

3100

2500

Laser Sealant

Sealant

550

450

Laser Pulpectomy

Pulpectomy

2100

1850

Table 2: Cost comparison in UAE Dirhams between laser and conventional treatment.

minium garnet developed in 1987
and approved by the Food and
Drug Administration in 1990. 4

Benefits
• Less thermal necrosis of adjacent
tissues is produced with lasers
than with electrosurgical instruments.5, 6
• Haemostasis can be obtained
without the need for sutures in
most cases.7, 8
• Little or no local anaesthesia is
required for most soft tissue
treatments.9–13
• Reduced operator chair time has
been observed when soft tissue
procedures have been completed using lasers.
• Lasers feature decontaminating
and bactericidal properties on
tissues, requiring less prescriptions of antibiotics post operatively.9, 10
• Lasers provide relief from pain
and inflammation associated
with aphthous ulcers and herpetic lesions without pharmacological intervention.13
• Erbium lasers can remove caries
effectively with minimal involvement of the surrounding
tooth structure because cariesaffected tissue has a higher
water content than healthy tissue.5, 7
• As erbium lasers have no direct
contact with hard tissue, the vibratory effects of conventional
high speed handpieces are eliminated, allowing tooth preparations to be comfortable. As a
consequence, anxiety in both
children and adolescents is reduced.9, 11, 14, 15

Mathematics in
pedonomics
The introduction of lasers into
the practice should be made in
an orderly and precalculated manner. Proper financial planning will
help ensure the successful introduction of laser and help to yield
its benefits better. Calculation of
economics used in paediatric dentistry and thus making decisions
in favour of economic benefits to
the practice are the basis of pedonomics. The concept of pedonomics and the time-economics model
are based upon the profitability
per unit of chair time which is the
most important factor in determining the -financial future of the
practice. Pedonomics work on the
presumption that the profit matters, not the income.16

Laser costs
Cost is the primary determinant in any acquisition. In the
most common manner, it is defined as the amount or equivalent
paid or charged for something. It
is termed as price in the economic
language. Another important factor here is the opportunity cost.
It is the added cost of using resources (as for production or speculative investment) forms the difference between the actual value
resulting of using this opportunity and that of its alternative.
Opportunity costs is a major
determinant as it describes the
following:
1. Cost of the acquisition of a laser.
2. Costs incurred when not having
the laser, which include: loss of

[11] =>

income due to loss of high-end,
cutting edge dentistry, loss of
referrals.
The final decision to purchase
is worked out after looking at
both financial and the opportunity costs.16

Laser as a profit
centre
There are many ways that can
help us calculate the profits based
on Laser procedures. In any private practice, time is money. This
can be best determined on the
basis of the average hourly income. There should be a certain
specific amount that needs to be
earned per hour that can keep the
practice flourishing. Apart from
this basic income, any additional
ability to perform the procedure
more efficiently means extra income. The average amount of one
hour chair time should be able
to yield approximately 500 to
750 US Dollars. This is not the
fixed amount but an approximate
average that can keep the practice
on profitable ends.

11

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2016

income derived from laser must
be monitored over time. A new
terminology used in pedonomics
is KPIs which stands for key performance indicators.

If KPIs seem to increase or
even remain at a good level, this
indicates that break-even and the
much awaited ROI will not be far
off.

These are the factors that are
used in evaluating the success of
the profit centre as follows:

Unique selling
preposition

1. Laser-assisted procedures.
2. In-referrals for laser procedures.
3. New patients that come asking
for laser.

The USP is the unique cutting
edge of any practice. When it
comes to paediatric dentistry,
lasers are indeed a unique sell-

ing preposition due to their contemporary benefits. In the field
of marketing and management,
USP is defined as the factor or
consideration presented by a
seller as the reason that the product or service is different from
and better than that of the competition. The USP of lasers are as
follows:
• Non-surgical minor procedures.
• No drill.
• No anaesthesia.

• No pressure on or contact with
the tooth.
• Easier healing.
• Less need of analgesics and antibiotics.

Six Sigma approach
of pedonomics
Six Sigma is defined as the set
of techniques and tools for process improvement. It was intro” Page 12
AD

The procedures that can be
effectively and efficiently performed by using laser in the paediatric dental office are:
1. Restorative laser dentistry
2. Laser-assisted endodontics
3. Frenectomy
4. Sealants
5. Minor surgical procedures
6. Tooth desensitisation
7. Lingual fraenum removal
8. Exposure of unerupted teeth
9. Laser tooth whitening
10. Treatment of orthodontic or
drug-induced hypertrophy.

Return on
Investment

16

Once the laser is bought, pedonomics suggests that there should
be a fair return on the investment
made. Just to break even, the income generated by laser must
include covering the price of the
laser, maintenance, supplies as
well as an additional amount to
cover the income lost from the
money used to purchase the
equipment and not otherwise
generating its own income. The
profit that exceeds the break-even
point is called the return on investment (ROI).
Some of the items that should
be included in ROI would entail
the profit from the following:
1. Novelty of procedures with lasers.
2. Reduced out-referrals, caused
by the new laser procedures.
3. In-referrals due to the uniqueness of laser-assisted paediatric
dentistry.

Dental Tribune International

ESSENTIAL
DENTAL MEDIA

Tracking
To actually calculate the accurate financial return of introducing the laser to the practice, the

www.dental-tribune.com

[12] =>

12
“ Page 11
duced by Engineer Will Smith in
1986 while working at Motorola.
Jack Welch centralised this as
a business strategy in 1995 at
General Motors. The main implication of the Six Sigma approach in
any industry is to be flawless and
error-free. It uses a set of qualitymanagement methods, mainly
empirical or statistical, and creates a spatial infrastructure of
people within the organisation
that are aware of this method.
AD

TRENDS & APPLICATIONS

A Six Sigma process is one in
which 99.99966 per cent of all
opportunities to produce some
feature of a part are statistically
expected to be free of defects
(3.4 defective features per million
opportunities). When applied to
medical or healthcare systems, the
most important dimensions of the
quality of the medical act are:
• Safety
• Professional competence
• Acceptability

Dental Tribune Asia Pacific Edition | 12/2016

• Efficacy and Relevance
• Efficiency 17 ref.
• Accessibility
• Continuity
• Interpersonal relations
• The patient’s satisfaction
• Patient compliance.

family, it must be fit to comply
with the level of patient acceptance. The average amount that
can be generated by laser treatment quite exceeds the amount
generated by conventional treatments.

Lasers as the Six
Sigma in pedonomics

The approximate amounts
ranging in our practice which
runs its costs parallel to the costs
in the United States can be seen
from table 1 and 2 and the following numbers:

To make the delivery of the
treatment best accepted by the

• The average amount spent on
purchasing as laser: 350,000
AED.
• Equated monthly instalments
calculated with interest: the purchase of laser was made with
complete down payment.
• Average cost per month over
three years period: 10,000 AED.
• Average increase in treatments
with laser vs conventional approach: about 200 per type of
treatment:
• Fillings: approximately: 300
more with laser than Conventional way; average 45 per
month.
• Pulpectomy: only lasers. Average
30 per month.
• Laser sealants: average 30 per
month.
• Laser frenectomy: 2 per month.
• Laser pulpotomy: 15 per month.
Based on the above numbers,
the approximate profit earned on
laser vs. conventional approach:
• Fillings: 50 x 300: 15,000 AED.
• Pulpectomy: 30 x 300: 9,000 AED.
• Frenectomy: 600 AED.
• Seals: 30 x 200: 6,000 AED.
• Sealants: 20 x 300: 6,000 AED.
• Pulpotomy: 15 x 300: 4,500 AED.
Based on the above figures,
the average amount gained from
laser approach of treatment:
41,000 AED.
• Net profit: 41,000 to 10,000
(monthly investment on laser
over three years period)
= 31, 000 AED per month.
Break even was tentatively
achieved at the end of 14 months.
Profit started roughly after this
period.

Conclusion
The Six Sigma approach with
lasers teaches us to apply the
zero-defects principal. This degree of excellence is not just
in a word, but there is a realistic
possibility of making it happen.
It is an approach that can actually accelerate the rhythm of development and of the distribution of new ideas within an
organisation. Laser is a tool that
helps in the application of the
Six Sigma principle in the dental
office. In conclusion, it is statistically proven that laser with all
its attributes is quite efficient in
bringing “more dentistry” to a
dental office.

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

Dr Imneet Madan
is working as a
specialist paediatric dentist
at the Children’s Dental
Center in Dubai
in the United
Arab Emirates. She can be contacted at
imneet.madan@yahoo.com.

[13] =>

[14] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2016

Enhanced gingival aesthetics

Once the appropriate programme
had been selected, the injection
process started. The result after
divesting matched the requirements. Even fine details of the
wax-up were exactly reproduced
(Fig. 9). The dentures fitted the
models accurately and required
only minimal reworking.

Optimising conventional dentures with an innovative veneering material
By Dr Jiro Abe & Kyoko Kokubo, Japan
Stability, function and aesthetics—
in fabricating complete dentures,
optimum results can only be
achieved if the individual details
are successfully combined. In addition to the rehabilitation of functional aspects, the aesthetic reconstruction of the teeth and soft oral
tissue can considerably enhance a
patient’s self-confidence.
Treating edentulous patients
using conventional complete dentures continues to be a frequently
applied therapy option. Yet, restoring the edentulous jaw with
denture teeth to achieve a functional and aesthetic rehabilitation

maxilla (Fig. 2). The alveolar ridge
showed an asymmetrical progression in the mandibular arch (Fig. 3).
After the initial assessment of
the patient’s oral condition and
consultation on the treatment options available to her, we decided
to create new dentures for the
maxilla and mandible. Conventional complete dentures were selected as the treatment option.

Model analysis
We began by taking a closedmouth impression to create a primary record of the jaw relations.
Accurate model analysis provided

were fabricated. In order to prevent the denture shifting upwards
and forwards, a wide labial rim
was created in the maxillary anterior vestibule. Dorsally, the tray
ended at the vibrating line. The
custom tray should also provide
a suction effect in the mandible.
Relatively voluminous margins
were created to achieve this. Sufficient tongue space was provided
and the anterior area was given
a slightly concave contour. The
retromolar pad was only thinly
covered and a concave buccal shelf
was created. A rim was placed on
the crest of the alveolar ridge to
provide a support surface for the

bility and patient-specific characteristics were considered in the
tooth set-up. The patient was in the
habit of chewing food with her anterior teeth because of her Angle
Class III malocclusion. This was to
be avoided in the new dentures by
providing enough freeway space
between the anterior maxillary
and mandibular teeth at the set-up.
A great deal of attention was given
to faithfully mimicking the natural oral soft tissue, as we wished to
provide a maximum level of aesthetics already at the try-in stage.
Five different shades of wax were
used for characterisation. By creating vestibular gingival portions

Customised soft-tissue
reconstruction using
SR Nexco
The 3-D soft-tissue contours
should be customised with shade
characterisations. In the same
way as different shades of wax
are used for the try-in, different
shades of resin should be used to
reproduce the colour variations
found in the natural gingiva. The
light-curing laboratory composite
SR Nexco (Ivoclar Vivadent) is ideally suited for this purpose. This
material is available in a compre-

Fig. 1: Profile photograph of
the initial situation (Angle
Class III).—Fig. 2: Edentulous
upper jaw with a flabby ridge
in the anterior region and
advanced bone resorption.—
Fig. 3: Asymmetrical alveolar
ridge progression in the mandibular arch.—Fig. 4: Articulated models: Angle Class III
6
7
8
9
malocclusion with anterior
open bite is clearly visible.—
Fig. 5: A customised impression tray and registration device form a unit.—Fig. 6: Setting up the maxilla: the premolars were positioned close to the alveolar crest.—Fig. 7: Setting up the mandible: premolars
were also used in the dorsal area.—Fig. 8: Converting the wax-up to PMMA material (IvoBase system).—Fig. 9: The dentures prior to soft-tissue customisation.

poses a tough challenge to the
treatment team. Biomechanical,
physiological and geriatric concerns must be considered. Trueto-nature replication of teeth and
soft oral tissue is fundamental
too. The objective is to restore patients’ appearance and confidence
by providing them with natural-looking dentures.

Initial situation
A 58-year-old female patient
presented with an edentulous
upper jaw. She wore a complete
denture in the maxillary arch and
defective metal–ceramic restorations in the mandibular arch. Her
existing teeth were damaged and
could not be used as abutments
for new restorations. They had
to be extracted. The patient was
diagnosed with Angle Class III
malocclusion. There was a severe
anteroposterior discrepancy between the upper and lower arches.
Seen in profile, the patient showed
a prominently jutting chin and a
protruding lower lip (Fig. 1). Her
aesthetic appearance was impaired. In addition, the patient
complained about the poor function and high mobility of the
maxillary denture. A flabby ridge
and severe bone resorption were
present in the anterior part of the

important information in preparation for the individual functional impression. These steps established the basis for a statically
and functionally correct design of
the dentures. The median palatine
raphe, incisive papilla, first large
palatine rugae, tuber maxillae
and crest of the alveolar ridge
were marked on the maxillary
model. On the mandibular model,
the crest of the alveolar ridge,
Pound’s line and the tuberculum
alveolare mandibulae were marked
as landmarks. The mucobuccal
fold was determined on both
models. The Angle Class III malocclusion can be clearly seen on
the articulated models (Fig. 4).
High demands are placed on
custom trays, because the functional impression is pivotal in
achieving precisely fitting dentures. The objective is to maximise the supporting area of the
denture base while taking into
account the movements of the
muscles. A suction effect must be
established between the mucous
membrane and denture base. For
this purpose, the functional margins need to be fully contoured.
The area of the flabby ridge was
marked on the model and covered
with a spacer to ease the pressure.
Subsequently, customised trays

placement of Gnathometer “M”
(Ivoclar Vivadent) used for recording the jaw-to-jaw relation (intraoral needle-point tracing). The bite
rims of Gnathometer “M” acted as
the preliminary vertical dimension. An assembly of custom tray
and registration device was used
to take an impression of the oral
situation (Virtual Heavy Body,
Ivoclar Vivadent) and to record the
jaw-to-jaw relation (Fig. 5).

Set-up and try-in
Designed for classic occlusal
schemes, the SR Phonares II moulds
(Ivoclar Vivadent) are ideally suited
for complete dentures. The facial
meter (alameter) integrated into
the SR Phonares II FormSelector
assisted in selecting the moulds
that were best suited for our patient. The teeth were set up in line
with the set-up criteria for the classic occlusion. In order to prevent
the flabby ridge from allowing the
denture to move, the maxillary
premolars were positioned close
to the centre of the alveolar ridge
(Fig. 6). We decided to place premolars in the dorsal area of the mandibular arch to achieve an external
seal with the buccal mucous membrane and the lingual wall at
closed-mouth position (Fig. 7). The
requirements of function and sta-

that have a delicate, yet effective,
appearance, the customised look
can be accentuated. Aesthetics,
phonetics, occlusal vertical dimension and centric relation were assessed at the try-in of the wax-up
and rated as good.

Completion
The wax-up was converted to
resin using a proven method. We
focused particularly on creating
natural-looking soft tissue to
enable the dentures to integrate
unobtrusively into the oral surroundings. Accurately designed
as they were, the dentures and
prosthetic gingiva were converted
to a PMMA resin (IvoBase High
Impact, Ivoclar Vivadent) using the
IvoBase system. As polymerisation shrinkage was fully compensated for, one-to-one replications
of the wax-ups were attained.
The denture wax-ups were
flasked and sprued (Fig. 8). Once
the moulds had been created and
the wax boiled out, the flasks and
teeth were prepared for the injection moulding process. The predosed denture base material was
mixed, and the capsules containing the mixed material and the
flask were mounted on the injection device (IvoBase Injector).

hensive range of gingival shades,
including intensive shade variants. Natural-looking soft-tissue
aesthetics can be reproduced
using a straightforward method.
Given its non-sticky consistency,
the composite is easy to apply and
does not need to be warmed up
prior to application. The laboratory composite offers vast scope
for individualised soft-tissue creations, as it is available in a broad
spectrum of SR Nexco Stains and
SR Nexco Paste Effect materials.
Variations in the degree of softtissue thickness, blood vessel density and pigmentation can be
easily replicated to resemble the
characteristics of the natural gingiva. The veneering material is
optimally coordinated with the
IvoBase denture base material. We
began by applying SR Nexco Paste
Basic Gingiva BG34 extensively
on to the denture base. A natural
depth effect was produced with
intensive SR Nexco shades, that is
SR Nexco Paste Intensive Gingiva.
Papillae and alveolar spaces were
faithfully replicated using these
materials. Next, the lighter and
more transparent SR Nexco Paste
Transpa was applied to enhance
the optical colour depth effect.
This method resulted in a naturallooking appearance. The interplay
of different shades, convex and

[15] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2016

Fig. 10: The interplay of different shades of laboratory composite (SR Nexco) resulted in a 3-D depth effect. Morphological aspects were also considered in the customisation of the soft tissue.—Fig. 11:
The completed maxillary denture.—Fig. 12: View from the reverse side: the broad functional margin in the labial vestibule would prevent the denture from shifting.—Fig. 13: Customised denture in situ: it is hardly
noticeable that the patient is wearing conventional complete dentures.—Fig. 14: Compared with the initial situation, the patient looks clearly younger and happier.

concave surfaces in the alveolar
area, and subtle stipplings allowed
us to achieve a 3-D depth effect
quickly and easily (Fig. 10). The
individual layers were light cured
for 20 seconds each. Intermediate
curing can, for instance, be performed with a Quick curing light
(Ivoclar Vivadent). Prior to final
polymerisation in a light furnace
(Lumamat 100, Ivoclar Vivadent),
a glycerine gel (SR Gel, Ivoclar
Vivadent) was applied on to the
denture base in a covering but not
too thick a coating to minimise
the formation of an inhibition
layer. Only minor shape corrections were necessary before polishing the dentures. Tungsten carbide burs are best used for this
step—the inhibition layer should
be removed from the entire surface. Finishing was achieved by
first smoothing the surfaces with
rubber polishers, followed by
mechanical high-gloss polishing
at low rotational speed using a
goat hair brush, leather buff and
Universal Polishing Paste (Ivoclar
Vivadent; Figs. 11 & 12).

and provided the desired suction
effect. Assessment of the phonetic

and functional criteria confirmed
the success of the treatment. Com-

pared with the preoperative situation, the new dentures imparted a

clearly more youthful appearance
to the face of the patient (Fig. 14).
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The Dental Tribune
International Magazines
www.dental-tribune.com

Result
The patient attained a revived
aesthetic appearance owing to the
natural aesthetics of the maxillary and mandibular dentures.
Her smile told us that she had her
self-confidence back, which was
the most satisfying reward for our
work. The dentures were characterised by a dynamic interplay of
shades and natural light reflections, nuanced gingival surfaces
and strong, healthy-looking teeth
(Fig. 13). They showed a stable fit

Dr Jiro Abe is
a clinical professor at Tohoku University’s
Graduate School
of Dentistry in
Sendai and a
visiting professor at Kanagawa Dental College in
Yokosuka in Japan. Abe founded the
Japan Denture Association and has
been chairman since 2006. He can be
contacted at abedent@kch.biglobe.ne.jp.

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Anatomy of a

champion.
Unsurpassed Access: An ultra-thin back
and headrest allow you to work in a
comfortable position—legs under the
patient, elbows at your side.

Easy Positioning: Chair swivels
60º for better positioning and easy
patient entry and exit.

Effortless Adjustability (Left/Right):
The delivery system easily glides on
either side of the chair.

Ergonomic Flex Arm: Rotating
arm easily moves up and down for
precise placement.

Exceptional Lighting: State-of-the-art
LED provides brilliant, balanced light
for an accurate view, and cure-safe
mode for working with composites.

See what makes A-dec 500 the best-selling
dental chair, year after year.*
Superior performance. Proven solution. No compromises. It’s all of
these attributes that make dentists continually choose A-dec 500.
Built to last and backed by a five-year warranty.
Call 1.800.547.1883 or visit a-dec.com to learn more.

* Based on research by Strategic Data Marketing.
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All rights reserved.

Innovative Components: USA made and
engineered components use fewer parts.

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[cover] => DT Asia Pacific No. 12, 2016

[toc] => Array ( [0] => Array ( [title] => Asia-Pacific News [page] => 01 ) [1] => Array ( [title] => World News [page] => 04 ) [2] => Array ( [title] => Business [page] => 05 ) [3] => Array ( [title] => Proving effective oral instructions in a clinical setting [page] => 06 ) [4] => Array ( [title] => Nothing compares to ROOTS [page] => 08 ) [5] => Array ( [title] => Pedonomics: lasers in paediatric dentistry [page] => 10 ) [6] => Array ( [title] => Enhanced gingival aesthetics [page] => 14 ) ) [toc_html] =>

Table of contents

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