Sunshine vitamin D and COVID-19: Is there a correlation? / News / Industry / News / When is too much light a bad thing in dentistry / News / Minimally invasive endodontics: challenging prevailing paradigms / The art of a personalised smile design / News
Sunshine vitamin D and COVID-19: Is there a correlation?
01 - 26 viewNews
02 - 04 viewIndustry
06 - 06 viewNews
08 - 08 viewWhen is too much light a bad thing in dentistry
10 - 10 viewNews
12 - 12 viewMinimally invasive endodontics: challenging prevailing paradigms
14 - 19 viewThe art of a personalised smile design
20 - 24 viewNews
28 - 28 viewArray
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DTMEA_No.5. Vol.10_DT.indd
NL
Y
O
LS
NA
IO
SS
FE
O
PR
NT
AL
DE
www.dental-tribune.me
PUBLISHED IN DUBAI
September-October 2020 | No. 5, Vol. 10
ENDO TRIBUNE
LAB TRIBUNE
IMPLANT TRIBUNE
ORTHO TRIBUNE
HYGIENE TRIBUNE
FKG Dentaire expands its legacy
with RACE EVO and R-Motion
Interview: Building rapport
between dental technicians and
dentists
Astra Tech Implant EV
Invisalign Scientifi c Symposium
2020
Natural toothpaste R.O.C.S. is
now available at Boots pharmacies in the UAE
ÿA1-4
ÿB1-4
ÿC1-2
ÿD1-4
ÿE1-4
Sunshine vitamin D and COVID-19:
Is there a correlation?
DENTAL TRIBUNE
LEIPZIG, Germany: Vitamin D, also
referred to as the sunshine vitamin,
is increasingly more difficult to obtain from sun exposure. The increase
in the number of people working in
offices today has drastically reduced
access to direct sunlight. The strict
confinement measures worldwide
to slow down the spread of SARSCoV-2 can only have worsened this
situation. Vitamin D deficiency has
been found to be associated with
dental implant failure and complications, and mounting evidence is suggesting that inadequate vitamin D
levels in the blood could play a major
role in SARS-CoV-2 susceptibility and
outcomes.
Vitamin D supports the immune
system and is instrumental in development of healthy bone and
muscles and strengthening of tooth
enamel. Yet, according to an article
published by the National Center for
Biotechnology Information earlier
this year, approximately one billion
people worldwide have vitamin D
deficiency, and 50% of the global
population has vitamin D insufficiency.
The World’s Dental Newspaper Middle East & Africa Edition
A recent article published by Dental
Tribune International (DTI) reported
on previous studies that highlighted
the impact of vitamin D deficiency
on osseointegration and failure of
immediate implants. Additionally,
an optimal diet rich in vitamin D
© Angela C/Pixabay
By Iveta Ramonaite, Dental Tribune
International
ÿPage 26
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20200723_AD_Implantmed_245x167mm_Register-now.indd 1
23.07.2020 12:58:55
[2] =>
DTMEA_No.5. Vol.10_DT.indd
2
NEWS
Dental Tribune Middle East & Africa Edition | 5/2020
Marketing cooperation agreement between EMOVA, representing ITI, and
CAPP Events & Training signed
By CAPP / Dental Tribune MEA
The International Team of Implantology (ITI) appointed EMOVA to
conduct a programme in the UAE
which will facilitate the fulfillment of
requirements for obtaining privileges to practice implant dentistry. The
ITI Implant Privilege programme
will be promoted by CAPP Events &
Training.
The clinical days are for delegates
to work with highly skilled mentors who will support and guide the
participants to achieve outstanding
implant placements and restoration
Petar Mollov (left), Marketing Director at CAPP Events and Training and Stephan Scherrer, Managing Director at EMOVA,
sign the marketing cooperation agreement at CAPP Training Institute in Dubai.
of 20 or 30 implants. The course will
also include a live surgery day with
Prof. Bilal Al-Nawas from University Medical Center of the Johannes
Gutenberg University Mainz (Germany) who is the main faculty lead
of the programme. At the end of the
course, the delegates will be awarded
the ITI Curriculum Intermediate Certificate.
The signing ceremony was held at
CAPP Training Institute and the marketing cooperation agreement was
signed by Stephan Scherrer, Managing Director at EMOVA "representing ITI" and Petar Mollov, Marketing
Director at CAPP Events & Training.
The focus of the agreement is the
marketing of the ITI Implant Privilege programme in the Middle East
and beyond.
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
The ITI Implant Privilege is a modular course with both theory and
mentored clinical elements, which
has the support of the ITI . The speakers are international, regional and
local, all of which are ITI Fellows or
Members.
The course is structured and provides evidence and scientific background to implantology. Within
the modules is a dedicated day in
detailed case documentation and
dental photography. Also provided
is supportive e-learning modules to
assist with home study and access to
the Simple Advanced and Complex
treatment planning tool. Based on
the SAC planning tool delegates will
simulate on models’ variable clinical situations in preparation for the
clinical modules.
IMPRINT
For further information can be found on
the website:
www.implant-privilege.ae
AD
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
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Tel.: +971 55 11 28 581
EDITING & DESIGN
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Tel.: +971 56 23 70 721
PRINTING HOUSE & DISTRIBUTION
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800 4585/04-4067170
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not reflect those of Dental Tribune International GmbH.
[3] =>
DTMEA_No.5. Vol.10_DT.indd
+971528423659
p.mollov@cappmea.com
www.cappmea.com/implant
Dr Charlotte Stilwell
Prof Giovanni Salvi
Prof Bilal Al-Nawas
Prof Urs Brägger
Dr Vladimir Kokovic
Dr Krzysztof Chmielewski
Prof Hani A. Salam
Dr Salma Al Jahdhami
University of Sharjah
UAE
DDS, MSc
Poland
ITI President Elect, Specialist in
Prosthodontic Surgery
UK
University of Berne
Switzerland
University of Mainz
Germany
McGill University
Canada
University of Berne
Switzerland
BDS, MFD, RCSI, OMSB,
FFD(OSOM), RSCI
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Evolution of Dental Implants, Anatomic Structures relevant to Implantology and Webinar on Dental Photography
THEORY FOUNDATION 2 I DATES TO BE ANNOUNCED I SURGICAL INTERVENTION
Programme Outline: Surgical Intervention Part 1, Surgical Intervention Part 2, Surgical Intervention Part 3
& Loading Protocols
THEORY FOUNDATION 3 I DATES TO BE ANNOUNCED I PROSTHETIC REHABILITATION
Programme Outline: Prosthetic Rehabilitation: Material Science, Prosthetic Rehabilitation: Partial Edentulous, Prosthetic
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THEORY INTERMEDIATE 4 I DATES TO BE ANNOUNCED I SURGICAL INTERVENTION ADVANCED
Programme Outline: Implant placement: Aesthetic Zone, Principles of Guided Bone Regeneration, Live Surgeries,
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Programme Outline: Advanced Aesthetic Rehabilitation Part 1, Advanced Aesthetic Rehabilitation Part 2
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Programme Outline: Biological Complication Management, Technical Complication Management, Assessment
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[4] =>
DTMEA_No.5. Vol.10_DT.indd
4
NEWS
Dental Tribune Middle East & Africa Edition | 5/2020
Prioritizing safety while reopening your office
By Ultradent
Reopening dental offices is a welcome sight to clinicians and patients
alike, but concerns about COVID-19
are still top of mind among doctors.
Ultradent knows how important it
is to get back to work and we want to
help you do it safely by making sure
you have everything you need while
protecting you, your staff, and your
patients.
Prioritizing effective products and
leaning on the procedures they assist
will smooth the transition as your
practice regains some normalcy.
Patient Protection
As we all get back to work, products
that reduce exposure are a necessity
to ensure everyone in your office
stays safe.
Ultradent Syringe Covers and VALO
Barrier Sleeves provide reliable,
medical-grade protection to prevent
cross-contamination. DermaDam
dental dams and DermaDam
Synthetic dental dams are strong and
tear resistant, and are powder free
to reduce allergic reactions. When
it comes to hygiene procedures,
Ultrapro Tx Sweep disposable
prophy angles feature an innovative
brush guard that helps prevent up to
95% of splatter.
Essential Products
Returning to work doesn’t necessarily mean a return to the normal work
day. Since dental offices were only
open for emergency procedures,
you may have patients who needed
something done, but weren’t able to
be seen. Now they’re ready, so make
sure you are, too.
From whitening procedures to root
canals, Ultradent tips allow you to
deliver any chemistry exactly where
it’s needed—they’re also single use
to prevent cross-contamination. For
tissue management needs, ViscoStat
hemostatic can stop bleeding
and sulcular fluid in seconds and
Ultrapak packing cord packs easily
and quickly.
The Omni-Matrix Disposable Retainer and Matrix is designed to perfectly
customize to any preparation. They
are available in winged and wingless
styles and stainless steel and mylar so you have the ideal matrix no
matter the circumstances. Consepsis
antibacterial solution can be used
for procedural endodontic disinfection, prior to pulp capping, and after
smear layer removal for canal disinfection.
You can utilize UltraCal XS Calcium
Hydroxide Paste as a temporary
dressing as per apexification procedures in endodontics.
Use Consepsis solution prior to DBA application to disinfect root surface with sensitive
root treatment or when bonding.
Ready to Sell
Help your patients keep their smiles
bright and healthy while they are at
home. These products can be sold to
your patients with minimal contact
or can be purchased from your office
over the phone and then mailed to
the patient's home.
Opalescence Go whitening trays allow your patients to whiten in the
AD
DermaDam rubber dam is made from pure latex rubber and is designed to be flexible
and durable.
Opalescence Go™ whitening gel is designed to maximize patient comfort and the
convenient prefilled trays can be worn right out of the package.
Bien-Air has always prioritized provider and patient safety by developing products that protects
against cross contamination. With the COVID 19 Pandemic, these features are more important than
ever.
The high-speed dental handpiece without anti-retraction valves may aspirate and expel the debris
and fluids during the dental procedures. More importantly, the microbes, including bacteria and virus,
may further contaminate the air and water hoses within the dental unit, and thus can potentially cause
cross-infection.
Bien-Air, being conscious of cross contamination risks, has designed its electric attachments and highspeed air handpieces with anti-retractive valves which protect fluid retraction from the oral cavity into
non-sterilizable dental handpiece tubing and water lines. Having an anti-retraction valve in the body of
the handpiece, which can be autoclaved, significantly reduces the backflow of oral bacteria and viruses
into the non-sterilizable dental unit hoses.
As an extra preventive measure for cross infection, Bien-Air Unifix® coupling are also equipped with a
unique anti-retraction features protecting the the exhaust air tubing.
Ultradent Syringe Cover provides an easy and reliable barrier to prevent contamination.
Products with anti-retraction valve :
TURBINES
COUPLING
Bora / L / LED
Unifix® (Anti-reflux valve)
CONTRA-ANGLES
CA 1:1 / CA 1:1 L
Prestige / L / LED
CA 1:5 / CA 1:5 L
Tornado X LED
CA 10:1 / CA 10:1 L
Tornado LED
CA EVO.15 1:1 L
TornadoS LED
CA EVO.15 1:5 L
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
safety and comfort of their own
home. The UltraFit tray conforms to
each patient’s smile, giving a closeto-custom fit for a comfortable whitening experience.
Opalescence Whitening Toothpaste
provides total oral care while keeping your patients’ smiles bright, plus
it is safe to use every day. It's the only
whitening toothpaste they need!
To see all the other products and offers we have available to you please
contact your exclusive distributor in
your country or
sophia.yadi@ultradent.com
For more information contact
Ultradent
505 West Ultradent Drive
South Jordan, UT 84095
Web: www.ultradent.com
[5] =>
DTMEA_No.5. Vol.10_DT.indd
3M ORTHODONTIC ONLINE CONFERENCE
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processed by 3M and third party partners on our behalf, in countries outside of the UK and European Union but always under strict obligations of confidentiality and security.
[6] =>
DTMEA_No.5. Vol.10_DT.indd
6
INDUSTRY
Dental Tribune Middle East & Africa Edition | 5/2020
The SphereTEC revolution continues…
New Neo Spectra ST flow – the simpler,
more versatile esthetic flowable composite
By Dentsply Sirona
the Neo Spectra ST flow resin matrix creates an excellent chameleon
shade blending effect, and a perfect
match to Neo Spectra ST universal
composite shades. The unique structure of SphereTEC fillers maximizes
composite strength and durability,
while their sub-micron primary particle size ensures excellent esthetics
and polishability.
Dentsply Sirona’s latest innovation in composite filler technology,
SphereTEC, was introduced to the
dental industry in 2015. Over 14 million composite restorations later,
Dentsply Sirona introduces an expanded portfolio with SphereTEC
technology. Clinicians will now be
able to enjoy SphereTEC benefits in
all composite cases with the comprehensive Neo Spectra ST portfolio. ‘Neo’, meaning ‘new’ or ‘revived’
emphasizes the modern, cutting
edge approach taken to optimize
our composite portfolio. The ‘Spectra ST’ part of the brand explains the
portfolio’s coverage of the full range
or ‘Spectra’ of handling preferences
and esthetic needs optimized with
SphereTEC (ST) technology.
© Dentsply Sirona
Dentsply Sirona’s new Neo Spectra™
ST flow extends the benefits of novel
SphereTEC® filler technology to
flowable composites. Excellent chameleon blending enables 5 shades
to cover the full VITA®* range, and
flow-on-demand handling provides
versatility across all traditional flowable indications.
Neo Spectra ST flow.
Designed to perfectly complement
Neo Spectra ST universal composite, new Neo Spectra ST flow is characterized by its cutting-edge filler
technology, SphereTEC - like with
its universal composite counterpart, SphereTEC technology enables
Neo Spectra ST flow composite to
excel in the areas that matter most
to dentists: handling, esthetics, and
durability. SphereTEC fillers, propri-
etary to Dentsply Sirona and Neo
Spectra ST Composites, are spherical-shaped, pre-polymerised fillers
created from sub-micron barium
glass. Spherical-shaped filler particles allow for excellent adaptation
to cavity surfaces, and work together
with smaller irregular-shaped filler
particles in the material to achieve
versatile, flow-on-demand-handling.
Precise match of SphereTEC filler to
The new Neo Spectra ST flow composite uses five universal CLOUD
shades A1 to A4 to cover the entire
VITA®1 Classic range, streamlining
flowable composite inventory and
ensuring highly aesthetic clinical results thanks to their distinct chameleon effect. Neo Spectra ST flow composite also offers one bleach shade
(BW), two opaque dentin shades (D1
and D3), and one translucent enamel
shade (E1) to accommodate less frequent case demands.
For further information about the
new Neo Spectra ST flow composite
available from Dentsply Sirona, or
to request a sample, please contact
your local Dentsply Sirona sales representative.
* VITA is not a registered trademark
of Dentsply Sirona Inc.
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
Introducing Axeos
Dentsply Sirona’s imaging solution for exceptional patient experiences
and greater practice success
Dentsply Sirona’s reimagined imaging solutions drive patient-centered
experiences, greater practice efficiency, and the opportunity for procedural expansion. To help deliver
on such a promise, Dentsply Sirona
introduces the new Axeos™ 3D/2D
imaging system, setting a new standard for extraoral imaging.
workflow practices, Dentsply Sirona
continues to develop new solutions
for both intraoral and extraoral imaging that produce superior images
that support patient satisfaction and
practice growth.
We’re excited to introduce two new
and reimagined imaging technologies that will ultimately help dental
professionals deliver happy and
healthy smiles to their patients:
As dental practices adapt to new
safety protocols and adjust their
Axeos - Experience the Difference
Recipient of the Red Dot Award for
Production Design 2020, the Axeos 3D/2D imaging system offers
enhanced clinical confidence, smart
connectivity, and an exceptional
experience, with the largest field of
view of any Dentsply Sirona 3D/2D
system. Axeos uses intelligent low
dose exposure to capture highquality images while providing easyto-use features to enhance patient
comfort, such as smart height adjustment and quick scan times, that
lead to exceptional patient experiences with high infection prevention
standards.
© Dentsply Sirona
Axeos is powered by Sidexis 4 and
seamlessly integrates with more
than 250 practice management
software systems and multiple treatment planning software like SICAT®
Implant, SICAT® Endo, SICAT® Function and SICAT® Air, giving dental
practices the opportunity to enhance current treatment offerings
or expand into new procedural offerings in the future.
“Our purpose is to support dental
professionals in providing healthy,
happy smiles. Working with dentists to understand their needs and
translating those into product solutions is what drives us. With our new
imaging solution, we not only offer
outstanding image quality, clinical
safety and an easy-to-use interface
but also smart integration to ensure seamless workflows and procedures,” says Don Casey, Chief Execu-
tive Officer at Dentsply
Sirona.
“Waiting is a bad experience for both dentist and
patient. Even worse, if I
am unable to see what I
need to see, I will have to
repeat the image; then
patient is gone because
he does not trust my
treatment," says Prof.
Chung How Kau, Department of Orthodontics,
Birmingham, Alabama,
USA. “Axeos has exactly
the right balance between
excellence, speed and precision. The big volume
exposure takes only 16
seconds and the image
quality is great in both
2D and 3D formats. The
‘wow’ effect of the Axeos
technology sells my treatment.”
© Dentsply Sirona
By Dentsply Sirona
For more information, visit
dentsplysirona.com/axeos.
Find out more by
scanning the QR code.
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
[7] =>
DTMEA_No.5. Vol.10_DT.indd
ECLIPSING THE COMPETITION
YE
ARS
WARRANTY
B L AC K | R E D RO C K | SA PPH I R E | M I D N I G HT
© 2 0 2 0 U LT R A D E N T P R O D U C T S , I N C . A L L R I G H T S R E S E R V E D.
[8] =>
DTMEA_No.5. Vol.10_DT.indd
8
NEWS
Dental Tribune Middle East & Africa Edition | 5/2020
Omnicam AF
The flexible tabletop unit. Now available in the Middle East & North Africa
By Dentsply Sirona
Benefits of Omnicam:
- Comfortable handling
- Powder-free scanning
- Fast and precise full-arch scans
- Natural colour and easy shade analysis
Dentsply Sirona is proud to announce the launch of the Omnicam
AF intraoral camera, in the Middle
East & North Africa region.
Proven reliability. Your way.
The camera can be easily taken from
one treatment room to another – a
big advantage for joint practices
and practices with several locations.
Scanning and designing can be done
separately. For example, you can
make the design in the first treatment room and your assistant or
colleague can start a new scan in the
next one.
© Dentsply Sirona
The portable Omnicam AF comprises the individual components
of Omnicam, including camera tray
and PC.
Omnicam AF.
In addition to the new Primescan,
the proven Omnicam is a real alternative. Omnicam is still one of
the smallest scanners available. It is
therefore particularly easy to han-
dle, scans powder-free and in colour.
Since 2012, it has impressed users
worldwide and is always up to date
thanks to the continuous software
updates.
With more than 7 million scans per
year, Omnicam is one of the most
widely used scanners on the market
– now with the option of the Acquisition Center (AC) and the flexible tabletop unit (AF).
The Omnicam intraoral scanner
gives you the flexibility to start your
digital dentistry journey and develop as your practice grows.
For more information about the full
Dentsply Sirona portfolio, please contact
your local representative.
Find out more by
scanning the QR code.
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
Medifil IX forte–glass ionomer filling
material for a variety of indications
Medifil IX forte can be used without
conditioner or adhesive. Its main
benefits are the non-sticky consistency and the perfect marginal adaptation.
Optimal material characteristics
and perfect handling
Medifil IX forte convinces by its great
material properties, such as high
compressive strength and abrasion
resistance. Due to a variable mixing
time the product’s consistency can
be adjusted to a certain extend. The
material can be modelled and polished immediately after the insertion without sticking to the instrument.
Perfect for various indications
Medifil IX forte is indicated for restorations of non-occlusion-bearing
Class I cavities, semi-permanent
restorations of Class I and II cavities, restorations of cervical lesions,
Class V cavities, root caries, restorations of Class III cavities, restoration
of deciduous teeth, as a base/liner,
for core build-ups, as well as for temporary restorations. The special capsule design is perfect for smaller cavities and areas in the mouth, which
are difficult to reach.
Benefits of the special capsule
Medifil IX forte comes in a special
kind of capsule, which can be activated without an activator. Instead, the
capsule is placed on a firm surface
(e.g. a table) and pushed down by
hand. The liquid containing flask is
pushed into the powder chamber in
order to combine powder and liquid.
After the ensuing mixing process,
the capsule is immediately ready for
use.
For more information, please contact
PROMEDICA
Dental Material GmbH
Domagkstraße 31
24537 Neumünster, Germany
Tel: +49 43 21 / 5 41 73
Fax: +49 43 21 / 5 19 08
Email: info@promedica.de
Internet: https://www.promedica.de/
© Promedica
By PROMEDICA
AD
Light-curing micro-hybrid composite
Glass ionomer filling material
• Applicable for various indications and all cavity classes
• High translucency and a perfect colour adaption
• Polishable to a high gloss
• Excellent physical properties for durable fillings
• High filler content
• Packable consistency
(also available as Composan LCM flow)
• Variable mixing time for adjustment of consistency
• Modulation is possible right after insertion
• Perfect marginal adaption
• High compressive strength and abrasion resistance
• Easy activation without the need of an activator
Temporary crown & bridge material
• Less than 5 min. processing time
• Strong functional load
• Perfect long-term aesthetics
• Excellent biocompatibility
Dental Material GmbH
Kaltpolymerisierendes provisorisches Kronenund Brückenmaterial, Paste-Paste-System
Material provisório polimerizável a frio
para coroas e pontes, sistema pasta-pasta
50 ml cartridge / mixing tips
Made in Germany
Visit www.promedica.de to see all our products
0482
24537 Neumünster / Germany
Tel.
+49 43 21 / 5 41 73
Fax
+49 43 21 / 5 19 08
eMail
info@promedica.de
Internet www.promedica.de
[9] =>
DTMEA_No.5. Vol.10_DT.indd
[10] =>
DTMEA_No.5. Vol.10_DT.indd
10
GENERAL DENTISTRY
Dental Tribune Middle East & Africa Edition | 5/2020
When is too much light a bad
thing in dentistry
The problem most hygienists
don't realize: Glare
Dental hygienists rely on two senses
to detect calculus: tactile sensitivity and direct observation. Take one
away, and hard-to-access areas are
bound to be overlooked, leading to
incomplete deposit removal.
This is why we strive to strengthen
our two key senses as much as possible, turning to instruments that
give us better tactile sensitivity and
an array of lights, lenses and mirrors
to improve our vision.
One would think the more light,
the better the view, right? That’s not
necessarily. When light bounces off
reflective surfaces and into our eyes,
it can make it harder to see minute
details intraorally. And that can be a
problem.
The problem with glare
Practical experience tells us there
can be such a thing as too much
light. If you’ve ever driven into the
sun in the early morning or late af-
ternoon, you know all too well how
blinding light can limit your vision.
Commutes at these times of day can
become a driving nightmare as you
squint, adjust your visor, and avert
your gaze to avoid the sun’s rays. The
moment the sun dips below the horizon is like sweet relief.
This demonstrates how unwanted,
undirected light can become distracting visual “noise.”
The impact of glare – reflected or
refracted light – in dental care deserves more study. But what is clear
is that there is a lot of light bouncing
around the typical dental operatory.
The light emitted by overhead lights
and headlamps is stronger than ever,
and banks of bright halogen bulbs illuminate many dental offices.
All this light can reflect off traditional metal instruments, limiting
visibility. The next time you provide
dental treatment, notice how often
you shift your position to get a better
viewing angle. The constant movement can add up, in terms of how
long it takes to treat each patient and
© Hu-Friedy
By Hu-Friedy
AD
Prof. Dr. Pedro Paulo Feltrin
• Master and PhD of Dental Clinics, School of Dentistry, USP.
• Specialist in Prosthodontics, CFO.
• Specialist in Temporomandibular Disorder and Orofacial Pain, CFO.
• Private practice and Professor since 1978.
Prof. Dr. Weber Adad Ricci
• Professor at Comprehensive Care Clinics, School of Dentistry, UNESP.
• Researcher in the area of bioinspiration.
• Specialist in Prosthodontics.
• Master and PhD in Oral Rehabilitation.
Access the 06 chapter
of the Logical Book.
When?
to perform occlusal remodeling
The selective remodeling of the occlusion can be performed by
c) Dire ct the forces in a
reductive (selective wear) or additive (strategic additions)
longitudinal and balanced way in the
methods. This second item became possible through the
face of interventions in periodontal
revolution led by Adhesive Dentistry, which allows for maximum
patients, thus eliminating possible occlusal
conservation of dental tissues and should be the strategy of
trauma and future Noncarious Cervical Lesions.
choice whenever possible. As a general rule, selective
remodeling is indicated in the following situations:
d) As an adjunct in the treatment of muscular and joint
pathologies promoted by mechanical breakdown of the TMJs.
a) Establish a stable and balanced occlusal pattern at the end of
interceptive treatments, such as orthodontics and oral
As a contraindication, the clinician should never perform this
rehabilitation.
procedure as a prophylactic measure, in the face of sudden
changes in the occlusion and in symptomatic patients in the
b) Eliminate before the rehabilitation of the anterior guide
acute phase. It should also be avoided by inexperienced
(especially when increasing crown length) pathological
clinicians without the correct occlusal diagnosis and technical
interferences (premature contacts) that result in trauma to this
knowledge of the process.
area leading to loose and fractured parts.
Extracted article from the book:
Logical - A clinical approach to occlusion
intelligent solutions
in the stress you inflict on your body.
Every dental professional is already
at risk for developing musculoskeletal issues, the DentistryIQ article
reports, “The ability to work with a
high level of accuracy and improved
control reduces treatment time and
operator fatigue.”
Glare may be more than a visual nuisance. A recent DentistryIQ article
pointed out that eye problems are
the third-most reported occupational health issue among dental professionals. Better vision promotes
better posture (which is one reason
loupes are recommended for practitioners over 40, the age when our
ability to focus up close begins to
degrade).
A 2013 study published in the Journal of the Tennessee Dental Association notes that the “white” LED
headlamps gaining popularity with
dental practitioners actually emit a
combination of green and blue light.
The hazards of retinal damage from
blue light are well-documented, the
study’s authors note. They also point
out “the effect of high-intensity light
reflective glare and magnification
back to the practitioner's eyes” is unexamined.
Reducing glare from mouth
mirrors
Mouth mirrors are multifunctional
instruments used in nearly every
dental procedure. Mirrors are essential for visual inspection and oral examination. But a mirror can also be a
significant source of glare.
Traditionally, mouth mirrors are
held in place by stainless steel handles. Metal can be highly reflective,
producing glare that obscures visibility.
Hu-Friedy has designed a new mouth
mirror that addresses this issue. The
new HD Black Line Mirror head and
handle are coated with a durable
matte black Diamond Like Carbon
coating, which reduces glare up to
80%* compared to shiny stainless-
steel instruments. The matte finish
cuts down on glare, while the black
color provides better visual contrast
in the mouth – both of which ensure
superior visibility. This may mean
you’ll find yourself needing to adjust your position less frequently to
avoid unwanted shine.
It’s also worth pointing out that the
material used in a dental mirror
plays an important role in visibility,
as well. Most mirrors are coated in
rhodium or feature a resin (plastic)
casing.
The High-Definition Mirror Glass
used in the HD Black Line Mirror is
38.5% brighter than rhodium-coated
mirror glass and 50% brighter* than
other front-surface mirror glass. The
matte finish of the handle means
this brightness does not increase
glare and instead facilitates a sharper, distortion-free image for quicker
and more accurate visibility.
Ultimately, light can be a friend or a
foe to a dental hygienist. When unfocused and undirected, light becomes
glare that can impede your vision
and make it harder to do your work.
But armed with the right tools, you
can marshal the focused light you
need to provide superior care for
your patients.
* Data on File.
Editorial note:
A list of references can be obtained
from the publisher.
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@HuFriedyEU
@hu_friedy_europe
To learn more about HD Black Line Mirror,
visit www.hu-friedy.eu or contact our local distributors.
Hu-Friedy Mfg. Co., LLC.
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E-Mail: info@hu-friedy.eu
Tel.: +49 (0)69 24753640
Fax: +49 (0)69 25577015
Free Call: 0080048374339
[11] =>
DTMEA_No.5. Vol.10_DT.indd
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[12] =>
DTMEA_No.5. Vol.10_DT.indd
12
NEWS
Dental Tribune Middle East & Africa Edition | 5/2020
Three possible steps into a digital workflow
Starting with an intraoral scan, explore more about three innovative ways
to implement a digital workflow in daily practice.
By Dentsply Sirona
open transfer options. The 3D data
can be further processed using software as part of planning for specific treatment areas including clear
aligners in orthodontics and guides
for dental implants.
Intraoral scanners are now becoming commonplace in dental surgeries, as dentistry moves increasingly
towards a fully digital workflow.
Impression taking has long been recognised as one of the more uncomfortable experiences for patients and
a time-consuming process for dental
practitioners. However, thanks to
digital intraoral scanners such as the
revolutionary Primescan® and wellestablished Omnicam from Dentsply Sirona, alongside major developments in CAD/CAM technologies,
the digital workflow is now revolutionising the standards of restorative
treatment.
These digital workflows enable
digital treatments in orthodontics,
indirect restorations and dental implants.
1. The seamless workflow
The seamless workflow refers to
Dentsply Sirona equipment, software and materials as an end-to-end
solution designed to meet the needs
of both practices and laboratories.
With the optimal interaction of hardware and software, even the most
complex treatments can be planned
and executed with confidence.
© Dentsply Sirona
Dentsply Sirona aims to help dental professionals streamline their
workflow through three digital
workflows. We refer to these as i)
seamless, ii) validated and iii) open,
enabling open STL file export, secure
data transfer to a chosen laboratory
and external partners, and with the
option of completing the restorative
programme at the chairside.
Thanks to Primescan’s unprecedented accuracy, powerful processing
speeds and ease of use, not only is
the taking of digital impressions now
much faster, but every step along the
preferred digital pathway is integrated and efficient. Transparently
priced, open, validated and futureproof, Primescan is your exciting
first step into any digital workflow.
Digital workflows with Primescan.
When planning for implant restoration for instance, having taken an
intraoral scan with Primescan you
can send the scan directly to your
preferred laboratory partner to outsource patient-specific CAD/CAM
abutments. As an alternative, temporary or final prosthetic solutions can
be seamlessly designed and milled at
the chairside using CEREC, providing
a restorative solution in a single visit
and giving clinicians the distinct advantage of having full control of the
restorative programme.
2. The validated workflow
The validated workflow works to the
same principle, but involves using
third party solutions validated by
Dentsply Sirona, to ensure specific
safety and efficiency standards are
maintained. This allows secure data
transfer to approved laboratories
or external service providers for a
wide range of appliances including
clear aligners, retainers and implant
guides.
3. The open workflow
The open workflow offers clinicians
total choice and flexibility. After taking an intraoral scan, the clinician
can export an open STL file and use
it on any equipment and workflow
options including; CAD/CAM design
and manufacturing in-practice, outsourcing to any chosen laboratory
or milling centre as well as collaborative implant, orthodontic or restorative treatment planning.
Primescan opens doors
Designed to support a range of digital workflows, Primescan offers the
choice of seamless, validated and
Find out more by
scanning the QR code.
To find out more about Primescan, visit
dentsplysirona.com/primescan.
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
ADA supports point-of-care COVID-19
testing by dentists
CHICAGO, Ill., USA: According to a
new policy from the American Dental Association, point-of-care testing
to screen patients for chronic diseases and other medical conditions,
including COVID-19, that could complicate dental care or put the patient
and dental staff at risk is within a
dentist’s scope of practice. “Yet currently, rapid and reliable COVID-19
tests are not available to dentists for
in-office use, which makes no sense,”
states ADA President Dr. Daniel
Klemmedson.
Klemmedson, who holds degrees in
both dentistry and medicine, points
out that dentists are doctors of oral
health. “It is well within dentists’
scope of practice to screen not just
for COVID-19 infection but also other
medical conditions that may affect
dental care such as glucose levels,
which help screen for diabetes, and
blood pressure, which help screen
for hypertension. Patients with abnormal test results would be referred
to a physician, other qualified medical professional or medical facility
for diagnosis and follow-up care.”
With strengthened infection prevention protocols and personal protective equipment (PPE), dental offices
have re-opened safely around the
country,” Klemmedson said. “Millions of patients have returned for
oral health care, which is an essential health service. Dentists should
be given access to FDA-authorized
point-of-care testing for COVID-19
infection to add to their ability to
screen patients and help to identify
those infected with the virus.”
Klemmedson pointed out that dentists’ areas of care include not only
their patients’ teeth, gums and supporting bone but also the muscles of
the head, neck and jaw, the tongue,
salivary glands, the nervous system
of the head and neck and other areas. When appropriate, dentists perform procedures such as biopsies,
and screen for chronic or infectious
diseases, salivary gland function and
oral cancer.
In addition, according to 2013-2016
data from the U.S. Centers for Disease Control and Prevention, 7.7% of
people (10.2 million) reported having seen a dentist in the previous 12
months but no other medical professional.
“It makes practical sense for
COVID-19 point of care testing to be
included in screening procedures
dentists perform,” Klemmedson
said.
The U.S. Food and Drug Administration includes dentists among
those professionals who can test for
COVID-19. In addition, the CDC recommends dental facilities consider
implementing pre-procedure testing for COVID-19, particularly during
PPE shortages.
The ADA and state dental societies
are actively advocating state and federal regulatory authorities to:
Publicly recognize that point-of-care
testing for COVID-19 is within dentists’ existing scope of practice, and
Make COVID-19 tests available for
use in dental practices.
“With dental practices reopened
across the country, dentists are already screening patients for signs
© www.sxc.hu
By Dental Tribune USA
According to the ADA, it makes sense for COVID-19 point-of-care testing to be offered
by dentists.
and symptoms of COVID-19, and
referring patients for appropriate
medical follow-up when indicated,”
Klemmedson said. “Unfortunately,
such screening alone will not identify all individuals who are infected.
Identifying infected patients is key
to being able to protect both patients
and dental team members from exposure to the virus.”
treatment may be pre-symptomatic
(infected but will develop symptoms
in the next 14 days) or asymptomatic
(infected but will never exhibit signs
or symptoms of disease), Klemmedson said it is critical to identify those
individuals carrying the virus so
that it is possible to minimize their
contacting and potentially infecting
others.
Given that patients receiving dental
(Source: ADA)
[13] =>
DTMEA_No.5. Vol.10_DT.indd
From British Academy of Restorative Dentistry
Prof. Paul Tipton, UK
Prof. James Prichard, UK
DUBAI
Dr. Matthew Holyoak, UK
2020-2022
Dr Eugene Marais, South Africa
Specialist in Prosthodontics,
President of British Academy of
Restorative Dentistry
BDS(ULond), MSc(ULond),
LDSRCS(Eng), MFGDP(UK),
FIADFE(USA), FBARD(UK), MFDTEd
BDS, Dip(Rest Dent), RCS(Eng),
MSc(Rest Dent)
BChD(Pret) MJDF RCS Eng., President of
British Academy of Dental Implantology
Dr. Elaine Halley, UK
Dr. Rami Haidar, UK
Dr. Adam Toft, UK
Dr. Ashish Rayarel, UK
BDS, MFGDP(UK), MSc, Accredited as
DSD Master by Dr. Christian
Coachman, Founder of British
Academy of Cosmetic Dentistry
BDS, MFDS, RCS(UK), Oral &
Maxillofacial Surgery Specialist,
Aesthetics Training Consultant
100% Money Back Guarantee
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If due to any circumstances a course is postponed, or you have
a travel restriction/quarantine period, you are entitled to a 100% refund.
Group 6 started on 01 October 2020. A delegate could start the programme from Module 2 (18-21 November 2020) and compensate Module 1 with Group 7.
As the modules are not required to be completed in a consecutive way, this will not impact the learning experience of the delegates in anyway.
Certificate | 4 Modules | 15 Days
Module 1 | 01-03 October 2020 | Prof. Paul Tipton, Dr. Adam Toft & Dr. Ashish Rayarel
Treatment Planning in Advanced Restorative Dentistry | The Principles of Occlusion in Advanced Restorative Dentistry | Tooth Preparation in Advanced
Restorative Dentistry
Module 2 | 18-21 November 2020 | Dr. Matthew Holyoak, Dr. Adam Toft & Dr. Ashish Rayarel
Adhesion Composites, Anterior Composite Restorations & Rubber Dam Isolation | Composite Veneers | Posterior Composites
Minimally Invasive Veneer Preparations
Module 3 | 22-25 January 2021 | Prof. Paul Tipton, Dr. Adam Toft & Dr. Ashish Rayarel
Occlusal Examination | Emax & Zirconia Anterior & Posterior Restorations | Bridge Design | Modern Post and Core Techniques
Module 4 | 17-20 March 2021 | Prof. James Prichard, Dr. Hugo Grancho Pinto & Dr. Adam Toft
Aesthetic Perio Connective Tissue Grafting | Aesthetic Perio Crown Lengthening | Enhance Your Expertise in Endodontics Parts 1 & 2
Diploma | 3 Modules | 12 Days
Module 5 | September 2021 | Prof. Paul Tipton, Dr. Adam Toft & Dr. Ashish Rayarel
Bridge Preparation Techniques | Articulator selection in Restorative Dentistry | Porcelain Inlays & Onlays | Tooth Wear: Diagnosis & Management
of Tooth Surface Loss
Module 6 | November 2021 | Prof. Paul Tipton, Dr. Adam Toft & Dr. Ashish Rayarel
Smile Design | Veneer Cementation Techniques Practical | TMD, It's Diagnosis and Treatment | Adhesive Bridge Preparation Techniques
Module 7 | February 2022 | Prof. Paul Tipton, Dr. Elaine Halley, Dr. Rami Haidar, Dr. Adam Toft & Dr. Ashish Rayeral
Botox & Dermal Fillers – A Dental Facial Aesthetics | Digital Smile Design (DSD) & Photography | Digital Dentistry, Orthodontics & Invisalign | Occlusion
3 Seminar, Treatment of the Worn Dentition, Vertical Dimension and Facial Aesthetics
+971 528 423659 | p.mollov@cappmea.com
www.cappmea.com/capptipton
[14] =>
DTMEA_No.5. Vol.10_DT.indd
14
ENDODONTICS
Dental Tribune Middle East & Africa Edition | 5/2020
Minimally invasive endodontics:
challenging prevailing paradigms
By A. H. Gluskin, C. I. Peters and O. A.
Peters, USA
The primary goal of endodontic
therapy is the long-term retention of
a functional tooth by preventing or
treating apical periodontitis. However, there are many other factors that
impact endodontic outcomes such
as the quality of the restoration and
structural integrity of the tooth after
root canal preparation. Contemporary research efforts are currently directed to better understanding dentin behaviour and structure during
aging and function. An alternative
approach is to minimise structural
changes during root canal therapy,
which may result in a new strategy
that can be labelled ‘minimally invasive endodontics’. This review addresses current clinical and laboratory data to provide an overview of
this new endodontic paradigm.
Introduction
Technological advances in optics, instrumentation, materials, robotics,
and computer systems over the last
decades have introduced new strategies and possibilities to the medical
profession. These innovations are
clearly beneficial to patients by dramatically improving morbidity and
mortality outcomes associated with
many surgical procedures.1
Compared to medicine, such a shift
to a non-invasive approach to surgery in dentistry2 has been more
moderate and cautious, perhaps
with the exception of endodontic
and periodontal microsurgery.3 It is
difficult to directly compare operative procedures done to the human
body versus those done on a tooth,
however, a rational approach to dental procedures aiming to remove
or reverse disease should be to conserve maximum structural integrity.
This in turn has the potential to increase the functional prognosis for
any given tooth.
The concept of minimally invasive
endodontics calls for the treatment
and prevention of pulpal pathoses
and apical periodontitis, while causing the least amount of change to the
dental hard tissues. This preserves
the strength and function of the
PAPER endodontically treated tooth
with the intent that it will last the patient’s lifetime.
Just as in medicine, the dental surgeon treating endodontic disease
must develop new skills and dexterity in order to adapt to a limited
working environment within the
confines of the pulpal space. These
skills include working with new instruments and irrigants for cleaning the system; utilising advanced
imaging modalities and computer
software for demonstrating both
the complexities of the root canal
system and improving the accuracy
of techniques; employing increased
magnification and lighting for visualising the pulpal space as well as applying new materials that enhance
the prognosis for restoring structure
and retaining the natural dentition.
There are, however, currently no
developed protocols for minimally
invasive endodontics. The aim of
this review is to illustrate the current
status of non-surgical endodontic
procedures highlighting the conservation of tooth structure to enhance
longevity after root canal treatment.
Preserving structural integrity
It is apparent that remaining structural integrity of the tooth (Fig. 1) is a
key factor that determines prognosis
as it relates to future function of the
tooth after restoration.4,5 Maintaining strength and stiffness that resists
structural deformation becomes the
recognised goal of all restorative procedures, especially in endodontics.
Appreciation for the biomechanical
behaviour of dentin, as the limiting
strength factor of any restorative
complex, requires the recognition
that dentin is weakened unequally
by our restorative procedures.6
2a
2b
Fig. 2 Vertical root fracture originating from post preparation
in tooth 15; (a) Periapical radiograph after attempted apical
surgery; (b) Extracted tooth 15 after complete fracture. Note
large and long post.
More than two decades ago a study
was designed to compare the impact
of endodontic versus restorative
procedures on tooth strength. The
stiffness of cusps was assessed when
comparing traditional cavity preparations to endodontic access openings on bicuspid teeth. It was found
that endodontic access openings by
themselves have only a small (5%)
impact on tooth stiffness as opposed
to any restorative preparation that
removes the tooth’s marginal ridges
(for example, a MOD preparation)
reducing cuspal stiffness by 63%.
The study identified approximately
a 20% loss of tooth strength with
each prepared surface. These findings highlight that marginal ridges
are a key factor in retaining tooth
strength.7
Another fundamental understanding of dentin behaviour within remaining structure comes with the
abandonment of the widely held
clinical perception that endodontically treated teeth are more brittle and hence more vulnerable to
fracture. An early investigation that
demonstrated moisture loss of 9%
after root treatment in dog’s teeth
gave credence to this hypothesis.8
While animal models have some
translation to humans, there is currently an abundance of studies in
human teeth showing that the dentin properties of endodontically
treated teeth do not differ in any
meaningful way from vital dentin.9–11
Conversely, the predominant reason
that endodontically treated teeth are
more prone to fracture relates more
than any other attribute to the structural loss of those root treated teeth
requiring restoration. Collectively,
these studies show minimal dehydration effects from pulpal removal
and demonstrate biomechanical
behaviours in strength and toughness testing that are similar to vital
dentin.9–11
Unfortunately, structural loss alone
cannot answer every clinical ques-
3a
3b
Fig. 3 Minimally invasive access preparation in tooth 37. (a) View
of the access preparation; (b) After root canal filling.
tion that relates to
dentin failure. The relevance of fatigue as a
main mechanism for
tooth fracture and the
resistance of dental tissues to both the initiation and propagation
of cracks is an important research area.12,13
Recently,
investigations have focused on
the impact of chemical
factors such as irrigants
and medicaments on
dentin; the effects of
bacteria on the matrix
of dentin; structural
loss; the effect of post
and core restorations
and the results of age
changes in dentin.6,14 Of
note, there is a reduction of up to 50% in the
tensile strength and fatigue strength of coronal dentin in seniors
(over 55 years) when
compared to that of
young adults. Similarly,
the resistance to propagation of fatigue cracks
in dentin decreases
with increasing patient
age and the incremental rate of crack extension is up to 100 times
greater in seniors.15,16
Biomechanical
behaviour of dentin
1a
1b
1c
Fig. 1 Undue dentin removal during access preparation
in tooth 16, forever compromising tooth strength;
(a) Bite-wing radiograph; (b) Pre-operative periapical
radiograph; (c) Composite build-up with fibre post in
the palatal canal after completion of the root canal
treatment in tooth 16.
When endodontically
treated teeth fail under
function, that outcome
is determined primarily by two aetiologies.
Those causes stated
most simply are: 1) the degree of
stress experienced by the tooth under load, and 2) the inherent biomechanical properties of the remaining
structure responsible for resisting
fracture. It appears that, among technical elements of root canal therapy,
access preparation and post preparation are most relevant in rendering the tooth more susceptible to
significant destabilisation.17 Unfortunately, only a minimal number of
long-term controlled clinical studies
are available to assess the relationship between restoration, especially
with posts, tooth fracture (Fig. 2) and
the biomechanical behaviour of restored dentin. Within the limitations
of bench top research, experimental
evidence compels us to utilise ‘best
practices’, yet our long-term data remains incomplete. The mechanical
demands of human mastication create an endless number of impacting
variables and only those long-term
clinical outcomes remain the gold
standard for evidence.
Teeth that physically fail through a
vertical or unrestorable root fracture
do not have to undergo endodontic
treatment to experience this outcome. It has been demonstrated in
the dental literature that all teeth,
especially molars, can fracture without any endodontic treatment, and
while some state this is not a common finding there are others who
declare that the incidence is underreported.18 However, when fracture
occurs, it will inevitably have a devastating effect on both the periodontal attachment and the bone adjacent to the fracture. Once a fracture
begins in the root and continues it is
characterised by involvement of the
root canal in the fracture progression; bacterial contamination of the
failed section; food-debris, cements,
necrotic tissue and bacteria; as well
as inflammation associated with a
reactive periodontium.19 Studies involving Chinese populations have
reported that fractures may occur
within teeth with vital pulps in individuals with excessive or repetitive
oral chewing habits.18 This is in agreement with Yeh who also suggested
heavy masticatory forces as a cause
for root fracture.20 In addition, root
fractures seem to be more prevalent
in seniors and male populations;
pre-existing attrition is often a component of the condition.18,21
Minimally invasive access strategies
Root canal anatomy and the complexity of human pulpal systems
provide significant challenges for
endodontic therapy. The first priority of effective therapy is to access,
shape and clean the system in a
manner that will allow efficient and
total filling of the root canal space,
while leaving the tooth with sufficient strength to function successfully.
For almost a century endodontic
textbooks have taught the student
of dentistry to expose the pulp
chambers of teeth with ‘straightline’ access to the orifice(s) of the
root canal. Access cavities were to be
prepared and expanded so that their
smallest dimensions were dictated
by the separation of the orifices on
ÿPage 16
[15] =>
DTMEA_No.5. Vol.10_DT.indd
Certificate & Diploma in
Clinical Endodontics
From British Academy of Restorative Dentistry
Prof. James Prichard, UK
BDS (ULond), MSc(ULond),
LDSRCS (Eng), MFGDP (UK)
FIADFE (USA), F BARD (UK),
MFDTEd
Dr. Antonis Chaniotis, Greece
DDS MDSC
100% Money Back Guarantee
If due to any circumstances a course is postponed, or you have a travel
restriction/quarantine period, you are entitled to a 100% refund.
DUBAI
Prof. Paul Tipton, UK
Specialist in Prosthodontics
President, British Academy
of Restorative Dentistry
Group 4
Registration Open
2020-2021
Dr. Adam Toft, UK
BSc (Hons), BDS (Hons),
MFGDP (UK), MMedSci (Rest Dent),
Dip Aesth (BARD)
FBARD PGCertEd (Sheffield)
Pathway to UK
Masters
140 CME & Daily
Hands-On
Group 4 started on 16 September 2020. A delegate could start the programme from Module 2 (09-12 December 2020) and compensate Module 1 with Group 5.
As the modules are not required to be completed in a consecutive way, this will not impact the learning experience of the delegates in anyway.
Certificate | 3 Modules | 12 Days
Module 1 | 16-19 September 2020 (4 days) | Fundamentals of Endodontics
Programme outline: Introduction to contemporary endodontics. Understanding of instrument design and its effect on the prevention of iatrogenic errors.
Maximising endodontic success and understand factors that influence it. Classification and diagnosis endodontically diseased teeth. Contemporary
endodontics. Dentine pulp complex. Radiographic assessment of cases both conventional, CBCT & others. Risk factors in endodontics. Principles of access
cavity design and locating canals and curve canals. Length determination. Standard / crown down / balance forces / modified double flare techniques.
Hands-on training: Hand Filing & Cold Lateral Compaction techniques. Rubber Dam application and access cavity preparation. Introduction to hand and
rotary nickel titanium shaping and carrier based obturation. Obturation Practical- Cold Lateral, single cone and carrier based Compaction. Hand steel files,
hand and rotary NiTi Protaper.
Module 2 | 09-12 December 2020 (4 days) | Aetiology and Diagnosis of Endodontic Disease (Application & Techniques)
Programme outline: Microbiology of endodontic disease and its relationship with the host immune response. Endodontic Microbiology and biofilm
development; Periapical pathology. Pulp reaction to caries. Apex location and length determination. Dental emergencies. Pain management and local
anesthesia. Examination, diagnosis and consent.
Hands-on training: Rotary NiTi and thermoplastic obturation techniques. Protaper Gold. GuttaCore Obturation. Wave One Gold. Warm Vertical and
Continuous Wave Compaction.
Module 3 | 03-06 March 2021 (4 days) | Traumatic Injury, Pain and its Management. Dental Resorption and Pattern of Tooth Fracture
Programme outline: Emergency endodontics and diagnosis in depth. Odontogenic and non-odontogenic pain diagnosis and management. Understanding
advanced endodontic problems. Dental Trauma. Resorption. Orofacial Pain. Obturation techniques. Tooth Fracture.
Hands-on training: Reciprocating NiTi and carrier-based thermoplastic obturation techniques. Advanced rubber dam placement. Race Scout / Race ISO 10
and Rotary Glide Path Management. iRaCe. Single cone obturation with calcium silicate-based sealers. XP Expandible NiTi Technologies. XPShaper / XP
Finisher.
Diploma | 2 Modules | 8 Days
Module 4 | June 2021 (4 days) | Restoration of Endodontically Treated Teeth
Programme outline: The Principles of Occlusion in Advanced Restorative Dentistry. Occlusion Examination. Post and Core Techniques. The restorative
endodontic Interface. Plastic restoration, posts, intra and extra-coronal restorations, cuspal coverage amalgam vs composite. Adhesive Techniques for
Restoration of the Root Filled Tooth.
Hands-on training: Placement of core restorations and post-retained restorations.
Module 5 | September 2021 (4 days) | Management of Endodontic Failure
Programme outline: Rational behind non-surgical endodontic retreatment. Disassembly of commonly used obturation materials. Removal of obturation
materials. Disinfection during retreatment. The 3-dimensional anatomy of root canal systems and its relation to root canal treatment failure. Outcome
studies on non-surgical root canal treatment. Prevention and management of broken endodontic instruments. Calcium silicate cements and their
application during non-surgical retreatment. Microsurgical Endodontics. Local aneasthesia for surgery, flap design, osteotomy preparation, root end
resection and retrograde preparation with microsurgical instruments, precision root end filling with calcium silicate cements and putty, suturing
techniques.
Hands-on training: Re-treatment of common endodontic obturation materials. Microscope powered hands-on. Removal of gutta-percha fillings. Removal
of carrier-based materials. Removal of fiber posts. Broken instrument removal and bypassing. Pulp floor perforation repair. Internal resorption defect
management. Apical plug placement. Hands-on training using porcine cadaveric specimens and microscopes.
+971 528423659 | p.mollov@cappmea.com
www.cappmea.com/endo
[16] =>
DTMEA_No.5. Vol.10_DT.indd
16
ENDODONTICS
Dental Tribune Middle East & Africa Edition | 5/2020
◊Page 14
5a
Fig. 4 Gouging of middle canal third due to use of
Gates-Glidden bur in tooth 46.
the pulpal floor and their widest dimensions were at the occlusal. In this
era of enhanced lighting and magnification, as well as highly flexible
rotary instruments, this approach to
a doctrinaire access paradigm is being questioned as perhaps overly invasive of the tooth and an approach
that may condemn a tooth to structural failure.22,23
5b
5c
Fig. 5 Tapered preparation aligned with access preparation in tooth 36;
(a) Bite-wing radiograph; (b) Pre-operative periapical radiograph; (c) Completed root canal treatment and temporary filling.
Recently, maintaining structural
integrity of the peri-cervical area of
the tooth (about four mm above and
below the alveolar crest) has been
emphasised. Maintenance of the
peri-cervical dentin (PCD), especially
in molars is felt to be critical to their
long-term survivability and optimum function.23 Some argue that in
treatment planning for endodontics,
on a molar tooth especially, clinicians must consider the significantly
higher overall compressive forces
that create a situation requiring a
different set of rules for the calculation of ferrule, post and core design,
resistance to fracturing, and most
importantly, endodontic access (Fig.
3) and removal of radicular dentin
during endodontic shaping.23
In keeping with this philosophy of
minimal invasion of bulk dentin
structure, the use of round burs and
Gates-Glidden burs is now discouraged. While both of these types of
instruments have been essential in
endodontics for decades, they are
now recognised in endodontic treatment as instruments that commonly gouge the endodontic access and
AD
Say Hello
the coronal third of the root canal
(Fig. 4), those areas adjacent to the
cemento-enamel junction (CEJ) of
the tooth with critical structural prerequisites. Gouging of the access and
coronal canal space must be avoided
in order to preserve maximal resistance to structural flexure and
ultimate failure.7,23 By directing the
conservation of dentin and protecting dentin above and below the PCD
the practitioner ensures a more viable and proven method to reinforce
the endodontically treated tooth. No
man-made material or technique
can compensate for tooth structure
lost in those key areas.
Shaping the root canal space
to the Cavitron® 300 Series
Ultrasonic Scaling System
Coming December 2020!
Root canals are sometimes depicted
as smooth hollow tubes that are
more or less tapered in shape. These
misleading images do not reflect the
intricate anatomical structure and
complexity of root canal systems.
They are often asymmetrical or oval
in cross section, they branch, dilacerate and divide and the canal walls
show concavities and convexities.24
Complex root canal anatomy should
be considered one of the most significant challenges in creating root canal
shapes that will support good obturation outcomes and leave sufficient
remaining strength in the root. After
biomechanical instrumentation, the
completed root canal shapes need to
withstand the internal compressive
forces of obturation; provide sufficient resistance form to contain softened and compressible filling materials and retain enough strength for
mastication (Fig. 5).
In a series of morphometric measurements on anterior and posterior teeth, Kerekes and Tronstad25–27
found a wide range of measurements at the apical constriction of
all teeth, thus creating two separate
philosophies for practitioners, each
focused on its own set of evidencebased protocols supporting a position on how to clean these apical
diameters and ultimately shape the
root.
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CAV28-0818-3
In another study that questioned our
understanding of the true horizontal
diameters necessary to clean the terminus, Jou et al.28 coined the term
‘working width’ to alert clinicians to
the critical need to understand the
horizontal dimension of apical size
and its clinical implication in cleaning the apical terminus.
Consequently, current shaping strategies employed by today’s clinicians
align with two general trends in contemporary endodontic practice. A
significant number of practitioners
believe that enhanced apical instrumentation and larger apical diameters with minimal taper in the canal
shape leads to weakening of the root
structure and a loss of control over
the obturation component of treatment. They advocate smaller apical
preparations, continuous taper, and
ÿPage 18
[17] =>
DTMEA_No.5. Vol.10_DT.indd
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[18] =>
DTMEA_No.5. Vol.10_DT.indd
18
ENDODONTICS
Dental Tribune Middle East & Africa Edition | 5/2020
◊Page 16
Fig. 7 Tooth 36: peparation of short canals to an apical size 55 (mb, ml size
55, d size 70) in an attempt to be antimicrobially effective.
Fig. 6 Tooth 36: extremely long roots makes minimal
preparation size a good strategy. Case by Dr Jordan
West.
a preparation that promotes resistance form, a tight apical seal and a
conservative approach to creating
sufficient shape for adequate disin-
fection (Fig. 6). Smaller apical sizes
preserve dentin. The arguments
are strategic and technique-driven,
albeit often supported by inferred
outcomes. The impetus for smaller
apical sizes has been directed at the
disinfection and obturation phase of
endodontic therapy.29–32
On the other hand, there is a significant body of literature that presents
evidence that larger apical canal
diameters (Fig. 7) are important to
shape the apical canal wall, flush
debris, allow deeper irrigation to
the terminus and decrease remaining bacterial contamination in the
system.33–38 Studies vary on which
size diameter will accomplish maximum cleaning. Some researchers
have suggested file diameters ranging from #35‑-#45 to accomplish significant bacterial reduction. Others
have shown that minimal sizes can
accomplish this task as adequately as
larger diameters.40,41 What is remarkably clear from the evidence is that
no matter which school of thought
one ascribes to, it is not possible that
any apical preparation technique
will render the terminus entirely free
of bacterial contamination in an in-
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Despite the general trend towards specialization, the majority
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It therefore goes without saying that the practice of today
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The perfect anchoring of implants of the jawbone and periimplant mucosa should be improved by the enhancements
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fected canal.24,42 In essence, structural
considerations in shaping continue
to remain a compelling argument
for conservative shapes.
Weine et al.43 and others44,45 have described and elucidated the structural
damage and preparation errors that
can occur while shaping root canals
with stainless steel instruments to
large sizes. Transportation, ledging,
apical perforation and loss of the
original canal position are all well
recognised shaping errors that often
lead to loss of working length, ledging and damage to the apical terminus leading to weakening of the root
structure at its most fragile levels.
There is now a large body of conclusive research quantifying the use of
rotary and hand nickel-titanium instruments first described by Walia,46
who report that the use of this
super-elastic metal alloy offers less
straightening and better centered
preparations compared to traditional stainless steel instruments in preparing the wide range of anatomical
variability seen in teeth.47–52
These studies have focused on
the geometry of shape produced
by these instruments alone or in
combination with stainless steel;
including conicity, taper, flow and
maintenance of original canal position. Most of these studies have
recorded the degree of change from
original position and have measured
the loss of original canal positions
based on the definitions by Weine.43
In comparing stainless steel versus
nickel-titanium, researchers have
focused on both the metallurgy of
the systems and the systems themselves.52,53 Collectively these studies
suggest that Nickel-titanium technology alone or in combination with
the conservative use of stainless
steel instruments provides shapes
that are better centered, maintaining the original canal positions with
greater conservation of dentin and
safer radicular preparations.
Disinfection and other considerations in minimally invasive endodontics
In order to address the microbiologic
aetiology of endodontic disease, that
is, periapical inflammation, disinfection is and will always remain,
a key element of the overall treatment strategy. At first glance, any
minimally invasive approach to root
canal treatment is at conflict with
disinfection. Microbiological studies
in vitro, however, do not provide a
definitive answer as to the required
preparation size for antimicrobial
efficacy. Table 1 shows selected studies suggesting a wide range of apical
sizes. More recently a clinical study
rekindled the notion of a preparation ‘three sizes larger than the initial
size’;66 however, a large clinical data
set does not support any particular
canal shape as being associated with
apical healing67 or retention of a root
canal-treated tooth.68
Current cleaning and shaping methods appear to be unlikely to predictably remove all bio-burden from the
root canal system. Therefore, and
particularly under the conditions
of smaller apical preparation sizes,
the search continues for techniques
to enhance irrigation efficacy. The
possibilities for physical means that
enable enhanced disinfection vary
from ultrasonic or sonic activation
up to and including laser activation.69–71
Danube Private University (DPU) - Faculty of Medicine/Dentistry
Steiner Landstraße 12, 3500 Krems-Stein, Austria
www.dp-uni.ac.at
ÿPage 19
[19] =>
DTMEA_No.5. Vol.10_DT.indd
PRACTICE
Dental Tribune Middle East & Africa Edition | 5/2020
19
ENDODONTICS
Table 1 Summary of selected evidence in the last decade to suggest apical preparation
Note the very wide variation for favoured apical sizes and several studies with
◊geometry.
Page 18
inconclusive findings
Size
Ref.
Conclusion
Design
Small
54
There was no significant difference in intracanal bacterial reduction
when Ni-Ti GT rotary preparation with NaOCl and EDTA irrigation was
used with or without apical enlargement preparation technique. It may
therefore not be necessary to remove dentin in the apical part of the
root canal when a suitable coronal taper is achieved to allow satisfactory
irrigation of the root canal system with antimicrobial agents.
in vitro
>#25
55
Root canal enlargement to sizes larger than #25 appeared to improve
the performance of syringe irrigation.
in vitro
#30
56
The minimum instrumentation size needed for penetration of irrigants
to the apical third of the root canal is a #30 file.
in vitro
>#30
57
Root canal preparation to apical size #30 and tapers 0.04, 0.06, or
0.08 did not affect canal cleanliness.
in vitro
58
The degree of root canal curvature decreased the volume of irrigant
at the working length for a given apical size and taper. An apical
preparation of #40.06 significantly increased the volume and
exchange of irrigant at the working length regardless of curvature.
in vitro
#40
59
An increase in apical preparation size and taper resulted in a
statistically significant increase in the volume of irrigant. In addition,
an apical enlargement to ISO #40 with a 0.04 taper will allow for
tooth structure preservation and maximum volume of irrigation at the
apical third when using the apical negative pressure irrigation system.
in vitro
#40
60
Endotoxin levels of dental root canals could be predicted by increasing
the apical enlargement size. Note: The diameters compared were
two sizes #25/.06, 30/.05, 35/.04, 40/.04.
in vitro
61
Better microbial removal and more effective irrigation occurred when
canals were instrumented to larger apical sizes. Although bacteria
may remain viable in dentinal tubules proper instrumentation and
adequate irrigation significantly reduces bacteria from the canal and
the dentinal tubules.
review
62
It was concluded that greater apical enlargement using LS rotary
instruments is beneficial as an attempt to further debride the apical
third region in mesiobuccal canals of mandibular molars.
in vitro
63
When comparing ProTaper size #30; taper 0.09-0.055 and Hero Shaper
size #30, taper 0.04, both to the full WL, the difference between
changes in bacterial numbers achieved with two instrumentation
techniques was statistically not significant.
in vitro
64
Root canals with mild curvature prepared with the #45.02 instrument
to the full WL showed the highest values for extruded material to the
periapical region (0.87 ± 0.22). It seems more reasonable to establish
final instrument diameters based on the anatomic diameter after
cervical preparation.
in vitro
#40
‘Large’
Large
Inconclusive
or statistically
insignificant
Inconclusive
or statistically
insignificant
a
8a
b
8b
8c
Fig. 8 Adhesive build-up with orifice plugs in teeth 13, 14, 15 as part of a full-mouth
rehabilitation. Restorative treatment by Dr Till N. Göhring; (a) Periapical radiograph
teethc14, 15; (b) Postoperative periapical radiograph with permanent restoration and
composite
into the
coronal root
canalorifice
area; (c) Corresponding
clinical view of
Fig. 8build-ups
Adhesive
build-up
with
plugs
teeth prepared for adhesive build-up.
in teeth 13, 14, 15 as part of a full-mouth
rehabilitation. Restorative treatment by Dr
N. Göhring;
Periapical
ableTill
change
in clinical (a)
strategies
for radiograph
Conclusion
using
and placing
An advanc- The
teeth
14, 15;posts.
(b) Postoperative
periapical
causes for post-treatment loss
ing radiograph
principle promoting
minimally restoration
of teeth after
with permanent
andendodontic therapy,
invasive therapy directs the nomi- when the therapy itself has been
composite build-ups into the coronal root
nal use of posts in endodontically successful, have been described in
canal
area;
(c)principle,
Corresponding
clinical view
treated
teeth.
That
based this
article by citing many diverse
teeth prepared
for retainadhesiveauthorities.
build-up The loss of a tooth after
on of
evidence,
affirms that
ing tooth structure is more valu- successful endodontic therapy can
able than the use of a post in almost invariably be attributed to one or
Inconclusive
shaping
continue
remain more
a compelling
every
circumstance
whereto
adequate
predictable explanations.
93,94
structure
exists
for
a
ferrule.
The
or statistically 65
in vitro
argument for conservative shapes.
long-term success 43of endodontic
insignificant
44,45 Often these sequelae are clinically
others
have described
Weinehas
et always
al. and
treatment
been
highly avoidable
and the result of an apdependent
on
the
restorative
treatand elucidated the structuralproach
damage
andthat is far more into therapy
ment that follows. A restored tooth vasive than required to remove and
Table 1 Summary of selected evidence in the last decade to suggest apical preparation geometry. Note the very wide variation for
preparation errors that can occur while
favoured apical sizes and several studies with inconclusive findings.
must be structurally sound and the cure the causes of apical periodontiof control over the obturation component flush debris, allow deeper irrigation to the sealed
shaping
canals
with stainless
steel include:
state ofroot
the root
canal system
tis. These outcomes
be maintained.
Most sizes.
endo- Transportation,
• Poor access cavity design and exof treatment. They advocate smaller apical terminus and decrease remaining bacterial must
instruments
to large
a 1.5 to 2 mm dontically treated teeth today are ecution
In the absence of adequate models during intracanal procedures in an tooth. The presence of33–38
preparations,
continuous
ledging,
and
loss of
contamination
in the
has system.
a positive effectStudies
on frac- restored
for clinical outcomes,
only direct taper,
effort toand
lessen aadditional
loads on a ferrule
with apical
adhesiveperforation
materials. • An
iatrogenic or procedural mishap
ture diameter
resistance will
of endodontically
clinical studies assessing
both apicalresistance
structurally
weakened
root.on which size
bonding provides
an im- weakening
vary
accomplish Adhesive
preparation
that promotes
form,
the original
canal position
are allperi-cervical
well
integrity
treated teeth.81–84 Teeth with a ferrule mediate seal of the pulpal spaces and • Instrumentation errors such a ledgbone fill and tooth function/survival
cleaning. Some researchers recognised shaping errors that often lead to
awilltight
apical seal and a conservative maximum
provide convincing evidence re- Micro-computed
tomography of one mm of vertical tooth struc- some immediate toughening of the ing, perforation, transportation from
have
suggested
diameters
ranging
approach
creatingeffi
sufficient
shape
lossThese
of working
ledging
and damage
garding canaltodisinfection
cacy. studies
not for
only show
overall
ca- ture file
doubled
the resistance
to frac- tooth.
materialslength,
are generally
centre
47–52
The
effect
of
a
modifi
ed
access
cavity
but
have
ture
compared
with
teeth
restored
nal
shaping
outcomes
not
dependent
on
gross
mechanical
Coronal
leakage and recontaminasignificant to the apical terminus leading• to
adequate disinfection (Fig. 6). Smaller apical from #35-#45 to accomplish
weakening
design has only recently been tested also demonstrated that hard tissue without a ferrule.82 Even if the clini- retention, so tooth structure can be tion of the pulpal space
reduction.
Others
have
sizes
preserve
dentin.
The arguments
are bacterial
of the root
at itscan
most fragile levels.
cal situation
does
not shown
permit a that
cir- preserved
in extracted
teeth. Using
a combined
debris is compacted
into unshaped
and structure
these materials
• Crown and root fracture.
ferrule, an
incomplete
micro-computed
tomography and canal
areas
rendering
them potenminimal
sizes cumferential
can accomplish
this
task as certainly
strategic
and technique-driven,
albeit
often
There
nowminimally
a large body
of conclusive
be is
termed
inload-to-failure approach, Krishan et tially inaccessible to irrigation.77 It is ferrule is considered a better
vasive
(Fig.
8).
Conventional
thought
40,41 option
What research quantifying the use As
supported
by inferred outcomes. The impetus adequately as larger diameters.
ofpractitioners
rotary andof the art and scial.72 found that in premolars shap- likely future root canal preparation than a complete lack of ferrule.85,86 has been that posts do not ‘reinforce’ ence of dentistry, poor outcomes in
is to
remarkably
clear from
evidence
for
smaller
apical sizes
hastobeen
directedwill
at have
hand
nickel-titanium
instruments
first
ing was
not impacted
and load
it canthe
be generally
con-is the
techniques
focus on However,
root. Early
restorative protocols
the course of endodontic treatment
46 posts,
failure
was significantly
higher
for balancing
that school
providingof
an thought
adequate considered
disinfection
capacity
and cluded
this by
trueWalia,
for metal
who report
that the reflection on the
no matter
which
the
disinfection
and
obturation
phase
of that
described
should encourage
teeth with minimal access
cavity
ferrule
lessens
the
destabilising
imiatrogenic
damage
with
enhanced
but there is now a growing body of careful and prudent practice of en29–32
one ascribes to,
it is not possible that any use of this super-elastic metal alloy offers
endodontic
therapy.
designs. While the idea of minimally debridement and disinfection.
pact of the post and core system85,87,88 evidence that bonded fibre posts can dodontics that safeguards against
On the
other hand,
there
centered
apical preparation
will81 render
invasive
endodontics
has been
pro- is a significant
and thetechnique
final restoration
in the beless
placedstraightening
with no removal of and
dentin better
undesired
consequences. Our obligamoted
recently,
there
is
a
scarcity
of
long-term
performance
of
restored
structure,
may
protect
the
root
and
Restoration
strategies
for
tion as experts
is to protect patients
body of literature that presents evidence the terminus entirely free of bacterial preparations compared to traditional
stainless
independent evaluations for such maximum protection and
root treated teeth.
from iatrogenic harm. This responsi24,42 make it more resistant to fracture.
that
larger
diameters
(Fig. 7) contamination in an infected canal.
steel instruments
in preparing
the wide
range
a strategy.
For apical
example,canal
root canal
Fibre-reinforced
resin posts
were in- bility
minimal invasion
is met when we as a profession
47–52
preparation
instruments
sometimes
When it comes
to severely damover 20 years
ago with the
Inserved
essence,
considerations
in troduced
are
important
to shape
the apical
canalare
wall,
of anatomical
variability
seencan
in teeth.
Patients
not well
if the structural
provide advanced and sophisassociated with this strategy such endodontic treatment is successful aged teeth with little or no coronal intent to provide more elastic sup- ticated therapies in a safe and conas V- Taper (SS White, Lakewood, NJ, but the tooth fails, especially with structure, in order to provide space port to the core. The reduced stress trolled manner with preservation of
USA) and Endo-EZE AET (Ultradent, the emergence of implants into the for a ferrule, orthodontic extrusion BRITISH
350
NO. dentition
6 MAR 21 as
2014
transferDENTAL
to toothJOURNAL
structureVOLUME
lowered216 the
an overriding priorSouth Jordan UT, USA) have not been mainstream of dentistry and their should be considered rather than the likelihood of root fracture. In ad- ity in all aspects of our treatments.
shown to actually perform in a supe- choice as an alternative
crown
lengthening.
ap- dition, posts made of materials with
© 2014
Publishers
Limited.
All rightsThis
reserved
to Macmillan
saving surgical
rior way to traditional rotary instru- the natural dentition.78 In extensive proach preserves more tooth struc- a modulus of elasticity similar to Editorial note:
mentation in the laboratory.73,74
reviews of evidence surrounding the ture and ensures a more favourable dentin were considered more resil- A list of references can be obtained
restoration of endodontically treated biomechanical behaviour of remain- ient; able to absorb similar impact from the publisher.
Another aspect of this discussion is teeth, preserving intact coronal and ing dentin structure.89,90 If neither of forces, and distribute the forces of
the finding of micro-cracks induced radicular tooth structure, especially the alternative methods for provid- mastication in a more protective This article was published in the
by various rotary shaping proce- maintaining the peri-cervical struc- ing a ferrule for the restoration can manner to remaining dentin than March 2014 issue of the British Dental
dures in canal preparation. In recent ture to allow a substantial ‘ferrule be performed, currently available stiffer metallic posts.78,94 Based on Journal.
years several investigations have effect’, is considered to be crucial for evidence suggests that a poor treat- the aforementioned evidence, it
illustrated such micro-cracks in ex- the optimal biomechanical behav- ment outcome and the ultimate the may be premature to describe adtracted teeth.75,76 While it is not clear iour of restored teeth.79,80 Encircling loss of the tooth has a high probabil- hesive technology as ‘reinforcing’ or
at this point if such cracks are gen- the parallel walls of remaining den- ity.5,82,91,92
‘root strengthening’ but in terms of
erated in vivo, it may be reasonable tin with the crown margin allows a
distributing forces throughout the
to develop instruments that reduce ferrule that provides a protective Is root strengthening a possibility?
remaining dentin structure it may
vibration and rotational stresses effect by reducing stresses within a The past decade has seen a consider- certainly be deemed ‘protective’.
An appropriate apical sizing method can help the operator avoid
unnecessary enlargement of the apex whereas predictably reducing
intracanal debris. Method: During crown-down preparation, the first
crown-down file to reach the apex during instrumentation was noted
(CDF). Teeth were then divided into three master apical file size groups
of CDF + 1, CDF + 2, and CDF + 3.
[20] =>
DTMEA_No.5. Vol.10_DT.indd
20
DIGITAL
Dental Tribune Middle East & Africa Edition | 5/2020
The art of a personalised
smile design
By Dr Galip Gürel, Turkey; Drs
Dimitar Filtchev & Georgi Iliev, Bulgaria; Dr Braulio Paolucci & Adriano
Schayder, Brazil
Introduction
Aesthetics has become one of the
most important out- comes of dental treatments. Regardless of the
complexity of the case, patients are
seeking better-looking smiles. For
many years, we, as dentists or laboratory technicians, have been using
all the basic aesthetic rules in order
to properly create a smile design.
These rules should be fundamental to the design. At the end of the
treatment, the patients should feel
happy. If one can evoke this feeling
with a smile design, both the dentist
and the patient will be satisfied giving and receiving more than standard, well-aligned teeth. However, the
final aesthetic results may often fail
to meet the patient’s expectations,
owing to a disharmony between
the smile design and the patient’s
identity. Patients’ demands and the
level of information needed have
driven the profession to question itself regarding the customisation of
smile designs, which if ignored may
lead to dissatisfaction with the aesthetic outcome, even though all the
aesthetic principles and rules which
tend to establish standards have
been taken into account.
The mock-up
Visualisation of the smile design will
have a great impact on the patient’s
understanding of the rest of the
2a
treatment. It is much more powerful than only verbally explaining
what will be done. Prior to initiating
any treatment, it is necessary to visualise the desired outcome. It then
becomes possible to formulate the
steps required to achieve this result.
Mock-ups facilitate significant improvement in communicating with
the patient by showing him or her
the potential final outcome of the
treatment and allowing an easy comparison of the pre- and postoperative
situations, and mock-ups allow the
clinician to be able to check the functional aspects. Whether it is a case of
worn dentition that requires altering the vertical dimension or just a
straightforward veneer case, the aesthetic plane of occlusion and function will be based on the length—incisal edge position—and position of
the anterior teeth. It is very difficult
to convey the envisioned final length
of the central incisors to the patient
just by adding composite to the incisal edges of the central incisors;
thus, the patient needs to see the
whole smile, including the length
and position of the posterior teeth.
There are different ways to make the
mock-up. It can be created directly
in the patient’s mouth or indirectly
either through a wax-up or by using
digital tools.
The personalised smile design
Every human being is unique and
special and the design of his or her
smile should reflect his or her personality. Shape, texture, colour and
Fig.1: When the dentist first evaluates a new patient with aesthetic concerns, many critical factors may be overlooked. The verbal information exchange should be translated into a visual representation in order to aid in understanding what the final expectations should
be at the end of the treatment, for the patient and the dentist. The basic means of this communication starts with a 3D preview of the
design in the patient’s mouth (APT: Aesthetic Pre-evaluative Temporaries) even before the rest of the treatment is planned. No matter
what clinical difficulties a dentist will face and how problems will technically be solved, if the patient does not like the final aesthetic
outcome, the treatment will be considered a failure.
combination of teeth convey direct
messages, and when it comes to creating smile designs, dentists must
consider the unity of the whole,
which means bringing the biology,
structure, function and aesthetics
together with a fifth element, personality. Personality is the quintessential part here, because the other
2b
cacy, sensuality and the feminine
gender.2
The combination of lines generates
the most basic forms, transferring to
them their own expressions. Thus,
the vertical rectangle expresses
strength by the pre- dominance of
the vertical element on the horizon-
dental shapes, standard dominance,
inclined incisal edge and angled 3D
dental positioning on the arch.
– Delicate: oval dental shapes, medium dominance, curved incisal edge
and standard 3D dental positioning.
– Calm or stable: smoothly rounded
2c
Figs.2a–c: The aim of this aesthetic treatment was to enhance the patient’s smile. However, additional to all the aesthetic smile design basics, the facial analysis and the personality of the patient should be reflected in this design,
in order to create the most natural, minimally invasive, personalised smile design.
four elements are traditionally laid
to balance it like a keystone. Through
the large number of smile design
elements, such as incisal edge, dominance of central incisors, tooth axis
and shape, as well as sub elements
such as morphological details of
each tooth, it is possible to establish,
based on the dental scientific literature, which should be determined
by the facial typology and which
could visually represent the unique
personality of each patient, beyond
his or her personal preferences and
expression of his or her will.
Visual language
Fig.3: Once the mock-up on the central incisor has been completed, it should be digitally
scanned. It can be scanned with any intraoral scanner that can produce an STL file. Most
intra-oral scanners convert the 3D scan into an STL file automatically. However, if the
dentist does not have an intra-oral scanner in the dental practice, an analog impression of the upper jaw (preferably with the direct mock-up done on the central incisors)
is taken and sent to the nearest dental laboratory that owns a scanner (laboratories
that work with a CAD/CAM machine will have a digital scanner). The dental technician
can digitalise this impression for the dentist and upload the STL file to Rebel, in order to
complete the order via a provided link.
Each type of line or shape has a
specific emotional meaning.1 Lines
represent the most basic elements
of visual language. Horizontal lines,
because they con- form to gravity,
express stability, passivity and calmness, while vertical lines represent
the movement of the point against
gravity, expressing strength and
power, just as inclined lines arouse
the sensation of instability, tendency to movement and dynamism.
Curved lines are associated with deli-
tal, the triangle dynamism, the oval
delicacy, the square stability and immobility with the balance between
its vertical element and horizontal
one. These basic shapes can be observed in the facial contour as well as
in the incisors’ shapes and 3D configuration of the dental arrangement,
thus the incisal silhouette.
The visual language knowledge applied to the main expressive elements of smile design, such as dental
shape, incisal edge, interdental ratio
or dominance of central incisors,
and 3D positioning of the teeth in
the arch, determines four smile design types with primary expression
(Fig. 1):
– Strong: composed mainly of rectangular dental shapes, strong dominance of the central incisors and canines over the lateral incisors (radial
symmetry), as well as plane incisal
edge and rectilinear 3D dental positioning on the arch from an occlusal
view.
– Dynamic: triangular or trapezoidal
square dental shapes, weak dominance (current symmetry), horizontal incisal edge and 3D rectilinear or
standard dental positioning on the
arch.
Case presentation
The patient had short teeth and was
not happy with the narrow buccal
corridors and the yellowish colour of
her teeth (Figs. 2a–c).
Aesthetic analysis and Rebel Simplicity
Aesthetic design can be challenging
for dentists. Rebel (Visagismile) is a
recent digital previsualisation technique that allows the clinician to:
– efficiently design the new smile;
– improve the communication between the dental team members involved in the treatment;
– obtain better communication and
achieve better patient motivation;
and
– visualise the final aesthetic result
even before the treatment is started.
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These are the three mandatory steps:
1. a single mock-up on a central incisor to be digitally scanned;
2. a full-face photographic protocol;
and 3. a simple questionnaire.
Single central incisor mock-up and
intra-oral digital scanning
4a
4b
4c
4d
4e
4f
Figs.4a–f: The forehead and the ears of the patient should be visible. It is crucial to keep the head upright (not tilted to the right or left, or up or down). The eyes should preferably be
positioned parallel to the horizon.
A composite mock-up is performed
on one (or two) of the central incisors
in order to identify the incisal edge
position vertically and the position
of the facial surface buccolingually
(Fig. 3). This is no different from creating any direct mock-up; however,
the greatest advantage of creating
this mock-up for Rebel is that the
dentist does not need to concern
himself or herself with the perfect design of this mock-up, meaning that
he or she does not need to choose
the shape of the tooth (square, triangular, rounded, etc.), the angulations
of the axes of the teeth, surface texture, etc. These details of the smile
design will be provided by the Rebel
artificial intelligence-based software,
according to the facial analysis and
the personality of the patient. Therefore, this will allow any dentist at any
level to start working with mock-ups
and end up with high-level wax-ups.
If the dentist does not wish to make
a mock-up, then he or she can alternatively write down the additional
length that would be needed to be
added to the central incisors vertically, and the volume on the facial aspect (e.g., 0.3 mm thicker facially). In
that case, the dentist can easily relate
the existing length of the teeth to
the upper lip position with the help
of a periodontal probe. This information should be noted (the additional
length that is needed to be added to
the central incisors vertically and
the volume on the facial aspect e.g.,
0.3 mm thicker facially) and included in the file that will be sent to Rebel.
Full-face photographic protocol
Fig.5: The optimal tooth shape is determined with the help of the interview. The questionnaire is based on popular psychological tests of personal self- assessment. The first question is an adapted test by Dellinger10 and the other three questions concern personality traits based on the theory and questionnaire by Eysenck and Eysenck.11 The questionnaire
is checked by a computer algorithm to classify the patient’s personality. Based on the data from the interview, a software algorithm automatically calculates the temperament as
perceived by the patient. The temperament is a combination of strong, dynamic, delicate and calm. After this procedure is done, the dentist and/or the technician will have a full idea
of the facial analysis and the personality of the patient.
6a
The software requires five full-face
photographs for facial analysis and
classification of the patient and for
relation of the 3D intra-oral digital
scan to the facial features. The following are the five full-face photograph types needed (Figs. 4a–f).
I. Full-face photograph in rest position
This photograph is for the automatic
facial recognition process of the software, and part of the new Rebel smile
design will be based on this facial
analysis of the patient. Technically,
it is very important that the forehead and the ears of the patient are
visible. If the patient has long hair, it
should be held away from the face.
It is crucial to keep the head upright
(not tilted to the right or left, or up
or down), preferably positioning
the eyes parallel to the horizon and
keeping the lips apart. The software
automatically checks the required
full-face photograph and sends a
message immediately to the dentist
if the necessary technical requirements have not been met so that he
or she can retake the photograph.
6b
II. Full-face photograph of patient
smiling
6c
6d
Figs.6a–d: Rebel is a recent digital previsualisation technique that allows the clinician to efficiently design the new smile, improve the communication between the dental team
members involved in the treatment, obtain better communication, and achieve better patient motivation thanks to the visualisation of the final aesthetic result even before the
case has started. By the same token Rebel will enhance the predictability of the entire treatment and guide the actual clinical treatment. This approach allows the sharing of the
treatment plan with team members and creates a 3D visual perception of the case in the patient’s mouth. The digital project will be tested and approved before the actual treatment
starts and allows the dentist to present the treatment solutions.
3D Rebel smile design plays an important role in the entire treatment
planning and will guide the actual
clinical treatment. This approach
makes it possible to share the treat-
ment plan among team members
and to create a 3D visualisation of
the case in the patient’s mouth. The
digital project will be tested and approved even before starting the ac-
tual treatment. Accordingly, it will
allow the dentist to present the treatment solution.
The Rebel workflow
Rebel offers probably the simplest
steps for transfer- ring all the necessary information to the Rebel digital
laboratory.
Keep the patient in the same position with the eyes open and parallel
to the horizon and the head upright
(not tilted to the right or left, or up
or down). This time, ask the patient
to keep his or her lips apart in a soft
smile (if possible, ensure the incisal
edges of the maxillary incisors are
displayed).
III. Photograph of face in 12 o’clock
position
There are two simple ways of taking
this specific photograph. An easy
ÿPage 22
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way is to keep the patient in the
same position and ask him or her
to incline his or her face 45° forward
while giving a full smile, taking the
photograph so that it shows the relationship to the maxillary central
incisors and the displayed arch position to the lower lip line. The dentist
can also move the patient to a supine
position on the dental chair and to
the 12 o’clock position, ask him or her
to smile fully, and take the photograph from a 45° angle.
his or her teeth closed and the occlusal plane parallel to the horizon.
IV. Full-face photograph with
mouth closed and lips retracted
V. Full-face photograph with mouth
open and lips retracted
The patient should be asked to hold
the full-mouth retractors, again
keeping the position of the eyes parallel to the horizon and his or her
head upright (not tilted to the right
or left, or up or down), and keeping
The same protocol as for the mouth
closed should be repeated, but this
time with the teeth (upper and lower
jaws) separated.
Questionnaire
An interview to reveal the character
and the personality of the patient
is completed through a questionnaire available in the software and
gives the dentist the primary and
complementary characters of the
patient (Fig. 5). The temperamental
type of each individual is defined
by a unique combination of diverse
characteristics of the four main
temperaments, and therefore, for a
precise and practical evaluation, it
is necessary to apply a specific questionnaire.
As the dentist is about to send the
three mandatory files, he or she will
also be asked to include for the Rebel digital laboratory, a description
of the clinical case regarding any
specific designs, such as the buccal
corridors and perfect imperfections,
and the intensity of the surface texture, or choose some of the optional
features provided if needed. When
the entire Rebel workflow has been
completed, the software will guide
the dentist to exit, and at a click of a
button, the file will immediately be
sent to the Rebel digital laboratory
via e-mail.
Rebel digital laboratory
7a
7b
7c
7d
Figs. 7a–d: After the STL file has been 3D-printed (a), the dentist can easily transfer this design to the patient’s mouth by making a silicone impression of the digital wax-up (b). The
harder this silicone transfer impression, the more precise this transfer will be, in order to duplicate all the details, such as the line angles that give the ideal shape of the teeth, as well
as surface texture. This transfer should be done prior to everything. The dentist should evaluate the new design well before starting the tooth preparation with the APT (Aesthetic
Pre-evaluative Temporaries) or as the final mock-up. This way, not only the ideal 3D smile design, but also a great 3D communication opportunity, will be given to the dentist and
the patient. The final aesthetic design should be approved at this time.
8a
8b
It has a very sophisticated simplicity,
owing to a very complex software
behind it which enables the dentist
to do the most simplistic, yet most
predictable and personalised, 3D
wax-up. For every level of dental
practice, reproducible and accessible to all professionals, a concept
for smile design customisation was
developed by Paolucci3 and Paolucci
et al.4 The concept, called “Visual
Identity of the Smile,” arose from the
association of different knowledge
such as aesthetic and functional
dental fundamentals, artistic visual
language, facial recognition and personality typology. For the objective
application of this concept, the Rebel
software was developed (Figs. 6a-d).
Rebel software is able to perform facial reading, personality assessment
and personal preference evaluation
of each patient and convert that information into mathematical language. Through pre-programmed
algorithms, an initial 2D smile design
is created. The software is capable of
transforming this 2D smile design
into a 3D customised model automatically. The model generation is
performed by a custom 3D library,
developed specifically for Rebel Simplicity. Every model is personalised
according to the proposed tooth configuration.
The Rebel system is actually a virtual laboratory that converts the 2D
design into 3D and creates a digital
wax-up immediately. The 2D design
is created by relating the facial perception and the personality of the
patient to the smile design, by applying algorithms for computing the
optimal combination of the incisal
silhouette, tooth axis, dominance
of the central incisors and the combination of individual tooth shapes
out of thousands of possibilities. It
may sound complicated; however, it
is the simplest way of creating one of
the best 3D digital wax-ups possible.
Rebel employs very sophisticated
artificial intelligence based software with algorithms; however, it
provides great simplicity to the end
users, the dentists and dental technicians (Figs. 6a–d).
Back to chairside/3D printing
This STL file is then sent to the dentist via e-mail, ready to be 3D-printed
(Figs. 7a–d).
Tooth preparation through
the Aesthetic Pre-evaluative
Temporaries
The design of the APT (Aesthetic
Pre-evaluative Temporaries). creates
a very solid reference for the tooth
preparation. With the use of a depth
cutter, the dentist can start prepar8c
8d
Figs. 8a–d: Once the final design has been approved by the dentist and the patient, the dentist can anesthetise the patient and start preparing the teeth through the APT (Aesthetic
Pre-evaluative Temporaries). As soon as the teeth have been prepared, it is then the choice of the dentist to continue the case digitally, by taking an intra-oral digital scan, or to continue with the conventional analog way. The patient leaves with the provisionals.
ÿPage 24
[23] =>
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Figs.9a–c: In the same way, the laboratory can produce these veneers digitally by milling or using pressable ceramics or utilising feldspathic veneers. In this case, the material chosen was the IPS e.max Press pressable ceramic
(Ivoclar Vivadent), after one-third incisal cut-back and feldspathic porcelain applied on top with the micro-layering technique and bonded to the teeth.
ing the teeth through the APT. His or
her work will lead to the most minimally invasive tooth preparation
(Figs. 8a–d).5, 6
Porcelain laminate veneers are triedin and after the aesthetic acceptance
of the patient and the dentist, they
are bonded to the teeth under rubber-dam isolation (Figs. 9a–c).
Conclusion
The combination of the basic rules
of aesthetics together with the reflection of the facial analysis and
the personality of the patient in the
smile design creates a more natural
and personalised smile.7–9 This principle presumes harmony between
the smile design and the patient’s
personality. However, in the dental
practice, its application has been
limited owing to the lack of an objective method for assessing the patient
personality and incorporating its results into the smile design.
Currently, Rebel can help the clinician to provide smile designs that
consider patients’ emotions, sense of
identity, behaviour and self-esteem.
Combining modern digital technologies with the classic treatment rules
can be used to achieve predictable
aesthetic results.
The Rebel concept, which can be applied very easily and rapidly, can help
the dentist or ceramist to achieve
this goal in the most simplistic,
practical and personalised way. The
authors’ clinical experience shows
a minimum of 80 per cent success
in the acceptance of the final smile
design treatment. Finally, before any
further investigation and research is
done, if the result by applying this
technique does not satisfy the patient owing to the subjectivity of the
matter, the dentist can always make
minor alterations in order to adopt
this design according to the patient’s
desires.
Editorial note: A list of references is
available from the publisher. This article was first published in the Clinical
Masters magazine, volume 6, issue
2020.
About the authors
Dr Galip Gürel
Private practice in Istanbul, Turkey; visiting professor in the Department of Prosthodontics, College of Dentistry, New York
University, New York, US
Dr Dimitar Filtchev
Associate professor in the Department of
Prosthetic Dental Medicine,
Faculty of Dental Medicine,
Medical University of Sofia, Bulgaria
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Dr Georgi Iliev
Assistant professor in the Department of
Prosthetic Dental Medicine,
Faculty of Dental Medicine,
Medical University of Sofia, Bulgaria
Dr Braulio Paolucci
Private practice in Barbacena, Brazil
Adriano Schayder
Certified dental technician at WELL LAB,
São Paulo, Brazil
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NEWS
Dental Tribune Middle East & Africa Edition | 5/2020
◊Page 1
has been found to reduce gingivitis,
and DTI has previously reported on
a study that showed that vitamin D
supplementation during pregnancy
improved the oral health of offspring during childhood.
vitamin D is cost-efficient, generally
considered safe to take and can be
widely scaled.
Taking vitamin D supplementation—is it necessary?
Expert in senior care pharmacy
practice, Dr William Simonson from
the College of Pharmacy at Oregon
State University in Corvallis in the
US noted in a recent article that, as
SARS-CoV-2 is a new virus, the link
between vitamin D and SARS-CoV-2
prevention is still highly speculative,
as is the case with other treatments.
However, he believes that there is
“sound reasoning behind this speculation”.
The role of vitamin D deficiency
in SARS-CoV-2 infection
They found that 15.6% of the participants infected with SARS-CoV-2
were deficient in vitamin D. Additionally, those who were deficient
in vitamin D tended to report body
ache, pain and fever, but not the respiratory symptoms associated with
COVID-19, such as breathlessness or
a continuous cough. The researchers
noted that the majority of the workers with low-level vitamin D came
from Black, Asian and minority ethnic backgrounds or were in junior
doctor roles. Vitamin D levels were
lower in younger participants and
male participants, as well as in those
with a high body mass index.
The findings also suggested an increase in the development of detectable SARS-CoV-2 antibodies in 72% of
the healthcare workers with vitamin
D deficiency compared with 51%
without a deficiency. Given these
results, the researchers concluded
that lower vitamin D levels in par-
© StockSnap/Pixabay
Vitamin D has been shown to have
a beneficial impact in preventing
infection with bacterial and viral diseases. In a recent study conducted by
University Hospitals Birmingham
NHS Foundation Trust in the UK,
researchers analysed blood samples
from 392 healthcare workers who
were recruited in May 2020, testing
them for the presence of SARS-CoV-2
antibodies and establishing the
concentration of vitamin D in their
blood.
ticipants could have increased their
susceptibility to the virus.
“Our study has shown that there
is an increased risk of COVID-19
infection in healthcare workers
who are deficient in vitamin D,”
said co-author Dr David Thickett,
professor in respiratory medicine
in the Institute of Inflammation
and Ageing at the University of
Birmingham in the UK, in a press
release.
“Our data adds to the emerging
evidence from studies in the UK
and globally that individuals
with severe COVID-19 are more
vitamin D-deficient than those
with mild disease. Finally, our
results, combined with existing
evidence further demonstrates
the potential benefits of vitamin D
supplementation in individuals at
risk of vitamin D deficiency or who
are shown to be deficient as a way
to potentially alleviate the impact of
COVID-19,” he added.
A similar study conducted at the
University of Chicago Medicine
in the US examined 489 patients,
whose vitamin Dlevels had been
measured within a year before being
tested for SARS-CoV-2. The researchers found that patients who had
untreated vitamin D deficiency, that
is, less than 20 ng/ml of vitamin D
in their blood, were almost twice as
likely to test positive for SARS-CoV-2
compared with patients who did not
suffer from vitamin D deficiency.
“Vitamin D is important to the function of the immune system and vitamin D supplements have previously
been shown to lower the risk of viral
respiratory tract infections,” commented lead author Dr David Meltzer, Fanny L. Pritzker Professor of
Medicine at the University of Chicago Medicine, in a press release. “Our
statistical analysis suggests this may
be true for the COVID-19 infection.”
“Understanding whether treating
Vitamin D deficiency changes
COVID-19 risk could be of great
importance locally, nationally and
globally,” he said and added that
Bodies such as the UK’s Scientific
Advisory Committee on Nutrition,
National Institute for Health and
Care Excellence, and Royal Society
have recently published reports in
which they advised adhering to the
current recommended vitamin D
daily intake for overall health and as
a possible precaution against the virus. To maintain the optimal level of
vitamin D in the blood, the National
Health Service advises taking a 10 µg
supplement of the vitamin a day.
The UK study, titled “Vitamin D status and seroconversion for COVID-19
in UK healthcare workers who isolated for COVID-19 like symptoms
during the 2020 pandemic”, was
published online on 6 October 2020
on medRxiv.
The US study, titled “Association of
vitamin D status and other clinical
characteristics with COVID-19 test results”, was published online on 3 September 2020 in JAMA Network Open.
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DTMEA_No.5. Vol.10_DT.indd
28
NEWS
Dental Tribune Middle East & Africa Edition | 5/2020
Dentsply Sirona World 2020
moves to localized in-person and global
virtual programs
By Dentsply Sirona
In addition to a robust general session, numerous opportunities for
networking and always-expected
exceptional entertainment, the
new program will feature dynamic
industry speakers in real time and
on-demand, with a varied range of
engaging course topics, making it an
expanded individual and personalized training event for all attendees.
Dentsply Sirona, the world’s largest
manufacturer of professional dental products and technologies, announced today that Dentsply Sirona
World 2020 will be reimagined into
dynamic localized in-person and
ucational sessions across 12 unique
tracks. The in-person program originally scheduled October 1-3, 2020 in
Las Vegas, NV will be postponed to a
later date.
globally-available virtual events. The
new formats – certain to delight attendees – will offer expanded oppor-
tunities for earning CE credit and feature the best and brightest speakers
in dentistry presenting engaging ed-
“The current circumstances prevent
an event the size and quality of Dentsply Sirona World to take place in
person,” said Senior Vice President
Eric Bruno. “Though we are postponing the event in Las Vegas, the localized in-person programs and the
new and expanded virtual event will
be packed with the same great content expected of The Ultimate Dental
Meeting presented in a new, innovative forum. We are taking a stand
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At its core, Dentsply Sirona World is
a celebration of dentistry combining incredible professional development courses, ample opportunities to connect and network with
thousands of dental professionals
and world-class entertainment in
an exciting, inspiring atmosphere.
The online event will feature a full
program with a general session and
cutting-edge breakouts tailored to
individual needs, with introductory
to expert-level courses ranging from
specialties such as implantology, to
laboratory courses, to hygiene topics.
“The Dentsply Sirona World 2020
localized in-person programs and
virtual event will bring an exceptional experience to attendees, with
our continued commitment for
delivering healthy smiles through
healthy practices” added Bruno. “The
virtual and local in-person programs
will allow attendees to interact with
our speakers, products and latest
technologies in an entirely new way
while continuing to shape the future
of dentistry.”
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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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Are you ready for CEREC?
For CEREC users, it’s simple: CEREC makes even the best dentists better. So going
digital was a great decision, but until they did it they too had their doubts. Would
everything go smoothly straight away? No. Could they learn to handle the technology?
Absolutely. What about the quality of restorations? Outstanding in every way.
There’s never been a better time to future-proof your practice with CEREC.
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
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DTMEA_No.5. Vol.10_DT.indd
Dentsply Sirona Imaging Solutions
Axeos.
Experience the difference.
A new generation of progressive imaging is here – experience the difference with Axeos.
• 2D/3D hybrid device equipped with new technology and a broad Field of View (FoV) range,
from a focused FoV (Ø5 x 5.5 cm) for endodontic cases up to a large FoV (Ø17 x 13 cm)
that covers complete dentition, including both TMJs
• Seamless connectivity and individualized treatment workflow with Sidexis 4 Software
• Patient Positioning and Image Assistant (PIA) for increased patient comfort and image accuracy
Because every patient deserves a healthy, happy smile and every practice team deserves the tools
to make this a reality. It’s time to elevate and expand your treatment offer. It’s time for Axeos.
For more information on Axeos please contact your local dealer,
Dentsply Sirona sales representative or visit
dentsplysirona.com/axeos
THE DENTAL
SOLUTIONS
COMPANY TM
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Table of contents
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Sunshine vitamin D and COVID-19: Is there a correlation?
01 - 26
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-
News
02 - 04
view
-
Industry
06 - 06
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-
News
08 - 08
view
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When is too much light a bad thing in dentistry
10 - 10
view
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News
12 - 12
view
-
Minimally invasive endodontics: challenging prevailing paradigms
14 - 19
view
-
The art of a personalised smile design
20 - 24
view
-
News
28 - 28
view
[toc_titles] => Sunshine vitamin D and COVID-19: Is there a correlation?
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/ Industry
/ News
/ When is too much light a bad thing in dentistry
/ News
/ Minimally invasive endodontics: challenging prevailing paradigms
/ The art of a personalised smile design
/ News
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