DT Asia Pacific No. 3, 2017

Dentist shortage to worsen / Asia-Pacific News / Interview: “A preventative health care system is also a cost-efficient health care system” / Business / Interview: “The field of tissue engineering has exploded during the last decade” / Adhesive cementation of partial veneers / Using the operating microscope and ultrasonics for root canal preparation

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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

REPORT

Vol. 15, No. 3

INTERVIEW

A paperback edition of the latest
Australian National Child Oral
Health Study is set to be released
this month.

RESTORATIONS

Jordanian endodontist Dr Ibrahim
Abu Tahun on how new developments are changing the way endodontics is practised.

This case report describes the use
of partial veneers for achieving
highly aesthetic results in the
anterior region.

” Page 10

” Page 12

” Page 2

Dentist shortage to worsen

MI World
Symposium

By DTI

HONG KONG/SINGAPORE: Owing
to their growing and ageing populations, Hong Kong and Singapore
are at risk of a serious lack of dentists in the years to come, experts
have warned. Both are not equipped
to meet the changing needs and
demands of an increasingly older
population with the current numbers of locally trained dentists.
According to a Hong Kong government report due to be released
in the next several months, most
of the city’s medical professions—
including dentistry—will face
shortages in the next ten years, the
South China Morning Post has
reported. Proposing solutions for
the predicament, the report’s commission recommends increasing
the number of overseas-qualified
health staff working in public hospitals under limited registrations,
among other measures.

Hong Kong and Singapore are in danger of a severe shortage of medical and dental professionals in the years to come,
experts have cautioned.

To date, public hospitals in
Hong Kong have been allowed to
recruit foreign doctors under a

In Singapore, this situation is
presently a lived reality in the
dental profession. Here, foreign-

registration scheme that is limited to one year. However, owing
to stringent conditions that restrict foreigners from working in
the private sector, only 12 medical
professionals joined via the
scheme last year, according to the
Post. In order to address the predicted shortage of health care

workers, these numbers would
have to at least triple and contract
terms be extended to attract more
doctors, the report’s experts cautioned.

trained dentists already made up
the majority of new dentists registered in recent years. For example,
in 2014, only 46 of the 187 newly
registered dentists were local
graduates, the Straits Times stated
in an article.
” Page 2

TOKYO, Japan: As host of the MI
World Symposium in Tokyo on
5 February, Japanese dental manufacturer GC Corporation arranged an impressive scientific
line-up to discuss the latest concepts in the field of minimal intervention dentistry. International and regional clinicians
and researchers discussed various topics, including MI management strategies and materials solutions, as well as clinical
aspects of the philosophy, taking into account parameters
such as age, disease status and
treatment options.
The company’s minimal intervention approach was developed based on an MI concept
proposed by the FDI World Dental Federation in 1999 and introduced one year later. In
order to enable realisation of
the concept in clinical practice,
the GC Europe MI Advisory
Board later developed the Minimal Intervention Treatment
Plan.

IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1

A skull being examined with the PlanScan intra-oral scanner. Read how Planmeca’s
3-D imaging devices have helped advance fossil research.
” Business Page 8

Regionally More free
connected dental care
Through analysis of the teeth of
two 7,700-year-old hunter-gatherer women discovered in a Russian
cave, UK researchers found that
their genetic make-up closely resembled that of modern-day populations in the region. This indicates
that certain ethnic groups across
north-east Asia have migrated very
little for around eight millennia.

The University of Queensland
is expanding its free dental care
for disadvantaged populations
owing to a new partnership with
Metro North Hospital and Health
Service. Through the alliance,
which began in January, the university expects to be able to serve
an additional 8,000 patients at its
new oral health centre in Herston.

Fighting
implant
infections
A team of researchers at KU
Leuven in Belgium has developed a dental implant that gradually releases antimicrobial
drugs to stop a biofilm forming
on the surface and thereby help
prevent infections. “Our implant
has a built-in reservoir underneath the crown of the tooth,”
explained lead author Dr Kaat De
Cremer.
“A cover screw makes it easy
to fill this reservoir with antimicrobial drugs. The implant is
made of a porous composite material, so that the drugs gradually
diffuse from the reservoir to the
outside of the implant, which is
in direct contact with the bone
cells.” So far, the implant has only
been tested in the laboratory.

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[2] =>

02

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 3/2017

Atopic dermatitis linked to
higher caries risk

IMPRINT
GROUP EDITOR:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
Tel.: +44 161 223 1830

MANAGING EDITOR AP:
Kristin HÜBNER

EDITOR:
Yvonne BACHMANN

© Luca Lorenzelli/Shutterstock.com

New findings from a Singaporean study suggest that infants with atopic dermatitis might be at a higher risk of developing caries as toddlers.

By DTI
SINGAPORE: New research from the
National University of Singapore
(NUS) and the Singapore Institute
for Clinical Sciences of the Agency
for Science, Technology and Research has suggested a link between two common childhood
diseases: atopic dermatitis and
dental caries. In the study, infants
who had symptoms of the skin
condition and were sensitive to

common allergens were three
times more likely to develop tooth
decay at 2 and 3 years of age compared with infants without the
skin inflammation.
Atopic dermatitis, also known
as atopic eczema, is a chronic, relapsing form of inflammatory skin
disease that is characterised by
symptoms such as itchy, red, swollen or cracked skin and a rash. Over
the last years, the condition has

been on the rise and affects approximately 15–30 per cent of children
in developed countries today. As for
dental caries, a 2009 NUS Faculty of
Dentistry study found that four in
ten preschool children in Singapore
suffered from some form.
In the current study, which
was part of the Growing Up in
Singapore Towards Healthy Outcomes programme, the researchers interviewed about 500 parents
during their child’s first year, at
three, six and 12 months, respectively, to identify infants with
eczema. Those children whose
mothers reported them as having
the skin condition were given skin
prick testing to assess their sensitivity to common allergens.
The results showed that infants who had eczema and were
positive to common allergens
were 3.29 times and 3.09 times
more likely to experience caries
when they were 2 and 3 years of
age, respectively, compared with
infants without the dermatitis.

“Our latest findings will give
parents and caregivers of babies
with eczema early warning of increased risk of developing tooth
decay in toddlers,” NUS researcher
Dr Stephen Hsu told the Strait
Times. “Regular dental check-ups
can then be conducted to help
minimise the incidence of tooth
decay in these children.”
According to the research
team, it is the first time a link between both conditions has been
discovered. A possible mechanism
behind the connection could be
structural defects that occur during tissue development in the
uterus. However, in order to confirm the underlying biological
mechanism of the relationship,
the researchers are now conducting further genetic analyses.

ASSISTANT EDITOR
Julia MICHEL

ONLINE EDITOR/SOCIAL MEDIA MANAGER:
Claudia DUSCHEK

MANAGING EDITOR &
HEAD OF DTI COMMUNICATION SERVICES:
Marc CHALUPSKY

JUNIOR PR EDITORS:
Brendan DAY
Julia MACIEJEK

COPY EDITORS:
Sabrina RAAFF, Hans MOTSCHMANN

CLINICAL EDITORS:		
Magda WOJTKIEWICZ
Nathalie SCHÜLLER

PUBLISHER/PRESIDENT/CEO:
Torsten R. OEMUS

CHIEF FINANCIAL OFFICER:
Dan WUNDERLICH

BUSINESS DEVELOPMENT MANAGER:
Claudia SALWICZEK-MAJONEK

PROJECT MANAGER ONLINE:
Tom CARVALHO

JUNIOR PROJECT MANAGER ONLINE:
Hannes KUSCHICK

E-LEARNING MANAGER:
Lars HOFFMANN

The study, titled “Atopic dermatitis and early childhood caries: Results of the GUSTO study”,
was published online on 22 January in the Journal of Allergy and
Clinical Immunology.

MARKETING SERVICES:
Nadine DEHMEL

SALES SERVICES:
Nicole ANDRÄ

ACCOUNTING SERVICES:
Anja MAYWALD
Karen HAMATSCHEK
Manuela HUNGER

Dental health of Australian
children still a concern

MEDIA SALES MANAGER:

By DTI

ADVERTISING DISPOSITION:

ADELAIDE, Australia: The University of Adelaide Press has made the
findings of the 2012–14 National
Child Oral Health Study (NCOHS)
available for free download, with a
paperback edition set to be released
in March. The NCOHS sampled
24,664 children aged between 5 and
14 years across 841 schools and collected data regarding their dental
health behaviours, access to dental
care services, overall oral health
status and other associated factors.
The collaborative work has
been collected in a report under
the title Oral Health of Australian

“ Page 1
However, while the integration
of foreign-trained dentists into the
local workforce may help to ease
the shortage in the years to come, it
is not the only challenge both cities
are facing owing to changing demographics. “With an ageing population, demand for dental services is not only increasing but also
changing due to the more complex
dental needs of geriatric patients,”
Singapore’s Chief Dental Officer
Dr Patrick Tseng Seng Kwong said.
There are currently too few
dentists specialised in geriatric

The study found that oral
health is still a significant health
issue for Australian children, despite some small improvements.

Over 40 per cent of children aged
between 5 and 10 years had experienced caries in their primary teeth,
and the overall rate of carious
lesions was consistently higher
among children from lower education, low-income households. Additionally, children living in Queensland and the Northern Territory—
two jurisdictions with more remote
communities and lower levels of
water fluoridation than the national average—were more likely to
have dental caries and at a greater
level of severity. The report ultimately offers a data set that can be
used for further analysis of methods for improving children’s oral
health, according to the editors.

care to serve the growing needs of
the population. In 2014, specialist
dentists made up 16.4 per cent of
dentists in Singapore, according to
figures from the annual Singapore
Dental Council report. Consequently, the city-state’s Ministry
of Health has started to offer
scholarships for postgraduate
studies in geriatric and special
needs dentistry. Other efforts to
improve the situation to this end
include the opening of Singapore’s
first dental centre functionally designed to cater for the elderly and
people with special needs, the
Geriatric Special Care Dentistry
Clinic, in Outram in June 2016.

With measures such as this,
Singapore might well be on its
way to improving the situation.
In Hong Kong, by contrast, a
planned reform of the Medical
Council of Hong Kong, a regulatory and statutory body that
grants licences to foreign doctors, has already faced substantial opposition. Medical professionals and patients alike have
raised concerns that relaxed licensing requirements for mainland and foreign doctors, aimed
at making it easier for foreign
doctors to practise in the city,
could compromise standards. In
a recent survey, 78 per cent of

Children: The National Child Oral
Health Study 2012–14 and aims to
provide an accurate and concise
look at children’s dental health
throughout the country. The information was collected through a
questionnaire filled out by parents
and an oral examination performed by a qualified dental professional. The data was then analysed
to estimate the prevalence of dental
caries, dental fluorosis and other
dental health issues and how these
varied with social characteristics.

Antje KAHNT (International)
Barbora SOLAROVA (Eastern Europe)
Hélène CARPENTIER (Western Europe)
Maria KAISER (North America)
Matthias DIESSNER (Key Accounts)
Melissa BROWN (International)
Peter WITTECZEK (Asia Pacific)
Weridiana MAGESWKI (Latin America)

EXECUTIVE PRODUCER:
Gernot MEYER
Marius MEZGER

DESIGNER:
Nora SOMMER

Published by DT Asia Pacific Ltd.
DENTAL TRIBUNE INTERNATIONAL
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
info@dental-tribune.com
www.dental-tribune.com

Regional Offices:
The 2012-14 National Child Oral Health
Study sampled 24,664 children across
Australia.

The report is available as a free
e-book from www.adelaide.edu.au/
press.

1,003 general public respondents
opposed the idea of exempting
overseas doctors from local examination to practise in Hong.
As for practitioner and Election
Committee respondents, 83 and
85 per cent, respectively, opposed
the plan.
This is despite the fact that
Hong Kong’s public hospitals
have been documenting chronic shortages in the medical
workforce for years. In 2016, the
city’s public clinics were understaffed by 250 doctors and 700
nurses, according to hospital records.

DT ASIA PACIFIC LTD.
c/o Yonto Risio Communications Ltd,
Room 1406, Rightful Centre,
12 Tak Hing Street, Jordan,
Kowloon, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199

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NY 10011, USA
Tel.: +1 212 244 7181
Fax: +1 212 224 7185
© 2017, Dental Tribune International GmbH

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 | 3/2017

Increase in healthy life years
through sugar, fat and salt taxes
By DTI
MELBOURNE, Australia: Modelling
the effect of different combinations of taxes on sugar, salt and fat
and a subsidy on fruits and vegetables on the death and morbidity
rates of Australians, a new study
has found that imposing a tax on
sugar could avert about 270,000
disability-adjusted life years. In
addition, the research estimated
that, when combined to maximise
benefits, taxes and subsidies could
reduce the country’s health care
spending by A$3.4 billion.

ence the consumption of healthy
foods. Based on the results of the
models, the formulation of a tax and
subsidy package should therefore be
given more prominent and serious

consideration in public health nutrition strategy, they concluded.

population health in Australia:
A cost-effectiveness modelling
study”, was published online on 14
February in the PLOS Medicine
journal.

The study, titled “Taxes and
subsidies for improving diet and

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In the Western world, noncommunicable diseases, such as
obesity, diabetes, cardiovascular
disease and dental caries, are
mainly attributable to an unbalanced intake of fats, sugars and salt.
In order to tackle the burden of
those diseases, an increasing number of countries have already implemented or proposed taxes on
unhealthy foods and drinks. However, the actual cost-effectiveness
of levies and subsidies on certain
nutritional items to reduce the burden of diet-induced diseases is uncertain and can only be estimated.

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In the current study, researchers at the University of Melbourne
simulated the effect of different
combinations of taxes on unhealthy foods and a subsidy on
fruits and vegetables based on the
Australian population of 22 million in 2010. The model analysis
set the sizes of the taxes and subsidy such that combined there
would be less than a one per cent
change in total food expenditure
by the average household.

The study adds to growing evidence of large health benefits and
cost-effectiveness of using taxes
and regulatory measures to influ-

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In comparison, a salt tax was
estimated to save 130,000 DALYs, a
saturated fat tax 97,000 DALYs
and a sugar-sweetened beverage
tax 12,000 DALYs. As for a fruit and
vegetable subsidy, the study was
unable to determine an isolated
clear health benefit, although it
too made for additional averted
DALYs and reduced health sector
spending, the researchers wrote.

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The results showed that a tax on
sugar had the greatest impact
among the taxes simulated. A sugar
tax could avert 270,000 disability-adjusted life years (DALYs), the
researchers calculated. DALYs are
years of a healthy lifespan that are
lost to disease. This equals a gain of
1.2 years of healthy life for every 100
Australians alive in 2010, which is a
health outcome that few other public health interventions could deliver across the whole population,
according to the researchers.

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[4] =>

INTERVIEW

Dental Tribune Asia Pacific Edition | 3/2017

“A preventative health care system is
also a cost-efficient health care system”
An interview with Prof. Jörg Eberhard, Australia
By Kristin Hübner, DTI
On the occasion of this year’s World
Oral Health Day (WOHD) on 20
March, Prof. Jörg Eberhard from the
University of Sydney will be pre-

Dental Tribune: Can you explain
what is meant by the title of your
lecture, “Putting the mouth into
health”?

Irrespective of this body of
knowledge, a holistic view on
medical conditions that includes
oral health has not been estab

major challenge for the dental
profession. Furthermore, teach
ing of the association between
oral and general health to medi

“A holistic view on medical conditions that
includes oral health has not been established
in clinical medical practice.”
Prof. Jörg Eberhard

senting the Australian WOHD lecture, titled “#PuttingTheMouthIntoHealth—Time for a paradigm
change in dentistry!”. Dental Tribune had the opportunity to speak
with Eberhard, who was appointed
the university’s first Chair of Lifespan Oral Health in 2015, about the
role of preventative care in research and clinical practice and the
general need for a more holistic
view on medical conditions and
oral health.

Prof. Jörg Eberhard: Research
over the last several decades has
shown that oral disease is linked
to general health and other dis
eases, including cardiovascular
disease, diabetes mellitus and
rheumatoid arthritis. The availa
ble evidence demonstrating this
association is based on epidemio
logical studies, clinical interven
tion trials and knowledge of
sound biological mechanisms.

A newly released WOHD brochure with tips on how to live mouth smart
for distribution in practice and clinic waiting rooms can be
downloaded at www.worldoralhealthday.com.

lished in clinical medical prac
tice. “Putting the mouth into
health” stands for the strategic
vision of overcoming this short
coming and is aimed at improv
ing the community’s health.
How does oral health affect general
health?
Dental caries and periodontal
disease are the most common
diseases worldwide and respon
sible for a large part of today’s
disease burden. Caries results in
pain, tooth loss and enormous
treatment expenses. Each of
these conditions negatively af
fects school attendance during
childhood, reduces the ability to
ensure good nutrition and to
participate in a healthy social
life among older people, and in
creases the load on health care
systems. Periodontal disease is
not limited to the oral cavity,
but releases inflammatory me
diators and bacteria into the
bloodstream over decades.
This may initiate or propagate
the development of athero
sclerotic plaques, leading to
stroke or heart attack, and
detrimentally affect blood
glucose levels in pre- or dia
betic states.
Do you think there is enough
awareness among the public about the relationship
between oral health, overall well-being and quality
of life?
There is very limited
awareness of the link be
tween oral and general
disease among the pub
lic; however, many health
care professionals too
are not aware of the as
sociation between oral
and general health,
even though it may sig
nificantly affect the well-being of
patients. Oral health literacy edu
cation of the community and
health care professionals is a

cal students is necessary to estab
lish a holistic view of health in
the future.
What is the dental community’s
role and that of national health
care policies in this matter?
The dental community must
realise that dentistry is not lim
ited to caries and infected root
surfaces; the work of the dental
community should be aimed at
easing a significant global disease
burden and improving the health
of the community. Policies must
recognise oral health as an inte
gral part of general health and
health services, inseparable if the
population’s health is to be main
tained or improved.
Do you think that there should be
an increased interdisciplinary exchange between dentistry and
medicine?
The exchange between den
tistry, medicine and other health
professions is fundamental to
make substantial contributions
to medical research and clinical
health care in the future. A holis
tic view on health and disease is
obviously highly relevant for
clinical decision-making, since
medical research has repeatedly
demonstrated the interdepend
ence of the various organ systems
owing to similar generalised
mechanisms.
With the rising burden of diseases
such as periodontitis and diabetes
on one hand and increasing awareness of prevention on the other,
where does dentistry stand today?
Since the introduction of
fluoridation, the dental research
community and the dental pro
fession have neglected preventa
tive pathways for decades, and re
search and clinical activities have
focused on restorative treat
ments. This trend is epitomised
by the use of artificial materials
like dental implants to restore
natural teeth, which have to be

extracted because of the lack of
adequate preventative treat
ment. This development is ad
vanced by policies that reward re
storative treatments and do not
support preventative dental treat
ments.
What role does the increasing use
of highly advanced and complex
technology in dentistry play in
achieving the goal of retaining the
natural dentition for as long as
possible?
Highly advanced and com
plex technologies should be lim
ited to those patients who have
suffered trauma or who have se
vere disease or genetic deteriora
tions. Health care systems are not
able to provide these technolo
gies to the broader community
and therefore these cost-inten
sive technologies are limited to
the privileged. A preventative
health care system is also a
cost-efficient health care system,
relieving individuals and the
public from suffering and high
costs.
In your opinion, concerning the
promotion of oral health and prevention among the public, what
will the main challenges to modern dentistry be in the years to
come?
The main challenge in the fu
ture for health professions will be
to introduce the concept of a holis
tic health care approach based on
preventative treatments rather
than on therapeutic interven
tions.
Thank you very much for the interview.
Editorial note: Eberhard will
be holding the 2017 WOHD lecture
on 20 March from 5 p.m. to
7.30 p.m. at the Australian Dental
Industry Association’s office in Alexandria in New South Wales. Registration for the event is open at
www.wohd.com.au/register.html.

[5] =>

[6] =>

06

BUSINESS

Dental Tribune Asia Pacific Edition | 3/2017

Koelnmesse Singapore: Mathias Kuepper
assumes management position
© Koelnmesse

By DTI
SINGAPORE: Having shared the
management position with Michael Dreyer for an interim period since June 2016, Mathias
Kuepper will now assume sole
responsibility as Managing Director of Koelnmesse Pte Ltd in
Singapore. The Asian subsidiary
of German event organiser Koeln
messe was established under
Dreyer in 2002 and organises
leading dental events IDEM Singapore and the Association of Orthodontists (Singapore) Conference, among others.
Paying tribute to Dreyer’s
contribution to the company,
Koelnmesse CEO Gerald Böse acknowledged that Dreyer helped
launch and sustain a substantial
part of Koelnmesse’s internationalisation efforts right from the

start and ultimately ensured the
success of these efforts. Furthermore, Böse said he was pleased to
welcome long-standing staff
member Kuepper as the new
managing director of the Asia
branch.
Kuepper, who is an economic
geographer with extensive event
and project management experience, has been working for Koelnmesse Singapore since 2002. Having been involved in the strategic
business development in the
Asian economic region for many
years, he is set to focus on the
implementation of Koelnmesse
events in South East Asia and on
the expansion of business activities in the local market.
With the change in staff, Koeln
messe’s centralised management performed by one regional

© Koelnmesse

Mathias Kuepper

centre for all of Asia will now be replaced with a market-specific decentralised organisational structure that works in close collaboration with the parent company
in Cologne, the event organiser
announced.

Deal collapses: Straumann decides
against investing in MegaGen
By DTI
DAEGU, South Korea/BASEL, Switzerland: Global dental implant manufacturer Straumann has announced that it will no longer be pursuing its plans to invest in or partner
with the South Korean implant
company MegaGen Implant. Instead of converting its US$30 million bond into MegaGen shares,
the group has received full repayment in cash with interest.

In 2014, Straumann purchased convertible bonds from
MegaGen and announced that
it would be exercising its right
to convert these bonds into
shares to acquire a controlling
stake in MegaGen in July last
year.
After the announcement,
MegaGen disputed the conversion price and calculation procedure, and despite significantly

increased offers from Straumann, initiated arbitration under
the International Chamber of
Commerce rules. This could have
taken up to two years, depending
on the progress of the arbitration.

corresponding long delay are not
in the interest of either company
and together with other recent
developments make the business case unattractive,” explained Straumann CEO Marco
Gadola.

“The collaborative spirit of
partnership that characterised
our relationship disappeared
when MegaGen’s owners initiated arbitration. This and the

“Due to the urgent need to
expand in the fast-growing nonpremium segment in China,
India, Russia and Eastern Europe,
we have invested in strong part-

ners like Anthogyr, Equinox Medentika and Zinedent—in addition to Neodent. The Straumann
Group brand, our shared technology platform and global network offer them considerable
leverage and we are very excited
about the opportunities that our
partnership with them is creating. Strategically, there is no
longer a compelling need for a
collaboration with MegaGen,” he
added.

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+49 43 21 / 5 19 08
eMail
info@promedica.de
Internet www.promedica.de

[7] =>

Dental Tribune Asia Pacific Edition | 3/2017

BUSINESS

Roland DG to establish new 3-D business
brand, DGSHAPE

According to the company, its
series of DWX dental milling ma-

Consequently, the company
decided to embark on restructuring its dentistry-focused 3-D business by launching it under the
new brand of DGSHAPE and transferring it to an autonomous company.
“Spinning the 3-D business off
as a separate company would allow
the management of DGSHAPE to
implement speedy decision-making and business execution,” com-

META BIOMED
launches EQ-V
By DTI

Roland DG President Hidenori Fujioka
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hout the expansion process. As a
company with more than 1,000
employees worldwide, establishing itself in Germany is recognition of the “made in Germany”
label as an international signifier
of high quality. This emphasis on
providing exceptional products reflects the company’s own corporate ethos.
META BIOMED’s EQ-V is a
brand-new system that offers a
revolutionary and convenient option for continuous wave obturation. With the user in mind, both
the EQ-V Pack and Fill are lightweight and ergonomically designed to allow for comfortable
handling. Each is protected with
chemically proven housing material and offers outstanding heating
performance, as the fill needs just
35 seconds to reach a temperature
of 200 °C. A highly efficient and replaceable lithium battery ensures
that the EQ-V has an extended
battery time, making it ideal for
longer and more complicated procedures. The device’s unique 360°
rotating cartridge provides dental
professionals with unparalleled
access and precision, and comes
with the added benefit of being
easily replaceable and disposable.
All in all, the EQ-V is a product that
embodies META BIOMED’s
commitment to providing
low-cost, high-quality so
lutions for everyday
dental procedures.

The EQ-V endodontic obturation system delivers accurate and reliable root canal obturation, and embodies
META BIOMED’s commitment to low-cost, high-quality
dental solutions. (Photograph: META BIOMED)

dependable

The decision to base META
BIOMED in Mülheim has been
warmly welcomed by local economic development company
Mülheim & Business and stateowned economic development
agency NRW.INVEST, both of
which have supported
META BIOMED
throug-

In addition to Tanabe, Hisashi
Bito will serve as Director and
Chief Technology Officer, Kouichi
Hashimoto as Outside Director,
and Toru Kajikawa as Audit and
Supervisory Board Member. The
executive board will be formally
appointed at an extraordinary
general meeting in March.

b
relia

HAMAMATSU, Japan: SEOUL,
Korea/MÜHLHEIM, Germany:
META B
IOMED has now established
its European headquarters in Mülheim in Germany and, with the
move, the Korean medical technology company is aiming at increasing its presence throughout Europe.
META BIOMED has a deserved reputation of being one of the dental industry’s primary innovators, as the
company’s focus on research and
development has achieved continual breakthroughs in the quality
and performance of its medical devices and biomaterials. The focus of
improvement through innovation
continues with the launch of META
BIOMED’s new EQ-V endodontic
obturation system, which promises
to deliver reliable, convenient and
precise root canal obturation.

mented Roland DG President Hidenori Fujioka on the decision to
transfer the business to a new
subsidy. “Led by a young executive
team—Representative Director, President and CEO Kohei Tanabe is 39
years old—I hope DGSHAPE will
advance the innovative concept of
3-D digital fabrication, exploit
next-generation technologies, and
take bold steps to develop cuttingedge products and solutions.”

+ZrO2

Li2O

3448 E

HAMAMATSU, Japan: In order
to increase visibility for its growing
3-D segment, Japanese manufacturer Roland DG has announced the
transfer of its digital businesses,
consisting of the development and
sales of 3-D milling machines, 3-D
printers, engraving machines and
photographic impact printers, to
a new, wholly-owned subsidiary,
DGSHAPE Corporation. The spinoff, which begins operating in April,
will be located at the Roland DG
headquarters in Hamamatsu.

chines has become a major driver
of growth of Roland’s 3-D business, accounting for 60 per cent of
sales in the segment in 2016. In
addition, industrial inkjet printer
sales accounted for 70 per cent of
digital printing business sales in
the same period.

high-strength

By DTI

SiO2

VITA SUPRINITY PC
®

VITA SUPRINITY PC belongs to the new generation of

features a particularly homogeneous structure that ensures

CAD/CAM glass ceramics. The glass ceramic in this inno-

simple processing and reproducible results. And what's

vative, high-performance material is reinforced with zirconia,

more, VITA SUPRINITY PC also offers the benefit of a very

resulting in a high-strength material that combines proces-

wide range of indications.

sing safety and an extraordinary degree of reliability. It

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VITA shade, VITA made.

[8] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 3/2017

3Shape’s new
lab scanners

By DTI

Next-generation laser
system launched

The BIOLASE
Waterlase Express
all-tissue
laser system is a small, easy-to-use
and cost-effective device. (Image: Business Wire)

IRVINE, Calif., USA: BIOLASE, a
global leader in dental lasers, has
announced that its new Waterlase
Express all-tissue laser system has
received 510(k) clearance for commercial distribution from the
Food and Drug Administration
(FDA). The product is now avail

able for sale to dentists in the US,
as well as selected international markets in Europe,
the Middle East and Asia.
Waterlase Express represents the newest addition to BIOLASE’s Waterlase portfolio of Er,Cr:
YSGG all-tissue lasers
and the fifth-generation laser of the most
widely used all-tissue
dental laser wavelength. Waterlase Express,
which was exhibited for
the first time at the Midwinter Meeting of the Chicago Dental Society in February,
will be unveiled internationally at
the International Dental Show in
Cologne, Germany, the world’s
leading trade show for the dental
industry, to be held from March 21
to 25.
The system was designed based
on extensive qualitative and quantitative research by a team of dentists around the world. According
to BIOLASE, Waterlase Express represents the new foundation of the

company’s strategy to greatly expand all-tissue laser use in dentistry.
“We are excited to launch the
Waterlase Express, our next-generation Waterlase system designed for easy and intuitive operation, integrated learning, and
portability. We believe the Express
user interface is to legacy laser
user interfaces what the Apple iPhone was to the flip phone,” said
Harold C. Flynn Jr., President and
CEO of BIOLASE.
“Express will enable significantly higher penetration and
adoption of all-tissue laser dentistry worldwide. With all the value
of Waterlase technology at nearly
one-quarter the size, one-third the
weight, and nearly half the US
retail price of our market-leading
Waterlase iPlus system, we believe
Express is the dental laser that is finally ready for the vast majority of
dentists around the world, many of
whom have waited to integrate our
all-tissue laser solutions into their
practices.”

CHICAGO, USA: Digital dentistry
specialist 3Shape has launched a
new line of cost-effective scanners
for the dental laboratory. According to the company, the E scanners
deliver high-quality images and
offer advanced scanning features
and precision CAD/CAM workflows, like other 3Shape scanners,
but at a more affordable price.
The E scanners feature two
5-megapixel cameras each, Blue

LED and multiline high-speed
scanning for optimal detail
capture and accuracy and thus
enable laboratories to complete
more cases in less time. More
over, features like 3Shape’s reliable impression scanning,
which allows laboratories to
scan conventional impressions
directly without having to pour
a model, and Auto-start, which
starts scanning as soon as the
model is placed inside the E scanner, save additional time and
costs.
© Koelnmesse

3Shape’s new affordable E scanners make advanced CAD/CAM accessible to laboratories of all sizes.

Planmeca intra-oral scanning systems
help promote fossil research

HELSINKI, Finland: Owing to their
compact size and precision, Finnish dental manufacturer Planmeca’s scanning systems have not
only advanced daily dental practice in recent years, but also helped
fossil research to go digital. Visiting the Finnish Museum of Natural History, the company met with
prominent researchers to learn

how digital technology is used to
unlock the past of fossilised teeth
and bones.
Back in 2015, Prof. Jukka Jernvall, an evolutionary developmental biology researcher at the University of Helsinki, was in need of
a suitable device for his latest project, researching the history of
Saimaa ringed seals and the development of their teeth. For this,
Jernvall was seeking a way to digitally record sets of teeth. However,
the imaging tools that were available to him then were slow and
their accuracy left much to be desired. Consequently, he contacted
Planmeca to request the use of the
company’s PlanScan intra-oral
scanner for his purposes.

ogy because, once the teeth have
formed, they change shape only
by wear. Originally from the US,
Moustakas-Verho moved to Finland six years ago to study fossilised teeth. “The University of Helsinki is one of the leading institutions in the world on fossil teeth
research. People come here to investigate teeth from all over the
world, like France and Japan,” she
said.

Among the subjects examined
using Planmeca’s 3-D imaging devices and software so far to study prehistoric life have been the teeth of
pandas, ancient cave bears and polar
bears, and even the tiny teeth of mice
and ancient vampire bat skulls that
are so small and thin that most scanners are unable to process them.
According to the museum’s
senior technician, Janne Gran-

roth, most researchers who visit
the museum use the Planmeca
technology for their projects.
“One day we hope to have systematically digitised our entire collection. Ideally, we would eventually
have an online system where the
serial number of every sample
would correspond to a digital impression, as this would enable us
to share the material with researchers all over the world.”
© Juha Kienanen/Planmeca

By DTI

According to Planmeca, the
scanner quickly proved itself both
fast and accurate, and its compact
size made it easy to carry along to
any research site. After this successful initial cooperation, the
Planmeca Romexis software was
fine-tuned at the university for research on the teeth of ringed seals.

Speaking with Planmeca Marketing Communications Specialist Sanna Tolmunen, researcher
Dr Jacqueline Moustakas-Verho
explained that teeth are an excellent subject for researchers of evolutionary and developmental biol-

Fig. 1: Scanning cave bear teeth with the Planmeca PlanScan intra-oral scanner. Fig. 2: Dr Jacqueline Moustakas-Verho.

[9] =>

Madrid, Spain
29 August - 1 September 2017

Bringing the World together
to improve oral health
THE BIGGEST INTERNATIONAL
DENTAL CONGRESS
Abstract submission deadline:
3 April 2017
Early-bird registration deadline:
31 May 2017

www.world-dental-congress.org

[10] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 3/2017

“The field of tissue engineering has
exploded during the last decade”
An Interview with Dr Ibrahim Abu Tahun, Jordan
By Kristin Hübner, DTI

Dr Ibrahim Abu Tahun, Jordan

Being actively involved as a founding member and president of several endodontic societies, Dr Ibrahim Abu Tahun has experienced the
changes in the field significantly
over the last decades. Dental Tribune had the opportunity to speak
with Tahun, who is an associate
professor in the Department of
Conservative Dentistry at the University of Jordan, about the most
influential developments in the
specialty and how these advances
are changing the way endodontics
is practised.
Dental Tribune: Dentistry is changing rapidly, with new materials, devices and treatment protocols being introduced constantly. What is
the situation in endodontics in particular? What are the major developments currently?
Dr Ibrahim Abu Tahun: At the
beginning of the 21st century, we
have greater understanding of
the pulp biology, pathophysiology
and its powers of healing. The field
of tissue engineering has exploded during the last decade, and
extensive reviews on dental applications are available, producing a
critical mass of knowledge and
methods that are likely to answer
the challenge issued decades ago.
Various animal and human
studies have shown high success
rates for vital pulpal therapy.
These investigations have demonstrated that the amputated pulp
can be repaired by itself or after
application of bioactive materials.
Recent approaches to pulpal
wound treatment have essentially
followed two lines: one has continued the conventional path to seeking improved synthetic materials
that provide better seals, resulting
in a breakthrough in bioactive
materials, while another line has
taken a biological approach with
the hope of identifying a biologically based strategy for treatment
of clinical conditions.

What are the advantages of new
treatment modalities compared with
conventional root canal therapy?
The potential benefits to patients and the profession are
groundbreaking. From a public
health point of view, the recent
advances in tissue management
and wound healing, compared
with the current form of root
canal therapy, which is more of a
mechanical and chemical process, should be reflected in our
clinical management to develop
more biocompatible treatment
modalities and increase tooth
longevity.
In the past, it was unthinkable
that the tissue in the periapical region of a non-vital infected tooth
could regenerate. Case reports
published during the last 15 years
have demonstrated convincingly
in humans that this type of environment may create the ideal
clinical outcome if disinfection
can be achieved, just as it is for the
canals in the case of dental avul-

When it comes to implementing
new treatment modalities in daily
practice, do you think the endodontic community is somewhat divided
or is the specialty as a whole on the
verge of a major paradigm shift?
The debate on clinical technique and the concept of regeneration and revascularisation per se
is not a product of modern medicine. The varying treatments for
the tooth pulp during the last
three centuries illustrate this
clearly. Recently, various treatment concepts have been suggested using less-invasive approaches. Even though an optimal
treatment protocol is lacking,
however, many case reports and
case series on pulpal therapy have
been published.
Once considered taboo, vital
pulpal treatment of symptomatic
permanent teeth with mineral trioxide aggregate has been reported
to be successful, and greatly improved prognoses for permanent
retention are now possible.

More high-quality cohort
studies would strengthen the evidence-based recommendations.
However, the current best available evidence allows clinicians to
provide these treatment modalities safely to patients.
Globally, what is necessary to
implement this new approach to
endodontic treatment?
A reparative, biological approach to pulpal therapy is not
only welcome, but also absolutely essential. Ideally, the delivery of biologically based endodontic procedures must be more
clinically effective than current
treatments and the method of
delivery must also be efficient,
cost-effective and free of health
hazards or side-effects for patients. A recent study has suggested that endodontic practitioners are supportive and optimistic about the future use of
regenerative endodontic procedures.

dodontic treatment means endodontics that is more ethical than
today.
In your opinion, what innovations
will influence endodontists most in
the years to come?
The tremendous and exciting
new research on regenerative endodontics from Japan, the US and
other countries has made the cultivation of potential in this field a
strategic priority without undermining the efficacy of conventional endodontic therapies, but
positioning practitioners at the
forefront of this field.
We are changing protocols,
towards going biological. This
path to the future with various
potential approaches based on
clinical and scientific results presented in the professional literature will lead to predicable conservative treatment that may enable practitioners to fill a root
canal with nature’s tissue in-

Source: Ibrahim Abu-Tahun & Mahmoud Torabinejad, Management of teeth with vital pulps and open apices. Endodontic Topics 2012, 23, 79–104.

“In the past, it was unthinkable
that the tissue in the periapical
region of a non-vital infected tooth
could regenerate.”
sion. These novel endodontic tissue engineering therapies offer
the possibility of restoring natural function and improving the
long-term outcome of teeth with
a poor prognosis.

A very recent study has found
that regenerative endodontic
treatment has the potential to be
used to retreat teeth with persistent periapical periodontitis after
root canal therapy.

Best practice guidelines must
be updated to include guidance to
maintain the self-respect of the
dental profession and the trust of
the patients we serve, as the fact
remains that more biological en-

stead of plastic materials or artificial surgical prostheses. The
important challenge facing us
now is to develop and adapt a
safe, effective and consistent
method for regenerating a functional pulp–dentine complex in
our patients.
Thank you very much for the interview.
Editorial note: At the 19th
Scientific Congress of the Asian
Pacific Endodontic Confederation,
which will be held from 5 to 8 April
in New Delhi in India, Tahun will
be addressing current endodontic
challenges and conflicting priorities between conventional therapies and new treatment modalities
in his lecture “Can we do it forever?”.

[11] =>

Dental Tribune Asia Pacific Edition | 3/2017

TRENDS & APPLICATIONS

Adhesive cementation of partial veneers
Achieving highly aesthetic results in the anterior region
By Dr Eduardo Mahn, Chile
The desire for aesthetically pleasing, minimally invasive and perfectly harmonious anterior restorations has existed since the beginning of dentistry. Only recently,
however, has it become possible to
translate this desire into reality. For
many years, dentists struggled
with the opacity of porcelainfused-to-metal crowns before allceramic crowns became available.
However, these ceramic materials
were not sufficiently durable to be
suitable for less invasive indications. Finally, ceramic veneers were
launched.
Veneer preparations are far
less invasive than crown preparations—some preparation is nonetheless still needed. In addition,
the veneers have to be designed in
such a way that they cover the
entire buccal surface. However,
given the advancements in ceramic technology and the luting
composites available today, it is
now possible to use partial veneers and to seat them without
any difficulty.

Partial veneers
Partial veneers are ceramic veneers that only cover that part of
the tooth that is missing, broken
off or abraded. As a result, the
tooth needs only partial preparation or none at all.
This approach has become feasible for two reasons:
1. New ceramic materials are
available: Dental technicians now
have the option of layering any
ceramic restoration. They can
choose to use a fluorapatite ceramic material such as IPS e.max
Ceram (Ivoclar Vivadent) or to
press the restoration from a highly
translucent ingot such as the Opal
or HT ingots of the IPS e.max Press
range (Ivoclar Vivadent).

Fig. 1: Pre-op situation. Fig. 2: Closeup of the pre-op situation. Fig. 3:
Prepared teeth. Fig. 4: Selecting the
shade of the luting composite: Variolink Esthetic LC in shade Warm.
Fig. 5: Try-in of both partial veneers.
Fig.6: Before seating the veneers:
the adjacent teeth were covered
with PTFE tape and separated with
a mylar strip. Fig. 7: Enamel etching
for 20 seconds. Fig. 8: Followed by
dentine etching for 10 seconds.
Fig. 9: Rising with a water spray.
Fig. 10: Applying the Adhese Universal bonding agent. Fig. 11: Close-up
of the bonding procedure. Fig. 12:
Applying Variolink Esthetic LC Warm
to the partial veneers. Fig. 13: Seating the partial veneers. Fig. 14: Careful removal of excess cement using a
brush. Fig. 15: Light curing for 5 seconds from both sides. Fig. 16: Final
light curing with two Bluephase
Style lights while cooling the teeth
with a water spray. Fig. 17: Excess
removal using a scalpel. Fig. 18:
Post-op view. Fig. 19:Close-up of the
final result after four weeks.

[12] =>

2. Luting composites have improved: A wide range of modern aesthetic cements have become available. They are offered in several degrees of brightness to match them
to the brightness of the natural
teeth being restored with a full veneer or partial veneer. In addition,
these luting composites contain
newly developed photoinitiators,
which improve their curing capability and long-term shade stability.
AD

TRENDS & APPLICATIONS

The ceramic material selected
for a restoration depends on the size
of the defect and/or the optical effects and stability that the dentist intends to achieve. The layering technique is likely to be the first choice
for teeth featuring multiple optical
effects. If large partial veneers that
do not require special effects, but include the entire incisal edge, are required, a high-strength ceramic such
as lithium disilicate is a likely choice.

When it comes to selecting a
luting material for full veneers
and partial restorations, Variolink
Veneer (Ivoclar Vivadent) is bound
to be the first choice for many dentists. Not long ago, the successor
product, Variolink Esthetic, was
launched. This luting material is
available in a dual-curing and
light-curing version. The Effect
shade concept on which the five
shades of the product are based

Dental Tribune Asia Pacific Edition | 3/2017

enables the dentist to adjust the
shade effect of the restoration to
make it appear warmer or lighter,
as required. In addition, the shade
effect can be checked prior to the
final cementation with the help of
try-in pastes in the corresponding
Effect shades. The composite contains the newly patented photoinitiator Ivocerin, which provides the
cement with long-term shade stability. In addition, Variolink Es-

thetic is easy to use owing to its
flexible situational consistency
and easy clean-up characteristics.
The clinical report below describes the placement of two partial veneers seated with Variolink
Esthetic LC in the shade Warm.

Clinical case
A 46-year-old male patient visited our practice with the request
to have his 20-year-old Mirage
partial veneer replaced. He felt
that the veneer needed replacing
because of the wear of the adjacent central incisor (Figs. 1 & 2). It
was decided to use partial veneers
to improve the situation; Figure 3
shows the preparation performed
on the teeth.
Once we had received the veneers (IPS e.max Press HT) from
the laboratory, we used the Variolink Esthetic try-in pastes to determine a matching cement shade
for the final cementation. In this
specific case, we achieved the best
result with the shade Warm (Figs. 4
& 5). Next, the adjacent teeth were
covered with PTFE tape and a
mylar strip was placed between
the teeth (Fig. 6). The enamel was
then etched for 20 seconds and
the dentine for 10 seconds (Figs. 7
& 8), followed by rinsing with
water (Fig. 9).
Afterwards, Adhese Universal
(Ivoclar Vivadent) was rubbed in
and allowed to react for 10 seconds (Figs. 10 & 11). Variolink Esthetic LC Warm was applied to the
partial veneers before they were
seated (Figs. 12 & 13). Excess cement was carefully removed with
a brush before light curing (Fig. 14).
The veneers were then illuminated simultaneously from both
sides for 5 seconds using two Bluephase Style curing lights (Ivoclar
Vivadent; Fig. 15).
In order to save time, final curing was also conducted using the
two Bluephase Style lights, as each
side had to be light-cured for
30 seconds (Fig. 16). Since light
curing for this length of time with
two curing lights operating at a
light intensity of 1,100 mW/cm²
may result in considerable heat
build-up, there is the potential
risk of damage to the pulp. It is
therefore prudent to cool the
teeth with a water spray, as shown
in Figure 16. After light curing, remaining excess cement was removed using a scalpel (blade no.
12; Fig. 17). The final result after
four weeks is shown in Figures 18
and 19.

Dr Eduardo
Mahn
Dr Eduardo Mahn
is the Director of
Clinical Research
in the aesthetic
dentistry programme at the
Universidad de los Andes in Santiago in
Chile. He can be contacted at emahn@
miuandes.cl.

[13] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 3/2017

Using the operating microscope and
ultrasonics for root canal preparation
By Dr Anthony C.S. Druttman, UK

Introduction
The purpose of preparing the
root canal system is well understood, and contemporary techniques involve the use of both
hand and rotary instruments, in
conjunction with an irrigation regime. However, the complexity
and variability of root canal morphology can make effective preparation very challenging, particularly in canals with irregular
cross-sections.
Current techniques are not
always completely effective, and
it has been well recognised that,
while some parts of the root
canal are over-prepared with rotary instrumentation, other surfaces are not touched. One study
concluded that at least 35% of the
surface area of canals had remained untouched by rotary
preparation.1 In another study,
the results were even worse: 60–
80% of untreated surfaces were
left in the distal canals of mandibular molars, with 65–75% in
the apical 4 m m after preparation. 2 Oval canals are particularly challenging, as the debris
collects in the extensions and
isthmuses (Figs. 1a & b). A review
of preparation techniques states
that “because of limited efficacy
of irrigation in such recesses, debris and smear layer may accumulate and remain on these unprepared root canals walls, de-

crease the quality of obturation
and jeopardise the long-term
treatment success”.3

Preparation of root
canal system
The cause of failure of endodontic treatment has been attributed to the presence of micro-organisms persisting in the apical
part of the root canal. 4 Much attention has therefore been focused on preparation and obturation of the apical part of the canal,
thereby depending on the apical
seal to prevent toxins from leaking out into the periradicular tissue. While success rates of endodontically treated teeth without
periradicular lesions are very
high, there can be a significant reduction in success in teeth with
periradicular periodontitis and in
those teeth in which endodontic
treatment has failed.5 This is predominantly due to the failure to
remove microbes from the root
canal system. The quest is to find
more effective irrigants and irrigation techniques, as well as rotary
files and preparation techniques,
to overcome these difficulties.
An ideal preparation shape
with a rotary instrument can only
be achieved in a canal with a
matched cross-section. Many canals are variable in shape. They
may have irregular and oval
cross-sections, and while much of
the debris is captured within the
flutes of the instruments, some is

compacted into those spaces between the instrument and the
canal wall (Fig. 2). The incidence of
isthmuses in both maxillary and
mandibular first molars is very
high.6 They are particularly liable
to have an accumulation of compacted debris after preparation,
and the inability to clean these
areas effectively has been implicated as a major cause of failure of
root canal treatment, particularly
in mandibular and maxillary first
molars (Fig. 3).7, 8
The more the debris is compacted, the more difficult it is for
chemicals such as sodium hypochlorite and calcium hydroxide
to penetrate through the interface. Paque et al. reported that approximately half of the debris that
accumulated during rotary instrumentation of the mesial canals of mandibular molars remained in the canal system after
irrigation.2
Failure of endodontic treatment in maxillary molars has
been attributed to the failure to
locate and treat the second mesiobuccal (MB2) canal.9, 10 Various
studies have shown the presence
of the MB2 canal in up to 90% of
maxillary first molars. Somma et
al. showed that, in 58% of teeth,
the MB1 and MB2 canals merge
apically into one canal.11 In a proportion of these failed cases in
which the MB1 canal has been located, cleaned, shaped and obtruded well, the question should
be asked whether the failure was

due to inadequate treatment of
the apical part of the MB1 canal or
because the MB2 canal and isthmus between the two canals had
been missed. Identification and
treatment of the MB2 canal with
concomitant retreatment of the
MB1 canal often lead to healing.
This suggests that the seals are not
always good enough to entomb
the bacteria. Indeed, coronal microleakage has been implicated as
a major cause of failure of endodontic treatment.12 Undoubtedly,
tracts of debris running alongside
root fillings are conduits for bacteria to cause failure by this method.
In an in vivo study, the mesial
canals of sixteen mandibular molars with infected root canals were
root-treated by conventional techniques in a single visit and the apical portions removed by flap surgery and evaluated by corrective
light and transmission electron
microscopy.13 In the majority of
cases, residual microbes were located in inaccessible recesses, uninstrumented areas of the main
canals, accessory canals and intercanal isthmuses.
If the lateral extensions feed
into the apical part of the canal,
then removing bacteria and nutrients from these areas reduces the
bacterial load and this has to be
beneficial for the outcome of
treatment. A variety of techniques
have been proposed to overcome
the inadequacies of mechanical
preparation in non-circular canals, including circumferential

filing using both hand and rotary
files and the use of a rotary self-adjusting file (SAF) that adjusts to
the shape of the canal. The SAF
system has been shown to be
more effective in cleaning oval
canals than conventional rotary
nickel–titanium instruments;
however, in De Deus et al. using
mandibular canines, even this
technique did not render the
canals completely clean.14 They
showed that rotary files were unable to access the recesses of oval
canals and that sodium hypochlorite had a “limited ability to compensate for the inadequacy of the
file itself”. They further suggested
that the common belief that “the
file shapes; the irritant cleans” is
based more on wishful thinking
than on experimental facts. In a
review article, it was recognised
that SAF was unable to prepare the
narrow isthmus of less than
0.2 mm.15 In the case of the narrow
isthmus, the challenge is to deliver sufficient quantities of irrigant effectively into a very small
area in which debris has been
compacted during preparation.
Recently, new concept files
XP-3D Finisher (Brassler) that
change their shape with temperature have been developed with the
expectation that they can deal
with canal irregularities. While
these may be helpful in removing
soft tissue in non-circular canals,
they may be of limited value in situations in which tissue or root filling materials are strongly adherent to the root canal wall.

Fig. 1a: Debris left after root canal treatment of the distal canal of a mandibular molar. Fig. 1b: Radiograph of the failed root canal treatment shown in Figure 1a. Fig. 2: Oval-shaped canal in the apical third of
the distal root of a mandibular molar. Fig. 3: Debris accumulated after preparation in the isthmus between the mesial canals of a mandibular molar. Fig. 4: Acoustic micro-streaming patterns produced by an
ultrasonically energised K-type-file. Fig. 5: Inspection of a prepared oval-shaped distal canal of a mandibular molar reveals residual debris apically.

[14] =>

TRENDS & APPLICATIONS

because lack of control produced
ledges, apical perforations and
instrument separation.17 In the
1980s, research showed that passive
ultrasonic irrigation (PUI) cleaned
canals more effectively than ultrasonic irrigation with simultaneous
instrumentation (UI), where the file
is intentionally brought into contract with the canal wall.18, 19 PUI
uses an ultrasonically energised file
to irrigate the canal and to remove
debris utilising a combination of

Among the numerous irrigation techniques that have also
been proposed, there are those
that make use of ultrasonic energy. Ultrasonics have played a
role in endodontics for many
years. Initially, ultrasonic canal
preparation was introduced by
Richman in 1957,16 and in subsequent years, there was a vogue for
using the ultrasonically energised
file to cut dentine in root canals.
The technique fell out of favour

Dental Tribune Asia Pacific Edition | 3/2017

acoustic micro-streaming and cavitational energy (Fig. 4).19–22

ardising the position of the instrument in the centre of the canal.24

PUI was found to be effective in
apical parts of curved canals and in
the isthmus area between two
canals. The technique has been
shown to remove tissue more effectively than hand irrigation and
does not cause damage to the canal
wall.23 Variation in the efficacy of
PUI reported in some studies was
explained by difficulties in stand-

Since the introduction of the
operating microscope, it has been
possible to carry out endodontic
treatment at varying magnifications, up to approximately 25 ×,
with the aid of direct light that can
penetrate into the depths of the
root canal. This means that visual
inspection of the prepared root
canal is possible. Once the canal

The 65th Annual Meeting of
Japanese Association for
Dental Research
JADR 2017
[ Dates ]

11 /18 (Sat.) - 19 (Sun.) , 2017

[ Venue ]

SHOWA UNIVERSITY, Tokyo, Japan

[ Theme
e]

Forefront of Dental Science

[U R L]

ht t p:/ / j a dr 6 5 . um i n .jp

- Toward the Global Standard in Medical Science

[ Congress President ]

Ryutaro Kamijo

Department of Biochemistry, School of Dentistry, Showa University

has been shaped by conventional
techniques and dried, the canal
can be visually inspected both
apically and laterally into the extensions of the canal. Straight canals can be inspected to the apical
constriction. Since rotary files
straighten the coronal and middle
thirds of curved canals, most of
these prepared canals can be inspected to within a few millimetres of their full working length.
Inspection through the microscope at about 10× and above can
identify those parts of the canal
system that have not been touched
by the rotary files and contain residual tissue (Fig. 5). These are usually the extensions of oval and
flattened canals, isthmuses and
fins.
The challenge is to prepare
these areas to produce a smooth,
predictable shape without removing excessive tissue, allowing irrigants to penetrate into the canals
more fully and therefore producing cleaner canals. Our expectations are that delivery into these
parts of the canal anatomy of irrigants and medicaments using a
variety of techniques will digest
residual tissue material and entomb remaining bacteria, rendering them ineffective. While they
have undeniable advantages in
the parts of the canal system that
cannot be inspected under the microscope, a significant part of the
bacterial load within the canal can
be removed by the use of a cutting
instrument directed towards a
specific part of the root canal,
such as a fin or isthmus. In the coronal part of the canal, this can be
done with either a long-shank
rosehead bur or a dedicated ultrasonic instrument. Long-shank
burs are very limited in their use,
however, because of the length of
the shank, relatively large diameter of the bur, lack of visual access
and their limitation to use in the
straight part of the canal. In the
deeper parts of the canal, ultrasonically activated instruments
can be used to great effect.

[ Congress Secretariat ]

Department of Biochemistry, School of Dentistry, Showa University
1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
TEL: +81-3-3784-8163 FAX: +81-3-3784-5555

[ Management Secretariat ]

Japanese Association for Dental Research
Academic Square Co., LTD. 2-348-302, Ryogae-machi, Fushimi-ku, Kyoto 612-8082, Japan
TEL: +81-75-468-8772 FAX: +81-75-468-8773 E-MAIL: jadr65@ac-square.co.jp

Fig. 6: An ultrasonically energised
K-type-file used to prepare an isthmus
under the operating microscope.

[15] =>

A very effective solution is to
use an ultrasonically energised
K-type-file (UEKF), the very instrument that was discarded after the
problems identified with ultrasonic instrumentation in the
1980s. The difference between
then and now is that, in conjunction with the operating microscope, the instrument can be used
with a great deal of control. Furthermore, power settings have
been considerably reduced to minimise the possibility of instrument separation. In many situations, the UEKF overcomes many
of the limitations presented by
other ultrasonic instruments.
The file can be curved in multiple directions so that the head of
the ultrasonic handpiece does not
impair visual access and the file
can be shaped to follow the curvature of the canal. When used in
conjunction with the operating
microscope, the file can be directed to the part of the canal that
has not been prepared by the rotary files. A size 20 UEKF with a 2 %
taper is an optimal size, although
a larger file may occasionally be
used. Because the file is relatively
flexible and removes only 0.2 mm
of tissue, unnecessary removal of
dentine is kept to a minimum
(Fig. 6).

ing separated instruments. Other
ultrasonic tips that cannot be
pre-curved can only be used in
straight parts of the canal.
The removal of gutta-percha
from oval canals often presents a
challenge, as rotary instruments
are not completely effective. A rigid
ultrasonic tip is more likely to plasticise the gutta-percha, while the
UEKF, with its increased tip amplitude, fragments the material.

Conclusion
Both ultrasonics and the microscope have become essential parts of
the armamentarium in endodontics.
When used together, they can produce minimally invasive preparations, which produce cleaner canals
in both primary and retreatment
cases. Conventional irrigation strategies should always be employed, particularly in those areas of the canal
system that cannot be visually in-

spected with the operating microscope, such as in the curved apical
third. However, the technique described in this article can aid in the
reduction of the bacterial load within
the canal system and this can result
in more predictable outcomes.
Editorial note: This article was first
published in Roots—international
magazine of endodontics, Issue
4/2016. A list of references is available from the publisher.

Dr Anthony C.S.
Druttman
Endodontic specialist Dr Anthony
C.S. Druttman is
a past president
of the British Endodontic Society
and an active member of the European
Society of Endodontology. He runs a private practice in the West End of London.
AD

2017

HKIDEAS
Hong Kong International Dental Expo
And Symposium

4 – 6 AUGUST
Hong Kong Convention and Exhibition Centre

www. hk id ea s . org

The file works in multiple
ways: it can easily be pre-curved
to follow the canal curvature and
can be used as either a cutting instrument by engaging the tip or as
a planing instrument by using the
flutes along its working length.
When used as a planing instrument, it can be used with variable
pressure against the walls of the
canal, such as in an oval canal extension or in an isthmus. The
greater the pressure applied, the
more effectively the file cuts dentine, in the same way as a hand
file, at the expense of the ultrasonic effect. As the pressure on
the file is reduced, so the ultrasonic effect is increased, achieving the benefits of PUI. The effectiveness of this technique is enhanced both by the flexibility of
the K-type-file so that it can be
pre-curved and by its rigidity so
that it can cut efficiently into a targeted area. The instrument can be
used in both modes interchangeably just by varying the lateral
pressure placed on the ultrasonic
handpiece.
In endodontic retreatment
cases, both the UEKF and the
dedicated ultrasonic tips can be
used to great effect to remove
endodontic obturation materials, separated instruments and
posts using minimally invasive
techniques. While the UEKF has
to be used at low power settings
to minimise the possibility of
fracture, it allows for excellent
visual control. Dedicated ultrasonic tips, such as the EndoSucess ET 25 tip (Satelec), can be
pre-curved to improve visual access and can be used at higher
power settings. It is, however,
only effective at its end. This tip
is particularly useful for remov-

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 3/2017

CALL FOR ABSTRACT

Deadline: 15 April 2017

E A R LY - B I R D R E G I S T R A T I O N
Deadline: 15 May 2017

P R E L I M I N A R Y F A C U LT Y
Professor Patrick Allen
(Singapore) – Geriatric
Dentistry
Dr. Yu-chih Chiang
(Taiwan) – Restorative
Dentistry
Dr. Jeanette Chua
(Malaysia) – Periodontics

Dr. Peter Pospiech
(Germany) – Prosthodontics
Professor Iain Pretty
(United Kingdom) –
Preventive Dentistry
Dr. Alan Reid
(Australia) – Medical
Emergency

NEW HORIZON IN DENTISTRY
Organizer

[16] =>

Dental Tribune International

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[cover] => DT Asia Pacific No. 3, 2017

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Table of contents

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