DT Middle East & Africa No. 3, 2020DT Middle East & Africa No. 3, 2020DT Middle East & Africa No. 3, 2020

DT Middle East & Africa No. 3, 2020

Dental professionals in France deliver care through telecommunication / Industry / News / Industry / Highly esthetic results with CEREC® Primemill / Fundamental principles in designing reprocessing areas / The copyCAD / Meeting patients' needs and transforming smiles with direct veneers / Testing a novel endodontic sealer / Researchers develop model to automatically localise mandibular canals

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NL
Y
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NA
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FE
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PR
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AL
DE

www.dental-tribune.me

Published in Dubai

May-June 2020 | No. 3, Vol. 10

ENDO TRIBUNE

LAB TRIBUNE

IMPLANT TRIBUNE

ORTHO TRIBUNE

HYGIENE TRIBUNE

AAE provides considerations
for dental and endodontic care
during COVID-19 crisis

What is the new generation of
all-ceramics capable of doing?

Implantology in 2020:
There is now something new
under the sun or rather ancient

Plaque control, a key element of
successful orthodontics

Want to maintain good oral
health? Start eating smarter

ÿA1-4

ÿB1-4

ÿC1-2

ÿD1-4

ÿE1-4

Dental professionals in France deliver care
through telecommunication

DENTAL TRIBUNE

LEIPZIG, Germany: Since 14 March,

France has been under COVID-19
Level 3 restrictions, including the
halting of all non-essential services.
To flatten the SARS-CoV-2 infection
curve and ensure the safety of dental
professionals, staff and patients, dental surgeries in France remain closed,
and dental surgeons are only available to answer any possible questions
that patients may have by phone or
email, other than emergency treatment.

In an interview with Dental Tribune
France, Dr Yassine Harichane, a graduate of the dental faculty of Paris
Descartes University, said that like
many other dentists, he too is only

providing emergency dental care,
mainly on the phone. Commenting
on the situation, he noted that the
impact of COVID-19 for dental companies and the profession as a whole
will be profound once operations resume and that the consequences will
be twofold. Owing to business interruptions, many companies will face
financial difficulties and trouble obtaining materials. Additionally, there
will be a change in the relationship
between dentists and patients as a
result of limited physical contact and
the constant fear of being infected.

The World’s Dental Newspaper Middle East & Africa Edition

French Dental Association’s
response
The coronavirus pandemic has created substantial challenges for den-

ÿPage 2

© Viacheslav Lopatin/Shutterstock

By Iveta Ramonaite, Dental Tribune
International

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[2] =>
2

NEWS

Dental Tribune Middle East & Africa Edition | 3/2020

◊Page 1
tal professionals, and many healthcare workers are being overloaded
with information. It has become difficult to differentiate real news and
facts from speculation in order to
decide how best to implement crosscontamination measures in treating dental patients. To help answer
some of the questions dentists may
have, the French Dental Association
has created a question and answer
section on its website as well as Facebook and YouTube pages that deals
with health, clinical, financial and
social issues.

ed that some dental professionals
have chosen to continue their dental
activities, ignoring the government’s
decision to close all dental clinics.
Fournier stated that he strongly opposes such behaviour, since it puts
the community and the dentists at
risk. Consequently, the organisation
has decided to sanction practices that
continue to operate their businesses
normally. The COVID-19 questions
and answers on the French Dental
Association website can be found at
https://www.adf.asso.fr/fr/covid-19/
questions-expresso-avec-ladf.

In a broadcast on 24 March, Dr Serge
Fournier, president of the Ordre national des chirurgiens-dentistes (national order of dental surgeons), stat-

Busier than ever?
Speaking to Dental Tribune International (DTI), Dr Laurence Bury, a
dentist and scientific editor at Dental

Tribune France, said that, despite the
pandemic, she is staying busy. “I go
to my office every morning, even on
Saturdays and Sundays, where I listen and reply to all the messages and
emails and send prescriptions. I’m
also in contact with three nursing
homes around my office and am fixing their broken dentures and looking at the photographs sent by the
nurses to understand the gravity of
their symptoms.”
“Four times a week, I see some patients from the neighbourhood for
pulpitis and then I wear two surgical masks to protect myself and put
a dental dam over the tooth being
treated. Patients come in, wash their
hands and rinse their mouths, and

then I start working,” she continued.
Bury also told DTI that she had found
a sensible solution for covering her
body while working. She uses a travel raincoat, which is reusable and can
be disinfected.
When dental activity resumes, hopefully on 11 May, when the lockdown
restrictions are to be lifted, Bury said
that she will manage one patient at a
time and allow 15-minute breaks between patients to be able to sterilise
the office.
Editorial note: This article was originally published online on 27 April
2020 at www.dental-tribune.com.

AD

POST-GRADUATE DENTAL EDUCATION
DUBAI | UAE

IMPRINT
PUBLISHER AND CHIEF EXECUTIVE OFFICER
Torsten R. OEMUS
CHIEF CONTENT OFFICER
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
General requests:
info@dental-tribune.com
Sales requests:
mediasales@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
Saudi Ortho Society
Lebanese Dental Association
Lebanese Orthodontic Society
Qatar Dental Society
Oman Dental Society
Kuwait Dental Association
International Federation of Dental
Hygienist
British Academy of Restorative Dentistry
British Academy of Dental Implantology
AALZ - Aachen Dental Laser Center
Singapore Dental Association
Saudi Dental Hygienist Society
DIRECTOR OF mCME
Dr. Dobrina MOLLOVA
mollova@dental-tribune.me
Tel.: +971 50 42 43072
DIRECTOR
Tzvetan DEYANOV
deyanov@dental-tribune.me
Tel.: +971 55 11 28 581
EDITING & DESIGN
Kinga MOLLOV
k.romik@dental-tribune.me
Tel.: +971 56 23 70 721
PRINTING HOUSE & DISTRIBUTION
Al Nisr Printing
P. O. Box 6519, Dubai, UAE
800 4585/04-4067170
Material from Dental Tribune International
GmbH that has been reprinted or translated
and reprinted in this issue is copyrighted by
Dental Tribune International GmbH. Such
material must be published with the permission of Dental Tribune International GmbH.
Dental Tribune is a trademark of Dental Tribune International GmbH.

Organiser

Partners

+971528423659 | p.mollov@cappmea.com

www.cappmea.com/diplomas

All rights reserved. © 2020 Dental Tribune International GmbH. Reproduction in any
manner in any language, in whole or in part,
without the prior written permission of Dental Tribune International GmbH is expressly
prohibited.
Dental Tribune International GmbH makes
every effort to report clinical information
and manufacturers’ product news accurately
but cannot assume responsibility for the validity of product claims or for typographical
errors. The publisher also does not assume
responsibility for product names, claims or
statements made by advertisers. Opinions
expressed by authors are their own and may
not reflect those of Dental Tribune International GmbH.


[3] =>
CEREC Primemill

Excellence made easy.
The new CEREC Primemill is uniquely equipped for superior chairside dentistry. Our fastest
milling unit ever, it’s also the easiest to use and compatible with the widest range of materials.
Above all, it empowers dentists to deliver consistently excellent treatment for multiple indications.
The CEREC Primemill seamlessly combines with the highly accurate CEREC Primescan and new
CEREC Software 5 to redefine performance in daily practice. Join us at your local CEREC event
and test it yourself.
The all-new CEREC. Now is the time.
Learn more at: dentsplysirona.com/cerecprimemill


[4] =>
4

INDUSTRY

Dental Tribune Middle East & Africa Edition | 3/2020

Success CD for perfect temporary
crowns and bridges
Success CD is Promedica’s composite-based, self-curing paste-paste
system for quick and easy chairside
production of temporary crowns,
bridges, inlays and onlays.

High-quality temporary
restorations within 5 minutes
After a retention time of 30 to
60 seconds in the oral cavity, the material takes on an elastic consistency,
which facilitates removal without
risking deformation. The material
cures completely within a further
3 minutes and can then be polished.
This procedure is timesaving and
thus highly economical.

Excellent physical properties
and great aesthetic results
As far as the material’s physical properties are concerned, Success CD con-

vinces with its excellent flexural and
overall strength as well as its capacity
to withstand high functional loads.
The product’s minimal polymerisation shrinkage results in precisely fitting temporary restorations. Success
CD’s high colour stability and brilliant, enamel-like gloss ensure longterm aesthetic results. Moreover, its
natural fluorescence and the choice
of available shades promote perfect
aesthetic results.

© Promedica Dental Material GmbH

By Promedica

For more Information, please contact

Promedica Dental Material GmbH
Domagkstraße 31
24537 Neumuenster, Germany
Tel: +49 43 21 / 5 41 73
Fax: +49 43 21 / 5 19 08
Email: info@promedica.de

Incredible inside. Incredible outside.
Ready for the future
with the new Lara sterilizer
By W&H
Be prepared for today and for tomorrow – with the new Lara sterilizer from W&H, users not only have
state-of-the-art today, but additional
high-tech for the future. Equipped
with fast cycle times and a safe
documentation system, Lara simplifies and speeds up the sterilization
process. Lara offers so much more:
with W&H´s new invented activation code system, users can easily
upgrade additional features. This allows Lara to be easily adapted to individual and future requirements of
the practice.

Enhanced functionality by easy
upgrade
Depending on future requirements
of the practice or regulatory needs,

the new Lara sterilizer can be easily
customised and upgraded by the activation code system. This allows users to activate even more speed and

an extended documentation. The
activation codes and functions at a
glance:

Activation Code “Fast Cycle”:
a type S fast cycle whenever needed,
the fast cycle allows sterilization of
unwrapped instruments in just 20
minutes.
Activation Code “Traceability”:
this functionality enables the customisation of the sterilizer to trace
back to the person who initiated the
sterilization cycle.
Activation “All-in-one”:
this code activates all functions mentioned above at once.

Incredibly fast,
incredibly easy to use
From inside a full power package,
from the outside a real eye-catcher: The new Lara convinces with
its smooth surfaces and its colour
touchscreen, which allows fast and
intuitive navigation through the
menu structure. The clear aim of the
operating concept is to save time in
order to have more time available for
the treatment of patients. Even the
standard version of Lara is equipped
with one of the fastest cycle-times
of its class. To meet the demand for
complete traceability, a high capacity USB drive automatically records
the cycle reports throughout Lara´s
entire service life. Users benefit from
control and safety during instrument reprocessing. Optionally available: a label and cycle report printer,
which offer printed documentation
without additional computer or
software. An automatic water filling
valve provides additional efficiency:
it allows connection to a demineralization system. This means manual
filling and draining are no longer
required.

Activation Code “Performance”:
even faster cycle times by upgrading
to Eco Dry +, which automatically
adapts the drying time to the mass
of load. Saving time and energy.

The new Lara: Incredible inside. Incredible outside. Excellent performance, safe documentation and ergonomic design.

Whatever happens in the future –
with Lara, you are well-prepared!
In addition to the standard Lara
functionalities with the high level
of W&H quality, the new activation
code system offers the opportunity
to prepare today for tomorrow's requirements. This gives dental practices more flexibility and, above all,
the certainty that they are optimally
equipped for all upcoming tasks.

For further information, please contact:

The type B sterilizer Lara: perfect ergonomics and functionality for incredible usability.

W&H Dentalwerk Bürmoos GmbH
Ignaz-Glaser-Strasse 53
Postfach 1
5111 Bürmoos, Austria
Tel: +43 6274 6236-0
Fax: +43 6274 6236-55
Email: office@wh.com


[5] =>
CAD/CAM &

CAPP DENTAL

Digital
Dentistry

CONFEXPO

Conference

Dental
Facial
1 2 - 1 4 N O V 2 0 2 0
Cosmetic
DUBAI | UAE
Conference

2 0 2 0

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www.cappmea.com/dental-confexpo
+971 50 279 3711

1 2 - 1 4 N O V
DUBAI, UAE

DENTAL
CONFEXPO HYGIENIST
SEMINAR

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13-14 NOV
DUBAI, UAE

1 3 N O V 2 0 2 0
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CAPP DENTAL

2 0 2 0

2020

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Centre for Advanced Professional Practices (CAPP) 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.

Exhibition

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+
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+
Temporize

3M™ Protemp™ 4
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+

Restore

3M™ Lava™ Plus
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3M, ESPE, Express, Lava, Protemp and RelyX are trademarks of 3M or 3M Deutschland GmbH. Used under license in Canada. © 3M 2017. All rights reserved.

Cement

3M™ RelyX™ U200
Self-Adhesive Resin Cement


[7] =>
2

3

Syringe

3M™ Intra-oral Syringe

Impress

3M™ Imprint™ 4 VPS
Impression Material

3M
M and Imprint are trademarks of 3M or 3M Deutschland GmbH. Used under license in Canada. © 3M 2018. All rights reserved.

1


[8] =>
8

INDUSTRY

Dental Tribune Middle East & Africa Edition | 3/2020

© Coltene

Digital endo assistance
TM
fully automated CanalPro Jeni Endo
Motor navigates through treatment

By COLTENE
Autonomous driving, operations
using a robot arm, computer-aided
design (or CAD for short) - there is
hardly an area in which humans
can now not be assisted by an electronic co-pilot. The more complex
the application, the more useful the
support via algorithms. Endodontic
treatment is no exception and also
requires the utmost precision and
reliability. Endo specialists therefore
increasingly rely on the fully automatic navigation of the latest endo
motors.

Electronically controlled
preparation
The internationally recognised,
leading dental specialist, COLTENE,
has achieved a breakthrough with

a virtually-self-propelled endo motor: the fully automatic CanalProTM
Jeni, named after its developer Prof.
Dr. Eugenio Pedullà, finds its way
through the root canal autonomously and thus accompanies mechanical and chemical preparation step
by step. Via touch screen, the Jeni
connects directly to the selected NiTi
file system such as the HyFlex CM or
EDM or the files of MicroMega from
the COLTENE group of companies.
What is new is that the user can work
forwards continuously from coronal
to apical applying only slight pressure and the motor decides independently on the progress of movement.
For this purpose, the Jeni assistance
system uses complex algorithms
and controls the variable file movements at millisecond intervals by

constantly regulating rotational
movement, speed, torque and file
stress. The endo motor adapts to the
individual root canal anatomy and
guides the preparation step by step.
Integrated length measurement is
available at the same time. The outstanding comfort and level of safety
that Jeni delivers during preparation,
is unmatchable.
Jeni recognises the risk of a potential fatigue fracture of the file and
informs the dentist with an acoustic
signal that a file change is necessary.
The CanalProTM Jeni is also very familiar with the common endodontic irrigation protocol: the device records
mechanical reprocessing progress
and notifies the chairside dentist
or assistant, acoustically, when and
how often irrigation should be per-

formed between file changes. This is
incredibly important when the longterm success of treatment depends
largely on thorough irrigation of the
prepared root canals.

Synchronised
endo instruments
With the CanalProTM Jeni Motor,
the COLTENE group of companies
has added another useful tool to its
range of ideally matched endodontic instruments and dental materials. COLTENE has always worked
closely with international scientists,
practice owners, key opinion leaders
and dental teams to design and realise concrete solutions for everyday
treatment routines.
On www.coltene.com or one of the
innovation leader's social media

channels, interested dentists can
find out about the latest trends and
ideas from the dental world. In addition, COLTENE also offers a wide
range of training courses and practical workshops to ensure the optimal
use of technical aids and digital assistants. This way, even endo beginners
will be able to achieve competent
and efficient preparation after only
a short time.

For further information, please contact:
Coltène/Whaledent AG
Feldwiesenstrasse 20
9450 Altstätten SG
Switzerland

Inject and shape for easier, faster and
stronger restorations
By SHOFU

signed Beautifil Injectable X syringe
provides additional protection
against cross contamination. Special
syringe design prevents oozing and
minimal residual paste in the tip for
greater savings.

The need for easier, simpler and
faster workflow is more critical in
dentistry, now more than ever before. Conventional composite restorations are time-consuming and require laborious build-up techniques
to minimize polymerization shrinkage, linked to staining, micro-leakage
and secondary caries.

© Shofu

Re-engineered nanotechnology with
the development of unique S-PRG
nano-fillers signals a new milestone
in restorative dentistry. Innovation
of the next-generation of universal bioactive injectable compositeBeautifil Injectable X streamlines
restorative workflow by offering predictable strength, durability, natural
aesthetics with self-polishing capability and the unique “Inject as you
Shape” convenience. Patented S-PRG
fillers impart anti-plaque and anticaries benefits for additional protection and longevity of the restoration.
Uniform filler microstructure im-

Available in 2 distinct viscosities in
2.2 gm syringe:
– Beautifil Injectable X – Universal
Restorative
– Beautifil Injectable XSL – Self-levelling high strength Flow

parts remarkable optical qualities for
easy shade match and effortless polish with the OneGloss 2-in-1 Smart
polishers. What’s more, restorations
exhibit self-polishing capability that

maintains gloss and resists surface
staining.
Restore a wide spectrum of anterior
and posterior restorations with ease

as you can now shape while injecting the non-droopy, shape retaining paste at the restoration site. Use
of custom-made disposable Barrier
Sleeves with the ergonomically de-

For further information, please contact:

SHOFU DENTAL ASIA-PACIFIC PTE LTD
10 Science Park Road, #03-12 The Alpha
Singapore Science Park II
Singapore 117684
Tel: (65) 6377 2722
Fax: (65) 6377 1121
E-mail: mailbx@shofu.com.sg
Web: www.shofu.com.sg


[9] =>

[10] =>
10

NEWS

Dental Tribune Middle East & Africa Edition | 3/2020

Celtra Press: The most stable
high-strength glass ceramic, regardless
of testing method
By Dentsply Sirona
Zirconia-reinforced lithium silicate
(ZLS) has been available from Dentsply Sirona under the name of Celtra
Press. With its three-point bending
strength of more than 500 MPa, it
has once again significantly raised
the benchmark for high-strength
glass ceramics. Experiments conducted by the University of Giessen, Germany have now shown that
Celtra Press is clearly ahead of its
competitors also in terms of biaxial
strength.
Internal measurements in a study of
three-point bending strength have
shown an average result of 567 MPa
for Celtra Press.1 In comparison, the
millable Celtra Duo ZLS (also from
Dentsply Sirona) comes in at 210
MPa after finishing and polishing
and at 370 MPa after optional glaze
firing.1 This extends the range of indications of the pressable variant of
ZLS for the dental technician, which
provides a tangible benefit: Celtra
Press can be used not just for singletooth restorations but also for three-

unit bridges with up to the second
premolar as distalmost abutment.
In addition to its superior three-point
flexural strength, Celtra Press also
exhibits the highest biaxial flexural
strength among the high-strength
glass ceramics, as researchers at the
University of Giessen determined
in recent laboratory experiments.2
The measured values were 678 MPa
(Celtra Press), 413 MPa (Celtra Duo after finishing and polishing), and 560
MPa (Celtra Duo after glaze firing)
(Fig. 1, Table 2).

Understanding strength
measurements
Product literature and technical publications sometimes highlight a material’s three-point bending strength
and sometimes its biaxial flexural
strength. According to the relevant
ISO 6872:2015 standard, both testing methods are acceptable, but the
results can be properly assessed only
by determining what values were obtained using which testing methods.
An important thing to note is that the
strength values obtained by the bi-

axial test method are usually higher
than those obtained by three-point
bending test. The reason for that is
that less effort is generally required
to break the standard bar resting on
two supports than the standard disk
with three supports (Figs. 2 and 3).3
This is only partially compensated
for by recalculation based on geometry data. In addition, the quality of
the edge preparation in the biaxial
samples is less important compared
to the three-point supports.
The exceptionally high strength of
Celtra Press is ensured by the addition of 10% of zirconia, which is
completely dissolved in the glass
matrix, and by a power firing step
that is already integrated into the
stain-and-glaze firing for monolithic
restorations. But there is still another
advantage of Celtra that will be immediately convincing to dentists:
The material’s excellent surface
properties permit intraoral polishing including, where required, finer
occlusal adjustments—no separate
glaze firing is required.

Table 1: Both the three-point bending test and the biaxial testing method result in
Celtra Press being top-of-the-class among its competitors.

References
1. In-house measurements by Dentsply Sirona.
2. Measurements carried out by the
Department of Dentistry, Clinic for
Dental Prosthetics, Justus Liebig University, Giessen, Germany.

3. Yongxiang Xu, Jianmin Han, Hong
Lin, Linan An. Comparative study of
flexural strength test methods on
CAD/CAM Y-TZP. Regen Biomater.
2015 Dec; 2(4): 239–244

Find out more by
scanning the QR code.

For more information about the full
Dentsply Sirona portfolio please contact
your local representative.

Fig. 1: A new benchmark for the strength of highstrength glass ceramics: three-point and biaxial flexural
strengths compared.

Fig. 2: In the three-point bending test, a bar resting on
two supports is loaded from above with a punch until
it breaks.

Fig. 3: The biaxial testing method loads a disk on three
supports. The results of this test are generally higher
than those of the three-point bending test.

Dentsply Sirona
21st Floor, The Bay Gate Tower
Business Bay, Al Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0) 4 523 0600
Web: www.dentsplysirona.com/en
E-mail: MEA-Marketing@dentsplysirona.com

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eMail
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Internet www.promedica.de


[11] =>
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s
n
i
r
s
o
u
t
f
a
o
l
e
u
c
c
n
i
t
tr a
r
o
A
p
m
e
i
l
e
b
h
a
T
t

Henrique José Piccin

•Esp. Restorative and Prosthetic Dentistry
•MBA in MKT
•National Sales Director of Bio-Art

s
u
j
d
A
i
m
e
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Fig. 1

WRONG TRAJECTORY
CORRECT TRAJECTORY

Fig. 2


[12] =>
12

INDUSTRY

Dental Tribune Middle East & Africa Edition | 3/2020

Minimizing the risk of sharps injuries
with Hu-Friedy IMS System
By Hu-Friedy

by implementing the Hu-Friedy
Instrument Management System.
That’s $57,310 over six months. A
practice that performs 30 procedures a day may see an additional
$171,930 over six months. The extra
revenue comes from having more
time to spend with current patients
or take on new patients.**

Dental practices count on their instruments day in and day out. But
the same instruments that help dental professionals treat their patients
effectively can represent safety hazards when not handled properly.
Sharps injuries–punctures and cuts
inflicted by instruments – are among
the most frequent and most costly
accidents that can occur in a dental
practice.

Hu-Friedy Instrument Management
System even makes staff training
easier. Every instrument has a spot
within the cassette. Colour coding
makes it simple to find the right procedural set-up.

Sharps injuries aren’t merely painful.
Dental instruments are routinely in
contact with blood and other bodily fluids, and therefore, may carry
dangerous infectious diseases such
as hepatitis B and C, and HIV. The
U.S. Centres for Disease Control and
Prevention (CDC) estimates that the
cost of treating each sharps injury in
a healthcare setting can range from
$500 to $3,000*. The CDC also notes
that there are “harder to quantify
costs,” including fear and anxiety,
lost work time, and litigation.
Dental instruments are always on
the move. As instruments cycle
through a dental office, they undergo cleaning and sterilization, wrapping, organisation and storage, preparation for procedures, and use with
patient treatment. Almost every step
along the way presents the potential
for a sharps injury.

If you’re interested in making your
dental practice safer and more efficient, contact a Hu-Friedy representative to learn more about getting
started with the Instrument Management System.
* According to "SHARPS INJURY PREVENTION WORKBOOK" page 6. CDC
(http://bit.ly/sharpinjuryprevention)
** When compared to single instrument decontamination - based on
market survey results. Data on file.

Cassettes

Accidental cuts and punctures happen most often when instruments
are kept and transported loose,
rather than organized and stored in
secure cassettes. The table attached
shows how loose instruments can
cause sharps injuries throughout the
typical dental office workflow.

taminated instruments directly.
Once cassettes have been configured
according to procedure, instruments
remain secure throughout the reprocessing cycle. The only time staff
members make direct contact with
any instrument is while treating patients.

How Cassettes Provide a Safer
Experience

Cassettes eliminate many of the dangers of working with loose instruments:
· Instruments do not slide out or fall

Cassettes keep dental staff safe by
reducing the need to handle con-

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COMMUNITY

off locked cassettes during transportation. Instruments stay safe even if
the cassette is dropped.
· Cassettes can be placed directly into
thermodisinfector and ultrasonic
cleaners, rinsed, dried, wrapped, and
then sterilized without removing
instruments. No need for pouches
– which can be punctured – or hand
scrubbing.
· Cassettes can be used to keep all the
instruments required for specific
procedures together. Clinicians do
not have to sort through loose instruments on a tray.
Cassettes also prevent the spread
of infection by helping ensure the
proper placement of instruments in
automatic cleaners and autoclaves.
(If instruments cannot be processed
right away, enzymatic spray can
keep the bioburden on the instruments moist.)

Efficiency Gains With Cassettes
A dental professional’s time is best
spent treating and caring for patients. All too often, too much time
is consumed searching for the right
instruments to use for patient procedures, cleaning and sterilizing individual instruments, and moving
slowly to avoid accidents.
Cassettes can help dental practices
get their time back. Practices that use
Hu-Friedy’s cassette-based Instrument Management System (IMS)
report saving 5 to 10 minutes per
procedure**. Over the course of a
day, that can translate into well over
an hour.
Another efficiency-boosting benefit
of cassettes is that they prolong the
life of instruments. Instruments can
be bent, broken, or lost during the reprocessing cycle, but cassettes keep
them sheltered and secure in a protective layer.

Implementing an Instrument
Management System
An Instrument Management System (IMS) based on cassettes organized by procedure is not without its
costs. Besides the price of the cassettes, dental offices may need to upgrade their sterilization areas to see
improved efficiency and productivity immediately. But the investment
will pay off in the long run.
According to our calculations, a practice that performs 10 procedures a
day can earn an additional $521 daily

Follow us on
@HuFriedyEU
@hu_friedy_europe
@Hu-Friedy Mfg. Co., LLC.EU

For more information visit
www.hu-friedy.eu,
www.imsuser.hu-friedy.eu
Hu-Friedy Mfg. Co., LLC.
European Headquarters
Astropark - Lyoner Str. 9
60528 Frankfurt am Main
E-Mail: info@hu-friedy.eu  
Tel.: +49 (0)69 24753640
Fax: +49 (0)69 25577015
Free Call: 0080048374339

CHAIRSIDE

When treating patients, clinicians must place instruments down and pick
them up with care to avoid injuries. An assortment of instruments loose on a
tray can also lead patients to question the cleanliness and organization of a
dental practice.

TRANSPORTING INSTRUMENTS TO AND FROM
CHAIRSIDE

In the hectic atmosphere of a busy dental practice, people can collide, trip,
or run into objects in their haste. Loose instruments can slide off trays
and inflict wounds. International and National Guidelines recommend that
contaminated instruments must be transported in closed, puncture-resistant
containers.

RECEIVING/CLEANING

Researchers at the New York University College of Dentistry conducted a
10-year survey and discovered that 31 percent of all exposures to blood in a
dental office***. happened during instrument cleanup – more than any other
scenario. One reason for this is that dental professionals continue to scrub
instruments by hand, risking sharps injuries, and exposure to aerosols and
pathogens.
Thermodisinfector and Ultrasonic cleaning technology negates the need for
hand scrubbing, but instruments should be divided securely into cassettes.
Dental office personnel can get poked while placing loose instruments
into and taking them out of the baskets of cleaning equipment. Loose
instruments should not be bundled together with rubber bands, as it will
prevent them from being properly cleaned.
Another safety concern is that many practices do not use the correct
personal protective equipment (PPE). The CDC and European Guidelines
recommend the use of puncture- and chemical-resistant utility gloves when
cleaning instruments.

INSTRUMENT PREP AND PACKAGING

Dental hygienists and assistants can get poked or cut while sorting and
organizing instruments by procedure type or placing them in pouches before
sterilization. While preparing for patients, staff must locate pouches and
assemble instruments onto trays for treatment – all the while risking sharps
injuries.

STERILIZATION

Loose instruments can puncture sterilization pouches and injure anyone who
handles them.

*** Journal of Dental Education - Volume 65, No. 5, 4/9/01.
Occupational Exposures to Blood in A Dental Teaching Environment: Results of a Ten-Year Surveillance Study.

Table 1


[13] =>
WHAT’S NEW FROM HU-FRIEDY

HIGH DEFINITION

AKRO-FLEX™

BLACK LINE MIRRORS

Create Beautiful Restorations

Proven to Reduce Glare up to 80%*
Designed for enhanced performance,
Hu-Friedy’s HD Black Line Mirror is
engineered to optimize clinical outcomes
by delivering superior visibility
throughout any dental procedure.

Akro-Flex™ is an extremely flexible
composite instrument which allows
clinicians to effortlessly manipulate
composite materials during
aesthetic restorations.
The inclusion of a ductile
material allows Akro-Flex to
perform as a solid brush.

The Diamond Like Carbon (DLC)
coating of the handle and mirror
frame reduces glare up to 80%!*
The durable black matte finish in
combination with the superior
brilliance and color of
Hu-Friedy’s proprietary HD
Mirror glass facilitates
quicker and more accurate
visibility of the mouth.

Watch the video
Frame the QrCode with your smartphone
and watch directly on Youtube.
Video courtesy of Werestore.it

Watch the video
Frame the QrCode with your smartphone
and watch directly on Facebook.
Video courtesy of Dr. Stavros Pelekanos.

SUPERIOR BRILLIANCE
& COLOR
HD Mirror provides superior brilliance and color for quicker
and more accurate visibility of the mouth. †
• 113% reflection factor for exceptional image
clarity. †
• 38.5% brighter than rhodium coated mirror glass. †
• 50% brighter than other front surface mirror glass. †

* When comparing the Hu-Friedy DLC coated mirror head and handle to the Hu-Friedy
non-coated stainless steel mirror head and handle.
† Data on file and available upon request.

YOUR HU-FRIEDY DEALER
Bahrain: Gulf Pharmacy
Egypt: Safwan Egypt Co.

Visit us online at hu-friedy.eu
©2020 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-373GB/0520

UNPARALLELED FLEXIBILITY
By incorporating Nickel Titanium, a material known for
its super elasticity, Akro-Flex acts as a solid brush. The
resilient working ends are excellent when creating fine
anatomical detail with delicate, artistic strokes.

ERGONOMIC HANDLE
The smooth, lightweight handle offers increased control due
to the large diameter. It creates an ergonomically friendly
option that provides maximum comfort and helps reduce
hand fatigue. Reducing hand fatigue can increase the
longevity of a clinician’s career.

HYPER-THIN PROFILE
Ultra thin working ends reach narrow interproximal
spaces with ease. The flexible, versatile working ends
allow for better visibility as compared to traditional
composite instruments.
Patent pending.
Werestore.it is not owned by or affiliated with Hu-Friedy.

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

Oman: Al Farsi National Enterprises LLC
Qatar: Ali Bin Ali
Saudi Arabia: Al-Turki Medical Group Ltd.
NEW! Utd.Arab Emirates: ALPHAMED General Trading LLC


[14] =>
14

INDUSTRY

Dental Tribune Middle East & Africa Edition | 3/2020

Tooth whitening that works for you—
Opalescence tooth whitening
By Ultradent

As proud—and grateful—as we are
of these accolades, they aren't why
Opalescence tooth whitening is a
success. Ultimately, each and every
one of our tooth whitening products
is a success because it works for you
and your patients! So, let's take a look
at the product itself and see what
makes Opalescence tooth whitening
so great.

Tooth whitening at home and
the dental office
Whether your patients want to whiten their teeth at home, at your dental

© Ultradent

As the global leader in tooth whitening, the Opalescence™ whitening family has become beloved and
trusted by patients and clinicians
alike. With multiple Townie Choice,
Reality's Choice, Dental Product
Shopper awards, and more, we've got
the laurels to prove it.

office, or as they go about their day,
Opalescence whitening products
give your patients options to get the
white smile they want. With in-office
whitener, prefilled whitening trays,
custom-made whitening trays, and

more, Opalescence tooth whitening
allows you more versatility and convenience in your whitening treatments.

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For example, Opalescence™ Boost™
in-office whitening is perfect for
those patients who need a brighter
smile fast, with most patients seeing noticeable results after a little
more than an hour. Opalescence™
PF custom whitening trays allow
your patients to comfortably whiten
at home and even overnight. Opalescence Go™ whitening's innovative
UltraFit™ tray is perfect for your patients who want to whiten practically
anywhere. It is ready to use right out
of the package and easily adapts to
any smile!
Opalescence tooth whitening also
offers specialty products that are
able to treat unique cases. Whether
you're lightening tetracycline stains,
whitening a non-vital tooth after a
root canal, or treating a patient with
braces, there's an Opalescence whitening product for everyone.

Tooth whitening that is safe
and actually work

The most reliable
turbine on the market
60 years of know-how and passion is the secret
that leads Bien-Air Dental today to offer exceptionally
reliable products. Discover all our expertise and
attention to detail in the new TORNADO X turbine.

Many patients think that tooth whitening is bad for their enamel, will
damage their teeth, or will be uncomfortable—or even painful! The
reality is that tooth whitening is very
safe. With Opalescence tooth whitening you are able to determine the
right whitening treatment for your
patients by tailoring their whitening based on strength and wear time.
Our products are also designed with
patients' comfort in mind to ensure
that they have the best whitening
experience possible.

tient's teeth will stay hydrated from
start to finish.
Tooth Whitening for Sensitive Teeth
For your patients searching for tooth
whitening but are concerned about
tooth sensitivity, we are here to help.
Tooth sensitivity varies from person
to person depending on what factors
are contributing to their discomfort.
Some may have sensitivity to hot or
cold temperatures or sensitivity after a filling or a crown, but no matter
the cause sensitivity is a pain!
There are many ways to help manage your patient's sensitivity prior to,
during, and following Opalescence
whitening treatment. Ultradent's
Enamelast™ fluoride varnish, UltraEZ™ desensitizing gel, and Opalescence™ Sensitivity Relief Toothpaste
can each be used at different stages
of the whitening process to treat
various contributing factors.
The versatility, effectiveness, and
convenience of Opalescence tooth
whitening makes it easy to use,
whether you're a whitening patient
or a dental professional. In the end,
that is what makes Opalescence so
great—that it works for you and
your patients.

One key factor that sets Opalescence
whitening apart is its patented sticky
viscous gel. Other tooth whiteners
can be hard to apply, making them
ineffective and discouraging to use.
But Opalescence PF whitening gel is
the perfect consistency, allowing it
to stay inside the custom-made tray
and in contact with the teeth rather
than seeping out past the gumline.

WWW.BIENAIR.COM
Bien-Air Dental SA Länggasse 60 Case postale 2500 Bienne 6 Switzerland
Tél. +41 (0)32 344 64 64 dental@bienair.com www.bienair.com

Not only will it stay in place, Opalescence whitening gel is designed with
a perfectly balanced and buffered
pH to closely match the pH of the
mouth. And unlike other whitening
products, Opalescence whitening
gels are water-based to keep teeth
hydrated during the whitening process. Its high-water content not only
helps reduce sensitivity, but it also
reduces the likelihood of shade relapse in the future because your pa-

For more information contact
Ultradent
505 West Ultradent Drive
South Jordan, UT 84095
Web: www.ultradent.com


[15] =>
Professional
teeth whitening.

Fast, easy,
effective.

© 2020 Ultradent Products, Inc. All rights reserved.
1008275AR01 102819


[16] =>
16

CAD/CAM

Dental Tribune Middle East & Africa Edition | 3/2020

Highly esthetic results with
CEREC® Primemill
By Dentsply Sirona
CEREC Primemill, Dentsply Sirona’s
new milling machine, has taken
chairside dental restorations to the
next level. Thanks to its state-of-theart technology, a wide range of restorations can now be manufactured
faster, using a large variety of materials with results that are very precise
and particularly easy to achieve.
Josef Kunkela, DMD, PhD, an innovative and renowned dentist and
founder of the Kunkela Academy
in the Czech Republic, has offered
chairside restorations in his practice for the past 13 years. As a clinical
tester for Dentsply Sirona, he had the
opportunity to comprehensively
evaluate the new milling machine.
The following is a description of his
first experiences with CEREC Primemill based on a patient case.
I have two essential requirements
for digital restorative dentistry: I
want to satisfy my patients to the
best of my ability for example by
producing accurately fitting and

very aesthetic restorations. I also
want to retain complete control over
the workflow. This is exactly what
CEREC has offered me for 13 years.
It's not just about switching from
conventional to digital impression
taking, it's about the entire process.
With the right workflow, I can work
very efficiently. This is where CEREC
Primemill takes us to a new level. It is
a machine that is simple to operate,
works with a really fascinating speed
and yields high-quality results.
As a beta tester of CEREC Primemill,
I had the opportunity to follow the
development process. When this
milling machine was set up in my
practice, I immediately noticed the
new touch interface. In my opinion,
it is a great feature to get information about milling cycles and the
right instrument recommendation
for every procedure.
The second striking point is that the
machine works very quietly and
above all quickly. CEREC Primemill
only takes approximately five min-

Fig. 2: This is the natural structure of the teeth we wanted to adapt in the final restorations.

utes using Super Fast mode to fabricate a zirconia crown. In my practice,
the assistant takes over the first scan
with the new CEREC Primescan. After I have examined the patient and
made the therapy decision (which
restoration, which shade), the assistant can prepare the CEREC Primemill. Meanwhile, I prepare the teeth
to be restored and take the digital impression with CEREC Primescan. The
fabrication process then starts directly after the design of the restoration, which is carried out by a dental
technician in my affiliated practice
laboratory. I can fully concentrate on
my work with the patient and on his
dental situation. This is efficient and
very important for me.
Of course, a perfect workflow also requires the right quality. How useful
is it to be finished with everything
in the shortest possible time if the
restoration does not fit exactly or is
visually unattractive? This is where
CEREC Primemill once again offers
impressive results. The surface of the
materials is extremely smooth and

Fig. 1: Initial situation: The patient wants to have an aesthetic solution for her
diastema.

the margins are very clearly defined.
From a clinical point of view, the following aspects convince me above
all else about CEREC: The entire scanning process, including bite registration and preparation control, is
very simple. In addition, there are
the advantages of the initial scan:
catalogue of beautiful natural smile,
recycle patient smile, family cross
copy smile, gingiva mask over de-

sign proposal model, index for direct
restorations. If you are going to fabricate a direct restoration of broken
incisal edge or corner and if you
would like to use layering technique,
you benefit from having scanned
the initial situation before and from
having made a silicone index according to the 3D-printed model
of patient's natural dentition. And
there is greater patient convenience
because of the reduction of appointments for treatment and temporary
restorations. From an organisational
and economic point of view, the efficient workflow, the reduced number
of appointments and the ability to
delegate many work steps are particularly noteworthy. My experience
shows that CEREC begins to pay off
at the reception desk when a welltrained assistant plans the appointments and can explain the advantages of this treatment method to
the patient.

Fig. 3: As there are different methods of copying natural teeth shapes, we decided to
categorize them into these three categories of Biocopy.

Fig. 4: Face scan for setting up the occlusal plane and the patient’s
midline.

Fig. 5: Mock-up design of the veneers in the inLab SW 19.

Fig. 6: Try-in of the milled mock-up veneers.

Fig. 7: Export of the data into the CEREC SW 5.1.1 and final design of
the veneers.

Fig. 8: Milling preview.

Fig. 9: Milled veneer in detail.

Fig. 10: Inserting the veneers using rubber dam for perfectly dry luting
surface.

Fig. 11: Close-up of the veneer surface which shows the good adaption
of the natural surface of the teeth.

Fig. 12: Final situation – the new smile.

ÿPage 17


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17

CAD/CAM

Dental Tribune Middle East & Africa Edition | 3/2020

◊Page 16
The most important thing is that
CEREC Primescan and CEREC Primemill work together to create a great
setup for everyday restorative dentistry. The CEREC system is exceptionally versatile and allows us to
freely scan, design and switch from
laboratory to chairside software according to our requirements and
the daily needs for different material
choices and workflows. The following case illustrates this.

Case study
A 23-year-old female patient came
to my practice and asked for an aesthetic solution to her diastema and
tremata. The challenge was to preserve the natural surface structure as
much as possible. In this case we used
the so-called Biocopy Stretch Technique. It is a fairly simple technique
that uses the scanned anatomy to
create a larger version of the original
while maintaining anatomical accuracy. It is essential that the scanned
anatomy is used for the restorations
that are to be fabricated. At the same

time, it is possible to build a custom
tooth library in this way. This can be
used for future restorations. This initial scan also offers the possibility to
use the gingival mask as a reference
for the emergence profile when designing anterior restorations.
With regard to the patient's youth,
we opted for non-prep veneers for
both the central and lateral anterior teeth. We used the initial scan
to make a mock-up of the planned
veneers in order to get a better idea
of the final treatment result. We sent
this scan via the Case Connect Centre to our own laboratory where it
was processed in the inLab software
19. To further modify the initial proposal, we used the aforementioned
Biocopy Stretch Technique. Subsequently, the virtual articulator was
used to ensure function in all jaw
movements (protrusive and laterotrusive). The mock-up was then
milled from PMMA in an MC X5
(Dentsply Sirona). I prefer this method to others because its distinct edge

sharpness helps to avoid undercuts
and transitions in the final restorations, especially laterally. The PMMA
veneers were then temporarily fixed
with a small amount of a flowable
composite.
A few days later, the patient returned
to the practice. Depending on the degree of satisfaction, the veneers are
either re-shaped or used directly as
a template for the final restoration.
In this case everything fit perfectly.
We then imported the data seamlessly from the inLab software into
the CEREC software in dxd-format.
In the CEREC software, we simply
changed the material setting to composite block and then fabricated the
veneers in the new CEREC Primemill.
In doing so, we were able to achieve
a high level of precision. We used the
fine mode because it is ideally suited
for the production of ultra-thin veneers.
In order to maintain the high transparency of her natural teeth, the

milled veneers were slightly cut back
at the incisal edge and constructed
with the same restoration material as the blocks used for milling. We
then polished the surface in a twostage system and bonded it adhesively under a rubber dam with composite. The result shows very natural
anatomy of the anterior teeth.
To sum it up: The CEREC system is
exceptionally versatile in allowing
us to freely scan, design and switch
from lab side to chairside software
and then mill or grind a restoration
in the extraordinarily precise and accurate CEREC Primemill. Capturing
the patient’s initial situation, position, shape and surface structure for
potential future reference, which can
also serve as donor anatomies for
other patients, will serve more and
more purposes not just in dental
prosthetics but also for the manufacturing of 3D models and silicone
keys, which are then used for layering restorative materials, digital implantology or dentures.

Find out more by
scanning the QR code.

For more information about the full
Dentsply Sirona portfolio please contact
your local representative.
Dentsply Sirona
21st Floor, The Bay Gate Tower
Business Bay, Al Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0) 4 523 0600
Web: www.dentsplysirona.com/en
E-mail: MEA-Marketing@dentsplysirona.com

All-ceramic rehabilitation with CAD/CAM
restorations made of a zirconia–reinforced
lithium silicate (Celtra Duo)
By Dr Tim Hausdörfer and Joachim
Riechel MDT, Germany

Abstract
Patient:
55-year-old patient with an insufficiently restored dentition and a reduced vertical
Dimension of occlusion.
Challenge:
The patient wanted an improvement
in her anterior tooth aesthetics and a
comprehensive oral rehabilitation.

Treatment:
A periodontal and conservative
pretreatment was performed. The
functional pretreatment included
raising the bite using a centric splint.
The posterior teeth were restored
supplied with veneered crowns and
bridges with zirconia frameworks.
The aesthetic restoration of the maxillary anterior teeth was performed
with crowns and veneers made of
zirconia-reinforced lithium silicate
ceramics (Celtra® Duo).

Introduction
Zirconia-reinforced lithium silicate
ceramics (ZLS) have good mechanical and optical properties. Their
mechanical strength makes them
well-suited for partial and full posterior crowns and also—thanks to their
good shade match and excellent polishability—for aesthetic anterior restorations (such as veneers). The present article illustrates the versatile
application of CAD/CAM-made ZLS
restorations (Celtra Duo; Dentsply
Sirona Restorative, Konstanz, Ger-

many) based on the complex case of
a patient with extensive restorative
treatment needs.

Case report
A 55-year-old woman presented at
the Department of Preventive Dentistry, Periodontology and Cariology
of the University of Göttingen. The
clinical and radiological examination revealed an adult dentition
that had been insufficiently treated
with fillings and dental restorations
and exhibited a loss of vertical di-

mension of occlusion (Figs. 1 and 2).
Insufficient restorations (secondary
caries) were found on teeth 24, 25,
26, 27, 37, 38, 35, 47, and 48. The existing bridge (17–15, 14) was insufficient
due to extensive ceramic fractures.
Part of the hard tissue of the upper
maxillary incisors with their—sometimes extensive—composite restorations had been lost to attrition and
vestibular erosion. The endodontic

ÿPage 18

Fig. 1: Clinical baseline situation

Fig. 2: Radiograph of initial situation

Fig. 3: Baseline situation for designing the aesthetic
anterior restorations following bite raising in the
posterior region

Fig. 4: Mock-up

Fig. 5: Preparation of the partial crowns and the
veneers, occlusal view

Fig. 6: Preparation, vestibular view

Fig. 7: Impression taken with Aquasil

Fig. 8: Digital model

Fig. 9: Digital design of the restoration

Fig. 10: Milled restorations fit on the model

Fig. 11: Single crown milled from a ceramic block

Fig. 12: Final customized restorations after staining
and glaze firing


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18

CAD/CAM

Dental Tribune Middle East & Africa Edition | 3/2020

◊Page 17

Fig 13

The preparations (Fig. 5) followed
the preparation guidelines for allceramic restorations1 and the appropriate minimum wall thickness
requirements for lithium silicate ceramic restorations. The preparation
for the partial crowns 24 and 25 had
rounded interior line angles and a
90° shoulder at the preparation margin. To prepare for the veneers (13, 12,
11, 23), approximately 0.5–0.7mm
of hard tissue was removed on the
labial aspect and a 0.5mm chamfer
provided (Fig. 6). The intact proximal surfaces remained untouched.
Otherwise, the teeth were prepared
for circular full veneers (“360-degree
veneers”). The crowns of teeth 21 and
22 were prepared with a 1-mm circular shoulder. Reduction of the incisal
edges could be dispensed with as a
consequence of raising the bite by
2mm.

Fig 14

Figs. 13 and 14: Final restorative result after adhesive cementing

Fig. 15: Preoperative smile and lip profile

treatment of tooth 34 was adequate,
while tooth 46 required a primary
endodontic treatment due to a irreversible pulpitis. All other teeth
were vital and free of symptoms. The
periodontal findings showed moderate gingivitis (periodontal screening
index < 3 in all sextants). Teeth 13, 23,
24, and 43 additionally exhibited vestibular gingival recessions.
In addition to an oral rehabilitation,
the patient also wanted to improve
her anterior tooth aesthetics.
She first received extensive oral hygiene instructions and professional
tooth cleaning. The insufficient restorations on teeth 24, 25, 26, 27, 35, 37,
and 47 were replaced by call restorations (Luxacore; DMG, Hamburg,
Germany) that were adhesively
cemented (OptiBond FL; Kerrhawe
SA, Bioggio, Switzerland). Teeth 38,
48 and the class V cavities of teeth
24 and 33 were definitely restored
by direct composite fillings (Venus;

Fig. 16: Postoperative smile and lip profile

Heraeus Kulzer, Hanau, Germany).
The gingival recessions on teeth 13
and 23 were not surgical covered
because a sufficient amount of attached gingiva was present and no
further progression was observed. In
addition, the patient had a low smile
line, meaning that this posed no aesthetic problems.
A formal treatment plan and cost
estimate was provided and checked
by a dental expert of the patient’s
health insurer. The following measures were approved: Crown restorations for teeth 11, 21, 22, 24, 25, 26, 27,
35, 37, and 47 plus a remake of bridge
17–14.
The functional pretreatment was
performed with the aid of a centric
splint in the maxilla which simulated a bite raised by 2mm. The patient
did not show any symptoms of myoarthropathy or craniomandibular
dysfunction after establishing her
new vertical dimension of occlusion.

In a first prosthetic treatment step,
the posterior teeth were supplied
with crowns (teeth 14, 26, 27, 37, and
47) and a bridge (teeth 17–15) in veneered zirconia. Teeth 32–42 were
bleached and their incisal edges
clinically lengthened by means of
direct composite restorations (Essentia and G-Premio Bond; GC, Bad
Homburg, Germany) in order to
obtain a uniform aesthetic result.
Within the framework of the Celtra Campus Challenge, the patient
could be offered a cost-effective and
aesthetic treatment offer upper jaw:
Teeth 21 and 22 were restored with
crowns and teeth 11, 12, 13, and 23 with
veneers. In addition, teeth 24 and 25
received partial crowns. For the planning of the ceramic restorations, a
wax-up was created and developed
into a composite mock-up (Figs. 3
and 4) (Luxatemp; DMG). The tooth
shade (A2) was selected based on the
Vita Classic shade guide (Vita, Bad
Säckingen, Germany).

AD

A conventional impression was taken of the prepared teeth and the casts
were scanned. Prior to taking the impression, retraction cords (UltraPak;
Ultradent, South Jordan, Utah, USA)
were placed for gingival retraction
around the prepared teeth. Retained
proximal contacts were separated
with thin matrix strips. The impression was taking using and additiontype silicone at one time and in two
phases (Aquasil; Dentsply Sirona Restorative) (Fig. 7). The conventional
impressions and casts facilitated the
digital design process by providing
a laboratory-made wax-up and subsequent adjustment of the restorations. This meant that hardly any
intraoral adjustments were required.
A transparent vacuum-formed
splint (Erkodent, Pfalzgrafenweiler,
Germany) was first made with the
aid of the wax-up, allowing provisional resin restorations to be produced (Luxatemp; DMG). These were
subsequently connected to the prepared teeth with Prime & Bond XP
(Dentsply Sirona Restorative) and a
flowable composite (Baseliner; Heraeus Kulzer).
The restorations themselves were
produced using the CEREC CAD/
CAM (Dentsply Sirona, Bensheim,
Germany). To this end, the saw-cut
models were scanned with a BlueCam (Dentsply Sirona) (Fig. 8). The
teeth of the wax-ups were copied
digitally and used for the design of
the restorations (CEREC software v.
4.4 using the Biogeneric Copy option; Dentsply Sirona) (Fig. 9).
The restorations were milled from
blocks of a zirconia-reinforced lithium silicate (Celtra Duo; Dentsply
Sirona Restorative) of A2 HT shade,
finished with water-cooled diamond
cutters and adapted on the model
(Figs. 10 and 11).
Having ensured that the restorations
were clean and free of grease and
residue, they were customized with
stains and glaze and subsequently
fired. A more intensive shade effect
(Fig. 12) was achieved by repeating
cycles of applying and firing the material. The first stain/glaze firing took
place at 820°C and the second one at
a lower 770°C.
The restorations were tried in with
the aid of a glycerine-based gel (TryIn; Ivoclar Vivadent, Schaan, Liechtenstein). Care was taken to ensure a
good marginal fit, correct proximal
contacts, a harmonious contour of
the incisal edges and an appropriate
shade. Minor corrections were carried out with a diamond cutter under irrigation, followed by polishing.
After the try-in, the teeth were isolated with rubber dam and cleaned. The
ceramic restorations were etched
on the adhesive surface using hydrofluoric acid (Ultradent Porcelain

Etch; Ultradent, South Jordan, Utah,
USA) for 30 seconds and conditioned
with a silane solution (Calibra, Dentsply Sirona Restorative) for 60 seconds. The teeth were conditioned
with 36% phosphoric acid (DeTrey
Conditioner 36; Dentsply Sirona
Restorative) for 30 seconds on the
enamel and 15 seconds on the dentin and subsequently with Prime
& Bond® XP + Self-Cure Activator
(Dentsply Sirona Restorative).
Calibra dual-curing resin cement
(Dentsply Sirona Restorative) was
used for adhesively cementing the
full and partial crowns. The veneers
were used with a light-curing cement (Calibra Esthetic Resin Cement,
Dentsply Sirona Restorative). After
thorough removal of any excess resin and light curing, the occlusion was
checked and the restorations were
polished (Figs. 13 and 14).
The zirconia-reinforced lithium silicate ceramics are characterized by
good polishability and shade adaptation to neighbouring structures
(Figs. 15 and 16).

Summary
ZLS ceramics already have a high
strength after milling2 and can be
cemented adhesively immediately
after polishing. In the present case,
however, we decided to work with
the laboratory to provide the restorations, since many restorations
have to be made at the same time
and since the aesthetic result and
the mechanical strength of the ceramic could be further improved by
additional stain and glaze firing. The
digital design of several restorations
was considerably facilitated by the
laboratory-made wax-up. By adapting the restorations on the model,
the patient’s chair time could be
reduced. Adhesive cementing with
Calibra was a very pleasant process,
since any composite residue was
easy to remove and the optical properties of the ZLS ceramic were not adversely affected. Very good aesthetic
results can be achieved with ZLS even
for monolithic ceramic restorations.
ZLS ceramics have improved mechanical properties compared to
lithium disilicate ceramics3. However, only a few case reports on clinical
use have become available so far2, 4.
Clinical trials are still pending.

References
1. Frankenberger R, Mörig G, Blunck
U, Hajtó J, Pröbster L, Ahlers MO. Präparationsregeln für Keramikinlays
und –teilkronen unter der Berücksichtigung der CAD/CAM-Technologie. J Cont Dent Educ. 2007; (6),
86–92.
2. Rinke S, Schäfer S, Schmidt A-K.
Einsatzmöglichkeiten zirkonoxidverstärkter Lithiumsilikat-Keramiken. Quintessenz Zahntech. 2014;
40(5): 536-546.
3. Elsaka SE, Elnaghy AM. Mechanical properties of zirconia reinforced
lithium silicate glass-ceramic. Dent
Mater. 2016; 32(7): 908–144. von der Osten P. Zirkonoxidverstärktes Lithiumsilikat für die Seitenzahnversorgung. Quintessenz Zahntech. 2014; 40(7): 900-904.

About the authors
Tim Hausdörfer. Dr. med. dent.
(Department of Preventive Dentistry, Periodontology and Cariology, University of
Göttingen, Germany)
Joachim Riechel. M.D.T.
(Center for Dentistry and Oral and Maxillofacial Surgery, University of Göttingen)


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[20] =>
20

GENERAL DENTISTRY

Dental Tribune Middle East & Africa Edition | 3/2020

Fundamental principles
in designing reprocessing areas
By Christian Stempf, Austria
It is recognized all too often that
very little consideration is given to
sterilization or reprocessing areas
in either existing or newly designed
dental practices. And yet reprocessing instruments between patients is
crucial to meet today's hygiene rules
in dental offices. Dental practitioners also have a moral and legal ‘duty
of care’ calling for effective, welldefined and implemented infection
control measures to prevent the
transmission of infectious diseases
to patients and staff.
Beyond the purely regulatory and
safety aspects, many dentists have
made the sterilization area a key
asset for their activity. Located in
a prime and visible location lets
patients understand up front that
their health and safety is important.
The staff don’t hesitate to share this
passion for hygiene with patients,
happy to answer any questions they
may have. Flattered by this attention,
it makes the patient feel confident
and secure. To create new reprocessing areas or enhance existing ones is
not an "insurmountable" challenge.
It simply requires some basic principles this article will outline.

Having sufficient space dedicated
to the reprocessing area is essential.
In most of the cases it is undersized.
The room must be functional, well
lit and in proportion to the size of
the dental practice and volume of instruments to be reprocessed. There
must be space for cleaning and sterilization devices with their respective
accessories as well as enough bench
space for intermediate stages i.e.
before/after cleaning; before/after
packaging and after sterilization.
The first fundamental principal is to
have two areas in the room; a dirty
zone and a clean zone. Rationally, instruments must travel in one direction from the dirty zone towards the
clean zone. As a consequence of this
one-way flow, processed (clean) instruments must not enter the dirty
zone; hence one preferred design for
a reprocessing area would be rectangular - a corridor with two doors (IN
& OUT) (Fig 1). Both zones require
ventilation and the airflow should
be designed to prevent air from the
dirty zone being forced into the clean
zone. Where the areas are beside one
another, this can be achieved by
pressurizing the clean area though
air conditioning outlets and/or having exhaust fans in the dirty area.

At the entrance, there should be a
hand washing basin equipped with
an eye washing station, vital in case
of accidental splashing of disinfectant or any harmful fluid. Liquid soap
and hydro-alcoholic gel dispensers
should have an automated dispensation (or elbow operated) which
avoids contaminating them with
soiled hands. It is recommended to
pat dry hands with paper tissues.

Form follows function
The configuration of each part of the
room follows the reprocessing steps
i.e. pre-disinfection, rinsing, cleaning,
rinsing, drying, packaging and sterilization. This room must not be used
for any other purpose. Floors and
working surfaces must be smooth,
avoiding sharp corners and edges
and be easy to clean and disinfect.

Waste
Waste should be disposed of into
bags or containers through openings in the bench. Sharps and cutting
items must be safely disposed of in
specific plastic containers to protect
staff, be collected and processed by
specialized companies in treating
contaminated waste. It is imperative
to follow your local national guidelines as they may vary from country
to country.

Pre-disinfection – Soaking

Packaging – Sterilization

In order to prevent blood, saliva and
debris from drying, all used and nonused instruments must be soaked as
soon as possible after the procedure,
using one or more disinfecting containers depending on the number,
type and size of the instruments i.e.
a small one for burs and files, bigger
one(s) for bulk of items, kits or cassettes, etc. Note the manufacturer’s
guidelines NOT to immerse or soak
certain instruments such as transmission instruments in solutions!
The manufacturer’s guideline on
the concentration and contact time
of the chemicals must be strictly observed. The temperature of the solution should not exceed 40-45°C, thus
preventing coagulation of blood proteins which increases the challenge
of cleaning.

An area should be considered for
a pouch sealing device as well as
an area for the temporary storage
of packages prior to process in the
bench top sterilizer. To ensure safe
and efficient sterilization it is crucial to check the load and cycle–type
for compatibility. Selecting a cycle
which is not designed and validated
for the type of load (instruments)
will lead to non-sterile products.

Another benefit of this crucial first
step is the reduction of the microbial
population, decreasing the risk of
infection during handling and cleaning. A basin will permit rinsing of the
instruments with tap water aiming
to remove any residual chemicals
particularly in hollow and hinged
items. Chemical residues could lead
to irreversible staining and damage
to instruments should a thorough
rinsing step be missed.

For extended storage time, pouched
items should be stored outside the
reprocessing area and surgery (operatory) in clean and dry drawers or
cabinets. In doing so, single pouched
items could safely be stored for up to
3 months.

Cleaning

IN

DIRTY
ZONE

OUT

CLEAN
ZONE

Basin
1

Sonic
cleaner

Garbage

Fig 1. Instruments must travel in one direction in the reprocessing area from the dirty zone towards the clean zone. Conversely,
airflow should be designed to prevent air from the dirty zone being forced into the clean zone.1

The cleaning step is of utmost importance. Mechanical cleaning by
means of an ultrasonic cleaner offers
a good level of performance.
Note: Manual cleaning is discouraged, as it is the least efficient
method of cleaning particularly for
complex or hollow instruments and
rough surfaces. The degree of cleanliness relies on the operator's experience and appreciation and also raises
the risk to staff of skin penetrating
injuries.
In order to remove chemicals and
bioburden, all instruments must be
thoroughly rinsed with tap water in
a second basin. Ideally this would be
followed by a second rinse with demineralized water to eliminate residues and salts present in tap water
that could lead to whitish stains on
sterilized instruments.
Washers or washer-disinfectors are
a preferred mechanical cleaning
method thanks to the higher performance of the cleaning cycle validated by the manufacturer in compliance with stringent applicable
standards (i.e. ISO-EN15833-1/-5). The
cycle process includes pre-washing,
rinsing, washing and drying without
manual intervention which allows
free space on the bench, sparing the
soaking container/s and one basin. It
is wise to keep the second basin.

Basin
2

Sharp

Disposal Soaking Rinsing Cleaning Rinsing
Demin. water
supply

Fig 2. Dirty instruments are cleaned and rinsed on entry to the reprocessing area.

Basin
1

Sonic
cleaner

Garbage

Buffer bench space
after cleaning

Basin
2

Area for
drying / highlow-speed
maintenance

Area for
storage
prior to
sterilization

Area for
cooling and
labelling

Sharp

Disposal Soaking Rinsing Cleaning Rinsing Drying - HPs

Packaging
Compressed
air supply

Fig 3. Clean and dry instruments are then packaged and sterilised

Sterilization

Next to the washing station, space
is reserved to check the dryness,
cleanliness and integrity of all instruments. Compressed air will assist
drying hinged instruments (scissors,
forceps, etc.) which may also require
periodic lubrication. Transmission
instruments will be maintained at
the same place. Internal and external
cleaning as well as lubrication should
be mechanically assisted by means
of an automated process validated
by the manufacturer. It is virtually
impossible to manually complete
internal cleaning.

Additional space beside the sterilizer
is intended for cooling and labelling of packages which have been
released by the operator for storage and use (Fig 3). Special attention
must be paid to ensure that pouches
are hermetically sealed and are completely dry. Damp instruments/
packages are not acceptable as sterile.

Conclusion
All readers should reflect on these
two definitions:
Reprocessing: "All activities required
to ensure that a used medical device
is safe for reuse" (ADA Guidelines for
Infection Control - 2012).
Sterilization: "validated process
used to render a product free from
viable microorganisms".
"…the presence of a viable microorganism on any individual item can
be expressed in terms of probability.
This probability may be reduced to
a very low number; it can never be
reduced to zero." (ISO/TS 11139:2006).
In other words; the better each step
is accomplished, the closer to "zero".
Always bear in mind that each step
of the reprocessing cycle is important. None shall be rushed or skipped
which would compromise sterility
and the safety of patients and staff.

About the author

Christian Stempf
has worked extensively within the European dental industry. He has been involved in infection prevention for nearly
30 years, with focus on reprocessing reusable medical devices, in particular sterilization and organization of sterilization
areas.
He has gathered valuable practical
knowledge and experience through his
daily activities and contacts with healthcare professionals and experts in the field
of infection prevention throughout the
world.
He is a member of the European (CENTC102) normalization committee participating to two working groups i.e. bench
top sterilizers (EN13060) and washer disinfectors (EN15883).
Christian shares this experience offering
lectures in all objectivity on the topic of
sterilization and infection prevention for
healthcare professionals as well as comprehensive courses for dental assistants
worldwide.


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[22] =>
22

DIGITAL DENTISTRY

Dental Tribune Middle East & Africa Edition | 3/2020

The copyCAD

Fig. 1: Initial situation, smiling.

Fig. 2: Initial situation, frontal view with lips retracted.

Fig. 3: V-Posil impression.

Fig. 4: Screenshot of the design software.

Fig. 5: Structur CAD disc.

Fig. 6: Screenshot of the nesting software.

By Dr Yassine Harichane, France

Introduction
Nature has always captivated us with
its beauty. Whether it is a landscape,
a sunset or the intricate details of a
leaf, one marvels at natural aesthetics. The goal of an artist is to copy
nature in every medium: painting,
sculpture, music, photography. It is
easy to see parallels in dentistry. The
teeth and soft tissue display details
on the macroscopic and microscopic
scale that make up all their beauty.
Even the smile has characteristics
that define what is beautiful and
what is not. Like an artist, the dentist and the dental technician use all

their combined talents to create lifelike restorations. The secret to imitating nature is in the details of daily
practice and hard work.
Fortunately for dental practices
and laboratories, technology has
advanced considerably, making the
ability to imitate nature much more
achievable while paving the way
for new practical methodologies.
Performing a single restoration on
a central maxillary incisor is a challenge, both technically and artistically. Whether it is a filling, a crown or
an implant, all the skills of the artistic
dentist must come into play because

the patient naturally expects a result
symmetrical to the contralateral
tooth. Using the latest technology,
it is as simple as the copy and paste
function one is so accustomed to using on a computer. The dentist has
gone from being an artist to a computer scientist with the same optics:
copying nature in all its perfection.
On the basis of a clinical case without the utilisation of an intra-oral
scan, I will demonstrate a workflow
with CAD/CAM technology. This will
show that the ability to copy nature
has now become accessible to all
practitioners.

Preparation
In this clinical case (Figs. 1 & 2), the
patient wanted the aesthetic aspects
of her smile to be improved without
losing unique features she had come
to consider as part of her look and
personality. The maxillary anterior
teeth showed caries and defective
restorations, but their overall shape
was satisfactory and they had a certain charm despite their defects. Although her premolars did not have
an optimal aesthetic appearance, the
patient’s budget limited treatment
to the incisors and canines.

The first step was to take an impression of the preoperative oral condition. Although the dimensions and
appearance did not conform to all
the rules of dental aesthetics, they
would be preserved because they
had characteristics specific to the patient and they respected the occlusal
dynamics. The impression of the
teeth can be taken with an intra-oral
scanner. However, the number of
dentists who own intra-oral scanners
is relatively low. The current materials allow for a satisfactory physicochemical impression and remain
accessible to all dentists. A polyvinylsiloxane impression was performed
in one step and two viscosities (VPosil Putty Fast and V-Posil X-Light
Fast, VOCO) to record the initial clinical situation (Fig. 3).

Temporisation

Fig. 7: Structur CAD provisional crown.

Fig. 8: Try-in of provisional crowns.

Fig. 10: Porcelain crowns luted with Futurabond DC and Bifix QM (VOCO).

Fig. 9: Smile with provisional crowns.

The second step was to prepare the
provisional crowns by copying and
pasting the patient’s teeth. After
preparing the teeth, the impression is sent to the laboratory, which
will scan and design the provisional
crowns. Most CAD/CAM software
possesses this copy and paste function (Fig. 4), so the scan and design
processes take less than 1 hour. The
six provisional crowns were then
milled over the course of 1 hour and
30 minutes from a resin disc suitable
for producing long-term provisional
restorations (Structur CAD, VOCO;
Figs. 5 & 6). Finishing the provisional crowns—checking the contact
points, controlling the occlusion and
polishing—required 30 minutes, allowing delivery of the crowns two
days after taking the impression. The
result obtained was strikingly natural (Fig. 7) thanks to the material’s
aesthetic properties: natural shade,
easy polishing and improvable with
characterization. Concerning the
form, the provisional crowns had
an asymmetry that is found only in

Fig. 11: Final result.

ÿPage 24


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24

DIGITAL DENTISTRY

Dental Tribune Middle East & Africa Edition | 3/2020

◊Page 22
nature, being both spontaneous and
pleasant. They were temporarily cemented in the mouth to validate the
prosthetic project (Figs. 8 & 9). The
material’s biocompatibility clinically
allows for a three-year maximum
period in which the crowns can be
worn, making it a material perfectly
suited for complex cases, or those
requiring periodontal rehabilitation.
The material’s composition provides
not only excellent resistance to abrasion, but also the possibility of repair with a compatible composite.
In this clinical case, the provisional
crowns were kept in the mouth for
one week—the time needed to prepare the definitive restorations. No
defects were observed.

Finalisation

Discussion

During the last stage, after the functional and aesthetic validation of
the provisional crowns, definitive
porcelain crowns (IPS e.max, Ivoclar
Vivadent) were milled also by copying the preoperative situation from
the original scan. The provisional
crowns were then removed, and the
underlying teeth were cleaned. After fitting and validation within the
mouth, the definitive crowns were
luted (Futurabond DC and Bifix QM,
VOCO; Fig. 10). The final result was a
harmonious smile that did not distort the features the patient considered to be an important part of her
facial personality (Fig. 11).

Therapeutic success is measured by
dental and periodontal health, as
well as by patient satisfaction and
feedback from the healthcare team.
The skills of a caregiver are not limited to making the right diagnosis or
defining the ideal treatment plan;
technical skills are essential and
mimicking nature is a daily challenge.
Dentistry has come a long way with
the introduction and implementation of digital technologies, becoming faster and more precise as a
result. These tools are becoming increasingly popular, and many practitioners are quickly equipping their
offices and operatories. Contrary to

what one might think, the acquisition of an intra-oral scanner for the
office is not an absolute obligation
for one to take advantage of the
digital dentistry revolution. Digital
dentistry, above all, is a concept and
we have just seen that it allows for an
unsuspected and perhaps surprising
function: copy and paste.
The advantages of copying and pasting are numerous and benefit everyone involved: dentist, dental technician and patient. For the dentist, the
main advantage of copying and pasting is obtaining an intuitive result.
On the one hand, the current materials (composite and porcelain), allow
for a natural rendering. On the other
hand, digital technology makes it

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possible to copy nature with all of
her details. The use of computergenerated provisional restorations
makes it possible to validate complex or demanding projects. In the
end, restorations are both functional
and aesthetic. They integrate perfectly with the occlusion because
no major changes have been made.
In addition, they integrate with the
overall harmony of the face.
For the dental technician, the copy
and paste function is part of his or
her skill set. On the one hand, the laboratory scanner can capture every
detail of the dental arch. On the other
hand, milling machines can deliver
strictly identical crowns over and
over again as needed. The milling of
a provisional disc or block will therefore validate the therapeutic project
before moving to more expensive
materials such as zirconia or lithium
disilicate. In the same way, if returned to the laboratory, the cost will
be lower by using a millable temporary resin. After provisional crowns
are validated, the dental technician
only needs to press a button to start
producing the definitive crowns in
the desired material.
For patients, digital dentistry is an
education on just how far dentistry
has evolved: technological advancements in clinical procedures are replacing many of those treatments
of their bad childhood memories. It
is now possible for the patient to reclaim the smile of his or her twenties.
Better still, it is possible to copy the
child’s juvenile smile and place it in
the deteriorated dental arch of the
father. The smile will become a legacy that will be passed down through
families.

Conclusion
Technology is making significant
progress in dentistry, it is up to us
to appropriate it. The emergence of
new tools, such as intra-oral scanners, and unique new materials, like
millable temporary resins, makes it
possible to develop new therapeutic
concepts and procedures. Copying
and pasting is now a part of the dentist’s, and dental technician’s, therapeutic armamentarium. A copycat
is an artist who tries to capture nature in all its glory through painting.
Now, a copyCAD is an artist who can
capture nature in all its perfection
through CAD/CAM technology.

Acknowledgements
The author wishes to thank Matthias
Mehring of VOCO for his friendly
support and support with materials.
The author congratulates French certified dental technician Christophe
Giraud for his talent and skills. The
author is grateful to Tom Kershaw
and Russ Perlman of VOCO America
for proofreading and improving this
article.
Editorial note:
This article was originally published
in digital-international magazine for
digital dentistry, Issue 1/2020.

About the author
Dr Yassine Harichane
graduated from the Paris Descartes University and conducted several research
there. He is an author of numerous publications and a member of the Cosmetic
Dentistry Study Group (CDSG) at the Paris
Descartes University in Paris, France.


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26

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 3/2020

Meeting patients' needs and transforming
smiles with direct veneers
By Dr Mohammad Zuhair Al Khairo,
UAE

Introduction
"I can`t afford e.max veneers, do you
have something more affordable?"
is a question often encountered in
clinical practice today!
Being a restorative dentist with more
than 15 years of experience in private practice, I have been asked this
question innumerable times. With
the recent advances in direct resin
technology, I am able to confidently
say “YES” and provide an alternative
of composite resin-bonded veneers
with an emphasis on preserving
tooth structure. The next question
the patient asks with much anticipation is “what is the difference?. Since
I started using a nano-hybrid, bioactive composite resin with a porcelain
like shade, the one-word answer to
this question is "COST!!".

Compared to a decade or two ago, today we encounter more internet-informed patients who visit the clinic
with a preconceived notion, which,
you are expected to fulfill. Therefore,
the dynamics of treatment planning
has changed towards providing a
suitable solution while managing
patient expectation.
The advancement in composite
resin technology with natural shade
replication has created an avenue
for clinicians to offer highly standardized, predictable restorations
in terms of aesthetics, strength,
polishability and durability. Shofu
composites are unique as they are
bioactive and provide an additional
acid neutralization and anti-plaque
effect to minimize caries risk while
enhancing longevity of the restorations.
Being a firm believer in prevention
and minimally invasive treatment,
we follow a stringent prevention

protocol that I call "3X Protocol". Part
of this protocol emphasizes "X for
Prevention from eXtension" which
has been modified from GV black
principle "Extension for Prevention".
Another " X” for eXpenditure", evaluates the cost benefit and to provide
cost-based treatment options to the
patient. The final “X” would be managing patient eXpectation as this is
a crucial element of cosmetic dentistry. The “3X Protocol” has enabled
us to provide a more conservative
patient-centred treatment with the
desired aesthetic outcome while preserving natural tooth structure.
The patient case presented below is
an anterior diastema with old discoloured composite restorations.
In clinical situations with multiple
diastema, It is important to first
evaluate treatment options from a
restorative point of view before considering orthodontic treatment. In
order to achieve long-term stability
and predictable outcomes over time,

the restorative plan should consider
different aspects such as:
1. Arch /space discrepancy in relation to occlusion.
2. Restorative material of choice
3. Biological cost and patient’s financial limitations.

Patient case
A young female patient visited the
clinic requesting for an enhanced
smile as she was unhappy with the
appearance of her front teeth after
completing orthodontic treatment.
Upon careful examination it was observed that composite resin restorations were used for diastema closure
before orthodontic treatment (Fig
1, 2). The filled teeth had chipped at
the incisal edge and had a grey discolouration. After careful evaluation
the following treatment options
were suggested to the patient:
1. e.max veneers with minimum
tooth preparation,
2. Direct resin-bonded veneers with
no tooth preparation.

After the treatment planning discussion, the patient requested to proceed with direct resin-bonded composite veneers to enhance her smile.
After the old composite fillings were
removed (Fig 3, 4), smile design, was
done to restore the golden proportion by modifying the shape and
size of the teeth. Based on the smile
design a mock-up was created to
help obtain patient approval on the
expected outcome and fabricate the
silicone index.

Materials used
- Prepare: Shade Selection & case documentation - EyeSpecial C II (Shofu)
- Restore: Beautifil II LS shade A2O,
A1, Beautifil Flow Plus F03 shade INC
and Beautifil II Enamel HVT Composite (Shofu)
- Finish: Yellow banded Fine diamond bur, Super-Snap Black disk, for
contouring and Super Snap Purple
disk for finishing (Shofu)
- Polish: OneGloss polisher, SuperSnap X-Treme Green and Pink disks
- Super polish: Super Buff impregnated buff disk for enamel like lustre
(Shofu)

Restorative approach:
Smile design

Fig 1: Pre-operative macro view of patient smile

Fig 2: Pre-operative retracted view

Fig 3: Smile after removal of old restorations

Digital Smile Design DSD, was used
to reestablish proper proportion of
the teeth and redesign the smile according to lower lip line, (Fig 5).
Tip: Smile design is a great aid to
establish correct golden proportion
and help convince the patient on the
treatment plan

Wax-up
Indirect wax up was performed according to the smile design, (Fig 6).
Tip: Since it is a prepless case the lab
should be informed not to prepare
the cast during wax-up.
Fig 4: Retracted view after removal of old restorations

Fig 5: Digital Smile Design

Fig 6: Indirect wax-up

Direct mock-up
Silicon mold was used to create a
direct mock-up trial to ensure proportion compatibility, occlusion and
obtain patient approval.
Tip: checking the occlusion at this
stage helps identify the points of interference that might affect the final
restoration design and minimize adjustments.

Silicon index
Fig 7 : Direct mock-up to assess occlusion and obtain
patient approval

Fig 8 : Silicone Index fabricated with putty impression
material

Fig 9 : index with incisal wrap to help duplicating the
thickness of the incisal edge

Silicone index with putty impression material was used to create the
palatal shell of the restoration for
each tooth separately (Fig 8).
Tip: make the index with incisal
wrap to help duplicating the thickness of the incisal edge (Fig 9).

Shade selection

Fig 10 : Direct placement technique for shade selection

Fig 11 : Final recipe of shades for the restoration

Fig 12 : Shade confirmation using the Isolate Shade
Mode of EyeSpecial CII camera

Fig 13: Shofu EyeSpecial camera

Fig 14: Natural aesthetics achieved with direct veneers

Fig 15 : Patient smile post treatment

Accurate shade selection was carried
out using the direst technique where
small buttons of each composite
material was placed directly on the
tooth surface. Beautifil II LS shade
A2O was identified for Hue specification, Beautifil II Enamel HVT was
identified to restore the value since
the case involved bleaching ten days
prior to the restorative procedure.
Beautifil II LS shade A1 and B1 were
compared under Shade Isolate Mode
using EyeSpecial C II to determine
the ideal Chroma and shade A1 was
identified as the most suitable shade
(Fig 10, 11). Beautifil Flow PLUS F03
INC. shade was selected to create the
palatal shell.

ÿPage 27


[27] =>
Dental Tribune Middle East & Africa Edition | 3/2020

27

RESTORATIVE

◊Page 26
Tip: Shade Isolate Mode removes the
influence of the background gingival
colour and helps obtain a more accurate shade selection (Fig 12, 13).

Composite layering
Teeth were polished using non-fluoridated paste, etched and bonded.
Restoration of each tooth was completed separately in a progressive
manner according to a customized
colour scheme, (Fig 14)
- Palatal shell was created using the
silicone index with a very thin layer
of Beautifil Flow Plus F03 shade INC
composite
- Proximal walls were created using
Beautifil II LS shade A1 with a layer of
Beautifil II Enamel shade HVT on top
- Beautifil II LS shade A2O was used
incisally as a very thin line to help
recreate the Halo effect and placed
cervically as the first dentin layer,
Beautifil II LS shade A1 was used to
build-up the body dentine layer leaving to restore dentine colour leaving
0.5mm for the final enamel layer
with Beautifil II Enamel shade HVT
(Fig 14).

Tip:
- A flowable composite Beautifil Flow
Plus F03 should be used to create a
thin palatal shell and ensure adaptation to tooth structure.
- A kidney shape matrix band was
adapted to create the proximal walls
and the contact with the adjacent
teeth. Lateral incisors were restored
before the central incisors to help
reduce finishing time and material
wastage.
- Use a brush such as Uni Brush
(Shofu) to adapt the composite and
refrain from using a resin liquid as it
affects the composite colour
• Final layer of enamel should be
0.5mm all around to ensure uniform
finish with proper shade characteristics

Contouring and finishing
protocol
- Yellow banded Super Fine Diamond
burs in high speed and Super-Snap
Black disks in low speed were used
to contour and create a uniform surface.

- Super-Snap Purple disks were used
to create the mesial and distal reflective line angles.
- One Gloss polisher was used in the
cervical area and to achieve the natural surface texture.
- Super-Snap X-Treme Green and
Pink disks were used to polish the
restoration.
- Super Buff impregnated super polisher was used for final polishing to
achieve enamel-like luster.

ment is to recreate a natural smile
that meets or exceeds the patient’s
expectations while ensuring longevity of the restorations. This concept
can be easily achieved today with the
help of innovative, bioactive composites capable of recreating natural
life-like aesthetics with a predictable
outcome.

Results and conclusion
The planned cosmetic restorative
treatment with non-prep composite resin veneers was successfully
completed and the patient was extremely happy with her enhanced
“natural” smile (Fig 14, 15). The emphasis on shade selection and adoption of the 3X protocol which takes
into consideration “prevention from
eXtension” by avoiding over-preparation, “prevention from undue eXpenditure” by eliminating cost while
maintaining quality and “managing
patient eXpectations”. As a clinician,
our final aim with cosmetic treat-

About the author
Dr. Mohammad Zuhair Al Khairo
Dr. M. Zuhair AK., earned his bachelor
degree in dental surgery from Mosul University, Iraq in the year 1999 with the
degree of honour. Two years later he
specialized and trained in Conservative
Dentistry where he was mesntored by the
renowned Prof. Abdul- Haq Abdul Majeed
Suliman. At the department of Conservative Dentistry, Mosul University, Iraq. He
had his own practice in Iraq early in year

2001 where he gained a very big reputation for his delicate, professional and
honest way of dealing with his patients.
In the year 2005 he moved to Dubai UAE
to extend his experience across a different
parts of the globe. His settling in Dubai
for more than 8 years now gave him the
chance to give his imprint by practicing
international quality healthcare standards which has been internally developed
and continuously improved over the
years through rigorous clinical compliance parameters. In year 2013 he gained
the German Board of Oral Implantology
from Muenster University/DGZI with the
first degree of honour among 29 students. Since then he has been awarded
the membership of the German Association of Dental Implantology DGZI. Today,
Dr. M. Zuhair`s philosophy of dental care
is more and more towards developing a
high standard dental practice that offers
a good quality dental service through
combining the experience of a highly
trained team and state of the art dental
equipment.

Mectron launches own
continuing education platform
By Dental Tribune International
The dental community is facing
extraordinary times, and it has responded by adapting and implementing new strategies. This is also
true for continuing education (CE) in
dentistry. Embracing the opportunities of e-learning, Italy-based dental company mectron has recently

launched a webinar platform, which
will provide dental professionals access to clinically relevant presentations 24/7 free of charge.
The new industry-wide dental CE
platform delivers free CE accredited
content through the convenience
of the Internet. After quick and easy
registration, dental professionals

will be able to attend live webinars
and watch recorded webinars ondemand, and these will cover a wide
range of topics relevant to the oral
healthcare professional community, including implant treatment
and prophylaxis. Twelve webinars
in English, French, German, Italian
and Portuguese are already planned
and will become available soon on

the platform. More webinars will be
scheduled in the second half of this
year.
Andre Reinhold, mectron’s international marketing manager, told Dental Tribune International that the
company had been planning to start
a Web-based education platform for
some time already. However, the

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recent COVID-19 outbreak and the
related restrictions on travel and
events, which have rendered maintaining customer relations almost
impossible, prompted mectron to go
online now.
“E-learning has become an effective
tool for us to stay in contact with
our customers and reach out to new
customers, especially in regions in
which mectron does not yet have
a local branch,” Reinhold said. “Although this online platform cannot
replace physical presentations in
the long run, it definitely facilitates
access to and helps raise interest in
our products. Through the webinars,
dental professionals are provided
with a comprehensive overview of
the advantages of our products in
daily practice,” he explained.
The feedback has been overwhelmingly positive. “Within the first week
of the launch, over 1,300 members
registered. The registrations for the
single webinars have also exceeded
our expectations,” Reinhold stated.

Join MyPD and get access
to unique materials,
case studies, clinical articles
and webinars.

Since 1979, mectron has been one
of the major players in the international dental industry, producing
surgical, ultrasonic, air polishing and
LED polymerisation devices, which
are available in over 80 counties
worldwide. With the introduction of
the first ultrasonic titanium handpieces, the first LED polymerisation
lamps for composite materials and,
in 2001, the first ultrasonic surgical
unit for piezoelectric bone surgery,
mectron has developed some of the
most important innovations in the
dental field.

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Visit pd-dental.com for more information
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More information about upcoming webinars can be found on the platform website at https://education.mectron.com/.


[28] =>
28

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 3/2020

Testing a novel endodontic sealer
By Drs Paolo Generali and Francesca
Cerutti, Italy
The aim of endodontic treatment is
to eliminate microorganisms and
their byproducts from the root canal
system, together with avoiding its recontamination1-3. The outcome of endodontic treatment is strictly linked
to several steps: root canal debridement, disinfection protocols, hermetic obturation of the canal space4.
Root canal obturation in a 3-dimensional space with a stable, nontoxic
material and the creation of a tight
seal is fundamental for the success of
the treatment, since the root filling
seals the communications between
the periodontium and the endodontium and, along with shaping and
disinfection, allows a further bacteriological defense5, 6.
Sealers should be used to fill the
morphologic root canal system irregularities, to avoid gap formation
between the dentinal walls and core
materials; moreover, sealers should
facilitate the placement of the filling core with a lubricant action,
penetrate into dentinal tubules to
prevent microleakage and entomb

Fig. 2a

any remaining bacteria2, 7, 8. Many
different sealers are available on the
market, but all of them ideally aim
to have the following features: tissue
tolerance, no shrinkage with setting,
slow setting time, adhesiveness, radiopacity, bacteriostatic properties,
absence of staining, solubility in solvents, insolubility to oral and tissue
fluids, easy handling9.
The different endodontic sealers are
categorized basing on their main
components: zinc oxide eugenol
(ZOE), calcium hydroxide, glass ionomer, resin-based, polydimethylsiloxane (silicon)-based and bioceramicbased sealers. Resin-based sealers
became popular because of their
adhesive properties and have been
reported to be used with single guttapercha cone technique for canal obturation[10]; even bioceramic sealers
can be used with this last technique11.
The most commonly used sealers in
root canal treatment are ZOE-based
sealers, modified for endodontic
purposes based on Grossman or
Rickerts’s formula. The powder of
these sealers contains zinc oxide
(ZnO), which combines with a liquid,
generally eugenol. ZnO is an envi-

ronment-friendly material, which
has been used widely in medical applications, with antibacterial properties and favorable characteristics in
terms of biocompatibility. Unlike
resin-based sealers, which are subject
to shrinkage, setting reaction of ZOEbased sealers is a chelation reaction
occurring between eugenol and the
zinc ion of the zinc oxide; this reaction might also occur with the zinc
oxide phase of gutta-percha along
with the calcium ions of dentin. This
might explain the decreased setting
shrinkage associated with the ZOEbased sealers10.
Michaud et al.12 have shown that volumetric expansion of gutta-percha
(almost 135.35%) occurred in contact
with eugenol during a 30-day period, and a pilot study done earlier
showed a remarkable increase in the
gutta-percha dimensions when
placed in eugenol that continued
even after 4.5 years.
Theoretically, sealer penetration into
dentinal tubules could improve sealing of a root filling by increasing the
surface contact area between the root
filling materials and dentinal walls.
Furthermore, retention of root filling

Fig. 2b

Fig. 1

material might be improved by mechanical locking. However, contrary
to common belief, a positive correlation between sealer penetration into
dentinal tubules and sealability has
never been established13.

Penetration refers to the amount of
sealer entering the dentinal tubules
and adaptation qualitatively describes the way in which the sealer
conforms to the dentine wall. Penetration and adaptation depend on
many factors, including the patency
and density of the dentinal tubules14.
A study by Russell et al15 investigated
the penetration and adaptation of
common types of root canal sealers (AH Plus, Kerr Pulp Canal Sealer,
MTA Fillapex and EndoREZ) in crosssections of tooth roots exhibiting
the butterfly effect and to determine
if this differs between coronal and
middle root sections. Penetration
and adaptation quality varied between obturation material groups
but this did not reach significance,
reporting AH Plus as the most performing material between the tested
cements and Pulp Canal Sealer and
EndoREZ as the less performing. The
superior adaptation and penetration
of a sealer may be attributed to its
pseudoplastic behaviour inside root
canals; this has been described as a
decrease in viscosity and an increase
in flow parallel to an increase in
shear rate during filling procedures.
When using gutta-percha with sealer
as core material for filling the canal
space; the amount of sealer should
be kept at the lowest, whereas the
amount of gutta-percha placed into
the canal must be maximized 16.
To reach the ideal consistency of the
sealer, it is important to calibrate the
powder/liquid or paste/paste ratio
of the mixed cement, because even
small alterations to this ratio may
cause a change in thickness and flow
of the material, affecting its penetration and adaptation to the dentine.

Fig. 3

Fig. 4

ZOE cements have some drawbacks,
such as the capability to stain the
tooth and to have a setting time depending on the heat/humidity of the
environments.
In order to improve ZOE powderliquid sealers, many attempts have
been done, adding various substances or substituting Eugenol in the

Fig. 5

Fig. 6

ÿPage 29


[29] =>
29

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 3/2020

◊Page 28
A clinical case shows the good penetration of the sealer into the root
canals and the absence of voids (Fig.
5-8). The white colour, the pleasant
scent and the good handling make
this product suitable for everyday
endodontic treatments, in addition
the interesting properties of TTO
against resistant micro-organisms
and biofilms suggest particularly its
use in retreatment procedures.
Editorial note:
A full list of references can be obtained
from the publisher.
Fig. 7

liquid component. This has given
rise to a number of Zinc Oxide NonEugenol-based sealers (ZONE).
In 2019, a new sealer containing Tea
Tree essential Oil (EssenSeal, Produits Dentaires SA, Vevey, Switzerland) has been launched on the market. (Fig.1)

Fig. 8

The clinical impressions while using this sealer are positive: mixing
and manipulation of the cement
are easily done (Fig. 2-3) and the final
product has a smooth consistency
that allows an easy placement of the

gutta-percha cone into the root canal. In addition, this sealer diffuses a
pleasant scent during manipulation
and its white colour should prevent
discolouration issues.

A procedure performed on a freshly
extracted tooth showed good penetration of root canal anatomy and
sufficient radio-opacity (Fig.4).

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Tea Tree Oil is the essential oil obtained from the Australian native
Melaleuca alternifolia or tea tree,
indigenous to northern New South
Wales and southern Queensland17.
Tea tree oil (TTO) is a complex mixture of essential oils, comprising approximately 100 components, most
of which are monoterpenes, sesquiterpenes, and their related alcohols18.
TTO has been shown to possess a
number of therapeutic properties,
including anti-inflammatory activities18, antimicrobial activity against
a wide spectrum of microorganisms,
for example Staphylococcus aureus
19
, a range of oral bacteria20, certain viruses, including herpes simplex and
influenza viruses20, many fungi including some azole-resistant yeasts21.
TTO has also demonstrated a potential biofilm inhibiting activity22. In an
animal study, TTO succeeded to promote healing of the extracted sockets and prevented alveolitis23.
According with Siqueira24, the microbial flora present in failed canals
has unique characteristics, with extremely resistant bacterial strain and
even yeasts, and these pathogens
survive in an inhospitable environment, often organizing in biofilms.
Incorporating plant extracts or
purified compounds derived from
plants has become an emerging area
of great interest in the medical and
scientific community. Antibiotic resistance has directed researchers toward alternative therapies, including
traditional plant-based medicines.
Many such plants are those traditionally used by indigenous communities to treat infectious diseases25.
This is the case of TTO, that has been
used therapeutically for long time,
being one of the plants used in traditional medicine by the Bundjalung
aborigines of northern New South
Wales26.
TTO is a natural compound with
reported antimicrobial and immunomodulatory activities, used
in traditional medicine. Its use in a
endodontic sealer for endodontic
retreatment could be an example of
the new trend towards the use of natural products derived from plants
in association with conventional
means, to overcome the problems
due to microbiological resistance.
EssenSeal is a powder-liquid cement
highly flowable with low paste thickness, that should be mixed according with manufacturer’s instruction,
1 drop of liquid with 1 of the provided
spoon of powder.

The Danube Private University: Studying where others go on holiday –
in the Wachau UNESCO World Heritage Cultural Landscape

© Thomas Eder

Do not miss out on the opportunity of
university-based continuing education
Master of Science in Oral Surgery/Implantology (MSc)
Academic Director: Prof. Dr. Dr. Ralf Gutwald

Master of Science in Orthodontics (MSc)
Academic Director: Prof. Dr. Dr. Dieter Müßig

The fields of implantology and oral surgery are important
elements of dental and oral medicine, and they support and
complement each other unequivocally in their understanding.
Implantology is thereby one of the major growth areas in
dentistry. No other field has developed as strongly, from a
diagnostic, therapeutic and scientific perspective, in recent
years. Other factors, such as demographic developments,
multimorbidity among older patients and the constantly
changing spectrum of medicine with new therapy possibilities,
also place new and increasingly greater demands on surgical
treatments. The needs of the patients should thereby not be
forgotten.

The high quality of our Master of Science in Orthodontics
(MSc) programme is known throughout the world, as can
be seen by the countless number of students coming from
abroad to attend our courses and complete the programme at
our university in English.

Despite the general trend towards specialization, the majority
of patients want holistic treatment from their family dentist.
It therefore goes without saying that the practice of today
should also offer implantology and oral surgery. Anyone who
has dealt with implantology and oral surgery, wants to expand
their intellectual and manual spectrum. One should not
immediately push oneself to one’s limits, but rather subject
oneself to a well-founded scientific learning process.

In addition to the predominant treatment of children and
adolescents practiced in orthodontics to this day, periodontaltherapeutic, functional-therapeutic, pre-prosthetic and
aesthetic treatments for adults also play a major role. New
treatment techniques and methods that meet the needs of
orthodontic treatments for adults are taught in great detail
and with a practical orientation. As a result, orthodontics
becomes a treatment method for (almost) all ages, thus
significantly expanding the area of activity for orthodontists
and making the orthodontic professional a valuable addition
to any practice.

The knowledge transfer of secure concepts and alternatives,
combined with manual skills, aims to enable the participants
of the Master of Science in Oral Surgery/Implantology
programme to also master the demands of successful implant
insertion and surgery in complicated situations and to also
handle complications with confidence. This university
course meets the modern and increasingly surgical demands.
Rise to the challenges of a modern society’s expectations
and qualify yourself for the future.

Recent programmes have included participants from, e.g. the
Netherlands, Poland, Switzerland, Austria, Greece, Egypt,
Libya, Dubai and Yemen. The current developments in the
field of orthodontics play an important role in the Master
of Science in Orthodontics (MSc) programme, which is
naturally also available in German.

For further information on our university-based Master of
Science continuing education programmes please contact:
PUSH Information Office Bonn,
Ms. Irene Streit (Mag.)
Tel .: +49 228 96 94 25 15
e-mail: streit@dp-uni.ac.at or info@dp-uni.ac.at

Danube Private University (DPU) - Faculty of Medicine/Dentistry
Steiner Landstraße 12, 3500 Krems-Stein, Austria
www.dp-uni.ac.at


[30] =>
30

NEWS

Dental Tribune Middle East & Africa Edition | 3/2020

Researchers develop model to
automatically localise mandibular canals

© Shidlovski/Shutterstock

By Dental Tribune International

AD

The Importance of Proper Light Curing
There are several clinical challenges dentists encounter if they choose an inadequate curing light or apply inappropriate light
curing techniques including weak adhesion and compromised physical and chemical properties of the restorative material.
In fact, studies revealed that more than 37% of composite restorations are insufficiently cured.1 This will likely have a negative
impact on the longevity of the restoration.
The following guidelines are based on the Consensus Statements on Light Curing (Northern Light Meetings, Halifax) and are
intended to help you achieve more predictable and reliable outcomes.
2

Shining A Light On Curing

Not all lights are created equal

Be aware of the key performance indicators: Make sure
your light delivers a minimum of 500 mW/cm2 in standard
mode. Be cautious when using high output lights (above
2.000 mW/cm2) that advocate very short exposure times
(e.g. 1-5 seconds).
• SmartLite® Pro: ~1.250 mW/cm2 over the whole curing area

SmartLite® Pro

Competitor

10 mm

7 mm

Maximize Coverage. Choose a light with a uniform
output that covers as much of the restoration as
possible. If the light tip is smaller than the restoration,
use overlapping exposures.
• SmartLite® Pro: Large active curing area of 10 mm diameter

Cure Over Distance. Select a light that offers the least
reduction in irradiance as distance from the tip increases.

REDUCTION

• SmartLite® Pro: Collimated beam for reliable curing over
larger distances

How To Properly Light Cure

0%
28%
40%

0 mm
4 mm
8 mm

Before getting started, be sure to:
• Use eye protection • Watch position of curing light

Inspect And Clean. First make sure the light is free of defects and debris. Apply barrier sleeve to protect
lens and handpiece from gross contamination.

Place Light. Position light as close as
possible (without touching) and with tip
parallel to the surface of the restoration.

Double Check. Light cure restoration for recommended time.
Follow the resin manufacturer’s curing table.

1. Boksman L, Santos GC. Principles of Light Curing. Inside Dentistry 2012; 8: Issue 3.
2. Price R., Light Curing Guidelines for Practitioners: A Consensus Statement from the 2014 Symposium on Light Curing in Dentistry,
Dalhousie University, Halifax, Canada, J Can Dent Assoc 2014;80:e61.
Strassler H., Oxman J., Rueggeberg F., What should you look for in a curing light? CDAessentials, 2015;3(6):30-3.
Price R., Guidelines For Using Bulk Fill Resin Composites, CDAessentials 2017;4:39

ESPOO, Finland: To place an implant,
dental professionals first have to localise the mandibular canal, which is
typically done using CBCT imaging
techniques. Since this often requires
considerable time and energy, Finnish researchers have recently developed a method for automatically localising mandibular canals with the
help of artificial intelligence in order
to facilitate the placement of dental
implants.
The study was a collaboration between researchers at the Finnish
Center for Artificial Intelligence,
Tampere University Hospital in Finland, Finnish manufacturer Planmeca and the Alan Turing Institute
in the UK. In the study, the researchers developed a novel deep learning
method that helps automatically determine the exact location of mandibular canals. The model is based
on training and using deep neural
networks, employing a dataset consisting of CBCT scans.
After training the model on the
coarsely annotated volumes, the
researchers were able to accurately
localise the mandibular canals of
the voxel-level annotated set, the
mean curve distance and average
symmetric surface distance being
0.56mm and 0.45mm, respectively.
The results show that the model successfully outperformed the statistical shape models typically used in
research.
According to the researchers, the
new model can achieve near-human
accuracy in cases in which the patient does not have any pre-existing
conditions and does not require special treatment. “In more complex
cases, one may need to adjust the
estimate, so we are not yet talking
about a fully stand-alone system,”
said lead author Joel Jaskari, a doctoral candidate at Aalto University in
Finland, in a press release.
The researchers noted that the aim
of the study was to optimise the
workflows of radiologists. “The aim
of this research work is not, however,
to replace radiologists but to make
their job faster and more efficient so
that they will have time to focus on
the most complex cases,” explained
Prof. Kimmo Kaski, senior adviser in
computational science at Aalto University.
Planmeca, which specialises in developing 3D and 2D digital imaging
devices, dental units, and CAD/CAM
solutions and software, is currently
integrating the model into its dedicated software. The model will be
used with Planmeca 3D tomography
equipment.
The study, titled “Deep learning
method for mandibular canal segmentation in dental cone beam
computed tomography volumes”,
was published online on 3 April 2020
in Scientific Reports.


[31] =>

[32] =>
» What drives me? Best
results. And Primescan
is my answer. «
Dr. Carlos Repullo, BDS, DipImpDent RCS (UK)

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


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