DT Middle East and Africa No. 1, 2019

SEHA AHS educates 30 upcoming national dental professionals at its new medical facility in Abu Dhabi / Industry News / About the development of the first super quick polyether / Industry News / Interview: 3D Printing – Sustainable additive innovations transforming the dental industry / A step-by-step guide to a direct diastema closure / Beverly Hills Formula enter 2019 on a High / Management of midfacial recession defects around adjacent maxillary implants using ‘screw tent-pole’ technique / Predictable steps to Biomimetic Class IV restorations / Interview: "The participants can share the up-to-date knowledge about the subjects in the field of Conservative Dentistry. / Is digitalisation the way forward for dentistry? / Industry News / CEREC and Single Visit Dentistry / News / 3M Oral Care Dental Programme Highlights / Endo Tribune Middle East & Africa Edition No. 1, 2019 / Lab Tribune Middle East & Africa Edition No. 1, 2019 / Ortho Tribune Middle East & Africa Edition No. 1, 2019 / Implant Tribune Middle East & Africa Edition No. 1, 2019 / Hygiene Tribune Middle East & Africa Edition No. 1, 2019

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www.dental-tribune.me

PUBLISHED IN DUBAI

January-February 2019 | No. 1, Vol. 9

ENDO TRIBUNE

LAB TRIBUNE

ORTHO TRIBUNE

IMPLANT TRIBUNE

HYGIENE TRIBUNE

How to give a second life to
third molars: A case series
with follow-up

The many characteristics
of a long-term hybrid
abutment crown

Interview: "It is not magic – it is
not going to make the diagnosis for you ..."

Taking care of our teeth is
a fundamental part of good
health

Roughness and loss of
substance of tooth surfaces
after biofilm removal

ÿA1-8

ÿB1-4

ÿC1-4

ÿD1-4

ÿE1-4

SEHA AHS educates 30 upcoming national
dental professionals at its new medical
facility in Abu Dhabi

DENTAL TRIBUNE
The World’s Dental Newspaper Middle East & Africa Edition

SEHA AHS Academic Affairs educated 30 of its upcoming young dental professionals in Abu Dhabi (Photograph: Dental Tribune MEA)

AD
By Dental Tribune MEA
ABU DHABI, UAE: SEHA AHS Academic Affairs
educated 30 of its upcoming young dental professionals on various multidisciplinary topics
in dentistry. The three days course was organized in close cooperation with Centre for Advanced Professional Practices and Tipton Dental Academy on the latest tips & techniques on
Posts & Core, Restoration of Post Endo Treated
Teeth and Veneer Cementation. The programme took place at the new flagship Sheikh
Shakhbout Medical City which is expected to
be the new hub for innovation and artificial
intelligence.

techniques were presented by the faculty lead
Professor Paul Tipton, President of the British
Academy of Restorative Dentistry (BARD) and
his faculty support staff with a programme of
three full days lectures and hands-on trainings
tailor made to the needs of the SEHA dental
professionals.
First day featured “Posts & Core – Modern
Techniques in dentistry” consisting of a seminar covering posts and the afternoon session a
hands-on practical covering shenker, duralay
and fibre post preps. Following a steep learn-

The latest scientific content, tips, tricks and

ÿPage 2

SEHA delegates during the hands-on training

Dr Ali Al Obaidli, Chief Academic
Affairs Officer of SEHA

Dr Sumaya Khalifa Al Rubei,
Health Centre Manager - Specialist

Dr Rola Al Hayek, Corporate Clinical Education Manager (Corporate Academic Affairs)

[2] =>

NEWS

IMPRINT
PUBLISHER/
CHIEF EXECUTIVE OFFICER
Torsten R. OEMUS

◊Page 1
ing curve, the second day continued
with “How to Restore Root Filled Posterior Teeth” with the course outlining lectures, seminar and hands-on
practical on adhesion and posterior
composites. The three days ended
on a high with the third day covering
“Porcelain Veneer Preps and Cementation Techniques” where the delegates learned impression taking, veneer preparation and cementation.

The young dental professionals had
access to the latest reading materials,
webinars and preparation ahead of
their courses which were practiced
on state-of-the-art Phantom Heads.
Dr. Ali Al Obaidli, Chief Academic
Affairs Officer of SEHA stated: "The
UAE is witnessing a rapidly growing
health and medical infrastructure
that comes from the belief in its im-

portance and priority in building a
human being, enjoying good health
and physical integrity. SEHA is committed to providing a world class
education to our dentists".
He added: "These workshops aim to
up-skill our dentists’ competencies,
keep them up-to-date with cuttingedge techniques and advancements
as well as becoming accustomed
with new materials".
He praised the workshop which was
structured around the latest dental
technologies and their applications
in modern dentistry.
Dr. Sumaya Khalifa Al Rubaei Health Centre Manager - Specialist
commented: "In line with SEHA’s
strategic objective to continuously
attract and retain qualified healthcare professionals & particularly
UAE Nationals, AHS Dental Services
at Ambulatory Healthcare Services
are committed to embracing the latest technologies and upgrading the
knowledge and the skills of our den-

tists, dental technicians and hygienists, in order to continue providing
high quality dental services to the
community.”
Dr. Rola Al Hayek – Corporate Clinical Education Manager (Corporate
Academic Affairs) further indicated:
"At SEHA, we are committed to the
highest quality of care to patients
which can only be delivered by welltrained and educated medical &
clinical professionals. SEHA is keen
to provide a variety of outstanding
continuing education programs and
training opportunities for our dentists. And so, these workshops are
part of our efforts to bring the latest
and best practices in prosthodontics.
Guests of honor included Dr. Sumaya Khalifa Al Rubei and Dr. Ali Al
Obaidli.

SEHA delegates

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NO
COMPROMISE.

DENTAL TRIBUNE MEA EDITION EDITORIAL
BOARD
Dr. Aisha SULTAN ALSUWAIDI, UAE
Prof. Paul TIPTON, UK
Prof. Khaled BALTO, KSA
Dr. Ninette BANDAY, UAE
Dr. Nabeel HUMOOD ALSABEEHA, UAE
Dr. Naif Almosa, KSA
Dr. Mohammad AL-OBAIDA, KSA
Dr. Meshari F. ALOTAIBI, KSA
Dr. Jasim M. AL-SAEEDI, Oman
Dr. Mohammed AL-DARWISH, Qatar
Dr. Dobrina MOLLOVA, UAE
Dr. Ahmed KAZI, UAE
Dr. Munir SILWADI, UAE
Dr. Khaled ABOUSEADA, KSA
Dr. Rabih ABI NADER, UAE
Dr. Ehab RASHED, UAE
Aiham FARRAH, CDT, UAE
Retty M. MATTHEW, UAE

Smart Wetting Impression Material

PARTNERS
Saudi Dental Society
Saudi Ortho Society
Lebanese Dental Association
Qatar Dental Society
Oman Dental Society
Kuwait Dental Association
American Academy of Implant Dentistry
International Federation of Dental
Hygienist
British Academy of Restorative Dentistry
British Academy of Dental Implantology
AALZ - Aachen Dental Laser Center
Arab Health Conference & Exhibition

YOU WORK ON MORE THAN TEXTBOOK CASES.

DIRECTOR OF mCME
Dr. Dobrina MOLLOVA
mollova@dental-tribune.me
Tel.: +971 50 42 43072

Aquasil Ultra+
®

SO DO WE.
This is no ordinary impression material. Experience better-than-ever performance with Aquasil Ultra+
impression material. The plus means you can now count on revolutionary intraoral hydrophilicity and
intraoral tear strength to optimise performance in all areas, not just one. Because not all cases are
textbook cases, and you deserve a material that works impressively on each and every one.
Learn more at www.AquasilUltraPlus.com.

DIRECTOR
Tzvetan DEYANOV
deyanov@dental-tribune.me
Tel.: +971 55 11 28 581
MANAGING DIRECTOR
EDITOR OF THE LAB TRIBUNE
Petar MOLLOV
dtmea@dental-tribune.me
Tel.: +971 52 84 23 659
PRINTING HOUSE & DISTRIBUTION
Al Nisr Printing
P. O. Box 6519, Dubai, UAE
800 4585/04-4067170
©2018, Dental Tribune International GmbH.
All rights reserved. Dental Tribune
International makes every effort to report
clinical information and manufacturer’s
product news accurately, but cannot assume
responsibility for the validity of product
claims, or for typographical errors. The
publishers also do not assume responsibility
for product names or claims, or statements
made by advertisers. Opinions expressed by
authors are their own and may not reflect
those of Dental Tribune International.

[3] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 1/2019

Introducing Primescan
Engineered for superior performance
By Dentsply Sirona
Innovation requires commitment to
ambition: Primescan sets new standards in dental technology, making
scanning more accurate, faster and
easier than ever. It is engineered to
enable all kind of treatments, from
single tooth to full arch. Primescan
produces highly accurate images
and allows for fast scanning consolidating 50,000 images per second.
The new patented “High Frequency
Contrast Analysis” delivers perfect
sharpness and an outstanding accuracy. With Primescan, intraoral scanning delivers excellent results like
never before.

Accuracy
The new Primescan gives not just
one new point of view but one million. The innovative Smart Pixel Sensor processes more than 1,000,000
3D points per second, producing
photorealistic and highly accurate
data. In fact, Primescan is the most
accurate intraoral scanner on the
market*. Its dynamic depth scan
technology enables perfect sharpness and outstanding precision, even
at a measuring depth up to 20 mm –
a crucial advantage for deeper-lying
indications.
What you see is what you get
Due to Primescan’s ability to scan at
an incredible data density, it delivers complete 3D structures of everything in its field of view – right from
the very first scan.

Usability
Enjoy the freedom of scanning. Primescan allows you to start scanning
right away. It offers continuous self-

heating for fog-free scanning – which
means you’re always ready to go.
Steep angles? Hard-to access areas?
Shiny materials? An easy job for Primescan. Thanks to the increased
field of view, you’ll be able to visualise larger areas with less sweeps and
immediate precision. The excellent
scan results are instantly displayed
on the touchscreen of the new Acquisition Centre.
Take control of infection:
Three different sleeves guarantee
that you’ll fulfill your practice needs
as well as all general hygiene requirements. Choose from stainless steel
sleeves with either sapphire glass or
as an autoclavable option. Single-use
disposable sleeves are also available.

Speed
Accelerate the process. Primescan’s
unique technology allows for easy
capturing and quicker processing of
more data in higher resolution. Intelligent processing in Primescan ensures optimum interaction with the
software by transmitting exactly the
data the software needs to proceed.
The result: complete 3D-scan models
are displayed immediately, no matter how fast you scan.
Enhance your connectivity
Thanks to seamless, validated and
open data transfer options, laboratories and other partners receive highresolution models in an instant. With
Primescan, you benefit from the
freedom to make the best choice of
workflows for you and your patients.

mind. It comes with a touchpad and
a 16:9 wide-format movable touchscreen, offering you a highly intuitive and ergonomic work platform.

Your benefits at a glance
• Touchscreen and touchpad for
highly convenient, intuitive use
• Kinematics for perfect ergonomic
positioning
• Smart Hygiene concept for fast and
easy disinfection
• Mobility concept for full mobility
with battery buffer of more than 60
minutes
The best choice for your practice –
Primescan meets your needs with
two individual software configurations:
1. Primescan AC with Connect Software:
• Supports data transfer options to
your preferred partners
• Secure and encrypted data transfer
through Connect Case Centre Inbox
• Easy upgradability to full chairside
workflow

“To me, Primescan sets new standards in
dental scanning technology. For both me and
my team, intraoral scanning is now more accurate,
faster and easier than ever.”
Dr. Verena Freier, Dentist

2. CEREC Primescan AC with CEREC
Software:
• Supports full chairside workflows
for single-visit dentistry
• Flexible data export options
• Automated workflow thanks to Artificial Intelligence

References
Mehl et al, Accuracy studies at University of Zurich, Int J Comput Dent.
(publishing date: March 2019)

The New Acquisition Center
A workstation designed for modern
dentistry and with the dentist in

Learn more at:
dentsplysirona.com/primescan
(Photograph: Dentsply Sirona)

MEMOSIL® 2 -

The “Index Technique” in worn dentition. A new no prep restorative approach

Ammannato R, Ferraris F, Marchesi G. Int J Esthet Dent 2015; 10:68-99

T h e

the expert for
special indications
By Kulzer
MEMOSIL 2 is a transparent Asilicone for special indications. Its
transparency allows optical control
when positioning aids (e.g. X-ray pellets). Light-curing is possible for filling and fixative materials through
placeholders with MEMOSIL 2.
The material is best suited for use as
an occlusal stamp for light-curing
posterior composites, an anterior
stamp for Provisionals, fillings and
veneers, a fixation material for x-ray
measuring spheres when planning
implants and a transfer matrix for
bracket constructions on the plaster
model.
With MEMOSIL 2, you and dental
technicians benefit from:
• Optical control: MEMOSIL 2‘s transparency facilitates the positioning

copy

of aids. It also allows light curing of
composites and fillings through the
material.
• More hygiene: Processing of MEMOSIL 2 is clean and hygienic due to its
direct and sterile application.
The automix cartridge system saves
you time and reduces the risk of registration errors. MEMOSIL 2 also increases treatment comfort for your
patients. Thanks to its short time
in mouth and the neutral taste and
odour, patients are more at ease. An
additional benefit for you is the time
saving, since it can be applied directly into the patient's mouth.

Kulzer
Airport Free Zone (DAFZA)
Bldg. 6EB (East Block) Office 839
P.O.Box: 371476 Dubai, UAE

L a b

MEMOSIL 2

Riccardo Ammannato, DDS

info@studioammannato.com • www.studioammannato.com

P o s t e r i o r s

A n t e r i o r s

paste

[4] =>

INTERVIEW

Dental Tribune Middle East & Africa Edition | 1/2019

About the development
of the first super quick polyether
Interview with Dr. Joachim Zech, Head of Research & Development of Dental Impression
Materials, 3M Oral Care, Seefeld, Germany

By Elke Kopp, New Procedure Marketer, Indirect Business Team, 3M
Oral Care, Germany
With the complexity of an indirect
restorative procedure, the requirements concerning impression accuracy tend to increase. An error in an
impression used to produce a crown
may lead to a poor fit, but manual
adjustments are usually sufficient
to produce a satisfactory result. If a
similar error occurs in an impression
involving multiple prepared teeth or
implants, a remake of the prosthetic
work is often necessary.
Does that mean that it is sufficient
to use a less accurate impression
material for small cases? It does
not, as optimizing impression quality means minimizing the risk that
impressions need to be retaken and
prosthetic work needs to be adjusted. This, in turn, it will save valuable
time and lead to a more efficient and
economic treatment procedure.
For this reason, many dentists rely
on 3M™ Impregum™ Polyether
Impression Materials even for their
small cases. So far, however, they had
to accept a drawback – the comparably long setting time of polyether
materials. It slowed down polyether
users in comparison to those us-

ing fast-setting VPS materials and
reduced the potential time savings.
This is no longer the case – due to the
launch of 3M™ Impregum™ Super
Quick Polyether Impression Material that is currently available in two
viscosities (medium and light body).
We talked about the development
of this innovation with Dr. Joachim
Zech, Head of the R&D Team for Impression Materials at 3M in Seefeld,
Germany.

to the fact that the number of single
tooth restorations placed increases
continuously and dentists simply
want to obtain the best possible results in the shortest possible time.

Dr. Zech, why did you decide to develop a new superfast polyether impression material?

It is always possible to adjust the setting times to a certain extent without fundamental changes, but we
had exhausted this potential for the
existing initiator. Thus, there was
no other way to reach our goal than
by altering the basic chemistry. We
were able to successfully accomplish
this task within a reasonable time
span thanks to the possibility of collaborating closely with our skilled
colleagues from the chemical synthesis plant and from production
in Seefeld. In this way, we were able
to streamline the complete process
from raw material development to
production.

The main aim of the project was developed based on market research
and user feedback. This gave us
the insight that the general interest in conventional impression
materials is still high – despite the
availability and evolution of high
performance intraoral scanners. In
addition, we found that polyether
users are generally very happy with
the existing polyether properties,
especially the great flow behaviour
and reliable performance in the presence of moisture. At the same time,
we identified a growing demand for
a material that offers these benefits
combined with a setting time ideal
for small cases. This may be related

How did you manage to reduce the setting time?

The reduction of the setting time was
challenging, as we needed to develop
a new initiator compound.

You said that the basic
chemistry was altered. Is
3M™ Impregum™ Super
Quick Polyether Impres-

sion Material still a true
polyether?

Yes, the new material is a true polyether. The new base paste also contains the aziridino-polyether – the
beating heart of every polyether
impression material. Hence, the reactive groups and the curing mechanism in this paste are still the same.
In addition, the newly developed initiator compound is made of a molecule that is similar to the existing
one. The small, but decisive difference lies in the substituents, which
are larger and exhibit a higher reactivity. The result is a faster setting reaction and – as a beneficial side effect
– a more neutral taste of the impression material. Exchanging the initiator also required us to exchange or
add a few other components mainly
in the catalyst paste, including plasticizers and pigments.

How is a high product
quality ensured?

Extensive testing of the basic raw
materials and the pastes in the development phase was carried out
to ensure that the proven polyether
properties are still offered. The raw
materials undergo comprehensive
chemical-physical analysis and
physical-mechanical tests are usually used for characterization of the
pastes. In the first step, the test results are used to identify the most
promising formulations and to adjust and fine-tune the components
for final product development. Later,
they are needed to ensure that the
internal quality standards are met,
while some of the tests are needed,
e.g. for FDA approval and CE certification of the final product. As a matter
of course, every batch of polyether
impression material produced in
Seefeld is subjected to strict quality
controls.

Is the high product quality the main argument for
dentists to test the new
material?

It is the well-balanced and proven
material properties combined with
the short setting reaction that make
the material worth testing in the
practice environment. Many dental practitioners prefer polyether
impression materials whenever intraoral moisture control is difficult.
For those who are not familiar with
the typical intrinsic hydrophilic-

Dr. Joachim Zech, Head of Research & Development of Dental Impression Materials, 3M Oral Care, Seefeld, Germany

ity of polyethers and the clinical
behaviour related to this feature, it
might be a perfect occasion to find
out more about it now. For existing
Impregum users, it might be interesting to start using a true polyether
for their small cases as well – or to
increase their productivity by replacing a slower setting polyether in this
situation. Many of those who have
already tested the innovative addition to the Impregum family are enthusiastic about it and would recommend it to their colleagues*.
*Source: 3M field evaluation with 447
participants from Europe and the
U.S., 2017.
To learn more about 3M™ Impregum™ Polyether Impression Materials please visit: www.3Mae.ae (Gulf
countries), www.3m.com.sa (Saudi
Arabia) or contact us at:
3MOralCareGulf@mmm.com
3M, ESPE and Impregum are trademarks of 3M Company or 3M
Deutschland GmbH. Used under license in Canada. © 3M 2019. All rights
reserved.
Looking forward to welcoming
you at 3M Oral Care Booth #6B01 at
AEEDC, Dubai, on 5-7 Feb 2019.

Fig. 1: Decanting of the base paste of 3M™ Impregum™ Super Quick Polyether Impression Material into a storage container.

Fig. 2: View into the preparative laboratory.

Fig. 3: Employees at the chemical synthesis plant of 3M in Seefeld.

Fig. 4: Reaction tank in the laboratory.

Fig. 5: Automatic packaging
of the cartridges.

[5] =>

© 3M 2019. All rights reserved.

The next generation polyether.

oming soon…

[6] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 1/2019

Hu-Friedy and WeRestore.it
release new restorative kit
ByHu-Friedy
FRANKFURT AM MAIN, Germany:
Creating aesthetic restorations requires a significant amount of attention to detail, as well as the right tools.
To aid dentists in performing their
best possible work, Hu-Friedy, in collaboration with Drs Gaetano Paolone
and Salvatore Scolavino of WeRestore.it, has recently announced the
release of a new and simplified basic
set for direct and indirect restorative
procedures, the 3SSENTIAL KIT.

Until now, the minimum number
of instruments in a kit was five, and
with an array of instruments on the
market, it has become increasingly
difficult for practitioners to make
the right choices. Aiming to create
something more compact, essential
and easy to use, the creators of the
3SSENTIAL KIT settled on just three
instruments: Anterior (red), Posterior (blue) and Spatula (grey).

Speaking about the new kit, Scolavino said: “The concept behind the
Posterior is very simple: we wanted
to go from a plug-and-play to a plugand-sculpt method. One tip is used
to plug the composite into the cavity and the other one can sculpt and
model composite in additive and
subtractive modelling techniques”.
According to Paolone and Scolavino,
the Anterior is referred to as a solid

brush, since it models and spreads
the composite just like a brush.
Giana Spasic, Manager of Key Opinion Leaders Strategy at Hu-Friedy,
said the company is always looking
to work with key opinion leaders,
specialists, private practitioners,
universities and educators, with the
purpose of finding new ways to help
clinicians to perform at their best.

The creators believe the kit is the
most straightforward restorative kit
ever made and is perfect for clinicians who want to save precious time
in the dental office during restorative
procedures and achieve remarkable
aesthetic and functional results.
Visit us at 2019 AEEDC Dubai at
booth 6F10.

Mectron prophylaxis
Full mouth periodontal treatment using the new perio anatomic inserts P15, P16R, P16L
By mectron S.P.A.
Mectron has recently launched on
the market 3 new ultrasound inserts
specially designed to perform gentle
and safe periodontal debridement.
The inserts guarantee the maximum
efficacy without risk of injury to the
soft tissues and the periodontal ligament.

The inserts’ shape allows an optimal
access to the areas difficult to reach
and characterized by deep periodontal pockets (furcations, root surfaces,
concavities).
The preserved tissues allow a new attachment formation.
The cavitation effect allows mechanical biofilm disruption, bacteria

dispersion and periodontal pockets
detoxification, thanks to the oxygen
delivery.

The inserts in detail

P15: universal curette for supra
and subgingival treatment. Recommended for the debridement of deep
periodontal pockets. Easy access to
canine and anterior teeth. Replaces
manual curettes n° 1-2, 3-4, 5-6, 7-8.

P15

P16R

P16L

P16R – P16L: right (P16R) and left
(P16L) angled periodontal curettes
for subgingival concrements and
biofilm removal from furcations and
deep pockets. Recommended for
supra and subgingival interproximal spaces and for an efficient root
planing on molars and premolars.
Replace manual curettes n° 11-12, 1314, 15-16, 17-18.

For more information contact:

mectron S.P.A.
Via Loreto, 15/A
16042 Carasco (GE) – Italy
Tel: +39 0185 35361
Fax: +39 0185 351374
E-mail: mectron@mectron.com
Web: www.mectron.com

[7] =>

→ THE EVOLUTION OF PROPHYLAXIS
COMBI touch

→ AIR-POLISHING AND ULTRASOUND IN ONE UNIT
→ easy switch from supra to subgingival air-polishing by a simple click
→ subgingival perio air-polishing tip – flexible, soft and anatomically
adjustable to the periodontal pocket
→ more than 40 inserts for scaling, perio, endo and prosthetics
→ soft mode: the ultra-gentle scaling for sensitive patients

R
→ VISIT OU
9
BOOTH 4D0 AI,
UB
AT AEEDC D RY
5-7 FEBRUA
2019

→ www.mectron.com
→ www.we-love-prophylaxis.com

[8] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 1/2019

Unlimited flexibility.
HyFlex EDM NiTi System with additional files
sizes allowing more flexible application
By Coltene
Due to limited access endo experts
often want more flexibility from
their instruments. Pre-bendable
tools can extend the horizon into
new dimensions. Particularly in a
limited working space, modular
nickel-titanium systems display
their full strength. From now on dentists can choose from a series of additional file sizes for a fast and safe instrumentation to the remotest parts
of the root canal system.

21 mm Agility
With a total of seven highly flexible
file variants, the Swiss dental specialist COLTENE is now expanding its
wide-ranging HyFlex NiTi program.
In addition to the usual lengths of
25 mm, all preparation files of the
popular EDM series are now also
available in 21 mm working length.

The application of the more agile,
shorter models is particularly recommended in the treatment of the
posterior molars and in patients
with cranio-mandibular problems.
Being just about the size of a five cent
coin, the new HyFlex EDM files enable comfortable work in insufficient
interocclusal space. The secured
working with the pre-bendable NiTi
files becomes now a straight forward
matter.
The new HyFlex EDM 20/.05 augments the existing HyFley EDM line.
The additional file enables fans of the
flexible NiTi range to treat curved
channels only with the efficient EDM
files. After creating a glide path with
the Glidepathfile 10/.05, the new file
with the same taper allows minimally invasive, fast preparation of the
canal. Subsequently the actual shaping can be done in the usual manner

with the universal file HyFlex EDM
OneFile, size 25. Depending on the
channel anatomy, apical preparation
can be finished with EDM files up to
ISO size 60. Even in these large sizes
the files work safely and without
transportation of the canal centre.
The good cutting performance and
fracture resistance of the flexible
NiTi files, is due to a special manufacturing process referred to as "Electrical Discharge Machining“(EDM in
short). Based on their robust high
performance they are ideal for both,
Endo specialists and general practitioners who want to produce reliable
results with a reduced number of
files.

at a time when other manufacturers did not yet know the difference
between austenitic and martensitic
files. HyFlex EDM files also benefit
from the so-called "CM" treatment
and can be modularly supplemented with the classic HyFlex CM series.
Apart from that, the COLTENE team
of experts supports ENDO specialists as well as general practitioners to
learn the optimal handling of welldesigned working aids with a large
selection of hands-on workshops,
training materials and personal service offers.

For more information visit:

Who invented it?
The Swiss dental specialist COLTENE
already introduced its HyFlex files to
the market in 2010, creating the new
era of "Controlled Memory" (CM) files

Coltene
Web: www.coltene.com

HyFlex EDM NiTi System

New Chiropro –
Bien-Air Dental
unveils its new
implant motor
Designed to simplify the fitting of
implants, the new Chiropro has been
fully developed around a single
philosophy: simplicity.

PURE SIMPLICITY
NEW CHIROPRO
IMPLANTOLOGY

By Bien-Air Dental

motor system

A single control knob allows you to
control the entire system. Simply
turn the knob to navigate via the
menus and adjust the settings, and
press it to confirm the selected value.
Moreover, the control knob - the
only point of contact between dentists and the unit during procedures
- can be easily removed and sterilised
to simplify maintenance. Thanks to
its clear and concise interface, the
new Chiropro plainly displays all the
information required for procedures
to go smoothly: type of instrument,
speed, torque, irrigation flow and direction of rotation. Pre-set operating
sequences and the option to modify
settings based on patients' dental
features, also make the new Chiropro
easier to use.

NEW CHIROPRO PLUS
IMPLANTOLOGY
motor system

ORAL SURGERY
motor system

Control your entire implant and oral surgery
motors using a single rotary knob. The new
Chiropros from Bien-Air Dental have been
designed around a single philosophy: simplicity.

WWW.BIENAIR.COM

Visit us !

181216_DTMEA_122x188.indd 1

AEEDC 2019
February 05-07, 2019 · Dubai
Swiss Pavilion, Booth #8E08

Powered by the Chiropro, the new
MX-i micromotor and CA 20:1 handpiece combine to offer you the very
best rotary technology for all your
implantology procedures. Coupled
with the MX-i micromotor, the CA
20:1 handpiece provides an exceptionally stable speed, for precise
and smooth procedures. As well as

IDS 2019
March 12-16, 2019
Booth H-050 J-051

09.01.19 12:29

offering an unparalleled service life,
the CA 20:1 handpiece is fitted with
a brand-new internal irrigation system. The irrigation line will not inconvenience dentists when they are
using the handpiece.

For further information, please contact:
Bien-Air Dental
Länggasse 60, 2500 Bienne 6, Switzerland
Email: fanny.vongunten@bienair.com
Web: www.bienair.com

[9] =>

What do you call an endodontic
file that is 700 % more breakage
resistant than others?
We call it

Upgrade Dentistry

One step ahead

HyFlex™ EDM & CM
Nothing is more annoying than a broken
file, a perforated or deformed root
canal and step formation. To prevent
those issues as much as possible it
requires not only great finesse, but also
endodontic files with special properties.
This is why the HyFlex EDM files
have been developed with optimum
cutting efficiency, perfect flexibility and
extremely high breakage resistance of
700 %. Upgrading an idea to a solution.

004388 01.19

Dietmar Goldmann
P +41 71 757 54 40
dietmar.goldmann@coltene.com
www.coltene.com

Better Quality. Better Reliability. Better Practice.

[10] =>

INTERVIEW

Dental Tribune Middle East & Africa Edition | 1/2019

Interview: 3D Printing – Sustainable additive
innovations transforming the dental industry
By Rik Jacobs, The Netherlands
It was about 12 years ago that I first
came into contact with additive
manufacturing technology, also
known as 3D printing. Back then it
was still a new—and astonishing—
technology, mostly being used in
applications related to hearing aids.
I had been working in the dental industry for decades at this point, and
it was clear to me that this technology should be adopted by the dental
market. I became inspired.
This was also around the same time
that “milling” technology became
extremely popular in the dental
industry, as well as in labs and clinics. This created an adopted market
in terms of scanning and designing
with software for dental applications. But, as I learned more about
the additive dental technology, I
knew that 3D printing stood to offer
a more sustainable and productive
technology that was also faster and
more flexible.
I wondered whether or not I could
successfully introduce 3D printing
technology to the dental market.
Could I be the first to do it by surfing on the “milling” wave and making use of the existing infrastructure
which was more or less under implementation?

printers that could address a broad
range of indications. These days, my
vision is supported by the 3D printing market research firm SMARTECH, who recently predicted that
additive 3D printing will become the
primary form of digital dental fabrication in both the laboratory and
the clinical setting by 2024, and that
3D printing in dental will become a
highly value-added process that will
dominate many of the dental segments in which it already has a share
today.

Along with my business partner,
Mrs. Connie Peterse, I set out to learn
the details of all the different 3D
printing technologies. We teamed
up with TNO, The Netherlands Organization, for applied scientific
research and started to formulate a
wide range of materials, which we
printed countless times, year after
year, until we found what we were
looking for. We founded NextDent—
“the next big thing in dental”—in
2012, and introduced these materials
to the worldwide dental market in
2013. The goal was to develop, register, and lean-manufacture a wide
range of printable dental materials
for as many different dental applications as possible.

Temporary crowns and bridges are
printable in MFH resins used by
Digital Light Processing (DLP) printers today, and I truly believe that our
current efforts to print long-term
temporaries, dentures, try-ins, orthodontic retainers, splints, surgical guides and models will quickly
prove successful and gain acceptance worldwide.

From 2014 to 2016, we built partnerships with many additive hardware
manufacturers and dental software
companies. We learned so much
about the workflow—from the scan
to the final printed object for placement in the patient’s mouth.
3D printed crowns and bridges with Micro Fiber Hybrid by NextDent 5100

At last, we had a winning combination: with our peerless plug-and-play
solution and the best possible training service and support, we were able
to win trust from the vast majority of
onlookers in this conservative professional market.
The milestones came in quick succession: First - we made national news

on January 23, 2016, when Professor
Dr. Daniel Wismeijer implanted a
Micro Filled Hybrid (MFH) crown in
my mouth that I myself had printed.
Two months later, we were named
the first company in the world to
achieve Class 2A biocompatible cer-

tifications for crown, bridge, denture
and orthodontic applications. Ten
short months later, we were acquired
by 3D Systems.
I knew by then there was a massive
and urgent need for a high-speed 3D

AD
05 - 07 February, 2019
The Dubai International Convention and Exhibition Centre,
Dubai, U.A.E.

Pleasure In The Job Puts Perfection In The Work - Meet Kulzer Formidable Team

Matthias Borst

Zsolt Fodor

Global Head of Sales & Service / CSO

General Manager
Eastern Europe & Middle East

Area Manager
Middle East

Gal Gergo

Mary Konstantinidou

Roman Barabach

Area Manager
SouthEastern Europe

Country Specialist
Ukraine

Regional Service Center Manager

Aboubakr Eliwa

Amr Alabode

Mohamed Habib

Toni Alcazar

Key Account Manager
Saudi Arabia and Bahrain

Key Account Manager
Gulf Region

Assistant & Office Manager
Middle East

Thomas Schwarz
Global Business Development Manager Digital Solution
Global Sales & Service

Nourhane Mamdouh
Marketing & Scientific Affairs
Middle East

Based on the recently published
analysis “3D Printing in Dentistry
2018” by SmarTech Publishing” it
appears increasingly likely that the
dental industry will transition to a
majority-additive—possibly even
an entirely additive—industry structure by 2027.
Our new additive solution powered
by the Figure 4™ technology is leading this change by helping dental
laboratories and clinics redefine their
workflow and achieve improved accuracy (within 50 microns), repeatability and productivity with a lower
total cost of operation with the widest range of materials in the market.
When used in conjunction with 3D
Systems’ robust portfolio of certified NextDent materials, dental labs
and clinics can address the broadest
range of indications from a single
printer available today. This plugand-play solution integrates with
the dental industry’s state-of-theart intra-oral scanning and software
solutions, delivering a much more
precise result than is available with
manual production. The benefits
of this revolutionary solution also
extend to the patient, as it reduces
both the time required to produce
orthodontic and prosthodontic devices and the number of office visits
needed to complete treatment. This
end-to-end solution combining materials, technology, software and services will help dental labs and clinics
revolutionize their businesses.
This transformation has been 20
years in the making, but its time has
come. And I couldn’t be more excited
as it continues to unfold.

Thomas Backscheider
Guest Speaker
Germany

For more information, please contact:

Amir HajHamou
Guest Speaker
UAE

Semha Alnagar
Guest Speaker
Egypt

Riccardo Ammannato
Guest Speaker
Italy

3D Middle East, 3D Systems Distributor
3204 Prism Tower, Business Bay
P.O. Box 28820, Dubai, UAE
Tel: +971 4 443 3853
Email: info@3d-me.com
Web: www.3d-me.com

[11] =>

Oral Health Care

[12] =>

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 1/2019

"One of the main challenges
A step-by-step guide to clinicians
face during anterior
closure is preventing or
a direct diastema closure diastema
eliminating a black triangle
between the teeth."

Case Report
By Dr. Ayad Mouayad Al-Obaidi, Iraq
A 28-year-old female patient had
the primary complaint of spacing
in the upper front tooth region. The
patient’s medical history did not reveal any systemic diseases and an
intraoral examination revealed presence of midline spacing between
maxillary central incisors (~2mm)
(Figs. 1 and 2).
For a more conservative, economical,
aesthetic, and quicker option, a direct
diastema closure was considered.
All maxillary incisors were isolated
with a rubber dam (Fig. 3) to ensure
complete control of moisture to keep
the area clean and dry whilst also
suppressing the papilla to reduce the
black triangle postoperatively.
The enamel surface was minimally
prepared with a diamond fissure
bur to increase the surface area for
bonding and to remove aprismatic
enamel (Fig. 4).
37% phosphoric acid was applied for

15 seconds on the mesial surface to
be restored, then rinsed for 20 seconds (Fig. 5), and dried with air gently (Fig. 6). Then a universal adhesive
system was used (Prime&Bond universal™), using a micro brush with
a light scrubbing motion for 15 seconds (Fig. 7).
This was then gently air dried for approximately 5 seconds. Blow to margin, or to thin if necessary, using a
light application of air and then light
cured for 20 seconds.
The key for papilla regeneration is
to provide aggressive cervical curvature that starts subgingivally and
this can be done with a mylar strip
placed subgingivally with a high
viscosity flowable composite or bulk
flow composite injected to the contact point area as reference (emergence profile) (Fig. 8).
The key to success in diastema cases
is to finish the first tooth completely
before starting the second tooth
(Fig. 9). Then some corrections can
be made to the size of the first tooth

so the final size of the centrals will
be the same at the end of treatment
(Fig. 10). In this case the proximal
wall was completed with a single
shade universal composite (ceram.
x® SpereTEC™ one universal) and
then began the emergence profile
to complete the proximal wall of the
second tooth (Fig. 11).
The teeth were then finished with
polishing discs and rubber points.
The rubber dam was then removed
and as you can see there is a small
black triangle in the cervical area (Fig.
12).

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The recall visits in diastema cases
are very important to see patient
satisfaction, to check the periodontal health and to do some polishing
and texture (Figs. 13 and 14). With
time, the interdental papilla filled
the space of the black triangle completely (Figs. 15 and 16).
Please contact your local Dentsply Sirona
representative for more information on
all the products featured in this direct diastema closure clinical case.

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Fig. 1: Preoperative extraoral view of the patient

Fig. 2: Preoperative intraoral view of the patient and
the midline diastema

Fig. 3: Maxillary anterior teeth were isolated with a
rubber dam

Fig. 5: Etching

Fig. 6: Dried enamel surface

Fig. 7: Application of Prime&Bond universal™

Fig. 8: Emergence profile of the 1st tooth

Fig. 9: 1st tooth completed

Fig. 10: Correction to the size of the 1st tooth

Fig. 11: Emergence profile of 2nd tooth

Fig. 12: Result immediately after removing the rubber dam

Fig. 13: After 4 days

Fig. 14: : Control image after one month

Fig. 15: Interdental papilla before direct diastema
closure

Fig. 17: Completed diastema closure

Dr. Ayad Mouayad Al-Obaidi BDS, MSc
Dr. Ayad Mouayad Al-Obaidi is an Assistant Lecturer in Conservative Dentistry, at Baghdad University, Iraq. He
graduated in 2004 from the University of Baghdad from where he then received his MSc in 2011. Between
2004 and 2015 he attended a number of refresher courses and developed skills in aesthetic adhesive restorations using direct and indirect techniques in the anterior and posterior. He lectures and provides hands-on
courses in the field of porcelain and composite restorations. He maintains a private practice with a special interest in adhesive and restorative dentistry at Baghdad Smile Centre in Baghdad.

Fig. 16: Interdental papilla after one month

Fig. 4: Teeth preparation

[13] =>

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[14] =>

ORAL HEALTH

Dental Tribune Middle East & Africa Edition | 1/2019

Beverly Hills Formula enter
2019 on a High
By Beverly Hills Formula
2018 has been a truly stellar year for
Irish oral care experts Beverly Hills
Formula. At the beginning of the
year, the brand had one clear objective in mind – to be the number one
at home teeth whitening brand in
the middle east. The well-established
brand currently retails in UAE, Jordon, Lebanon, Oman, Qatar, Kuwait,
Bahrain, Iran and Saudi Arabia and
have been hugely successful in growing their presence there this year as
well as across the globe.

The brand knew that further growth
would be no easy, given that there are
more teeth whitening products than
ever available on the market today.
They attribute their success to several factors – scientifically formulated
products that are safe to use and truly make a difference, as well as devotion to continuously researching and
providing highly innovative and first
to market products. Last year, the addition of cutting-edge new products
to their already hugely successful
portfolio has allowed them to enjoy
continuous success and growth in
the region.

The brand has always kept a close eye
on market trends and have ensured
they are always one step ahead, releasing the latest formulations well
ahead of the crowd. They are continuously seen as innovators, not imitators and are known throughout the
middle east for their award winning,
scientifically formulated products,
as well as their bright stand out colours that are designed to make an
impact as well as keeping the brand
well ahead of their competitors.
New product development was huge
for the brand last year, with three

innovative products joining their
hugely successful Perfect White
Range. The products caused a huge
hype within the oral care industry
and have seamlessly integrated with
the bold and daring range.
The Perfect White Range consists of
Perfect White Black, the brand’s hero
product. The toothpaste is scientifically formulated with Activated
Charcoal known for its love of tannins – a compound found in coffee,
tea, wine, berries and spices, all of
which stain your teeth and helps
remove these without harming the
enamel. Also found in the range is
Perfect White Black mouthwash,
Perfect White Black Sensitive and
Perfect White Gold – which contains
real gold particles designed for their
antibacterial properties.

Joining the Perfect White
family were:

Perfect White Optic Blue
Using Blue Filter Technology, a market first, which forms a special layer
over teeth during brushing to reflect
the light which creates an optical
whitening effect visible after one use.
The time-tested formulation containing Advanced Hydrated Silicas
and Pyrophosphates also provides
effective stain removal, and the 1400
ppmF Sodium Fluoride protects
your enamel at the same time ensuring strong and healthy teeth.

Chart

Perfect White Gold Mouthwash
Made with real gold, known for its
anti-bacterial,
anti-inflammatory
and blood flow regulating properties, this luxurious mouthwash
eliminates bad breath and provides
a long-lasting freshness. The new
‘shake to activate’ formula contains
Pyrophosphates which help to re-

move surface and deep stains for a
brighter and whiter smile, whilst the
scientific formulation combats bad
breath each time.
Perfect White Whitening Kit
Scientifically formulated to reduce
plaque and harmful bacteria, the
whitening kit includes 28 whitening
strips and as well as a highly innovative whitening pen. The transparent
and flexible strips are coated with
tooth whitening gel which ensure
whitening results after one use. The
whitening pen is ideal for touch-ups
on the go. This ultimate whitening
duo contains safe levels of Hydrogen
Peroxide – ensuring a whiter, brighter smile!
2019 Plans
Building on the monumental success of 2018, this year will certainly
catapult the brand to further heights.
New product development is at the
forefront of this year’s objectives,
although for now the brand remain
tight-lipped on what’s to come.
Beverly Hills Formula are delighted
to be at this year’s International Dental Conference and Arab Dental Exhibition (AEEDC) and look forward to
showcasing their latest products to
dental professionals across the globe.

Beverly Hills Formula
Unit P1/P2 North Ring Business Park
Swords Road
Dublin, 9, Ireland
Web: www.beverlyhillsformula.com
E-mail: info@beverlyhillsformula.com
Tel: + 353 1 842 6611
Fax: + 353 1 842 6647

[15] =>

[16] =>

mCME

Dental Tribune Middle East & Africa Edition | 1/2019

Management of midfacial recession defects
around adjacent maxillary implants using
‘screw tent-pole’ technique
mCME articles in Dental Tribune have been approved by:
DHA awarded this program for 1 CPD Credit Points
ADA C.E.R.P for 1 C.E Credit

By Dr Bach Le, USA
Soft-tissue recession around dental implants often results in metal
exposure and can present a major
aesthetic challenge.1,2,3 Unfortunately, soft-tissue recessions around
implants have been frequently observed,4 with one study reporting
midfacial recessions greater than 1
mm were present in 61 percent of
the cases.5 Treatment and coverage
of periimplant soft-tissue recessions
can be challenging despite reports in
the literature indicating that recessions up to 2 mm can be successfully
grafted with a combination of coronally advanced flap and subepithelial connective tissue grafts.1,3 Longterm data on the success of these
grafting techniques is limited.3, 6-7
Thoma, et al, conducted a systematic
review8 and reported that the combination of an apically positioned flap/
vestibuloplasty and soft-tissue augmentation using a free gingival graft,
subepithelial connective tissue graft
or collagen matrix resulted in a 1.43.3 mm increase in keratinised tissue.
Overall, soft-tissue connective tissue
augmentation resulted in the best
gains in soft-tissue volume at implant and partially edentulous sites,
and a combination of better papilla
fill and higher marginal mucosal levels as compared to non-grafted sites
around immediately placed dental
implants.8 A recent systemic review9
did not find a single acceptable randomised clinical triall (RCT) in the
world literature to recommend the
best incision designs, suturing techniques or materials to correct or augment periimplant soft tissues.
One of the aim of soft-tissue augmentation procedures is to correct
mucosal recession. To address bone
loss and associated gingival recession
around implants in the aesthetic
zone, a combination of guided bone
regeneration (GBR)10 and soft-tissue
augmentation11 are often performed.
When multiple implants are placed
in the aesthetic zone, vertical and
horizontal bone augmentation of
more than 2 mm from the implant
platform is often necessary to overcome the normal pattern of bone
remodeling and soft-tissue recession.12 The use of coronally advanced
flaps and connective tissue grafts can
sometimes jeopardize the aesthetic
appearance of the treatment site by
altering the colour and thickness of
the transplanted tissues.13
The use of a particulate mineralized
bone allograft covered with a collagen membrane (GBR) for the correction of gingival recession has been reported in the dental literature by Le,
et al.14 This case report demonstrates
an innovative surgical technique to
restore hard tissue and increase mucosal width and keratinised gingival
height around maxillary implants

CAPP designates this activity for 1 CE Credit

in the aesthetic zone without the
colour discrepancy associated with
soft-tissue grafts.

Case report
The patient was a healthy 22-year-old
male nonsmoker with a history of
traumatic fracture of the maxillary
right lateral incisor and two central
incisors. The teeth were extracted
with immediate placement of three
external hex dental implants (Biomet 3i Dental, Palm Beach Gardens,
Fla.). Three years after definitive restoration, the patient presented with
a chief complaint of, “I can see the
metal portion of my implants.” Examination at this time revealed long
unaesthetic maxillary crowns with
visible abutment metal and a dark
shadow along the gingival sulcus
(Figs. 1-4). Clinical and radiographic
evaluations were conducted to assess the patient’s soft-tissue health,
position and emergence profile of
the implant relative to the alveolar
housing and adjacent teeth, gingival
contour, amount of gingiva visibility when the patient smiled, and the
shapes of the prosthetic and clinical
crowns. There were no active signs
of inflammation or infection around
the peri-implant mucosa and all
three implants appeared to be in
good three dimensional position.
A two-stage surgical approach was
planned. The first stage would involve augmentation of the missing
labial bone using guided bone regeneration with tenting screws (“screw
tent-pole” technique described by Le,
et al), followed by a second stage surgery to remove the middle implant
with additional bone augmentation
to develop a pontic site. Following a
healing period, provisional restorations would be used to sculpt the
soft-tissue architecture prior to definitive restorations.
On the day of surgery, the patient
was asked to rinse with 0.12 percent
chlorhexidine gluconate (15 mL)
prior to IV sedation. A crestal incision
and distal, curvilinear, vertical incision that followed the gingival margin of the distal proximal tooth were
made. A full-thickness, subperiosteal
flap15 was elevated to expose two to
three times the treatment area (Figs.
5-6). Significant labial bone loss was
noted in the anterior maxilla with
moderate thread exposure on two
adjacent implants. Decontamination of the implant surfaces was
not performed because the patient
did not exhibit signs of mucositis,
periimplantitis related infection or
purulence around the peri-implant
gingival sulci. The soft tissue was
generously released and advanced to
ensure tension-free closure.
Prior to graft placement, three
roughened titanium tenting screws
were placed 3-4 mm below the implant platforms to create a tenting
effect over the graft site and help

Figs. 1-2: Patient with gingival recession and discolouration due to exposure of the underlying dental implants (teeth No. 7, 8, 9) three
years after implant placement. Note the lack of keratinized peri-implant mucosa. (Photos/Provided by Dr. Bach Le)

Figs. 3-4: Patient with gingival recession and discolouration due to exposure of the underlying dental implants (teeth No. 7, 8, 9) three
years after implant placement. Note the lack of keratinized periimplant mucosa.

Fig. 5: Flap elevation illustrating labial
bone dehiscence and implant exposure.

Fig. 6: Screw ‘tent-pole’ grafting technique; placement of three titanium tenting screws placed 3-4 mm below the gingival margin.

Fig. 7: Placement of a mineralized allograft material over the defect site with
coverage with a pericardial membrane.

Fig. 8: Re-entry at four months after grafting showing excellent graft healing and consolidation over
the previous defect.

reduce tension over the graft (Fig.
6). Mineralized bone allograft was
placed over the defect sites and overcontoured by approximately 20-30
percent to compensate for the anticipated apical migration and partial
resorption of the augmentation material during remodeling (Fig. 7). Prior
to use, the allograft material was hydrated according to the manufacturer’s directions and mixed with
the patient’s blood, which served as a
coagulant. After graft placement, the
material was covered with a percardial membrane.
The mucoperiosteal flap was ap-

proximated and sutured in place.
The patient was provided with an
interim prosthesis to be worn during
four months of healing and was dismissed with postoperative instructions, antibiotics and analgesics until
the follow-up visit seven to 10 days
later.
After a four-month healing period, a
second stage surgery was performed
to remove the middle implant in the
maxillary right central incisor position to create a pontic site (Figs. 8-9).
The “screw tentpole” technique was
again utilized with mineralized al-

Fig. 9: The middle implant
at the maxillary right central incisor position was removed in the second surgery
to create a pontic site.

lograft and a collagen membrane for
additional vertical augmentation of
the pontic site (Figs. 10-11). A consolidation period of 12 months was allowed to ensure proper maturation
of the bone and overlying soft tissue
(Fig. 12). Screw-retained provisional
restoration were utilized (Fig. 13) for
six months to develop the soft-tissue
architecture prior to the delivery of

ÿPage 17

[17] =>

mCME

Dental Tribune Middle East & Africa Edition | 1/2019

◊Page 16
the definitive restoration (Fig. 14).
The final restoration with soft-tissue
profile is shown at eight years (Figs.
15-16) and 13 years (Fig. 17) followup, along with CBCT and periapical views (Fig. 18-20). There were no
complications or adverse events during surgery or postoperative healing.
The preoperative crestal bone thickness for both implants increased
to 1.8 mm and 2 mm, respectively,
approximately one year after treatment. Significant increases in softtissue thickness, keratinised tissue
width and gingival height were also
unexpectedly achieved and maintained through 12 years of follow-up.

Discussion
This clinical case reports on unexpected improvements in peri-implant soft-tissue dimensions after
GBR procedures to correct labial
dehiscences around implants in the
maxillary anterior jaw. Peri-implant
bone loss can result in soft-tissue
resorption followed by plaque attachment at or near the implant
abutment interface. This, in turn,
can trigger soft-tissue inflammation
with additional bone loss and gingival recession.16-20 It has been reported
that gingival margin levels may be
affected by the thickness of the gingival tissues and that a thin tissue
biotype may favour apical displacement of the soft tissue margin.21 To
maintain gingival health, maintaining an adequate width (~2 mm) of
keratinised gingiva around dental
implants has been suggested;16,19,21
however, this has been disputed.22
A correlation has been reported between the presence of keratinised
tissue and plaque levels and the incidence of mucositis.20 It has been
suggested that sites with minimal
keratinised tissue might be prone
to a lower incidence of periodontal
pocket formation.20,23
In the anterior maxilla, as labial
bone thickness resorbs, there is a
corresponding loss in labial soft tissue thickness around the implant.24
Moderate recession can make thin,
pink gingival tissues appear dark because of the presence of the underlying metal abutment and implant,
and further bone loss can cause unsightly metal exposure above the
gingival margin. In general, implants
carry a higher risk of soft tissue complications when placed in thin tissue
bio types or with labial inclinations
when the labial plate thickness is <2
mm.24-25 Use of an opaque abutment,
such as zirconia, has been reported
to produce the least amount of gingival colour change when gingival
thickness was <2 mm, whereas any
abutment material resulted in satisfactory aesthetics when gingival tissue thickness was >2 mm.24,26
The goal of the GBR procedures in
the present case was to treat the facial bone defects as well as restore
the aesthetic gingival margin. The
efficacy of allografts and GBR surgical protocols in repairing alveolar
defects is documented in the dental
literature.27-29 While some allogenic30-31 and xenogenic32 tissues have
demonstrated efficacy in soft-tissue
augmentation, the use of a collagen
membranes with a mineralized allograft for soft-tissue augmentation is
not well documented. In the present
case, use of a collagen membrane
in combination with a mineralized
bone allograft resulted in gain in
keratinised tissue width and gingival
height.
While the goal of the GBR procedure
was to treat the bone defect in the
present case, improvements were
coincidentally observed not only in
the soft-tissue dehiscence, but also in
the keratinised tissue width and soft-

tissue thickness. The use of mineralized allograft placed around 1.5 mm
titanium screws (“screw tentpole”) to
tent out the soft-tissue matrix and
periosteum has been previously reported for successful alveolar ridge
reconstruction.33 Although there are
no reports of a GBR procedure resulting in clinical increases in both of the
latter soft-tissue dimensions, a limited number of retrospective studies14,24,34 have reported an increase in
soft-tissue thickness around dental
implants primarily in the anterior
maxilla after increasing the thickness of the facial bone through GBR.
Furthermore, the membrane placed
over the particulate graft in the present clinical case was essentially a
collagen matrix similar to a connective tissue graft, which adds to the
thickness of the overlying tissue.35
Scoring of the periosteum and underlying bone tissue prior to grafting and foreign body reaction from
placement of a graft and membrane
may also result in scar tissue formation that augments the soft-tissue
profile. The present technique is not
ideal for restoring the gingival margins for poorly positioned implants
or when there is significant thread
exposure. For example, implants
placed outside of the alveolar housing or with significant labial inclination associated with labial bone loss
should be excluded.
Zucchelli et al.36 reported on a surgical-prosthetic treatment for implants with buccal soft-tissue dehiscence defects in the aesthetic zone.
The technique involved removing
the crown, shortening the abutment
and then treating the dehiscence
defect with a coronally advanced
flap and connective tissue graft.36
After one year, mean soft-tissue dehiscence coverage was 96.3 percent
with complete coverage in 75 percent of the treatment sites.36 While
patients were satisfied during shortterm follow-up, the ability to camouflage a bony defect with or without
exposed implant threads is highly
limited without the support of the
underlying bone, which is the main
cause of soft-tissue recession.24, 37-38

Figs. 10-11: Screw tent-pole grafting technique was again employed to enhance the vertical dimension of the pontic site. The mineralised allograft was covered with a cross-link collagen membrane.

Fig. 12: Healing at 12 months after implant removal. Note improvement in the vertical height of the ridge and soft tissue dimensions around the implants at the pontic site.

Fig. 13: Screw-retained provisional restoration.

Fig. 14: Delivery of definitive restoration.

Fig. 15: Eight years follow-up.

Fig. 16: Eight years follow-up.

Fig. 17: 13 years follow-up, illustrating continued tissue stability.

In addition to soft-tissue recession,
marginal bone loss has been associated with increased peri-implant
stress concentrations in the crestal
bone region. Over time, elevated
stress concentrations can trigger additional bone loss and further softtissue recession.39 If left untreated,
increased stresses can result in screw
loosening, metal fatigue and component fracture over time.39-40 Implants
placed in the anterior maxillary jaw
with thin buccal plates are highly
susceptible to the adverse effects of
marginal bone loss.39-40
In summary, the use of a mineralized bone allograft and a collagen
membrane effectively increased alveolar hard- and soft-tissue dimensions in the aesthetic zone of the
anterior maxilla. Restoring the missing buccal bone decreased the risk
of developing peri-implantitis from
bacterial biofilm attachment to the
exposed implant abutment crevice
and roughened implant surface. Secondly, the soft-tissue thickness was
increased, which made the restored
tissues more resistant to future recession and mask the underlying
titanium components.31,40-41 Thirdly,
guided bone regeneration also unexpectedly increased the width of
keratinised tissue, which has also
been reported to help provide a
peri-implant soft-tissue seal against
bacterial invasion, in addition to providing resistance against recession.33
While increases in soft-tissue thickness and keratinised tissue width
have been reported after placement

Figs. 18-20: CBCT and periapical views at eight years after GBR procedure showing stable bone and healthy tissue thickness around
both implants.

of connective tissue and free gingival grafts,33 this phenomena has not
been previously reported after guided bone regeneration procedures
around dental implants. The author
has reported the results of using this
same technique in 11 patients who
achieved similar outcomes after
short-term follow-up.14
The value of individual clinical case
reports is that their anecdotal data
can provide preliminary evidence
for developing new hypotheses that
lead to larger randomised clinical
trials,42 which are needed to determine if the present approach will
effectively serve as an alternative for
soft-tissue augmentation in instances where tissue thickening is needed.

References
1. Fickl S. Peri-implant mucosal reces-

sion: Clinical significance and therapeutic opportunities. Quintessence
Int. 2015 ;46:671-6.
2. Kohal RJ, Att W, Bachle M, Butz F.
Ceramic abutments and ceramic
oral implants. An update. Periodontology 2000 2008;4:224–243.
3. Roccuzzo M, Gaudioso L, Bunino
M, Dalmasso P. Surgical treatment of
buccal soft tissue recessions around
single implants: 1-year results from
a prospective pilot study. Clin Oral
Implants Res 2014;25:641-6.
Editorial note: A list of references is
available from the publisher.
This article was originally published
in implants international magazine
of oral implantology, Issue 1 2018.
mCME article membership instructions are available upon request.

Dr. Bach Le, DDS, MD, FICD, FACD
He has completed his specialty training in
oral and maxillofacial surgery at Oregon
Health Sciences University. He is currently
clinical associate professor of oral and
maxillofacial surgery at the Herman Ostrow School of Dentistry at USC, where he
has been an active faculty member since
2000. Le has lectured internationally on
bone regeneration and dental implant-related surgery and has taught on six continents around the world. He has authored
or co-authored more than 13 chapters
in textbooks on bone regeneration and
dental implants and has published extensively in professional peer-review journals.
Le served as editor of the Dental Implant
section of the recognized Fonseca Oral
& Maxillofacial Surgery textbook (third
edition), which was recently released in
2017. His primary focus has been in hardand soft-tissue regeneration for improving aesthetic outcomes.

[18] =>

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 1/2019

Predictable steps to Biomimetic
Class IV restorations
By Dr Anand R. Narvekar, India

Introduction
Composite Artistry has become an
important element of direct restorative treatment in dental practice
today enabling clinicians to create
life-like restorations with individualized characterizations to match the
patient’s natural teeth.
Anterior restorations in the aesthetic
zone tend to constantly challenge
the clinician’s skill, therefore it is
important to plan carefully by combining art and science. Adopting the
Minimally invasive Cosmetic Dentistry (MiCD) concept, introduced by
Dr Sushil Koirala in my treatment
protocol with emphasis on preservation of natural tooth structure “Do
No Harm Dentistry” has helped create predictable aesthetic restorations
that exceed patient expectations.
Fractured upper central incisors are
one of the most common cases of
dentoalveolar trauma in the permanent dentition. The following clinical
case highlights a simple technique
to achieve predictable aesthetics
with natural optical characteristics in a class IV restoration using a
sculptable bio-mimetic direct restorative “Beautifil II LS”

Patient Case
A 35 years old male patient visited
our dental office with a complaint
of chipped upper front teeth ( tooth
# 11,21) resulting from a childhood
injury with no pain or sensitivity .
The patient requested to enhance his
smile with minimally invasive treatment.

Treatment Plan
After Intraoral examination, photographs were taken (Fig. 1) and a
treatment strategy was formulated
keeping in mind the patient high expectations for aesthetic restorations
with less invasive treatment.
A direct composite restorative material with low shrinkage, predictable aesthetics, sculptable handling
and easy polishability- Beautifil IILS
was selected. High value translucent
enamel shade was identified to create optical effects of youthful teeth
Materials
Tooth preparation – Diamond Bur
FG, Super-Snap Coarse Disk (Black)
Restoration – Beautifil II LS – shade
A2O, A2, Beautifil Injectable - shade
INC, Beautifil II
Enamel – shade HVT (High-Value
Translucent enamel shade)
Bonding system – Etchant and 2 step

Adhesive system (FL-Bond II)
Finishing & Polishing – Fine Diamond Bur (Red Band on shank) , OneGloss , Super-Snap X-Treme, Direct
Dia Polishing Paste, Super Snap Buff
Disk

Step by Step Restorative
Technique

Shade Selection
Vita Shade guide was used for shade
selection while tooth was hydrated.
Black and white photo is recommended for assessing value. Shade
A2 was selected. (Fig. 2)
Mock Up
• An impression is taken and model
poured using die -stone material.
Freehand build-up of composite for
both teeth to evaluate the final outcome. Both teeth were carefully analysed and identified that each tooth
required a different recipe for layering the composite material. (Fig. 3)
• Silicon putty index made from the
plaster model to create an enamel
shell to guide the build-up of the
palatal enamel layer.
Tooth Preparation
• Rubber dam isolation from premolar to premolar, Rubber dam inverted and floss tied around teeth

Before and after

for further retraction of gingiva to
eliminate contamination with sulcular fluid. (Fig. 4)
• Infinite bevelling of margins to
blend the composite material on

both sides, labial and palatal with a
round ended tapered Diamond bur

ÿPage 20

Fig. 1: Fractured maxillary anterior incisal edge of tooth #11 and 21

Fig. 2: Black and white photo taken with classic Vita shade guide for value
assessment, Shade A2 matches with natural dentition compared to A1

Fig. 3: Buccal view of the composite build-up on the tooth model, showing differences of a fractured incisal edges

Fig. 4: Rubber dam isolation with floss ties

Fig. 5: Labial bevelling of fractured area

Fig. 6: Smoothing incisal edge with the Super Snap Black disk

Fig. 7: Putty index checked intra orally after placing rubber dam

Fig. 8: Palatal shell made using Shofu Injectable INC enamel shade

Fig. 9: Build-up of deep dentin with Shofu Beautifil II LS A20, note the
different amount placed in each tooth

Fig. 10: Thin layer of Beautifil II LS shade A2 placed after placement of
Garrison anterior matrix band with silicon wedge between both central
incisors for better contact and contour of the tooth

Fig. 11: Final enamel layer build-up with Beautifil II Enamel shade HVT of
achieve high-value translucency and finished with an art brush in horizontal motion strokes

Fig. 12: After contouring, finishing done with dura white stone

[19] =>

[20] =>

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 1/2019

◊Page 18
(Fig. 5). Finish with a Super snap
Black disk to avoid leaving any unsupported enamel. (Fig. 6)
• Putty index checked intra orally
and modified to ensure a perfect fit.
(Fig. 7)
• Teflon tape is placed on adjacent
teeth to protect from accidental
etching and bonding.
Restoration
• Selective enamel etching was done
using 32% Phosphoric acid with microbrush agitation and slight overetching of vestibular enamel. Rinse
the etchant, generously with water
for 20 seconds. After gentle air drying, frosted enamel was visible
• 2 Step Adhesive System FL- BOND
II was used. First applied Primer and
left for 10 sec., air dried and followed
by application of the bonding agent,
excess bonding agent is carefully removed by high vacuum motorized
suction, and light cured for 10sec.
• Palatal shell was created us-

ing Beautifil Injectable composite
enamel Shade Inc. Due to excellent
handling properties, a very smooth
palatal shell can be made.
Clinical Tip : this method helps reduce
chair time during the finishing & polishing protocol. (Fig. 8)
• Build-up deep dentin with a layer of
Beautifil II LS shade A2O on the palatal shell to block the light transmission . More quantity was applied in
tooth 21 compared to tooth 11 due to
the extent of fracture. (Fig. 9)
• To attain good contact and emergence profile for better contouring,
a Garrison Anterior band with No. 1
yellow wedge was placed in between
both centrals. A thin layer of Beautifil II LS shade A2 was placed leaving
sufficient space for build-up of final
enamel layer (Fig. 10)
• Final layer of enamel was restored
using Beautifil II High-Value translucent enamel shade HVT to create
some natural surface characteriza-

tions and achieve a high value. The
enamel layer was smoothened with
the help of an art brush. (Fig. 11)
Clinical Tip: final curing is done after
applying glycerine to avoid oxygeninhibited layer.
Finishing and Polishing
• Rubber dam was removed carefully
before starting the finishing & polishing procedure
- The first step of finishing was to
mark the line angles.
- Contouring was done using a tapered fine (red band) diamond point
and Super Snap disk (purple).
- High points were checked and adjusted with 40 micron articulating
paper in static occlusion & 200 micron articulating paper in Dynamic
occlusion.
- Finishing was done with Dura
White stone (Fig. 12) and One gloss,
Clinical Tip: avoid touching the line
angles in order to highlight the line

angles for a more natural contour
- Polishing was done using Super
Snap X-Treme green and red disks
(Fig. 13) until a glossy and reflective
composite surface is achieved
- The final Super polishing was done
with Direct Dia diamond paste with
Super Snap Buff Disk for a high gloss
effect that matches the natural teeth
• Patient recalled after one week for
assessment of restoration and photos taken after rehydration from different angles to check teeth contour
and anatomy.(Fig. 17)

Results
It is often challenging to restore cases
with small fractured incisal edges as
there is limited space available to
manipulate and blend the composite shades.
Proper understanding of the composite material and optical properties of different shades of opaque
dentin, dentin and
enamel help to explore
the natural blending
ability of colours for
this patient and create
restorations that harmonize with natural
teeth.
Attention to detail was
key to achieving surface characterization to

Fig. 13: Polishing with Super Snap X-Treme green disk followed by pink
disc clearly showing the reflection on the tooth

Fig. 14: Intra oral image showing final restoration

Fig. 15: Before and after image digitally overlapped to showcase extent
of actual build-up of the composite restoration

Fig. 16: Frontal view of maxillary anterior teeth showcasing bio mimetic
aesthetics of composite resin with a close match to natural tooth translucency and effects in the incisal area

maximise the aesthetic outcome of
the restoration.
The use of a proper protocol for finishing and polishing helped achieve
a glazed-like composite surface
similar to ceramic or natural teeth as
seen in the extreme close up clinical
photographs

Conclusion
The before and after clinical photos
of this patient case highlights that
predictable life-like restorations can
be created to mimic natural teeth
using a conservative approach with
minimal tooth preparation, selection of the right type and shades of
composites followed by a comprehensive finishing and polishing protocol.

Acknowledgment
Author wish to thank Shofu Dental
Asia-Pacific Pte. Ltd. and Garrisons
USA for their Support.

Shofu Dental Asia-Pacific PTE LTD
10 Science Park Road, #03-12 The Alpha
Singapore Science Park II
Singapore 117684
Tel: (65) 6377 2722
Fax: (65) 6377 1121
E-mail: jwu@shofu.com.sg
Web: www.shofu.com.sg

Fig. 17: Artistic side view of both dental arches in anterior guidance 1
week post-treatment showcasing complete rehydration of tooth and
natural life-like aesthetics

Interview: "The participants can share the
up-to-date knowledge about the subjects in
the field of Conservative Dentistry."
By Dental Tribune MEA
SHARJAH, UAE: The University of
Sharjah organized the first regional
ConsAsia 2018 conference of the
Asian Oceanian Federation of Conservative Dentistry last December.
The event was under the patronage
of His Highness Sheikh Dr. Sultan bin
Mohammed Al Qasimi, Member of
the Supreme Council, Ruler of Sharjah, and President of the University
of Sharjah.
The University inaugurated the first
regional ConsAsia 2018 International
Conference as part of the annual
meeting of the Asian and Oceanian
Federation of Conservative Dentistry
(AOFCD). The conference comes under the theme "Contemporary Conservative Dentistry: Innovations for
Tomorrow's Practice." The University's College of Dentistry organized
the Conference in collaboration with
the AOFCD and the Dental Division
of the Emirates Medical Association
(EMA), and with the participation of
over 30 countries.
Amongst the list of VIP attendees

included Prof. Elsiddig Ahmed ElMustafa El Sheikh, Vice Chancellor
for Academic Affairs, attended the
ConsAsia along with Prof. Qutayba
Hamid Al Heialy, Vice Chancellor for
Medical Colleges and Health Sciences and Dean of College of Medicine;
Mr. Majid Al-Jarwan, Vice Chancellor
for Public Relations; Prof. ByeongHoon Cho, President of the AOFCD
and ConsAsia 2019; Prof. Hien Chi
Ngo, Dean of the College of Dental
Medicine; Dr. Aisha Sultan, President
of the Dental Division of the EMA;
and a number of faculty and staff
members at the University.

Dentistry, Seoul National University
School of Dentistry, Seoul, Korea. I
am also the Founding President of
the Asian-Oceanian Federation of
Conservative Dentistry (AOFCD),
the President of the Local Organising Committee (LOC) for its inaugurating scientific meeting, ConsAsia
2019, Seoul, Korea, the immediate
past president of Korean Academy of
Conservative Dentistry (KACD), and
the Editor-in-Chief of the Restorative Dentistry & Endodontics. I am
establishing the AOFCD and organising its biennial scientific meeting,
ConsAsia.

Dental Tribune had the pleasure to
interview Prof. Byeong-Hoon Cho,
President of the AOFCD and ConsAsia 2019 to get his view on the conference in the Middle East and beyond.

When the ConsAsia initiative was
proposed by the KACD, 16 scholars
from 9 countries joined the first
preparatory meeting and showed interests in founding an international
organization in the field of Conservative Dentistry. Although the
Conservative Dentistry is a very dynamic discipline, there had been no
international organization, except
ConsEuro, which is hosted by European Federation of Conservative
Dentistry (EFCD). I felt they were eager for a platform where they could

Could you please share
with us an introduction
about yourself and your
experience as president of
the AOFCD.

I am Byeong-Hoon Cho, Professor of Department of Conservative

collaborate and communicate with
each other in education, research,
and practice in the field of Conservative Dentistry.
Considering the dynamic features of
Conservative Dentistry, we all needed to have a platform where we can
meet and communicate with each
other and collaborate for the innovation and the future of Conservative Dentistry, so it was possible to
establish AOFCD and hold ConsAsia.
The international ConsAsia scientific
conference will promote academic
pride and clinical excellence for
scholars, researchers, students, and
clinicians in the field of Conservative
Dentistry, ultimately contributing
to the quality of care and improving
oral health in the region.

For our MEA audience,
could you please provide
more information about
the AOFCD and ConsAsia?

It is established to contribute to the
promotion of oral health in the public interest and to facilitate communication and cooperation amongst

the members in the Asian and Oceanian regions by encouraging excellence in the clinical practice, teaching
and research pertinent to the scope
of Conservative Dentistry.
In the early days of 2016, the ConsAsia initiative was proposed by the
KACD to construct a network among
the clinicians, researchers, and scholars of Asian and Oceanian countries
in the field of Conservative Dentistry, and as a result, to contribute
to improving the oral health of the
populations in these areas. Hence,
the KACD proposed to establish
AOFCD and to hold biennial ConsAsia scientific meetings.
At first, scholars from 9 countries
(Australia, Hong Kong, India, Japan,
Korea, Singapore, Malaysia, New
Zealand, and Taiwan) agreed with
the initiative and met first in Seoul,
Korea, on October 21, 2016 (First
preparatory meeting). According to
the decision of the first preparatory
meeting, the LOC for the first ConsA-

ÿPage 22

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INTERVIEW

Dental Tribune Middle East & Africa Edition | 1/2019

◊Page 20
the ConsAsia homepage (www.consasia.org). It would be beneficial in
the registration fee if the participants
would be AOFCD members whether
they are to be individual members
or their organization be a full member (Please refer to the Newsletter
[Newsletter ver. 02] and ConsAsia
2019 Brochure from the Download
Center in the main page of ConsAsia
homepage (www.consasia.org).

sia 2019 meeting was composed in
Korea in January, 2017. We prepared
the Constitution and Bylaws of
AOFCD and Guidelines for ConsAsia
scientific meeting. As the scope of
Conservative Dentistry, most participants agreed to include all aspects of
the disciplines for saving teeth, such
as Operative Dentistry, Restorative
Dentistry, Prosthodontics, and Endodontics. Different from the ConsEuro, the ConsAsia meeting will be
supported by the Korean Academy
of Endodontics and the Korean Academy of Adhesive Dentistry, as well as
the KACD.
Professor Stephen Dunne from
Great Britain, the Immediate Past
President of European Federation
of Conservative Dentistry (EFCD)
and Professor Lorenzo Breschi from
Italy, the President of EFCD, agreed
with the ConsAsia initiative and
supported the ConsAsia meetings
with various means. With the help
of EFCD, we revised the draft of the
constitution and by-laws. They supported the ConsAsia team with their
know-how to manage the federation
and meetings and speakers.
During the 2nd preparatory meeting in Sharjah, UAE, on Nov 16, the 24
participants from 8 countries (Hong
Kong, India, Korea, Malaysia, Singapore, Taiwan, Turkey, UAE) agreed
most of the agenda: the draft of Constitution and Bylaws of AOFCD and
Guidelines for ConsAsia scientific
meeting, the Keynote speakers, and
the rough draft for the scientific programs were discussed and agreed.
Main topics of ConsAsia 2019 were
Cariology, Preventive Dentistry,
Minimal invasive treatment, Vital
pulp therapy, Dental education,
Adhesives, Resin-based composites,
Ceramic, Zirconia, CAD/CAM, Novel
biomaterials, and New technologies.
The LOC figured out 14 world-widely
well-known keynote speakers and
continues to construct the scientific
programs (http://www.consasia.org/
speakers/index_new.php). We have
received suggestions for country
representative speakers.
In order to promote interests in Conservative Dentistry and organization
of regional societies, the Middle East
Regional Conference, ConsAsia 2018,
Sharjah, UAE was suggested and successfully held as an international
meeting on December 6-7, 2018 by
Professor Dean Hien Chi Ngo and
Professor Hatem El-Damanhoury of
University of Sharjah. As the inaugurating meeting, ConsAsia 2019, Seoul
meeting will be held on November
8-10, 2019 at Grand Ballroom of
COEX Convention Center, Seoul, Korea, and the second ConsAsia meeting will be held in 2021, Cochin, India.
For more information, please refer
to the home page for the AOFCD and
ConsAsia meeting 2019 (www.aofcd.
org and www.consasia.org, respectively), to which we will add contents
continuously. The corporation for
the AOFCD was established in Seoul,
in January 23, 2018. The membership
application opened in November,
2018. Abstract submission will be
open on March 1, 2019. The LOC will
do its best for success of ConsAsia
2019, Seoul, Korea.

How did ConsAsia 2018
come to Sharjah in the
United Arab Emirates?

As mentioned above, in order to promote interests in Conservative Dentistry and organization of regional
societies, Professor Dean Hien Chi
Ngo proposed the Middle East Regional Conference. Professor Hatem
El-Damanhoury as Secretary General of the LOC for the ConsAsia 2018,
Sharjah, UAE held the meeting suc-

Prof. Byeong-Hoon Cho, President of the AOFCD and ConsAsia 2019

cessfully. Professor Dean Hien Chi
Ngo promised to continue organizing Conservative Dentistry societies
and holding the Regional Conservative Dentistry meeting.

What will happen at ConsAsia 2019 and how can
our Middle East dental audience engage with this
event?

The 1st General Meeting of the AsianOceanian Federation of Conservative Dentistry (ConsAsia 2019) will be
held on November 8 (Fri) – 10 (Sun),
2019 at Grand Ballroom of COEX
Convention Center, Seoul, Korea. The
main theme of the ConsAsia 2019 is
‘Conservative Dentistry: the Path
from Research to High-quality Care’.
The main topics of its Scientific Programs are Cariology, Preventive dentistry, Minimal invasive treatment,
Vital pulp therapy, Endodontics,
Dental education, Adhesives, Resinbased composites, Ceramic, Zirconia,
CAD/CAM, Novel biomaterials, and
New technologies. Approximately
1,500 scholars and clinicians from
more than 30 Asian and Oceanian
countries will join the ConsAsia 2019
Seoul meeting.
Fourteen most famous internationally well-known keynote speakers
will participate to the scientific programs to give lectures on the up-todate knowledges about the recently
most-attracted subjects in the field
of Conservative Dentistry. More
than 30 country representative
speakers will give lectures in concurrent sessions. We invite researchers,
clinicians, and students from all of
the Asian and Oceanian countries
to submit abstracts for presentation
to share and discuss their latest findings. There will be chances to discuss
your issues with world most famous
speakers. The presentation will be
open for Research (Oral and Poster),
Clinical Case Reports (Oral and Poster, for Residents and Graduate students only). For the presentations,
Awards for Excellent Clinical Case
Presentation, Excellent Research
Presentation, and Student Research
Presentation will be granted. A commercial exhibition of dental supply
companies and other relevant organizations will also be concurrently
held in the Grand Ballroom and Lob-

by. These exhibits will complement
and enrich the scientific program
and reflect its wide scope.
All accepted abstracts will be published in the Restorative Dentistry &
Endodontics Vol. 44, No. 4, which will
be published on November 30, 2019.
RDE is indexed/tracked/covered
by PubMed, KoreaMed, Synapse,
KoMCI, Crossref, DOAJ, and Google
Scholar.
The LOC will organize social/tour
programs as well as well-balanced
scientific programs to make your
trip to Korea very fruitful and interesting (Please refer to the recent
newsletter:
http://www.consasia.
org/newsletter/mail_181227.html).
During the days of ConsAsia 2019,
the Autumn color of Korea will be
fantastic.
In summary, ConsAsia 2019 Seoul
Meeting will be attractive due to:
1. It is the first and only conservative dentistry conference where the
world of Conservative Dentistry
comes together.
2. Be a part of the frontier of Conservative Dentistry in Asia and Oceania where innovative ideas will be
exchanged.
3. Meet with new vendors and suppliers where the newest and best
products and services will be introduced
4. Make connections with friends
and colleagues where you will find
the greatest opportunities to build
professional connections, all within
just a few hours’ flight.
5. Explore Korea. You never imagined Seoul - Korea’s capital city is a
mega city of over 10 million with
more than 2000 years of history. It
is a city of the past, present, and the
future, full of stories, excitements
(K-pop), culture, adventure, and intrigue.
Anyone who is interested in the Conservative Dentistry can join the ConsAsia 2019. The abstract submission
system will open on March 1, 2019.
Abstract submission deadline will be
May 31, 2019. Submit your abstract
via Online Abstract Submission system through the ConsAsia homepage (www.consasia.org). Abstract
acceptance notification will be on
June 28, 2019.
Online registration will also be available from May to August through

Can be part of the AOFCD:
Any national society, association,
or other organization in the field of
Conservative Dentistry and related
disciplines in Asia and Oceania shall
be eligible to apply for Full Membership of the AOFCD. Other organizations and institutions which have a
special interest in the object of the
AOFCD. Manufacturers of dental
materials, equipment and instrumentation, publishers and other
commercial organizations with a
special interest in the object of the
AOFCD. Individuals with interests in
the object of the AOFCD.
Now the registration site for the
AOFCD membership registration
has finally been constructed.
1. Registration for AOFCD membership: Please refer to the AOFCD hompage (http://www.aofcd.org/membership).
2. Advisory Board of ConsAsia 2019:
Would you please participate as
an Advisory Board member of the
ConsAsia 2019 Scientific Meeting? If
your and/or related associations participate, the name of the Association
will be added as an Advisory Association at AOFCD homepage (http://
www.aofcd.org/about/sub3.php)
and ConsAsia homepage (http://
www.consasia.org/info/related.php),
as well as in the Program Book.
After discussing with the Board of
your affiliated Association whether
your Association joins the AOFCD
Membership and/or is willing to
participate and become an Advisory
Association of the ConsAsia 2019 Scientific Meeting,
A. Please proceed your registration
for the membership, and
B. Please let us know the name, representative, and contact details of the
Association.

The initiative started by the
Korean Academy of Conservative Dentistry (KACD),
what is the main message
when it comes to Conservative Dentistry?

At first, the ConsAsia initiative was
conceptualized in the KACD as a way
to internationalize the academy and
its member.
As mentioned in the answer to the
first question, although the Conservative Dentistry is a very dynamic discipline, there is no international organization, except ConsEuro, which
is hosted by European Federation
of Conservative Dentistry (EFCD). I
felt the participants at the first preparatory meeting showed interests
in founding an international organization in the field of Conservative
Dentistry and were very eager for a
platform where they could collaborate and communicate with each
other in education, research, and
practice in the field of Conservative
Dentistry.
Considering the dynamic features of
Conservative Dentistry, we all needed to a platform where we can meet
and communicate each other and
collaborate for the innovation and
the future of Conservative Dentistry.
The international ConsAsia scientific
conference will promote academic
pride and clinical excellence for
scholars, researchers, students, and
clinicians in the field of Conservative

Dentistry, ultimately contributing
to the quality of care and improving
oral health in the region.

Therapy, diagnostics, prevention—what are your
concrete
recommendations?

As mentioned in the answer to the
question 4, the main theme of the
ConsAsia 2019 is ‘Conservative Dentistry: the Path from Research to
High-quality Care’. Since the scope
of the ConsAsia includes all the disciplines that aim to preserve teeth,
the main topics of its Scientific Programs include from the basic sciences to the high-quality practices; such
as Cariology, Preventive dentistry,
Minimal invasive treatment, Vital
pulp therapy, Endodontics, Dental
education, Adhesives, Resin-based
composites, Ceramic, Zirconia, CAD/
CAM, Novel biomaterials, and New
technologies.
The participants can share the up-todate knowledge about the recently
most-attracted subjects in the field
of Conservative Dentistry and discuss the issues with internationally
well-known keynote speakers and
the country representative speakers.
As a general conference, the speakers
in the ConsAsia 2019 are the expertise from in the basic sciences to in
the clinical disciplines of prevention,
diagnostics and therapy. Concurrent
exhibition of dental supply companies and other relevant organizations will complement and enrich
the scientific program and reflect its
wide scope.

What advise can you give
to dentists looking to specialize in a certain specialization in dentistry?

Dental caries and periodontal disease are the most prevalent diseases
of humans. The impact of maintaining oral health on the general health
and longevity of individual person
is well-accepted. The elderly population is rapidly increasing, and demand for improving quality of life
will also expand rapidly. With the
development of the mass media, the
desire for aesthetic treatment of the
patients has greatly increased. All
these environments have driven the
dynamics of Conservative Dentistry,
leading to the development and innovations of new dental materials,
particularly aesthetic dental materials, and requiring changes in the
daily clinical protocols. The dynamic
characteristics of Conservative Dentistry will be a new challenge and
opportunity for young dentists who
are looking for a speciality.

Finally, what is your intake
on Dentistry in the Middle
East?

In view of the dynamic characteristics of Conservative Dentistry, the
clinicians, scholars, and researchers who major in the disciplines
related to preservation of teeth are
required to ensure academic excellence and clinical professionalism of
Conservative Dentistry, to increase
their pride, and to contribute to the
future of Conservative Dentistry. For
the purpose, we should organize local and global academic meetings
and research conferences as a platform that allows us to cooperate and
share information with each other.
I sincerely hope that the Regional
Conservative Dentistry Societies will
be organized in the Middle East and
its own academic conferences will be
held continuously.

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INTERVIEW

Dental Tribune Middle East & Africa Edition | 1/2019

Is digitalisation the way forward for dentistry?
By Simon Beard, Senior Vice President and Managing Director, Align
Technology EMEA
Digitalisation is changing the way we
live and work. The UAE – in particular
Dubai – is at the forefront of this innovation, using technology to build
a ‘smart, happy city’ in line with H.H.
Sheikh Mohammed bin Rashid Al
Maktoum’s vision of Dubai becoming one of the most technologically
advanced cities in the world by 2021.
The transformational influence of
digital world is evident also in dental
sector, with cutting-edge technology used by doctors to serve patients
better – and help clinicians achieve
more efficient outcomes.
Aesthetics, after all, play an increasingly important role. Studies have
found that a genuine smile can help
you land a job, close a sale transaction and even motivate others to
perform better. In fact, recent report
by the American Academy of Orthodontics, conducted on individuals
who had had orthodontic treatment
as adults, states that as many as 75
per cent of people surveyed have
noticed positive effect of the new
smile on their personal and professional life. More people than ever are
realising the value of investing in orthodontic treatment as it may help
them appear younger and feel more
self-assured in various situations.

toum, UAE Vice President and Prime
Minister and Ruler of Dubai, digitalisation of the dental sector driven by
3D printing is a natural progression,
expected to gain even wider acceptance in the years to come.

to patients as well as to the clinics,
as they provide better care at lower
costs. This is even more relevant to
the regions where insurance coverage of dentistry services is not a luxury available to all.

From 3D printed villas, set to become
a reality still in 2018, to the recently
announced 3D Printing Institute,
Dubai offers a perfect platform to
strengthen advanced manufacturing using digital technologies for the
dental sector. It also fits in with the
industrial strategy of Dubai, whereby a significant focus is placed on
customized manufacturing.

On the operational side, digital dentistry can helps optimize processes
and create more streamlined digitised workflow that covers every
aspect of the patient journey – from
diagnostics to planning and dental
lab production as well as follow-up.

The practical application of 3D printing in the medical sector is well-documented. A report by Science Trends
highlights that researchers are looking at using 3D printing as a means
to create organs and other body
parts, where bioprinters ‘manufacture’ tissues and organs from human
cells. The pharmaceutical industry is
also going full steam ahead, developing 3D pills, which can combine all
patient`s medications into one personalised pill.
Digital dentistry is up to speed in
this regard. As Dubai Health Authority has announced plans to use 3D
printing for dentistry, there is significant interest in digital dentistry
in Saudi Arabia, where the dental devices market is projected to grow at a
CAGR of 6.58 percent by 2021.

Digital technologies may help more
people smile with more confidence
and we can certainly see the trend
taking strong roots in the UAE and
the wider region. In fact, digital dentistry has been a pioneer of sorts in
today’s digital narrative. For example, as one of the early adopters of 3D
printing, dentistry is transforming
the manufacturing process, assuring
patients receive custom-made solutions, suited to their specific needs.

The rise in demand for digital dentistry is driven as much by the cost
efficiencies it can generate even for
the more expensive dental procedures as by growing focus of dental
providers to scale up their technology to stay relevant in the era of fastpace changes. There is also, of course,
the aesthetic value and comfort new
technological advancements bring
to the patients.

With the current focus of the UAE
(especially Dubai) in ushering in 3D
printing adoption and utilization, led
by the vision of His Highness Sheikh
Mohammed bin Rashid Al Mak-

Most industries that are either digitally driven or disrupted have witnessed lowering the costs. Dental
industry is no different. Imagine
the benefit digital tools would bring

Globally, the restorative industry is
set to reach US$25.9 billion by 2025,
growing at a CAGR of 6.7 percent,
according to a Grand View Research
report. It states that growing consumerism and the higher disposable income of patients are fuelling
demand for cosmetic dentistry
procedures and implantology. The
advent of digital industry has been a
key driver of this growth. Moreover,
its positive impact is being reflected
across the MENA region.
The value of digital dentistry goes
deeper than this, from helping patients get that ‘perfect selfie’ to undertaking both routine and more
complex procedures, such as intraoral imaging, radiography, caries
diagnosis and computer-aided implants, which all contribute to improved precision and accuracy.
The Invisalign system has been in
the driver’s seat in adopting digital
technology to achieve state-of-theart solutions in modern dentistry.
Align Technology, a global medical
device company engaged in the design, manufacture and marketing of
the Invisalign system, is home to one
of the largest dedicated 3D printing
facilities in the world, creating about
300,000 units daily of custom aligners through 3D printing and almost
405 million aligners made to date.
88 percent of the company’s global
net revenues from Q1 2018, which
clocked over US $436.9 million, come
from clear aligners. Having ramped
up our operations in the Middle East,
we are now facilitating direct provi-

sion of our advanced suite of digital
solutions in orthodontics.
Our clear aligners help move teeth
without the use of braces, miniscrews or mini-implants. Clear aligner technology is developed through
a combination of proprietary virtual
modelling software, rapid manufacturing processes and mass customization using highly innovative materials. With the Middle East and Africa
orthodontic supply market valued at
US$266 million in 2016, the growth
prospects are bright.
One area where digital dentistry has
transformed dental care is the discreet orthodontic system, of which
Invisalign has been the pioneer for
over 21 years now. Assuring quicker
and higher quality results in teeth
straightening with minimal invasion, the Invisalign clear aligners are
increasingly being sought after by
customers in the MENA region.
Created using 3D imaging and printing technology, the Invisalign system helps move teeth step by step till
they reach to the correct final position. A 3D simulation treatment plan
is created for every patient to ensure
that the clear aligners produced are
the precise fit for the individual. Each
aligner shifts the teeth slightly, moving them horizontally and vertically,
and even rotating them when needed. The aligners are also engineered
to use the right amount of force in
the right place at the right time.

goes back to 1999, when the Invisalign system was first introduced.
Within the next two years, one million unique clear aligners were manufactured. Today, the number of users has crossed over five and a half
million, including 1,3 million teenage
patients, and the system is offered in
over 100 countries.
We are also driving the evolution
from analogue to digital with the
iTero Intraoral scanner − helping to
modernize today’s practices by replacing physical impressions, creating digital treatment planning, and
leveraging the potential to revolutionise almost every type of dental
treatment offered. We believe the future of dental industry is digital.
Maintaining healthy teeth is very
important for one’s well-being – underpinning how digitalisation of
dentistry services is contributing to
the all-round wellness of individuals.
By offering doctors and patients our
digital, end-to-end solutions, we give
all a reason to smile.

Our clear aligners are comfortable,
removable, easy to clean, and made
of an advanced, patented, medical
grade SmartTrack material, which
differentiates them from traditional
braces and alternative clear aligner
offerings. Suitable for teenagers and
adults alike, the Invisalign system
also helps address several other
problems such as overbite, under
bite, cross bite, crowding and gaps
between teeth.
This builds on Align Technology’s
role as a pioneer in the invisible orthodontics market, a history that

Simon Beard, Senior Vice President and
Managing Director, Align Technology
EMEA

AEEDC 2019
05.- 07. 02. 2019
Dubai/ UAE

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• Excellent physical properties for durable fillings
• High filler content
• Packable consistency
(also available as Composan LCM flow)

Visit www.promedica.de to see all our products

Dental Material GmbH

24537 Neumünster / Germany
Tel.
+49 43 21 / 5 41 73
Fax
+49 43 21 / 5 19 08
eMail
info@promedica.de
Internet www.promedica.de

[25] =>

GUIDED BIOFILM
THERAPY
R

MAKE ME SMILE.

[26] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 1/2019

Roughness and loss of
substance of tooth
surfaces after biofilm
removal with different
processing methods
By Michael Haas, Martin Koller,
Behrouz Arefnia, Austria

Aim
To assess the roughness and loss
of substance of tooth surfaces after instrumentation with AirFlow,
ultrasonics, hand instruments and
polishing methods or their different combinations. This was a pilot
study.

Materials and methods
Post extraction, impacted 3rd mo-

lars were marked and stored teeth
were then divided and subjected to
the following treatments:
• 1A – Airflow EMS PLUS powder at
2mm distance for 5 sec with a pressure of 1.8 bar at an angle of 45° with
a wiping movement
• 1B – Airflow EMS PLUS powder
+conventional polishing with rubber cup and polishing paste of varying RDA 170>120>40>7
• 2A – Ultrasonic EMS with PS instrument for 60 sec/ surface, brushstroke movements, pressure ~ 30p
• 2B – Ultrasonic + Airflow EMS
PLUS powder used as above

Tetric N-Ceram Bulk Fill
®

• 2C – Ultrasonic + conventional
polishing used as above

The nano-optimized 4-mm composite

• 3A – Hand scaler/ curette. On
enamel scaler curved. On root
Gracey curette from Deppeler blue,
scaling movement per position one
stroke

Discover the new

• 3B – scaler/ curette + Airflow EMS
PLUS powder as above

time-saving

composite

• 3C – scaler + Airflow EMS PLUS
powder +Conventional polishing
as above
• 3D – scaler + conventional polishing as above
• Substance loss and roughness
were assessed 2 control groups:
enamel untreated, cementum untreated

4 mm

Results

On enamel: Group 1: Airflow
• There are no additional benefits in
conventional polishing and Airflow
in comparison to using AIRFLOW
alone

PATENTE

4 mm to success
• Bulk filling is possible due to Ivocerin®, the patented light initiator
• Special filler technology ensures low shrinkage stress
• Esthetic results are achieved quickly and efficiently in the posterior region

rin

I N I T I AT O

Ivoclar Vivadent AG

Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60

Conclusions
• Air-Flow with PLUS powder produces the highest level of cleaning
on enamel and cementum in comparison to ultrasonics or hand instrumentation.
• Repeated instrumentation, too
high pressure and too long exposure times lead to high substance
loss with all systems.
• Use of conventional instrumentation leads of unnecessary over instrumentation especially in use on
ceramics or restorations
• Airflow is the most efficient solution providing maximum tooth
preservation
• Ultrasound and hand instruments
enable a stripe-shaped cleaning
pattern through punctiform contact with the tooth surface. A planar
pattern is achieved with Air-Flow.
This makes it easier to achieve a
homogeneous result on large surfaces. This is much more difficult
with ultrasound and hand instruments and quickly leads to grooves
and furrows.
Recommended treatment
approach is:
• Assessment followed by disclosure for motivation
• Deep cleaning with Air-Flow followed by ultrasonic if necessary
• Quality check for remaining
stains, biofilm or calculus

Group 3: Hand instrument
• Hand instrument scaler also causes a loss of substance in the enamel.
No additional improvement by additional instrumentation with AirFlow, conventional polishing or a
combination of both.
On cementum: Group 1: AirFlow
Slight roughness due to additional
conventional polishing.

www.ivoclarvivadent.com

Group 3: Hand instrument
Gracey curette: A smooth surface is
produced of the processed cementum, addition of Air-Flow worsens
the result, polishing measures as
already described above lead to an
apparently smoother surface.

LIG

Ivoce

Group 2: Ultrasonic
• In comparison to Air-Flow, all
other instrumentations produced
small roughness values. Additional
conventional polishing does not alter the overall results.

with Air-Flow or conventional polishing.

Group 2: Ultrasonic
Ultrasonic produces a smooth cementum surfaces with low roughness values, which are not significantly altered by combinations

E.M.S. Electro Medical Systems S.A.
Ch. de la Vuarpillière 31
1260 Nyon - Switzerland
Tel: +41 22 994 26 60
Mob: +41 79 569 12 14
Web: http://www.ems-company.com
Web: http://www.ems-dent.com

[27] =>

Dental Tribune Middle East & Africa Edition | 1/2019

INTERVIEW

CEREC and Single Visit Dentistry
Interview with Dr. Khaled Ibrahim Mattar
Prosthodontist and Operational Manager Andalusia Dental Center, Jeddah, Saudi Arabia

By Dentsply Sirona

Please briefly explain how
long you have been working at your clinic and your
background in dentistry.
I’ve worked as a dentist from 15 years
now. I joined Dr. Rizk Girgis’ clinic as
a general dentist in 2005, before travelling to Saudi Arabia in 2011 to join
Andalusia Dental Group in Jeddah
working as a prosthodontist.

Please tell us about your
specialisms within your
practice?

During my early years I worked as
general dentist. Now I focus solely on
prosthodontic procedures.

What triggered your initial
interest in digital dentistry?
The digital impression and CAD/
CAM systems

How long have you been
working with Dentsply Sirona products?
More than 10 years now.

When did you invest in
your first piece of Dentsply Sirona equipment, and
what was it?

The first pieces of equipment that we
bought was a Cone Beam SL, Omnicam and MCXL milling machine.

Your practice uses Dentsply Sirona products and
equipment predominantly. What would you say
is the advantage to your
workflow and your practice by making this decision?
Ultimately it means that the end
product that I am delivering to my
patients becomes more accurate,
faster and safer. I trust the technology and the quality of the equipment.

How do you find the CEREC
workflow? From scanning,
designing, to grinding/
milling and sintering/finalsation.
Put simply, it’s more than perfect.

Why did you choose CEREC
over other CAD/CAM systems?
CEREC is the most accurate chairside
CAD/CAM system I’ve encountered.
The software is easy to use and versatile, and the speed of digital impressions with the Omnicam is fantastic.

Can you explain your experience with the Dentsply
Sirona sales process, from
initial interest through to
purchase and after sales
support?

The service from all at Dentsply Sirona has been excellent throughout
each stage.

What are the types of cases
you do with CEREC? E.g.
restoration, implantology,
orthodontics.
Primarily we are focusing on crowns,
endo crowns, veneers and implants –
for now!

How has CEREC, and single visit dentistry, affected
the satisfaction of your patients?

Single visit dentistry has had a significant effect on my patients satisfaction. It gives them their time back
in the week, and it also helps me to
have more time for additional patients.

How has CEREC and digital
dentistry impacted your
business?
Most importantly I save my time. I
stop using impression material and I
save on lab costs. Again this gives me
more time to see more patients and
have quality time with them and
their procedures.

In your opinion, can you
achieve a high return on
investment with CEREC
and digital dentistry?

It can certainly be achieved but you
must have a turnover of patients using the equipment, which is more
often than not.

What would you say was
your goal with CEREC, and
would you say you have
achieved this yet?
I can definitely say that I’ve achieved
my initial goals of saving time, increasing accuracy, and moving chairside to avoid lab costs and errors.

What do you think your
biggest achievement was
in your career to this point
and how did Dentsply Sirona help to make that a
reality?

When I was child I loved drawing,
then in my faculty I loved the carving. My biggest achievement now is
that I can draw and carve up to the
finest of details for my cases very
easily. In the past I had to go to the
lab and carve the wax or build the
porcelain which for me took too
much time and effort, but now my
dreams have come true and I can
draw and carve my crowns very easily without losing my time.
I would like to say thanks to Dentsply
Sirona for letting me achieve this.

Find out more about the benefits of
CEREC by reaching out to your local Dentsply Sirona representative.

Dr. Khaled Ibrahim Mattar, Saudi Arabia
• Graduated from Ain Shams University (Faculty of Dentistry), 2002.
• Master’s degree in Prosthesis from Ain Shams University, 2010.
• Advanced International CEREC courses 2013 - 2018 • Certified CEREC trainer 2018

[28] =>

28

NEWS

Dental Tribune Middle East & Africa Edition | 1/2019

Faculty of Dentistry, Oral & Craniofacial
Sciences at King's College London:
Celebrating rich histories and legacies
By King's College London
In 1998, the London hospital dental schools at the Royal, Guy’s, St
Thomas' and King’s merged with the
university of King’s College London,
uniting their rich histories and legacies to lead the way in dental education and oral & craniofacial research.
The Faculty of Dentistry, Oral &
Craniofacial Sciences at King’s College London celebrated the 20-year
anniversary of this merger in November with a party in London’s
Science Gallery, a commemorative
video, and the launch of an Inaugural Lecture Series.
Professor Jenny Gallagher, Dean for
International Affairs and NewlandPedley Professor of Oral Health
Strategy at King’s College London,
gave the first Inaugural Lecture with
an overview of her own career and
insights into the career of Frederick
Newland-Pedley, the namesake of
her Professorship.

Newland-Pedley was the pioneering
founder of academic dentistry and
the dental hospital at Guy’s in 1889,
and his legacy has benefitted generations of staff and students at Guy’s.
Professor Mike Curtis, Executive
Dean of the faculty said: “Jenny gave
a fascinating account of the life and
times of Frederick Newland-Pedley,
and his tremendous legacy in terms
of education, research and patient
care.”
Professor Gallagher is an honorary
consultant in Dental Public Health
with King’s Health Partners and, externally with Public Health England,
working to link research, education,
policy and practice.
Professor Gallagher’s research takes
a population health perspective to
serving the oral health needs of society, particularly vulnerable groups.
She has contributed to national and
international working groups and

is a past President of British Association for the Study of Community
Dentistry, the Odontology Section
of the Royal Society of Medicine and
Co-President of European Association for Dental Public Health. She is
involved in a range of global health
initiatives including working with
the World Health Organization. In
2015 Professor Gallagher received an
MBE for services to oral health.
Watch the 20th anniversary commemorative video here: https://bit.
ly/2ANpyd0

(L-R) Executive Dean Dentistry Oral & Craniofacial Sciences, Professor Mike Curtis; Senior
Vice President/Provost (Health, Professor Sir Robert Lechler; Professor Jenny Gallagher;
Vice President/Vice-Principal (International) Professor Funmi Olonisakin.

King's College London
London WC2R 2LS, England, UK
Web: www. kcl.ac.uk/dentistry
Tel: +44 (0)20 7836 5454

AD

Discover our range
of master’s level and
short courses.

Whose gnashers?
The form and
function of
mammalian teeth

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• Advanced Minimum Intervention
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• Masterclasses, short and CPD
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American Black Bear © The Royal College of Surgeons of England

By King's College London
Teeth are key to the survival of mammals, and knowledge of tooth form
and function is essential in mammalian biology.

RANKED NUMBER ONE IN EUROPE FOR
DENTISTRY QS WORLD UNIVERSITY
RANKINGS 2018

RANKED NUMBER TWO IN THE
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Find out more:
kcl.ac.uk/dental-postgraduate | dental-postgraduate@kcl.ac.uk | @KingsDentistry

Dr Barry Berkovitz, King’s College
London, and Dr Peter Shellis, University of Bern, have published a
new book ‘The Teeth of Mammalian
Vertebrates’ exploring the teeth of
all mammals based on material
gathered from global museums and
researchers, and drawing on the authors’ knowledge acquired over 40
years of teaching and research experience in dental anatomy.
There has recently been a resurgence
of interest in several aspects of comparative dental anatomy such as
function, the development of individual teeth and their arrangement.
Classically, teeth clearly exemplify
the relationship between form and

function, and mammalian dentitions provide an array of examples.
The book contains over 700 highquality photographs, x-rays, CT scans
and histological images, including
from the Royal College of Surgeons
archives, and explains how the structure and properties of dental tissues
support tooth function.
To celebrate the publication of ‘The
Teeth of Mammalian Vertebrates’,
King’s College London has created a
photo quiz. Take the quiz at https://
bit.ly/2Ft60yn and see how many
you can identify.
‘The Teeth of Mammalian Vertebrates’, was co-authored by Dr Barry
Berkovitz, Emeritus Reader in Dental
Anatomy, King’s College London,
and Dr Peter Shellis, Department of
Preventive, Restorative and Paediatric Dentistry, University of Bern, and
can be purchased from Elsevier.

[29] =>

Dental Tribune Middle East & Africa Edition | 1/2019

NEWS

Bluephase G4:
Ivoclar Vivadent has
developed the first ever
intelligent Bluephase
Stylish, reliable and clever: that’s Bluephase G4 – the
first Bluephase curing light featuring an automated
assistance system. For even better results.

The new Bluephase G4: carefree light-curing thanks to intelligent Polyvision technology

AD
By Ivoclar Vivadent AG
Sound materials and reliable equipment are indispensable for achieving successful direct and indirect
restorations. Here is something that
many are not aware of, though: the
precision with which the light-curing process is performed has also
a substantial effect on the durability of composite restorations. This is
where the Bluephase G4 - the latest
curing light from Ivoclar Vivadent comes in. The fourth generation of
the Bluephase family does not only
look stylish but it also offers a new
and uniquely user-friendly feature:
Polyvision technology.

Vibration alerts users to
application error
Polyvision technology enables the
Bluephase G4 to detect if the handpiece is moved during the exposure
process and if the restoration can no
longer be cured reliably. If this happens, the light emits a vibration alert
to inform the operator of the error
and, if necessary, automatically extends the exposure time by 10 per
cent. If the handpiece moves too
much – for example the light guide
slips out of the oral cavity - the light
automatically switches off so that
the curing procedure can be repeated correctly. The advantages for the
operator are: easy handling, discreet
assistance, reliable curing results and
satisfied patients.

A curing light that communicates with the operator
With its automated assistance system, the Bluephase G4 represents
a whole new generation of curing
lights that can do both: cure reliably
and communicate with their operators. The curing light offers a light
output of 1200 mW/cm2, polywave
LED technology in a broadband spectrum of 385 to 515 nm and a 10-mm
wide light guide with a homogeneous beam profile. These features allow an exceptionally efficient application to achieve high-quality results
in very short times.
Bluephase is a registered trademark
of Ivoclar Vivadent AG.

Ivoclar Vivadent AG
Bendererstrasse 2
9494 Schaan/Liechtenstein
Tel.: +423 235 35 35
Fax: +423 235 33 60
E-mail: info@ivoclarvivadent.com
Web:www.ivoclarvivadent.com

[30] =>

30

EVENT

Dental Tribune Middle East & Africa Edition | 1/2019

3M Oral Care Dental Programme Highlights
Impressions from the 3M Oral Care Symposium dental programme which took place in
Abu Dhabi on 04-05 October 2018. Over 200 dentists and orthodontists attended.

Robert Nichols, Managing Director at 3M Middle East and North Africa
opened the symposium with an overview of 2018.

Walid Feghali, General Manager at 3M Health Care Business Group during the introduction of the 3M Oral Care Symposium.

Over 200 dentists and orthodontists attended the two days parallel programme which included lectures and workshops at the Grand Hyatt Hotel &
Residences Emirates Pearl Abu Dhabi, UAE.

Dr Samer Aouad, Division Manager - Oral Care Solutions Division Gulf
region introducing the speakers.

Prof Louis Hardan from Lebanon presented a masterpiece workshop on
Composites.

Prof Louis Hardan lecturing on Direct Composite Restorations

Prof Ivo Krejci, Switzerland lectured on Dental Fitness - A modern type of
Dentistry aiming to keep the patient in good oral health.

The 3M Oral Care team was the driving force behind the success of the
symposium.

Dr Rasha Ahmed - Scientific Affairs Manager was the conference programme chair

During the questions and answers session, a large number of delegates stayed behind to get more information from the speakers.

Dr Galip Gurel, Turkey was the keynote speaker of the symposium lecturing on his famous The State-of-the-Art in Aesthetic Dentistry.

[31] =>

THE COMPACT
MAKES
A BIG
CHANGE
To help any user of air driven handpieces
conver t to electric and enjoy the full
b e n e fi t s o f i t s h i g h f u n c t i o n a l i t y. A b i g
change in treatment environment is
brought with only a minor addition to the
current equipment in your off ice.

ELECTRIC MICROMOTOR UPGRADING SYSTEM
*NLZ E ：with Endo Function

[32] =>

»What drives me? Best
results. And Primescan
is my answer.«
Dr. Verena Freier, Dentist

Primescan

Engineered for superior performance.
Innovation requires commitment to ambition: Primescan sets new standards in dental technology, making scanning
more accurate, faster and easier than ever. It is engineered to enable all kind of treatments, from single tooth to
full arch. Primescan produces highly accurate images and allows for fast scanning consolidating 50.000 images
per second. The new patented “High Frequency Contrast Analysis” delivers perfect sharpness and an outstanding
accuracy. With Primescan, intraoral scanning delivers excellent results like never before.
Enjoy the scan.
Learn more at: dentsplysirona.com/primescan

[33] =>

4/18

issn 2193-4673 • Vol. 14 • Issue 4/2018

roots
international magazine of

endodontics

opinion

3-D endodontic instrumentation:
Revision of a historical protocol

industry report

Strategies for the treatment of
extremely curved root canals

case report

Management of referred pain

Adapted to Nature
Single-file system
Shape memory alloy
Adaptive Core
Preserves dentine,
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ENDO DONE !

Discover our products on
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www.fkg.ch

[34] =>

[35] =>

[36] =>

X-Smart IQ® Handpiece
with Propex IQ® Apex Locator

Increase your IQ
X-Smart IQ®
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Endo IQ® App

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• Enhances the functionality of your
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• Easy access and excellent visibility

• Enables apical-reverse and shaping target
features (only with app)

• Quickly switch from reciprocating to
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dentsplysirona.com/iq

• Supports all iPad® sizes in landscape mode

Propex IQ® Apex
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80 grams

[37] =>

PUBLISHED IN DUBAI

January-February | No. 1, Vol. 9

www.dental-tribune.me

The many characteristics
of a long-term hybrid abutment crown
Viteo Base is the basis for the production of implant-supported single tooth restorations

By Marie Reinhardt, Liechtenstein
This article presents the new titanium bonding base Viteo Base for implant-supported single tooth restorations. The prefabricated prosthetic
component has been specially developed for use together with ceramic
restorative materials: Viteo Base has
various characteristics that simplify
the path to aesthetic, long-lasting
implant restorations. The prefabricated connecting surface geometries
are compatible with various implant
systems. Viteo Base can be processed
using the press technique (IPS e.max
Press) and, alternatively, with CAD/
CAM technology (Telio CAD, IPS
e.max CAD). In the present case, the
working steps involved in producing a pressed implant crown and the
advantages of the Viteo Base will be
shown.
Implant prosthetics is an ever growing segment. It is becoming more
and more popular to close single
tooth gaps with an implant and the
corresponding restoration in order
to preserve the surrounding tooth
substance. Modern prosthetic concepts and state-of-the-art materials
enable the fabrication of functional
and aesthetic restorations. Titanium
bonding bases unite the advantages
of a prefabricated component with
those of a custom-made abutment:
In a comparatively simple manner,
the natural oval shaped emergence
profile of the tooth is adapted to the
round emergence profile of the implant. The design of the restoration
and its connection to the underlying
titanium bonding base are ultimately the elements which are essential
for the success of the restoration.

Many characteristics,
specifically incorporated to enhance the restoration material
With the new Viteo Base, the dental
technician is provided with a titanium bonding base which ideally
compliments press and CAD ceramics (Fig. 1). This has numerous advantages, which will be discussed further
throughout this article. The special
soft edge design without sharp edges
and protrusions, the recessed rotation protection and the preconditioned bonding surface of the titanium bonding base are responsible
for these benefits. The connection
between the titanium bonding base
and the implant is certified and coordinated with the most commonly
used implant systems. Viteo Base is
available in two diameters: MD (Medium Design) and SD (Small Design).
The chosen implant system determines the diameter to be used. Infor-

mation on which implant system is
suitable for which Viteo Base; which
scan abutment is to be used; which
restoration material can be applied
and which Viteo Base components
are available, is provided in a special
combination table. This is available
on the Ivoclar Digital website.

Shortening from 6 to 4 mm
Depending on the prosthetic situation, the Viteo Base can be shortened
from 6 mm to 4 mm. This is carried
out easily using a separating disc. A
special tool, the Viteo Base Trimmer,
restores the soft edge design (rounded design for even force distribution)
after the shortening process. The following case study illustrates this procedure: A hybrid abutment crown is
produced using the press technique
in the usual manner. The crown is
created in wax on the titanium base
according to the respective clinical
situation, then converted into press
ceramic and cemented to the Viteo
Base before being screwed into the
patient’s mouth.

when it is cemented to the restoration material and it acts as a “guide”.
In addition, the minimum thickness
of the restorative can be maintained;
the cement gap is even throughout
the restoration. Stress can therefore
be avoided.
The space available in relation to the
antagonist tooth was ideal for the
full-ceramic crown supported by a
6-mm titanium bonding base (Fig. 3).

In other cases, it may be necessary to
reduce the height of the Viteo Base
to 4 mm with a separating disc. The
shaft height must be no less than
4 mm. This is laser-marked on the
abutment shaft.
The Viteo Base Press Sleeve, a modelling aid made from acrylic, is used
to support the wax crown. The adhesive surface of the titanium bonding
base is preconditioned, which means

it is too rough for the wax to be applied directly. This is where the Viteo
Base Press Sleeves come into play.
As with the titanium bonding bases,
they are available in two sizes (SD,
MD). In this case the sleeve diameter
was size MD, to suit the selected Viteo Base (Fig. 4). The Viteo Base Press
Sleeve was then shortened with a

ÿPage B2

Starting situation in
the laboratory
An osseointegrated implant in region 46 required a full ceramic
crown. The soft tissue was optimally
shaped during the healing phase
with a temporary restoration (Telio
CAD). This was the ideal preparation
method for an implant-supported
crown made from IPS e.max Press.
A screw-retained crown was selected
in order to avoid any risk of residual
cement. The master model was produced from the implant impression.
A gingival mask was created to allow
an exact assessment of the soft tissue
situation and the emergence profile.
The press technique was selected for
this case, which meant that the modelled tooth shape and the occlusion
could be transferred directly into the
ceramic. In order to benefit from a
high degree of material strength and
good aesthetics, a monolithic restoration was selected.

The
original

Preparation
The titanium bonding base Viteo
Base was chosen according to the implant system in size MD, then placed
on top of the laboratory implant and
screw-fixed with a torque of approx.
5 Ncm (Fig. 2). The recessed anti-rotation protection (vertical groove) was
positioned distally in the jaw for the
production of the restoration. The
Viteo Base can also be positioned in
a mesial direction. The recessed antirotation protection is located vertically throughout the entire length of
the shaft. It ensures that the titanium
bonding base is situated correctly

All ceramic,
all you need.

www.ivoclarvivadent.com
Ivoclar Vivadent AG

Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60

[38] =>

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2018

◊Page B1

Fig. 1: The assortment: Viteo Screw Channel Pin,
Viteo Base Press Sleeve, Viteo Base, Viteo Screw, (from
the left),

Fig. 2: The Viteo Base MD screwed together with the
laboratory implant

Fig. 3: Starting situation with the titanium bonding
base on the model

Fig. 4: Viteo Base with the unshortened Viteo Base
Press Sleeve in place

Fig. 5: Shortening the Viteo Base Press Sleeve with
the separating disc

Fig. 6: Isolating the Viteo Screw Channel Pins to
lengthen the screw channel

Fig. 7: Carving of the crown in wax

Fig. 8: Checking the wax crown for shape and function on the model

Fig. 9: The wax crown lifted from the Viteo Base

Fig. 10: Spruing the crown in preparation for the
pressing procedure

Fig. 11a: Checking the position of the crown in the
ring base with the IPS Multi Sprue Guide.

Fig. 11b: IPS Multi Sprue Guide

Fig. 12: In preparation for pressing: IPS e.max Press Multi ingot, disposable plunger, aluminium oxide plunger

diamond separating disc (Fig. 5). The
fit of the press sleeves on the titanium base in the region of the screw
channel and margin was thoroughly
checked. In order to ensure that the
wax can be simply lifted off later on,
the titanium bonding base was first
isolated in the area of contact to the
Press Sleeve.

Waxing-up the crown
The crown in region 46 was waxedup according to the required shape,
morphology and function. For this
purpose, the screw channel had to
be lengthened in the occlusal area.
A special pin (Viteo Screw Channel
Pin) made of acrylic was inserted
directly into the screw channel.
This also protected the screw channel from contamination. After the
crown had been waxed-up, the pin
was simply removed. The detailed
occlusal surface was left undamaged.
The pin was isolated before being
inserted into the screw channel and
the crown was subsequently carved
in wax (Figs. 6 and 7).
The crown was waxed-up in the
conventional manner, taking both
dynamic function as well as static
occlusion into consideration (Fig. 8).
The wax crown was lifted easily from
the titanium base (Fig. 9). Time and
effort invested in this working step
proves worthwhile after the pressing
process: The more detailed the wax
pattern is, the less rework is necessary on the pressed restoration.

Fig. 13: Cooling the ring down after pressing

Transferring the wax crown
into ceramic
Lithium-disilicate glass ceramic
IPS e.max Press is well proven for
good press results in ceramic. High
strength of 470 MPa, exceptional
esthetics and excellent light-optical
properties ensure a life-like restoration. The polychromatic press ingot
IPS e.max Press Multi, with lifelike
graduating colour and translucency
from the dentin structure to the incisal edge, gives monolithic restorations the desired aesthetic appearance. In general, after pressing, the
restoration only requires glazing or
it can be customized with the IPS
Ivocolor stains.

The versatile Press Multi ingot
The IPS e.max Press Multi ingot
has significantly more chroma in
the lower region than in the upper
third. A special spruing technique is
used in order to ensure that the ingot’s colour layers are in the correct
position on the crown after pressing. For this purpose, the waxed
crown was connected to the side of
the ring base. Instead of wax rods, a
prefabricated precision wax pattern
(IPS e.max Press Multi Wax Pattern)
was used. The wax crown was positioned vertically centred to the wax
pattern and attached at the mesiobuccal side, so that an optimal colour
graduation could be achieved in the
visible area (Fig. 10). The crown was
sprued onto the 200-g IPS Multi ring

base. The occlusal surface of the wax
crown was pointed towards the bottom of the ring base. The sprue position was checked with the IPS Multi
Sprue Guide 200 g (a type of template) (Fig. 11).

New investment material used
The object was invested using a new
investment material: IPS PressVest
Premium. After mixing, investing
and setting, the ring was placed in a
preheating furnace (850 °C) for 60
minutes. The press ingot (IPS e.max
Press Multi, shade A 3.5), the disposable plunger and the aluminium
oxide plunger (IPS e.max Press Multi One Way Plunger and IPS Alox
Plunger) were then placed into the
preheated furnace (Fig 12). The ingot
and the plungers were not preheated. After placing the assembled press
ring into the preheated press furnace
(Programat EP 5010), the pressing
program was started.
After pressing, the ring was removed
from the furnace and allowed to cool
slowly (Fig. 13). Using glass blasting
beads, the ring was first divested
roughly (4 bar pressure) and then
finely (2 bar pressure).
The fit of the pressed crown on the
Viteo Base was checked. In this case,
the crown was a little too tight; it
was adjusted with a diamond grinding bur (Fig. 14). The crown was then
screwed onto the master model together with the titanium bonding

Fig. 14: Fitting the ceramic crown on the Viteo Base

base. The proximal contact points were checked,
along with the static and
dynamic occlusion. Any
interfering contacts were
removed before the try-in
in the mouth.

Fig. 15: For better handling, the Viteo Base, screwed
onto the laboratory implant, was attached to the
Viteo Holder and then silicone was applied for the
first clinical try-in.

Trying-in the hybrid
abutment crown in
the mouth
Before the ceramic crown was permanently cemented with the Viteo
Base, there was a clinical try-in. The
two parts were temporarily attached
to each other with a thin flowing impression silicone (Virtual Extra Light
Body Fast Set). The titanium bonding
base was screwed to the laboratory
implant. In this case, the Viteo Holder made handling easier.
The ceramic structure was then
placed correctly on the Viteo Base
and the position was marked with
a water-resistant pen. The two parts
were then separated from one another and cleaned with the steam jet.
Then the screw channel of the Viteo
Base was closed with the Viteo Screw
Channel Pin. The silicone (Virtual Extra Light Body Fast Set) was applied
to the adhesive surfaces of the Viteo
Base and the pressed ceramic structure. Both objects were then reconnected into the correct, previously
marked position (Figs 15 to 17). Excess
material was carefully removed with

an instrument after the silicone had
set (Fig. 17).

The try-in confirmed
the good fit
In the clinical try-in, the dentist
checked the emergence profile, the
proximal contacts and the occlusion of the crown. The try-in in the
patient’s mouth confirmed the good
fit of the restoration. Note: The lightoptical properties cannot be assessed
during the try-in. Firstly, the ceramic
is still matt at this time as it is still unfinished. Secondly, the permanent
luting composite (Multilink Hybrid
Abutment) has different degrees of
translucency, through which the
Viteo Base visually “disappears”. Regardless of these limitations, it was
apparent that IPS Ivocolor stains
would be needed to optimally adjust
the shade of the crown’s occlusal surfaces to adapt to and harmonize with
the surrounding teeth.

ÿPage B3

[39] =>

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 6/2018

◊Page B2

Fig. 17: Removing the excess silicone after setting

Figs 18 to 19: Characterization of the ceramic crown with the universal stain and glaze assortment of IPS
Ivocolor

Fig. 20: These instruments are required for luting the
Viteo Base together with the ceramic object.

Fig. 21: Conditioning the surface of the titanium bonding base

Fig. 22: Etching the bonding surface of the ceramic object.

Fig. 23: Applying the luting composite

Fig. 24: Removing the excess material during the setting phase

Fig. 25: Carefully polishing the joint

Fig. 26: Polishing the crown after insertion

Finishing the crown/individualization
The pressed IPS e.max crown was
stained with the universal stain and
glaze range of IPS Ivocolor (Fig. 18). A
warm colour was applied to the central fissure to give the impression of
depth. The cusp tips were accentuated with white (Fig. 19). A wash of blue
stain was gently added to the incisal
area to intensify the translucency of
the crown. After the stains had been
fired, the IPS Ivocolor Glaze Paste was
applied to the crown and Glaze firing
was carried out. The contacts were
then checked again in the articulator.

Permanent cementation of
the prosthetic implant restoration (Fig. 20)
The cementation process of a ceramic crown and titanium bonding
base is a delicate working step, which
requires high precision. Since the
Viteo Base is already preconditioned,
it does not have to be sandblasted
before cementation. This saves one
working step and therefore saves
time. Nevertheless, this does not apply if the abutment was shortened.
The shortened surfaces have to be
re-sandblasted in order to achieve an
ideal bond and a good marginal seal.
In this case, however, the Viteo Base
was used with a 6-mm shaft height
and was not shortened. The titanium bonding base was immediately
cleaned in the ultrasonic bath and
then additionally steam cleaned. In
doing so, all wax residues and other
impurities could be removed thoroughly prior to the bonding procedure. A uniform matt surface colour
showed that the drying and conditioning process was successful.
As with the temporary placement
procedure, the titanium bonding
base was cemented on the laboratory implant and placed in the Viteo

Holder for easy handling. The ceramic object had been previously
marked with a water-resistant pen
for correct positioning and subsequent bonding with the Viteo Base.
The universal primer Monobond
Plus ensures optimal bonding to the
metal. It was applied to the bonding surface of the Viteo Base and allowed to act for 60 seconds (Fig. 21).
Any excess was dried with oil-free
compressed air. Etching gel was applied to the bonding surface of the
ceramic object (IPS Ceramic Etching Gel) (Fig. 22), then the area was
thoroughly rinsed and dried. Next,
Monobond Plus was applied to the
ceramic surface and allowed to act
for 60 seconds. Any excess was
blown away. Alternatively, the innovative single-component primer
Monobond Etch & Prime can be used
here: It etches and silanizes the glassceramic surfaces in one working
step. Before cementation, the screw
channel had to be closed in order to
prevent composite residues from
falling into it. The Viteo Screw Channel Pin was used for this purpose. For
easier handling, this was shortened
and then inserted into the Viteo Base
screw channel.
The IPS e.max Press ceramic structure was bonded to the Viteo Base
using the Multilink Hybrid Abutment self-curing luting composite,
which is specially developed for the
permanent cementation of ceramic
structures to titanium/titanium alloy bases. It is available in two levels
of translucency. In this case we used
the version with a higher degree of
opacity (HO 0) (Fig. 23). The Multilink
Hybrid Abutment composite was
applied to the bonding surface of the
Viteo Base and to the inner surfaces
of the ceramic object. Thanks to the
previously applied pen mark, both
components could be easily placed
in the correct end position. The ro-

tation protection, which runs along
the entire length of the shaft, acted
as a guide.
Both components were firmly
pressed together for five seconds.
Any excess composite – a gel-like
consistency – was removed with
an instrument during the setting
phase (Fig. 24). The application of
Liquid Strip glycerine gel on the joint
prevented an inhibition layer from
forming during setting. After seven
minutes, the glycerine gel was rinsed
off with water and the Viteo Screw
Channel Pin was removed from the
screw channel. Finally, the joint was
carefully smoothed over with a fine
rubber polisher at low speed (<5000
rpm) and gentle pressure. In order to
leave the connection to the implant
as untouched as possible, it is advisable to leave the Viteo Base in the
Viteo Holder, or at least screw it onto
a laboratory implant. The restoration
was polished with goat hair brushes
and universal polishing paste (Fig.
25). A smooth and homogeneous
surface is important, so that the gingiva can adapt properly to the restoration.

Inserting the prosthetic
implant restoration
The assembled and cleaned hybrid
abutment crown was prepared for
insertion in the mouth. It is advisable
to autoclave the hybrid abutment
crown prior to intraoral insertion.
The temporary Telio CAD restoration in region 46 was removed by
the dentist, the implant lumen was
flushed (Cervitec Liquid) and the
peri-implant tissue (emergence profile) was examined. The crown was
screwed to the implant using the
originally packed Viteo Screw. It was
tightened according to the torque
specified by the manufacturer. By
screwing the crown in place instead
of cementing it, the risk of cement

residues in the peri-implant area
could be excluded. The screw channel in the occlusal area was sealed
with the light-curing esthetic composite IPS Empress Direct.
The restoration adapted harmoniously to the surroundings in the
mouth in terms of its shape, shade
and function. The emergence from
the soft tissue corresponded to that
of the natural dentition thanks to the
prepared emergence profile and the
individual design of the structure
(basal).

Conclusion
Ideally coordinated with
ceramic materials
The Viteo Base is ideally suited for
use with ceramic materials: It helps
to avoid chipping problems, the
lack of or weakness of a bond or inadequate force distribution. One of
the advantages of the Viteo Base is
the special soft edge design without
sharp edges and protrusions, which
on one hand strengthens the restoration material and on the other hand
provides optimal force distribution
under pressure.
The preconditioned, in other words
sandblasted surface saves an additional working step and therefore
saves time. In combination with
the appropriate composite system,
it ensures a secure connection of
the titanium base and the restoration material. This is a key factor
for the longevity of the restoration
and its integration into the oral environment. Due to the industrial
preconditioning the surface of the
Viteo Base is very uniform. Together
with the appropriate composite (e.g.
Multilink Hybrid Abutment), it ensures a permanent marginal seal.
The recessed rotation protection
means the cement gap is very even.
Compressive or tensile stresses are

avoided. The restoration material is
strengthened.
In addition, the Viteo Base’s shaft
height can be easily adjusted to suit
the prosthetic restoration: It can be
shortened from 6 mm to 4 mm. As
a result, optimal support of the restoration material is achieved by the
titanium bonding base. The restorative material and the Viteo Base together form a coordinated unit and
are the basis for clinical success.
In the production of an implantsupported single-tooth restoration,
the Viteo Base components enable a
smooth manufacturing process. In
this present case, a hybrid abutment
crown was produced in IPS e.max
Press using the press technique. The
ceramic crown, produced in the conventional manner, was cemented to
the Viteo Base. The recessed rotation
protection acted as a guide. An ideal
bond was achieved with the appropriate materials for conditioning and
placement. The hybrid abutment
crown was screwed in place in the
mouth. It fits harmoniously into the
overall appearance of the mouth.

Marie Reinhardt, DT
Schaan/Liechtenstein

[40] =>

[41] =>

PUBLISHED IN DUBAI

www.dental-tribune.me

January-February | No. 1, Vol. 9

Interview: “It is not magic—it is not
going to make the diagnosis for you...”
By Dental Tribune MEA
The Ormco Forum Dubai 2018 took
place from 06 to 08 December 2018
at Palazzo Versace, Dubai, UAE
Dental Tribune had a pleasure to ask
the key speakers of the Ormco Forum Dubai 2018 about the Damon
System.

Could you please share
more about yourself?

Dr Firas Hamzeh: I am simply an orthodontist, working in a private practice in Dubai, who has a special interest in digital orthodontics and all the
new concepts in orthodontics. I am
always willing to give the best treatment options to my patients. Over
the past few years, I have become
an educator for Damon System and
Insignia and I started spending more
time educating other doctors and
sharing my clinical experience with
them.
Dr Bill Dischinger: I am a licensed
orthodontist in the United States
of America and I received my certification in 1999. I have two private
orthodontics practices in the northwest area of America. I also teach at
the University of the Pacific’s Orthodontics Department in San Francisco.
Dr Matias Anghileri: I am from Buenos Aires, Argentina. I am married to
a dentist and we have been together
since our first year at university. We
have two kids, aged 6 and 8. I have
been a full practice orthodontist for
the past 16 years. I am the third generation of dentists in my family and
I enjoy my work every day in my office, as well as my work as an educator.

When did you first hear
about the Damon System?

Hamzeh: It was in 2003, and I started
using the Damon System in 2004. A
few years later I became an exclusive
Damon user.

Dr Firas Hamzeh

Dischinger: I first heard about the
Damon System—as presented by
Dr Damon himself—during my
residency in 1998. It was an amazing
paradigm shift with regards to my
way of thinking about orthodontics.
Anghileri: It was 15 years ago at a conference. I was completely amazed by
the system and its results.

What prompted you to
provide it as a solution in
your practice?

Hamzeh: It is the quality of treatment that we got at the end and the
entire Damon System philosophy
that made me change my mindset
of how I was treating my patient. I
especially like the concept of using
light forces, reducing the number of
extractions in my practice and the
quality of the finishings.
Dischinger: Immediately after hearing Dr Damon teaches about his system, I decided that it was how I was
going to treat my patients. From the
viewpoint of pure biology—of how
to move teeth in a healthy, non-invasive manner—the system just made
sense to me and I wanted to use that
effectively in my practice.
Anghileri: I felt that by using the
Damon System I was going to provide better results to my patients in
a shorter time.

Could you explain what
Damon braces are?

Hamzeh: I do not call them Damon
braces, in fact, I call it the Damon
System. I do not deal with the braces
as a new product or as a new bracket
with special features—it is a philosophy and a new treatment concept. If
we use the Damon braces, we should
use the Damon protocol and the Damon mechanics, because if we use
the Damon braces with traditional or
conventional mechanics, we will not
obtain the results we are aiming for.
With the Damon System, we apply
very light forces to the teeth that are
very close to the physiologic forces.
Considering both aesthetics and

Dr Bill Dischinger

functionality at the same time, we
reduce the treatment time with less
sessions and more clinical efficiency.
One more point worth mentioning,
is that we do not only treat teeth and
jaws, we treat faces, which is why we
call it “face-driven orthodontics”.
Dischinger: Damon braces are a
type of brace that holds the wire in
place using a gate or a door system
rather than the wire having to be
“tied into” the brace. By doing this,
the amount of friction that the braces and the wires have within their
system is reduced. If the system has
less friction within it, then the wires
do not have to be so strong or have
to apply as much force to move
the teeth, since they do not have to
overcome all that friction. It is kind
of like moving furniture on a carpet; compared to moving furniture
over hardwood or tile flooring. Think
about the force you would need to
push the furniture across in each of
those instances.
Anghileri: Damon braces are, from
my point of view, a turning point in
modern orthodontics. Undoubtedly,
self-ligating brackets are the present
and future of our specialty. Since the
launch of the first version in 1996, we
have seen that every company has
developed this type of bracket.

What are the main advantages of the system?
Hamzeh: The main advantages of
the Damon System are a reduction
in treatment time with less sessions
and a reduction in the number of
extractions. No headgear or expanders are required (as with traditional
braces) and the improved aesthetics
and functional results of the system.
Dischinger: As mentioned above,
the force required to move the teeth
with the Damon System is much
lower than with traditional braces.
This leads to less inflammation within the teeth, bone and gums, which
allows the teeth to move more efficiently, with little or no damage
done to the body during the process.

Dr Matias Anghileri

The teeth hurt less with this process
(I know as I have had both types of
braces in my mouth). This leads to
a healthier, more biologically sound
way of moving the teeth, in my opinion.

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international magazine of orthodontics

technique

Accelerated treatment modalities
in clear aligner treatment

industry report

Anghileri: Well, I think in your
question is the answer. It is not just
a bracket with a door. It is a system
with three pillars—the three main
concepts of the Damon philosophy—using low forces and prioritising facial features, using high-technology Copper NiTi archwires and
finally, the solid bracket with more
than 20 years of evolution behind it.

What is the main difference between the Damon
System and other traditional braces?

Indirect bonding: Digital technique
vs conventional method

industry report

Hybrid Aligner Therapy

some doctors are hesitant to change.
We have many patients come to our
office, because they are searching
for a more natural way—a healthier
way—of moving teeth or they have
heard of the Damon System or have
done research on it online. It has
helped our practice to be known as
one of the foremost Damon System
practices in the world.

Hamzeh: A lot of the mechanics are
different from traditional braces,
but the main difference lies with the
philosophy of the Damon System.
For example, with Damon System
braces we use very light elastics on
light wires from the very beginning,
which we cannot do with traditional
braces. We also use variable torque
for the front teeth—based on each
individual’s case—which we cannot
do with traditional braces.

Anghileri: Many patients come to
my clinic asking for the Damon System, because they have seen the results on other former patients. When
they start a Damon treatment with
me, they know there is a guarantee
of success.

Anghileri: We have to understand
that the biology is always the same.
A bracket or a system will not change
that. However, I see the same positive results every day in each and
every one of my patients: teeth
move faster and healthier, because
of the low forces acting on them. The
treatments turn out to be simpler
and more comfortable for the patient—with reduced treatment time.

Hamzeh: I would encourage every
orthodontist to use the Damon
System, but not with the same conventional mechanics that were used
before. Follow the Damon System’s
treatment protocol and use its mechanics and compare the results
and treatment time with previous
results. Of course you cannot apply it
only to a few cases, you need to treat
more and more Damon cases. We
keep learning from our mistakes and
the mistakes of the others, which
is also why we attend the Damon
courses.

What are the overall results of using the Damon
System in a practice, not
just clinically, but also in
terms of patient loyalty?

Hamzeh: Using the Damon System
improves the entire patient journey
during their orthodontic treatment.
You will also end up treating more
patients, because you spend less
time and less sessions on the treatment, which affects the practice’s
productivity, allowing the orthodontist to treat more and more new patients, which would result in a better
reputation.
Dischinger: When we explain the
Damon System process to patients,
it just makes sense to them. They
often ask us why is it that everyone does not use this system. Our
answer is that it is more expensive
than traditional braces and there is
a learning curve required to get comfortable and knowledgeable in using
the system, because of these reasons,

What would you say to
your colleagues who are
hesitant about using the
system?

Dischinger: Look at the biology of
moving teeth. We are in the health
care world and we need to do everything we can to move teeth in the
most efficient, healthiest way we
can. Take courses that teach you how
to use the system and try some cases
with it. You will immediately see the
difference in how the teeth move, in
the comfort to the patient and the
overall efficiency of the cases being
treated. Do not be afraid to make a
change.
Anghileri: It is not magic—it is not
going to make the diagnosis for
you—but I can assure you that if you
are a good orthodontist, with the Damon System in your hands, you are
going to achieve wonders in your
patients.

[42] =>

ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 1/2019

Six keys to effectively using alveolar corticotomy
A different perspective on surgically assisted tooth movement

research

Tab. 1: Surgical protocols for performing alveolar corticotomy.

By Dr Raffaele Spena, Italy

Introduction
Alveolar decortication (corticotomy)
has long been used with orthodontic
treatment in order to accelerate orthodontic tooth movement (OTM)
while reducing the undesired effects
of root resorption, loss of vitality,
periodontal problems and relapse
of the corrections. The acceleration
of tooth movement should shorten
the therapy. However, the scientific
and clinical assumptions of the early
days were totally different from the
more recent ones: we moved from a
pure mechanical approach to a biological and physiological one.
In 1983, Suya1 proposed a great improvement of the surgical approach
described in 1959 by Kole2 modifying the horizontal osteotomy in a
corticotomy, avoiding the alveolar
crest in the vertical cuts and eliminating the luxation of the blocks.
He proposed this “corticotomyfacilitated orthodontics” to treat adult patients, ankylosed teeth and crowded
malocclusions to avoid premolar
extractions. Like Kole, Suya believed
he was creating bony blocks and
suggested accomplishing most of
the movements in the first three to
four months of treatment before the
fusion of the blocks (healing of the
bone).
The concept of corticotomy-assisted
OTM drastically changed in 2001
after the publication of Wilcko et
al.3 In this key case report, two adult
patients received a selective corticotomy, along with alloplastic resorbable grafts, to increase the bone level
and avoid the risk of recessions. An

Fig. 1

Fig. 4

accurate evaluation with CT scans
before and after treatment, and
histological sections in one case, allowed the authors to formulate a
new hypothesis about what really
happens at the bone level after corticotomy. No movement of tooth–
bone blocks, but a transient reduction of mineralisation of the alveolar
bone and modifications similar to
those described by Frost4–7 during
the healing of fractured bones and
named “regional acceleratory phenomenon” (RAP) most likely occur.
The surgery -orthodontic protocol
proposed by Wilcko et al.3 has been
subsequently patented as Periodontally Accelerated Osteogenic Orthodontics (PAOO). The claims of PAOO
are (a) accelerated tooth movement
with reduction of the total treatment
time; (b) osteogenic modifications
with transportation of the bony matrix, and final improvement of hardand soft-tissue support of the teeth
treated orthodontically; (c) increase
of the short- and long-term stability
of the orthodontic treatment. So far,
scientific evidence has been given
only on the acceleration of tooth
movement that is transient, and lasts
as long as there is a RAP modification
in the alveolar bone surrounding the
teeth.
After more than one and a half decades of clinical experience with alveolar corticotomy, in light of the
current literature published on this
topic, six rules have been established
that should be taken into account
when considering using alveolar corticotomy in a complex orthodontic
case. These keys are the best way to
ensure effectiveness and reduce the
risk of producing no positive effect

or, worse, causing damage. The six
keys are as follows:
1. Alveolar corticotomy is to facilitate
OTM.
2. Alveolar corticotomy has limited
effect in time.
3. Alveolar corticotomy has limited
effect in space.
4. A proper surgical procedure must
be followed.
5. Proper orthodontic management
after corticotomy must be performed.
6. Proper patient selection for corticotomy is essential.
A detailed description of each rule
follows.
1. Alveolar corticotomy is to facilitate orthodontic tooth movement
(Periodontally Facilitated Orthodontics)
Speed is a fascinating issue in life.
We like to go fast in cars, motorbikes,
boats, airplanes and so forth. Speed
in orthodontics is a different matter. It is one of the main objectives
of modern orthodontics to reduce
treatment time, but we must recognise that a great number of variables
may affect it.8–11
The initial difficulty of the malocclusion and tooth malposition, the
age of the patient, the variability of
the individual response to the treatment, the quality of the end result,
and the patient’s compliance are just
a few of the variables that should
be considered. Numerous case reports have been published showing
how treatment time can be reduced
when patients are treated with corticotomy. Case reports, however, have
limited scientific validity.

Fig. 2

Open-flap corticotomies

Flapless corticotomies

· Periodontally Accelerated Osteogenic Orthodontics

· Fiberotomy

· Segmental corticotomy

· Corticision

· Any corticotomy performed during an open-flap surgery

· Piezocision
· Micro-osteoperforations

Tab. 1: Surgical protocols for performing alveolar corticotomy.

The predictability and quantifica- reducing treatment time: the risk of
tion of treatment time reduction not obtaining either as desired may
are still not scientifically possible. be high.
The additional expenses and morbidity associated with the use of Despite this scientific evidence
alveolar corticotomy should always against its major claims, alveolar corbe carefully evaluated to determine ticotomy has its place in orthodontic
whether they are worth the saving of therapy. Let us consider the surgical
few months. A shorter orthodontic insult and the associated RAP reacFig. 5
Fig. 6
treatment
is desirable, but certainly tion produced at a biomechanical
not at the expense of a high- quality level: the increased metabolism, the
ticotomy is performed only on the buccal side and middle
in association with the decortication. Piezo-surgical
reduced regional density
end
result.
third of the roots.
calibrated
micro-saws are preferred to rotating surgical transient
burs because of their selective, safer, micrometric and (osteopenia) created by the increased
They are definitely not minimally invasive surgeries as
more precise cuts; better irrigation/cooling effect from
activity, the reduced unRegarding
OTM, numerous studies osteoclastic
claimed and are quite expensive for the patient, since
cavitation; better comfort for the surgeon; and better
dermining
resorption
and
hyalinihave
shown
that
its
speed
is
influonly a well-trained periodontist/oral
surgeon
can perform
healing for the patient. The open-flap corticotomy prothem
and
they
often
require
complex
planning
with digicedure
is
routinely
used
during
orthognathic
surgery,
enced by bone turnover and the indi- sation (we still do not know exactly
tally designed 3-D surgical guides.
when exposing impacted teeth, to treat transverse maxwhat happens in humans) facilitate
vidual
response
to mechanical
illary deficiencies
and periodontally
involvedforces
cases.
The The
Micro-Osteo-Perforations
(MOPs) is
described
decorticated tooth
less by
and it is not related to the level of the OTM.
Flapless surgery has been proposed as an alternative
Alikhani et al. and Teixeira et al. are an effective and minto orthodontic forces and
forces.12–15
Clinical experience con- resistant
way of performing a corticotomy. Corticision and Piezoimally invasive way of producing insult to the cortical alveobe These
easier
tomay
move
andwithwill
re-instrufirms
there
slow
movers
lar bone.
MOPs
be created
manual
cision this:
have been
an are
attempt
to reduce
the and
invasive- will
ments (Excellerator,
Propel Orthodontics)
or with
ness of
the decortication
and
thestill
possible
less anchorage.
Spena et
al.dedicated
in
fast
movers,
but we
are
far periodontal
from quire
burs on a reduced-speed electric handpiece (Fig. 5).
damage and postoperative discomfort with raising a flap.
recognising
them. In addition to this two studies conducted on a total of 12
Even if attractive, they seem to have surgical and biomepatients
withwith
Class
II maloccluchanical limitations.
MOPs
are produced
a penetration
in the cortex
variability,
there is the temporary ef- adult
of a maximum of 1–2 mm. Instead of conventional local
fect of alveolar corticotomy, which sions treated with distalisation of the
anaesthesia, a strong anaesthetic gel placed on the
The surgical limitations include risks when pershowed
howtomaxwe
will
underlimited
the third
mucosa for molars
three minutes
is sufficient
control the
formed
in discuss
crowded arches,
visibilitykey.
whenApro- maxillary
patient’s
pain
and
discomfort.
It
is
advisable
to produce
ducing
the
cuts,
limitation
of
the
cuts
to
the
interfaster treatment may be a secondary illary molars could be bodily distaltwo to three MOPs in each interproximal area of the teeth
proximal areas and to the middle third of the
with simple buccal mechanics
advantage
and may be obtained in a ised
and both buccally and lingually (Fig. 6), to ensure that the
roots, difficult control of the grafting in the apicono anterior
anchorage.16,
17 entire
Cor-radicsubstantial
only
in those
“simmetabolic
changes are
extended around the
coronal direction way
and need
for optimal
extension
of the and
ular alveolarwas
bone.performed
Manual MOP isonly
usuallyon
created
attached gingiva in the area of decortication. The biome- ticotomy
the in the
ple”
orthodontic cases that require a
frontal areas, whereas drilled MOP is usually performed
chanical limitations are strictly related to the fact that corteeth
be moved,
thus
reducing
naturally short treatment.
in the to
posterior
and lingual
areas
(Figs. 7–9).the
The proanchorage needs and their resistance
In conclusion, alveolar decortica- to distal forces.
ortho
tion should not be combined with
1 2018
orthodontic treatment with the only The term “Periodontally Facilitated
objective of accelerating OTM and Orthodontics”, instead of “Periodon33

Fig. 3

Fig. 5

Fig. 6

tally Accelerated Osteogenic Orthodontics”, is used to describe a procedure that has the primary goal of
simplifying, enhancing and improving OTMs that are difficult or risky,
from a biomechanical and biological
point of view. The surgical procedure
and the associated orthodontic treatment and biomechanics depend on
the initial problems and the goals of
every single specific treatment. This
is in agreement with Oliveira et al.:
corticotomies should be used to “…
facilitate the implementation of mechanically challenging orthodontic
movements and enhance the correction of moderate to severe skeletal
malocclusions”.18
2. Alveolar corticotomy has limited
effect in time
Since the early studies of Frost on
the biology of fracture healing, it is

Fig. 7

Fig. 8

Fig. 9

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◊Page E2
known that the altered metabolism
of bone after a traumatic (or surgical) event has limited duration: it is
the natural search for equilibrium or
homeostasis.
The burst of hard- and soft-tissue
remodelling starts a few days after
the insult, peaks at the first or second month, and returns to a normal
pace after a maximum of four to six
months. This RAP reaction, when applied to the alveolar bone, causes an
accelerated/facilitated movement
of the teeth subjected to applied orthodontic forces. The effect lasts for
as long as there is this reaction, so
for a limited part of an orthodontic
therapy. This has been confirmed

by experimental studies on animals
and by clinical studies on patients.19
Clinically, this temporary phenomenon leads to the need to perform the
alveolar corticotomy when the RAP
is necessary. Timing is fundamental.
Alveolar corticotomy may be repeated during the treatment with the
objective of prolonging the effect.20
The effective benefit, cost and risks
must be taken into account. Sanjideh et al. in a split-mouth study on
foxhounds found that a second corticotomy performed after 28 days in
the mandible produced a higher rate
of tooth movement and a greater
total tooth movement.21 However,
they concluded that proper timing

for a second corticotomy needed to
be better determined.
Wilcko,22–24 Dibart25 and Murphy26, 27 claimed that continuously
activated orthodontic forces applied
after decortication may maintain a
constant mechanical stimulation,
and allow a prolonged osteopenic
state during which teeth can be
moved rapidly.
In order to achieve this effect, they
recommended seeing patients frequently (every two weeks) and continuing the activation of the applied
orthodontic forces. If not, remineralisation would complete the healing process and bring the bone me-

tabolism to a normal level. It must
be said that these claims have never
been demonstrated either clinically
or histologically.
3. Alveolar corticotomy has limited
effect in space
The effects of alveolar corticotomy
are localised to the area immediately
adjacent to the site of injury.28 This
finding is of outmost importance.
Different surgeries may affect differently the resulting OTM. Glenn
et al.29 and Tuncay and Killiany,30
in two experimental studies on
animals published before the new
trend on corticotomy, found that
fiberotomy (a corticotomy limited
to the crestal side of the alveolar

Fig. 10

Fig. 11

Fig. 12

Fig. 13

Fig. 14a

Fig. 14b

Fig. 14a

Fig. 13

ÿPage E4

Fig. 17

Fig. 18c

Fig. 18b

Fig. 18a

bone) affected the rate of OTM and
shifted the centre of rotation toward
the apex of the roots, thus modifying the biomechanical behaviour
of the teeth under the orthodontic
forces. If the surgical insult is applied
to a limited area of the alveolar bone
(i.e. middle third and only buccal surface; Fig. 1), the RAP reaction will not
be extended to the entire root area.
The modifications at the bone level
will be limited at the area of the decortication, and control of the apical
and lingual sides will not be influenced as desired.

Fig. 19a

Fig. 19b

Fig. 19c

Fig. 19d

Fig. 20

Fig. 21a

Fig. 21b

Fig. 22c

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◊Page E3
tion has to be managed and when an
extended grafting is planned.

Fig. 22a

Fig. 22b

Fig. 22c

As a general rule, if a mesiodistal
bodily movement or better control
of the apical area are the biomechanical needs of the OTM to be achieved
and enhanced (i.e. intrusion/extrusion), the decortication needs to be
extended to the entire alveolar bone
surrounding the roots of the teeth,
buccally and lingually (Fig. 2); if the
movement is less complex or anatomical limitations of the surgical

Fig. 22d

site impede an extended decortication, the cuts may be limited in the
direction of the OTM. These biomechanical needs determine the type of
procedure in both the openflap and
the flapless surgeries.

been proposed. Most of them have
been tried in the last 15 years on several patients. These surgeries may be
divided into two groups: the openflap and the flapless corticotomies
(Tab. 1).

4. A proper surgical procedure
must be followed
Several surgical protocols for performing alveolar corticotomy have

The original corticotomies were performed after raising a flap. This type
of surgery is still preferred when an
extended or critical area of decortica-

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The flap can be designed according
to the periodontal characteristics of
the site and has to be full thickness
in the area of decortication and split
thickness below this area to ensure
a good blood supply. Interproximal
and subapical cuts of 1–2 mm in the
cortical bone (Figs. 3 & 4) are performed together with a light scraping of the external cortex in between
the cuts. This extended surgical insult will produce a wide RAP reaction
and prepare a bleeding bed for any
grafting material eventually placed
in association with the decortication.
Piezo- surgical calibrated micro-saws
are preferred to rotating surgical
burs because of their selective, safer,
micrometric and more precise cuts;
better irrigation/cooling effect from
cavitation; better comfort for the
surgeon; and better healing for the
patient. The open-flap corticotomy
procedure is routinely used during
orthognathic surgery, when exposing impacted teeth, to treat transverse maxillary deficiencies and
periodontally involved cases.
Flapless surgery has been proposed
as an alternative way of performing
a corticotomy. Corticision31 and Piezocision32 have been an attempt to
reduce the invasiveness of the decortication and the possible periodontal
damage and postoperative discomfort with raising a flap. Even if attractive, they seem to have surgical and
biomechanical limitations.
The surgical limitations include risks
when performed in crowded arches,
limited visibility when producing
the cuts, limitation of the cuts to the
interproximal areas and to the middle third of the roots, difficult control
of the grafting in the apico-coronal
direction and need for optimal extension of the attached gingiva in
the area of decortication. The biomechanical limitations are strictly
related to the fact that corticotomy
is performed only on the buccal side
and middle third of the roots.
They are definitely not minimally
invasive surgeries as claimed and are
quite expensive for the patient, since
only a well-trained periodontist/oral
surgeon can perform them and they
often require complex planning
with digitally designed 3-D surgical
guides.33
The
Micro–Osteo–Perforations
(MOPs) described by Alikhani et al.34
and Teixeira et al.35 are an effective
and minimally invasive way of producing insult to the cortical alveolar
bone. These MOPs may be created
with manual instruments (Excellerator, Propel Orthodontics) or with
dedicated burs on a reduced-speed
electric handpiece (Fig. 5).

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MOPs are produced with a penetration in the cortex of a maximum of
1–2 mm. Instead of conventional local anaesthesia, a strong anaesthetic
gel placed on the mucosa for three
minutes is sufficient to control the
patient’s pain and discomfort. It is
advisable to produce two to three
MOPs in each interproximal area
of the teeth and both buccally and
lingually (Fig. 6), to ensure that the
metabolic changes are extended
around the entire radicular alveolar
bone. Manual MOP is usually created in the frontal areas, whereas
drilled MOP is usually performed in
the posterior and lingual areas (Figs.
7–9). The procedure and the precautions are similar to the insertion of
mini-screws. Orthodontists can easily create MOPs at the chairside, and

the cost is a great deal more affordable for the patient. Finally, they can
easily be repeated during treatment
if additional bone stimulation is
needed. No packing and no sutures
are necessary after MOP. The limit
is that no grafting can accompany
MOP.
Whenever possible and desirable,
grafting may accompany alveolar
corticotomy. The grafting is usually
planned before surgery, based upon
initial clinical and radiographic
evaluation, the desired OTM, and the
short- and long-term periodontal
considerations. In situations of thin
bone and a thin gingival biotype,
with risky movements like expansion, labial proclination or antero
-posterior movements in reduced
bone volumes, grafting may be indicated to reduce/eliminate fenestrations and dehiscences, produce
additional support for the roots, and
improve final aesthetics and stability.
Grafting may include hard-tissue,
soft-tissue and autologous growth
factors. Quality and quantity may be
modulated at the surgery depending on the clinical conditions of the
surgical site. As a general rule, composite bone grafts where allogeneic
bone (bone from human cadavers
that is freeze-dried to reduce antigenicity and demineralised to expose the underlying collagen and its
growth factors, like bone morphogenetic protein) with osteoinductive
properties, is mixed with xenogenic
bone (bone usually from bovine animals that provides a physical matrix
or scaffold suitable for deposition of
new bone and that prevents its rapid
resorption) with osteoconductive
properties are preferred (Fig. 10).
Soft-tissue grafts are added to bone
graft when a thin biotype or gingival
recession is present. If the area to be
regenerated is small, an autologous
connective tissue graft is the gold
standard procedure. Large areas may
be managed with allogenic human
acellular dermal matrices, that are
available in different sizes and thicknesses (Fig. 11).
Soft-tissue grafts are sutured with
resorbable sutures. Both bone and
soft-tissue grafts are coupled with
autologous growth factors. With ageing, the number of stem cells rapidly
decreases. These cells are important
in case of injury and healing processes. Studies have shown that growth
factors from platelet- concentrated
plasma (platelet- derived growth
factor, vascular endothelial growth
factor, transforming growth factor
beta 1 and 2) may rapidly increase the
number of the available stem cells,
stimulate their activity, as well as
reduce inflammation and pain during the healing processes.36 Plateletrich fibrin (PRF)37, 38 and the platelet
rich in growth factors (PRGF)39, 40
are prepared via two different protocols in which blood centrifugations
allow separation of the plasma platelets from the white and red cells. PRF
contains leucocytes and the process
for its preparation produces membranes with a light compression of
the centrifuged fraction.
The process for preparing PRGF allows the separation of three fractions with different concentrations
of platelets. They may be mixed with
bone grafts (increasing the graft’s viscosity and adherence to the surgical
site, thus facilitating its application)
and soft -tissue grafts. Activating and

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Dental Tribune Middle East & Africa Edition | 1/2019

ORTHO TRIBUNE

◊Page E4

Fig. 23a

Fig. 23b

Fig. 24a

Fig. 24b

Fig. 25a

Fig. 25b

Fig. 26a

Fig. 26b

Fig. 27a

Fig. 27b

Fig. 28a

Fig. 28b

molar to molar and generous hardand soft-tissue grafting (Figs. 24a &
b). Treatment started a week after
the surgery and continued with visits every two to three weeks. Once
arch coordination had been slowly
achieved with 0.019 × 0.025 in.
stainless-steel archwires (Figs. 25a &
b), followed by 0.021 × 0.025 in. stainless-steel archwires (Figs. 26a & b and
27a & b), the anterior open bite spontaneously closed (Figs. 28a & b). The
CBCT images before and after treatment reveal the increased volume
of the maxillary alveolar bone that
allowed the successful expansion of
the upper arch, despite the age of the
patient and the initial periodontal
problems (Figs. 29a & b).

Conclusion

Fig. 29a

heating the PRGF fraction produces
clots/membranes of fibrin that are
placed on the bone grafts, stabilising
their position (Fig. 12).
When using grafts along with alveolar corticotomy, a tension-free flap
closure must be achieved at the end
of the surgery, to provide optimal
coverage of the decorticated area
and the grafted material, and to enhance final soft-tissue healing. Nonresorbable sutures are left for at least
14–21 days.
5. Proper orthodontic management after corticotomy must be
performed
Orthodontic treatment associated
with periodontally facilitated orthodontics may be carried out with any
fixed or removable appliances. It
is the clinician’s choice to combine
periodontally facilitated orthodontic
procedures with fixed, active selfligating appliances (In-Ovation) with
the new prescription of the CCO System (GAC-Dentsply Sirona; Fig. 13).41
The management and wire changes
are similar to those of any orthodontic case. No initial heavy force is
necessary. There is no rule regarding timing of the bond ing: in some
cases, appliances are placed a week
after the surgery, while in others (for
example, when distalising maxillary

Fig. 29b

molars or repositioning impacted
teeth) several months before corticotomy.
The enhanced tooth movement deriving from the RAP reaction is obtained when needed. The major difference is that, after the periodontal
surgery and until tooth movement
is clearly enhanced, the visits for wire
activations or wire changes are every
two weeks instead of the usual six to
eight weeks.
When corticotomy is performed
along with aligner treatment, the frequency of appliance changes is every
three to four days.
Alveolar corticotomy may easily
be associated with skeletal anchorage devices. Temporary anchorage
devices are used to increase anchorage, while corticotomies are used to
reduce anchorage.
6. Proper patient selection for corticotomy is essential
Alveolar corticotomy is not for every
patient, and it is not feasible to use it
on a routine basis in clinical practice.
The main indication is in clinical
cases with complex OTMs. Openflap surgery is indicated in impacted teeth, surgery-first procedures
with extractions, orthognathic
surgery with major postoperative

OTMs, complex space closures with
reduced supporting tissue, and
maxillary expansion in periodontally compromised cases. MOP is indicated in treatments with aligners,
complex OTMs without periodontal
problems and patients with financial
limitations.
One case treated with open-flap corticotomy and two cases treated with
MOP will be shown to elucidate the
concepts described in this article.
Case 1
A 19-year-old male patient with a
Class III dental malocclusion with anterior midline discrepancy wanted
to be treated only with aligners (Figs.
14a & b). Treatment was carried out
with 71 aligners and two MOPs performed at the second month and at
the fifth month of treatment, only
on the premolar and molar maxillary dentition (Fig. 15). Class III elastics were prescribed throughout the
therapy. Treatment was completed
in seven months with acceptable intercuspation in the buccal segments
and correction of the midlines (Figs.
16a & b) and with good anchorage
control in the lower arch (Fig. 17).
Case 2
A 22-year-old female patient with
a Class II, Division 1 dental malocclusion with a missing mandibular

right first molar and mandibular anterior midline deviated toward the
right presented for treatment (Figs.
18a–c). The treatment plan was to
extract the maxillary first premolars
and close the mandibular right molar space with minimum anchorage.
MOPs were performed after insertion of the mandibular working wire
(0.019 × 0.025 in., stainless steel; Figs.
19a–d). Nickel-titanium closed coil
springs were applied right after the
decortication (Fig. 20). Treatment
was completed with good intercuspation, coincident midlines and all
spaces well closed (Figs. 21a–c). Figures 22a to d show the dental panoramic tomograms and lateral cephalometric radiographs before and
after treatment.
Case 3
A 30-year-old male patient, after two
unsuccessful previous orthodontic
treatments, with a Class II malocclusion with an anterior open bite, a
unilateral cross bite and generalised
recession on the buccal aspects of
maxillary teeth presented for treatment (Figs. 23a & b). The ideal treatment would have included surgically assisted maxillary expansion,
followed by combined orthodontic–
orthognathic surgery. The patient
refused this treatment, but accepted
an alternative treatment with openflap corticotomy extended from

Alveolar corticotomy (or periodontally facilitated orthodontics as we
prefer) is an effective procedure in
which alveolar decortication is associated with orthodontic treatment
with the primary goal of enhancing
OTM and reducing anchorage needs.
By accelerating the rate of OTM and
reducing the complexity of a clinical
case, bone decortication may reduce
treatment time. However, this effect
is considered a side-effect and not
the primary reason for using this
periodontal surgery. According to
the patient’s needs, it may be performed with an openflap or a flapless
procedure and may be associated
with hard- and soft-tissue grafting.
Further studies are still needed to
evaluate indications, contra-indications and risks. The procedures described here will certainly evolve and
improve with the improvement of
the materials, devices and appliances
utilised.
Editorial note: A list of references is
available from the publisher.
This article was originally published
in ortho international magazine of
orthodontics, Issue 1 2018.

Dr Raffaele Spena
Via dei Mille, 13
80121 Napoli, Italy
rspen@tin.it
www.raffaelespenaortodonzia.it

[46] =>

ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 1/2019

Align Technology reaches 6 millionth
Invisalign patient milestone with tween
patient from China
By Align Technology Inc

align patient coming from China: “I
was absolutely delighted and proud
to hear that 6 millionth patient is
from Asia Pacific. China is our fastest growing country market with
approximately 70% annual growth
rate**. I believe there is an enormous
opportunity in the region for Invisalign providers to treat millions of
young patients like Yuzhe. I would
like to thank Dr Wo for his confidence in treating Yuzhe with the Invisalign system, and Yuzhe’s parents
for trusting that it is the best solution
for their daughter.”

Align Technology, Inc. (NASDAQ:
ALGN) today announced that over
6 million patients have begun treatment with Invisalign - the most advanced clear aligner system in the
world, including 1.4 million teenage
patients*. This is a significant milestone for the company and the over
150,000 Invisalign-trained doctors
worldwide, reflecting accelerating
adoption of Invisalign treatment by
adults and teens alike.
The 6 millionth Invisalign patient,
Yuzhe, is a 12 year-old student of
the International School of Beijing,
who began treatment in October
2018 using Invisalign Comprehensive with Mandibular Advancement
treatment with Dr. Jiawei Wo from
Yuxueyuan Dental clinic. Dr Wo is a
Gold Invisalign trained doctor based
in Beijing, China who specializes in
pediatric orthodontics.
Dr. Wo prescribed Invisalign clear
aligner therapy to his patient Yuzhe
to address her class II type of teeth
misalignment and because it fit well
into her busy, student lifestyle: “Invisalign treatment with Mandibular
Advancement is great, because it
moves the lower jaw forward, while
simultaneously aligning the teeth.
With the Invisalign system, my patients need much fewer appointments than with traditional ortho-

In support of this major milestone
for the company, Yuzhe will be featured in an upcoming Invisalign
global campaign, entitled “6 Million
Invisalign Smiles” that will follow
Yuzhe and her family through her
Invisalign treatment journey. The
campaign will highlight key reasons
why she and her parents decided to
choose Invisalign clear aligners to
help her achieve a new, beautiful
smile.

Invisalign 6 millionth patient

dontic appliances. This allows them
to continue their studies and daily
activities without interruption”.
“We are delighted to be celebrating another significant milestone
with Invisalign trained doctors and
their patients. This achievement is
a reflection of growing demand for
Invisalign clear aligners from international markets, especially China,

which is our second largest country market, nearly doubling each
year since the Invisalign system
was launched in China back in 2011.
I would like to thank Dr. Jiawei Wo
and all of the Invisalign trained doctors around the world for helping
us make Invisalign treatment the
clear aligner orthodontic method of
choice among teens such as Yuzhe,

as well as for giving our patients a
chance to have beautiful, straight
teeth and smile with confidence” –
said Joe Hogan, Align Technology
president and CEO.
Julie Tay, Align Technology senior
vice president and managing director, Asia Pacific recognized the
importance of the 6 millionth Invis-

For additional information about the
Invisalign system or to find an Invisalign doctor in your area, please visit
www.invisalign.com. For additional
information about iTero digital scanning system, please visit www.itero.
com.

Interview: “We will continue to commit to our
clients the best orthodontic customer service
experience in the industry...”
By Dental Tribune MEA
Dental Tribune MEA had a pleasure
to speak with Dr Ramy El Zoghby, Regional Saes Director – Dealers EMEA
at Ormco.

Dr. Ramy, congratulations
on yet another successful
year. The highlight of the
year must have been the
3rd ORMCO Forum Dubai.
How do you reflect on this
unique event for the regions Orthodontists?

I have to say that 2018 has been an
exceptional year for Ormco in the
region and the 3rd Ormco Forum in
Dubai was the great highlight of this
success through the whole EMEA region. Another new and exceptional
record of participation with more
than 350 Orthodontists & 8 International speakers coming from more
than 15 countries all over the world,
sharing their knowledge and clinical experiences using the most advanced techniques in Orthodontics
and definitely our unique products.

How important is it for
ORMCO to have such annual events and be close to
your regional partners and
clients?
Ormco partners are a crucial part of
our success in the region. We do our
maximum efforts to ensure the best
customer service experiences to all
our clients especially in terms of continuous products availability and on
time delivery.

Moreover, keeping our clients’ satisfaction at the highest level possible
is one of our major goals within the
whole Ormco organization.

What was the base for the
choice of your scientific
speakers and content for
the event?

We tried to diversify the scientific
content, and the speaker’s backgrounds taking the participants
through an exciting journey during
the three days. The delegates could
discuss their concerns and find
out all the new updates in conventional esthetic systems, self-ligating

techniques and digital orthodontic
which is our future blighting trend
in Ormco.

The past year have been
very dynamic, not only for
ORMCO but also the dental industry. How do you
manage to continue delivering top quality products,
services and education to
your client base, distributors and partners in the
Middle East?
I agree with you that 2018 was one
of the most challenging and dynamic years for the whole industry
in the region, however, we successfully completed the year smoothly
by continuing to focus on the best
products we sell in Ormco globally.
In terms of education, more than
25 international scientific courses
were conducted successfully, keeping our clients updated with the latest techniques and products. It also
makes our partner’s job easier to
deliver Ormco’ s message to the largest number of clients in the shortest
possible timeline.

In the year of IDS Cologne
2019, what can we expect
from ORMCO and your
Middle East partners?
We will continue to commit to our
clients the best orthodontic customer service experience in the industry
whilst continuing to focus more and
more on educating orthodontics.

What are your plans for the
region in the coming year?

This year, we have an ambitious plan
to increase our educational courses
by more than 20% in comparison
to last year, strongly participating in
the big regional orthodontic conferences (i.e.: Saudi Orthodontic Society meeting – SOS in Jeddah/ KSA.
Moreover, we will be having our 2nd
Ormco Forum in Saudi Arabia in November 2019 with more and more
exciting speakers and topics.
After the success of the 2nd MENA
Symposium in 2015 Ormco has recently launched their 3rd edition of
the Dubai Forum , that took place in
Palazzo Versace Hotel between the
6th-8th of December 2018.

Dr Ramy El Zoghby, Regional Saes Director
– Dealers EMEA at Ormco.

This is considered the biggest Ormco
scientific event EMEA region with
more than 300 participants and 8
international speakers from around
the globe. Not only International
speakers but also international delegates from 15 different countries
including Middle East, E, and East
Europe, Russia and Africa all gathered to attend the big event as well
as the launch of the 2 new products
Damon Q2 and Symetri Clear and Insignia new technologies in the world
of digital Orthodontics.
Looking forward for more success in
the next edition of the Ormco Forum

[47] =>

E7

ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 1/2019

Ormco Forum Dubai 2018 Impressions
06-08 December 2018 | Palazzo Versace | Dubai | UAE
After the success of the 2nd MENA
Symposium in 2015 Ormco has recently launched their 3rd edition of
the Dubai Forum, that took place in
Palazzo Versace Hotel between the
6th-8th of December 2018.

This is considered the biggest Ormco
scientific event EMEA region with
more than 300 participants and 8
international speakers from around
the globe. Not only international

speakers but also international delegates from 15 different countries
including Middle East, Europe, and
East Europe, Russia and Africa all
gathered to attend the big event as

well as the launch of the 2 new products Damon Q2 and Symetri Clear
and Insignia new technologies in the
world of digital orthodontics

Looking forward for more success in
the next edition of the Ormco Forum

Participants

Main Conference

Dr Skander ELLOUZE, Mini Screw Lecture

Main Conference

Main Conference

Damon Workshop with Dr Bill Dschinger

TADs Workshop with Dr Skander ELLOUZE

Damon Workshop with Dr Bill Dischinger

Ormco team

Ormco team with heads of Saudi Orthodontic Society

New relaease of the MBT bracket Symetri Clear

[48] =>

E8

ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 1/2019

3M Oral Care Ortho Programme Highlights
Impressions from the 3M Oral Care Symposium orthodontic programme which took place
in Abu Dhabi on 04-05 October 2018. Over 200 dentists and orthodontists attended.

Dr Anoop Sondhi, USA presented two lectures as the keynote speaker on Contemporary Orthodontic Treatment
with Self-Ligating Appliances as well as a full day seminar on TMD

Dr Jose Chaques Asensi from Spain during his workshop on The Path to Excellence with Class II correctors.

Dr Khaled Al Khayat, Kuwait presented The ABC’s of growing your Practice Today.

Over 40 delegates attended the TAD & Self Ligating workshop.

Three parallel workshops took place on various hot topics

Dr Abdelhakim El-Gheriani, UAE lecturing during the Ortho programme

Prof Albert Waning from The Netherlands lectured on Prevention for
Orthodontics, a new trend of clean, treat, protect and maintain the
health of teeth.

Seminar: Current Concepts in the Management of Temporomandibular
Disorders by Dr. Anoop Sondhi, USA.

The newly opened Grand Hyatt Hotel & Residences Emirates Pearl was the magestical venue of this unique symposium in Abu Dhabi, UAE.

Dr Jose Chaques Asensi lecturing on How to Define Clinical Excellence
Today.

[49] =>

PUBLISHED IN DUBAI

January-February | No. 1, Vol. 9

www.dental-tribune.me

Taking care of our teeth is
implants
a fundamental part of good health
SUBSCRIBE NOW

https://me.dental-tribune.com/e-paper/
issn 1868-3207 • Vol. 19 • Issue 3/2018

3/18

international magazine of oral implantology

Dental problems can affect what we eat, and the aesthetics of our teeth
has a major impact on how we see ourselves and others.
case report
Minimally invasive implant dentistry

By Neoss Ltd.
Taking care of our
teeth is a fundamental part of
good health: dental
problems can affect
what we eat, and
the aesthetics of
our teeth has a major impact on how
we see ourselves
and others.
Dental implants are
a key treatment option for many with
damaged, broken
or decayed teeth, and the transformation can be life changing. For
some patients, the process can seem
expensive or intimidating and patients may be tempted by a ‘quick
fix’ - but such procedures may be a
false economy, potentially requiring
significant further treatment in the
future.

Dental implants replace the roots of
teeth and can be used to anchor a
single dental crown(s), a bridge or a
denture. Neoss has an approach to
dental implants that keeps both the
patient and the practitioner in mind:
Intelligent Simplicity.
Whilst every patient - and their dentist - is different, they ultimately
want to achieve good results, spend
less time in the chair, and for the final implants to last; practitioners
want the process to be straightforward and worth the investment of
the patient.
Neoss answers all these needs with
patented technology, including the
NeoLoc Implant-Abutment connection and the Neoss ProActive surface.
This creates one of the strongest
dental implants on the market and
standardises surgical instruments so
that practitioners don’t have to carry
so much inventory.

Neoss continues to innovate and invest in Research and Product Development - designing, manufacturing
and selling products of the highest
quality which offer market-leading
functionality.
Its products are available internationally and the continuous business development programme has
resulted in expanded geographical
coverage - with revenues being developed in the major Asia markets
including China and Japan - and the
development of a significant presence within the MEA region.

industry
Implant retreatment

interview
Measuring implant stability

‘When we are working in a clinical
environment on patients, the situations can sometimes be fairly tense,
fairly stressful and highly pressured.
A system that is simple, straightforward and easy to use minimises the
risks throughout the clinical procedures, not only for us as dentists but
also our assistants.’

‘Simplicity is something we work
very hard to achieve for our customers,’ says Neoss’s Chief Operating
Officer Ruth Keeling. ‘What we hear
from patients is that they wish they
had sorted their dental problems
sooner.’
Dr Kavit Shah, Dental Surgeon and
Specialist in Prosthodontics, says:

Please visit www.neoss.com to get further
information or call +44 (0)1423 817 733

patient was re-examined three years
after the initial treatment. The patient’s smile showed an infiltration
at the right lateral incisal level and
that the prosthetic teeth were placed
off-centre. The lip support, ensured
by a large false gingiva, was correct.
The cosmetic material of the right
maxillary canine was fractured (Figs.
1 & 2).

ten the case with maxillary overdentures. The right implant showed a
loss of the majority of its vestibular
bone, causing significant recession.
The tissue was hyperplastic, making
hygiene difficult. The framework
was off-centre presumably because
of the implants, which explained
the off-centre axis of the prosthetic
teeth.

Once the patient’s prosthesis had
been removed and an examination
of the site conducted, an extremely
negative prognosis was determined
for the implants (Fig. 3), which is of-

Over the past several years, many
authors have observed recurrent

Implant retreatment
By Dr Philippe Leclercq, France; JeanFrançois Martinez, France & Michael
Brüsh, Germany
When working with dental implants,
a number of specific rules must be
followed regarding both the implant
surgery and the prosthesis itself
(fixed protheses tending to have a
more favourable prognosis than
overdentures). If these rules are not
adhered to, the results are often unsatisfactory, requiring retreatment.
In such cases, and despite the patient’s desire to quickly forget the

previous treatment, a very strict
protocol must be followed, specifically concerning the length of healing periods. Despite an increase in
the overall treatment duration, this
will ensure success of each stage of
treatment. The implant retreatment
case outlined in this article will emphasise these different stages in this
type of clinical situation.

Initial case
At the age of 28, the patient was involved in a traffic accident, which
resulted in significant trauma to her
maxilla, including the loss of her cen-

tral and lateral incisors and left canine. The shock also led to the loss of
alveolar bone in the same area. The
first premolars were absent, probably owing to previous orthodontic
treatment.
The original treatment consisted of
placing two implants in the residual
bone and an anchorage reinforcement screw-retained bridge to maintain a removable prosthesis, which
included five teeth and a large false
gingiva (Fig. 1).
Dissatisfied with the treatment, the

Figs. 1 & 2: Initial prostheses: Lip support was ensured by a large false gingiva, and fractured cosmetic material at the right maxillary canine was
evident. The patient’s smile showed the prosthetic teeth placed off-centre and an infiltration at the right lateral incisal level.

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Fig. 3: Examination after three years revealed a negative short-term
prognosis for the implants owing to significant recession at the right implant and hyperplastic tissue.

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Figs. 6 & 7: The grafts were harvested from the chin symphysis and firmly attached by surgical screws in the recipient site.

Fig. 4: The framework was unscrewed, abutments removed and implants easily removed.

Fig. 5: Implant removal site showing even greater deterioration in bone volume

gingival inflammation as a reaction
to using implants for this indication.
Engquist noted a gingival increase
in 25 per cent of the cases1; Naert et
al. showed that out of 86 overdentures (6 maxillary, 80 mandibular),
8 observed gingival hyperplasia,
primarily in the maxilla (9.3 per
cent)2; and Jemt et al. observed that
after one year out of 92 maxillary
overdentures, 19 patients showed
gingival hyperplasia (20.9 per cent),
13 patients had one gingival correc-

Figs. 8 & 9: The properly compressed PRF membranes permitted complete coverage of the surgical site, in this instance on the maxilla.

Fig. 10: Panoramic radiograph showing the grafts to
be correctly healed and satisfactorily adhered to the
recipient bone sites.

tion and five had two corrections.3 In
a 1993 study on maxillary overdentures, Smedberg et al. observed: “The
results show that the prevalence (p
< 0.05) for Lactobacillus, Prevotella
(subspecies) and yeasts in the subjects with removable prostheses was
significantly higher than in subjects
with fixed prostheses. Removable
prosthetics were accompanied by
a more aggressive peri-implant
plaque.”4 In view of our patient’s unsatisfactory treatment results, it was

Fig. 11: Increased vestibular bone volume allowed
positioning of the teeth at the crestal bone level and
reduction of the false gingiva.

thus decided to restart treatment
completely.

Retreatment
The retreatment followed an extremely precise protocol, especially
regarding the length of the healing
periods. To begin, dental impressions
were taken to create a resin-based
temporary removable prosthesis.
The prosthesis included palatal support to relieve the vestibular gingival tissue as much as possible. An

Fig. 12: A key of the added wax was taken and fabricated in clear casting resin.

aesthetic fitting of the appliance was
conducted to straighten the axis of
the incisors.
Implant removal
Owing to insufficient osseointegration, the removal of the implants
was fairly easy (Fig. 4). Removal was
accomplished with the aid of an implant removal tool.

prosthesis with palatal support was
inserted.
To permit the rapid elimination of
inflammatory residue, it was contraindicated to suture the recipient implant site.
Assessment after implant removal
Three months after implant removal, a clinical and radiographic

Immediately after implant removal,
the temporary removable resin

ÿPage D3

Fig. 13: The reopened site showing correct graft integration, a notable
increase in cortical bone and excellent vascularity.

Fig. 14: Testing of the sterilised surgical drilling guide proved drilling
would be at the centre of the reconstructed bone ridge.

Fig. 15: Aadva self-tapping implants were placed.

Fig. 16: All five implants equipped with threaded cover screws and the
surrounding tissue sutured.

Fig. 17: Loaded implants, healing abutments in situ.

Fig. 18: The healing abutments were removed and replaced with pick-up
impression copings secured with self-curing resin.

Figs. 19 & 20: Removal of the impression and fitting of the impression copings with their laboratory equivalent.

Fig. 21: Model of the framework, temporarily including the canine, cast
in pattern resin.

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◊Page D2
assessment was conducted. The assessment showed further significant
vertical bone loss and loss in bone
volume (Fig. 5). Significant vertical
bone loss is difficult to correct owing
to random gingival recovery. It was
thus decided to augment the bone
volume by performing a chin bone
graft.
Bone graft
Anaesthetic was administered in the
maxillary and mandibular anterior
region. For the mandible, the sample
was taken from the cortical bone and
a section of the cancellous bone by
piezoelectric surgery. The grafts were
harvested from the chin symphysis,
as close as possible to the mandibu-

lar inferior ridge to avoid disturbing
the incisor’s sensitive innervation,
which can be a frequent complication of the procedure. The vestibular cortical bone scar was perforated
with a small round bur, allowing for
rapid revascularisation of the grafts.
The grafts were then positioned and
secured in place with mini-screws
(Figs. 6 & 7).
To increase success, a blood sample
was taken and centrifuged according to the Choukroun platelet-rich
fibrin (PRF) technique5 in order to
recuperate the fibrin clots. The clots

ÿPage D4

Figs. 22 & 23: The model was scanned before being transferred to a machining centre.

Fig. 24: After scanning, the computer prefiguration of the framework
was validated.

Figs. 25 & 26: Testing of the titanium framework on the working model and verification of stability.

Fig. 27: The cosmetic material placed onto the framework.

Figs. 28 & 29: The prosthesis was attached with screws and the necessary occlusal verification was conducted.

Fig. 30: The patient’s smile showing now well-balanced incisors in line
with the face’s sagittal plane, lip support appearing to be correct.

Fig. 31: Removal of the validation prosthesis and examination of the
areas of compressed mucosa and difficult for dental hygiene. Reinstallation of validation prosthesis after correction.

Figs. 33: Final prosthesis framework and the coping for the right canine
tested on the working model.

Figs. 34 & 35: After fitting of the zirconia framework, the ceramic was cast using the exact parameters validated by the resin prosthesis.

Figs. 36 & 37: Installation of the final prosthesis and verification of correct occlusion. Screw channels filled with composite.

Figs. 32: Final prosthesis framework and the coping for the right canine
tested on the working model.

Figs. 38: Final cosmetic check-up showing correct lip support with the
new extremely reduced false gingiva.

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◊Page D3

Figs. 39: Final cosmetic check-up showing correct lip support with the new extremely
reduced false gingiva.

Fig. 40: Radiographic check-up after seven years.

were compressed between two compresses to evacuate the serum and
to form the membranes which were
then applied to the surgical site and
in the mandibular harvesting sites
(Figs. 8 & 9).

this stage a “temporary prosthesis”
or “provisional prosthesis”, it is more
appropriate to call this temporarily placed prothesis, a “validation
prosthesis of the implanto-occlusoprosthetic concept recommended
to the patient”7. Over the course of
several months, this prosthesis validates –– the osseointegration of the
implants;
–– the aesthetic aspect, especially for
the anterior teeth;
–– phonation, which is also important for the maxillary anterior region;8
–– the patient’s ability to correctly
clean the prothesis; and occlusion
and, in this case, the ability of the anterior to guide the disclusion of the
canine groups in protrusion.

Pre-implant prosthetic study
After four months, according to radiographic examination, the tissue
had healed and the bone mass appeared stable (Fig. 10). New impressions were taken to prepare for the
next step in treatment: the implant
drilling guide. After four months
of healing, the increased vestibular
bone volume allowed positioning
the teeth at the crestal bone and reduction of the false gingiva using
additional wax (Fig. 11). A key of the
added wax was taken and fabricated
in clear casting resin. The implant
positions were decided on and finalised by drilling placement holes,
determining the exact position of
the implants (Fig. 12). The correct positioning of implants in relation to
the future prothesis is an important
prerequisite for aesthetic and functional success.
Implant placement
Local anaesthesia was administered and the bone site reopened.
The site showed correct integration
of the grafts, a notable increase in
cortical bone and excellent vascularity throughout the site (Fig. 13).
The sterilised surgical drilling guide
was tested and showed that drilling
would in fact be at the centre of the
reconstructed bone ridge (Fig. 14).
After removal of the screws stabilis-

ing the grafts, the guide was placed
and drilling (using physiological saline solution) completed. Five Aadva
(GC Tech.Europe) self-tapping Grade
5 titanium microstructure implants
were inserted by slow drilling (Fig. 15).
Aspiration with physiological saline
solution was not used at this time
so that the first contact with the titanium oxide would be the patient’s
blood, thus promoting the implants’
osseointegration. This specific implantation technique was validated
by Brun et al.6 All of the implants
were equipped with threaded cover
screws and the surrounding tissue
was sutured (Fig. 16).
To minimise risks, the implants were
left unloaded for four months, as immediate loading of a site such as this
one could have proven to be problematic.
Implant loading and impressions
After four months, the implants
were loaded using an apically positioned flap. The healing abutments
were placed and the flap sutured
around them (Fig. 17). Radiographic
analysis and especially a percussion
test showed the implants’ perfect
osseointegration. After 15 days of
gingival healing around the abutments, they were removed and the
impression copings were placed and
secured with a self-curing resin (Fig.
18). Impressions were taken and the
healing screws were reinserted (Figs.
19 & 20).
Validation prosthesis
Rather than calling the appliance at

This prosthesis serves as a model for
the final prosthesis. It is made with
easily modifiable material like resin,
but with a metal framework to guarantee a certain level of rigidity. In the
first step, a model of the framework,
which temporarily included the canine to increase stability, was cast in
pattern resin (Fig. 21). The model was
then scanned (Aadva, GC Tech.Europe; two cameras, 2 MP, precision:
10 µm) before being transferred to
a machining centre (GM 1000, GC
Tech.Europe; Figs. 22–24). Once back
from the machining, the titanium
framework was tested on the working model and its stability was verified (Figs. 25 & 26).
The cosmetic material (UNIFAST III
resin; surface rendering: OPTIGLAZE
colour, GC Tech.Europe) was then

placed on the framework (Fig. 27).
The bone graft permitted a maximum reduction of the vestibular
false gingiva.
In the following step, the prosthesis was attached in the mouth with
screws and the necessary occlusal
verification was conducted, including maximum intercuspation, protrusion and lateral excursion. The
natural canine on the right was also
equipped with a verification tooth.
It should be noted, that in lateral
excursion on the left, with the antagonist being the original tooth
equipped with its periodontal ligament receptors, the canine function
was retained; however the group
function, which is usually preferred,
was neurophysiologically inept (Figs.
28 & 29).
The patient’s smile showed that the
incisors were now well balanced and
in line with the face’s sagittal plane.
Lip support appeared to be correct
and, as often is the case, this would
all be validated by the patient’s surrounding friends and family (Fig. 30).
After three months, the validation
prosthesis was removed in order to
examine the areas where mucosa
had been compressed and dental hygiene difficult. These areas were corrected and the validation prosthesis
reinstalled (Fig. 31).

Final prosthesis
After six months, all of the parameters were validated.
The final prosthesis was then fabri-

cated as an exact copy of the validation prosthesis, but in a more durable material:
zirconia for the framework and ceramic for the aesthetic material.
As with the titanium validation prosthesis, the framework and the coping
for the right canine were scanned
and transmitted to the machining
centre. They were then tested on the
working model (Figs. 32 & 33). After
fitting of the zirconia framework,
the ceramic was cast using the exact
parameters validated by the resin
prosthesis (MB Dentaltechnik, Figs.
34 & 35).
In the following step, the final prosthesis was installed and the correct
occlusion verified: maximum intercuspation, protrusion and lateral
excursion. The screw channels were
filled with composite (Figs. 36 & 37).
The final cosmetic check-up, validated by the resin prosthesis, showed
the lip support with the new extremely reduced false gingiva to
be correct (Figs. 38 & 39). This was
achieved owing to the bone graft.

Regular check-ups
Retreatment was regularly monitored with patient check-ups (Fig.
40). All implant treatments, no matter of what type, must be rigorously
monitored in all treatment phases,
but a retreatment requires even
more diligence.
A patient affected by the failure of a
previous treatment will not accept
even the smallest problem. To this
end, the role of healing periods is
thus essential to retreatment success.
Editorial note: This article was originally published in implants international
magazine of oral implantology, Issue
3/18.

Dr Philippe Leclercq
President of SIOPA (Society for
Oral Implantology and Applied Prosthesis)
Implantological practice
45, rue de Courcelles
75 008 Paris, France
ph.leclercq@siopa.fr

Implants – Immediate loading with
NO patient selection
By Vivek Gupta, UK
At EAO 2017, Dr Göran Urde presented a paper titled “Evolution of surgical protocols in implant dentistry”
as part of the scientific programme.
Dr Göran Urde, is the Program Lead
for Tipton Training’s PG Certificate
in Dental Implantology and is the
Director of the Futurum Clinic at
Malmö University’s Faculty of Odontology in Sweden. Extracts from his
presentation are below.
In the good old days, as he put it, implants were only placed by specialists in oral surgery and prosthetics.
One had to be thoroughly trained
to even purchase implants. Companies kept records of the clinician’s
success rates and if someone had a
higher than normal failure rate, they
showed up at their door! This obvi-

ously has changed now as technology and consequently education of
dental implants has evolved.
Over the years he has been involved
in developing concepts like “Tooth
Now” or Immediate Loading, according to which a tooth is extracted
and immediately replaced with an
implant and loaded with the final
abutment and a temporary crown,
with extremely high success rates for
both implant survival and aesthetic
outcome. He appreciates the benefits of immediate loading, but, warns
that patient selection is very important and often not appreciated.
Consider this, patients for decades
have not taken care of their natural
dentition are now being treated in
accordance with concepts like immediate loading. Within an hour,

any remaining decayed teeth are
removed and replaced with implantsupported crowns and bridges in the
belief that the patients will start taking care of their new teeth. Unfortunately, this is not realistic!
In his opinion, this is a ticking time
bomb. It is just a matter of time before patients will come back with
problems like peri-implantitis and
failing implants. Who is going to
sort that out? Think litigation! That
is why training courses are so important. Placing implants is a great
skill and income generator, however,
there is no substitute to Patient Selection and Treatment Planning.

Prof Urde with his students during the surgery (Photograph: Dental Tribune MEA)

[53] =>

www.dental-tribune.me

PUBLISHED IN DUBAI

January-February | No. 1, Vol. 9

Gain a child, lose a tooth?
By Prof. Nicole Arweiler, Germany
The most important physiological,
hormonal and perhaps also most
beautiful changes in a woman’s life
occur during pregnancy. And the
mouth is one of the main areas involved in these changes. Although
gingival inflammation during pregnancy tends to increase—even with
correct oral hygiene—pregnancy
gingivitis does not normally cause
lasting damage to the periodontium.
In the post-partum phase, even
women with periodontitis who did
not receive periodontal treatment
during their pregnancy show an improvement in all clinical periodontal
parameters. So all is well, right? Unfortunately not. The research agrees:
pregnant women require special
oral hygiene instructions, owing
to hormonal changes, in order to
avoid periodontitis. This is because
periodontal treatment can be nerveracking, time-consuming and bad
for their health.
How important is periodontal health
for pregnancy really? Its significance
is actually increasing with current research findings. Pregnancy gingivitis
is one of the most important periodontal diseases. Like other forms
of gingivitis, untreated it can lead
to periodontitis. No specific type of
periodontitis is linked to pregnancy,
but periodontitis seems to be a potential risk factor for negative pregnancy outcomes. But how strong
are the connections between periodontitis and negative pregnancy
outcomes like premature birth, low
birthweight and pre-eclampsia really? More on that later.
The legislature has already known
for decades about the importance
of periodontal health for expectant
mothers. The maternal health passport guides women in Germany and
Austria through pregnancy. Federal
committees and health insurance
companies also require that gynaecologists and dentists speak about
the importance of oral hygiene for
mother and child in the last trimester as needed. Unfortunately, the
reality is that only 5–10 per cent of
pregnant women worldwide see a
dentist during pregnancy. Certainly,
socio-economic status, fear and perhaps also apathy mean that many
patients avoid the dentist. Many
expectant mothers say they do not
have time to go to the dentist several
times. “Gain a child, lose a tooth,” as
your grandmother used to say.

What is pregnancy gingivitis?
Various periodontal diseases, including pregnancy gingivitis, granuloma
gravidarum (pregnancy tumour,
also epulis gravidarum) and periodontitis, affect the (oral) health of
pregnant women. Pregnancy gingivitis is therefore among the classic
gingival diseases. Besides plaqueinduced gingival disease, pregnancy
gingivitis ranks among the diseases
altered by systemic factors. This

Prof. Nicole Arweiler, Germany

includes hormonal influences, like
puberty, menstruation, pregnancy
and diabetes mellitus or even blood
disorders.

sitive to bacteria that reach the oral
cavity.

In appearance and form, pregnancy
gingivitis does not differ from classic gingivitis, but it does differ in
prevalence. Already in 1933, Ziskin et
al. spoke of a 30–100 per cent occurrence.1 In more recent studies,2–4 this
varied between 38 per cent and 93.7
per cent. Gingivitis has been found
to correlate with hormone level and
plaque. In the second and third trimesters, pregnant women generally
notice an increase in gingivitis and
bleeding, since the body produces
the steroid hormones progesterone
and oestrogen more strongly. The
more plaque, the higher the risk of
gingivitis.

Generally, science assumes that
periodontal inflammation plays an
important role in pregnancy complications. Periodontitis as a chronic
inflammation is ultimately caused
by a bacterial infection and thus
represents a potential source of
circulating inflammatory biomarkers. These inflammatory mediators
spread throughout the entire body
and are related to possible negative
pregnancy outcomes. In studies on
periodontitis in pregnant women,
the occurrence of the disease varied
between 0 per cent5 and 61 per cent.3

The causes of pregnancy gingivitis,
however, seem to be more complicated than previously believed.
Even small quantities of plaque in
pregnant women lead to an excessive inflammatory reaction in the
susceptible tissue. Not only does the
immune system change, but so do
blood circulation and the cell system.
The entire oral mucosa prepares for
the birth. The practice team must
therefore pay particular attention
to the dental biofilm. Progesterone
and oestrogen directly promote the
pathogens Prevotella intermedia
and Porphyromonas gingivalis. Indirectly, the soft tissue is more sen-

Does pregnancy gingivitis
lead to premature birth?

Clinical studies further suggest that
bacteria, like P. gingivalis, Treponema
denticola, Tannerella forsythia and
Fusobacterium nucleatum, from the
oral cavity colonise the foetus and
the placenta, with blood being the
most likely transfer medium. These
periodontal pathogens may therefore represent a risk factor for negative pregnancy outcomes, including
low birthweight, premature birth
and pre-eclampsia (high blood pressure). Actually, there is still no clear
proof to support the connection
between periodontitis and negative
pregnancy outcomes. Some studies
indicate that there could be a link.
Further studies are needed, however,
to understand the complex biologi-

cal processes. Three facts remain.
First, a pre-existing periodontal condition in the woman can exacerbate
periodontitis during pregnancy. Second, after the birth, the periodontal
status of women with periodontitis
improves without active periodontal
therapy. However, the disease does
not disappear and can even worsen
after the birth. Third, pregnancy gingivitis alone does not lead to negative pregnancy outcomes.

Treatment and prevention
Whether the mouth is healthy, has
gingivitis or even periodontitis,
nowadays, organisations and researchers recommend that pregnant
women make three visits to the dentist, ideally once per trimester. This
way, dentists can advise them comprehensively in the first trimester.
The second trimester is suitable for
a professional tooth cleaning and
periodontitis treatment. The practice
team should use the third trimester
for consultation on the dental health
of the baby. Ideally, prophylaxis
should begin for the child during
pregnancy. Different studies show
how important it is to educate women during pregnancy and right after
the birth in order to reduce the risk
of caries in children.
In the dentist’s office, pregnant patients should learn everything important about the development of
dental caries, routes of infection and
nutrition; however, the emphasis

here is not just on the information,
but also on targeted, preventative
therapy. Expectant mothers who
become enthusiastic about prophylaxis pass this experience on to their
children. This way, prophylaxis for
the child, the first primary prophylaxis even before the birth, becomes
the focus of dentistry.

Mechanical and professional
plaque control
Mechanical plaque control has always been the focus of pregnancy
prophylaxis. Brushing with a toothbrush with soft bristles and fluoride
toothpaste, and using instruments
for interdental care and, if necessary,
chemical plaque control are key instruments for the prevention of gingivitis and periodontitis even before
pregnancy. That is why, for example,
Oral-B recommends electric toothbrushes with oscillating rotations.
At the same time, every system of
mechanical plaque control is suitable in principle, whether manual or
electric, as long as the correct technique is used regularly and with persistence (120 seconds).
In the case of gingivitis, toothpastes
with antibacterial agents such as
stannous fluoride are beneficial, and
mouth rinsing solutions are suitable as additional therapy. For acute

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gingivitis, patients should use chlorhexidine therapeutically for a short
time, best in a concentration of 0.1–
0.2 per cent or 1 per cent. Different
meta-analyses have found that chlorhexidine can be used with confidence during pregnancy. Long-term
chemical plaque control is suitable
for pregnant women with nausea
and poor oral hygiene, particularly
in the molar area. Other alternatives,
such as tea tree oil and propolis, have
not shown any effectiveness in studies.

What to keep in mind with
periodontal therapy
If the practice team has to treat pregnant patients for periodontitis, neither has any special procedures to be
considered first. Research shows that

non-surgical periodontal therapy is
safe and sensible during the second
trimester. Scaling and root planing
are quite possible during pregnancy.
Radiographs can be taken and local
anaesthesia can be administered
without additional risk to the foetus
or the mother. Articaine is the agent
of choice in this case. Periodontal
therapy does not reduce the occurrence of negative pregnancy issues.
However, it can lower the frequency
of negative pregnancy outcomes in
women at high risk of pregnancy
complications or who respond better to periodontal treatment.

Modern pregnancy
prophylaxis
Professional tooth cleaning as part

Prof. Nicole Arweiler, Germany

of modern biofilm management is
an indispensable component of gingivitis and periodontal therapy in
the context of a prophylaxis session.
Professional tooth cleaning, in combination with oral hygiene products
and instructions, clearly reduces
moderate or severe gingivitis. The
second trimester is therefore best
suited for professional tooth cleaning. At this point, nausea has usually
disappeared and the patient can stay
lying down for a whole hour.
An optimal pregnancy prophylaxis
also includes nutrition from a dentistry point of view. Here patients
should not limit themselves, but
enjoy their pregnancy. Nevertheless, patients should forgo acidic
foods and beverages. A craving for

#SayAhh
#WOHD19

Prof. Nicole Arweiler, Germany

SAY

sour and sweet foods, often in high
frequency, also increases the risk of
caries or an erosive change in the
tooth enamel. In addition, the buffering capacity and rinsing function
of the saliva is reduced during pregnancy; the mouth tends to be dry,
which promotes the development of
dental caries. Even allegedly healthy
foods and drinks, like fruits or fruit
juices, which are acidic, can quickly
damage the tooth enamel.

LT
A
E
H
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T
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O
M
ACT ON

A healthy mouth and
body go hand in hand.

Speaking of erosion, morning sickness also leads to the production of
gastric acid, which can again lead to
dental erosion of varying intensity.
Toothbrushing should be avoided
after an episode. The pellicle needs
2 hours to reform after vomiting.
Helpful means of neutralising are
the consumption of milk, cheese
and, above all, chewing gum. Instead
of brushing right after, antibacterial
mouth rinsing solutions and fluoride rinsing solutions are suitable
first.

Teach your patients how good
oral care contributes to overall
health and well-being.

DEN

CHE TAL
CK-U
P

Spread the

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word an
N ME FOR
SCA
MORE INFO

Supporters

Global Partners

Organized by

www.worldoralhealthday.org

Pregnancy is a major challenge with
regard to teeth and gingivae. The
main task of periodontal treatment
during pregnancy is to improve
the periodontal and overall health
of pregnant women. Oral hygiene
training and nutrition advice reduce
plaque and gingivitis and thus periodontitis. With respect to affecting
negative pregnancy outcomes, intervention even before pregnancy
may be more effective. If the practice
team controls the gingivitis and so
avoids periodontitis, it has made its
contribution to a problem-free pregnancy. In all cases, prevention is better than cure and every tooth counts.
Editorial note: A list of references can
be obtained from the publisher.
This article was originally published in
prevention international magazine
for oral health, Issue 1/2018.

[55] =>

Advertorial

New Technology Briefing:
®
New Colgate Total
The next generation toothpaste for Whole Mouth Health
- pathway to everyday prevention

Colgate® announces the launch of its next generation Colgate Total® toothpaste designed
to proactively protect hard and soft oral tissues - tongue, teeth, cheeks and gums - against
the most prevalent oral diseases: gingivitis and caries.
Periodontal disease and caries are both
preventable in their early stages (Gingivitis and
White Spot Lesions, respectively). Yet, despite the
efforts of the dental profession to improve oral
hygiene, these diseases continue to be a public
health concern, with up to 50% of the global
population estimated to be affected.1 Moreover,
patients are looking for guidance and support
from their dentist to make sure they are being as
proactive as possible for better oral health.

The next generation toothpaste, a
clinically proven step forward in the
quest for Whole Mouth Health
Decades of research have led to the
development of a patented formulation for
new Colgate Total®. This advanced toothpaste
helps achieve Whole Mouth Health with a new
technology that works with dual zinc plus
arginine to provide proactive protection to
the whole mouth, and help prevent the most
relevant oral diseases and conditions.

Reducing periodontal disease and caries
offers societal benefits

The economic burden of these untreated diseases is
likely to increase due to population longevity which
is an important aspect to policy makers2,3. Attention
has focused on controlling bacteria in dental
plaque, while the value of Whole Mouth Health has
been underestimated.

Whole Mouth Health and the role of
dental biofilm
The concept of Whole Mouth Health is based on
the importance of achieving more than just healthy
teeth -all oral tissues need to be healthy. Teeth, the
hard tissue, account for only 20% of oral structures,
while the soft tissue, tongue, cheeks and gums
represent the 80% majority. To retain a healthy
mouth, protection of all surfaces is needed.

Disrupting the cycle
Bacteria can colonize on the teeth, initiating the
formation of dental biofilm, but they also adhere
to soft tissues in the mouth. From here they
recolonize on the surface of teeth that have been
brushed, rebuilding the dental biofilm causing
diseases to reoccur. Protecting the soft tissues
prevents adherence of bacterial biofilm and so
protects the soft tissue and hard surfaces from
bacterial colonization.
Regular fluoride toothpaste* is not enough to
achieve Whole Mouth Health - it only protects hard
surfaces with fluoride. Regular fluoride toothpaste*
does not protect the hard surfaces from repopulating
with bacteria harbored in the soft tissues.

Whole Mouth Health as the new
paradigm for prevention
The route to improving Whole Mouth Health
is to prevent the build-up of oral biofilm and
achieve good bacterial control on all oral
surfaces, both hard and soft tissues.
The best way to achieve this is having an
everyday prevention routine with the daily use
of a toothpaste with proven protection against
bacteria - a toothpaste that can strengthen the
mouth’s natural defenses.

•

Prevents tooth
decay/cavities

•

Superior reduction
in sensitivity†

•

Superior plaque
reduction†

•

Superior reduction
in tartar†

•

Superior reduction
in gingivitis†

•

Reduces stains and
stain intensity

•

Superior reduction
in gum bleeding†

•

Protects against
erosive damage

•

Fights bacteria to
keep breath fresh

•

Helps repair
weakened enamel

A toothpaste designed to work with the
chemistry and biology of the mouth:
The formulation of dual zinc plus arginine effectively
controls biofilm, through:5
•

Weakening to kill bacteria by interfering in bacteria
metabolism and reducing their nutrient uptake

•

Slowing bacterial growth

•

Enhancing soft tissue’s natural defense with a
protective barrier that adheres to tongue, teeth,
cheeks and gums

•

Limiting bacterial adherence to hard and soft
tissues for 12 hour protection6,**
Additional benefits:

Clinically proven whole mouth
antimicrobial protection
Studies show that new Colgate Total® reduces
bacteria on teeth, tongue, cheeks, and gums
(TTCG) by up to 38.3% on Teeth, 39.7% on
Tongue, 35.4% on Cheeks, and 25.9% on Gums.6,**†

Clinically proven to reduce plaque and
gingivitis
New Colgate Total® is clinically proven to reduce plaque
(by 30.1%; p < 0.001) and gingivitis (by 26.3%;
p < 0.001) when compared to ordinary nonantibacterial fluoride toothpaste after six months.7

vs Ordinary Toothpaste*
35

% Reduction (6 months)

Reducing the incidence and prevalence of caries
and periodontal disease has the potential not only
to improve health and wellbeing in the general
population, but also to reduce the growing financial
pressure on publicly funded healthcare systems.

New Colgate Total® - proactive
protection for Whole Mouth Health

30.1

30
25

26.3

10
5

New

Long lasting freshness8

•

For 12 hours fresh breath9,#

•

The fluoride level meets with the
international standards for toothpaste
efficacy in caries prevention

New Colgate Total® is the advanced way to achieve
Whole Mouth Health by proactively controlling
and protecting against bacteria on 100% of mouth
surfaces, Teeth, Tongue, Cheeks and Gums.
By recommending new Colgate Total® to your
patients, they will have an advanced single
solution for better, more complete oral health†

If you would like more information about the
clinically proven benefits and efficacy of new
Colgate Total®, visit our website at:
www.colgateprofessional.com
References:

•

Plaque

Gingivitis

1. Nazir MA. Int J Health Sci (Qassim). 2017 Apr-Jun; 11(2): 72–80.
2. Kassebaum, N.J., et al. Global Burden of Untreated Caries. A
Systematic Review and Metaregression. Journal of Dental Research.
Vol 94, Issue 5, 2015. 3. https://www.efp.org/publications/Tonetti_
et_al-2017-Journal_ofClinical_Periodontology.pdf 4. Perio & Caries
Project. Available at: http://www.efp.org/publications/projects/
perioandcaries/ 5. Enhanced in vitro zinc bioavailability through
rational design of a Dual Zinc plus Arginine dentifrice, Manus, L et
al, J Clin Dent, Submitted August 2018. 6. Prasad & Mateo, July, 2016
internal report. 7. A clinical investigation of a Dual Zinc plus Arginine
dentifrice in reducing established dental plaque and gingivitis over
a 6-month period of product use, Garcia-Godoy, F et al, J Clin Dent,
submitted August 2018. 8. The science of developing appealing
flavors to drive compliance, Lee, C et al, J Clin Dent, Submitted
August 2018. 9. A clinical investigation of the efficacy of a Dual Zinc
plus Arginine dentifrice for controlling oral malodor, Hu, D., et. al., J
Clin Dent, Submitted August 2018.
* defined as non-antibacterial toothpaste
** after 4 weeks use, 12 hours after brushing
† vs ordinary non-anti-bacterial fluoride toothpaste
# with continuous use, after 3 weeks

www.colgateprofessional.com www.colgatetalks.com

[56] =>

What you say can make
a real difference.

®

New Colgate Total with Dual-Zinc + Arginine for
Whole Mouth Health. Reinvented to proactively work with
the biology and chemistry of the mouth.
Protects teeth, tongue, cheeks, and gums
• Superior reduction of bacteria on
100% of mouth surfaces, 12 hours
after brushing*1

NEW

Next generation technology

• Weakens to kill bacteria
• Creates a protective barrier on hard and soft
tissue to protect against bacterial regrowth
†
For better oral health outcomes,
advise
your
patients
®
about New Colgate Total
*Statistically significant greater reduction of cultivable bacteria on teeth, tongue, cheeks, and gums with Colgate Total® vs non-antibacterial fluoride
toothpaste at 4 weeks, 12 hours after brushing.
†
Significant reductions in plaque and gingivitis at 6 months vs non-antibacterial fluoride toothpaste; p<0.001.2
References: 1. Prasad & Mateo, July 2016, internal report. 2. Garcia-Godoy F, et al. J Clin Dent, submitted August 2018.

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[cover] => DT Middle East and Africa No. 1, 2019

[toc] => Array ( [0] => Array ( [title] => SEHA AHS educates 30 upcoming national dental professionals at its new medical facility in Abu Dhabi [page] => 1 ) [1] => Array ( [title] => Industry News [page] => 3 ) [2] => Array ( [title] => About the development of the first super quick polyether [page] => 4 ) [3] => Array ( [title] => Industry News [page] => 6 ) [4] => Array ( [title] => Interview: 3D Printing – Sustainable additive innovations transforming the dental industry [page] => 10 ) [5] => Array ( [title] => A step-by-step guide to a direct diastema closure [page] => 12 ) [6] => Array ( [title] => Beverly Hills Formula enter 2019 on a High [page] => 14 ) [7] => Array ( [title] => Management of midfacial recession defects around adjacent maxillary implants using ‘screw tent-pole’ technique [page] => 16 ) [8] => Array ( [title] => Predictable steps to Biomimetic Class IV restorations [page] => 18 ) [9] => Array ( [title] => Interview: "The participants can share the up-to-date knowledge about the subjects in the field of Conservative Dentistry. [page] => 20 ) [10] => Array ( [title] => Is digitalisation the way forward for dentistry? [page] => 24 ) [11] => Array ( [title] => Industry News [page] => 26 ) [12] => Array ( [title] => CEREC and Single Visit Dentistry [page] => 27 ) [13] => Array ( [title] => News [page] => 28 ) [14] => Array ( [title] => 3M Oral Care Dental Programme Highlights [page] => 30 ) [15] => Array ( [title] => Endo Tribune Middle East & Africa Edition No. 1, 2019 [page] => 33 ) [16] => Array ( [title] => Lab Tribune Middle East & Africa Edition No. 1, 2019 [page] => 37 ) [17] => Array ( [title] => Ortho Tribune Middle East & Africa Edition No. 1, 2019 [page] => 41 ) [18] => Array ( [title] => Implant Tribune Middle East & Africa Edition No. 1, 2019 [page] => 49 ) [19] => Array ( [title] => Hygiene Tribune Middle East & Africa Edition No. 1, 2019 [page] => 53 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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