cosmetic dentistry No. 1, 2023
Cover
/ Editorial
/ Content
/ News
/ “Nowadays, most of our patients ask for laser treatment”
/ “Nowadays, most of our patients ask for laser treatment”
/ The future of dentistry: What will oral care look like in 2040? - Smarter ways of doing dentistry will benefit patients and dental teams
/ Going it alone as a solo practice with purpose - An interview with Dr Florian Fries
/ KATANA Zirconia UTML veneers and crown on zirconia implant cemented with PANAVIA Veneer LC
/ Diastema closure using a direct two-matrix technique
/ Conservative aesthetic management of white spot fluorosis lesions
/ Interdisciplinary treatment of an adult patient with worn anterior teeth
/ Pushing the boundaries with clear aligners: Multidisciplinary treatment planning
/ Is digital dentistry the solution to the sustainability dilemma?
/ Manufacturer news
/ Meetings
/ Submission guidelines
/ Imprint
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[1] =>
issn 2193-1429 • Vol. 17 • Issue 1/2023
cosmetic
dentistry
1/23
beauty & science
opinion
The future of dentistry:
What will oral care
look like in 2040?
case report
Interdisciplinary treatment
of an adult patient
with worn anterior teeth
meetings
International
Esthetic Days 2023
in Baden-Baden
[2] =>
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[3] =>
editorial
|
Dr Sushil Koirala
Editor-in-Chief
Dear reader,
Welcome to this year’s first issue of cosmetic dentistry!
After the expansion of the clinical horizons of Minimally
Invasive Cosmetic Dentistry (MiCD) from cosmetic to
comprehensive dentistry in 2021, MiCD education has
widened in scope and has started demanding newer
concepts, protocols and innovative technologies to help
clinicians worldwide offer MiCD Care to their patients at
MiCD Cost. Simple, fast, reliable and practical clinical
protocols lay the groundwork for successful practice.
In the pursuit of expanding MiCD Care globally, our team
has realised that the MiCD Global Academy should now
focus on MiCD clinical skills training and equipping
“MiCDians” with minimally invasive smart technology.
In this regard, the MiCD Global Academy has recently
established the MiCD International Training and Dental
Innovation Center in Nepal. The idea is to form a team of
knowledge philanthropists from different fields of science
and technology willing to work together to contribute their
skills, knowledge and experiences to make MiCD Care
practically useful, widely accessible and affordable to
all interested dental professionals around the world.
To kick off the mission, we have started collaborating
with innovative minds and have already initiated a handful
of projects on digital dentistry and dental artificial intelligence with a special focus on MiCD Care education
and services.
I personally believe that innovation and philanthropy
should go hand in hand—they complement each other
beautifully. Innovation requires encouragement, proper
mentoring and financial support, and philanthropy can
provide both funds to sustain innovation and knowledge
to mentor and encourage young minds. Translating an
idea into reality requires proper incubation with skilled
guidance. My aim with the MiCD International Training
and Dental Innovation Center is to nudge young minds
towards innovation in dentistry with the aim of developing
start-up dental businesses that help MiCD Care reach
every corner of the globe. Through this editorial, I would
like to appeal for your kind support to help MiCD Care
flourish in do-no-harm dentistry.
In this issue of cosmetic dentistry, we have excellent
clinical articles that support the premise of MiCD Care.
I hope you will enjoy reading this issue and hopefully grow
eager to share your own clinical cases, clinical research
findings and experiences with us so that our readers can
benefit from them.
Sincerely yours,
Dr Sushil Koirala
Editor-in-Chief
cosmetic
dentistry
1 2023
03
[4] =>
| content
editorial
Dear reader
03
Dr Sushil Koirala
news
page 10
Study uses artificial intelligence for gingivitis detection
06
Agreement frees thousands of clear aligner patients
from non-disclosure agreements
08
Hyaluronic acid fillers: Can fuller lips be too full?
10
opinion
page 26
“Nowadays, most of our patients ask for laser treatment”
12
The future of dentistry: What will oral care look like in 2040?
14
interview
Going it alone as a solo practice with purpose
18
user report
page 62
KATANA Zirconia UTML veneers and crown
on zirconia implant cemented with PANAVIA Veneer LC
22
case report
Diastema closure using a direct two-matrix technique
26
Conservative aesthetic management
of white spot fluorosis lesions
36
Interdisciplinary treatment of an adult patient
with worn anterior teeth
40
Pushing the boundaries with clear aligners:
Multidisciplinary treatment planning
48
feature
Cover image courtesy of
Straumann Group (www.straumann.com)
issn 2193-1429 • Vol. 17 • Issue 1/2023
cosmetic
dentistry
58
manufacturer news
60
meetings
1/23
beauty & science
Registration for ROOTS SUMMIT 2024 now open
61
International Esthetic Days 2023 in Baden-Baden
62
International events
64
about the publisher
opinion
The future of dentistry:
What will oral care
look like in 2040?
case report
Interdisciplinary treatment
of an adult patient
with worn anterior teeth
meetings
International
Esthetic Days 2023
in Baden-Baden
04
Is digital dentistry the solution to the sustainability dilemma?
cosmetic
dentistry
1 2023
submission guidelines
65
international imprint
66
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[6] =>
| news
Study uses artificial intelligence
for gingivitis detection
By Iveta Ramonaite, Dental Tribune International
The applications of artificial intelligence (AI) in
dentistry have been widely explored in recent years.
However, a recent study is one of the first to employ AI to
detect gingivitis, enabling monitoring of the effectiveness
of patients’ plaque control. The technology has the potential for improving the early detection and prevention of
oral and systemic diseases associated with periodontal
disease, one of the most prevalent oral diseases globally.
According to the World Health Organization, nearly onethird of cases of periodontal disease are severe.
The interdisciplinary study was a collaboration between
researchers from Hong Kong, Guangzhou in China and
Kuala Lumpur in Malaysia. In it, the researchers trained
and tested a novel AI model on a data set of over 567 intraoral photographs of gingiva with varying degrees of
inflammation. The study found that the AI algorithm can
accurately (> 90%) analyse patients’ intra-oral photographs to detect signs of inflammation, such as redness,
swelling and bleeding along the gingival margin. Its
accuracy in identifying sites with and without gingival
inflammation is close to that of a dentist.
Lead researcher Dr Walter Yu-Hang Lam, a clinical assistant
professor in prosthodontics at the University of Hong Kong,
said in a press release: “Many patients do not attend regular
dental check-ups, and they only seek dentists to alleviate
pain when their teeth are at the end stage of dental disease,
in which tooth loss is inevitable, and only expensive rehabilitative treatments are available. Our study shows that AI can
be a valuable screening tool in detecting and diagnosing
gum disease, one of the key indicators of periodontal disease,
allowing earlier intervention and better health outcomes for
the population,” he noted.
Discussing the benefits of using intra-oral photographs in conjunction with AI technology, lead author
Dr Reinhard Chun-Wang Chau, a clinical research coordinator in restorative dental sciences at the University of
Hong Kong, said that, based on intra-oral photographs,
patients could see which areas they had not cleaned well
and seek dental care earlier.
The researchers now plan to make the technology
accessible to elderly and underserved communities
to improve their oral health outcomes and reduce
healthcare disparities.
Editorial note: The study, titled “Accuracy of artificial
intelligence-based photographic detection of gingivitis”,
was published on 26 April 2023 in the International
Dental Journal, ahead of inclusion in an issue.
From left: Drs Walter Yu-Hang Lam and Reinhard Chun-Wang Chau. (Image: © University of Hong Kong)
06
cosmetic
dentistry
1 2023
[7] =>
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21.09. – 23.09.23 | BADEN-BADEN, GERMANY
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A0046_1/en/B/00/CD 05/23
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[8] =>
| news
By Dental Tribune International
Patients who
are unhappy with
their orthodontic treatment must
be allowed to speak out about it and file complaints
if necessary. This was the take-home message from a
recent settlement between at-home orthodontics company SmileDirectClub (SDC) and the office of the attorney
general (OAG) for the District of Columbia, who spatted
over the company’s refund policy for unhappy patients.
The OAG sued SDC in 2022 for allegedly preventing
patients who were unhappy with its services or injured
by its products from filing complaints and making negative
statements. Local news outlet NBC4 Washington reported
at the time that the orthodontics company required
customers who sought refunds after 30 days to sign
non-disclosure agreements in order to have their money
returned—a practice that the OAG said violated consumer protection laws in the district. Karl Racine, then the
attorney general, said at the time that signing the nondisclosure agreements prevented patients from making
negative statements about their treatment and SDC and
forced them to remove negative comments already
made.
The settlement requires SDC to release around
17,000 former patients around the US from provisions of
non-disclosure agreements, to change its refund policy
for all US customers and to pay US$500,000 to the
District of Columbia.
08
cosmetic
dentistry
1 2023
© Ignacio Javier Bidart/Shutterstock.com
Agreement frees thousands of
clear aligner patients
from non-disclosure agreements
The parties failed
to agree on any wrongdoing.
Attorney general Brian L. Schwalb commented in a
press release that SDC “promised a simple, safe and
affordable way to straighten teeth and touted five-star
reviews—but behind the scenes, the company silenced
dissatisfied consumers and buried complaints about
injuries caused by its products”.
Susan Greenspon Rammelt, chief legal officer at SDC,
maintained that claims of the company seeking to
quell unhappy consumers were baseless. Rammelt
said in a statement: “For too long [has there] been
a misinformation campaign claiming [SDC] stifles
negative consumer feedback through the use of
non-disclosure agreements. While we were disappointed this misinformation caused the District of
Columbia to file its complaint, we are pleased to set
the record straight and work with the District of
Columbia’s office of the attorney general in its efforts
to create new policy for the industry and increase
customer transparency.”
Dr Myron Guymon, president of the American Association
of Orthodontists, commended the OAG in an association
press release for “recognising potentially deceptive and
unfair business practices and for taking action to
ensure that such practices do not harm unsuspecting
orthodontic patients”.
[9] =>
TRIOS 5
simply.hygienic
Introducing a new standard of infection control
in intraoral scanning. TRIOS 5 is easy-clean and
hygienic by design. It includes a completely closed
autoclavable scan tip and ultra-thin sleeve to minimize the risk of cross-contamination.
Protect your patients
with every scan
FDA
c l e a re d
[10] =>
© djtrenershutter/Shutterstock.com
| news
A recent study has reported that thicker lips were considered less attractive by respondents after augmentation.
Hyaluronic acid fillers:
Can fuller lips be too full?
By Iveta Ramonaite, Dental Tribune International
10
Lips come in many shapes and sizes, but fuller lips
are often seen as a physical representation of youth
and beauty. To that end, thousands of women undergo
lip augmentation procedures every year. But do lip fillers
always increase lip attractiveness?
According to the 2017 American Society of Plastic
Surgeons statistics report, surgical lip augmentation
increased by 60% between 2000 and 2017. In 2016,
2.6 million filler procedures were performed in the US,
and the number is projected to grow every year.
Various studies show that facial appearance plays
a vital role in social interactions, which is one of the
reasons why facial aesthetic treatment has become
mainstream. Lip augmentation procedures, especially,
are easily accessible and particularly trendy among
celebrities and people with naturally thin lips.
Hyaluronic acid is a minimally invasive treatment for
lip augmentation that is safe and predictable and
has high patient satisfaction. To guide clinicians in their
use of hyaluronic acid that is tailored to the patient,
researchers from Brazil investigated whether natural
lip thickness before filling affects attractiveness after
cosmetic
dentistry
1 2023
[11] =>
news
|
lip augmentation. They asked dentists, specialists in
facial harmonisation and laypersons to evaluate the
attractiveness of the lips of 16 women, grouped into
eight with thin and moderately thick lips and eight
with thick and full lips, before and after filling with
hyaluronic acid.
The researchers reported that, according to the
respondents’ evaluations, participants who had
thinner lips pretreatment were assessed as having
significantly improved lip attractiveness after the
filling procedure. However, they found that, although
thicker lips were considered more attractive than
thinner lips both before and after lip augmentation,
they decreased in attractiveness after the filling
procedure.
The findings suggest that greater lip volume is not
always more aesthetically pleasing. “There seems to
be a limit to the amount of filler to be injected in patients
who already have a certain volume in the lips before
filling,” the researchers wrote in the study.
In light of the findings, they suggested that dental
professionals should recommend to their patients
the amount of filler to be injected based on the
patient’s lip volume pretreatment and other factors
that significantly impact lip shape preferences, such
as ethnic background and profession. “Clinicians
must be aware that beauty is an ever-evolving
concept subject to trends. The patient expects his
doctor to be up to date with the latest scientific
literature published in the field and aware of beauty
trends. A good talk between the professional and
the patient will awaken trust between them,” they
concluded.
1a
1b
2a
2b
Editorial note: The study, titled “Evaluation of the
attractiveness of lips with different volumes after
filling with hyaluronic acid”, was published online on
21 March 2023 in Scientific Reports.
Fig. 1: Patient from the group with thinner lips before lip filling (a) and
ten days after lip filling (b). Fig. 2: Patient from the group with thicker lips
before lip filling (a) and ten days after lip filling (b). (Images: © De Queiroz
Hernandez et al., licensed under CC BY 4.0)
“[...] dental professionals should recommend
to their patients the amount of filler to
be injected based on the patient’s lip volume
pretreatment and other factors that
significantly impact lip shape preferences [...]”
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[12] =>
| opinion
“Nowadays, most of our patients
ask for laser treatment”
By Dental Tribune International
before laser and after laser. So many procedures have
been significantly improved with the introduction of
a laser. Nowadays, most of our patients ask for laser
treatment and don’t want to undergo traditional therapy
when it comes to frenectomy, gingivectomy, facial
aesthetic treatments and other treatments.
Why did you decide to extend your treatment
portfolio to include aesthetic procedures? Are
these possible with the same laser device that
you use for dental applications?
I’ve been doing facial aesthetic treatments for the past
15 years—mostly with toxins and fillers, but for some
patients who wanted their skin quality improved and for
treating vascular lesions, I had no treatments to offer.
That is why I decided to extend my clinic portfolio to
offer laser treatments too. I use the same laser device
for dental treatments and facial ones. The best thing
about the Fotona laser is that you can use only one
device for so many different applications, and dental
treatments and facial treatments go hand in hand
nowadays.
Dr Alexandra Marques
12
Has your dental practice grown since introducing
laser aesthetic treatments to your practice?
Yes, the practice has grown by 20%, mostly in oral
surgery, facial aesthetics, paediatric dentistry and
snoring treatment.
Dr Alexandra Marques is a doctoral student at the
Universitat Internacional de Catalunya in Barcelona in
Spain and holds a master’s degree in endodontics and
surgery/apical surgery from the same university. She
also holds a master’s degree in implantology, as well as
postgraduate diplomas in advanced surgery and maxillofacial osteogenic distraction and in dental aesthetics
and aesthetic injectables. In this interview, Dr Marques
talks about her experience with lasers in dentistry.
What laser aesthetic treatments do you provide
for your patients, and which is your personal
favourite?
In my clinic, we offer many laser aesthetic treatments,
including for eyelids (SmoothEye protocol), dark spots,
resurfacing, tightening, lips, scars and facelifts
(Fotona3D). My favourite is the LipLase treatment,
which gives natural volume to the lips without injecting
anything artificial into the body but by stimulating new
collagen formation instead.
For how long have you been using a laser system
in your dental practice, and how has this changed
your everyday work routine?
I’ve been using a Fotona laser in my clinic for the past
six years, and sometimes I jokingly refer to the time
Could you share an example of one treatment you
recently undertook?
I do a lot of combined treatments. Recently, I’ve been
doing a lot of SmoothEye treatments for wrinkle
reduction in the periocular region, combined with
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[13] =>
opinion
microinjections of a multivitamin complex. The results
are beautiful and very attractive.
What about the end results? Is laser technology
effective, patient-friendly and safe? How long do
the results last for aesthetic procedures?
The end results with the laser are very natural and
very effective. These are patient-friendly, non-invasive,
walk-in, walk-out procedures that require no recovery
time. This makes laser aesthetic treatments more profitable for the dentist, as the patient turnover is higher.
The only thing is that some laser aesthetic treatments
have to be repeated more frequently than do treatments with fillers or botulinum toxin, making it more
expensive for the patient.
What are the benefits of laser-assisted treatments
compared with using a traditional approach?
When we use a laser, we’re not putting something
artificial inside the body like with fillers. Instead, we
work with the patient’s own collagen, stimulating natural
new collagen production. Another benefit is that no
recovery time is required after laser treatment. Patients
can leave the clinic and immediately go to dinner with
friends without concern.
|
Was it difficult for you personally to learn how to
use your laser system, such as selecting the
appropriate parameters? Would you say that laser
technology is suitable for beginners, experienced
users or both?
I went to university to obtain a degree in laser dentistry,
but that’s not necessary. If you want to work with a
laser, you have to learn about laser principles so that
you can play with the parameters and understand
all the processes: provide the right diagnosis, plan
the treatment, find the optimal parameters and that is it.
For each clinical case, you have to know which laser
to choose: the Nd:YAG or the Er:YAG. This choice is
determined by the absorption characteristics of the tissue
being treated. Therefore, I think that lasers are suitable
for both beginners and experienced users.
Let’s look into the future. Where do you see laser
aesthetic treatment in the dentist’s office in ten
years’ time?
Every clinic that wants to be at the top will have to
use laser technology. Our patients want pain-free care,
non-invasive treatments, no sutures and no recovery
time. There is only one thing that will give you all this:
the laser.
“The best thing about the Fotona laser
is that you can use only one device for so many
different applications, and dental treatments and
facial treatments go hand in hand nowadays.”
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[14] =>
| opinion
The future of dentistry:
What will oral care look like in 2040?
Smarter ways of doing dentistry
will benefit patients and dental teams
Dr Anne Mette Stougaard, Denmark
Smart toothbrushes and intra-oral sensors that
continually monitor biomarkers in the oral cavity,
efficient and free dental services based on preventive and collaborative care strategies, a mobile app
that provides patients with preliminary triage and
dental care guidance—a new way of doing dentistry may be just around the corner. Let us gaze
into the crystal ball and see what might be possible
if we dare to imagine it.
Screening on the playground
The calendar reads 2040. Five-year-old Ava is at
the playground with her mother after her afternoon
snack. Suddenly, Ava holds her cheek and says:
“Ouch, my tooth hurts!” Her mother asks: “Which
tooth is it, honey?” and Ava points and says:
“Right there by my finger.” Her mother responds:
“Okay, sweetie. Let’s take a picture and send it to
tooth chat for help.”
© vectorfusionart/Shutterstock.com
Ava opens her mouth, and her mother takes out
her phone and opens tooth chat in her dental
app, where she is greeted by the app’s chatbot,
which is powered by artificial intelligence (AI) and
guides her in taking a perfect photograph of the
area. Using augmented reality, she can see what
the photograph should look like before she takes
it. Once happy with the photograph, she sends
it off in the app. The chatbot asks her a few
follow-up questions, which she answers either
in text or verbally.
A few seconds later, Ava’s mother receives an
answer from the chatbot: it looks like food
impaction in the interdental space between the
molars. The chatbot sends some advice and
short videos with instructions on how Ava and
her mother could try to clean the space between
the teeth and thus solve the problem by themselves at home without having to go to the
dental clinic.
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opinion
To be sure of the preliminary diagnosis, the chatbot
recommends that Ava’s mother take a better intra-oral
photograph with Ava’s smart toothbrush when they get
home. The whole family has electric toothbrushes with
built-in intra-oral cameras, making it easy to monitor the
health of their teeth and mouths from home.
Ava and her mother walk home to join the rest of the
family for dinner. When it is time to brush their teeth
before bed, Ava’s mother scans Ava’s teeth with the
smart toothbrush, which automatically sends the scan
via the dental app. While Ava is sleeping, her mother can
check the response from the app, which always gives a
preliminary diagnosis and some home care advice.
The final diagnosis can only be made at the clinic.
If further remote assessment is needed, or if Ava’s mother
has any follow-up questions, an on-call dentist or dental
hygienist is always available for a remote tele-consultation
via chat or voice or video call.
Biohacking and dental care on subscription
Ava’s mother is a biohacker and has gone one step
further, having had an intra-oral sensor attached to
the buccal side of one of her own mandibular molars.
The sensor is a bit like an orthodontic bracket and can
constantly monitor the condition of the oral cavity via
various biomarkers in the saliva. This means that most
dental diseases and imbalances in the oral microbiome
can be detected early, allowing disease development
to be discovered and reversed before requiring treatment. The electronic dental equipment is obviously
expensive to acquire, but its cost is covered by the
compulsory dental insurance package that all citizens
now have.
Of course, the dental care package also includes a
fixed quarterly subscription to all the oral care products
that have been prescribed by the dental practitioner.
Each quarter, a new pack of oral care products is provided,
and the old products can be returned in the same box for
sustainable recycling.
Healthcare turned upside down
The healthcare system long ago reoriented to care focused on prevention first. Anything else could no longer
be justified. When you look back at the system in the
2020s, you shake your head. Back then, dentistry was
predominantly geared towards treatment, which made it
both extremely expensive and inefficient. Dental staff
were perpetually treating oral conditions in patients and
were consequently stressed and suffering burn-out,
having to take time off work frequently or leaving the
profession early owing to the subsequent effects on their
mental and physical health.
|
Fortunately, in 2025, a few far-sighted health professionals,
financial experts and politicians reached a broad policy
agreement that reshaped the financing of dental care.
Under the agreement, basic dental care for all citizens is
funded by income tax and additional oral care is financed
through a combination of compulsory dental insurance
and treatment fees.
Central specialist clinics
and local prophylaxis clinics
Celina, a dentist, is resting in the staffroom wearing virtual
reality glasses for engaging in a few minutes of guided
mini-meditation before she sees her next patient.
She is pregnant and needs a little break in which she
can put her feet up and take calming deep breaths in
a nature-based setting.
“The clinics will communicate
with each other via a
cloud-based dental and
medical record system,
enabling data sharing and
remote monitoring [...].”
She is a specialist in oral–systemic medicine, having completed a relatively new multidisciplinary master’s degree
programme that is offered by a collaboration between
dental faculties and hospitals. She works at the specialist
clinic for complicated oral–systemic co-morbidities, where
patients from all over the country can have complicated
oral diseases treated and monitored and major reconstructions done. Patient capacity at the specialist clinic
has been reached, and satellite specialist clinics are set to
open in other major cities.
The clinics will collaborate closely, the specialist clinic acting
as a mini-hospital and providing the complicated treatments,
and the local satellite clinics providing the important basic dental
treatments and regular check-ups, prophylaxis and health
promotion, as well as the often overlooked trust-creating social
interaction between the patient and the dental staff.
The clinics will communicate with each other via a cloudbased dental and medical record system, enabling data
sharing and remote monitoring on the basis of extra-oral
images, intra-oral scans and AI-assisted radiographs,
among others. The system communicates with the common
dental app, through which the entire population has
access to their own dental records.
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[16] =>
© vectorfusionart/Shutterstock.com
| opinion
The work environment
is the strongest currency
Anton, chief of staff at the specialist clinic, is extremely
focused on creating the best workplace in the country,
where employees want to stay on, take on responsibility
and develop their professional skills. Indeed, Anton
knows that recruiting great staff is now an advanced art
form, as there is an extreme shortage of competent staff
in all sectors.
He has taken the prevention first model one step further
by adopting a well-known simple but extremely important
approach that prioritises employees. Simply put, if employees are happy, patients and employers are happy
too.
At the specialist clinic, the team no longer works with
a schedule of fixed appointment times; rather, time
intervals are provided. Patients can check in at a fixed
time in the local area and then stay within a maximum of
5 minutes’ walking distance to the clinic until they receive
a notification that the team is ready to receive them for
treatment.
“These possibilities
will only become reality
if someone takes
the lead and dares
to try out new methods
and workflows.”
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Rounding up
This look into the crystal ball shows us that the future
of dentistry offers many fascinating new possibilities.
However, these possibilities will only become reality if
someone takes the lead and dares to try out new methods
and workflows. The saying “If you are not evolving,
you are dying” can be aptly applied to the recruitment
(and retention!) of good staff who look forward to each
workday and experience a deep sense of purpose and
joy in their work.
I hope you have enjoyed this little sketch of how I think the
future of dentistry may look. It is meant solely as inspiration
for dental professionals and is based on dental innovation
that is happening around the world, futuristic trends,
scientific research and current scientific projects. Indeed,
some of the technologies mentioned are already being
implemented in several countries, and others are still in
the developmental stage.
Editorial note: This article was first published in
Dental Tribune Nordic Edition issue 2/2023.
about
Dr Anne Mette Stougaard is a
dentist, futurist and entrepreneur based
in Denmark. Readers can follow her on
social media (@annemettestougaard),
subscribe to her newsletter at
https://dentalinsights.substack.com
or contact her via e-mail at
info@annemettestougaard.dk.
[17] =>
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[18] =>
© Dr Florian Fries, WHITEVISION
| interview
Going it alone as a solo practice
with purpose
An interview with Dr Florian Fries
By Marlene Hartinger, OEMUS MEDIA
Right in the heart of the southern German town of
Friedrichshafen, dentist Dr Florian Fries runs a modern practice for oral health, seeking to treat patients
with empathy, mindfulness and transparency. To
achieve this, he develops comprehensive treatment
plans based on state-of-the-art prevention. In this interview, he discusses his practice philosophy and
points out how the practice format he has chosen
supports this.
Dr Fries, larger practice structures are the current
trend. Why did you decide to do the opposite?
You are quite right, dental practice chains and franchises are increasing significantly, particularly in the
larger German cities, and this has been the case for
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some time now in Switzerland too. For me, however,
a solo practice was the way to go. The practice which
I established in Friedrichshafen in 2018 is the second
one I have been able to pursue as a dentist in private
practice. In 2009, I took over a practice in Überlingen
and managed it as a solo practice until 2014. After
handing over this practice to two successors, I completed an MBA in healthcare management at the
Munich Business School, enabling me to understand the
complex German health insurance system from a business
management perspective. I then considered a career in
the dental industry and explored this area; however,
having a passion for the intricate craft of dentistry,
I ultimately decided to return to a career as a selfemployed dentist.
[19] =>
interview
|
“I decided to work with marketing professionals right
from the outset and teamed up with
WHITEVISION (www.whitevision.de), an excellent
communications agency with expertise in the field of
white-label brands, as it was clear to me that a start-up in a well-served
location such as Friedrichshafen could only be a success
if it had a clear communication and brand strategy.”
cooperative relationship—an opportunity supported by
the practice being small. I value the freedom to be able
to determine independently all aspects of my practice,
whether in patient communication and treatment, respectful staff management, interior design or external
image.
Are there also trade-offs with this kind of practice?
Do you see yourself in a larger structure in the long
term?
Being able to practise almost entirely in an autonomous
manner is in itself a great opportunity, but at the same
© Dr Florian Fries, WHITEVISION
What are the advantages of a solo practice?
After my first practice, I made the conscious decision
to start up a new practice in which I could freely develop and design my very own concept of a dental
practice. A key factor for me in the conceptual design
of my boutique practice in Friedrichshafen was to deliver particularly individual, personal and professionally
demanding care for my patients. From the very beginning, it has been a special concern of mine and my
team to engage with patients holistically, taking their
personality into account too, to jointly achieve an individually optimal treatment result in a close, trusting and
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[20] =>
© Dr Florian Fries, WHITEVISION
| interview
with a colleague. It would also make sense from a
business standpoint to be able to extend practice
hours and avoid closing the practice during holidays
and to better amortise purchased inventory. Therefore,
I cannot say conclusively whether there might one day
be a Florian Fries and partner dental practice after all.
It’ll be exciting to see what the future holds in store in
this regard.
© Dr Florian Fries, WHITEVISION
You offer a wide range of dental services—what
is at the core of your approach regarding your
offering?
We do indeed offer a wide range of dental treatments in
our practice, but we are also aware of our limitations.
For example, we refer complex surgical therapies, such
as complex augmentations, to experienced maxillofacial surgeons to be able to guarantee that our patients
will receive reliable and optimal results.
© Dr Florian Fries, WHITEVISION
time also presents a constant challenge. There are
certainly also days and weeks when I would like to
have more of an exchange with colleagues, days when
I would like to share some of the burden and be able
to conceptualise and further develop ideas together
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Of course, your question quite rightly relates to whether
general dentists or dental specialists achieve better
and more reliable treatment results. I believe there is
absolute justification for both approaches. Of course, in
these times, it is very difficult to follow all the often-rapid
developments in the individual disciplines; however,
complex restorations often require a very broad and
nevertheless optimal therapeutic approach on an ad
hoc basis, and for this reason, it’s not always possible
to involve a specialist. Also, referral practices in small
towns such as Friedrichshafen do not always cover all
[21] =>
|
© Dr Florian Fries, WHITEVISION
interview
disciplines; for example, we do not yet have a specialist
endodontic practice.
Why did you integrate Guided Biofilm Therapy (GBT)
into your practice concept?
From the very beginning, it was very important to
me to offer my patients state-of-the-art prophylaxis.
GBT is the right concept for me. On the one hand, the
AIRFLOW Prophylaxis Master is a great device, and
the instruments are proven to be effective and gentle on
tissue and are therefore patient-friendly. On the other
hand, the GBT protocol is clearly structured and can
be individually adapted to all clinical indications. It is
very well suited for preventive professional tooth
cleaning but also for secondary prophylaxis treatment
in periodontitis and peri-implantitis patients.
For the GBT certification, you first had to invest in
equipment and the further training of your staff.
Was that worth it?
Indeed, the costs were initially higher than for other
methods, the equipment is more expensive, and
I had three of my staff trained at the Swiss Dental
Academy. But it has been worth it in every respect.
GBT allows us to treat patients who were previously
not interested in prophylaxis or who had reservations
because of past bad experiences. Patients understand that the systematic preventive approach
benefits them in the long term and are therefore
much more accepting of an extensive treatment plan.
For all these reasons, GBT prophylaxis is very well
booked and fits in perfectly with the positioning of my
practice. It also facilitates my ambition of dealing with
patients and my team with empathy, mindfulness
and transparency.
Editorial note: This interview is an edited version
of an article that was published in the 1+2/23 issue of
the ZWP spezial magazine.
about
Dr Fries’ treatment focus is aesthetic
dentistry, microscopic endodontics
and guided implantology. Prophylaxis,
based on EMS’s Guided Biofilm Therapy
protocol, forms an integral part of his
practice concept. Complex overall
restoration leading to lasting, stable
and aesthetically pleasing outcomes
is the primary focus of treatment.
After the initial diagnosis, Dr Fries prepares a detailed treatment
plan, depending on the patient’s needs and wishes, with the
objective of restoring oral health, aesthetics and function.
In addition, reliable backward planning with digital support such
as intra-oral scanning, digital radiographs, CBCT and digital
photography plays an important role in detecting any stumbling
blocks early on and in supporting a predictable outcome.
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| user report
KATANA Zirconia UTML veneers
and crown on zirconia implant
cemented with PANAVIA Veneer LC
Dr Bassem Jaidane, Tunisia
1
2
Fig. 1: Initial clinical situation. Fig. 2: Occlusal view revealing the volume and position of the crown on the central incisor.
Introduction
Among the most common problems in modern dentistry
is that of restoring the patient’s dental aesthetics. New
technologies are available to practitioners to support this.
For anterior teeth, for which aesthetics is paramount, dentists prefer the least mutilating treatments possible, such as
layered veneers (cutback). In cosmetic dentistry, practitioners
are often faced with cases requiring a multidisciplinary
treatment plan or the use of different types of restorative
materials. For cases of prosthetic restoration combining
veneers, crowns and bridges, a difference in shade may
be noticeable in the final result, owing to the difference in
restorative material, product, adhesion technique, thickness
of the restoration and colour of the abutment, whether it is
a vital or devitalised natural tooth or even an implant abutment.1, 2 If the treatment plan requires veneers, crowns and
bridges, it is prudent to choose zirconia as the only restorative material in light of the limited mechanical properties of
lithium disilicate and feldspathic porcelain, contra-indicating
their use for bridges.
There may be some reluctance among practitioners to
use the zirconia veneer technique.3 This is attributable
to various factors, one being the absence of a vitreous
phase, making impossible to create an optimal adhesion
surface with hydrofluoric acid at the level of the intaglio
surface of the zirconia veneers. Another factor is the lack of
translucency of the first-generation zirconia materials.
3
Fig. 3: Pre-op photograph.
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Modern zirconia materials, however, are particularly well
suited for cases requiring a combination of veneers,
crowns and bridges of the same optical appearance.
This is due to their greater translucency and excellent
mechanical properties. The following article describes
and discusses a clinical case treated with veneers
and a crown made from KATANA Zirconia UTML
(Kuraray Noritake Dental). The veneers were cemented
with PANAVIA Veneer LC (Kuraray Noritake Dental).
[23] =>
user report
|
4
Fig. 4: Virtual model.
The patient presented with an aesthetic problem at the
level of an anterior implant-supported crown.
Case presentation
A 29-year-old female patient with no significant pathological history presented to my dental office in January 2023
owing to an aesthetic problem negatively affecting her
smile. The extra-oral examination was without abnormalities, and the intra-oral examination showed good oral
hygiene, healthy soft tissue, thin free gingiva and a protruding zirconia crown on an implant in the region of the
maxillary right central incisor (Figs. 1 & 2).
During the first consultation, it was established that the
implant had been placed in 2020. The patient wished to
have the crown aligned and the aesthetics of her smile
improved before her wedding, taking place ten days after
the first consultation. The patient’s former dentist had
left Tunisia, and the patient had no documentation or
information on the dental implant.
without replacing the abutment. This was due to the
lack of information about the implant type and the lack
of time.
Treatment
After taking the preoperative photographs (Fig. 3), choosing
the colour of the veneers and anaesthetising the maxillary
anterior region, the incisal overlap preparation was carried out on the seven maxillary teeth and the zirconia
crown was removed from the implant. A cylindrical
diamond bur was used to separate the crown from the
abutment. Subsequently, a bite registration and impressions were taken using the wash technique. In addition,
a temporary crown was produced and placed on the
abutment.
Treatment plan
In the dental laboratory, virtual models were created
based on the conventional impressions (Fig. 4).
The zirconia restorations were then designed in full
contour, cut back for the veneering porcelain and
finished by layering with CERABIEN ZR porcelain
(Kuraray Noritake Dental).
After obtaining the informed consent of the patient for
replacement of the crown and for the placement of veneers for aesthetic reasons, the treatment was initiated.
According to the treatment plan, seven maxillary anterior
teeth (from first premolar to first premolar) would receive
an incisal overlap preparation (depth of 0.1–0.3 mm) for the
placement of veneers made of KATANA Zirconia UTML.
For the implant, it was planned to replace the existing
crown with a crown made of KATANA Zirconia UTML
At try-in during the second session, we checked the
insertion, the gingival margins and the contact points
between the veneers and the crown on the implant.
Given the superior mechanical properties of the zirconia
used, the shape and thickness of the veneers were
modified chairside to obtain a harmonious anterior curve
and a better aesthetic rendering. After determining the
colour of the resin cement, the temporary crown was
put back in place.
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| user report
than earlier generations of zirconia. With this translucency, this zirconia allows us to achieve restorations
with remarkable optical properties (Fig. 5).
The patient chose Shade B1 and requested a transparent
incisal edge (Fig. 6). For this reason, a cutback design of
the zirconia veneer (Fig. 7) with porcelain layering was the
technique of choice. The zirconia veneer technique was
chosen to avoid a colour difference between the crown
on the implant and the veneers. The pleasant aesthetic
appearance and harmonious smile were confirmed by
the postoperative photograph (Fig. 8).
5
6
Fig. 5: Remarkable optical properties of the final restorations. Fig. 6: Slight
transparency at the incisal edges of the restorations.
After glazing and preparation of the bonding surfaces in
the laboratory, the veneers were cemented according to
the PANAVIA Veneer LC protocol. We ended the session
by removing excess cement. An occlusion check and
postoperative photographs were taken after three days.
Discussion
The zirconia used for the veneers and the crown has an
yttrium oxide proportion of 5 mol%, leading to about
70% cubic zirconia phase, and therefore a higher translucency—51% (according to Kuraray Noritake Dental)—
7
Fig. 7: Cutback design of the restorations.
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According to the manufacturer, the flexural strength of
KATANA Zirconia UTML is 557 MPa, which is higher
than that of lithium disilicate and feldspathic porcelains.
As zirconia veneers will be more resistant to shear forces,
it is possible to eliminate contact points that interfere during
try-in or even safely modify the shape of the restorations
in situ. This is done with specific burs adapted to zirconia
during different stages of the fitting, according to the wishes
of the patient.4 In the present case, we were able to adjust
the crown until we had a perfect anterior line. It was thus
possible to optimise the inclination of the crown without
replacing the dental implant and in just one week.
Given the significant shear resistance, the laboratory
technician made the veneers with an average thickness
of 0.3 mm. Such a thin veneer requires less preparation
of the dental tissue, limiting preparation to the enamel
instead of extending into the dentine, where the adhesion
value is lower owing to dentine’s lower mineral composition.5
[25] =>
user report
8
|
9
Fig. 8: Immediate post-op photograph. Fig. 9: Treatment outcome. New smile designed according to the individual desires of the patient.
The expected difficulty in bonding zirconia veneers is explained by the absence of a vitreous phase, given the poor
adhesion of the crystalline phase to the bonding cement.
However, the desired surface modification can be achieved
with a different procedure: a tribo-chemical silica coating.
This was used in the present case to improve the adhesion
of the zirconia veneers to the resin cement system. Indeed,
it was found in an in vitro evaluation that the tribo-chemical
preparation technique and the application of the MDP
monomer provide an optimised adhesive interface.6 In that
study, dual-beam focused ion beam technology and scanning electron microscopy were used to compare the resin–
zirconia bonding interface with tribo-chemical preparation
and MDP and the bonding interface between resin and
zirconia without this preparation.
The tribo-chemical process involves aero-abrasion of the
zirconia surface with particles coated with silica combined
with a silane primer containing MDP. The phosphate ester
groups of this silane bind to the surface oxides of the zirconia,
and the methacrylate group makes covalent bonds with
the resin matrix of the PANAVIA Veneer LC cement.7 In the
present clinical case, the KATANA Zirconia UTML veneers
were abraded with silicon dioxide. As a primer, we chose
CLEARFIL CERAMIC PRIMER PLUS (Kuraray Noritake
Dental), because it contains the original MDP monomer
developed by Kuraray Co.8
To clean the veneers before applying CLEARFIL CERAMIC
PRIMER PLUS, KATANA Cleaner (Kuraray Noritake Dental)
was used. The presence of saliva and residue from fittings
can alter the interface with the resin cement, posing a risk
of bonding failure of zirconia veneers.9
One of the most important challenges in this case was
hiding the greyish colour of the implant abutment, which
was visible through the zirconia crown. To hide the grey
of the abutment, a resin opaquer was applied. This,
combined with PANAVIA Veneer LC in white, gave us an
optimal result (Fig. 9).10
Conclusion
KATANA Zirconia UTML veneers have better mechanical properties
compared with some other conventional veneer materials, allowing
users to combine bridges, crowns and veneers without a noticeable
difference in shade. It offers acceptable translucency and aesthetics according to our observation. The technique of bonding
the zirconia veneers with PANAVIA Veneer LC combined with
a tribo-chemical treatment and the application of MDP to the
adhesion surfaces allowed for secure bonding and effective
concealment of the discoloration caused by the implant abutment.
Editorial note: Please scan this QR code
for the list of references.
about
Dr Bassem Jaidane obtained his
DDM in 2010 from the University
of Monastir in Tunisia. He opened
his own clinic that same year,
specialising in aesthetic dentistry and
dental implants, as well as veneers.
A general practitioner passionate about
all areas of dentistry, he has advanced
his knowledge in dental prosthetics,
specifically concerning 3D design, ceramic layering, finishing
and glazing of crowns, bridges and veneers. Dr Jaidane has
therefore acquired expertise in the different types of veneers,
including pressed ceramic veneers, machined veneers, layered
veneers with the cutback technique and Lumineers veneers,
after having carried out numerous cases, as well as veneer
materials. He is a pioneer of the zirconia veneer technique.
cosmetic
dentistry
1 2023
25
[26] =>
| case report
Diastema closure using a direct
two-matrix technique
Dr Gianfranco Roselli & Trifone Lorenzo Bruno, Italy
The patient presented with spaces between teeth #11
and 21 and between teeth #12 and 11. During the diagnostic phase, a digital screening of the smile line
was carried out. The treatment involved the closure of
the anterior spaces with a direct technique using a
nano-hybrid composite. The operative steps to close
the gap between teeth #11 and 21 provide photographic
guidelines on a direct technique presented here with the
name: “two-matrix technique” for diastema closure.
1
Case presentation
Clinical history
The patient came to the initial dental consultation for an
aesthetic assessment. The patient was in good health
without any systemic conditions and had never undergone any orthodontic treatment. The treatment steps
necessary to improve the aesthetics were explained to
the patient after a careful diagnosis. The patient desired
complete closure of the anterior spaces for aesthetic
purposes.
2a
Record taking and diagnosis
On clinical examination, there were no signs of structural impairment related to previous treatments. On
radiographic examination of the crowns, pulps, roots
and periodontium, there were no findings. The diagnosis
was a diastema between teeth #11 and 21 and minimal
gap between teeth #12 and 11.
2b
Treatment plan
The adhesive technique consisted of the two-matrix
technique for diastema closure between teeth #11
and 21 and the transparent-matrix technique for
closure of the space between teeth #12 and 11. A nanohybrid composite, in combination with a universal
adhesive, was used as the material for the gap closures. For spaces < 1.5 mm, it is recommended to
restore freehand (like in this case), whereas for gaps
> 1.5 mm, it is advisable to use a silicone key to achieve
proportional tooth widths and an aesthetic result
(Fig. 1).
2c
2d
Fig. 1: Assessment of the proportions of the tissues and the smile line.
Figs. 2a–d: Choice of shade values.
26
cosmetic
dentistry
1 2023
The Digital Smile Design (DSD) visual technology (DSD
Planning Center) for a thorough analysis based on the
proportions between the teeth was used. The patient
[27] =>
case report
3
4
5
6
7
8
9
10
11
12
|
Fig. 3: Assessment of the distance between the contact point and the bone crest. Fig. 4: Dental dam in situ. Fig. 5: Acid etching of the surfaces to be restored.
Fig. 6: Situation after suction of the etching gel, rinsing and careful drying of the conditioned surfaces. Fig. 7: Application of the bonding agent to the surface
of the enamel. Fig. 8: Placement of the wedge and matrix system between teeth #12 and 11. Fig. 9: Gap closure on tooth #12. Fig. 10: Simultaneous use of
the two matrices (placed vertically). Fig. 11: Construction of the mesial wall of tooth #21. Fig. 12: Marked transition lines.
cosmetic
dentistry
1 2023
27
[28] =>
| case report
13
14a
14b
Fig. 13: Achievement of the surface texture. Figs. 14a & b: Control and smoothing of the marginal contour.
was shown the new geometric lines of the planned
restorations.
We followed a thorough analysis of the chromatic
spectrum, as described by Naorungroj, to accurately
and precisely establish the shades to be used in the
operative steps (Fig. 2).1 The photographic material was
carefully analysed to determine the ideal work planes to
gain the information required to achieve the ultimate
aesthetic aim of the treatment.
In order to avoid a negative gingival influence and
an unaesthetic open gingival embrasure, the complete
papillary filling of the interdental area was set as a goal.
Among other concerns, black triangles are a plaque
and food trap.2, 3 For complete papillary filling of the
interdental area, the distance between the proximal
contact point and the crest of bone must be < 5 mm
(Fig. 3).4
Timeline of treatment steps
Having completed the assessment steps, it was possible
to proceed with the operative steps for the aesthetic
and functional management of the factors affecting the
smile line.5, 6 As a first step, a dental dam was positioned
(Fig. 4).7 Conditioning of the enamel and bonding then
followed. Acid etching (Vococid, VOCO) of the interproximal surfaces of teeth #11 and 21 as well as of the
15a
15b
Figs. 15a & b: Control of restoration.
28
cosmetic
dentistry
1 2023
mesial surface of tooth #12 was performed for 20 seconds
(Fig. 5). The etching agent was then aspirated and
rinsed off with water for 15–30 seconds and the surfaces dried with a gentle air stream to obtain a chalky
white opaque appearance (Fig. 6). The universal bonding agent (Futurabond U, VOCO) was applied to and
rubbed on the conditioned enamel surfaces (Fig. 7),
and the solvent was carefully evaporated using compressed dry air for at least 5 seconds so that the layer
of adhesive became thin, immobile and shiny. The
bonding agent was then light polymerised for 10 seconds
with a high-power LED lamp (Celalux 3, VOCO).
Reconstruction of the contact point mesial to tooth
#12 and distal to tooth #11
A wedge and matrix system (Ena Matrix, Micerium) was
inserted. To ensure good visual control and proper
polymerisation on tooth #12, a transparent matrix was
chosen (Fig. 8). After the application of an initial layer of
packable composite, a nano-hybrid very low-viscosity
flowable composite (GrandioSO Light Flow, VOCO) was
used to ensure proper sealing of the conditioned
enamel (Fig. 9).
Closure of the diastema between teeth #11 and 21
The operative steps chosen to close the space between
teeth #11 and 21 were carried out using a technique we
adapted involving the simultaneous use of two appropriate
[29] =>
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Tribune Group GmbH is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or
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[30] =>
| case report
“For complete
papillary filling of
the interdental area,
the distance between
the proximal
contact point and
the crest of bone must be
< 5 mm (Fig. 3).4”
16
Fig. 16: Completed restoration.
sectional matrices (Fig. 10) applied sequentially as described next. This was done drawing inspiration from
scientific work aiming to restore, in a single clinical session, the natural smile line of patients with periodontal
disease8 or to manage the matrices in a versatile
manner.9
First of all, the first metal sectional matrix (thickness of
60 μm) was positioned vertically and fixed with a wedge
(Ena Matrix). To obtain a clinical preview of the contact
point of the central incisors,10 we then added a second
matrix, again in a vertical position, with the intention of
defining the emergence profile when performing the
cervical restoration. It acts passively on the wedge and
pushes it against the interdental papilla. Having stabilised
17a
17b
Figs. 17a–c: Pre-op (a) and post-op radiographs (c). Post-op photograph (b).
30
cosmetic
dentistry
1 2023
the wedge and matrix system, the first layer of sculptable composite (Admira Fusion, Shade A2; VOCO) was
applied to the mesiovestibular wall of tooth #11 using
the median landmark created by the physical contact
generated between the two matrices. Not too much
material should be applied in the vestibular-palatal direction. This system offers the advantage that, once a
matrix has been removed, the special wedge can be left
in place for haemostatic purposes ready for the insertion of another matrix of the same system. The sectional
matrix was removed from the wall of tooth #11 while
maintaining the previously achieved anatomical limits
(Fig. 11). We then applied a composite increment to
the mesial wall of tooth #21, as here the matrix was still
in place.11
17c
[31] =>
case report
Texturing of the surface
Transition lines were drawn on the vestibular surfaces
of teeth #12–21 using a pencil (Fig. 12) to provide guidance for the contouring.12 Lastly, the texture steps were
performed (Fig. 13), creating vertical texture with a
rough appearance for the demarcation of vestibular
features and giving an appropriate curvature to the area
of the contact point;13 as well as creating microtexture:
after proper mirror polishing, restorations can be made
brighter depending on how the incident light is dispersed, absorbed and reflected on the irregular vestibular surface geometry (Figs. 14 & 15).14
Once the dental dam had been removed, abrasive
discs were used (Sof-Lex, 3M) to optimise the mesial
margins by reducing hinderances to the passage
of dental floss.15 The shine and three-dimensionality
of the treated surface were enhanced by polishing with
a rubber cup and a diamond paste or zirconium powder16 (Fig. 16), all the while paying attention to the interdental spaces.17 To complete the polishing, a felt disc
(Super-Snap Buff Disk, SHOFU) and a diamond-impregnated
polishing paste (DirectDia Paste, SHOFU) were applied to
the enamel, and the final polishing step was performed
using silicone polishers (Dimanto, VOCO). Conventional
radiographic checks were conducted to confirm that
the restoration had been optimally carried out and was
free of potential infiltration sites (Fig. 17). Radiographs
would serve as confirmation at the DSD check.
At the six-month follow-up appointment, the patient’s
situation was very different to that at the initial consultation. There was proper closure of the interdental gaps
and consequent formation of papillary tissue that
harmonised the shape of the attached gingiva and
of the reconstructed enamel perimeter (Figs. 18–21).
In addition, the examination showed no fractures of
the restoration or wear, no marginal discoloration or
other staining, adequate marginal seal, adequate
colour stability and translucency, very good surface
structure and anatomical shape, excellent contact
points, very good integrity of the teeth and no inflammation.
Special advantages of the VOCO products used
The materials used proved to be particularly useful on
account of their aesthetic and functional characteristics. Futurabond U was chosen because it can be
applied as a single layer with a total working time of just
35 seconds, has exceptional adhesion values, expanding its use to materials such as metals and ceramics,
and has high moisture tolerance. Admira Fusion was
used because it is universally applicable, has perfectly harmonious translucency and opacity, enabling
high-quality results that respect anatomical characteristics, and affords the flexibility to work with a singlecolour or multicolour system. GrandioSO Light Flow offers
|
18a
18b
19
20
Figs. 18a & b: Space closure comparative check on the digital smile design
before (a) and after (b). Fig. 19: Frontal image with fluorescence. Fig. 20:
Aesthetic result achieved.
low viscosity with exceptional fluidity, pinpoint application
and outstanding aesthetic results.
Results
The patient was satisfied with the aesthetic accuracy in
terms of restored anatomy, the gaps in the interdental
space have been resolved. This result gave an implicit added value to the direct restoration technique:
micro-invasiveness. The patient did not feel any discomfort during the operative steps, as no significant
preparation of the teeth was needed.
Discussion
For the diagnostic steps, we chose a digital approach
that respected dentofacial symmetry. It was necessary
to carry out a smile line study with a corresponding
cosmetic
dentistry
1 2023
31
[32] =>
| case report
“Diastema closure,
which was previously
mostly performed
using prosthetic or
orthodontic procedures,
can be solved with
direct restorations.”
21a
on the dentistry system and, in many cases, the shortage
of economic resources on the patient’s part for covering
the costs of treatment result in the need to carry out
anterior restoration treatments that are reliable, easy
and quick and, therefore, more affordable, instead of
the more demanding indirect restorations, such as
veneers or crowns.22
21b
Conclusion
The patient was very satisfied with the aesthetic result
and the enormous advantages it would bring in terms
of hygiene and speaking. Diastema closure, which
was previously mostly performed using prosthetic
or orthodontic procedures, can be solved with direct
restorations.
21c
Editorial note: Please scan this QR code
for the list of references.
Figs. 21a–c: Six-month follow-up.
aesthetic diagnosis and treatment plan to provide us with
a correct interpretation of the margins and emergence
profile. This was made possible using DSD technology.
Radiographic monitoring was required to record the
pre- and post-restoration anatomical characteristics.
The intra-operative photographs made it possible to
establish the correctness of the interdental contours.
The clinical and therapeutic factors that led us to choose
a direct approach with a chairside technique were
concerned with the aesthetics.18, 19 The use of novel
chameleon effect nano-hybrid composites ensures the
optimisation of the operating time in the chair, making it
possible to obtain restorations with mechanical and
aesthetic properties identical to those of restorations
obtained using a build-up technique.20 A further, advantageous aspect was the economic one, since the
reduced use of prosthetic procedures afforded considerable cost-savings.21 The increasing economic pressure
32
cosmetic
dentistry
1 2023
about
Dr Gianfranco Roselli works at
the F. Miulli general regional hospital
in Acquaviva delle Fonti in Italy.
Dr Roselli can be contacted at
gianfrancoroselli88@gmail.com.
Trifone Lorenzo Bruno is a student
at the Faculty of Dental Medicine at
Titu Maiorescu University in Bucharest
in Romania. He can be contacted at
trifonebruno99@gmail.com.
[33] =>
[34] =>
[35] =>
[36] =>
| case report
Conservative aesthetic management
of white spot fluorosis lesions
Drs Akimasa Tsujimoto & Ahmad Alkhazaleh, USA
1a
1b
Figs. 1a & b: Maxillary canine to canine view. Prior to vital tooth bleaching (a). After bleaching (b).
Introduction
Dental fluorosis is an enamel anomaly that adversely
affects inorganic phase deposition and organisation,
causing enamel hypomineralisation.1 Despite the essential effect of fluoride in remineralisation of dental
hard layers when used topically, a direct relationship
has been established between the frequency and
quantity of fluoride ingestion during tooth development
and the severity of fluorosis.2 The severity of enamel
fluorosis varies and may affect deeper layers of enamel,
causing excessive porosity that renders the enamel
fragile and prone to fracture once the tooth emerges
into the oral cavity.3 Clinically, this disease is manifested
by white, yellow or dark brown stains within enamel
layers that may be pitted.4
stage. As the maturation stage begins, these proteins
are degraded by protease activity and spatially replaced by hydroxyapatites. In the case of fluorosis, an
increased level of fluoride ions (instead of calcium ions)
is detrimental to protease activity, leading to protein
and water molecule retention within the enamel layers;
as a result, the affected enamel is low in mineral
content and is porous.4
Histologically, enamel scaffold proteins, such as
amelogenin, are routinely secreted by ameloblasts and
deposited within immature enamel during the secretion
Several treatment modalities have been suggested for
treating fluorosis enamel discoloration, ranging from
ultra-conservative tooth bleaching to invasive complete crowning of the affected teeth.4 Resin infiltration,
enamel macro- and micro-abrasion, and facial veneers
are other options for correcting shade discrepancy.5
Choosing the appropriate treatment depends greatly
on the size and depth of the lesion, the clinician’s
experience and the patient’s choice. In mild cases,
bleaching alone may provide satisfactory aesthetic
results, as the discoloured spots will blend better with
2a
2b
2c
Figs. 2a–c: Maxillary incisors prior to resin infiltration treatment. Note the increased contrast between the white spot lesions and sound enamel after vital tooth
bleaching. Anterior view (a). Right lateral view (b). Left lateral view (c).
36
cosmetic
dentistry
1 2023
[37] =>
case report
3a
|
3b
Figs. 3a & b: Transillumination of the maxillary right and left central incisors using different light filters to visualise lesion depth and extent (after dental dam
application and tight floss ligation). The darker areas suggest deeper lesions. Transillumination with a green filter (a). Transillumination with an orange filter (b).
Note the consistent presentation between the different light filters. Transillumination suggested a slightly deeper lesion on the left central incisor.
the surrounding healthy enamel.5 Alternatively, mild to
moderate cases may be approached by bleaching
treatment followed by resin infiltration, enamel macroor micro-abrasion, resin or porcelain veneers, or a
combination treatment. Nevertheless, deeper lesions
are more challenging and often require more invasive
procedures, such as complete crown coverage.4
Dental bleaching is routinely done in office or at home,
both achieving similar long-term success.6 Resin
infiltration is a technique that utilises a low-viscosity,
polymerisable resin after the external enamel surface
has been treated with 15% hydrochloric acid. A single
application of 15% hydrochloric acid to enamel surfaces can dissolve and remove 37–58 µm of superficial enamel, rendering the deeper fluorosis lesion
more accessible by the infiltrate. This novel technique
was initially introduced as a conservative approach
to arresting incipient carious lesions.5 Over time, clinical evidence has emerged that suggests its ability to
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cosmetic
dentistry
1 2023
37
Tribune Group is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA
CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.This continuing education activity has been planned and implemented in
accordance with the standards of the ADA Continuing Education Recognition Program (ADA CERP) through joint efforts between Tribune Group and Dental Tribune Int. GmbH.
[38] =>
| case report
4a
4b
Figs. 4a & b: Maxillary canine to canine view under dental dam isolation. Before resin infiltration treatment (a). Immediately after resin infiltration treatment (b).
mask opacities associated with hypomineralised
enamel lesions.7 In theory, treating white spot lesions
with resin infiltration obliterates enamel pores with a
material (i.e. resin) that has a refractive index closer to
that of healthy enamel (RI = 1.62; resin RI = 1.42) than
air (RI = 1.00) and water (RI = 1.33). In contrast to resin
infiltration, micro-abrasion utilises an acidic slurry of
hydrochloric acid and pumice that is actively brought
into contact with affected enamel using a rubber cup
rotating at a slow speed. A recent systematic review
concluded that resin infiltration has the highest effectiveness in treating mild to moderate lesions, followed
by bleaching and then micro-abrasion. Macroabrasion simply utilises a dental bur to eliminate the
affected hypomineralised area, which is subsequently
restored with a restorative material. This case study
aimed to visually evaluate the effectiveness of home
bleaching followed by resin infiltration in resolving the
aesthetic concerns of a patient with fluorosis-affected
central incisors.
most likely due to the high fluoride content of the drinking water. Periapical radiographs were within normal
limits, and vitality testing (liquid carbon dioxide) revealed
a normal response. Conservative treatment options to
correct shade discrepancy included resin infiltration,
enamel macro- and micro-abrasion, and/or porcelain
veneers.
Case presentation
Tooth bleaching was suggested to reduce colour discrepancy and enhance the blending effect between
the lesion body and the surrounding enamel. The
patient opted for home bleaching using 10% carbamide peroxide with potassium nitrate and fluoride
(Opalescence PF 10%, Ultradent). Custom-made trays and
home instructions were also provided at the same visit.
The patient was asked to discontinue bleaching two
weeks prior to her upcoming infiltration treatment
appointment. According to a review, a waiting period
of one to three weeks is recommended prior to resin
composite bonding to reverse the detrimental effect of
any remaining oxygen on resin polymerisation and
bonding.8
A 27-year-old female patient attended the Operative
Dentistry Clinic at the University of Iowa College of
Dentistry and Dental Clinics complaining of white spot
enamel opacities on her maxillary anterior teeth, mainly
the central incisors (Fig. 1a). There was no discomfort
or history of sensitivity. Other family members had
similar white spot complaints, according to the patient.
Her local dentist suggested that her condition was
Six weeks after the initial appointment, the patient
returned with visually whiter teeth, but the lesions were
still noticeable (Figs. 1b & 2). To determine the most
conservative and effective technique to address her
aesthetic concerns, coloured filters were attached to a
curing light tip, the light was projected from the lingual
aspect and the colour changes on the facial surface
were observed (Fig. 3). This procedure can assist
5a
5b
Figs. 5a & b: Maxillary canine to canine view after resin infiltration treatment. One-week follow-up (a). Fourteen-month follow-up (b). Note the colour
stability after 14 months.
38
cosmetic
dentistry
1 2023
[39] =>
case report
|
“A recent systematic review concluded that resin infiltration
has the highest effectiveness in treating mild to moderate
lesions, followed by bleaching and then micro-abrasion.”
the clinician in estimating the depth of the lesion;
the deeper the lesion, the greater the light blockage.
For deeper lesions, a combination of various treatment
means may be more appropriate. In this patient’s case,
the right central incisor lesion was less extensive than
the left central incisor lesion, and thus, a better outcome was anticipated. Resin infiltration was selected to
treat both lesions.
A dental dam with tight floss ligation was placed (Fig. 4a)
to assist in isolation, prevent saliva contamination
and protect the soft tissue from the hydrochloric acid.
Both central incisors were polished with a non-fluoride
polishing paste and a rubber cup. The resin infiltration
treatment was performed according to the manufacturer’s instructions. Icon-Etch (15% hydrochloric acid;
DMG) was applied passively to the affected areas and
periodically massaged for 2 minutes. The surfaces
were then wiped with a cotton pellet to remove the acid
gel, and the residue was rinsed off with copious water
irrigation for 30 seconds. The surfaces were then
thoroughly dried with a continuous stream of oil-free
and water-free air.
Icon-Dry (99% ethanol; DMG) was applied to and left
on the surface to slowly evaporate, facilitating the elimination of water molecules located within the enamel
porosities. Shade improvement was observed, but the
process was repeated to further enhance the result.
After the second Icon-Dry application, a substantial
shade enhancement was observed clinically, and the
TEGDMA-based Icon-Infiltrant (DMG) was applied to
the etched and dried surfaces and periodically massaged to enhance penetration for 3 minutes. Excess
material was removed with a cotton pellet and dental
floss before light polymerising at a minimum intensity of
800 mW/cm2 for 40 seconds. The infiltration process
was then repeated with only 1 minute of application
time. Finishing cups and polishing discs were utilised
to smooth the surfaces (Fig. 4b). The dental dam was
removed, and the patient asked to assess her outcome. She was happy with the result and the shade
modification (Fig. 5a).
At the 14-month follow-up appointment, the patient
expressed her great satisfaction with the result
and agreed that no further treatment was needed
(Fig. 5b).
Conclusion
Dental fluorosis is an increasingly prevalent phenomenon. According to a Centers for Disease Control
and Prevention website review paper,9 the prevalence
of fluorosis in 2011/2012 has doubled from 30% in
2001/2002.10 This rapid increase in fluorosis cases, accompanied by growing public awareness and aesthetic
demands, requires dental care providers to be creative
in offering the most conservative treatment modalities,
such as tooth bleaching and resin infiltration. A combination of home bleaching and resin infiltration was used
in this case to successfully resolve anterior white spot
fluorosis. The 14-month follow-up indicated both colour
stability and patient satisfaction.
Editorial note: This article originally appeared in Oral Health
Magazine, and an edited version is provided here with
permission from Newcom Media.
Please scan this QR code for the list of references.
about
Dr Akimasa Tsujimoto is an
associate professor of operative
dentistry at the University of Iowa
College of Dentistry and Dental Clinics
in Iowa City in the US. He obtained
his BDS and PhD at Nihon University
in Japan and holds a tenured
professorship in operative dentistry
at the same university and visiting
professorships at Creighton University in Omaha in Nebraska
in the US and at the University of Hong Kong.
Dr Ahmad Alkhazaleh is an
assistant professor of restorative
dentistry at the Oregon Health and
Science University School of Dentistry
in Portland in Oregon in the US.
He obtained his BDS from the
Jordan University of Science and
Technology in Ar-Ramtha and MS
in operative dentistry and certificate
in operative dentistry from the University of Iowa College
of Dentistry and Dental Clinics in Iowa City in the US.
cosmetic
dentistry
1 2023
39
[40] =>
| case report
Interdisciplinary treatment
of an adult patient
with worn anterior teeth
Drs Elia Diana Boangar & Ionut Branzan, Romania
1a
1b
1c
1d
1e
1f
Introduction
The process of decision making is nowadays influenced
by the continuous flux of information, the advancement
of technology and the development of new protocols
and evidence-based procedures, but the most powerful
tool that we have available is collaboration with other
specialists. Published in 2010, a study conducted by the
Massachusetts Institute of Technology and Union College
demonstrated that collective intelligence exceeds the
cognitive abilities of individual group members.1
cosmetic
dentistry
In such cases, the calibration of knowledge, technology and treatment objectives, as well as excellent
communication between dentists, dental technicians
and patients, is paramount for aesthetic and functional outcomes.
“The present case report
describes the orthodontic
and prosthetic treatment
of an adult patient
with worn maxillary and
mandibular anterior teeth.”
2
40
This principle also applies to dentistry, where
complex problems can usually be solved by the
intervention of several specialists, with the aim
of making treatment more predictable and less
invasive.
1 2023
[41] =>
case report
3a
3b
3c
In daily practice, we are used to requests for functional
or aesthetic improvements from adult patients with
multiple associated problems and deal with these in a
very precise, objective-oriented manner. The present
case report describes the orthodontic and prosthetic
treatment of an adult patient with worn maxillary and
mandibular anterior teeth, open bite and implants
replacing the mandibular first molars.
Case report
The 38-year-old female patient complained of her deteriorating maxillary and mandibular incisors and associated sensitivity to cold and warm food and beverages.
Her medical history was non-specific. On history taking,
the patient reported past and present sleep bruxism
(apparent from night-time sounds reported by her husband), morning muscle fatigue in the masseter area,
and daytime clenching and bracing of the mandible.
She drank carbonated drinks on a daily basis. In the psychosocial evaluation, she reported high scores of anxiety and
stress. On palpation, the bilateral anterior articular space was
slightly painful (as a value of 5, reported on a scale of 1–10).
There were also bilateral reciprocal articular clicks, but no
3d
3e
|
3f
functional restriction and no pain on movement or on loading
of the temporomandibular joint. The retrospect, the history
and the clinical examination indicated that she likely had
sleep and awake bruxism.2
The clinical evaluation revealed maxillary and mandibular
wear extending into the dentine. She presented with
a left class II subdivision occlusion and 1.5 mm of
anterior overbite and with two lithium disilicate crowns
supported on implants in the positions of the mandibular
first molars. The implants had been placed two years
prior (Figs. 1a–f).
The gingival phenotype was thin, and there was localised gingival recession. There was increased probing
depth of 4 mm distal to the maxillary right first and left
second molars. There was a probing depth of 7 mm
distal to the left implant and 5 mm distal to the right
implant, and both exhibited bleeding on probing.
Therefore, the patient was referred to the periodontist
for initial therapy and re-evaluation.
As the wear facets of the anterior teeth could not be
solely explained by the grinding activity,3 we considered
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them to be of mixed aetiology: chemical (erosion)
and mechanical (attrition). Therefore, the patient was
advised to abandon drinking carbonated drinks and to
control the daytime clenching and bracing of the
mandible by using visual reminders (coloured stickers
that she would change every week for eight weeks).
She was also prescribed a night-time Michigan splint
(Fig. 2) in order to protect the dentition during
grinding.
After eight weeks of behaviour control, the muscle
tenderness disappeared and the pain on palpation of the
anterior articular space decreased to a value of 2 (as reported on a scale of 1–10). The patient then requested
restoration of the worn maxillary and mandibular incisors
and canines. A complete aesthetic and functional analysis
was therefore done, and the following points were established: slight facial asymmetry and good middle–lower
facial third proportion, good projection of the mandible,
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prominent chin, 4 mm display of the maxillary incisors
at rest, normal smile line, straight incisal curve, asymmetric gingival margins, maxillary occlusal plane was
irregular and canted to the left (maxillary first molars
had overerupted), altered dental proportions and maxillary midline deviation 0.5 mm to the right (Figs. 3a–4f).
However, when determining the arc of closure, a single
intermaxillary contact was found (tooth #18 with tooth #48)
and anterior and posterior open bite, a bilateral Class II
occlusion and an anterior shift into intercuspal position
(Figs. 5a–c).
Because the occlusal scheme would have not allowed
for minimally invasive prosthetic restoration, the patient was referred for orthodontics first. As the patient
was not bothered by the facial asymmetry, and her
facial and skeletal balance were satisfactory, she
declined orthognathic surgery and opted for an orthodontic and prosthodontic solution for her deteriorating
dentition.
After orthodontic case analysis and interdisciplinary
discussion with the prosthodontist, the following
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“Because the occlusal
scheme would have not
allowed for minimally invasive
prosthetic restoration, the
patient was referred for
orthodontics first.”
treatment objectives were established: levelling of
the gingival margins of the maxillary incisors and
canines, intrusion of the overerupted maxillary
molars, reduction of the Class II occlusion and overjet, levelling of the mandibular occlusal plane and
uprighting of the mandibular second molars, removing
the premature contacts and allowing for multiple,
stable intermaxillary contacts in the registered arc
of closure.
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Sometimes, after removing premature posterior contacts by extraction of third molars and/or intrusion
of terminal molars, the mandible autorotates into a
Class I occlusion, making the orthodontic strategy clear:
vertical control. That is why, on the registered and
mounted casts, we removed the mandibular second
(which would have been intruded using the existing
implant-supported crowns) and third molars in order
to see whether we would obtain any change in the
sagittal intermaxillary relationship (Figs. 6a–c). Unfortunately, this quick treatment simulation showed us that
vertical control would not be enough and that sagittal
correction biomechanics would also need to be
considered.
The best anchorage in orthodontics is skeletal anchorage. In the mandible, the implants would be used
for intrusion and uprighting of the second molars, and
in the maxilla, we had planned to use orthodontic
mini-implants to intrude the overerupted first molars4, 5
and for en masse distalisation of the maxillary arch into
a Class I occlusion.
After the treatment strategy was decided on, an orthodontic digital set-up (Figs. 7a–c) was created and
discussed with the prosthodontist and then with the
patient so that she could better understand and
visualise the need for treatment and the restoration
requirements after orthodontics. This step was very
important for the interdisciplinary treatment, as the
patient needed to understand that, in order to reach
the desired aesthetic and functional result, she needed
to complete both orthodontic and prosthodontic
treatment.
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After she gave her informed consent, extraction of
all four third molars was performed and orthodontic
treatment was initiated. Four mini-implants (MCTBIO)
were placed buccally between the first and second
molars and palatally between the second premolars
and first molars. They were used at first for vertical anchorage for intrusion of the maxillary first molars and
then for en masse distalisation of the maxillary arch
in order to reduce the Class II occlusion and overjet
(Figs. 8a–f). When the orthodontic treatment entered
the finishing phase, the case was discussed again with
the treating prosthodontist, who validated the results.
The intention of doing so was to make the case less
invasive and more predictable.
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After bonding of fixed retention wires in order to
maintain tooth position, the patient entered the
prosthodontic phase. First, new implant-supported
crowns were delivered for the mandibular first molars
with the aim of gaining interproximal and occlusal
contacts with the neighbouring teeth. A new aesthetic and functional analysis was then performed
(Figs. 9a–10f), after which a wax-up for the six
maxillary and mandibular anterior teeth was done
(Figs. 11a–f)—in order to restore tooth proportions
and correct dental contacts and function. The
wax-up was transformed into a mock-up, which was
tested both aesthetically and functionally, without
any modifications (Figs. 12a–13f).
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about
After the test-drive phase, because of the minimal
additive requirements of the mandibular anterior teeth,
composite was chosen as the restorative material.
However, feldspathic ceramic restorations were chosen
for the maxillary anterior teeth owing to the high aesthetic
demands of the case.
Minimally invasive preparations were performed, as
the patient did not want colour changes, with the aim
of allowing space for the restorations and having a path
of insertion (Figs. 14a–c). In the same appointment,
the colour of the substrate and an analogue impression
were taken (Fig. 15). The restorations were received
from the laboratory the following week and were then
tried in and bonded using the split-dam technique
(Figs. 16a–17f). The composite build-ups on the
mandibular anterior teeth were done in the same
appointment. After one week, the restorations were
biologically, aesthetically and functionally integrated
(Figs. 18a–19f). At the three-year recall, the restorations
were still performing very well aesthetically and functionally, and the interdisciplinary treatment results
remained stable (Figs. 20a–f).
Conclusion
By integrating orthodontics, challenging prosthodontic
cases can be managed in a less invasive and more
aesthetic, functional and predictable way. Good communication between the professionals involved and
with the patient, as well as a comprehensive case
analysis, is of utmost importance for the success of
such cases.
Editorial note: Please scan this QR code
for the list of references.
Dr Elia Diana Boangar graduated
from the Iuliu Hațieganu University of
Medicine and Pharmacy in Cluj-Napoca
in Romania in 2006 and finished her
master’s degree in orthodontics in
Cluj-Napoca and Bordeaux in France in 2010.
Ever since, she has been exclusively
practising orthodontics in Cluj-Napoca
and Zalău in Romania. In 2015, she
joined the Romanian Learning by Doing multidisciplinary educational
platform, which advocates for solid professional and ethical
principles in dentistry. Apart from her private practice, she likes
to share her experience and advocate for the integration of
interdisciplinarity in the protocols of complex treatment planning.
She lectures nationally and internationally on the subjects of
skeletal anchorage and interdisciplinary treatment of adult
patients, emphasising the importance of properly sequencing
orthodontic, periodontal and restorative treatment. She is an
active member of the World Federation of Orthodontists, American
Association of Orthodontists and European Orthodontic Society.
Dr Ionut Branzan graduated from the
Iuliu Hațieganu University of Medicine
and Pharmacy in Cluj-Napoca in
Romania in 2005. Since then, he has
been working in Zalău in Romania,
where he established an interdisciplinary
clinic and team. Currently, he focuses
on dental and implant prosthetics.
He lectures extensively in Romania
and abroad on the topic of aesthetics in dentistry and implant
prosthodontics. He is a member of the Romanian teaching
platform Learning by Doing, a project aimed at educating young
dentists of different specialties. Dr Branzan has published
articles concerning the clinical aspect of his work in numerous
journals in Romania, Italy, Japan, China, Germany, Canada
and Poland. He contributed several chapters to Incursiune
în Estetica Dentară (Society of Esthetic Dentistry in Romania,
2013; available in English as Comprehensive Esthetic Dentistry,
Quintessence Publishing, 2015). In 2017, he won the Award
Excellence in Prosthodontics, presented by the Italian Academy
of Prosthetic Dentistry, American Prosthodontic Society,
Journal of Prosthetic Dentistry and Zerodonto blog.
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Pushing the boundaries
with clear aligners:
Multidisciplinary treatment planning
Dr John Hagiliassis, Australia
aesthetic solutions with minimally invasive dentistry and/or
surgery (Fig. 1). The principles can be grouped into:
1. extra-oral considerations;
2. peri-oral considerations; and
3. dentition considerations.
This article demonstrates the application of these principles in clear aligner treatment for cases of gummy smile
and buccal corridor asymmetries and cases requiring
restorative augmentation. The cases are drawn from the
AORTA Clinical Handbook written by me and Dr George
Abdelmalek and the AORTA online continuing professional development course (www.aortaaustralia.com)
presented by me and Dr Abdelmalek.
1
Fig. 1: Visual representation of the AORTA principles, demonstrating the
hierarchy of importance of each factor involved in aesthetic orthodontic
principles when undertaking a smile transformation.
Introduction
The evolution of clear aligner therapy has transformed
the way we connect and communicate with our patients.
As clinicians, it has also redefined our ability to diagnose
and plan treatment for our patients’ wants and needs.
We are all aware that the age of connectivity and social
media means that our patients’ wants have gravitated
around aesthetics. The digital workflow of clear aligners
has enabled technology to arm the modern clinician with
the ability to automate visual differential treatment plans.
This allows the visual collaboration of orthodontic, facial
aesthetic and prosthodontic principles. Importantly, this
visual and accurate simulation provides patient interaction with and connection to the treatment plan. It empowers the patient to try the treatment before committing
and to establish an emotional connection to what he or
she wants.
The principles that I apply are the AORTA (Aesthetic
Orthodontic and Restorative Training Academy) principles, amalgamating prosthodontic, aesthetic orthodontic
and facial aesthetic principles to establish functional and
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Gummy smile
The clinician needs to evaluate whether gummy smile
situations can be managed with a minimally invasive
approach using clear aligners for intrusion and/or other
minimally invasive modalities, such as tooth augmentation,
gingivectomy, facial injectables, lip fillers and dermal fillers,
or whether we should approach treatment invasively
with a conventional surgical intervention by orthognathic
surgery to correct vertical and/or transverse discrepancies
based on skeletal discrepancies in conjunction with clear
aligner therapy. The preferred approach is becoming
clear. Digitising the diagnostic process and using minimal
intervention is the preferred approach. It is not only in the
sphere of orthodontic principles that we must look for
the solution: we must also look at means of camouflage
and/or use multidisciplinary modalities like facial aesthetic enhancers and/or prosthodontic principles. Gone
are the days of the choice of orthognathic surgery and
conventional orthodontics or nothing!
Based on the AORTA simple, advanced, complex (SAC)
protocols of predictable movement, a gummy smile
can be improved by 3 mm intrusion of the maxillary
anterior teeth. The principle here is that the gingival
height will follow the intrusion of the teeth in relation
to the enamel exposed supragingivally. It is then up
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Fig. 2: Patient’s facial photograph to be considered in the treatment plan. Fig. 3: Close-up view of the patient’s smile. Fig. 4: Orthodontic digital simulation
using Invisalign software to show the pretreatment position (blue) and the predicted result after treatment (white). Fig. 5: Patient’s facial photograph after
aligner treatment. Fig. 6: Close-up view of the patient’s smile after aligner treatment. Fig. 7: Digital planning of soft-tissue recontouring done in-house at
the AORTA dental laboratory. Fig. 8: Close-up view of the surgical guide created using 3D planning, the PRO 4K printer and Zendura thermoplastics.
Fig. 9: Patient’s facial photograph after soft-tissue recontouring. Fig. 10: Close-up view of the patient’s smile after soft-tissue recontouring. Fig. 11: Patient’s facial
photograph after soft-tissue recontouring, direct restoration and whitening. Fig. 12: Close-up view after soft-tissue recontouring, direct restoration and whitening.
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Fig. 13: Patient’s facial photograph to be considered in the treatment plan. Fig. 14: Orthodontic digital simulation using Invisalign software to show the
pre-treatment position (blue) and the predicted result after treatment (white). Fig. 15: Close-up view of the patient’s smile. Fig. 16: Patient’s facial photograph
after aligner treatment. Fig. 17: Close-up view of the patient’s smile after aligner treatment.
to the clinician to decide how to augment this gummy
smile reduction from an orthodontic beginning by
gingivectomy, lip fillers and injectables in the upper lip
facial muscles rather than conventional or orthognathic
surgery modalities.
Case 1
This patient desired improvement of her smile aesthetics
with minimal restorative involvement (Figs. 2–4). She presented with significant excess gingival display in the maxilla,
producing a gummy smile from tooth #15 to tooth #25
of about 5 mm. The patient also had a maxillary midline
towards the left side and a thin upper lip. The patient had
a dental Class II/I relationship on the left side and healthy
gingival tissue of a medium-thickness biotype with no
signs of local or general gingivitis or periodontitis. There
were also no signs of any restorations or risk of or active
dental caries.
After six months of weekly changeover of aligners
(25 out of 33 aligners in the maxillary arch and 25 out of
25 aligners in the mandibular arch and no refinement) and
achieving adequate intrusion of the six maxillary anterior
teeth, the pre-restorative segment of the treatment was
complete (Figs. 5 & 6). The next phase was a digitally
planned soft-tissue recontouring of the labial tissue of
the six maxillar anterior teeth. For this purpose, a digital
surgical guide was made by our laboratory at AORTA using
our PRO 4K printer (Asiga; Figs. 7–10). This was followed
by in-chair tooth whitening and then composite augmentation of the incisal edges of teeth #13–23 (Figs. 11 & 12).
The patient was then placed into retention with Zendura
FLX thermoplastic retainers (Bay Materials) based on
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resin 3D-printed models produced by our PRO 4K printer,
providing accuracy and superior fit as observed by the
patient. The retainers and models were all made by our
dental laboratory at AORTA.
Case 2
This 14-year-old patient too desired improvement of her
smile aesthetics with minimal restorative involvement.
She did not want fixed orthodontics. She presented with
significant excess gingival display in the maxilla, producing
a gummy smile from tooth #14 to tooth #24 of about
3 mm. The patient also had a maxillary midline coinciding
with her facial midline and a thin upper lip. The patient had
a dental Class I relationship bilaterally with an overjet
of 4 mm and overbite of 80% (Figs. 13–15). This patient
presented with healthy gingival tissue of a medium-thickness
biotype with no signs of local or general gingivitis and/or
periodontitis. There were also no signs of any restorations
or risk of or active dental caries.
After 18 months of fortnightly (39 maxillary and mandibular
aligners) and then weekly changeovers of two refinement
aligners, the result was achieved by masking the gummy
smile, broadening the smile and balancing the buccal
corridors. The patient was placed into retention phase
with clear thermoplastic retainers made by our laboratory
using the PRO 4K.
The overjet was reduced to 1.5 mm and the overbite
finished at 30%. There was no need for any restorative
or soft-tissue augmentation. Anterior maxillary intrusion
of 1.5–2.9 mm was achieved, reducing the gummy smile
from tooth #13 to tooth #23 (Figs. 16 & 17).
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Fig. 18: Patient’s facial photograph to be considered in the treatment plan. Fig. 19: Close-up view of the patient’s smile. Fig. 20: Using AORTA’s simple,
advanced, complex protocols to demonstrate the treatment goals. Fig. 21: Patient’s facial photograph. Fig. 22: Orthodontic digital simulation using Invisalign
software to show the pre-treatment position (blue) and the predicted result after treatment (white). Fig. 23: Patient’s facial photograph after aligner treatment.
Fig. 24: Close-up view of the patient’s smile after aligner treatment.
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Fig. 25: Patient’s facial photograph to be considered in the treatment plan.
Fig. 26: Close-up view of the patient’s smile. Fig. 27: Occlusal view of the
maxillary arch. Fig. 28: Orthodontic digital simulation using Invisalign software
to show the pre-treatment position (blue) and the predicted result after
treatment (white). Fig. 29: Patient’s facial photograph after aligner treatment.
Fig. 30: Close-up view of the patient’s smile after aligner treatment.
Fig. 31: Occlusal view of the maxillary arch after aligner treatment.
not symmetry, and use clear aligners to expand the arch
non-parabolically.
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Buccal corridors
In this section, we will explore how clear aligners can
balance facial aesthetic asymmetry. The AORTA principles
encourage clinicians to establish extra-oral, peri-oral and
dental parameters. When evaluating the patient’s buccal
corridors, the clinician needs to assess the patient’s
extra-oral vertical fifths and establish the patient’s facial
midline (glabella and/or Cupid’s bow). Establishing these
reference points helps the clinician to identify buccal corridor
asymmetries from the perspective of facial aesthetic
balance.
Clear aligners can provide non-surgical alternatives
and non-parabolic arch expansion to reduce the buccal
corridors’ negative space and improve facial balance.
Based on the AORTA SAC protocols of predictable
movement, buccal corridors could be improved by
2–4 mm labial translation of the maxillary posterior teeth.
The principle here is to optimise facial aesthetic balance,
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Case 1
The patient presented wanting to enhance his smile.
He had undergone fixed orthodontic treatment as a child, for
which tooth #31 had been extracted. He had an inverted
smile line, a wider buccal corridor on the right and wider
maxillary vertical fifths on the left. The treatment objective
was to align his smile as well as use the clear aligner software to broaden the non-parabolic arches to balance the
asymmetrical buccal corridors and ensure that the smile
line was parallel with the interpupillary line (Figs. 18–22).
The key is to assess the smile line and choose a reference
tooth according to which the other teeth in the smile line
are moved to balance the facial aesthetic objectives.
In this case, tooth #21 was the reference tooth according
to which the other teeth were extruded to correct the
inverted smile line. The treatment was completed within
13 months, including in-chair tooth whitening, and the
patient has been in retention for five years (Figs. 23 & 24).
Case 2
The patient presented with the goal of enhancing her
smile. She had a narrow smile, bilateral posterior crossbite and an anterior crossbite with tooth #12. From the
extra-oral perspective, the patient was also wider on
the right vertical fifth (Figs. 25–28). The treatment objective
was to correct the anterior crossbite and posterior
crossbite and to simultaneously correct the asymmetrical
buccal corridors by further broadening the arch on the
right more than the left. Once the alignment had been
completed, the case was finished with in-chair tooth
whitening and composite augmentation of teeth #12 and 22
(Figs. 29–31).
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31a
Restorative augmentation—introducing
Virtual Interdisciplinary Smile Simulation
clear aligners by simulating a restorative-only solution for
comparison with the clear aligner simulation.
In this third section, we will explore how clear aligner
simulations with Virtual Interdisciplinary Smile Simulation
(VISS; Fig. 14) can be digitally enhanced to demonstrate
restorative augmentation after orthodontic treatment.
This digital diagnostic and treatment planning service
from AORTA digital laboratory has evolved since
2018 and is able to create a digital simulation of
treatment with any aligner system, as well as of any
direct or indirect restorative treatment or soft-tissue
augmentation.
Now more than ever, when a patient is seen wanting
a smile makeover involving veneers to straighten and
whiten his or her teeth, the clinician can provide better
digital visual and transparent treatment plan options.
This can demonstrate what the consequences would
be for restoration with veneers compared with a clear
aligner solution with minor augmentation of embrasures
with direct restorative solutions. The clinician can evaluate how much tooth preparation is required and provide
more information on the risks of tooth preparation of
misaligned teeth versus clear aligner treatment followed
by tooth restoration with either direct or indirect restorations.
This concept of a virtual smile simulator evolved from the
notion of seeking to create patients’ emotional connection to treatment through the clear aligner software. Its
purpose is better smile creation by digitising the diagnosis,
treatment planning and patient engagement process.
This software enables the clinician to better diagnose
and plan treatment using aesthetic orthodontic, prosthodontic and facial aesthetic principles from an extra-oral,
perioral and dentition perspective.
When evaluating the STL files after clear aligner simulation
of any aligner system, the clinician can assess whether
there are hard- or soft-tissue augmentation options.
From the soft-tissue perspective, if there is asymmetry of
the zenith heights of the anterior gingival tissue or a need
to lengthen tooth dimensions, this can be digitally simulated. The tooth perspective of the post-treatment STL file
can digitally simulate direct or indirect restorations to
optimise the golden proportions regarding tooth length–
width ratio. This can provide choices for both the clinician
and the patient. This digital workflow can also provide
superior informed choice preand post-treatment with
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Fig. 32: Patient’s facial photograph to be considered in the treatment plan, alongside a close-up view of the patient’s smile. Fig. 33: Patient’s facial photograph
to be considered in the treatment plan, alongside the Invisalign software simulation. Figs. 34a–e: Simulated VISS images showing the situation pre-treatment
(a & d), post-treatment (c & e) and after restorative treatment (purple). Fig. 35: Patient’s facial photograph after clear aligner treatment, alongside a close-up
view of the patient’s smile. Figs. 36a–e: Simulated VISS images showing the situation pre-treatment (a), post-treatment (b & e) and after restorative treatment
(purple; c & d). Fig. 37: Patient’s facial photograph after restoration and tooth whitening, alongside a close-up view of the patient’s smile.
The following cases will demonstrate the revolutionary
power and choice given to both the patient and the
clinician by VISS to engage transparently and collaboratively for successful treatment outcomes. This enables
the patient and the clinician to establish a clear emotional connection to the patient’s wants and needs
(Figs. 31a & b).
Case 1
This first case was a female patient in her twenties
wanting to improve her smile. She had a traumatic
anterior crossbite with dentinal and enamel fractures
on teeth #11, 21, 31 and 41. She had received a plan
elsewhere for veneers as her only option. I decided
to use the clear aligner software to demonstrate what
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was possible and then demonstrate her restorative
options using VISS. Furthermore, to be transparent
with the patient, we decided to simulate the restorative solution before aligner treatment to assist and
educate the patient on what it would look and feel
like.
This powerful visualisation tool (Figs. 32–34e) creates
the best-informed consent for the patient and protects
the clinician by demonstrating the true differences and
consequences of both scenarios and risks. The patient
can see the difference in tooth preparation required and
therefore the consequences and risk associated with it.
This approach trumps any verbal consent or generic
brochure available.
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Figs. 38a & b: Patient’s smile before (a) and after aligner treatment (b). Figs. 39a & b: Patient’s smile after aligner treatment (a) and after veneers and soft-tissue
recontouring (b). Figs. 40a & b: Patient’s smile prior to any treatment (a) compared with after clear aligner treatment, veneers and soft-tissue recontouring (b).
The patient, based on the VISS simulation, decided to
undergo Invisalign treatment, which lasted for ten months.
Her choice of direct or indirect restoration was then
rediscussed, and we decided on Philips in-chair whitening
and IPS e.max veneers (Ivoclar) on the six maxillary
anterior teeth and the mandibular central incisors
(Figs. 35–37).
Case 2
The second case using VISS demonstrates the power
of visualisation of a restorative solution, clear aligner
solution or both. This technique predictably engages the
patient to realise that it is not necessarily a decision of
one or the other but both. The patient desired veneers and
presented with an anterior crossbite of teeth #11 and 21,
narrow teeth #12 and 22 in relation to teeth #11 and 21,
asymmetrical buccal corridors and a gummy smile
tendency (Figs. 38a–41).
In collaboration with the clear aligner software and VISS,
we provided the patient with choice and collaboration for
both a restorative and orthodontic solution. We began
with clear aligners first to balance the buccal corridors,
creating space equally and symmetrically around teeth
#12 and 22. This treatment was orthodontically established
within ten months. VISS was then engaged to facilitate
soft-tissue recontouring and a restorative solution on
teeth #12 and 22 only versus soft-tissue recontouring and
a restorative solution for the eight maxillary anterior teeth
(Figs. 42 & 43). The patient proceeded with optimal tooth
colour and shape via IPS e.max veneers on the eight
maxillary anterior teeth after alignment and soft-tissue
recontouring of the maxillary anterior teeth (Figs. 44–46).
Fig. 41: Patient’s facial photograph pre-treatment during the consultation
phase, alongside a close-up view of the patient’s smile. Fig. 42: Patient’s
facial photograph before aligner treatment, alongside the Invisalign software
simulation. Fig. 43: Patient’s facial photograph and close-up view of the patient’s
smile after clear aligner treatment had commenced, but prior to soft-tissue
recontouring and veneers.
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47a
47b
47c
47d
Fig. 44: Demonstrating the VISS protocols by showing the patient simulated soft-tissue recontouring of the eight maxillary anterior teeth to present to the patient
as a treatment option. Fig. 45: A second option presented to the patient showing soft-tissue recontouring of the two maxillary lateral incisors for comparison.
Fig. 46: The result after veneers, soft-tissue recontouring and whitening. Figs. 47a–d: Patient’s photograph to be considered in the treatment plan, alongside
close-up photographs of the patient’s smile from different views.
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[57] =>
case report
|
48
49
50a
50b
50c
50d
Fig. 48: Simulated VISS images showing the situation pretreatment and post-treatment with six veneers superimposed (purple) and the final result.
Fig. 49: Simulated VISS images showing the situation pretreatment, after aligner treatment and after direct restoration too (purple). Figs. 50a–d: The result after
veneers, soft-tissue recontouring and whitening.
Case 3
The final case was a patient in her late teens wanting to
improve her smile. Owing to social media exposure, she
wanted veneers, but was apprehensive of the risks. VISS
enables optimal informed consent based on demonstration of what a veneer option can achieve and how versus a
clear aligner solution with direct restoration enhancement.
The patient chose what made her feel comfortable by visualising the risks without pressure or bias. She could make
a self-assessed decision based on how both options made
her feel and rationalise the result (Figs. 47a–49).
As the clinician, I achieved ideal informed consent, as
both options were viable, predictable and acceptable.
My responsibility was to present the visual aids with the
risks, pros and cons to allow the patient to determine
the path best for her. We proceeded with six months of
Invisalign to align and improve her smile. Once orthodontic
treatment had been completed, we performed tooth
whitening and augmented teeth #12 and 22 (Figs. 50a–d).
Conclusion
As these cases indicate, clear aligner and digital treatment
planning can provide the clinician and patient with comprehensive and minimally invasive alternatives to camouflage
and address the patient’s aesthetic concerns effectively
and predictably. VISS provides better smile creation by
digitising the diagnosis, treatment planning and patient
engagement process. It could not be done without digitising
the dental practice and patient experience with intra-oral
scanners and the dental laboratory, whether in-house or
external, and using cutting-edge 3D printers like PRO 4K.
Editorial note: This article was first published in aligners—international
magazine of aligner orthodontics, vol. 2, issue 1/2023.
about
Dr John Hagiliassis graduated
from the University of Melbourne
in Australia with a BDS in 1998.
His passion for cosmetic dentistry
saw him complete a graduate diploma
in aesthetic orthodontics at the
Postgraduate School of Dentistry
in Double Bay, New South Wales,
in Australia in 2017. He founded an inner
city-based dental clinic in 2007, which appeared on the BRW
Fast 100 list of businesses in Australia for 2011 and 2012.
He regularly speaks and mentors at the Postgraduate School
of Dentistry, SmileStyler, Ivoclar, 3DMEDiTech, Angel Aligners,
Smile Academy, Dental Axess and the Dental Hygienists Association
of Australia and is a key opinion leader for Philips and DentalMonitoring.
Dr Hagiliassis absolutely loves technology and finding ways
to incorporate it into his practice’s workflow to enhance the
patient experience. He has been the largest provider of
Philips Zoom! whitening treatment in Australasia since 2012 and
one of the largest Invisalign providers in Australasia since 2014.
He has treated over 5,000 clear aligners cases
to date using five different systems and has been
a Black Diamond Invisalign provider since 2014.
Dr Hagiliassis also founded the non-profit Australasian
Clear Aligner Society in 2018 and an education and digital
dental laboratory called AORTA (Aesthetic Orthodontic
and Restorative Training Academy) in 2017.
contact
Dr John Hagiliassis
john@aortaaustralia.com.au
www.aortaaustralia.com.au
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[58] =>
| opinion
Is digital dentistry the solution to
the sustainability dilemma?
Dr Les Kalman, Canada
I think we can agree that dentistry is not the most
environmentally friendly profession. Just take into consideration the number of single-use materials such as
plastics, stone and plaster, barrier protection, and, of
course, personal protective equipment. Are they all
necessary to maintain the standard of care and appropriate infection control? Now, consider the steps in a
typical analogue workflow for an indirect restoration.
The impression is taken, boxed up, sent by vehicle to
the laboratory and poured up. The crown is fabricated
and sent back to the clinic, again by vehicle. Is this sustainable? I believe that we have tools at our disposal
that can help improve the workflow and the environmental footprint.
© M-SUR/Shutterstock.com
The evolution of digital dentistry has had a significant
impact on the dental profession. The acquisition of
digital intra-oral impressions, scanned impressions
and models has improved efficiency, accuracy and
the clinical workflow. But what about sustainability?
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Is taking an analogue impression and sending it to a
laboratory by vehicle more environmentally damaging
than sending a file digitally? The digital method would
immediately reduce carbon dioxide emissions; however, it would be necessary to consider the sourcing of
all the materials and the fabrication of all the components required for the digital transfer based on the total
cumulative energy demand throughout the life cycle of
a product.
What impact does digital design have on sustainability?
The analogue workflow would require impressions, casts,
registration and an articulator to design and develop the
prosthesis. The storage of models must also be considered.
This requires physical space and utilities compliant with
regulatory requirements. Digital design has a completely
different workflow, allowing image capture, cloud storage,
visualisation and planning on a device, all done remotely.
It also provides a simple approach for design modifications and remakes.
[59] =>
opinion
What impact can the output or fabrication of dental
prostheses have on sustainability? Initially casting required investing, melting and significant finishing and was
heavily reliant on materials and time. Milling provides an
accurate and predictable workflow but has limitations on
design and sustainability.
How does additive manufacturing (AM) or 3D printing
fit into the equation? There are a multitude of AM processes that provide accurate and efficient prostheses in
plastic (resins), metals and ceramics (zirconia and lithium
disilicate). These approaches can create any geometry
and typically offer superior accuracy and improved
sustainability. Additionally, recent research has quantified
that the AM workflow is more sustainable than conventional fabrication pathways. A further advantage is that
prostheses made digitally offer impressive physical
properties.
The possibility of bypassing digital design by using
indirect onlay restorations has also been explored.
This would be a novel approach that could save an enormous amount of time, money and resources. And this is
just the beginning, since artificial intelligence is already
having an impact on diagnosis and treatment planning,
and virtual and augmented reality are being used for
education and training. Another factor to be considered
is the developing metaverse.
However, digital dentistry comes with a significant
caveat: the user must have an excellent understanding
of its applications and limitations in a clinical setting.
After all, digital dentistry provides another set of tools
in the dentist’s toolbox. Clinicians must know which
tool to use and when. For example, there was a
recent report of a clinical full-arch implant case which
included a bone reduction guide and a guide for
implant placement. Both were acquired through a fully
digital workflow. Unfortunately, during the surgical
session, neither guide fitted well, and the clinician
had to detour to a free-hand approach. Kudos to
the clinician for realising the errors, but what an
unnecessary environmental impact and waste of
time and money!
I have heard similar stories where the implant surgical
guides did not fit intra-orally owing to the patient’s limited
mouth opening—another unfortunate situation in which
digital dentistry was improperly used.
The last scenario I will highlight concerns a clinician
who bought a 3D resin printer to complement his
intra-oral scanner. In this case, all patients received a
diagnostic scan and printed models for educational
and marketing reasons. Is this an appropriate use of
digital dentistry? How does this reflect sustainability?
What happens to those models when the patients
|
have no use for them? Are they recyclable? This
scenario reminds me of that meme where a gaspowered generator is being used to charge an
electric vehicle.
“Digital dentistry provides
another set of tools
in the dentist’s toolbox.”
If we collectively strive for dentistry to have improved
sustainability, we must consider the entire picture.
Here are a few recommendations for implementing digital
dentistry as related to sustainability:
– consider the clinical workflow and assess how
sustainability can be improved without compromising
the standard of care;
– understand and follow the fundamentals and principles
of digital dentistry. It is merely a set of tools to improve
the workflow;
– be curious and explore new technologies;
– be critical. For example, consider whether a fully guided
case is essential;
– consider a hybrid or fused workflow, combining the
best aspects of analogue and digital, until there is a
strong grasp on predictable digital workflows; and
– exercise the Rs: recognise, reduce, recycle, repurpose,
rethink and rejoice!
Digital dentistry is a strong technological tool that
can help dentistry become more sustainable. However,
dental professionals have to ask the right questions,
perform due diligence and make appropriate decisions
that benefit patients and the planet.
about
Dr Les Kalman is an educator and
medical device researcher focusing on
additive manufacturing and software.
He is a fellow of the Academy of
Osseointegration, American College
of Dentists and Academy for
Dental Facial Esthetics and a diplomate
of the International Congress of
Oral Implantologists. He is the recipient
of an Alumni of Distinction Award from the Schulich School of
Medicine and Dentistry at Western University in London
in Ontario in Canada and a CES Innovation Awards honouree.
cosmetic
dentistry
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[60] =>
| manufacturer news
Next-generation digital impression solution
3Shape’s TRIOS 5 Wireless intra-oral scanner
digital impression taking smoother and faster. Significantly, because of
its new scanner tip design, TRIOS 5 does not need calibration.
Simply hygienic—
a new standard in patient protection and infection control
TRIOS 5 reimagines intra-oral scanner design. The scanner is
hygienically sealed up to its battery inlet, leaving no cracks or
crevices in which contaminants may collect. A sapphire glass window
encloses the autoclavable tip to create a sturdy microbial barrier
between the patient and the scanner. Additionally, single-use body
sleeves cover the entire area touched by the dental professional
to reduce the risk of cross-contamination. These changes make
TRIOS 5 especially easy to clean and disinfect.
TRIOS 5 complies with the US Food and Drug Administration’s
most recent hygiene requirements for dental devices and has
received market clearance from the agency.
Since its release in late 2022, 3Shape’s TRIOS 5 Wireless has won
Best New Imaging Product in DrBicuspid’s 2023 Cuspies Awards,
IOS of the Year in the Institute of Digital Dentistry’s 2022 Intraoral
Scanner Awards and High Technology Launch of the Year in the
Dentistry magazine’s 2022 Dental Industry Awards. It is clear that
both the industry and dental professionals recognise the nextgeneration digital impression solution for its ease of use, ergonomics
and hygienic design.
Dr Austin Vetter, a US dentist, recently purchased his second
TRIOS 5 Wireless. He commented: “3Shape has unlocked the key
to happiness for me in dentistry. With their scanners and software,
I feel like we can achieve anything.”
Simply ergonomic—30% more compact body design
TRIOS 5 Wireless is 20% smaller and 30% lighter than the previous
scanner model. The scanner, battery and tip weigh only 300 g.
With a sleek, pen-grip design, TRIOS 5 houses an improved battery
that scans for up to 66 minutes on a single charge. Its simple two-button
operation makes capturing scans quick and easy, and the wand can
also be used as a remote control to navigate the software.
Simply effortless—intelligent alignment technology during scanning
TRIOS 5 introduces the all-new ScanAssist engine with intelligent
alignment technology to ensure precise scanning. ScanAssist optimises
the scan to remove misalignment and distortion in 3D models. Haptic
feedback and an LED ring also guide the user during scanning to make
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Digital dentistry at your fingertips—powered by 3Shape Unite
TRIOS 5 Wireless, like all 3Shape TRIOS scanners, includes the
3Shape Unite platform free of charge. 3Shape Unite connects
dentists online to over 75 seamlessly integrated dental companies,
treatment solutions and practice management systems and more
than 8,000 laboratories. The user can connect to treatment partners
simply by clicking on their respective apps.
TRIOS owners can also take advantage of the free, clinically approved
3Shape intuitive engagement apps that are included with the scanner.
These include the TRIOS Treatment Simulator and TRIOS Smile Design
apps with tooth whitening simulation, TRIOS Patient Monitoring and
TRIOS Patient Specific Motion for jaw tracking. These engagement
apps help dentists to boost treatment acceptance.
TRIOS 5 service agreement for peace of mind
When it comes to protecting dentists’ investment, TRIOS 5 Wireless
offers two TRIOS service agreement options that dentists can
sign up for. TRIOS Care, which is included free for the first year,
provides personal instruction, training, unlimited support, drop
coverage and express replacement if the scanner is damaged.
Alternatively, dental professionals can switch to TRIOS Only after
their first free year of TRIOS Care. TRIOS Only is a scan-ready free
service agreement with no monthly costs.
For additional information, visit 3Shape website.
www.3shape.com/TRIOS5
[61] =>
|
© Rawpixel.com/Shutterstock.com
meetings
The wait is over: passionate endodontists can now sign up for ROOTS SUMMIT 2024, which will be held from 9 to 12 May 2024 in Greece.
Registration for
ROOTS SUMMIT 2024 now open
By Franziska Beier, Dental Tribune International
The ROOTS SUMMIT organisers are pleased to
announce that online registration for the endodontic
meeting is now open. This highlight event will be held
from 9 to 12 May 2024 at the Eugenides Foundation
in Athens. Attendees can expect the great experiences
that ROOTS SUMMIT participants always enjoy in addition
to the same high level of clinical practice that members
of the online endodontic study group have relied on
for over 20 years. Speakers from nine countries and
par ticipants from 50 countries are expected to attend.
The organisers are offering an early bird discount until
the end of the year.
Speakers will include Dr Mitsuhiro Tsukiboshi from
Japan, Prof. Matthias Zehnder from Switzerland,
Dr Josiane Almeida from Brazil, Dr Ruth Pérez Alfayate
from Spain and Dr Antonis Chaniotis from Greece.
In addition to the lecture programme, attendees will
have the opportunity to participate in hands-on workshops, connect with industry professionals and learn
about new equipment, procedures and protocols in
endodontics.
ROOTS SUMMIT 2024 will be taking place in the landmark
building complex of the Eugenides Foundation, which
has been hosting educational events for over 60 years.
Two large lecture halls and two exhibition floors assure
enough space for education, showcasing and socialising.
The organisers are inviting endodontists, dental professionals in other fields, dental students and industry
representatives to attend next year’s meeting. Those
quick to decide can take advantage of the superdiscounted flash sale (€595), valid until midnight (CET)
on 15 July. The early bird discount (€695) will run until
31 December. The standard registration fee thereafter
will be €795. A student rate (€595) will be offered permanently. Hands-on courses will be charged separately,
and the rates for these will announced later.
ROOTS SUMMIT originally started as a mailing list of
a large group of endodontic enthusiasts in the 1990s.
Since setting up a private Facebook group, ROOTS,
in 2012, the group has increased its membership from
just under 1,000 to almost 29,000, including many
global endodontic experts. Its members represent
more than 100 countries.
More information on the registration, programme and
speakers can be found on the ROOTS SUMMIT website
(www.roots-summit.com). News will also be posted
regularly on the event’s Facebook page.
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[62] =>
| meetings
1
International Esthetic Days 2023
in Baden-Baden
By Straumann Group
As the organisers of the International Esthetic Days,
we believe that aesthetic dentistry is a true art. At this
extraordinary event, participants will have the opportunity
to experience creative and innovative ways to give their
patients healthy and natural smiles.
What can you expect?
More than 25 world-class experts—and the list is growing—
will share their clinical and technical expertise and dive into
exciting new technologies, treatments and means of practice growth in the field of aesthetic dentistry. This knowledge
will be conveyed in engaging and interactive formats, including
clinical presentations, lively discussions, interactive workshops
and a spectacular community-building feature.
The topics will be wide-ranging and comprehensive.
Particular highlights include anterior zone aesthetics, patients’
expectations of dentistry (today and tomorrow), artificial
intelligence-based smile designs, aligner therapy, immediate
treatment, and how to scale your practice and be at the forefront of dentistry by actively embracing digital technologies.
2
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Why should you not miss it?
If you are a dental expert who is driven by perfect technical
and aesthetic results, practising the art of aesthetic dentistry,
then we strongly believe that you will greatly benefit from the
exceptional concentration of expertise and the many opportunities for professional and social interaction that this event
will provide. By providing a supportive and encouraging environment, we hope for you to be inspired to put your new
knowledge into practice as soon as you can. This event will
thus help you to continuously advance your practice. Participants will also be able to earn continuing education credits.
At the social event “The Night”, to be held on the second
evening, you will be able to mingle with the most creative
minds in the industry and enjoy an unforgettable night with
great artists and delicious food and delightful drinks.
Who will be there?
The speakers for the International Esthetic Days are Dr Algirdas
Puisys (Lithuania), Dr André Chen (Portugal), Dr Andrea Bazzucchi
[63] =>
meetings
3
Fig. 1: The International Esthetic Days will take place from 21 to 23 September in Baden-Baden in Germany. Fig. 2: According to the organisers, participants can
expect presentations of the highest level. Fig. 3: The event will be an opportunity for the dental community to meet and exchange experiences. Fig. 4: During the
meeting, participants will be able to learn more about new product innovations. Fig. 5: In addition to an engaging scientific programme, the organisers have created
a fun social and entertainment programme. Fig. 6: The modern venue will provide all the technological support for a first-class event in a beautiful setting.
(Italy), Dr Andreas Benecke (Germany), Dr Armand Bedrossian (US),
Dr Barbara Sobczak (Poland), Björn Roland (Germany), Dr Daniel
Neves (Brazil), Dr David Norré (Belgium), Dr Eirik Salvesen (Norway),
Dr Eric van Dooren (Belgium), Dr Fernando Franch (Spain),
Dr Florin Cofar (Romania), Dr Gabor Tepper (Austria), Prof. Irena
Sailer (Switzerland), Dr Kay Vietor (Germany), Dr Krzysztof
Chmielewski (Poland), Dr Laurence Adriaens (Spain), Dr Maja
Chmielewska (Poland), Dr Martin Gollner (Germany), Dr Rebecca
Komischke (Germany), Dr Romain Doliveux (France), Prof. Ronald
Jung (Switzerland), Dr Sepehr Zarrine (France), Prof. Tim Joda
(Switzerland) and Vincent Fehmer (Switzerland). Even more
speakers are still signing up!
Please scan the QR code for further details
about the event.
Where and when will the event take place?
All this will be happening from 21 to 23 September at the
Kongresshaus in the unique destination of Baden-Baden in
Germany. This famous spa town in south-western Germany has
been attracting visitors for centuries, particularly for its therapeutic
waters, elegant architecture, cultural events and picturesque setting
in the Black Forest. The language of the congress will be English,
and there will be simultaneous interpretation into German.
4
Where can you register and find further information?
Any dental professional interested in attending the event can now
register and book accommodation at www.estheticdays.com
and benefit from the early bird rate—valid until the end of
June. The ticket for “The Night” is not included in the registration fee. We encourage you to secure your spot for
“The Night” during registration, but you will be able to purchase your ticket on-site if spots remain. Participants may
purchase a maximum of two tickets for “The Night”.
5
Using the official International Esthetic Days event app, you can
create your own personalised agenda, browse the programme,
receive the latest event-related news alerts, interact with other
participants, ask questions at Q & A sessions, and much more.
6
|
[64] =>
| meetings
International events
Dentsply Sirona World 2023
36th Int’l Dental ConfEx
CAD/CAM Digital
& Oral Facial Aesthetics
21–23 September 2023
Las Vegas, USA
www.dentsplysirona.com/
en-us/lp/ds-world.html
27–28 October 2023
Dubai, UAE
https://cappmea.com
64
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Formnext 2023
24–27 September 2023
Sydney, Australia
www.fdiworlddental.org/
world-dental-congress-2023
7–10 November 2023
Frankfurt, Germany
www.formnext.mesago.com
EAO-DGI Joint Meeting
GNYDM 2023
28–30 September 2023
Berlin, Germany
www.congress.eao.org/en
24–29 November 2023
New York, USA
www.gnydm.com
ICOI World Congress
ADF 2023
28–30 September 2023
Dallas, USA
www.icoi.org
28 November–2 December 2023
Paris, France
https://adfcongres.com
ESCD Annual Meeting
ROOTS SUMMIT
5–7 October 2023
Wrocław, Poland
www.escdonline.eu/wroclaw-2023
9–12 May 2024
Athens, Greece
www.roots-summit.com/en
© 06photo/Shutterstock.com
FDI World Dental Congress
[65] =>
|
© 32 pixels/Shutterstock.com
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[66] =>
| about the publisher
Imprint
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t.oemus@dental-tribune.com
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[67] =>
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[68] =>
Partners
in excellence.
United
by smiles.
ClearCorrect®, the Straumann
Group’s flagship orthodontic
brand, is excited to announce
new products and clinical
features, an improved digital
workflow, added support, and
treatment planning services
to help doctors treat more
complex cases.
To become a partner
or learn more visit:
clearcorrect.com
Acc.1249_en_01
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[cover] => ![cosmetic dentistry No. 1, 2023]()
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[title] => Cover
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[1] => Array
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[title] => Editorial
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[title] => “Nowadays, most of our patients ask for laser treatment”
[page] => 10
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[title] => “Nowadays, most of our patients ask for laser treatment”
[page] => 12
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[6] => Array
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[title] => The future of dentistry: What will oral care look like in 2040? - Smarter ways of doing dentistry will benefit patients and dental teams
[page] => 14
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[7] => Array
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[title] => Going it alone as a solo practice with purpose - An interview with Dr Florian Fries
[page] => 18
)
[8] => Array
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[title] => KATANA Zirconia UTML veneers and crown on zirconia implant cemented with PANAVIA Veneer LC
[page] => 22
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[9] => Array
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[title] => Diastema closure using a direct two-matrix technique
[page] => 26
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[10] => Array
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[title] => Conservative aesthetic management of white spot fluorosis lesions
[page] => 36
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[11] => Array
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[title] => Interdisciplinary treatment of an adult patient with worn anterior teeth
[page] => 40
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[12] => Array
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[title] => Pushing the boundaries with clear aligners: Multidisciplinary treatment planning
[page] => 48
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[13] => Array
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[title] => Is digital dentistry the solution to the sustainability dilemma?
[page] => 58
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[title] => Manufacturer news
[page] => 60
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[15] => Array
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[title] => Meetings
[page] => 61
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[16] => Array
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[title] => Submission guidelines
[page] => 65
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[title] => Imprint
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[toc_html] =>
[toc_titles] => Cover
/ Editorial
/ Content
/ News
/ “Nowadays, most of our patients ask for laser treatment”
/ “Nowadays, most of our patients ask for laser treatment”
/ The future of dentistry: What will oral care look like in 2040? - Smarter ways of doing dentistry will benefit patients and dental teams
/ Going it alone as a solo practice with purpose - An interview with Dr Florian Fries
/ KATANA Zirconia UTML veneers and crown on zirconia implant cemented with PANAVIA Veneer LC
/ Diastema closure using a direct two-matrix technique
/ Conservative aesthetic management of white spot fluorosis lesions
/ Interdisciplinary treatment of an adult patient with worn anterior teeth
/ Pushing the boundaries with clear aligners: Multidisciplinary treatment planning
/ Is digital dentistry the solution to the sustainability dilemma?
/ Manufacturer news
/ Meetings
/ Submission guidelines
/ Imprint
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