DT Asia Pacific No. 3, 2018
Asia News / World News / VladMiVa—success comes with persistence / Trends & Applications
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DTAP0318_01-16.pdf
DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
www.dental-tribune.asia
Published in Hong Kong
Vol. 16, No. 3
INTERVIEW
“FROM A PATIENT TO A FAN”
Dental Tribune Asia Pacific had
the opportunity to speak with
Prof. Hien Ngo about the concept
of “life-long oral health” and the
major demographic change in
ASEAN countries.
” Page 03
W&H Marketing Director Anita
Thallinger talks about the background, objectives and challenges
of her company’s new image
campaign.
” Page 10
Children are not getting
dental check-ups early
enough, global survey shows
By DTI
GENEVA, Switzerland: Maintaining
a healthy mouth is crucial to keeping it functioning correctly and to
maintaining general health and
well-being. Ahead of World Oral
Health Day, celebrated annually on
20 March to raise global awareness
of the prevention and control of
oral disease, the FDI World Dental
Federation asked parents around
the globe how they cared for their
children’s oral health growing up.
Their responses suggested room
for improvement.
The survey, carried out online
in ten countries and completed by
11,552 adults in total, found that
only 13 per cent of parents with
children aged 18 and under had
taken their child to the dentist before their first birthday—the recommended age for the first dental
visit. Most parents first had taken
their child to the dentist when he
or she was between 1 and 3 years
old (24 per cent) or between 4 and
6 years old (22 per cent). Alarmingly, 20 per cent of parents reported never having taken their
child for a dental check-up.
SAY
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“It’s worrying to learn that
most children are not getting a
dental check-up at the recommended age,” said FDI President
Dr Kathryn Kell. “Good oral health
habits start early. Parents should
visit the dentist after their child’s
first tooth starts erupting as a preventive measure to avoid risk of
developing early childhood caries.
Oral disease can impact every aspect of life and is associated with
many general health conditions.
This World Oral Health Day, we
want people to make the connection between their oral health and
general health and understand the
impact that one has on the other.
Knowing how to protect your
mouth and body at all ages contributes to a better quality of life.”
Half of the parents who had
taken their child to the dentist
identified the reason as being a
regular dental check-up. However,
while this was the most frequent
answer in the UK (82 per cent),
Sweden (77 per cent), Argentina (65
per cent), France (63 per cent), the
US (63 per cent), Australia (56 per
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” Page 12
cent) and China (34 per cent), the
most reported response for having
gone to the dentist in Egypt, the
” Page 2
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[2] =>
DTAP0318_01-16.pdf
ASIA NEWS
02
“ Page 1
Dental Tribune Asia Pacific Edition | 3/2018
IMPRINT
Peter WITTECZEK (Asia Pacific)
Weridiana MAGESWKI (Latin America)
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K
IN
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Philippines and Morocco was pain
or discomfort in their child’s
mouth (56 per cent, 43 per cent
and 38 per cent, respectively).
More than 43 per cent of the parents said that they personally ensured that their child’s teeth were
brushed before bedtime to avoid
oral disease—a key message promoted by the FDI. The survey also
found that 40 per cent of parents supervised their child’s toothbrushing
twice a day, and 38 per cent of them
said they limited sugary foods and
drinks in their child’s diet to prevent
oral disease. Only 26 per cent reported personally having cleaned
their child’s teeth from as soon as
the first tooth erupted, and just
8 per cent mentioned having encouraged their child to wear a
mouth guard when playing sport.
The FDI recommends practising good oral care, avoiding risk
factors such as an unhealthy
diet—particularly one high in
sugar—and having regular dental
check-ups to protect oral health
and general health at all ages. Parents should start cleaning their
child’s teeth before bedtime with
the eruption of the first tooth, supervise toothbrushing twice a day
with a small amount of fluoride
toothpaste, and schedule regular
dental check-ups, starting no later
than the first birthday.
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[3] =>
DTAP0318_01-16.pdf
ASIA NEWS
Dental Tribune Asia Pacific Edition | 3/2018
03
“The oral environment becomes more
hostile with age”
An interview with Prof. Hien Ngo
Professor Hien Ngo has extensive
experience in private practice, research and education. Over the last
30 years, he has been active as an
international speaker on cariology,
minimal intervention and restorative dentistry. At present, his focus
in research revolves around the
clinical management of caries, especially in elderly and medically
compromised patients and the interactions between glass ionomers
and the oral environment. Dental
Tribune Asia Pacific had the opportunity to speak to him prior to his
presentation at IDEM 2018 in Singapore about the concept of “lifelong oral health” and the major demographic change in ASEAN countries.
There is a global phenomenon of
population ageing on an unprece-
dented scale. What is the situation
in South East Asia?
Ageing is universal and there
is no exception among ASEAN
countries. It is expected that the
percentage of the population aged
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Prof. Hien Ngo
Dental Tribune Asia Pacific: The
term “lifelong oral health” was used
by the FDI World Dental Federation
in one of its policy statements.
What does it mean?
Prof. Hien Ngo: Previously,
edentulous among older individuals was accepted as a norm. However, with recent advances in preventive and restorative dentistry,
the FDI stated, “The goal of reaching old age with a full set of teeth
is feasible if preventive measures
and oral healthcare are accessible
throughout life.”
The key term here is “throughout life” because a good oral health
foundation in childhood is the key
determinant of oral health at a
later stage in life.
Lifelong Oral Health was the
title of a policy statement that
was adopted by the FDI General
Assembly in August 2017. It identified the four pillars supporting
lifelong oral health as oral health
promotion, risk assessment, disease prevention and early diagnosis and intervention at all stages of
life. These four pillars will form
the framework for discussing clinical cases during the Silver Wave
symposium at IDEM.
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[4] =>
DTAP0318_01-16.pdf
ASIA NEWS
04
“Ageing is universal and there is no
exception among ASEAN countries.”
over 60 will more than double in
the next 30 years. By 2050, 2 out of
10 people in the region will be
aged over 60. However, the pace of
change is much faster in Singapore than in neighbouring countries. It is predicted that by 2050,
4 out of 10 Singaporeans will be
over 60 while this ratio will be 2
out of 10 in Indonesia and approximately 3 out of 10 in Thailand and
Vietnam.
Dental Tribune Asia Pacific Edition | 3/2018
What are the consequences of this
demographic change for oral health
professionals?
If you are working in the private
sector, it means that a higher portion of your clientele base will be
older individuals and most of them
will be dentate. As they belong to the
baby boomer generation and were
born between 1946 and 1964, they
grew up during a period of rising living standards after economic prosperity, so their expectations are different from previous generations.
AD
www.idem-singapore.com
13 -15 APRIL 2018
SUNTEC SINGAPORE
THE LEADING DENTAL EXHIBITION
AND CONFERENCE IN ASIA PACIFIC
THE BUSINESS OF DENTISTRY
The Australian Institute of
Health and Welfare proposed a
broad classification for this group:
active and capable, limited activity
and capability and very limited activity and capability. For the last
two groups, you may need to modify your practice to allow accessibility, or there is the option of referring them to specialised public
institutions and specialists.
For clinicians, the care pathways for elderly patients are more
complex, as damage to their dentition is accumulative, so its manifestation is much more severe
later in life. The oral environment
also becomes more hostile with
age. Root caries, which are rare in
younger individuals, are common
in the older patients.
“…the care
pathways
for elderly
patients
are more
complex...”
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When these conditions are
coupled with either severe health
or mental illness, then referral to
a specialist in geriatric dentistry
could be required. Gerodontology
is now a recognised dental specialty; however, specialists in this
field are still not common in
ASEAN countries. The engagement of international bodies such
as the FDI and WHO on the concept of lifelong oral health will encourage healthy discussions and
policy developments to ensure
that preventive measures and
oral healthcare are accessible.
What is happening in this field during
the IDEM conference in Singapore?
Singapore recognised the importance of this major demographic change and has made large
investments to ensure that lifelong
oral health is delivered to its population.
With the Silver Wave Symposium at IDEM 2018 on Saturday
14 April, there will be a full day
dedicated to managing the ageing
population and patients. Six international speakers and clinicians
will be brought together to discuss
the management of oral health issues, of the ageing population,
and of older individuals. The day
will start with discussions on the
changes that were made in the
public health and education institutions, then move on to clinical issues. The day will be clinically
oriented and discussions will be
patient focused. The symposium
will be supported by The Silver
Wave booklet, which will be distributed during IDEM.
[5] =>
DTAP0318_01-16.pdf
Dental Tribune International
ESSENTIAL
DENTAL MEDIA
www.dental-tribune.com
[6] =>
DTAP0318_01-16.pdf
WORLD NEWS
06
Dental Tribune Asia Pacific Edition | 3/2018
Study shows toothpastes do not protect fully
against erosion and hypersensitivity
By DTI
BERN, Switzerland: Over the years,
more and more toothpastes have
been released on to the market
claiming to aid with one thing or
another—with a particular focus
on dentine hypersensitivity and
dental erosion. However, in a new
study, researchers have shown
that, out of nine analysed toothpastes, none were capable of mitigating enamel surface loss, a key
factor in tooth erosion and dentine hypersensitivity.
Conducted at the University
of Bern in Switzerland with the
participation of a researcher supported by a scholarship from
the São Paulo Research Foundation, the researchers tested
eight toothpastes claiming to
be anti-erosive and/or desensitising and one control toothpaste, all of which are available
from pharmacies in Brazil and
Europe.
and not as a full treatment. According to João-Souza, at least
three factors are required for a
comprehensive approach: treatment prescribed by a dentist, use
of an appropriate toothpaste and a
change in lifestyle. “Dental erosion
is multifactorial. It has to do with
brushing, and above all, with diet.
Food and drink are increasingly
acidic as a result of industrial processing,” she said.
“Research has shown that
dentine must be exposed with
open tubules in order for there to
be hypersensitivity, and erosion
is one of the causes of dentine exposure. This is why, in our study,
we analysed toothpastes that
claim to be anti-erosive and/or
desensitising,” said lead author of
the study Dr Samira Helena JoãoSouza, a PhD student at the Department of Restorative Dentistry
at the University of São Paulo’s
School of Dentistry in Brazil.
To simulate the effect on tooth
enamel of brushing once a day
with exposure to an acid solution
for five consecutive days, the study
used human premolars donated
for scientific research purposes,
artificial saliva and an automatic
brushing machine. The physical
analysis consisted of weighing the
abrasive particles contained in the
toothpastes, measuring their size
and testing the ease with which
the toothpaste mixed with artifi-
© gvictoria/Shutterstock.com
cial saliva could be spread on the
tooth surface.
According to the results, all of
the analysed toothpastes caused
progressive tooth surface loss in
the five-day period. “None of them
was better than the others. Indication will depend on each case. The
test showed that some [toothpastes] caused less surface loss
than others, but they all resem-
bled the control toothpaste [for]
this criterion. Statistically, they
were all similar, although numerically, there were differences,” said
co-author of the article and
João-Souza’s doctoral supervisor,
Dr Ana Cecília Corrêa Aranha.
The authors of the study emphasised that these toothpastes
perform a function, but that they
should be used as a complement
“We’re now working on other
studies relating to dentine in order
to think about possibilities, given
that none of these toothpastes was
found capable of preventing dental erosion or dentine hypersensitivity, which is a cause of concern,”
said Aranha.
The study “Chemical and physical factors of desensitizing and/or
anti-erosive toothpastes associated
with lower erosive tooth wear” was
published on 20 December 2017 in
the Scientific Reports journal.
Wine polyphenols may prevent caries and periodontal disease
By DTI
WASHINGTON, US: Evidence suggests that sipping red wine has
several health benefits for the
body, possibly because of the beverage’s abundant and structurally
diverse polyphenols and probiotic
strains.
Now, a study, published
through the American Chemical
Society, has reported that wine
polyphenols might also be good for
oral health by preventing the adhe-
sion of bacteria that could cause
periodontitis and other diseases.
Conventionally, some health
benefits of polyphenols have been
attributed to these compounds being antioxidants, meaning they
likely protect the body from harm
caused by free radicals. However,
recent research indicates that
polyphenols might also promote
health by actively interacting with
bacteria in the gut. Study author
Dr M. Victoria Moreno-Arribas, Director of the Instituto de Investi-
gación en Ciencias de la Alimentación, Madrid, Spain, and her colleagues aimed to investigate
whether wine and grape polyphenols would also protect teeth and
gingivae, and how this could work
on a molecular level.
The Spanish researchers studied the effect of two red wine
polyphenols, as well as commercially available grape seed and red
wine extracts, on Porphyromonas
gingivalis, Fusobacterium nucleatum and Streptococcus mutans
bacteria, which are associated with
dental caries and periodontal disease. Working with cells that
model gingival tissue, they found
that the two wine polyphenols—
caffeic and p-coumaric acids—in
isolation were generally better
than the total wine extracts at reducing the bacteria’s ability to adhere to the cells.
When combined with Streptococcus dentisani, which is believed
to be an oral probiotic, the
polyphenols had an even better
anti-adhesive capacity. The researchers also showed that metabolites formed when digestion of
the polyphenols begins in the
mouth might be responsible for
some of these effects.
The study, titled “Inhibition of
oral pathogens adhesion to human gingival fibroblasts by wine
polyphenols alone and in combination with an oral probiotic,” was
published online in the Journal of
Agricultural and Food Chemistry
on 21 February.
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[7] =>
DTAP0318_01-16.pdf
BUSINESS
Dental Tribune Asia Pacific Edition | 3/2018
07
ADIA and BDIA to sign agreement and
strengthen ties
By DTI
SYDNEY, Australia: Seeking to
strengthen existing ties, the Australian Dental Industry Association
(ADIA) and the British Dental Industry Association (BDIA) have signed a
cooperative agreement in March.
Formalising their informal working
relationship of more than 50 years,
the new agreement is intended
to aid in mutual interests through
the sharing of information, working
with regulatory offices and promoting their respective members’ products overseas.
As part of their collaborative
work, both organisations will be
hosting national pavilions at key
international dental trade shows,
such as the International Dental
Show in Cologne in Germany and
the International Dental Exhibition and Meeting in Singapore.
The agreement was signed at
ADX18 Sydney, Australia’s premier
dental event and the nation’s largest healthcare trade show.
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ADIA and the BDIA share the
policy objective of achieving convergence of the regulations for
the market approval of medical
devices. According to ADIA, given
that in Australia and in Britain the
regulatory framework for the approval of medical devices is based
upon that of the European Union,
the two organisations will benefit
owing to a broad understanding
and different perspectives on the
same regulatory approach.
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product manufacturers in new and
innovative patient treatment options and in this area there is so
much that the ADIA and BDIA
membership can learn from each
other,” said ADIA CEO Troy Williams.
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framework may eventually look increasingly like that of Australia. We
expect that in the coming years,
just like in Australia, the regulations
will be based heavily upon those of
Europe but with some opportunities for important changes that reflect local conditions,” said BDIA
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[8] =>
DTAP0318_01-16.pdf
ADVERTORIAL
08
Dental Tribune Asia Pacific Edition | 3/2018
VladMiVa—
success comes with persistence
By VladMiVa
Employees of VLADMIVA company
VladMiVa, a large Russian holding
company that unites a number of
Belgorod-based companies and is
invested in the development and
manufacturing of materials, tools
and equipment for dentistry, celebrated its 25th anniversary in 2017.
General Manager Vladimir Chuev
VladMiVa’s activities and products
have not only been recognised nationally and by the Commonwealth
of Independent States (CIS) countries, but also in the global dental
market, the company is known as
the largest manufacturer of dental
materials and instruments in Russia.
On the night of the anniversary, we
interviewed the founder and general manager of VladMiVa, Vladimir
Chuev, who is also a doctor of technical sciences and a professor and
the head of the Department of
Medical and Technical Systems at
Belgorod State University (BSU).
Prof. Vladimir Chuev, tell us the
story of how your enterprise began.
Prof. Chuev: The critical moment when people are “on the edge”
is often a decisive moment. Someone drops his hands and someone
starts to act despite of their fears,
difficulties and an uncertain future. In 1992, the state funding for
the laboratory that I directed was
stopped, but our developments
were of an applied nature, so we
could try to find use for them. I decided to create a commercial enterprise, invested my own savings
in it and convinced almost all my
colleagues to stay and work with
me. Our first development was very
successful. In the same year, 1992,
we received a silver medal from
the USSR Exhibition of Achievements of the National Economy
for the technology we developed
to manufacture amalgam fillings.
The next important step was the
development of a technology for
the production of dental cements
for the Voronezh-based enterprise,
Raduga-R. Our first success inspired
our small team.
VladMiVa consists of a group of companies. What kind of companies are
they and which idea unites them?
We very quickly realised that
focussing only on technological
development is not very promising business. Therefore, in 1994,
the commercial department began its work. We started with direct sales on 2 m² of exhibition
space—that seems ridiculous today—but we managed to find our
customers and see a clear picture
of real consumer demand. In 1998,
JSC «VLADMIVA» EXPERIMENTAL
PLANT was opened.
The idea of “Development—
Production—Realisation”, upon
which we laid the foundation of
the company’s activities, was soon
realised. Between 2001 and 2002,
we mastered the production of dental equipment and diamond burs
and by 2009 we had produced
more than two hundred kinds of
products. In 2004, we opened our
own dental centre, which was not
only a place to confirm the high
quality of our materials, but also a
prime example of a world-class
dental centre. The holding company today also includes Trade
House, our own transport company with branches across Russia.
Over the past 25 years, the
number of employees has grown
from four to four hundred, we produce more than three hundred
kinds of products and our consumers are not only in Russia, but
also in more than 50 countries
around the world. The main activities of the company today include
the development and manufacturing of medical products for dentistry, providing raw materials for
their development, pharmaceutical production, the production of
modern disinfectants for medical
institutions, developing veterinary
medicine and consumer services.
Do you participate in programs with
state support? What is the role of
science and education in your work?
The first aid that we received
from the state was a small grant
from the Foundation for Assistance to Small Innovative Enter-
Experimental Plant
prises in Science and Technology.
Since 1997, we have participated in
many programs of the foundation
and are very grateful to its leadership for their assistance. Participation, together with the BSU, in the
federal project on government’s
resolution of the RF No. 218 became
an interesting experience and has
led to the emergence of the first
Russian certified nanocomposite,
DentLight as well as the creation of
two small innovative enterprises,
NANOAPATIT and Keramos-BSU.
We also actively cooperate with
leading scientific centres, such as
the Federal State Institution Central Research Institute of Dental
and Maxillofacial Surgery, Dmitry
Mendeleev University of Chemical Technology of Russia, Moscow
State University of Medicine and
Dentistry, Samara State University, I.M. Sechenov First Moscow
State Medical University and Tula
State Medical Academy. By 2010,
the employees of VladMiVa have
among them received four PhD
degrees as well as a doctoral thesis.
Furthermore, at the Department of Medical and Technical
Systems at BSU, the nominal audience of VladMiVa was opened and
five scholarships were awarded to
the best students. Our dental centre is also a clinical base for these
students. We want to realise one
more idea, which is to further educate our young employees.
What about your employees today?
How do you solve their social problems?
Today, our companies employ
a total of 400 people of different
professions. Of course, like any
other company, we experience a
shortage of skilled employees, such
as technologists, but this does not
diminish the quality of our work.
We value each of our employees.
Even in the most difficult times of
crisis, we do not delay the payment
of wages. We also never refuse payments on sick leave or on paid
leave. We have developed a corporate program of material assistance to employees who are in difficult socioeconomic situations.
[9] =>
DTAP0318_01-16.pdf
ADVERTORIAL
Dental Tribune Asia Pacific Edition | 3/2018
09
Medical and technical systems department
NC machine
Surgical osteoplastic materials section
Technical Control Department
Technological section
Warehouse
All our employees also receive
dental care on preferential terms.
We have also built a new plant with
a work environment that meets
all the modern requirements of
labour protection.
For 25 years, we have formed
corporate traditions, such as joint
holidays and excursions where the
families of our employees participate and we can enjoy children’s
performances and competitions.
We try to create a comfortable environment for all our people. We
have built a chapel, planted flowers
and always aim to provide good
production and living conditions.
We respect our veterans. We also
love our city Belgorod and participate in its development.
VladMiVa products have a high
quality. Can they keep up with, or
even replace, the imported goods?
In 2011, our production received a Certificate of Compliance
with the requirements of International Standards (ISO 13485:2003).
Later, we obtained the right to label our products with the mark of
European conformity (CE), which
means compliance with EU standards. In 2014, JSC «VLADMIVA» became one of the first 25 enterprises
that have the right to label their
products as “Russian nanotechnological products”, which is a confirmation of the high quality of our
products.
Out of our three hundred
products, more than 190 are in demand on the foreign market. In
Russia, we have to overcome the
phenomenon of “Westernism” in
dentistry and persuade consumers through systematic participation in exhibitions, conferences
and seminars that “Made in Russia” means quality.
We are always pleased to offer
to Russian dentists a large selection of dental materials, including
prophylactic, restorative or treating materials, as well as materials
for paediatric dentistry, biomaterials for the regeneration of bone
tissue and various tools, of excellent quality, at a reasonable price.
AD
Cements packing
Composites section
Crucibles production
[10] =>
DTAP0318_01-16.pdf
TRENDS & APPLICATIONS
TRENDS & APPLICATIONS
10
Dental Tribune Asia Pacific Edition | 3/2018
“From a patient to a fan”
An interview with W&H Marketing Director Anita Thallinger about the company’s new image campaign
One could describe them as everyday heroes: the dentists and dental
professionals who, through their
dedication, professional skill or
simply a friendly smile, manage to
transform dental appointments
into positive experiences for their
patients. They do this simply because they care and want to ensure
Dr X. Pert.
their patients feel comfortable. This
is precisely the focus of W&H’s new
image campaign, “From a patient
to a fan”, which aims to put the
spotlight on dentists and their
AD
teams. In this interview, W&H Marketing Director Anita Thallinger
talks about the background, objectives and challenges of the company’s new advertising campaign.
In February, the new W&H image
campaign was launched in dental
markets worldwide. What objectives were set for the new
campaign?
Anita Thallinger: One of
the objectives of the new
campaign, of course, is to
draw the attention of the
world of dentistry to W&H
and to distinguish the company from the competition.
Moreover, we want to show
dentists and their practice
teams that W&H is there for
them as a solutions provider
and does its utmost to support them in overcoming
their day-to-day challenges.
W&H’s new image campaign
does not focus on the company itself, but on dentists
and their teams. Why did you
choose this approach?
We want our customers
to know that W&H values
their work, dedication and skills.
As a manufacturer of innovative
dental solutions, it is our aim to
provide users with products that
offer added value. As practice
teams need to give patients their
undivided attention throughout
W&H Marketing Director Anita Thallinger (right) talking to W&H Corporate Communication Manager Susanne Kreuzhuber
about the background, objectives and challenges of the new image campaign.
the entire treatment process, W&H
sees its primary task as being to
optimise and facilitate the workflow. Our innovative products are
not only high in quality, but also
intuitive, reliable and above all
precise in their functioning. Our
goal is to support dentists and
their teams and offer them products that meet these requirements.
The new campaign features smiling
dentists and patients. What makes
your current campaign different
from that of your competitors?
At first glance, the new image
campaign seems to take a very traditional approach compared with
our previous campaign. However,
W&H is known for its slightly
tongue-in-cheek advertisements.
This is evident in the current campaign from the names given to the
dentists in the ads.
If someone is exceptionally
good at something, or becomes
synonymous with something, he
or she becomes the epitome of it,
thereby gaining fans. W&H has applied this approach in the new
campaign. In the eyes of patients,
the dentists pictured in the advertisements become Dr Phil Good,
Dr X. Pert, Dr I. Novativ, Dr S. Mile,
Dr I. Trust or Dr Sue Perstar, and
thus become the living embodiment of trust, well-being, expertise,
happiness and innovative spirit.
Instead of using models, you put
W&H employees at centre stage for
the campaign. Why did you opt for
this approach, and how did your colleagues feel about the photo shoot?
At W&H, the concept of togetherness plays an important role.
Our employees are in contact with
at least one area of dentistry every
day. They enjoyed the change of
perspective and putting themselves in our customers’ shoes. For
the photo shoot itself, we were
able to find three dentists in Salzburg in Austria who offered their
modern facilities as sets. The dentists and their assistants were also
on hand to offer advice during production; that is why the images
look authentic. I think the fun that
all the participants had in the process is evident from the emotion
in the photos.
Have you already received some initial feedback on the image campaign from your customers and
partners? What has the response
been?
We carried out a survey involving around 100 dentists during the
development phase. The concept
in itself, the idea with the names
and many other aspects were put
to the test and received excellent
feedback across the board. So, we
are looking forward to an exciting
year.
Thank you very much for taking the
time to answer our questions.
With its new image campaign W&H places dentists and dental professionals
in focus. W&H supports the practice team with its daily work and, thanks to its
innovative product portfolio, is a cornerstone of its success, according to the
company.
[11] =>
DTAP0318_01-16.pdf
[12] =>
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TRENDS & APPLICATIONS
12
Dental Tribune Asia Pacific Edition | 3/2018
Highly aesthetic interdisciplinary
treatment
How fine-structure feldspathic ceramic can bestow a natural smile
By Dr Babak Varzideh & Ludger Schlütter, Germany
The smile dwells only on the lips,
but laughter has its place and its
grace among the teeth, noted the
French scholar Joseph Joubert in the
nineteenth century. Tooth morphology, surface texture, the interplay of
colour and light, as well as tooth position, all have a decisive effect on
laughter. However, for rehabilitation of the aesthetic zone, the smile
line and the gingival margin must
be taken into consideration in the
treatment plan in order to make the
patient’s smile complete.1 Often, a
matter of millimetres determines
whether something is perceived as
aesthetic or not.2
As a result, meticulous planning and consistent and active involvement of the patient are even
more important in developing the
final treatment result.3 This is the
only way for the final restoration
central incisors appeared to have
shifted in the vestibular direction
and had left the dental arch. The vitality test was positive. Massive diastemata could be seen between
teeth #11 and 21, as well as between
teeth #21 and 22. On the mesial surface of tooth #12, an attempt had
been made to cosmetically compensate for the tooth gap with
composite. A palatal splinting of
teeth #11 and 21 with a retainer wire
was visible through the gap. A recession at tooth #11 interrupted the
harmonious course of the gingival
margin. In the vestibular area, generalised decalcification could be
seen, indicating fixed orthodontic
treatment. Functional disorders
were not diagnosed. Habitual intercuspation and central condylar position did not show any deviation.
Moderate bone loss could be seen
at teeth #11 and 21 in radiographs.
2
result. For this purpose, the
self-hardening composite material
Structur 3 (VOCO) was applied to
the silicone key and it was repositioned in the patient’s mouth. This
produced a long-term temporary
that was similar to the wax-up. The
patient was now able to obtain a
first impression of the appearance
of the final restoration.
Highly aesthetic
material selection
The decision was made for a
splinted restoration of teeth #11
and 21 to relieve the teeth functionally and to ensure a long-term fixation of the orthodontic result at
the same time. In order to produce
highly aesthetic work, the dentist
and dental technician decided on
a zirconium dioxide framework
3
1
Fig. 1: Initial situation with PFM crowns and diastemata.
lope technique).7 For optimal healing, the fixation was performed
with microsurgical single-button
sutures. The consistent proximal
splinting of the temporary on the
incisors also allowed a tensionfree, coronal fixation of the gingival area through double-crossed
sutures (Fig. 3).8 After the gingival
architecture had stabilised as de-
portion of 1M1 in the mixing ratio
in order to achieve a fresher effect
and to compensate for the opaquer
zirconium dioxide framework.
Preparation in enamel
Owing to the initial caries, a
classic veneer preparation was carried out on teeth #12 and 22. In do-
4
Fig. 2: Idealised wax-up with labial trimming.—Fig. 3: State after microsurgical gingiva correction at tooth #11.—Fig. 4: Precise shade-taking procedure with the VITA Toothguide 3D-MASTER.
to be harmoniously integrated
into the overall appearance and invisibly attractive to the observer.
In the following case, this could
only be achieved by an interdisciplinary orthodontic, microsurgical and restorative procedure.4
Case description
A 28-year-old female patient
presented to the dental practice
stating that she was dissatisfied
with the aesthetics of her maxillary anterior. At the age of 8, she
had had a bicycle accident that led
to a crown fracture without pulp
involvement of teeth #11 and 21.
Up to this point, the accident had
significantly affected the patient’s
appearance. Up to her 20th birthday, dentists had tried to stabilise
the situation with composite. In
the end, teeth #11 and 21 were restored with porcelain-fused-tometal (PFM) crowns (Fig. 1).
At first glance, the crowns
seemed dull, without any interplay
of light, and showed exposed metallic crown margins. Furthermore,
the restorations were oversized in
the incisal area and did not match
the remaining teeth or the face of
the young woman. In general, the
The young woman had already
visited numerous dental practices
and several dentists had even
warned her that little could be
done. Her expectations and psychological strain were correspondingly high.
Orthodontics
and wax-up
After eight months of orthodontic treatment using a multiband appliance, teeth #11 and 21
were harmoniously integrated into
the dental arch. During the course
of the therapy, it was possible to reduce the diastemata and level the
asymmetrical tooth position for
the subsequent restoration. A
model of the maxilla was created
using an anatomical impression
and could be idealised with a
wax-up on the maxillary incisors
(Fig. 2).5 The course of the gingival
margin was subtractively corrected through labial trimming. A
key was made of this target state
with kneading silicone. The PFM
crowns were slit and removed at
the next session. The stumps were
prepared again, and the incisors
were then restored with a splinted
temporary to fix the orthodontic
made of pre-coloured VITA YZ TColor LL1/light (VITA Zahnfabrik). The
high-strength material ensures a
high stability, and its opacity reliably covers discoloured dentine areas. The framework was to be veneered with the fine-structure
feldspathic ceramic VITA VM 9
(VITA Zahnfabrik) to ensure a natural and youthful interplay of colour and light of the restoration.
Similar to this and in the same operation, extremely thin veneers
were to be layered on teeth #12 and
22, also with VITA VM 9, to guarantee the structural harmony of the
four adjacent layers.6
Plastic microsurgery
Even after the orthodontic
treatment and the idealising temporary restoration, gingival flaws
could still be seen at tooth #11. Together with the patient, the decision was made for a microsurgical
correction of this vestibular recession. In the course of the gingival
management, a free mucosal graft
was harvested from the palate. After the minimally invasive sulcular preparation of a mucosal
pocket at tooth #11 vestibularly,
the autologous connective tissue
was plastically positioned (enve-
sired, tooth shade determination
and preparation followed.
Three-dimensional
colour space
In order to prevent the teeth
from drying out and thereby to
avoid determining a basic tooth
shade that was too light, the tooth
shade was determined with the
VITA Toothguide 3D-MASTER
(VITA Zahnfabrik) before the
preparation (Fig. 4).9 This method
allows an absolutely precise tooth
shade determination in three
quick and systematic steps, since
the complete 3-D tooth shade
space can be reproduced here. In
the first step, the basic value is
determined. Then, the correct
chroma is selected and the hue is
matched. This shade-taking procedure with a larger shade spectrum
has especially proven its worth in
the highly aesthetic area. In this
case, the tooth shade determination was oriented to the opposing
dentition and the remaining teeth
#12 and 22. A mixture of 1M2 (80 %)
and 1M1 (20 %) was determined for
the veneering on teeth #12 and 22
(Fig. 5). For teeth #11 and 21, the decision was made for a larger pro-
5
Fig. 5: Diagram of the tooth shade-taking procedure.
ing so, careful attention was paid to
the retention in enamel and to the
removal of demineralised areas in
order to ensure optimised adhesive
bonding during the course of treatment.10 Teeth #11 and 21 were
cleaned just before impression taking. The minimally invasive preparation on teeth #12 and 22 was performed with a fine-grain torpedoshaped bur and a flame-shaped
bur. The iso-gingival preparation
margin showed a considerable
chamfer and stretched from the
vestibular area into the interdental
areas, then tapered out straight in
the palatal direction. The incisal
area was only slightly rounded off.
The impression was taken with Aq-
[13] =>
DTAP0318_01-16.pdf
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[14] =>
DTAP0318_01-16.pdf
TRENDS & APPLICATIONS
14
6
7
Dental Tribune Asia Pacific Edition | 3/2018
8
Fig. 6: Master model with heat-resistant stumps and zirconium dioxide framework.—Fig. 7: Natural-looking layering of VITA VM 9 with silicone key.—Fig. 8: The finished restorations on the control model.
uasil Ultra (Dentsply Sirona). This
was used as the basis for creating a
master model with heat-resistant
stumps at teeth #12 and 22 (Fig. 6).
The silicone key based on the
wax-up was now used to create a
splinted temporary also with Structur 3 directly in the patient’s mouth.
The temporary was cemented in
the crown area with Temp-Bond
(Kerr), and the veneers were temporarily fixed with spot etching.
Natural-looking
layering
The heat-resistant stumps
were fabricated with the metalfree investment material Cosmotech VEST (GC). This investment
material has a coefficient of thermal expansion (CTE) of 13 for
metal–ceramic restorations, which
prevents tension and cracks during the firing processes in the furnace. The CTE of the stump surface
was adjusted to a CTE of 9 through
a double-connector firing with
VITA AKZENT Plus GLAZE (VITA
Zahnfabrik). This way, a uniform
and harmonious layering of the
maxillary anterior could be carried out with VITA VM 9. A palatal
silicone key was used to transfer
the morphology of the wax-up to
the layering and ensure a position-stable layering (Fig. 7).
In the course of the first and
second dentine firing, the dentine
core was created using a mixture
of BASE DENTINE 1M2 and 1M1 and
the mamelon structures using
strongly fluorescent and beige
MAMELON 1 (MM1). This determined the length of the veneer,
and an alternating layering in the
incisal area could be carried out on
this basis. The edges were created
using blue EFFECT ENAMEL 10
(EE10). The remaining vestibular
proportion was layered in the
incisal edge using a mixture of
9
10
11
12
Figs. 9 & 10: The highly aesthetic and natural smile from the lateral directions.—Figs. 11 & 12: Inserted restorations in colour
and in black and white.—Fig. 13: The happy patient with her new smile.
EE2 (pastel), EE3 (pink-translucent), EE9 (bluish-translucent)
and a minimum proportion of
EE7 (orange-translucent). After the
enamel firing, subtractive changes
in shape were made with a conical
diamond tip. A correction firing
subsequently allowed additive
compensation for morphological
and colour flaws.
The surfaces were now able to
be finished with a fine-grain, diamond-coated flame-shaped bur.
The edges were given fine details at
the same time. The restoration
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[15] =>
DTAP0318_01-16.pdf
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 3/2018
surfaces were then rubber-coated.
A worn diamond flame-shaped
bur served to create perikymata in
the surface texture. The sunshine
yellow VITA AKZENT Plus EFFECT
STAINS (ES04) were only used to
make slight characterisations interdentally in the cervical area before the final glaze firing. No glazing or finishing agent was used, in
order to maintain the detailed surface texture. VITA VM 9 already
allowed a homogenous surface
without microporosity during the
layering. For this reason, only minimal final polishing was done with
pumice and a goat hair brush after
the glazing firing (Fig. 8).
sharp scalpel. No rotating instruments were used at all, in order not
to damage the surface texture of
the restorations. Habitual intercuspation and protrusion were
checked with articulating paper to
ensure functional integration of
the restorations. After minimum
selective grinding with a fine, diamond-coated instrument without
any pressure, the polishing was
done with ceramic polishers (NTI)
to seal the surface again and pre-
vent microcracks. Finally, impressions were taken for the fabrication of a splint for long-term functional relief of the periodontium
and restorations and to support
lasting treatment success.
Haute couture
for the mouth
The initial situation could only
be optimally treated with an inter-
15
disciplinary treatment concept
and the active involvement of the
patient. The treatment result
shows a highly aesthetic rehabilitation harmoniously integrated
into the patient’s overall appearance. A confident smile appears
on the patient’s lips, emphasising
her personality (Figs. 9 & 10). The
interaction of red and white aesthetics appears natural and original (Figs. 11 & 12). Feldspathic ceramic, a natural product with a
balanced interplay of colours and
light, ensures a natural appearance. The patient’s graceful smile
found a new home in the ceramic
layering (Fig. 13).
Editorial note: This article originally appeared in the October/December 2016 issue of Dental Technology, published by MediMedia
India. A list of references is available from the publisher.
AD
#SayAhh
Fully adhesive seating
The temporary was removed
for the final seating. The preparation areas were cleaned with a
powder jet and reworked with a
one-gloss polisher (SHOFU). The
feldspathic ceramic veneers for
teeth #12 and 22 were conditioned
with 5 % hydrofluoric acid and si-
Educate your patients about the
mouth and body connection.
#WOHD18
Fig. 13: The happy patient with her new
smile.
lane after a careful try-in of all restorations. The lumen of the veneered zirconium dioxide framework at teeth #11 and 21 was sandblasted with aluminium oxide.
Teeth #11 and 21 were seated first.
The excess of the self-adhesive cement RelyX Unicem (3M ESPE) was
hardened with the polymerisation
light and then exfoliated. The subsequent polymerisation occurred
chemically with the catalyst that
was mixed in. The veneers were
seated with Variolink (Ivoclar
Vivadent).
The preparation areas on teeth
#12 and 22 were adhesively pretreated with the acid-etch technique. Composite cement was selected in the shade neutral for
seating. After the cement application, the extremely thin veneers
were placed without pressure. The
excess was removed analogously
to the splinted crowns. Remaining
cement residue was selectively removed from all restorations with a
Day on
h
lt
a
e
H
l
ra
O
d
Celebrate Worl
SAY
vement
o
m
l
a
b
lo
g
e
th
nd be part of
20 March a
Organized by
LTH
K HEA
IN
H
T
H
T
U
O
M
THINK
www.worldoralhealthday.org
Official World Oral Health Day Partners
Supporters
[16] =>
DTAP0318_01-16.pdf
From a patient to a fan.
With first-class dental solutions by W&H
for every challenge.
#patient2fan
Together we make it happen.
wh.com
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