cosmetic dentistry international
Cover
/ Editorial
/ Content
/ Welcome letter
/ Tooth whitening: A conservative approach
/ Non-invasive mini porcelain veneers: An alternative to direct resin restorations
/ Maximum aesthetics with minimal intervention
/ Aesthetic inlays and onlays: The coming of age
/ CAD/CAM was just the beginning
/ A smile says more than a thousand words: Reconstruction & modification of anterior teeth
/ Nobel Biocare adds to its NobelActive implant system
/ The Asian Academy of Aesthetic Dentistry: A brief history
/ Products designed for dentists by dentists
/ Naxos—life - the Greek way
/ The International Congress on Dental Aesthetics in Sofia
/ Cosmetic events
/ About the publisher
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Projekt2
issn 1616-7390
Vol. 3 • Issue 1/2009
cosmetic
dentistry
_ beauty & science
1
2009
_case study
Tooth whitening
_clinical technique
Minimal intervention
_lifestyle
Naxos —life, the Greek way
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editorial _ cosmetic dentistry
I
Dear Reader,
_Welcome to this year’s first edition of cosmetic dentistry! 2008 was a very successful year,
as we were able to expand our professional network with various aesthetic institutions and individuals. I would hereby like to express my sincere gratitude to all editorial board members, advisors,
authors, and institutions for their professional support and guidance. We are also much obliged to
all our valued readers for accepting this new publication.
Dr Sushil Koirala
Editor-in-Chief
During my recent visits to Japan, India, and Thailand, workshops and lectures were organised in
collaboration with many aesthetic dentists, both new and well established. I was pleased to note that
most professionals are quite serious about the various ethical concerns of cosmetic dentistry.
Irrespective of geographic and cultural differences, all of us face the same practical difficulties in
differentiating between need- and desire-based treatments. Cosmetic dental treatment is generally
related to the personal desires of a patient and may not necessarily improve health or function of
the oral tissues. Therefore, dentists have an ethical responsibility to educate their patients about
realistic goals and appropriate treatment options.
Patient psychology, health, function, and aesthetics are the four fundamental components of
comprehensive aesthetic dentistry that need to be adequately addressed during smile-design procedures. I differentiate three different grades of aesthetic dentistry, which can be summarised as
follows: Grade I (preventive) helps to prevent or intercept diseases, habits, and other factors that
may adversely affect the existing or future smile aesthetics; Grade II (mimetic) helps to restore or
mimic the natural aesthetic, with emphasis on health and function; and Grade III (cosmetic) helps
to enhance or supplement the aesthetic component, which may not be in harmony with the patients
sex, race, or age and not necessarily be beneficial for the health or function of the oral tissues.
Personally, I feel that a patient’s cosmetic desires alone should not be the rationale for cosmetic
treatment. The most critical aspect of cosmetic treatment is indeed the treatment’s benefit for the
health or function of the oral tissues. During any aesthetic treatment where healthy oral tissue is
being treated with no direct benefit to health or function, the treatment modalities
must be restricted to non-invasive or minimally-invasive procedures. Do no harm!
should always be the credo pertinent to all dental treatment procedures.
In this issue of cosmetic dentistry, we have tried to incorporate various
clinical cases that are mostly related to natural, cosmetic desires of patients
who are treated exclusively with non-invasive to minimally-invasive
procedures. I hope you will enjoy this issue of cosmetic dentistry and am
eagerly awaiting your comments and contributions!
Sincerely,
Dr Sushil Koirala
cosmetic
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I content _ cosmetic dentistry
page 08
page 12
I editorial
I industry news
03
34
Dear Reader
_ Sushil Koirala, Editor-in-Chief
07
Welcome to our Asian colleagues
page 16
Nobel Biocare adds to its
NobelActive implant system
I feature
_ Wynn Okuda
36
I case study
08
12
_ Seok-Hoon Ko
Tooth whitening: A conservative approach
_ So-Ran Kwon
38
Non-invasive mini porcelain veneers:
An alternative to direct resin restorations
_ Dinos Kountouras
40
Maximum aesthetics with
minimal intervention
Naxos—life, the Greek way
_ Annemarie Fischer & Daniel Zimmermann
I meetings
_ Sushil Koirala
I opinion
22
An interview with Cosmedent Inc.
co-founders Michael O’Malley &
Dr K. William ‘Bud’ Mopper
I lifestyle
I clinical technique
16
The Asian Academy of Aesthetic
Dentistry: A brief history
44
Aesthetic inlays and onlays:
The coming of age
_ Ronald D. Jackson
The International Congress on
Dental Aesthetics in Sofia
_ Nadejda Kuyumdjieva
48
Cosmetic events
I industry report
I about the publisher
26
49
50
CAD/CAM was just the beginning
_ Manfred Kern
30
_submissions
_ imprint
A smile says more than a thousand words:
Reconstruction & modification of anterior teeth
_ Ronaldo Hirata
page 26
04 I cosmetic
dentistry
1_ 2009
page 30
page 40
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all ceramic
all you need
IPS e.max restorations fabricated by Prof. Dr. D. Edelhoff / O. Brix, Germany
IPS e.max offers exceptional metal-free
aesthetics and strength both for the press
and CAD/CAM technique.
IPS e.max offers:
• Outstanding aesthetics
• Self-adhesive or conventional cementation
• Choice of high-strength materials including zirconium
oxide and glass-ceramic
• Press and CAD/CAM processing techniques for
optimum strength and accuracy of fit
• One single layering ceramic for the IPS e.max System
www.ivoclarvivadent.com
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503/504 Raheja Plaza | 15 B Shah Industrial Estate | Veera Desai Road, Andheri (West) | Mumbai 400 053 | India
Tel.: +91 (22) 2673 0302 | Fax: +91 (22) 2673 0301 | E-mail: info@ivoclarvivadent.firm.in
Ivoclar Vivadent Marketing Ltd Singapore
171 Chin Swee Road | #02-01 San Centre | Singapore 169877
Tel.: +65-6535 6775 | Fax: +65-6535-4991
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editorial _ welcome letter
I
Welcome to our
Asian colleagues
_The American Academy of Cosmetic Dentistry (AACD) is dedicated to advancing excellence in the art and science of cosmetic dentistry and encouraging high standards of ethical
conduct and responsible patient care. The AACD fulfils its mission by offering superior educational opportunities, promoting and supporting a respected accreditation credential, serving
as a user-friendly and inviting forum for the creative exchange of knowledge and ideas, and
providing accurate and useful information to the public and dental professionals.
Wynn Okuda
It is my honour to invite you to the 25th Anniversary AACD Scientific Session, Excellence in
Cosmetic Dentistry 2009, in Honolulu from 27 April to 1 May 2009. As aesthetic dentistry continues to evolve at a rapid pace, it is becoming increasingly important for dentists and laboratory technicians to seek out progressive dental education at an international level. The annual
AACD Scientific Session does just that, with world-renowned international educators, such as
Dr Galip Gürel, Dr John Kois, Dr Akira Senda, and Dr Toru Masuo.
It is the AACD’s goal to bring East and West together to share ideas and innovations and
promote global aesthetic synergy. Honolulu is the perfect backdrop for this session, as AACD
members from around the world join us in celebrating our 25th anniversary.
The AACD has formed the Global Forum that seeks to promote global participation at the
25 Anniversary AACD Scientific Session. The Global Forum will take place on 29 to 30 April
2009 and will present some of the best clinical courses in the field of aesthetic and restorative
dentistry. If you plan to attend throughout the entire week, you will receive a 10 per cent
discount on member and non-member tuition rates.
th
We are also excited to announce the return of the Matrix Band! This rock band, whose band
members are AACD members, and the 90s popstar Glenn Medeiros, are performing on 29 April
at 7 pm at the Pipeline Café in Honolulu. The Rockin’ in Paradise concert celebrates the band’s 10th anniversary, and proceeds will be donated to the
Give Back a Smile charitable programme.
The AACD and I look forward to hosting you at our
scientific session and fostering great relationships
as dental colleagues and friends. To sign up for the
AACD Hawaii 2009 meeting go to www.aacd.com.
To sign up for the Rockin’ in Paradise concert go to
www.aacd.com/matrixband. I hope to see you there!
Mahalo,
Wynn Okuda, DMD FICD FICOI
Past President and Board-accredited member of the AACD
International Ambassador and Liaison of the AACD International Advisory Council
cosmetic
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I case study _ tooth whitening
Tooth whitening:
Aconservative approach
Author_ So-Ran Kwon, Korea
Fig. 1_Smile analysis before
whitening.
_A beautiful smile tends to be associated with
health, self-confidence, and happiness, and because
of this, it influences a person’s self-esteem and even
social perception by others. Among many other treatment options for obtaining a beautiful smile, tooth
whitening is a relatively cost-effective, minimallyinvasive, and highly effective treatment method. The
success rate depends mainly on the type of discolouration and ranges from 90 to 97 per cent. Satisfactory retention of the colour can be expected for one
to three years and may last up to ten years posttreatment.
Sensitivity of the tooth and irritation of the gingiva
are common during tooth whitening; however, all side
effects cease upon completion of treatment. Nevertheless, a comprehensive examination followed by
proper consultation is required to meet the patient’s
aesthetic expectations with an emphasis on maximum conservation of healthy dental tissue.
_Case report
In many cases, patients are well aware of their
dental problems and request specific dental treatment. In this case, a 33-year-old female patient
wished for tooth whitening and re-contouring of her
prominent upper canines.
A comprehensive examination and smile analysis
using a spectrophotometer (Spectroshade, MHT)
revealed healthy dentition with a shade range between D4 and A4 (Fig. 1).
The upper right first premolar presented a cervical
abfraction area with moderate sensitivity to cold. The
left first premolar had a Class V composite resin filling
with slightly worn margins. Localised white decalcification areas were visible on the upper lateral incisors
(Fig. 2).
Tooth whitening, aesthetic re-contouring of the
upper cuspids, and a Class V composite resin filling on the
right first premolar were proposed to the patient. The
Fig. 1
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I
Fig. 2
Fig. 3
Fig. 4
Fig. 5
possibility of additional treatment of the upper lateral
incisors was given in case the white decalcification areas
would not blend in naturally with the whitened teeth.
Tooth whitening can be performed either at home
with the use of a relatively low concentration of
whitening agent delivered in a custom-fabricated
tray or in the office with higher concentrations of
hydrogen peroxide and a resin barrier to prevent the
gel from irritating the soft tissue. Generally, the use
of light activation to accelerate the procedure is
optional.
Fig. 2_Intra-oral view before
whitening.
Fig. 3_Power whitening with a
light-activating device.
Fig. 4_Distinct colour difference
between the upper and lower teeth.
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I case study _ tooth whitening
Tooth number
Shade guide units
⌬E
#13
10
16.32
#12
5
9.05
#11
10
13.68
#21
11
14.64
#22
8
10.19
#23
10
16.01
Summary of the shade changes of the six anterior teeth in terms of shade guide units and ⌬E values.
In order to obtain a favourable result in a relatively
short time, the patient preferred a combination of
home and power whitening. An alginate impression
was taken prior to the first in-office whitening session
(Fig. 3). While the patient received whitening of the
upper arch for 40 minutes, a model was poured and a
customised tray was fabricated. Thus, it was possible
to deliver the upper tray and the home whitening kit
on the day of treatment.
Fig. 5_Intra-oral view after
whitening.
Fig. 6_Smile analysis after
whitening.
Routine explanations on the possibility of sensitivity to cold, irritation to the gingiva, and limitation of
whitening in the cervical area were given to the
patient. The patient was scheduled for her second in-
office whitening session with an interval of three to
four days. During that time, home whitening was performed for maximum efficacy of the treatment. After
the third in-office whitening session, a remarkable
difference was observed between the upper and lower
teeth (Fig. 4). Although the decalcification area on the
left lateral incisor was slightly more noticeable at this
stage, the patient was very happy about the distinct
colour difference between the upper and lower teeth.
Treatment on the lower teeth was conducted in the
same manner as the upper teeth. She received three
in-office whitening sessions on the lower arch with an
interval of three to four days combined with home
whitening.
Aesthetic re-contouring was cautiously performed with 12-fluted carbide burs to reduce the tips
of the cuspids. The Class V composite resin filling was
placed two weeks after whitening to allow for colour
stability and recovery of bond strength of the enamel.
At this stage, the decalcification area finally blended
in naturally with the whitened teeth (Fig. 5).
A smile analysis after treatment revealed the
efficacy of tooth whitening and confirmed that
the treatment had been completed successfully
(Fig. 6).
Shade changes can be measured as shade guide
units on a value-oriented, classic vita shade guide
or as ⌬E values defined by the Commission Internationale de l’Éclairage (CIE) L*a*b* colour system.
⌬E is the shortest distance in the CIE L*a*b* colour
space between the colours being compared and is
determined using the equation ⌬E= (⌬L*2 + ⌬a*2
+ ⌬b*2)1/2 where L* represents lightness, a* corresponds to the red–green axis (positive value indicates red, negative indicates green), and b* corresponds to the yellow–blue axis (positive value indicates yellow, negative value indicates blue). The
shade change as indicated by ⌬E was obtained by
overlapping the image of the same tooth before
and after tooth whitening (Fig. 7), using the Spectroshade analysis software (Version 2.41).
An increase in ⌬E after tooth whitening is usually attributed to an increase in L* values and a decrease in b* values. It is interesting to note that ⌬E
values varied according to the teeth although all
teeth were treated with the same concentration and
same exposure time. This suggests that each tooth
has its own degree of whitening, which is a very
Fig. 6
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case study _ tooth whitening
I
important factor that influences the efficacy of
tooth whitening.
A combination of home and power whitening
gives the advantage of faster whitening with the
benefit of monitoring and motivating the patient
throughout the treatment.
_Conclusion
Tooth whitening is a non-invasive, economical,
and highly effective aesthetic treatment for creating
a bright smile. It should always be considered in aesthetic treatment planning to provide patients with a
beautiful smile, giving them self-assurance and
bringing them happiness._
_References
1. Chu SJ et al. Fundamentals of color. Quintessence Publishing
Co. Inc., 2004.
2. Goldstein RE, Garber DA. Complete Dental Bleaching. Quintessence Publishing Co. Inc., 1995.
3. Haywood VB. Tooth Whitening Indications and Outcomes of
Nightguard Vital Bleaching. Quintessence Publishing Co. Inc.,
2007.
4. Kwon SR,Ko SH,Greenwall L.Tooth Whitening in Esthetic Dentistry. Quintessence Publishing Co. Inc., 2009.
Fig. 7
_author info
cosmetic
dentistry
Fig. 7_Synchronisation of the same
tooth before and after whitening to
measure the shade change.
Dr So-Ran Kwon, Founder and President of the
Korean Bleaching Society,
lectures internationally on
tooth whitening. She has
written many articles and
books on tooth whitening,
including Tooth Whitening
in Esthetic Dentistry published by Quintessence. She is currently a visiting
professor at Yonsei University and maintains a
private practice in Seoul, Korea. Dr Kwon can be
contacted at smileksr@hotmail.com.
AD
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I case study _ mini veneers
Non-invasive mini
porcelain veneers:
An alternative to direct
resin restorations
Author_ Dinos Kountouras, Greece
Fig. 1
Fig. 2
Fig. 1_Pre-op view of the smile.
Fig. 2_Pre-op view. Note the incisal
edges.
_Aesthetic dentistry is featured widely in the media as the field of dentistry that can change or enhance
the appearance of the face, leading to an improved
quality of life and increased self-confidence for the
patients. Of course, the patients as clients can decide for
themselves whether they want to have brighter teeth,
but in granting this request, sound tooth structure is
often removed.
when these are not immediately sealed after preparation, and deteriorate the condition of the pulp leading
to future endodontic problems. So, apart from the obvious ethical questions, a financial gain for the dentist can
unfortunately be short-lived when legal action procedures are taken by patients, who blame the dentist for
harming them, not acting professionally, and not judging correctly based on scientific evidence.
I will apply dietetic measures for the benefit of the
sick according to my ability and judgement; I will keep
them from harm and injustice is at the core of the
Hippocratic Oath. Dentists not adhering to the Oath risk
losing their physician status, especially when they provide aesthetic treatments based solely on their patients’
demands. Without critically analysing these demands,
they can satisfy the patients’ cosmetic needs but may
cause harm when otherwise healthy teeth are prepared.
Unfortunately, our society considers the ‘denture
look’ the only aesthetically acceptable smile design look.
Therefore, the question is: how can natural-looking
smiles that are in harmony with the patient’s appearance be delivered, while conserving tooth structure and
generating income for our practices? The answer lies in
appropriate material selection; allowing for the adoption of minimally- or non-invasive methodology;
possibly, the involvement of other specialties, like
orthodontics, to facilitate tooth movement, in order to
allow for less tooth preparation; and of course, on patient education and appropriate fee selection. Patients
should be informed about the possible long-term
When a tooth is prepared and dentine is exposed, the
physiology of the tooth is affected. Oral bacteria can migrate through the exposed dentinal tubules,2 especially
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case study _ mini veneers
results of aggressive tooth preparation. They should
take responsibility in their care and actively participate
in their diagnosis and treatment. Through communication methods, like mock-up or imaging, patients should
be given the opportunity to visualise and value the
results that minimally- or non-invasive procedures can
have for their smile. Often, a combination of bleaching,
aesthetic re-contouring, bonding, or minimal veneering
can enhance the appearance of the smile and simultaneously maintain the individuality and look of the patient.
Adhesive dentistry allows more conservative approaches to restorative solutions, allowing practitioners to choose ‘addition’ over ‘resection’ of the remaining
sound tooth structure whenever indicated.
Composite materials are the most commonly used
for correcting small to medium aesthetic discrepancies.
Owing to their reduced expense, improved physical and
optical characteristics, and direct application in a single
appointment, they have become increasingly important
I
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
in contemporary aesthetic dentistry. Their minimal
invasion requirements satisfy both the patient and the
dentist.
Alternatively, porcelain provides superior colour stability and physical durability with greater longevity and
superior optical and aesthetic properties. Traditionally
though it has been associated with more invasive techniques. Nevertheless, when it comes to enhancing the
smile with porcelain in order to improve the aesthetics,
porcelain veneering is one of the most conservative and
aesthetic techniques that we can apply. The prognosis
of the veneers is very good especially if the right indications are chosen and the correct techniques are applied.
Fig. 3_Frontal view of the cast.
Fig. 4_Occlusal view of the cast.
Fig. 5_Frontal view of the diagnostic
wax-up.
Fig. 6_Occlusal view of the wax-up.
Fig. 7_Frontal view of the veneers in
the cast.
Fig. 8_Occlusal view of the veneers
on the cast.
The feldspathic type of porcelains can be baked at
thicknesses of 0.2 mm when considering minimally- or
non-invasive indirect veneering options. This allows for
a minimal amount or no removal of tooth structure,
while maintaining the ability to improve the appearance
of the tooth.
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I case study _ mini veneers
Fig. 9
Fig. 10
not pleased with the palatal position of her right lateral incisor (Fig. 1). Owing to her profession—she
works as a violinist with regular TV appearances—she
often performs in studios, where the lights accentuate the dark space in the area of the lateral incisor. She
also wanted to correct the pointed incisal edges of her
upper canines (Fig. 2). Apart from reporting these specific problems, the patient requested an overall
enhancement of her smile. A main concern of the
patient was that all treatment should be done without preparing any of her teeth.
Fig. 11
Fig. 9_Try-in of the facings to evaluate their fit.
Fig. 10_Frontal view of the cemented
veneers.
Fig. 11_Occlusal view of the
cemented veneers.
The preparations remain almost entirely in enamel,
which is important from a longevity standpoint. The
longevity of a bonded veneer is in correlation with the
amount of enamel substrate supporting it. The dentine–enamel junction is very important for the structural strength of the tooth because it is regarded as a
fibre-reinforced bond. When our preparations lay on
enamel, the tooth will not flex. However, if we finish our
preparation on large amounts of dentine, we will not
only create bonding issues and possibly cause
endodontic problems, but we will also increase the flexing of the tooth structure. When a rigid material like a
porcelain veneer is bonded on top, the difference in the
rigidity may cause the luting resin at the margin to start
peeling off slowly in function. In these situations, we will
most likely end up with some micro-leakage or delamination. In order to avoid these problems, we have to be
very precise and careful in case selection and tooth
preparation. Minimally-invasive, controlled reduction
techniques have been developed to safeguard tooth
structure10 and increase the veneer treatment prognosis, while still delivering the designed final aesthetic
result.
This article presents a case report featuring an indirect treatment approach using non-invasive mini
porcelain veneers to enhance the aesthetics of the smile
as an alternative to direct composites.
_Case report
A 36-year-old female patient presented for a consultation concerning her anterior aesthetics. She was
14 I cosmetic
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1_ 2009
On examination, there was an anterior open-bite.
When the patient was in centric occlusion, she did not
contact the lateral incisors and canines. Even though,
orthodontic treatment was the ideal choice for
restoring this case, the patient felt she did not want to
undergo this type of treatment at this time.
The aesthetic problem could be corrected using
either composite resin or porcelain. Porcelain was
chosen for this case, as the patient is a frequent coffee drinker and was concerned about possible future
discolouration. Feldspathic porcelain offers superior
colour stability and physical durability compared with
composite resins. It can also be manufactured in very
thin layers, allowing for a very conservative reversible
treatment.
Full-arch impressions were taken using a vinyl
polysiloxane material, and casts were poured (Figs. 3
& 4). No gingival retraction was needed because all
margins were supra-gingival. No provisional veneers
were fabricated.
A diagnostic wax-up was made (Figs. 5 & 6) for
evaluative purposes. We decided to elongate teeth 11
and 21 by adding and simultaneously shaping up the
incisal edges, and increasing the bulk of the contour
facially, to complement the appearance. We also
added bulk to tooth 12, to make it part of the arch, and
shaped the facial contour of tooth 22 similarly. In
addition, we added a little bit of bulk mesially to the
incisal edges of the canines, in order to minimise the
pointed incisal edges. All changes in the contour were
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additive and no teeth needed to be prepared. The
veneers were manufactured in the laboratory using
IPS d.SIGN porcelain (Ivoclar Vivadent), keeping the
same shape as the wax-up model. A full facial coverage porcelain veneer was manufactured in teeth 12
and 22. Very thin porcelain edges were fabricated in
teeth 13, 11, 21, and 23 (Figs. 7 & 8).
The porcelain veneers were first tried to evaluate
their fit (Fig. 9). Using glycerine try-in gels (Variolink
Veneer, Ivoclar Vivadent) the aesthetic appearance was
also evaluated. The transparent Variolink glycerine gel
(MV 0) was chosen in this case as the most appropriate
for aesthetics, and therefore, the equivalent transparent luting resin (MV 0, Variolink Veneer, Ivoclar
Vivadent) was picked as the cementation medium of
choice. A retraction cord (Ultrapak E #00, Ultradent)
was placed to prevent gingival fluids from contaminating the teeth during the bonding process.
The surface of the teeth was cleaned with pumice
and then the teeth were acid-etched for 30 seconds
with 37 per cent phosphoric acid gel. A bonding agent
was then applied (Heliobond, Ivoclar Vivadent) according to the manufacturer’s instructions. The internal
aspect of the veneers was treated with 5 per cent hydro-fluoric acid for 30 seconds, then silane treated
(Monobond-S, Ivoclar Vivadent) for an additional 30
seconds, and finally air-dried with warm air to increase
the bond between the ceramic and bonding resin. A
bonding agent (Heliobond, Ivoclar Vivadent) was
applied over the dried, silanated fitting surface. After
gently air thinning the bonding agent, the transparent
luting resin (MV 0, Variolink Veneer System, Ivoclar
Vivadent) was placed inside the veneers, and the veneers were placed on the teeth. Excess luting composite was removed with a brush and then each veneer was
cured for 3 seconds before additional excess resin was
removed while still in gel form. Dental floss was used to
remove excess resin from the interproximal areas.
Final curing was accomplished by using the curing
light on the facial and lingual surfaces of each tooth.
Carbide-finishing burs (Safe End Tapered Round, SS
White) were used to remove excess luting resin at the
margins and then aluminium oxide polishing strips
were used to smooth these areas. Occlusal adjustment was accomplished with carbide-finishing burs
(SS White Flame). Diamond and silicone carbideimpregnated rubber polishing cups and points were
used to polish all surfaces (Jazz P3S, SS White).
The final images can be seen in Figures 10 and 11.
The veneers were manufactured in harmony with the
patient’s face and overall appearance (Fig. 12). The
aesthetic demands of the patient were met, no teeth
were prepared, and an overall enhancement of the
smile was achieved.
I
Fig. 12_Patient showing her new
smile.
Fig. 12
_Conclusion
The adoption of non-invasive methodology during
aesthetic treatment is in agreement with not only ethical considerations but also physiological ones. By using
non-invasive mini porcelain veneers, we are able to
enhance the smile of patients, with a completely
reversible approach, without removing any of their natural tooth structure and therefore with no interference
with the physiology of their teeth. Owing to the
presence of enamel under the whole fitting surface,
bonding procedures are very strong and the flexural
properties of the underlying natural teeth are also unchanged; thus, they are expected to last for many years.
Naturally, non-invasive methodology cannot
always be adopted because of various clinical situations and treatment demands. Nevertheless, whenever possible, additive procedures should be preferred to resectional ones.
Our smile design deviates from the ‘one-smile-fitsall’, ‘denture look’ approach. We aim to create smiles
that safeguard the individuality and variability that natural aesthetics exhibit and that are always in harmony
with the unique appearance and style of our patients._
_Acknowledgements
I would like to thank August Bruguera, MDT, for
undertaking all the technical work in this case.
Editorial note: A complete list of references is available from the publisher.
_author info
cosmetic
dentistry
Dr Dinos Kountouras is the founder and president of
the Hellenic Academy of Aesthetic Dentistry (EAAO).
He can be contacted at dinos@kountouras.com.
cosmetic
dentistry 1
I 15
_ 2009
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I clinical technique _ minimal intervention
Maximum aesthetics with
minimal intervention
Author_ Sushil Koirala, Nepal
_Many of us find it difficult and confusing to
distinguish between the aesthetic and cosmetic desires of our patients. Proper understanding and
analysis of the psychology, health, function, and aesthetic components of smile design are essential to
satisfying such desires.
Fig. 1a_Pre-op smile showing
discoloured teeth 11 &12 with uneven
incisal edges.
Fig. 1b_Pre-op full frontal view of the
anterior teeth with lips retracted.
Fig. 1c_Close-up view of the upper
anterior teeth.
Fig. 1d_Planning for selective home
bleaching. Note the spacer on the cast.
Fig. 1e_Bleaching tray placed in the
upper arch.
In my 17-year-old aesthetic dentistry practice,
I have found that the cosmetic desires of most of the
patients cannot be fulfilled by only applying the rules
of natural smile aesthetics because such desires are
mostly at odds with their sex, race, and age (SRA) factors and are guided by trends and culture. For example, an older patient seeking white (A1, B1, or bleached
white) teeth and a youthful-looking smile has a cosmetic desire that is contrary to the natural aesthetics
of dentition according to his age. However, should a
young patient whose anterior teeth are darker (A3 or
A3.5) and attrited want to restore natural shade and
shape, this should be regarded as an aesthetic desire.
In my opinion, patients’ desires for dental treatment that are not harmonious with SRA factors and
do not directly benefit the health or function of oral
tissues should be categorised as cosmetic desires. And
when such cosmetic desires are to be fulfilled, noninvasive to minimally-invasive restorative techniques
should be preferred.
In the following cases, the patients’ desires were
within the natural parameters in terms of their SRA
factors. For both of the cases, I tried to mimic the
natural aesthetics using minimally-invasive techniques.
Fig. 1a
_contact cosmetic
dentistry
Dr Sushil Koirala, VISA
president, can be reached
at skoirala@wlink.com.np.
16 I cosmetic
dentistry
1_ 2009
_Case I
A 19-year-old female patient presented with discoloured upper anterior teeth 11 and 12. The teeth were
non-vital and treated endodontically. The patient was
examined as per the Smile Design Wheel protocol, taking the psychology, health, function, and aesthetic
components into consideration. The patient’s major
concerns were the discolouration of teeth 11 and 12 and
the uneven incisal edges of the upper anteriors.
The intra-oral examination and dental history of the
patient revealed bruxism. After proper counselling
about her existing para-functional habit and aesthetic
problems, various treatment options were discussed.
Initially, the case was treated with the selective walking
and home bleaching of teeth 11 and 12, followed by the
re-contouring of the upper anteriors. A night guard was
fabricated to prevent the loss of tooth structure. The
patient was extremely satisfied with the treatment
outcome.
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clinical technique _ minimal intervention
I
Fig. 1b
Fig. 1c
Fig. 1d
Fig. 1e
Fig. 1f
Fig. 1g
Fig. 1h
Fig. 1i
cosmetic
dentistry 1
I 17
_ 2009
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I clinical technique _ minimal intervention
Fig. 1j
Fig. 1k
Fig. 1l
Fig. 1m
Fig. 1f_Nupro White Gold (15% carbamide
peroxide gel) used for home bleach.
Fig. 1g_Pola Zing (35% carbamide
peroxide gel) used as walking bleach.
Fig. 1h_Teeth 11 & 12 seven days
after bleaching.
Fig. 1i_Close-up view of teeth 11 & 12
after bleaching. Note uneven incisal edges.
Fig. 1j_Planning for cosmetic contouring.
Note area to be contoured
marked in black.
Fig. 1k_Contouring of the incisal surface
with Super-Snap black disk.
Fig. 1l_Anterior view after cosmetic
contouring.
Fig. 1m_Close-up view with black
background.
Fig. 1n_Night guard fabricated for
preventing tooth structure destruction
due to bruxism.
Fig. 1o_Smile after completion
of the treatment.
Fig. 1n
Fig. 1o
18 I cosmetic
dentistry
1_ 2009
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clinical technique _ minimal intervention
I
Fig. 2a
_Case II
A 26-year-old female patient unsatisfied with her
existing smile presented. Her aesthetic desire was less
gum visibility with prominent upper centrals in her full
smile. After thorough clinical examination and smile
analysis, the patient was informed about her existing
smile aesthetic defects and possible treatment options
were discussed. We decided to treat the case with minimally-invasive techniques. The patient was treated
with minor gum re-contouring and direct bonding
restorations. The outcome of the treatment was much
praised by the patient and her family._
Fig. 2b
Fig. 2c
Fig. 2d
Fig. 2e
Fig. 2f
cosmetic
dentistry 1
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I clinical technique _ minimal intervention
Fig. 2g
Fig. 2h
Fig. 2i
Fig. 2j
Fig. 2a_Pre-op smile. Note excessive
maxillary gingiva, poorly restored midline
diastema, and less prominent upper
centrals.
Fig. 2b_Pre-op full frontal view of the
anterior teeth with lips retracted.
Fig. 2c_Maxillary gingival contouring.
Fig. 2d_Close-up of the upper central incisors after gingival re-contouring and removal of the poor composite restorations.
Fig. 2e_Application of acid etchant on
tooth 11.
Fig. 2f_Application of bonding on tooth 11.
Fig. 2g_Flowable frame technique using
Beautifil Flow, SHOFU Inc.
Fig. 2h_Lingual frame ready on tooth 11.
Fig. 2i_Final application of enamel layer
(Beautifil II, INC Shade, SHOFU Inc.).
Fig. 2j_Post-op full frontal view of the
anterior teeth with lips retracted.
Fig. 2k_Close-up view of the restorations.
Fig. 2l_Aesthetic smile after completion
of the treatment. Note harmonious gingival level and the central dominance.
Fig. 2k
Fig. 2l
20 I cosmetic
dentistry
1_ 2009
[21] =>
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[22] =>
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CDE0109_22-24_Jackson
13.03.2009
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Seite 1
I opinion _ inlays & onlays
Aesthetic inlays and
onlays: The coming
of age
Author_ Ronald D. Jackson, USA
Fig. 1
Fig. 2
Fig. 1_Fractured cusp, no caries
present.
Fig. 2_Indirect resin composite onlay
at 15 years.
_There are many prominent teaching clinicians who feel that inlays and onlays (of whatever
colour) are a grossly underutilised restoration, and
that crowns are an overutilised restoration.1–3
I think it is worthwhile to examine some of the possible reasons for this unfortunate situation (for our
patients’ sake) and see if the reasons for dentists’ reluctance to incorporate these restorations into
their routine services are really valid today.
Reason No. 1: Large amalgam fillings are easier
and more affordable than inlays and onlays.
Reason No. 2: It’s just easier to do a crown than an
onlay.
Same response as above. However, I will agree
that when doing a crown, the clinician isn’t faced
with the decision of which cusps to keep and which
to remove—you just unthinkingly remove them all.
But as practitioners, we have to ask, are we deserving of patients’ trust and their money by only recommending that which we perceive (possibly because of lack of training or practice) as expedient?
Reason No. 3: Inlays and onlays are expensive.
Both terms—easier, affordable—are relative.
Whether something is easy or not in dentistry depends on your training and how often you’ve done
it. Our first amalgam filling or crown in dental
school wasn’t easy either. As for affordable, isn’t
that for the patient to decide? People generally buy
what they want or what they perceive is in their best
interest.
22 I cosmetic
dentistry
1_ 2009
Not any more than crowns or root canals! We
have no trouble recommending these services when
they are indicated. Maybe it would be easier for dentists to accept and recommend these restorations if
an onlay (gold or tooth coloured) was referred to,
and thought of, as a partial crown and carried the
same fee as a crown.
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opinion _ inlays & onlays
Reason No. 4: Crowns last longer and are more
predictable.
Although longevity is important and ingrained in
the dental psyche, it is not the only criteria of value.
In the age of adhesive dentistry, respecting remaining tooth structure and aesthetics have become
components of value as well. Keeping in mind that
patients are living longer and want and expect to
keep their teeth for a lifetime (something we tell
them can be done) means, in most instances, it is
best to recommend a crown only when it’s truly indicated.
The name of the game in dentistry today is ‘bank
the tooth structure’ for future use. Regarding durability, aesthetic inlays and onlays are not new anymore.
They have a track record, and it is good.4–9 With
today’s materials, longevity is mainly a matter of diagnosis, correct treatment planning and proper execution of technique (Figs. 1–4).
Although not aesthetic, well-done gold inlays
and onlays are considered to have a proven durability and longevity similar to crowns. If aesthetics is
not an issue, gold is still the standard and what I always recommend for second molars when a conser-
I
Fig. 3
Fig. 4
Fig. 5
Fig. 6
vative indirect restoration is indicated. However, it’s
interesting to note the number of people and the
types of people who still desire tooth-coloured or
non-metal restorations even in these teeth.
Reason No. 5: Posterior direct resin restorations
are less costly to the patient and can be completed in
one appointment.
It is a fact that more and more patients today are
selecting tooth-coloured restorations for their posterior teeth,10 and there is no question that wellplaced Class I and Class II direct resin restorations
are proving to be viable alternatives to amalgam.11,12
However, the indications for these restorations do
have limits.
Fig. 3_Failing amalgam and poor
contact due to tipped teeth.
Fig. 4_Indirect resin composite
inlays at 21 years.
Fig. 5_Recurrent caries evident in
both molars.
Fig. 6_The second molar was treated
with a direct composite resin restoration. It was thought that a better contact, cuspal contour, occlusal morphology, and correctly placed functional stops could be achieved in the
first molar with an indirect approach.
Generally, when the cavity is large or the tooth is
under excessive functional demand (heavy bruxer or
clencher), indirect restorations (resin or ceramic) are
indicated. Certainly, when a cusp is missing, many
clinicians feel the standard of care is best satisfied
by an indirect restoration (Figs. 5–10). After all, there
is no question that a laboratory technician working
with mounted models at the bench is going to provide a more accurate occlusal morphology, contact
and overall contour as well as properly located functional stops of the right intensity than we can by
grinding all the blue spots in the mouth. It’s also very
cosmetic
dentistry 1
I 23
_ 2009
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I opinion _ inlays & onlays
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 7_Molars with failing restorations and recurrent decay.
Fig. 8_Both distal cusps of the first
molar were onlayed due to a horizontal crack in the middle of the pulpal
floor that stopped halfway across.
The distal buccal cusp of the second
molar was onlayed due to a crack
on the pulpal floor at the base
of the cusp.
Fig. 9_This 44-year-old patient was
pleased that crowns could be avoided
and no sound healthy tooth structure
was unnecessarily removed.
Fig. 10_Indirect resin composite
onlays at four years. Note contacts
and marginal integrity at gingival
margins as seen on the radiograph.
difficult to achieve quality contacts in large restorations with poor tooth alignment or spacing.
No matter how good the direct resin materials get,
the above situations will usually be better served by indirect restorations in the same way that gold
inlays/onlays are considered superior to large amalgams, especially those that replace cusps.
Reason No. 6: Many third-party payment plans
don’t pay benefits for aesthetic inlays and onlays, but
most pay a benefit toward porcelain-fused-to-metal
crowns.
In a health care profession, it shouldn’t be necessary to even respond to such a statement, but I will. If
a properly informed patient would rather sacrifice
healthy tooth structure to save a few dollars or for a
cosmetic
dentistry
_author info
Dr Ron Jackson has published many articles on aesthetic and adhesive dentistry and
has lectured extensively across the United States and abroad. He has presented at all the
major US scientific conferences. Dr Jackson is a fellow in the American Academy of
Cosmetic Dentistry, a fellow in the Academy of General Dentistry and is director of the
Advanced Adhesive Aesthetic Dentistry and Anterior Direct Resin programmes at the Las
Vegas Institute for Advanced Dental Studies. He maintains a private practice in Middleburg,VA, USA, emphasising on comprehensive restorative and cosmetic dentistry.
24 I cosmetic
dentistry
1_ 2009
perceived greater longevity, well, that’s his or her
choice. It may be what that patient feels is best for himself or herself at that time. The operative words, however, are ‘properly informed’ (pros vs. cons) and ‘his or
her choice.’ We shouldn’t make the choice for a patient
based on an assumption that all patients want the
cheapest option or what their insurance will partially
pay for.
In conclusion, for many dental practices, offering
only low-cost (at least initially), large fillings or expedient crowns where they may not be the best our profession has to offer, is questionable and short-sighted.
The bottom line in dentistry today, as it always has
been, is to recommend treatment, which according to
the clinician’s professional judgment, is in the patients’
best interest. This is usually what the clinician would
select if he or she were the patient. The patients may
not always want that particular service and decline to
have it done, but they always deserve the choice.
The trend in dentistry is clearly toward more aesthetic and less invasive. Indirect resin and ceramic inlays and onlays are not only compatible with this trend,
but fulfil very nicely the restorative void between fillings and crowns._
Editorial note: A complete list of references is available from the publisher.
[25] =>
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[26] =>
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I industry report _ CAD/CAM
CAD/CAM
was just the beginning
Author_ Manfred Kern, Germany
26 I cosmetic
dentistry
1_ 2009
_Today, practising dentistry without digital
technology and CAD/CAM procedures is unimaginable. Intra- and extra-oral imaging, scanning of
antagonists and impressions, on-screen 3-D designing, the use of innumerable tooth shapes from
the tooth database, the design of anatomic occlusal
surfaces, functional articulation on virtual models,
subtractive processing of high-performance ceramics—none of this would be possible without the
use of computers.
Relatively recently, discussion was centred on
accuracy of fit, cost-effectiveness, and userfriendliness. The quality of CAD/CAM restorations
was viewed critically, and only a few leaders in the
field investigated this technology with scientific
rigour. Currently, the initially hesitant, and even
sceptical, attitude towards computer-manufactured dental prostheses has been replaced by one of
approval, and this technology has become a standard procedure.
The groundwork for this quantum leap in dental
technology was laid in 1985. Using a Fairchild video
sensor (which at the time was only used for military
purposes and for which special permission was required for use in dentistry), for the first time it was
possible for a preparation—made visible intraorally with a triangulation camera—to be measured
multidimensionally and transferred onto a screen.
Then, with the help of a PC, imaging software, and
a connected CNC grinding unit, the first inlay of
silicate ceramic was produced at the University
of Zurich.
From a technical point of view, the development
of 3-D image capture was propelled not only by
more powerful microprocessors, but also by CCD
image sensors with high-resolution photodiodes,
as well as optical and tactile scanners that help read
and upload preparations and models to the software. Laser scanners provide an impulse capacity
for reproducing tooth surfaces at a rate of thousands of measured points per second. Upgraded
CAD software with 3-D graphics applications receives the digital signals and recreates the clinical
surface needing restoration.
In those days, only a few could imagine the new
technologies and revolutionary treatment possibilities awaiting dentistry thanks to this development.
Since then, more than 28 million all-ceramic
restorations have been produced worldwide using
CAD/CAM technology, both chairside and in the
dental laboratory. Computerised milling machines
have made subtractive processing of glass- and
oxide ceramics possible from which to fabricate
aesthetic, high-quality restorations with a reproducible, consistent material quality at a reduced
cost.
Using ‘occlusal settling’ with preformed occlusal
surfaces from the tooth databank, the software
then virtually rebuilds the tooth surface. The cusps
of the occlusal surface are ‘settled’ into their occlusal position. An articulation programme takes
the occlusal characteristics of antagonists and the
adjacent teeth’s occlusal surfaces and creates a
contact-point pattern that fulfils the criteria of the
individual function. An acquired, regional functional generated path registry detects sites that interfere with the gliding space and reduces them automatically (Fig. 1).
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industry report _ CAD/CAM
Fig. 2
Fig. 1
Fig. 3
The impetus for this development in dental technology stems from two sources. The first was protagonists of computerised chairside restoration desiring to process an industrially fabricated ceramic
with defined physical properties directly at the
treatment unit (chairside) and provide the patient
with the definitive restoration (omitting temporaries) in one appointment. The second was the idea
of employing oxide ceramics, like ZrO2, for crownand bridge frameworks, by using CAD/CAM technology or digitally controlled milling techniques.
Other ceramics, such as lithium disilicate, also
exhibit better properties after mechanical processing, as the blanks used are industrially manufactured under optimal conditions. In addition, the
technology of CAD/CAM systems has been substantially improved. In the 1990s, computers became
more powerful and measurement methods more
effective, making it possible to adapt 3-D data
acquisition systems to the needs of dentistry and
simplify equipment handling. The evolution of CAD
software enabled the development of a variety of
I
construction possibilities and improved the quality
of grinding/milling units (Fig. 2). Cost-effectiveness
and high-quality restorations are the defining
characteristics of CAD/CAM technology. Dentist
and dental technician alike profit from this through
standardised and controlled treatment and manufacturing processes—and so does the patient. Today, approximately 82 per cent of all-ceramic
restorations in Germany are made using computer
technology, which indicates that CAD/CAM technology is establishing itself in dental offices and
laboratories. The next step in its evolution is now
anticipated.
_Where do we stand today?
New methods constantly change customary
processes, and advancements simplify the workflow. This is reflected in the increased mention of
construction models, articulation on a Windows interface, biogeneric occlusal surface design using
intelligent software, rapid prototyping, and 3-D
printing in the context of CAD/CAM in scientific
Fig. 4
Fig. 1_Virtual automatic reconstruction:
the scan data of the antagonist,
the functional movement, the adjacent
teeth, and the preparation can be taken
into consideration in their entirety to
design an occlusal surface that fits
according to all requirements.
(Image: Mehl)
Fig. 2_CAD construction of a widespanning ZrO2 bridge framework.
The system examines the connectors
for minimum thickness and loadbearing capacity.
(Image: Mehl)
Fig. 3_Individual intra-oral images are
anatomically correct, as they are
compiled in a virtual quadrant model.
(Photo: Sirona)
Fig. 4_The intra-oral camera scanner
enables an optical impression of the
entire maxilla or mandible, leading the
way for the impression-free practice.
(Image: Wiedhahn)
cosmetic
dentistry 1
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_ 2009
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I industry report _ CAD/CAM
Fig. 5
Fig. 6
Fig. 5_Milling centres have an ingenious quality-control system for processing ZrO2 ceramic for crown- and bridge
frameworks.
(Photo: Etkon–Straumann)
Fig. 6_Milling centres operate costeffective and according to standardised
manufacturing procedures.
(Photo: Heraeus Kulzer)
Fig. 7_Automatic reconstruction of inlay cavities. Top: undamaged original
tooth; centre: cavity; bottom: occlusal
surface automatically reconstructed
given only the remaining tooth
substance (centre).
(Image: Mehl)
Fig. 7
28 I cosmetic
dentistry
1_ 2009
publications. The impression-free practice is the latest step in this development. At IDS 2009, the use of
intra-oral 3-D measurement to, in part, make the impression-free practice possible will be demonstrated
(Figs. 3 & 4). With data from an intra-oral image sequence, e.g. of a quadrant, working models can be
produced using a wax-processing 3-D printer in a
rapid prototyping system, on which prostheses can
be manufactured conventionally or with CAD/CAM.
Via internet portals, the dentist can send optical
impressions from intra-oral scans to the dental technician, which are then fed into the stationary CAD
system. The impression-free practice is much more
comfortable for patients because impression-taking
and its incident gag reflex are eliminated. Addition-
ally, production time can be cut and the dental technician’s productivity increased considerably.
What is the future of CAD/CAM?
Those long familiar with the field were able to
predict early on that manufacturing centres would
play a crucial role: high efficiency, specialised personnel, centralised material purchasing, and high
quality standards for the ‘standard restoration’
enable an efficient output that in turn makes it possible to pay off investments in high-tech manufacturing machines, while increasing cost-effectiveness
(Figs. 5 & 6). Mid-sized and smaller dental laboratories will make best use of their core competency in the
computer-supported manufacture of high-quality
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industry report _ CAD/CAM
Fig. 9
Fig. 8
aesthetic restorations and in the specialised production of partial and implant-supported prostheses.
Another trend is the computerised fabrication of
inlays, onlays, and partial and single crowns, either
chairside or in the office’s own CAD/CAM-equipped
laboratory. Biogeneric occlusal surface design enables the reconstruction of the missing occlusal
surface with inlays, onlays, and partial crowns as naturally as possible (Fig. 7). The one-appointment
treatment saves the patient time and removes the
need for provisional restoration, which minimises
the risk of cusp fracture, enamel-margin chipping,
and weakening of the dentine bond.
CAD/CAM and all-ceramics are frequently mentioned together, which falsely implies that CAD/CAM
is limited to all-ceramics. The enormous potential inherent in the milling and, most recently, the laser
sintering of metals is often completely overlooked.
The fabrication of metal restorations (e.g. nonprecious metals and titanium) will eventually become a domain of CAD/CAM technology.
In the field of implantology, it is already possible
to create long-term provisional restorations, abutments, and crowns using computer-assisted methods, which also shorten treatment steps. Digital
volume tomography (DVT) yields a 3-D image of the
bone structure, thus enabling much higher quality
diagnosis, including the exact localisation of the
alveolar nerve. Particularly in dental arches bearing
partial prostheses, the DVT image quality is better
than that of CT images, and the X-ray dosage required is much lower. The DVT thus provides the basis
for the surgical planning of the implant.
In the future, the implant site and adjacent teeth
will be scanned with an intra-oral digital camera, and
I
a virtual model will be calculated. The 3-D volume tomogram will be superimposed on this model and the
crown will then be exactly positioned in the X-ray image (Fig. 8). The position of the endosseous abutment
will be suggested in the centre of the crown’s basal
surface and in its insertion pathway, and based on
this the situation will be examined for its surgical
feasibility. When selecting the implant system for
a given case, the case will be able to be completely
simulated in a three-dimensional radiograph. Using
special software, it will soon be possible to construct
a stereolithographically manufactured drilling
template, which will guarantee that the holes drilled
in the bone and the implants are exactly positioned
(Fig. 9).
Fig. 8_DVT image with superimposed suprastructure to determine
implant postion.
(Image: Bindl/Sicat)
Fig. 9_Special software will help
construct a stereolithographically
manufactured drilling template for
exact positioning of drilling holes
and implants.
(Image: Nobel Biocare/Geiselhöringer)
The demands of CAD/CAM technology have inspired topics in basic research and hence propelled
progress in other areas of dentistry too. Universities
and industry can collaborate and thereby promote
and shape these exciting developments. Thus far,
CAD/CAM or computerised dentistry has not been
a central area of interest at universities. But as
CAD/CAM technology is relatively new and its performance potential is significant, this is likely to
change in the next few years. In turn, this development will influence dental education curricula and
thereby influence treatment options in private practices to the benefit of our patients._
_author info
cosmetic
dentistry
Manfred Kern, Secretary Society for
Dental Ceramic (SDC) can be contacted at
info@ag-keramik.de.
www.ag-keramik.eu
cosmetic
dentistry 1
I 29
_ 2009
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I industry report _ veneers & composites
A smile says more than
a thousand words:
Reconstruction & modification
of anterior teeth
Author_ Ronaldo Hirata, Brazil
established or if a guard splint has to be produced upon
completion of the restorative treatment. This article
describes the reconstruction of anterior teeth with a
nano-optimised hybrid composite material.
_Case report
Fig. 1
Fig. 1_Initial situation: worn incisal
edges, enlarged interdental spaces,
and aesthetic shortcomings.
_Ceramic veneers and direct composite build-ups
present the two most popular treatment options in
modern dentistry for modifying anterior teeth; both
attain a harmonious aesthetic appearance and reestablish an anatomically correct form and proportion
of incisor teeth. Ceramic veneers necessitate tooth
preparation, which in most cases involves the reduction
of tooth structure. Hence, ceramic veneers are categorised as irreversible dental treatments. The progress
achieved in the field of dental adhesives and the continued improvement of the mechanical and optical
properties of dental composites have opened up new
possibilities in restorative dentistry. It is now possible to
fully restore the aesthetic appearance and function of
anterior teeth that have lost their original length due to
parafunctional habits or physiological abrasion, using
resin-bonded composite restorations. Careful treatment planning is, however, essential for keeping the
reduction of healthy tooth structure to a minimum.
Direct composite build-ups provide a treatment
method for rebuilding worn anterior teeth, if the treatment is accurately planned and performed. This is particularly important if anterior guidance has to be
30 I cosmetic
dentistry
1_ 2009
A male patient presented with abraded anterior
teeth. The abrasion was caused by para-functional
habits, resulting in a loss of canine and anterior guidance. In addition, the aesthetic appearance was compromised (Fig. 1). As a large portion of healthy tooth
structure was still present, we opted for a minimallyinvasive treatment method using composite material.
In addition, this method would allow us to restore the
teeth with ceramic veneers at a later stage, should this
become relevant.
Initial treatment planning is best carried out on the
basis of digital images of the patient’s situation, providing the dentist and the dental technician in charge of
producing the wax-up with all the necessary information. A silicone key was prepared from the wax-up and
used to fabricate a mock-up. In addition, the silicone key
provided a spatial reference for the composite build-up.
The dentition was bleached before commencing the
restorative treatment. As a result, a consistent tooth
shade was established before the aesthetic intervention
was started.
The appointment for restoring the teeth was scheduled for two weeks later—this is the minimum interval
that should be observed between the bleaching process
and restorative treatment, to ensure a firm bond to the
tooth structure and a stable tooth shade, which is
essential to accurate shade selection. As the existing
restorations exhibited hardly any defects, only those
portions that were close to the surface were removed.
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industry report _ veneers & composites
If existing restorations demonstrate an acceptable
shade and tight restoration margins, repairing them is
often the best solution.
Relative isolation may be sufficient in conjunction
with cosmetic treatment in the anterior region. In the
present case, untreated retraction cords were used.
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Two points have to be considered when restoring anterior teeth with composite materials: first, the restorative treatment should start with the central incisors, and
second, the central incisor that shows the least damage,
i.e. is closest to the ideal final result, should be restored
first. Restoring several teeth simultaneously may lead to
problems in the proximal region, such as inappropriate
proximal contact areas.
The prepared surfaces were etched for 30 seconds
using the total etch technique. Next, Tetric N-Bond was
applied and light-cured for 20 seconds (Fig. 2). If a silicone key is sited, composite stratification is started in
the palatal area, for which a translucent shade is utilised.
In the present case, Bleach I (Tetric N-Ceram) was
applied. The composite was placed in a very thin layer in
order not to impair the subsequent reconstruction of
the incisal edge (Fig. 3). After the material was lightcured for 20 seconds, the dentin core was rebuilt using
a shade that offered an appropriate level of opacity and
saturation. In the present case, Tetric N-Ceram A3.5
Dentin was applied and light-cured for 20 seconds. An
opaque halo effect resulted. This thin visible line is produced regardless of the patient’s age or degree of tooth
abrasion. The halo effect is caused by the variation in the
arrangement of vestibular and lingual enamel prisms.
For this purpose, Tetric N-Ceram in shade A3.5 Dentin
was utilised. The same shade was also used to rebuild the
dentin body. Since this material was applied in only a
thin layer, light-curing for 20 seconds was sufficient to
achieve an optimum depth of cure.
I
Fig. 2_Tetric N-Bond adhesive is
applied to the central incisor after
etching with phosphoric acid.
Fig. 3_The incisal edge is built up
with translucent composite material
(Tetric N-Ceram Bleach Incisal) with
the help of a silicone key, which has
been fabricated based on the waxup. After this layer has been lightcured, dentin material (Tetric
N-Ceram A3.5 Dentin) is applied.
Fig. 4_After special effects have
been applied, the incisal edge is
rebuilt using a specially designed
spatula (OptraSculpt).
Fig. 5_After the first incisor has been
built up, the proximal contact areas
are roughly contoured to facilitate the
subsequent re-establishment of
adequate contact areas.
Fig. 6_The same procedure is used
to build up the other teeth. After
restoring the central incisors, the
lateral incisors and canines are
reconstructed.
Next, the incisal effects were recreated using
Bleach I (Fig. 4). The same shade was used for the reconstruction of the palatal surfaces. This material provides
a slightly bluish translucent effect and thereby enhances the degree of translucency and accentuation in
this area. After the incisal and palatal surfaces were
rebuilt, Tetric N-Ceram A2 was applied to the entire
surface in the vestibular region. The material was
applied in slightly thinner layers in the marginal and incisal areas, to save space for the application of an incisal
material with a higher degree of translucency. This
method enhances the passage of light and slightly reduces the colour saturation of the basic material. Here,
Tetric N-Ceram T was utilised for this purpose.
Before final light-curing, the composite surfaces
should be covered with a thin layer of glycerine to prevent the formation of an oxygen-inhibited layer and to
cosmetic
dentistry 1
I 31
_ 2009
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I industry report _ veneers & composites
Fig. 7
Fig. 8
shaped diamonds (Jota) and a T2 Revo R170 angled
hand-piece (Sirona).
Fig. 9
Fig. 7_The restorations are polished
with Astropol.
Fig. 8_The surface texture is
rendered visible with ceramic powder. Shortcomings and inadequacies
are now easily identifiable and
can be corrected if needed.
Fig. 9_Completed restoration of the
aesthetic anterior region.
_contact cosmetic
dentistry
Prof Ronaldo Hirata
R.Candido Xavin 80
80240-280 Curitiba – PR
Brazil
E-mail:ronaldohirata@
ronaldohirata.com.br
www.ronaldohirata.com.br
32 I cosmetic
dentistry
1_ 2009
ensure complete curing of all layers including the top
layer. The goal of the layering technique is to pre-empt
work-intensive adjustments and to keep the shape of
the restoration close to the original. Polishing discs were
employed for contouring of the occlusal outline and
vertical dimension of the mesial contact areas (Fig. 5).
Tooth 21 was the second incisor to be restored
(Fig. 6). The same technique used for the restoration of
the first central incisor was employed. Here, particular
care was given to the reconstruction of the contact
areas between the two incisors. For this purpose, the
restoration was first built up with shades A2 and T until
contact with the first restoration was established. At
this point, the build-up was light-cured, the proximal
surfaces were separated, and composite material was
applied from the palatal to the vestibular surface by
means of a transparent matrix. After the central incisors were restored, the lateral incisors and canines
were reconstructed according to the same principles.
After all composite build-ups had been completed, the
restorations were finished and polished. Further
details may be applied at a later appointment, if
desired. First, the occlusal outline and marginal ridges
were finished using polishing discs. Here, it is important to pay attention to providing mirror-image symmetry. In other words, the distance between the
marginal ridges of a central incisor should not only be
physically symmetrical, but the distance should also be
optically the same in relation to the other incisor in
what is known as symmetrical virtual width. Vestibular lines and depressions can be created with spiral-
The 3-step polishing system, Astropol, allows the
restorations to be polished to an optimum surface finish.
Finishing is carried out with silicone finishers (Astropol,
grey finishing cup) (Fig. 7). The Astropol set is used
directly on the composite surfaces in conjunction with
indirect water cooling (from a rotating instrument or
multifunctional syringe with water spray); a polishing
gel or paste is not necessary. Polishing should be
performed with intermittent movements, which can be
easily accomplished with silicone rubber polishers. The
grey finishers facilitate the finishing process considerably. The green Astropol polishing cups are used to polish the surfaces, providing a very smooth surface finish.
In some cases, it is necessary to apply additional
surface characteristics to the labial surface. A variety of
options is available for this purpose. In the present case,
a spiral-shaped diamond was utilised to apply irregular,
frequently interrupted lines of varying depths mainly on
the central third of the incisor (the lines can be marked
in pencil before they are cut). The lines are clearly visible.
After having been cut, they were levelled off with grey
finishing tips (Astropol) without, however, eliminating
them. The pink polishers (Astropol HP) were subsequently utilised for high gloss polishing. The resulting
surface texture, marginal ridges, and mirror surfaces
can be viewed more clearly by dusting dry ceramic
powder onto the restorations. After the surfaces had
been examined, the powder was removed with oil and
water spray (Fig. 8). Final polishing was carried out with
aluminium oxide polishing pastes.
_Conclusion
Direct build-ups of composite restorations are
suited, in selected cases, to re-establish the aesthetic
properties and function of worn, aesthetically unpleasing anterior teeth. It is however important to select
a composite that offers appropriate optical and mechanical properties. In the above clinical case, a group of
anterior teeth were aesthetically restored with the Tetric
N-Ceram nano-hybrid composite system (Fig. 9)._
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The beauty of precision.
Made by DMG.
Luxatemp
Provisionals should not only look good they should, above all,
fit well, immediately and precisely. Luxatemp from DMG
offers the perfect fit you can rely on. It is therefore no
surprise that the material is a worldwide success – and has
been the Number 1 in the US for a decade. Plus, DMG offers
an entire system for temporary restorations to be used in
combination with Luxatemp
DMG. A smile ahead.
A complete system
for perfect temporaries
LuxaFlow
Esthetic extensions and repairs
Additional information is available at www.dmg-dental.com
DMG Beijing Representative Office, Room 908, Zhongyi Mansion, No. 6 Xi Zhi Men Wai Street, Xicheng District, Beijing, Tel: 010-8831 6969, Fax: 010-8831 6968, E-mail: info@dmg-dental.com.cn
AZ_Lx_Fam_E_0801_3_Varianten.indd 2
13.06.2008 11:12:58 Uhr
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CDE0109_34_NobelBiocare
13.03.2009
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Seite 1
I industry news _ Nobel Biocare
Nobel Biocare adds
to its NobelActive
implant system
_LOCATOR attachments
and GoldAdapt abutments
are Nobel Biocare’s two new
additions to its NobelActive
implant system. They were
both developed by the company in response to customer
demand, further expanding
clinicians’ treatment options.
LOCATOR is a
highly durable implant
attachment
system for easy use
with implant retained
overdenture. It features a
lower abutment restoration height than most other
solutions and is usable for up
to 40 degrees divergent implants.
Its self-aligning feature provides
ease of use for patients. It also facilitates maintenance for clinicians, with
one tool for mounting a LOCATOR retention male.
GoldAdapt is a predictable, individual
casted abutment. It has a prefabricated,
high precision interface for casted solutions, for use in limited interocclusal and/or
interdental spaces. GoldAdapt can be used
for single and multiple implant restorations,
and for both screw and cement retained
restorations.
34 I cosmetic
dentistry
1_ 2009
With these new offerings, Nobel Biocare
demonstrates its commitment to maintaining the
NobelActive system as the number one choice for
clinicians and patients, continually updated to meet current market needs.
Nobel Biocare is a leader in innovative restorative and aesthetic
dental solutions, providing dental professionals with state of
the art evidence-based rootto-tooth solutions, including
dental implants, all-ceramic
crowns, bridges and laminates, guided surgery
planning, scanners, and
biomaterials. The company is headquartered in
Zurich, Switzerland, and
has over 2,500 dedicated,
interdisciplinary, and highly skilled employees across the world._
_contact info
Nobel Biocare AB, HQ
Box 5190
40226 Gothenburg
Sweden
E-mail: info@nobelbiocare.com
www.nobelbiocare.com
cosmetic
dentistry
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Anschnitt DIN A4
24.04.2008
11:06 Uhr
Seite 1
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Seite 1
I feature _ AAAD history
The Asian Academy of
Aesthetic Dentistry:
A brief history
Author_ Seok-Hoon Ko, Korea
_This year, the Asian Academy of Aesthetic
Dentistry (AAAD) is celebrating its 20th anniversary.
In honour of this, I would like to present an
overview over the Academy’s history. We are
pleased to have this article appear in cosmetic
dentistry_beauty & science Asia Pacific Edition, which was recently named an official
publication of the AAAD.
_The beginnings
Twenty years ago, leading dental professionals from Korea, Japan, and Singapore met to
lay down the foundation of the AAAD. The purpose of the Academy was to popularise and advance the practice of aesthetic dentistry and to
encourage research in the field.
The first business meeting took place on 25 April
1989 in Seoul in Korea, which the following representatives from Japan, Korea, and Singapore attended:
Dr Seok-Hoon Ko, Dr In-Chool Park, Dr Seok-Kyun Kim,
Dr Toru Matsuo, Dr Peter Tay, and Dr Chee Peng Sum.
At this meeting, the parties agreed that Academy
membership was to be based on personal invitation to
prospective members via the Academy’s representatives in various countries. A copy of the proposed constitution was circulated and following modifications,
it was unanimously accepted. Furthermore, the venue
for the first scientific meeting was decided upon and
was to be held in Singapore, while Korea was to host
the second one.
The second business meeting took place in Hong
Kong on 15 January 1990. At this meeting, it was evident that the AAAD had the key to promoting aesthetic dentistry in the Asia Pacific region and was increasingly attracting membership from other countries.
36 I cosmetic
dentistry
1_ 2009
With Prof Stephen Wei (Hong Kong) as the chairperson, the following representatives were present:
Dr Gerald Chow (Hong Kong), Prof Sison Renato
(Philippines), Prof Joo-Loon Lui (Malaysia), Dr Ko
(Korea), Dr Park (Korea), Dr Kim Choy Low (Republic
of China), Prof Takao Maruyama (Japan), Dr Sum
(Singapore), and Dr Tay (Singapore). Unfortunately,
Dr Choung Min Lin (Republic of China), Dr Lucas
Kustarjo (Indonesia), and Dr Matsuo (Japan) were not
able to participate.
The growth and development of the AAAD since
its inception called for a comprehensive constitution, which was the major item on the agenda for
the second business meeting. At this meeting, concerns regarding the inadequacy of entire sections
in the constitution were raised.
Dr Ko proposed that a constitutional and by-law
review subcommittee be set up to address the matter.
The Constitutional Review Committee consisted of
Prof Wei, Dr Ko, Prof Renato, and Dr Sum.
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feature _ AAAD history
_The first scientific meeting
On 8 September 1990, the AAAD held its first scientific meeting in Singapore, at which the latest developments and practice in aesthetic dentistry were
promoted and shared with the help of well-known
speakers from various backgrounds. The meeting now
takes place biennially and is a forum for dental professionals working in aesthetic dentistry.
Guest speakers at this meeting were Dr Patrick
Henry (Australia), Dr Dominic Leung (Singapore), and
Dr Jan Pameijer (Holland). In addition, Dr Hisashi
Hisamitsu, Prof Maruyama, Dr Kunihide Terakawa,
and Dr Masahiro Naito from Japan; Dr Kim, Dr Park,
Dr Ko, and Dr Kwang-Woo Baek from Korea; Dr Kim
Choy Low and Dr Choung-Min Lin from the Republic
of China; Prof Lui and Dr Booi Cie Ling from Malaysia,
as well as Dr Sum and Dr Jennifer Neo from Singapore
were invited to speak at the meeting.
The following board members were elected to ensure progressive and dynamic management of the
AAAD:
_President:
Prof Jae-Hyun Lee (Korea)
_President-elect:
Prof Takao Maruyama (Japan)
_Vice-president International:
Dr Seok-Hoon Ko (Korea)
_Vice-president Membership:
Dr Choung Min Lin (Republic of China)
_Secretary/Treasurer:
Dr Peter Tay (Singapore)
_Deputy Secretary/Treasurer:
Dr Seok-Kyun Kim (Korea)
_Editor:
Prof Joo-Loon Lui (Malaysia)
_Country Representatives:
Dr Gerald Chow (Hong Kong),
Dr Lucas Kutarjo (Indonesia),
Dr Hisashi Hisamitsu (Japan),
Dr In-Chool Park (Korea),
Prof Booi-Cie Ling (Malaysia),
Dr Kim Choy Low (Republic of China),
Prof Sison Renato (Philippines),
Dr Peter Tay (Singapore).
_AAAD presidents
Since its foundation, the AAAD has prided itself on
its past and upcoming presidents, who have devoted
themselves to the Academy and its goals and showed
exceptional leadership in contributing to the development of the Academy. There is more to aesthetic
I
dentistry than simply creating a smile. Various factors
and contributions from different areas of aesthetic
dentistry play a role and must be combined to achieve
a truly beautiful smile. That is where the AAAD found
its niche, serving as a worldwide hub for leaders in
aesthetic dentistry to stimulate the exchange of ideas
and raising of relevant issues to make a major contribution to aesthetic dentistry._
_Dr Michio Haga
(Japan) 1989–1990
_Prof Jae-Hyun Lee
(Korea) 1990–1992
_Prof Takao Maruyama
(Japan) 1992–1994
_Dr Choung Min Lin
(Republic of China) 1994–1996
_Dr Peter Tay
(Singapore) 1996–1998
_Dr Sandesh Mayekar
(India) 1998–2000
_Dr Seok-Hoon Ko
(Korea) 2000–2002
_Dr Toru Matsuo
(Japan) 2002–2004
_Dr T.C. Phua
(Singapore) 2004–2006
_Dr Robert Dharma
(Indonesia) 2006–2008
_Dr Sim Tang Eng
(Malaysia) 2008–2010
_Dr Hisashi Hisamitsu
(Japan) 2010–2012
cosmetic
dentistry
_author info
Dr Seok-Hoon Ko, DDS (Seoul), MS (Michigan), MS (Michigan), was a founding member and Past President (1997–
2002) of the Korean Academy of Esthetic Dentistry. He was
also a founding member and Past President (2000–2002) of
the AAAD, for which he dedicated himself to further the
development of aesthetic dentistry in Asia. He also held the
position of President (2006–2007) of the International
Federation of Esthetic Dentistry. He served as Editor-inChief of the Asian Journal of Aesthetic Dentistry (2002–
2007) and is the scientific advisor for cosmetic dentistry Asia Pacific Edition. From
the start, Dr Ko has devoted himself to creating the most favourable academic
environment for aesthetic dentists, an environment which fosters young dentists to
become leaders in the field of aesthetic dentistry.
Michigan Dental Clinic
Seungwon B/D 6F., 1699-2
Seocho-dong, Seocho-ku
Seoul 137-070, Korea
Tel.: +82 2 3477 0012 3
Fax: +82 2 534 2751
E-mail: midental@unitel.co.kr
cosmetic
dentistry 1
I 37
_ 2009
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13.03.2009
12:28 Uhr
Seite 1
I feature _ interview
Products designed for
dentists by dentists
An interview with Cosmedent Inc. co-founders Michael O’Malley & Dr K. William ‘Bud’ Mopper
knowledge of composite dentistry and showing
dentists the remarkable things these materials
could do for dentistry—for both the patient and
the dentist. In the earliest days we published The
Forum of Esthetic Dentistry, a newsletter that
promoted a dialogue among the first users of
composite resins. We also continued to lecture
across the United States and Canada, showing
clinicians the vast possibilities of direct resin
bonding as both a restorative material and a
cosmetic procedure.
The company’s co-founders: Michael O’Malley (Cosmedent President, left) and Dr K. William ‘Bud’ Mopper
(Cosmedent Chairman and CEO, and Director of The Center for Esthetic Excellence).
_cosmetic dentistry: Back in 1982, some 25
years ago, Cosmedent opened an office in
Chicago. Here you began to offer the first handson training and lectures devoted to composite
resins. What were you both involved in at the time
and what was the impetus behind this decision?
Mr O’Malley: I was working for a dental consulting company when I met Buddy in 1980 to
consult with him on one of his dental practices.
Buddy and his friend, Dr Norman Feigenbaum,
were lecturing on the use of the new composite
materials for aesthetic dentistry. Over dinner, the
three of us agreed to start an educational company dedicated to sharing our enthusiasm and
38 I cosmetic
dentistry
1_ 2009
Dr Mopper: In 1982, there was a total lack of
reliable information about how to use composite
materials. I was lecturing around the country
showing dentists how to get the best results with
these versatile materials. As a practicing dentist
working with these materials everyday, I realised
that direct resin bonding offered the dentist an
opportunity for a rewarding personal experience
making patients feel better about themselves as
well as a way to significantly increase their office
revenues. This was the main reason that I became
such an enthusiastic advocate of using composites in dentistry.
There is a saying that goes, “Necessity is the
mother of invention.” In the case of Cosmedent,
this applies to dentists as your products are created to meet their needs. You also clearly state
that your products are “designed for dentists by
dentists.” Can you elaborate on how this process
works in the company?
Mr O’Malley: Cosmedent has working relationships with many dentists who come to us with
innovative ideas they would like to bring to the
marketplace. These ideas are evaluated by our
product development team of dentists and
chemists. A royalty is paid once the product has
been successfully developed.
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feature _ interview
Dr Mopper: The process works in this company
by taking ideas and using them in practical application. Products are evaluated on a clinical basis
considering ease of application, durability and
final results. Cosmedent products stand the test
of time because of their chemistry and quality
control.
_Would you explain how the Center for Esthetic
Excellence (CEE) functions and what it offers?
Mr O’Malley: The CEE focuses on teaching
what we know best—how to work with modern
resin materials to accomplish beautiful aesthetic
results. Classes are small, limited to 15 dentists, so
there is always a lot of individual attention to
problem solving and teaching current dental
techniques. A hands-on experience is included
with each class.
Dr Mopper: The CEE is dedicated to teaching
the bonding experience better than any other facility in the country. For those who want to learn
the artistry of direct resin bonding, the CEE is the
place to come. We consider ourselves a very
motivational institution; we motivate clinicians
to increase respect for themselves when they
acquire the skill to be dental artists. Because
cosmetic dentistry is not a part of the curriculum
in dental schools, the CEE fills this void in the
educational system and gives dental professionals
a place to focus on current aesthetic techniques.
Cosmedent’s Renamel Microfill has been the
No. 1 rated composite for a remarkable 17 years
and it also has received REALITY’s Product of the
Year award three times. Now you have expanded
this line to include Renamel NANO. Would you tell
me about this new product?
Dr Mopper: Cosmedent had a nano composite
from the beginning of the company. Renamel
Microfill was the first true nanofill resin and continues to be recognized as the No. 1 composite in
dentistry. Renamel NANO was recently developed
with the handling properties and aesthetics of a
microfill and the strength of a hybrid, combining
many of the best qualities of these products in a
single use composite. Renamel NANO will provide
excellent restorative results in all types of aesthetic restorations, both anterior and posterior.
Our Renamel NANO is also completely integrated
to the Renamel Restorative System for dentists
who prefer to use a layering technique.
Mr O’Malley: Over the years we noticed a need
in the marketplace for a universal composite that
not only handled well, but also performed aesthetically. Renamel NANO was really born out of
I
this need. Renamel NANO was designed for the
dentist who wants to use just one composite, but
does not want to sacrifice on the end aesthetic
result.
_Would either of you be willing to share with
me some pearls of wisdom you have learned after
25 years?
Dr Mopper: “Don’t believe everything you
read.” If I had believed all of the early negativism
surrounding composite dentistry, I would never
have experimented with these materials and
realised how they would change dentistry and my
life forever. “You never get more satisfaction out
of dentistry than what you do yourself.” When
you work directly with composite resin you feel a
higher sense of gratification. This is your chance
to really shine as a dentist as well as an artist. You
can be as creative as you choose to be while
remaining fresh and innovative. It will not take
long for you to realise the effects composite has on
your confidence, your patients smile and your
office revenues. “A dentist who improves a smile
gives a gift both to the patient and himself/herself.”
Mr O’Malley: I really share the same pearls of
wisdom as Buddy. “Don’t believe everything you
read.” Despite the popularity of cosmetic dentistry, there are still a lot of misrepresentations
and faulty product claims circulating in the
industry. Consumers are overloaded with information, making it very difficult to recognise what
is real and what is not. It is therefore always important to ask questions, stay open-minded, and
always think for yourself. “You never get more
satisfaction out of business than what you do
yourself.” Although starting a business involves a
lot of hard work and an extreme time commitment, there is nothing more satisfying. The excitement Buddy and I share towards our products
and contribution to dental aesthetics extends far
beyond anything I could have imagined. “Nothing
spreads joy better than a smile.” I have seen
countless lives improve after a smile makeover. A
beautiful, real smile radiates from the inside out.
I am very proud of the role that Cosmedent played
in fostering the success, innovation and growth
of the cosmetic dental field._
_contact info
cosmetic
dentistry
Cosmedent,Inc.
401 N.Michigan Ave.,Ste.2500
Chicago,Ill 60611,USA
Tel.:+1 800 621 6729
Fax:+1 312 644 9752
www.cosmedent.com
cosmetic
dentistry 1
I 39
_ 2009
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I lifestyle _ travel
40 I cosmetic
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1_ 2009
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CDE0109_40-42_Lifestyle
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lifestyle _ travel
I
Naxos — life, the
Greek way
Authors & Photographers_ Annemarie Fischer & Daniel Zimmermann, Germany
_The old landlady is waving to visitors from afar.
In Lionas Bay, however, no further invitation is
needed to indulge in dolmades and tsatsiki, followed
by a serving of grilled fish. During the off season, the
remote beach strip in the northern part of Naxos is
only inhabited by a dozen people, all making their living at the local taverns. The few visitors, who stray
from the main roads and wander down the narrow,
dusty path, are treated to a delicious meal and homemade wine bottled in plastic water bottles—one of
the many provisional arrangements you are certain
to fall in love with.
dream of life best”; on Naxos, this dream is still much
alive. According to the myth, Dionysus and Ariadne
were married here. Like the gods, the island combines
opposites that make it attractive: white sandy
beaches cover the southern coast, while sparse
mountain ranges and solitary villages dominate the
northern regions. Roman Catholic and Greek Orthodox churches along massive Venetian castles and
Hellenic cult sites tell of the island’s multicultural
history. Greeks, Persians, Italians, and Turks long
fought for dominance in the Aegean, and only since
1832 has the island been part of Greece.
Upon exploring the Hellenic civilisation, the famous German writer Johann Wolfgang von Goethe
remarked: “Of all peoples, the Greeks have dreamt the
Naxos lures locals, as well as tourists, with a more
peaceful ambience nowadays. Visitors are greeted by
the iconic Portara, the entrance to an unfinished
cosmetic
dentistry 1
I 41
_ 2009
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I lifestyle _ travel
temple from the 5th century BC. Although Chóra—as
the capital is called by locals—has an airport, most
visitors take the ferries that leave from Piraeus in
Athens three times a day. On the airy decks, weekenders unite with backpackers and Greek grandmothers, who occasionally feed tourists with cookies and fruit. Security instructions should always be
followed, since the ferries here tend to be overcrowded. Only recently have ferry workers protested
against their poor working conditions.
With an area of 500 square kilometres, Naxos is the
largest island of the Cyclades; yet, it managed to resist the mass tourism that swept through Greece in
the 1980s and 1990s. As a result, you will not be able
to find resorts or big holiday complexes that are common on other islands, like Crete and Rhodes. Instead,
the island offers a vast number of decently priced
apartments that will make you forget the buffet when
you can enjoy breakfast on your sea-view balcony.
42 I cosmetic
dentistry
1_ 2009
The tourism business has brought moderate wealth
to Naxos, which was formerly known only for its marble mining industry and its excellent citrus liqueur.
There is plenty to explore on the island: the still intact, picturesque Castro in Naxos-City with the
Venetian Museum; the Temple of Demeter in the
Naxos-City centre; the unfinished Kouros statue of
Apollonas; the Dimitra temple near Sangri; and the
Dionysus temple at Glinado, to the centre and north
of the island. Agia Anna and Plaka, just outside
Naxos-City, are the most well known beaches. But
only a few kilometres south, each remote and beautiful beach is followed by another, connected only by
twisting dirt tracks that challenge even the most
experienced drivers.
A dusty road meanders invitingly down to Lionas
Bay, and the journey is absolutely worth it as the
landlady is sure to be expecting you already._
[43] =>
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Order_Form_web
04.03.2009
14:37 Uhr
Seite 1
Dental Tribune International GmbH | Contact: Nadine Parczyk
Holbeinstraße 29 | 04229 Leipzig | Germany
Tel.: +49 341 484 74 330 | Fax: +49 341 484 74 173
n.parczyk@dental-tribune.com | www.dental-tribune.com
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I hereby order 4 issues of COSMETIC
DENTISTRY for 35 € (1 year)*
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for 35 € (1 year)*
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GERMAN EDITION for 70 € (1 year)*
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*plus shipping and handling. Your personal data will be recorded and retained by Dental Tribune
International GmbH, which has its registered office in Holbeinstr. 29, 04229 Leipzig, Germany. Your
personal data is used for internal purposes only. After the payment has been made, the shipping process for the subscribed publication(s) will start. The subscription will be renewed automatically every
year until it is cancelled six weeks in advance to the renewal date.
Date/Signature
Fax form to: +49 341 484 74 173 or subscribe online at www.dental-tribune.com
[44] =>
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CDE0109_44-46_Meetings
13.03.2009
I meetings _ ICDA Sofia
44 I cosmetic
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meetings _ ICDA Sofia
I
The International
Congress on Dental
Aesthetics in Sofia
Author_ Nadejda Kuyumdjieva, Bulgaria
_On 1 November 2008 the long-awaited
International Congress on Dental Aesthetics, organised by Dental Tribune Bulgaria Ltd. and the Bulgarian Academy of Cosmetic Dentistry, was held at the
Sheraton Sofia Hotel Balkan. With combined vision
and ambition, the organising partners were able to
arrange one of the most spectacular events in the
Bulgarian dental field last year.
As a special guest, the mayor of Sofia, Boiko
Borisov, officially welcomed the 400 attendees, consisting of leading Bulgarian and foreign dentists,
dental technicians, dental companies, honoured
guests, and media representatives. It was the first
time that a Bulgarian dental event was arranged for
a broad international audience.
Highly acclaimed lecturers in the field of dental
aesthetics, namely Dr Galip Gurel (Turkey), Dr Roberto
Spreafico (Italy), Dr Gernot Morig (Germany), and
Fig. 1
MDT Michael Brusch (Germany), had travelled to the
Bulgarian capital to share their knowledge with congress attendees.
In his lecture, Dr Gurel focused on the minimallyinvasive preparation of anterior teeth for allceramic restorations—veneers and crowns. With his
charisma and appealing visual presentation, he
easily held the audience’s attention.
Fig. 2
Fig. 1_The guest lecturers,
Dr Galip Gurel, Dr Gernot Morig, and
Dr Roberto Spreafico (left to right).
Fig. 2_Uliana Vincheva, President of
Dental Tribune Bulgaria Ltd., and
Dr Selar Frances, President of the
Bulgarian Academy of Cosmetic
Dentistry.
The second lecturer on the podium was Dr
Spreafico, a well-known professional, international
speaker, and co-author of the bestseller Adhesive
metal-free ceramic restorations. Dr Spreafico’s
presentation, which focused on direct and indirect
cosmetic
dentistry 1
I 45
_ 2009
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CDE0109_44-46_Meetings
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12:34 Uhr
Seite 3
I meetings _ ICDA Sofia
composites and emphasised patient concerns,
addressed the audience at a high academic level.
In the afternoon session, two long-time friends of
Bulgaria and exceptional professionals, Dr Morig and
MDT Michael Brusch, together presented the first
3-D lecture on the use of ceramics and composites in
Bulgaria. The images were projected on a special
screen, which attendees viewed with 3-D glasses.
Overall, the attendees enjoyed a well-organised
event, including simultaneous interpretation, with
a very high academic level. The day was concluded
with a party at the piano bar, The Voice, where everyone was able to meet in an informal setting.
3M ESPE (General Sponsor), First Investment Bank
(Golden Sponsor), Colgate (Silver Sponsor), and Axis
Bulgaria supported the event financially. During the
congress, a trade exhibition took place at which 14
companies showcased their products and services.
The event was arranged and announced by the
organisers throughout the year, accompanied by an
international advertising campaign. The Dental
Tribune International Group supported its licensing
partner, Dental Tribune Bulgaria Ltd., and ran a
media campaign for the event in over ten countries.
Advertisements were published in the Dental
Tribune editions in Germany, Austria, the UAE, Italy,
Greece, Turkey, Croatia, Poland, and Romania.
The International Congress on Dental Aesthetics
in Sofia provided attendees with the opportunity to
meet other practitioners and specialists who are
conducting valuable work in the field. The organisers of the event would like to thank the general
sponsor, 3M ESPE, for their efforts to publicise the
event in the country. _
46 I cosmetic
dentistry
1_ 2009
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CDE0109_48_Eventlist
13.03.2009
12:36 Uhr
Seite 1
I meetings _ events
Cosmetic events
2009
AACD 25th Anniversary Scientific Session
Where:
Honolulu, HI, USA
Date:
27 April–1 May 2009
Tel.:
+1 800 543 9220
E-mail:
pr@aacd.com
Web site: www.aacd.com
IACA Annual Meeting
Where:
San Francisco, CA, USA
Date:
30 July–1 August 2009
Tel.:
+1 866 669 4222
E-mail:
info@theIACA.com
Web site: www.theiaca.com
EAED Spring Meeting
Where:
Gleneagles, Scotland
Date:
28–30 May 2009
Tel.:
+39 02 295 236 27
E-mail:
info@eaed.org
Web site: www.eaed.org
AAED 34th Annual Meeting & IFED 6th World Congress
Where:
Las Vegas, NV, USA
Date:
2–5 August 2009
Tel.:
+1 312 981 6770
E-mail:
meetings@estheticacademy.org
Web site: www.estheticacademy.org
2nd International Meeting by Dental
Tribune Italian Edition
Where:
Salerno, Italy
Date:
5–7 June 2009
Tel.:
+39 39 39 34 00 44
E-mail:
cosmeticmeeting@tueor.com
FDI Annual World Dental Congress
Where:
Singapore, Singapore
Date:
2–5 September 2009
Tel.:
+33 450 4050 50
E-mail:
congress@fdiworldental.org
Web site: www.fdiworldental.org
ACE 2009 Symposium on Esthetic Dentistry
Where:
Scottsdale, AZ, USA
Date:
11–14 November 2009
Tel.:
+1 80 07 01 62 23
E-mail:
contact@ACEsthetics.com
Web site: www.acesthetics.com
SAAAD Aesthetic Dental Conference
Where:
Kathmandu, Nepal
Date:
21–22 November 2009
Tel.:
+977 142 425 64
E-mail:
skoirala@wlink.com.np
2010
EAED Spring Meeting
Where:
London, UK
Date:
27–29 May 2010
Tel.:
+39 02 295 236 27
E-mail:
info@eaed.org
Web site: www.eaed.org
AAED 35th Annual Meeting
Where:
Kapalua, HI, USA
Date:
3–6 August 2010
E-mail:
meetings@estheticacademy.org
Web site: www.estheticacademy.org
48 I cosmetic
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1_ 2009
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CDE0109_49_Submission Kopie
13.03.2009
12:37 Uhr
Seite 1
I about the publisher _ submissions I
submissions:
formatting requirements
_Please note that all the textual elements of
your submission:
_the complete article,
_all the figure captions,
_the complete literature list, and
_the contact info (bio, mailing address,
E-mail address, etc.)
must be combined into one Word document.
Please do not submit multiple files for each
of these items.
In addition, images (tables, charts, photographs, etc.) must not be embedded into the
Word document. All images must be submitted separately, and details about how to do
this appear below.
If you would like to emphasize certain
words within the text, please only use
italics (do not use underlining or a larger
font size). Boldface is reserved for article
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Please do not ‘center’ text on the page,
add special tab stops, or use underling as
all of this must be removed before layout. If you require a special layout, please
let the word processing programme you
are using help you to do this formatting
rather than doing it by hand on your
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If you need to make a list, or add footnotes or endnotes, please let the Word
processing programme do it for you automatically. There are menus in every
programme that will help you to do this.
The fact is that no matter how careful
one might be, errors have a way of creeping in when you try to hand number
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Larger images are always better, and
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Thus, if you have an image in a large size,
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Also, please remember that you should
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You may submit images through a zipped
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images directly to us (please contact us
for the mailing address as this will depend upon where in the world you will be
mailing them from).
Text length
Article lengths can vary greatly—from a mere
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subject matter. Our approach is that if you
need more or less words to do the topic justice then please make the article as long or
as short as necessary.
We can run an extra long article in multiple
parts, but this is usually discussing a subject
matter where each part can stand alone because it contains so much information. In addition, we do run multi-part series on various
topics.
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Please number images consecutively
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number for each image. If it is imperative
that certain images are grouped together, then use lowercase letters to designate the images in a group (ie, 2a, 2b,
2c).
In short, we do not want to limit you in terms
of article length, so please use the word
count above as a general guideline and if you
have specific questions, please do not hesitate to contact us.
Please put figure references in your article wherever they are appropriate,
whether that is in the middle or end of a
sentence. If you are not directly mentioning the figure in the body of your article, when it appears at the end of the
sentence the figure reference should be
enclosed within parenthesis and be inside the sentence, meaning before the
period.
Text formatting
In addition, please note:
Please use single spacing and un-indented
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We also ask that you forego any special formatting beyond the use of italics and boldface, and make sure that all text is left justified.
_We require images in TIF or JPEG format.
_These images must be no smaller than
6 x 6 cm in size at 300 DPI.
_Images cannot be any smaller than 80
KB in size (or they will print the size of a
postage stamp!).
Please do not forget to send us a head
shot photo of yourself that also fits the
parameters above so that it can be
printed along with your article.
Abstracts
An abstract of your article is not required.
However, if you choose to provide us with
one, we will print it in a separate box.
Contact info
At the end of every article is a Contact
Info box with contact information along
with a head shot of the author. Please
note at the end of your article the exact
information you would like to appear in
this box and format it according to the
previously mentioned standards. A short
bio may precede the contact info if you
provide us with the necessary information (60 words or less).
Questions?
Please contact us for our Author Kit, or if
you have other questions:
Managing Editor
Claudia Salwiczek
c.salwiczek@dental-tribune.com
cosmetic
dentistry 1
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_ 2009
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CDE0109_50_Impressum
13.03.2009
12:39 Uhr
Seite 1
I about the publisher _ imprint
cosmetic
dentistry
_ beauty & science
asia pacific edition
Publisher
Torsten R. Oemus
t.oemus@dental-tribune.com
Editor-in-Chief
Dr Sushil Koirala
skoirala@wlink.com.np
Co-Editor-in-Chief
Dr So-Ran Kwon
smileksr@hotmail.com
Managing Editor
Claudia Salwiczek
c.salwiczek@dental-tribune.com
Product Manager
Bernhard Moldenhauer
b.moldenhauer@dental-tribune.com
Executive Producer
Gernot Meyer
g.meyer@dental-tribune.com
Designer
Nadine Ostermann
n.ostermann@dental-tribune.com
Copy Editors
Hans Motschmann
Sabrina Raaff
International Administration
President/CEO
Peter Witteczek
p.witteczek@dental-tribune.com
Executive Vice President
Finance
Dan Wunderlich
d.wunderlich@dental-tribune.com
International Media Sales
Europe
Antje Kahnt
a.kahnt@dental-tribune.com
Advisory Board
Dr Michael Miller, USA
Dr Seok-Hoon Ko, Korea
Editorial Board
Asia Pacific
Peter Witteczek
p.witteczek@dental-tribune.com
North America
Humberto Estrada
h.estrada@dtamerica.com
International Offices
Europe
Dental Tribune International GmbH
Contact: Daniela Zierke
Holbeinstr. 29
04229 Leipzig, Germany
Tel.: +49 341 484 74 302
Fax: +49 341 484 74 173
www.dti-publishing.com
Dr Anthony Au, Australia
Dr Bao Baicheng, China
Dr Helena Lee, Singapore
Dr Hisashi Hisamitsu, Japan
Dr Jiraporn Charudilaka, Thailand
Dr Mostaque H. Sattar, Bangladesh
Dr Ratnadeep Patil, India
Dr Sim Tang Eng, Malaysia
Dr Suhit Raj Adhikari, Nepal
Dr Takashi Nakamura, Japan
Dr Vijayaratnam Vijayakumaran, Sri Lanka
Asia Pacific
Dental Tribune Asia Pacific Ltd.
Contact: Tony Lo
Room A, 26/F, 389 King’s Road
North Point, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
www.dti-publishing.com
The Americas
Dental Tribune America, LLC
Contact: Anna Wlodarczyk
213 West 35th Street, Suite #801
New York, NY 10001, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185
www.dti-publishing.com
cosmetic dentistry_Copyright Regulations
_cosmetic dentistry asia pacific edition is published by Dental Tribune Asia Pacific Ltd. and will appear in 2009 with one issue every quarter. The magazine
and all articles and illustrations therein are protected by copyright. Any utilisation without the prior consent of editor and publisher is inadmissible and liable
to prosecution. This applies in particular to duplicate copies, translations, microfilms, and storage and processing in electronic systems.
Reproductions, including extracts, may only be made with the permission of the publisher. Given no statement to the contrary, any submissions to the
editorial department are understood to be in agreement with a full or partial publishing of said submission. The editorial department reserves the right to
check all submitted articles for formal errors and factual authority, and to make amendments if necessary. No responsibility shall be taken for unsolicited
books and manuscripts. Articles bearing symbols other than that of the editorial department, or which are distinguished by the name of the author, represent
the opinion of the afore-mentioned, and do not have to comply with the views of Dental Tribune Asia Pacific Ltd. Responsibility for such articles shall be borne
by the author. Responsibility for advertisements and other specially labeled items shall not be borne by the editorial department. Likewise, no responsibility
shall be assumed for information published about associations, companies and commercial markets. All cases of consequential liability arising from inaccurate or faulty representation are excluded. General terms and conditions apply, legal venue is North Point, Hong Kong.
50 I cosmetic
dentistry
1_ 2009
[51] =>
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Anschnitt DIN A4
12.02.2009
16:28 Uhr
Seite 1
(XURSHULR
-XQH 6WRFNKROP6ZHGHQ
The event of the year in
Periodontology and Implant Dentistry
&ORVHWRDEVWUDFWVVXEPLWWHG
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$OOPDMRUVSRQVRUVDUHMRLQLQJXV
6SHFLDOSURJUDPVIRU'HQWDO+\JLHQLVWV'HQWLVWVDQG6SHFLDOLVWV
[52] =>
Projekt2
Website_AD_A4
04.03.2009
15:49 Uhr
Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper
The first worldwide online newspaper aimed
at dental professionals and the dental industry
is now online!
online
now!
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