DT Asia Pacific No. 12, 2018

CAD/CAM-integrated glass fibre post and core restoration improves tooth fracture strength / Asia Pacific News / Implants should only be inserted when periodontal conditions are stable / World News / Business / Interview: A new splash of life

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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

DENTAL FEE SURVEY

Annual dental fee survey conducted by the Australian Dental Association, summarizes the fees charged by its private practice members
have remained relatively stable, with
only a small increase.
” Page 04

Vol. 16, No. 12

CLINICAL

No Implantology without Periodontology workflow should provide stable tissue prior to implantation through prevention. Patients
will be pleased with the successful
treatment.
” Page 06

LOST OF FIRST TOOTH

Researchers from the University of
Zurich have found that children
mostly experience the loss of their
primary tooth as something positive.
” Page 09

CAD/CAM-integrated glass fibre post
and core restoration improves tooth
fracture strength
By DTI
BEIJING, China: Researchers from
the General Hospital of the Air Force
of the Chinese People’s Liberation
Army in Beijing recently evaluated
the fracture resistance properties
of maxillary incisors with flared
root canals restored with CAD/
CAM-integrated glass fibre posts
and cores. The study found that this
approach achieved improved results compared with conventional
treatments.
The researchers treated 30 prepared flared root canals in vitro and
restored these with CAD/CAM-integrated glass fibre posts and cores,
prefabricated fibre posts and cast

gold alloy, respectively. After exposure to fatigue loading, each specimen was subjected to static loading
until fracture.
The findings showed that the
mean fracture strengths of the
teeth treated with CAD/CAM-integrated glass fibre posts and cores,
and cast gold alloy were significantly higher than those restored
with prefabricated fibre posts,
whereas no differences were observed between the first two treatments. In addition, reparable
fracture modes were mostly observed in teeth treated with CAD/
CAM-integrated glass fibre posts

and cores, while irreparable and
catastrophic fractures were mainly
found in the other teeth. These results demonstrate that, in comparison with conventional treatments,
CAD/CAM-integrated glass fibre
post and core restoration significantly enhances the fracture resistance of maxillary central incisors
with flared root canals.
The study, titled “Fracture behaviors of maxillary central incisors with
flared root canals restored with CAD/
CAM integrated glass fiber post-andcore”, was published online in Dental
Materials Journal on 1 November 2018
ahead of inclusion in an issue.

New standard to be developed
for sterile reprocessing in
dental practices

A recent study found that placing a CAD/CAM-integrated glass fibre post and
core decreases the risk of fracture of an endodontically treated and restored
tooth. (Photograph: Lighthunter/Shutterstock)
IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1

By DTI
SYDNEY, Australia: Among the issues arising for small dental practice owners is adhering to regulations that are more applicable to
larger institutions such as hospitals.
In what the Australian Dental Association (ADA) is calling a “significant advocacy win”, Standards Australia has accepted a proposal to
develop a new standard for sterile
reprocessing of reusable medical
devices and surgical instruments.

prevent Australian and New Zealand Standard (AS/NZS) 4187 from
becoming the required standard
applicable to small office-based
practices. The new standard that
will now be developed over the next
several years will replace both AS/
NZS 4187 and AS/NZS 4815.

to a single document that would meet
the needs of any situation where sterile reprocessing is required.

The decision follows a discussion
on whether there was an ongoing
need to maintain two different standards, given the confusion over which
standard applied in which setting,
or if it would be preferable to move

In response, newly elected ADA
Federal President Dr Carmelo
Bonanno praised the decision as an
important positive step forward,
noting that “AS/NZS 4187 is a standard more applicable to large health
care organisations and would have
placed unreasonable demands on
dental practices which would have
resulted in increased costs for patients”.

The ADA has hailed Standards Australia’s decision to implement a new standard
for sterile reprocessing in dental practices as a positive step forward.
(Photograph: Okrasyuk/Shutterstock)

It is envisaged that the single
standard will be supported by a set
of complementary implementation
guides that will explain the application of the standard to particular
settings. Throughout the development of the new standard, the ADA
will remain closely involved and
eventually align its own infection
control guidelines to it once ready;
however, until then the existing
standards remain in place.

According to the ADA, it has
lobbied for the past few years to

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[2] =>

02

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 12/2018

Combination of breast milk and babies’ saliva
shapes healthy oral microbiome, study suggests
By DTI
BRISBANE, Australia: There is much
debate of the pros and cons of breastand bottle-feeding. A research team

from the Queensland University of
Technology (QUT), in collaboration
with the University of Queensland,

both in Australia, has found that
breastfeeding, at least in terms of
oral health of the baby, is beneficial.

According to lead author Dr
Emma Sweeney, from the Institute
of Health and Biomedical Innova-

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tion at QUT, the team’s earlier studies had found significant differences
in the prevalence of key bacteria in
the mouths of breastfed and formula-fed babies and that breastmilk
and saliva interactions boost innate
immunity by acting in synergy to
regulate the oral microbiome of
newborn babies.

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A recent study conducted by the
Queensland University of Technology
demonstrated that breastfeeding
improves the oral immune system of
newborns. (Photograph: wong sze
yuen/Shutterstock)

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For the recent study, a variety
of microorganisms were exposed
to breastmilk and saliva mixtures.
The results showed that inhibited
growth of the microorganisms took
place immediately and for up to
one day regardless of whether the
microorganisms were considered
pathogenic or commensal in an infant’s mouth.

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“Our findings suggest that
breastmilk is more than a simple
source of nutrition for babies because it plays an important role in
shaping a healthy oral microbiome,” said Sweeney. “Our previous
research found that the interaction
of neonatal saliva and breast milk
releases antibacterial compounds,
including hydrogen peroxide. The
release of this chemical compound
also activates the lactoperoxidase
system, which produces additional
compounds that also have antibacterial activity, and these compounds are capable of regulating
the growth of microorganisms,”
she added.
According to the research team,
the composition of a baby’s mouth
microbiota has an important role
in its health and well-being and also
has an impact on infections and
diseases in babies’ early lives.
The study, titled “The effect of
breastmilk and saliva combinations on the in vitro growth of oral
pathogenic and commensal microorganisms”, was published online in Scientific Reports on 11 October 2018.

[3] =>

03

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 12/2018

University of Otago receives NZ$10 million
to aid construction of new dental clinic
By DTI
DUNEDIN, New Zealand: As reported
by Dental Tribune in September,
the University of Otago announced
that it would be building a dental
teaching facility and patient treatment clinic in South Auckland. In
a positive new development, internationally renowned businessman
and philanthropist, Graeme Hart
and his wife Robyn have announced
that they will be donating NZ$10
million towards the clinic’s construction.

on the development of our dental
teaching facility in the Counties
Manukau region and it will assist

us in making a substantial positive
difference to the healthcare and
wider wellbeing of residents of New

Zealand’s largest city,” said University of Otago Vice-Chancellor Harlene Hayne.

The donation is the most significant single donation in the University’s near 150-year existence.
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Businessman Graeme Hart and his
wife Robyn have donated NZ$10
million to the University of Otago
towards the construction of a new
dental clinic in South Auckland.
(Photograph: Cozine/Shutterstock)

The University of Otago Foundation Trust Chair John Ward said,
“this funding will make a significant contribution to the development of a new dental teaching facility, which will not only provide
students with diverse practical
learning opportunities, but will
also provide dental care for the local
diverse communities at a highly
accessible cost.”
The NZ$28.2 million, two-storey, 32-chair building will be built
at the Counties Manukau District
Health Board’s Super Clinic’s site.
With 48 final-year dentistry students assigned to the South Auckland clinic at any one time, the clinic
will follow the long-standing social
contract model that operates successfully in Dunedin, whereby patients receive treatment provided
by students under supervision at a
very accessible cost.

“The University of Otago remains highly committed to providing outstanding education and
to contributing to the communities
where our campuses are located.
The Hart family’s donation will
allow us to proceed with certainty

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Hart, who lives in Auckland, was
awarded an honorary Doctor of
Commerce degree by the university
last December in recognition of his
contribution to the business sector
and for his philanthropy in supporting education and children’s
health. “We are delighted to be able
to assist our university in providing a dental school that will meet
the needs of lower socio-economic
groups. We are very pleased that
the youth and young children of
this region will benefit from this
facility,” Hart commented.

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[4] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 12/2018

Survey of Australian dentists’ fees
indicates a small increase
By DTI
SYDNEY, Australia: Each year, the
Australian Dental Association (ADA)
conducts a dental fee survey to gain
a better understanding of how private practices across the country are
billing for their work. According to
this year’s results, pricing has remained relatively stable, with only
a small increase. However, as seen
in previous surveys, there were significant variations in the different
levels of fees that are charged, both
within and between different states.
The survey, conducted by ACA
Research, summarises the fees
charged by ADA members in private
practice as at 1 July 2018. According
to the ADA, there were 303 more
practitioners who took part this year
than last year, with a total of 1,740
valid responses received. The total
participants were broken down into
1,454 general practitioners (GPs) and
286 specialist dentists.
The fees charged by GPs remained relatively stable from 1 July
2017 to 30 June 2018 across the 121
items that were surveyed. However,
there has been a continuous upward
trend over the past five years. In
line with the Consumer Price Index,
the accumulative year-on-year increase in fees over the previous five
years is eight per cent. Additionally,
the changes in fees charged by GPs
varied across all different service
categories, with the highest increase
in GP fees was noted for general
dental services (1.6 per cent). Periodontics saw a decrease of 4.5 per
cent; whereas preventive services
and oral surgery went down 0.4 per
cent and 0.3 per cent, respectively.
As with previous years’ surveys,
less than a quarter of GPs reported

The annual survey by the Australian Dental Association to summarise fees charged by its private practice members has indicated that fees have increased slightly.
(Photograph: MIND AND I/Shutterstock)

charging an hourly rate for their
services. For the 23 per cent who do,
the average rate billed was A$469
an hour, which is a four per cent increase from the previous A$449 an
hour that was reported in 2017. On
average, GPs in Western Australia
charged the lowest fees, while GPs
in Australia Capital Territory (ACT)
and Tasmania charged the highest.

The ADA did however warn that due
to the small sample sizes in the ACT
and Tasmania, these results should
be regarded with caution. On average, GPs in Victoria charged the
highest mean hourly rate of A$524,
while their counterparts in South
Australia charged the lowest mean
hourly rate of A$360. Generally, GPs
in the state capitals charged a higher

fee for the same item of service than
GPs in the rest of the state.
Approximately 11 per cent of
private practice dentists in Australia are specialists. From the 286
specialists surveyed in this year’s
survey, 29 per cent charged an average hourly rate of A$632, which
increased from A$539 in the 2017

survey. Specialists in New South
Wales charged the highest average
hourly rate of A$684, while specialists in South Australia charged the
lowest rate of A$400. However, these
results should be also be regarded
with caution, due to the relatively
small number of specialists included
in the survey results, according to
the ADA.

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Dental Tribune Asia Pacific Edition | 12/2018

05

[6] =>

CLINICAL

Dental Tribune Asia Pacific Edition | 12/2018

Implants should only be inserted when
periodontal conditions are stable
By Dr Jan H. Koch, Germany
Biofilm is the most significant cause
of inflammatory bone loss around
teeth and implants. Diagnostics, biofilm management and, where necessary, treatment help in patients with
this problem. The W&H No Implantology without Periodontology workflow should provide stable tissue prior
to implantation through prevention,
and implant success in the long term
through aftercare – something that
is advantageous to both the patient
and the treatment team.
Implant treatment can significantly improve quality of life after
tooth loss. 1, 2 The long-term prognosis is generally good, but biological complications are common. 3
Peri-implantitis and its preliminary
stage, mucositis, occur in a substantial proportion of patients. 4 As is
the case for periodontitis and gingivitis, oral biofilm is the main
cause.5, 6 This microbial biocoenosis
can also encourage the development of severe systemic disease in
the event of pathological changes,
such as endocarditis and inflammatory bowel disease.7

This means untreated periodontitis patients have an increased risk
of peri-implant inf lammation
through to implant loss.10 The risk
is also higher when patients who
are initially treated are not included
in a supportive periodontitis treatment/recall programme. 11
Leading periodontists therefore recommend carrying out a
screening procedure before implant treatment using, for example, the periodontal screening index
or periodontal screening and recording.12 Bleeding on probing and
pocket depths are determined at
selected positions. An extensive
check of the periodontal status
should be carried out if the results
are abnormal. 13
Taking a careful medical history, including previous systemic
exposure, is also important.13 This
provides important information
about increased risk of inflammation, for example in patients with
diabetes that is not being optimally
managed.14 Furthermore, patients
should be informed of the risks
relating to implants.

The only difference in the microbial flora in periodontitis and
peri-implantitis is in the detail. 8
Compared with healthy conditions,
the quantity and aggressiveness
of the pathogenic microorganisms
change in both diseases. 5, 6 Bone
loss around implants is generally
more rapid and leads to more extensive defects than when it occurs
around teeth. 9 Accordingly, preventative care is advised even before implant treatment.

Where necessary, initial periodontal treatment is carried out.
First, professional tooth cleaning
establishes healthy gingival conditions. In this procedure, calculus
(Fig. 1) and biofilm (Fig. 2) are removed as far as the gingival sulcus.
In combination with careful instruction on oral hygiene, this gives
the patient the basis for long-term
freedom from inflammation.15

Determining risks and providing
periodontal treatment
Periodontitis is a key risk factor for peri-implant inflammation.

Removal of subgingival coatings (debridement) is carried out
using sonic or ultrasonic devices
and special periodontal tips as ini-

tial periodontal treatment (Fig. 3).
Manual instruments can also be
used. Further surgical and/or regenerative measures may be necessary, depending on the situation.
Periodontal aftercare for long-term
success
In the periodontal aftercare
subsequent to implantation, soft
(biofilm) and hard coatings are
regularly professionally and mechanically removed.16, 17 In the subgingival and supragingival areas,
ultrasonic devices are generally
used for this (Fig. 4), in combination with manual instruments
where necessary. Alternatively,
subgingival air polishing can be
used in combination with periodontal attachments and powders.18
Checking for individual risk
factors, such as smoking and diabetes, and working towards a healthy
lifestyle are also recommended for
a good long-term prognosis after
periodontitis treatment.13, 19 If the
patient had severe periodontitis
before the initial treatment, the recall frequency will be increased accordingly, partially to prevent
peri-implant inflammation. 20
Proactive implant treatment
If the patient has received good
preventative treatment and where
necessary has received preliminary periodontal treatment, implant treatment can be planned. A
suboptimal implant-supported
prosthesis increases the likelihood
of biofilm forming. 21 In order to
avoid this, the correct implant position, sufficient distances from
adjacent teeth and an ideal axial
alignment should be considered
during the planning phase. A sufficiently sized bone site and soft

tissue that is well supplied with
blood are needed for successful
implant healing and a good longterm prognosis. Prior or simultaneous augmentation may be needed
to achieve this. In contrast to this,
the time at which the implant is
inserted and the treatment is provided plays a less significant role.22, 23
In order to support predictable
and stable implant treatment, it is
also necessary to prepare the implant bed using suitable methods
and equipment. This can be achieved
using high-performance implantology motors in combination with
surgical contra-angle handpieces.
Using a low speed and an ample
supply of sterile cooling fluid is essential during preparation. 24 Otherwise, the bone can overheat and
affect the healing process.
Alternatively, the implant bed
can be prepared with piezo-surgical systems, for which special sets
of instruments are available.25 Bone
can be worked on in a gentle yet
highly effective manner using other
special instruments. Indications
include alveolar ridge splitting, surgical tooth removal, and the preparation of bone blocks or lateral windows for augmentation. 26 Highly
advanced piezo-surgical devices
are also minimally invasive in soft
tissue.
Stability measurement and bone
surgery
Once the implant has been
screwed into its final position, the
primary stability can be safely and
precisely determined using resonance frequency analysis. The technology is available either separately
or as an optional module in an implantology motor. If the ISQ (Im-

plant Stability Quotient) value measured is 66 or higher, early intervention is possible, and if it is over
70, treatment must be provided
immediately. 27
An exposure protocol based on
the ISQ value improves the prognosis of treatment. Simply measuring the torque resistance, however, does not provide the same
level of clinical safety.28 If reduced
ISQ values are measured after the
implant has been inserted, a twophase protocol is generally chosen.
After exposure, a new measurement can then be used to determine whether osseointegration
has been successful (secondary
stability) and loading will be predictable at this point. 29
Hygiene-friendly prostheses
The emergence region should
be designed to ensure that it is atraumatic to the tissue for long-lasting implant restorations. The implant–abutment connection, material, surface and emergence profile must be biocompatible and
mechanically resilient over the
long term. The transgingival components should also be accessible
for individual and professional
cleaning and for probing. 20
Definitively integrating abutments or other components at implant level immediately (“one abutment, one time”) has also proved
to be effective. 30 In combination
with good hygiene and correspondingly healthy tissue, this concept
can probably be used to achieve a
more stable attachment of the implant to the oral cavity than if the
components have to be replaced
several times - a requirement for
peri-implant health.

Fig. 1: Calculus removal using an ultrasound (W&H Tigon (+) with a 3U tip) is a key part of professional tooth cleaning. (Photograph: W&H) Fig. 2: Rotary cleaning with prophylaxis polishing cups and brushes (W&H
Proxeo prophylaxis contra-angle handpiece) ensures smooth surfaces on teeth. It enables patients to check biofilm effectively at home. (Photograph: W&H) Fig. 3: If marginal periodontitis is diagnosed, the initial
debridement can be carried out very efficiently with an air scaler (sonar technology, W&H Proxeo with 1AP tip). (Photograph: W&H) Fig. 4: Ultrasound devices are particularly suitable for UPT, for example in
combination with periodontal tips (W&H Tigon (+) with 1P tip). (Photograph: W&H) Fig. 5: Implants and suprastructures are routinely cleaned, for example using ultrasound devices and special plastic instruments
(W&H Tigon (+) with 1I tip). (Photograph: W&H)

[7] =>

Whether it is with crowns,
bridges, partial or complete prostheses, the implant-supported superstructure should be designed
so that the patient can maintain
it without any difficulty. 20 Additionally, a distance of at least 2 mm
between the bone and the mucosal
edge of the prosthesis appears to
be advised to prevent infection
and subsequent bone loss.31
Peri-implant aftercare
Experts recommend treatment
immediately after the initial occurrence of symptoms of inflammation to avoid peri-implant bone loss
from the start. 20 Mucositis affects
almost half of all implants, and
since patients often have several
implants, it occurs in a high percentage of patients.32 The prophylactic or periodontal recall programme established after the implant has been inserted should
therefore be continued.20, 33 At-home
oral hygiene should be carefully
tailored to the new prosthesis and
the patient accordingly instructed
on this.34 In combination with professional biofilm management, good
preventative efficacy can be achieved
in this way.35

flamed tissue and cleaning the surface of the implant using, for example, ultrasonic or piezo-surgical
systems. Measures designed to regenerate the bone carried out after
this procedure have been successful. 40 Special piezosurgical instruments are available for the surgical
treatment of periodontal defects.
After treatment, the patient is
once again intensively instructed
on oral hygiene and made aware of
the need for continual recall. If
necessary, the frequency can be

selected to be higher than previously in line with periodontal aftercare. If biofilm management is
carried out consistently, the implantological results can remain stable
for several years even after the periodontitis, mucositis or peri-implantitis has healed.33, 39
No Implantology without Periodontology
Successful implant treatment
requires consistent, long-term preventative thinking. In each phase,
this includes regular periodontal

If a patient has mucositis, professional supragingival and subgingival biofilm removal reduce
the risk of the inflammation advancing to peri-implantitis. Local
and systemic antibiotics used as
supportive measures or air polishing, however, show no additional
benefit. 20, 39
Treating peri-implantitis
Peri-implant bone loss can develop even if good preventative
care is provided, for example if
the patient’s oral hygiene is not
sufficient. Most minimal defects
should be treated in a non-surgical manner using peri-implant
debridement. 37 Mechanical removal of coatings using suitable
ultrasonic systems, supported by
Er:YAG lasers, antibacterial photodynamic treatment, air polishing, or treatment with local or
systemic antibiotics, where appropriate, has shown promising results. 37
If closed treatment is no longer
possible, the defect must be surgically exposed and carefully decontaminated. This is carried out after
flap preparation by removing in-

and peri-implant screening in combination with individually tailored
risk management, oral hygiene
training and professional biofilm
management where possible for
every patient.

ment and will be pleased to return
to a practice or clinic they trust.

Ideally, this preventative workflow should start well before each
restorative measure, before periodontitis can develop. It is essential
if implant prosthetic treatment is
planned or has already been integrated. Patients will be pleased with
the long-term success of the treat-

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The risk of peri-implantitis decreases from 43.9 per cent (no recall)
to 18.0 per cent if a patient receives
a recall appointment carried out
carefully each year, in other words
by more than half.36 Ultrasonic systems with special instruments that
do not affect the materials are suitable for this, such as those made of
PEEK (Fig. 5), or appropriate manual
instruments.37
Mechanically preventing mucositis
As for periodontitis patients,
peri-implant recall includes regular
screening with a clinical check of
both periodontal and peri-implant
tissue for symptoms of inflammation, probing and, where necessary,
radiographic diagnosis.9 A frequency
of two to four times a year has proved
to be effective.17 Deep probing values and bleeding occur more commonly in patients with peri-implantitis than in those with mucositis;
pus secretion only occurs in patients
with peri-implantitis.38

07

CLINICAL

Dental Tribune Asia Pacific Edition | 12/2018

– latest industry developments
– event specials
– exclusive interviews
with key opinion leaders
– product information
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WORLD NEWS

Dental Tribune Asia Pacific Edition | 12/2018

BDA warns against restricting dental
visits to once every two years
By Dental Tribune UK
STIRLING, UK: A recent survey conducted by the British Dental Association (BDA) has found that a

Scottish government initiative to
potentially extend the time between dental appointments to 24

months has caused concern among
Scottish dentists regarding possible
delayed diagnosis of oral cancer.

Earlier this year, the Scottish
government launched the Oral
Health Improvement Plan, which

BDA Scotland has cautioned against
attending dental check-ups only
once every two years, as it may negatively impact the ability of dentists
to detect oral cancers at an early
stage. (Photograph: Andrey_Popov/
Shutterstock)

outlines, among other things, a focus on improving prevention, reducing oral health inequalities, and
meeting the needs of an ageing
population. Though the BDA welcomed these ambitions, it expressed
dismay that the plan recommends
that certain patients with good oral
health should only attend dental
check-ups once every two years. A
subsequent BDA survey of Scottish
dentists found that 97 per cent of
respondents are concerned that
these extensions of recall intervals
could undermine the detection of
oral cancers, which 77 per cent regarded as a major or severe risk.
Scotland has seen a 37 per cent
increase in oral cancer deaths over
the past decade, and incidence rates
are among the highest in Europe.
Though it is primarily caused by
smoking, excessive alcohol consumption and human papillomavirus infections, oral cancer can
also occur in individuals leading
generally healthy lifestyles. Given
that survival rates for oral cancer
i mprove f rom 50 per cent to
90 per cent with early detection,
regular check-ups are essential.
Dr David Cross, Vice Chair of the
BDA’s Scottish Council, said: “Dentists are on the front line of a battle
against some the fastest rising cancers in Scotland. Early detection is
key, but now risks becoming a casualty of a cost-cutting exercise.”
“People in otherwise good health
are succumbing to this disease. Telling our ‘lower risk’ patients to come
back in two years will only handicap
efforts to meet a growing threat,
while putting further pressure on
NHS cancer services,” he continued.
“Oral cancer now claims three
times as many lives in Scotland as
car accidents. Rather than chasing
quick savings we need to see concrete plans and real investment to
help turn the tables on this devastating but preventable disease,”
Cross advised.

[9] =>

Dental Tribune Asia Pacific Edition | 12/2018

WORLD NEWS

The MAP System: A versatile tool for
endodontic therapy
By DTI
PARIS, France: According to Produits Dentaires, its M A P (Micro-Apical Placement) System,
provides a unique and efficient
method for precisely placing endodontic filling materials by orthograde or retrograde approaches.
At the ADF 2018 congress , the company is showcasing the professional system, considered the
product of choice for perforation,
root-end filling, pulp capping and
retro-obturation therapies, Produits Dentaires said.
The MAP System is available
in three kits (Intro, Universal and
Surgical), which each contain a
Swiss-quality stainless-steel sy-

ringe with a bayonet catch designed
for a large range of exchangeable
application needles. The respective
kits also contain the relevant needles, reusable medical-grade polyox y methylene plungers, NiTi
cleaning curettes for removing
material residue inside the needles.

The MAP System provides a unique and efficient method for placing root canal
repair materials in orthograde or retrograde obturation. (Photograph: Produits
Dentaires)

The Classic single-angle needles
are designed for precise non-surgical endodontic procedures, while
the Surgery triple-angle needles are
optimal for surgical endodontic
procedures. The NiTi Memory Shape
needles can be manually shaped to
any required curvature and adjust
easily to the shape of the root canal
for effective placement of repair

materials. Because the NiTi Memory Shape needles are versatile, they
are ideal for orthograde and retrograde therapies.
In combination with PD MTA
White, the company’s exclusive
mineral trioxide aggregate cement
developed for placement with the
MAP System, dental professionals
can achieve durable and predictable
outcomes for their patients, Produits Dentaires said.
For more information about
Produits Dentaires’s products, dental professionals are invited to visit
the company’s booth (#1S12) at ADF
or visit www.pdsa.ch.

Majority of children perceive loss of
first tooth positively
By DTI
ZURICH, Switzerland: Although losing primary teeth can be unsettling
and painful for children, an interdisciplinary research group at the
University of Zurich (UZH) has now
found that children’s feelings towards this experience are predominantly positive. The study also
established that previous visits to
the dentist, as well as parental background and level of education, affect how children experience the
loss of their first tooth.
Children generally lose their first
primary tooth when they are about
6 years old. This gradual process is
probably one of the first biological
changes to their own bodies that
children experience consciously.
The emotions that accompany this
milestone are extremely varied,
ranging from joy at having finally
joined the world of grown-ups to
fear about the loss of a body part.
An interdisciplinary team of researchers at UZH, in cooperation

with the City of Zurich’s school dental services, has examined the feelings that children experience when
they lose their first primary tooth
and what factors play a role. The scientists surveyed parents of children
who had already lost at least one of
their primary teeth. Of the nearly
1,300 responses received, around
80 per cent of parents reported positive feelings, while only 20 per cent
told of negative emotions.
The researchers found that previous visits to the dentist played a
role regarding children’s feelings.
Those whose previous visits were
cavity-related and thus perhaps associated with shame or guilt experienced fewer positive emotions
when they lost their first primary
tooth. If, however, previous dental
appointments were the result of an
accident, and thus an abrupt, unexpected and painful event, the
loss of the first primary tooth was
more likely to be associated with
positive emotions. According to

lead author Dr Raphael Patcas, from
the Clinic of Orthodontics and Pediatric Dentistry, one possible explanation for this is that primary
teeth loosen gradually before falling out—a process that, unlike an
accident, unfolds slowly and predictably. This is also supported by
the finding that children who experience the loosening of a tooth
over an extended period tend to
have more positive feelings. The
longer the preparation and waiting
time, the greater the relief and pride
when the tooth finally falls out.
Moreover, the study found that
socio-demographic factors are related to children’s feelings. For example, children were more likely to
have positive feelings such as pride
or joy if their parents had a higher
level of education and came from
non-Western countries. The researchers indicate that cultural differences could be at play here. These
include education style and norms
that parents pass on to their chil-

Researchers from the University of Zurich have found that children mostly
experience the loss of their first primary tooth as something positive.
(Photograph: Alexxndr/Shutterstock)

dren, as well as transitioning rituals
that accompany the loss of the first
baby tooth.
“Our findings suggest that children deliberately process previous
experiences concerning their teeth
and integrate them in their emotional development,” said study
co-author Prof. Moritz Daum, from
the institute of developmental psychology at the university. This finding is important for dentists and
parents alike: “Especially where

cavities are concerned, it’s worth
communicating with children prudently,” added Daum. “This way,
emotions in connection with teeth
and dentists can be put on the most
positive trajectory possible.”
The study, titled “Emotions experienced during the shedding of
the first primary tooth”, was published online on 15 September 2018
in the International Journal of Paediatric Dentistry ahead of inclusion
in an issue.

New study links poor toothbrushing habits to heart disease
By DTI

New research suggests that brushing
one’s teeth less than twice a day for
less than 2 minutes at a time may
lead to a threefold increase in risk of
developing cardiovascular disease.
(Photograph: Aleksandr Lupin/
Shutterstock)

CHICAGO, US/LONDON, UK: A new
study presented during the 2018
American Heart Association Scientific Sessions held recently has suggested that brushing one’s teeth at
least twice a day for at least 2 minutes may reduce one’s risk of developing cardiovascular disease.
In response, the Oral Health

Foundation, a leading charity working to combat oral disease in the
UK, stressed the importance of taking charge of one’s oral health, stating that it can provide benefits that
go far beyond the mouth.
“Findings like this may sound
slightly scary to hear but it could
prove to be just the push we need

to take better care of our oral health,”
said Dr Nigel Carter, OBE, CEO of
the Oral Health Foundation. “This
study adds to the growing scientific
evidence that this is a strong link
between the health of our mouth
and that of our body.”
“For many years, gum disease
has been linked with conditions

like strokes, diabetes, dementia, and
pregnancy outcomes. These are all
serious conditions that could impact on a person’s quality of life,”
he continued.
“Looking after our mouth should
be a priority every day and the benefits of doing so are simply too important to ignore,” Carter said.

[10] =>

10

BUSINESS

Dental Tribune Asia Pacific Edition | 12/2018

Hu-Friedy and WeRestore.it release
new restorative kit
By DTI
FRANKFURT AM MAIN, Germany: Creating aesthetic restorations requires
a significant amount of attention to

detail, as well as the right tools. To
aid dentists in performing their best
possible work, Hu-Friedy, in collabo-

ration with Drs Gaetano Paolone and
Salvatore Scolavino of WeRestore.it,
has recently announced the release

of a new and simplified basic set for
direct and indirect restorative procedures, the 3SSENTIAL KIT.

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The 3SSENTIAL KIT contains just three
tools, is colour-coded, and is designed
to simplify and improve the possibilities of restorative procedures.
(Photograph: Hu-Friedy/WeRestore.it)

Until now, the minimum number of instruments in a kit was five,
and with an array of instruments on
the market, it has become increasingly difficult for practitioners to
make the right choices. Aiming to
create something more compact, essential and easy to use, the creators
of the 3SSENTIAL KIT settled on just
three instruments: Anterior (red),
Posterior (blue) and Spatula (grey).
Speaking about the new kit, Scolavino said: “The concept behind the
Posterior is very simple: we wanted
to go from a plug-and-play to a plugand-sculpt method. One tip is used
to plug the composite into the cavity
and the other one can sculpt and
model composite in additive and
subtractive modelling techniques”.
According to Paolone and Scolavino,
the Anterior is referred to as a solid
brush, since it models and spreads
the composite just like a brush.
Giana Spasic, Manager of Key
Opinion Leaders Strategy at HuFriedy, said the company is always
looking to work with key opinion
leaders, specialists, private practitioners, universities and educators,
with the purpose of finding new ways
to help clinicians to perform at their
best.
The creators believe the kit is the
most straightforward restorative kit
ever made and is perfect for clinicians who want to save precious time
in the dental office during restorative
procedures and achieve remarkable
aesthetic and functional results.

[11] =>

Dental Tribune Asia Pacific Edition | 12/2018

INTERVIEW

Interview: A new splash of life
Numerous innovative restorative and aesthetic dental solutions, which are considered
an industry standard today, have been brought to market by Nobel Biocare.
By Oemus Media
relevant experience and data available in a clinical setting. In addition
to five-year follow-up studies by
Prof. Andrea Mombelli from Geneva,
Switzerland, there have already
been meaningful mechanical studies conducted and statistics compiled from over 15,000 implants.
As usual, we are going to start our
own clinical studies in the coming
months.
The claim that modern dental ceramics are biocompatible seems to be
sufficiently proven, but what influence does the quality of the implant
surface has on successful tissue and
bone integration?
Similar to titanium implants,
the hydrophilic surface of the NobelPearl implant is acid-etched and
sand-blasted. The resulting microand macroroughness allows good
osseointegration, which was confirmed by two recently published
studies from the universities in
Innsbruck in Austria and Bern in
Switzerland.

Prof. Stefan Holst, Vice President Global Research, Products & Marketing at Nobel Biocare. (Photograph: Nobel Biocare)

Recently, the company expanded its
product portfolio of dental implants
and is now offering a complete metal-free, two-piece screw-connected
option with NobelPearl. The new
ceramic implant system was first
introduced at EuroPerio9 in Amsterdam, the Netherlands. In this interview with ceramic implants Prof.
Stefan Holst, Vice President Global
Research, Products & Marketing at
Nobel Biocare, discusses the new
product line and what makes it stand
out from other systems available on
the market.
With NobelPearl, Nobel Biocare is
now at the forefront of modern
ceramic implant systems. What has
been the response so far to this new
product line?
We have been pleased with the
very positive response to this new
product in our implant range. The
market launch was announced at
the end of last year and we recently
presented NobelPearl to the public
in the German-speaking regions in
June and to international markets
at the EuroPerio9 congress in
Amsterdam. We are currently midway through the market launch.
The interest in our innovative twopiece metal-free screw-connected
ceramic implant is continuously
growing, and we are sure that it will
further increase with approval in
new markets.
In your opinion, what should be the
key features of a modern ceramic
dental implant system?
Aesthetics and material compatibility are very important features for ceramic implants, but
they should not come at the expense
of pr imar y stabi lit y. Moder n

ceramic implant systems such as
NobelPearl are now capable of
meeting our quality requirements
in terms of strength, rigidity, and
fracture toughness. For these reasons, among others, we decided to
permanently add it to our product
portfolio.
What are the main indications for
your system?
NobelPearl was designed to
support a natural soft-tissue appearance. Its zirconia material is especially beneficial for patients with a
very thin mucosa, as studies have
shown that microcirculatory dynamics in peri-implant mucosa around
zirconia are comparable with those
around natural teeth. The material
has further demonstrated low affinity to plaque.

among other developments.
While ceramic implants can still
be considered a niche, their market
share is expected to increase in the
coming years. The movement and
innovation that can be seen in this
area at the moment is a clear indication for this trend.
A special feature of the new system
is the metal-free carbon-based
VICARBO screw. Experts still seem
to argue about the biocompatibility
and long-term stability of this type
of material in the moist environment
of the mouth. What would you tell
them?
Carbon fibre-reinforced PEEK
(Polyether ether ketone) has been
used in orthopaedics for some time,
and therefore has been tried and

“We are seeing growing demand for
metal-free implant solutions.”
Is it possible to achieve multi-piece
restorations and even fixed total
prostheses with NobelPearl?
The t wo -pie c e , r ever sible
screw-connected concept allows us
to cover many indications. Therefore, the NobelPearl implant can
also be used for bridges and even
in edentulous jaws.
What role does the “metal-free”
feature play in this?
Nowadays, patients are much
more conscious about their health
and therefore carefully choose
products and treatments. That is
why we are seeing growing demand
for metal-free implant solutions,

tested in clinical use. The same holds
true for dental applications such as
temporary restorations. The material exhibits very good biocompatibility and is also highly resistant
to corrosion.
There are still not many long-term
studies available on modern ceramic
implant systems. Do you see a problem there and how well has your
own system been scientifically validated?
We decided to base NobelPearl
on an implant body design that our
partner Dentalpoint from Switzerland has had successfully on the
market for five years, so there is

Is there something we still do not
know about ceramic implants, e.g.
looking at inflammation-free but
failed osseointegration?
As with all innovations, of
course, there is still little long-term
experience. In other words, there
are not many studies available with
5, 7 or even 10 years of follow-up.
However, there is no “big unknown”.
We based NobelPearl on the latest
available knowledge, and the current products have been extensively
tested and scrutinised.
The “aseptic loosening” you
mentioned, is an observation from
the field of orthopaedics, which is
now being used to explain individual cases involving ceramic implants,
but this is certainly not something
we are unaware of.
Nowadays, an implant system
must be “modern”, meaning that it
can be integrated into the digital
workflow. How much progress have
you made in that regard? After all,
Nobel Biocare only recently presented a dynamically guided navigation system.
From digital diagnostics to
implant planning with the DTX
Studio suite or CAD/CAM work processes, NobelPearl, like our titanium
implants, is fully integrated into
the Nobel Biocare digital workflow.
Therefore, clinicians who want to
offer that treatment option should
not have any difficulties with the
transition. The X-Guide system, you
mentioned, which will soon be
available in all key markets, will be
supported as well.
Prof. Holst, thank you very much for
the interview.
Editorial note: This interview was
originally published in Ceramic
Implants – international magazine of ceramic implant technology No. 02/2018.

IMPRINT
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of product claims, or for typographical errors.
The publishers also do not assume responsibility
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[12] =>

Planmeca Emerald intraoral scanner
™

Precious things
come in small packages
™

The brand new intraoral scanner Planmeca Emerald is a small, lightweight,
and exceedingly fast scanner with superior accuracy. Taking digital impressions has
never been as easy. Together with the Planmeca PlanCAD® Easy software, it is
the perfect tool for smooth and efficient chairside workflow.

It is a true game-changer!

Find more info and your local dealer!
www.planmeca.com

Planmeca Oy Asentajankatu 6, 00880 Helsinki, Finland. Tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com

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[cover] => DT Asia Pacific No. 12, 2018

[toc] => Array ( [0] => Array ( [title] => CAD/CAM-integrated glass fibre post and core restoration improves tooth fracture strength [page] => 01 ) [1] => Array ( [title] => Asia Pacific News [page] => 02 ) [2] => Array ( [title] => Implants should only be inserted when periodontal conditions are stable [page] => 06 ) [3] => Array ( [title] => World News [page] => 08 ) [4] => Array ( [title] => Business [page] => 10 ) [5] => Array ( [title] => Interview: A new splash of life [page] => 11 ) ) [toc_html] =>

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