digital international No. 3, 2022

Cover / Editorial / Content / Dental imaging market: Product innovation to stimulate demand / Dentists across Scotland are testing AI program that can identify dental caries / Digital readiness in dentistry - An interview with Prof. Andrew Dickenson and Dr Hatim Abdulhussein / Digital scans and human identification / Help your patients say yes! / Integrating digital smile design into the analogue aesthetic workow / Two-piece zirconia implant for global metal-free restoration / Guided implant placement and immediate loading: A five-year follow-up case report / Digital implant restoration of a single arch / Immediately loaded full-arch restoration on four implants in the maxilla / Full-arch rehabilitation using ceramic implants in guided surgery protocol / Industry news / Both digital and analogue dental workflows need to be your best friend! / Manufacturer news / Meetings / Submission guidelines / Imprint

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issn 2193-4673 • Vol. 3 • Issue 3/2022

digital

international magazine of digital dentistry

case report

Integrating digital smile
design into the workflow

industry news

KATANA Zirconia YML
—Sense the difference!

meetings

Digital Dentistry Conference
and Exhibition 2022

3/22

[2] =>

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editorial

Dr Scott D. Ganz
Editor-in-Chief

The next dental frontier: Materials
Dentistry is forever changing in an attempt to provide improved care for our patients. Researchers are
constantly looking to find faster, more accurate, costeffective, simple and beneficial methods, protocols,
technology and products for the industry. Patients with
dental caries can expect to be restored with a stateof-the-art filling material which is expected to mitigate
the decay process and resist the forces of mastication
while mimicking the aesthetics of the natural teeth. It
is not always an easy task to match the shade, texture
and shape of a natural maxillary central incisor requiring
a full-coverage crown or porcelain laminate veneer.
When teeth are to be extracted, it is advantageous to
preserve the bony architecture to maintain the width
and volume of the alveolus with autologous bone or
bone material from other sources. The choice of material utilised can affect the healing time, maintenance
of bone volume and quality of newly generated bone.
Biological barriers and membranes can facilitate healing
and are available in assorted sizes, shapes and materials, such as collagen, pericardium and new amnion–
chorion membranes. Material choice is important in all
these examples.
When patients are missing or will be missing natural
teeth, an implant-supported restoration may be an
appropriate treatment alternative. The dental implant
usually fabricated from titanium could alternatively be
made from ceramic (zirconia) materials. Most dental
laboratories have become very experienced in new digital protocols to facilitate a model-less workflow in place
of physical impressions used to create physical stone
models in analogue protocols. The digitally designed

restorations can then be fabricated from a variety of
different materials available through dental laboratory
technicians. The evolution of CAD/CAM technology
has continued to offer improved materials for crown
and bridge dentistry, as well as dental implant abutments and screw-retained and cement-retained crowns
through full-arch monolithic zirconia.
With the advent and adaptation of 3D printing by
dental laboratories and in-house printing by clinicians,
we are truly limited only by our imagination in terms
of design, aesthetics and functionality. However, the
devices we use are one part of the equation. Perhaps
the area of most important research and development
has been the actual materials that we use every day.
We live in extremely exciting times for the dental industry,
as these materials offer improvement over conventional
analogue fabrications. Can 3D-printed restorations be
used for both transitional and long-lasting restorations
for natural teeth and implants? How can we compare
CAD/CAM-milled restorations to those printed using
stereolithography? Will the deciding factor be the enhanced properties of the materials used? This provides
some food for thought. Material science may just be
the new frontier for dentistry, forever changing how we
treat our patients.
Enjoy this latest edition of digital. We hope that you will
continue to engage, learn and prosper.

Dr Scott D. Ganz
Editor-in-Chief

3 2022

[4] =>

| content
editorial

The next dental frontier: Materials
Dr Scott D. Ganz

industry

Dental imaging market: Product innovation to stimulate demand
Ali Shakerdargah & Dr Kamran Zamanian

03
06

news

Dentists across Scotland are testing AI program that can identify dental caries 10
page 18

Anisha Hall Hoppe

interview

Digital readiness in dentistry

An interview with Prof. Andrew Dickenson and Dr Hatim Abdulhussein

trends & applications

Digital scans and human identification

Dr Botond Simon, Dr Ajang Armin Farid, Dr George Freedman & Prof. János Vág

patient communication
page 48

Help your patients say yes!
Dr Kübel Özkut

case report

16
18

Integrating digital smile design into the analogue aesthetic workflow

22

Two-piece zirconia implant for global metal-free restoration

28

Guided implant placement and immediate loading:
A five-year follow-up case report

32

Digital implant restoration of a single arch

36

Dr Robert A. Lowe

Dr Riccardo Scaringi

page 52

12

Dr Hani Tohme

Drs Abdelrahman Khalaf & Kirollos Hany

Immediately loaded full-arch restoration on four implants in the maxilla 38
Dr Marco Toia

Full-arch rehabilitation using ceramic implants in guided surgery protocol 40
Dr Alexandr Bortsov

industry news

CleanImplant Foundation promotes awareness
of clean implant surfaces at IAOCI 2022

44

KATANA Zirconia YML—Sense the difference!

46

Franziska Beier

An interview with Antonio Corradi

opinion

Both digital and analogue dental workflows need to be your best friend! 48
Cover image courtesy of
MStockPic/Shutterstock.com
3/22

issn 2193-4673 • Vol. 3 • Issue 3/2022

digital

international magazine of digital dentistry

Dr Michael D. Scherer

manufacturer news
meetings

Digital Dentistry Conference and Exhibition 2022:
Boosting use of digital technology in dental practice

56

“Dentsply Sirona World provides a window into the future
of dentistry, which is digital”

60

International events

64

submission guidelines
international imprint

65
66

Iveta Ramonaite

Iveta Ramonaite

about the publisher

case report

Integrating digital smile
design into the workflow

industry news

KATANA Zirconia YML
—Sense the difference!

meetings

Digital Dentistry Conference
and Exhibition 2022

04

3 2022

50

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| industry

Dental imaging market: Product
innovation to stimulate demand
Ali Shakerdargah & Dr Kamran Zamanian, Canada

imaging market. Most companies direct their funds towards research and development in the CBCT market
owing to its leading position.
One of the main trends in the dental imaging market is a
shift towards AI and data insights to improve patient care.
AI-driven technology can provide a personalised dental
solution that fully adjusts to the specific clinical needs of
each individual patient.
Research and development in AI technology has taken
place mostly in dental radiography, and this new technology is establishing its role as a smart assistant that
brings dentists a number of benefits. These include, but
are not limited to, being able to quickly and easily identify
problems, having automated and more precise diagnostics for dental radiographs and receiving suggested
treatment plans.

1
Fig. 1: The total volume of global dental imaging procedures is increasing every
year, and most of that growth is in the CBCT segment. (Image: © iData Research)

Dental imaging is a crucial part of oral care, and the
volume of imaging procedures is predicted to increase as
the global population ages and experiences more dental
problems. According to the latest market insights from
iData, harmful consumer behaviours and artificial intelligence (AI) are also expected to have an influence on the
growth of the dental imaging market.
The global dental imaging market saw less than two
million procedures performed in 2021, and the European
market accounted for less than 400,000 of them. The
total volume of procedures is increasing every year, and
most of that growth is in the CBCT segment. As a result
of the COVID-19 pandemic and the shutdown of dental
offices, the total global market experienced a sharp decline in 2020 but had almost fully recovered by the end
of 2021. Global market growth has been relatively steady
in recent years as a result of product innovation and the
ageing population.

Innovation driving growth
in dental imaging market
The CBCT market is the largest segment in the dental
imaging market, followed by the intra-oral radiographic

3 2022

The use of AI technology in dental imaging is expected
to grow rapidly and become one of the main drivers of
the dental imaging market.

Cosmetic usage boosting CBCT
Increased prevalence of harmful consumer behaviours,
such as regular increases in sugar and fatty food consumption and inactivity, may result in dental caries.
As a result, the overall volume of cosmetic procedures
to restore normal oral and dental health is expected
to rise.
Traditionally, 2D dental imaging machines have been
used as the main tool for capturing an image of the mouth
prior to procedures; however, 2D machines have a huge
limitation in depicting the shape and form of mouth,

“The dental imaging market
has met growth expectations,
and the volume of procedures
presents an opportunity
for manufacturers.”

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| industry
COVID-19’s impact
on the dental imaging market
The global and European dental imaging markets experienced a steep decline in 2020; however, the effects of
the COVID-19 pandemic on the dental imaging market
are expected to vary by market segment. During the
pandemic, non-essential visits to dental clinics were not
possible, and this limited the ability of manufacturers to
sell their products.
Crucially, the COVID-19 pandemic reduced the number of dental procedures in 2020, and this reduction
was directly tied to respective countries’ hospital and
clinical prioritisations. Urgent procedures were performed, but patient safety necessitated meticulous
preparation.
2
Fig. 2: In terms of value, Western Europe’s dental imaging market trails
behind that of North America. (Image: © iData Research)

as looking at a 3D object in 2D is not very accurate. Therefore, the complication rate of dental procedures was
higher before the availability of 3D dental imaging tools.
The birth of CBCT scanners was a revolution in the
dental industry, as it enabled dentists to capture 3D images
and see the mouth from any angle. CBCT helps dentists
to visualise the structures without the need of superimposition, and this advancement helps dentists to
identify a patient’s issues more clearly and to adopt
a better treatment.

Dental imaging market set
to keep growing
The dental imaging market has met growth expectations,
and the volume of procedures presents an opportunity
for manufacturers to enter the market. The market is
predicted to grow alongside the ageing population
and the increase in number and significance of dental
imaging product innovations.
Overall, the global dental imaging market was valued
at less than US$2.5 billion (€2.2 billion) in 2021, and
the European market was valued at slightly above
US$500 million. The global market is expected to grow
moderately, and the European market is expected to
experience a slight decline.

The use of CBCT in the dental industry is expected
to increase as a result of the rise in need for cosmetic
surgeries.

An ageing population requires
more dental imaging

about

Dental problems can occur at any time in life, but the
probability of their occurrence has a strong positive
association with advanced age. In other words, as you get
older, you are more likely to have dental and oral problems.
Age-related dental problems include, but are not limited to,
periodontitis and root and coronal caries.

Ali Shakerdargah is a research
analyst at iData Research.
He develops and composes
syndicated research projects
regarding the medical device industry,
publishing the Global Dental Imaging
Market research report.

Globally, there has been a shift in population dynamics.
For example, across Europe, a significant proportion of
the population is now geriatric. People in this age category require more extensive dental care, for example
for the provision of implants and overdentures or for the
treatment of age-related conditions. As the number of
people in this age bracket needing these procedures increases, dental professionals will require more advanced
dental radiographic devices.

Dr Kamran Zamanian is CEO and
founding partner of iData Research.
He has spent over 20 years working in the
market research industry with a dedication
to the study of dental implants, dental
bone grafting substitutes, prosthetics,
as well as other dental devices used in
the health of patients all over the globe.

3 2022

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1. 80% of studies (4 of 5) show patients choose digital impressions over conventional (Chandran et al. 2019).

[10] =>

© NicoElNino/Shutterstock.com

| news

Dentists across Scotland are
testing AI program that
can identify dental caries
By Anisha Hall Hoppe, Dental Tribune International
A pioneering study is being carried out across both
National Health Service (NHS) and non-NHS dental practices
in Scotland in which software driven by artificial intelligence (AI)
is helping practitioners locate caries more effectively. The
program, AssistDent, was developed by Manchester Imaging,
a spin-off company from a collaboration between dentistry and
imaging sciences at the University of Manchester in the UK.
Aimed at early detection, AssistDent utilises machine learning
algorithms to evaluate dental radiographs to note or confirm
areas of potential enamel-only proximal caries. With early
identification of dental caries, patients can avoid fillings
through preventive care such as fluoride treatments.
With more than 65 practices and 200 dentists serving
over half a million patients across Scotland, Clyde Munro
Dental Group is using AssistDent in a pilot test with five
of its dentists located across Scotland. Fiona Wood, the
chief operating officer for Clyde Munro, explained the use
of AI as a powerful tool for prevention, stating: “We always
aim for prevention—and this technology has the potential

10

3 2022

to support our dentists in identifying the early signs of
tooth decay before it develops and to direct the prevent
care needed to the correct teeth. The AI is a useful tool to
show and demonstrate to patients areas of dental need or
concern to give the patient the chance to reverse enamel
changes with support from Clyde Munro dentists.”
AssistDent’s capability has been evaluated in peer-reviewed
research conducted by experts from the University of Manchester’s dental school published in the British Dental Journal.
In the study, the group that used AssistDent found 76% of the
caries previously identified by expert dentists on 24 bitewing
radiographs, compared with 44% of the problem areas found
by the group that did not utilise the AI software. The researchers
concluded that AssistDent significantly improves dentists’
ability to identify enamel-only proximal caries.
According to the 2019 Global Burden of Disease study and
the World Health Organization, untreated dental caries affects
44% of the global population, some 3.5 billion people, making
it the most common condition out of nearly 300 evaluated.

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| interview

The concept of digital readiness refers to “the ability to be digitally literate and work in a digital society”, according to Dr Hatim Abdulhussein.

Digital readiness in dentistry
An interview with Prof. Andrew Dickenson
and Dr Hatim Abdulhussein
By Brendan Day, Dental Tribune International

Though the era of digital dentistry is well and truly
underway, there are still significant numbers of dental
professionals and patients who are not in a position to
take advantage of it. Recently, Prof. Andrew Dickenson,
Dr Hatim Abdulhussein and Jessie Tebbutt published an
article on this topic, titled “An overview of digital readiness
in dentistry—are we ready?”, in the British Dental Journal.
Dental Tribune International spoke with Prof. Dickenson
and Dr Abdulhussein about the concept of digital readiness and asked them what they felt should be considered
in order to improve access and education moving forward.
In your article, you wrote “The digital divide will
continue to be a persistent challenge unless actively
addressed”. In your view, where does this digital
divide lie, and what factors have caused it?

3 2022

Prof. Andrew Dickenson: It’s quite a complex issue, and
there are a number of reasons for this digital divide. The
most significant factor is education. Dentistry is delivered
by small teams, working in relative isolation, where access to regular educational updates can be a challenge.
Funding is another factor because dentistry in the UK is
still very much an owner-provider service—dentists own
their practices, and investment in digitally compatible
equipment will have a financial implication.
It’s an issue that reaches the policy level within healthcare.
We really do not have a framework that sets out what
the expectations and potential benefits are of adapting
to a more technologically driven health service, and so it
becomes harder to bid for sustainable investment. This
ties into the final factor, which is an underlying suspicion

[13] =>

interview

Left: Prof. Andrew Dickenson. (Image: © Andrew Dickenson) Right: Dr Hatim Abdulhussein. (Image: © Hatim Abdulhussein)

of technology. As we wrote in the article, technology is
not a tool to be adopted but a culture to be grown. There
has been investment in technology that has subsequently
been under-utilised because the underpinning educational
element is missing. This inevitably generates a negative
attitude that can be difficult to overcome. Frustration not
only leads to practitioners abandoning technology but
also reinforces the assumption that it does not work.
So, it is increasingly important to instil in people the confidence to believe that digital tools can actually support
their clinical practice. However, for this to be sustainable,
all members of the team need to be provided with appropriate education and training.
Dr Hatim Abdulhussein: This digital divide isn’t just a
dentistry thing but rather a larger societal issue. We’ve
massively changed the way we do things; for example,
many of us do online banking and online shopping. The
way in which we interact with technology on a daily basis creates a divide itself because not everyone has internet access or the skills and the capabilities to use digital
devices effectively. If you then consider healthcare providers, dental care providers and so on, you’ll realise that
there is a wide range of technical proficiency, going from
those who are very proficient to those who need considerable training and support. This divide exists in patients
too and affects how they access care and how they are
able to access dental services.

Overall, the digital divide is something that, as Andrew
said, needs to be tackled with an approach that involves
educating the dental workforce so that everyone is able
to have similar capabilities. This will help to reduce any
sort of divide in terms of the way services are provided to
different patient groups.
Does the general level of digital readiness vary between dental professionals and patient groups? Are
dentists able to influence their patients in this regard?
Dickenson: Dentistry is a very adaptive profession—one
that has adopted a great deal of clinically oriented technology—and so I think there is a real opportunity for dentists to educate their patients. Currently, dentists are generally seeing fewer patients than before COVID-19, and
so we need to maximise the time we have with them and,
if possible, empower them to communicate through digital technologies. For example, tools such as QR codes
haven’t really been widely used in dentistry but have the
potential to benefit patients by providing instant access to
digital self-care resources. The availability of remote consultations and treatment monitoring software, available
through smartphone technology, allows members of the
dental team alternative ways to interact with patients. This
offers significant benefits for patients in terms of personalising care while also influencing their health behaviour.
Of course, we need to consider that not all patients may
have the digital literacy or the equipment to access this

3 2022

[14] =>

| interview
type of care, but it is important to help those who might
have some resistance to digital technology to overcome it.
Abdulhussein: Last year, the Health Foundation published
an interesting report called Switched On. It investigated
the level of familiarity with artificial intelligence (AI) found
among different members of the healthcare workforce
and the general public. The results showed that dentists
and doctors clearly have a higher familiarity with AI than
members of the general public do. However, the report
stated that the majority of healthcare workforce members
are still not familiar with AI and might be suspicious of

“The digital divide is
something that [...] needs to
be tackled with an approach
that involves educating the
dental workforce so that
everyone is able to have
similar capabilities.”—
Dr Hatim Abdulhussein
its benefits. So, there’s clearly a divide not just between
dentists and the general public but also between different
members of the healthcare workforce.
Many factors contribute to these divisions, but the greatest impact comes from prior experience. If healthcare
professionals train in an area with substantial technological infrastructure, they’re going to be more digitally ready.
If they train in a more rural practice with less technological
infrastructure, their skills and experience in this area may
be lacking. Overcoming this difference in digital readiness between different groups of healthcare workers is
key if these workers are then going to have an impact on
the readiness of their own patients.
What role could artificial intelligence and robotics
play in the future of dentistry, and what needs to be
considered to ensure that these technologies are
adopted safely and ethically?
Abdulhussein: For AI, it comes down to the quality
and the accuracy of the data you obtain. AI is going to
augment healthcare and support the way we work—
it might support our decision-making, automate certain
processes and take away some of the administrative
burden. An area in which we believe AI has much potential
is the prevention of oral disease. The gathering of infor-

3 2022

mation about the way in which patients manage their own
health can guide dentists in providing advice about what
patients can change in their oral health routines in order
to stay healthy or what new ideas they can implement.
To ensure that AI and similar technologies are used ethically and safely, there have to be clear regulations regarding their use. They need to provide a clear benefit for your
patients and make a difference in their experiences and
to their health. Also, the dentist needs to clearly understand how he or she can use this technology to enable
these benefits to be experienced by patients.
Dickenson: I think that’s a really important point because,
in the past, UK government funding has gone to different
parts of the health system to invest in technology without
the educational underpinning that should go with it. And
this is the point at which people become suspicious about
whether a new technology will work and safety concerns
arise. What COVID-19 has helped us to understand is that
we can use certain digital technologies to conduct remote
check-ups and monitoring more successfully than we ever
thought possible, but this requires greater adoption if we
are to effectively expand into AI. Further investment in
research, product development, software design and education will be necessary to lead the growing integration
of AI into clinical practice. Equally, we must ensure that the
public are involved in these developments, as their compliance is essential in safely adopting new technology.
Are there any frameworks in other countries or regions
regarding digital readiness in the dental profession
that could serve as an example for the UK to follow?
Dickenson: Scandinavia is a good place to look in this
regard. I have seen dental practices there utilise simulation technologies for the education of both dental teams
and patients, and provide in-house training on new equipment using innovative interactive resources. This concept
of in situ simulation for training teams, within their own
clinical area and not in the artificial environment of an
education centre, is something we’ve started to adopt.
Abdulhussein: So digital readiness, broadly speaking, is
the ability to be digitally literate and work in a digital society.
Measuring it can be difficult—you need to understand
what the individual needs to know in order to succeed at
his or her job. On a wider level, this means understanding
what the learning needs are for digital healthcare technologies, and this is something which we’re working on
in the UK but which has already been implemented in
other countries. The Australian Medical Council, for example, published a capability framework for digital health
and medicine last year that acts as a really useful guide
for what medical practitioners in Australia need to know in
order to work with their digital infrastructure. I think this is
an important process that could help dentists understand
how being digitally ready applies directly to their work.

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| trends & applications

Digital scans and human identification
Dr Botond Simon, Dr Ajang Armin Farid, Dr George Freedman & Prof. János Vág, Hungary & Canada

Background
The exponential growth of digital technology in dentistry is inherently accompanied by a significant expansion of 2D and 3D dental
image records. Traditional stone models are impractical to keep
long term owing to storage volume and fragility. Comprehensive
and accurate models offer an excellent record of the preoperative dentition for the complete restoration of a smile that matches
the original.1, 2 The longer-term storage of dental models facilitates
the resolution of legal cases and might aid bite mark analysis in
some criminal cases.3 Yet another application of dental models is
for human identification. In addition to DNA and fingerprints, dental examination is a primary tool for disaster victim identification
(DVI).4, 5 Dental models that are discarded or lost may deprive biologically driven oral rehabilitation of historical tooth, bite and bone
reference points and may hamper positive identification.

Figs. 1a–c: The surface comparison maps of non-relatives of the maxillary
first molars (a), of the maxillary second molars (b) and of the palate (c). None
of the teeth had restorations. Deep red and blue areas indicate a distance
deviation higher than the range of the colour scale.

Population-wide databases for fingerprints6, 7 and DNA8, 9 are
limited and very fragmented. After the 2004 tsunami disaster in Thailand, 46% of the victims were identified by dental
records, compared with only 19% by DNA and 34% by fingerprints. The dental identification method is an analogous
visual comparison of the ante mortem and post-mortem
dental records.10, 11 The basis of this concept is that dental
treatments are always very specific and unique.12, 13 To confuse matters somewhat, teeth are continually impacted by
abrasion, disease, trauma and dental treatment. Thus, the
available ante mortem data might not correlate well to the
post-mortem data. Furthermore, treatment notation and information are not standardised, and it is exceedingly difficult
to run an automatic search in a large, fragmented database.
Identifying the victim’s dentist, or, at the very least, the area
where the victim was treated, is a mandatory prerequisite for a
DVI search. Ante mortem dental records can be very challenging

3 2022

if no other victim information is available. In fact, younger patients
may have only orthodontic records. The search process can
be accelerated dramatically by accessing the ever-increasing
number of digital scans and cloud-based data storage systems.
Digital dental records must be retained, depending on national
regulations, for years to decades.14, 15 Thus, digital dental records
open new pathways for DVI. The logical next step is to determine
oral cavity characteristics to employ that are universal, unique,
invariable (stable throughout the life) and easy to access.
Monozygotic (MZ) twins cannot be distinguished by DNA
analysis,16 and they look very similar (phenotypes). Hence,
one way to prove the uniqueness of an identification method
is its ability to reliably distinguish between MZ twins. It has
recently been revealed that palatal morphology (palatal vault
and surface texture) can differentiate MZ twins through intraoral scans.17 Rugoscopy (also known as palatoscopy or calcorrugoscopy) is based on the difference in palatal rugae
patterns and can distinguish among ethnic and race groups,
offering great assistance during DVI.18–25 The palate is more
resistant to burn deformation injury compared with the skin.26
It is stable over time and little varied after orthodontic treatment.27–30 The aim of this pilot study was to compare tooth
and palate uniqueness using the intra-oral scans of MZ twins.

Methods
Three pairs of MZ twins, ages 17, 22 and 26, were enrolled in
the study. The complete maxillary arch, including the palate,
was scanned with the Emerald intra-oral scanner (Planmeca;
software: Romexis Version 5.2.1). The palate was carefully
isolated on each scan and was exported to a separate model.
The left maxillary first molar was intact in five participants and
filled in one participant. The left maxillary second molar was
intact in each participant. These two teeth were segmented,
and the images were exported to respective new files.
Digital palatal models and digital tooth models were aligned
between non-relatives (Fig. 1) and between siblings. The
superimpositions were made using the GOM Inspect software
(GOM Metrology), utilising the local best-fit algorithm. The mean
absolute deviations were calculated for each superimposition
with the surface comparison tool. The data was statistically
analysed by the generalised linear mixed model using SPSS
(IBM SPSS Statistics for Windows, Version 27.0; IBM Corp.).

Results and discussion
The mean absolute deviations (± the standard deviation)
of the first and second molars between non-relatives were

[17] =>

trends & applications

MZ twins.17, 37 Recent and ongoing developments in intra-oral
scanning technology will further improve the reliability. Digital
casts of twins can also be used to study genetic and environmental factors in odontogenesis.38 It is of great importance that
dentists should not discard digital models after completion of
the dental work. These archived models are very useful for legal,
forensic and rehabilitation purposes, now and far into the future.
Editorial note: A list of references is available from the publisher.
This article originally appeared in Oral Health Magazine, and an edited
version is provided here with permission from Newcom Media.

about

2d
Figs. 2a–d: The digital casts of two siblings (grey and blue) and the surface comparison (colour map). Two maxillary first molars of the 22-year-old MZ pair (pair #3; a).
The teeth had occlusal restorations, resulting in increased deviation (red arrows).
Two maxillary second molars of pair #3 (b). These teeth had no restorations or abrasions.
However, the occlusal surface morphology was quite different between siblings.
Two maxillary first molars of 19-year-old MZ pairs (c). There were no restorations, and
the cusp shapes were very similar. However, a sign of abrasion could be seen in the first
sibling (blue), creating an increased deviation between scans (red arrows). The palate of
pair #3 (d). The colour range in the palate was three times more than in the tooth map.

not significantly different (0.259 ± 0.039 mm, 0.277 ± 0.037 mm;
p = 0.733), but the mean absolute deviation of the palates
was significantly higher (1.061 ± 0.314 mm; p < 0.001). Previous studies have found that a single tooth’s trueness is
between 14 µm and 72 µm.31–33 The trueness of the palate
has been reported to be between 80.5 μm and 130.5 μm.34, 35
Accordingly, the intra-oral scan can distinguish between
unrelated people based on either tooth or palate imagery.
Molars in MZ siblings look very similar (Fig. 2). The mean absolute deviation of the first molars between siblings was significantly lower than the second molar deviation (0.087 ± 0.032 mm
vs 0.137 ± 0.038 mm; p < 0.05). Notwithstanding that one of the
first molars of the MZ pairs had restorations, these values were
significantly (p < 0.001) lower than the deviations between
non-relatives. Since these values are not much higher than
the intra-oral scan trueness, they jeopardise the confidence in
MZ twin identification. The palatal deviation between siblings
was three to four times higher (0.393 ± 0.079 mm; p < 0.001) than
the tooth deviation. Although, the deviation was significantly
(p < 0.001) lower than the values between non-relatives, it was
ten times higher than the precision (i.e. reproducibility, 35 µm)
of a recent intra-oral scan.17 It was three times more than the
trueness of the intra-oral scan regarding the palate.33, 34
Along with the present findings, there is increasing evidence
that the 3D digital palatal model could serve as a highly reliable
tool for human identification30, 36 and for distinguishing between

Dr Botond Simon is a PhD student
at Semmelweis University in Budapest
in Hungary. He is a specialist in
restorative dentistry and prosthodontics.
He is co-founder of Scrunch, an early-stage
start-up company that provides
personalised online dental care, and
maintains a private practice in Hungary.
Dr Ajang Armin Farid is the chief
forensic odontologist of Hungary’s Interpol
disaster victim identification dental unit
and a member of Interpol’s disaster victim
identification odontology sub-working group.
He is a fellow of the American Academy
of Forensic Sciences and a member of the
American Society of Forensic Odontology.
He lectures at Semmelweis University in
Budapest in Hungary and maintains a private practice in Budapest.
Dr George Freedman maintains a private
practice in Toronto in Canada limited to
aesthetic dentistry. He is adjunct professor
of dental medicine at Western University
of Health Sciences in Pomona in California
in the US and a visiting professor and director
of the MClinDent programme in restorative
and cosmetic dentistry at BPP University in
London in the UK. Dr Freedman is a regent
and fellow of the International Academy for Dental-Facial Esthetics
and a diplomate and chair of the American Board of Aesthetic Dentistry.
He is a founder and past president of the American Academy of
Cosmetic Dentistry and a founder of the Canadian Academy for Esthetic
Dentistry and the International Academy for Dental-Facial Esthetics.
Prof. János Vág is professor and head
of the Department of Restorative Dentistry
and Endodontics at Semmelweis University
in Budapest in Hungary. He is a specialist
in restorative dentistry, endodontics and
prosthodontists. He is co-founder of Scrunch,
an early-stage start-up company that
provides personalised online dental care.

3 2022

[18] =>

| patient communication

Help your patients say yes!
Dr Kübel Özkut, Turkey

The last two years have certainly been challenging
times, and many of us have been understandably worried
about what it all means for the future of our businesses.
The additional weakness of systems that were already
struggling prior to the COVID-19 pandemic have become
even more magnified and that certainly is not helping us
regain our patient numbers.

18

3 2022

Since the beginning of the pandemic, we as dental
professionals have put a great deal of effort into making our patients feel safe and protected so that they
can properly maintain their oral health by receiving any
necessary treatment. However, knowing how to execute
excellent dental treatment and having the opportunity
to provide treatment to our patients are two different

[19] =>

© sirtravelalot/Shutterstock.com

patient communication

|

nity to make improvements to our systems to raise case
acceptance rates.
If we want patients to accept treatment, we need to fully
understand what it is they really desire. When we have
the same priorities as our patients, our practices’ retention and case acceptance rates will go up. Patients will
feel more in control of the process and appreciate that we
have really understood their needs and values—thereby
fostering loyalty and trust.2 They will not feel pressured
into accepting treatment they do not really want. Instead,
they will gladly accept treatment that will help them meet
their oral health goals.

Engagement with patients
Effective listening is the key to finding out what motivates
patients, what they think about their smiles and what it
is that they would like to improve.3 It is not about selling
dentistry; it is about getting to know our patients and
even partnering with them so that we can create a winwin situation. Asking questions, particularly open-ended
ones, can help encourage patients to communicate their
oral health-related desires; for example:
– On a scale of 1–10 (1 being poor and 10 being
excellent), what level of oral health would you like to
achieve?
– Have you ever encountered problems with chewing,
or have you had mouth or tooth pain?
– How important is your smile to you and to your confidence when interacting with people, both personally
and professionally?
– If you had a magic wand, what would you like to change
about your smile, if anything?
– Diet affects oral health. Could you please tell me about
your diet?

things. Getting patients to schedule the treatment we
recommend can be difficult, but it is vital to our practices’ success. The acceptance rate should be greater
than 80% for existing patients and between 50% and
75% for new patients.1
It is imperative to take the time to explain to each patient
why he or she needs the particular treatment, and we
must do our best to answer all of his or her questions.
Despite receiving all the necessary information concerning
the proposed treatment, many patients leave the office
without scheduling an appointment for the treatment—
some never to be heard from again. While this can be
quite a frustrating situation, it can also be an opportu-

We dentists may be excellent clinicians and superior
at treatment planning, but presenting treatment plans
to the patient is something better delegated to a welltrained staff member. For example, having a treatment
coordinator who goes over every detail with the patient
in a comfortable, quiet environment, giving him or her
the opportunity to ask questions without feeling rushed,
can be very effective.
Conversations supported with digital tools to demonstrate treatment options visually also help patients
understand the benefits of the suggested treatment
and help them feel more connected to the practice,
which of course makes them more comfortable about
scheduling treatment. If we want to improve case
acceptance in our practice, we should ask for the patient’s final decision after presentation of the suggested
treatment and explore any barriers to acceptance with
the patient.

3 2022

19

[20] =>

| patient communication
Dental fears

Efficient recall and retention programme

Unfortunately, dental fears are common and often keep
patients from getting the treatment they need. When
patients look at before and after photographs of similar cases we have completed, it can help to ease their
fear and earn their trust, making them much more likely
to accept the treatment. It is imperative that the patient understands exactly what the treatment involves
and how we plan to keep him or her comfortable. This
includes enquiring about his or her concerns, covering the possible consequences of not receiving treatment and focusing on the advantages of the proposed
treatment.

Retaining a current patient is far easier and more costeffective than attracting a new patient, so investing time
and effort in an efficient patient recall and retention
strategy is essential. In an effective recall and retention
programme, patients should visit twice a year.

Research has found that nearly 68% of those who avoided
or delayed visits to the dentist gave the expense as the
primary reason.4 While multiple reasons were given, the
cost of going to the dentist was mentioned more than
twice as often as anything else.4 Most patients do not
put money away specifically for dental care and have
no idea how they are going to pay for treatment.5 In my
experience, if they are not in pain, patients often convince
themselves that they do not need treatment, which inevitably leads to more complicated problems and additional
costs down the road.
We should take the time to educate patients in detail before talking about costs, making sure that they
understand the value of the care we provide. If it is
because they do not really see the value of the treatment, we should educate them about their condition
and the possible consequences of not receiving the
treatment. Once patients understand why they need
treatment, price becomes less of a barrier. In our clinic
policies, we should offer different financing options for
our patients, showing them that we are also ready to
support them.

Lack of time
Lack of time is a common reason for treatment delay.
Like most people, our patients are often very busy and
may forget to call to schedule treatment once they leave
the practice, sometimes despite knowing the importance
of their dental health and the importance or urgency of
the proposed treatment. To overcome this, we can train
our treatment coordinator to follow up with the patient
two days or a week after the initial case presentation
is made. That way, the conversation is still fresh in the
patient’s mind.
We can use these calls as an opportunity to educate patients even further and address any lingering concerns.
Patients will appreciate the extra effort and gain a better
understanding of the recommended treatment and why
it is necessary.

3 2022

The recall and retention strategy should involve making
patients aware of the practice’s services and the value of
the ongoing care that the team provides. This includes
the amazing advancements in dental materials and
digital technologies and the treatment options available.
It is important to emphasise the improved patient experience and faster results that can be achieved with
these tools.
In summary, an efficient, structured case presentation
policy ensures that patients say yes to our treatment
plans. It also addresses one of the core values of dentistry, which is commitment to oral health as a component of the general health of our patients. When we gain
and retain patients who value our practice, we will have
the opportunity to practise with less stress and more joy
in our clinics.

Editorial note: A list of references is available from the
publisher.

about
Dr Kübel Özkut graduated in dentistry
from Istanbul University in Turkey
in 1996 and received her MBA with
a focus on healthcare management
from Yeditepe University in Turkey
in 2003 and her master’s degree in
prosthodontics, aesthetics and digital
dentistry from the University of Siena
in Italy in 2020. She is an adjunct
professor of business and administration at the dental school
of the University of Siena, teaching in its residency master’s
programme in prosthodontic sciences, and is a visiting lecturer
at Acıbadem University in Istanbul. Since 2009, she has
been the clinic director of the dental department of
Acıbadem Health Group’s Maslak Hospital in Istanbul.
Her special interests are aesthetics, advanced restorative
and digital dentistry. She also gives consultations and
lectures on the management of healthcare organisations.
Dr Özkut is the president of the Turkish Academy of Esthetic
Dentistry and a scientific committee member of the European
Academy of Digital Dentistry, European Association for
Osseointegration and European Society of Cosmetic Dentistry.

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[22] =>

| case report

Integrating digital smile design into
the analogue aesthetic workflow
Dr Robert A. Lowe, USA

Fig. 1: Pre-op photograph taken with the EyeSpecial C-III (SHOFU Dental) to convey shade information to the ceramist. Fig. 2: Retracted view of initial provisional
restorations made of Tuff-Temp Plus (Pulpdent) after removal of the existing restorations and registration of master impressions and interocclusal records.

Introduction
Achieving a successful outcome in aesthetic dentistry
can be a formidable challenge for all dental practitioners,
regardless of their experience level. The patient describes
his or her expectations of treatment to the dentist, who
then diligently works with provisional restorations to satisfy
those aesthetic desires, only to have to rely on the dental
technician (ceramist) to duplicate what the dentist and
patient have worked out in the mouth. This process may
involve several appointments, adjustments and try-ins

until a case can be finalised successfully. Digital dentistry
now offers the dentist many different tools to design and
communicate outcomes to the patient and laboratory that
can take much of the guesswork out of creating an aesthetic result that the patient will be happy with. For dentists
who have been in practice for several years, digital technologies may be difficult to incorporate into their practices
because of costs and/or suffering through learning to use
these in order to adopt a different workflow from what
they are accustomed to. However, every dentist can enter
digital dentistry even if taking conventional impressions

5
4
Fig. 3: Poured master impression. Fig. 4: Original digital proposal for the case based on the patient’s previous restorations. Fig. 5: Occlusal view of the digital
proposal, showing the ach form and occlusal design for the case.

3 2022

[23] =>

case report

Fig. 6: Situation after removal of the provisional restorations on the maxillary right side prior to placement of the PMMA prototype restorations. Fig. 7: Situation
after removal of the provisional restorations on the maxillary left side prior to placement of the PMMA prototype restorations.

and interocclusal records as long as the dental technician
can scan the impressions or master casts and convert
this analogue information into STL files. This article will
describe one way to use digital technology in a unique way
to close the loop between the patient, dentist and technician with the goal of providing a predictable outcome
that saves much of the trial and error and chair time that
is typically associated with difficult aesthetic cases.

Digital smile design and
aesthetic communication
The elements of smile design have been taught and
applied by dentists for several years. The digital aspect

“Digital dentistry offers
the dentist many different
tools to design and
communicate outcomes to the
patient and laboratory [...]”
of smile design now allows the dentist and/or dental
technician to take preoperative photographs along with
conventional impressions and interocclusal records

Fig. 8: Occlusal view of the posterior segments (teeth #15–13 and teeth #23–25) of the original digital proposal milled in PMMA for intra-oral evaluation.
Fig. 9: Posterior PMMA prototypes in place with provisional cement and prepared teeth #12–22 after removal of the provisional restorations in preparation
for evaluation of the anterior proposed aesthetic designs. Fig. 10: First PMMA prototype for teeth #12–22 based on the original digital proposal that was
a bio-copy of the patient’s original maxillary restorations. Fig. 11: First PMMA prototype in place. The margin on tooth #12 of the prototype had been trimmed
short of the margin in the laboratory during finishing.

3 2022

[24] =>

| case report

Fig. 12: Second PMMA prototype for teeth #12–22. A slightly angular modification of the first prototype gave a more squared-off appearance to the incisal
embrasures and angles. Minor irregularities on the incisal edges also added to a more characterised look. Fig. 13: Second PMMA prototype in place. Note the
reflection of the facial surfaces of the second proposal compared with the first. While the first prototype was smoother in surface texture, the second proposal
was more textured to accentuate the individual lobes of the facial surface. Fig. 14: Third PMMA prototype. A more softened look to the embrasures and incisal
angles, with surface texture to delineate the individual lobes on the facial surface. Fig. 15: Third PMMA prototype in place.

and then to manipulate parameters within software to
design potential aesthetic and functional outcomes.
Next, this digital information can be programmed into
a milling machine to produce a 3D copy or prototype
that can be evaluated in the patient’s mouth. The challenge with digital smile design when used solely as a
tool for patient presentation is that sometimes a proper
evaluation can only be made if the digitally manipulated
image can somehow be transferred to the patient’s
actual smile. Just because something looks good on
a computer screen does not necessarily mean that it

will look good and function well in the patient’s oral
cavity. Only when the prototype is placed in the patient’s
mouth can a realistic aesthetic and functional evaluation
be made.1–3

Entering digital dentistry
The first step before starting any aesthetic case is an
interview with the patient to establish what the patient
wants and what the patient does not like about his or
her smile. Digital photographs are taken of the patient’s

Fig. 16: Anterior guidance and canine disclusion were shown in the right working movement, displaying separation of all posterior teeth. Fig. 17: Anterior
guidance and canine disclusion were shown in the left working movement, displaying separation of all posterior teeth.

3 2022

[25] =>

case report

Fig. 18: Right lateral view of the patient’s smile, showing the facial surface texture of the PMMA prototype and the incisal plane nicely following the contour
of the lower lip. Note the beautiful aesthetic textures of these prototype restorations. Fig. 19: Frontal view of the patient’s full smile.

full face, full smile, teeth in centric occlusion and lips
retracted, teeth slightly separated and lips retracted,
mouth in the “E” position, and maxillary and mandibular teeth from the occlusal aspect. These photographs
will help the patient and dentist discuss what is possible to achieve and help to set the patient’s expectations.
Also, photographs with shade tabs will aid the ceramist
in choosing an initial shade for the restorations, as well
as in making decisions on individual characterisation,
such as cervical chroma, incisal translucency and internal
effects. One camera on the market designed specifically for dentistry, the EyeSpecial C-III (SHOFU Dental),
has a particular setting that will isolate the shade of the
tooth and shade tab, greying out the rest of the intra-oral
structures (Fig. 1). With this information, the ceramist
can create custom shade tabs that can be used to
verify the final shade prior to fabrication of the definitive
restorations. A digital aesthetic proposal for the case
is then designed based on the diagnostic and visual
information provided.

The digital aesthetic proposal
Using the power of digital design and in-laboratory
milling, it is possible to create several versions of
potential smile designs that can be milled from PMMA
and evaluated in the patient’s mouth for aesthetic approval and functional design. It has been suggested
that having a choice between two or three options
when making emotional decisions will make someone
feel more confident that he or she is making the correct choice.4 Based on this premise, digitally produced
PMMA prototypes can be milled and tried in to give the
patient a more realistic choice in the emotional part of
the decision-making process. This process can save
hours of chair time and hit or miss decision-making
when adjusting and editing the provisional restorations
manually.
The patient featured in the article had chosen to
upgrade her 10-year-old porcelain veneer restorations

to brighten the shade. The ceramic material was carefully removed with rotary instrumentation and diamond
burs down to the original preparations. After minor
modifications to gingival margin placement, a master
impression was taken using the two-cord impression
technique. First, a #00 retraction cord is placed at the
base of the gingival sulcus of each preparation. Next,
a #1 cord is placed on top of the #00 cord at the level
of the preparation margins. When ready to proceed
with the impression, the #1 cord is removed, leaving
the #00 cord in place. Next, a light-bodied impression material is placed into the gingival crevice around
each preparation, and the impression tray with heavybodied impression material is put into place over the

“The first step before
starting any aesthetic case
is an interview with
the patient to establish what
the patient wants [...]”

20
Fig. 20: Definitive zirconia restorations on the master model.

3 2022

[26] =>

| case report

21
Fig. 21: One-week post-op retracted view of the definitive restorations after
cementation.

preparations until set. In this case, the basic shapes
and contours of the original restorations were satisfactory for the fabrication of provisional restorations,
so a polyvinylsiloxane stent of the original restorations
was made before the restorations were removed. After
preparation, the stent was filled with a rubberised urethane provisional material (Tuff-Temp Plus, Pulpdent),
contoured chairside and luted into place using a
flowable composite (Fig. 2).
The master impression was then poured by the ceramist and scanned to create the digital master model
(Fig. 3) in STL to be used in the design software to develop the case proposals. From that point, the opposing
model was also digitised, as was the bite relationship.
The case was then mounted on a digital articulator, and
a case proposal was designed for the ten zirconia
veneer restorations. The technician can work out canine
disclusion and anterior guidance virtually as the restoration contours are shaped and modified in the software
(Figs. 4 & 5). Using this finished proposal, PMMA restorations were then milled for both right and left posterior
segments (first and second premolars, and canine) and
the four maxillary anterior teeth (lateral and central incisors). For the purposes of providing a choice of slightly
modified aesthetic parameters for the patient to evaluate,
two other proposals were designed by the ceramist for
the maxillary incisors with slight variations to the incisal
edges, embrasures and surface texture. The plan at
the patient’s try-in was to cement the canine–premolar
segments with provisional cement. The occlusion and
canine guidance built into these segments would not
vary in the evaluation; only the three different incisor
segments would be looked at and evaluated by the
patient.

The patient try-in
The chairside provisional restorations fabricated at
the preparation appointment were removed and the
preparations were cleaned with an antibacterial scrub

3 2022

(Consepsis, Ultradent; Figs. 6 & 7). The milled PMMA
provisional segments for teeth #15–13 and teeth #23–25
(Fig. 8) were then cemented with provisional cement, and
the excess was cleaned from the restoration margins
(Fig. 9). The provisional restorations on teeth #12–22
were then removed, and the anterior proposed aesthetic designs were tried in. The first PMMA prototype
(Fig. 10) was based on the patient’s preoperative smile
design (Fig. 4). Once this prototype was in the mouth,
it was apparent that the marginal gingival tissue had
been moulded by the contours of the original provisional
restorations placed at the time of tooth preparation such
that the tissue would not necessarily fill the contours
of the milled PMMA provisional restorations at initial
placement (Fig. 11). With some time, the gingiva would
adapt to the contours of the PMMA prototype once
cemented into place.
The second proposal (Fig. 12) was designed to be a
bit more angular than the first proposal. Whereas the
first proposal had more softened incisal angles and
embrasures, like the patient’s original restorations,
this second PMMA proposal had incisal angles that
were more squared and minor irregularities on the
incisal edges to achieve a more natural appearance.

“Based on the patient’s
preview of the three aesthetic
proposals [...] the delivery
was smooth, and the patient
loved the final result.”
The patient was not happy with its appearance (Fig. 13),
so this prototype was not considered in the final decision.
The third proposal for this case was a combination
of the first and second ones (Fig. 14). While the incisal angles and embrasures were softened like in first
prototype, the facial surfaces were textured, similar to
the second prototype. The patient chose the third proposal as the one to use to mill her definitive restorations
(Fig. 15). The prototype is also checked for canine guidance and anterior disclusion and modified, if necessary
(Figs. 16 & 17).
Next, the PMMA prototype was cemented with temporary cement. At a postoperative visit, full smile lateral and
frontal view photographs were taken of the cemented
proposal to evaluate aesthetic and functional parameters when the patient was not anaesthetised prior to the
fabrication of the definitive restorations (Figs. 18 & 19).
The patient was then able to take these restorations

[27] =>

case report

Fig. 22: Post-op right lateral view of the patient’s completed smile. Comparison with Figure 18 shows how nicely the definitive restorations followed the
approved PMMA restorations. Fig. 23: Frontal view of the patient’s full smile once the case was completed. Fig. 24: Superior view of the smile, showing
the facial surface texture of the definitive restorations and how nicely they followed the lower lip.

for a test-drive to verify that she was completely satisfied
with the smile design.

the third one, the delivery was smooth, and the patient
loved the final result (Figs. 21–24).

Delivery of the definitive
restorations

Conclusion

Once the patient gave her approval, the ceramist used
the same STL files to mill the definitive restorations
based on the third PMMA prototype (Fig. 20). Once the
patient was anaesthetised, the PMMA prototype restorations were removed, and the preparations cleaned
with an antibacterial scrub. Each individual restoration
was tried on the respective preparation and evaluated
for marginal integrity. Next, all ten restorations were
tried on collectively to evaluate interproximal contacts
and occlusion. The definitive restorations were milled
in zirconia that was cut back to layer on effects. The
restorations were first cleaned with a cleaning agent
(ZirClean, BISCO) to remove any surface contamination
from the try-in phase. After rinsing and drying, the restorations were then treated with a metallic primer (Z-Prime
Plus, BISCO) to enhance the bond of resin cement
to zirconia. The preparations were etched with 38%
phosphoric acid (Etch-Rite, Pulpdent) for 15 seconds
and then rinsed with water from an air–water syringe
for 15 seconds. After air-drying, the preparations were
re-wet with a dentine desensitiser and then the excess
was removed with high-volume suction, leaving the
preparations visibly moist.
The restorations were then cemented with resin cement
(Embrace Resin Cement, Pulpdent) two at a time,
starting with the central incisors and moving distally to
the second premolars. As each two restorations were
briefly light-polymerised, the resin cement excess was
removed with a sable brush and then the restorations
were light-polymerised according to the manufacturer’s
instructions. Dental floss was used interproximally prior
to full polymerising to ensure that the resin cement had
been cleared out. Based on the patient’s preview of the
three aesthetic proposals and her definitive choice of

Using digital smile design technologies, the dentist can
enter digital dentistry via chairside scanning or through
the digital dental laboratory to help design and refine the
aesthetic parameters of a case and create PMMA prototypes which the patient can then wear and evaluate to
arrive at the final desired aesthetics prior to completion.
This step helps ensure patient acceptance and allows
the dentist complete confidence that the delivery of the
definitive restorations will be a resounding success.
Acknowledgement
The author would like to acknowledge the expertise
of master ceramist and digital smile design specialist
Vincent Devaud of West Hollywood in California for his
beautifully artistic work on this case.

Editorial note: A list of references is available from the
publisher. This article originally appeared in Oral Health
Magazine, and an edited version is provided here with
permission from Newcom Media.

contact
Dr Robert A. Lowe graduated
magna cum laude from the then
Loyola University School of Dentistry in
Chicago in the US in 1982. He maintains
a private practice in Charlotte in North
Carolina in the US and publishes and
lectures internationally on aesthetic
and restorative dentistry. Dr Lowe can
be reached at boblowedds@aol.com.

3 2022

[28] =>

| case report

Two-piece zirconia implant
for global metal-free restoration
Dr Riccardo Scaringi, Italy

1

2a

2b

2c

2d

Fig. 1: Occlusal image of the coronal fracture of the partially medicated tooth to soothe the thermal sensitivity caused by uncovering of the pulp chamber.
Figs. 2a–d: Initial radiographic image showing the close proximity to the floor of the maxillary sinus in addition to the viability of the tooth and the absence of
periradicular infection (a). Extracted root (b). CERALOG Hexalobe implant (c). The result of implant placement with respect to the sinus floor and the osseous
and interradicular relationship (d).

Zirconia in dentistry has historically been known for its
strength and biocompatibility characteristics in simple
or complex prosthetic rehabilitation. Only in the last decade has it become more widely used in implantology
as well. Zirconia is a mixture of composites based on
zirconium dioxide. Zirconium is the metal from which the
eponymous dioxide is derived. The powders used to obtain zirconia have a very high degree of purity and are
obtained through complex chemical and co-precipitation
procedures.1 The crystalline structure of zirconia occurs
in different geometric shapes depending on the temperature to which it is subjected and reversibly changes
from a monoclinic state at room temperature to a tetragonal state up to 1,100 °C and a cubic state at around
2,400 °C. Therefore, the density of the material is determined by the shape and size of the geometric state,
which determines a different final size and a different
physical property, depending on the heat treatment.2
Sintering takes place at temperatures above 1,170 °C,
determining a change of state from tetragonal to monoclinic. This causes stress that leads to fracture of the
artefacts, which is why oxides were introduced to stabilise the composite and prevent fracture. In the medical field, various oxides, such as magnesium oxide, titanium dioxide, alumina, yttrium oxide and ceric oxide,
are used in small percentages combined with zirconia,
creating stability in various sintering processes and cre-

28

3 2022

ating a family of zirconia-based ceramics with different
chemical, physical and structural characteristics.3
Advancement in dental implantology occurred with the
addition of yttrium oxide to zirconia, generating yttrium
tetragonal zirconia polycrystals (Y-TZP). Although this
achievement has only recently been translated to clinical practice, the initial studies date back to the early
1960s with ceramic materials that allowed such maturation and knowledge that today allow a degree of excellence for biomechanics and integrative biocompatibility with the hard and soft tissue of the oral cavity.4
Zirconia does not cause systemic or local cytotoxicity,
and cytocompatibility in vivo and in vitro has been reported.5 In order to accelerate the healing time, osseointegrative properties were achieved through surface
treatment by increasing hydrophilicity with different
procedures.11 Bacterial colonisation and adhesion to
the implant surface are related to the material type
used, Y-TZP having significant advantages over titanium.10 In vitro tests have shown less accumulation of
the various bacterial strains present in the oral cavity,
and significant results of less adhesion on zirconia or
titanium abutments has been demonstrated in vivo.12–16
The absence of metal oxides allows for improved biological response of the gingival tissue, resulting in reduced bacterial formation and subsequent inflammatory onset.18

[29] =>

case report

Fig. 3: Occlusal view of the CERALOG implant placed using a flapless technique and filling of the spaces between the bone and implant. Fig. 4: Provisional PEEK
abutment in situ, to which the provisional crown produced by CAD/CAM was to be bonded. Fig. 5: The tissue conditioning and bone healing situation after
56 days of functional loading with the provisional crown.

The characteristic white colour of zirconia implants
blends in better below the gingival tissue, especially in
thin phenotypes, avoiding those unsightly grey shadows peculiar to titanium implants, especially for those
implant designs with a smooth collar. Moreover, even in
the case of gingival recession, no exposure of metal
portions occurs.17
An important aspect that characterised the first generation of zirconia implants was the frequency of fracture, being about 4%, especially in the first year of
loading, in cases of particular tightening of the abutments with metal screws and in two-piece implants
with a diameter of less than 3.5 mm.19 The rate has
dropped below 0.5% owing to advancements in the
manufacturing process, in material preparation and in
implant fabrication whether by milling or isostatic
pressing.20
As an additional fact to be noted in the knowledge of
this new implant material concerns the ageing of the
structure, better known as hydrothermal degradation
(low-temperature degradation), that occurs at temperatures above 150 °C in an environment with the
presence of water.21 In order to fully control such degradation, ceric oxide or alumina was added to the zirconia powder composite.22 Based on the experience
gained in these 30 years of research and development, we can now consider zirconia implants a viable
substitute for titanium implants, especially in highly

aesthetic areas or in those patients in whom tissue
quality or particular susceptibility to bacterial colonisation may require a greater guarantee of long-term outcome.23, 24

Clinical case report
The male patient was a 53-year-old non-smoker in an
excellent state of health, ASA I, with vertical fracture of
the crown of tooth #25 associated with spontaneous
pain. In the first phase of treatment, we conducted an
accurate clinical and diagnostic diagnosis in which we
ascertained the possible therapeutic variables aimed at
coronal restoration after crown lengthening, root canal
therapy and core reconstruction on which to finalise a
clinical crown. The patient presented to the clinic with
masticatory trauma that had caused a clear fracture of
the palatal cusp of the vital tooth restored according to
a direct composite technique. The fracture was extensive in depth to at least 1 mm subcrestally, in addition
to uncovering the pulp chamber (Fig. 1). After careful
evaluation and comparison of procedures, the patient
was shown the various treatment options and opted to
have the fractured tooth replaced with an implant. The
choice of a ceramic implant was considered for a number of factors, including global metal-free restoration
and an aesthetic outcome. We decided on a two-piece
Y-TZP implant (CERALOG™, BioHorizons Camlog)
made using a high-tech production process for molding
(Ceramic Injection Molding–CIM).

Fig. 6: The scan body on the implant. Fig. 7: The sectional design of the crown allowed for a broad evaluation. Fig. 8: The design showing subtraction from
the vestibular aspect to accommodate the ceramic layering.

3 2022

[30] =>

| case report

Fig. 9: View of the design in the context of the virtual model, showing the transition points in the adjacent contacts and the access hole in the occlusal aspect,
avoiding compromise of aesthetics and of resistance to masticatory forces. Fig. 10: The final abutment of PEKK, a biocompatible material that is resistant
to oral fluids and masticatory forces.

Root extraction was performed according to a flapless
technique, avoiding injury to the cortical bone. The use
of piezo-surgery allowed for facilitated removal without
cortical compression (Fig. 2). Site preparation is a delicate step in implant surgery, especially for zirconia implants. In fact, ceramic implants tolerate screwing
stresses poorly; therefore, the site must be carefully
prepared with adequate irrigation and possible tapping of the site, especially in cases of Class D1 and D2
compact bone. In the present case, subcortical insertion was not necessary, but in the event of need, there
is a countersinking fuction available in the CERALOG
system, which allows placing the implant subcrestally
while avoiding cortical compaction that usually induces
vertical resorption.
Like with titanium implants, placement of zirconia implants requires primary stability. The difficulty is initially
associated with the point of engagement of the first drill
to match the centre of the implant with the inter-coronal
distance. It is not always possible to use this point for
implant insertion because of the variables associated
with root shape and the number of roots present. The
maxillary second premolar usually presents a single
root or in some cases two fused roots, and therefore it
lends itself more easily to a contextual replacement.
The only problem is associated with the upper boundary with the cortical floor of the maxillary sinus that
could limit the excursion of the pilot drill beyond the
apex in search of greater primary stability (Fig. 2).
In this case, a cylindrical body zirconia two-piece implant of 12.0 mm in length and 4.1 mm diameter was
used considering that the prosthetic collar had a diameter of 4.5 mm. The spaces between the bone and the
implant were filled with slowly resorbing biomaterial to
better preserve the alveolar bone. The implant was deliberately not restored immediately, because although
the primary stability achieved was 55 ISQ, we preferred
to leave the implant to heal naturally and not expose it
to further occlusal trauma (Fig. 3). A healing abutment
was placed on the implant.

3 2022

After eight weeks, we removed the healing abutment and
took a digital impression for the preparation of a provisional restoration placed on a PEEK temporary abutment
for an additional four weeks (Fig. 4), at the end of which
we removed the screw-retained provisional crown and
noted the degree of peri-implant mucosal conditioning.
We took a new impression with an intra-oral scanner using a scan body (Figs. 5 & 6). By using the implant system’s scan body, we were able to capture the implant’s
specifications or the dental technician. The scan body
stops at the implant connection and does not interfere
with the soft tissue. The digital impression also allows for
excellent reading of the conditioned tissue so that the
aesthetic margins achieved can be followed. The file was
sent to the dental laboratory after filling out the attached
data sheet listing the implant type and model, the type of
restoration desired, whether screw-retained or cemented, and the material with which it was to be finalised. The software is able to detect colour values so that
an initial colour indication can be defined.
The choice of a two-piece zirconia implant allows a single restoration or possibly a multi-unit cemented restoration thanks to the design of dedicated frameworks
utilising CAD/CAM and the DEDICAM CAD libraries.
The data collected is supported by photographic status
and spectrophotometric images. Digital data has great
versatility of use and limited cost and offers great potential for use and communication effectiveness even at
a distance. The dental technician was able to make a
careful assessment of the implant position, the possibility of making a screw-retained prosthesis, the aesthetic margins, and the prosthetic components to be
used. The dental technician is able to determine the feasibility of the restoration according to the prescription,
sharing with the clinician the potential and limitations
present in the specifications. It is not always possible to
have an angulated screw-retained abutment allowing
an access hole in a region congruous with the aesthetics and function of the implant in case the implant–abutment connection is modified by inclining the bearing
surface of the implant shoulder (Fig. 7).

[31] =>

case report

Fig. 11: View of the completed crown, the abutment to which it is bonded and the ceramic analogue. Fig. 12: Vestibular view three years after loading.

Given the special attention to the aesthetic component,
we preferred to add ceramic to the coronal zirconia
structure, maintaining a high-strength structure in the
portion bordering the access hole and simultaneously
enhancing the aesthetics with a portion characterised
by ceramic layering and not simply coloured. Having
established the prosthetic design and chosen the material, the design proceeded with subtraction from the
vestibular aspect in the appropriate volume to accommodate the ceramic addition (Fig. 8). When deciding on
a technical procedure for layering, it is crucial to have a
model that can facilitate the dental technician in fabrication (Fig. 9). The abutment used for the definitive restoration is different from the one used for the provisional
restoration, in material and shape. The portion of the
abutment that seals the connection with the implant
cannot be modified by either subtraction or addition, so
the crown would be cemented in the laboratory to the
abutment (Fig. 10). A removable transfer of both the implant and digital models would be housed on the model,
enabling its specifications to be entered into the prosthetic design software. All this data that seems obvious
in reality should be verified before taking and sending
the impression to the laboratory (Fig. 11). Radiographically, the abutment appears as a space between the
implant and the crown, being radiolucent.
Prosthetic placement was performed according to the
manufacturer’s instructions by dynamometric tightening with a Unigrip screwdriver to 15 Ncm for Holisticor
screws in gold or 25 Ncm in titanium. The three-year
follow-up found no signs of clinical concern, and the result was a functional implant restoration that appeared
perfectly natural (Fig. 12).

Discussion
The particular conformation of the prosthetic connection (CERALOG™ Hexalobe) firmly stabilises the abutment to the implant, preventing unscrewing, even in the
long term and even if tightening was not done with a
torque wrench. The PEKK abutment comparing to a
standard polymer abutment in PEEK has a higher tensile strength and excellent thermoplastic performance,

ensuring resistance to masticatory stress. It is possible
to employ cemented or screw-retained crowns, depending on the type of rehabilitation and especially depending on the inclination of the implant and the aesthetic requirements of the prosthetic restoration.

Conclusion
The choice of a zirconia implant is now a wellestablished procedure especially in cases like this one
where aesthetic requirements and the desire for metalfree treatment are combined. Tissue response is always
positive, and its maturation improves over time by
stabilising and improving the mucosal surface. Probably poor bacterial colonisation and adhesion is a significant factor in the absence of peri-implant inflammation,
and this is an ideal prerequisite for progressive and evolutionary tissue maturation. Tissue response improves
over time.
Editorial note: This article was first published in ceramic
implants—international magazine of ceramic implant
technology, Vol. 6, Issue 2/2022. A list of references is
available from the publisher.

about
Dr Riccardo Scaringi teaches
specialisation courses in dental
implant prosthetics and digital support
technologies at various universities
in Italy. He is frequently invited to
speak at national congresses on topics
related to surgical prosthetics.
He is also an active member at the
most prestigious international scientific
associations in the field of technological and digital surgery.
Dr Scaringi is the author of various scientific texts.

contact
Dr Riccardo Scaringi
info@riccardoscaringi.com
www.riccardoscaringi.com

3 2022

[32] =>

| case report

Guided implant placement
and immediate loading:
A five-year follow-up case report
Dr Hani Tohme, Lebanon

1

2

3

4

5

6

Introduction
The continuous development of computer technology
and dental processing provides new possibilities in the
field of fixed prosthodontics. Nowadays, we can easily

manage implant positioning in relation to the required
prosthetic outcome by utilising a precise surgical guide
and a fully digital workflow. This is very favourable, especially when immediate implant placement and loading are
involved. However, a thorough risk assessment before
the implant treatment is also essential.
The following case report describes a successful treatment of a hopeless mandibular premolar in a young
patient and a five-year follow-up. The treatment included
a fully digital workflow and the use of a Straumann Bone
Level Tapered implant that was immediately placed and
loaded.

Initial situation
7

32

3 2022

The 25-year-old female patient, who was a non-smoker
with no notable medical issues, presented to our office

[33] =>

case report

8

9

10

11

for a consultation regarding food impaction in the right
lower jaw, giving her bad breath despite her efforts
to maintain good oral hygiene. She also stated that
the tooth concerned had changed colour over time and
that she was very dissatisfied with its aesthetic appearance.
The intra-oral examination revealed that tooth #45 had a
failing distoocclusal provisional restoration and a greyish
colour compared with the adjacent teeth. Furthermore, the
gingival tissue around the tooth was inflamed (Figs. 1 & 2)
and presented with bleeding on probing in all directions.
Given these clinical characteristics, a vitality test was
carried out. The cold test was negative, but the percussion test was positive. The radiographic examination
showed a crown fracture of tooth #45 extending to the
root (Fig. 3).

12

13

|

“The following case report
describes a successful
treatment of a hopeless
mandibular premolar
in a young patient and
a five-year follow-up.”
Treatment planning
After a thorough discussion of the treatment options with
the patient, she opted for immediate implant placement

14

3 2022

33

[34] =>

| case report

15

16

and provisional restoration. The corresponding treatment
workflow was as follows:
– digital planning to establish a prosthetically driven
implant position (Figs. 4 & 5);
– provisional crown preparation before the surgery and
design for the Variobase abutment (Straumann; Fig. 6);
– design of the surgical guide to be completely tooth
supported to prevent rocking;
– atraumatic tooth extraction and guided implant placement;
– implant loading prior to achieving primary stability
(35 N insertion torque; 75 ISQ);
– screwing in of the provisional crown extra-orally bonded
to the Variobase; and
– after healing, use of a Variobase of the same gingival and
abutment height for the digitally fabricated zirconia crown.

34

Surgical procedure
Local anaesthesia with 2% lidocaine and 1:100,000 adrenaline was administered, and an atraumatic extraction of
tooth #45 was performed. The tooth-supported surgical guide was stabilised after tooth extraction (Fig. 7).
The implant bed was prepared following the manufacturer’s instructions for guided surgery, and the implant
was placed to an optimal insertion torque (Figs. 8–11).

Prosthetic procedure
An immediate provisional crown was placed, and a periapical radiograph of the implant with the Variobase was
taken immediately after the surgery (Figs. 12 & 13). After
three months of healing, the mucosal dimensions and
contours were found to have been preserved (Fig. 14).

17

18

19

20

3 2022

[35] =>

case report

22a

21a

21b

22b

After insertion of a Straumann scan body, digital impressions were taken. The intra-oral scan registering the
emergence profile, intra-oral scan body and antagonist
was sent to the laboratory (Fig. 15). Based on this information, the definitive restoration was digitally designed
and fabricated (Fig. 16).
At the next visit, the definitive crown was screwed
in place, and a periapical radiograph was taken as
control (Figs. 17 & 18). After the fit of the abutment
and the restoration had been evaluated, the screw
access hole was closed with teflon tape and composite (Figs. 19 & 20). The patient received detailed
oral hygiene instructions and participated in a yearly
maintenance programme that included clinical and
radiographic assessment.
After four years, the clinical and radiographic images showed stable peri-implant hard and soft tissue
(Figs. 21a–22b). The patient returned for her five-year
follow-up, and the hard and soft tissue were stable according to the clinical and radiographic assessments
(Figs. 23–25). The outcome for the peri-implant hard and
soft tissue was outstanding thanks to a correct diagnosis
and treatment plan but also to the use of optimal materials and the participation of the patient in a customised
maintenance programme.

“The outcome for the
peri-implant hard and soft
tissue was outstanding
thanks to a correct diagnosis
and treatment plan but
also to the use of optimal
materials [...]”
about
Dr Hani Tohme graduated in
dental surgery from and specialised
in prosthodontics at Saint Joseph
University of Beirut in Lebanon.
He is the founder and head of the
digital dentistry unit, the director
of prosthodontic postgraduate
studies and the head of
removable prosthodontics at
Saint Joseph University of Beirut. Dr Tohme is a fellow
of the International Team for Implantology.

3 2022

[36] =>

| case report

Digital implant restoration
of a single arch
Drs Abdelrahman Khalaf & Kirollos Hany, Egypt

masticatory problems and the inability to eat, resulting
in a decrease in his quality of life. After struggling with
this problem for a long time, the patient presented for
help, hoping to have his masticatory function restored
and to have beautiful teeth. Taking the patient’s wishes,
oral condition and existing technology into consideration,
we designed a digital implant treatment for the patient
after clinical and radiographic examination.
1

Design and manufacture of surgical guide

Fig. 1: Implant surgery planning on CBCT scan. Fig. 2: Surgical guide design.

Introduction
As digital technology becomes widely used and takes
root in the dental field, an increasing number of dentists
are switching from conventional to digital treatment globally. Digital technology plays a positive role in promoting
aesthetic implant restoration and improving treatment
efficiency. The case presented demonstrates a typical
application of digital technology in the field of oral implantology, making the complex treatment process simple,
controllable, comfortable and efficient.

Initial situation
The 42-year-old male patient had an edentulous upper
jaw and only seven teeth in the lower jaw and severe
gingival recession. This poor oral condition had led to

3
Fig. 3: Printed surgical guide.

3 2022

Digital implantation helps dentists complete implantation better using digital technology. The first step of implantation is pre-op diagnostic and virtual implantation.
Dentists can simulate dental implants in design software.
According to the thickness of alveolar bone and bone
plate, the implant angle and depth can be set in advance,
and the surgical guide can be designed as well. The surgical guide can accurately orient and guide the entire
surgery, avoiding the most common problems, such as
side wall perforation and poor implant position, direction and depth. The restoration-oriented surgical guide
ensures appropriate placement of the implant and improves the final aesthetic effect. With the assistance of
a surgical guide, dentists can place multiple implants
in one surgery with higher efficiency. All these digital
technologies have greatly improved the success rate of
implant surgery.
In this case, we tried to preserve all the patient’s dental
tissue of the lower jaw and, after a comprehensive assessment, decided on a restoration supported on five
implants in the upper jaw, as the patient did not want any
bone augmentation or a sinus lift. We designed a surgical guide using exoplan dental software (exocad), placing
implants in positions #14, 12, 11, 22 and 24 (Figs. 1 & 2).
The surgical guide design was printed with the AccuFab-D1s from SG01 photosensitive polymer resin (both
SHINING 3D) and was used directly for the implant surgery
(Fig. 3). The AccuFab-D1s printer has been designed
especially for dental applications, and it can print almost
all kinds of components for clinical use, such as models,
temporary restorations, wax-ups and customised impression trays, from various photosensitive polymer resins.
The accurate surgical guide was a great help for carrying out the implant surgery according to our initial plan.

[37] =>

Fig. 4: Upper jaw scan. Fig. 5: Bite scan. Fig. 6: CAD in exocad. Fig. 7: Printed temporary bridge. Fig. 8: Occlusal view of the definitive restoration in situ.
Fig. 9: Labial view of the definitive restoration in situ.

Scan
In the stage of dental implant restoration, instead of taking
a traditional physical impression with silicone or alginate,
we employed a digital impression using an intra-oral
scanner to obtain oral data. A digital scan is very helpful
for simplifying the workflow by optimising several steps.
There is no physical impression taking, transportation,
stone model pouring, waxing, investment or casting.
Fewer processing steps mean less material cost and less
labour and time needed for the whole process. What
is more, the digital process makes the workflow much
easier to check, analyse and manage. Compared with
paper documents, digital files are easy to record, search
and modify. Also, little space is needed to store all this
information compared with the physical space needed to
store stone models. For patients, the entire treatment process is more comfortable, since no physical impressions
are needed, which may cause patients to have symptoms
such as nausea or vomiting. Even the inexperienced
user can finish a single full-arch scan in 30 seconds with
Aoralscan 3 (SHINING 3D), which is much quicker than
the 5 minutes required with a traditional impression.
In this case, we scanned the upper jaw first. The edentulous upper jaw was difficult to scan, since there were
almost no landmarks in the target scanning area. However, placing one scan body on implant #11 changed this,
making it easier to scan and decreased the risk of distortion of the dental arch. After removing the gingival data
around the implants, we placed all five scan bodies and
rescanned the upper jaw (Fig. 4) and then took the lower
jaw scan and bite scan (Fig. 5).

Design
The design of implant restorations is different from that
of natural supporting teeth. In designing implant resto-

rations, more attention is paid to the transmission of force
in the occlusal process, occlusal contact morphology,
buccolingual diameter, emergence profile design and
other factors which determine the direction and size of
the force, as well as its distribution along the implant.
Furthermore, owing to the edentulous upper jaw, it was
important to pay attention to the anterior tooth aesthetics.
In this case, a bridge extending from implant #15 to implant #25 was designed using exocad (Fig. 6).

Try-on of temporary bridge
We tried the temporary bridge (Fig. 7) on the printed model
to check whether the occlusion, margin, proximal contact
and overall morphology of the restoration met the requirements. Had the restoration not been correct, this could have
been identified and adjusted. After everything was ready,
the temporary bridge was seated in the patient’s mouth.

Definitive restoration
After layering with porcelain and glazing, the definitive
restoration made of zirconia was seated in the patient’s
mouth (Figs. 8 & 9). Through a series of treatments and
recovery, the patient finally had new teeth and could eat
freely without limitation. This is the great power of digital
technology when used in dentistry, to help dentists and
patients obtain a good result in the most appropriate way.

about
Drs Abdelrahman Khalaf and Kirollos Hany work at
the Faculty of Dentistry of Assiut University in Egypt, where
they have been promoting the use of digital technology in
dentistry for years. Their goal is to provide patients with more
accurate diagnoses, a more comfortable treatment process
and better treatment results through advanced equipment.

3 2022

[38] =>

| case report

Immediately loaded full-arch
restoration on
four implants in the maxilla
Digital workflow and surgery,
including definitive restoration
Dr Marco Toia, Italy

A 78-year-old male patient with an ASA physical status
of II and a previous history of implant treatment requested
an implant-supported restoration. Four PrimeTaper EV
implants (Dentsply Sirona) were inserted according to
digital planning, and the two distal implants were angled
to make the best use of the height of the bone crest.
1

3

2

MultiBase EV abutments (Dentsply Sirona) were inserted,
and an immediate impression was taken. Four hours after the start of the appointment, a temporary screwretained implant-supported restoration was delivered to
the patient. After healing of the site, a digital impression
was taken for the definitive restoration, which was realised with a full monolithic zirconia sleeve on an Atlantis
BridgeBase suprastructure.

4

5

6

7

8

9

10

Fig. 1: Pre-op view of the edentulous maxilla, showing the healing area on the right side where the original implants had been removed. Fig. 2: Digital implant
treatment planning was performed in Simplant software (Dentsply Sirona) with a bone reduction guide mask for four implants in the maxilla. Fig. 3: A surgical
guide was used for the first drill to ensure precise implant positioning. Fig. 4: After making the surgical incision, the bone reduction guide was placed to

38

3 2022

[39] =>

case report

18
24

determine the amount of bone reduction needed. Fig. 5: The FRIOS MicroSaw
(Dentsply Sirona) was used to remove bone to create a flat and homogenous
bone plate. Guide pins were used to check the implant positions. Fig. 6: The
recommended drilling protocol for PrimeTaper EV was followed for implant
placement in position #12. The drilling procedure ended with the #4 PrimeTaper
drill. The #5 PrimeTaper drill was used for 2 mm cortical preparation. Fig. 7:
A PrimeTaper EV 4.2 × 11.0 mm implant was placed in position #12. Fig. 8:
A PrimeTaper EV 4.2 × 13.0 mm implant was placed at a 30° angle in position #15. Fig. 9: Occlusal view of the four abutments in place. Fig. 10:
MultiBase EV pick-up copings were attached and tightened (5–10 Ncm) for
the impression, taken using Aquasil Ultra+ low-viscosity impression material
(Dentsply Sirona). Autopolymerising flowable resin was used to secure the
copings. Fig. 11: MultiBase EV temporary cylinders and autopolymerising
resin were used to attach the denture. Fig. 12: Occlusal view of the temporary screw-retained restoration. Fig. 13: Radiographic evaluation of the temporary screw-retained restoration. Fig. 14: Temporary restoration in place
four hours after the start of the appointment. Fig. 15: Healed soft tissue
with abutments in place. Fig. 16: Atlantis IO FLO-S scan bodies in place for
intra-oral scanning for manufacturing of the definitive restoration. Fig. 17:
Try-in of the fixed Atlantis BridgeBase suprastructure. Fig. 18: Radiographic
evaluation showing passive fit of the suprastructure. Fig. 19: The full monolithic zirconia sleeve was tried in on top of the suprastructure prior to cementation finalising the definitive restoration. Fig. 20: Definitive restoration seated.
Fig. 21: Radiographic evaluation twelve months after implant placement.

Editorial note: This article was first published in implants—
international magazine of oral implantology, Vol. 23, Issue 3/2022.

about
Dr Marco Toia graduated in dentistry
from the University of Milan in Italy in
2001 and specialised in orthodontics in
2004 and oral surgery in 2007 at the
same university. He received his PhD
from Malmö University in Sweden in
2020 on clinical and mechanical aspects
of implant-supported screw-retained
multi-unit CAD/CAM metal frameworks.
Dr Toia is in private practice in Milan and conducts research in affiliation
with Malmö University. He is an active member of the Italian Academy
of Osseointegration, the Italian president of PEERS (the Platform for
Exchange of Experience, Research and Science, founded by
Dentsply Sirona) and an ordinary member of the Italian Academy of
Prosthetic Dentistry and European Association for Osseointegration.

contact
Dr Marco Toia, +39 0331 623144, www.studiotoia.com

3 2022

[40] =>

| case report

Full-arch rehabilitation using
ceramic implants in
guided surgery protocol
Dr Alexandr Bortsov, Russia

2

1
Fig. 1: Initial situation. Fig. 2: Straumann PURE monotype ceramic implant.

Patients with metal allergies and heightened allergic
status represent a challenge for dental implant treatment. Nowadays, ceramic implants are emerging as
a viable solution for such patients, offering the advantages of tooth-like colour, enhanced soft-tissue healing
and lower affinity to plaque accumulation. However,
fast and efficient treatment protocols with ceramic
implants are still very demanding, particularly when it
comes to full-arch restorations.

3

Initial situation
A 62-year-old patient (Fig. 1) with a history of multiple
metal allergies and advanced periodontal disease
turned to the clinic for aesthetic fixed restoration. The
patient was concerned about surgical trauma and
hoped for a fast and painless procedure. Further
examination revealed a heightened allergic status
(increased immunoglobulin E level), painful occlusion

4
Fig. 3: CoDiagnostiX planning. Fig. 4: Surgical guides and prefabricated provisional restorations.

40

3 2022

[41] =>

case report

Fig. 5: Surgical guide fixed on the mandible. Fig. 6: Surgical guide fixed on the maxilla. Fig. 7: Guided implant bed preparation Fig. 8: PURE ceramic
implant mounted on handpiece adaptor. Fig. 9: PURE ceramic implants placed via the insertion guide in the mandible. Fig. 10: PURE ceramic implants in
place in the mandible. Fig. 11: PURE ceramic implants placed via the insertion guide in the maxilla. Fig. 12: PURE ceramic implants in place in the maxilla.
Fig. 13: Immediate provisional restorations cemented.

with several mobile teeth and a largely hopeless dentition.

Treatment planning
Given the patient’s allergic status, Straumann PURE
monotype ceramic implants (Fig. 2) were the option of
choice to support full-arch restorations in the upper
and lower jaws. To minimise surgical trauma and
ensure precise, parallel implant placement, it was decided to use the Straumann guided surgery solution to
place the implants flaplessly. To increase the precision
of fit of the surgical guides, it was planned to use some
of the remaining teeth for the surgical guide fixation
and to extract them after implant placement. Furthermore, guided surgery based on fully digital workflows
also allowed immediate provisionalisation at the end
of surgery, thus facilitating patient comfort.

The patient’s CBCT data, together with the data from
the intra-oral scan, were imported into coDiagnostiX
(Dental Wings), and virtual planning was done (Fig. 3).
Based on that planning, the surgical protocol was determined and the surgical guides and the immediate
provisional restorations were fabricated (Fig. 4).

Surgical procedure
To facilitate the precision of the implant placement, two
dedicated surgical guides were used: one guide for the
drilling and another one for the guided insertion of the
implants. The insertion guide was produced based on the
dimensions of the transfer piece for the PURE ceramic
implant.
To further control potential deviations, the implant bed
preparations were done starting from the distal sections

3 2022

[42] =>

| case report

Fig. 14: Soft-tissue healing at the two-month follow-up. Fig. 15: Result and smile line. Fig. 16: Definitive restorations cemented. Fig. 17: Dental panoramic
tomogram at the one-year follow-up.

and moving mesially while fixing every prepared osteotomy with the additional fixation pins (Figs. 5–7). The insertion guide was then fixed, and the fully guided implant
placement was carried out (Figs. 8–12). Finally, the prefabricated provisional restorations were cemented and
the patient could leave the office (Fig. 13).

Editorial note: This article was first published in ceramic
implants—international magazine of ceramic implant
technology, Vol. 6, Issue 2/2022.

Prosthetic procedure
At the two-month follow-up visit, the clinical examination
showed good soft-tissue healing (Fig. 14). Conventional
closed-tray impressions were taken. It was decided to
leave the distal teeth in the maxilla to provide better proprioception. At the final appointment, the definitive fullarch zirconia restorations were cemented (Figs. 15 & 16).
The patient was satisfied with the functional and aesthetic outcomes. The dental panoramic tomogram at the
one-year follow-up showed stable results (Fig. 17).

Conclusion
This clinical case illustrates a successful full-arch rehabilitation using Straumann PURE ceramic implants in a digital protocol. The Straumann guided surgery system
helped to manage several clinical challenges: digital
tooth extraction, prefabrication of immediate provisional
restorations and post-extraction placement of multiple
PURE monotype implants precisely parallel to each
other—all in an efficient and minimally invasive protocol.

3 2022

about
Dr Alexandr Bortsov graduated with
a DDS from South Ural State University
in Chelyabinsk in Russia. As a surgeon,
his focus areas are implantology and
guided surgery, aesthetic dentistry
and digital dentistry. Dr Bortsov is the
director of the Dental Art clinic
in Chelyabinsk and of the International
Team for Implantology study club
in Chelyabinsk. He is the head of surgery and prosthodontics
at the Central Dentistry clinic in Russia.

contact
Dr Alexandr Bortsov
+7 905 839850
89058398504@mail.ru

[43] =>

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Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist
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[44] =>

| industry news

CleanImplant Foundation
promotes awareness of clean implant
surfaces at IAOCI 2022
By Franziska Beier, Dental Tribune International

2
Fig. 1: From left: Dr Dirk Duddeck, founder of and head of research at the CleanImplant Foundation, presenting the certificate of “Trusted Quality” to
Arthur J. Francis, vice president of SDS Swiss Dental Solutions USA. Fig. 2: In cooperation with renowned universities, the CleanImplant Foundation
coordinates global quality assessments of dental implants and awards the “Trusted Quality” seal to those systems that meet the criteria for cleanliness
according to a strict peer-review protocol.

The CleanImplant Foundation recently introduced its
non-profit initiative at the 11th annual meeting of the International Association of Ceramic Implantology (IAOCI),
held in Washington from 19 to 21 May, and awarded the
foundation’s “Trusted Quality” seal to a second implant
system from SDS Swiss Dental Solutions. An important topic discussed over the three days was the impact
of dental implant materials on implant success and the
fast-growing problem of peri-implantitis.

of factory-related contaminants on sterile-packaged
implants”. In it, he presented the latest results of the
organisation’s SEM analysis of sterile-packaged implant
systems, reporting significant quantities of foreign particles caused by the production or packaging process
found not only on titanium implants but also on ceramic
implants. All these implant systems had received the
CE mark or U.S. Food and Drug Administration market
clearance.

During the meeting, Dr Dirk Duddeck, founder of and
head of research at the CleanImplant Foundation, gave
a lecture titled “50 shades of white—the hidden danger

“Unfortunately, we see far too many surface impurities and contaminants that are technically avoidable,”
Dr Duddeck pointed out. “The fact that implants can

3 2022

[45] =>

industry news

3

|

4
Fig. 3: The 11th annual meeting of the International Association of Ceramic Implantology (IAOCI) was the ideal place to meet friends and colleagues.
From left: Dr Saurabh Gupta, CleanImplant ambassador in India; Dr Sammy Noumbissi, president of the IAOCI; and Dr Dirk Duddeck. Fig. 4:
Dr Dirk Duddeck giving a lecture titled “50 shades of white—the hidden danger of factory-related contaminants on sterile-packaged implants” at the
11th annual meeting.

5

be produced and packaged cleanly is evidenced by all
the implant manufacturers which have been awarded
the CleanImplant ‘Trusted Quality’ seal for their implant
system.”

president of SDS Swiss Dental Solutions USA, received
the certificate on behalf of the ceramic implant manufacturer. In October 2021, the company received the
seal for its SDS2.2 implant system.

During the meeting, SDS Swiss Dental Solutions was
awarded the “Trusted Quality” mark for the surface
cleanliness of its SDS1.2 implant. Arthur J. Francis, vice

More information about the CleanImplant Foundation can
be found at www.cleanimplant.com.

6
Fig. 5: From left: Dr Saurabh Gupta and Dr Tudor Cocerhan, CleanImplant ambassador in Romania, asking Dr Dirk Duddeck questions after his presentation.
Fig. 6: From left: Dr Dirk Duddeck and Barbara Sonntag of the CleanImplant Foundation introducing the organisation’s certification and benefits of membership
for dentists to Dr Tudor Cocerhan from Romania.

3 2022

45

[46] =>

| industry news

KATANA Zirconia YML—
Sense the difference!
An interview with Antonio Corradi, scientific marketing
manager at Kuraray Noritake Dental Europe
By Kuraray Noritake Dental
In July 2021, Kuraray Noritake Dental
introduced KATANA Zirconia YML.
With KATANA Zirconia UTML, STML
and HTML PLUS already available, it
was the fourth multilayered zirconia in
the company’s portfolio, and for dental
technicians striving for simplification
and standardisation, it is the only zirconia they will need.

Corradi, scientific marketing manager at
Kuraray Noritake Dental Europe.
Mr Corradi, who should consider
using KATANA Zirconia YML?
Offering strength and translucency
exactly where needed in the blank,
KATANA Zirconia YML is suitable for the
whole range of indications, from crowns
to monolithic long-span bridges. With
these properties, it is the perfect choice
for anyone who would like to use one single zirconia for the production of any kind
of ceramic restoration. Instead of playing
with different blanks depending on the
indication and patient-specific needs,
the increasing fan base of KATANA
Zirconia YML uses the same zirconia
every time and plays with the position of
the restoration in the blank to make it particularly strong or translucent (Table 1).

Its inner structure is different from that
of the others in that it features the
next-generation multilayer technology
with not only colour but also translucency and flexural strength gradation.
This makes KATANA Zirconia YML a
true all-rounder, covering every zirconia
indication. While translucency and flexural strength gradation are key prop- 1
erties differentiating KATANA Zirconia
YML from other zirconia options within Fig. 1: Antonio Corradi during the interview.
the KATANA Zirconia multilayered series, many factors differentiate it from other materials in the
What are the finishing options available for users of
market. It has also been developed to work perfectly with
KATANA Zirconia YML within the Kuraray Noritake
Kuraray Noritake Dental’s specialised products for polishing,
Dental product portfolio?
staining, glazing and porcelain veneering. To learn more about
Kuraray Noritake Dental offers a well-aligned portfolio of
the differentiating factors, we had a conversation with Antonio
feldspathic ceramics for various finishing techniques. Purely
natural aesthetics are obtained by full porcelain layering. The
framework is milled from KATANA Zirconia YML, and afterwards, different layers of CERABIEN ZR Shade Base, Opacious
Table 1: KATANA Zirconia YML: Layers and
Body, Body, Enamel, Internal Stain and Luster porcelain are
their translucency and flexural strength values.
applied and fixed in various bakes (Fig. 2). For morphological
corrections and final polishing, suitable products from Kuraray
Translucency
Flexural
Layer
Layer ratio
Noritake Dental like Noritake Meister Finish polishing points
strength
and Pearl Surface Z polishing material are available.

49%

750 MPa

Enamel

35%

47%

1,000 MPa

Transition

15%

45%

1,100 MPa

Transition

15%

45%

1,100 MPa

Dentine

35%

3 2022

However, a highly aesthetic zirconia-like KATANA Zirconia YML
usually does not require such a complex finishing approach.
Instead, a micro-cutback on the vestibular side of the restora
tion or even a monolithic design with a thin or ultrathin layer of
liquid ceramics is sufficient. For the micro-layering approach, we
offer a set of CERABIEN ZR Internal Stain and Luster porcelain
materials that are usually applied in a two-step procedure (Fig. 3).

[47] =>

industry news

Fig. 2: An even more simplified approach is ultramicro-layering on monolithic surfaces with liquid ceramics such as CERABIEN ZR FC Paste Stain. Fig. 3: Purely natural aesthetics are
achieved with a complex combination of porcelains. BSB = shade base stain (CERABIEN ZR); OB-B-E = opaque body–body–enamel (CERABIEN ZR). Fig. 4: For highly aesthetic zirconia like
K ATANA Zirconia YML, a simplified micro-layering approach is usually sufficient. Fig. 5: Resin cement recommendations depending on the indication, preparation design and margin position.

The occlusal and lingual surfaces not covered by porcelain are
merely polished with, for example, Pearl Surface Z. For the further simplified ultramicro-layering approach, CERABIEN ZR FC
Paste Stain is the perfect choice (Fig. 4). The liquid ceramic can
create texture and a 3D effect on the monolithic surface without
adding so much volume to require a reduction of the zirconia.
Which of these finishing approaches do you recommend to users of KATANA Zirconia YML?
All three approaches are suitable, and I think that ultramicrolayering is often the best option with highly aesthetic zirconia when weighing the time and effort involved against
the aesthetics of the outcome. However, a dental technician
should always take into account the indication-specific requirements and the needs of the patient (e.g. regarding treatment cost, time available and aesthetic demands), as well
as of the dentist, in the selection of the appropriate material combination and finishing approach. A monolithic design
finished with ultramicro-layering is definitely worth a try for
those new to KATANA Zirconia YML.
Are there other materials in the Kuraray Noritake Dental
portfolio that work perfectly with KATANA Zirconia YML?
Many additional products are perfect for use with KATANA
Zirconia YML. One such material is KATANA Cleaner, which
removes saliva or blood from zirconia restorations and from
prepared tooth structures after try-in. With its high cleaning
effect, it is the ideal product for an optimised bond quality
and streamlined adhesive procedures.
For adhesive bonding carried out in the laboratory or the
dental office, different types of resin cement are offered by
Kuraray Noritake Dental. As some dental practitioners might
ask for recommendations regarding cement selection and
restoration pretreatment, it is worth knowing these products
and their range of indications. For KATANA Zirconia, we recommend using the self-adhesive resin cement PANAVIA SA
Cement Universal for restorations with a retentive design

and an adhesive cementation procedure with PANAVIA V5
for all other types of zirconia restorations (Fig. 5).
What else differentiates KATANA Zirconia YML from
similar materials?
Kuraray Noritake Dental is a true expert in the processing
of dental zirconia. This profound knowledge has been leveraged to align the different layers within KATANA Zirconia
YML with their varying yttria concentrations so that shrinkage ratios and coefficient of thermal expansion values are
harmonised and a smooth transition from one layer to the
next is achieved. This adjustment is only possible because
an end-to-end in-house production process has been established, which provides full control over every detail.
Unlike companies who purchase ready-mixed powder,
Kuraray Noritake Dental uses natural ores to produce the
required metal oxides and its own proprietary additive combination for powder production. In addition, an extremely
meticulous pressing process is used to minimise the risk
of contamination by airborne particles, and specific ingredients are added to increase blank stability. All this leads
to high-quality blanks without transition lines or impurities
for well-balanced mechanical and optical properties, a high
accuracy of fit, a brilliant surface quality and edge stability,
and high design flexibility that users will love.
Why do you recommend KATANA Zirconia YML to
potential users?
To my mind, the new material is definitely worth testing in the
laboratory environment. It offers many properties that have
the potential to reduce inventory and streamline procedures
without compromising the outcomes. Material selection is
simplified, sintering may be accelerated and finishing becomes a lot easier with the proposed techniques and
adjusted materials. However, words alone are not enough
to reveal the real difference, which can only be sensed when
processing the material and creating impressive outcomes.

3 2022

[48] =>

| opinion

Both digital and analogue dental
workflows need to be your best friend!
Dr Michael D. Scherer, USA

they? Computers help people spell better and write in a
more grammatically correct manner. Using computers,
people may not have become any more creative, but they
certainly have become more efficient. Has this freed them
up to be more expressive and inventive with their writing?
Dentistry is at a similar crossroads. Digital dentistry techniques will not necessarily make you a better dentist or
more creative overnight, but in my experience, they will
improve your technique, and make your dentistry more
predictable and efficient, just like the word processor did
for writers.

Scan of the maxillary prosthesis and the opposing arch.

Many of the world’s greatest literary achievements
were created with a pen or typewriter. And then, along
came computers and word processing software such
as Microsoft Word and Apple Pages. Did anyone notice
an improvement in storytelling? Maybe it got faster, but
digital tools did not expand anyone’s imagination, or did

I have heard many dentists complain that digital technology cannot make you a better dentist. In my opinion, that is not the case. I know because I am proof.
I am just an average clinical dentist, but because of
digital pathways, I can do things in dentistry that I could
never imagine doing, and I can do the basic tasks
effortlessly.

It should not be a question
of one over the other
When it comes to dentures, implants and full-mouth
reconstructions, digital pathways have made my work
more predictable and time-efficient, but I am not ignoring analogue techniques because I employ more digital ones now. Ever since adopting intra-oral scanning
almost ten years ago, I have only made a small handful
of physical impressions for routine crown and bridge
cases, but I still use analogue workflows for larger
cases.
Analogue and digital workflows are like good friends,
especially for complete dentures and implant workflows.
They just work together. When dentists ignore digital
pathways because they believe it can only be one or the
other, they are mistaken.

Scanning of the mandibular prosthesis.

3 2022

I am a better digital dentist because of my analogue
mindset. In my mind, the digital pathways that I take are
no different from the analogue workflows, except that
I eliminate the polyvinylsiloxane. In addition, digital technology enables me to leverage the data I collect for design and production or, at the very least, share it more
easily with a treatment partner.

[49] =>

opinion

In a denture workflow, for example, you can choose
the analogue workflow, taking a traditional custom
tray impression using polyvinylsiloxane, or the digital
one, using an intra-oral scanner. You scan the identical arch, do a fully digital design, but ultimately, you
get to that same point as you would with a physical
impression.
Our inclination is to separate digital and analogue workflows, to treat them as if they are competing, but I argue
that there is no such thing as a 100% digital dentist, just
like there is no longer a need for a 100% analogue mindset. Our clinical reality is that we should be thinking about
how analogue and digital can live together.
Studies have clearly documented that digital pathways
for any number of indications are at least as accurate as
analogue.1 I am not sure that anyone would argue about
which one is faster or more comfortable for the patient.
But again, I am not saying you need to choose one over
the other. I think we should be taking advantage of both
digital and analogue techniques to provide the optimal
treatment for our patients.

Making the case for digital
and analogue hybrid workflows
On my instructional website, learndentistry.com, you will
notice that nearly every one of the cases that I demonstrate utilises both analogue and digital pathways.
This is especially true for denture workflows when
the maxillomandibular relationship must be accurately
documented. You simply need to use an analogue technique to do this, for example a conventional wax recording technique. The studies I have reviewed have
not concluded that this can be done both accurately
enough and simply using a digital pathway—for now.
Once you determine the relationship, the occlusal rims
can be scanned and then you return to a digital workflow for design and production.
Likewise, beginning your denture workflow with an intraoral scanner has tremendous advantages too. Intra-oral
scanners capture oral tissue in a passive state. You create a mucostatic impression that can result in a much
better fitting denture, especially when your patient presents with thin, flat, sharp or flabby residual ridges. If you
are still one of those wondering whether you can accurately scan edentulous patients, the literature supports
that it can be done,2 and I know because I do it regularly
in my clinical practice.
I encourage you to go to my website or the 3Shape case
study page (www.3shape.com/en/case-studies) to review cases. There you will find real-world examples of
how the two pathways work together to provide terrific
treatments.

Dr Michael D. Scherer and his team.

If you are not using an intra-oral scanner at this point,
I suggest you consider it. You can get started with
simple crown and bridge workflows, send the cases to
your laboratory partner and, when you are comfortable,
expand your repertoire.
Going digital is not about learning new techniques; it is
about doing what you have always done, digitally. I will
say, however, that being digital means that you will need
to improve your tooth preparations, but that is a skill any
dentist could use, even if he or she decides to throw out
the scanner the next day and go back to conventional
workflows. To tell you the truth: once you get used to
intra-oral scanning, you will never go back to goo.

Editorial note: A list of references is available from the
publisher.

about
Dr Michael D. Scherer is an assistant clinical professor
at Loma Linda University in California and a clinical instructor
at the University of Nevada, Las Vegas and maintains a practice
limited to prosthodontics and implant dentistry in Sonora in
California, all in the US. He is a fellow of the American College
of Prosthodontists and has published articles, books, and
in-person and online courses related to implant dentistry,
clinical prosthodontics and digital technology with a special
emphasis on full-arch reconstruction. As an avid technology
and computer hobbyist, Dr Scherer’s involvement in digital
implant dentistry has led him to develop and pioneer new
CAD/CAM surgical systems, interactive CBCT implant planning,
outside-of-the-box radiographic imaging and digital design
concepts, and new approaches to 3D printing.

3 2022

[50] =>

| manufacturer news
Digital impressions for greater convenience and efficiency

Ceramill Map DRS intra-oral scanner allows for complete
arch scans in just 1 minute
time, making conventional impression taking superfluous. With the
scanner, both dentulous partial and complete jaws—before and
after preparation—as well as occlusal relationships and implant
positions, with the aid of scan bodies, can be scanned. Scanning tips
of different heights are available for areas that are difficult to access.
Intelligent features in the corresponding software, such as the automatic deletion of superfluous data and the counting of autoclave
cycles, offer clinicians further convenience. In addition, the preparation line can be defined and checked by the dentist in the scanning
software and then be adjusted if necessary.

Every restorative or orthodontic treatment starts with an intra-oral
impression, and dentists are increasingly employing digital technologies to achieve this. In addition to offering patients greater comfort,
these technologies help streamline the daily routines in the practice.
For example, the dentist can scan a jaw in just 1 minute with the
comprehensive Ceramill Map DRS intra-oral scanner from Amann
Girrbach. The end-to-end digital workflow also simplifies collaboration between the practice and the laboratory.
With Ceramill Map DRS, the clinician can digitally record the patient’s dental status and transmit the data to the laboratory in real

In order to facilitate access to these digital technologies, Amann
Girrbach offers various kits, which can be extended in stages. The
basis consists of the Ceramill DRS Connection Kit, which includes
the intra-oral scanner, the corresponding software and connection
to the company’s AG.Live digital platform. The Ceramill DRS HighSpeed Zirconia Kit allows zirconia to be sintered in the laboratory or
dental practice in just 20 minutes. Extension with the Ceramill DRS
Production Kit allows simple restorations to be fabricated in the
practice and placed in a single session.
“By digitising the data, smaller units can be fabricated and inserted
on the same day, depending on the distance to the laboratory.
At the same time, users benefit from our comprehensive training
and service offers,” explained Elena Bleil, product manager for
Amann Girrbach’s global clinical CAD/CAM business unit.

www.amanngirrbach.com/en/ceramill-drs

Safe surgery with always sharp drills

MIS releases replacement kits for guided surgery drills
Orit Kario, digital solutions product manager at MIS, commented:
“The kits are part of the MIS Stay Sharp approach.” She continued:
“We encourage clinicians to replace their drills before reaching the
recommended number of cycles. Working with worn drills increases
the bone temperature and may lead to implant failure. Sharp
drills meet the best conditions of safe and adequate implant bed
preparation.”

MIS Implants Technologies has recently added two drill replacement kits to its MGUIDE surgical sets line. These convenient kits
are compatible with both the conical and the internal hexagon
implant connections. They include the most used drills in guided
surgery procedures: pilot drills and site preparation drills.

3 2022

The guided surgery drill replacement kits are a welcome addition
to the MIS C1 and SEVEN drill replacement kits and help ensure
that a sharp new drill is available whenever it is time to replace a
worn-out one, thus contributing to patient safety and the success
of the treatment.
www.mis-implants.com

[51] =>

manufacturer news

New and open platform that integrates the whole workflow

Dentsply Sirona opens the gateway to a new digital universe
with cloud-based solution DS Core
DS Core seamlessly integrates with devices, services and
technologies in dental practices, bringing improved efficiency
to workflows, from diagnosis to final treatment
In a recent virtual event, Dentsply Sirona unveiled DS Core, a new and
open platform that integrates the whole workflow of digital dentistry
across its devices, services and technologies. DS Core has been developed in collaboration with Google Cloud and empowers dentists to do
more so that they can focus on their patients and facilitate ways to collaboratively work with laboratories, partners and other dental professionals.
“We are very proud that we are now ready to take the next step in our
mission to make digital dentistry easy to integrate into dental offices.
In line with our recently launched collaboration with Google Cloud, this
enables seamless workflows and the highest level of connectivity with
the ultimate goal in mind: the best treatment outcome for patients,”
commented Dr Cord Staehler, chief technology officer at Dentsply Sirona.
DS Core gives dentists the power to do more
The cloud-based DS Core platform is designed around the needs of
dentists and modern dental practices and places great focus on security.
The platform is efficient, cost-effective and easy to use. Through
automatic software updates, it offers dental professionals access to
the latest version and features.
DS Core seamlessly connects to Dentsply Sirona equipment and is accessible across multiple devices, facilitating the work of a dental practice.
By simplifying workflows and enabling easy adding and integrating of new
ones, it also allows dentists to maximise the productivity of their practice.
Practitioners can use DS Core to store different types of patient files,
making them accessible from multiple locations outside their practice.
Additionally, DS Core supports patient file sharing and cloud storage
that are compliant with EU and US data protection laws.
Dentsply Sirona has also introduced two services that will help dentists
to get the most out of digital dentistry: DS Core Create and DS Core Care.

“By launching this digital universe with DS Core at its centre and services like DS Core Create and DS Core Care, as well as solutions like
Primeprint, we are positioning Dentsply Sirona at the forefront of digital
dentistry. Most importantly, we help dental practitioners to unlock the
full potential of their work so that they can focus on what matters most:
treating patients and giving them healthy smiles,” Dr Staehler explained.
Primeprint Solution—medical-grade 3D printing
Primeprint Solution is a highly automated, end-to-end medical-grade
3D-printing system for dentists and dental technicians who want to
expand their treatment and service offerings. It is a smart hardware
and software solution that is optimised for dental applications and can
run the entire printing process, including post-processing. The high
level of automation helps reduce handling times, allows delegation and
enables maximised productivity. Primeprint Solution enables practitioners to print biocompatible devices with reproducible and accurate
results. The printing process has been developed in line with U.S. Food
and Drug Administration guidelines for additive manufacturing of
medical devices, and outputs from the system are medical products.
www.dentsplysirona.com

DS Core Create—high-quality expert designs with a few clicks
DS Core Create is an excellent tool for next-level dental design services.
With just a few clicks, dental practitioners can gain access to highquality expert designs that are tailored to each patient’s needs across
a broad range of indications. The cloud-based platform makes it easy
to delegate the design workflow, saving valuable time in the dental
practice. The service integrates smoothly with Dentsply Sirona’s new
Primeprint Solution and will grow in the future.
DS Core Care—seamless service and support
DS Core Care is a comprehensive, integrated and easy-to-use equipment service and support solution that harmonises equipment with
service offerings to provide a seamless customer experience. This
helps to increase equipment uptime and gives dentists peace of mind
so that they can focus on their patients.

3 2022

[52] =>

| manufacturer news
A next-generation intra-oral scanner

3Shape introduces TRIOS 5 Wireless and five reasons
why you’ve got to have it

When 3Shape engineers set out to create a next-generation intraoral scanner, we enlisted dental professionals to help us decide
what it should include. Now, five years later, the results are awesome. The brand-new TRIOS 5 Wireless delivers over 50 improvements in ease of use and design!

TRIOS 5 introduces our new ScanAssist engine with intelligent
alignment technology. ScanAssist optimises your scan while you
scan to minimise misalignment and distortion. In fact, it makes
impression taking so simple that, with it, you can create a scan
strategy or scanning routine you prefer.

You will notice immediately that it is smaller and lighter. 3Shape
engineers have managed to pack all that award-winning TRIOS
power into an even more compact body. But that’s not all. Here
are five reasons why you will find TRIOS 5 irresistible.

In addition, TRIOS 5 includes a built-in LED ring around the
scanner body and haptic feedback (think Apple watches) that
help guide you while you scan to make digital impression taking
even smoother and faster. It uses the same artificial intelligence
technology that 3Shape scanners are famous for and removes
soft tissue optionally from your scans.

1. Simply ergonomic—30% more compact body design
At 26.7 cm in length and just over 300 g (with battery) in weight,
TRIOS 5 Wireless is our smallest and lightest intra-oral scanner to
date. The redesigned body is optimally balanced to fit comfortably
in any hand. In comparison, some competitor scanners weigh up
to 468 g and are more than 33 cm in length. A smaller, lighter
scanner makes it easier to manoeuvre and can mean less physical
stress on your team.
2. Simply effortless—intelligent alignment technology
when scanning
If you have used an intra-oral scanner, then you have experienced
misalignment or distortion in your 3D models. To remedy this,

3 2022

3. Simply powerful–optimised battery life
The TRIOS 5’s batteries have been redesigned to be more
powerful and longer lasting. Combined with our new smart
power management that automatically switches TRIOS 5
to sleep mode to save energy, you can scan all day with
just one battery, giving you up to 66 minutes of scan time per
battery.
The batteries now also feature integrated LEDs, so you can
quickly gauge a battery’s charge level, and they charge four
times faster than our previous batteries.

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manufacturer news

4. Simply easier—no more calibrating your intra-oral scanner
This is something only present scanner owners will appreciate.
Every intra-oral scanner needs to be calibrated regularly to make
sure that the colours are imaged correctly. Thanks to its design
and re-engineering, the new TRIOS 5, however, does not need
calibration. Imagine not having to calibrate your scanner every
couple of weeks or when a patient is waiting in the chair!
5. Simply hygienic—a new standard in patient protection
and infection control
TRIOS 5 has reimagined intra-oral scanner design. The new-look
TRIOS is hygienically sealed up to its battery inlet with no cracks
or crevices that can collect any contaminants. A sapphire glass
window now encloses the autoclavable tip to create a sturdy
microbial barrier between patient and scanner. And we’ve included
single-use body sleeves that cover the entire area touched by
you to reduce cross-contamination risks. These changes make
TRIOS 5 especially easy to clean and disinfect.
More reasons for you to switch to TRIOS 5:
Three big bonus benefits
True wireless freedom
By now, you have heard about the advantages of having a wireless
intra-oral scanner, like not tripping on the cable, not pulling the
scanner off the table and not having it draped over your patient.
Being wireless, TRIOS 5 too has these advantages, but it takes your
wireless scanning to a whole other level: TRIOS 5 introduces TRIOS
Share, the world’s only solution that enables you to scan and plan
on every PC in your practice using just one TRIOS wireless scanner.

TRIOS Share connects your TRIOS 5 via Wi-Fi. That means you
can walk with TRIOS in your hand from room to room. You can also
use whatever PC is in your respective operatory to scan and plan
with (using our software)—even on your practice management
system PCs!
Digital dentistry at your fingertips—powered by 3Shape Unite
TRIOS 5 Wireless, like all 3Shape TRIOS scanners, includes the
3Shape Unite platform free. Together, TRIOS and 3Shape Unite
seamlessly connect you to over 2,000 dental companies, treatment solutions, practice management systems and laboratories,
represented as apps on the dental world’s most open and collaborative platform. Dentists can also take advantage of 3Shape
engagement apps, included free with TRIOS 5 Wireless, to help
boost treatment acceptance.
TRIOS 5 service agreement for your peace of mind
TRIOS 5 Wireless owners can take advantage of two TRIOS
service agreement options: TRIOS Care, which delivers focused
and extensive training and unlimited support for practitioners,
including express replacement if your scanner is damaged; and TRIOS
Only, a scan-ready free service agreement with no monthly costs.
From the moment you switch your TRIOS 5 on, TRIOS Care
provides you with complete assurance to enable you to focus on
delivering great treatments and reaching your full digital potential!

www.3shape.com

3 2022

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| manufacturer news
NeoScan 1000 intra-oral scanner

Digital dentistry made easy

As part of Neoss’ milestone celebration delegates at the Neoss
Integrate 2022 congress in Gothenburg, Sweden were given the
first access to the NeoScan 1000 intra-oral scanner which is set
for full commercial launch in September 2022. “I am excited to
introduce the NeoScan 1000 into our range of intuitive dental solutions. The performance of the scanner is beyond my expectations
with clear competitive advantages. The scanner will allow Neoss
to significantly expand its proprietary digital dental offering,” says
Dr Robert Gottlander, CEO and President of Neoss Group. Designed
for scanning accuracy and speed, the compact, lightweight scanner provides the possibility for a flexible workflow with open and
compatible output at a competitive price. “The NeoScan 1000 is a
superfast, lightweight, and easy-to-use scanner. I had the pleasure

of being part of early testing and have used the scanner for
several digital impression indications at my clinic with excellent
results. Digital dentistry is in need of more cost-efficient solutions
so that clinicians can use it to its full potential. The NeoScan 1000
has the potential to do just this,” says Dr Marcus Dagnelid, DDS,
board-certified prosthodontist. With an easy USB cable connection
and full touch screen support, the NeoScan 1000 is sure to please
and excite dental professionals alike!

www.neoss.com/neoscan1000

BioHorizons Camlog expands its portfolio

The next generation soft-tissue augmentation material
When choosing a biomaterial, there is a strong demand in clinical
practice for predictable outcomes. For over 20 years, LifeCell, a
leading global medical technology company, has developed innovative products for use in a wide range of applications. BioHorizons
Camlog expands its soft-tissue portfolio to bring NovoMatrix, an
innovative soft-tissue augmentation material. NovoMatrix is an
acellular extracellular dermal matrix consisting of tissue-engineered

porcine material. It is a breakthrough in xenogeneic processing
ensuring a structurally intact, undamaged scaffold that supports
cell and microvascular ingrowth. The proprietary tissue processing allows for rapid revascularisation, cell repopulation and
minimal inflammation. NovoMatrix comes pre-hydrated and ready
to use and offers a true alternative to autogenous soft-tissue
grafts and current products on the market. The NovoMatrix
indications include guided tissue regeneration
procedures in recession defects for root coverage, localised gingival augmentation to increase
keratinised tissue (KT) around implants and
natural teeth, and alveolar ridge reconstruction
for prosthetic treatment.

www.biohorizonscamlog.com

3 2022

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[56] =>

| meetings

Digital Dentistry Conference and
Exhibition 2022: Boosting use of
digital technology in dental practice
By Iveta Ramonaite, Dental Tribune International

Dr Ali Nankali is a clinical senior lecturer at Barts
and the London School of Medicine and Dentistry at
Queen Mary University of London and the president of
UKDentalCourses (UKDC), an online education platform that
offers continuing professional development opportunities to dentists worldwide. Just a couple of years ago,
Dr Nankali organised UKDC’s first international event,
the Digital Dentistry Conference, and in July this year,
he hosted the second edition of the event. In this interview with Dental Tribune International, he talks about
the expansion of the business and discusses dental
professionals’ growing interest in digital dentistry.
Fig. 1: Dr Ali Nankali.

56

3 2022

Dr Nankali, UKDC was officially launched in June
2019 and it had approximately 4,000 registered
members on its website in May 2020. How has the
platform evolved since then?
The UKDC website (www.ukdentalcourses.com) was
launched in June 2019, and we had some preliminary
plans for growth and for the provision of courses for
UK clinicians. We began with hands-on courses for
dentists only and received encouraging feedback.
In the first few months, the courses were run by me or
in collaboration with a few other lecturers. This changed

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meetings

Fig. 2: Impressions from the exhibition.

over time, and we soon began inviting well-known and
experienced professionals to collaborate with us.
The business growth accelerated very quickly, and
the expansion exceeded our expectations, resulting in
4,000 members. UKDC’s reputation grew beyond its
borders, and we attracted new overseas active members, prompting the formation of UKDC-World, which
pushed us to act more globally.
I am very pleased to share that the number of people
registered on our platform had reached 9,000 by
the end of 2021 and is now over 10,000, although
our policy does not seek or force us to increase followers and members. We believe that membership
should grow naturally, provided that we do our jobs
properly.
Just a year after launching the website, you organised the first Digital Dentistry Conference in
London. What was the impetus for the event, and
what was the overall feedback from dental professionals?
One of our primary goals is to advance dentistry around
the world by meeting the needs of dental professionals.
After our appearance as a professional society, our
followers asked for more courses, events and conferences. Since they were most interested in digital dentistry, my colleagues from Queen Mary University of
London encouraged me to organise our first conference, the Digital Dentistry Conference, and helped to
stage a prestigious event.
The feedback from attendees was highly satisfactory,
which was motivating. However, since we were new

in the dental industry, we faced a few challenges, the
most noticeable of which was the announcement of
COVID-19 just a few days before the planned conference. Although there were no restrictions at the time,
the government encouraged people not to travel
across the city or country, which resulted in numerous
cancellations.
The second edition of the event, the Digital Dentistry
Conference and Exhibition 2022, took place in July.
How was this year’s event different from the first
one?
The second Digital Dentistry Conference and Exhibition was better organised in terms of both planning and
the materials provided. This time, we had a larger team,

“Digital dentistry is
becoming an accepted part
of dental schools.”
and our goal was to familiarise professionals with digital dentistry and its history; related technologies, such
as scanning, designing and printing; and useful and
reliable digital methods in clinical settings. Attendees
had the opportunity to meet experienced speakers in
the field and visit our exhibition. We hosted Planmeca,
Sweden & Martina, UKloupes, ProSomnus, Crown
Dental Burs, Panthera Dental and 3Dental, and the
attendees were able to test some of their most recently
developed high-tech devices.

3 2022

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| meetings

Fig. 3: Dr Ali Nankali (right) with dental students at the Digital Dentistry Conference and Exhibition 2022.

The 2022 event combined talks and exhibitions, which
made it more productive. It turns out that we are the
only organisation that provides a conference with an
exhibition section, whereas other organisations primarily
provide exhibitions with some related talks.
Another exciting aspect is that the conference was held
not only in-person but also online, since we realised
that many people would be unable to attend owing to
the pandemic. Based on the feedback, the system ran
smoothly and our virtual attendees were satisfied with
the service provided.
What were some of the highlights of the Digital
Dentistry Conference and Exhibition 2022, and
what topics were of particular interest to dental
professionals this year?
In our second conference in London, we attempted
to provide attendees with an opportunity to see the
effects of digital dentistry in our healthcare services.
We attempted to look at more clinical aspects, rather
than just theory, and introduced novel devices and presented their effects on our treatments. The main goal of
the conference was to boost the use of digital dentistry
by demonstrating its reality. The conference provided
an opportunity to gain a better understanding of digital
dentistry and its use in dental practices. We also interviewed the attendees to hear their voices and created a

3 2022

YouTube channel (UKDentalCourses) so that everyone, including those who were not able to travel, can
access the recordings.
The conference covered some new topics, such as
sleep apnoea. Dr Aditi Desai, president of the British
Society of Dental Sleep Medicine and the British Academy
of Dental Sleep Medicine, shone light on the topic. She
was supported by Panthera Dental and ProSomnus
Sleep Technologies.
Finally, the name of everyone who purchased a
ticket to the conference was entered into a prize
draw. We had two winners, one for dental loupes
provided by UKloupes and one for a Planmeca
Somia intra-oral camera provided by Planmeca UK.
Also, we gave awards for the best poster presentation and the most collaborative organisation of the year
2022/2023.
Digital technology is rapidly advancing dentistry.
Have you noticed a shift in dental professionals’
acceptance and use of digital technologies recently?
Not long ago, I could see an uncertain expression on
people’s faces when there was a discussion about
digital dentistry and its future. It was as if I were talking
about the next century. Yet, it’s already happening, and

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meetings

“High costs and
complicated software
are the two main
issues that slow
down progress [...]”

I can definitely notice that dental students are attracted
to this field. In an interview with the Dental Mirror,
published in February 2022, I explained that I have been
involved in digitalisation since 1981, when I was using
a massive IBM computer at a time when personal
computers were not yet available to the public.
It was not an easy task, as we had to use DOS with
the C programming language. During the past four
decades, this science has reached an entirely new
level, and it is evident how attached society is getting
to these high-tech systems. The demand for computers
is on the rise and increasing faster than anticipated.
The reason behind this is digitalisation—the rising
volume of data being stored electronically—which allows
us to create exciting software for improving many
aspects of life in society, including our careers as dental
professionals.
In the next ten years, we will see great changes. High
costs and complicated software are the two main
issues that slow down progress, yet I think that these
issues will be tackled relatively soon.
What further advances in technology do you
expect? What would you like to see in dentistry in
the future?

Digital dentistry is becoming an accepted part of dental schools, and this is motivating dental students—who
are the future of dentistry—to embrace the technology.
They recognise its effectiveness and are ready and
willing to work with digital devices.
In addition, the running of professional courses and
events by organisations such as UKDC-World will help
digital dentistry to become more mainstream quickly.
If we consider in more detail what has been happening recently, we see that physical attendance is slowly
disappearing, and a combination of hands-on and
virtual courses is replacing conventional teaching
methods. This way of learning helps advance patient
care services and is beneficial to both the attendees
and course organisers.

3 2022

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Prof. Rainer Seemann believes that:

“Dentsply Sirona World provides a
window into the future
of dentistry, which is digital”
By Iveta Ramonaite, Dental Tribune International

I am the vice president of global clinical research and
currently act as chief clinical officer for Dentsply Sirona.
Furthermore, I am a professor in the department of
operative, preventive and paediatric dentistry at the
University of Bern in Switzerland. I previously worked
in several positions at the dental school and clinic of
Charité—Universitätsmedizin Berlin in Germany before
I joined Dentsply in 2006.
How exactly does your academic expertise benefit
your position as vice president at one of the world’s
largest dental companies?
As the largest manufacturer of professional dental
products and technologies, we do research and education in partnership with researchers and education
providers all around the globe. Dentsply Sirona is also
one of the world’s top providers of clinical education
programmes in the dental industry.

Every year, Dentsply Sirona (DS) World offers a
comprehensive educational programme with breakout sessions, live demonstrations of surgery, hands-on
courses, networking opportunities and live entertainment.
This year will be no different, since the event is guaranteed to meet every dental practice’s needs. In the run-up
to DS World 2022, Dental Tribune International had the
opportunity to speak with Prof. Rainer Seemann, who is
an integral part of Dentsply Sirona, about working at one
of the world’s largest dental companies and about how
it is helping to shape the future of oral health.
Prof. Seemann, could you please introduce yourself to our readers by giving them some information
about your professional and personal background?

3 2022

My academic background allows me to confidently
assess the quality of research partners and understand
the needs of both dental students and professionals,
especially when it comes to training and clinical education. I have an influence on the choice of programmes
offered, and thus it is my responsibility to keep a finger
on the pulse in order to be able to guide our teams in
developing the most up-to-date courses in a variety of
formats.
Dentsply Sirona promotes the development of innovative training programmes with state-of-the-art
technology through extensive cooperation with
universities around the world. How would you define Dentsply Sirona’s main objectives with regard
to improving global oral health, and what role does
the dental industry play, in general, in shaping the
future of oral health?
Let me start with answering the last part of your question by asking what dentists can do to improve the
health of their patients. By providing science-based
dental products and solutions, Dentsply Sirona enables

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Dentsply Sirona World attendees can try new product innovations such as Primeprint Solution, a medical-grade 3D-printing system for dental practices and laboratories.

dental professionals to create healthy smiles. That is our
wonderful mission!
As far as education is concerned, aside from our own
programmes, we collaborate with the leading universities and institutions that are shaping the dentists of
the future. To date, Dentsply Sirona has supported
1,000 universities, clinics and hospitals around the
globe in the planning and construction of new wings
and training facilities. These include the National University Centre for Oral Health in Singapore, the University Center for Dental Medicine in Basel in Switzerland
and the University of Otago in New Zealand. We believe
that, with reliable simulation units and treatment centres
as well as modern digital dentistry solutions, students
will be well prepared to provide the best care for their
future patients.
Everything we do, including empowering the dental
community with state-of-the-art training programmes
and ensuring young dental students are equipped to
thrive in this new digital era, is done with the aim of improving oral health globally and creating healthy smiles.
And when people can confidently smile, they can do
more, achieve more, be the best version of themselves.
It really is more than just teeth, and I am inspired to
work with our partners who are passionate about the
same vision.
Recently, students’ outstanding achievements in
restorative dentistry were honoured as part of
Dentsply Sirona’s Global Clinical Case Contest.
Could you please tell us a bit more about this
competition?

You have really chosen a personal favourite of mine!
The Dentsply Sirona Global Clinical Case Contest, or
GCCC, has been held since 2004/2005. The competition is aimed at dental students with less than two years
of clinical practice. Each participant documents his or
her successful treatment case in text and images and
is supported by a university tutor.

“Everything we do [...]
is done with the aim of
improving oral health globally
and creating healthy smiles.”
This year, over 520 students from around 73 dental schools took part in the competition, and the top
three contestants were presented with an award and an
array of opportunities for networking and education.
I was truly fascinated by the clinical case submission of
the first prize winner, Nanthiphorn Pongam from Mahidol
University in Thailand. At a young age, she is displaying
confident skill, careful knowledge and genuine passion.
Applications for GCCC 2022–2023 are open. I encourage all interested dental students to submit their
applications by going to the Dentsply Sirona GCCC
website (www.dentsplysirona.com/en-us/discover/
discover-by-topic/our-programs/gccc-global-clinicalcase-contest.html). I look forward to seeing some
incredible cases!

3 2022

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Networking, education, entertainment, innovation—all happening at Dentsply Sirona World 2022.

Dentsply Sirona has been providing sophisticated
training for about 20 years, for example through its
academy in Bensheim in Germany. How has the
SARS-CoV-2 pandemic and the related increasing
demand for online training influenced clinical education programmes at Dentsply Sirona?
Looking back, the pandemic was a difficult period
for everybody. However, we took it upon ourselves
to adapt quickly in order to meet the changing needs
of dental professionals globally. Thanks to that, 2021
saw more than 280,000 dental professionals from
74 countries take part in one or more courses offered
by Dentsply Sirona, even as COVID-19 restrictions
eased and dental practices grappled with a return to
business as usual.

Dentists, technicians, hygienists, dental assistants, students and distributor sales representatives took part
in almost 8,000 courses altogether, including live lectures, product training and self-instructional courses.
Since restrictions have lifted, appetite for in-person experiences is back on the rise, and dental professionals
joined 2,246 live, in-person training sessions on specific
Dentsply Sirona technologies in 2021—up from 1,367 in
the previous year, making this the most popular course
format above both self-study courses and live webinars.
Online on-demand courses also grew in popularity.
Therefore, we offered 275 on-demand courses in
2021, compared with 175 the year before, addressing
the need for more flexible programmes to fit around

Dentsply Sirona offers a wide variety of courses and programmes to the dental community, including in-person training.

3 2022

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meetings

When students train using reliable equipment and the latest digital solutions, they are better prepared to provide the best care for their future patients.

increased workloads now that dental appointments
are full again.
All our efforts remain focused on improving dentistry in
order to provide safer and better dental care. We will
continue to listen to the needs of dental professionals
around the world and meet their demands so that we
can collectively move the industry forward.
This year’s DS World event will run under the theme
“Ultimate experience in digital dentistry”. How is
Dentsply Sirona living up to this theme, both at the
event and beyond?
DS World provides a window into the future of dentistry,
which is digital. And the future is already here. Attendees will be among the very first to experience the latest
groundbreaking digital innovations live. One of these is
DS Core, a platform that connects products, services
and technology in the dental clinic. This is a cloud solution, which we developed in collaboration with Google
Cloud. DS Core increases efficiency and facilitates
working with colleagues and partners. It is the gateway
to the digital universe of Dentsply Sirona. Also available in our main exhibition hall is Primeprint Solution,
our medical-grade 3D-printing system for dental
practices and laboratories, which easily integrates into
existing digital workflows, efficiently expanding a range
of indications.
We do not stop here. The magnitude of DS World
makes it an event every dental professional does not
want to miss. It is the ultimate experience in digital
dentistry because it is a very complete and compelling
event. Aside from the technologies and innovations
one can experience here, it is the only event that brings
together leading clinical education, networking among

peers and world-class entertainment. This year’s
headliners are stand-up comedian, television host and
Saturday Night Live legend David Spade and multiaward-winning Rock & Roll Hall of Famers Journey.
I can feel the electricity in the air as people from around
the world gather in one place to learn, share, exchange
and connect, which, in turn, helps dental professionals
provide better care to patients. It truly is unbeatable!

“The magnitude of
DS World makes
it an event every dental
professional does not
want to miss.”
In March, Dentsply Sirona announced its collaboration with Google Cloud and Primeprint, a new
3D-printing solution. Are there any other new research projects in the pipeline for this year?
That’s the thing about being pioneers—the end is
never in sight. There will always be a new technology to
unlock, a new dental challenge to address, a new piece
of information to uncover. This is what makes it exciting
to be in Dentsply Sirona and in the dental industry in
general. I cannot give away anything specifically, but
with regard to my area of responsibility, you can expect
our future solutions to always have dentists’ needs in
mind, backed by clinical research and data, all for
helping patients achieve healthy smiles.

3 2022

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International events

7–9 October 2022
Singapore
www.idem-singapore.com/
about-idem

Dental World Budapest 2022
13–15 October 2022
Budapest, Hungary
https://dentalworld.hu/
dental-world-2022-en

3 2022

25–30 November 2022
New York, USA
www.gnydm.com

AEEDC Dubai 2023
7–9 February 2023
Dubai, UAE
https://aeedc.com/
see-you-at-aeedc-dubai-2022

19th ESCD Annual Meeting

158th Chicago
Dental Society
Midwinter Meeting

13–15 October 2022
Rome, Italy
https://escdonline.eu

23–25 February 2023
Chicago, USA
www.cds.org/midwinter-meeting

Formnext 2022

64

GNYDM 2022

IDS 2023

15–18 November 2022
Frankfurt am Main, Germany
https://formnext.mesago.com/
events/en.html

14–18 March 2023
Cologne, Germany
www.ids-cologne.de

ADF Congress 2022

ICOI World Congress

22–26 November 2022
Paris, France
https://adfcongres.com

13–15 April, 2023
Sydney, Australia
www.icoi.org/events

© 06photo/Shutterstock.com

IDEM Singapore 2022

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© 32 pixels/Shutterstock.com

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Questions?
Magda Wojtkiewicz
(Managing Editor)
m.wojtkiewicz@dental-tribune.com

3 2022

65

[66] =>

| international imprint

Imprint
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International Administration

International Headquarters

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All rights reserved. © 2022 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH is
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Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical
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International GmbH.

3 2022

[67] =>

DIGITAL DENTISTRY –
VERSATILE AND
CONVENIENT.
The Ceramill DRS system for the dental practice and the laboratory!

CONNECTION KIT
PRACTICE

PRODUCTION KIT
PRACTICE

HIGH-SPEED ZIRCONIA KIT
PRACTICE

LABORATORY

FALL-SHARING

With its Ceramill DRS system, Amann Girrbach offers a future-oriented, convenient and versatile
solution for digital dentistry. As open and flexible as you want it to be.
It provides for convenient CAD/CAM workflows in your own practice as well as for interdisciplinary
collaboration with the laboratory, thus giving you more freedom for the essentials.

www.ceramill-drs.com/en
Amann Girrbach AG
Tel +43 5523 62333-105
www.amanngirrbach.com

[68] =>

KATANA Zirconia
YML
™

EMPOWER YOUR DENTAL LAB

DISCOVER NEXT EVOLUTION MULTI-LAYERED
This innovative raw material combination of highly translucent zirconia with high strength will empower
your dental lab. “KATANA™ Zirconia” YML delivers efficiency, clarity, simplicity and precision in handling
without compromising the quality of the outcome!
Visit kuraraynoritake.eu/katana-zirconia-yml for more details on KATANA™ Zirconia Yttria Multi-Layered.

BORN IN JAPAN

Kuraray Europe GmbH, BU Medical Products, Philipp-Reis-Str. 4, 65795 Hattersheim am Main, Germany, +49 (0)69-30 535 835, dental.eu@kuraray.com, www.kuraraynoritake.eu

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[cover] => digital international No. 3, 2022

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Table of contents

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