DT Middle East and Africa No. 5, 2019
News
/ Industry
/ News
/ Oral Health
/ Minimally invasive veneer restoration with hybrid ceramics
/ Easy and efficient: Composite resin blocks for the CAD/CAM technique
/ Implant maintenance care solution
/ Customised aesthetics for provisional profile prosthesis with ceramage gum
/ News
/ Interview: "There has been tremendous growth in access to knowledge and technology..."
/ Interview: "Dentistry in the GCC region has developed more in the last five years than ever before..."
/ Endo Tribune Middle East & Africa Edition
/ Lab Tribune Middle East & Africa Edition
/ Implant Tribune Middle East & Africa Edition
/ Ortho Tribune Middle East & Africa Edition
/ Hygiene Tribune Middle East & Africa Edition
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DTMEA_No.5. Vol.9_DT.indd
NL
Y
O
LS
NA
IO
SS
FE
O
PR
NT
AL
DE
www.dental-tribune.me
Published in Dubai
September-October 2019 | No. 5, Vol. 9
ENDO TRIBUNE
LAB TRIBUNE
IMPLANT TRIBUNE
ORTHO TRIBUNE
HYGIENE TRIBUNE
Novel applications of a bioactive resin in perforations, root
resorption and endodontic...
The new Multimat Cube from
Dentsply Sirona: powerful,
user-friendly, reliable...
Study determines reasons for
dental implant failure and
removal techniques...
Interview: I try to think of
solutions for common problems
Interview: “Naturally occurring
substances will find their place
in oral health”
ÿA1-4
ÿB1-4
ÿC1-4
ÿD1-4
ÿE1-4
By The National
DENTAL TRIBUNE
The World’s Dental Newspaper Middle East & Africa Edition
Expo 2020 Dubai will host 10 dedicated conferences that will present cutting-edge practice in
healthcare, including the use of virtual reality
and 3D printing.
The announcement came just weeks after it
unveiled its state-of-the-art on-site emergency
centre that includes an isolation room, emergency care room and a helicopter pad.
ÿPage 2
© EXPO 2020 Dubai
Expo 2020 Dubai to
present next-gen healthcare
innovations
Expo 2020 Dubai will take over the emirate for six months from next October
AD
Embryonic tooth germs are generated from dental pulp cells in a laboratory using a special method of cultivation.
Help your patients wipe away
the main cause of gum problems
meridol® – Clinically proven
antibacterial efficacy
A powerful combination of stannous ions (Sn2+) and
aminofluoride (AmF) directly targeting bacterial plaque.
For effective prevention of gum problems
[2] =>
DTMEA_No.5. Vol.9_DT.indd
2
NEWS
IMPRINT
PUBLISHER/
CHIEF EXECUTIVE OFFICER
Torsten R. OEMUS
CHIEF FINANCIAL OFFICER
Dan WUNDERLICH
1 Arab Perio Meeting
st
DIRECTOR OF CONTENT
Claudia DUSCHEK
SENIOR EDITOR
Michelle HODAS
CLINICAL EDITORS
Nathalie SCHÜLLER
Magda WOJTKIEWICZ
EDITORS
Franziska BEIER
Brendan DAY
Monique MEHLER
Kasper MUSSCHE
COPY EDITOR
Ann-Katrin PAULICK
Sabrina RAAFF
© ASP
BUSINESS DEVELOPMENT & MARKETING
MANAGER
Alyson BUCHENAU
By Arab Society of Periodontology
On the 24th of July with the representatives of Perio societies and
clubs from five Arab countries
(Egypt, Lebanon, KSA, UAE and Jordan the hosting country). The first
meeting was held in Amman, the
participants stated the importance
of having a Pan Arab society for Arab
periodontists in the Arabic countries.
Where ASP (Arab Society of Periodontists) will be the Scientific and
social tribune of all Periodontists &
dentists who have the Perio passion.
ASP will partner with all international Perio societies, at the same
time the attendees stressed on the
importance of expanding this society to all local societies in the Arabic
countries.
The attendees drafted the internal
bylaws of the society and agreed to
hold the first regional Arab Perio in
Amman on April 6th, 2020 and the
2nd one will be held in Beirut in 2022.
The attendees elected: Dr. Ala' Ersheidat (President), Prof Nada Naaman
(Vice-president), Dr. Abdallah Al
Amri (Treasury).
DIGITAL PRODUCTION MANAGER
Tom CARVALHO
Andreas HORSKY
Hannes KUSCHICK
PROJECT MANAGER ONLINE
Chao TONG
WEBSITE DEVELOPMENT
Serban VERES
E-LEARNING MANAGER
Lars HOFFMANN
SALES & PRODUCTION SUPPORT
Puja DAYA
Hajir SHUBBAR
Madleen ZOCH
EXECUTIVE ASSISTANT
Doreen HAFERKORN
◊Page 1
© EXPO 2020 Dubai
© EXPO 2020 Dubai
© EXPO 2020 Dubai
ACCOUNTING
Karen HAMATSCHEK
Anita MAJTENYI
Manuela WACHTEL
EXECUTIVE PRODUCER
Gernot MEYER
ADVERTISING DISPOSITION
Marius MEZGER
DENTAL TRIBUNE INTERNATIONAL
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48 474 302
Fax: +49 341 48 474 173
www.dental-tribune.com
info@dental-tribune.com
DENTAL TRIBUNE ASIA PACIFIC LTD.
Room A, 20/F
Harvard Commercial Building
105–111 Thomson Road, Wanchai, HK
Tel.: +852 3113 6177
Fax: +852 3113 6199
AD
THE AMERICA, LLC
116 West 23rd Street, Ste. 500, New York
N.Y. 10011, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
Ten healthcare
conferences will put spotlight on virtual reality,
3D printing and wearable
technology
High-speed 3D printing
Redefining digital dentistry
The conferences, which will focus on technological advances in health care, will include a Virtual Reality and Robotics Expo with artificial intelligence, 3D printing and wearable technology
being the subject of several panel discussions.
The conferences will be held at the Expo’s colocated Dubai Exhibition Centre, in collaboration with Medetarian Conferences Organising,
a medical conference and consumer events
specialist.
Certified and Biocompatible materials
"The 10 cutting-edge medical conferences and
specialist events that will be hosted at DEC during Expo 2020... will serve as an invaluable addition to the UAE’s medical landscape,” Najeeb
Al Ali, executive director of Expo 2020 Dubai
Bureau said.
The UAE already hosts a number of high-level
healthcare and medical-related conferences.
These include the annual Arab Health conference, which has grown over the past 45 years to
become, arguably, the world’s flagship healthcare event.
3D Middle East General Trading - 3D Systems Distributor
www.3d-me.com | +97144433938 | info@3d-me.com
Editorial note: Teh article was originally published in The National:
https://www.thenational.ae/uae/health/expo2020-dubai-to-present-next-gen-healthcareinnovations-1.905277
DENTAL TRIBUNE MEA EDITION EDITORIAL
BOARD
Dr. Aisha SULTAN ALSUWAIDI, UAE
Prof. Paul TIPTON, UK
Prof. Khaled BALTO, KSA
Dr. Ninette BANDAY, UAE
Dr. Nabeel HUMOOD ALSABEEHA, UAE
Dr. Naif Almosa, KSA
Dr. Mohammad AL-OBAIDA, KSA
Dr. Meshari F. ALOTAIBI, KSA
Dr. Jasim M. AL-SAEEDI, Oman
Dr. Mohammed AL-DARWISH, Qatar
Dr. Dobrina MOLLOVA, UAE
Dr. Ahmed KAZI, UAE
Dr. Munir SILWADI, UAE
Dr. Khaled ABOUSEADA, KSA
Dr. Rabih ABI NADER, UAE
Dr. Ehab RASHED, UAE
Aiham FARRAH, CDT, UAE
Retty M. MATTHEW, UAE
PARTNERS
Saudi Dental Society
Saudi Ortho Society
Lebanese Dental Association
Lebanese Orthodontic Society
Qatar Dental Society
Oman Dental Society
Kuwait Dental Association
American Academy of Implant Dentistry
International Federation of Dental
Hygienist
British Academy of Restorative Dentistry
British Academy of Dental Implantology
AALZ - Aachen Dental Laser Center
Singapore Dental Association
DIRECTOR OF mCME
Dr. Dobrina MOLLOVA
mollova@dental-tribune.me
Tel.: +971 50 42 43072
DIRECTOR
Tzvetan DEYANOV
deyanov@dental-tribune.me
Tel.: +971 55 11 28 581
EDITING & DESIGN
Kinga MOLLOV
k.romik@dental-tribune.me
Tel.: +971 56 23 70 721
PRINTING HOUSE & DISTRIBUTION
Al Nisr Printing
P. O. Box 6519, Dubai, UAE
800 4585/04-4067170
©2018, Dental Tribune International GmbH.
All rights reserved. Dental Tribune International makes every effort to report clinical information and manufacturer’s product news
accurately, but cannot assume responsibility
for the validity of product claims, or for typographical errors. The publishers also do not
assume responsibility for product names or
claims, or statements made by advertisers.
Opinions expressed by authors are their own
and may not reflect those of Dental Tribune
International.
[3] =>
DTMEA_No.5. Vol.9_DT.indd
Solutions for better,
safer, faster dental care
Dentsply and Sirona have joined forces to become the world’s largest
provider of professional dental solutions. Our trusted brands have empowered dental professionals to provide better, safer and faster care in all fields
of dentistry for over 100 years. However, as advanced as dentistry is today,
together we are committed to making it even better. Everything we do is
about helping you deliver the best possible dental care, for the benefit of
your patients and practice.
Find out more on
dentsplysirona.com
[4] =>
DTMEA_No.5. Vol.9_DT.indd
3M™ Impregum™ Super Quick
Polyether Impression Material
Capture every
detail in 2 minutes?
Yes, it can.
Quicker set.
So fast, so good: With just a two minute setting
time the new Impregum Super Quick Material
allows for faster impressions in less complex cases
like single-unit crowns, implants, inlays/onlays and
smaller bridges up to 3 units.
100 % Polyether. Trusted
precision.
Like all polyethers Impregum Super Quick
Materials demonstrate excellent performance in
moist situations and exhibit great flow behaviour,
leading to higher levels of accuracy and detailed,
high-precision restorations.
The nature of polyether allows you to get the full
45 seconds of working time, avoiding inaccuracies
associated with premature setting times common
with VPS materials.
Make your patients
feel comfortable.
An improved fresh, minty taste together with a
short time in the mouth significantly increases your
patients’ comfort.
3M Deutschland GmbH
Location Seefeld • 3M ESPE •
ESPE Platz • 82229 Seefeld • Germany
Info3MESPE@mmm.com
www.3MESPE.com
3M, Garant, Impregum, Penta and Pentamix are
trademarks of 3M Company or 3M Deutschland
GmbH. Used under license in Canada.
All other trademarks are owned by other companies.
© 3M 2019. All rights reserved.
3M™ Impregum™
Super Quick Polyether
Impression Material
• First superfast polyether
with 45 sec. working time
and quick 2-minute setting
• Available in heavy,
medium and light body
consistencies
• For monophase and 1-step
impression techniques
• Perfect for impressions
for single-unit crowns,
implants, inlays/onlays
and smaller bridges up
to 3 units
[5] =>
DTMEA_No.5. Vol.9_DT.indd
Your restorations.
Your composite.
Your day.
3M™ Filtek™ Universal Restorative
Universally simpler.
8 Designer shades. 1 Universal opacity. It doesn’t get any simpler.
Efficiency is key to navigating a tight schedule. That’s one reason dentists use a single-shade
restoration for about 80% of their cases.* Making those restorations easier is why we created
*3M Internal Data
3M™ Filtek™ Universal Restorative.
It starts with simplifying
shade selection.
Your 8 designer
shades:
Just 8 designer shades plus an Extra White
(XW) cover the 19 VITA classical and bleach
shades.* Plus, the shades have a universal
opacity that meets most clinical needs.
• NaturalMatch technology (made up
of nanofillers, proprietary low-stress
monomers and pigments) enables oneshade esthetics to blend more naturally
with dentition.
• Fluorescent pigments enhance the
lifelike appearance.
A1
A2
A3
A3.5
B1
A4
• 3M filler technology allows for
increased radiopacity.
B2
D3
Enhancements like an Extra White (XW) and a
Pink Opaquer (PO) help you deliver excellent
esthetics in unique situations.
Create Extra
White restorations
to meet the
expectations of
patients who
bleach.
XW
Keep dark areas
from diminishing
esthetic results.
A Pink Opaquer
effectively masks
metal and stained
dentition.
A new class of
universal composite
From the moment of cure,
restorations are challenged by
chewing, brushing and grinding.
We raised the bar for durability by
combining two proven proprietary
dental technologies for the first
time in a universal composite.
Low-stress
monomer
technologies
Pioneered in
our bulk-fill
AUDMA
composites,
they help protect restorations
from problems caused by
shrinkage and shrinkage stress.
AFM
3M’s patented TRUE
nanotechnology
Pink Opaquer
(PO)
A1 shade
Gives restorations
excellent polish that
lasts, as well as high
strength and excellent
wear resistance.
100K magnification of nanocluster. SEM photo
courtesy of Dr. J. Perdigão, University of Minnesota.
3M Deutschland GmbH
Location Seefeld • 3M ESPE •
ESPE Platz • 82229 Seefeld • Germany
Info3MESPE@mmm.com
www.3MESPE.com
3M and Filtek are trademarks of 3M or 3M Deutschland GmbH. Used
under license in Canada. © 3M 2019. All rights reserved.
[6] =>
DTMEA_No.5. Vol.9_DT.indd
6
INDUSTRY
Dental Tribune Middle East & Africa Edition | 5/2019
Hybrid Technologies grows business with fullarch palatal Jigs 3D printed on NextDent 5100
Small dental laboratory now offers full-arch shell temps with palatal jig enabled
by 3D Systems’ NextDent 5100 3D printer
By 3D Systems
Hybrid Technologies is a small dental laboratory in Orlando, Florida, that specializes in highly
esthetic multiple unit implant restorations.
Since incorporating 3D Systems’ NextDent™
5100 dental 3D printer, owner Matt Mills reports “absolutely nonstop” use that has generated new business opportunities for his lab.
tal workflow with the NextDent 5100 improves
the process for both the dentist and patient.
Mills says the dentists he works with like the
shell temp service because it allows them to
be highly accurate with shorter appointment
times. Hybrid Technologies also polishes and
textures the NextDent prints for highly attractive results, which means the patients are
happy with their smile throughout treatment.
Cost-effective 3D printing with wide
material choice
3D printed palatal jigs indispensable
to full-arch restorations
Mills has extensive professional experience
with dental 3D printers, so when it came time
to choose the right solution to bring in-house,
he knew what to look for. As a small lab owner,
pricing and capability were his top concerns. Of
the options he researched, some were too expensive to consider, and others had recurring
costs beyond the materials used.
“Cost was the first thing that drew me towards
the NextDent 5100, followed by the breadth of
materials,” Mills says. “The fact that I can own
this printer rather than lease it makes it a better value, and the fact that resins are the only
consumable is a big plus to keep my recurring
costs low.” In terms of addressable indications,
Mills says 3D Systems’ NextDent resins cover
every category his lab will ever need to print.
Application versatility, from 3D printed temporaries and palatal jigs to
white digital wax ups
3D Systems’ NextDent material portfolio
includes 30 unique biocompatible and CEcertified materials to address a broad range of
clinical needs. Hybrid Technologies takes advantage of several of these materials, including
NextDent C&B MFH, NextDent Model 2.0 and
NextDent Tray.
3D printed temporaries improve accuracy, shorten appointment times
In addition to providing high quality lab work
for final dental restorations, Hybrid Technologies offers esthetic 3D printed temporaries
(shell temps) for in-mouth wear while the final
restoration is being made. Hybrid Technologies
works with dentists on esthetically demanding
cases, in which the temporaries are extremely
important because they function as a communication tool between the patient, the doctor,
and the lab. “Using NextDent MFH material for
shell temps looks ten times better than anything you can mill, and it’s so much more costeffective,” says Mills.
Whereas the conventional process for temporization involves a considerable amount of
chair-side manipulation by the dentist, a digi-
Without teeth for the dentist to index the
placement of a temporary or final restoration,
full arch edentulous cases require a palatal jig.
The NextDent 5100 has made it possible for
Hybrid Technologies to offer 3D printed palatal
jigs for full-arch restorations as a cost-efficient
alternative to conventional palatal jigs.
Conventional palatal jigs are milled using a
special milling puck that is taller than average
to accommodate the height of the device. The
material costs and wear and tear to the milling
machine of traditional palatal jigs made these
tools too expensive for Hybrid Technologies
to offer conventionally. However, Mills says
his lab is now able to 3D print palatal jigs using
the NextDent 5100. “3D printing versus milling is definitely a positive in more than one
area,” says Mills. “The cost savings on materials
is huge, but by 3D printing you are also able to
save the integrity of your milling machine for
materials like zirconia.”
Using a two-stage build process, Hybrid Technologies prints a kind of bite splint that shows
where the shell temps will fit. The anterior teeth
are prepped in the first stage, and the posterior
teeth are prepped in the second. This allows a
constant frame of reference for positioning.
“When you break up the shell temps into sections like that, placing them in the mouth becomes very accurate and esthetic,” says Mills.
“Providing accurate temporaries that are precisely placed in the mouth increases the predictability of the final outcome, along with the
patient’s satisfaction in the final restorations.”
Mills says his business has been able to grow
tremendously with this new offering. “Offering shell temps with a palatal jig is probably
one of the biggest and most profitable parts of
my lab,” Mills says. “That workflow has really
opened a lot of doors for me.”
White digital wax ups help doctors
sell treatment
Mills reports enthusiastic feedback on the esthetic quality of NextDent prints across indications, including the digital wax ups he is able to
3D print in a true white color using NextDent
Mills says 3D Systems’ NextDent resins cover every category his lab will ever need to print.
Mills reports enthusiastic
feedback on the esthetic
quality of NextDent prints
across indications.
Model 2.0 material. “A lot of companies offer
ivory, peach, or gray materials for digital wax
ups, but NextDent Model 2.0 is an actual white
material, and that’s huge,” Mills says.
Access to white dental materials has been a
game-changer for the doctors Mills works with
who need to give their patients a preview of
their anticipated treatment. “Patients need to
be able to trust their doctor with what they are
going to do with their smile, and when they’re
looking at peach-colored teeth, the patient
starts second-guessing,” Mills says. Since offering digital wax ups with NextDent Model 2.0,
Mills has been able to help his doctors sell more
cases with white and shiny teeth that represent
the smile makeover patients want to see.
Speed of printing enables same-day
services
Hybrid Technologies works with several doctors who also have the NextDent 5100 inhouse, and supports their workflow with dental design services. Together, the dental lab and
dental offices coordinate to deliver enhanced
and accelerated patient care.
The dentist books Hybrid Technologies’ time
to match the patient’s appointment, and while
the patient is in the chair for treatment, the
dentist sends the patient’s intraoral scan to the
lab for concurrent design work. Hybrid Technologies completes the work and sends back
a file for 3D printing within the appointment
window. The dentist 3D prints the file in-house
and sends the patient home with an esthetic
result. “The NextDent 5100 can print a full arch
in 30 minutes, which means massive improvements to same-day dentistry,” says Mills.
According to Mills, the print speed of the NextDent 5100 is a tremendous advantage for his
lab work as well: “On any other printer, I’d maybe get two prints done in a day, run another
overnight, and hope to catch up in the morn-
CHALLENGE:
Expand small dental lab capabilities and business withcost-effective, high quality solution
SOLUTION:
3D Systems’ NextDent™ 5100 dental 3D
printer and NextDent materials
RESULTS:
– New service offering with 3D printed shell
temps and palatal jigs
– 30 minutes to print full arch
– Four-fold increase in productivity compared
to other 3D printers tested
– White digital wax ups help dentists sell
treatment
– High print speeds eliminate backlog
– Improving same-day dentistry
ing. With the NextDent 5100, I can easily get 10
to 12 prints done in a day, in between my other
work.”
Mills reports a user-friendly experience operating the NextDent 5100. In addition to excellent functionality of the included 3D Sprint®
software, he says part and support removal are
quick and easy. “3D Sprint is awesome,” Mills
says. “It’s much better than other nesting software I’ve used, and the process to get parts off
the build plate is much improved over other
printers as well. I haven’t broken a single model, and the Smart Supports pluck right off.”
To learn more about the NextDent 5100 3D
printer, visit www.3d-me.com/nextdent-5100
3D Middle East, 3D Systems Distributor
3204 Prism Tower, Business Bay
P.O. Box 28820, Dubai, UAE
Tel: +971 4 443 3853
E-mail: info@3d-me.com
Web: www.3d-me.com
The NextDent 5100 can print a full arch in 30 minutes according to Matt Mills, owner of Hybrid Technologies.
[7] =>
DTMEA_No.5. Vol.9_DT.indd
ZirCAD MT Multi
The most esthetic high-strength,
1
multi-translucent zirconia
All ceramic,
all you need.
1
Composed of different material classes
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60
[8] =>
DTMEA_No.5. Vol.9_DT.indd
8
INDUSTRY
Dental Tribune Middle East & Africa Edition | 5/2019
Size is everything
NiTi system HyFlex EDM extended with
new glide path file
EDM GPF 15/.03 is a flexible glide
path file that ensures optimum
shaping of the access cavity. Even
S-shaped canals can be prepared
safely and competently with the additional instrument. As accustomed,
the dentist subsequently enlarges
with the glide path file size 10/.05
and the HyFlex EDM preparation file
20/.05. The recommended sequence
for very narrow canals thus remains
clearly structured and well manageable for the entire practice team. Depending on the initial situation and
personal preferences, the 25/.12 orifice opener can be used beforehand
as an option.
By Coltene
© Coltène/Whaledent AG
Modular nickel-titanium systems
enable the endo-expert to work flexibly in a variety of indications. Meanwhile, most patient cases can be prepared efficiently and reliably with
a reduced file sequence. For slightly
more curved canals, the dentist can
now use a special glide path file in
addition to the classic file sequence.
Additional glide path file for
strongly curved canals
The internationally leading dental
specialist COLTENE once again complements its versatile HyFlex NiTi
range with a further useful component: a new HyFlex EDM glide path
file is now available in the range for
the preparation of strongly curved
and very narrow canals. The HyFlex
The good cutting performance
and break resistance of the flexible
nickel-titanium files is due to a special manufacturing process referred
to as "Electrical Discharge Machin-
ing“ (EDM for short). The robust
high-performance instruments are
predestined for endo beginners and
dentists who wish to produce reliable results quickly with a reduced
number of files.
Expanded file sequence for
maximum flexibility
The novel HyFlex EDM GPF 15/.03
fits harmoniously into the existing
portfolio of HyFlex files from COLTENE. One of the special features of
the NiTi file series is the specially developed "CM" treatment: due to the
"Controlled Memory" process, the
files can be pre-bent similar to classic
stainless steel files and demonstrate
almost no recovery effect. This allows them to move optimally in the
centre of the canal, to prepare all canal walls evenly and thus significantly improve preparation efficiency. In
addition, the risk of a false canal is
also minimised.
With the HyFlex EDM Shaping Set
Max Curve, the complete sequence
of special files for strongly curved
canals will also be available as a practical box from dental retailers from
the 2nd quarter of 2019. Due to its
high flexibility, the file configuration
is suitable for preparatory work in
limited spaces as well as for instrument use in normal to extremely
curved canals.
Incidentally, the COLTENE Group's
merger with the French endo expert
MicroMega in autumn 2018 will also
expand its portfolio of clever endo
solutions ranging from preparation
to obturation in the long term.
© Coltene
ADA, FDI and industry leaders join
centennial global launch
SAN FRANCISCO, U.S.: The International College of Dentists (ICD),
conceived in 1920 by two visionary
leaders, is today the 12,000-strong
foremost global honor society for
dentists and supports hundreds of
humanitarian and educational projects worldwide. Global leaders met
for the launch of the ICD’s centennial
celebrations during the FDI World
Dental Congress held last week in
San Francisco.
Witnessed by an enthusiastic crowd
of over 800 attendees, the global
launch of the ICD’s centennial celebrations kicked off during the dinner dance held by the US section.
Leaders from the ICD, ADA and FDI
were joined by ICD centennial partner Henry Schein and ICD global
media partner Dental Tribune International to support the commemoration. Adding to the excitement of
the evening was the screening of the
new promotional video, capturing
the impact of 100 years of the ICD
and the upcoming events in Japan.
The video has already registered
over 2,000 views on different social
media channels!
As part of the global launch, registration was officially opened on the
centennial website, icd100.org, for
the once-in-a-century meeting to be
held Nov. 11–13, 2020, in Nagoya.
For more information about Nagoya
registration, hotel accommodation
and tours, visit the centennial website or contact the college office.
© ADA
By Nathalie Schüller, DTI
Global leaders (from left): Torsten Oemus, CEO and President of Dental Tribune International (ICD global media partner); Steve Kess, Vice President of Global Professional Relations at Henry Schein (ICD centennial partner); Dr. Kathryn Kell, President of FDI; Dr.
Bettie McKaig, President of the ICD International Council; Dr. Jeff Cole, President of the
ADA; David Kochman, Vice President of Corporate Affairs and Deputy Chief of Staff at
Henry Schein; and Dr Dov Sydney, International Editor/Director of Communications and
General Chair of the College Centennial Committee at the ICD.
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[9] =>
DTMEA_No.5. Vol.9_DT.indd
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[10] =>
DTMEA_No.5. Vol.9_DT.indd
10
INDUSTRY
NEWS
Dental Tribune Middle East & Africa Edition | 5/2019
Has 3D imaging finally come of age?
As 3D dental imaging technology
continues to improve, making it possible to get accurate diagnosis-improving images at ever lower doses,
Adam Cartwright, Digital Imaging
Specialist at Dentsply Sirona, believes it’s now a technology no practice can afford to do without.
The benefits that accurate and detailed X-rays bring to areas of dentistry, such as implantology, are
well-known; the ability to see the
position of nerves and tooth roots
and the location and density of bone
is essential for the effective planning
of implant placement and any bone
augmentation. More recently, the
benefits of 3D X-rays are being recognised in other areas, such as endodontics and orthodontics.
In essence, a detailed 3D Cone Beam
Computed Tomography (CBCT) scan
removes the element of surprise by
showing a detailed 360-degree view
of the oral cavity. Many orthodontists are now becoming aware of the
added benefits of using 3D X-rays as
opposed to the traditional 2D X-ray
for diagnosing and planning teeth
movement. The clearer, more accurate 360-degree view makes correctly understanding the oral situation
and identifying possible complications easier.
Balancing the benefits
and risks
Radiation regulations mean practitioners must expose the patient only
to a radiation dose “as low as reasonably achievable” - the ALARA princi-
ple. Helpfully, recent hybrid 2D/3D
imaging systems offer high dose and
low dose options which give the dental practitioner the choice and flexibility required. The imaging power
of the latest machines has increased
dramatically, and they are capable
of extremely precise, high definition
images delivering unprecedented
detail, which is increasingly good
even at their lowest dose settings.
What can today’s dental
X-ray technology offer?
The latest CBCT units, such as the
Orthophos® SL and the Orthophos®
S, offer the following features which
are designed to make 3D X-rays as
safe, clear and easy to capture as possible.
© Dentsply Sirona
By Dentsply Sirona
A clearly stated,
independently verified
low dose setting
The only way for dental practitioners to adhere to the ALARA principle
is to make sure the X-ray unit they
choose has clearly stated radiation
dosage levels for each setting. It’s
also important that the dosage data
is supported by independent references and can therefore be verified.
The latest image-capturing
technology
When exposure to the lowest dose is
the determining factor, it is essential
to be able to rely on the equipment
to capture the requisite detail every
time. The technology behind dental
X-ray equipment continues to advance, enabling sharper images to be
captured at lower doses.
Easy to use
Some manufacturers have invested
time in developing in-built aids to
help the operator. These functions
make it easier to capture the sharpest image possible, reduce the risk of
retakes and optimise the chances of
adhering to the ALARA principle.
Supported by a long
warranty and training
As with all products, the longer the
warranty, the more confidence a
manufacturer has in the quality and
longevity of their equipment. And
to make sure customers are sufficiently trained to use them safely,
purchasers of the Orthophos range
of 3D imaging units are required by
Dentsply Sirona to attend complimentary training to ensure they can
confidently interpret and report on
their 3D X-rays.
The Orthophos S and Orthophos
SL are hybrid 2D and 3D X-ray units
which offer the perfect stepping
stone from 2D to 3D. With no further need to send your patients elsewhere for their 3D X-rays, and set up
and training all part of the package,
there really is no reason not to invest
in one and thus open the doors to a
world of 3D-enabled opportunity!
To find out more about Dentsply Sirona’s
extensive range of imaging solutions
please visit dentsplysirona.com/NOS
Dentsply Sirona
21st Floor, The Bay Gate Tower
Business Bay, Al Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0)4 523 0600
Web: www.dentsplysirona.com/en
E-mail: MEA-Marketing@dentsplysirona.com
AD
E
Mister E
Time for introductions.
Meet the New Orthophos Society. Here each
one is a master of their class – and always
your best choice for extraoral imaging. No
matter if you’re a digital beginner or already
an expert, you’re sure to pick your favorite
and join the NOS.
dentsplysirona.com/NOS
S
Lady S
SL
Sir SL
[11] =>
DTMEA_No.5. Vol.9_DT.indd
[12] =>
DTMEA_No.5. Vol.9_DT.indd
12
INDUSTRY
Dental Tribune Middle East & Africa Edition | 5/2019
How I reduced Class II
postoperative sensitivity
By Dentsply Sirona
Dr. Lindsay Ford, associate dentist at Lushington Road Dental Practice in Eastbourne (UK),
explains how Dentsply Sirona’s Class II solution
has had a dramatic effect in reducing postoperative sensitivity in her patients.
© Dentsply Sirona
Class II restorations are something my colleagues and I deal with every day. Working as
an associate in a fully private, amalgam-free
practice, our challenge was to find a compositebased restorative solution which would reduce
the existing level of postoperative sensitivity
amongst our patients.
Problems with
postoperative sensitivity
When I first joined Lushington Road Dental
Practice in 2017, I was happy to try out the re370 Class II Inforgraphic FINAL.qxp_Layout 1 14/09/2017 07:30 Page 1
AD
storative materials already established in the
practice. However, I found that a number of
my Class II patients were returning to me,
complaining
of postoperative sensitivity and
ciently, you
can be more
long settling in periods. Their radiographs
sometimes showed marginal contractions,
lack of compression or small air gaps. Something wasn’t right and it was costing us time
and money. It was time to look for an alternative.
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OF EACH STEP OF THE CLASS II PROCEDURE
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DENTAL PROFESSIONALS’ PRIMARY CONCERNS WHEN PERFORMING POSTERIOR RESTORATIONS1 :
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THE MOST VULNERABLE INTERFACE
Dentsply
Sirona products
work together to
Studies show that the #1 reason for composite failures is recurrent. caries.
Dentsply
Sirona products
protect
the floor of
the
proximal
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interface.
Protect
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THE
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proven
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Studies
show that
the #1 proven
reason for
composite failures is recurrent caries. Dentsply Sirona products work together to
protect the floor of the proximal box, the most vulnerable interface.2 Protect it with the power of four proven products.
1. ISOLATE the restorative
field with a tight gingival
seal—
the restorative
first with
step in
protecting
the seal field
a restorative
tight
gingival
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the
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seal—
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3. MAINTAIN
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adaptation.
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integrity
while
achieving
excellent
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also achieving excellent
adaptation.
Palodent® V3
Prime&Bond universal™
SDR® Plus
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most
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Sectional Matrix
System with a s
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Efficient esthetics is where artistry and efficiency meet. Deliver smooth, contoured surfaces and
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FINISHING
AND
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RESTORATIONS
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SIMPLIFY shading and preferred
SIMPLIFY shading and preferred
handling, for lifelike results in less time.
handling, for lifelike results in less time.
SIMPLIFY shading and preferred handling,
ceram.x®
SphereTEC™
SphereTEC™
forceram.x®
lifelike results
in less time. one one
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between
restored
and
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patients are reportedly
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FINISH and improve your likelihood
FINISH and improve your likelihood
of success while saving time.
of success
saving time.
FINISH and while
improve your likelihood of
success while saving time.
Universal
Nano-Ceramic
Restorative
Universal
Nano-Ceramic
Restorative
ceram.x® SphereTEC™ one
Universal Nano-Ceramic Restorative
CHAMELEON
CHAMELEON
EFFECT
EFFECT
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EFFECT
SURFACE
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3
DENTSPLY Caulk procedure timing breakdown study. Data on file.
4
Christensen, G J. (2014). Simplifying your Class II Composite Finishing Technique.
Clinicians
Report, Colum 7 Issue 4
5
Joiner A. Tooth colour: a review of literature. JDent. 2004; 32(Suppl. 1): 3-12
Staining
gingival irritation and recurrent caries.
SOURCES
1
Dental Products Report April 2015 posterior composite survey.
2
Durable Bonds at the Adhesive/Dentin Interface. Braz Dent Sci. 2012; 15(1): 4-18
3
DENTSPLY Caulk procedure timing breakdown study. Data on file.
4
Christensen, G J. (2014). Simplifying your Class II Composite Finishing Technique. Clinicians Report, Colum 7 Issue 4
1
Dental5Products Report April 2015 posterior composite survey.
Joiner A. Tooth colour: a review of literature. JDent. 2004; 32 (Suppl. 1): 3-12
2
Durable Bonds at the Adhesive/Dentin Interface. Braz Dent Sci. 2012; 15(1): 4-18.
SOURCES
Staining
Gingival Irritation
By
By reducing
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withproper
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gingival irritation
recurrent
you canand
avoid
thingscaries.
like staining, plaque retention,
gingival irritation and recurrent caries.
In a class of its own
I tried Dentsply Sirona’s Class II solution:
– Palodent® V3 sectional matrix - a simple
matrix system that provides predictable and
accurate contact points and a tight marginal
seal
– Prime&Bond® universal - universal and reliable exhibiting excellent spreading capability and moisture control
– SDR Plus - with outstanding flowability and
self-levelling properties to avoid voids and air
bubbles, a frequent cause of postoperative
sensitivity
– ceram.x® SphereTEC universal composite
- exceptional handling and aesthetics with a
simplified shade matching system
– Enhance® Finishing System - capable of
removing excess composite, contouring and
polishing simply by adjusting the pressure
applied, and delivering a beautifully aesthetic
result
What a result!
The fantastic handling of all of the materials enables me to achieve full coverage of
adhesive and composite within the cavity to
ensure no bubbles or voids which could later
lead to postoperative sensitivity.
After my success with it, I persuaded my fellow colleagues to give it a try. As a result, instances of postoperative sensitivity across the
practice have dramatically reduced and now
we are all benefitting from the predictability
and confidence it engenders.
What’s more, it’s been a cost-effective move
as patients are no longer returning and taking
up valuable clinical time and we are all now
working with the same materials.
Switching to Dentsply Sirona’s Class II solution has been a positive move in every way.
I wouldn’t hesitate to recommend it to any
other clinician.
This suite of individually exceptional products works together to deliver excellent and
predictable clinical outcomes. It’s clear from
their simplicity, ease of use and high performance that they have been developed with
clinicians in mind.
AD
[13] =>
DTMEA_No.5. Vol.9_DT.indd
[14] =>
DTMEA_No.5. Vol.9_DT.indd
14
NEWS
Dental Tribune Middle East & Africa Edition | 5/2019
Scan perfectly with CEREC Primescan, and gain
time for what is really important:
your patients
By Dr. Bernhild-Elke Stamnitz, Germany
At a practice in which digital technologies have been prioritized right
from the start, new devices are a real
pleasure, rather than a duty. That's
why Dr. Bernhild-Elke Stamnitz,
from Langen, Germany was delighted to be one of the first dentists to
be able to use CEREC Primescan, the
new intraoral scanner from Dentsply
Sirona, for her daily work. As a CEREC
coach, she is very familiar with digital
impressioning, but she is convinced,
from her first experiences with the
device, that CEREC Primescan represents a great advance in quality.
"I simply love new technologies,"
explains Dr. Bernhild-Elke Stamnitz. She has her own fully digital
practice, which she has been running in Langen since 2004. During
her studies in Heidelberg, she had
her first encounters with CAD/CAM
technologies in dentistry. "At the
time, it was a long way from being
perfect, but in my opinion, the idea
behind it was ground-breaking," she
says. "Whereas, in the early days of
digital impressioning, we still asked
ourselves which indications it could
really be used for, today we ask ourselves: Where can't it be used?"
For Dr. Stamnitz, the advantages
are obvious. "First of all, it's simply
faster," she explains. "One only has
to consider the various steps of the
process: lay out spoons of various
sizes,and try them for size. Afterwards, all of them have to be prepared for use. Then the material for
the impressioning has to be selected,
and the first time it might not work
perfectly, so you have to repeat some
steps. All of that can be omitted if
you use digital impressioning." The
dentist from Langen also sees a path
to more sustainability in digital impressioning because nothing has to
be thrown away afterwards, the need
to store materials is reduced, and –
most importantly for Dr. Stamnitz
– the focus is centered more on the
patient. "Digital technologies are also
a great communication tool. During
digital impressioning, the patient
experiences what's going on, they
can see the situation in their mouth
on the screen and they are far better
able to understand where and why
the treatment is necessary."
"Very Good" becomes
"Virtually Perfect"
Once she had recognized it as correct
and appropriate for her practice, Dr.
Stamnitz could no longer imagine
doing her daily work without digital
impressioning. In her opinion, the
technology in this area has developed enormously in recent years.
On the one hand, this is thanks to the
software updates. The calculation
of the 3-D models, the quality of the
first suggestions and the accuracy of
the fit have improved constantly. On
the other hand, CEREC Primescan's
intraoral scanner, which has now
entered the marketplace, speeds up
and simplifies the process noticeably, and produces results that have
hardly been possible to achieve until
now. "Impressioning was already really good before, but now, it is simply
better."
In her opinion, this can be concretized by several points: With CEREC
Primescan, scans can be done in situations where the patient shows signs
of periodontally damaged teeth,
which are characterized by long
crowns and exposed areas of roots.
If subgingival preparations need to
be made, the scanner can also reach
those positions. "Until now, that has
been an issue that many people have
raised as an argument against digital
impressioning," says the CAD/CAM
expert. "Places that are difficult to
reach can easily be captured with
Primescan, without having to make
too much effort with the scanner.
That really is a great advantage." Another important improvement is the
representation of the margins of the
prosthesis. This is very important for
the further processing of the scan,
because on the one hand, it simplifies the further process of design
and fabrication when manufacturing the restoration in the practice.
On the other hand, the scan reliably
delivers all the information that the
technician requires. They can work
on the model, and they can set the
occlusion and articulation with ease.
Dr. Stamnitz mostly works chairside
("I make up to three teeth directly
beside the chair"), but she also hands
over larger jobs to her dental technician in the in-practice laboratory.
"Overall, it is a very useful concept
for the practice," says Dr. Stamnitz.
"Digital impressioning makes sense,
from both a clinical and an economical perspective," she explains. "But
the additional advantage for the
patients, who really appreciate the
"digital experience", and talk about it
to others, is just as important."
CEREC Primescan –
a practical test
A case history demonstrates how
CEREC Primescan proves its worth
in everyday practice: A patient came
to the practice with an inadequate
crown, with secondary caries, in
position 37. After excavation, a new
CEREC crown was to be mounted.
In order to do so, the new acquisition center, CEREC Primescan AC,
with its significantly larger, tiltable
touch screen, was first disinfected,
quickly and thoroughly. Thanks to
the seamless surfaces, it is possible
to do so, quickly and simply, at any
time. Before beginning with the
scans, the patient data was called up
in CEREC Primescan AC, and a new
case was created. Overall, the scanner
was used three times during treatment: after the preparation of the
lower dental arch with tooth 37, for
the scan of the opposing dental arch
and for the scan of the buccal bite on
both sides. All of that could be delegated to an assistant, but the experienced CEREC user prefers to do it by
herself: "I am interested in this technology, and – I'll be completely honest – scanning is so much fun." After
the removal of the inadequate crown
and the final preparation, it was time
to use the CEREC Primescan. Dr.
Stamnitz describes it as follows: "As a
long-time user of a CEREC Omnicam,
I realized immediately that CEREC
Primescan felt different in my hand.
The scanner is even better balanced
now. The actual scanning is quick
and easy – partially due to the fact
that I don't have to consider specific
scanning angles or scan procedures.
It all went intuitively and fluidly. The
full dental arch scan was completed
in less than a minute, which certainly cannot be taken for granted.
What made it really special, was that
the patient was immediately able to
see the results on the monitor, with
me. The scan was converted into a
3-D image immediately. Compared
to previous scanners, I noticed immediately that it is also able to scan
other materials, e.g. gold crowns.
Therefore, no information on the adjacent teeth or antagonists was lost. I
consider that to be real progress."
After the scan, the software automatically delineates the preparation
margin. If so desired, they can be
adjusted manually. "I find that to be
a great advantage," says the digital
expert, "because that way, I can decide for myself, every time, whether
I want to accept the suggestion –
which, by the way, I generally do with
a clear conscience." It is operated via
the touch screen which replaces the
trackball. A tool that many users,
including Dr. Stamnitz, wished for.
Finally, the CEREC Software 5 made
an initial suggestion. "I also always
look at this very carefully," she says.
"The software can do a lot. I am often
surprised at how good the suggestions are. Mostly, as in this case, I am
very satisfied after just a few minor
adjustments."
The software learns
together with the user
The reason for the significantly improved initial suggestions with the
CEREC Software 5 is the use of artificial intelligence. With immediate effect, the new generation of software
learns, together with the user, so that
it is able to create even better initial
suggestions for future versions. Not
only are the initial suggestions for
the crown improved by artificial
intelligence, the entire workflow is
supported by the software, in many
areas. In this way, the indications for
the restoration are automatically
recognized, and the preparation
margin is delineated. The axis for the
model is also set fully automatically.
Dr. Stamnitz is fascinated by working
directly on the screen: "The workflow
is very simple, and thanks to the operation via the touch screen, I can
maintain my concentration. I can
keep my eyes on the screen constantly." During the designing and the
preparations for making the crown,
the patient was there, and she could
watch her dentist at work. "In cases
like this, the treatment experience
is always something very special for
my patients," Dr. Stamnitz remarks.
"They are included at all times, and
they are able to ask questions and
they can experience, live, how the
crown is made." This one was milled
from a Celtra Duo block, a zirconiareinforced lithium silicate with excellent aesthetic properties and a
high degree of stability. The crown
was ready after just 11 minutes. Even
during fitting, it was evident that it
was a perfect fit. The crown was individualized and glazed with color
and glazing material. Then it was
cemented into the patient's mouth
with a high-strength, dual cure
composite cement adhesive (Calibra ceram). In this case, the overall
time required for the treatment was
about 90 minutes. This proved to be
particularly advantageous to the patient, who was pressed for time.
Better quality in less time
The accuracy of the scan, and the
speed of the data acquisition and
processing obviously have an effect
on the end result – to an experienced
user, this becomes apparent immediately. The structure of the crown,
especially on the edges, is highly
dependent on the quality of the impression – and this is where it pays to
use CEREC Primescan. Dr. Stamnitz:
"Thanks to the new CEREC Software
5, the ground or milled restorations
are worked even more finely and
in more detail. And all of this in an
even shorter process, from scan to
insertion. I spend the time I save on
the entire process on my patients.
We gain the time to build up a good
relationship with them. We are not
simply treating a tooth. We are dealing with a patient every time. That's
exactly who should be the centre
of focus. Because there is more to
the lovely smile we help them to
achieve, than just attractive, healthy
teeth."
About the author
Initial situation, tooth 37
Scan of lower jaw, with prepared tooth 37
The preparation margin is automatically delineated by
the software, but, if desired, it can also be adjusted manually
The user interface for designing the restoration, which
can be operated via the touch screen
The user interface for the beginning of the restoration of
the crown
Final situation for tooth 37
Dr. Bernhild-Elke Stamnitz
A dentist from Langen, Germany is full
of praise for Primescan, the device that
makes intraoral scanning easier than ever
before.
[15] =>
DTMEA_No.5. Vol.9_DT.indd
THE COMPACT
MAKES
A BIG
CHANGE
To help any user of air driven handpieces
conver t to electric and enjoy the full
b e n e fi t s o f i t s h i g h f u n c t i o n a l i t y. A b i g
change in treatment environment is
brought with only a minor addition to the
current equipment in your off ice.
ELECTRIC MICROMOTOR UPGRADING SYSTEM
*NLZ E ：with Endo Function
[16] =>
DTMEA_No.5. Vol.9_DT.indd
16
ORAL HEALTH
Dental Tribune Middle East & Africa Edition | 5/2019
Perfection once more
from the Perfect White Range
Oral Care experts Beverly Hills Formula have
proven once more that their safe, stylish and
affordable range of teeth whitening products
continue to be firm favourites with consumers
worldwide.
And it is one range in particular that has truly
cemented their place as the market leaders in
oral care – the now infamous and superior Perfect White Range. Since it’s launch in 2012, the
Perfect White Range has gone from strength to
strength, continuously triumphing over competitors and earning the brand a number of
prestigious awards.
The Perfect White Range is unique in the sense
that it has earned respect from both dental professionals and consumers alike – a trait that is
uncommon in most oral care products on the
market today. They credit it’s success to cutting
–edge formulas coupled with first to market ingredients that are yet to be found in any other
product. Stylish packaging and bold colours
ensure the range stands out in the noisy space.
All products in the range remove up to 90% of
surface stains without the need for harsh abrasives – meaning the enamel is protected and it
is 100% safe for daily use.
The range consists of Perfect White Black,
the brand’s hero product. The toothpaste is
scientifically formulated with Activated Charcoal – known for its love of tannins. The brand
were the first to bring such a formulation to the
market and to this day, it is seen as the superior
product to it’s copycat competitors. Also in the
range is Perfect White Gold. Gold is known for
it’s anti-bacterial and anti-inflammatory properties. The combination of Beverly Hills Formula’s non-abrasive stain removal power as well as
the luxurious gold colour has meant that this
has become a best seller for the brand.
Over the past number of years, new product
development has been at the forefront of their
plans, resulting in a number of prestigious
products being added to the Perfect White
Range.
Joining the range last year was Perfect White
Optic Blue, again with a first to market formulation. The innovative Blue Filter Technology
forms a special layer over teeth during brushing
to reflect the light, creating an optical whitening effect providing immediate results. Along
with Optic Blue was the introduction of Perfect
White Gold Mouthwash, a shake to activate formula containing real gold particles.
Noting the success of their charcoal products,
the brand have dedicated a huge amount of
time and research into bringing new products
to the market with this component, adding the
following to the range:
Perfect White Black Sensitive, formulated for
sensitive teeth to help remove surface and deep
stains, as well as Perfect White Black Mouth-
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wash, scientifically formulated to combat bad
breath to the Perfect White Range.
It will be this year however, that the brand announce their most exciting product launch
yet: the Perfect White Black Whitening Kit. Scientifically formulated with activated charcoal
and hydrogen peroxide, the kit is designed to
offer superior whitening results whilst reducing plaque and harmful bacteria. The black
and flexible strips are coated with tooth whitening gel as well as the brand’s award winning
formulation which ensures visible results after use.
The Perfect White Range continues to gain
traction across the globe, with a wide reaching
fan-base and a constant demand for products.
The brand are looking forward to the release of
Perfect White Black and anticipate this being a
massive success.
For more information contact:
Beverly Hills Formula
Unit P1/P2 North Ring Business Park
Swords Road
Dublin, 9, Ireland
Web: www.beverlyhillsformula.com
E-mail: info@beverlyhillsformula.com
Tel: + 353 1 842 6611
Fax: + 353 1 842 6647
AD
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18
RESTORATIVE
Dental Tribune Middle East & Africa Edition | 5/2019
Minimally invasive veneer restoration
with hybrid ceramics
By Dr Andreas Kurbad, Germany
Aesthetic corrections with veneers
should be minimally invasive and
limited to the enamel and, despite the thin layer thickness in
the mouth, develop a natural play
of shade and light. The multichromatic CAD/CAM hybrid ceramic
blank VITA ENAMIC multiColor
(VITA Zahnfabrik, Bad Säckingen,
Germany) has an integrated shade
and translucency gradient with six
finely graduated layers. The natural
appearance of the tooth can be reconstructed almost at the touch of a
button. Characterisation with stains
can usually be omitted. The dual
ceramic-polymer network structure
of the hybrid ceramic allows narrow
wall thicknesses of up to 0.2 millimeters, while remaining very edgestable. These are the best conditions
for restoring two upper middle inci-
sors, as Dr. Andreas Kurbad (Viersen,
Germany) shows in this case report.
clinical mock-up was created which
satisfied all participants.
1. The aesthetic challenge
2. CAD/CAM-supported
fabrication
A 45-year-old female patient presented in the office and was dissatisfied with the aesthetic effect of her
front teeth. The middle incisors had
presumably lost incisal edge contour and length, due to abrasive and
erosive processes. In addition, the
anterior teeth were clearly discolored. The patient wished to restore a
natural appearance to these teeth
using minimally-invasive therapy.
For targeted therapy, the situation
was scanned with the CEREC Omnicam (Dentsply Sirona, Bensheim,
Germany), and photos were taken of
the situation. The software Smile Designer Pro (Tasty Tech, Toronto, Canada) simulated the extension of the
incisal edge and the recontouring
of the morphology. On this basis, a
The mock-up was scanned intraorally to be included in the virtual design in the CEREC software as a biogeneric copy. Due to the vestibular
loss of substance on teeth 11 and 21,
the preparation was performed in
a very minimally invasive manner
with a micro chamfer, applied in the
cervical area. The clinical situation
was now rescanned so that the virtual construction of the veneers and
their CAD/CAM-based fabrication
could take place. When working with
rotating diamond tools, the focus
was mainly on the surface texture.
Finally, the veneers were polished to
a high gloss and were incorporated
in the same session.
3. Seating and final results
After clinical try-in, the two restorations were fully adhesively incorporated. The dominant feldspar
ceramic network (86 wt%) of the
hybrid ceramic veneer was etched
in a proven manner with hydrofluoric acid and then silanized. The
conditioning of the enamel was carried out with phosphoric acid and
a light-curing singlecomponent adhesive. After incorporation with a
shade-matched composite cement,
the hybrid ceramic veneers fit harmoniously into the aesthetic zone.
Thanks to the rapid production
without any crystallisation or sintering firing and the integrated shade
gradient, the two central incisors
could be efficiently and aesthetically
restored. The patient was highly satisfied with the minimally invasive
and fast result.
VITA® and other VITA products mentioned are registered trademarks of
VITA Zahnfabrik H. Rauter GmbH &
Co. KG, Bad Säckingen, Germany.
About the author
Dr. Andreas Kurbad
Viersen, Germany
Member of the editorial board of the
International Journal of Computerized
Dentistry; German Quintessence Journal
of Dental Technology; International Digital Dental News Journal.
More than 100 publications about AllCeramics, computerized dentistry, implantology, epidemiology. Co-Publisher
of the Quintessence book "CAD/CAM and
All-Ceramics".
Fig. 1: Initial situation: Erosion and abrasion led to a
shortened incisor and the loss of the morphology of
teeth 11 and 21.
Fig. 2: With the software Smile Designer Pro, ideal
middle incisors were constructively simulated.
Fig. 3: With a transparent silicone key and light-curing
composite, the mock-up was fabricated intraorally.
Fig. 4: The mock-up corresponded to the aesthetic expectations of the patient.
Fig. 5: The minimally invasive preparation during the
application of a micro chamfer in the cervical area.
Fig. 6: The clinical situation was scanned with the
CEREC Omnicam.
Fig. 7: The design of the hybrid ceramic veneer in the
CEREC software.
Fig. 8: With the CEREC-Smile Design Application, the
restorations can be evaluated together with the lips.
Fig. 9: The sheer veneers made of VITA ENAMIC multiColor immediately after grinding out.
Fig. 10: The incorporation of texture and morphology
with the rotating diamond tool.
Fig. 11: A simple high-gloss polish was enough to finish the restorations.
Fig. 12: The finished veneers just before the clinical
try-in.
Fig. 13: Conditioning with hydrofluoric acid creates a
micro-retentive surface.
Fig. 14: A light-curing one-component adhesive was
applied to the tooth surfaces.
Fig. 15: Both veneers integrated completely and naturally into the aesthetic zone.
Fig. 16: Result: The curve of the incisal edges harmonized with the curve of the lips.
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20
RESTORATIVE
Dental Tribune Middle East & Africa Edition | 5/2019
Easy and efficient: Composite resin blocks
for the CAD/CAM technique
Single-tooth restorations with Tetric CAD
By Dr Hidetaka Sasaki, Japan
Composite blocks for CAD/CAM applications are on the rise, particularly for producing small restorations,
such as inlays, onlays and occlusal
veneers. And quite rightly so, for this
type of material has a lot to offer: it
exhibits sound mechanical properties combined with an extraordinary grinding accuracy and it is easy
and efficient to process in day-today procedures.
The following clinical report describes the workflow to create an
esthetic single-tooth restoration using the new Tetric CAD® composite
block. The blocks are available in
two degrees of translucency – HT
and MT – and in a variety of shades.
They exhibit a pronounced chameleon effect to provide restorations
that blend in well with the optical
characteristics of the surrounding
residual tooth structure. The material can be polished to a high gloss in
a few seconds both intraorally and
extraorally. In addition, it can be easily repaired intraorally with conventional composite resins.
Clinical case
The pre-op showed a defective amalgam filling on tooth 36 in the lower
posterior region. The filling needed
replacing (Fig. 1). The indication for a
multi-surface inlay was given.
It was the patient’s wish to have an
esthetic, i. e. tooth-coloured restora-
tion. We decided to opt for the Tetric
CAD composite blocks. This material
is part of the portfolio of Ivoclar Vivadent blocks and is suitable for permanent single-tooth restorations. It
is supplied in industrially processed,
pre-cured blocks that exhibit superior strength and a higher filler
content than direct restoratives.
Because they have undergone an
industrial polymerization process,
shrinkage stress is not an issue with
Tetric CAD.
Designing the restoration
Shade selection is performed on the
natural dentition, primarily on the
neighbouring teeth. We decided to
use shade HT A2. The HT blocks are
a good choice, particularly when
it comes to producing fairly small
restorations such as inlays as they
provide a pronounced chameleon
effect. Once the old amalgam was
removed, the tooth was prepared in
line with the recommended preparation guidelines (Fig. 2). Then, an
optical impression was taken using
an intraoral scanner and the inlay
was designed in the CAD module
(Fig. 3). Subsequently, the restoration was ground from the block.
Grinding times are considerably
shorter for CAD/CAM composite
resins compared with other materials. Although the composite is
softer to grind, the restoration is not
affected by this. It only means that
the grinding tools are less quickly
worn and offer a long service life,
maximizing the cost efficiency of
the practice.
Composites are “flexible” materials. Their modulus of elasticity is
similar to that of dentin. High flexural strength provides adequate
resistance and stability. Given their
low brittleness, composites can be
ground to exhibit highly homogeneous surfaces and to obtain accurate, thinly tapered margins withou
loss of strength. Marginal chipping
or crack formation are unlikely to
occur.
In the present case, a try-in was performed immediately after the grinding process to check the fit of the
inlay with the natural residual tooth
structure (Fig. 4).
Conditioning the restoration
The attachment point was easy to
smooth out with fine-grit diamonds.
This was followed by extraoral polishing using composite polishers
(e. g. OptraPol®) (Fig. 5). Particularly
noteworthy was the speed with
which the restoration was polished
to a high gloss. It only took a few seconds to achieve a glossy surface (Fig.
6). Composites do not require an additional glaze firing cycle. This has a
positive effect on the time resources
of the practice.
It is essential to condition and pretreat the bonding surface correctly.
This requires the use of an adhesive
system that is appropriate for this
type of material to ensure the longevity of the restoration. The manufacturer’s instructions should be followed at all times.
adhesive at this point: the adhesive
will be cured together with the luting composite when the inlay is
placed on the tooth.
In the present case, the bonding
surface of the inlay was air-blasted
with aluminium oxide (50–100
μm) at a pressure of 1–1.5 bar, followed by thorough rinsing (Fig. 7).
The restoration can be cleaned either in an ultrasonic unit or with a
steam cleaner. It is recommended
to additionally clean the restoration
with 70 % ethanol to disinfect it. Pretreating the restoration in this way
is mandatory for Tetric CAD because
air-blasting increases the surface
area and creates a retentive pattern
that acts as a basis for the adhesive
cementation. Pre-treating therefore
ensures a reliable bond between the
luting material and the restoration.
Pre-treating the prepared
tooth
To condition the restoration, Adhese® Universal adhesive was applied and scrubbed into the pretreated bonding surface for 20
seconds using a microbrush (Adhese
Universal is also available in the
VivaPen® delivery system for direct
applications). It is important to observe the recommended agitation
time to ensure that the adhesive can
penetrate sufficiently (Fig. 8). Excess
material is carefully dispersed using
compressed oil-free air until a glossy
immobile film results. Pooling must
be avoided.
It is not necessary to light-cure the
Adequate isolation of the operating
field is required for reliable bonding.
The tooth preparation was cleaned
and then conditioned, rinsed and
dried using a conventional etch &
rinse procedure. Adhese Universal adhesive was scrubbed into the
tooth structure for 20 seconds and
then dispersed (Fig.9). The adhesive
was then light cured for 10 seconds
using the Bluephase Style curing
light (Fig. 10). According to the manufacturer’s recommendation, a curing light emitting a light intensity of
least 500 mW/cm2 should be used
for this step.
Placing the restoration
The inlay was seated using Variolink® Esthetic luting composite.
The luting composite was applied
directly from the syringe onto the
bonding surface and then the inlay
was seated and retained in position applying light pressure (Fig.11).
Variolink Esthetic is particularly well
suited for this step because excess
material can be removed from the
cement line with ease and it does
not cause a “buffering effect” as is of-
ÿPage 22
Fig. 1: Preoperative situation: defective amalgam
filling on tooth 36
Fig. 2: Prepared tooth
Fig. 3: Designing the inlay in the CAD module
Fig. 4: Checking the fit and shade match of the inlay\
after the grinding process
Fig. 5: Extraoral polishing with OptraPol
Fig. 6: Restoration after high-gloss polishing
Fig. 7: Air-blasting the bonding surface wit 50 – 100
μm aluminium oxide at 1 – 1.5 bar; followed by
cleaning
Fig. 8: Scrubbing Adhese Universal into the bonding
surface for 20 s followed by drying with air
Fig. 9: Conditioning the prepared tooth with Adhese
Universal for 20 s, followed by drying with air
Fig. 10: Light-curing for 10 s using Bluephase Style
Fig. 11: Applying Variolink Esthetic luting composite
to the bonding surface
Fig. 12: Inserting and positioning the inlay on the
tooth; followed by the removal of excess material
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22
RESTORATIVE
Dental Tribune Middle East & Africa Edition | 5/2019
◊Page 20
At the final curing stage, the adhesive on the bonding surface and the luting composite are cured
togehter (exposure time: 10 seconds per mm of composite and segment). It is recommended to use
a curing light that produces a light intensity of at least 1,000 mW/cm2 for this step.
Fig. 13: Applying Liquid Strip to prevent the formation of an inhibition
layer
Fig.14: Light-curing all segments for 10 s per mm of composite using a
Bluephase Style
Fig. 15: Occlusal check followed by intraoral polishing with OptraPol
ten the case with harder luting composites (Fig. 12). Tack-curing from
all sides for 2 seconds facilitates the
clean-up process. The cement line
should be covered with air block
gel (e. g. Liquid Strip) to prevent the
formation of an oxygen inhibition
layer (Fig. 13).
Fig. 16: Inlay in situ: great optical integration thanks to chameleon effect
AD
At this stage, the adhesive and the
luting composite applied to the
bonding surface are polymerized
by the light passing through the
restoration. In the process, a reliable
adhesive bond forms. Upon completion of the light-curing step, Liquid
Strip can be rinsed off (Fig. 14).
with the composite blocks of the Tetric CAD range in really short times.
The guidelines for the adhesive
technique need to be observed and
a coordinated luting system must
be used.
Easy and rapid processing and polishing procedures and the possibility for effecting intraoral repairs,
similar to conventional filling composites, enable a highly efficient
treatment workflow and increase
the efficiency of day-to-day procedures in the dental practice.
Finishing and outcome
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An occlusal check was carried out
and any interferences were removed
using fine diamonds. In the present
case, final intraoral polishing was
performed with the OptraPol polishers (Fig. 15). This procedure resulted
in a highly esthetic single-tooth restoration. Because of the chameleon
effect, the inlay blends seamlessly
into the surrounding natural tooth
structure (Fig. 16).
About the author
Dr Hidetaka Sasaki
es Dental Office
www.es-dental.net
Conclusion
Highly esthetic permanent singletooth restorations can be achieved
AD
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GENERAL DENTISTRY
Dental Tribune Middle East & Africa Edition | 5/2019
Implant maintenance care solution
By Dr Olivier Carcuac, Sweden
Proper monitoring and maintenance
are essential to ensure the durability and health of a dental implant.
The long-term success of implants
is fundamentally dependent upon
both the patient’s maintenance of
effective home care and on the dental team’s administration of professional prophylaxis procedures in the
dental office.
Implant maintenance
care programme
the supra- and subgingival peri-implant areas.
Among these instruments, plastic,
carbon fiber, stainless-steel and titanium curettes are included. Some
studies have been performed to
evaluate these different materials regarding to their cleaning efficacy and
potential of alteration of the implant
surface and prosthetic component,
which could affect its biocompatibility, biofilm formation and therefore
the implant longevity3, 4, 8.
Benefit of the titanium
implant scalers
• Efficient removal of the bacterial
deposits11, 13.
• Gentle on titanium implant surfaces.
• Unlike plastic scalers, titanium scalers don’t leave contaminants on the
treated implant surface8.
To avoid alteration or scratching of
the implant’s surface, the practitioner
should use very light pressure, approximately 30 grams, during maintenance scaling procedures.
Proper monitoring and maintenance
are essential to ensure the durability and health of a dental implant.
Following the completion of the
surgical and prosthetic procedures
in implant therapy, it is imperative
to inform the patient about how to
carry out selfperformed infection
control procedures.
The long-term success of implants
is fundamentally dependent upon
both the patient’s maintenance of
effective home care and on the dental team’s administration of professional prophylaxis procedures in the
dental office10.
Professional infection control procedures are necessary to achieve longterm success of our implant treatments6 and include the removal of
hard and soft bacterial deposits on
implant and suprastructure components with scalers.
Great care and caution should be
practiced when cleaning the dental
implant and the instruments to be
used should ideally be capable of
removing efficiently the bacterial deposits without altering the implant
surface, the implant components
and the surrounding tissues7, 12.
Effects of hand instruments
on the implant surface
SEM investigation of instrumented
titanium implant surface shows significantly less scratching caused by
titanium curettes compared to other
commonly used metal curettes and
sonic insert9.
Control: untreated implant surface
Hu-Friedy titanium implant
scaler & curettes
The new Hu-Friedy Titanium Implant Scalers are expertly designed
and manufactured for implant
maintenance, debridement, biofilm
removal and can be used both supraand sub-gingival.
• Improved visual acuity and enhanced contrast to the abutment
surfaces with Hu-Friedy’s signature
teal-colored anodized titanium
• Optimized sharpness with cutting edges that are finely honed and
sharpened post anodization process
• Made from the same titanium alloy as implants and abutments, the
working ends are gentler on these
delicate surfaces than stainless steel.
• Increased instrument value with
the ability to be sharpened at any
time.
The new line of Titanium Implant
Scalers proposes a range of titanium
curettes with different shape and
profile in order to address all kind of
clinical situation.
The Titanium Implant Scalers kit includes:
B: Implant surface treated with stainlesssteel curette
C: Implant surface treated with plastic
curette
When should Hu-Friedy
implant scaler and curettes
be used?
During Maintenance
All subjects who present any signs of
peri-implant disease should be thoroughly informed about the disorder
and instructed on how to carry out
self-performed infection control.
Whether the disease is mucositis or
peri-implantitis, the initial phase of
therapy must always include professional infection control procedures.
The main objective is to remove periimplant biofilm and calculus with
scalers, without altering the implant
surface, with the goal of re-establishing a healthy peri-implant mucosa5.
The treatment of peri-implantitis requires often but not always surgery.
The purpose of surgical therapy is to
provide access for debridement and
decontamination of the implant surfac1, 2.
References
1. Carcuac O, Derks J, Charalampakis
G, Abrahamsson I, Wennström J, Berglundh T. Adjunctive Systemic and
Local Antimicrobial Therapy in the
Surgical Treatment of Peri-implantitis: A Randomized Controlled Clinical Trial. J Dent Res. 2016 Jan;95(1):507.
2. Carcuac O, Derks J, Abrahamsson I,
Wennström JL, Petzold M, Berglundh
T. Surgical treatment of peri-implantitis: 3-year results from a randomized controlled clinical trial. J Clin
Periodontol. 2017 Dec;44(12):12941303.
3. Dmytryk JJ, Fox SC, Moriarty JD.
The effects of scaling titanium implant surfaces with metal and plastic instruments on cell attachment.
J Periodontol. 1990 Aug;61(8):491-6.
4. Fox SC, Moriarty JD, and Kusy
RP,“The Effects of Scaling a Titanium
Implant Surface With Metal and Plastic Instruments: An in Vitro Study”, J
Periodontol,August 1990, Vol. 61, No.
8, Pages 485-490.
5. Heitz-Mayfield LJ, Salvi GE, Botticelli D, Mombelli A, Faddy M, Lang
NP. Anti-infective treatment of periimplant mucositis: a randomised
controlled clinical trial. Clin Oral Implants Res 2011: 22: 237–241.
6. Heitz-Mayfield LJ. (2008) Periimplant diseases: diagnosis and risk
indicators. Proceedings from the 6th
European Workshop on Periodontology. Journal of Clinical Periodontology, (Suppl), 35, 292-304.
7. Hultin M, Komiyama A, Klinge B.
Supportive therapy and the longevity of dental implants: a systematic
review of the literature. Clin Oral
Impl Res. 2007 Jun;18(3):50-62.
8. Mann M, Parmar D, Walmsley AD,
Lea SC. Effect of plastic-covered ultrasonic scalers on titanium implant
surfaces. Clin Oral Implants Res.
2012;23(1):76–82.
9. Mengel R, Buns CE, Mengel C, Flores-de-Jacoby L. An in vitro study of
the treatment of implant surfaces
with different instruments. Int J
Oral Maxillofac Implants. 1998 JanFeb;13(1):91-6.
Editorial note:
A list of references can be obtained
from the publisher.
About the author
Dr. Olivier Carcuac, DDS, PhD
Department of Periodontology,
University of Gothenburg, Sweden
D: Implant surface treated with Cavitron
ultrasonic scaler with universal insert
E: Implant surface treated with Densonic
sonic scaler with universal tip
and lingual aspects of affected implants. Inflamed tissue is removed,
and titanium-implant curettes are
used to remove hard deposits on
implants. The implant surfaces are
then decontaminated with saline
for 2 min. Osseous recontouring is
performed when indicated, and flaps
are adjusted and closed with single
interrupted sutures1.
Whenever possible, the supraconstructions are removed to facilitate
the accessibility around the diseased
implants.
During surgical treatment of periimplantitis
Debridement
of implant surfaces
Hand curettes of different materials
have been proposed as instruments
for removing bacterial deposits of
Attention and care are required from
the clinician during instrumentation and cleaning of these surfaces in
order to prevent any damage of the
delicate peri-implant biological seal.
Upon insertion of the instrument,
the blade will be placed close against
the abutment and then opened past
the deposit. With a light pressure, a
vertical, horizontal, semi-circular or
oblique stroke will then be applied
to remove all hard and soft bacterial
deposits. After removing bacterial
plaque and calculus from the abutment or implant, the surface can be
polished with rubber cups to prevent
additional plaque accumulation14.
During non-surgical treatment of
peri-implant mucositis and initial
peri-implantitis
A: Implant surface treated with Titanium
curette
In this context, it is imperative to highlight that deep instrumentation, such
as “subgingival debridement” that
normally is performed around teeth,
is not recommended in non-surgical
treatment of peri-implant disease.
The reason for this difference in strategy is related to the geometry of the
implant device with its threaded part
and other obstacles to access. The risk
of causing injury to the inflamed tissues when performing “blind” instrumentation must be emphasised.
ment-to-implant collar connection
and sometimes implant body.
During the maintenance visit, all
surfaces that can accumulate deposits and harbor bacteria are cleaned,
scaled and polished thoroughly.
These surfaces include the prosthetic
suprastructure, the prosthetic abut-
Following local anesthesia, full-thickness flaps are elevated on the buccal
[25] =>
DTMEA_No.5. Vol.9_DT.indd
TOO HARD
TOO SOFT
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©2019 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-038GB/0819
[26] =>
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26
AESTHETICS
Dental Tribune Middle East & Africa Edition | 5/2019
Customised aesthetics for provisional profile
prosthesis with ceramage gum
By Dr Alisa Tapananon & Dr Pongrapee Kamolroongwarakul, Thailand
Case Presentation
A 61-year-old Thai female presented
with loosening 9-unit fixed dental
prostheses (FDPs). Her chief complaint concerned her loose and unpleasing front teeth with unsatisfactory removable gingiva. The initial
clinical examination revealed a
long-span Porcelain-Fused-to-Metal
(PFM) FDPs of teeth 14-25 fixed with
temporary cement since 2009 at
private hospital (Fig 1,2). The patient
had maxillary hard and soft tissue
defects associated with alveolar ridge
resorption and loss of lip support.
Removable Acrylic Gingival Veneer
(AGV, Fig 3.) was used to cover those
FDPs in order to improve extra-oral
soft tissue profile (Fig 4.). Without
AGV, the patient has concave profile
(Fig 5.). FDPs were removed to evaluate the existing abutments condition (Fig 6.). Abutment teeth 13,24,25
had first degree mobility. Panoramic
XRAY (Fig 7.) revealed that tooth 13
had cast post and core with vertical
root fracture. Tooth 25 was endodontically treated with a periapical
lesion. After thorough diagnosis and
analysis, the treatment plan was presented to the patient with the following phased treatment approach:
1) Aesthetic evaluation
2) Restorative phase with fabrication
of provisional full arch bridge
3) Flapless guided-surgery with immediate loading protocol
Phase 1
Aesthetic evaluation
Aesthetic analysis was performed
with evaluation of the smile line, incisal profile, length and proportion.
Diagnostic wax-up was fabricated according to the aesthetic evaluation.
(Fig. 8)
Phase 2
Provisional full arch bridge
fabrication (Fig. 8 - 19)
Preparation cast with a diagnostic wax-up ca st was sent to a local
laboratory for scanning and transforming into STL (Stereolithography) digital impression file. (Fig
8,9.) Two sets of STL impressions
were super-imposed in the software
in order to subtract the overlapping data. This process was done
in order to transform the diagnostic wax-up into the STL digital
impression. Consequently, the STL
data was sent to the laboratory for
milling. (Fig10.) A monochromatic
milled-PMMA temporary bridge was
fabricated in a local laboratory and
returned to the dentist for composite layering. (Fig 11.) Gingival cutback
was made to create sufficient gingival space for pink composite layering (Fig 12). Prior to composite layering CeraResin Bond 1 was applied
and left for 10 seconds to prime the
surface, followed by application of
CeraResin Bond 2 for 10 seconds and
light cured for 20 seconds (Fig 13.).
Ceramage Indirect Composite gingival shade GUM-O (GUM Opaque)
ÿPage 28
Fig 1. Pre-operative Fixed Dental Prosthesis with Acrylic Gingival Veneer
Fig 2. Pre-operative without AGV
Fig 3. Acrylic Gingival Veneer. AGV
Fig 4. Extraoral smile with FDP in place
Fig 5. Concave facial profile
Fig 6. Pre-operative without 9-unit FDPs
Fig 7. Pre-operative Panoramic XRAY
Fig 8. Full-contour waxing was made according to teeth proportion and
position.
Fig 9. Prepared cast and Diagnostic cast were scanned and transformed
into STL file.
Fig 10. Two sets of STL data were super-imposed and sent for milling.
Fig 11. Milled Full-contour PMMA bridge
Fig 12. cutback was made to create gingival space for pink composite
layering.
Fig 13. CeraResin bond 1 and 2 (CRB1 and CRB2) were applied to bond
the Ceramage pink composite.
Fig 14. Ceramage GUM Opaque (GUM-O) was applied to mask the color
of PMMA.
Fig 15. Ceramage GUM Dark (GUM-D) was applied on the attached
gingiva area to the buccal flange
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GUIDED BIOFILM
THERAPY
R
MAKE ME SMILE.
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28
AESTHETICS
Dental Tribune Middle East & Africa Edition | 5/2019
◊Page 26
Fig 16. Ceramage GUM light (GUM-L) was applied in order to imitate
the free gingival area.
Fig 17. Ceramage Flowable GUM Red (F-GUM-R) and White (F-W) were
painted to mimic the mucogingival junction and vascular alveolar
Fig 18. Ceramage GUM translucent (GUM-T) was applied to reproduce
of reddish translucent gingiva areas.
Fig 19. Completed Provisional Profile Prosthesis with gingival aesthetics
that mimic nature
Fig 20. A Surgical guide with fully-guided sleeves
Fig 21. Fully-guided surgery was performed using Nobel Active
Fig 22. Post-operative panoramic XRAY
Fig 23. Post-operative occlusal view
Fig. 24. Post-operative frontal view
Fig 25. Post-operative smile with provisional profile prosthesis
Fig . 26. Post-operative smile with provisional profile prosthesis
Fig 27. Post-operative smile with provisional profile prosthesis
was applied to mask the color of
PMMA (Fig 14.). GUM-D (GUM Dark)
was applied on the attached gingiva
area to the buccal flange (Fig 15.).
GUM-L (GUM Light) was applied in
the region of free gingiva (Fig 16.). FGUM-R (Flowable GUM Red) and F-W
(Flowable GUM White) were painted
to mimic the mucogingival junction and vascular alveolar mucosa
(Fig 17.) GUM-T (GUM Translucent)
was applied to reproduce of reddish
translucent gingiva areas (Fig 18) to
achieve natural gingival aesthetics.
Contouring, Finishing
and Polishing of temporary
restoration
Meticulous finishing and polishing
of the restoration is a crucial step
to achieving the desired aesthetics.
Dura-Green stone was used to contour the macro anatomical details
while the Robot Carbide Fissure Bur
was used to shape the interproximal
and papilla areas. The course silicone
points followed by Dura-Polishing
paste Al2O3 with a medium strong
brush was used to finish and prepolish the restoration. Dura-Polish
DIA, diamond polishing paste was
applied with a fine brush followed
by the cotton buff to achieve the final high-luster polishing (Fig 19.)1.
Phase 3
Flapless guided-surgery with
immediate loading protocol
The questionable teeth (13, 24 and
25) were extracted under local anaesthesia. The surgical guide was
secured in place on the maxillary
arch with two anchor pins. (Figs. 21)
Flapless surgery was performed using guided tissue punch. Sequential drilling were made according
to the manufacturer’s protocol. All
implants were placed through the
surgical template. All implants were
torqued 35 NCm to ensure primary
stability. The extraction socket were
filled with small particle Xenograft
(Bio-Oss, Geistlich) and covered with
resorbable collagen plug (Collar plug,
Zimmer Biomet). Straight and angle
multi-unit abutments were seated
and torqued 15 NCm on each implants (Fig. 23)
The existing provisional bridge was
utilized for converting to a provisional screw-retained prosthesis. An
immediate loading protocol was utilised2. Metal temporary abutments
were connected on each implant.
Provisional full arch bridge was perforated to match the position of the
metal temporary abutments, placed
in their correct position and OVD,
relined with self-cure acrylic resin.
All surfaces were fine-polished. A
light-cure denture sealant (Palaseal,
Kulzer) was applied on the intaglio
surface. The provisional bridge was
delivered to the patient’s mouth.
(Figs. 23-27) Post-operative panoramic XRAY revealed that implants
were placed according to the pre-operative planning (Fig. 22) Suture was
removed after surgery 14 days. A final
profile protheses3 will be fabricated
after implant osseointegration.
Conclusion
When treatment planning for resorbed maxilla, it is important to
consider a holistic approach which
includes replacement of missing
teeth, restoration of significant segments of missing alveolar bone and
soft tissue contours to achieve optimal aesthetics. This case helps to
showcase the benefits of using a provisional profile prosthesis fabricated
with CERAMAGE Gum Colors to help
improve extra-oral soft tissue profile
of the patient and result in an aesthetically pleasing maxillary full arch
restoration.
Editorial note:
A list of references can be obtained
from the publisher.
About the author
Alisa Tapananon
DDS (Mahidol),
M.Sc. (Prosthodontics, Mahidol)
Cert. of Advanced Clinical Programme in
Aesthetic and Restorative dentistry, UCLA,
USA
Part-time faculty, Department of Prosthodontics, Mahidol University, Bangkok,
Thailand
Part-time dentist Phayathai 2 Hospital,
Bangkok, Thailand
Pongrapee Kamolroongwarakul
DDS (Mahidol),
M.Sc. (Prosthodontics, Mahidol) , AFAAID
Cert. of Fellowship in Implant Dentistry,
Loma Linda University, USA
Part-time faculty, Department of Prosthodontics, Mahidol University, Bangkok,
Thailand
Full-time dentist Phayathai 2 Hospital,
Bangkok, Thailand
Associate Fellow of American Academy of
Implant Dentistry
[29] =>
DTMEA_No.5. Vol.9_DT.indd
→ THE EVOLUTION OF PROPHYLAXIS
COMBI touch
→ AIR-POLISHING AND ULTRASOUND IN ONE UNIT
→ easy switch from supra to subgingival air-polishing by a simple click
→ subgingival perio air-polishing tip – flexible, soft and anatomically
adjustable to the periodontal pocket
→ more than 40 inserts for scaling, perio, endo and prosthetics
→ soft mode: the ultra-gentle scaling for sensitive patients
→ www.mectron.com
→ www.we-love-prophylaxis.com
[30] =>
DTMEA_No.5. Vol.9_DT.indd
30
NEWS
Dental Tribune Middle East & Africa Edition | 5/2019
Mectron Spring Meeting 2020
The first-class event dedicated to innovation
By Mectron S.p.A.
After the success of the first edition, it is with
great pleasure that Mectron is announcing the
Spring Meeting 2020 which will take place in
Venice on Friday 8th and Saturday 9th of May in
the spectacular venue of Isola San Servolo, in the
lovely Venetian setting.
The scientific programme is focused on the new
REX PiezoImplant, a revolutionary wedge-shaped
implant specifically developed to simplify the
surgical treatment of narrow ridges.
© Planmeca
The second important topic involves a new piezoelectric surgical protocol dedicated to thirdmolar extraction procedure, in order to make
such an advanced technique safer and faster in
the daily clinical practice.
For the first time the Mectron Spring Meeting will
offer a parallel Dental Hygiene programme highlighting ultrasounds and air-polishing benefits
in daily prophylaxis practice. A joined session of
dentists and dental hygienists will focus on surgical and non-surgical periimplantitis management.
Hands-on sessions will help each participant to
acquire an improved understanding of the new
techniques thanks to the several exercises the
participants are going to perform on bone models.
Prestigious international and national speakers
will illustrate their own techniques through detailed protocols and a vast assortment of clinical
cases, the result of extensive experience and continuous scientific research.
For Courses and congresses
section:
8th-9th May 2020 – Venice
MECTRON SPRING MEETING 2020
“Advances in daily practice”
Speakers
T. Vercellotti, J. Motta, F. Fontanella, U. Consolo,
AD
What is the
ClearSmile
Aligner?
ALIGNER
Made in Dubai supervised by
orthodontists in UK
ClearSmile Aligner employs a series
of plastic appliances, called
aligners, to gently reposition and
align the teeth creating a beautiful
new smile.
R. Vinci, G. Grusovin, E. Conserva, S. Verardi, R.
Carvalho Da Silva, P. Russe, M. A. Pikos, Shon
Dong Sek, T. Gerlach, L. Trombelli, C. Makary,
C. Stacchi, T. Traini, A. Rebaudi, A. Ordonez, L.
Rubino, A. Alberghini Maltoni, L. Parisi, G. Gaßmann, A. Genovesi, M. Roncati, M. E. Bezzina,
G. M. Nardi, S. Wingrove.
Info and registration
Eve-Lab:
Tel. +39 055 0671000
Email: nora.naldini@eve-lab.it
www.mectron.com/spring-meeting
Children with clefts
to receive improved
oral healthcare
By Dental Tribune International
GENEVA, Switzerland/NEW YORK, US: Orofacial clefts are the most common birth defects in the US. Children with orofacial clefts
can be at an increased risk of caries, periodontal disease and other oral health issues even
after undergoing surgery. FDI World Dental
Federation (FDI) and Smile Train are working to address the issue and have recently
launched a two-year project to improve oral
healthcare guidance and treatment for children with clefts.
The project is funded by GlaxoSmithKline
(GSK) Consumer Healthcare and is aimed at
developing oral health education resources
for dentists and other healthcare professionals. The project team will create educational
materials for cleft patients and their families,
raise awareness of the oral healthcare challenges that may occur after the cleft surgery,
and provide oral healthcare instructions.
www.clearsmilealigner.com
www.iasortho.com
www.mdentlab.com
Venue
Isola S. Servolo – Venice, Italy
Tel : 04-332901
Whatsapp +971 557590217
info@mdentlab.com
“Clefts affect one in 700 children worldwide,”
said Dr Kathryn Kell, immediate past President of FDI. “In India alone, we estimate that
100 babies with clefts are born every day, and
many of these children do not survive. In the
US, a baby with a cleft is born every 75 minutes. FDI is committed to supporting this vulnerable patient group.”
Postoperative care for patients with clefts
may require various specialists who have
thorough knowledge in nursing, plastic surgery, paediatric dentistry, speech therapy
and orthodontics. As most of these services
are unavailable in low- and middle-income
countries, many patients with clefts are unable to receive the required comprehensive
treatment and care.
“We aim to highlight the important role of
dentists within the cleft care team,” said Susannah Schaefer, President and CEO at Smile
Train. “Regular dental care for children with
clefts is essential to help manage their increased risk for oral diseases. It’s important
for oral health professionals to guide cleft patients and their families in their oral hygiene
and help them maintain healthy mouths and
the highest possible quality of life.”
“Comprehensive cleft care is a key area of focus for our partnership with Smile Train and
the general dental practitioner role is vital in
this,” said Jayant Singh, Head of Global Oral
and Skin Health at GSK Consumer Healthcare.
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DTMEA_No.5. Vol.9_DT.indd
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32
NEWS
Dental Tribune Middle East & Africa Edition | 5/2019
Align Technology Promotes
Markus Sebastian to Senior Vice President
& Managing Director of the EMEA Region
Align Technology, Inc. (Nasdaq:
ALGN) announced that Markus Sebastian has been appointed senior
vice president, managing director
for the EMEA (Europe, Middle East
and Africa) region. The promotion
follows Simon Beard`s appointment
as senior vice president, managing
director of the Americas region. In
this role, Mr. Beard has assumed responsibilities for the North America,
Canada and Latin America country
markets.
Mr. Sebastian joined Align Technology in September 2018 and has been
responsible for Align’s core Europe
commercial organizations, focused
on growing the orthodontist chan-
nel. He has also served as interim
General Manager of the Germany,
Austria and Switzerland as well as
France country markets. Prior to
Align, he spent more than 25 years
in the healthcare and medical device industries, including as chief
commercial officer for Lohmann &
Rauscher, and in multiple commercial, strategic and general management positions for Smith & Nephew,
and Coloplast.
“Markus is an experienced leader
and general manager with a proven
track record in global commercial
operations and sales, strategic marketing, product development, and
change management processes. His
deep understanding of the healthcare markets in EMEA, Asia Pacific,
and the US are an asset to our company, and I am very pleased to have
him join our executive team.” – said
Joe Hogan, Align CEO.
Commenting on his new role, Mr.
Sebastian said: “I am delighted to be
joining Align`s executive leadership
team, and to drive the expansion of
the EMEA commercial organization
as the region continues to grow. We
see tremendous prospects across
our 44 markets, including the United
Arab Emirates and Saudi Arabia. I
very much look forward to supporting Invisalign trained doctors
in helping them treat their patients
with our technology, and to enable
them to create many new beautiful
smiles.”
© Align Technology
By Align Technology
Markus Sebastian, Senior Vice President & Managing Director of the EMEA Region
Connect Case Center: Send and manage
scan data quickly and reliably
By Dentsply Sirona
Easy, quick, and above all, accurate
– intraoral scanning with the new
Primescan from Dentsply Sirona
meets the clinical requirements for
impressions, making it a first-class
method. The Connect Case Center is
a portal for further processing of the
scan with versatile options and full
flexibility. The Connect Case Center
replaces the Sirona Connect Portal
which, until now, has enabled practices to link to laboratories that use
the inLab software.
The basic function of the new platform is the secure transmission of
scan data and case information. Photos can also be transmitted to the lab
as attachments. If you want to communicate directly with the dental
technician, you can make use of the
chat function.
Numerous interfaces,
improved communication
with the Inbox
The new Connect Case Center has
numerous validated interfaces to
important partners of the dental
practice: The seamless connection
to Simplant enables users to use the
Dentsply Sirona implant planning
service quickly and easily. There is
also a seamless interface to Atlantis,
the central production service for
© Dentsply Sirona
A seamless transition into digital impressions and CAD/CAM dentistry:
With the new Primescan from Dentsply Sirona, the new Connect software and the Connect Case Center,
it's a breeze. The portal for cooperation with the lab, which has been
known as Sirona Connect until now,
has been completely overhauled and
is now even more convenient and
flexible. Validated interfaces enable
secure transmission of data to many
important partners.
Dentsply Sirona's Connect Case Center replaces the Sirona Connect Portal, with both proven and new functions. Via the Inbox, all labs can access the Connect Case Center.
patient-specific abutments and suprastructures on implants.
The connection to SureSmile was
created for the IDS 2019. This enables
the user to order full service aligners,
a model print, IDB trays for indirect
bracket bonding and the production
of aligners directly from the practice
following the clinical diagnosis and
Smile Design in the lab. Labs that
work with the inLab software are also
seamlessly integrated and can offer CEREC users an attractive design
service.
One significant new feature is the
Connect Case Center Inbox – receiver software that enables all labs
to access the Connect Case Center,
regardless of their CAD software.
The Inbox clearly displays all of the
cases that need to be processed with
the corresponding information on
a dashboard and it also enables a 3D
preview of the order, which can be
accepted with a mouse click. For further processing with the preferred
lab software, the Inbox generates
common open data formats, such as
STL and OBJ.
The Inbox has proven to be particularly convenient in the workflow
with inLab or exocad labs that are
connected via appropriate interfaces: It provides a format that is
validated by exocad that includes
model and case data, color information and preparation margins. In this
way, dentists also have the option
of cooperating with exocad labs in a
validated workflow.
Portal for all intraoral scanners from Dentsply Sirona
When purchasing a Primescan AC
or a new Omnicam AC, dentists also
receive the Connect software, which
enables quick and easy access to the
Connect Case Center. The user also
gets a license for the Inbox, which
can be passed on to the lab of choice,
so that the lab is also able to access
the portal. Of course, labs can also
buy their own Inbox license to obtain
access to the Connect Case Center.
"Users of both Primescan and Omnicam benefit from modern digital impression technology, while remaining flexible in selecting partners for
the manufacture of restorations,
orthodontic devices and implant
abutments," explains Dr. Alexander
Völcker, Group Vice President CAD/
CAM and Orthodontics at Dentsply Sirona. "The new Connect Case
Center thus provides the ideal environment for the digital workflow between laboratory and practice."
[33] =>
DTMEA_No.5. Vol.9_DT.indd
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DTMEA_No.5. Vol.9_DT.indd
34
INTERVIEW
Dental Tribune Middle East & Africa Edition | 5/2019
Interview: "There has been tremendous
growth in access to knowledge
and technology..."
Interview with Dr David Donelson, an
American educated and trained General Dentist with 10 years’ experience in
General and Esthetic Dentistry. Dr. David is an expert in digital smile design.
He is also a Platinum Invisalign provider and certified using Inman Aligner
teeth straightening methods.
Dr. David, tell us about your background and your experience as a dentist?
Originally, I hail from the deep south of
the United States, Atlanta, GA. I graduated from UMASS Amherst with a Bachelor's degree in Business Administration
in 2003. I then proceeded to stay in Massachusetts to spend another 4 years at
Tufts School of Dental Medicine in Boston, where I earned my DMD in 2009.
An alternative track taken by some dental graduates in the USA is to complete a
General Practice Residency or Advanced
Education in General Dentistry program to further expand on the knowledge gained from dental school. I was
accepted into a 1 year certificate AEGD
program at the University of Florida
College of Dentistry in 2009. At the time
they had an extensive implant program
teaching comprehensive full mouth
dentistry.
I remained in Jacksonville, FL after the
program and jumped right into private
practice as a solo practitioner for several
years. Life circumstances moved me to
New York City where I began working
part time in several different offices and
also as Part Time Clinical Faculty at NYU
Dental School.
In 2012, I had thought about potentially
looking for work in KSA with Saudi Aramco but it never gained any traction. I
began speaking to a fellow Tufts Alumni
who had been living in Dubai for several
years. She put me in touch with her employer who I subsequently had a skype
call with shortly after. One month later
I was on a one-way flight with two suitcases halfway across the world to someplace I had never been before.
Within my move to Dubai I have spent
time employed with Dr’s Nicolas and
Asp and Dr Michael's Dental Clinic before accepting the role as Head of the
Dental Department at Valiant Clinic in
2016.
In 2015, I passed my fellowship exam
for the American Academy of General
Dentistry. This was a huge step for me
in that only 6% of dentists in the US
obtain this status. It requires 500 hours
of CE and success at a very difficult 250
question standardized test reflecting all
disciplines of general dentistry.
© Dr. David Donelson
By Kinga Mollov, DTMEA
Tell us please about the Valiant Clinic
and what treatments are available for
the patients?
Valiant Clinic is a premium, multi-spe-
AD
cialty outpatient clinic offering world class diagnostic and wellness
services. The physicians and allied health professionals provide evidence-based care following international standards of excellence.
They encourage healthy living and increased awareness about early
detection and diagnosis for all of their patients. The Clinic is regarded for providing Essential and Premier Check-ups designed as you
would get in the U.S. It is affiliated with Houston Methodist Global
Health Care Services, the international arm of the world-renowned
Houston Methodist Hospital, located in Houston, Texas, USA, and
brought to Dubai by Meraas.
In addition to all facets of General Dentistry, we have an American
hygienist heading up our hygiene department. We also have an
Oral Surgeon on staff to provide all forms of Maxillofacial Surgery
including having procedures done under General Anesthesia in our
own Operating Theatres.
How being a dentist in UAE compares to the US?
Dentistry in the UAE is remarkably similar to the USA. The DHA has
modeled itself in many ways after an American model. The use of
the ADA coding system, albeit we are still using coding from 2008,
was a very easy transition for me. Most of the materials and suppliers in the US are represented in some form or fashion in the UAE.
A large difference practicing in the US compared to the UAE is the
difference in educational backgrounds and philosophies reflected
by clinicians from so many different countries. The 66 CODA accredited dental schools in the US all have the same requirements in
regards to the standard of care and competency.
What would be your advice for anyone wanting to practice in
UAE?
My advice for anyone wanting to practice in the UAE would be to
clearly define what their job expectations are and what they require
to be fulfilled and happy. There are such huge differences in jobs
here that encompass substantially different salaries, different patient demographics, different quality of facilities and different patient management philosophies. It's important to be aware of the
labor laws and the nuances of what is usual and customary with
regards to contracts for their particular specialty. I would also recommend to have a portfolio of work to show prospective employers. Pictures speak volumes about the quality of work and what a
clinician is capable of. Get a camera and start taking pictures now!
What is your take on dentistry in the Middle East?
To me dentistry in the Middle East still has time to grow and learn
from more established markets like Europe and America. There has
been tremendous growth in access to knowledge and technology
in the time I have been here. I anticipate it becoming more similar
than different as we move forward with dental technology. There is
much better adoption by more clinicians of new technology in this
region, which I feel will help it become an epicenter for new techniques.
Thank you very much for the interview.
[35] =>
DTMEA_No.5. Vol.9_DT.indd
35
INTERVIEW
Dental Tribune Middle East & Africa Edition | 5/2019
Interview: "Dentistry in the GCC region
has developed more in the last five years than
ever before..."
By Kinga Mollov, DTMEA
Dental Tribune MEA recently had
the opportunity to interview Dr Mohammad Dashti, President of the Kuwait Dental Association (KDA), and
asked him about his new role and the
association and its future plans.
Dr Mohammad, congratulations
on your presidency. We are very
interested to know a little more
about you and your experience as
a dental professional.
I completed my PhD in Oral and
Maxillofacial Surgery in 2016, MSc
in 2009 and BDS in 2005. I currently
work in the Kuwait Army Hospital
and am the general manager of 32
dental clinics. I joined the KDA in
2006 as a member of the social committee, and thereafter was head of
the scientific committee, treasurer
and then general secretary, and now
president of the association.
"The Kuwait Dental Association (KDA) is the only
association that represents dentists in Kuwait."
How do you view dentistry in the
Middle East, particularly in Kuwait
and the Gulf Cooperation Council
(GCC) region? What are some of the
key notable indicators we should
be aware of?
Dentistry in the GCC region has developed more in the last five years
than ever before to the extent that
we can be compared with other
countries in Europe and America
and indeed worldwide.
In Kuwait, we have many achievers
in the dental field and a good dental
culture and have attracted many patients from different countries. Our
aim in the KDA is to increase dentists’ knowledge and experience by
organising more scientific activities,
and I believe that we will develop
even more in the future.
Thank you very much for the interview.
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Could you please tell us about the
KDA and what it stands for, its major activities and who it represents?
The KDA is the only association
that represents dentists in Kuwait.
All dentists working in the country
should join it to facilitate their work
in the country and to participate and
share in the benefits of its scientific
activities.
The KDA has been active since
1974. How has it developed since its
foundation?
The KDA has developed scientifically
and in many other related fields, especially in the last ten years, and this
has been noted socially and in the
media.
What motivated you to accept your
appointment as President of the
KDA?
I had been a board member of the
KDA for quite a while already and
my colleagues’ decision to choose
me to represent them as president
will, I hope, place me in a better position to serve the profession well.
Our readers are interested to learn
more about the KDA’s plans for the
future. What are your main goals,
and what does the association wish
to achieve?
As I mentioned, we are now focusing
more on our scientific programmes.
We have weekly scientific activities,
such as lectures and workshops,
and have started working with CAPP
[Centre for Advanced Professional
Practices] to increase our scientific
activity. Our main conference is held
every two years in November—the
next one will be in 2020—but we are
planning to hold it yearly. We will
also this year begin to organise the
first Kuwaiti dentists’ conference.
The idea is to have a conference with
all the speakers being from Kuwait
only.
3563E
As General Secretary of the KDA
you were actively involved in the
association. What has changed
since you became president?
Firstly, I changed the way we deal
with any case related to dentistry by
communicating with dentists and
the ministries to solve it. I now focus
more on our scientific activities and
am working on new guidelines for
our profession
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25.06.2019 09:48:16
[36] =>
DTMEA_No.5. Vol.9_DT.indd
» Prompt results are my ambition.
And Primescan is my answer. «
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[37] =>
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www.dental-tribune.me
Published in Dubai
September-October 2019 | No. 5, Vol. 9
Novel applications of a bioactive resin
in perforations, root resorption and
endodontic-periodontic lesions
By Dr Marta Maciak, Poland
During the last decade, a considerable amount of attention has been
directed towards the development
of so-called bioactive materials. To
understand this phenomenon better and to avoid misinterpretation,
a condensed review of the literature
and an assessment of various definitions need to be considered.
There are already several commercially available dental materials
that can be defined as bioactive. For
instance, any fluoride-releasing material, calcium silicate- and calcium
aluminate-based cements, and calcium-based or calcium-containing
materials. Biomaterial scientists
in the field of implantology have
adopted the word “bioactive” to
mean materials that are bound to
each other through a biomineralised
interface. There appears to be confusion within the dental profession, including among scientists, clinicians
and industry persons, to what extent
biomineralisation can be achieved
with dental materials and which ma-
terials can be appropriately termed
“bioactive” or “biomineralising”.1
Bioactivity has been defined and
can be interpreted in various ways.
A broad definition that has several
meanings is the following: a material
that is able to have a biological effect or a material that is biologically
active and forms a bond between
the tissue and the material.2 In the
field of tissue engineering, the term
“bioactivity” is related to the cellular effects induced by the release of
biologically active substances and
ions from the biomaterial, for example from bioactive glasses both
in soft- and hard- tissue engineering
applications.3, 4 In addition, its activity has been demonstrated in pulp
capping experiments in non-human
primates.5
Thus, in medicine, bioactivity covers all interaction of materials with
living cells and tissue, including the
effects of pharmaceuticals. In biomaterial science, with bioceramics
and bioactive glasses, bioactivity of
a material usually denotes that the
material is capable of forming hydroxyapatite minerals on its surface
in vitro and in vivo.6
The following theoretical question
should be asked: can a material that
releases ions for biomineralisation
be considered bioactive or is the
substrate on which the biomineralisation occurs bioactive? Thus, bioactivity of dental materials relates to
their potential to induce specific and
ÿPage A2
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ENDO TRIBUNE
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◊Page A1
ACTIVA BioACTIVE-RESTORATIVE
and ACTIVA BioACTIVE-BASE/LINER
in lieu of mineral trioxide aggregate
(MTA) and Biodentine (Septodont)
for selected endodontic and other
procedures.
Fig. 1
The cases presented here are offlabel treatments using ACTIVA BioACTIVE-BASE/LINER in cases with
a poor prognosis and in which extraction (and an implant) may have
seemed a more obvious choice of
therapy. These procedures are not
listed in the company’s indications
for use and were carried out by the
author after explaining the possible
potential benefits, as well as the risks
to the patient. All of the patients
agreed to the treatment and signed
an informed consent form for endodontic treatment.
Fig. 2
Case 1
Fig. 3
A 28-year-old female patient was
referred and presented with pain of
tooth #46. The referral letter stated
that endodontic retreatment was
needed and the perforation had been
closed with MTA. The patient was in
considerable pain when eating and
when closing her mouth. Her medical history did not present any contraindications to dental treatment.
Fig. 4
Fig. 5
The clinical examination showed a
temporary filling in tooth #46. A radiograph taken on 20 October 2015
showed extrusion of MTA into the
furcation, as well as a bony defect
(Fig. 1). Perforation of the floor of the
pulp chamber was diagnosed.
Fig. 6
Fig. 7
Upon removal of the temporary
filling, a large amount of purulent
exudate filled the pulp chamber and
was evacuated. After the MTA had
been removed, the furcation was
flushed with metronidazole (liquid;
Polpharma) and 2% chlorhexidine
(Cerkamed). The borders of the perforation were refreshed with a carbide
bur, and then the pulp chamber was
etched with 37% orthophosphoric
acid for 10 seconds, followed by a
thorough rinse. Through the perforation, a collagen sponge (ANTEMA,
Molteni Dental) was applied to support the ACTIVA Bio-ACTIVE-BASE/
LINER and to protect the underlying bone defect. The sponge was not
visible on the radiograph. The canal
orifices were protected with cotton
pellets and the entire pulp chamber
was treated with a dentine bonding
agent (DenTASTIC UNO, Pulpdent),
which was light-cured, and then covered with ACTIVA BioACTIVE-BASE/
LINER, covering the floor of the pulp
chamber (Fig. 2).
Fig. 8
Fig. 9
Fig. 10
The tooth was closed with GIZ glass
ionomer (Ihde Dental) as a temporary filling. The patient was painfree within two days. A follow-up radiograph taken on 3 November 2015
(14 days postoperatively) showed the
beginning of the healing of the bone
in the furcation area (Fig. 3).
Case 2
Fig. 11
Fig. 12
intentional mineral attachment to
the dentine substrate.7
Another definition has been presented in an article by Lööf et al.:
“Bioactivity of a ceramic material is
a surface property that provides a
bond between the material and living tissues without fibrous encapsulation.”8 In yet another definition,
bioactivity is described as follows: “A
bioactive material is one that forms
a surface layer of an apatite-like material in the presence of an inorganic
phosphate solution.”9
ACTIVA
BioACTIVE-RESTORATIVE
and ACTIVA BioACTIVE-BASE/LINER
(Pulpdent) have been shown to exhibit bioactive properties based on
this last definition. ACTIVA BioACTIVE products are the first dental
resins with a bioactive ionic resin
matrix. They have a shock-absorbing
rubberised resin component and
reactive ionomer glass fillers that
mimic the physical and chemical
properties of natural teeth. These bioactive materials actively participate
in the cycles of ion exchange that
regulate the natural chemistry of the
teeth and saliva and contribute to the
maintenance of tooth structure and
oral health. ACTIVA has the strength,
aesthetics and physical properties of
resin composites and is more bioactive than glass ionomer cements.10
ACTIVA seals teeth against mi croleakage11, 12 and its continuous release
and recharge of significant amounts
of calcium, phosphate and fluoride
ions provide patients with long-term
benefits.
In the US, the bioactivity claim for
ACTIVA, being the first bioactive
resin material, has been accepted.
Based on its strength and durability
due to a patented rubberised resin
molecule that absorbs stress and
resists fracture, the author has used
A 16-year-old patient was referred
with root resorption of tooth #21. A
CBCT scan and radiograph (Figs. 4
& 5) taken on 30 March 2017 clearly
demonstrated the root resorption.
Note the temporary filling in the
pulp chamber. The patient’s medical
history was non-contributory. The
diagnosis was mixed internal and
external root resorption.
After removal of the temporary filling, inflamed granulation tissue was
seen inside the canal. In spite of the
fact that the apical portion of the canal was calcified, it was located. The
canal was shaped and cleaned with
the Self-Adjusting File (SAF) System
(ReDent NOVA) and XP-endo Finisher (FKG Dentaire), and flushed with
5.25 % sodium hypochlorite (NaClO),
17% EDTA (Cerkamed) and metronidazole (Polpharma). As a first temporary canal filing, Dexadent (Chema-Elektromet) was applied for one
week to treat the inflammatory tissue in the canal. During subsequent
visits, the canal was rinsed with
40% citric acid (Cerkamed) and 2 %
chlorhexidine (Cerkamed) using the
SAF System and XP-endo Finisher. A
temporary filling of Multi-Cal (Pulpdent) mixed with 2% chlorhexidine
(liquid) was inserted into the canal.
Initially, the temporary dressing was
replaced every two weeks to accomplish removal of granulation tissue
and to stimulate bone regeneration. Over the course of about seven
months, a reduction of the bone lesion was observed, as evidenced by
radiographs (Fig. 6) and CBCT and
under high mag- nification.
The final treatment after approximately 11 months (Fig. 7) consisted of
cleaning the canal with the XP-endo
Finisher and EDTA and 2% chlorhexidine irrigation. The resorption area
was plugged with a collagen sponge
(Antema) to provide support for
ACTIVA BioACTIVE CEMENT and to
prevent it from flowing beyond the
root structure. A dentine bonding
agent (All-Bond Universal, Bisco) was
applied to the canal space, but not
polymerised, just slightly air-dried,
and the root was filled from the apex
to the pulp chamber with ACTIVA
BioACTIVE-BASE/ LINER. A fibre post
(Cytec blanco, Hahnenkratt) was immediately placed, following which
the pulp chamber was filled with ACTIVA. After 20 seconds, the restoration was light-cured from three different directions for 20 seconds each.
The final result can be seen on a radiograph from 13 February 2018.
Complete bone healing adjacent to
the resorption area was observed
(Fig. 8). While the radiograph shows
the fibre post, the collagen sponge
and ACTIVA BioACTIVE CEMENT do
not possess sufficient radiopacity to
be seen on a radiograph.
Case 3
A 63-year-old female patient presented for dental treatment. A panoramic radiograph (Fig. 9) revealed
a heavily restored dentition with
single crowns, a three-unit bridge
and multiple missing teeth in both
arches. She complained of pain in
the mandibular right premolar area.
Her medical history did not present
any contra-indications to dental
treatment.
When the patient was informed
that tooth #45 would have to be
extracted, she objected and asked
if anything could be done to save it,
even if only on a temporary basis, as
she was reluctant to commit to wearing a removable partial denture. She
thus consented to a treatment that
offered no guarantee of success.
Clinical examination showed thirdstage luxation and pus in the gingival pocket. A radiograph showed
a three-wall infrabony pocket (Fig.
10A) reaching the apex of the root.
The diagnosis was periapical periodontitis with purulent exudate and
root caries on the mesial aspect. The
treatment consisted of endodontic
and periodontal treatment after a
panoramic radiograph and realtime
polymerase chain reaction (PET test,
PET Plus, MIP Pharma) were performed.
Endodontic treatment was performed on 2 July 2014 with a HyFlex
file of size 25.04 (COLTENE) and the
SAF System. The pus was evacuated
from the root canal and the canal was
flushed with 5.25% NaClO and met-
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ENDO TRIBUNE
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◊Page A2
ronidazole, and Dexadent ointment
was applied and left for one week. To
avoid extra expenses, no bone grafting material was used; only a deep
curettage was performed.
An occlusal cavity was prepared
and filled with ACTIVA BioACTIVERESTORATIVE, and the tooth was
splinted to the adjacent premolar
with fibreglass and ACTIVA (Fig.
10B). The purpose of the splint was
to lend support to the tooth, which
presented with a Class III mobility,
thus promoting healing. After a few
days, the patient reported being free
of pain, and no exudate in the canal
was observed.
period of two weeks. Two weeks later,
the Multi-Cal was removed with the
SAF System using 40 % citric acid
and distilled water. Then the canal
was rinsed with 2% chlorhexidine
and dried with suction. GuttaFlow
(COLTENE) was used as a sealer, and
a master cone was softened in chloroform and placed in the canal. Vertical hot condensation was carried out
in the apical part. The remainder of
the root canal was filled with a continuous wave of gutta-percha. The
period until the next appointment
determined whether the treatment
would be successful or not. Healing
of the infrabony lesion continued
during this period (Fig. 11).
On 10 July 2014, the canal dressing
was changed to Multi-Cal mixed
with 2% chlorhexidine and left for a
Three months later, the gutta-percha
was partially removed from the canal, which was etched and rinsed, fol-
lowed by application of the dentine
bonding agent (All-Bond Universal).
The canal was filled with ACTIVA CEMENT and a fibre post was placed,
and after 20 seconds, it was lightcured (Fig. 12). After three years, a
radiograph showed complete bone
healing and periodontal attachment
(Fig. 13).
Conclusion
Based on the available published
research and after early favourable
results had established the effectiveness of ACTIVA BioACTIVE materials,
and based on the pH, release of calcium and phosphate ions and apatite
formation in the presence of saliva,
the decision was made to expand the
number of suitable cases. Although a
favourable outcome could not be
guaranteed, clinical cases followed
over a period of three and more
years presented with positive results
and provided evidence that the bioactive properties of ACTIVA BioACTIVE materials through their ability
to stimulate apatite formation and
osteoblasts provided a viable treatment option. The evidence has been
presented here with radiographs
and CBCT scans showing new bone
formation. Although histopathological evidence has not been provided,
a periodontal evaluation demonstrated periodontal attachment in
the cases presented here.
Editorial note: A list of references is
available from the publisher.
This article was originally published
in roots-international magazine of
endodontics, Issue 4/2018.
About the author
Dr Marta Maciak, Poland
PhD, graduated with a DDS from the
Medical University of Białystok in Poland
in 1999. In 2007, she graduated with a
specialty in conservative dentistry and
endodontics from the university’s Department of Restorative Dentistry. From 2004
to 2009, she was an assistant in the same
department. In 2009, she received a PhD
in medical sciences in dermatology. She
is a member of the Polish Dental Association and Polish Endodontic Association.
She has authored many publications, and
since 2005, she has lectured in Poland and
numerous other countries, in addition to
presenting practical training in the fields
of endodontics and aesthetic dentistry.
Her main interests are aesthetic dentistry,
endodontics and prosthetics. She can be
contacted at martamaciak2012@gmail.
com.
Five quick questions with Dr Jorge Vera
By Dental Tribune International
Dental Tribune International asked
Dr Jorge Vera five quickfire questions
about his background in dentistry
and what inspires him to practice
endodontics every day. In the interview, Vera also shed some light on
his favourite products that he uses
in his private practice and provided
some useful tips for aspiring endodontists.
Dr Vera, what is your background
in endodontics?
After finishing my DDS in Mexico,
I did my postdoctoral programme
in endodontics at Tufts University
School of Dental Medicine in Boston
in Massachusetts in the US, from
1991 to 1993, helping to teach in the
undergraduate clinic and doing
many research projects under a great
team consisting of Drs Joseph Tenca,
Robert White and Melvin Goldman.
Once I got my certificate, I returned
to practising and teaching in Mexico.
What are your three favourite
things about endodontics?
Firstly, I like the challenge of properly diagnosing and treating orofacial and dental pain, and, of course,
relieving the affected patients. And
then being able to treat symptomatic and previously endodontically treated teeth with retreatment
techniques using CBCT, the micro-
scope or endodontic microsurgery,
and returning them to functionality.
Lastly, the tremendous load of basic
science that endodontists must carry
requires continuous study to better
perform clinically in fields like pharmacology, physiology and others.
Which endo products couldn’t you
do without and why?
I would not be able to work without
a microscope and ultrasonic tips because they change the approach to
removing interferences like calcifications and previously placed materials from the root canal system in a
conservative way. Also, the use of
rotary/reciprocating instruments is
essential in my everyday practice—
their evolution is making root canal
preparation easier while maintaining more dentine—and, finally, the
use of hydraulic calcium silicate/
bioceramic cements and CBCT for
many cases.
What inspires you in your day-today work?
Being able to bring new techniques,
devices and materials into my practice about which I have learnt in
lectures and courses. Documenting their use and eventually seeing
those patients on which they were
used, heal and remain functional for
a long time. I also enjoy preparing
lectures for students and peers on
those same topics.
What is one piece of advice that
you would like to share with aspiring endodontists?
To be both open and critical about
new techniques and devices arriving on the market; to always bring
basic science into everyday practice
because therein lies the foundation
of our profession, so that whatever
we use on patients helps both them
and us; to study every single day; to
revise old notes from school and to
read the journals. Finally, it is advisable to take new courses every year.
Thank you very much for the
interview.
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26-27 March 2020
Thursday-Friday
09:00 - 18:00
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Area of interest:
Endodontics
28-29 March 2020
Saturday-Sunday
09:00 - 18:00
AED 4,400
$ 1,200
CAPP Training Institute
Dubai | UAE
Area of interest:
Endodontics
Dr. Antonis Chaniotis, Greece
Prof. James Prichard, UK
He currently serves as an active member of the Hellenic Society of
Endodontology and the Academy of Microscope Enhanced Dentistry
and is a certified member of the European Society of Endodontology.
Visiting Professor and Programme Leader, MClinDent in Endodontology at BPP University.
Course Objectives
Course Objectives
DAY 1 - Delegates will be able to:
DAY 1 - By the end of the course delegates will understand:
Remove guttapercha obturations from root canals.
Remove Carrier based obturations from the root canals.
Remove paste obturations and remove fiber posts.
Have the oportunity to use most of the current technology used during retreatment
procedures.
DAY 2 - Delegates will be able to:
• Bypass and remove broken endodontic files.
• Understand all the preventive measures to avoid complications during endodontic
instrumentation.
• Repair a pulp floor perforation.
• Obtutrate an internal resorption defect.
• Perform apical plugs with biocompatible materials.
www.cappmea.com/courses
CONTACT
CAPP EVENTS
Onyx Tower 2 | Office P204 & P205
The Greens | Dubai | UAE
Mob/WhatsApp: +971502793711
Tel: +971 4 347 6747
E-mail: events@cappmea.com
Web: www.cappmea.com
AED 4,400
$ 1,200
ACCREDITATION
Est. DHA 12 CME
CAPP designates this activity for 14 CE Credits
•
•
•
•
•
•
•
•
Outcomes of endodontic microsurgery vs traditional apicectomy.
The science behind effective local anaesthesia in endodontic microsurgery.
The use of a dental operating microscope in endodontic microsurgery.
Flap design and tissue handling to improve post-surgical healing.
How to effectively prepare an osteotomy.
Correct methods of ultrasonic root-end preparation and how to identify anatomical markers.
Which equipment is appropriate for use in micro-surgical techniques.
Effective suturing and postoperative care including analgesia.
DAY 2 - By the endo of the course delegates will have:
•
•
•
•
•
•
•
Been calibrated to a dental operating microscope.
Have identified cases where surgical intervention is appropriate.
Have raised a flap with microsurgical instruments.
Created an osteotomy and identified anatomical markers.
Performed root end resection and retrograde preparation of the root canal space.
Performed microsurgical suturing.
Developed a post-operative care strategy to minimize complications and improve healing.
www.cappmea.com/courses
CONTACT
ACCREDITATION
CAPP EVENTS
Onyx Tower 2 | Office P204 & P205
The Greens | Dubai | UAE
Mob/WhatsApp: +971502793711
Tel: +971 4 347 6747
E-mail: events@cappmea.com
Web: www.cappmea.com
CAPP designates this activity for 14 CE Credits
Est. DHA 12 CME
[40] =>
DTMEA_No.5. Vol.9_DT.indd
Dentsply Sirona Endodontics
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prefers simplicity and confidence in their endodontic treatment - we’ve got the solution for you. Our
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Find out more about the endodontic solutions from Dentsply Sirona by contacting your local
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[41] =>
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Published in Dubai
www.dental-tribune.me
September-October | No. 5, Vol. 9
An exciting change
Comparison of the IPS d.SIGN and IPS Style ceramic systems
By Velimir Žujic, Croatia
Change is exciting – also in day-today dental lab work. The author
switched to using IPS Style layering
ceramic some time ago. Before he
started working with this ceramic
system, he thoroughly tested the
material and compared it to the
product he had previously used.
The main aim of switching to a new
ceramic system is to improve the
quality of one’s results. We regularly
used the fluorapatite-leucite glassceramic IPS d.SIGN® in our laboratory. Then, one day we asked ourselves
the following question: Would IPS
Style® (the first patented metal-ceramic material containing oxyapatite) offer a sound alternative to our
accustomed product? We decided to
test the new material on flat cobaltchromium alloy samples. These test
specimens enabled us to take a closer
look at the layering ceramic. We used
these base metal alloy samples (Colado CC) to examine and compare
several properties of IPS d.SIGN and
IPS Style: for example shade, brightness, shrinkage, fluorescence and dimensional stability.
Conditioning
and opaquer application
One specimen was oxidized at 950°C
with a holding time of one minute.
The other sample was treated with
a bonding agent. Two metal specimens with different bases were now
sufficiently prepared for the application of the ceramic materials.
Next, the samples were coated with
IPS d.SIGN Paste Opaquer and IPS
Style Ceram Powder Opaquer. The
opaquer products of both systems
have a smooth consistency. We had
never used an opaquer in powder
form before, so applying the IPS Style
material was completely new to us.
Nevertheless, we were impressed by
its ease of application and the excellent results.
Shrinkage behaviour
and shade effect
In the next step, we compared the
Dentin and Transpa T Neutral materials as well as the Opal Effect OE1
materials. Each of the ceramics was
applied to one of the metal samples.
A line was drawn down the middle
of the sample with a spatula for the
Fig. 1: Test samples showing shrinkage behaviour.
Left: Application of the ceramic on the metal sample. Centre: IPS d.SIGN Right: IPS Style
purpose of comparing the shrinkage
behaviour. The two different ceramics showed the same colour after
firing. It was interesting to note that
IPS Style exhibited less horizontal
shrinkage than IPS d.SIGN (Fig. 1). The
vertical shrinkage of both ceramics
was almost identical. The samples
were held next to each other and
examined under a polarizing light.
IPS Style was shown to be somewhat
brighter than IPS d.SIGN.
Both materials exhibited almost the
same level of fluorescence. In this
comparison IPS Style was at a slight
advantage because its Transpa T
Neutral and the Incisal materials displayed a more lifelike fluorescence.
Dimensional stability
and test results
The dimensional stability of the ceramics was clearly visible after the
first firing cycle. The IPS Style layers
successfully maintained their shape
after firing. In contrast, IPS d.SIGN
did not retain its shape completely.
After this test series, we felt that we
had gained enough information
about the new material for our purposes. Even though the tests were
relatively simple, they provided us
with valuable insights into the two
ceramic systems. Now we were ready
to compare the two materials on the
basis of an actual case study.
Case study
The patient was dissatisfied with the
appearance of her upper teeth (Fig.
2). She wanted a new tooth colour,
but wished the shape and position of
her teeth to be maintained as best as
possible. This simplified shade selection, since we “merely” had to select
Fig. 2: Initial situation. The patient wished to have the appearance of
her upper teeth enhanced.
Fig. 3: Teeth 15 to 25 were prepared.
Fig. 5: Comparison of the opaquer (left: IPS d.SIGN; right: IPS Style)
Fig. 6 & 7: Application of the ceramic margin using the Margin materials of the two ceramic systems (left: IPS d.SIGN; right: IPS Style)
Fig. 8 & 9: The ceramic materials were mixed with Liquid Visual Eyes for the purpose of visually comparing the two materials during the layering
proces (left: IPS d.SIGN; right: IPS Style)
Fig. 11: Adjustment of the incisal teeth with Transpa and Mamelon materials
(left: IPS d.SIGN; right: IPS Style)
ÿPage B2
Fig. 4: Printed model with SLM metal copings
Fig. 10: Comparison of the crowns after the first firing (left: IPS d.SIGN;
right: IPS Style)
Fig. 12: Application of Transpa Dentin, Transpa Incisal and Transpa Impulse for the
corrective firing cycle
Fig. 13: The two anterior crowns after the corrective
firing (left: IPS d.SIGN; right: IPS Style)
[42] =>
DTMEA_No.5. Vol.9_DT.indd
B2
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 5/2019
◊Page B1
Fig. 14: The final restoration (IPS d.SIGN) after the second corrective firing cycle
Fig. 15: The final restoration (IPS d.SIGN) after the second orrective firing cycle
us incredible flexibility and satisfies all our demands. Moreover, the
ceramic system is geared towards
modern manufacturing techniques:
At present, we use printed, milled
and conventionally cast metal to
fabricate the frameworks used in our
laboratory. The different fabrication
methods involve a wide range of
CTEs. IPS Style accommodates this
requirement and does not cause any
problems related to fracture during
firing. The ceramic is characterized
by minimal shrinkage and high dimensional stability.
IPS d.SIGN, however, shows less dimensional stability and therefore
does not perform as well in interdental areas and deep fissures. In this
respect, it is less predictable than IPS
Style. Nevertheless, the shade stability of IPS d.SIGN is comparable to
that of IPS Style. In terms of fluorescence, both materials equally meet
our criteria (Fig. 6). IPS Style Ceram
Incisal and IPS Style Ceram Transpa T
Neutral have a slightly more lifelike
fluorescence than the corresponding
IPS d.SIGN materials.
Fig. 16: In terms of fluorescence, both
materials met our criteria.
Fig. 17: The final choice fell on the IPS Style restorations: shown in the
mouth.
a slightly lighter tooth shade. Next,
the teeth 15 to 25 were prepared (Fig.
3). Then a digital impression of the
situation was taken with an intraoral
scanner. From the manufacturing
centre we were able to order both
printed models and selective laser
melting (SLM) metal copings. Both
the models and the copings were
produced simultaneously. This allowed us to start with the ceramic
application immediately (Fig. 4). The
restorations were built up on the
frameworks with the two ceramic
materials so that we could compare
IPS Style and IPS d.SIGN in the patient’s mouth. A detailed description
of the procedure involving the two
ceramics is provided below.
Preparation of the copings
First, the metal copings were oxidized according to the instructions
of the manufacturer and then the
opaquer was applied. The IPS d.SIGN
Paste Opaquer and the IPS Style
Ceram Powder Opaquer exhibited
excellent flow and masking properties (Fig. 5). Two firing cycles were
adequate for producing the desired
masking effect. The opaquer in paste
form was easy to apply, since the material is supplied ready for use from
the syringe. Depending on its application, the rather dense paste may
have to be diluted with some Paste
Opaquer Liquid.
The IPS Style Ceram Powder
Opaquer, however, is mixed to the
desired consistency with a matching
liquid component. The product is
easy to apply with a brush or a glassceramic or ceramic instrument.
Margin material was used to create
a shoulder, thereby enhancing the
aesthetic appearance of the restoration and establishing a tight seal to
the gingiva. The Margin materials of
the IPS Style and IPS d.SIGN systems
helped to create a beautiful margin
(Figs 6 and 7).
First firing
In order to make a visual comparison of the layers placed with the two
ceramics, the materials were mixed
with Liquid Visual Eyes (Harvest
Dental). The Visual Eyes Liquid is a
product that renders the colour of
the fired ceramic visible before the
material is actually fired (Figs 8 and
9). The basic dentin layer was created
with 25 % Cervical Transpa orangepink and 25 % Cervical Transpa khaki
mixed with 50 % Dentin B2. Unmixed Dentin material was used in
the central part. The incisal mamelons were produced with a mixture of
80 % Dentin B2 and 20 % Special In-
Fig. 18: The seated restorations (layered with IPS Style)
harmoniously blend into the overall natural oral environment.
cisal grey. In the horizontal cut-back
space, Effect material Inter Incisal
white-blue was applied. The incisal
margin was completed with Opal
Effect OE 1 and Transpa materials
(neutral, orange grey). The mamelons and internal characteristics were
created with a very fine separating
instrument. After the first firing, the
colours of IPS Style and IPS d.SIGN
looked good and appeared almost
identical (Fig. 10). IPS Style Ceram
and IPS d.SIGN Transpa as well as
Mamelon materials were used to
make some slight adjustments to
the shape of the anterior teeth. At
this stage, a comparison showed that
a few distal areas in the incisal edge
of the IPS d.SIGN restoration were
slightly more translucent.
Customisation of the layers
and second firing
After the first corrective firing cycle, the teeth were customized with
suitable IPS Ivocolor® stains. These
materials are used to characterise
restorations (e.g. mamelons), imitate
enamel cracks and adjust the colour
intensity and translucency of certain
areas. Subsequently, the stains were
fired.
In this case, a reddish hue was imparted to the incisal edge with IPS
Ivocolor Essence E21 basic red to
achieve a “lip gloss infiltrated” effect
in the dental enamel. For the second
firing, the crowns were coated with
Transpa Dentin, Transpa Incisal and
Transpa Impulse (Figs 11 to 13).
Comparison of the results
After the second corrective firing of
the different IPS Style Ceram Transpa
materials, we were convinced that
the product fulfilled all our criteria:
The dimensional and shade stability
of the ceramic was impressive. We
effectively controlled the brightness
of the material by adding Transpa T
neutral. All in all, we were completely
satisfied with the result. The colours
of IPS Style were lifelike and they
were identical to those of IPS d.SIGN.
A direct comparison clearly shows
the excellent colour coordination of
the different ceramic ranges (Figs 14
and 15). Furthermore, the same shade
system applies to the IPS e.max® allceramics and the SR Nexco® lightcuring laboratory composite.
Conclusion
In the end, the IPS Style solution had
a slight advantage. We chose it for
the final restoration because of its
beautiful tooth shapes and vital appearance in the mouth (Figs 17 and
18).
Acknowledgements
I would like to thank Dr Patricia Žujic
for her collaboration on this case and
Iris F., our patient, for her patience
during this project. I would also
like to thank all my colleagues and
friends from the TTT Group at Ivoclar Vivadent in Vienna. This group
provides us with incredible opportunities to exchange experiences and
new ideas.
About the author
Velimir Žujic
Privatni zubotenicki laboratorij
Franje Belulovica 15
51000 Rijeka, Croatia
velimir@indentalestetica.hr
Summary
IPS Style is definitely capable of replacing IPS d.SIGN, which we used in
our laboratory for quite some time. It
completely satisfied us in terms of its
shade and dimensional stability and
its high strength. This ceramic offers
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[43] =>
DTMEA_No.5. Vol.9_DT.indd
B3
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 5/2019
The new Multimat Cube from Dentsply Sirona:
powerful, user-friendly, reliable
By Dentsply Sirona
of the Multimat Cube press. Besides
the range of applications offered by
the Multimat Cube, it also offers the
possibility of processing pressable
ceramics. For example, this system
allows the user to press the popular
high-strength glass ceramic Celtra
Press using pre-installed programs,
and then to fire the veneering ceramic Celtra Ceram.
Working with the Multimat ceramic
furnaces has been a staple for dental
lab technicians worldwide for many
years due to their ease of use and reliable performance. Dentsply Sirona
is excited to introduce the Multimat
Cube and Multimat Cube press. Both
the Multimat Cube and Multimat
Cube press combine the classical virtues of previous models with modern comfort of the digital world.
First of all, the Multimat Cube and
Multimat Cube press deliver exactly
what every experienced dental technician expects of them. It is a universal furnace for all commercially
available dental ceramics, including
lithium silicate and lithium disilicate. A multi-stage heating program
and a two-stage cooling program,
together with the automatic resumption of the program after a
brief power cut, ensure a high level
of process reliability and guarantee
cutting-edge firing results.
Specifically, the intelligent pre-heating program and the reliability of
the restoration impresses users. A
mobile furnace chamber indepen-
Fig. 1: As a universal furnace for all commercially available dental ceramics, theMultimat Cube scores in the dental lab thanks
to its flexibility and process reliability.
dently balances out any vibrations.
The Multimat Cube represents quality “Made in Germany”, and it is also
approved according to international
standards (ETL). This abbreviation
stands for Edison Testing Laboratories, a renowned safety seal of approval that originates from the famous inventor, Thomas Edison.
Fig. 2: The new variation of the furnace, Multimat Cube press, is
also suitable for processing pressable ceramics – for example, for
the popular high-strength glass ceramic Celtra Press.
Besides the high level of performance and reliability, the operation
is also intuitive. It is operated via a
large, clear touch display. It has a
highquality, three-millimeter thick
tempered glass cover and guarantees clear access to the programs.
The system gives the dental lab
technician constant feedback on the
With their minimalistic design, both
of the new models are real eyecatchers when seen in the lab. Both the
Multimat Cube furnace and the Multimat Cube press pressing and firing
unit are recommended as reliable
options, which are robust in day-today operation and offer a high level
of user comfort.
current status of the firing process
via an LED indicator. Two USB ports
enable you to back up the data on a
USB stick.
The programs for ceramic systems
by Dentsply Sirona are pre-installed.
Performance, reliability and operating comfort are also integral features
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technician he gained a lot of experience in various commercial and in-office laboratories, where he got to
know all facets of dental technology.
Course Objectives
In this seminar and hands-on course, two highly aesthetic framework materials are combined with the same veneering ceramic.
Different procedures such as aesthetic veneering, cut-back technique or painting and glazing are demonstrated.
Every day new challenges arise for a dental technician. Different materials, depending on the indication, must have the same colour
in the final restoration.
Every dental technician knows from experience that the perfect shade selection is crucial for an aesthetically satisfying result.
Choosing the right framework material with the right translucency and colour saves time and extra work. This is important when
different preparation shapes have to be managed in parallel in the same jaw.
Refinements using the cut-back technique add extraordinary aesthetic value at low cost in terms of time and effort.
The aim of the workshop is to benefit from the speaker's experience in selecting the shade to accelerate lab processes by purposeful shade matching. Simple build-ups and staining with maximum effect, shapes and surface structures with little effort and the final
restoration with different materials and with different materials the same colours.
www.cappmea.com/dental-lab-aesthetics
[44] =>
DTMEA_No.5. Vol.9_DT.indd
B4
LAB TRIBUNE
Dental Tribune Middle East & Africa Edition | 5/2019
Successful collaboration between
Fraunhofer scientists and Dentsply Sirona
Award goes to ZLS researchers
By Dentsply Sirona
rial required subsequent process steps such as
crystallization firing (20-40 minutes).
The Fraunhofer-Gesellschaft (Fraunhofer), Munich, a globally recognized link between basic
research and applied sciences, awarded its renowned Joseph von Fraunhofer research prizes
on May 8, 2019. In the category "Technik für den
Menschen" [Human-Centered Technology], Dr.
Bernhard Durschang and Dr. Jörn Probst from
the ISC (Fraunhofer Institute for Silicate Research, Würzburg, www.isc.fraunhofer.de) won
the award with the prosthetic material ZLS
(zirconia-reinforced lithium silicate). A wealth
of ideas and successful collaboration with industrial partners, including Dentsply Sirona
Lab (formerly: DeguDent), contributed to the
success, but the main factor here was courage.
German Chancellor Dr. Angela Merkel did not
miss out on personally appearing at the awards
ceremony and making a welcome speech,
which included offering her congratulations
for the big anniversary (70 years of Fraunhofer). "The Fraunhofer Model is a shining
example of successful collaboration between
science and the economy," she said, outlining
in her speech a whole series of various fields
of innovation, from digitalization to artificial
intelligence and robotics, right through to battery cell production.
In the category "Technik für den Menschen"
[Human-Centered Technology], the Fraunhofer-Gesellschaft honored two researchers
A block for all cases
A handful of researchers did not want to accept
that the status quo that existed at that time is
the best option. Therefore, the joint efforts of
the Fraunhofer researchers and the industrial
companies involved (DeguDent, Vita Zahnfabrik) produced CAD/CAM blocks for all cases
(e.g., Celtra Duo) in 2013. This resulted in a combination of the beneficial properties of zirconia
and lithium disilicate. After grinding, the (single tooth) restoration could be inserted immediately (e.g., for inlays, onlays, partial crowns)
or it could be glaze fired to give it the strength
of lithium disilicate (e.g., crowns), now going
clearly beyond this.
Fig. 1: High-strength glass ceramics have been developed with vast detailed knowledge, a new analysis method,
and great courage – the pressable zirconia-reinforced lithium silicate Celtra Press from Dentsply Sirona Lab in
A1, A2 and A3, in B1, B3, C1, C3 and D2 and D3 as well as in B3, C3 and D3, each available in MT (medium
translucency) and LT (low translucency). MO1 and MO2 (medium opacity) are available to cover discolored or
devitalized stumps.
who developed a new material for prosthetic
restorations in collaboration with the industry.
The high level of effort with which the partner
Dentsply Sirona carries out its research and
development paid off. Dentsply Sirona's investments in this field amount to around 150
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million dollars each year. This results in a multitude of innovations in the digital and analog
fields of dentistry. The high number of equally
competent and motivated employees in the
various research departments secures the
company's leading role and makes it the partner of choice for universities and other scientific institutes. "The project to develop ZLS shows
an outstanding example of these successful
collaborations," said Dr. Markus Vollmann, Research & Development at Dentsply Sirona Lab.
Why did it need such a high level of courage?
Quite simply because the researchers attempted something that was supposedly physically
impossible. Until six years ago, glass ceramics
were considered to be exhausted for use in
dentistry. People were more or less resigned to
this fact: Zirconia ceramics for structures with
high strength (e.g., posterior bridges) and glass
ceramics for beautiful, high translucency, but
with considerable limitations regarding the
indication.
If you explore the topic further, until six years
ago there were two types of glass ceramics
available on the market: The conventional
variant was able to be integrated directly after
milling. The high-strength lithium disilicate,
however, stood out due to its higher strength
and its ability to (non-adhesively) bond with
glass ionomer cement. However, this mate-
Furthermore, pressable ZLS (e.g., Celtra Press,
Dentsply Sirona Lab) is now available. Dental
technicians value it for both its esthetics and its
higher strength. It even allows three-unit bridges in the anterior tooth region up to the second
premolar as the terminal abutment.
An essential requirement: The course of development enabled the microstructure and surface quality of high-strength glass ceramics to
be significantly improved. This allowed fields
to be explored such as those that – putting it
mildly – no-one had ever thought possible.
Complete analytical method
specifically for ZLS research
At the industrial partner Dentsply Sirona Lab
(or DeguDent), the material testing team developed a number of things including a new
method specifically for the analysis of crystal
distributions and densities. This does not require the usual etching of the test specimen.
Differential thermal analysis (DTA) was also
used. This helped to clarify how the structure
behaves at different temperatures, where
phase transitions occur, and how they affect
the manufacturing process. Even the researcher group was amazed by how well its ZLS could
ultimately be milled in the machine, e.g., the
inLab MC XL (Dentsply Sirona Lab), in its final,
crystallized (tooth-colored) state.
Since then, zirconia-reinforced lithium silicate has become a key all-ceramic material as
it enables the dental technician to make firstclass restorations quickly and safely, impressing both dentists and patients. The result can
always be predicted well, just like the effort
required for it.
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in dentistry!
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Tribune Group GmbH is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA
CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Tribune Group GmbH designates this activity for one continuing education credit.
Fig. 2: Celtra Ceram: A highly versatile veneering system specifically for all-ceramic frameworks made of materials such as lithium silicate and zirconia.
[45] =>
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Published in Dubai
www.dental-tribune.me
September-October | No. 5, Vol. 9
Study determines reasons
for dental implant failure and
removal techniques
ZURICH, Switzerland: Dental implants have become a great treatment option to replace missing
teeth, and various treatment concepts have reported high success
rates. Nevertheless, like in every
medical procedure, biological complications can occur which may
lead to complete implant failure
and, consequently, in the worstcase scenario, to the removal of
the implant. A recent study by researchers from the University of
Zurich has revisited the reasons for
implant failure and compared different removal techniques.
A literature search included 28
studies which had been conducted
up to 2018. The studies assessed
titanium implant failure, removal
techniques and the reinsertion of
implants in a previously failed site.
The research team identified different categories of factors causing
implant failure. Biological factors
include peri-implantitis and failure to attain or to maintain osseointegration. Implant fracture is
an example of a mechanical factor.
Medical errors causing implant failure include bone overheating, site
contamination and malpositioning. Functional reasons for implant
failure include design of prosthesis
and functional overload.
The researchers found that early
implant failure is normally caused
by the lack of attaining or maintaining osseointegration, or bone
overheating or site contamination.
Late implant failure is triggered by
implant fractures, malpositioned
implants and progressive peri-implantitis. The last causes 81.9% of
late implant failures. Early implant
failure results in implants that are
normally mobile and easy to remove. Late implant failure means
the implants can be at least partly
osseointegrated and, therefore,
more difficult to remove.
As options for implant removal, the
study determined tooth extraction,
trephine burs, piezo-surgery, laser
surgery, the counter-torque ratchet
technique (CTRT) and electrosurgery. Even though trephine burs
seem to be the best-known method for implant removal, the CTRT
method, alone or combined, should
be the first choice for the clinician
because of its low invasiveness.
Furthermore, the research team
found that implantation in previously failed sites, irrespective of
early or late failure, results in a 71–
100% survival rate over five years.
© Kasama Kanpittaya/Shutterstock
By DTI
According to a recent study, peri-implantitis is currently the main reason for dental implant failure.
Regarding zirconia implant removal, little data is available. Because
of zirconia’s physical properties,
it is supposed that these implants
require a different approach to removal compared with titanium
implants.
“If removal is required, interven-
AD
tions should be based on considerations regarding minimally invasive
access and management as well
as predictable healing. (Post) Operative considerations should primarily depend on the defect type
and the consecutive implantation
plans,” concluded the authors in
their paper.
The study, titled “Removal of failed
dental implants revisited: Questions
and answers”, was published online
in Clinical and Experimental Dental
Research on 21 August 2019, ahead
of inclusion in an issue.
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[46] =>
DTMEA_No.5. Vol.9_DT.indd
C2
IMPLANT TRIBUNE
Dental Tribune Middle East & Africa Edition | 5/2019
An intelligent treatment concept for
the implant-supported individual tooth crown
By Dr Oliver Schubert, Germany
For good healing success and predictable gingiva management during implantation, the soft tissue
needs as much rest as possible. Gingiva formers, which also act as a scan
body, provide the opportunity to
perform a scan without disturbing
the healing process. In this case, Dr.
Oliver Schubert, M.Sc. (Munich, Germany), shows how he implements
such a process. He also explains why
he uses a hybrid ceramic blank (VITA
ENAMIC IS, VITA Zahnfabrik, Bad
Säckingen, Germany) with an integrated interface to a titanium base.
He shows how the abutment crown
made of hybrid ceramic directly
after the removal of the gingiva former supports the final shaping of the
emergence profile.
1. The patient case
A 55-year-old female patient presented with complaints regarding tooth
26. After careful clinical and radiographic diagnosis, the molar proved
unsustainable. After extraction, the
gap was to be closed with an implant
and a monolithic abutment crown
made of VITA ENAMIC IS.
Due to the dual network structure of
the polymer-infiltrated feldspar ceramic, the material shows a comparatively high elasticity, which allows
the material to absorb masticatory
forces. This property could be very
beneficial in the long run for restorations on rigidly anchored implants.
In addition, laboratory tests show
that microcracks caused by a potential point overload can be stopped,
thanks to the integrated polymer
structure, which minimizes fracture
risk.
At the patient’s request, the restoration of the previously root canaltreated tooth 25 was to be done later.
2. Implantation and scan
After bone-sparing extraction and
sixteen weeks of healing, the gap in
the edentulous space should be restored with the 3i T3 Tapered implant
(Zimmer Biomet, Warsaw, USA). After the formation of a full flap, the
bone bed was prepared accordingly
and the implant inserted and aligned
with the prosthetic, so a primary stability of 35 Ncm could be achieved.
Subsequently, the two-part, scannable gingiva former BellaTek Encode
(Zimmer Biomet, Warsaw, USA) was
fixed on the implant and the wound
area was fixed with microsurgical
sutures.
Eight weeks after implant insertion,
the intra-oral scan of the gingiva
former and the digital implant impression were performed. With its
specific notches on the surface, the
screwed-in and left-in gingiva former now also served as a scanbody.
The upper and lower jaws were digitized using the 3M True Definition
Scanner (3M, Seefeld, Germany).
3. Fabrication and
integration
The scan data was transmitted to
the Zfx Süd milling center (Munich,
Germany) and downloaded there as
an STL dataset. Then the scan record
of the gingiva former was decrypted
with the Zfx Application Manager.
This automatically reduces the gingiva former, and the shape of the
emergence profile is displayed in
the CAD software. The abutment
crown made of VITA ENAMIC IS has
now been designed virtually with an
idealized emergence profile. After
CAM-based manufacturing, the hybrid ceramic abutment crown was
bonded to the industrially produced
titanium base. Immediately after
unscrewing the gingiva former, the
abutment crown could be screwed
in to immediately support the soft
tissue and provide it with its final
shape. The screw channel was finally
closed by Teflon tape and composite.
VITA® and other VITA products mentioned are registered trademarks of
VITA Zahnfabrik H. Rauter GmbH &
Co. KG, Bad Säckingen, Germany.
About the author
Dr Oliver Schubert
M.Sc., Munich, Germany
Fig. 1: Initial situation following the extraction of
tooth 26 and healing phase.
Fig. 2: The vestibular ridge after the bone-sparing
extraction.
Fig. 3: The exposure of the alveolar ridge using
full-flap formation.
Fig. 4: The implant is inserted into the prepared
bone bed.
Fig. 5: The gingiva former was screwed on, and the
surgical area was microsurgically sutured.
Fig. 6: The gingiva former BellaTek Encode after eight
weeks.
Fig. 7: With its specific notches, the gingiva former
also acted as a scanbody.
Fig. 8: The clinical situation in the CAD software
digitized with the 3M True Definition Scanner. The
implant is inserted into the prepared bone bed.
Fig. 9: The virtual titanium base as interface between
implant and hybrid ceramic abutment crown.
Fig. 10: The titanium-based abutment crown constructed from VITA ENAMIC IS.
Fig. 11: The components of the superstructure,
consisting of abutment crown, titanium base and
screw.
Fig. 12: The abutment crown made of VITA
ENAMIC IS glued to the titanium base.
Fig. 13: The emergence profile after unscrewing the
gingiva former.
Fig. 14: The abutment crown with open screw channel that was screwed in immediately afterwards.
Fig. 15: After the closure of the screw channel
with composite, this is no longer visible.
Fig. 16: Result: A check-up after a few weeks
showed excellent soft tissue conditions.
[47] =>
DTMEA_No.5. Vol.9_DT.indd
Dental Tribune Middle East & Africa Edition | 5/2019
C3
IMPLANT TRIBUNE
Prevention 0: The best way
to prevent peri-implant disease?
Figs. 1a & b: Implant in position #14 affected by peri-implantitis: peri-implant probing a) with the prosthetic crown in
situ and b) after prosthetic crown removal.
By Prof. Magda Mensi, Timothy Ives
& Dr Gianluca Garzetti, Italy
In dentistry, periodontitis is one of
the major chronic non-communicable diseases. World experts in periodontics and science have published
several principles regarding the prevention of periodontal diseases.2
by inflammation in the peri-implant
mucosa and subsequent progressive
loss of supporting bone.3 The main
reasons for concerns in this area
are an aetiology in which several
risk factors can play a determining
role4 and a lack of a gold standard
therapy. Primary and secondary
preventative measures are really
important to prevent mucositis and
peri-implantitis and to avoid recurrences, but there are many details to
consider before placing implants to
mitigate iatrogenic problems. There
are many different prosthetic solutions besides implants that dental
professionals could propose to patients if consideration is given from
the beginning to the entire situation.
Implants may not always be in the
best interest of the patient.
Peri-implantitis is a twenty-firstcentury version of periodontitis and
increasing in occurrence as implant
placement is increasing (Figs. 1–3).
Like periodontitis, it is a biofilm-associated pathological condition, but
instead of affecting periodontal ligaments and bone, it is characterised
For these reasons, every clinician,
before placing an implant, should
consider not only patient- and sitespecific aspects, but also surgeon,
prosthodontist, dental hygienist
and dental technician skills in order
to minimise the possibility of periimplantitis in the future.
The philosophy of prevention in all
medical professions is increasing
from a global perspective. In fact,
prevention of chronic non-communicable diseases, the major burden
of illness and disability in almost
all countries in the world, has been
strengthened in recent years.1 The
motivation is to ensure a better quality of life for people and to reduce
public health expenditures.
Fig. 2: Radiographic examination of the
implant
The following should be considered
before primary and secondary prevention, and it is the proposal of the
au- thors that this approach be called
“Prevention 0”.
Patient-specific
considerations
When deciding to rehabilitate a patient with dental implants, before
surgical planning, we have to carefully inform the patient about the characteristics of this procedure. It is important to underline that personal
daily maintenance at home and appropriate compliance regarding follow-up controls and dental hygiene
therapies are effective preventative
measures.5 Procedure awareness and
compliance are the foundation for
success, but the clinician must also
inform the patient about the impact
of systemic disorders (osteogenesis
imperfecta, ectodermal dysplasia,
diabetes), medications (bisphos phonates), therapies (radiotherapy in the
jawbone), habits (smoking, poor biofilm control) and a history of aggressive periodontitis6 as being relevant
risk factors for peri-implant disease.7
Fig. 3: Excess resin cement around the implant.
Site-specific considerations
The healing process after tooth loss
leads to a variable reduction of the
alveolar process, inducing hard- and
soft-tissue deficiencies. The clinician must evaluate carefully all sites
exposed to the following factors,
because they have the potential for
major healing deficiencies: loss of
periodontal support, endodontic infections, longitudinal root fractures,
thin buccal bone plates, buccal/
lingual tooth position in relation to
the arch, extraction with additional
trauma to the tissue, injury, pneumatisation of the maxillary sinus,
medications and systemic diseases
reducing the amount of naturally
formed bone, agenesis of teeth and
pressure from soft-tissue-supported
removable prostheses.
Other site considerations relate to
anatomical knowledge and in respect
to the suitable anatomical structure
of the area (maxillary sinus, inferior
alveolar nerve), endodontic and periodontal health of adjacent teeth, and
patient phenotype. According to
Linkevicius et al. there is significant
Figs. 4a–c: Peri-implant home care with a) AirFloss (Philips), b) X-Floss (ROEN) and c) interdental brush (TePe).
Figs. 5a–c: Professional peri-implant biofilm removal by a) AIRFLOW with erythritol powder (PLUS powder, EMS), b) PERIOFLOW with PLUS powder and c) with PEEK tip (PI, EMS).
evidence that thin soft tissue leads to
increased marginal bone loss compared with thick soft tissue around
implants.3,8 Lack of bone has led to
the development of various alternative surgical techniques to avoid
large bone regenerations or grafts,
such as short implants, tilted implants, pterygoid implants and palatal implant mesh, with questionable
results, but definitely decreasing the
cleanability and maintainability of
implants and prostheses.
Dental hygienist skills
and devices
This professional figure plays a key
role in disease prevention and oral
health promotion.9 Dental hygienists should not limit their activities
to being an oral cleaner, but act as
the patient’s dental coach or personal oral trainer, motivating patients
not only in dental habits but also
in lifestyle, for example regarding
smoking cessation and diet. This is
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a friendly expert who strengthens
patient fidelity to the dental office,
even in fearful patients, and maintains restorative work and rehabilitations undertaken by the dentist.10
To perform professional care in a
minimally invasive way, wearing
loupes and using plaque disclosing agents and appropriate devices
are mandatory, especially if prosthetic rehabilitation is difficult for
the patient to maintain. Correct and
periodic biofilm removal should
be considered the standard of care
for prevention and management of
peri-implant disease.11 For this reason, patients should be motivated
and instructed in daily implant
maintenance, which should begin
before implant placement and be
continued after treatment within a
regular, personalised recall regime
(Figs. 4 & 5).
Surgeon skills
Nowadays, especially in Italy, a new
professional figure has appeared:
the implantologist, who is a graduate dentist, generally a co-worker,
and goes to different dental offices or
clinics and mainly places implants,
often without sufficient expertise
in periodontal and prosthetic fields.
That means, in some cases, implant
mispositioning, resulting in reconstructive and maintenance problems. In order to avoid fabrication of
specific prosthetic parts, unrestored
implants and surgical interventions
to remove or reposition them in favourable prosthetic positions, this
surgical intervention should only
be performed by an elite clinician.7
This is an expert dentist with the
necessary surgical skills to manage
both soft and hard tissue (before and
after implant placement) perfectly
and with adequate expertise in the
prosthetic field to allow a prothesisguided implant surgery and, subsequently, a functioning, not overloaded, patient-tailored, cleanable and
aesthetically pleasant rehabilitation.
Prosthodontist skills
Fig. 6: Improper planning led to poor performance
Fig. 7: Careful removal of excess cement after prosthesis
cementation using a PEEK tip (PI)
Fig. 8: Careful removal of excess cement with dental floss
after prosthesis cementation
Dentsply Sirona does not waive any right to its trademarks by not using the symbols ® or ™. 32670635-USX-1612 © 2016 Dentsply Sirona. All rights reserved.
AD
Astra Tech Implant System®
Simplicity without
compromise
Prosthesis fabrication
and cementation
Dental technicians should work in
direct contact with prosthodontists
in order to create aesthetically pleasant, patient-tailored and comfortable cleaning spaces. After dental
hygienist instruction and training,
patients should be able to clean their
prostheses daily with minimal effort to maintain healthy mouths.13
Another important factor associated
with clinical signs of peri-implant
disease is excess cement.14–17 To avoid
excess cement, restoration margins
should be located at or above the
peri-implant mucosal margin; otherwise, excess cement must to be
removed.18
Despite world literature demonstrating an increased interest in excess
cement as one of the key factors in
aetio-pathogenesis of peri-implant
disease, a standard protocol guiding
clinicians in this delicate removal
procedure is still needed. From the
authors’ point of view, the cementation procedure requires time, attention, loupes and meticulousness. For
these reasons, an accurate protocol,
dependent on cement composition,
should be published (Figs. 7 & 8).
Conclusion
The design philosophy of the Astra Tech Implant System EV is based on the natural
dentition and supported by flexible surgical protocol and a simple prosthetic workflow
for increased confidence and satisfaction for all members of the treatment team.
Implant rehabilitation provides a
therapeutic alternative that is more
similar to natural teeth than other
alternatives. Nevertheless, while an
implant-supported prosthesis can
be a permanent successful solution,
it lasts only if carefully planned with
the patient, properly surgically performed, correctly loaded, and constantly maintained by the patient
and the dental professionals. Successful results can be achieved only
by an expert, patient-centred dental
team.
– Unique interface with one-position-only placement
for Atlantis patient-specific abutments
– Self-guiding impression components
– Versatile implant designs
– Flexible drilling protocol
The foundation of this evolutionary step remains the unique
Astra Tech Implant System BioManagement Complex.
www.dentsplysirona.com
32670635-USX-1612_ad_ATIS EV_Simplicity without compromise.indd 1
Skilled clinicians know that there
is no such thing as a gold standard
prosthesis, but every patient needs
a tailored rehabilitation, which takes
into consideration his or her resources and requirements and which has
to be planned before surgical intervention. After data collection and
decision planning regarding the
numbers of implants requested, Toronto versus overdenture, cemented
versus screwed work, with a motivated and aware patient, the surgical and prosthetic work with careful
load management can start.12 Only
careful and considerate planning can
prevent poor outcomes (Fig. 6).
Editorial note:
This article was originally published
in implants-international magazine
of oral implantology, Issue 4/2018.
2017-05-19 13:41
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September-October | No. 5, Vol. 9
Interview: I try to think of solutions for
common problems
Dr Luis Carrière is the inventor of
both the Carriere SLX Self-Ligating
Bracket System and the Carriere
Motion 3D Appliance. He travels the
world teaching at several universities and lecturing internationally
on these products and orthodontic
topics. Carrière maintains a private
practice in Barcelona in Spain. During the 2019 Annual Session of the
American Association of Orthodontists in Los Angeles in the US, Carrière
presented three new products developed through his collaboration with
Henry Schein.
Dr Carrière, when we met last year
at the European Aligner Society
congress, we talked about the ability of clear aligners to speed up the
treatment process. You are now
presenting new products, the Carriere SLX 3D Bracket System, the
Carriere M-Series Wires and the
SLX Clear Aligner System. Do these
new products help to speed up the
process?
I feel that one of the most important trends in orthodontics today is
the provision of premium quality.
Nowadays, more and more companies are producing aligners and selling them directly to the consumer,
bypassing the orthodontist. This is
of course jeopardising how an orthodontic treatment should take place,
one in which the patient is protected
at every level of treatment.
Orthodontic treatment is not only
about aligning teeth and establishing good occlusion. Teeth are connected to the patient by bone, being anchored in the maxilla and the
mandible. If the relation of the mandible and maxilla is incorrect, the
temporomandibular joint structure
is disrupted, which will affect the patient in many ways, including clicking, pain and airway obstruction and
the subsequent effects on well-being,
life expectancy, etc. The expertise of
a specialist is therefore vital.
The Motion appliance adopts the
Sagittal First philosophy. Solving the
sagittal problem will make it easier
and simpler to finish a case. If we additionally use self-ligating high-end
brackets combined with a smooth
and steady archwire sequence that
load physiologically friendly forces,
we will be able to avoid compression
of the blood vessels, which would
diminish the blood flow in the area
of movement. We start 95% of our
cases with Sagittal First to adjust the
sagittal condition, then switch to the
new Carriere SLX 3D Bracket System
or aligners. This combination is intended to simplify the overall orthodontic procedure.
Henry Schein now has its own
aligner system, right?
Yes, the SLX Clear Aligner System,
which reduces and can even eliminate the need for attachments in
most cases. Attachments can still be
placed if the dentist feels more comfortable placing them, but they are
not necessary.
Starting treatment with the Motion appliance for both approaches,
brackets or aligners, will give the patient the option to decide whether
he or she wants brackets or aligners
right after the sagittal correction.
Isn’t the orthodontist in a better
position to decide which is better,
brackets or aligners?
It used to be so, but using the Motion appliance to convert every case
to a Class I posterior occlusion at the
beginning of treatment makes it possible for every case to be treated with
either brackets or aligners. We have
solved the majority of complexities
that previously prevented treatment
with aligners. Therefore, the patient
has the choice of treatment.
Wouldn’t most patients more likely be drawn to aligners? Is there
thus any point in offering brackets,
besides perhaps lower cost?
The SLX 3D brackets come with a
new wire sequence, the M-Series
Wires with the innovative 3-Wire Sequence. The sequence is designed to
enable a simplified wire progression
protocol, to reduce the number of
wires used and finish cases in about
12 months in total, including the Motion stage.
After the Motion process, there are
three options for the next step in
treatment: the SLX 3D metal bracket,
which is less expensive, the SLX 3D
clear bracket or the SLX Clear Aligner
System. We do not charge more for
aligners versus clear SLX 3D brackets;
we don’t even do so when we start
with the Motion appliance. The motivation for choosing brackets over
aligners is that the new Carriere SLX
3D bracket together with the M-Wire
Sequence makes the treatment very
fast and efficient. Many patients
choose brackets because the treatment is indeed so effective. It is just
amazing how drastically you can cut
the treatment time with an organised protocol and the appropriate
tools.
If one uses the Motion system, do
you still see a need for acceleration
devices?
To me, one of the most interesting
aspects of using the Motion appliance is that once you have succeeded
in obtaining a Class I occlusion, there
is a space between the incisors. So,
when we use aligners, we can change
them every five days instead of every
ten. It is therefore not really necessary to use acceleration devices. If
we have a patient who is really in a
© Luca Scalzo
By Nathalie Schüller, DTI
Dr Luis Carrière.
hurry and wants to be treated to get
results as fast as possible, then we
use an accelerator, an alternative to
switching aligners more often. Personally, unless we have such a patient, I don’t find it necessary to use
acceleration devices, but it is nice to
offer the patient all the possibilities
and alternatives available.
Do you think many orthodontists
use the Motion appliance or a similar system to correct malocclusion?
As an example, there are 9,000 orthodontists in the US, over half of
whom have used the Carriere Motion 3D Appliance, totalling an actual
market share of 42%. Today, Motion
3D is the leading Class II and Class III
appliance.
What is the Happiness Revolution?
The Happiness Revolution views
treatment as balancing the patient’s
face, its beauty, pain related to a
sore joint when it is not in the correct position, the patient’s airway for
better breathing and of course the
dentition. If you consider all of these
aspects to find a balance when treating a patient, you will have not only
a shorter, smoother treatment but a
happy patient too.
What about airway and breathing
problems? Are these related to certain classes of malocclusion?
These problems require multidisciplinary treatment. An orthodontic
treatment can be a solution for certain functional and skeletal obstruction problems, such as problems
due to anatomical components or
maxillary-mandibular relation, but
other reasons—like the tonicity of
the airway musculature, fat around
the airway and soft-tissue anatomical deformities—will also narrow the
airway. Other medical specialties will
have to act at those levels. Therefore,
the orthodontist has to take care
of the part he or she is responsible
for and find the best solution to obstruction problems. I believe that the
treatment of obstructed airway will
soon be driven by multidisciplinary
teams in which the orthodontist will
have a very important role.
What motivates you to come up
with new products? Maybe the
knowledge of something that is
lacking, your drive, a need to always challenge yourself?
I love orthodontics. I love to be able
to find solutions to help improve the
lives of patients or colleagues. I have
some ability in identifying new concepts, and I have a passion for creating new things. I see a problem and
think about it until I identify a possible solution. I try to think of solutions for common problems and not
only in the orthodontic field. To me,
it is enjoyable.
Do you have anything in preparation for a new Carriere revolution?
All the time, we always have something on the back burner. Innovation
is at the core of Henry Schein, and
we are committed to innovating as
much as possible. What drives our
innovations is the goal to simplify,
to minimise the complexity of the
orthodontic treatment and to try to
obtain predictable treatment results.
Our objective is to be successful in
solving not only the dental problem
we are trying to address but also related problems.
Thank you very much for the
interview.
AD
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Widening the scope
of aligner application: A case report
By Drs Gurkeerat Singh, Sherif
Kandil & Aswathy Menon, India &
Germany
Over the last two decades, extensive
research has been carried out to alleviate the two major shortcomings of
orthodontic treatment: visibility and
duration.
In order to decrease treatment duration, three methods have been
proposed: chemical-led interactions,
surgery, and device-assisted therapies.2 The chemical-led interactions
require further research to be accepted as routine methods and the surgical methods are found to be invasive
and rarely acceptable to the patient.
A simpler and less invasive method
is the use of micro-osteoperforation,
which increases the local inflammatory response, promotes osteoclastogenesis and leads to faster tooth
movement through the bone.3 This
process has been proven to be safe
and repeatable and well tolerated and
accepted by patients.4
Deepbites are difficult to treat using
aligners and often lead to prolonged
treatment time.5 To facilitate this
movement, Invisalign uses attachments on the premolars for anchorage, while an active intrusive force is
placed on the incisors as well as bite
ramps built into the lingual of the
Fig. 1a-e
aligner of the upper anterior teeth
that act as a bite plane; as yet no data
exist on the effectiveness of these
auxiliaries5. Active intrusion can be
facilitated with TADs.5
Even though aligners might be the
most aesthetic, hygienic, as well as acceptable treatment modalities available with the orthodontist, a decrease
in treatment time is often desired
by the adult patient. A case report is
presented with the combined shortterm use of bonded appliances, TADs
combined with clear aligners from K
Line Europe GmbH, Düsseldorf, Germany (K Clear) for an aesthetically
conscious patient.
Case report
A 24-year-old male patient presented
to the practice with a chief complaint of overlapping front teeth. As a
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Fig. 1f-h
Fig. 2a-d
Fig. 3a-d
Fig. 4a-d
model he wanted to avoid the use of
bonded appliances. On examination,
he presented with Class II features
with the maxillary lateral incisors labially inclined and palatally inclined,
supraerupted maxillary central incisors with a resultant 100 % deep bite
(Figs. 1a–h). He had an impacted mandibular incisor along with another
incisor congenitally missing. The patient insisted on getting only the upper arch treated in the shortest time
possible with an aesthetic appliance,
as he had a modelling assignment
starting in 4 months!
Fig. 5a-b
Fig. 6a-d
Treatment procedure
Keeping the patient’s professional
commitments and the limitation of
aligner therapy in mind it was decided to place a fixed bonded appliance
for a short duration, along with TADs
placed between the maxillary central
and lateral incisors bilaterally for intrusion of anterior teeth (Figs. 2a–d).
Force systems to achieve intrusion
of the incisors to be in force from day
1 for a duration of 3–4 months (Figs.
3a–d) and subsequently to shift him
to K Clear for residual bite opening,
space closure and final finishing. Attachments on the maxillary first molar and premolars, bilaterally were
provided to provide better retention
to the aligners. The K Clear aligners
were placed for 5 months (Figs. 4a–d).
At the end of active treatment, retainer was bonded from canine to canine
in upper arch (Figs. 5a & b). Additionally, the patient was provided an Essix retainer for night time wear. The
patient is in retention for the past 1
year and the occlusion as well as other movements achieved are stable
(Figs. 6a–d).
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Fig. 7a
Fig. 7b
Discussion
The presented case involves three
major aspects of orthodontic treatment, from a patient’s perspective,
aesthetics and duration of active
treatment and, from a clinician’s
perspective, the control of planned
tooth movement. Any clinician who
has had the opportunity to work
with traditional pre-adjusted appliances as well as aligners understands
the pros and cons of both appliance
Fig. 7c
systems. It is this recognition of
limitations that propels us as clinicians to seek better appliances in
order to deliver treatment results in
the best interest of our patients. The
aim of orthodontic therapy ought
to include words such as ‘in the least
amount of time’. It has been postulated by Nicozisis6 that aligners can
be changed as frequently as 3–4 days
when micro-osteoperforations are
used along with aligner therapy to in-
AD
itiate the RAP phenomenon. The use
of TADs not only provides the means
of stable anchorage to apply forces
from an ideal location avoiding any
untoward movement, but also cause
a local insult leading to an inflammatory response.
This case was started with a preadjusted bonded appliance along
with the use of TADs placed close to
the teeth requiring intrusion. When
used in this manner, the flexible NiTi
wires cause alignment and the vertical forces generated lead to intrusion
and flaring of the incisor teeth. Since
TADs also cause trauma, a RAP phenomenon is generated, which causes
an increase in the rate of tooth movement. The bite opening led to the
increase in the upper incisor to NA
from 12 degrees to 22 degrees (Figs.
7a & b). This led to minor spacing appearing between the anteriors. Clear
aligners have been shown to provide
good control where tipping movements are used5 and such controlled
movements led to a near ideal finish
for this case. The K Clear appliance
was selected in this case based upon
the variable thickness used to achieve
different movements in a predictable
manner and our experience with it.
A bonded retainer is a must
for all adult cases.
A 0.175 coaxial wire was used for
this purpose and bonded to all incisors individually. Retroclined incisors
have a high tendency to relapse, especially when not supported by the
mandibular incisors, hence the night
time use of a K Clear retainer. The settling in this case was excellent and
that sometimes is one of the pit falls
of treating cases with aligners5.
Conclusion
Creating the ideal smile
in the best possible way
An appliance that satisfies the aesthetic needs of the patient and also
the orthodontic goals of the treating
clinician in a short duration should
be chosen to treat patients. Customisation is the new in thing in orthodontics.
For better, safer, faster orthodontic care.
Editorial note:
This article was originally published
in ortho-international magazine of
orthodontics, Issue 1/2017
When it comes to orthodontics, each patient is a unique case. Creating
their ideal smile means balancing many variables, including treatment
eff ectiveness, visibility, and time. Our range of innovative solutions,
spanning from traditional to low visibility braces, provides the options dental
professionals need.
About the author
For more information, please contact your Dentsply Sirona representative,
or visit dentsplysirona.com/Orthodontics
Dr Gurkeerat Singh
Prof. and Head, Sudha Rustagi College of
Dental Sciences and Research Faridabad
Haryana, India
drgurkeeratsingh@gmail.com
Dr Sherif Kandil
Orthodontic Consultant, K Line Europe
GmbH,
Düsseldorf, Germany
s.kandil@kline-europe.de
Dr Sherif Kandil
Orthodontic Consultant, Digital 32 Dental Solutions
Pvt Ltd, Molar bandh, New Delhi-110076,
India
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September-October | No. 5, Vol. 9
Interview: “Naturally occurring substances
will find their place in oral health”
By Kasper Mussche, DTI
A graduate of the specialisation programme in
periodontics at the University of Zurich in Switzerland, Dr Alex Solderer mostly treats severe
cases of periodontitis in his daily routine. In
addition, he conducts research on periodontal
and dental implant topics. In his latest research
paper, Dr Solderer conducted a systematic review of the efficacy of chlorhexidine rinsing
after periodontal or implant surgery.
Dr Solderer, chlorhexidine is considered the
gold standard for oral antiseptics. In your experience, would you agree with this?
Yes, I would. Just with regard to the literature
alone, a search for chlorhexidine on PubMed
yields 10,000 results. It is clearly the best-docu-
AD
mented oral antiseptic you can find. Every new
antibacterial rinse is and has to be compared
with chlorhexidine.
After writing your review, what is your conclusion about chlorhexidine’s efficacy after
surgery?
Well, after surgery, patients should not brush
the teeth in the operation area until the stitches have been removed. Until then, chlorhexidine works like a “chemical toothbrush” in this
area. Formation of plaque and gingival inflammation can be successfully suppressed. From
the point at which normal oral hygiene can be
re-established, I do not see any indication that
the patient should continue to rinse with chlorhexidine.
Chlorhexidine is good at reducing biofilm,
plaque and inflammation, but your paper
says it has no effect on periodontal pocket
depth.
Only mechanical therapy, such as scaling,
root planing and periodontal surgery, can reduce pockets, as these procedures include the
removal of the aetiological factors for periodontal pockets: biofilm and biofilm retention
structures, such as calculus. Oral antiseptics
should always be seen only as an adjunctive
therapy.
Chlorhexidine has a number of side effects,
such as tooth discoloration and taste disturbances. It also tastes unpleasant. Have
you had any problems because of this when
treating patients?
Patients who come to me for treatment normally have severe periodontal issues and are
aware of them. After informing patients thoroughly on their oral health and disease, the
benefits of chlorhexidine therapy and its temporary side effects, they generally do not complain about taste and discoloration. Patients do
not like the side effects, but owing to their temporary character, they normally accept them.
However, in a few cases, patients suffer from
mouth burning, and then we have to stop the
rinsing therapy. I never prescribe a chlorhexidine rinse for longer than two weeks, as side
effects begin to increase after this period. After
termination of the prescribed rinsing time, I always schedule an appointment for removal of
the discoloration.
What is the importance of compliance during periodontal treatment?
Patient compliance—especially correct oral
hygiene at home—is crucial. In my opinion, it
makes no sense to start periodontal treatment
before adequate oral hygiene has been established. In a university department, this might
work more easily than in a private practice. We
work with plaque-disclosing methods to reveal
biofilm and that helps patients to visualise
their problem areas and to know where brushing is particularly important.
In other words, the key factor is to educate
patients. This also includes instructing the patient how long, how often and in what manner the rinse should be used. After surgery, for
example, in the time during which the patient
should refrain from toothbrushing, the stitches are still in place and the wound needs to heal.
Here, I instruct patients to bathe the operation
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site with chlorhexidine rather than
rinse vigorously.
use of green tea during non-surgical
periodontal therapy.[iii] Furthermore, my colleagues are currently
investigating the role of superfoods
in periodontics.
If we take a step back and look at
non-surgical periodontal therapy,
in my experience, I have found that
people overestimate the efficacy of
mouthrinses, and here I would say
the biggest problem is making it
clear to patients that, although they
are using a mouthrinse, for example,
after scaling and root planing, it is
still more important to brush properly and clean interdentally. As mentioned before, rinsing can be considered only an adjunctive treatment.
Furthermore, as we can see in the trials run by the Bernese periodontics
group, herbal extracts can partially
substitute for chlorhexidine, showing the same efficacy with less staining and irritation. Another study as-
© Alex Solderer
How can additives improve a chlorhexidine mouthwash?
By adding herbal extracts or essential oils, it is possible to reduce the
concentration of chlorhexidine. The
lower the concentration, the lower
the staining will be. Moreover, it
has been suggested that herbal extracts combined with toothbrushing might actively remove discoloration; however, further research is
needed.
[i] Duss C, Lang NP, Cosyn J, Persson
GR. A randomized, controlled clinical
trial on the clinical, microbiological,
and staining effects of a novel 0.05%
chlorhexidine/herbal extract and a
0.1% chlorhexidine mouthrinse adjunct to periodontal surgery. J Clin
Periodontol. 2010 Nov;37(11):988–97.
Dr Alex Solderer is convinced natural substances will find their way to periodontal therapy, and could serve as a way to reduce chlorhexidine and its side-effects.
sessed a mouthrinse with a partial
substitution of chlorhexidine with
essential oils, showing no loss of efficacy.[i, ii]
Your paper discusses how rinsing
with 0.12 per cent chlorhexidine
reduces side effects; however, therapeutic doses of chlorhexidine are
normally around 0.2 per cent.
It is right that 0.2 per cent chlorhexidine was seen in the past as the gold
standard. In our research, which included 11 clinical trials, 0.12 per cent
shows comparable antiseptic capacities with reduced side effects and
better patient acceptance.
Do you see any potential for natural antiseptics in oral health?
I feel there is a lot of research going
on in this area nowadays, and I am
convinced that naturally occurring
substances will find their place in
oral health. For example, recently
published research from our group
showed promising results for the
[ii] Laugisch O, Ramseier CA, Salvi GE,
Hägi TT, Bürgin W, Eick S, Sculean A.
Effects of two different post-surgical
protocols including either 0.05 %
chlorhexidine herbal extract or 0.1
% chlorhexidine on post-surgical
plaque control, early wound healing
and patient acceptance following
standard periodontal surgery and
implant placement. Clin Oral Investig. 2016 Nov;20(8):2175–83.
[iii] Gartenmann SJ, Weydlich YV,
Steppacher SL, Heumann C, Attin
T, Schmidlin PR. The effect of green
tea as an adjunct to scaling and root
planing in non-surgical periodontitis therapy: a systematic review. Clin
Oral Investig. 2019 Jan;23(1):1–20.
Hyperglycaemia not associated with poor
oral health, study finds
By DTI
previously identified obesity and
increasing age as risk factors for gestational diabetes mellitus (GDM).
Some scholars believe that chronic
oral and dental infections may also
play a role in the progression of
GDM. A recent study sought to examine whether poor oral health is
associated with a history of GDM in
women at high risk of the condition.
Contrary to their hypothesis, the researchers discovered that GDM did
not negatively affect women’s oral
health.
The researchers assessed the oral
health status of 115 women with
and without a history of GDM. They
performed full-mouth examinations five years after childbirth and
calculated the number of teeth, the
total dental index, and the number
of decayed, missing and filled teeth.
They also recorded bleeding on probing, probing depth, visible plaque
index (VPI) and clinical attachment
level and calculated the periodontal
inflammatory burden index (PIBI).
The researchers used questionnaires
to assess the participants’ oral health
habits, symptoms and own opinion
of their oral health.
© Pixel-Shot/Shutterstock
HELSINKI, Finland: Scientists have
Nearly half of the women examined (45%) had a history of GDM.
During the examination, the majority of the participants were found to
have mild periodontitis (62%) and
experienced bleeding on probing
(46%). The data revealed that the VPI
and PIBI scores were lower among
AD
A recent study has found no link between poor oral health status and
high blood sugar in women with a history of gestational diabetes
mellitus
women with a history
of GDM. According to
the researchers, all the
women reported good
subjective oral health.
Women with a history of GDM, however,
showed slightly better
oral health parameters
compared with women without a history of
GDM.
“We need to emphasize the importance of
oral health, especially
for metabolically highrisk patients, and to
provide them with
adequate oral healthcare,” said co-author
Hanna Poulsen, a researcher at the
University of Helsinki. “We are now
planning on studying the metabolic
health status of study participants
five years after delivery and also
their oral microbiology and salivary
biomarkers. In the future, it would
also be important to focus on the
oral health of women at risk for GDM
before, during and after pregnancy,”
she concluded.
The study, titled “Oral health in
women with a history of high gestational diabetes risk”, was published
online on 3 September 2019 in Dentistry Journal.
[55] =>
DTMEA_No.5. Vol.9_DT.indd
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/ Customised aesthetics for provisional profile prosthesis with ceramage gum
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/ Interview: "Dentistry in the GCC region has developed more in the last five years than ever before..."
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/ Lab Tribune Middle East & Africa Edition
/ Implant Tribune Middle East & Africa Edition
/ Ortho Tribune Middle East & Africa Edition
/ Hygiene Tribune Middle East & Africa Edition
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