DT Middle East and Africa No. 6, 2019

Dentsply Sirona World in Las Vegas: Ultimate Dental Meeting impresses thousands of guests / News / Solving aesthetic issues in the anterior region with composite / Printing the future / Industry / Diverse applications of lasers in dentistry / Preoperative digital planning / The new frontier restorative dentistry / CAD/CAM can be an incredible teaching tool / Dentsply Sirona World 2019 – Las Vegas / "... the beginning of leading network of dental clinics in the UAE..." - Interview with Mr Álvaro Martínez-Arroyo López, Asisa Internacional Salud General Manager and General Manager and Director of True Smile Works Dental Network LLC / News / “I look back with pride and gratitude” - An Interview with Robert Ganley, Ivoclar Vivadent’s CEO 2003 – 2019 / Events / 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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www.dental-tribune.me

Published in Dubai

November-December 2019 | No. 6, Vol. 9

ENDO TRIBUNE

LAB TRIBUNE

IMPLANT TRIBUNE

ORTHO TRIBUNE

HYGIENE TRIBUNE

Better technology and
referral relationships
Are they related?

Precisely Controlling Shade
Saturation with VITA AKZENT
Plus CHROMA STAINS

Full-arch implant rehabilitation

Three-dimensional
“technologies are going to
become the standard of care”

Oral microbiota, intestinal
microbiota and inflammatory
bowel disease

ÿC1-4

ÿD1-4

ÿA1-4

ÿB1-2

ÿE1-8

DENTAL TRIBUNE

By Dentsply Sirona

cessful with aDental
superlative program.
Stars like
The World’s
Newspaper
Middle East & Africa Edition

Innovations, trends, and high-caliber specialist
presentations – Dentsply Sirona World 2019
brought together thousands of dentists, dental
technicians, and dental experts in Las Vegas
(Nevada, USA). From October 3 to 5, the soldout "Ultimate Dental Meeting" was very suc-

stand-up comedian Jerry Seinfeld and multiple Grammy Award winner Zac Brown Band
brought special moments to life.

ÿPage 35

© Dentsply Sirona

Dentsply Sirona World in Las Vegas:
Ultimate Dental Meeting impresses
thousands of guests

Don Casey, CEO of Dentsply Sirona, opened Dentsply Sirona World 2019 in Las Vegas in front of thousands of
guests.

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[2] => DTMEA_No.6. Vol.9_DT.indd

NEWS

From the Maldives to Malawi and Nigeria
– Dentsply Sirona’s worldwide mission
for dental care
By supplying innovative equipment, Dentsply Sirona International Special Clinic Solutions (ISCS)
empowers dental professional to provide better dental care all over the world
– even in remote and underserved regions.
By Dentsply Sirona
From the Maldives to Nigeria to Malawi – in 2018,
Dentsply Sirona completed successfully three exceptional clinic projects. Now, the patients in these
regions can benefit from advanced dental care
thanks to modern equipment.
“It is important for us, to contribute to the development of dental care services in less-favored
countries by providing technologies that improve
access to better oral health”, explains Joerg Vogel,
Vice President Sales International Clinic Solutions
at Dentsply Sirona. These projects reflect Dentsply
Sirona’s presence in over 40 countries worldwide
and – in terms of sales presence – in more than 120
countries.

The Maldives – high-quality dental
equipment for an amazing region

On the Maldives, Dentsply Sirona delivered treatment centers, a 3-D imaging unit as well as CAD/
CAM systems such as CEREC and inLab to the Indira
Gandhi Memorial Hospital in the capital Malé. The
innovative equipment will serve both, the local
inhabitants and the tourists. As the largest govern-

Exemplary dental project for the region – the Dental Department of the Nigerian Navy Reference Hospital with (from
the left): Ojo/Lagos (NNRH Ojo) Rear Admiral OC Medani (retired) – Enimed Global Limited, Lutz Kinas,Specialist Digital X-Ray at Dentsply Sirona, Rear Admiral Abubaker Yusuf, Director Nigerian Navy Medical Services, Zahi Janho, Head
of International Special Clinic Solutions France & MEA at Dentsply Sirona, Eni Eni, Enimed Global Limited, and Commander Aliyu, commanding Officer NNRHOjo.

mental healthcare facility in the Maldives with
approximately 300 beds and a total of 21 departments the clinic provides services to about
150,000 inhabitants.

Malawi – giving access to dental care
in disadvantaged regions
Another project is part of Dentsply Sirona’s corporate social responsibility program to improve
access to dental health care in underserved areas.
In the Sengaby Baptist Medical Clinic in Salima,
central Malawi, Dentsply Sirona donated and installed one Intego treatment center. Established
in the early 1970s, the Baptist Medical Clinic is the
only facility that provides dental services in the
Salima district besides the district’s hospital. The
clinic provides free dental services since the average income of most of the surrounding people is
less than one US dollar per day.

Nigeria – exemplary dental project for
the region and next steps

High-speed 3D printing
Redefining digital dentistry

Certified and Biocompatible materials

3D Middle East General Trading - 3D Systems Distributor
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In the third project example, Dentsply Sirona
equipped the Dental Department of the Nigerian
Navy Reference Hospital Ojo /Lagos (NNRH Ojo)
with high-quality dental technologies. The new
dental equipment consists of Teneo and Intego
Pro treatment centers as well as intraoral, 2-D and
3-D imaging units and last but not least the CAD/
CAM systems CEREC and inLab.
At the official inauguration ceremony, his excellency Muhammadu Buhari, President and
Commander-in-Chief of the Armed Forces of the
Federal Republic of Nigeria, thanked Dentsply
Sirona and encouraged other states in Nigeria
to take the Ojo project as a good example. So,
similar dental equipment like in the Ojo example is currently on its way to the Nigerian Navy
Reference Hospital in the capital Lagos where it
will be implemented until the middle of the year.
Besides the Navy’s employees and their relatives,
the state-of-the-art dental care center will also be
accessible in terms of public oral health services.
Therefore, a team of
the Nigerian Navy
dental professional
and
technicians
completed a comprehensive clinical and
technical educational
program at Dentsply
Sirona’s training facilities in Bensheim,
Germany.

IMPRINT
PUBLISHER/
CHIEF EXECUTIVE OFFICER
Torsten R. OEMUS
DIRECTOR OF CONTENT
Claudia DUSCHEK
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 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
Dr. Mohd Dashti, Kuwait
Aiham FARRAH, CDT, UAE
Retty M. MATTHEW, UAE
PARTNERS
Saudi Dental Society
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Lebanese Dental Association
Lebanese Orthodontic Society
Qatar Dental Society
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American Academy of Implant Dentistry
International Federation of Dental
Hygienist
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British Academy of Dental Implantology
AALZ - Aachen Dental Laser Center
Singapore Dental Association
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DIRECTOR OF mCME
Dr. Dobrina MOLLOVA
mollova@dental-tribune.me
Tel.: +971 50 42 43072
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Tzvetan DEYANOV
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Tel.: +971 55 11 28 581
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800 4585/04-4067170
©2018, Dental Tribune International GmbH.

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accurately, but cannot assume responsibility
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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.6. 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.6. Vol.9_DT.indd

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 6/2019

Solving aesthetic issues in the anterior
region with composite
Clinical Case

About the Case

A 50-year-old male patient presented for professional tooth cleaning. He had deep erosive lesions affecting the vestibular aspects of his
maxillary central incisors, which he
did not consider an issue. Neverthe-

less, the team informed him about
the options to improve the aesthetics and protect the remaining tooth
structure.
The patient agreed to carry out a
home-bleaching treatment followed
by a direct restorative treatment
with composite.

Before

By Dr Paulo Monteiro, Portugal

Challenge

The biggest challenge was to mask
the heavy discoloration while restoring the teeth to a natural shape and
shade. 3M™ Filtek™ Universal Restorative was selected to accomplish
this task. The Pink Opaquer was applied in a thin layer to cover and optically mask the discolorations.

Outcome

The patient was happy with the
treatment outcome. Three things
were achieved with minimal effort.
The discolorations were masked, the
teeth were restored to their natural
shape and the shade blended naturally with the adjacent teeth.

Dr. Paulo Monteiro
Dr. Paulo Monteiro obtained his doctorate of dental medicine at the Instituto
Superior de Ciências da Saúde Egas Moniz
(ISCSEM) in Caparica, Portugal, where he
developed a passion for aesthetic dentistry. He completed the postgraduate
programme in Aesthetic and Restorative
Dentistry at ISCSEM in 2005. Dr. Monteiro
is coordinator of and
professor in the restorative postgraduate programme, Aesthetic and
Restorative Dentistry, at
Instituto Universitário
Egas Moniz. He has an
exclusive dental practice
in Lisbon that focuses on
aesthetic and cosmetic
dental treatments.

After

Case Overview: Step by Step

INITIAL SITUATION: Preoperative frontal view of the
patient’s teeth, showing severe erosive tooth wear on
the vestibular surfaces and incisal edges.

Detailed view of the maxillary incisors. The teeth
didn’t show any highly translucent areas, so the use
of a single shade/opacity of 3M™ Filtek™ Universal
Restorative was selected.

Lateral view of the anterior teeth revealed the depth
of the lesions on the vestibular surfaces.

Tooth shade was determined with the aid of the VITA
classical A1-D4® shade guide. The shade A1 matched
the sound tooth structure. This corresponded with
3M™ Filtek™ Universal Restorative’s A1 shade.

INITIAL SITUATION: Preoperative frontal view of the
patient’s teeth, showing severe erosive tooth wear on
the vestibular surfaces and incisal edges.

Detailed view of the maxillary incisors. The teeth
didn’t show any highly translucent areas, so the use
of a single shade/opacity of 3M™ Filtek™ Universal
Restorative was selected.

Lateral view of the anterior teeth revealed the depth
of the lesions on the vestibular surfaces.

3M™ Scotchbond™ Universal Adhesive was applied
to the rinsed and dried tooth structure. The adhesive
was rubbed for 20 seconds, treated with a gentle
stream of air for solvent evaporation, and light cured
for 10 seconds.

Two anterior matrices were placed to help create a
natural anterior tooth shape and facilitate restoration of the interproximal and cervical margins.

A 1 mm layer of the Pink Opaquer (PO) was placed
onto the discolored sclerotic dentin to mask dark areas and light cured for 20 seconds. The material offered a similar creamy handling as the body shades
of 3M™ Filtek™ Universal Restorative.

Appearance of the teeth after the first application of
3M™ Filtek™ Universal Restorative A1 shade. No additional body shades were needed (to mask sclerotic
dentin) when using the Pink Opaquer.

Refer to Instructions for Use (IFU) for complete product information.

To learn more:
www.3M.com/FiltekUniversal

Immediate Post-Op
Placement of the second and final layer of 3M™
Filtek™ Universal Restorative A1 shade.

Restorations after polishing using the 3M™ Sof-Lex™
Diamond Polishing System.

Treatment outcome immediately after rubber dam
removal. The discolorations were gone, the restorations and the adjacent teeth had a similar shade, and
a natural shape was achieved.

3M Oral Care - Gulf Region
3M Gulf Ltd. Dubai Internet city.
Bldg 11, 3rd floor, Dubai, UAE
Office: +97143670752
Clinical dentistry and photography
by Dr. Paulo Monteiro

[5] => DTMEA_No.6. Vol.9_DT.indd

Filtek

™

Universal Restorative

What if a composite
could make your
busy days easier?

[6] => DTMEA_No.6. Vol.9_DT.indd

INTERVIEW

Dental Tribune Middle East & Africa Edition | 6/2019

Printing the future
Interview with Rik Jacobs about the rise of 3D printing in dentistry

By 3D Systems
The 21st century has not turned out
exactly as predicted by the science
fiction writers of the past. There
aren no flying cars filling the skies
or robots walking the streets, but
there are devices in our homes, like
Amazon’s Alexa, which listen for our
voices and carry out our commands.
Companies like Boston Dynamics
have taken impressive steps towards
creating eerily lifelike robots and
the US Navy is even testing incredibly precise laser weapons onboard
its ships. 3D printing is also seeing
a massive expansion in its applications, from the inspiring printing of
functioning human organs to the
more sinister ability to download
and create working fire-arms. But
where does dentistry fit into this?
Dentistry is currently undergoing a
fundamental move towards digital
workflows, with digital scanning,
design, compatible materials and 3D
printing all set to become essential
parts of providing oral healthcare in
the future. 3D printing especially has
the capacity to largely democratise
the production process of many dental appliances, and dentistry is one of
the areas best suited to take advantage of the advances the technology
allows for. The largest 3D printing
operation in the world is carried out
for Align Technology Ltd, well known
in the dental industry as the creator
of the Invisalign clear aligner, who
utilise 3D Systems' 3D printers to
print over 359,000 unique retainers
every day. 3D Systems, a company
co-founded by the inventor of the 3D
printing process, Chuck Hull, in 1986
has clearly recognised the potential
of the dental industry and recently
released the NextDent5100. I spoke

with Rik Jacobs, vice-president of 3D
Systems’ dental business, to get his
views on the past, present and future
of the technology.
Rik didn’t study dentistry, instead
opting to study international marketing management. He became
active in the dental sales and marketing sphere around 20 years ago
where he sold polymers and monomers, materials which he also sold
for the hearing aid market.
Explaining this, Rik said, “I wasn’t
at the forefront in the hearing aid
market in those days. That market
transformed from analogue into
digital over a period of two or three
years between 2007 and 2009, and
I learned my lesson. When digital
technology came to dental I wanted
to be at the forefront, so I went back
to school in 2009 and learnt everything I could about 3D printing.”
Rik was privy to how quickly digital
technologies came to dominate one
market and didn’t want to miss out
on the next. This affected his approach to the dental market, and in
2012 he co-founded NextDent, which
focused on reformulating existing
polymers into printable, biocompatible materials which would pass
regulations.
Creating printable and biocompatible materials was essential for the
progression of 3D printing, and the
concept attracted interest from big
players in the market. NextDent was
acquired by 3D Systems in January
2017.
As Rik explained however, there
wasn’t always a belief in the uses of
3D printing for dental applications.
He elaborated, “People still had some

hesitations and questions about the
durability of the materials even five
years ago; they weren’t sure that you
could print crowns or dentures that
would stay in a patient’s mouth for
very long. Back then a few things
still needed to happen to make 3D
printing viable in dentistry; software companies needed to develop
software design solutions, materials
needed to be proven and more advanced 3D printers needed to be developed. I was convinced it could be
done but people were very cautious,
so it was only in 2018, when we were
able to combine all these factors, that
there was a real tipping point for 3D
printing.”
Digitalisation in the dental profession and industry is an oftdiscussed
topic that most agree will come to
define dentistry in the near future.
Every dentist will be able to find a
personal use for some piece of digital
technology, but the same isn’t necessarily true of a 3D printer.
3D printing’s relationship to the
digital dental revolution is important however, and I asked Rik about
what role the technology plays. He
said, “Most dentists will find a use
for an intraoral scanner as a more
accurate and convenient alternative
to analogue impression materials,
but what gets done with that scan afterwards is important. If the patient
needs a denture the dentist can send
the scan to a lab so that a denture
could be designed and printed, or
with a 3D printer the dentist could
print the denture themselves in their
practice. Completely new business
models are coming into the market
with this technology. A one-surgery
practice probably won’t have much
use for a 3D printer, for example, but

Rik Jacobs, vice-president of 3D Systems' dental business.

even the smallest of practices will
benefit from outsourcing to a lab
with a printer because of the higher
speeds, accuracy and lower cost.” Rik
explained that 3D Systems primarily
sell their printers and materials to
labs, but that dental practices interested in keeping some of their production in-house are increasingly
purchasing 3D printers.
As complicated pieces of equipment,
learning to use 3D printers to their
fullest can require a fairly significant
amount of training. Rik explained,
“3D printing can sound a little too
good to be true, but we’re sometimes

faced with people that think they can
start using their printer without any
training and expect great results;
if you put rubbish into the printer,
you’ll get rubbish out. That’s something I’m always explaining and emphasising.”
3D printing is sure to play an important part in the digital future of dentistry, and as materials become more
and more advanced the applications
of the technology will only grow. But
printers in labs and in practice are
already changing dental workflows,
with labs able to provide faster, more
reliable and very precise end products with incredible efficiency.
The future may not end up being
characterised by a deluge of sci-fi robots and lasers, but there’s no doubt
that 3D printing will play an incredibly important role in the increasingly digital profession of dentistry.

An example of a 3D printed dental splint.

Rik Jacobs, The Netherlands
Rik Jacobs is a founder and the former
CEO of NextDent B.V. The company was
founded in 2012 in the Netherlands as an
independent subsidiary of Vertex Global
Holding to complement the dental materials portfolio of its affiliate Vertex-Dental
B.V., which has a 77-year track record in
developing and producing traditional
denture materials and products. Within
four years, NextDent became the leading developer and manufacturer of biocompatible dental 3D printing materials.
In January 2017, Vertex Global Holding
merged with 3D Systems, a company that
provides comprehensive Additive Manufacturing products and services, including 3D printers specifically designed for
dental applications, print materials, ondemand parts services and digital design
tools. Upon this merger, Rik became the
VP, General Manager of the Dental business. He holds a degree in International
Marketing Management from NHL University of Applied Science.

[7] => DTMEA_No.6. 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.6. Vol.9_DT.indd

INDUSTRY

Dental Tribune Middle East & Africa Edition | 6/2019

The future is bright
for Beverly Hills Formula
By Beverly Hills Formula
For oral care experts Beverly Hills
Formula, 2018 would prove to be
a tough year to beat. With a large
number of accolades already under
their belt, new product development
has once again been at the forefront
of their 2019 objectives. Known for
their bold formulations such as Activated Charcoal and Real Gold Particles, the brand is set to once more
shock the industry with an amazing
first to market formulation – Silver.
Thanks to their sheer dedication and
hard work, the name Beverly Hills
Formula has now become synonymous with high quality, safe and affordable oral care products. A recent
study carried out in an independent
laboratory showed that Beverly Hills
Formula’s products are the least
abrasive, yet most effective on the
market today.
What can we expect from Beverly
Hills Formula in 2020?

Expert Whitening Kits

Following years of scientific research,
the brand responded to consumer
demand with the introduction of
their first whitening kit. The Perfect
White 2 in 1 Whitening Kit and Pen
offers consumers rapid whitening
results thanks to its safe and effective
hydrogen peroxide formula.
Following on was the development
of a first to market product – the Per-

With its cutting-edge formula, Professional White Advanced Sensitive looks to be the best product on
the market for those with sensitivity issues. The new formula contains
Idorxyplus Complex whilst combining Hydroxyapatite, Arginine and
Calcium Carbonate to fill micro-injuries in enamel and dentin. Specifically developed for enamel and gums,
the product provides immediate
sensitivity relief. Containing remineralizing filler along with strong antibacterial and anti- plaque protection,
the product also assists with tissue
regeneration.

fect White Black Whitening Kit - scientifically formulated with activated
charcoal, the kit is designed to offer
superior whitening results whilst reducing plaque and harmful bacteria.
The brand will enter 2020 with a
brandnew whitening kit – the Professional White Advanced Silver Whitening 2 in 1 kit. Containing Rapid
whitening strips and a pen formulated with Hydrogen Peroxide and
professional whitening ingredient
PAP for extra whitening power. This
powerful formulation is also boosted
with Silver for strong antibacterial
and anti-plaque action.

The Professional Range

Most exciting however, is the brand’s
new and improved Professional
Range. With a new formula, new ingredients and now an extra level of
stain removal, the brand is quietly
confident this range is destined to
become a best seller.
The range includes Perfect White Advanced Black Pearl Whitening, with
its new advanced formula which
contains Activated Charcoal to help
eliminate bacteria causing bad
breath. Combined with professional
whitening ingredient PAP, Advanced
Pyrophosphates, Hydrated Silica and

Pearl Powder help remove surface
and deep stains without harming the
enamel. A recent study showed that
this product removed almost 70% of
surface stains after 5 minutes when
compared with leading brands.
Joining the range is Professional
White Advanced Silver Whitening
with its combination of Nano-Silver,
Hyaluronic Acid and professional
whitening ingredient PAP, all of
which help to achieve strong antibacterial and anti- plaque action
while providing advanced level professional gum protection assisting
tissue regeneration.

Beverly Hills Formula’s hard work
this year has culminated in them
becoming the top of mind oral care
brand for consumers as well as catching the eye of dental professionals
across the globe. The brand will enter
2020 with an impressive portfolio of
high quality, safe and highly effective oral care products all of which
are cruelty free.

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

Treatment centers and dental chairs
– just a part, or the heart, of the practice?
Today’s technological and design
innovations have seen the humble
dental chair evolve into state-of-theart treatment centers, putting ergonomics and patient comfort at the
forefront. Eybi Becerra, Brand Marketing Manager at Dentsply Sirona,
explains more.
There are many items of equipment that clinicians and their teams
couldn’t be without. But arguably,
the most indispensable piece of
equipment in the practice, and the
one that’s now at the heart of providing the very best of care for patients,
is the treatment center.
The treatment center is so much
more than a functional piece of
equipment. Designed to create a lasting impression, the latest treatment
centers feature a variety of colour
combinations, soft, comfortable upholstery and centralised functionality that supports a range of workflows.

Total Reliability

Patient satisfaction is a top priority,
but the prospect of sitting in a dental chair surrounded by unfamiliar
equipment can cause anxiety for
some. Consequently, anything that
helps ease such anxiety is to be welcomed and this includes patient

comfort and positioning during
treatment.

terms of fabric, colour and finish,
fitting seamlessly into any practice
design scenario.

The dental chair is often the place
where patients have the opportunity
to talk about how they feel and ask
questions. Ensuring the dental chair
is well-designed and comfortable
will help create a calm and reassuring environment that is conducive
to effective communication.
Patients need to have complete
trust in their clinician, and clinicians
need to have complete trust in the
reliability of their treatment center.
Any failure of this essential piece of
equipment can mean cancelled appointments and the consequential
loss of revenue, not to mention patient dissatisfaction. So, reliability
should be top of the list when making the choice of manufacturer and
model.

Innovation and Integration

Having relaxed patients is a good
thing, but what about the dental
team? Posture can be both negatively and positively impacted by
the design of a treatment center, so
pay particular attention to the ease
with which instruments, equipment
and the patient can be reached. Poor
posture will ultimately take its toll in
terms of aching muscles and general
fatigue and can even lead to longerterm health problems.

Built to last

By Dentsply Sirona

The ultimate design

The latest treatment centers are designed with both dental professionals and patient positioning in mind.
Cutting edge technology allows the
team to work ergonomically and
safely in a neutral position, preventing strain, especially on the back and
neck, whilst still allowing unrestricted access to the patient.
Dentsply Sirona’s Teneo® treatment
center places everything a clinician
and the team needs within easy
reach. Offering speed and efficiency,
the Teneo features:
• Motorised sliding track
• Motorised cuspidor
• Adjustable, motorised headrest
• Large EasyTouch touchscreen

• Anti-stress massage and lumbar
support
• Optional integrated endodontic
and implant workflows
• Wireless foot control

The treatment center is the focal
point of any surgery and something
unlikely to be routinely replaced, so
longevity and reliability are important considerations when making a
purchase decision.
Making the right choice of treatment
center and placing it at the heart of
the surgery will aid patient satisfaction and help create a pleasant working environment for clinicians and
their teams – making them feel fulfilled and inspired to deliver the very
best treatment outcomes.

The Teneo even memorises the clinician’s ideal working position. This
ensures optimal treatment with the
mouth point always at the same
working height, regardless of the patient’s size or build.

An all-round experience

Smooth, ergonomic surfaces that
can be easily cleaned and disinfected,
integrated design features plus stylish upholstery together provide the
ultimate in patient comfort. All of
Dentsply Sirona’s treatment centers are completely customisable in

Find out more by
scanning the QR code.

[9] => DTMEA_No.6. Vol.9_DT.indd

[10] => DTMEA_No.6. Vol.9_DT.indd

INDUSTRY

Dental Tribune Middle East & Africa Edition | 6/2019

COMBI touch
The all in one in prophylaxis
By Mectron S.P.A.
The COMBI touch combines ultrasound and air-polishing in one unit
to provide a complete prophylaxis
treatment from removal of supragingival and subgingival calculus to
gentle removal of stain and biofilm
and even implant cleaning.
Thanks to the ergonomic touch panel, allows to control every function as
fast and intuitive as never before and
at the same time clean and disinfect
the device in literally no time.
The ultrasound unit, thanks to its
“SOFT-MODE” function, allows for
ultra-gentle scaling, which reduces
the insert's oscillation amplitude,
rendering its motion compatible
with even the most sensitive of patients. While also guaranteeing optimal performance with prosthetics
and extractions treatments thanks
to the “pulse mode” function transforming the ultrasound oscillation
to a new profile.
The air-polishing unit allows for
the use of different types of powder

(supra- or subgingival), depending
on the desired treatment type. The
greatest advantage is the ability to
manage the use of both powders on
the same patient with a simple click.
Furthermore, it is not necessary to
change the air-polishing handpiece.
Instead, simply insert any one of the
3 available spray nozzles with different orientation (120°, PERIO and the
optional 90°), COMBI touch technology made it possible for the operator
to decontaminate the oral cavity in
an effective manner, with the advantage of being able to work in an
ergonomic fashion, easily reaching
all necessary sites.
The greatest advantage for the operator, therefore, is that the technology provides a complete set of tools
for effective, fast and minimally
invasive Non Surgical Periodontal
Therapy, even in periodontal pockets deeper than 5 mm, thanks to
the dedicated subgingival perio tips
simply attached to the PERIO nozzle. Soft, flexible, and anatomically
adjustable to the periodontal pocket,
this tip gentle removes bacterial bio-

films from the periodontal and periimplant pockets.
This new combined technique allows the operator to obtain an excellent clinical result, with an advantage
in the timing of the procedure much
appreciated by patients.
Device maintenance is fast and simple, thanks to containers that can be
removed without having to switch
off the device, and an exclusive anti-clogging system for the powder.
What's more, it can either be hooked
up to the office’s regular water system or used with a 500ml external
bottle.

For more information contact:
mectron S.P.A.
Via Loreto, 15/A
16042 Carasco (GE) – Italy
Tel: +39 0185 35361
Fax: +39 0185 351374
E-mail: mectron@mectron.com
Web: www.mectron.com

COMBI touch

Flow variations
The flow variant of the universal composite BRILLIANT EverGlow
makes ﬁlling extremely simple
By COLTENE
Undercuts, sharp angles or cervical bevels present particular challenges when placing conventional
composites. Therefore clinicians will
benefit substantially from an innovative dental material with an optimal thixotropic property and allows

effortless positioning. The flowable
consistency is particularly suited for
treating areas with difficult access
and saves valuable treatment time.

Rapid, voidless ﬁllings

To complete the classical presentation form, the Swiss dental specialist COLTENE additionally offers its

BRILLIANT EverGlow submicron
universal composite in a flowable
variant. The low viscosity filling material combines convenient application with high stability. Among
other things, BRILLIANT EverGlow
Flow is ideally suited for filling areas with difficult access as well as
for sealing fissures. Due to its flow

properties, the restorative material
fully comes into its own when filling
cavity linings. The flow variant can
be applied directly from the syringe
to the bonded surface which saves
material and time. The composite,
which flows under pressure, can
then be comfortably brought into
the required position until curing.

The exceptionally smooth consistency of BRILLIANT EverGlow high
performance composite has already
captivated many clinicans. Owing
to its sophisticated composition of
special fillers, the pliable material
can be applied easily into all classes
of cavities without sticking to the instrument. Not only that, it has long
gloss stability and excellent polishability. BRILLIANT EverGlow Flow,
a user-friendly and highly aesthetic
flowable, rounds off the programme.
Depending on the indication, dentists can in future choose a suitable
variant from the extended product
range.

BRILLIANT EverGlow Flow

The versatile filling material is available from dental wholesalers in a
2g syringe. Next to six universal
shades, the flowable variant is also
available in a translucent enamel
shade and an opaque material in
shade A2. As usual, the assortment
includes shades in the sophisticated
"Duo Shade" system which cover two
classical VITA shades in one, ranging
from A1/B1 to A4/C4.

For further information, please contact:

BRILLIANT EverGlow Flow

Coltène/Whaledent AG
Feldwiesenstrasse 20
9450 Altstätten SG
Switzerland

[11] => DTMEA_No.6. Vol.9_DT.indd

Enduring gloss –
made brilliant

BRILLIANT EverGlow

®

Universal Submicron Hybrid Composite

Ò Outstanding polishability and gloss retention
Ò Brilliant single-shade restorations
Ò Ideal handling through a smooth consistency
Ò Good wettability on the tooth surface

005086 10.19

dietmar.goldmann@coltene.com | P +41 71 757 54 40

[12] => DTMEA_No.6. Vol.9_DT.indd

INDUSTRY

Dental Tribune Middle East & Africa Edition | 6/2019

Tight contacts are just the beginning
– Dr Laura Beresford Pratt

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also achieving excellent
adaptation.

Prime&Bond universal™

SDR® Plus

high bond strength and low

cavity adaptation.

Universal Adhesive

Posterior Bulk Fill Flowable Base

cient esthetics is where artistry and effi

Achieve efficientESTHETICS
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SIMPLIFY shading and preferred
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SIMPLIFY shading and preferred

handling, for lifelike results in less time.
SIMPLIFY shading and preferred handling,
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FINISH and improve your likelihood
of success while saving time.

FINISH and improve your likelihood

Universal Nano-Ceramic Restorative

SURFACE
SURFACE
IRREGULARITIES
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Plaque Accumulation

extrinsic staining, lighting, and shade availability.

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like staining, plaque retention,
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gingival irritation and recurrent caries.

SOURCES
1
Dental Products Report April 2015 posterior composite survey.

SOURCES
Durable Bonds at the Adhesive/Dentin Interface. Braz Dent Sci. 2012; 15(1): 4-18

Keeping in contact

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 composite-based restorative solution which
would reduce the existing level of
postoperative sensitivity amongst
our patients. The design and methodology of Dentsply Sirona’s Palodent® V3 sectional matrix system
makes creating predictable, tight
contact points and a natural tooth
shape much more achievable. The
matrix band is shaped to fit snugly
around the tooth and is thin so that
good contact is easier to achieve. It
is then held firmly in place by the
wedges and the ring.
Using the Palodent® V3 System I am
able to perform composite restorations in really deep cavities and I now
use it for all my Class II restorations
that require a matrix.

Moisture-defying adhesive

success while saving time.

ceram.x® SphereTEC™ one

Helps dentist
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including
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andselection
shade availability.
offsetting
variables
in shade
including
extrinsic staining, lighting, and shade availability.

I perform Class II restorations every
day as part of my private practice in
Hailsham, East Sussex, so I require
materials that enable me to deliver
long-lasting and aesthetic restorations to my patients. Key to that is
finding a matrix that can give me
reliable contact points even for deep
cavities.

of success

saving time.
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improve your likelihood of

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CHAMELEON
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EFFECT
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EFFECT

By Dentsply Sirona

The second product in the Class II Solution that I had experience with was
Prime&Bond® universal, Dentsply
Sirona’s universal adhesive. I was
particularly fascinated by a video
showing how the adhesive mixes
with water in over-wet conditions
so that it forms a gap-free adhesive
layer. Since adopting Prime&Bond
active my patients have reported
very little sensitivity.

depth of cure. I find that the surface
finish of SDR flow+ is so smooth that
I can use it on its own for paediatric
fillings. It flows and adapts to the cavity well and has even proved to be an
excellent alternative to amalgam
in a deep box if I use it with the Palodent® V3.

A great surface ﬁnish

And finally, I use Ceram.x®
SphereTEC universal as my capping
composite which gives a great surface finish to all my Class II restorations. I find the handling very easy
as it is a lot less sticky than the previous composite I used, which means I
have far better control. The composite adapts well to the cavity and gives
great aesthetic results with minimal
polishing required.

The power of choice

As an associate in my practice, I felt
it was important to ask my practice principal for the materials that
would enable me to give the best
restorative solutions to my patients.
I am fortunate that she has given me
the freedom to choose.
My restorative failure rate is low
which I believe is partly due to the
quality of the materials I am using.
What gives all of these products from
the Dentsply Sirona Class II Solution
an extra edge is that they are designed to work together. Along with
the added efficiency that the Class II
Solution has made possible, it means
that I can fit in more treatments,
which is a win for both me and my
practice.

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
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.
3

DENTSPLY Caulk procedure timing breakdown study. Data on file.

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

An eﬃcient
and versatile bulk ﬁll

I also now use SDR® Plus which is
the Dentsply Sirona Class II solution
bulk fill. It is a good, versatile material which is easy to use and makes
me more efficient with its 4mm

Find out more by
scanning the QR code.

[13] => DTMEA_No.6. Vol.9_DT.indd

[14] => DTMEA_No.6. Vol.9_DT.indd

14

LASER DENTISTRY

Dental Tribune Middle East & Africa Edition | 6/2019

Diverse applications of lasers in dentistry
Recent literature
By Dr Igor Cernavin, Australia
When considering whether to work with lasers and in which field they could be applied,
recent studies provide many application options and issues for practitioners to consider.
The following presents some of the newest
research on possible areas of application and
further investigation.
Petrov et al. used a femtosecond laser with
a high repetition rate, which is probably the
future of lasers for hard-tissue removal to
achieve fast and more precise ablation in
dentine and enamel.1 They concluded that
the ultra-fast femtosecond laser used in
their work holds the promise of a significant
drilling ability without collateral thermomechanical effects. It achieved high processing
efficiency, overcame disadvantages of other
laser systems reported, and can be used to
develop an instrument for cavity preparation based on fast and precise ablation.
Their further aim is to exceed the speed of
conventional drilling instruments and thus
to reduce the treatment time, which in turn
will bring comfort to the patient.
Levine published an article on how to choose
the right laser for one’s practice, which readers may find of interest.2
Hashimoto et al. investigated fluoridated
hydroxyapatite for application as an implant coating for titanium bone substitute
materials for dental implants.3 They concluded that fluoridated hydroxyapatite
coatings are suitable for real-world implantation applications.
Giannelli et al. carried out a double-blind,
randomised, single-centre, split-mouth
clinical trial investigating the efficacy of and
patient-reported outcomes after one year
of treatment of severe periodontitis with a
laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing.4
Their study confirmed the efficacy of combined phototherapy and scaling and root
planning, which had emerged from previous clinical trials, extending its field of application to severe periodontitis.4
Belcheva et al. carried out a study whose aim
was to evaluate the positive effects of the

AD
carbon dioxide laser (10,600nm) with acidulated phosphate fluoride gel on enamel acid
resistance.5 Their conclusion was that this
combination was more effective in protecting the enamel surface and resisting demineralisation than was carbon dioxide laser
irradiation or fluoride alone.5
Campos et al. published a double-blind
study on immediate laser-induced haemostasis in anticoagulated rats subjected to oral
soft-tissue surgery.6 There has been much
controversy about the management of patients on oral anticoagulants requiring oral
surgical procedures. The haemostatic properties of high-power lasers were perceived
to be potentially helpful during oral softtissue surgeries in anticoagulated patients.
The authors concluded that laser-induced
haemostasis is an alternative for intra- and
postoperative bleeding control in patients
on anticoagulation therapy.6
As oncological treatment can result in changes in the oral cavity, Carvalho et al. drafted a
guide, based on a systematic review, directed
at the team of health professionals involved
in the oral care of oncological patients.7 The
review concentrated on randomised clinical
trials involving paediatric and adult oncological patients, focusing on the prevention
and treatment of oral complications.7 The
studies included in the review emphasise
the provision of Low Level Laser Therapy,
among other interventions, to minimise the
severity of oral problems in such patients.7
Tani et al. carried out an in vitro study that
compared photo-biomodulation potentiality using red (635 ± 5nm) or near-infrared
(808 ± 10nm) diode lasers and vio- let-blue
(405 ± 5 nm) LED operating in a continuous
wave with a 0.4J/cm energy density, on human osteoblast and mesenchymal stromal
cell viability, proliferation, adhesion and
osteogenic differentiation.8 They concluded
that the 635nm laser had a potential effective option for promoting/improving bone
regeneration.8
Ghouth et al. carried out a systematic review
of the evidence on the use of laser Doppler
flowmetry in the assessment of the pulpal
status of permanent teeth compared with
other sensibility and/or vitality tests. They

concluded that, despite the higher reported
sensitivity and specificity of laser Doppler
flowmetry in assessing pulp blood flow, this
data is based on studies with a high level of
bias and serious shortfalls in study design.9
More research is needed to study the effect
of different laser Doppler flowmetry’s parameters on its diagnostic accuracy and the
true cut-off ratios by which a tooth could be
diagnosed as having a normal pulp.9
Kaur et al. compared soft-tissue wound
healing using diode lasers (810nm) versus
the conventional scalpel approach as an
uncovering technique during second- stage
surgery for implants.10 They found that it
can minimise surgical trauma, reduce the
amount of anaesthetic required, improve
visibility during surgery owing to the absence of bleeding and eliminate postoperative discomfort.10
Efficiency in debonding porcelain laminate
veneers was studied by Al-Balkhi et al. using
several laser parameters and two different
application modes of the Er:YAG laser (contact and non-contact mode).11 Their finding
was that the Er:YAG laser is an effective tool
in debonding porcelain laminate veneers.
The non-contact application mode was
more efficient in reducing debonding time
than the contact application mode, but resulted in a higher change in pulp temperature.11
Kellesarian et al. carried out a comprehensive review to assess the effectiveness of
erbium lasers in the removal of all-ceramic
fixed dental prostheses and found that the
benefits of lasers over mechanical instrumentation for crown removal encompassed
efficient restoration retrievability without
restoration or tooth surface damage and a
relatively easier and more time-effective
procedure with no prerequisite for anaesthetic agents.12 It is, however, imperative for
clinicians to be well trained and exhibit adequate knowledge regarding recommended
power settings and laser-safety parameters
with reference to interactions between light
and different tissues and ceramics.12

PRINT
EVENTS

EDUCATION

SERVICES

DIGITAL

Dental Tribune International

The World's
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Marketplace
www.dental-tribune.com

ÿPage 16

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[15] => DTMEA_No.6. Vol.9_DT.indd

From British Academy of Restorative Dentistry

DUBAI

2020-2022

Prof. Paul Tipton, UK
Specialist in Prosthodontics
President, British Academy
of Restorative Dentistry

Prof. Edward Lynch, UK
Prof. James Prichard, UK
The University of Warick, Coventry
BDS (ULond), MSc(ULond),
PhD, Lond, MA, BDentSc, TCD, FDSRCSEd,
LDSRCS (Eng), MFGDP (UK)
FIADFE, FDSRCSLond, FASDA, FACD FIADFE (USA), F BARD (UK), MFDTEd

Prof. Adam Nulty, UK
BChD MJDF RCS Eng
PGCert MSc (Dist.)
MAcadMEd

Dr. Matthew Holyoak, UK
BDS, Dip Rest Dent
(RCS Eng), MSc (Rest Dent)

Dr. Hugo Grancho Pinto
Portugal
Specialist in Periodontics
Academic Clinical Lecturer
- University of Manchester

Dr. Rami Haidar, UK
Dr. Adam Toft, UK
BDS MFDS RCS (UK),
BSc (Hons), BDS (Hons), MFGDP (UK),
MMedSci (Rest Dent),
Oral & Maxillofacial Surgery Specialist,
Aesthetics Training Consultant
Dip Aesth (BARD)
FBARD PGCertEd (Sheﬃeld)

Dr. Ashish Rayarel, UK
BDS MFGDP(UK) MSc
(Aesthetic and Restorative Dentistry)

Mr. Gary Jenkinson, UK
RDT, MBA, DipCDT, RCS

Group 6
Registration Open

Patway to UK
Masters

210 CME & Daily
Hands-On

Certificate | 4 Modules | 15 Days

Module 1 | 01-03 October 2020 | Prof. Paul Tipton & Dr. Adam Toft & Dr. Ashish Rayarel

Treatment Planning in Advanced Restorative Dentistry | The Principles of Occlusion in Advanced Restorative Dentistry
Tooth Preparation in Advanced Restorative Dentistry

Module 2 | 11-14 November 2020 | Prof. Paul Tipton & Dr. Matthew Holyoak & Dr. Adam Toft & Dr. Ashish Rayarel

Minimally Invasive Veneer Preparations | Master the Art of Composites Part 1- Adhesion Composites & Anterior Composite Restorations
Master the Art of Composites Part 2- Composite Veneers | Master the Art Composites Part 3- Posterior Composites

Module 3 | February 2021 | Prof. Paul Tipton & Prof. James Prichard & Dr. Adam Toft & Dr. Ashish Rayarel
Enhance Your Expertise in Endo Part 1 | Enhance Your Expertise in Endo Part 2 | Occlusal Examination
Emax & Zirconia Anterior & Posterior Restorations

Module 4 | May 2021 | Prof. Paul Tipton & Dr. Hugo Grancho Pinto & Dr. Adam Toft & Dr. Ashish Rayarel

Bridge Design | Aesthetic Perio Connective Tissue Grafting | Aesthetic Perio Crown Lengthening | Modern Post and Core Techniques

Diploma | 4 Modules | 15 Days

Module 5 | September 2021 | Prof. Paul Tipton & Dr. Adam Toft & Dr. Ashish Rayeral

Bridge Preparation Techniques | Articulator selection in Restorative Dentistry | Porcelain Inlays & Onlays | Veneer Cementation Techniques Practical

Module 6 | November 2021 | Prof. Paul Tipton & Mr. Gary Jenkinson & Dr. Adam Toft & Dr. Ashish Rayeral

Smile Design, Composite Veneers, Anterior Tooth Anatomy & Lab Communications (Part 1& 2) | TMD, It's Diagnosis and Treatment |
Adhesive Bridge Preparation Techniques

Module 7 | February 2022 | Prof. Edward Lynch & Prof. Adam Nulty & Dr. Adam Toft & Dr. Ashish Rayeral

Tooth Whitening, Silver Diamine Fluoride and an Update on Adhesive Dentistry – Minimal Invasive Dentistry | Same Day Crowns Finishing and Polishing
and Clinical Applications of Lasers in Dentistry – Minimal Invasive Dentistry | Restoration of Dental Implants | Digital Dentistry & Photography

Module 8 | May 2022 | Prof. Paul Tipton & Dr. Rami Haidar & Dr. Adam Toft & Dr. Ashish Rayeral
Occlusion 3 Seminar, Treatment of the Worn Dentition, Vertical Dimension and Facial Aesthetics
Botox & Dermal Fillers – A Dental Facial Aesthetics Part 1 & 2

+971 528 423659 | p.mollov@cappmea.com

www.cappmea.com/capptipton

[16] => DTMEA_No.6. Vol.9_DT.indd

16

LASER DENTISTRY

Dental Tribune Middle East & Africa Edition | 6/2019

◊Page 14
The effect of Er:YAG (Smart
2940D Plus, DEKA) and
Er,Cr:YSGG (Waterlase iPlus,
BIOLASE) lasers on the shear
bond strength between
orthodontic brackets and
dental porcelain in comparison with conventional
acid etching with 9% hydrofluoric acid (Ultradent
Products) was investigated
by Mirhashemi et al.13 They
concluded that with the laser groups the failures were
mostly adhesive, while they
were mostly cohesive with
the controls.13 They found
that the Er:YAG laser with
the specifications they used
was not a suitable alternative
to hydrofluoric acid etch-

AD

ing.13 In the case of the Er,Cr:YSGG
laser, although the conditioning
outcome met the bond strength requirement for orthodontic brackets
(6–8MPa) they concluded that the
bond strength must be further improved by fine-tuning the irradiation parameters.
Yassaei et al. assessed the efficacy of
an Er:YAG laser and pastes containing casein phosphopeptide-amorphous calcium phosphate (CPPACP) with and without fluoride and
their combination for prevention of
white spot lesions in the enamel.14
They found that the Er:YAG laser
was able to decrease demineralisation.14 It further proved to be a potential alternative to preventative
dentistry and was more effective
when combined with CPP-ACP products.14 This would be useful especially for orthodontics.
Sarmadi et al. evaluated patients’
experiences of two excavation
methods, the Er:YAG laser and rotary bur, and the time required with
these methods, as well as objective
assessments of quality and durability of restorations over a two-year
period.15 Their conclusions were
that the Er:YAG laser technique was
more time-consuming than the rotary bur, but despite this, the laser
technique caused less discomfort
and was preferred as an excavation
method by patients.15

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Li et al. carried out a meta-analysis to
systematically evaluate the applications of Er:YAG lasers for the removal of caries and cavity preparation in
children.16 They concluded that the
time required for Er:YAG laser treatment was longer than that for the
conventional mechanical method,
but there was less pain associated
with the Er:YAG laser treatment.16
There were no significant differences in the complete retention rate,
marginal discoloration and marginal adaptation when compared with
the conventional method.16
Pinheiro et al. assessed the utility
of dental acid etchants containing
37% phosphoric acid and methylene
blue dye as a sensitising agent for
photodynamic therapy to reduce
Streptococcus mutans in dentinal
caries.17 They concluded that this
treatment can be used as a photosensitising agent for photodynamic
therapy to reduce the S. mutans burden in dentinal caries.

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Laser dentistry offers many application options and numerous research
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consideration of recent literature
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Dr Igor Cernavin
Prosthodontist
Honorary Senior Fellow at the
University of Melbourne School of
Medicine, Dentistry and Health Sciences
Director and Co-Founder of the
Asia Pacific Institute of Dental Education
and Research (AIDER)
Australian representative of WFLD
Private practice
274 Main Rd East
St Albans VIC 3021, Australia

[17] => DTMEA_No.6. Vol.9_DT.indd

[18] => DTMEA_No.6. Vol.9_DT.indd

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 6/2019

Preoperative digital planning
RAW workflow: A professional’s approach to planning monolithic
restorations on single-tooth implants
By Florin Cofar, DDS, Romania, and
Dr Eric van Dooren, Belgium
Digital planning and preparation
provides a high level of reliability in
implant-prosthetic procedures. Preliminary virtual simulation of the
surgical intervention can provide
the necessary confidence and certainty to carry out the actual surgery
with peace of mind. Two dental professionals describe their procedure.
Every workflow begins with an information gathering exercise. If a
digital workflow is followed, the information consists of data that can
be processed by the software being
used. Our prosthetics team employs
a photo-video protocol to examine
the esthetic-functional relationship
between the smile, dental situation
and face of the patient. In addition
to conventional photographic documentation and video sequences,
we use digital volume tomography
(DVT) and intraoral scans in the assessment of implant prosthetics
cases. By merging all the information gathered we obtain what we call
a “digital clone”. These amalgamated
data sets enable us to plan all steps in
a virtual treatment suite as if we were
working on a clone of the patient. Below we present our procedure, using
the example of an implant prosthetic single-tooth restoration.

Creating a digital clone

The process begins by obtaining a
high-quality portrait photograph, a
DVT and an STL file (Figs 1 to 3). In the
case presented here, tooth 12 can no
longer be preserved and needs to be
replaced with an implant prosthetic
restoration. Designing the prosthetic
restoration forms the first stage of
the implant planning sequence. In
the present case, the shape of the existing tooth should be maintained.
If an analogue workflow is followed,
the premise for the implant is the
extraction of the tooth. This scenario
also forms the first step in the digital
procedure described here - however,
the tooth is “only” extracted virtually. We can extract the tooth digitally
to design e.g. the future alveolar cavity (emergence profile) and generate
an optimized emergence profile. An
alveolar model is required for:
1) designing the drill template (navigated implant insertion) and
2) fabricating a temporary restoration / abutment prior to the surgical
intervention.
We only ever use copies of the data
files. Theoriginal data sets remain
untouched. Several methods can
be employed to perform the virtual
tooth extraction. In our opinion, the
most effective approach is to use the
“Provisional Pontic” CAD process
and to design the alveolar cavity to
have an optimum shape. You should
always work on two levels when executing this step. The working scan
represents the first level. The original
scan with the tooth represents the
second level in this scenario.

Implant prosthetic planning

The implant crown is designed (virtual wax-up). In the present case, the
tooth being replaced serves as the
template. The crown reflects the position and proportions of the original tooth. A copy of the scan file is
again used as working file on which
the virtual tooth extraction is per-

formed. This allows us to go back to
the original data and compare it with
the working file. We define the ideal
implant placement position and
design the peri-implant soft tissue
contours on the screen to provide
an adequate emergence profile (Fig.
4). We then prepare a drill template
for safe transfer of the implant position to the oral cavity. Even though
most dentists are familiar with this
procedure, we will briefly address
the fundamentals: Basically, three
data sets are required for preparing a
drill template:
1) a scan showing the digitally extracted tooth,
2) a data file of the DVT, and
3) a scan showing the CAD design of
the tooth being treated; in the present case, this means the original
scan with the existing tooth.
At the next step, we simulate the surgical procedure on the screen. The
implant is inserted digitally and then
a template of the procedure is exported. The conditions of the alveolar
bone can be assessed to determine
the bone’s fitness for the planned
procedure. If necessary, the alveolar
bone may be adjusted, for instance
by planning a bone transplant. Alternatively, a compromise may be
made and it may be preferable to
opt for a cemented restoration or a
change in the design instead. We take
all the major decisions at the virtual
implant insertion stage. The details
can then be transferred to the clinical
situation by means of the drill template. The position of the implant is
established with the help of the waxup (3 to 4 mm deeper). The implant
angle and position should be selected so that the available bone structure can be used to optimum effect,
without deviating too much from
the specifications of the prosthetic
restoration. In this case, the aim is to
provide a screw-retained restoration.
We are still using our “digital clone”
to plan these steps. Once the preparatory steps have been completed,
the drill template is printed (Fig. 5). In
addition, the STL file of the implant
model including the optimized alveolar cavity design and digital scan
body (Fig. 6) are prepared to design
the temporary restoration.

Fig. 2. DVT data set in the software program

Fig. 1. Portrait image prior to the intervention

Fig. 3. Surface scan of the preoperative situation

Fig. 4. Virtual extraction of the tooth in need of treatment

Fig. 5. DVT data set in the software program

Fig. 6. Surface scan of the preoperative situation

Designing the temporary
restoration

The virtual implant model (Fig. 6) is
imported into the construction software to design the abutment and/or
temporary restoration. The crownabutment interface should be placed
in an optimum position in the previously prepared alveolar cavity. The
Ti base has been defined at the time
when the implant depth was determined during the implant planning
step. In the present case, the implant
has a depth of 3 to 4 mm. The optimum length of the Ti base is therefore 1.5 mm.
The temporary restoration is placed
on a Ti base with free rotation to prevent potential problems caused by
the implant index position.

Fig. 7. Printed drill template (Mguide, MIS)

Fig. 8. Immediate temporary restoration

Fig. 9. Atraumatic tooth extraction

Fig. 10. Implant insertion (NP implant, MIS) with drill template

Fig. 11. Drill template and implant after insertion

Fig. 12. Temporary restoration after the surgical intervention

Whether a screw-retained or cemented restoration is chosen is at
the discretion of the dentist. We
tend to prefer screw-retained restorations. However, the ultimate deci-

ÿPage 20

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GUIDED BIOFILM
THERAPY
R

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[20] => DTMEA_No.6. Vol.9_DT.indd

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 6/2019

◊Page 18

Fig. 13. Clinical situation with scan body

Fig. 14. Implant prosthetic restoration

formed at the time of the temporary restoration. In the present case,
the thickness of the gingival tissue
should be additionally increased.
For the final restoration, a Ti base of
the same length as the one for the
temporary restoration is used. This
time, however, the base features an
anti-rotation lock. A large selection
of materials is available for the final
restoration. We normally use hybrid
restorations for the restoration of
single implants. Here, the restoration consists of a monolithic zirconium oxide abutment (Zenostar)
and a monolithic multi-shaded allceramic crown (IPS e.max ZirCAD
MT Multi). The restoration is characterized with stains and completed
without any shape modifications
(Figs 14 to 16).

Conclusion

Fig. 15. Close-up of the final situation

sion about which restoration to use can only
be made at the point when the surgical intervention is planned. Whether the prosthetic
restoration is made in one piece or as a hybrid

Fig. 16. Portrait image after completion of the restoration

crown is also at the discretion of the dentist.
Hybrid restorations are normally preferred in
esthetically demanding situations and onepiece
restorations in the posterior region.

YEARS
WARRANTY

Surgical phase

All the items required for the surgical intervention have
been prepared and are now ready for use: This includes
the printed drill template (Fig. 7) and the temporary
implant restoration (Fig. 8). Tooth 12 is now extracted
atraumatically in the “real world” (Fig. 9).
Immediately afterwards, the fit of the drill template is
checked in the oral cavity and the implant is inserted according to the drill protocol (Fig. 10). This is followed by
the augmentative measures planned in advance and finally, the temporary crown is screwed on (Figs 11 and 12).

Prosthetic restoration

After a healing phase of at least eight weeks, the temporary restoration is removed and the design is copied.
This is the first time in the entire procedure that the
actual scan body is used (Fig. 13). The scan body assists
in recording the position of the implant. This position
corresponds to the originally planned position and also
reflects the implant index position.
This method ensures the accuracy of the restoration
procedure. The transgingival areas have already been

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Errors can be avoided by planning
the intervention on a “digital clone”
and preparing any auxiliary and
therapeutic devices ahead of the
actual surgical procedure. If this approach is used, suboptimal implant
placement – both prosthetically
and surgically – can be detected and
corrected in advance. In addition,
necessary augmentative measures
are already evident at the planning
stage and can be prepared accordingly. This way, “surprises” during
the intervention on the patient can
be avoided as far as possible. This
brings a high level of reliability and
certainty to the treatment process.

Florin Cofar, DDS
S.C. DENTCOF s.r.l.
Simion Barnutiu Nr 62 etj. 5
300302 Timisoara
Romania
Florin.cofar@dentcof.ro
Dr Eric van Dooren
Tandartsenpraktijk van Dooren
Tavernierkaai 2, 8e verdieping
2000 Antwerp
Belgium

[21] => DTMEA_No.6. Vol.9_DT.indd

[22] => DTMEA_No.6. Vol.9_DT.indd

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 6/2019

The new frontier restorative dentistry
Federico Ferraris Adhesthetics Theca Kit
aligned against the preparation
bevel, allows for the thickness of dentinal material and residual buccal
enamel to be determined.

By Hu-Friedy
The Adhesthetics Theca kit is comprised of four unique instruments
designed by Dr. Federico Ferraris in
collaboration with Hu-Friedy. It is a
unique set of instruments created
for use during the clinical phases of
both direct and indirect restorative
dentistry to help clinicians achieve
positive results through clinical excellence.
The Main Shaper, the Fine Shaper,
the 3D Shaper and the Direct Caliper
are all made using XTS technology,
a dark Aluminum Titanium Nitride
(AlTiN) coating that offers superb
contrast in comparison to composite
materials and tooth structure.
The coating is also incredibly slick,
resisting the adhesion of sticky composite materials. The smooth handle
is not only ergonomic and lightweight, but each instrument has its
own distinct set of colour cones,
making instrument identification
simple. The set of four instruments
includes an IMS Cassette, which prevents the instruments from being
damaged during transportation and
sterilization protocols.
TNFF1/2
FF1
Manipulation of composite on buccal surfaces during direct anterior
restorations, Class IV and V cases, direct veneers restorations and general
esthetic restorations. The tip’s lance
shape and flexibility allow for it to
adapt to restorative material and
is also effective in removing excess
material from the vestibular region
by using its edge (Fig. 7). Its flexibility
allows for restorative materials to be
manipulated with a delicate touch.
It is sturdier than a standard brush
however less rigid than a standard
spatula.

Fig. 7

Fig. 12

Fig. 17

Fig. 8

Fig. 14

Fig. 23

TNFF3/4 Fine Shaper /Cord Packer
Modelling of restorative materials
on anterior and posterior teeth as
well as the placement of retraction
cord. A distinctive characteristic of
this spatula (FF3 straight and FF4 angled) is its flexibility. Its thin design
allows for precise modelling (Fig. 9,
12).
It is particularly useful for deep cavities. It is also helpful during procedures where high magnification is
used because its length allows for
easier access to these deep regions
while not interfering with the clinician’s field of vision. Retraction cord
can be placed precisely with the thin
instrument tip (Fig. 14).

TNFF5/6 3D Shaper
FF5
Anatomical modelling of restorations of posterior cusps (Fig. 17) or
of anatomical dentinal or superficial elements on anterior teeth. The
unique teardrop shape of this point
makes it excellent for sculpting materials in both posterior and anterior
cases.

FF2
Application of medium-great quantity of material directly on the tooth
or as a material carrier. Its round
shape and rigidity allow for the manipulation of restorative materials in
wide cavities. It is also effective when
placing material on wide surfaces
(Fig. 8). Dimensions of working part:
length 11,5 mm; width 2,5 mm and
thickness 0,4mm.

The FF7 can be used to assess an
enamel thickness of 0.5mm (the universal thickness in the third medium
of the crown), while the FF8 can be
used to assess a thickness of 0.9mm
(which is preferred in incisal areas, or
times when the thickness of the natural enamel is of critical importance).
The shape of the dentin in the incisal
direction in addition to the thickness
to the margin can be determined
with this instrument.

Fig. 29

FF6
Sculpting thin sulcus as well as finishing of the margins and thin modellings on posterior and anterior
direct restorations. Application of
fluid material in deep cavities (Fig.
23), positioning of flowable materials
in occlusal sulcus, coating low viscosity materials, removal of excesses of
high viscosity cementation material
and control of margins after cementation (Fig. 27) point makes it excellent for sculpting materials in both
posterior and anterior cases.

TNFF7/8 Direct Caliper
Measuring thickness of enamel margin in direct restorations on anterior
teeth, measuring thicknesses of direct and indirect restorations during
various clinical phases (Fig. 29), creating definition of dentinal curving
(Fig. 30).

Its distinctive curved shape allows
the tip to easily reach areas in both
the anterior and posterior arch. Fine
details can be created in restorative
materials due to the tip’s thin design.

This instrument is a restorative
probe with a flat head (not rounded,
as most periodontal probes) with
grooves at 0.5mm increments. The
tip is angled at 45° which when

Fig. 27

Fig. 30

To learn more about Federico Ferraris’ Adhesthetic Theca Kit visit
www.hu-friedy.eu or contact our local distributors.
Follow us on
@HuFriedyEU
@hu_friedy_europe

Fig. 9

Align Technology showcases its
digital dentistry solutions at DLS4 Bahrain
By Align Technology, Inc.
Align Technology, Inc. (NASDAQ:
ALGN), a global medical device company engaged in the design, manufacture and marketing of the Invisalign system, the most advanced
clear aligner system in the world,
and iTero intraoral scanners and services for orthodontic and restorative
dentistry, will highlight its digital solutions that have helped transform
the lives of millions of patients at the
fourth International Dental Conference & Exhibition (DLS4). The event
will take place at Art Rotana Hotel,
Amwaj Islands in Bahrain, from Nov.
14 to 16, 2019.

One of the highlights of the event will
be an Invisalign seminar, hosted by
Dr. Mario Greco, the visiting professor at the University of Ferrara, who
will discuss in detail the advantages
of clear aligners versus conventional
appliances. The seminar is open to
all delegates of DLS4, and will be held
on November 15 from 1 to 3pm. Dr.
Greco will also lead a plenary lecture
on November 15 from 10.30 to 11.30
am on ‘the Effective Affinities for
Aligner Digital Orthodontics.”
In addition to the lecture and the
workshop, Align Technology’s exhibition stand will showcase its digital
dentistry solutions, including the

Invisalign clear aligner system that
helps straighten teeth of teenagers
and adults without the need for a
brace.
Invisalign`s Mandibular Advancement feature combines the benefits
of the most advanced clear aligner
system in the world with features
for moving lower jaw forward while
simultaneously aligning the teeth.
Invisalign treatment with mandibular advancement offers convenient
and barely visible treatment in comparison to functional appliances. The
treatment is done without the need
for elastics typically used to treat
teen Class II patients.

Mawlid Chaoui, Align Technology
general manager for Middle East and
Africa, said: “DLS4 Bahrain is a truly
global event that brings together dental experts and medical professionals
to discuss evolving trends as well as
the challenges faced. We are extending our support to the event as a Diamond Sponsor in addition to hosting
Dr. Mario Greco at the event to present
the advances we have made in digital
dentistry. Today, our Invisalign clear
aligner systems and iTero Element
scanner are a popular choice among
practitioners and we aim to leverage
our participation to strengthen doctor
awareness about our innovative products and solutions.”

Invisalign clear aligners help move
teeth without the use of braces,
mini-screws or mini-implants. Invisalign aligners are removable, easy to
clean and made of a proprietary material called SmartTrack, developed
specially for Align, which differentiates the Invisalign system from traditional braces as well as alternative
clear aligner offerings.

[23] => DTMEA_No.6. Vol.9_DT.indd

RESTORATIVE

Federico Ferraris’

ADHESTHETICS THECA KIT
Incorporating these techniques
into everyday procedures allows
for predicable results in direct
and indirect restorative
dentistry. Constantly challenging
yourself and continuously
makingpersonal improvements
is the personal motto of
Federico Ferraris.

Do Better Than Yesterday
— DR. FEDERICO FERRARIS

ADHESTHETICS:
The Concept
Adhesthetics is the fusion of Adhesion
and Esthetics and represents the
process by which protocols are codified
during the different phases of the
treatment. This philosophy gives
successful protocols to those clinicians
who wants to achieve excellence in
Restorative Dentistry.

The Instruments
With four instruments including the
Main Shaper, the Fine Shaper, the 3D
Shaper and the Direct Caliper, the kit
is conceived to obtain the best results
in Adhesthetics. The kit has been
designed by Dr. Ferraris himself in
collaboration with Hu-Friedy.

MIDDLE EAST
YOUR HU-FRIEDY DEALER

Egypt: Safwan Egypt Co.
Iraq: Al-Hijazi scientific bureau
Jordan: Basamat Medical Supplies
Kuwait: Advanced Technology Company K.S.C.
Lebanon: Pharmacol

Visit us online at hu-friedy.eu
©2019 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-289GB/1119

Main
Shaper

Fine
Shaper/
Cord-packer

GULF REGION
YOUR HU-FRIEDY DEALER

3D
Shaper

Direct
Caliper

Bahrain: Gulf Pharmacy
Oman: Al Farsi National Enterprises LLC
Qatar: Ali Bin Ali
Saudi Arabia: Al-Turki Medical Group Ltd.
Utd.Arab Emir.: ALPHAMED General Trading LLC

[24] => DTMEA_No.6. Vol.9_DT.indd

INTERVIEW

Dental Tribune Middle East & Africa Edition | 6/2019

CAD/CAM can be an incredible teaching tool
Is the learning curve greater for
students now that they have to
learn these digital technologies?
There really is no learning curve.
These students pick it up within
minutes, to a point where they understand it better than I do! They
grew up with computers and are naturally drawn to this technology, are
passionate about it and are excited
to bring it into their future dental
practices.

By Brendan Day, DTI

Dr. Hack, you’ve been in dental
education for more than three decades. When did you first introduce
CAD/CAM tools into your teaching?
Let me give you a little background.
In the early 2000s, there were some
representatives from Sirona who
came to conduct a demonstration at
our dental school. At that time, they
had the CEREC Red Cam. I had been
teaching in the crown and bridge
course for many years at that point,
but when I saw this technology firsthand, I was overwhelmed. I knew
that this was the future of dentistry.
I knew that this would introduce an
incredible level of excitement for the
dental students. And I knew about
the students’ passion for computers
and technology.
In 2006, the University of Maryland
School of Dentistry moved into a
new building. Our dean at that time
was a visionary. He wanted to teach
to the future, not to the past. I said to
him, “The future is digital dentistry.”
We were still making impressions
while working under a light, just as
I did when I was a student back in
the 1970s. With his permission, I arranged for a gift from Sirona of ten
Red Cams and ten compact milling

Dr. Gary Hack is an associate professor at the University of Maryland
School of Dentistry, where he teaches
in the Department of Advanced Oral
Sciences and Therapeutics. In this
interview, he outlines how he integrated dental CAD/CAM technology
into his teaching methods and how
his students have responded to this.

Dr. Gary Hack has employed dental CAD/CAM technology in the classroom since 2006.

machines, personally driving them
back myself in a truck from Sirona’s
headquarters and setting them up in
our so-called Dream Room. That was
the beginning.
How did you incorporate CAD/
CAM into your teaching methods
at that time?
I began trying to integrate digital
dentistry into everything we were
teaching from that point onward.
At that time, I was teaching a freshman course on amalgams and
composites, and the general thinking was that you couldn’t gain any
value from scanning amalgam and
composite preparations because
they have undercuts. What I quickly
learned, however, was that it was
very easy to scan these. Instead of ten

or 15 students gathered around you
and a typodont, failing to really see
anything while you try and explain
the walls of an intracoronal preparation, a single scan allowed for me to
show everybody all the different elements in a way that was much easier
for them to understand.
I soon became aware that, not only
was this CAD/CAM equipment good
for same-day dentistry in a private
practice setting, but it could also be
utilized as an incredible teaching
tool. I saw that it wasn’t just useful
for crown and bridge preparations
but intracoronal preparations as
well.
Now, with the software that is available on certain CAD/CAM devices,

What is the
ClearSmile
Aligner?

the students have the ability to evaluate their own preparations and get
feedback from the computer. After
35 years of teaching, I can tell you
that it’s almost impossible to get ten
dentists to look at the same dental
preparation and each come up with
the same grade. Everyone has his or
her own bias, his or her own way of
looking at things. However, the computer has no bias.
At the school, we’re using digital dentistry solutions for crowns, bridges,
veneers, implants and so on, but we
now have to integrate it into CBCT
imaging and surgical guide printing. I think the current students are
getting into dentistry at one of the
most exciting times in dental history. I’m passionate about this and
want Maryland to be at the forefront
of dentistry.

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.

Many of our graduates who apply
for jobs working under older, more
experienced dentists are also already
ahead of the rest of the pack as a result of their familiarity with digital
dentistry. The older dentists might
be a little nervous about integrating CAD/CAM technology into their
dental practices, but realize that
CAD/CAM is nonetheless the future
of dentistry.
Do you think that the price of investing in CAD/CAM tools and
technologies can be prohibitive?
Let me begin with the private practice. The return on investment is
clear: If you buy this technology, it
can often pay for itself within a few
years as a result of savings. If you mill
in-house or simply digitally scan at
your practice and still send away to
a dental laboratory for fabrication,
you will be saving money over using
conventional techniques.
In my opinion, all dental schools
are, to some degree, struggling with
this decision. Clearly, they know that
they have to do this, that it is incumbent on them that they teach their
students this technology, since if
they don’t, they are not properly preparing them for their future practice.
Yes, the financial cost can be a barrier, but this is clearly outweighed by
the benefits that come with integrating CAD/CAM devices into current
methods of teaching.
Is there a role for industry to play
in supplementing this classroom
learning?
My thinking is that, yes, it can play
a role. As teachers, we can go back
to the manufacturers and tell them
what we would like to see in their
evaluation software and they will
work on it. There is a collaboration
between dental school education
and the manufacturers that becomes a win-win situation. The manufacturers know that, if the students
are being taught digital dentistry,
then chances are, when they get into
private practice, they’ll move in that
direction.

www.clearsmilealigner.com
www.iasortho.com
www.mdentlab.com

Tel : 04-332901
Whatsapp +971 557590217
info@mdentlab.com

Dr. Gary Hack

Dental students in the 'Dream Room' at the University of Maryland School of Dentistry.

[25] => DTMEA_No.6. Vol.9_DT.indd

[26] => DTMEA_No.6. Vol.9_DT.indd

INTERVIEW

Dental Tribune Middle East & Africa Edition | 6/2019

Dentsply Sirona World 2019 – Las Vegas
ULTIMATE DENTAL MEETING
REVOLUTION IN DENTISTRY
OR FAMILY REUNION

8,000 PARTICIPANTS
153 BREAKOUT SESSIONS
110 SPEAKERS

Interview with Don Casey, CEO of Dentsply Sirona

Dentsply Sirona World 2019 is presented as the ultimate dental meeting. What makes this event the ultimate dental meeting?
We believe that Dentsply Sirona
World is the ultimate dental meeting because it combines significant
clinical education and hands-on
opportunity to work with products
right after completion of that clinical education. We have learned
that, if dental professionals are going to invest time with us, we want
them to interact with each other in
an environment in which they can
have some fun. So, whether it’s the
Las Vegas location or the entertainment, we are giving them an opportunity to spend three days away
from their practice to learn how to
improve their practice, learn about
new technology and equipment, and
then to have some fun. It’s the ultimate dental meeting because of the
uniqueness of the show—it’s not a
conference, it’s not a trade show, it’s a
combination of the two built around
what they need. For Dentsply Sirona,
it is rare to have an opportunity to
talk to thousands of customers. We
have close to 600 people here talking to dental professionals every
single day and that helps us to gain
insight into what they are thinking.
Thus, while we would like every dentist in the US to think of this as the
ultimate dental meeting, it is also the
ultimate dental meeting for us because of the amount of feedback we
get from our customers.
Dentsply Sirona World 2019 attendees are dental professionals
who truly care about their practices and businesses, but more importantly, about the health and satisfaction of their patients. How does
Dentsply Sirona monitor patients’
satisfaction, and what is the future
of oral health in your opinion?
If you look at the evolution in dentistry over the last several years,
there has been a rapid growth in the
amount of money going into aesthetic treatment, whether it’s clear
aligners, implants, veneers or other
cosmetically oriented products, and

Dentsply Sirona employs 15,000
people globally who focus every
day on research, innovation and
the manufacture of high-quality
equipment and consumables. You
literally bring new products to the
marketplace every day. How do
you manage such a large portfolio
of products, and how do you follow
up with your customers on their
feedback on new launches?
I’m always thinking about ways to
reach the dental professional and
to reach our people so that they can
come up with great products and
think about the product and the
end customer right from the start.
Firstly, we’ve been working hard to
determine a new purpose and at
present that purpose is for all of us
at Dentsply Sirona to wake up every
morning with the focus on serving
the dental professional and providing him or her with every tool he
or she needs to deliver great oral
health and give patients their smiles
back. And, what we have found is
that, whether you’re in manufacturing in Bensheim in Germany or in
our commercial team in Dubai or
in manufacturing in Japan, all over
the world, people are inspired by
the opportunity to help their father,
their mother, their brother, their
sister, their kids. Thus, we start with
a purpose first. Secondly, and this is
very interesting, the single biggest
commonality in every product at
Dentsply Sirona is that it has been
developed in conjunction with key
opinion leaders. There have always
been key opinion leaders who have
served an incredibly foundational
role in our product development.
When we develop a new product, it
is with the helpful guidance of a lot

In this interview, conducted at Dentsply Sirona World 2019 in October,
Dr Dobrina Mollova, Dental Tribune Middle East & Africa (DTMEA),
speaks with Don Casey, CEO of Dentsply Sirona.

as a result, many dentists have been
pursuing that. In many cases, the
companies advertising those products almost serve as fuel for more
rapid growth. This requires Dentsply
Sirona to reconsider our traditional
focus, so that over time we will have
to commit to helping our dentists
reach patients in an efficient manner. I don’t think we’ll ever be the
type of company that is driven by
patient advertising. I think our role
is to help the dentist innovate and
deliver great patient care, but part of
our commitment to serving dentists
well is our ability to help them manage their business in a space that is
becoming increasingly customerdriven.

By Dr Dobrina Mollova, DTMEA

of dental professionals. We trust that
we have motivated, excited people
delivering great products that the
key opinion leaders have helped us
shape. And we think we have the best
worldwide commercial organisation.
We can commercialise products in
over a hundred countries as rapidly
as we can get registration. So, we believe we are a unique company in the
dental environment.
Education is one of the most important aspects of the Dentsply Sirona
life and philosophy. The company
is the most important and largest
supporter of CAPP and the CAPP
Dental Training Institute in Dubai.
Together, we have trained more
than 65,000 dental professionals
over the past 15 years through conferences and clinical educational
programmes. What do you think is
important for sustaining this kind
of collaboration, and what is your
advice for the future? What is your
strategy for dental education in the
short and long term, especially in
the Middle East?
I am still new to dentistry after
18months. The thing that is very surprising to me is how quickly dental
professionals get into habits and in
some areas therefore adopt technology slower compared with other
medical professions. And one of the
commitments that I want Dentsply
Sirona to make is that we will stand
behind people who can help advance the profession. If we can do
that synergistically with a partner,
that would be better for us because if
both parties can invest it means our
reach can be amplified, so I am highly supportive of collaborative efforts
in trying to reach dental professionals. In a case of a place like Dubai, we
may partner with CAPP and another
manufacturer to create an even bigger event that would make it worthwhile to get a larger numbers of
dentists there. Because I believe our
products are the best in the market,
I also believe our products are going
to help general dentists to perform
specialist procedures. I believe that,
if we build the best products and if
people become educated in their use,
we will win. So, let’s educate and let’s
press for it. Last year, we had over

430,000 dentists, in one year, take
one of 12,000 courses we did around
the world. So, if we could double that,
say, in five years, and if we could do
that together with partners, I think
that would be very important.
Digital technologies are developing at an unprecedented rate. CAPP
is the founder of the CAD/CAM
and Digital Dentistry Conference,
a world first, in Dubai (the first edition was in 2005). Next year, we
will be celebrating the 20th global
edition (in Dubai and Singapore)
during Expo 2020 in Dubai. CAPP
is the official partner of Expo 2020,
and we expect thousands of dental
professionals to attend the event.
How do you see and what do you
expect from Dentsply Sirona’s participation in this event?
If we were on a journey of a 1,000
km in digital, we are still at the beginning. We’re very, very early. My
children’s generation—I have three
daughters aged 31, 30 and 25—don’t
know what it takes to own a car, they
use Uber; they don’t know what a
record was, their music is all digital.
I believe that that group coming
into dentistry is going to want dentistry to function in the same way
that they operate everything in
their lives. So, the demand for digital
technology will be huge. For us as a
manufacturer, digital is transformative; however, we have to start thinking about things differently to the
way we think today. We have always
thought, here’s the product and
here’s the software we need to enable
the product. I think that is going to
change to: here’s the products, here’s
the software that works together,
collaboratively, with the products,
so that if you take an image and you
take a digital impression, you should
be able to seamlessly put the two
together and put that into a set of
easy-to-use treatment protocols. We
could provide the algorithms, or the
dentist could do all that work, if he
or she wanted to—the choice would
be his or hers. I think that, within the
next three to five years, the advances
we have seen elsewhere will reach
dentistry regarding integrated, inthe-cloud, easy-to-use data and regarding how we retrieve the data and

use the data generated, because artificial intelligence will be a really important part of the treatment planning. There are things that we don’t
even understand yet. For instance, I
was trained on how to use the CEREC
Omnicam and I’m not a skilled dentist, but it used to take me about 5
minutes to do a full arch and I can
now do a full arch in under a minute
using Primescan.
I don’t think we have any idea of what
it’s going to mean to follow a patient
from age 8 to age 50 with scans every
year. What will that mean and how
are we going to think about that? To
my mind, the plethora of data that
will be generated is going to create
whole new fields, whole new opportunities in areas that will allow us to
provide the patient with better care.
Dentsply Sirona appreciates the importance of Expo 2020. We will make
sure that we are there, and we will be
prominent and give you the support
you need.
How important is the Middle Eastern market for Dentsply Sirona,
and what are your expectations
for it for the near future in terms of
business opportunities and dental
education?
The Middle East market has been
and will always be a focus market for
us, we are investing here since 2005
on setting our team structure. In
2016 we moved in to our new showroom and training facility in Dubai
which we aim that it will be a new
gate of education to the dental Technicians and Dental professionals in
the region. We also have our Riyadh
– KSA Showroom fully active and
soon in early 2020 we are opening
our new showroom in Cairo – Egypt,
Education is one of our main goals
at Dentsply Sirona and enriching
the industry with the appropriate
knowledge is a target which we are
always focusing on.
Our full dental solution portfolio allows us flexibly to look into a broad,
bright future for business opportunities in the Middle east market and
we are planning to grow our business there with the cooperation of
our partners.

ÿPage 27

[27] => DTMEA_No.6. Vol.9_DT.indd

Dental Tribune Middle East & Africa Edition | 6/2019

INTERVIEW

◊Page 26

Interview with Julie Mroziak, Vice President of Dentsply Sirona

Many dental technicians from
around the globe are attending
the event today. How important is
the dental laboratory’s portfolio of
products and equipment for Dentsply Sirona?
What makes it so important that we
have laboratory technicians in a setting like this for Dentsply Sirona is
that we really have to understand the
dynamics of what’s changing chairside in the clinical space. If a laboratory technician can truly understand
what’s happening in that digital age,
the change in technology, he or she
can be a better partner to their dentists. So we feel that the value of the
Dentsply Sirona Lab organisation is
supporting technicians in the pivot
of evolving digital communication
channel. Dentists and dental technicians have to be able to grow in that
space together, and by both of them
hearing and learning what’s happening in each other’s space—materials,
technology and chairside—they can
be better partners together. We can
come alongside of them and support
them with that change. Therefore,
it’s really critical that the laboratory group is part of and supportive
of the technicians that come to DS
World. We think that we can make
them more confident in that change
process.
Dentsply Sirona Laboratory introduced a number of important
innovations at the International
Dental Show (IDS) this year. Can
you please tell us what were the
most important ones, what is new
about the Cercon xt Multilayer and
will attendees of Dentsply Sirona
World 2019 find anything new?
We had a number of different things
that we launched this year. One of
them highlighted the Cercon xt Multilayer. That’s really our new way in
which we can support laboratories in
zirconia science with integrated layering for better light dynamics, just
an easier workflow for technicians to
be able to mill and finish cases without really doing extra work—cutback or extra staining. It also falls in
the family of other Cercon products.
They all can fire at the same time, so
there’s efficiency that laboratories
gain by having a multilayer version
that can fire in the same cycle as a
traditional Cercon xt or ht version.
Zirconia is still a very strong-growing

category, so that is important for us.
We also highlighted our new Multimat Cube and Cube press ceramic
furnaces, one for firing and one for
pressing, and they are for the lithium
silicate and lithium disilicate categories as well as other pressable ceramics. The regular Cube can work with
all ceramics and with metal veneering as well.
There is also the inLab Prosinter,
which is a furnace that enables the
technician to have more efficient
flow in one device, that is the metal
sintering as well as the ceramic sintering. Those are some of the highlights in equipment and material at
IDS.
We have tracks for all of those different types of materials. We have the
ceramic and zirconia material training. We’re completing work around
the digital denture category. We are
also creating integrating workflows
by connecting digital impression
taking through software, equipment
and materials. It is a really wide range
and combination of what we’re offering through the laboratory track
here.
Dentsply Sirona has great expertise in scanning and CAD/CAM
software, such as Lucitone®, IPN®
and inLab®, which are globally
recognised for quality. In the beginning of 2019, you entered into a
strategic partnership with Carbon.
What can dental technicians expect from this partnership?
Dentsply Sirona has continued to
be an innovator in the material and
technology space. It’s something that
we’ve really put a lot of energy into
and focus on. What we find is there
are spaces where another company
could support a part of the process
to enable greater advancement. We
will always be open to looking into
those opportunities. In this particular space, Carbon was one of those
potential partners that we could collaborate with to take us to another
level in the new additive technology
category of 3D printing. They really
have a superior way in which their
equipment can process digital lightcuring materials. The Carbon-crafted
science, together with the specific
formulations that Dentsply Sirona
brings for material, was able to allow
us to advance to the second generation of 3D printing materials for digital dentures. This is really unique, the

first high-impact denture base material in the market. I think Carbon
brings great confidence for laboratory technicians because they provide
such great service, installation and
support, and because of their technology, and people trust the Dentsply Sirona material brands, so together this has been a very powerful
message of partnership and collaboration. We’ve announced it in early
2019, and at the beginning of 2020
is when we are going to fully open
up that new digital denture category
to the US market. Thereafter, we will
expand to other places around the
world. But it’s a very exciting time for
that partnership and collaboration.
Printing machines are individual
and different in how they work, and
part of what Dentsply Sirona Lab
wants to do is to help educate technicians about those differences. The
way materials come through a printer affects the physical properties you
can get from those materials. It takes
time to perfect the way that materials can form and then be ultimately
cured to achieve the physical properties, so we want to help educate people. There are many good printers
on the market and we really see great
advancements in lots of technologies. Some of them are very good for
model production, potentially other
indications, splints, chairside guides.
However, for our Lucitone 3D Digital
Print denture, Carbon M-series printers are the only devices that are validated and indicated for achieving
the device physical properties that
we claim. It is important that laboratories understand the importance of
following the steps of the workflow.
It is critical to us that we can help
educate technicians, who are wary of
the science in the beginning, on why
we chose this partner and why the
material works well and that we are
continuing to conduct a lot of testing. We are partnering with universities to provide independent studies
on the material and the workflow in
the Carbon unit. As previously mentioned, it is only designed for their
M-series printer; it won’t perform
the same way in other printers. It’s
important that we educate so that
there is no failure and we can have
confidence for our customers. When
they print the device out, they must
know that not just the fit but the
long-term performance is going to
be there. I think we have a responsi-

bility as a company to help educate
in that space because we don’t want
people to be misled. Not all devices
work the same, not all materials in
those devices will work the same
way. It’s very important as this last
analogue part of laboratory work is
pivoting to digital. We have to help
them through that process. We think
we can partner with laboratories to
help them make that last transition
from traditional dentures to digital
dentures.
Education is one of the most important aspects of the Dentsply Sirona
life and philosophy. The company
is the most important and largest
supporter of CAPP and the CAPP
Dental Training Institute in Dubai.
Together, we have trained more
than 65,000 dental professionals
over the past 15 years through conferences and clinical educational
programmes. What do you think is
important for sustaining this kind
of collaboration and what is your
advice for the future? What is your
strategy for dental education in the
short and long term, especially related to the Middle East?
Dentsply Sirona will continue to be
a good innovator. That’s a part of
our DNA. We are great at developing innovation science. What we
understand is that it doesn’t mean
anything unless we can truly educate people properly on how to use
the material and the science to de-

liver excellent patient care. It’s all
about advancing dentistry in the
best way. If we are going to change
patient’s lives, we have to make sure
that technicians and clinicians feel
confident it will deliver that technology. For us, bringing forward
partnerships around the globe in
locations where we can couple local
expertise and regulation, whatever
that would be—as we’ve said, it cannot be an infomercial, it needs to be a
true training education format that’s
credited—is really important and
will continue to be important. We
can’t do it all on our own, so having
partnerships in key places like Dubai,
the referencing of CAPP, is critically
important to success because, again,
the material doesn’t mean anything
if you can’t utilise it properly and
deliver it properly—both go hand
in hand in a very special way. We
believe that whole dental family is
needed to work together, especially
now with this digital change in
process. Dentists and laboratories
are going to need to be connected
through our Connect Case Center. As
files come through digitally, dentists
and laboratories are going to be able
to talk much faster about design,
materials, and how they’re going
to finish a case. That just improves
and strengthens our relationship
between the laboratory and dentist,
so partnerships like these are critically important and we will continue
to invest in them. Dentsply Sirona is
training 432,000 dental professionals globally through 12,000 courses
every year—you can see it’s something that we really care about investing in.
Digital technologies are developing at an unprecedented rate. CAPP
is the founder of the CAD/CAM
and Digital Dentistry Conference,
a world first, in Dubai (the first edition was in 2005). Next year, we
will be celebrating the 20th global
edition (in Dubai and Singapore)
during Expo 2020 in Dubai. CAPP
is the official partner of Expo 2020,
and we expect thousands of dental
professionals to attend the event.
How do you see and what do you
expect from Dentsply Sirona’s participation in this event?
Twenty years in CAD/CAM technology; how dramatically different
the industry has become since that
advancement. CAD/CAM and the
materials that are going through
CAD/CAM devices, like zirconia,
have revolutionised the crown and
bridge workflow, so for us those

ÿPage 28

You said that the conference was
a revolution in dental education.
What makes it a revolution?
I think what makes this event revolutionary is the unique way in
which we are able to put together
high-value attracted-talent lectures
combined with specialty tracks of
breakout training and exceptional
entertainment. It’s really a nice way
to bring together several different
laboratory and clinical specialties
and also be able to provide some
good networking and social time in
a place like Las Vegas. It’s an unusual place to come to; there are not
many places where you can put
implant specialists together with
orthodontists, prosthodontists and
laboratory technicians, all in one setting. And I think learning from each
other is what makes this a special,
well-rounded type of revolutionary
event. There’s great excitement here,
a lot of positive energy coming from
people learning together.

In this part of the interview, conducted at Dentsply Sirona World 2019,
Las Vegas, USA, in October, Dr Dobrina Mollova, Dental Tribune Middle
East & Africa (DTMEA), speaks with
Julie Mroziak, Vice President of Dentsply Sirona Lab.

[28] => DTMEA_No.6. Vol.9_DT.indd

28

INTERVIEW

Dental Tribune Middle East & Africa Edition | 6/2019

◊Page 27
milestones are really important. Of
course, Dentsply Sirona will want to
partner together, especially with our
teams that are located in Dubai. Even
though it’s global, we can help to
promote those events together. We
want to celebrate and recognise what
those advancements have done, how
technology has really been able to
provide final restorations that help
to make patients’ lives better. Truly,
it’s very different to what it was 20
years ago and we’re looking for that
same type of technology to expand
into the digital dentures field as

well, so that you’ve got everything,
crown and bridge, digital denture,
but I think those are really important
events and we would be proud and
honoured to be a part of promoting
and supporting those types of global
congresses. For us, it is important as
well to make sure that we continue
to wrap people into the process of
continuing the workflow around
digital between the laboratory and
the dentist. It’s an exciting time and
we are proud to be partnered along
with you to do that.

We create modelling that shows all
the efficiency time-savings that a
laboratory will have, but also from
the material side, so we run it all
together like a business model and
then educate the laboratory on that.
If you can produce traditionally say
eight dentures in a day, now with
this Carbon and Dentsply Sirona
technology, you can produce almost
32 dentures in a day. When you put
the investment of the equipment
together with the material, your savings per denture are much lower,
and you can return the case faster to

the dentist, with equivalent properties that you’re getting today. So you
have to think about the whole story
and that is why we are trying to help
them. Since most Lab’s focus is on
the craft of making the devices, we
try to help support them on the business model and profitability.

sure that we can guide a laboratory
so that they can choose the right
thing. I don’t think there will ever
be a time where printing will totally
take over milling, but there are times
when it’s important, so having both
processes is really valuable.

There’s going to value and reason
for both milling and printing. We
still believe that there’s places where
milling is really important, and
there’s places where printing is really
valuable and we’re trying to make

Thank you very much for your time
and the interview.

C

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CM

MY

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CMY

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[29] => DTMEA_No.6. Vol.9_DT.indd

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[30] => DTMEA_No.6. Vol.9_DT.indd

30

INTERVIEW

Dental Tribune Middle East & Africa Edition | 6/2019

"... the beginning of leading network of
dental clinics in the UAE..."
Interview with Mr Álvaro Martínez-Arroyo López, Asisa Internacional Salud
General Manager and General Manager and Director of True Smile Works Dental Network LLC

By Kinga Mollov, DTMEA
True Smile Works Dental Network
clinic offers the expertise of international, modern and dynamic dental
services to the UAE residents while
concentrating on providing quality,
integrity and world-class premium
standards across dental care in the
region.
Could you please explain the vision behind True Works Dental
Network Clinics?
True Smile Works is a joint venture
between Faisal Holding and the Asisa
Group, one of Europe’s largest medical corporations. True Smile Works
Dental Network was launched to provide the expertise of an international
dental services company to the UAE
residents while concentrating on
quality, integrity and world-class
standards. Our mission is to develop
long-term relationships with our patients and to ensure distinguished
services through personalized, honest, ethical and informed care.
The objective of our team of qualified dentists is to take care of our
patients’ oral health and provide
specialty services.
Which specialized treatments are
provided by the clinic?
We are specialized in the following:
• General Dentistry
• Cosmetic Dentistry – Veneers,

smile makeovers, Teeth Whitening
• Prosthodontics – Dental Crowns &
Bridges
• Endodontics (Root canals treatment)
• Children Dentistry, Orthodontics
(Braces)
• Periodontics – gum disease treatments, Dental Hygiene/cleaning;
• Laser Dentistry
• Oral Surgery – Dental Implants,
wisdom tooth extractions
• Sedation Dentistry
True Works Dental Clinics are the
first international dental network
which sets its presence in UAE.
Could you elaborate more?
As you may know, ASISA Group is
one of the leading Spanish private
health care establishments, international expansion of the company led
by ASISA Dental units and ASISA International allows us to develop projects in new countries and offer high
quality service and treatment.
We distinguish UAE as a strategic
business location for the regional
growth, and an essential market
where we recognized the opportunities to develop and establish our
presence.
We have embarked on a joint venture with Faisal Holding and established TRUE SMILE WORKS Dental
Network. A network of dental clinics
in the UAE that will provide the ex-

pertise of an international dental services to the UAE residents following
the successful model of Asisa Dental,
the international dental network of
Asisa Group. With more than 40 clinics in 5 countries and over 20 years of
patient satisfaction.
Which doctors have been selected
to work at the clinics as advertised
- providing international standard
treatments.
• Dr Veronica Ramirez Montes – General Dentist – Restorative Dentistry,
Oral Rehabilitation & Cosmetic
Dentistry; Doctor of Dental Surgery/
Chile/Spain.
• Dr Layal Ksaybi – General Dentist –
Cosmetic Dentist; Doctor of Dental
Medicine/Canada
• Dr Fernando Arroyo Meneses
– General Dentist, Oral Surgeon,
Implantogist; Doctor of Dental Surgery/Spain
• Dr Ihab Attieh – General Dentist –
Endodontist; Doctor of Dental surgery/Lebanon
• Dr Muge Kasim Dilmen – Specialist
Orthodontist; Doctor of Dental Surgery, Phd/Turkey
How else do you set yourself apart
from other international dental
clinics?
One of our parent companies ASISA
Group, is founded and managed by
doctors. Our model is the same one
we have been applying in Europe
for decades: a combination of first-

Mr Álvaro Martínez-Arroyo López, Asisa Internacional Salud General Manager and General Manager and Director of True Smile Works Dental Network LLC

class professionals working in clinics
equipped with the latest technology and using the most advanced
medical techniques. We focus on
the patient and the constant pursuit
of excellence whilst concentrating
on customer’s satisfaction and wellbeing.
Additionally, our customers have a
big advantage being part of our clinic. We are not only the dental clinic,
we are the network of more than 40
clinics, which means our patients
can have access to international pro-

fessionals available in Spain, Italy,
Portugal and Brazil.
How many clinics do you plan to
open across UAE and how many in
Dubai?
Our first Dental Clinic at Marsa Plaza,
Dubai Festival City, is the beginning
of the leading network of dental clinics in the UAE that we hope to become in a few years’ time.
In a span of four years, we are planning to open up to 11 clinics throughout the UAE.

[31] => DTMEA_No.6. Vol.9_DT.indd

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→ soft mode: the ultra-gentle scaling for sensitive patients

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[32] => DTMEA_No.6. Vol.9_DT.indd

NEWS

Dental Tribune Middle East & Africa Edition | 6/2019

Dentsply Sirona presents the new generation 5
of CAD/CAM software with OraCheck
By Dentsply Sirona
The possibilities offered by Primescan, Omnicam and CEREC are noticeably increasing with the new generation 5 software updates: Dentsply
Sirona announced today that it has
signed an agreement to acquire OraCheck. The new OraCheck 5.0 will enable Dentsply Sirona to offer patient
monitoring before, during and after
treatment. Additionally, the updated Connect Software 5.1 now offers
more digitally feasible treatment

options, especially for orthodontics
and implant dentistry. CEREC SW 5.1
brings the performance upgrade of
CEREC generation 5 also to existing
CEREC Omnicam units. All software
updates will be available in October.
The acquisition of OraCheck and applicable updates of its software will
enable Dentsply Sirona to provide
dentists with a valuable tool for patient analysis. OraCheck offers advanced software and supplements
conventional assessment with valu-

able three-dimensional information
developed for dental professionals to
register and illustrate changes in the
patient's mouth over time. It is a key
tool to analyze and follow-up examination. A comparison of the most recently scanned image with an image
that was taken at a previous point in
time facilitates precise assessment
of any changes. The new generation
of OraCheck is available for all scanners and carts running with the new
Software Generation 5 with of CEREC
SW, Connect SW and CEREC Ortho 2.1.

Common start for OraCheck
and new Software
Generation 5

Dentsply Sirona is also launching the
latest updates of CEREC SW and Connect SW as part of the new Software
Generation 5. All software updates
represent a new design and an upgraded, more user-friendly and intelligent interface. Generation 5 SW
runs on all Primescan and Omnicam
systems and requires Windows 10.
Depending on the hardware model,

an upgrade might be required. "We
are fulfilling an explicit request from
customers and providing added value for dentists," explained Dr. Alexander Völcker, Group Vice President
CAD/CAM & Orthodontics at Dentsply Sirona. "We're realizing our idea
that any dental workflow should
start with an intraoral scan."

OraCheck: more possibilities
for dentists

In conjunction with a digital optical
impression system, OraCheck is designed to visualize three-dimensional change on virtual optical scans on
the computer. The changes could
include movement, tilting as well as
geometric changes to the surface.
Depending on the clinical situation
as interpreted by the dental professional, these changes could be a hint
for abrasion, swelling, recession,
plaque build-up and change of tooth
position.

Connect Software 5.1:
expanded options

The updated Connect SW 5.1 enables
a guided scan with Omnicam and
more accurate results when scanning the whole jaw compared to
software generation 4. It now offers
expanded scan options for aligners,
splints, individual impression trays
as well as improvements of scan
quality for Primescan and Omnicam.
For new customers, the Connect
Software 5.1 is supplied with every
intraoral scanner.

CEREC Software 5.1:
improved scanning accuracy

The updated CEREC Software 5.1 for
fabricating chairside restorations
has undergone numerous enhancements. The calculation of the 3D
model and the quality of the pre-proposals for the restorations benefit
from the precise scans of the Omnicam in combination with the CEREC
SW 5.1. Automatic artifact removal
and artificial intelligence-based algorithms – already introduced with
CEREC 5.0 – will find their way into
the previous generation CEREC AC.
The ability to export STL files is always part of the software now.

X-Smart IQ® Handpiece
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"With Primescan, we took a huge
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ease of use," said Völcker. "With this
new software generation, we have
taken a further step in digital workflows: the indications have become
more extensive, and clinical success
can also be ensured in the long-term
through monitoring.”

• Lightweight, ultra portable, weighing only
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Due to different approval and registration times, not all technologies and
products are immediately available
in all countries.

dentsplysirona.com/iq

Find out more by
scanning the QR code.

[33] => DTMEA_No.6. Vol.9_DT.indd

Mastership Programme
Lasers in Dentistry
Certiﬁcation Course

From Aachen Dental Laser Center &
RWTH International Academy - RWTH Aachen University & CAPP

DUBAI
AACHEN

Group 8
Registration Open

Prof. Dr. med. dent.
Norbert Gutknecht
DDS, MS, PhD
Germany

Dr. Dimitris Strakas
DDS, MSc, PhD
Greece

Dr. Miguel Rodrigues Martins
DDS, MSc, PhD
Portugal

Priv.-Doz. Dr. rer. medic.
Rene Franzen
Germany

Pathway to
German Masters
84 CME
& Daily Hands-on

One-year clinical specialisation course for selected wavelengths
Module 1 | 25-28 November 2020 (4 days) | Laser Safety, Laser Devices and Diode Lasers
Laser Safety Ofﬁcer course | e-learning | Laser technique (Diode lasers) | High power Diode lasers (clinics) |
Scientiﬁc background and clinical indications | Skill training every day of every clinical indication | Patient treatments (demonstrations)
Hands on: Pigmentation on soft tissue, gingivectomy and gingivoplasty, frenectomy, ﬁbroma removal, crown lengthening,
depigmentation, endodontic procedure- canal irradiation performed on sheep heads | Patient treatments (demonstrations)
Module 2 | 23-26 March 2021 (4 days) | Module Erbium Lasers
Erbium Lasers (clinics) | Laser technique (Erbium lasers) | Er:YAG and Er,Cr:YSGG | Scientiﬁc background and clinical indications |
Skill training every day of every clinical indication | Patient treatments (demonstrations)
Hands on: Preparation in enamel and dentine, generation of a retentive surface, canal decontamination, apicectomy, soft-tissue
cut with short pulses, soft-tissue cut with long pulses, open curettage, crown lengthening and bone preparation performed on
sheep heads. | Patient treatments (demonstrations)
Module 3 | 12-15 December 2021 (4 days) | Combined Wavelengths Therapy Concepts & Mastership Exams
Laser therapy concepts with the use of 2 diﬀerent wavelengths | Written multiple-choice exam |
Oral Exam (presentation of 5 patient treatments cases with diode or Erbium lasers) |
Graduation Ceremony, after successful completion of an examination at RWTH Aachen University |
600 hours total workload | Over the complete course duration: case documentation & discussions

The programme targets dentists who would like to specialise in certain wavelengths. Over the course of one year, participants are taught fundamental
physical and technical knowledge, and how to recognise primary, secondary, and tertiary indications on 12 attendance days split into 3 modules held
over 3 educational blocks. This programme concludes with an official certificate of RWTH Aachen University, and is offered in collaboration with the
RWTH Aachen International Academy, the post graduate education wing of the University..

+971 528423659 | p.mollov@cappmea.com

www.cappmea.com/laser

[34] => DTMEA_No.6. Vol.9_DT.indd

NEWS

Dental Tribune Middle East & Africa Edition | 6/2019

200 days, 100 countries:
Primescan users experience
digital impressions in a completely new way

Primescan user Dr. Carlos Repullo
particularly appreciates the accuracy and speed of the scans.

Digital impressions made with Primescan: simple, fast and very accurate.

By Dentsply Sirona
It is standard practice to review feedback after
a product has first been launched: Primescan,
Dentsply Sirona’s new intraoral scanner, was
introduced about 200 days ago. It provides
dentists in more than 100 countries with a
completely new experience of taking digital impressions. The feedback after the first months
in practice shows that Primescan was able to
meet and even exceed the high expectations of
demanding users.

With Primescan, Dentsply Sirona presented the
latest generation of intraoral scanners at the beginning of February in Frankfurt (Germany): It
enables users to take a digital impression with
very high accuracy. This has been substantiated
by a study at the University of Zurich1. Since the
launch of this new intraoral scanner users in
more than 100 countries have been using Primescan in their practices and reporting on their
experiences.
For dentist Dr. Carlos Repullo from Sevilla,
Spain, the perfect end result for the patient has

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MASTER OF SCIENCE IN:

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Extensive clinical
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3-year program

Postgraduate students
practice at the ﬁrst and largest
dental hospital in Dubai,
the Dubai Dental Hospital

Opportunities to
participate in overseas
scientiﬁc presentations

International
academic faculty

Admissions open to
all nationalities

Eligibility for the Royal College of Surgeons of
Edinburgh and for the Royal College of Surgeons in
Ireland Specialty Membership examinations

admissions@mbru.ac.ae

mbru.ac.ae
@MBRUniversity

Dr. Verena Freier, Primescan user
from day one, is particularly impressed by the touch screen operation.

top priority. For several years
now, he has relied on the support of digital procedures
such as CAD/CAM. From his
point of view, the technology of intraoral scanners has
developed enormously – this
is especially true for Primescan. "The accuracy of the
scan is remarkable. This also
applies to the whole jaw scan,
which can be taken in a very
short time. This is exactly
the quality that we need in Frankie Acosta is particularly Dr. Alexander Völcker, Group
practices. The handling must pleased with the optimized pro- Vice President at Dentsply Sirona
be simple, fast and safe, the cesses and the high quality of the CAD/CAM & Orthodontics, sees
promising prospects for digital
function must be stable. The impression.
impressions in dental and orthonew intraoral scanner offers
dontic practices.
all this. Primescan does have
a small 'disadvantage': "If the
restoration does not fit now, I can no longer flows – in practice with CEREC as well as in collaboration with the dental laboratory or other
blame the technology."
partners. Using the new Connect software, a
digital 3D model can be transferred directly to
Primescan meets
the laboratory of choice for further processing.
very high quality standards
Frankie Acosta, a dental technician from MurFor quite some time, Dr. Mike Skramstad, den- rieta, California (USA), is particularly pleased
tist from Orono, Minnesota (USA), has been with the optimized processes and the high
observing the development of intraoral scan- quality of the impression.
ners in the dental market. For a long time, no
system was able to fully meet his high require- "As a dental laboratory that has been working
ments in terms of accuracy, user-friendliness, with digital impressions for around ten years,
speed, integration capability and possible ap- we are delighted that it is now even easier for
plications. He also took a close look at Primes- dentists to take impressions with an intraoral
can in his practice. 200 days after the new in- scanner. The accuracy with which Primescan
traoral scanner’s launch, he is now more than works convinces us in our daily work. This also
satisfied: "With the introduction of Dentsply enables us to deliver work at a high level. The
Sirona's Primescan, things have changed con- automatic download from the Inbox of the
siderably. Scanning is very easy and more ac- Connect Case Center is a real time saver".
curate than with the CEREC Omnicam. What
impresses me most about Primescan is the "With Primescan, we are providing our cusoutstanding software performance, which tomers with a technology that decisively
has been further enhanced by artificial intel- improves digital impression taking in many
ligence. I'm excited about the many dental points," says Dr. Alexander Völcker, Group
applications that allow me to work with Pri- Vice President CAD/CAM and Orthodontics at
mescan."
Dentsply Sirona. "With a completely new techDr. Verena Freier, a dentist from Bad-Soden
in Germany, sees an improvement in the accuracy of Primescan, especially for whole jaw
scans. " With the new intraoral scanner Primescan, which also works with CEREC, I am
bringing the treatment of my patients to a
very high level. If the results were really good
before, for me they are now even better. And
everything is easy and relaxed - I don't really want to put the scanner out of my hand
anymore. I particularly like the operation via
a touch surface. Since patient satisfaction is
very important to me, I am especially pleased
that patients ask specifically for this impression method and talk about it once they have
experienced it themselves.”

Accredited by Ministry of Education

*Non-UAE Nationals will have to meet the licensure requirements

800 - MBRU (6278)

Primescan meets Dr. Mike Skramstad's requirements for accuracy,
ease of use, speed, integration,
and deployment.

Primescan improves workﬂow with
dental laboratories

In addition to accurate and fast digital impression taking, another advantage of Primescan
is that it is designed for different digital work-

nology, the high-frequency contrast analysis,
Primescan enables our customers to achieve
very high accuracy in every digital impression.
This offers possibilities for using it in many
indications. The positive feedback from users
all over the world encourages us to drive the
development in this area."
Unless stated otherwise, all statements in this
press release refer to a comparison of Dentsply
Sirona products.

References

1. Ender et al, Accuracy of complete- and partialarch impressions
ofactual intraoral
scanning systems
in-vitro, Int J Comput Dent 2019;
22(1);11-19

Find out more by
scanning the QR code.

[35] => DTMEA_No.6. Vol.9_DT.indd

Dental Tribune Middle East & Africa Edition | 6/2019

NEWS

◊Page 1
Dentsply Sirona World in Las Vegas
is an absolute highlight of the dental industry, and this year was sold
out weeks before the event. The
successful concept also impressed
thousands of participants – with a
unique mix of clinical training units,
presentations by more than 100
renowned dental experts, an inspiring exchange between colleagues,
and a first-class entertainment programme.
One of the absolute highlights was
the live treatments, which were
streamed into the auditorium. For
instance, Dr. Tarun Agarwal performed a full arch restoration using
the Smartfix concept with the new
Astra Tech Implant EV, Dr. Erin Elliot
presented a treatment for obstructive sleep apnea, Dr. Meena Barsoum
shared an orthodontic session with
SureSmile with the audience.

Optimal X-ray diagnostics is the basis for almost all indications. With
the three different Orthophos models with varying features, every user
– whether general or specialized
dentist – can use the latest X-ray
technology for the specific needs of
his or her practice. In the future, images created with the Orthophos S
3D and Orthophos SL 3D devices can
also be used to plan treatment with
SureSmile aligners. In conjunction
with an optical scan, they were validated for use in the SureSmile Aligner and SureSmile Ortho software.

At the cutting edge
of hygiene

Dentsply Sirona World focused extensively on this topic again this year
with its own hygiene track, including
presentations by Linda Harvey, Dr.

Mia Geisinger, and Katrina Sanders.
When it comes to hygiene, Dentsply Sirona offers a comprehensive
product range that greatly simplifies
treatment for patients and hygiene
assistants. For example, the Nupro
Freedom cordless prophylaxis handpiece allows uncomplicated and
thorough tooth polishing with easy
intraoral access and no annoying
cables.
The ultrasonic scaling system of
the Cavitron 300 series is the latest member of the Cavitron system
family. The exclusive Steri-Mate
360 rotating handpiece allows easy
handling without stopping, adjusting, and laboriously turning the
ultrasonic probe during scaling
treatment. The new digital operating system generates less heat and

requires less water for improved patient comfort.

This year's highlights:
Jerry Seinfeld and Zac Brown
Band
The first-class entertainment program has made Dentsply Sirona
World an industry event that continues to thrill dental experts and
dentists. This year, Dentsply Sirona
surprised the participants with two
special highlights. On the first evening, the world-renowned standup
comedian, actor, screenwriter, producer, and author Jerry Seinfeld welcomed the audience to the evening
event in the Mandala Bay Resort and
Casino. After an intensive day of advanced training, another highlight
awaited the participants on Friday

evening: Multiple Grammy Awardwinning Zac Brown Band rocked the
stage in a private concert.
As Dentsply Sirona World has ended,
planning for the next one begins:
Next year the successful congress
will take place in Las Vegas again, this
time at the Caesars Forum, October
1-3.

You can find more information on
Dentsply Sirona World at:
www.dentsplysironaworld.com.
Due to different approval and registration times, not all technologies
and products are immediately available in all countries.

The live treatments were frequently
used as an opportunity for discussions about the topics that practitioners deal with in their practice
routines. "It is precisely these interactions that are crucial to us," said
Don Casey, Chief Executive Officer
of Dentsply Sirona. "We consistently
direct our innovations to what our
customers need in practices and
labs. This is why we focus on entire
workflows and solutions that integrate seamlessly with one another.
Underlying these solutions is our
commitment to R&D, into which we
are investing more than 150 million
US dollars this year alone. Over the
past several years we invested close
to one billion dollars – more than
any other company in the dental industry.”

Specialist training:
Personal and intensive

The advanced training programme
offered a broad overview with more
than 100 intensive workshops on a
comprehensive range of topics and
lectures in twelve different areas,
such as implant dentistry, laboratory and hygiene, and presentations
of new products and solutions by
Dentsply Sirona. On the podium,
dentists such as Dr. Karyn M. Halpern, Dr. Todd Ehrlich, Dr. Sameer
Puri, Jasmin Haley, Dr. Tarun Agarwal, and Shannon Pace Brinker, as well
as many other well-known names of
the industry, spoke about trends and
developments.
For Dentsply Sirona it is certain: Continuous, professional clinical education is a factor to success for practices and laboratories. In addition,
innovative product solutions and a
close relationship with customers
are part of the common goal which
is bringing healthy smiles to more
people through happy and healthy
practices.

Astra Tech Implant System:
The development continues
Dentsply Sirona World proved again
this year to be an excellent platform
for getting first hand knowledge of
new products and solutions. The
new Astra Tech Implant EV is a further development of the Astra Tech
Implant System, one of the bestdocumented implant systems on
the market. The modified implant
design brings significant improvements: The apical implant thread
ensures that the desired primary
stability can be achieved. Additionally, the handling for inserting the
implant has been simplified. This
innovation will be available starting
October 2019 in the North American
market and from the beginning of
2020 in Europe.

Digital, validated
and successful workﬂows

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[36] => DTMEA_No.6. Vol.9_DT.indd

INTERVIEW

Dental Tribune Middle East & Africa Edition | 6/2019

“I look back with pride and gratitude”
By Ivoclar Vivadent AG
Robert Ganley, US-born, has been
Ivoclar Vivadent’s CEO for 16 years.
This summer, he will pass the baton
to Swiss-born Diego Gabathuler. In
this interview, he reveals the secret
behind Ivoclar Vivadent’s success,
he talks about the new products
presented at IDS and reflects on his
career.
Mr Ganley, why is Ivoclar Vivadent
so successful?
We deliver what the customer needs
and wants: Innovation that creates
opportunities and esthetics. In all
that we do we focus on the needs of
our customers. Dentistry can be a
simple business. The most important strategic tool is “listening”. If
you “connect” with your customers
and ask them about their business
and their challenges they will tell you
the problems and even propose the
solutions. You simply need to listen
and then to act. We are the leaders
in quality innovations for esthetic
dentistry.
Which new innovations did you
present at IDS 2019?
At IDS, we showcased perhaps our
strongest portfolio of innovative
products for dental laboratories and
dental practices. I will mention the
most important ones:
1. The 3s PowerCure product system:
a direct restorative system that allows dentists to reduce treatment
times by more than half, while still
achieving the same level of qual-

ity and esthetics. Many clinicians are
seeking a composite that delivers
treatment efficiency and reliability.
The 3s PowerCure product system
is optimally coordinated for direct
restorative procedures to enhance
efficiency and esthetics.
2. The Bluephase G4 curing light: the
first intelligent light featuring an automatic curing assistant
3. IPS e.max ZirCAD Prime: This innovative product is the Next Generation of All-Ceramics from the Leader
in All-Ceramics. Prime features a
unique combination of two raw
materials and the new Gradient
Processing Technology. It is the first
all-ceramic material with anterior
esthetics that can be used anywhere
in the mouth and for all indications.
Prime is the high-esthetic, highstrength all-ceramic solution that
the market has wished for since the
launch of IPS Empress.
4. The PrograPrint 3D printing system for dental laboratories: This
innovative system includes printing materials and equipment for
printing, cleaning and post-curing.
It extends the existing Ivoclar Digital
portfolio and ideally complements
the PrograMill milling machine
range. High accuracy and high efficiency in a controlled system – another wish of the market fulfilled.
You will soon pass the baton to
Diego Gabathuler, who will succeed you as CEO. As you look back
on your 16 years atIvoclarVivadent
what stands out for you about your
tenure?

A retrospective of Ivoclar Vivadent’s successful history
An Interview with Robert Ganley, Ivoclar Vivadent’s CEO 2003 – 2019

Looking back on what we have
achieved thanks to the many dedicated employees in our company,
I feel a particular sense of pride
and gratitude. Ivoclar Vivadent has
revolutionized the dental world in
many ways. We have been a leading
innovator in both material development and product marketing. We
introduced “esthetics as a primary
goal” to the market with the launch
of the “Esthetic Revolution”. In doing
so we changed material science, we
changed processes and we changed
the expectations of the laboratory
technician, the dentist and the patient.

In your dual role as CEO of the Ivoclar Vivadent Group and Managing Director of the North American subsidiary, you commuted
between the US and Liechtenstein
for many years...
Yes, that’s true. Although it was demanding, I had the benefit of being
in two important dental markets
every week. This gave me the opportunity to be with customers and listen to customer needs all of the time.
I was promoted in the same year as
were the new CEOs of Sirona, Straumann and Nobel Biocare, all central
European companies. Each CEO
would travel 50 % of the time and
each would be in the US and Europe

every month. So you see my schedule was not so different.
I am often asked still today how I am
able to maintain the schedule. I describe it this way – I do my best every
day and I receive from my job more
energy than I put in. My job energizes me! I consider myself lucky.
What are your plans for the future?
I will remain very active both on
the Supervisory Board of Ivoclar
Vivadent and in other positions. It
is likely that I will fly less. I am confident, however, that Swiss will survive even without my weekly flights!

Fig. 1. Specialized information and entertainment at Ivoclar Vivadent’s IDS booth

Fig. 2. The exhibition team conducted many inspiring sales conversations.

Fig. 3. The exhibition team conducted many inspiring sales conversations.

Fig. 4. The highly motivated Ivoclar Vivadent exhibition team.

Fig. 5. Every evening, customers were received at the Rheinterrassen.

Fig. 6. Robert Ganley (right) and his successor Diego Gabathuler

[37] => DTMEA_No.6. Vol.9_DT.indd

[38] => DTMEA_No.6. Vol.9_DT.indd

38

EVENTS

Dental Tribune Middle East & Africa Edition | 6/2019

11 Dental Facial Cosmetic
Conference & Exhibition Highlights
th

Impressions from teh 11th Dental Facial Cosmetic Conference & Exhibition which
took place in Dubai on 08-09 November 2019 at InterContinental Hotel, DFC.

[39] => DTMEA_No.6. Vol.9_DT.indd

Dental Tribune Middle East & Africa Edition | 6/2019

EVENTS

39

[40] => DTMEA_No.6. Vol.9_DT.indd

» What drives me? Best
results. And Primescan
is my answer. «
Dr. Verena Freier, Dentist

Primescan

Engineered for superior performance.
Innovation requires commitment to ambition: Primescan sets new standards in dental technology, making scanning
more accurate, faster and easier than ever. It is engineered to enable all kind of treatments, from single tooth to
full arch. Primescan produces highly accurate images and allows for fast scanning consolidating 50.000 images
per second. The new patented “High Frequency Contrast Analysis” delivers perfect sharpness and an outstanding
accuracy. With Primescan, intraoral scanning delivers excellent results like never before.
Enjoy the scan.
Learn more at: dentsplysirona.com/primescan

[41] => DTMEA_No.6. Vol.9_DT.indd

NL
Y
O
LS
NA
IO
SS
FE
O
PR
NT
AL
DE

www.dental-tribune.me

Published in Dubai

November-December 2019 | No. 6, Vol. 9

Better technology and referral relationships
—Are they related?
By Dr Gary Glassman, CA
Advancements in technology have
made it easier for dental professionals to deliver successful endodontic
treatment. Nevertheless, endodontics continues to be a specialty that is
best handled by trained experts.
It is appropriate for a general dentist
to perform endodontic treatment on
a patient when he or she is properly
trained to perform the said procedure, has the appropriate equipment and possesses the requisite
skill set for the treatment. However,
if there is any doubt that the clinician
can perform the procedure to the
same standard of practice as an endodontic specialist, the case should
be referred out. The American Association of Endodontists offers its

case difficulty assessment form and
guidelines to help general practitioners with case selection.
Rapid advancements in endodontic
technology have permitted dental
professionals to enjoy higher success
rates. Patients can retain their teeth
for as long as possible, reducing the
need for retreatment and/or extraction, and thereby limiting the high
costs they once faced.
The dental operating microscope is
a prime example. As it enables clinicians to visualise the anatomy of the
pulp chamber, they can locate the
canal anatomy more proficiently
and offer minimally invasive treatment by keeping access openings as
small as practical while maintaining
the structural integrity of the tooth.

In addition, practitioners are able to
maintain a more ergonomically favourable position, thereby reducing
stress on their back and neck.
Ultrasonic instruments with specially designed endodontic tips allow
clinicians to uncover calcified canals,
remove pulp stones, refine access
preparations, and remove posts and
cores. They aid in the debridement
of the root canal system during irrigation protocols in a controlled and
predictably safe manner.
Cone beam computed tomography
(CBCT) offers unprecedented accuracy and acuity. We can visualise the
tooth in 3D; it is like a road map to the
anatomy of the root canal system. In
addition, the resolution of the CBCT
is higher than that of traditional ra-

diography, allowing the detection of
periradicular pathology, which may
have otherwise gone undetected.
The type, location and extent of internal/external resorption can now
be definitively diagnosed and the
relationship of normal anatomical
structures can be assessed with ease.
Dental service organisations offer
specialists like endodontists an opportunity to connect with general
dentists and their patients, who may
require advanced care. An open
dialogue between endodontists and
their general dentist colleagues will
help ensure that patients receive the
best possible treatment. Plus, the accessibility of the patients through
their general dentist’s office is often
more practical and convenient, both
for the patients and the practitioners.

Communication and continuing education are key components of the
relationship between endodontists
and general dentists, noting that a
true partnership between practitioners ultimately leads to better patient
care.

Dr Gary Glassman
Endodontic Surgery
https://www.rootcanals.ca

FREE WORKSHOPS
AT THE BOOTH

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Discover our products
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[42] => DTMEA_No.6. Vol.9_DT.indd

ENDO TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

Dentsply Sirona launches the TruNatomy™
solution, redeﬁning root canal treatment
Combining Swiss precision and advanced engineering, the TruNatomy™ range offers
clinicians a solution that provides efficient performance and increased respect
of the tooth anatomy, combined with a smooth user-experience.

TruNatomy’s™ unique combination
of features was developed in partnership with skilled practitioners, Dr.
George Bruder and Dr. Ove Peters,
leaders in the field of endodontics,
working in partnership with the
Dentsply Sirona’s Maillefer Research
and Development Engineering
teams. TruNatomy™ capitalizes on
Dentsply Sirona’s 130 years of experience in manufacturing files like
ProTaper® and WaveOne® Gold families. Combining Swiss precision and
advanced engineering, the TruNatomy range offers clinicians a solution
that provides efficient performance
and increased respect of the tooth
anatomy, combined with a smooth
user-experience.
Additionally, there is a growing interest in maximizing the preservation of dentin in endodontics and
TruNatomy™ addresses that need,
thanks to its slim, highly-ﬂexible alloy wire and regressive taper. TruNatomy™ enables clinicians to provide a smooth predictable root canal
treatment even in cases with curved

canals or limited straight line access. TruNatomy™ is available with
matching ConformFit gutta-percha
points, paper points and irrigation
needle.

Innovations simplify
traditional workﬂows

By Dentsply Sirona

“Our developments in consumables
provide solutions to dentists’ challenges in filling treatment and endodontics as well as with the emerging digital dentistry,” says Thomas
Leonardi, Group Vice President Consumables Dental Product Group at
Dentsply Sirona. And, as a result we
expect reduced chair time for our
patients and improved patient satisfaction.”

– Respect of the natural tooth anatomy thanks to its superior canal
centering ability. The instrument adjusts to the canal (and not the other
way around).

– A smooth experience with files
that, progress down the canal with
almost no screwing in effect, giving
you a full sense of control during the
whole preparation.

With a unique set of features, TruNatomy™ offers a host of benefits including:
– Better performance and more
space for debridement and debris
removal thanks to a new file design
with an enhanced off-centered cross
section, a slimmer NiTi wire. Its higher speed of operation provides greater efficiency with less torque.

– Preservation of the tooth integrity
achieved by the combination of the
file geometry, the slim wire and its
increased ﬂexibility together with a
shorter 9.5mm handle that perfectly
fits micro-head handpieces, allowing
to perform efficient root canal treatments without straight line access,
only removing dentin where clinically needed.

– Simplicity since this single-file
shaping system (following the use
of the TruNatomy™ Orifice Modifier and TruNatomy™ Glide Path) is
an easy to learn rotary endo solution
complemented by matching paper
points, Conform Fit™ gutta-percha
points and a ﬂexible irrigation needle.

Find out more by
scanning the QR code.

By Dentsply Sirona
With Propex IQ®, Dentsply Sirona is
now launching the first apex locator on the market that can be combined with a smart handpiece – the
X-Smart IQ® – and that can be fully
integrated into an iPad platform –
the Endo IQ® application. The apex
locator offers clinicians the latest
technology for root canal treatment
to the highest standard.
In root canal treatments, it is important to work with extreme accuracy and precision. For every root
canal that needs shaping, the dentist
must determine the working length.
The new Propex IQ® apex locator
from Dentsply Sirona Endodontics
brings state-of-the-art technology to
endodontic practice. The accurate
and reliable detection as well as the
visualization of the progression of
the endodontic file in the root canal
– which can be compared to a parking sensor in the car – provide security for the dentist and enable him to
focus more on the patient.
Propex IQ® offers the most comprehensive package of tools when the
apex locator is used together with
the X-Smart IQ® handpiece and the

Endo IQ® application. It is a consistent ecosystem where Endo IQ® is the
core and Propex IQ® and X-Smart
IQ® are the functional supplements.
When the devices are used together,
they allow clinicians to customize individual settings before the
treatment of the canal they want
to treat. If the feature Shaping Target for instance is enabled, once the
pre-set point has been reached, and
auto-reverse feature is activated, the
X-Smart IQ® handpiece automatically changes the motions of the files
and reverts them back. A further
advantage: With the app, clinicians
can monitor the progression of the
file on their iPad throughout the full
course of the treatment.
“Digital technologies can bring real
added value to clinicians in endodontic practice today”, says Valerie
Baschet, Group Vice President Global
Endodontics, Dentsply Sirona. “At
Dentsply Sirona we are pleased that
our new Propex IQ® apex locator
combines latest technology with our
many years of experience in endodontology. This way, we help clinicians to treat the root canals even
more efficiently and accurately.” It
is planned that Dentsply Sirona will
further expand its endodontic prac-

New Propex IQ® apex locator from
Dentsply Sirona: Cutting-edge technology
for more efﬁcient root canal treatments

The Propex IQ® apex locator with the X-Smart IQ® handpiece and the Endo IQ® platform:
Cutting-edge technology for more efﬁcient endo treatments.

tice ecosystem based on the Endo
IQ® software with further elements
in the future.
With a weight of just 80 grams, the
apex locator is ultra-light and portable. The device can be placed on
the tray during treatment. Propex
IQ®, X-Smart IQ® and Endo IQ® can
be used together for 16 treatments
without having to re-charge the
batteries. The smart handpiece is ergonomically shaped and meets the

highest demands of everyday practice. It is connected to the apex locator with a cable. The communication to the Endo IQ® app takes place
wirelessly. Firmware upgrades for
using the Propex IQ® apex locator
and X-Smart IQ® handpiece are fully
integrated in the Endo IQ® application and can be easily installed by
updating it. Propex IQ® can also be
used modularly, without the smart
handpiece and the app.

Find out more by
scanning the QR code.

[43] => DTMEA_No.6. Vol.9_DT.indd

TruNatomy™ Orifice Modifier

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TruNatomy™

[44] => DTMEA_No.6. Vol.9_DT.indd

ENDO TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

E=mc : Endodontics is equal to the third
power of many changes
3

By Dr Kenneth S. Serota, USA
Revolutionary protocols and materials science demonstrate the evolving
sophistication of modern era root
canal therapy. The technological advances of the past three decades have
enabled greater debridement and
disinfection of the labyrinthine root
canal space. Iterations of apex locators, enhanced magnification and
illumination, new file designs and
metallurgy provide for bio-minimalism and diminished fracture poten-

tial. The development of bio-active
adherent sealers has enhanced the
biologic potential of root filling. However, the sum of these innovations
has not as yet produced a substantive
increase in treatment outcome percentages. For years, clinicians have
accepted on faith the purported marketing claims of company-supported
in vitro testing. Fortunately, scientific
determination of the metrics of success of productneutral studies has
replaced the possibility of experimental bias.

The most profound change in endodontics is the recognition that
root canal therapy is a restoratively
driven discipline. Bio-smart materials used in the root and crown do not
require egregious removal of tooth
structure as dictated by classical protocols. Clinicians blinded by the optics of the “artistry” of radiographic
results are recognizing that this does
not represent the totality of the biologic requirements of success.
The “look” academically disenfran-

chised the clinician from the understanding of the biomechanical
dynamics of dentine and its impact
on the potential for fracture. The ex-

EdgeEndo

The rigid restorative mandate of
posts and cores had the propensity
to cause catastrophic failure. Fortunately, reduced taper, new irrigation
products have reduced the retention
of greater volumes of tooth structure
and the costs of new equipment.
Overprepared tooth structure is not
necessary in the adhesion era.
The dogma of the protocol of cleaning shaping, irrigation and “monobloc obturation” is axiomatic folly.
The pendulum swings of new
equipment and treatments are not
necessarily best practices. The primary disease vector of pulpal and
peri-radicular is biofilms and to date,
the mechanism for their removal
remains elusive. The work of Kishen
and Shrestha on biofilm disruption
by nanoparticles shows the greatest
hope for elimination of recrudescent
disease as a consequence of biofilm
resistance intractability.

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To learn more about EdgeEndo and the offering, please access the website www.edgeendo.com

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• EdgeOne Fire™ is designed to shape canals in a
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• EdgeOne Fire™ can be used with the same motor and
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• EdgeOne Fire™ features our heat-treated Fire-Wire™

Differences in cyclic fatigue lifespan: WaveOne® Gold vs
EdgeOne Fire.TM
Background:
Aim of this study is to investigate the cyclic fatigue resistance
of the Gold treated WaveOne® Gold and the Firewire treated
EdgeOne FireTM instruments.
Conclusions:
Firewire instruments resulted to be about two times more resistant
to cyclic fatigue when compared with identical instruments made
with Gold treatment.

The ebbs and ﬂows of endodontic
growth, even if measured in dollops,
has always have been part of the tenets of interdisciplinary dental therapeutics. The recognition that endodontics is an equal member at the
table of disciplines is now assured as
it has chosen to extend its involvement beyond the orifice. Endodontics is a foundational component of
the state of oral health. Its outreach
is now extended to a point commensurate with its potential.

J Clin Exp Dent. 2019;11(7):e609-13

HEAT-TREATED FIREWIRE™ NiTi

cessive removal of tooth structure to
enable treatment needs was counterintuitive to long term success
and is fortunately a protocol of the
past. As well, the overlooked impact
of both light and heavy parafunctional loading on endodontically
treated teeth is now recognized as
the most important tipping point in
the configuration of the restoration
required.

Dr Kenneth Serota
graduated with a DDS from the University of Toronto Faculty of Dentistry in Canada in 1973 and received his Certiﬁcate in
Endodontics and Master of Medical Sciences from the Harvard–Forsyth Dental
Center in Boston in Massachusetts in the
US. Active in online education since 1998,
he is the founder of the ROOTS endodontic forum and the NEXUS interdisciplinary
forum. Dr Serota is an adjunct clinical instructor in the University of Toronto postdoctoral endodontics department.

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Published in Dubai

www.dental-tribune.me

November-December | No. 6, Vol. 9

Dental Lab Technicians:
Aesthetics at Its Best Highlights
Impressions from the event with Umit Pak for dental technicians,
part of Dental Facial Cosmetic Conference & Exhibition,
which took place in Dubai on 08-09 November 2019 at InterContinental Hotel, DFC.

[46] => DTMEA_No.6. Vol.9_DT.indd

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

Precisely controlling shade saturation
with VITA AKZENT Plus CHROMA STAINS
By VITA
In the case of reconstructions that
have an intermediate shade in whole
or in part, near-natural reproduction of the tooth shade is typically
demanding. The chroma of the restoration must be adjusted selectively
or completely to consistently match
the tooth shade. With the new VITA
AKZENT Plus CHROMA STAINS
(VITA Zahnfabrik, Bad Säckingen,
Germany), the shade saturation of
ceramic restorations can be controlled in a targeted manner. Dental
Technician Renato Carretti (Zurich,
Switzerland) uses an anterior crown
to show how the shade effect can be
systematically influenced with the
new stains.

Patient case

Tooth 12 of a retired woman had been
repeatedly restored with composite.

Due to the size of the defect, chipping and fractures of the direct restoration occurred again and again.
After careful consideration, the patient decided to have the tooth fully
crowned. This was no easy task. Due
to the aging process, the neighboring
natural teeth in the aesthetic zone
showed an individual play of shade
and light that had to be reproduced
ceramically. For the demanding
single-tooth reconstruction, it was
to be anatomically reduced from the
vestibular side, and multichromatic
zirconia and the multifaceted veneering ceramics VITA VM 9 were to
be used. In the first session, the tooth
was prepared, scanned and provisionally restored. The determined
basic tooth shade was between A2
and A3.

conia was designed, milled and sintered in the CAD/CAM workflow.
The vestibular reduction was cervically layered with VITA VM 9 BASE
DENTINE A3, and the body area was
layered with A2. Due to the high
translucency of the natural residual
dentition, NEUTRAL and a very thin
layer of WINDOW were used on the
incisal edge. For a translucent depth
effect, the flanks were accentuated with bluish translucent EFFECT
ENAMEL 9. This was followed by
the first dentin firing. The restoration was still too bright on tryin. The
cervical area was then characterized
with a three-to-one mixture of BASE
DENTINE A3 and EFFECT CHROMA
3 (light yellow). A translucent effect
on both flanks was achieved with EFFECT STAINS 11 (blue).

In order to replicate the multifaceted
shade nuances in the incisal edge
and in the body area of the crown,
VITA AKZENT Plus CHROMA STAINS
was used on a selective basis. “The
CHROMA STAINS are very intense
and also visible in a thin layer. This is
fantastic, especially with monolithic
restorations,” says Carretti, describing the benefits of the stains, which
allow a targeted control of chroma
staining. The mesial and distal incisal area, as well as the body area,
were characterized with CHROMA
STAINS A, and the middle incisal area
with the more intense B. After visual
intraoral comparison in the patient,
all characterizations were fixed with
a stain firing.

Vestibular individualisation

Play of shade
with VITA AKZENT Plus

After a follow up clinical try-in, all
participants were satisfied with the
result. After the completion of the

The crown framework made of zir-

Fig. 1: Initial Situation: Condition of tooth 12 after full crown preparation, intraoral
scan and provisional restoration.

Result and conclusion

Fig. 2: For the raw and stain try-ins, the temporary was removed.

crown with fine diamond and sandpaper, the glaze firing could be carried out. For a natural effect, the gloss
was finally reduced with a polishing
brush and pumice, without reducing the shade effect. The controllable
chroma of the VITA AKZENT Plus
CHROMA STAINS enabled a play of
shades that matched the natural residual dentition. The restoration met
the high expectations of the patient.

VITA® and other VITA products mentioned are registered trademarks of
VITA Zahnfabrik H. Rauter GmbH &
Co. KG, Bad Säckingen, Germany.

DT Renato Carretti
Zurich, Switzerland

Fig. 3: The raw firing try-in after the first dentin firing still shows a crown that is much too bright.

Fig. 4: The play of shade at the incisal edge and the body area was reproduced with VITA AKZENT Plus
CHROMA STAINS A and B.

Fig. 5: After the stain firing, all participants were satisfied with the result.

Fig. 6: Result: The crown was polished and finally integrated. The restoration harmonized with the remaining
tooth substance.

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Published in Dubai

November-December | No. 6, Vol. 9

www.dental-tribune.me

Full-arch implant rehabilitation
By Dr David García Baeza, Spain
An implant-supported restoration
is a good alternative to conventional
complete prostheses for patients
with edentulism. This treatment
has been performed successfully in
recent years and constitutes a highvalue clinical reality.
Oral implantology has undergone
great advances in recent years, as it
allows lost teeth to be replaced with
a high degree of satisfaction on the
functional and aesthetic level. A partial or total loss of teeth affects not
only facial aesthetics but also vital
functions, like chewing and phonation. A prosthodontic rehabilitation
with a high success rate can be obtained for this type of patient. The
prosthetic options for rehabilitating
an edentulous patient with dental
implants are divided into two categories: fixed and removable restorations.1
A hybrid prosthesis consists of a cast
metal framework covered by acrylic,
which supports artificial fixed teeth.
The original design of the hybrid
prosthesis (fixed-removable) was
developed by Swedish researchers using the two-stage endosseous
implant system developed by PerIngvar Brånemark. The prosthesis
consisted of a gold alloy framework
attached to the copings of the implants, and on this framework conventional acrylic resin denture teeth
were secured with acrylic resin.2
The factors that determine the type
of implant-supported restoration
for a completely edentulous patient
are the amount of space from the
bone to the occlusal plane (prosthetic space) and the lip support.
The prosthetic space needed for a
hybrid prosthesis is a minimum of
11mm and a maximum of 15mm,
with lip support given by the bone
structures. When a space of 10mm
or less is available and there is lip
support, a porcelain-to-metal restoration is suggested. When there is
more than 15 mm of prosthetic space
and absence of lip support, a type of
implant-supported overdenture restoration is recommended, which will
give the lip support not provided by
the bony structures of the patient.1
Cox and Zarb described the treatment of severely resorbed completely edentulous maxillae with a hybrid
prosthesis using a metallic structure
with acrylic and artificial teeth, with
prosthetic spaces larger than 15mm.3
An incorrect adaptation between
metal structures and implants can
cause bone loss and failure of osseointegration, which is clinically
decisive. It is generally accepted in
the literature that the passive fit of
a prosthesis is required for maintenance and long-term success of an
implant treatment. In addition, the
literature has implied that incorrect
adaptation of metal structures is a
decisive and significant factor, causing mechanical and biological complications. The loosening of both the

prosthesis and the abutment screws
and even the fracture of various system components have been attributed to the lack of adjustment and
adaptation of the prosthesis.
In this article, the clinical case of a patient with a completely edentulous
maxilla and advanced periodontal
disease in the mandible is presented.
The patient’s mandible was rehabilitated with a hybrid prosthesis on six
implants. The implant-supported
prosthetic treatment that was performed to restore the patient’s aesthetics and functionality, thereby
improving his quality of life, is described step by step, as is the preparation process of the prosthesis.

Fig. 1: Frontal view of the initial patient situation.

Fig. 2: Intraoral view of the initial situation.

Case presentation

A 68-year-old patient presented to
our facility with a complete maxillary mucosa-supported denture,
with which he was relatively comfortable. He had all of his original
teeth on the lower arch, but with
very advanced periodontal disease,
which had caused him a loss of support of more than 80 per cent. These
teeth presented with Class II and III
mobility, which made it very difficult to chew (Figs. 1 & 2).
The proposed treatment plan for the
patient was to extract the mandibular teeth and rehabilitate the lower
arch using implants and a fixed prosthesis to maintain the same feeling
as with his natural teeth. In addition,
it was decided to replace the complete denture of the upper arch.
Normally, when teeth are extracted
from a complete arch and an immediate restoration is placed, it creates a problem of adaptation for the
patient, especially in the mandibular
area. To help the patient during this
period of healing and osseointegration of the implants, it is recommended to place two provisional
implants.
Once the extractions had healed, six
Aadva tapered implants (GC Tech.
Europe) of 4mm in diameter and
10mm in length were placed in the
position of the molars, first premolars and central incisors (Figs. 3a & b).
The bone quality and quantity were
good, and once the expected osseointegration time had passed, transitional abutments were placed. In this
case, two abutment diameters were
used, narrower (SR Abutment of 3.8
x 2.0mm, GC Tech.Europe) for the incisal and premolar areas, where there
was less inserted gingival tissue, and
wider (SR Abutment of 4.3 x 2.0 mm)
in the posterior area (Figs. 4 & 5).
Before beginning with the prosthetic
phase, there was a waiting period
for the tissue to mature. For this, an
impression was taken with closedtray copings, which is very simple,
but does not give a very exact model
(Figs. 6 & 7). This was subsequently
used to make a rigid impression tray
that was made of metal and was secured with plaster to only one of the
implants (Fig. 8).

Figs. 3a & b: After extractions: a) Frontal and b) occlusal view.

Figs. 4a & b: Healing abutments: a) Frontal and b) occlusal view.

Fig. 5: SR Abutments at gingival level.

Fig. 6: Impression taking with closed-tray copings.

Fig. 7: Preliminary impression.

Fig. 8: Rigid metal tray impression taking: Fixing with plaster.

Fig. 9: First step of final impression taking.

Fig. 10: Final impression.

Fig. 11: Master model.

Once the rigid impression tray was
placed in the mouth, open-tray copings were then used and they were
splinted to the structure with a special plaster mixture; once this had

hardened, everything was registered
with a polyvinylsiloxane impression
(Figs. 9 & 10). This technique yields a
very reliable master cast, ensuring a
very good structure fit (Fig. 11).

Once the final model with the different analogues was ready, the plan-

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ning started. First, the old complete
maxillary denture was analysed.
In this type of case, it is very useful
to perform a lateral analysis, thus
photographs and radiographs were
taken. A step that differentiates our
technique from other dentists’ is
that a narrow lead foil strip is placed
on the maxillary and mandibular
central incisors. This provides extra
information to see the relationship
between the position of the anterior
teeth and the bone (Fig. 12).

Fig. 12: Lateral radiograph taken with lead foil
on the old denture for radiographic evaluation.

With the lateral radiographs, the
situation of the transitional abutments can be visualised, which is
very important, as all the manipulation based on the different tests that
need to be done will be carried out
far from the head of the implant.

Fig. 13: Fox plane test.

Fig. 14: Panadent articulator phase.

Fig. 15: Wax test confirming smile parameters.

Once the fulcrum points and the inclination of the maxillary incisors for
lip support had been analysed, the
new upper arch was designed in order to give the patient a new occlusal
plane and a new incisal position. The
Fox plane helped us to obtain the
correct plane and then we used the

Figs. 16a–c: Wax try-in: a) Left, b) right and c) frontal view.

Kois Bow for the cranial-maxillary
reference (Fig. 13).

Fig. 17: Models in final position.

Figs. 18a: Models in the articulator.

Once the models had been placed in
the articulator and the parameters
taken from the patient, the laboratory technician began to make a set
of test teeth from wax for both the
upper and lower arches so that the
correct fit could be assessed, including the patient’s occlusion and aesthetics (Figs. 14 & 15).
As Figures 16 to 19 show, the upper
arch was narrower than the lower
one because those teeth were lost
much earlier, which meant that, for
correct functioning of the complete
maxillary prosthesis while chewing,
the posterior areas were to be placed
at a crossbite. That way, the axis of
force when chewing food would fall
on the alveolar process and not displace the prosthesis.

Figs. 18b: Models in the articulator.

Figs. 18c: Models in the articulator.

Figs. 19a: Final wax test.

Once confirmed that everything
worked properly, the next step was
constructing the metal structure
that would be closely linked to the
wax tooth design (Figs. 20 & 21). This
was once again checked with the
teeth in position to give a last confirmation before the final manufacturing. At that time, confirmation of the
modifications made could be carried
out again by using the lead foil strip,
as well as confirmation of the occlusion, in case there was any variation
(Fig. 22).
Subsequently, the final prostheses
were made. The maxillary one was

Fig. 20: Aadva software: Structural design.

Fig. 21: Anterior view, final test.

Figs. 19b: Final wax test.

Fig. 22: Lead foil test for the new design.

made as wide as possible in the posterior area so that it would be as stable as possible, and the mandibular
one was placed on implants. Confirmation and small adjustments had
to be performed in the mouth to
counterbalance the small misalignments that normally occur in manufacturing (Figs. 23–25).

Discussion

The treatment of a completely edentulous patient with an oral restoration on implants begins by discussing treatment expectations, followed
by an accurate clinical evaluation.
Thus, a detailed intraoral and extraoral examination are performed
following a work plan to help in the
diagnosis. This includes studying patient photographs and radiographs,
which have evolved remarkably
in recent times, using models on a
semi-adjustable articulator and following the protocol for the design
of a proper prosthetic restoration on
implants, choosing from overdentures, or hybrid or fixed prostheses.
The choice will depend on what the
dentist plans using a multifunctional
guide—tomographic/surgical/prosthetic—for implant placement and a
suitable type of oral restoration.
Rehabilitation with implant-supported hybrid prostheses is a fixed
treatment in completely edentulous
jaws where the prosthetic space is
11mm or 15mm,3 but where the need
for lip support for prosthetic restoration is not a determining factor.4 An
implant-supported hybrid prosthesis can be a questionable alternative
treatment when a fixed restoration
of porcelain and metal does not meet
the patient’s requirements for aesthetics, good phonetics, proper oral
hygiene and oral comfort.5,6
Bidra and Agar proposed a classification system for edentulous patients
for using implant-supported fixed
prostheses, classifying them into
four classes according to the following factors:
1. amount of tissue loss;
2. position of the anterior teeth in relation to the location of the residual
ridge;
3. lip support;
4. smile line; and
5.need for prosthetic material for gingival colouring (pink acrylic).4
Class I includes patients who require
gingiva-coloured prosthetic material such as pink acrylic to obtain
aes- thetic tooth proportions and optimal prosthetic contouring to attain
adequate lip support. Class II patients
require pink acrylic only to obtain
aesthetic tooth proportions and for
prosthetic contouring. Lip support is
not a consideration, since the difference in lip projection with or without
any prosthesis is generally insignificant. Class III contains patients who
do not require gin giva-coloured
prosthetic material. Class IV is assigned to patients who may or may
not require pink acrylic, depending
on the result obtained after surgical
intervention.4 Following this classification, the patient in this report was
determined as Class II.
The fabrication of hybrid dentures
in patients with adequate interocclusal space provides the dentist
with several advantages regarding
the aesthetic appearance, including
replacement and decrease of softtissue support owing to the bulkiness of the metal substructure and in
the height of crowns compared with
a metal-supported porcelain prosthesis. In addition to these aesthetic
advantages, hybrid prostheses work

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as shock absorbers, reducing load
forces on implants.7
The success rate of implant-supported hybrid prosthetic treatments is
high, as demonstrated by a systematic review published in 2014, which
included 18 studies for evaluation. In
a period of five to ten years, high survival rates of 93.3–100 per cent for
the prostheses and of 87.9–100 per
cent for the implants were found.8
In a retrospective study evaluating
the main complications after rehabilitation with an implant-supported hybrid prosthesis, it was observed
that the main complication was mucositis, which affected 24 per cent of
the cases, followed by problems with
the prosthetic screws in 13.7 per cent
of the cases, including thread wear
or loss, and the same percentage was
found for fracture of the prosthetic
teeth or prosthesis detachment.
These problems were related to an
incorrect record of vertical dimension, inadequate occlusion or a lack
of passive fit of the metallic structure. Another problem encountered

Figs. 23a & b: Final restorations: a) Lateral and b) frontal view.

Fig. 24: Final smile.

concerned the access to the entrance
holes of the prosthetic screws (7.8 per
cent).9

Conclusion

A lower jaw hybrid restoration is a
good option for the rehabilitation
of an edentulous mandible, and it
should be included in the treatment
options when evaluating a patient,
as it improves aesthetics, functionality and proprioception. It is furthermore easy to clean, requires less
prosthetic maintenance, and can be
removed at any time and repaired at
a very low cost.
Editorial note:
This article was originally published
in implants-international magazine
of oral implantology, Issue 4/2018.

Dr David García Baeza
CIMA private dental practice
Laguna Grande 4
28034 Madrid, Spain
clinica@cimadental.es

Fig. 25: Final restoration.

Delivering innovation, digital solutions
and versatility—the Astra Tech Implant
System evolution continues…
By Dentsply Sirona Implants
Dentsply Sirona Implants continues to deliver innovation, digital
solutions and versatility in implant
dentistry. With the latest product developments, the Astra Tech Implant
System continues to evolve, based
on customer needs and the latest
digital technology.
With a comprehensive product and
solutions portfolio for all phases of
implant dentistry, Dentsply Sirona
Implants continually strives to increase the application of implant
therapy, based on science and with-

out compromising safety and efficacy.
“The implant solutions that we
develop are based on the needs of
our customers, as well as centered
around our well-documented and
clinically proven implant systems.
We’re all about providing long-term
functional and aesthetic solutions
for the many different situations
that happen in clinics and laboratories every day all over the world. And
we help dental professionals deliver
the absolute best care for their patients,” says Gene Dorff, Group Vice
President at Dentsply Sirona Implants.

Azento for single
tooth replacement

This digital implant workflow solution streamlines the implant planning, purchasing and delivery of
products. For the clinician, this custom implant solution increases convenience, seamlessly and efficiently
connects with qualified laboratories,
and enables consistent, excellent results for patients.

Each patient treated with Azento
gets a custom treatment plan, including surgical guide, instruments,
drills, a case-specific Astra Tech Implant System or Xive implant, an Atlantis custom healing abutment and
an optional temporary restoration.

Introducing Astra
Tech Implant EV

Azento is the latest innovation in the
Dentsply Sirona Implants’ implant
solutions portfolio, helping implant
dentistry professionals with one of
their most common indications—
single tooth replacement—in implant therapy.

The Astra Tech Implant System just
got even better—with the new Astra
Tech Implant EV. As one of the most
well-documented implant systems
in the market today—documented
in over 1,000 publications in peerreviewed journals—it continues to
evolve and provide great clinical
benefits.
In fact, the revised implant design
change comes with significant advantages—with a deeper implant
thread design apically, it is easier to
reach preferred primary stability
and the handling experience is enhanced for easy installation.
Dr. Mark Ludlow, Division Director of Implant Prosthodontics and
Associate Professor at the College
of Dental Medicine at the Medical
University of South Carolina, agrees:
“You still have all the wonderful
properties of TX and EV, but with
this new implant, you get better handling that helps hit that primary stability—it literally just sinks into the
osteotomy.”

Fig. 1: Azento is a digital implant workflow solution that streamlines the implant planning, purchasing and delivery for single tooth
replacement.

With this new change in design properties also comes the new name—
Astra Tech Implant EV. The new implant line will be available starting in
the North American market in October 2019 and in the European market
in early 2020.

Fig. 2: The Astra Tech Implant EV has a
deeper implant thread design apically,
making it easier to reach preferred primary stability and enhances the handling
experience for easy installation.

Latest clinical data on Astra
Tech Implant System

The Astra Tech Implant System OsseoSpeed implants show excellent
long-term clinical results, as described in the article by Windael et.
al.** Patients in this study received a
total of 105 immediately loaded implants in the edentulous mandible.
Minimal bone loss, 100% implant
survival and 100% prosthetic survival rates were reported at the 10-year
follow-up.
Using short implant is a solution
for patients with limited bone that
are unwilling or unable to undergo
bone grafting. In a recently pub-

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lished study* lead by Professor Hämmerle from the University of Zürich,
a randomized clinical multicenter
study compared the use of short 6
mm OsseoSpeed implants (Astra
Tech Implant System) with 11-15 mm
implants and grafting. In the study,
they show important benefits when
using OsseoSpeed short implants:
a simplified surgical procedure (no
need for grafting), reduced surgical
time (with 30%) and reduced surgical
cost (with 50%), and higher patient
satisfaction (due to less pain and less
complications, as well as cheaper
treatment).

Fig. 3: Astra Tech Implant System provides surgical and prosthetic flexibility, maintains marginal
bone levels, and delivers reliable and predictable clinical results as well as natural aesthetics in the
short and long term.

Astra Tech Implant System’s OsseoSpeed Profile implant is a solution
for sloped ridge situations that can
be used instead of bone augmentation. The OsseoSpeed Profile im-

plant has been evaluated in a 10-year
study, showing well maintained
hard and soft tissue levels. This data
will be presented for thefirst time by
Dr. Robert Noelken, Germany, at the
EAO meeting in Lisbon.

The evolution of the Astra
Tech Implant System
Since its launch over 30 years ago,
Astra Tech Implant System has been
one of the world’s most documented
dental implant systems, with over
1,000 published scientific references
in peer-reviewed journals. Ongoing clinical documentation demonstrates that Astra Tech Implant
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natural aesthetics, in the short and
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This top-of-the-line implant system
features pioneering and groundbreaking innovations that are the
result of knowledge and understanding of the biological and clinical processes involved in dental implant
therapy. These innovations, such as
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It was clear from the beginning that
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Conical Seal Design™ and Connective Contour™—that is at the core of
Astra Tech Implant System.
With the right design philosophy,
you get an implant system that provides the versatility needed to meet
the needs of each individual clinical
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In addition, the design philosophy of
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This evolutionary step—Astra Tech
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References

*Thoma DS, Haas R, Tutak M, et al.,
Randomized controlled multicentre study comparing short dental
implants (6 mm) versus longer
dental implants (11-15 mm) in combination with sinus floor elevation
procedures. Part 1: demographics
and patient-reported outcomes at
1 year of loading. J Clin Periodontol
2015;42(1):72-80.
**Windael S, Vervaeke S, Wijnen L, et
al. Ten-year follow-up of dental implants used for immediate loading in
the edentulous mandible: A prospective clinical study. Clin Implant Dent
Relat Res 2018;20(4):515-21.

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Published in Dubai

www.dental-tribune.me

November-December | No. 6, Vol. 9

Three-dimensional “technologies are going to
become the standard of care”
Interview with Dr Sean K. Carlson
By Nathalie Schüller, DTI
Dr Sean K. Carlson is Associate Professor of Orthodontics at the University of the Pacific’s Arthur A. Dugoni
School of Dentistry in San Francisco
and maintains a private practice in
Mill Valley, both in California in the
US. Carlson is also a senior investigator in the Craniofacial Research
Instrumentation Laboratory at the
dental school. He lectures nationally
on a variety of clinical and theoretical subjects, with a focus on 3-D im-

aging in orthodontics. His primary
focus is on using computer technology to improve the way we study,
teach and practise orthodontics.
During the Spring Meeting of the
European Aligner Society, which
took place in Venice in Italy from 29
to 31 March, Carlson shared some of
his thoughts on making the change
to 3-D technology in orthodontics,
the use of clear aligners and treating
sleep apnoea.
Why did you choose to specialise

in orthodontics? Did your need for
creativity have anything to do with
your choice?
Of course! Orthodontics is incredibly creative, and I think, depending
on the type of orthodontist you become, you can express that creativity in ways that are difficult in other
careers. I’ve always liked the idea of
healthcare; I am very altruistic in
nature and like to help people, so all
fitted very well in choosing orthodontics. It is a very clean profession
in healthcare: your patients are not

truly sick, but you are helping them
with your engineering skills and
spatial relationships, which always
interested me, so it all came perfectly
into place with my personality traits
and I’ve never found anything more
interesting.
What do you mean when you say
that depending on the type of orthodontics you practise you can
express your creativity better?
I think there are both creative and
non-creative orthodontists. Some
people follow the rules, follow what
was done before and never think
for themselves and, in doing so, just
repeat what’s been done. That’s fine
but is not going to push the specialty
forward. If you are going to be creative, your job is to find the next level,
find the horizon, and not everybody
wants to do that because it is challenging.
You spoke about altruism being
important to you. How can we apply it in orthodontics?
Giving back is essential and I think
you should do it at every opportunity you can, but I think value in
delivering service is important. Doctors tend to think that caring is about
providing free treatment. That’s not
fair. Human relationships are about
exchange. If you are expected to
give with nothing in return, people
won’t value what they are receiving.
I have no problem with the cost of
something; if it has value to you, I
think the cost is worth it. That does
not mean you should ignore people
that are less fortunate, so I love programmes that help patients who
can’t afford the treatments.
Dr Melissa Shotell in her presentation stated that only 20 per cent
of dentists use CAD/CAM technology and Dr Adriano Marotta
Araujo that only 10 to 20 per cent
use aligners. Three-dimensional
technology is at the core of your
treatments, possibly your teaching and research too. Why do you
think so many dentists do not use
these amazing technologies, and
how could we change that?
There are two major reasons people
don’t use them: cost and experience
or the lack thereof. They either don’t
want to pay for it, which brings us
back to our discussion about service
with orthodontics. Even if the technology is great, such as a 3-D CAD/
CAM camera or a CBCT device, if you
think it is overpriced, you will find
any excuse not to use it. So, the challenge with these new types of technologies is that people don’t understand the value until they have paid
the cost to own them. Once you get
into new technologies and you realise you can’t live without them, then

the price does not matter, but getting
people to that point is very hard.
The other reason is the learning
curve of these new technologies.
Whether it’s using CAD/CAM to
produce crowns using 3-D milling
machines or using impression-free
imaging or CBCT, learning how
to use them is difficult; you need
practice and it’s hard work. Many
dentists and orthodontists are very
comfortable; we have a very good
life, so why make it hard? I think we
just use the excuse to avoid pushing
through the pain, and it stifles our
progress. But there are always going
to be doctors who understand that
pushing through that pain ceiling to
become better is a constant pursuit
in daily practice. And if you do that,
you adopt these new technologies
very quickly and end up being on the
leading edge of technology.
These technologies are going to become the standard of care; there is
no question about it. It is just going
to take a generation or two to happen.
Since you teach as well, you’d be
able to say whether I’m correct in
surmising that the next generation
does not plan to have a practice
without 3-D technologies, right?
There is no question that my students understand these types of
technologies ten times better than
a seasoned orthodontist who is 50
years old and has a really hard time
adapting to new technologies because he or she, like the rest of us, is
really comfortable and doesn’t want
to feel pain. The young doctors understand this and are very eager. The
challenge for them is cost because
they are fearful of not being able to
afford things. I think that the young
students who understand that this
technology is necessary will thrive,
but the students who are focused
on the cost issue will end up stalling their practice growth and be five
years behind the ones who use it. So,
a lot is about fear. The main answer
to your question is that people are
scared and that is just human nature; we don’t like change, whether
it is where you live, or in your relationships or career. Anything that’s
unknown is scary and hard. By nature, human beings don’t like pain,
so that’s what’s keeping people behind.
There are nowadays many companies on the market, and competition will drive the price down,
don’t you think?
Yes, that is one answer but not the

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◊Page D1
ers conventional brackets are slightly
better at certain things. I just don’t
think it is going to be an all or nothing game; it just depends on the type
of practice you have.

Aligners are not suitable for everyone. Can you tell me when you do
not see them as a treatment possibility, and if you use them as part
of a hybrid treatment plan?
My practice treats children exclusively—a conscious decision I took
four years ago when I decided to
commit to what I was really good
at and really loved, which is building faces and young bites that are
healthy and will last a lifetime.
I do a lot of developmental treatments, a lot of two-phase treatments.
Therefore, I have very small interventions, often in children aged 7 to
10, in which we develop facial bones,
correct jaw width and allow the dentition to erupt quite straight. Cleaning that up with conventional fixed

real answer. Bringing costs down is
not the way to solve fear. An example is CBCT. When I got into it, almost
12 years ago, it was very expensive
and there was no education available—it was like diving off a cliff.
My first CBCT machine cost over
US$200,000 and that was a lot of
money! You can now get a machine
for much less; so yes, the cost will
always come down as technology
advances, but seeing something that
offers so many new possibilities, that
insight, as happened for me when I
first saw what CBCT could do, meant
I could not go back; I had to have it.
The value overcame the cost; I could
not practise consciously and not
have that because I knew it was out
there and how it could improve the
treatments and care I was giving my
patients.

appliances to get a perfect occlusion
is what we do in our second phase,
which usually happens around 12
years old. Conceptually, you can do
that with any appliances, so it does
not matter if one uses lingual or labial appliances or aligners; it is just
about knowing what your goal is and
how to get there, and making sure to
evaluate your results to get to a result
that is good and stable. Therefore, as
long as you are paying attention, you
can use anything. Personally, I do
not use aligner therapy a lot simply
because what works well in my practice is conventional labial appliances,

which are on for very short periods.
For my practice model, it is very efficient and the only reason I do it
that way. I think someone can have
a practice exactly like mine and do
it with aligners completely; it is just
not what I developed. If I wanted
to switch my practice to aligners,
thought that it is that much better
than what I am doing, I would push
through the pain we talked about
before and do it. But I don’t yet see
someone getting results that are remarkably disruptive to what I am doing, results that I cannot achieve with
the way I work.

Okay, but do you use them in particular cases or in combination
with conventional fixed appliances? Do you see that one day they
will replace conventional appliances?
Much depends on the area where
you live and the demand for it. In my
area, a very wealthy community with
a lot of discretionary income and
high education, and because I treat
children, the demand for aligners is
not as high. Will conventional fixed
appliances ever go away completely?
Maybe, but I think that because there
are still certain challenges with align-

In your presentation, you spoke
about a 91 per cent decrease in the
apnoea–hypopnoea index with
maxillary expansion and removal
of adenoids and tonsils. Is it a possible solution to snoring for both
children and adults?
If you identify and can remove those
tissues, it is beneficial. I think that, at
least in the US, adenoids and tonsils
are largely overlooked now compared with the 1970s. I believe in the
late 1970s or early 1980s, a study had
come out stating that recurrent infection was not a reason to remove
adenoids and tonsils, so doctors decided not to do it anymore and insurance didn’t cover it so readily. What
they did not know at the time was
that all these breathing issues were
also related to obstruction in the
adenoid and tonsil areas. They probably overlooked the fact that many
of these children were suffering
from sleep-disordered breathing because of their tonsils and adenoids.
If you can identify this problem, it
is a life changer for these children,
and I think that, if you don’t look at
that, you could be missing a massive
health benefit for your patients, and
I therefore believe all of us should
consider this.
Does expansion or adenoid and
tonsil removal cure sleep apnoea?
No, it is a very complex disease. We
do a lot of early expansion in my
practice, called rapid palatal expansion, which is sutural distraction of
the maxilla, to improve the width
of the maxillary bones, and this is
now also done more commonly on
adults, using temporary anchorage
devices to produce larger maxillae.
There are many studies in the literature that show an increase in upper airway volume with maxillary
expansion, so physically, you create
a larger airway space. That does not
necessarily correlate with curing
sleep apnoea. For some patients with
a structural issue, it improves their
sleeping quality tremendously and
sometimes you can eliminate intraoral appliances.
If you can benefit many patients
and understand that you won’t cure
or benefit all patients, then I think it
is an important thing to do. I think
what is happening, at least in the US,
is that people are trying to make it an
all or nothing argument. They either
want to know that it definitely works
and cures everybody, or it definitely
does not work. The problem is that,
it is never that easy. Biology, healthcare and medicine are never that
easy. Getting a study to tell you one
way or another is not how research
works; you are never going to get the
answer from one study, but people
want black and white.
Editorial note:
This article was originally published
in ortho-international magazine of
orthodontics, Issue 1/2019.

Dr Sean K. Carlson
ORTHOSCIENCE
163 Miller Avenue, Suite 4
Mill Valley, CA 94941
+1 888 673 2827
info@orthoscience.com

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ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

Treatment of a moderate to severe Class II
malocclusion using Invisalign® treatment with
mandibular advancement—a case report
By Dr Donna Galante, USA

Introduction

Minimizing the use of elastics in
Class II treatments not only addresses a patient compliance concern, it
also addresses a treatment efficiency
concern. The vertical force component of Class II elastics tends to
extrude teeth, which redirects mandibular growth in a vertical direction
and makes the A-P correction less efficient. Avoiding clockwise rotation
of the mandible (i.e., downward and
backward) helps to keep mandibular
growth along a horizontal trajectory
in order to maximize the sagittal
change.

Case Report

Patient information:
• 14 years old
• Male
• Chief concern: overbite and crowding Orthodontic diagnosis:
• Right side: Class II molar and canine
(moderate)
• Left side: Class II molar and canine
(severe)
• Overbite: severe deep bite
• Upper arch: moderate crowding,
with retroclined incisors
• Lower arch: moderate crowding
Invisalign treatment with mandibular advancement utilize integrated
precision wings to advance the man-

Intraoral view of Invisalign treatment with mandibular advancement

INITIAL RECORS
Horizontal mandibular development
(green arrow) has a greater amount of
sagittal change than mandibular development which contains a vertical component (blue arrow)

dible without the use of interarch
elastics. The precision wings in the
lower aligners position the mandible
forward by sliding against the precision wings in the upper aligners. At
the same time, the active portions
of the aligners straighten the teeth
and coordinate the arches to remove
interarch interferences and stabilize
the sagittal changes. This approach
maximizes the horizontal component of the mandibular advancement and minimizes unwanted vertical changes.

KEY CEPHALOMETRIC VALUES
Measurement (deg)

Initial

Norm

Std Dev

SNA

83.1

82

2.0

SNB

73.3

80

2.0

ANB

9.9

2.0

1.5

U1-SN

82.8

103

6.0

L1-MP

84.9

90

4.5

Interincisal angle

138.4

135

6.0

FMA

35.5

25

2.0

Treatment plan: How the precision wings (in blue) appear in the ClinCheck set-up.

3 month progress records (weekly aligner changes)

6 month progress records (weekly aligner changes) – Class I molar and canine relationship was achieved, but the
transverse and posterior vertical dimensions still needed correction.

End of mandibular advancement phase (12 months, U: 23 + 26; L: 23 + 26; weekly aligner changes)

Final after an additional aligners phase of U:25 + L:25 aligners, changed weekly (10 months total)

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KEY CEPHALOMETRIC VALUES
(POST-MANDIBULAR ADVANCEMENT):
Measurement (deg)
SNA
SNB
ANB
U1-SN
L1-MP
Interincisal angle
FMA

• Total treatment time: 22 months
• Pre-mandibular advancement aligners: not
used in this case (see discussion)
• Mandibular advancement aligners: U:23+26;
L:23+26, changed weekly (12 months total)
• Additional aligners: U:25; L:25, changed weekly
(10 months total)
• Retention: Invisalign retainers 16 hours a day
for 6 months, then at night for life

Discussion

Removing anterior interferences was important
for maximizing the correction of the sagittal dimension, and expansion of the upper arch was
critical for preventingposterior crossbites from
forming as the mandible came forward. When
the upper arch is constricted, the posterior teeth
are unable to interdigitate fully due to premature posterior contacts as the mandible advances. Widening the upper arch form removes
these interferences so that the lower posterior
teeth can fully seat against the upper teeth.
By doing this, mandibular plane divergence
is avoided, and the horizontal component of
the sagittal correction is maximized. The deep
bite is also improved when the mandible is advanced downward and forward.
In the additional aligner phase, the goal was to
continue leveling the curve of Spee by intruding
the lower incisors. Anterior interferences after
Class II correction can lead to a mild posterior
open bite. By intruding the incisors to remove
these interferences, interdigitation of the posterior teeth is restored.
To help stabilize the A-P correction during additional aligner, the patient wore Class II elastics
(4 oz., 3/8” diameter) connected to precision cuts
in the aligners near the upper canines and lower
first molars. Elastics were worn for 10-12 hours a
day (typically at night only), for 3 months.
The sagittal improvement and the amount of
upper incisor torque achieved, were both good
(∆ANB = -3.5˚ and ∆U1- SN = +10.0˚, respectively). The final upper incisor position was esthetically pleasing, but slightly under-torqued
relative to orthodontic norms (U1-SN = 92.8˚),
so additional incisor inclination might have allowed the mandible to advance a little bit more.
Avoiding excessively proclined lower incisors
was an important factor in successfully correcting the Class II, especially since a mild tooth-size
discrepancy was also present. If the lower incisor torque control had been poor, the amount
of sagittal correction achieved could have been
significantly reduced due to incisor interferences.
Excellent vertical control was maintained
throughout treatment (∆FMA = -10.5˚) even
with the use of Class II elastics during additional
aligners, in large part because extrusive forces
on the posterior teeth were kept to a minimum.
Not opening the mandibular plane angle allowed the horizontal component of the mandibular advancement to be maximized, in order
to establish a solid Class I relationship at the end
of treatment.

Summary

Overall thoughts and learnings about how to
be successful with using the mandibular advancement feature:
If a deep curve of Spee is present, a lateral/
posterior open bite will often appear when the
mandible advances. Removing anterior interferences early allows the mandible to come forward gradually, into a comfortable and stable
position. To help identify anterior and transverse interferences with the potential to create
a lateral open bite, the patient can be asked to
posture their jaw forward into a Class I canine
relationship during the initial consultation. This
should reveal anterior interferences and areas

Initial
83.1
73.3
9.9
82.8
84.9
138.4
35.5

Post-MA
81.4
73.9
7.5
96.0
94.9
134.8
34.3

KEY CEPHALOMETRIC VALUES

Norm
82
80
2.0
103
90
135
25

Std Dev
2.0
2.0
1.5
6.0
4.5
6.0
2.0

of arch constriction that need to be addressed in
the aligner setup.
If the patient has significant anterior interferences, a pre-mandibular advancement phase
of aligners (included as part of Invisalign treatment with mandibular advancement) is highly
recommended, so that lingual root torque/buccal crown torque can be introduced to the upper
anterior teeth early. Pre-mandibular advancement aligners can also be used to widen the upper arch form, rotate the upper molars distally
(typically up to 20 degrees), and level the curve
of Spee.
Case selection recommendations when first
starting to use this feature:
Growing children—particularly those with
mandibular retrognathia—are best treated with
mandibular advancement. Ideal patients are
those with hyper-divergent growth patterns.
Start with mild to moderate Class II, division 1
patients.

Measurement (deg)
SNA
SNB
ANB
U1-SN
L1-MP
Interincisal angle
FMA

Initial
83.1
73.3
9.9
82.8
84.9
138.4
35.5

Post-MA
81.4
73.9
7.5
96.0
94.9
134.8
34.3

Final
80.0
73.6
6.4
92.8
92.2
140
25

Norm
82
80
2.0
103
90
135
25

Std Dev
2.0
2.0
1.5
6.0
4.5
6.0
2.0

Cephalometric superimpositions (black = initial / red = ﬁnal)

General superimposition (cranial base at sella)
shows mostly downward maxillary growth, with
the mandible moving downward and forward.

Maxillary superimposition shows that positive
upper incisor torque was achieved.

What kind of cases to try after that:
Severe Class II patients can be considered once
the doctor becomes familiar with the clinical
steps and processes associated with the precision wings feature.
What kind of conditions are favorable and
unfavorable for treatment using this aligner
feature:
Creating adequate anterior clearance early is the
key to successful sagittal correction. Retroclined
upper incisors and flared lower incisors should
be addressed as soon as possible. It is also very
important to level the curve of Spee early, to
give sufficient time for the mandible to advance. If anterior interferences are present, the
mandible may not reach its maximum forward
potential, and without a leveled curve of Spee, a
lateral open bite may appear.
What was learned from treating this particular case:
Using precision wings instead of Class II elastics removes the unpredictable variable of patient compliance with elastics wear for Class II
correction. If elastics are needed, they are only
used for a short period of time during the additional aligner phase, to help stabilize and fine
tune the sagittal correction. The precision wings
were convenient to use and comfortable for the
patient, and they did not compromise the key
esthetic benefit of Invisalign clear aligners. The
patient’s oral hygiene and aligner wear compliance were both excellent throughout treatment.
Anterior interferences from tooth-size discrepancies are typically resolved by slenderizing the
lower incisors or by building up the upper lateral incisors with cosmetic bonding or veneers.
Anterior interferences due to tooth-size discrepancies can also be avoided by controlling the lingual root torque of the incisors and by carefully
leveling the curve of Spee. In this patient, the
mild tooth-size discrepancy was successfully
managed by establishing proper lingual root
torque of the incisors and by complete flattening of the curve of Spee.
Common challenges/problems experienced
during teen treatment with this aligner feature:
If adequate anterior clearance is not initially
present, consider spending 3 to 6 months to remove any protrusive interferences first. A brief
premandibular advancement phase of aligner
treatment (an included option with Invisalign
treatment with mandibular advancement
product) is an effective solution for leveling the
curve of Spee, torqueing the upper incisors, and
rotating the upper first molars into an ideal arch
form. If the lower incisors are flared to begin

Maxillary superimposition shows that positive
upper incisor torque was achieved.

with (which they were not, in this patient), the
pre-mandibular advancement aligners can
also be used to upright and intrude them.
© 2018 Align Technology (BV). All Rights Reserved. Invisalign,® ClinCheck® and SmartTrack,® among others, are trademarks and/

or service marks of Align Technology, Inc. or
one of its subsidiaries or afﬁliated companies
and may be registered in the U.S. and/or other
countries. Align Technology BV, Arlandaweg
161, 1043HS Amsterdam, The Netherlands
205340 Rev A

THREE KEY TAKE AWAY POINTS
1. The precision wings feature of Invisalign treatment with mandibular advancement product maximizes the horizontal component
of mandibular advancement while minimizing the vertical dental component typically associated with the use of Class II elastics
(which tend to extrude the anchor teeth). As a result, excellent vertical control during Class II correction can be expected.
2. Any retroclined upper incisors need to be set up with proper inclination (positive incisor torque) in order for the mandible to advance
into a stable Class I relationship. This can be initiated early in a premandibular advancement phase of aligner treatment if needed. Excessive lower incisor proclination should be avoided, since anterior
interferences will limit how far the mandible can come forward.
3. Transverse problems should also be addressed early with a premandibular advancement aligner phase. The crowns of the upper
molars and premolars (and often times the canines) should be uprighted buccally to properly coordinate the arches while the lower
arch is moving forward into a Class I relationship. If the clinical
crowns are short, additional attachments can be added to the setup
to improve aligner retention during arch development.

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Published in Dubai

www.dental-tribune.me

November-December | No. 6, Vol. 9

Dental Hygienist Seminar Highlights
Impressions from Dental Hygienist Seminar and hands-on courses for dental hygienists,
part of Dental Facial Cosmetic Conference & Exhibition,
which took place in Dubai on 08-09 November 2019 at InterContinental Hotel, DFC.

[56] => DTMEA_No.6. Vol.9_DT.indd

HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

Ozone therapy in dentistry:
notably effective in accelerating pre- and
postoperative healing
By DTI
Over the last few decades, the use of
ozone in dentistry has been established as an effective, minimally invasive therapeutic modality with an
increasing number of applications.
Sixty years after Dr Joachim Hänsler
patented his OZONOSAN, the first
medical ozone water generator with
an exact dosage output, familyowned company Dr. J. Hänsler has
become a leader in ozone technology with applications in medical
and dental hygiene. We interviewed
Managing Director Dr Renate
Viebahn-Hänsler, who is also a board
member of the European Committee of the International Ozone Association, and Yvonne Hoffmann,
Managing Director of Hoffmann
Dental Manufaktur, which took over
the global sales and distribution of
the OZONOSAN dental water unit in
2017.
What is ozone used for
in dentistry?
Dr Renate Viebahn-Hänsler: The
use of ozone in dentistry extends
back to the 1930s, which is when scientists first discovered its properties
and started to use it for a number of
applications, such as wound cleansing, mouth rinsing and disinfecting.
Ozone is also notably effective in
accelerating pre- and postoperative
healing of the oral mucosa. Nowadays, ozone therapy in dentistry is
mainly used in clinics for holistic
dentistry, but owing to its disinfectant properties, ozonised water could
be of great help after dental implant
surgery and should be introduced in
periodontal treatment, as well as any
form of oral or dental surgery, in the
future.
How did you become aware of
ozone’s potential?
Viebahn-Hänsler: I have been in
the medical ozone business for over
30 years. In this time, a significant
amount of research on the topic has
been conducted, including much
research specifically related to dentistry. Those who are interested can
find these publications listed on our
website, www.ozonosan.de.
Yvonne Hoffmann: In 2014, Hoffmann Dental took over Proxidentis
Dentale Biomaterialien, a producer

of natural oral health products, including ozone oil for periodontal
treatment. After learning about
ozone oil, it was only a small step
towards developing ozone water
rinses.
What are the differences in application between ozone as a gas mixture and ozone dissolved in water?
Viebahn-Hänsler: Gaseous ozone
cannot possibly act as a disinfectant.
Owing to its polar molecular structure, ozone has great solubility in a
polar solvent like water. As hydrogen bonds stabilise ozone, ozone’s
half-life in water by far exceeds that
of its gaseous version. As such, we
recommend ozone water or oil for
disinfecting wounds, not an ozone–
oxygen gas mixture. Moreover, the
gas mixture cannot be used safely

in dentistry owing its toxicity to the
respiratory epithelium. Ozone water,
however, can be used as a mouthwash to rinse wounds and periodontal pockets. Owing to its pronounced
disinfectant and healing effects,
ozone is a perfect alternative to tooth
cleaning with sugar alcohols or sodium bicarbonate.

conventional periodontal treatment?
Hoffmann: Rinsing with ozone water followed by the application of
ozone oil is a great complement to
conventional periodontal treatment
or professional dental cleaning.

Ozone water must be generated onsite. Is training necessary?
Viebahn-Hänsler: Our ozone water
generator is subject to the Medical
Device Act and requires instruction
and training by a medical device
consultant. Nonetheless, its handling
is very simple.

Viebahn-Hänsler: Ozone water does
not distinguish between aerobic and
anaerobic bacteria. It destroys the
cell membrane and ultimately the
DNA/RNA of bacteria and viruses
that come into direct contact with
the ozone molecules. Additionally,
ozone water improves healing processes by activating the cellular metabolism.

How does ozone inhibit anaerobic
periodonto-pathogenic bacteria?
What advantages does it have over

Hoffmann: Ozone oil works differently in that it only kills anaerobic
bacteria, which are the bacteria spe-

cifically linked to periodontal disease. Because of its density, ozone oil
easily adheres to interdental spaces
and periodontal pockets, where it is
retained for longer than ozone water.
Unlike chlorhexidine, ozone water
and ozone oil in excessive amounts
cannot possibly lead to altered taste
or tooth discoloration. They do
not provoke any allergies, have no
known side-effects and are a safe, effective way to reduce the postoperative use of antibiotics and cortisone.
What are the benefits of ozone beyond dentistry?
Is it used elsewhere?
Viebahn-Hänsler: Medical ozone
is used for wound disinfection and
treating chronic inflammatory diseases. Other therapeutic applications are auto-haemotherapy, in
which the patient’s blood is exposed
to ozone and then reinjected, or rectal insufflation.
Hoffmann: Ozone is also used in water purification in municipal waterworks to destroy bacteria and parasites such as Cryptosporidium and
Giardia. Unnoticed by most of us, it is
also used in public swimming pools
to reduce the total chlorine level
needed to improve the water quality.

Dr Renate Viebahn-Hänsler

Yvonne Hoffmann

Editorial note:
This article was originally published
in prevention-international magazine for oral health, Issue 1/2018.

[57] => DTMEA_No.6. Vol.9_DT.indd

[58] => DTMEA_No.6. Vol.9_DT.indd

HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

Oral microbiota, intestinal microbiota
and inflammatory bowel disease
By Prof. Denis Bourgeois, France

Intestinal microbiota

There exists a close relationship
between the human host and the
intestinal microbiota—a mixed
community of microorganisms that
protect the intestine from being
colonised by exogenous pathogens.
In a healthy individual, the host
and microbiota coexist in mutual
harmony, allowing both to function
properly.1 The balance of the intestinal microbial ecosystem can be disrupted by a number of factors, such
as antibiotics, vaccinations, certain
foods and stress. An intestinal bacterial disorder primarily manifests
in terms of quantitative changes in
bacterial location, causing excessive
bacterial growth in the intestine. This
can damage the intestinal mucosal
barrier, thereby releasing enterotoxins as a means to increase intestinal epithelial permeability so that
bacteria and products can enter the
intestinal lamellae, causing an immune dysregulation of the mucous
membranes and inducing inflammatory bowel disease (IBD). Changes
in intestinal microbes are associated
with the development of IBD.

IBD comprises a group of idiopathic
diseases characterised by chronic
inflammation of the bowel. This
inflammation may affect any part
of the gastrointestinal tract. IBD
represents a group of two principal
intestinal disorders: Crohn’s disease
(CD) and ulcerative colitis. These two
disorders have distinct clinical and
pathological features, yet they do
overlap.
The pathogenesis of CD is most notably associated with a deterioration
of the immune system, which becomes incapable of destroying bacteria, viruses and other potentially
harmful foreign organisms, as well
as the intestinal microbiota. There
is currently good evidence that the
intestinal flora or microbiota plays
a key role in the development of
IBD. Recent studies have shown that
certain strains of intestinal bacteria
are responsible for ulceration and
chronic inflammation in IBD. Ulcerative colitis, as opposed to what was
initially believed, is not an autoimmune disease, but rather an infectious disease elated to an imbalance
in the intestinal microbiota.2

According to He et al., the CD microbiota is grouped into two distinct
meta-communities, which would indicate subject variation in the structure of the microbiome.3 Specific
functional changes in the CD metacommunity show increased levels
of pro-inflammatory hexa-acylated
lipopolysaccharides and a reduced
potential to synthesise short-chain
fatty acids. Moreover, disruption of
ecological networks in CD is associated with reduced growth rates of
many bacterial species. The authors
concluded that the microbiota of CD
patients can be layered into two distinct meta-communities, in which
the most seriously disrupted metacommunity exhibits functional potentials that substantially deviate
from those of a healthy individual,
with a possible implication for the
pathogenesis of CD.
Various explanations have been
advanced, such as the hygiene hypothesis, which blames the frequent
use of antibiotics and microbicidal
compounds; the partial elimination
of enteric microflora after suffering from infectious acute gastroenteritis; certain food components,

Prof. Denis Bourgeois

for example refined sugars used in
developed countries, which could
promote the growth of certain types
of bacterial species; and even certain
types of toothpaste.

Oral microbiome

Individuals’ oral microbiomes are
highly specific at the species level,
although overall, the human oral
microbiome is largely homogenous.
If the symbiotic balance between the
host and the microbiota of the oral
cavity is disrupted, the microbiota
may become harmful. Distinctions
in microbial composition have been
found between carious and cariesfree microbiomes, as well as periodontally diseased and periodontally
healthy microbiomes. Although
caries and periodontitis are clearly
bacterial diseases, they are not infectious diseases in the classical sense,
since they result from a number of
factors: commensal microbiota, host
susceptibility and environmental
factors, such as diet and smoking.

Join the largest
educational network
in dentistry!
www.DTStudyClub.com

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.

The literature on interdental applied to carious lesions is extremely
limited. However, it has been established that the effective presence of
the red complex, particularly Porphyromonas gingivalis, a pathogen
of heart disease and other systemic
diseases, is a strong indicator of the
need to develop new methods to
disrupt interdental biofilm through
daily oral hygiene. Indeed, it has been
shown that low levels of P. gingivalis
(< 0.01% of the total load) were able
to induce changes in the composition of the biofilm.4 Likewise, the
presence of Candidas albicans in significant quantities in the interdental
spaces is cause for concern. Understanding the impact of such bacteria
and yeasts in the interdental spaces
within an oral environment, including, of course, the salivary environment—which have the potential to
spread at any time of their lives within the digestive tract—is a priority.

The relationship
between the two

Though there is still much to be
learnt about the interaction between
the oral and intestinal microbiota,
numerous recent studies have shed
some light on it. By examining the
oral health of patients with dyspepsia who were candidates for diagnostic upper gastrointestinal endoscopies, Zaheda et al. found a direct
relationship between Helicobacter
pylori, a bacterium known to irritate the stomach lining and induce
chronic gastritis, as well as poor periodontal health.5 This observation is
supported by existing literature on
the subject, which suggests that dental plaque may harbour H. pylori and
cause recurrences of gastric infection.
A 2017 study by Hujoel and Lingström traced an overview of the
historical role of nutrition in the development and prevention of dental
caries, gingival bleeding and periodontal disease.6 Given how much
recommendations on nutrition
have changed over time—the World
Health Organization has only since
2015 recommended the restriction
of sugar intake, for example—it is interesting to see that the current evidence suggested a low-carbohydrate
diet high in non-vegetable fats, micronutrients (e.g. vitamin C and B12)
and protein was correlated with periodontal health. However, the ability
to absorb these nutrients can be influenced by gastrointestinal health.
As the Canadian Society of Intestinal
Research has reported, the improper
functioning of the gastrointestinal
tract can reduce nutrient absorption,
leading to vitamin and mineral deficiencies that may cause oral lesions
and tongue inflammation.

Editorial note:
A list of references can be obtained
from the publisher.
This article was originally published
in prevention-international magazine for oral health, Issue 1/2018.

[59] => DTMEA_No.6. 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

[60] => DTMEA_No.6. Vol.9_DT.indd

HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2019

A shift in biofilm management
By Dr Klaus-Dieter Bastendorf, Switzerland
Centuries ago, dentistry identified
mineral deposits, such as tartar or
calculus, as the main cause of dental disease. Further research then
recognised bacterial infections in
the roots and the periodontium as
the cause of periodontitis. So, what
was the logical conclusion? Calculus
(tartar) was removed completely.
Today, we know that calculus has a
porous surface that provides a niche
environment for bacteria and endotoxins. Endotoxins are not absorbed
into the calculus, so it can be easily
removed.
However, extensive removal of calculus is contraindicated and counterproductive.
When I started out as a dentist over
40 years ago, prophylaxis was still in
its infancy. At my university, there
was minimal literature on everyday
oral hygiene. An eye-opening moment for me was during a visit to
see Prof. Jan Lindhe in Gothenburg.
There, we studied cases of periodontitis that caused almost everyone to
cry out: full dentures! We then saw
images of the same patients ten
years later—they still had their natural teeth, solely thanks to prophylaxis. The thing that made me opt
for prophylaxis in dentistry was the
birth of my first daughter. I would
never have been able to forgive myself if she developed a dental disease.
This private passion for preventive
dentistry and the vision of Prof. Axelsson and Prof. Lindhe have stayed
with me to this day. Although my
children and grandchildren’s teeth
are healthy, I do see a lot of unhealthy teeth in people in my own
generation.
40 years ago, there was a limited understanding of biofilm, individual
diagnostics and individual prophylaxis. We removed calculus twice a
year, but only introduced individual
diagnostics and treatment in 1994.
Today, we know the value of prophylaxis. One major reason is that we
have a greater understanding of the
causes of the most prevalent dental
illnesses. The trigger for cavities, gingivitis, periodontitis, peri-implant
mucositis and peri-implantitis is always biofilm and not calculus. However, the amount of biofilm is not the
determining factor, rather, it is the
biofilm’s ecological make-up, type
and balance.
Biofilm is a microbial, “organised”
collection of microorganisms. The
microorganisms are embedded in
a matrix of extracellular polymer
substances that the microorganisms produce themselves. Microorganisms in biofilm show a different
phenotype regarding growth rate
and gene expression compared to
suspended living cells. Dental plaque
is a kind of biofilm and since biofilm
forms an adhesive layer, special attention is required to destroy and/or
remove it.

Classic...

Currently, there are two technologies
available for the manual destruction
of oral biofilm, everyday manual
biofilm management and professional manual biofilm management.
In professional manual biofilm management, we have a range of tools
available, including manual debridement with handheld instruments
and classic surface polishing, as well

as debridement with sonic and ultrasound instruments, such as air polishing systems.
Most dental practices still clean the
surface of the teeth with manual
tools. In initial therapy, after the
use of Piezon, we sometimes still
use manual tools, though never for
maintenance therapy. The correct
use of these manual tools is technically challenging and requires a good
tactile feel and extensive training.
The treatment itself is very timeconsuming and tiring for the practitioner, but indispensable for deep
pockets of periodontitis that are not
being treated surgically. The procedure often leads to oversensitive
roots and aesthetically displeasing
and noticeable recessions. Manual
tools are not well received by patients either and often cause dental
practitioners’ hand and arm ligaments to tire. These reasons have led
to the need for new tools to be used
at regular intervals.

...Or modern?

Axelsson and Lindhe have begun
to use ultrasound tools in their
maintenance therapy. This technology broke through in the 1980s as
bulky ultrasound tips were replaced
with fine tips based on periodontal
probes. I can still remember the introduction of gentler piezo-ceramic
ultrasound devices—a real scientific
and technological innovation.
Only this ultrasound technology allowed linear, low-pain movements.
A consensus paper on this topic,
published during the EuroPerio 2012
Congress in Vienna, can be summarised as follows:
– Piezo-ceramic technologies have
proven effective for manually removing build-up
– They can be used universally (both
sub- and supragingival) to remove
mineralised build-up and bacterial
biofilm
– They are gentle on soft tissue
– They allow for shorter treatment
times
– They cause less pain for the patient
– They can be used after a short training period
Today, we know even more. Powder jet devices can be used to clean
sub- and supragingival biofilm and
staining more efficiently and quick-

ly. Low-abrasion powder based on
glycine or erythritol and new subgingival nozzles perform exceptionally well. The literature on powder
and water jet technology with lowabrasion powders in biofilm management, compared with manual
and ultrasound tools, highlights the
benefits of this new technology.
Furthermore, air polishing with lowabrasion powder removes more bacteria than manual and ultrasound
tools. Many studies have shown that
air polishing can remove supragingival build-up and stains much more
effectively than classic polishing
methods. This applies to soft tissue,
hard tissue or restorative materials.
Therefore, subgingival air polishing
with low-abrasion powder is gentle
enough and therefore suitable for
use on all dental tissue.

A short guide to powder

The most commonly used powders
are sodium bicarbonate, glycine
and erythritol. Sodium bicarbonate
is a white, crystalline powder with
a range of applications in food and
medicine and it breaks down at temperatures above 56 degrees Celsius.
In wet conditions, sodium bicarbonate, a hydrogen carbonate anion,
can neutralise acids. This property
explains its central role as the most
important blood buffer, since it can
regulate the acid-alkali balance in the
human body.
Glycine is the simplest stable amino
acid that can be made by the human body, where it acts as a radical
catcher and neurotransmitter. Glycine is found in almost all foods that
contain protein as it is a common
building block of almost all types of
protein. Glycine is also found in collagen, an important component of
tendons, bone, skin and teeth. Glycine is an approved dietary supplement with no maximum dose as it
supports various bodily functions.
In the food industry, it is often used
as a flavour enhancer or humectant. Studies from 2008 onwards
have shown that air polishing with
glycine powder does not irritate the
gingivae.
Now, we come to erythritol. Since
2012, we have almost exclusively
used this white, crystalline powder
with a pleasantly sweet taste. Erythritol is found in small amounts in
nature, for example, in honey, wine

grapes, melons and mushrooms
and it is produced by the fermentation of natural sugar. Due to its
sweet taste, erythritol is used as a
sweetener to replace sugar. It has almost no calories when absorbed by
the human body and is suitable for
diabetics. Oral bacteria are also not
able to metabolise erythritol, so it is
tooth-friendly and not cariogenic.
Various studies have shown that
only glycine and erythritol powders
do not change the surface structure
of composite fillings, while erythritol
powder showed no changes on glass
ionomer surfaces.

Guided Biofilm Therapy (GBT) is
a new individual clinical treatment
protocol. Decades of experience and
research are reflected in a clear eightstep solution: diagnosis, disclosing,
motivation, AIRFLOW®, PERIOFLOW®,
PIEZON®, control and recall. Only
GBT gives the practice team the skills,
motivation, training and products for
the most professional dental cleaning
of patients. EMS offers a new brochure
for more information, available at
ems-dental.com

Guided
Biofilm Therapy–GBT

GBT perfectly combines air polishing
devices and low-abrasion powders.
Developed in collaboration with universities and dental practices, GBT is a
concept designed for contemporary
prophylaxis. Based on decades of sci
entific knowledge and evidence, GBT
is the next step in prophylaxis. The
eight steps that comprise GBT can
be adapted to suit the treatment and
patient, including patients in initial
therapy to patients in maintenance
therapy, healthy patients, patients
with dental caries (especially in the
initial stadium), patients with gingivi- tis, patients with periodontitis,
patients with perimucositis and patients with peri-implantitis.
The GBT concept ensures a systematic, quality-orientated approach, from greeting the patient to
collecting diagnostic data, everyday
oral hygiene advice, professional
teeth cleaning, the dentist’s final
diagnosis and check-ups and chemically-supported plaque removal, as
well as recalls. Alongside the dyeing
of the supragingival biofilm, the process of professional teeth cleaning
has changed considerably. The modern approach begins with sub- and
supragingival biofilm removal using
air-polishing technology with AirFlow Plus Powder®.
This erythritol-based powder guarantees a targeted, gentle, risk-orientated removal of the biofilm to
support the initial diagnosis. This is
followed by the targeted and minimally invasive removal of mineralised build-up with Piezon No Pain®.
This approach has many addi tional
benefits, including short treatment

times and maximum comfort for
both the technician and the patient.
Finally, we can carry out professional biofilm management effectively,
gently, safely, quickly and without
pain.
Going forward, it is especially important to use the correct devices
and tools, such as GBT. Currently,
there are a few new products on the
powder market. However, in addition to the powders’ properties and
scientific evidence that these powders are biocompatible and do not
cause damage, it has become more
and more important for powders to
be compatible with dental devices.
This is a strength exhibited by Switzerland-based EMS, who have not
only significantly contributed to the
development of GBT, but have also
provided suitable devices and tools
(AIRFLOW® PROPYHXLAXIS MASTER, AIR-FLOW® POWDER PLUS, AIRFLOW® handpiece, PERIO-FLOW®
handpiece, PERIO-FLOW® nozzle, Piezon No Pain®).
The scientific knowledge and technological progress for a paradigm
change in professional prophylaxis
has now been established. Now
comes the time to integrate these developments into our everyday practice for the well- being of our patients
and ourselves.

Editorial note:
This article was originally published
in prevention-international magazine for oral health, Issue 1/2017.

[61] => DTMEA_No.6. Vol.9_DT.indd

HELP PATIENTS
STOP THE CLOCK ON
GINGIVITIS NOW
GINGIVITIS

TOOTH
LOSS

HALITOSIS

GINGIVAL
RECESSION

Parodontax helps stop the clock on gingivitis
and gets your patients back to healthy gums.

CHSAU/CHPDX/0001/19 - Production Date: January 2019
With twice daily brushing
Please read the label before use
We Value your Feedback
+973 16500404 - Gulf & Near East countries
contactus-me@gsk.com
www.gsk.com

[62] => DTMEA_No.6. Vol.9_DT.indd

) [page_count] => 62 [pdf_ping_data] => Array ( [page_count] => 62 [format] => PDF [width] => 808 [height] => 1191 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT Middle East and Africa No. 6, 2019

[toc] => Array ( [0] => Array ( [title] => Dentsply Sirona World in Las Vegas: Ultimate Dental Meeting impresses thousands of guests [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => Solving aesthetic issues in the anterior region with composite [page] => 04 ) [3] => Array ( [title] => Printing the future [page] => 06 ) [4] => Array ( [title] => Industry [page] => 08 ) [5] => Array ( [title] => Diverse applications of lasers in dentistry [page] => 14 ) [6] => Array ( [title] => Preoperative digital planning [page] => 18 ) [7] => Array ( [title] => The new frontier restorative dentistry [page] => 22 ) [8] => Array ( [title] => CAD/CAM can be an incredible teaching tool [page] => 24 ) [9] => Array ( [title] => Dentsply Sirona World 2019 – Las Vegas [page] => 26 ) [10] => Array ( [title] => "... the beginning of leading network of dental clinics in the UAE..." - Interview with Mr Álvaro Martínez-Arroyo López, Asisa Internacional Salud General Manager and General Manager and Director of True Smile Works Dental Network LLC [page] => 30 ) [11] => Array ( [title] => News [page] => 32 ) [12] => Array ( [title] => “I look back with pride and gratitude” - An Interview with Robert Ganley, Ivoclar Vivadent’s CEO 2003 – 2019 [page] => 36 ) [13] => Array ( [title] => Events [page] => 38 ) [14] => Array ( [title] => Endo Tribune Middle East & Africa Edition [page] => 41 ) [15] => Array ( [title] => Lab Tribune Middle East & Africa Edition [page] => 45 ) [16] => Array ( [title] => Implant Tribune Middle East & Africa Edition [page] => 47 ) [17] => Array ( [title] => Ortho Tribune Middle East & Africa Edition [page] => 51 ) [18] => Array ( [title] => Hygiene Tribune Middle East & Africa Edition [page] => 55 ) ) [toc_html] =>

Table of contents

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