Cosmetic Tribune Asia Pacific No. 1, 2017
Charcoal-based dentifrices under review / Interview: “Good design will pay off” / Non-ablative melanin depigmentation of gingiva
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Untitled
Cosmetic TRIBUNE
The World’s Event Newspaper · Asia Pacific Edition
www.dental-tribune.asia
PUBLISHED IN HONG KONG
VOL. 15, NO. 10
Charcoal-based dentifrices under review
whitening, oral detoxiication, or
provide any therapeutic properties—antibacterial, antifungal, or
antiviral,” said lead author Prof.
John K. Brooks from the Department of Oncology and Diagnostic Sciences at the university.
searchers at the University of
Maryland School of Dentistry
have now challenged the marketed beneits of these products.
For the review, the research team combed the
MEDLINE and Scopus databases for clinical studies on the use of charcoal
and charcoal-based dentifrices, as well as laboratory
investigations on the bioactivity or toxicity of these
products. Overall, 118 eligible
articles published through
February 2017 were considered
in the study. In addition, the researchers selected the irst 50 consecutive charcoal dentifrice offerings from searches on Google and
Amazon in order to determine
product assortment and advertising promotions.
“Recently, use of charcoalbased toothpastes has gained
popularity in the marketplace.
However, there is insuficient scientiic evidence that these products effectively promote tooth
The results showed that the
marketing claims of some of the
charcoal products failed to relect
the actual beneits. For example,
38 per cent of the products were
promoted as strengthening or
© Sergey Tay/shutterstock.com
By DTI
BALTIMORE, USA: With promises of
whiter and cleaner teeth, charcoal-based oral hygiene products
have enjoyed a boost in popularity
in recent times, with new products
steadily entering oral hygiene
racks and online shopping sites
alike. However, the results of a literature review conducted by re-
Aesthetics in focus
By DTI
DUBAI, UAE: For dental professionals wanting to learn about the latest
in cosmetic and aesthetic dentistry,
the ninth edition of the Dental Facial Cosmetic Conference and Exhibition in Dubai will be the place to
be this year. The main event is being
staged together with the sixth
Global Conference Dental Hygienist Seminar of the American Academy of Implant Dentistry on 3 and
4 November at the InterContinental
Dubai Festival City hotel. Before,
during and after the congress, attendees will be able to partake in a
range of hands-on courses in various disciplines (1–5 November). According to the organiser, the Centre
for Advanced Professional Practices
(CAPP), the capacity of the courses
is limited in order to provide participants with the best possible opportunity to practise in small groups.
The list of available courses can be
found on the event website.
According to the organisers, the
event is intended to provide a practical view of aesthetic dentistry, a
stimulus for greater adoption of the
areas that are proven, and faster integration of new technologies from
which the dental profession can
beneit. The conference programme
will include a number of lectures by
experts in aesthetic dentistry, such
as Dr Daniel Vasquez from the US,
who will be talking about Digital
Smile Design 360, and Dr Faysal
Succaria from Lebanon, with a
paper on the mechanics and aesthetics of veneer cementation.
As part of the event, the Dental
Hygienist Seminar on 3 November
will offer scientiic lectures and
hands-on courses focusing on various aspects of the profession. Among
the speakers will be President of the
International Federation of Dental
Hygienists Robyn Watson, from Australia, who will be discussing contemporary approaches to maximising eficiency in periodontal assessment. Mary Mowbray from New Zealand will be presenting a paper on
diagnosis and integrating oral cancer screening into dental practice.
An industry exhibition will be held
alongside the scientiic programme
and be free for registered attendees. Dental professionals can register online now or on-site during the
event. The opening hours of the
show are from 9.00 a.m. to 5.30 p.m.
on both days.
More information can be found at
www.cappmea.com/aesthetic.
remineralising teeth, according to
the authors, yet only one of the examined products contained luoride, a compound well established
to enhance enamel mineralisation.
According to Brooks, the review further showed unproven
claims of safety, particularly in regard to the principal ingredient,
charcoal, and in some products, to
bentonite clay. The latter belongs
to a heterogeneous group of clays
with various industrial applications and is an ingredient in skin
care products, medication and
toothpaste. Among other concerns, charcoal has been recognised as a mineral abrasive to the
teeth and gingivae. Inclusion in
products may cause damage to
these tissues and could increase
caries susceptibility owing to the
potential loss of enamel. In this regard, 28 per cent of the products
reviewed in the study claimed to
be low abrasion, although laboratory test results for dentin abrasiveness were provided for only
one product, the authors noted.
To establish conclusive evidence about the eficiency and
safety of charcoal-based dentifrices, larger-scale studies are
needed, the researchers concluded. Until then, dental practitioners should educate their patients about the unproven claims
of oral beneits and safety associated with such products.
Using charcoal for oral hygiene purposes is no new trend. In
fact, powdered charcoal was used
as an ingredient for toothpastes as
far back as ancient Greece. For use
in present-day oral hygiene products, charcoal is mostly activated
by steam or chemical methods at
an extremely high temperature.
Once activated, charcoal has the
ability to bind with toxins, stains,
calculus and bacteria on the surface of teeth and the mouth in
general—a process known as
adsorption. Charcoal is further
claimed to balance the pH of the
mouth to a value that prevents
bacteria from thriving and reproducing in the mouth, thus helping
to protect teeth from infections
caused by bacteria and other microorganisms.
The study, titled “Charcoal and
charcoal-based dentifrices: A literature review,” was published in the
September issue of the Journal of
the American Dental Association.
AD
[2] =>
Untitled
18
SCIENCE & PRACTICE
Cosmetic Tribune Asia Pacific Edition | 10/2017
“Good design will pay off”
An interview with Drs Mona Patel and Marcus Riedl
By DTI
Just as in dentistry in general, where
aesthetic aspects are becoming ever
more important, dentists today are
pursuing intentional design of their
dental practices. With the launch of
four new design lines, Dentsply
Sirona Treatment Centers presents
dentists with the opportunity to
enhance worklows and treatment
eficacy through clever and cutting-edge solutions while conveying
Impressions from Dr Patel’s practice in Milwaukee in the US.
When deciding on a particular design or the overall look of your practice, what did you put special emphasis on?
Patel: Dental anxiety is a huge
component of what we have to
manage, so we need to create an environment that irst and foremost
has a calming, spa-like feel and re-
not see any units at irst. As for dental phobia, in my opinion, reducing
anxiety mainly is the responsibility of the staff. However, a calming
atmosphere is a great support, of
course.
Patel: In healthcare, wholebody awareness and preventative
health are becoming ever more important. A practice today is not just
about treating tooth pain, but
about establishing a dental home,
Drs Mona Patel and Marcus Riedl in talks with Dental Tribune.
their individual style. Dental Tribune spoke with German dentist Dr
Marcus Riedl and Dr Mona Patel
from the US, both of whom have ensured careful design of their practice
environment based on their needs
and preferences with a Dentsply
Sirona line, about the role of aesthetics in daily dental practice.
Dental Tribune: Design can convey
emotions and distinguish a dental
practice from others. In your opinion, what relevance does design
have in this regard?
Dr Mona Patel: In the US market, it has not played an important
role for a long time. Now, with the
newer generation of dentists, design is increasingly signiicant. I
think it is just as important as the
type of equipment that one purchases or the insurance one carries, because image is everything.
In my opinion, the design of the
practice is a direct relection of how
one provides care as a dentist. This
correlation was not present in previous generations, but it is now.
Dr Riedl’s practice in the rural town of Stein in Germany.
Alps. Incorporating this love for nature into the design of my practice
gives me a holiday feel at work.
Dr Marcus Riedl: I can speak for
Germany and I think design aspects were mostly neglected in the
past. Now, the inluence of design
in our practices is increasing. One
has to consider that we spend almost half of our lives in our practice, so we should feel comfortable.
For example, I love the mountains,
skiing and the atmosphere of the
duces our patients’ anxiety when
they walk through the door. Secondly, in my practice, I wanted the
design to be evidently smart, because that relects my meticulous
personality. I equipped the whole
ofice with Dentsply Sirona products—in fact, it was the irst
all-Dentsply Sirona ofice in the
US. I wanted to showcase the hightech equipment and design a nice,
simple ofice around that—not to
compete with the equipment, but
to enhance it.
Riedl: For many of our patients,
the design aspect is just an outer
shell, since they come to us for the
content. We designed our practice
for patients to feel at home. When
they come into the ofice, they do
creating a place where patients can
establish a relationship with their
dentist and their hygiene team.
Dentsply Sirona has developed four
different design worlds: Embellished
Elegance, Cheerful Patterns, Honest
Materials and Pure Shapes. Which
one did you decide on and why?
Patel: We chose Honest Materials
because our practice has all this enhanced digital technology, which
can be intimidating. I wanted to balance this digital aspect of our practice with natural and organic materials. We have a lot of birch and wood—
clean, sleek, simple and balanced materials that hopefully move the focus
from the equipment. My design in
general is very monochromatic,
nothing too messy or cluttered.
Susanne Schmidinger, Director Product Management Treatment Centers, Dr Marcus
Riedl and Dr Mona Patel.
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[4] =>
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SCIENCE & PRACTICE
20
Riedl: We too choose Honest
Materials, mainly because I like nature. In our previous ofice design,
we used the colours white, grey
and green. In order to preserve our
corporate identity, we wanted to
keep these and combined them
with a lot of wood and glass, because we wanted to convey the nature aspect to our patients. Technology is cold and patients do not
want to be confronted with it
directly, so we created the look of
a mountain lodge. Our loors
are even called “valley station”,
“middle station” and “mountain
station”, for example.
Do you feel that patients appreciate
the effort?
Riedl: Some do; some do not. Patients who share the same values as
we do feel more comfortable than
those who think the design is unnecessary for dentistry or think it makes
the cost of their care more expensive.
Patel: Good design does not
have to be expensive. Nevertheless, for some reason, if one puts a
great deal of effort into the design
of one’s practice, it is perceived as
though one put a lot of money into
it, which is not always the case.
Would you say that the investment
in the design is also relected in the
success of the practice?
Patel: In the US, many things
are based on return on invest-
Cosmetic Tribune Asia Pacific Edition | 10/2017
ment. It is easier to convince oneself to invest in a CEREC or CBCT
device, because one sees an immediate return on investment. However, trying to convince oneself to
invest in the design with nicer
cabinetry or loorplans, where
there is not a direct return on investment, is more dificult. But, I
am a irm believer that if one
works in a beautiful and happy
place, it relects one’s standards
and that is the greatest return on
AD
investment. Patients see that. If
one sees that love is in every detail, the inancial aspect fades in
importance; the design fulils one
as a person and one’s patients appreciate the resulting work.
Riedl: Sometimes, it is about
the little things. For example, my
wife puts fresh lowers in every
corner of the practice, which I
love. However, design polarises. It
divides our patients into at least
two groups. Those who are interested in and impressed by our design appreciate it, of course. Others do not. I believe that treatment
units and high-end equipment establish a sense of professionalism,
quality and exclusivity. No patient
can judge a dentist’s quality and
knowledge at irst sight, but, in the
eyes of the patient, design and
technology often are equivalents
for quality, so good design will pay
off.
There are countless treatment
units on the market and they differ
a great deal. What did you consider
when deciding on a system?
Riedl: The treatment units are
our workbenches—very expensive ones (laughs), but workbenches nonetheless. It has to be
stable, easy to use, intuitive, ergonomic and comfortable for the patient, as well as for the dentist and
the assistants—and, of course,
easy to clean. It has to aid our
treatment and therefore our daily
work as a dentist. It is like the assistance systems in one’s car or a
smartphone. A good design, of
course, is welcome too. That is
why the Teneo was our system of
choice.
Please join us!!
You both use Teneo. What sets the
unit apart from those you have
used before?
Riedl: As a dentist, I have always worked with Sirona, now
Dentsply Sirona. Therefore, there
was no question of the brand I
would choose. In our previous
ofice, we used the M1 for almost
30 years—I, of course, used it
only for about ten years—and I
did not want to change my habits
and movements during treatment. Comparing the M1 with
the Teneo is like comparing an
old Mercedes-Benz with a new
one. It is the same quality. The
Teneo might be not as solid as
the good old M1, but has more
features that are useful.
Patel: I was designing a new ofice, so I had a clean slate to work
with. I did a great deal of research
and comparisons. For me, the look
and the design were important, as
were functionality, integration,
longevity and being able to sanitise it easily. I was instantly drawn
to Teneo, because, as I said, I do
not like clutter. The fact that
everything was integrated was an
instant attraction to me. I found
solutions to all my wishes in the
Teneo. It was an easy decision to
make and we designed the ofice
around the units.
Thank you very much for the interview.
Official language : English
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Cosmetic Tribune Asia Pacific Edition | 10/2017
TRENDS & APPLICATIONS
21
Non-ablative melanin depigmentation
of gingiva
By Dr Kenneth Luk, Hong Kong
Melanin depigmentation of gingiva
using various laser wavelengths have
been reported for over ten years.1–5
Layer by layer, the mucosa is ablated
to the basal layer of the epithelium
where the melanocytes are located.
The use of lasers has been compared
with the use of a scalpel and diamond
bur (Fig. 1).6–9 By combining the optical properties and absorption characteristics of the 810 nm laser wavelength with speciic power parameters, a non-ablative technique was
developed (Fig. 2).10, 11 Another similar
non-ablative technique, described as
micro-coagulation, using a 20 W,
980 nm diode laser has also been
reported.12 The 445 nm blue wavelength was introduced to the dental
market in 2015. By using a 320 μm
uninitiated ibre delivering 1 W in a
continuous wave (cw) of 445 nm, the
Case report
The author used the 810 nm
wavelength (elexxion claros 810 nm
diode laser, elexxion) with the
power parameters of 30 W, 20 kHz
and 16 μsec, yielding an average
power of 10 W. Under local anaesthesia, a non-initiated 600 μm
ibre was used. The ibre was
placed at a distance of 2–5 mm
from the pigmented mucosa. Coagulation was observed with immediate effect upon irradiation.
A constant movement must be
performed in order to avoid thermal damage deep in the tissue.
Water irrigation can be used as a
coolant during the treatment.
A 26-year-old female patient of
Chinese ancestry presented with
melanin pigmentation in 2007.
Congenital melanin pigmentation
of the labial gingiva was diagnosed
and depigmentation of the upper
arch was carried out.
There is no surface ablation of
the pigmented mucosa; rather,
the haemoglobin and melanin absorb the laser energy (Fig. 2). This
technique (Figs. 3–6) achieves a
treatment time of 2 min com-
same non-ablative procedure and
result can also be realised.
A diode laser wavelength of
810 nm is poorly absorbed in
water, but it is well absorbed by
pigment such as haemoglobin and
melanin. The use of high power
and short pulse duration concentrates the thermal energy on the
surface compared with deep-tissue thermal conduction obtained
with lower power and long pulse
duration.13, 14
pared with the ablative technique,
which requires up to 30 min in an
area extending from the irst premolar to the irst premolar of one
dental arch. The wavelength of
445 nm is much better absorbed
by melanin and haemoglobin
than 810 nm is (Fig. 7). Hence, a
much lower power density may be
used to produce the same effect.
Eight years postoperatively,
there was mild relapse of pigmentation, but the patient was satisied with the cosmetic appearance, and requested removal of
the melanin pigmentation on her
mandibular anterior segment
(Fig. 8). Pigment removal in the
requested sites using a 445 nm
diode laser was discussed. The
same technique would be used
and the patient consented to the
treatment.
The SiroLaser Blue (Dentsply
Sirona) with an emission wavelength of 445 nm was used at 1 W
in cw, delivered through a 320 μm
ibre. The depigmentation technique used was the same as described for the 810 nm wavelength. Under local anaesthesia,
the non-initiated 320 μm ibre delivered the energy at a distance of
2 mm to the pigmented area with
constant movement. Immediate
change to the pink colour without
surface ablation of the pigmented
mucosa was observed. The procedure took approximately 40 s to
complete from the mandibular
left to right canine region.
In this case, the mucosa
turned pink without any signs of
surface mucosal ablation other
than one spot between teeth #31
and 32 (Fig. 9). Subsurface coagula-
3
1
4
5
2
6
Fig. 1: Depigmentation by ablation.—Fig. 2: Depigmentation by absorption of melanin and haemoglobin.— Figs. 3–6: Depigmentation of upper arch: pre-op (Fig. 3), immediate coagulation (Fig. 4), three
weeks post-op (Fig. 5), eight years post-op (Fig. 6).
[6] =>
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TRENDS & APPLICATIONS
22
Cosmetic Tribune Asia Pacific Edition | 10/2017
tion of blood vessels imparted a
pink appearance. There was very
mild postoperative discomfort for
about 1 h after loss of the anaesthetic effect. No analgesics were
required, as the feeling of discomfort disappeared rapidly. Laser
peeling of the mucosa between
teeth #31 and 41 was noted during
photograph taking at the one-day
postoperative review (Figs. 10 & 11).
The three-day postoperative photograph taken by the patient
showed that the peeling had disappeared, with new gingival mucosa formation (Fig. 12). The twoweek postoperative appointment
showed complete recovery of the
gingival mucosa and no melanin
pigmentation (Fig. 13).
Fig. 7: Absorption spectra of biological
materials. (Courtesy of J. Meister)
Figs. 8–11: Depigmentation of lower
arch: pre-op (Fig. 8), immediate
post-op (Fig. 9), one day post-op
(Fig. 10), one day post-op laser peeling
between teeth #31 and 41 (Fig. 11).
Fig. 12: Three days post-op (photograph taken by the patient on holiday).
Fig. 13: Two weeks post-op.
Fig. 14: Diagram and calculations regarding the area of effect of the
445 nm wavelength.
Fig. 15: Diagram and calculations regarding the area of effect of the
810 nm wavelength.
7
Discussion
8
9
10
11
There is little information
available on this new wavelength.
From Figure 7, the absorption coeficient is estimated at 7 × 10²/
cm –1 for haemoglobin and 10³/
cm –1 for melanin. Penetration
depth is calculated at 140 μm for
haemoglobin and 10 μm for melanin. The penetration depth of haemoglobin and melanin with an
810 nm wavelength is 2 mm and
0.1 mm, respectively. Furthermore, the scattering curve showed
a higher tissue scattering effect
with 445 nm than with 810 nm. In
comparison with near-infrared
diode lasers, the absorption of collagen and scattering increases in
the blue light spectrum. In view of
this, together with the high absorption of 445 nm by haemoglobin and melanin, 1 W in cw was
used. A power density of 88 W/cm²
(Fig. 14) delivered at 88 J/cm² luence at a 2 mm distance was calculated. Although the power density
of 1,697 W/cm² (Fig. 15) delivered at
543 J/cm² luence of the 810 nm
was higher than the 445 nm delivered, the eight-year postoperative
review showed a stable gingival
contour with no recession (Fig. 6).
An understanding of the optical
properties of the wavelength, its
power parameters and the laser–
tissue interaction is important for
the clinician to achieve the desired treatment outcome.
Conclusion
12
13
The use of a 445 nm blue diode
laser at 1 W in cw is effective in
non-ablative depigmentation of
oral mucosa. This non-ablative
technique provides immediate aesthetic results in a very short procedure time. To the author’s knowledge, this is the irst case presented
using the 445 nm wavelength for
melanin depigmentation.
Editorial note: This article was irst
published in cosmetic dentistry No.
1/17. A list of references is available
from the publisher. Dr Luk reported no
potential conlicts of interest.
14
15
Dr Kenneth Luk
completed a Master of Science in Lasers
in Dentistry at RWTH Aachen University in Germany and runs his own clinic,
Laserdontic, in Hong Kong. He can be
contacted at laserdontic@me.com.
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Dental Tribune International
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