digital international No. 3, 2023
Cover
/ Editorial
/ Content
/ Researchers developing novel AI platform for dental disease identification
/ Tracking periodontal disease with electronic dental records may enhance diagnosis and treatment
/ Study uses artificial intelligence for gingivitis detection
/ CBCT data could help create patient-specific scaffolds for periodontal tissue regeneration
/ Industry news
/ Immediate or delayed loading in the fully edentulous maxilla
/ Implant treatment of the fully edentulous patient—contribution of digital techniques
/ The transparent gingiva project IV - Non-invasive measurement of the height and width of the peri-implant soft tissue using an enhanced digital merging methodology
/ Refer forward: Digital technology empowering removable prosthodontics
/ An aesthetic, minimally invasive restoration using a fully digital workflow
/ Predictable aesthetic success
with a digital workow
/ How to master intra-oral scanning - Full-arch scans in 45 seconds are within your reach
/ Dentistry stands among top-ranked degrees in 2023
/ “Dental schools should consider incorporating haptic VR simulation devices” - An interview with Dr Szabolcs Felszeghy
/ Time to celebrate PANAVIA’S 40th anniversary! - An interview with Mitsunobu Kawashima, Japan
/ Industry report
/ Manufacturer news
/ Meetings
/ Submission guidelines
/ Imprint
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[1] =>
issn 2193-4673 • Vol. 4 • Issue 3/2023
digital
international magazine of digital dentistry
research
Immediate or delayed loading
in the fully edentulous maxilla
case report
An aesthetic, minimally invasive restoration
using a fully digital workflow
opinion
How to master intra-oral scanning
3/23
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[3] =>
editorial
|
Dr Scott D. Ganz
Editor-in-Chief
Have you noticed?
Have you noticed changes in your everyday world since
the pandemic? Has the practice of dentistry changed
in your region of the world? Have you instituted new
protocols for safety or sterilisation or added additional
protective equipment for patients and staff? Have you
taken extra continuing education courses which deal
specifically with pandemic-related issues?
The pandemic has had a great impact on the world of
dentistry, and it appears that the actual impact differs
greatly depending on where you practise. One area that
has affected many in the US is the hiring of employees,
including front desk personnel, dental assistants, dental
hygienists and dental laboratory technicians. This may
hold true for urban or suburban areas, where finding the
right employee at the right salary can be a difficult task.
In many instances, staff will require specific training to
learn new skills or to enhance existing ones. This training
is an investment for the practice.
When there is a shortage of staffing, all aspects of the
clinical practice can be affected, and perhaps we have
overlooked the impact on the digital workflows that
now play a major role in the treatment of patients. When
we think of the current digital workflow for any type of
dental practice, who is responsible for completing the
necessary tasks? Who has been designated for taking
intra-oral scans, CBCT scans and digital radiographs and
for managing the resin tanks for the 3D printer? Usually,
it is not the clinician but one of the trained staff.
Is this a serious problem? Ask Dr Roger Levin, one of
the most well-known practice management consultants.
In an article published in February in Dental Economics,
he was quoted as stating: “It’s no secret that dentistry
has been dealing with an unprecedented staffing shortage for the past several years, and its effect has been
widespread.” “For the first time in dental history,” said
Dr Levin, “we are noting numerous practices that have
lower production and revenue because they cannot
properly staff or hire skilled staff members.”
While we at Dental Tribune International continue to
present state-of-the-art procedures, protocols and digital
technology within our pages, we must also be aware of
what is happening within our chosen industry which may
have a direct impact on maintaining high standards of
patient care and overall practice success. Please enjoy
the latest issue of digital. We welcome your comments.
Respectfully submitted,
Dr Scott D. Ganz
Editor-in-Chief
3 2023
03
[4] =>
| content
editorial
Have you noticed?
03
news
page 20
Researchers developing novel AI platform for dental disease identification 06
Tracking periodontal disease with electronic dental records
may enhance diagnosis and treatment
08
Study uses artificial intelligence for gingivitis detection
09
CBCT data could help create patient-specific scaffolds
for periodontal tissue regeneration
10
industry news
IADR Innovation in Implantology Research prize awarded to Dr Alberto Monje 12
CleanImplant Foundation provides dentists and patients with
guidance for clean oral implants
14
page 36
research
Immediate or delayed loading in the fully edentulous maxilla
16
case report
Implant treatment of the fully edentulous patient—contribution of digital techniques 20
The transparent gingiva project IV
24
page 63
Refer forward: Digital technology empowering removable prosthodontics 30
An aesthetic, minimally invasive restoration using a fully digital workflow 36
Predictable aesthetic success with a digital workflow
40
opinion
How to master intra-oral scanning
46
feature
Dentistry stands among top-ranked degrees in 2023
50
interview
“Dental schools should consider incorporating haptic VR simulation devices” 52
Time to celebrate PANAVIA’S 40 th anniversary!
54
Cover image courtesy of
YAKOBCHUK_VIACHESLAV/Shutterstock.com
3/23
issn 2193-4673 • Vol. 4 • Issue 3/2023
digital
international magazine of digital dentistry
industry report
PANAVIA: 40 years of success in adhesive luting
58
manufacturer news
60
meetings
All about the patient: The 2024 ITI World Symposium
International events
about the publisher
research
Immediate or delayed loading
in the fully edentulous maxilla
submission guidelines
international imprint
case report
An aesthetic, minimally invasive restoration
using a fully digital workflow
opinion
How to master intra-oral scanning
04
63
64
3 2023
65
66
[5] =>
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[6] =>
© William Potter/Shutterstock.com
| news
Researchers developing
novel AI platform for
dental disease identification
By Iveta Ramonaite, Dental Tribune International
Dental disease identification is often cumbersome and
time-consuming. To assist dental professionals in better
detecting dental problems, researchers in the UK are
currently developing an artificial intelligence (AI) model
for the recognition of dental abnormalities in anatomical
structures.
The project aims to provide a comprehensive solution
for collecting and annotating dental radiographs and
has recently received £1.55 million (€1.79 million) in grant
funding from the National Institute for Health and Care
Research.
The project is being led by the University of Surrey in
partnership with King’s College London, Royal Surrey
NHS Foundation Trust and the Oral Health Foundation.
Discussing its relevance, Dr Yunpeng Li, one of the two
project leads and a senior lecturer in AI at the University of
Surrey, commented in a press release: “The technology
could save valuable time and money if rolled out more
06
3 2023
widely, enabling dentists to have abnormalities pop up in
front of them and read radiograms with higher accuracy.”
“This next phase of the project is incredibly exciting as we
work collaboratively to build a working prototype suitable
for real-life clinical settings. Efforts so far have included
gathering a representative set of annotated radiograms
and training a custom-built AI model on dental disease
detection. We look forward to comprehensive outcomes
over the next few years,” he added.
To be trusted by dental professionals as a reliable tool, the
system first needs to achieve a high degree of accuracy.
Dr Owen Addison, professor of oral rehabilitation at
King’s College London and the joint project lead, noted:
“AI systems that support more accurate diagnosis and
clinical decision-making will help patients, but they must
be trustworthy. We look forward to supporting this
project by providing dental expertise and consideration
of the needs of end users.”
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[1] Semper-Hogg, W, Kraft, S, Stiller, S et al. Analytical and experimental
position stability of the abutment in different dental implant systems with
a conical implant–abutment connection Clin Oral Invest (2013) 17: 1017
[2] Semper Hogg W, Zulauf K, Mehrhof J, Nelson K. The influence of torque
tightening on the position stability of the abutment in conical implant-abutment connections. Int J Prosthodont 2015;28:538-41
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[8] =>
| news
Tracking periodontal disease
with electronic dental records may
enhance diagnosis and treatment
By Franziska Beier, Dental Tribune International
For their study, the researchers used data on
28,908 patients who had received a comprehensive
oral evaluation at the dental school’s clinics between
2009 and 2014. They developed two algorithms to
extract periodontal disease-related information from
the patients’ electronic dental records and to classify them into three groups—patients with disease
progression, patients with disease improvement and
patients with no disease change. The algorithms were
applied to the 15 years of electronic dental record
data to generate the final patient cohorts. Both
algorithms showed a high accuracy of 98%, and
they have been made publicly available for use by
other researchers.
“Gum disease, which is typically underdiagnosed,
is reversible if caught at an early stage before it has
affected underlying structures and adversely impacted
tooth support. Enabling dentists to track the disease
using both the information in clinical notes and the
periodontal charting data contained in a patient’s electronic dental record can enable diagnosis and hope,”
said co-author Dr Thankam Thyvalikakath, head of
the institutions’ joint Dental Informatics programme,
in a press release.
She added: “We are here to develop and establish
a culture of documenting and diagnosing cases in a
structured manner as is done in medicine.”
08
3 2023
The high usage of electronic dental record systems
to document patient care information provides a
significant opportunity to study the clinical course of
periodontal disease and the influence of risk factors.
“I think the advantage of our approaches is that,
using routinely collected data, we can automate and
monitor gum disease treatments and changes that are
visible only clinically, so we can catch gum disease
at an early, potentially reversible, stage. This contrasts
with other approaches that leverage only radiographs,
which only show advanced gum disease,” said
Dr Thyvalikakath.
The authors concluded that their study demonstrated
the viability of using longitudinal electronic dental record data to track periodontal disease changes and
that their algorithms were successful in classifying
the three different patient cohorts using the data. This
approach can be used to study the clinical course of
periodontal disease using artificial intelligence, including
machine learning methods.
In addition, Dr Thyvalikakath commented on the importance of tracking periodontal disease for an interdisciplinary treatment approach: “There is a bidirectional relationship between certain risk factors and
gum disease. For example, having diabetes increases
risk of periodontal disease and having periodontal
disease negatively affects the course of diabetes.
A similar relationship exists between cardiovascular
disease and periodontal disease. Recognising, monitoring, and treating gum disease is an important part
of overall patient health.”
Editorial note: The study, titled “Developing automated
computer algorithms to track periodontal disease change
from longitudinal electronic dental records”, was published on 8 March 2023 in the special issue Advances
in Biomedical and Dental Diagnostics Using Artificial
Intelligence of Diagnostics.
© fedrunovan/Shutterstock.com
Despite advances in periodontal disease research
and treatments, it remains a growing health issue
in the US. To address this topic, researchers from
Regenstrief Institute and the Indiana University School
of Dentistry in Indianapolis have developed algorithms
to track periodontal disease changes through electronic
dental records. This method could help dental professionals follow disease progression and diagnose the
disease early—when it is potentially still reversable—
and thereby reduce the risk of other systemic diseases
associated with periodontal disease.
[9] =>
news
|
Study uses artificial intelligence
for gingivitis detection
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.
In the study, the researchers trained and tested a novel AI model
on a data set of over 567 intra-oral photographs of gingiva with
varying degrees of inflammation. They 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.
Lead researcher Dr Walter Yu-Hang Lam, a clinical assistant
professor in prosthodontics at the University of Hong Kong,
commented: “Many patients […] 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.”
According to Dr Reinhard Chun-Wang Chau, a clinical research
coordinator in restorative dental sciences at the University of
Hong Kong, using intra-oral photographs in conjunction with
AI technology could allow patients to see which areas they had
not cleaned well and seek dental care earlier.
© SvetaZi/Shutterstock.com
By Iveta Ramonaite, Dental Tribune International
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.
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is just the beginning
From TRIOS to patient outcome.
Unite everything in between.
3Shape TRIOS gives you accurate scans
and an unparalleled scanning experience.
3Shape Unite is the workflow engine that
unlocks a world of possibilities with your scan.
Learn more at www.3shape.com/unite
[10] =>
© Veles Studio/Shutterstock.com
| news
CBCT data could help create
patient-specific scaffolds for
periodontal tissue regeneration
By Iveta Ramonaite, Dental Tribune International
Leveraging advancements in 3D printing, researchers
in Greece have outlined a methodology for designing
patient-specific 3D scaffolds for periodontal tissue regeneration using CBCT data. Early results suggest that using this
CBCT data to create 3D models of the hard tissue around
periodontal defects holds promise for individualised periodontal treatments. The ultimate goal is to produce bioabsorbable 3D-printed scaffolds that double as sustainedrelease drug carriers, targeting periodontitis.
Periodontitis leads to osseous defects compromising tooth
support. Traditional methods like grafting utilise donor bone
tissue as scaffolds for new bone formation. However, ensuring
a perfect fit to prevent soft-tissue proliferation remains a
challenge. The emergence of CBCT-based 3D modelling offers
a promising solution. This innovative approach aims to design
patient-specific scaffolds, setting the stage for personalised
periodontitis treatment and broader clinical applications.
The process involves two key scaffold design methods:
one for periodontal defect customised block grafts and
another for extraction socket preservation customised grafts.
The significance of the methods lies in the personalisation of
treatment using CBCT data to model the teeth and alveolar
bone in regions with periodontal defects.
10
3 2023
Both models of the scaffolds and models of the hard tissue
around the periodontal damage were 3D-printed using a
fused deposition modelling 3D printer. Such advancements
lay the foundation for the 3D printing of bioabsorbable
scaffolds which are tailored for periodontitis treatment and
which can also potentially act as drug delivery systems.
The research’s novelty resides in its emphasis on detailing
the scaffold design process and its capability of capturing
intricate osseous defects and thereby producing highly
accurate scaffolds. This research paves the way for future
exploration and clinical applications, including improved
image segmentation algorithms, comparisons of 3D-printing
techniques, utilisation of biodegradable materials for drug
delivery and the clinical testing of 3D-printed grafts in patients.
However, a significant limitation is the study’s inability to
compare the accuracy of the CBCT models with real patient
scenarios, underscoring the need for future collaborations
with clinical researchers. As biotechnological advancements
continue, it is anticipated that related ethical and regulatory
challenges will be addressed.
Editorial note: The study, titled “CBCT-based design of patientspecific 3D bone grafts for periodontal regeneration”, was
published online on 30 July 2023 in Journal of Clinical Medicine.
[11] =>
© MIS Implants Technologies Ltd. All rights reserved.
REVOLUTION
IN A BOX!
TM
FULL PROCEDURE IN EVERY IMPLANT PACKAGE. MAKE IT SIMPLE
Every MIS C1 implant is now supplied with XD Single-Use drills. These single-use drills are designed
for optimal implant-drill compatibility and high initial stability, while ensuring safe and simplified
procedures. Learn more about MIS at: www.mis-implants.com
[12] =>
| industry news
IADR Innovation in Implantology Research
prize awarded to Dr Alberto Monje
© MIS Implants Technologies
By MIS Implants Technologies
Explaining the reasons behind MIS’s support for this
award, Dr Serge Szmukler-Moncler, the director of research at MIS, stated: “MIS specifically chose to endorse
this innovation award to recognise a mid-career independent investigator who is a rising star in innovative
research. This selection aligns perfectly with the mission
and policies of MIS.”
During the award presentation, Dr Samy Akerman, the
representative of MIS in Colombia, emphasised the significant presence of MIS—which is known for its extensive
prosthetic digital library—in the dental implant discipline.
He highlighted that even highly experienced implantologists are switching to the MIS implant system owing to its
comprehensiveness and flexibility.
Dr Alberto Monje was recently awarded the Innovation in Implantology
Research prize for his contributions to research in implant dentistry.
Dr Alberto Monje, who is an associate professor in the
periodontics department at the International University of
Catalonia in Barcelona in Spain, has been honoured with
the prestigious Innovation in Implantology Research prize,
sponsored by MIS Implants Technologies and awarded
by the International Association for Dental, Oral, and
Craniofacial Research (IADR). This recognition celebrates
Dr Monje’s remarkable achievements and scientific contributions as an independent researcher. Despite being
in his mid-thirties, he has already participated in over
100 research publications.
The accolade acknowledges the exceptional work of researchers in the middle phase of their careers, that is, those
with up to ten years of independent research experience.
While IADR awards traditionally recognise students and
distinguished researchers, there are limited opportunities for
mid-career investigators to receive recognition. This award
honours rising talents whose groundbreaking research holds
great promise for advancing the field of implantology.
Dr Monje was selected as the winner by a scientific committee, and the award was presented by Prof. George Kotsakis,
the president-elect of the IADR Implantology Research Group.
The award was made during the 101st general session and
exhibition of IADR held in Bogotá in Colombia in June.
12
3 2023
“MIS stands for ‘Make It Simple’,” explained Dr Akerman.
“The core value of MIS is simplifying the entire dental
implant treatment process, from planning to surgery and
prosthetic rehabilitation. The goal is to make implant treatment more affordable for a wide range of practitioners and
patients. In research, there are occasions where in-depth
investigations are necessary to develop simpler and userfriendly implants and protocols,” he continued.
During the ceremony, Dr Monje graciously shared some
insights about himself and his research accomplishments.
He stated: “I was trained at the University of Michigan
and the University of Bern under the mentorship of
Profs. Hom-Lay Wang, William Giannobile and Daniel
Buser. Currently, I am committed to serving as a role
model for my students and colleagues. I run a private
practice limited to periodontics and implant dentistry, with
a particular emphasis on prevention and management of
peri-implantitis.”
When asked about his contribution to research, Dr Monje
stressed that his work was aimed at establishing surgical
strategies to prevent biological and aesthetic complications. Additionally, he has explored the potential and limitations of reconstructive and resective therapy and how
the use of soft-tissue grafts can enhance the prevention
and resolution of peri-implantitis.
More about this topic can be found in his first book,
titled Unfolding Peri-Implantitis: Diagnosis | Prevention |
Management. The book was edited by Prof. Wang and
published by Quintessence Publishing last year.
[13] =>
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GMT 85991 GB 2308 © Nobel Biocare Services AG, 2023. All rights
reserved. Nobel Biocare, the Nobel Biocare logotype and all other
trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to
nobelbiocare.com/trademarks for more information.
[14] =>
| industry news
1
CleanImplant Foundation provides
dentists and patients with
guidance for clean oral implants
By CleanImplant Foundation
In March, the Astra Tech EV implant system (Dentsply
Sirona) was awarded the coveted “Trusted Quality” seal,
and now two other implant systems have received it:
SuperLine (Dentium) and INVERTA (Southern Implants).
2
14
3 2023
The scientifically based seal of quality, which attests to the
first-class surface purity of dental implants, is only awarded
by the CleanImplant Foundation’s scientific advisory board
after a rigorous peer-reviewed analysis and testing process.
[15] =>
industry news
|
CleanImplant “Trusted Quality” seal – Five-step approach
STEP 1
Neutral sampling
of five implants
Batch-spanning random sampling: Three implants are ordered ex factory,
and two implants of the same type are purchased via mystery shopping from practices.
STEP 2
Unpacking and scanning
under clean room conditions
All five collected samples are carefully unboxed, mounted and scanned in a clean room
environment according to Class 100 FED-STD-209E and Class 5 DIN EN ISO 14644-1.
STEP 3
Externally audited process
of analysis
Scanning electron microscope (SEM) imaging and elemental analysis (energy-dispersive
X-ray spectroscopy) are performed according to the DIN EN ISO/IEC 17025 accreditation
process (competence of testing and calibration laboratories). The independent test
laboratories are regularly monitored in external audits by the accreditation body.
STEP 4
Full-size and high-resolution
SEM images
A special full-size, high-resolution SEM image—digitally composed of more than
360 single SEM images at 500× magnification—always shows the implant surface
from shoulder to apex.
STEP 5
Peer-review process
Two members of the scientific advisory board independently review
the comprehensive a nalysis report and sufficient clinical documentation or multi-annual
Post-Market Clinical F ollow-Up studies of the analysed implant system
showing survival rates of > 95% for the device or device family.
Fig. 1: Dr Dirk Duddeck placing an implant on the sample holder of the scanning electron microscope. Fig. 2: Implant sample on the sample holder of the
scanning electron microscope. (All images: © CleanImplant Foundation) Table 1: CleanImplant five-step approach.
“This award is an objectively transparent proof that colleagues are using a residue-free implant system for their
patients by manufacturers who have implemented the
highest-quality standards,” explained Dr Dirk Duddeck,
founder and head of research at CleanImplant. To obtain
this valid, objective proof, a five-step approach was established in cooperation with the eight-member scientific
advisory board (Table 1).
Every award of the quality seal is valid only for
two years and has to be renewed after this period.
Currently, the following implant systems also carry
the “Trusted Quality” seal: Kontact S (Biotech Dental),
whiteSKY (bredent group), UnicCa (BTI Biotechnology
Institute), (R)Evolution and Patent/BioWin! (Champions-
Implants), In-Kone (Global D), ICX-PREMIUM (medentis
medical), AnyRidge and BLUEDIAMOND IMPLANT
(MegaGen), T6 (NucleOSS), Prama (Sweden & Martina),
and SDS1.2 and SDS2.2 (Swiss Dental Solutions).
Other testing and analysis results are pending.
In addition, the contract manufacturers of ceramic
implants, CeramTec Group and Komet Custom Made,
received the CleanImplant Certified Production Quality
Award.
More and more dentists are supporting the CleanImplant
Foundation. Certified by CleanImplant, they pass on the
trust they have gained in the products to their patients
and referring dentists.
“This award is an objectively
transparent proof that
colleagues are using
a residue-free implant
system for their patients.”
CleanImplant will be present at the 2023 joint congress of the European Association for Osseointegration and German Association of Oral Implantology in
Berlin in Germany (booth #C06), where dentists will
have the opportunity to check dental implants for
cleanliness under a scanning electron microscope
on-site.
contact
CleanImplant Foundation CIF
Berlin, Germany
www.cleanimplant.org
3 2023
15
[16] =>
| research
Immediate or delayed loading in
the fully edentulous maxilla
Drs Yassine Harichane, Rami Chiri & Benjamin Droz Bartholet, France
Although scientific and technical advancements have
been made in the field of dentistry, there are still many
patients who are either partially or fully edentulous. Edentulism has a negative impact on both dental and general
health, leading to physical problems like inability to eat
normally and mental health issues such as a decrease
in self-esteem.
offer them a maxillary implant solution that is supported
by scientific research? Can patient management be improved by modifying implant placement and loading
protocols? These are the two questions we will aim to
answer with the aid of recent scientific literature.
Oral implantology has made tremendous progress, allowing patients to have clinical outcomes similar to
natural dentition. Implant-supported prostheses provide
edentulous individuals with daily satisfaction, enabling
them to enjoy food and social interactions.1 When a single
tooth or multiple teeth are lost, fixed solutions are suggested, whereas in the case of complete edentulism, the
patient can choose between an overdenture or a fixed
complete denture on implants.
In implant surgery, considering anatomical obstacles is
crucial. Regarding the maxilla, the nasal cavity and maxillary sinuses pose challenges, while in the mandible, the
inferior alveolar nerve and mental foramen can be problematic (Fig. 1). The two areas also differ regarding bone
density, the maxillary bone usually being less dense than
that of the mandible. To overcome anatomical obstacles
like the maxillary sinus, either axial implants can be placed
after sinus lift or zygomatic implants can be placed to bypass the obstacle (Fig. 2).2, 3 Many implant designs have
been developed to provide satisfactory primary anchorage, regardless of bone density.
The McGill consensus statement recommends an overdenture supported on two implants as the first choice for
the edentulous mandible. Numerous protocols describe
technical aspects of implant surgery and prosthetic restoration, whether in immediate or delayed loading. While
the McGill consensus statement considers a conventional tissue-supported denture for the maxilla to be
problem-free, some patients may wish for a more comfortable solution to improve their dental health. Can we
1
Surgical steps
Brånemark’s work in oral implantology established success criteria that have become standard in implant practice. Scientific research has enabled advancements in
oral implantology, such as immediate placement after
extraction procedures for single or multiple teeth in both
the maxilla and mandible.
2
Fig. 1: Maxillary anatomical obstacles. Fig. 2: Maxillary prosthesis on axial and tilted implants.
16
3 2023
[17] =>
research
|
While the McGill consensus statement recommends an
overdenture on two implants for the mandible, there is no
established consensus for the maxilla. This is due to the
heterogeneity of results and the difficulty of conducting
systematic reviews on the subject. However, Malò et al.
have pushed the clinical boundaries of maxillary implant
treatment with the All-on-x procedure (Fig. 3), which is
demanding but effective and satisfying for patients.4
Digital workflows have also improved surgical protocols
through static guides and dynamic navigation (Fig. 4).
Static guides involve planning the implant position in
software and reproducing it in a surgical guide, while
dynamic navigation allows for real-time adjustments
based on CBCT imaging during surgery, providing greater
precision.5
Prosthetic steps
Brånemark initially recommended allowing several months
for implants to heal, but current literature supports the
possibility of immediate loading, whether for a single
implant or multiple implants in the maxilla or mandible
(Fig. 5). Research has validated immediate loading in fully
edentulous maxillae, whether using conventional or zygomatic implants, with high success rates. However, certain conditions need to be considered.3
3
This accelerated-care approach has prevented patients
from experiencing disabling edentulism and has been
shown to improve their overall satisfaction and oral healthrelated quality of life. Studies have found that implantsupported overdentures can improve the general wellbeing of edentulous patients and that fixed implant prostheses are even more effective (Fig. 6).1
The effectiveness of immediate loading of implants is
comparable to that of delayed loading, although the evidence is not strong enough to make a definitive clinical
recommendation. Studies have shown that there is no
statistically significant difference in survival rates between immediate and delayed loading of implants and
prostheses.6 However, it is worth noting that early implant
failure in the maxilla is quite common, half of the failing
implants being lost within the first six months. This is often
attributed to poor bone quality of the maxilla.2
Patients may be more satisfied with a functional fixed
prosthesis regardless of the time of loading, but there is
limited evidence to support this. Prosthesis instability may
also contribute to differences in loading times. For example, one study showed no difference in patient satisfaction between immediate and delayed loading after three
Fig. 3: All-on-4 and All-on-6 prostheses. Fig. 4: Surgical guide and dynamic
navigation.
4
3 2023
17
[18] =>
| research
5
6
Fig. 5: Implant loading timeline. Fig. 6: Patient satisfaction timeline.
months, although patients in the delayed-loading group
had relined provisional restorations. At 12 months, patient
satisfaction levels were similar, suggesting that the perception of the prostheses does not change much over
time. Studies have shown that patients have an excellent
level of satisfaction with immediate loading, and the protocol is generally well tolerated with careful preoperative,
perioperative and postoperative management.6
Recent research has expanded the indications for zygomatic implants, which offer sufficient primary stability, but
may still be susceptible to lateral forces that can cause
implant fracture. This is particularly problematic in clinical
cases in which the maxillary fixed prosthesis opposes
natural mandibular dentition. One possible solution is to
use a hybrid prosthesis on a bar.3
Marginal bone loss data indicates a loss of 1.67 mm for
the maxilla after ten years, regardless of the type of implant used. However, a more pronounced loss was observed around implants supporting acrylic prostheses
than those supporting ceramic prostheses, beginning at
the fifth year of follow-up. This underscores the importance of surface polishing to reduce plaque build-up
when using acrylic prostheses.2
bar overdentures are also effective and well tolerated
by patients. Patients seem to be at least as satisfied with
immediate loading, and clinical complications may be comparable to those of delayed loading. The choice of immediate
loading should be based on the practitioner’s expertise in
providing such treatment and on patient selection.
Editorial note: This article was first published
in implants international magazine of oral
implantology, Vol. 24, Issue 2/2023. Please
scan this QR code for the list of references.
about
Dr Yassine Harichane graduated from
the former Paris Descartes University
in France and conducted a number of
research projects there. He is an author
of numerous publications and a member
of the cosmetic dentistry study group at
the University of Paris. He can be contacted
at yassine.harichane@gmail.com.
Dr Rami Chiri holds a DDS
and is in private practice in France.
Conclusion
Dynamic navigation is a promising technique that allows
for precise implant placement in fully edentulous patients.5
Zygomatic implants are a reliable and predictable option
for maxillary rehabilitation.3
The existing literature provides limited evidence on the
comparative efficacy of immediate versus delayed loading of implants. Evidence supports the effective use of
immediate loading for fixed complete dentures without
the need for augmentation. Immediate loading and fixed
hybrid restorations are the most commonly used methods for their rehabilitation. However, delayed loading and
18
3 2023
Dr Benjamin Droz Bartholet
holds a DDS and is in private practice
in France.
[19] =>
[20] =>
| case report
Implant treatment
of the fully edentulous patient—
contribution of digital techniques
Dr Renaud Noharet, France
2
3
1
Fig. 1: Initial situation. Patient’s face showing a visible lack of dental support for the lower lip. Fig. 2: Intra-oral view of the maxillary bridge, the significant
recession and the three residual mandibular teeth. Fig. 3: Dental panoramic tomogram of the clinical situation.
Clinical case description
ent with any general pathology, and her only complaint
was difficulty while chewing.
An 82-year-old patient presented for complete rehabil
itation. The existing maxillary bridge showed Grade III
mobility and the residual mandibular teeth between
Grade II and Grade III mobility. The patient did not pres-
4a
4b
Clinical evaluation showed a lack of dental support for the lower lip and significant gingival recession around the maxillary bridge and the three
4c
Figs. 4a–c: Combination of the various essential files to collect all the data necessary for the diagnosis, treatment plan and proper execution of the plan.
CBCT (DICOM; a). Intra-oral scan (STL; b). Intra-oral photograph (JPEG/MPEG; c).
20
3 2023
[21] =>
case report
5
6a
|
6b
Fig. 5: Intra-oral view of the mandible showing the partial edentulism and stickers with radiopaque beads. Figs. 6a & b: Implant planning with DTX Studio
Implant (a). The vestibular-lingual view highlights the benefits of the radiopaque beads on the stickers for the good combination of DICOM and STL data (b).
residual mandibular teeth (Figs. 1 & 2). After clinical
and radiographic examination (Figs. 3 & 4), the decision to perform a full-mouth fixed rehabilitation
with implants was made in agreement with the
patient.
The combination of DICOM and STL data in the context of full or partial edentulism is complicated by the
lack of reliable fixed reference points. The solution is
to place stickers with radiopaque beads. These beads
can be identified both radiographically by their opacity and on the optical impression by their volume. This
facilitates the combination of the data (Fig. 5). During
the planning of implant treatment, DTX Studio Implant
software was used (Fig. 6). It was decided to place four
implants.
The prosthetic design (previously validated in the mouth)
can also be digitised in an STP file, and therefore, it can
be combined with the STL file of the initial situation.
This makes it possible to show the prosthetic design
on the bone data, making the planning more functional
and biological. At the same time, it is possible to transform this prosthetic plan into a provisional prosthesis
(DTX Studio Lab) adapted to the planning (perforation
of the prosthesis adjacent to the position of the future
implants and abutments). This prosthesis had four rods
at the level of the intrados for insertion into the bone.
After drilling with dynamic navigation (X-Guide, X-Nav
Technologies), they enable the prosthesis to be positioned correctly (Fig. 7). The provisional prosthesis was
prepared from PMMA and made up with pink composite
resin to simulate the gingiva (Fig. 8).
7
Fig. 7: Design of the prosthesis.
3 2023
21
[22] =>
| case report
8
Fig. 8: Provisional prosthesis of PMMA and pink composite resin.
Navigated implant surgery was performed. The patient tracker
was fixed to the bone, and the calibration was done by tracking bone points with a specific probe (X-Mark protocol; Fig. 9).
It had been decided to use N1 implants (Nobel Biocare;
Fig. 10). The prosthetic abutments were placed and
tightened to the recommended torque, and the tem
porary titanium abutments were screwed on to the
prosthetic abutments (Fig. 11).
9
10
Afterwards, the provisional prosthesis was placed on the
temporary abutments and positioned precisely thanks to
the rods, which were received by the intraosseous lodgement created during navigation, thus ensuring their precise
positioning. Flowable composite was then injected to attach the temporary abutments and the provisional prosthesis (Fig. 12). After the injected composite was polished,
the provisional prosthesis was screwed on (Fig. 13).
A radiograph performed after placement of the provisional
prosthesis showed good integration of the implants
(Fig. 14).
Overview of the digital solutions used
in the presented case
DTX Studio Implant (formerly NobelClinician) supports
the image-based diagnostic process and treatment
11
22
3 2023
Fig. 9: Navigated implant surgery (EDX patient tracker arm attached). Fig. 10:
Occlusal view of placed implants. Fig. 11: The temporary titanium abutments
screwed on to the prosthetic abutments.
[23] =>
case report
12
|
13
Fig. 12: The provisional prosthesis placed on the temporary abutments. Fig. 13: The provisional prosthesis in situ.
planning. It offers a visualisation technique for CBCT
images of the patient. In addition, 2D image data such
as photographic images, radiographic images and surface scans may be visualised to bring diagnostic image data together. Prosthetic information can be added
and visualised to support prosthetic implant planning.
For a guided surgery plan, the software can be used
for a variety of integrated options: static pilot guides,
fully guided surgery or dynamic navigation. The surgical
plan, including the implant positions and the prosthetic
information, can be exported for the design of dental
restorations in DTX Studio Lab.
DTX Studio Lab integrates CAD software to render the
digital design of a dental restoration. The resulting output file of the design can be used for either centralised
or localised manufacturing.
X-Guide is a dynamic navigation system for 3D real-time
guidance of drill positioning with no surgical guide.
It is designed to improve the precision and accuracy
of the position, angle and depth of the implant. Reference points are tracked and displayed in real time via
two cameras that are positioned 60–80 cm above the
patient. The display guides the surgeon in drilling in
the location according to the DTX Studio Implant plan.
Virtual registration of the patient’s anatomy can be done
with the X-Mark protocol, meaning no CBCT marker is
required for the scan. Three points are marked on the
CBCT rendering in X-Guide, and the same three points
are marked in the patient’s mouth with a probe tool.
For edentulous cases, the EDX patient tracker arm
is attached to the patient and clears the lip, and
does not interfere during surgery. It is suitable for
both flapped and flapless surgery, and different arm
designs are available based on the surgeon’s hand
edness.
Studies have confirmed better accuracy and less deviation from the planned implant positioning, compared
with freehand surgery.1, 2 Compared with other tested
dynamic systems, X-Guide is three to four times more
accurate.3
14
Fig. 14: Radiograph control after placement of the provisional prosthesis.
The N1 implant system is suitable for all indications
in all bone types and for immediate function and fully
digital workflows. It enables productivity and predictability through a faster surgical protocol, including site
preparation that is less traumatic.
Editorial note: This clinical case originally appeared in May 2023 in CLINIC No 425, and an
edited version is provided here with permission
from IS Media/1Healthmedia. Please scan this
QR code for the list of references.
about
Dr Renaud Noharet graduated
with a DDS from the Claude B ernard
Lyon 1 University in France and
holds various university diplomas
and certificates of specialised studies
in implantology and prosthetics.
He is an international lecturer and has
a private practice in Lyon focused
on implantology and the overall
rehabilitation of patients. He is the founder of
DCO France Prothèse training institutes.
3 2023
23
[24] =>
| case report
The transparent gingiva project IV
Non-invasive measurement of the height
and width of the peri-implant soft tissue using
an enhanced digital merging methodology
Drs Ariel Savion, Serge Szmukler-Moncler & Roni Kolerman, Israel
1a
1b
1c
Figs. 1a–c: Pre-op situation. Occlusal view of the edentulous first left molar site of the maxilla (a). Buccal view of the edentulous site (b). Sagittal section
of the site taken from the CBCT examination (c).
Introduction
Digitalisation has penetrated the dental implantology
field extensively, considerably changing how patients are
treated. Widespread access to digital tools has expedited
clinical research focused on peri-implant soft tissue.1–4
CBCT uses a digitalisation process to provide a
3D visualisation of the bone and soft tissue;3, 5 however,
the radiation emitted drastically limits its use in clinical
research. Intra-oral scanning generates an accurate image
of the external outline of the gingiva, and the absence
of emitted radiation and its user friendliness make it a
valuable tool in clinical research. The efficacy of soft-tissue
augmentation protocols can be observed by comparing
intra-oral scans (IOSs) taken before and after treatment
and following changes over time.6–9
IOSs are easily superimposed and matched on dedicated software with the help of a specific digital feature.
It is then possible to follow locally the evolution of the
external outline of the gingiva and translate it into
gained or lost tissue dimensions and volumes. However,
these merging protocols can only convey the relative
changes of the soft-tissue dimensions. For example,
Lilet et al.10 showed that implementation of a custom-made
sealing socket abutment, combined with peri-implant
socket filling, led after one year to a –0.66 ± 0.79 mm
24
3 2023
change in the buccal gingival envelope 1 mm below the
gingival margin. With this methodology, however, they
were unable to determine whether the lost buccal width
occurred to a 1, 2 or 3 mm soft tissue substrate.
Determination of the absolute horizontal and vertical
dimensions of the supracrestal peri-implant soft tissue
can be obtained by probing with endodontic files,11 by
histology12–14 or by CBCT scans;5, 15 none of them can
be used extensively and without limitation. The dental implant scientific community is still looking for an
affordable methodology that gives direct access to
these critical dimensions. Recently, a group of authors
described a straightforward methodology that leads
to a direct reading of the dimensions of the gingiva at
the level of the healing or prosthetic abutment.16–18
They found that introducing the STL files of the implantrelated components, that is, the healing abutment,
the prosthetic abutment and the prosthesis, into the
merged IOSs rendered the gingiva transparent. It was
then possible to read the height and width of the
peri-implant gingiva at every step of the treatment.
The aim of the present report is to illustrate, using a
case study of an edentulous site in the posterior maxilla,
some of the possibilities that this enhanced digital
merging workflow creates for clinical research.
[25] =>
case report
Description of the case
A 45-year-old female patient attended for restoration
of her missing left first molar in the maxilla (Fig. 1a).
The patient had no history of smoking or alcohol consumption at the time of treatment and did not have any
medical conditions that would affect implant therapy.
Clinical examination showed a moderate loss of the
local buccal convexity and height of the gingival margin (Fig. 1b). The radiographic examination revealed a
residual bone height of 5.25–7.10 mm below the maxillary sinus (Fig. 1c). These conditions allowed placement
of an 8 mm long implant after crestal sinus lift involving
osseodensification burs.19
The treatment plan called for restoration of the
edentulous site with an implant-supported crown
after a one-stage surgery and a transmucosal healing
period of ten weeks. The patient signed an informed
consent allowing her data to be used for research
purposes.
Surgical steps
After extra-oral disinfection of the surgical site, the patient
was instructed to rinse with a 0.12% chlorhexidine solution for 1 minute. Antibiotics were not prescribed either
before surgery or afterwards because of the use of laser
for local decontamination.20
2a
2d
2b
2e
|
The osteotomy was prepared according to an osseodensification crestal sinus lift protocol.19 A 4.2 × 8.0 mm
conical connection implant (C1, MIS Implants Technologies)
was placed in a slightly sub-crestal position with a 60 Ncm
insertion torque. A modified palatal roll flap technique with
two intrasulcular incisions involving the adjacent mesial
and distal teeth was performed21 with the aim of increasing the width of the soft tissue and improving the buccal tissue volume. De-epithelialisation was realised with a
Er,Cr:YSGG Laser, photon emission at 2.78μm (Waterlase iPlus,
BIOLASE) and a gold handpiece with the new Z-type glass
MZ6 tip (0.6 × 17.0 mm) using the following parameters:
an average output power of 2.5 W, a pulse duration of
60 μs (H-mode), a pulse repetition rate of 50 Hz and a water
spray (air: 20%; water: 40%). The graft was rolled under
the buccal flap. It was allowed to heal standing against a
4.8 × 4.0 mm anodised concave healing abutment affixed
to the implant. The flap was repositioned buccally and
sutured with two simple interrupted sutures (5/0 GLYCOLON,
Resorba Medical) on the mesial and distal sides. Primary
closure of the occlusal gingiva was not intended. The
monofilament sutures were removed after five days to
promote a healing process of secondary intention.
Ten weeks after surgery, the patient returned for an
osseointegration check of the implant (Fig. 2a). The usual
clinical and radiographic examinations were performed,
and it was found that the graft had healed uneventfully
2c
2f
Figs. 2a–f: Restoration of the edentulous site. Occlusal view of the implant site with the healing abutment in place at the end of the healing period (a).
Health of the soft tissue after removal of the healing abutment (b). Buccal (c) and palatal view (d) of the marginal gingiva at prosthesis delivery. Note the gingival
bleaching due to compression by the crown. Buccal (e) and palatal view (f) of the gingiva after relaxation of the bleaching.
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3
4a
4b
4c
Fig. 3: Standard superimposition of the intra-oral scans taken before surgery (yellow line), at soft-tissue healing (green line) and at prosthesis delivery (purple line)
on the pre-op CBCT scan (the right side is the buccal side). Figs. 4a–c: Implementation of the enhanced merging methodology at the end of the soft-tissue healing.
Superimposition of the intra-oral scan taken before surgery (yellow line) and the one taken at soft-tissue healing (green line). In all the following figures the bony
background of the CBCT is the one obtained before surgery; it is not representative of the crestal bone situation afterwards (a). Merging of the STL file of the healing
abutment (white line) (b). Drawing of the shape of the peri-implant gingiva around the healing abutment (red lines) after merging of the STL file of the implant (c).
and provided a satisfactory contour to the peri-implant
soft tissue. In addition, the implant was biomechanically
tested, as recommended by several authors,22–25 with a
30 cm reverse torque.23 The manufacturer recommends
a 30 Ncm torque for attachment of the prosthetic components.
5a
5b
5c
5d
Figs. 5a–d: Implementation of the enhanced merging methodology at prosthesis delivery. Superimposition of the intra-oral scan taken at prosthesis delivery
(purple line) on the pre-op CBCT scan (the right side is the buccal side) (a). Merging of the STL file of the crown (white line) in addition (b). Merging of the STL file of
the prosthetic abutment (thin white line) with the previous superimposition (c). Merging of the STL file of the implant according to its height (d).
26
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[27] =>
case report
Prosthetic steps
The healing abutment was removed to check the health of
the gingiva (Fig. 2b) and start the prosthetic steps. An IOS
(TRIOS 4, 3Shape) was taken with a scan body affixed to
the neck of the implant. The STL file was sent to the dental
laboratory for CAD/CAM processing. A monolithic zirconia
crown was milled (Roland DGA) and prepared based on
the digital design. The crown was cemented on a 1.5 mm
high titanium base (Ti-Base; MIS Implants Technologies).
The crown with the Ti-Base was screwed in by applying
the 30 Ncm torque recommended by the manufacturer.
Pressure of the crown on the gingival margin provoked
a transient buccal and palatal bleaching (Figs. 2c–f).
Merging procedures
Before surgery, a CBCT scan was obtained to analyse the
local bone features and determine the various anatomical
obstacles to be aware of. IOSs were subsequently taken
at the various milestones:
|
6a
6b
– before surgery (IOS #0);
– at the end of the healing period with the healing abutment in place (IOS #1); and
– at prosthesis delivery, after pressure on the gingival
margin had resolved (IOS #2).
The digital merging involved the STL files of the healing
abutment, the prosthetic abutment and the crown. These
were provided by the manufacturer and the dental laboratory, respectively. The digital superimposition sequence
was performed with exoplan software (exocad). The mere
merging of IOSs, as reported by other authors,6, 7 does not
enable measurement of the dimensions of the peri-implant
soft tissue (Fig. 3). It is only after merging the IOSs with the
STL file of each implant-related component that the height
and width dimensions of the gingiva can be read.16–18
First, IOS #0 was merged with the CBCT scan and then with
IOS #1 (Fig. 4a). At this stage, the STL file of the healing abutment was then merged with these (Fig. 4b). The implant was
then added to the file, and the shape of the gingival margin,
including the gingival seal, was identified (Fig. 4c). The superimposition enabled measurement of the height and width of
the gingiva at the end of the healing period.
After prosthesis delivery, IOS #2 was superimposed on the
previous set of IOSs. The STL files of the crown, of the Ti-Base
and of the implant were then merged sequentially. This superimposition enables measurement of the dimensions of the periimplant soft tissue at the time of prosthesis delivery (Fig. 5).
Reading of the vertical and horizontal
dimensions of the gingiva
Before surgery
Reading the height of the gingiva at the crest and on
the buccal and palatal sides of the abutment was made
6c
Figs. 6a–c: Dimensions (mm) of the gingiva at the end of the healing period.
Comparison, before surgery (yellow line) and at the end of healing (green
line), of the gingival height (GH) measured at the middle of the crest and
on the buccal and palatal sides of the healing abutment (a). Measurement
of the GH variables—change in GH (∆H) and GH at the level of the implant
neck (GHNeck) on the buccal and palatal sides by the end of the soft-tissue
healing. The surgical technique did not increase the GH on the buccal side,
and GH on the palatal side decreased slightly. Red lines = the limits of
the healing abutment (b). Measurement of GW by the end of healing and
of the change in gingival width (∆GW) on the buccal side from before
surgery until the end of the healing period. GW was measured at 1 mm
(GW1mm) and 2 mm (GW2mm) from the gingival margin and at the level of
the implant neck (GWNeck) (c).
possible by superimposing IOS #0 and IOS #1 on top of
the CBCT scan (Fig. 6a). This helped determine the height
of the gingiva at the implant site.
At the end of the healing period
Merging of the STL file of the healing abutment and of
the implant with the IOS superimposition set provided
access to the gingival height (Fig. 6b) and width (Fig. 6c)
at the end of the healing period. The changes in gingival height induced by the flap surgery on the buccal and
palatal sides were measured by comparing IOS #0 and
IOS #1. The gingival height down to the implant neck
was also measured on both sides. Similarly, changes
in the gingival width at the end of the healing period
were followed at various levels of the healing abutment.
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7a
7b
7c
7d
7e
7f
Figs. 7a–f: Dimensions (mm) of the gingiva at prosthesis delivery. The prosthesis (white line) compressed the soft tissue as evident from the changes in the
gingival height between the end of the healing (green line) and prosthesis delivery (purple line) (a). Height available for the gingiva down to the level of the neck
of the implant (b). Comparison of the shape and estimated length of the gingival seal at the end of healing (red line) and at prosthesis delivery (blue line).
On the palatal side (left side of the image), the gingival seal at prosthesis delivery under the crown is larger by 0.95 mm than the one obtained at the end of
the healing. Yellow dotted lines = top of the gingival margin and beginning of the sulcus (c). Measurement of the gingival width (GW) at various levels of the
abutment, according to the various steps of implant therapy. Yellow line = pre-op. Green line = at the end of the healing period. Purple line = at prosthesis
delivery. The numbers for each step are shown in the respective line colours (d). Measurement of the negative change in GW on the buccal side between the
end of the healing period and prosthesis delivery at the level of the sulcus (∆GW) and the most apical level of the crown (∆GW1mm). GW lost 1.57 mm at the
level of the sulcus (e). GW at prosthesis delivery measured at 1 mm from where the sulcus begins (GW1mm) and at the level of the implant neck (GWNeck).
Despite a loss of thickness, GW was still above 3 mm (f).
In addition, the entire thickness of the gingiva resulting
from the modified palatal roll flap technique could be
determined. The gingival width at the level of the implant
neck was 4.87 mm.
At prosthesis delivery
The addition of IOS #2 and the STL file of the crown and
of the Ti-Base to IOS #1 showed precisely to what extent
the gingiva was compressed apically at crown delivery
(Fig. 7a) and how much gingival height remained up to
the level of the neck of the implant (Fig. 7b). It was then
possible to visualise the changes induced by the fastened
crown at the level of the gingival margin and the biological
seal (Fig. 7c). Both the shape and the dimensions of the
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gingival seal had changed. On the buccal side, 0.34 mm
of the external slope of the sulcus was compressed
under the crown. On the palatal side, it was 0.95 mm
of the keratinised epithelium that would undergo histological modification in order to form the sulcus and the
soft-tissue sealing structure. The final gingival width and
its changes from the previous stages could also be determined (Figs. 7d–f).
Discussion
The aim of this report was to describe, through a clinical
case, the type of dimensional data that it is possible to
obtain from the peri-implant soft tissue with an innovative
[29] =>
case report
digital protocol that was very recently published16–18 and
that cannot be obtained otherwise. The additional clinical effort to gain this data is minor: it requires performing
three IOSs and obtaining the STL files of the various items
from the manufacturer and the dental laboratory.
The preoperative gingival height can be read by merging
IOS #0 with the CBCT scan.1–3 Determining gingival
height during implant planning is important because
this variable can affect how deep the implant should be
placed sub-crestally without risking the implant neck
being insufficiently surrounded by bone.26, 27 The routine
way to measure the thickness of the gingiva is with a
periodontal probe on the crest of the ridge after flap
elevation;26 however, the actual place to determine the
thickness is where the biological width (BW) concept
applies, that is, at the emergence of the gingival margin
in contact with the healing abutment. Szmukler-Moncler
et al. showed that determination of the thickness at the
crest does not provide an accurate estimate of the gingival thickness measured at the buccal and palatal sides
of the healing abutment.28
In the present case, the 2.38 mm measured at the crest
suggests that the gingiva is thicker than 2 mm and might
be classified as thick.26, 29 However, at the place it should
be measured, taking into account the biological width
concept, the initial gingival heights on the buccal and
palatal sides of the abutment are 1.73 mm and 1.41 mm,
and therefore the gingiva should be characterised as thin.
Consequently, it makes sense to anticipate crestal bone
loss down to at least the implant neck in order to achieve
acceptable dimensions of the biological width.
At the end of the healing period, it appeared that the
modified roll technique did not affect the gingival height;
however, it did increase the width of the buccal gingiva
significantly. The gain in width was 1.84 mm and 1.73 mm
at 1.0 mm and 2.0 mm below the gingival margin, respectively, and the overall width reached 4.66 mm and
4.87 mm. Today, this digital protocol is the only way to
access these clinical variables in a non-invasive way.
Placement of the crown instantly and substantially modified the gingival height by 0.70–1.33 mm on the buccal
side and by 0.54–1.44 mm on the palatal side. Pressure
on the gingiva was clinically evidenced by bleaching of
the buccal and palatal gingiva. Again, only this digital
methodology is able to provide such a precise insight into
the resulting dimensional changes. One can legitimately
assume that this compression of the gingiva might lead to
a subsequent rearrangement between the compressed
soft tissue and the underlying crestal bone and in turn to
bone resorption. After delivery of the crown, the digital
superimposition showed that part of the width gained
by the end of soft-tissue healing by the time-consuming
modified palatal roll technique had vanished.
|
Conclusion
The inventive step of the present digital methodology
consists of merely merging the IOSs that are typically obtained6, 7 with the STL files of the various implant-related
items.16-18, 28 This single addition brings about an illuminating
difference, as it renders the gingiva transparent, enabling
reading of the vertical and horizontal dimensions of the
peri-implant gingiva and their changes at every level of
the abutment and at every stage of the treatment. This is
otherwise unattainable in clinical research.
Implementation of this digital workflow in clinical research
will help refine the data acquired from protocols and
techniques of soft-tissue thickening, providing information
on not only the tissue thickness that has been gained
but also the entire thickness of the gingiva.
Please scan this QR code for the list of
references.
about
Dr Ariel Savion holds an MSc in oral
implantology from Goethe University
in Frankfurt am Main in Germany,
an MSc in laser-assisted dentistry
from the RWTH Aachen University in
Germany and a mastership certificate
in laser dentistry from the World Clinical
Laser Institute. He is a board-certified
diplomate in oral implantology
(International Congress of Oral Implantologists), specialises
in microsurgical laser therapy and periodontal plastic surgery,
and is a board member of the Microscopic Dental Club.
He maintains his own private practice in Rishon LeZion in Israel.
Dr Savion can be contacted at savion.clinic@gmail.com.
Dr Serge Szmukler-Moncler,
DDS, PhD, is a director of research at
MIS Implants Technologies in Israel.
Dr Roni Kolerman, DMD,
is a senior lecturer at the Department
of Periodontology of the Maurice
and Gabriela Goldschleger
School of Dental Medicine
at Tel Aviv University in Israel.
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Refer forward:
Digital technology empowering
removable prosthodontics
By Eric D. Kukucka, Canada
1a
1b
Transitioning from analogue to digital dentures has significant benefits for oral healthcare professionals, laboratories
and patients. The implementation of digital denture technology at Aspen Dental has created exciting opportunities for
teams to become more effective, efficient and predictable,
particularly regarding the reference denture workflow.
A brief history of dentures
Like most materials used in healthcare, denture materials
have evolved profoundly over the last 300 years or so. For
centuries now, people desiring to replace all their teeth have
searched widely—often futilely—for biocompatible, comfortable,
aesthetically appealing and long-lasting materials. Early dentures were more often than not embarrassing, unattractive
and barely functional replacements of natural teeth.
2
30
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In the pre-industrial world, before the 1800s, dentures
were predictably primitive. Removable oral prostheses
were often studded with genuine human teeth, sometimes
reclaimed from cadavers. Otherwise, false teeth were
typically made from natural materials like wood or animal
bone. Some historical dentures were carved entirely from
ivory, but they required a high-skill, time-intensive process
only accessible to the wealthy.1 While these devices could
be relatively convincing, they were held in place crudely
(i.e. painfully and unreliably) with springs and weights and
prone to staining and decay.2
Denture access finally democratised in the middle of the
nineteenth century, when Charles Goodyear developed
vulcanite, which quickly became the preferred material
for fabricating dentures and held its position through the
first third of the 1900s. Of course, polymethylmethacrylate (PMMA) has been the industry standard for denture
base fabrication since its introduction in the late 1930s.3
Over the decades since, while manufacturing processes
have been refined and new innovations have come and
gone, PMMA has remained the most widely used denture
material.
With the benefit of historical perspective, we can now look
back on early devices and understand them as unsophisticated, unhygienic and otherwise limited. In a few years’
time, I contend we ought to similarly appraise removable
prosthodontics from earlier this century.
3
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4
5
The analogue to digital evolution
base in a pink material which is then bonded to a carded
denture teeth or a monolithic or segmented printed tooth
material arch. Such systems include the Lucitone Digital
Print Denture System (Dentsply Sirona) and the SprintRay
High Impact Denture Solution.
In 1994, the first digital denture study appeared in the International
Journal of Prosthodontics.4 The paper introduced a novel
process wherein the authors used a laser scanner to take denture impressions and 3D-printed a tooth and base contour jig,
which allowed a denture to be fabricated using photopolymerising resin. While the ideas in the study were groundbreaking,
3D printing at the time was frankly not mature enough for
clinical use, so the emerging digital dentures industry focused
instead on CAD/CAM milling. A proof of concept detailing a
technique for milling a denture duplicate out of wax was published in the Journal of Oral Rehabilitation in 1997.5
The first commercial digital denture was not produced
until 2011—well over a decade later. Global Dental Science
designed and fabricated the device, which it marketed as
AvaDent Digital Dentures. AvaDent remains as an authority
in the current digital denture system market, alongside
options from competitors like Ivoclar Vivadent, Dentsply
Sirona, SprintRay, VITA Zahnfabrik (Vita Vionic) and Merz
Dental (Baltic Denture System).6
|
The development of dedicated digital denture design software was another groundbreaking innovation. In some cases,
commercially available software systems were proprietary
suites custom-designed for digital denture fabrication
(e.g. AvaDent Connect). Elsewhere in the industry, leading
companies like Ivoclar use 3Shape-built specialised
modules to extend the capacities of pre-existing dentistry
design software.
The varied benefits of digital dentures
The tech industry favours the word “disruption” to describe
paradigm-shifting changes in methodologies—and I’ve been
guilty of using it myself. Lately, I find it more productive to shift
my focus away from how digital dentures destroy old ways
of doing work and instead foreground how digital dentures
actively benefit clinicians, patients and laboratories alike.
Milled denture manufacturers developed and standardised
PMMA pucks to place in computer numerical controlled
mills. The first milled dentures still involved a significant
amount of technical, hands-on work, as fabricators were
able to mill the denture base only; they bonded carded
denture teeth into the base one by one. Over time, dental
laboratories developed improved systems which allowed
a full set of teeth to be milled as a single piece. This piece
would then be bonded with a separately milled base and
returned to the mill for finalisation (Ivoclar’s oversize milling
process). Today, the best milled denture systems fabricate
one-piece monolithic dentures.
3D printing is now playing a greater role in denture fabrication owing to its already low cost and impressive scalability.
In recent years, the development of novel photopolymers
and sophisticated fabrication techniques has lowered the
cost of entry to this exciting technology significantly, such
that it has become a viable option for working laboratories.
Today, properly equipped laboratories can print a denture
6
3 2023
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factor that can accompany complete denture therapy in
general. With traditional methodologies, a single mistake
can send a clinician back to square one; this reality generates a significant fear factor. Because digital workflows
preserve patient records perfectly, clinicians gain peace
of mind, allowing them to do better work unencumbered
by trepidation.
7
8
9
Many leading clinicians are already taking advantage of
digital technology, which makes design and prostheses
infinitely reproducible. In basic terms, modern digital dentures replace error-prone plaster moulds with precise
computerised data sets, allowing sufficiently trained dental professionals to scan a patient’s mouth or physical
impressions or casts, transform them into computerised
3D renderings and initiate a precise CAM process at the
push of a button—all while improving a denture’s aesthetic
dimensions and fit, if a patient so desires.
Digital modalities simplify several potential points of friction
in the reference denture workflow. The analogue reference
denture workflow is popular in part because it condenses
clinical steps and allows clinicians to use past experience
as indicators of complexity, measurably improving predictability.7 However, clinicians using conventional laboratory
techniques have often been unable to accurately reproduce complex existing dentures.8 Importantly, for inexperienced clinicians, digital workflows mitigate the intimidation
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In almost all cases, digital denture workflows require fewer
and shorter appointments—including postoperative visits.9, 10
While the advantages of reduced in-office hours should be
obvious to clinicians, we must not overlook the potentially
profound benefits to patient access. Statistically, patients
requiring removable complete dentures are disproportionately likely to have complex medical profiles and/or difficult
socioeconomic circumstances. Specifically, they are less
likely to have private transport, more likely to experience
mobility issues and less likely to live near a dental practice.
As a general rule, we should not take these patients’ ability
to come into the office for granted.
Patients also benefit from digital dentures’ greater degree
of precision (meaning better fit) and superior functional quality.
According to Drs Brian J. Goodacre and Charles J. Goodacre
of Loma Linda University in California in the US, most rigorous comparisons of conventional denture base materials and the milled bases commonly used in digital workflows have concluded that milling produces greater flexural
strength and the highest accuracy and trueness,11–15 allowing milled bases to respond more positively to accidental
damage.
Across-the-board outcomes are likely to improve further
as future generations of dentists and technicians enter the
workforce familiar with these new workflows. According to
Wendy Auclair Clark, clinical assistant professor in prosthodontics at the University of North Carolina at Chapel Hill
in the US, digital dentures are now an integral part of
complete denture curricula at leading dental schools.
The digital reference denture technique
I have written and lectured extensively elsewhere on the
reference denture technique, also called the “denture
duplication workflow”. In the right hands, I believe that
this seamless and technically and clinically integrated
workflow delivers the greatest possible standard of
predictable precision care and craft.
The increasingly popular technique is ideal for edentulous
patients who are generally satisfied with their existing
dentures at the end of their regular lifespan. In appropriate
situations, the digital reference denture workflow provides
technicians with a sophisticated digital record of a patient’s
existing information, allowing clinicians to rehabilitate the
patient more confidently, predictably and precisely than
would otherwise be possible.
[33] =>
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10
11a
Using traditional methods and materials, reproducing an
existing handcrafted denture within acceptable limits—
never mind perfectly—is laborious. As I am sure you know,
the final quality of an analogue denture is determined
largely by the hand–eye coordination and motor dexterity
of the person fabricating it. The risks of human error are
significant and unavoidable.8
Clinical case
|
11b
smile and excessive gingival tooth display (Fig. 3). At the
approximate desired VDO, the patient showed adequate
inter-arch space and exhibited Prosthodontic Diagnostic
Index Class 2 edentulous arches.14 After a thorough explanation of all treatment options and their objectives and
limitations, the patient consented to treatment of the edentulous arches utilising a combination of traditional analogue
and digital CAD/CAM techniques.
Clinical record acquisition
An 80-year-old male patient presented for prosthodontic
evaluation and replacement dentures (Figs. 1a & b). His
existing maxillary and mandibular complete dentures were
five years old and lacked retention and stability. The peripheral border extensions of both the maxillary and man
dibular dentures were under-extended, and there was
an extensive increase in vertical dimension of occlusion
(VDO; Fig. 2). The patient was not pleased with the appearance of his dentures, as they displayed a reverse curve
The existing dentures were evaluated for VDO, phonetics,
aesthetics and peripheral border extensions. The existing
dentures presented with under-extended flanges, which
were to be captured during initial border moulding of the
functional impression technique. If the existing denture is
overextended, it is adjusted accordingly prior to taking the
impression. It is important to notify the patient that you
will be making modifications to the denture. You have the
12a
12b
13a
13b
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14a
14b
ption to place a soft liner (COE-SOFT, GC) once the initial
o
appointment is complete to stabilise the existing denture
while the new one is being fabricated.
The existing dentures were utilised to take the definitive
impressions. Border moulding movements were preformed
through various functional movements of the patient’s
muscles of mastication and facial expression. This was
carried out on the periphery, utilising hydrophilic poly
vinylsiloxane impression material (Virtual Heavy Body Fast
Set, Ivoclar). Once the peripheral border movements had
been captured, the excess border moulding material on
the cameo and intaglio surfaces was removed to maintain
a 3 mm roll internally and externally. The dentures were prepared to undergo a wash impression to capture the high
affinity of detail of the alveolar ridge and soft tissue. This was
also conducted using hydrophilic polyvinylsiloxane impression
material (Virtual Light Body Fast Set, Ivoclar; Fig. 4).
Once set, the impression was completed with the jaws in
centric relation utilising Blu-Bite HP Fast Set (Henry Schein).
The centric relation record is evaluated or verified with
clinical confidence that it is “the most retruded position
of the mandible to the maxillae at an established vertical
dimension which is repeatable and recordable” (Fig. 5).16
An extra-oral scan was performed with an intra-oral scanner
(TRIOS 4 wireless, 3Shape) with both dentures in situ,
14c
assuring that the intaglio surfaces, cameo surfaces,
peripheral borders and buccal surfaces of all teeth were
captured.17 This ensured that we were providing all the
necessary information for the designer to follow the existing
tooth positions (Fig. 6).
The jaw relations can be captured intra-orally with the intra-
oral scanner or extra-orally. Green stick compound or a leaf
gauge may be used to capture the maxillomandibular relationship at the desired VDO if increase is required.
CAD using digital design software
STL files from the initial appointment were sent to the laboratory for digital design and tooth arrangement. The Dental
System 2023 software (3Shape) allows the ability to visualise
the existing situation of the patient’s dentures (Fig. 7). The software also gives the designer the ability to evaluate the alveolar
ridge position and set teeth anatomically and physiologically
according to the principles of tooth arrangement (Figs. 8 & 9).18, 19
The maintenance of the initial tooth positions supports the
information from both the dentist and the current protheses,
assuring that the changes for the desired tooth set-up of the
new dentures are complete. The desired tooth moulds and
shade as well as the denture teeth set-up are optimised at
the desired VDO and set in a lingualised occlusal scheme.20
The design prototype (STL file) can be manufactured at a
commercial laboratory or printed in-office.
Monobloc try-in
A monobloc prototype was 3D-printed (SprintRay Pro95S)
in resin (Try-In 2, SprintRay; Fig. 10) and used to check the
peripheral seal and assess the aesthetics, phonetics and
VDO of the occlusion (Figs. 11a & b). This step is considered
optional, but is preferred if many aesthetic and/or functional
changes are desired from the existing dentures.
15
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Although changes in length, shape and occlusion can
be made on the 3D-printed monobloc try-in, a limitation of
this digital technique is the inability to move teeth during
the appointment (compared with the traditional wax try-in).
[35] =>
case report
16a
16b
Modifications to the monobloc try-in can be conducted,
undergo a wash impression, as described in the first step,
and be scanned to assure adequate peripheral seal and
intaglio adaptation and either sent back to the laboratory
or scanned and the scan sent to the laboratory.
Manufacture and delivery
Manufacture
There are various methods of manufacturing digital dentures
as mentioned. The Lucitone Digital Print Denture System
offers a complete, validated and approved workflow for
producing dentures (Figs. 12a–13c). Smart polymers in the
base double in strength in response to body temperature
with BAM! (body-activated material) technology, providing
double the fracture resistance of commercially available denture base materials. The SprintRay High Impact Denture Base
and High Impact Denture Teeth materials with NanoFusion,
a ceramic-infused resin, offer high resistance to fracture
and staining and improved colour stability.
Delivery
The digital complete dentures were inserted and evaluated
for efficacy, fit, form and function (Figs. 14a–c). Minimal
adjustments to the intaglio surface were necessary when
assessed using “Pressure Indicator Paste (white silicone spray;
Keystone Industries).” Occlusion, stability and retention
were evaluated and determined to provide superior improvements compared with the initial situation (Figs. 15–17).
Oral hygiene instruction and recall maintenance were
discussed with the patient.
Conclusion
Digital denture workflows are effectively infinite in that
multiple ways exist to use digital technology for the design
and fabrication of removable dentures. This methodology
gives both the clinician and the digital technician all the
information necessary to fabricate a removable denture
predictably. The ability to digitise such a rich data set is
still in its infancy with respect to broad adoption; however,
this approach is gaining much traction in the industry.
|
16c
The reference denture technique in conjunction with digital
technology empowers us with a pathway to establishing
a protocol with respect to a viable clinical and technical
workflow that cohesively form a relationship that renders
high satisfaction for clinicians, technicians and most
importantly the patient.
17
Please scan this QR code for the list of
references.
about
Eric D. Kukucka is vice president
of Clinical Removable Prosthetics &
Design Technologies at ADMI.
He is responsible for the efficacy
and high standards in the delivery
of removable prosthetics. Through
i nnovation, upskilling denture talent,
providing scalable solutions and
maintaining strong strategic partners
throughout the industry to develop procedures that advance
removable prosthodontics at Aspen’s 1,000 + locations.
An active researcher, educator, author, and key opinion leader,
he helped develop protocols materials used
by clinicians around the world.
3 2023
35
[36] =>
| case report
An aesthetic, minimally invasive
restoration using
a fully digital workflow
Dr Carlo Massimo Saratti, Italy
1a
1b
Figs. 1a & b: Initial extra-oral photographs.
Case introduction
A 42-year-old male patient presented to our practice hoping to improve his smile. He was conscious
of the worn dentition of the maxillary anterior sextant
and some posterior teeth. This situation had led to
exposure of a significant area of dentine, which had
created a high level of sensitivity and negatively
affected the aesthetics of his smile in the anterior
region (Fig. 1). He also presented with some crowding
and a Class III molar relationship that had resulted in
some modification to the occlusion, a tendency to
a Class III incisor relationship and an edge-to-edge
bite (Fig. 2).
2a
2b
2c
The patient had undergone partial restoration at
another clinic two to three years before, but treatment
of the mandibular molars, mandibular right second
premolar and maxillary left first premolar remained
incomplete. The patient’s request was to maintain
the restorations already delivered if they were still in
good condition.
Treatment
2d
2e
Figs. 2a–e: Initial intra-oral photographs.
36
3 2023
The first step was to increase the vertical dimension
of occlusion (VDO) by placing occlusal veneers on the
abraded and eroded teeth, especially teeth #17–14,
[37] =>
case report
|
5a
3
5b
4a
4b
6a
4c
4d
4e
4f
6b
7a
7b
7c
7d
8a
8b
Fig. 3: Digital impression of the occlusion. Figs. 4a–f: Design in exocad for posterior restoration. Figs. 5a & b: Vertical dimension of occlusion augmentation.
Figs. 6a & b: The situation pre- and post-orthodontic treatment. Figs. 7a–d: Direct composite restoration of the mandibular anterior sextant. Figs. 8a & b: Anterior wax-up.
3 2023
37
[38] =>
| case report
8c
8d
8e
9a
9b
9c
9d
9e
9f
10a
10b
10c
11a
11b
12
13
14a
14b
Figs. 8c–e: Anterior mock-up. Figs. 9a–f: Guiding grooves for preparation. Figs. 10a–c: Situation after preparation. Figs. 11a & b: Digital impressions of the
maxillary anterior crowns. Fig. 12: Thickness control. Fig. 13: Final design (with space for anterior stratification). Figs. 14a & b: Final restorations.
38
3 2023
[39] =>
case report
15a
|
15b
Figs. 15a & b: Adhesive procedures.
25–27, 34, 35 and 44. A digital impression was
taken with the DEXIS IS 3800W intra-oral scanner
(Dental Imaging Technologies Corp.) of the increased
VDO with the jaws in centric relation and stabilised
with a posterior occlusal jig (Fig. 3).
The restorations were designed on exocad software
(Fig. 4), and lithium disilicate was chosen for their
fabrication (Fig. 5). The restorations were bonded
adhesively in the patient’s mouth. After the increasing
of the VDO, the patient’s anterior occlusion was ideal
for restoration of anterior guidance. It was therefore
necessary to provide the patient with orthodontic
treatment (Fig. 6). After the orthodontic treatment
had been completed, the incisal edges of the
mandibular incisors were restored directly with
composite (Fig. 7).
Subsequently, the final aesthetic wax-up of the
anterior sextant was completed in order to ultimately validate the aesthetic restoration and to guide
the minimally invasive preparation of the maxillary
crowns (Fig. 8). The final preparation was guided
by the mock-up (Fig. 9) and, for the most part, was
limited to the interproximal areas (Fig. 10). After that,
we took a final digital impression of the anterior
crowns after displacement of the gingiva with retraction cord (Fig. 11).
For the digital design, limited reduction of the inferior
half of the buccal surface of the monolithic restorations was performed in order to allow stratification
of porcelain for achieving the best possible aesthetic
result (Figs. 12 & 13). Ultimately, the final restorations (Fig. 14) were bonded adhesively in the mouth
17a
17b
under dental dam isolation (Fig. 15). The patient was
followed up several weeks after the cementation
(Figs. 16 & 17).
16a
16b
Figs. 16a & b: Final extra-oral photographs.
about
Dr Carlo Massimo Saratti received
his DDM from the University of
Florence in Italy in 2011. Between
2014 and 2016, he completed
the Master of Advanced Studies in
Microinvasive Aesthetic Dentistry
programme—of which he is now
coordinator—at the University of
Geneva in Italy. Since September 2016,
he has been a senior assistant in the division of cariology
and endodontics of the University of Geneva. Dr Saratti is also
involved in research on dental materials for restorative dentistry
and has published internationally on this subject.
Alongside his academic activities, he works in the
Geneva Smile Center as a specialist in aesthetic adhesive
restorations for single-tooth and full-mouth restoration.
17c
Figs. 17a–c: Final intra-oral photographs.
3 2023
39
[40] =>
| case report
Predictable aesthetic success
with a digital workflow
Dr Tyler Wynne, USA
2
1
3
4
Fig. 1: Full-face view of the patient. Fig. 2: Frontal view of the patient’s smile. Fig. 3: Full-face retracted view of the patient, demonstrating functional
and aesthetic challenges. Fig. 4: Right lateral profile view.
Introduction
Dentists today are living during exciting times when
advancements in materials, techniques and diagnostics
allow us to predictably improve the quality of our patients’
lives and their overall health. Digital treatment planning
and workflows enable clinicians to accurately attain
healthy form and function of the stomatognathic system even in the most complex of cases. Patients often
seek aesthetic dental care to improve their appearance
and function and often present with numerous complications and factors that require a comprehensive
focus to attain a successful aesthetic result. If all factors
present are not treated, a clinician can make improvements, but the case will not be ultimately successful.
Identifying all of these factors and involving the patient in
these treatment goals is essential.1–3 Besides providing
aesthetic solutions for our patients, we should aim to
preserve and improve our patients’ systemic health with
40
3 2023
the treatment options, techniques and materials utilised.
A healthy dentition and periodontium, stable temporomandibular joint health, and good airway health should
all be taken into account.
The patient in this case presented with obvious aesthetic
and functional deficits associated with the effects of
severe wear, periodontal disease and tooth loss. This
case report demonstrates that, through meticulous
treatment planning using digital smile design and a digital
workflow for both the surgical and restorative treatment
phases, the quality of life and systemic health of our
patients can be dramatically improved.
Diagnosis and treatment planning
Upon examination, biological, functional and aesthetic
deficits were present (Figs. 1–10). Several periodontal
defects were located in the maxillary and mandibular
[41] =>
case report
5
6
7
8
9
10
|
Fig. 5: Frontal view showing multiple aesthetic and functional deficits. Fig. 6: Right lateral view showing multiple aesthetic and functional deficits.
Fig. 7: Left lateral view showing multiple aesthetic and functional deficits. Fig. 8: Frontal view of the teeth in maximum intercuspation. Fig. 9: Right lateral view
of the teeth in maximum intercuspation. Fig. 10: Left lateral view of the teeth in maximum intercuspation.
anterior sextants and bilateral posterior quadrants. Severe
wear due to attrition with compensatory overeruption of
the mandibular anterior alveolar crest had contributed to
occlusal plane discrepancies. Irregularities in the curve
of Wilson and curve of Spee had resulted in occlusal
disharmony and no anterior guidance. Excessive overbite and overjet and vertical maxillary anterior excess
were noted. Other aesthetic deficiencies included a lip
line that did not match the smile line and irregular and
asymmetrical gingival zeniths, incisal embrasures and
incisal edge positions. The patient’s profile view showed
a retruded chin and deficient lower facial third height.
Increasing the lower facial third height would allow for
improved chin prominence and a more youthful appearance. This “triangle of youth”, present in people with ideal
vertical facial thirds, as described by Gelb, is an inverted
triangle from the facial view in which three straight lines
connect the most lateral aspects of the right and left
cheek bones to the mental protuberance of the chin.4
An aged face is often due to a loss of ideal lower facial third
height and a retruded chin, in which from the facial view
a triangle can be outlined with a straight line connecting
the left and right angles of the mandible to the inferior
aspect of the nasal bone.4 The treatment objectives were
to restore ideal function and aesthetics by correcting
these various deficiencies.
When numerous functional and aesthetic challenges
are present, one of the first steps in establishing an
aesthetic reconstruction is to define the proper plane
of occlusion.5 According to Dawson, “the form of the
occlusal plane is directly related to specific functional
requirements, alignment of teeth in relationship to the
arc of closure for best resistance to loading and ease
of access for positioning of the food on the occlusal
surface”.6 Without a proper plane of occlusion, the
remaining features that establish proper form and
function are adversely affected. Tooth dimensions and
“Without a proper
plane of occlusion,
the remaining features
that establish proper
form and function
are adversely affected.”
embrasures will not be balanced and oriented properly,
and an aesthetic outcome will be compromised.7
To restore proper form and function and correct the
identified deficiencies, our treatment plan involved fullarch implant-retained prostheses following a predictable
and streamlined digital workflow.
Clinical protocol
Using the NavaGation Synergy Guided Workflow
(Absolute Dental Services), the restorative and surgical
planning phase began with collaboration between the
11
Fig. 11: Frontal view of centric relation bite registration.
3 2023
41
[42] =>
| case report
12
13
Fig. 12: Maxillary surgical treatment planning using coDiagnostiX. Fig. 13: Mandibular surgical treatment planning using coDiagnostiX.
guided surgery specialist (Matt Vrhovac from Absolute
Dental Services), surgeon (Dr Teresa Biggerstaff) and
restorative dentist (me). To correct the patient’s aesthetic and functional deficiencies, the planning began
by obtaining an accurate CBCT scan taken at the patient’s current vertical dimension of occlusion in centric
relation position (Fig. 11). Several digital photographs
were taken, including full-face smile photographs
to identify the lip position and high smile line, profile
photographs and retracted views (Canon Rebel T5i with
a 100 mm L macro lens with both a Canon EL-100 flash
system and a Canon MR-14EX II macro flash). Digital
photographs are essential for the digital treatment planning workflow, as they are needed to assess aesthetics,
tooth position and smile design and to guide the treatment planning process.
surgery specialist, surgeon and restorative dentist to
evaluate the smile plan for implant placement based
upon the final prostheses. During the treatment planning meeting, the surgeon and guided surgery specialist planned for implant position, model matching
and bone reduction using Absolute Dental Services’
in-house surgical planning software and coDiagnostiX
software (Dental Wings; Figs. 12–15). The plan was
to place eight maxillary implants and five mandibular
implants for full-arch implant-retained zirconia prostheses.
A digital wax-up was designed using 3Shape software to idealise the occlusal plane and correct the
aesthetic and functional deficiencies. PreVu cosmetic
simulation and smile design software (PreVu Dental)
was used to superimpose the digital wax-up on to
the patient’s digital photographs, enabling the guided
To streamline an accurate and precise surgical protocol,
the NavaGation Synergy Guided Workflow was utilised.
A unilateral key fixation foundation guide was placed and
the position verified with a 3D-printed PMMA (Flexcera,
Desktop Health) tooth stabilisation guide aligner. After
extraction of the failed dentition, a 3D-printed Flexcera scalloped maxillary bone reduction guide was used to idealise
the maxillary alveolar ridge contours, and a mandibular
bone reduction guide was used to reduce the overerupted
mandibular anterior osseous segment. Buccal fixation pins
were used to secure the foundation and bone reduction
14
15
Fig. 14: Maxillary surgical treatment planning with the maxillary prosthesis using coDiagnostiX. Fig. 15: Mandibular surgical treatment planning with the
mandibular prosthesis using coDiagnostiX.
42
3 2023
[43] =>
case report
|
18
16
17
19
20
Fig. 16: Maxillary and mandibular key fixation foundation guides made from Flexcera with indexed transitional Flexcera Smile prostheses prior to pick-up.
Fig. 17: Complete maxillary and mandibular Flexcera Smile transitional prostheses, one day after surgery. Fig. 18: Occlusal view of the maxillary Flexcera Smile prosthesis.
Fig. 19: Occlusal view of the mandibular Flexcera Smile prosthesis. Fig. 20: Full-face retracted view of the centric relation bite registration with Blu-Mousse
for the final impression using the acrylic transitional duplicates.
“The plan was to place
eight maxillary implants
and five mandibular
implants for full-arch
implant-retained zirconia
prostheses.”
21
24
guides accurately and securely to the maxillary and
mandibular bone. Implant placement guides were subsequently utilised to guide precise implant placement.
Eight Straumann Bone Level Tapered Roxolid SLActive
Regular CrossFit implants were placed in the maxillary arch
(4.8 × 8.0 mm implants in sites #16 and 26, 4.1 × 12.0 mm
implant in site #14 and 4.1 × 14.0 mm implants in sites #13,
11, 21, 23 and 24). Five Straumann Bone Level Tapered
Roxolid SLActive Regular CrossFit implants were placed
in the mandibular arch (4.8 × 12.0 mm implants in sites
#36 and 46, 4.1 × 14.0 mm implants in sites #33 and 43,
and 4.1 × 12.0 mm implant in site #31).
Once the implants had been placed, the implant placement guide was removed and Regular CrossFit screwretained 17° multi-unit abutments were placed using
a 3D-printed Flexcera multi-unit abutment aligner guide.
The transitional prostheses made from Flexcera Smile
were then picked up with a dual-polymerising polymer
(Triad, Dentsply Sirona), after placing the temporary
22
23
25
Fig. 21: Frontal view of the try-in Flexcera Smile final prostheses duplicates to assess function and aesthetics. Fig. 22: Occlusal view of the
complete maxillary try-in Flexcera Smile duplicate of the final prosthesis. Fig. 23: Occlusal view of the complete mandibular try-in Flexcera
Smile duplicate of the final prosthesis. Fig. 24: Full-face view of the
try-in Flexcera Smile final prostheses duplicates, confirming improved
aesthetics and function. Fig. 25: Full-face retracted view of the try-in
Flexcera Smile final prostheses duplicates, confirming improved aesthetics
and function.
3 2023
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[44] =>
| case report
26
27
28
29
30
31
32
33
34
35
Fig. 26: ArgenZ HT+ Multilayer final prostheses with characterised gingiva.
Fig. 27: Frontal view of the patient’s smile, showing improved aesthetics and function.
Fig. 28: Right lateral view of the patient’s smile. Fig.29: Left lateral view of the patient’s smile.
Fig. 30: Frontal view of the patient’s improved vertical dimension, function and aesthetics.
Fig. 31: Right lateral view of the teeth in maximum intercuspation. Fig. 32: Left lateral
view of the teeth in maximum intercuspation. Fig. 33: Frontal view of the completed case.
Fig. 34: Right lateral view of the completed case. Fig.35: Left lateral view of the completed case.
36
“Digital treatment
planning for improved
aesthetics and function
can be both rewarding for
the clinicians and fulfilling
for the patient.”
titanium cylinders, each blocked out with silicone blockout tubes, on to the multi-unit abutments (Figs. 16 & 17).
PTFE tape and flowable Filtek Supreme Ultra (3M ESPE)
composite were used to seal each access hole prior
to assessing the occlusion (Figs. 18 & 19). At this time,
Flexcera Smile duplicates of the transitional prostheses
were picked up with the same protocol to use when the
time came for the final impressions, capturing the desired
vertical dimension, tooth position and healed soft tissue.
Bilateral masseter Botox injections were administered
to manage excessive occlusal forces during the osseointegration phase.
Forty-eight hours after surgery, the occlusion was assessed
and minor adjustments were made to the Flexcera Smile
transitional protheses. After five months of osseointegration,
Flexcera Smile final impression duplicates of the transitional prostheses were seated and hand tightened to the
multi-unit abutments, and a minor adjustment to the midline
was marked on the impression duplicate for communication
with the laboratory. A light-bodied polyvinylsiloxane (VPS)
impression material was used to capture the intaglio
space between the tissue and the impression duplicate
of both prostheses. During the osseointegration phase,
soft-tissue shrinkage is a normal sequela of the healing
process; therefore, the light-bodied VPS helps to ensure
seamless intaglio adaptation of the final prostheses to
the soft tissue. A centric relation bite registration was
taken using Blu-Mousse VPS bite registration material
(Parkell; Fig. 20).
37
Fig. 36: Maxillary occlusal view of the completed case. Fig. 37: Mandibular occlusal view of the completed case.
44
3 2023
[45] =>
case report
|
39a
38
39b
Fig. 38: Full-face retracted view of the completed case. Figs. 39a & b: Before (a)
and after profile views (a) showing improved lower facial third proportion and
autorotation of the mandible.
This NavaGation Synergy guided surgery and prosthetic protocol eliminates the need for guesswork,
verification jigs, occlusal rims and wax set-ups. The final
impression duplicates of the transitional prostheses
served as both final impression trays and correct vertical dimension and tooth position guides. At the subsequent visit, prototypes made from Flexcera Smile
were tried in and aesthetics, function, phonetics and
occlusion were assessed (Figs. 21–25). Adjustments
to the gingival embrasures were made to idealise the
gingival scalloping and guide papillae fill-in, and a
final bite registration was obtained using Blu-Mousse.
The final prostheses were fabricated from full-contour
solid zirconia (ArgenZ HT+ Multilayer, 1,250 MPa; Argen)
and were custom stained and glazed to transition naturally with the gingival characterisation (Figs. 26–40).
The multi-unit prosthetic screws were torqued to
the manufacturer’s recommendations and the access
holes sealed with PTFE tape and Filtek Supreme Ultra.
A full-coverage maxillary flat plane occlusal night
guard was fabricated to be worn indefinitely to reduce
and manage occlusal parafunctional forces on the
prostheses and implants.
Conclusion
Digital treatment planning for improved aesthetics
and function can be both rewarding for the clinicians
and fulfilling for the patient.7 Predictable surgical and
prosthetic results are possible with a streamlined
digitally guided workflow that eliminates guesswork.
The collaboration of the surgeon, restorative dentist
and guided surgery specialist in treatment planning
enables visualisation of the desired outcome prior to
surgery. Numerous aesthetic and functional deficiencies were addressed and resolved in this patient’s case,
40
Fig. 40: Full-face view of the patient’s new smile.
resulting in much improved dental health, function and
appearance. The patient and all involved with the case
were pleased with the outcome.
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 Tyler Wynne received his DDS
in 2014 from the University of North
Carolina at Chapel Hill Adams School
of Dentistry in the US, where he is an
adjunct faculty member. He practises
general dentistry in Clemmons in
North Carolina, is an editorial team member
of REALITY Ratings & Reviews and
is a scholar of the Dawson Academy.
Dr Wynne is a fellow of the International Academy for
Dental-Facial Esthetics and Academy of General Dentistry
and a member of the American Society for Dental Aesthetics.
3 2023
45
[46] =>
| opinion
How to master intra-oral scanning
Full-arch scans in 45 seconds are within your reach
Dr Ahmad Al-Hassiny, New Zealand
1
Fig. 1: A range of different scanners in both cart and laptop configuration at the Institute of Digital Dentistry.
Intra-oral scanning has taken the dental industry by
storm. Over the past decade, we have watched traditional impression taking become completely disrupted
by technology. It is well established both in the literature
and by countless anecdotes by dentists worldwide that
intra-oral scanning provides many benefits compared
with taking a physical impression.1, 2 This includes
offering better efficiency and comfort for the patient,
being faster to carry out than traditional methods and
being as accurate if not more accurate than physical
impressions.3–5
2
Fig. 2: An example of a clean and dry crown preparation with the gingiva
retracted sufficiently ready for scanning.
46
3 2023
The question now is not a matter of whether a clinic
should digitise but when and—more importantly—
how. We have seen the industry grow significantly over
the past five years. Now, there are over 15 intra-oral
scanners on the market. It can be difficult for clinicians
to decide on an intra-oral scanner in the first place,
but once they finally take the plunge and purchase one,
they may not know how to use it.
[47] =>
opinion
|
Table 1: An example of recommended computer requirements
(for the Medit i700 intra-oral scanner).
Operating system
Windows
MacOS
Windows 10, 64 bit
Windows 11 (recommended for 12th Gen or later Intel Core processors)
MacOS Monterey
MacOS Ventura
PC type
Laptop
Desktop
Laptop/desktop
CPU
Intel Core i7-12700H
Intel Core i7-12700H
AMD Ryzen 7 5800X
M1 Pro (10-core CPU, 16-core GPU)
M2 (8-core CPU, 10-core GPU)
M2 Pro (10-core CPU, 16-core GPU)
RAM
Graphics card*
32 GB
24 or 32 GB
NVIDIA GeForce RTX 3070 (VRAM 8 GB or higher)
NVIDIA RTX A4000 (VRAM 8 GB or higher)
–
* AMD Radeon is not supported.
Some distributors provide excellent training, while
others will simply send the scanner to you and that is it.6
You are left to figure out the rest for yourself. Just like
any new method or technology, there is undoubtedly
required training for and practice using an intra-oral
scanner. Although there are countless benefits of digitising, it is necessary to realise and appreciate that
you need to train yourself on how to use the device
proficiently. Thankfully, these days, it is much simpler
to learn how to use an intra-oral scanner. Software
employing artificial intelligence (AI) helps bridge the
gap between new and experienced users, and generally, in my experience of training thousands of dentists
on how to use these devices, it should not take more
than a month of training to become confident in most
day-to-day scanning indications.
“The question now is not a
matter of whether a clinic
should digitise but when and
—more importantly—how.”
In saying that, I have seen countless instances of
dentists not using scanners correctly, because of either
poor understanding of the technology or a lack of training. In this article, I will share some of my tips on how
to become proficient in intra-oral scanning based on
my personal experience in training dentists on how to
take full-arch dentate scans easily within 45 seconds.
My personal best is 18 seconds. This is doable for
everyone reading; it is just a matter of training and practice.
Intra-oral scanning will be the best thing that ever
happened to your practice once you become confident
in it. You will never look back.
The first piece of advice may be self-evident, but is
important to mention. Scanners come in two forms,
either carts (with built-in PCs), such as CEREC, 3Shape
TRIOS MOVE and iTero, or scanners that are used with
3
Fig. 3: An example of scanning a patient. Note that both my dental assistant
and I are retracting the cheeks.
3 2023
47
[48] =>
| opinion
The next piece of advice is to ensure proper fluid and
soft-tissue control. Clinicians need to understand that
intra-oral scanners are basically cameras. They project light in different forms, and this is reflected off the
oral tissue and captured by a sensor. Based on this
principle, therefore, if we are trying to accurately capture the teeth or gingiva, we need to ensure three main
things: that there is nothing in the way, such as the
tongue, lips or cheeks; that the area is sufficiently dry
and clean, meaning that there is no blood or pools of
saliva that will impact the light projection (Fig. 2); and
that the tissue does not move when capturing. The last
point mainly applies to edentulous scanning, which is
part of the reason that this is much more difficult than
scanning teeth.
4
Fig. 4: How to hold an intra-oral scanner in a pen grip.
third-party PCs or laptops that are either supplied by
the distributor or purchased by the clinician separately (Fig. 1). This is the more common type of scanner configuration and includes 3Shape TRIOS, Medit
scanners, Virtuo Vivo and almost every Chinese-made
scanner.
It is crucial to make sure that the computer you use
with your scanner not just meets but exceeds the minimum requirements for the scanner of your choice
(Table 1). If the computer is not powerful enough, you
will have a buggy, laggy and generally frustrating experience with your scanner. Expect to spend anywhere
between US$3,000 and US$5,000 on a good enough
laptop, or ensure that your distributor is supplying you
with one that is excellent.
5
Fig. 5: Standard scanning strategy when using an intra-oral scanner to take
a full-arch scan.
48
3 2023
The easiest way to achieve all of these things for a
crown preparation scan, for example, is to simply look
through your mirror at your preparation before scanning. If there is any bleeding or any crevicular fluid
seeping, this needs to be controlled. If there is gingiva
that is slumped over the margin, this needs to be controlled. In general in my practice, I routinely use retraction cord every time I scan, as it allows me to control
all these factors with one technique. You can use any
gingival retraction technique you like, as we all practise differently, but you must use retraction if scanning
equigingival or subgingival preparations. It is vital to
make sure that all soft tissue is controlled properly before scanning. Although your laboratory may accept
the scans and produce the work, without proper gingival retraction, scans will not be accurate, especially
around margins.
You must control the soft tissue too. Retraction is imperative. Most of us work with a dental assistant, so
train your assistant to retract the soft tissue properly
when you are scanning. I use my finger or mirror to
retract the cheeks. My dental assistant also retracts
the tongue and cheeks while we move across the arch
(Fig. 3). If your scanner keeps starting and stopping,
commonly it is because the scan keeps being interrupted by the cheeks or lips as they slump over the
teeth. Proper retraction will no doubt make your scans
much more efficient.
The next tip concerns how you actually scan. How to
hold an intra-oral scanner properly is something that
is overlooked, and all clinicians seem to do it slightly
differently. Generally, scanners are held in a pen grip
and the index finger is over the scanner button to be
able to start and stop the scanner within the mouth
(Fig. 4). One basic tip is to never start scanning before moving the scanner into the mouth and having
it in position. The reason for this is simple: once you
press the scanning button, the software will immediately
start capturing images, so if you start this process
[49] =>
opinion
|
“Current literature shows that
full-arch dental impressions
can have extremely high
accuracy if adequate
scanning strategies are used.”
outside the mouth and then move into position, you
will likely capture an artefact like the lips as you move
into position.
The next tip is scanning strategy. A scanning strategy refers to how you move the scanner around the
mouth to take a scan. The pathway is almost always
the same when followed properly. Although AI software makes it easier to take a full-arch scan and is
more forgiving, following a scanning strategy still has
multiple benefits, including ensuring high accuracy
and efficiency. Current literature shows that full-arch
dental impressions can have extremely high accuracy
if adequate scanning strategies are used.7 The typical scanning strategy is as follows: starting on the
occlusal surface of the terminal molar and moving
across the occlusal surfaces to the opposite side
(Fig. 5).
A vital piece of advice is to tilt the scanner facially while
moving across the incisors to ensure that you capture
the incisal edges in their entirety to prevent double
images and inaccuracies in this part of the scan (Fig. 6).
Once on the occlusal surface of the opposite molar,
you simply tilt your scanner lingually/palatally and then
continue to capture the tooth surfaces, moving back to
the original point you started at, finally tilting over to the
facial surface and capturing the last remaining data.
When using most intra-oral scanners, it is not critical
whether you capture facial or lingual/palatal surfaces
after carrying out the occlusal aspect scan of a full-arch
scan strategy. Rather a smooth and steady motion is
much more important.
Carrying out this scanning strategy requires practice
and muscle memory. There are no shortcuts. At first
you will feel uncomfortable and likely lose your spot
many times. With time and repetition, you will be able
to do this without looking into the mouth, but rather
watching the computer screen to see exactly what
you are capturing. Once you feel confident with intra-
oral scanning, you should be able to take a full-arch
scan easily within 45 seconds. I highly recommend to all
clinicians to practise as much as possible when they first
acquire a scanner. Practise on models, your staff or even
6
Fig. 6: An example of double images at the incisal edges.
your spouse. You will not get better at intra-oral scanning
by keeping the scanner in a cupboard.
In summary, these are some of the tricks and tips
I teach our associates and the thousands of dentists
we train at the Institute of Digital Dentistry, both in our
live courses and online. We also have an entire library
of online content in which I demonstrate these tips
and tricks which you can find on the institute’s website
(instituteofdigitaldentistry.com).
The first step to becoming proficient in scanning
is to accept that this is the best way to take an
impression. If you do not believe in the technology,
you will not bother learning it. Digital dentistry is the
future of dentistry, and you do not want to fall behind.
It does take practice, and learning to use a scanner
can be frustrating at times, but with perseverance,
there is no doubt that you will be fully confident in
taking scans within a few weeks of proper training
and practice.
Please scan this QR code for the list of
references.
about
Dr Ahmad Al-Hassiny is a global
leader in digital dentistry and intra-oral
scanners, carrying out lectures as a
key opinion leader for many companies
and industry. He is one of the few in
the world who owns and has tested all
mainstream scanners and CAD/CAM
systems in his clinic. Dr Al-Hassiny
is also the director of the Institute of
Digital Dentistry, a world-leading digital dentistry education
provider with a mission to ensure dentists globally have easy and
affordable access to the best digital dentistry training possible.
3 2023
49
[50] =>
© O-IAHI/Shutterstock.com
| feature
Dentistry stands among
top-ranked degrees in 2023
By Iveta Ramonaite, Dental Tribune International
In the rapidly evolving landscape of higher education,
the value of degrees is constantly shifting to align with the
demands of a dynamic job market. In recent decades,
technology has taken dentistry by storm, and its evergrowing influence extends to multiple specialties. It thus
comes as no surprise that, according to a recent survey
conducted by Forbes Advisor, the most valued degrees
this year are innovation- and technology-driven.
According to the survey, the most prestigious degrees this year
are those focusing on artificial intelligence (AI; 25%), information
technology (IT; 21%) and computer science (18%), whereas
medicine and dentistry came in at joint fifth place (16%). In a
world where technological advancements are reshaping industries, dentistry’s inclusion among the most esteemed degrees
of 2023 reflects its enduring importance and recognition as a
field that stands at the intersection of healthcare and innovation.
The survey also found that, according to 25% of UK businesses, degrees centred around AI have become highly
prized. Additionally, 21% regard an IT degree as immensely
desirable, whereas 18% perceive a computer science
degree as the most pre-eminent in 2023.
Highlighting AI’s omnipresence in today’s society, AI skills
emerged as the most requested abilities in the job market,
50
3 2023
and an astounding 40% of the survey participants believe that AI expertise is the most in-demand expertise in
the workplace. The growth of AI is also likely to boost the
need for experts in the field in the future, and a staggering
96% of respondents are convinced that AI will significantly
affect the future job market.
Commenting on the survey results, Kevin Pratt, a business expert at Forbes Advisor, said in a press release:
“The continued dominance of technology-related degrees, particularly those with a strong focus on AI, in
the list of most valued degrees by employers underscores the profound way that AI is set to change the
workplace.”
According to Pratt, technology-related degrees have
been highly sought after for a couple of decades now,
and this trend is likely to grow even further. He went on to
emphasise that obtaining sought-after qualifications not
only imparts relevant skills to graduates but also positions them at the forefront of innovation and the evolving
employment landscape.
The integration of AI into dentistry holds significant
promise for improving patient care, enhancing diagnostics
and making dental practices more efficient.
[51] =>
Register at
www.dds.berlin
Digital
Dentistry
Show
In collaboration with
Digital
Dentistry
Society
OF DENTISTRY
OF DENTISTRY
D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E
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DENTISTRY
SHOW
D I G I TA L D E N T I S T R Y S H O W • U N V E I L I N G T H E F U T U R E
28 & 29 JUNE 2024
[52] =>
| interview
“Dental schools should consider
incorporating haptic
VR simulation devices”
An interview with Dr Szabolcs Felszeghy
As haptic technology slowly makes
its way into dentistry, dental students are increasingly using haptic
virtual reality (VR) simulation in their
training. Combined with traditional
phantom head practice, the technology may help improve students’
tooth preparation and offers benefits such as increased manual dexterity. Dental Tribune International
spoke with Dr Szabolcs Felszeghy,
a senior researcher at the University of Eastern Finland who has
conducted several studies on haptics in dentistry, about dental students’ experience with using haptic
VR simulation in preclinical training
and the benefits it offers compared
with phantom head simulation and
discussed how haptic technology
may evolve in the future.
to repeat the exercise as many times
as necessary and the possibility of
training at a time suitable for each
student. In addition, students may
feel more self-confident after practising in the haptic VR environment
using a dental trainer. Another advantage compared with traditional
methods is consistency of scoring.
Haptics-enhanced VR has become
increasingly popular in the recent
decade. However, fewer than
150 dental institutions worldwide
have had haptic VR equipment
installed. How might this slow
adoption rate be explained?
Haptic feedback technology has
received increasing attention in
dental schools, and there are no
questions about the effectiveness
of haptic VR dental trainers in preDr Felszeghy, why should dental
clinical operative dentistry courses
Dr
Szabolcs
Felszeghy,
a
senior
researcher
at
the
University
of
students use haptic VR simulation?
as an adjunct to conventional
Eastern
Finland
working
on
haptics
in
dentistry.
Learning tooth preparation techphantom head training. I believe
niques and the finesse required is
that the major reason for the slow
an important part of preclinical dental education. The tradiadoption rate is not based on the benefits of a haptic VR dental
tional phantom head simulation laboratory learning is really
trainer, such as Simodont (Nissin Dental Products), but rather
important to mimic clinical dental procedures in preclinion the financial aspect. It costs over €1 million for complete
cal dental education. In our experience at the Institute of
installation of 15 haptic VR training units ready for use.
Dentistry at the University of Eastern Finland’s School of
Medicine, combining haptic VR with conventional tooth
The University of Eastern Finland was the first university
in the country to install VR dental trainers in 2021. Have
preparation exercises in dental education allows us to immore universities in Finland followed suit since then?
prove dental students’ learning outcomes, improving their
manual dexterity, increasing their efficiency and improving
Yes, three more haptic VR Simodont dental trainers were inwork performance.
stalled in the dental faculty of the University of Turku this spring.
What other benefits does haptics-enhanced VR offer
to dental students?
Haptic VR training is a great method for achieving the required level of skill for tooth preparation. The benefits of haptic
VR practice especially include its relative informality, the ability
52
3 2023
From your experience, what do students value the most
when using VR to enhance their manual skills?
In general, our undergraduate dental students viewed our
de novo training module positively and felt that they had learned
new skills and gained new clinical information in a relaxed scenario.
© Damir Khabirov/Shutterstock.com
By Iveta Ramonaite, Dental Tribune International
[53] =>
interview
Can haptic training replace using phantom head simulation, or do you think that the two types of training
methods should complement each other?
Phantom head simulation training for invasive dental procedures must be a core component of the preclinical dental curriculum. However, besides the conventional training
methods, dental schools should consider incorporating
haptic VR simulation devices to facilitate the transition of
preclinical students from the simulated dental learning environment to the clinical setting.
You have recently worked on a study that examined
dental practice that combined VR haptics and frasaco
plastic tooth model preparation exercises. What were
the most significant results?
The combination of haptic VR technology provided by
the Simodont dental trainer with frasaco simulation can
successfully meet the learning and teaching needs for tooth
preparation.
What is the future of haptic technology in dentistry?
The future of haptic technology looks bright, as it has the
potential to revolutionise a wide range of dental training.
In the recent past, haptics helped make things perceptible,
for example phone vibration and Rumble Paks in gaming
controllers. We now have haptic VR dental trainers, and the
|
A haptic virtual reality Simodont dental trainer. (All images: © Szabolcs Felszeghy)
use of artificial intelligence (AI) in dental training is just around
the corner. The combination of AI with haptic VR devices
would definitely enhance training and engagement, and
this could potentially reduce the risk of surgical errors and
improve patient outcomes.
However, further development and evidence-based clinical
validation of haptic VR dental trainers are needed to improve engagement and learning outcomes for more dental
students around the world. I am convinced that, as the technology continues to advance, it is likely that dental educators
will see even more innovative and exciting dental applications
of haptic VR technology in the coming years.
Editorial note: The study has been accepted for publication
in the International Journal of Computerized Dentistry.
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[54] =>
| interview
Time to celebrate PANAVIA’S
40th anniversary!
An interview with Mitsunobu Kawashima, Japan
By Kuraray Noritake Dental
In 1983—exactly 40 years ago—the resin cement PANAVIA EX
was introduced in Japan as the first product of the PANAVIA family
and the first product containing the original MDP monomer.
Since then, the PANAVIA family of resin cements has been continuously expanded by developing new resin cement materials
tailored to the contemporary demands of dental practitioners.
The current line-up of easy-to-use, high-performance adhesive luting materials is globally available and used by dental
practitioners wishing to attain a high standard of care. In this
interview, we spoke about PANAVIA EX as a groundbreaking
innovation in the field of dental resin cements and subsequent
steps towards the current well-balanced resin cement portfolio
with Mitsunobu Kawashima, manager, Technology Division of
Kuraray Noritake Dental Inc. He is responsible for the development
of chairside materials in Kuraray Noritake Dental’s technology
division and has been part of the team developing many products
of the PANAVIA family for more than 30 years.
Mitsunobu Kawashima, manager, Technology Division of Kuraray Noritake Dental Inc.
54
3 2023
The resin cements developed by the company before
the introduction of PANAVIA EX contained the adhesive
monomer Phenyl-P. Why did you decide not to use
Phenyl-P in the new formulation?
When we were developing PANAVIA EX, we were engaged in the development of new adhesive monomers
[55] =>
interview
to replace Phenyl-P. The main aim of this project was an
improvement of our products’ bond strength for metal
alloys and dentine. Among the new adhesive monomers
being developed, we decided to use the MDP monomer
because it features excellent bonding to tooth structure
and metal alloys used in dentistry, as well as superb resistance to water. Incidentally, our first products to contain
the MDP monomer were PANAVIA EX and the bonding
agent CLEARFIL NEW BOND.
Where did the name PANAVIA come from?
The name is a compound of the Greek word “pan” and
the Latin word “via”, meaning “everything” and “way”
or “method”, respectively. Consequently, PANAVIA describes a method for bonding everything; it represents
our desire to have products launched under the PANAVIA
brand recognised as dental materials that can bond to all
types of restorations and tooth structure.
Would you please tell us the story behind the development of PANAVIA EX?
Back in the early 1980s, it was vital for us to develop new
adhesive monomers as part of our project to develop a
new resin cement with unprecedented adhesive properties. In this context, we conducted a comprehensive literature search for compounds thought to be involved in
adhesion. At the same time, we carried out a variety of
R & D activities, including basic research to quantitatively
clarify the relationship between the molecular structures
of monomers and their adhesive qualities, synthesis trials
of various monomers and bond strength tests. Consequently, we succeeded in developing the MDP monomer
that had the physical properties we were working to ob-
|
tain. After the development of this adhesive monomer, we
were finally able to create PANAVIA EX in our laboratory.
In early 1982, we completed the first prototype of
PANAVIA EX for external evaluation and asked a dental
colleague in Japan to evaluate it. He found that the prototype cement might polymerise too quickly in clinical use.
This was due to fact that we had not taken into account
the difference between room temperature and intra-oral
temperature, which has a huge impact on the polymerisation time. This mistake made us recognise how important clinical evaluations are during the development of
dental materials. To this day, we continue to place great
importance on the opinions of clinicians whenever a new
material is being developed.
What were the key technological features of the
PANAVIA EX cementation system?
The system had five key features: appropriate film thickness, appropriate flow properties, radiopacity, improved
bond strength and improved surface polymerisation characteristics. At the time that PANAVIA EX was developed, a
film thickness of 30 μm or less was desired for luting cements. The largest components we wanted to use in the
formulation—the silica filler particles present in our composite resin—had a maximum particle diameter of 50 µm.
We were able to achieve a film thickness of 30 μm or less
by significantly extending the silica grinding time, which
made the filler particles much finer. An appropriate paste
consistency—a low level of viscosity and good flowability—
was achieved by using low-viscosity monomers for
PANAVIA EX. In order to make the cement radiopaque, we
dispersed radiopaque filler within the powder component.
3 2023
55
[56] =>
| interview
In fact, we were convinced that it was really important to
be able to check for the presence of excess cement under
the gingival margins after a restoration had been placed.
The increase in bond strength was achieved by blending
the MDP monomer into the liquid component.
PANAVIA SA Cement Universal, which works as a stand-alone
product without separate primers; and PANAVIA Veneer
LC, the latest product in the PANAVIA family. The last is a
light-polymerised resin cement with the specialised purpose
of bonding laminate veneers.
What about the surface polymerisation characteristics
of the cement?
Every dental practitioner knows that the surface of resin
cements must be protected from oxygen in the air in order
to polymerise properly. For this purpose, we developed
OXYGUARD, a water-soluble gel material. It is applied to
the restoration margins to cover the unpolymerised resin
cement surface and protect it from exposure to oxygen.
In this way, the formation of an oxygen inhibition layer—
a layer of unpolymerised resin on the surface that
compromises the marginal integrity of the restoration—
is prevented and an intact, fully polymerised cement surface can develop. For this reason, the use of OXYGUARD
has contributed greatly to improving the polymerisation
characteristics of cements.
In retrospect, what did the introduction of PANAVIA EX
mean to Kuraray Noritake Dental?
In the development of new resin cements, it is important
to respond quickly to the rapidly changing trends in the
market. As new prosthodontic treatment concepts appear—
like adhesive bridges as a minimally invasive treatment
option replacing a single tooth—or new restorative materials are introduced—such as different types of ceramics—
we need to check whether our resin cement systems are
suitable for the tasks that come with these changes and
possibly develop new ones. After the launch of PANAVIA EX,
we received a wide range of feedback from experts working
at dental clinics and laboratories. We leveraged this feedback in subsequent development projects, always with clinical considerations in mind. After Kuraray Medical merged with
Noritake Dental Supply Co., this attitude was embedded in
the work ethic of all employees of Kuraray Noritake Dental.
What do today’s PANAVIA products and PANAVIA EX
have in common?
The PANAVIA family of products, including PANAVIA EX,
are resin cement products that create new possibilities in
dentistry. PANAVIA EX was our first resin cement, and it was
conceived as a cement for a new era. It can bond to tooth
structure and dental metals very well, thanks to the use of
the MDP monomer. This important adhesive monomer is still
used today in many of our products. Ever since the launch of
PANAVIA EX, Kuraray Noritake Dental has continued to take
on new challenges and has developed many new products
in the growing PANAVIA family. These include PANAVIA 21,
a cement in paste form used in combination with a selfetching primer; PANAVIA Fluoro Cement, a dual-polymerising
cement paste that releases fluoride; and PANAVIA F2.0,
which can be used with an LED curing unit. The current
portfolio consists of PANAVIA V5, which features the substantially improved bonding performance that was achieved
after a major review of the basic composition of the series;
56
3 2023
Would you briefly tell us about the PANAVIA EX journey
to the current PANAVIA family portfolio?
Since the launch of PANAVIA EX 40 years ago, six different PANAVIA products have been released. Each of them
has received high acclaim for its unique features, both
in the Japanese resin cement market and abroad. For
40 years, we have been improving PANAVIA in response to
the demands of the times. We developed a product with increased adhesion when non-retentive preparation designs
(adhesive bridges) and smaller bonding surfaces (due to
less invasive preparations) became popular. For users concerned about secondary caries, we developed a material
with fluoride-releasing properties. At the same time, we
focused strongly on making dental cementation easier by
finding ways to make our resin cements bond well to various types of crown restoration materials, including precious metals and ceramics. During these efforts towards
[57] =>
interview
improvement, achieving reliable general luting has always
been at the forefront of our goals. We believe that the
successful evolution of the PANAVIA brand owes a great
deal to our continual efforts to obtain a high-strength bond
to dentine after chemical polymerisation.
How has the R & D department evolved over the years?
Initially, our efforts in the development of dental materials had
focused on bonding agents and restorative composite resins.
PANAVIA EX was just one of our new development projects,
and only a few staff members were assigned to that product.
After PANAVIA EX was launched in 1983 and gained popularity worldwide, our product line-up of resin cements was
expanded considerably. Consequently, we increased the number
of development staff assigned to resin cements and set up a
special development team responsible for the self-adhesive
resin cement product line that includes PANAVIA SA Cement
Universal. As a result, the size of the staff assigned to resin
cements has expanded substantially.
How has production changed?
When PANAVIA EX was launched in 1983, the product
was manufactured exclusively for the Japanese market in
a relatively small facility. Today, in order to manufacture all
products of the PANAVIA family for the global market, we
have automated our production facilities and increased
the manufacturing equipment and systems dedicated to
producing the resin cement paste. To support our product
quality, we have also set up a quality control system that
assures that we turn out safe and high-quality products,
based on our over 40 years of technical know-how and
experience in the production of resin cements.
When did external researchers start showing interest
in PANAVIA?
The development of PANAVIA EX was carried out with the
active participation of researchers at a dental college in
Japan, involving such activities as performing basic
adhesion tests and experimenting with clinical applications
using adhesive bridges. At that time, resin cements that
|
provided a strong bond to tooth structure or metal alloys
were not widely used. I believe that overseas researchers
were interested in the development of PANAVIA EX at a
relatively early stage for this reason.
What goal do you have in mind as you continue developing the company’s adhesive cements?
We have two basic central goals: achieving greater bond
strength and delivering easier handling characteristics.
I think that the shades of resin cements are also devised
in each product in order to realise characteristics that support aesthetic restorations. We have achieved greater bond
strength with PANAVIA V5 and easier handling characteristics with PANAVIA SA Cement Universal. We are going
to continue to explore the development and introduction
of various new technological applications to bring even
higher-performance products to market.
What is the strength of Kuraray Noritake Dental’s R & D team
in your opinion?
We conduct R & D activities continuously, focusing on the
development of luting materials. In our product development department, the same person is often responsible
for one product category for a long time. For example,
I have been engaged in the development of PANAVIA
products for most of the time since I joined the company.
The result is that each person in the development department can be said to be an expert in a certain category of
products. They leverage the technical knowledge acquired
in the past for the development of new products, resulting
in entirely new discoveries.
Do you have any ideas about what the future of
PANAVIA will be?
We will continue to focus on the development of even simpler,
easier-to-use resin cements suitable for a wide range of
applications—products based on the concept of universality.
They should allow users to focus more on actual treatment than
ever before while, of course, delivering a strong and durable
bond between the tooth structure and the restoration.
3 2023
57
[58] =>
| industry report
PANAVIA: 40 years of success
in adhesive luting
By Kuraray Noritake Dental
Have you ever wondered why the products of the
PANAVIA brand offer such outstanding performance?
You probably know that they all contain the original MDP
monomer developed in the early 1980s. It has attracted
much attention because it is such an excellent adhesive monomer. This phosphate ester monomer forms a
very strong bond to tooth structure, zirconia and dental m
etals. However, alongside MDP are other important
catalytic technologies and constituents that support the
performance of our cementation solutions.
Constituents affecting
the polymerisation reaction
One of these decisive additional technologies and
constituents is the polymerisation catalyst that triggers
the polymerisation process. Different from the MDP
monomer used in every PANAVIA product, the polymerisation catalyst has been continuously improved since
the introduction of PANAVIA EX in 1983. New versions
have been developed for PANAVIA 21, PANAVIA Fluoro
Cement and PANAVIA V5, for example. Another important
component also affecting the polymerisation process
is the touch-cure technology used in two of the three
major products of the current PANAVIA portfolio:
PANAVIA V5 and PANAVIA Veneer LC. This technology
was first used in PANAVIA 21, which was launched in 1993.
58
3 2023
Contact of the chemical polymerisation activator contained in the self-etching primer with the resin cement
paste accelerates the polymerisation of the cement
from the adhesive interface, thus providing better adhesion of the resin cement. In developing PANAVIA V5,
we reviewed the chemical composition of the existing PANAVIA products and updated it substantially.
Touch-cure technology has also been adapted for use in
PANAVIA V5 Tooth Primer and the concomitantly used
PANAVIA V5 Paste. When cementing veneers with
PANAVIA Veneer LC, we also use PANAVIA V5 Tooth
Primer for conditioning teeth. This also involves the use
of touch-cure technology for achieving an adhesive
connection with the tooth without compromising the
working time of the cement paste.
Additional adhesive monomers
Even in the field of adhesive monomers, however, our
development efforts did not come to a halt: we developed the LCSi monomer, a long-chain silane coupling
agent which made it possible to integrate the function
of a ceramic primer in our self-adhesive resin cement
PANAVIA SA Cement Universal. With its high level of
hydrophobicity, this monomer provides stable, long-term
bond strength. Generally speaking, it may be said that the
reason bond durability may drop is a hydrolytic reaction
[59] =>
industry report
|
damaging the chemical bond between the silica contained in glass-ceramics and the silane coupling agent.
Three products covering
virtually every need
By combining these technologies and constituents in
a smart way, we have succeeded in developing a resin
cement portfolio that covers virtually every need. With
PANAVIA V5, PANAVIA SA Cement Universal and
PANAVIA Veneer LC, it is possible to treat a wide variety of cases. The products allow for the luting of various
types of restorations and prosthetic appliances and for
the placement of posts and produce great outcomes if
used according to the instructions for use.
It is possible for the dental practitioner to choose the right
cement system for treatment according to the case
and patient needs from among these three major resin
cement products. PANAVIA SA Cement Universal is a
simple and easy-handling self-adhesive resin cement.
PANAVIA Veneer LC is used for bonding laminate veneers.
PANAVIA V5 has the widest range of uses among these
three cement systems, covering almost all the intended
uses of the other two.
Exploring new opportunities
The good thing about developing technologies in a company
like Kuraray Noritake Dental is that their application is not
limited to a certain product or product group. The research
and development department always carries out research
on how to leverage the benefits of the technologies in other
applications. Take, for example, KATANA Cleaner, which was
released in 2019. This cleaning agent can be used to remove
saliva, blood, temporary cement or other contaminants that
can adhere to the surfaces of teeth or prosthetic devices
during trial fitting and temporary cementation of a prosthetic
device. This unique product has been developed by taking
advantage of the surfactant function of the MDP monomer.
Conclusion
Hence, it is mainly our long-standing knowledge and
experience in the development of dental resin cements
and adhesive solutions that provides for the excellence
of the current PANAVIA portfolio. We know how to
improve existing technologies, never stop developing
new ones and continuously look for the best way to
combine proven and new components to obtain the
best possible outcomes. In the steps of the product
development procedure, clinical tests are conducted
and feedback from dental practitioners is gathered to
take into account the extreme conditions found in the
oral environment. In the past 40 years, this strategy has
proved successful, and we are sure that it will help us
develop many other innovative products that offer ideal
support to the dental practitioner in striving to improve
the oral health of patients.
3 2023
59
[60] =>
| manufacturer news
3Shape intra-oral scanner
TRIOS 5 wins Cellerant Best of Class Hygiene Award
The 3Shape TRIOS 5 intra-oral scanner has been given the
Cellerant Best of Class Hygiene Award for 2023. The achievement
underscores the consistent excellence of the TRIOS line of intraoral scanners, which have won ten consecutive Cellerant Best of
Class Technology Awards. The award is presented to innovative
solutions that improve clinical outcomes, enhance clinician ergonomics and optimise hygiene treatment.
The recently introduced TRIOS 5, which has been cleared by the
US Food and Drug Administration, revolutionises the look and feel
of intra-oral scanners. Hygienic by design, the TRIOS 5 body is
sealed up to its battery inlet and devoid of cracks or crevices where
any contaminants can accumulate. Enclosed by a sapphire glass
window, the autoclavable scanner tip creates a robust microbial
barrier between the patient and the scanner. Additionally, TRIOS 5
Wireless includes single-use body sleeves that cover the entire
area touched by the operator, offering further protection against
contamination.
60
3 2023
3Shape CEO Jakob Just-Bomholt expressed his gratitude to the
Cellerant panel, saying: “Winning the award is a terrific honour for
our team and made even more so because the Cellerant panel is
made up of dental professionals. We appreciate their considering
TRIOS for the award.”
Dr Lou Shuman, Cellerant Consulting Group CEO and creator
of the Cellerant Best of Class Technology Awards, commented:
“We are excited to present 3Shape TRIOS with our Cellerant Best of
Class Hygiene Award. Over the past few years, due to the pandemic, the dental industry has sought to focus more on hygiene.
3Shape TRIOS 5 helps lead the way with its revolutionary hygienic
design. The award acknowledges their innovation.”
www.3shape.com
[61] =>
manufacturer news
|
An innovative implant solution
Introducing DS OmniTaper Implant System—
the newest member of the EV implant family
The DS OmniTaper Implant System is an innovative solution that
combines the proven technologies of Dentsply Sirona’s EV implant
family with new features that deliver efficiency and versatility.
Unique to the implant system is an intuitive drilling protocol for
reduced chair time and a pre-mounted TempBase for immediate
restorations and efficient workflows.
The DS OmniTaper Implant System is the newest member of the
EV implant family, alongside the Astra Tech Implant System and
DS PrimeTaper Implant System. The EV implant family offers surgical flexibility to cover virtually every indication. All three implant
systems deliver biologically driven implant designs for natural aesthetics and lasting bone care, have one connection for restorative
simplicity and are optimised for a seamless integration into digital
dentistry workflows.
Like the rest of the EV implant family, the DS OmniTaper Implant
System features the OsseoSpeed implant surface and the conical
EV connection that provides access to the harmonised and
comprehensive EV prosthetic portfolio for restorative flexibility
and immediate chairside solutions.
www.dentsplysirona.com
AD
THE GLOBAL DENTAL CE COMMUNITY
REGISTER FOR FREE
www.dtstudyclub.com
DT Study Club – e-learning community
@DTStudyClub
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.
[62] =>
| manufacturer news
Contributing to the development of dental care
Kuraray Noritake Dental
Kuraray Noritake Dental is quintessentially Japanese, combining
historical achievements with continuous technological advancements. It was formed in 2012 by the well-established companies
Kuraray Medical and Noritake Dental Supply coming together
to combine their core competencies. Today, our craftsmanship,
underpinned by our groundbreaking dental technologies and
reflected in outstanding product quality, is recognised across
the globe.
The parent company of Kuraray Medical—Kuraray—was
founded in 1926 in Kurashiki in Japan. Kuraray began to
develop dental products in the 1970s and introduced its first
adhesive key technology—the MDP monomer—in 1981.
The parent company of Noritake Dental Supply—NORITAKE—
was founded in 1904 in Nagoya in Japan. Its ceramic tableware
and industrial abrasion wheel are well known globally. In 1987,
NORITAKE launched its first dental products, establishing an
entirely new class of veneering ceramics.
62
3 2023
The combination of both companies’ long-standing expertise in polymerbased organic chemistry and ceramic-based inorganic chemistry,
respectively, has enabled Kuraray Noritake Dental to develop a whole
range of groundbreaking dental products. These include gold-standard
self-etching and innovative universal adhesives, an array of cuttingedge resin cements for streamlined workflows, easy-to-use composites for direct restorations, highly aesthetic zirconia blanks for indirect
restorations, and pioneering liquids and porcelains for virtually every
finishing and staining technique in use today. The company’s brands,
like CLEARFIL, PANAVIA, KATANA and CERABIEN, represent groundbreaking technologies integrated into products that make an enormous
difference to the dental professional’s work.
By improving these technologies and creating new ones, we will
continue to provide dental professionals with products and information that can be used safely and comfortably. Our overarching aim
is to continue to contribute to the development of dental care.
www.kuraraynoritake.com
[63] =>
|
Singapore © ITI
meetings
All about the patient:
The 2024 ITI World Symposium
By ITI Foundation
The ITI World Symposium is back and better than
ever. In Singapore from 9 to 11 May 2024, more than
50 world-renowned speakers will present at the
world’s largest scientific implant dentistry event.
Building on the highly successful online edition, the 2024
ITI World Symposium will once again put patients at
the centre of the action.
Over three days, more than 4,000 participants will
experience real patients and their stories on stage.
The speakers will discuss various treatment options based on the latest scientific evidence. Additionally, world-class clinicians will provide commentary on exclusively recorded clinical procedures live
on stage.
“With our unique, patient-centred programme, we aim
to combine practical, clinical insights with the discussion of scientific findings,” explained International
Team for Implantology (ITI) President Dr Charlotte
Stilwell. “We ran a survey in our community last year to
identify the topics of greatest relevance currently, and
these form the core of our scientific programme: softtissue management, guided bone regeneration/bone
augmentation, immediate implants, peri-implantitis and
the digital workflow.”
Registration for the ITI World Symposium is open
at worldsymposium.iti.org. ITI members as well as
those who register early will benefit from significant
discounts.
3 2023
63
[64] =>
| meetings
64
3 2023
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
PRAGODENT
CIOSP 2024
12–14 October 2023
Prague, Czech Republic
https://pragodent.eu/en
24–27 January 2024
São Paulo, Brazil
www.ciosp.com.br/en
36th Int’l Dental ConfEx
CAD/CAM Digital
& Oral Facial Aesthetics
AEEDC Dubai 2024
27–28 October 2023
Dubai, UAE
https://cappmea.com
6–8 February 2024
Dubai, UAE
https://aeedc.com
Formnext 2023
DDS Berlin
7–10 November 2023
Frankfurt, Germany
www.formnext.mesago.com
28–29 June 2024
Berlin, Germany
www.dds.berlin
© 06photo/Shutterstock.com
International events
[65] =>
|
© 32 pixels/Shutterstock.com
submission guidelines
How to send us your work
Please note that all the textual components of your submission must be combined into one MS Word document.
Please do not submit multiple files for
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In addition, images must not be embedded into the MS Word document. All images must be submitted separately, and
details about such submission follow below under image requirements.
Text length
Article lengths can vary greatly—from
1,500 to 5,500 words—depending on
the subject matter. Our approach is that
if you need more or fewer words to do the
topic justice, then please make the article
as long or as short as necessary.
We can run an unusually long article in
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In short, we do not want to limit you in
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You may submit images via e-mail
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Please number images consecutively
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then use lowercase letters to designate
these in a group (for example, 2a, 2b, 2c).
An abstract of your article is not required.
Please place image references in your
article wherever they are appropriate,
whether in the middle or at the end of a
sentence. If you do not directly refer to the
image, place the reference at the end of
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Author or contact information
The author’s contact information and a
head shot of the author are included at
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exact information you would like to appear in this section and format it according to the requirements stated above. A
short biographical sketch may precede
the contact information if you provide us
with the necessary information (60 words
or less).
In addition, please note:
We also ask that you forego any special
formatting beyond the use of italics and
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certain words within the text, please only
use italics (do not use underlining or a
larger font size). Boldface is reserved for
article headers. Please do not use underlining.
· We require images in TIF or JPEG format.
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· These image files must be no smaller
than 80 KB in size (or they will print the
size of a postage stamp!).
Questions?
Magda Wojtkiewicz
(Managing Editor)
m.wojtkiewicz@dental-tribune.com
3 2023
65
[66] =>
| international imprint
Imprint
Publisher and Chief Executive Officer
Torsten R. Oemus
t.oemus@dental-tribune.com
Editor-in-Chief
Dr Scott D. Ganz
Managing Editor
Magda Wojtkiewicz
m.wojtkiewicz@dental-tribune.com
Designer
Franziska Schmid
Copy Editors
Sabrina Raaff
Ann-Katrin Paulick
Editorial Board
Prof. Gerwin Arnetzl (Austria)
Dr Christian Brenes (USA)
Dr Ansgar Cheng (Singapore)
Dr Scott D. Ganz (USA)
Hans Geiselhöringer (Germany)
Lars Hansson (USA)
Uli Hauschild (Italy)
Dr Stefan Holst (Germany)
Prof. Albert Mehl (Switzerland)
International Administration
International Headquarters
Chief Financial Officer
Dan Wunderlich
Dental Tribune International GmbH
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
General requests: info@dental-tribune.com
Sales requests: mediasales@dental-tribune.com
www.dental-tribune.com
Chief Content Officer
Claudia Duschek
Clinical Editors
Nathalie Schüller
Magda Wojtkiewicz
Editors
Franziska Beier
Jeremy Booth
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04420 Markranstädt, Germany
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Gernot Meyer
Advertising Disposition
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Alexander Jahn
Magazine
subscription
digital
— international magazine of
digital dentistry
Scan the QR code to register and read
the magazine online free of charge.
For print subscriptions, contact
info@dental-tribune.com (fees apply).
Copyright Regulations
All rights reserved. © 2023 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH is
expressly prohibited.
Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical
errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune
International GmbH.
66
3 2023
[67] =>
rative
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ntu
De
ep
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Simplify
workflows and
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NEW DEXIS IS 3800
DEXIS™ IOS Solutions seamlessly
integrates into your dental workflow,
helping you to simplify processes,
increase productivity, and facilitate practice
expansion. Say hello to more time for what
really matters — your patients.
Find out more at dexis.com
© 2023 Dental Imaging Technologies Corporation. All rights
reserved; DXIS00275 /RevA
dexis.com
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/ Editorial
/ Content
/ Researchers developing novel AI platform for dental disease identification
/ Tracking periodontal disease with electronic dental records may enhance diagnosis and treatment
/ Study uses artificial intelligence for gingivitis detection
/ CBCT data could help create patient-specific scaffolds for periodontal tissue regeneration
/ Industry news
/ Immediate or delayed loading in the fully edentulous maxilla
/ Implant treatment of the fully edentulous patient—contribution of digital techniques
/ The transparent gingiva project IV - Non-invasive measurement of the height and width of the peri-implant soft tissue using an enhanced digital merging methodology
/ Refer forward: Digital technology empowering removable prosthodontics
/ An aesthetic, minimally invasive restoration using a fully digital workflow
/ Predictable aesthetic success
with a digital workow
/ How to master intra-oral scanning - Full-arch scans in 45 seconds are within your reach
/ Dentistry stands among top-ranked degrees in 2023
/ “Dental schools should consider incorporating haptic VR simulation devices” - An interview with Dr Szabolcs Felszeghy
/ Time to celebrate PANAVIA’S 40th anniversary! - An interview with Mitsunobu Kawashima, Japan
/ Industry report
/ Manufacturer news
/ Meetings
/ Submission guidelines
/ Imprint
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