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WHO endorses public health care / Asia News / Opinion / World News / Eye on India (part1) / Interview with Prof. Van B. Haywood - USA / Eye on India (part2) / Trends & Applications / Miniscrews—a focal point in practice (Part4)

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DTAP0509_01-03_TitleNews

29.05.2009

17:00 Uhr

Seite 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG

www.dental-tribune.asia

NO. 5 VOL. 7

File selection

Miniscrews

Special: Eye on India

Dr Buchanan reveals why
geometry matters

More clinical examples
from Dr Ludwig

An insight on the biggest
dental market in Asia

Page

23

Page

24

Pages

7–22

WHO endorses public health care Czechs
Geneva meeting shortened to fight new influenza virus
LEIPZIG, Germany/GENEVA,
Switzerland: The improvement of
primary health care and pandemic
influenza preparedness are two
of the main resolutions adopted
at this year’s World Health Assembly in Geneva in Switzerland.
Last week, the 193 Member States
adopted a final plan of action on
public health, innovation and intellectual property, which includes an agreed list of stakeholders who will be involved in the
process, as well as a time frame
and indicators by which to monitor
progress. The plan of action aims,
amongst other things, to reduce
exclusion and social disparities in
health-care systems worldwide
and to promote public policy reforms in order to integrate health
into all public sectors.
The WHO World Health Report
2008 found striking inequities in
health outcomes and the access
to care. Globally, annual government expenditure on health varies
from as little as US$20 per person
to well over US$6,000. For 5.6 billion people in low- and middleincome countries, more than half
of all health-care expenditure is
through out-of-pocket payments.

seek
expertise
in Japan
Scientists from the Masaryk
University in Brno in the Czech
Republic have signed a cooperation agreement with the Faculty
of Dentistry at the Tokyo Medical
and Dental University in Japan
to co-develop new materials for
use in dentistry.

WHO officials during the high-level consultation on influenza A(H1N1). (DTI/Photo Cédric Vincensini, WHO)

This year’s meeting in Geneva
was closed after only five days
to give senior high officials the
chance to return to their home
countries and prepare for a possible influenza pandemic.
During the high-level consultation on the new H1N1 virus,
WHO Director-General Dr Margaret Chan was called upon to
consider criteria other than geographical spread when evaluat-

ing the phases of influenza pandemic alert. Dr Chan further
stated that her decision to declare
an influenza pandemic would
consider the scientific information available and would be supported by advice from the Emergency Committee, a body of international experts established
in compliance with the International Health Regulations. The
Director-General outlined what
might be seen, based on current

knowledge, as the virus continues
to spread over the coming weeks
and months.
She called for close monitoring of the virus as cases begin to
appear in the Southern Hemisphere, where the new virus will
have opportunity to inter-mingle
with other currently circulating
influenza viruses as the seasonal winter influenza epidemics
begin. DT

According to the Czech News
Agency ČTK, the researchers will
focus on special titanium alloys
for dental implants and determine whether the materials
have a negative impact on general health. In addition, the two
universities have announced
that they will arrange the exchange of students on a regular
basis.
Tokyo Medical and Dental
University is the largest public
dental school in Japan, with over
3,000 students. The university
hospital treats 19,000 patients
per year. DT
AD

British
Asian kids
avoid the
dentist
This photo shows a model of the new Oral Health Centre in Brisbane in Australia. Completion
is scheduled for 2010. (DTI/Photo sourtesy of University of Queensland) ASIA NEWS, page 3

New college
for Pakistan

Devices for
snoring fail

Pakistan has opened the new
Sheikh Khalifa bin Zayed Bin
Al Nahyan Medical and Dental
College in Lahore. The school is
the first of many in the country to
be opened this year to tackle the
shortage of medical and dental
personnel. DT

A survey by the UK watchdog
Which? has shown that threequarters of over-the-counter
remedies for snoring do not work
for their users. Among others,
the magazine tested dental devices that hold the jaw forward
to keep the airway open. DT

Children of Bangladeshi, Indian and Pakistani origin in the
UK visit the dentist less frequently than any other ethnic
group, according to recent research. Three-quarters of all
children under 16 in England
have been for a check-up in
the last year, but for all British
Asian groups the statistics are
low. The government claims that
Bangladeshi children from deprived backgrounds, who often
have a high amount of sugar in
their diet, are the worst affected.
The Department of Health is
developing guidance notes for
all Primary Care Trusts, aiming
to provide ideas on promoting
oral health care to the British
Asian community. DT

[2] => untitled

DTAP0509_01-03_TitleNews

29.05.2009

17:00 Uhr

Seite 2

Asia News

HK company stocks up on face
masks to fight swine flu pandemic
The Hong Kong-based biotech company Filligent announced the mobilisation of its
anti-infective BioMask stocks to
help combat the global spread of
the H1N1 virus, also called swine
flu. The mask, which was introduced to the public at the Asia
Pacific Congress of Medical Virology in February 2009, is said
to be the first medical face mask
to kill viruses within seconds
after contact, while retaining
the breathability required by
medical workers.

viruses, including influenza
viruses, are known to bind to
a terminal sialic acid residue on
the surface of the human cell
membrane.
The new strain of the swine
flu virus that swept through
Mexico and other parts of the
world has killed about 100 people worldwide, primarily in

Malaysia confirmed its second
case of swine flu—a female student who was on the same flight
as a 21-year-old man whom
authorities a day earlier announced had tested positive.
The WHO has changed the
current phase of pandemic alert
to five, which is one step away
from a global pandemic. In a

“Humanitarian organisations
and governments are on the
front line of containing infection, especially among children.
We’re allocating our resources
to respond to their needs,” said
Filligent CEO Melissa Mowbrayd’Arbela. She added that BioMask was designed to withstand
the rigours of pandemic logistics.
“We are working with retailers and humanitarian organisations to get the BioMask and
our other anti-infective products out to the people as soon
as possible,” Ms Mowbrayd’Arbela said.
Filligent’s BioMask is based
on an ‘intelligent filtration’
technology and fabricated from
a tested multilayer material
that has highly targeted antimicrobial properties. According
to the company, this patented
BioFriend textile layer captures
pathogens by mimicking the
sites on human cells to which
they normally attach and destroys them by disrupting their
surfaces and cell walls. Many

The BioMask will help dentists and physicians to hold off from swine flu, the
company says. (DTI/Photo Courtesy of Filligent)

North America and Mexico. Latest data of the World Health Organization showed 13,398 people in 48 countries were confirmed to have caught the virus.
India and Turkey have confirmed their first cases of swine
flu and Japan has recorded its
first domestic case of the illness.
Meanwhile, the Turkish Health
Ministry says an American flying
from the United States via Amsterdam was found to be suffering
from the virus after arriving at Istanbul Airport en route to Iraq.

press conference in May, Dr Keiji
Fukuda, Assistant Director-General ad Interim for Health Security and Environment at WHO,
said that despite all efforts to
contain the outbreak, his organisation is expecting a large number of people to get infected
worldwide.
“It would be a reasonable
estimate to say that perhaps a
third of the world’s population
would get infected with this
virus,” he said. DT

International Imprint
Licensing by Dental Tribune International

Publisher Torsten Oemus

Group Editor/Managing
Editor DT Asia Pacific

Daniel Zimmermann
newsroom@dental-tribune.com
Tel.: +49-341/4 84 74-107

Editorial Assistants

Managing Editor
German Publications

Jeannette Enders
j.enders@dental-tribune.com

Claudia Salwiczek
c.salwiczek@dental-tribune.com
Anja Worm
a.worm@dental-tribune.com

Copy Editors

Sabrina Raaff
Hans Motschmann

International Editorial Board
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
Dr George Freedman, Esthetics, Canada
Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published by Dental Tribune Asia Pacific Ltd.
© 2009, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information
and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility for
product names or claims, or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International.

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[3] => untitled

DTAP0509_01-03_TitleNews

29.05.2009

17:00 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

Asia News

Aussie university receives budget for new Oral Health Centre
Daniel Zimmermann
DTI

LEIPZIG, Germany/BRISBANE,
Australia: The Australian government has provided for a new
US$79.2 million Oral Health Centre at the University of Queensland
in Brisbane in Australia. It will
bring together the University’s
School of Dentistry and sections of
Queensland Health’s Oral Health
Services for treating about 17,000

dental and cancer patients each
year and thereby meeting the national dentist shortage, University
officials said. The Centre is scheduled for completion in 2012.
The University has hailed the
decision announced last night in
the Federal Budget, which will
help build Australia’s largest and
most advanced specialist oral
health service and support up to
700 jobs in the construction, prop-

erty, business, and manufacturing industries. The Centre will
have up to 160 full-time equivalent staff and train an additional
20 dentists, as well as 15 oral
health therapists each year.
Students in these programmes
will treat members of the public
at the Oral Health Centre, under
close supervision.
Vice-Chancellor Prof. Paul
Greenfield welcomed the an-

nouncement as the start of a new
era in dental care and education
for Queensland. He said that plans
for a new School of Dentistry date
back 20 years.
“The new centre will substantially expand and improve oral
health facilities and services for
patients, particularly cancer patients and others with complex
dental care needs,” Prof. Greenfield added. “Patients will also

benefit from research, which will
target better treatment outcomes
and prevention.”
Research is to be conducted in restorative dentistry,
paediatrics, orthodontics, oral
radiology, oral medicine, periodontics, endodontics, special
needs dentistry and other specialist areas. The centre will also
house the largest dental library in
Australia. DT
AD

Open
borders for
Filipino
dentists

Tetric

Doctors and dentists from the
Philippines will soon be able to
practise in all member countries of
the Association of Southeast Asian
Nations (ASEAN), according to
a new agreement recently signed
by ASEAN education ministers in
Phuket in Thailand. The agreement will make way for free movement of professional medical and
dental labour from the Philippines
to countries like Singapore, Indonesia or Vietnam. Currently, the
Philippines has 8,500 dentists.

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Similar arrangements have already been introduced by the
ASEAN regarding architects, surveyors, engineers and nurses. In
December 2006, for example,
ASEAN economic ministers signed
a mutual recognition agreement
on nurses, which are amongst the
Philippines’ major human resource exports. The new agreement on physicians and dentists
will be effective in August this year.
Under the agreement, physicians and dentists from the Philippines can apply for recognition in
another ASEAN country, if they have
a valid professional licence from the
host country’s Professional Regulation Commission or have been practising as a general medical practitioner or dentist in the host country
for no less than five continuous
years, Education Secretary of the
Philippines Jesli A. Lapus said. He
added that the agreement requires
dentists to comply with requirements imposed by the host country
and have no pending administrative
or criminal case in relation to the
practice of their profession.
“We welcome these developments because these are concrete
steps to realising a true ASEAN
community that is inclusive, harmonious, and borderless and one
that expands the opportunities for
personal growth and development
for our countrymen,” Lapus said.
The ASEAN, with a combined market of about 550 million people,
aims to achieve a single market by
the year 2015, in order to be able to
compete with other emerging markets in the region, such as China
or India. The bloc has a combined
gross regional product of US$1.1
trillion and total trade of about
US$1.6 trillion. DT

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[4] => untitled

DTAP0509_04-05_News

29.05.2009

16:41 Uhr

Seite 1

Opinion

DENTAL TRIBUNE Asia Pacific Edition

Dear
reader,

Procedures
against the
Influenza A
H1N1 Virus

“Has anything
been bothering
you lately?”

Daniel Zimmermann
DTI

Being the Group Editor of
DTI, I am in regular contact
with dental publishers around
the world and, occasionally, I
am honoured to welcome new
faces to our group. This year, for
example, I am particularly
looking forward to our new collaboration in India. Jaypee
Brothers (JP), who joined the
DTI network in March, is not
only one of the biggest medical
and dental publishers on the
subcontinent, but also the
perfect addition to our group.
JP represents a country with
a large population and the
biggest output of dentists
worldwide. I am sure that
Dental Tribune Asia Pacific
(DTAP) will benefit from their
expertise and knowledge in the
future.
On this occasion, you will
find this year’s first special—
Eye on India—within DTAP. Inside you will find a number of
exclusive features and interviews with experts that we hope
will interest you. Amongst others, we spoke with Prof. Raman
Bedi, who was born in India and
held the position of Chief Dental Officer in the UK from 2002
to 2005. Our interview with
the German consultants Dr
Johannes Wamser and Mike
Batra about the current market
conditions in India revealed
that the Indian dental market
is indeed very attractive for
foreign manufacturers of medical and dental equipment.
Unfortunately, another disturbing issue is still with us. Although the media frenzy about
the swine flu outbreak has died
down, the world is still far from
having overcome the crisis.
Over the last two months, the
virus has found its way from
North America through Europe
to Asia. There, the World Health
Organization has warned, it
could combine with avian flu
and mutate into a more virulent
form, sparking an influenza
pandemic that could be expected to circle the globe up to
three times. Infection control
has never been more important! DT
Daniel Zimmermann
Group Editor
Dental Tribune International

Dental Tribune
welcomes comments,
suggestions
and complaints at
feedback@
dental-tribune.com

Dr Enrique Acosta-Gio
Mexico

Evidently, there are still
new cases of Influenza A
caused by the H1N1 Virus.
Throughout the world, the
strategic response to the virus
has been to slow and limit its
spread. Basic measures for
prevention and control of infection are the most effective
means of achieving this.
The recommended procedures for preventing possible
spread of respiratory infections include frequently washing the hands, covering the
mouth with tissue when
coughing or sneezing, avoiding physical contact with patients, using surgical masks
and, if necessary, isolating infected patients.
Successful infection control
is based on our execution of
procedures and exercise of
caution.

Aesthetics and the brain
Dr David L. Hoexter
DT US

The age-old question as to
what constitutes beauty has been
subjected to yet another wrinkle.
Research has been presented
showing that left-sided brain
people perceive beauty differently than right-sided ones.
Beauty is and has been perceived
through the ages through individual eyes. Perhaps different
cultures encourage different
zones of desire and contentment;
also, people of different ages may
have different views. Whatever
the cause or conditioning, our visions encourage that beautiful
zone. Is it due to our youth’s environment, perhaps where our
mother’s left side of the brain influenced our concepts early, relating to beauty?
When I was presenting cosmetic periodontal techniques in
Sicily, Italy, at a congress dedicated to aesthetics in dentistry,
Dr DeLucca, an exquisite
prosthodontist with exceptional
aesthetic prosthetic results,
brought up factors and questions
regarding the effects of aesthetics from the right and left sides of
the brain as well as the male/female dominance in their respective spheres.
In general, the right side is
usually related to males. The left

side of the brain is, in general, attributed to the female gender. Its
characteristics are said to be
non-verbal, intentional, emotional, excellence in spacial relationships, and good colour perception.
In the past 20 plus years of
dentistry, aesthetics has changed
the face of the profession. This is
not meant to be a pun but an actual fact. At about the same time
that cosmetic improvement was
encouraged by our profession,
the profile of the dental school
population started to change. The
number of female dental students
became more predominant than
ever before in the United States.
Was this the left side of the brain
making its mark?
The initiating pioneers in the
dental aesthetic field, Drs Irwin
Smigel and Ron Goldstein,
forged awareness to the public as
well as dentists, and encouraged
the patient to request looking
better orally. In turn, they encouraged the dentist to provide
the services that stimulated dental companies to research and
provide better aesthetically appearing, yet formidable, restorative materials. Did it take these
pioneers the use of the right side
of their brain to forge this field of
aesthetics?
In other countries throughout the world, the number of female dental school graduates has
been higher than males for years.
In addition, 85 per cent is the

common percentage of female
dentists practicing in many such
countries. In the US, that number
hovers at about 50 per cent.
Does the right side of the
brain dominate our field with the
necessary precision that is demanded? Have the materials in
dentistry today improved so
much that there is compensation
in techniques to allow the left
side of the brain’s activity to transcend and emit an aesthetic sensitivity for the patient’s appearance? Can the individual dentist
utilise the left and right side of his
or her brain as noted in today’s
terminology by the expression
‘crossover’?
Will the economic turmoil of
today affect the demand by patients for cosmetic dentistry beyond the necessary health requirements? I know that for me to
find the answer regarding the
male/female, left and right brain
relationships, I should smilingly
have to ask my wife. DT

For our own safety, as well
as our patients’ health, all
health workers should regard
the following as potentially
infectious: body fluids (with or
without visible blood), mucous
membranes, and non-intact
skin—these are standard precautions.
Additionally, during the flu
season or an influenza outbreak such as the recent one,
dental professionals with viral
respiratory diseases should
suspend all clinical activities
until they are healthy.
In order to avoid the exposure of the dentist to flu, it is
recommended that patients
with symptoms of a respiratory
infection of viral origin continue their dental treatment
when they are free of symptoms.
Resources for dental professionals on the Influenza A
(H1N1) virus are available
from the Organization for
Safety and Asepsis Procedures
a t w w w. o s a p . o r g / d i s p l a y common.cfm?an=1&subarticlenbr=1216. DT

Contact Info
Contact Info
Dr David L. Hoexter is director
of the International Academy
for Dental Facial Esthetics, and
a clinical professor in periodontics at Temple University,
Philadelphia, and maintains
a practice in New York City,
USA. He can be reached at
drdavidlh@aol.com.

Dr Enrique Acosta-Gio is Head
of Infection Control and
Occupational Safety at the
School of Dentistry at the National University of Mexico
(UNAM). He can be contacted
at acostag@servidor.unam.mx.

[5] => untitled

DTAP0509_04-05_News

29.05.2009

16:42 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

World News

5

Scientists find someone new to target
in periodontitis fight
in both osteoporosis and periodontitis, disrupting the healthy
balance of bone destruction
and formation. “Most studies
focus on the part that NF-kB
plays in the regulation of osteoclasts—bone-resorbing cells.
For the past five years, we
looked closely at the effect of
NF-kB on osteoblasts—boneforming cells,” said Dr Wang.
“We knew that NF-kB promoted resorption. What we discovered in our in vitro and in
vivo studies is that this protein
also inhibits new bone formation, giving us a fuller picture
of its role in inflammation and
immune responses.”

Sandra Shagat
USA

SAN DIEGO, CA, USA:
Researchers at the School of
Dentistry at the University
of California, Los Angeles
(UCLA) in cooperation with
the University of Michigan and
the University of California,
San Diego have identified
a potential new focus of treatment for osteoporosis, periodontitis and similar diseases.
Dr Cun-Yu Wang, who holds
UCLA’s Dr No-Hee Park Endowed Chair in Dentistry NoHee Park Endowed Chair in
the dental school’s Division of
Oral Biology and Medicine,
and his team suggested that
inhibiting nuclear factor-kB
(NF-kB), a master protein that
controls the genes associated
with inflammation and immu-

Dr Cun-Yu Wang in the Laboratory of Molecular Signaling in the division of oral biology and medicine at the UCLA School of Dentistry. (DTI/Photo courtesy of UCLA)

nity, can prevent disabling
bone loss by maintaining bone
formation.

The NF-kB protein, a culprit
in inflammatory and immune
disorders, plays a major role

The findings could offer
new hope to millions who fight
osteoporosis and periodontitis
each year. The US National
Institutes of Health estimates

that in the US alone more than
ten million people have osteoporosis, and many more have
low bone mass, putting them at
risk for the disease, as well as
broken bones. According to the
American Academy of Periodontology, mild to moderate
periodontitis affects the majority of adults, while between
5 and 20 per cent of the population suffers from advanced
periodontitis.
Many available treatments
work to prevent further bone
loss but are not able to increase
bone mass. Dr Wang’s research
results support the idea that
a new drug that prevents the
action of NF-kB in cells may
represent a major therapeutic
advance. DT
(Edited by Claudia Salwiczek, DTI)

AD

Gum disease and
myocardial infarction
may share genetic
predisposition
The link between periodontitis and myocardial infarction
likely has a genetic cause. German and Dutch scientists recently presented the first evidence of a shared genetic variant
of both conditions on chromosome 9, at the annual conference
of the European Society of Human Genetics in Vienna in Austria. The chromosome, which
represents approximately 4.5 per
cent of the total DNA in cells, has
been found to be associated with
other health disorders, such as
bladder cancer and leukaemia.
A mutual epidemiological relationship between aggressive
periodontitis and myocardial infarction has been shown in the
past, but researchers were not
certain of it. “We have examined
the aggressive form of periodontitis, the most extreme form of
periodontitis which is characterised by a very early age of onset. The genetic variation associated with this clinical picture is
identical to that of patients who
suffer from cardiovascular dis(DTI/Photo Sofia)

ease and have already had a myocardial infarction,” said Dr Arne
Schaefer from the Institute for
Clinical Molecular Biology at
Kiel University in Germany, one
of the lead authors of the study.
Periodontitis affects over 90
per cent of adults over 60 and is the
major cause of tooth loss in adults
over 40. Because it has to be assumed that there is a causal connection between periodontitis and
myocardial infarction, the condition should be taken seriously by
dentists and thus diagnosed and
treated at an early stage.
“Aggressive periodontitis has
shown itself to be associated not
only with the same risk factors
such as smoking, but it shares, at
least in parts, the same genetic
predisposition with an illness that
is the leading cause of death
worldwide,” warned Dr Schaefer.
He added that knowledge of the
risk of heart attacks could also induce patients with periodontitis
to keep the risk factors in check
and take preventive measures. DT

[6] => untitled

DTAP0509_06_News

29.05.2009

16:42 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Leukaemia drug helpful in treating head and neck cancer
Daniel Zimmermann
DTI

LEIPZIG, Germany: A new
anti-leukaemia compound,
currently being studied at the
Albert Einstein College of
Medicine of Yeshiva University
in New York City in the US, has
revealed promising results for
treating head and neck cancer.
According to a press note
released by the university

last week, the new class of
chemotherapy agents, known
as histone deacetylase inhibitors (HDAC), succeeded
in killing tumour cells that
had been removed from head
and neck cancer patients and
grown in the laboratory.
Head and neck cancer
refers to tumours originating
from the upper aerodigestive
tract, including the lips, oral

and nasal cavity, as well as
paranasal sinuses, pharynx,
and larynx. It is the sixth most
frequent cancer worldwide,
comprising almost 50 per cent
of all malignancies in some developing nations, such as India.
In the US alone, approximately
30,000 new cases and 8,000
deaths are reported each year.
Until now, the common
form of treatment has been

radiation therapy, and in some
cases also surgery or targeted
therapy, which uses drugs or
other substances to identify
and attack specific cancer cells
without harming normal cells.
HDAC inhibitors, such as
LBH589 tested at Einstein,
appear to combat cancer by
restoring the expression of key
regulatory genes that control
cell growth and survival to
normal levels.

In addition, the researchers
identified a set of genes whose
expression levels change in
response to the HDAC inhibitors, which could help
doctors identify the patients
most likely to respond to the
drug. Plans call for testing
LBH589 on head and neck tumour cells from more patients,
so that the set of genes that respond to the drug can be more
firmly established. DT

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Fred Michmershuizen
DTA

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NEW YORK, NY, USA: The International Federation of Esthetic
Dentistry (IFED), an international consortium of 30 aesthetic
dental organisations, including
the Asian Academy of Aesthetic
Dentistry, has announced its 6th
World Congress, to be held from
2 to 5 August at the Bellagio Resort
in Las Vegas in the US.
According to the meeting organisers, the event will be the premier aesthetic dental meeting of
the year. The meeting, titled Passion, Esthetics and New Technology: The Future of Dentistry, is
chaired by Dr Vincent G. Kokich
Sr., with the scientific programme
developed by Drs Baldwin W. Marchack and Ronald E. Goldstein.
The programme is designed to
encompass the broad spectrum
of dental aesthetics, including
prosthodontics, periodontics, endodontics and general dentistry.
“I am very proud of this scientific programme,” said Dr Kokich.
“First of all, it will feature experts
from all over the world in the area
of aesthetics. Second, the topics
are divided into various categories, including controversies,
point/counterpoint, state of the
art, panel discussion, interdisciplinary aesthetics, as well as extensive clinical documentation of
the wonderful treatments that
dentists and specialists from
many different disciplines can offer in order to enhance dento-facial aesthetics. Since the lecturers
will only have from 20 to 30 minutes to present their material, the
programme will be very lively and
will cover a broad range of topics.”
The meeting is also designed
to appeal to an international audience, according to Dr Kokich.
“Attendees from different countries will see a compilation of
speakers that have never been
assembled together previously
on one stage,” he said. “There
will be speakers from many different countries, as well as the
United States, to entertain and
educate the audience.”
A trade show featuring more
than 100 global dental companies will be held in conjunction
with the biennial meeting. DT

[7] => untitled

DTAP0509_07_India

29.05.2009

16:43 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Eye on India

7

Joining the Dental Tribune International Group
Naren Aggarwal
DT India

We are excited to be the
new licence partner of Dental
Tribune International in India
and to be able to introduce new
publications in the country’s yet
under-represented segment of
dental professional media. Indian dentists in private practice
will now be able to access a wide
range of information on current
trends in dentistry through
DTI’s offerings, including their
flagship publication Dental
Tribune and five speciality magazines. The high demand for
online information and educational tools will be met through
DTI as well.
Our company Jaypee Brothers (JP) is India’s largest pub-

lishing house with an operating
revenue of US$28 million. The
group has four decades of
publishing experience and
maintains ten regional offices
throughout the country. The
group is moving forward with
a commitment to the medical
and dental community to publish

Dental media by JP are also
available worldwide in regions
such as the Middle East, Eastern
Europe, Africa and Southeast
Asia. In the US, McGraw-Hill
Publishers distributes JP titles on
an exclusive basis, with a similar
model in place for McGraw-Hill
medical books in India. Overall,

With the addition of 32 titles
last year, and 55 new titles to
be released this year to add to the
existing 211 titles, the growth
of JP’s print portfolio in dental
medicine has been consistent
and rapid. The portfolio includes undergraduate and postgraduate textbooks, reference

“With Dental Tribune as our new title for general
practitioners, we hope to benefit from an already
existing network of 25 international publishers”
scientific content in all areas of
science, and is continuing to
expand its current range of
publishing ideas. A dedicated inhouse team of 80 professionals in
the editorial and design division
continually evolves the product
and content quality, in order to
meet new market demands and
support growth plans.

despite a deep global slowdown, JP registered double-digit
growth in its business last year.
In order to achieve a global
presence and enhance its brand
value through media and consumer interest in JP products,
the group showcased its new
products at over 40 international
conferences in 2008.

books and handbooks for various specialities, and ranges
from basic subjects, such as
anatomy, physiology, oral histology and dental hygiene, to
more advanced subjects, such
as maxillofacial surgery, periodontics, prosthodontics and
restorative dentistry. The target
readership of dental titles is

dentists, dental assistants, dental hygienists, dental technicians and dental therapists. In
addition, the dental titles are
read in all 280 of the country’s
dental colleges.
The group is also expanding its journal portfolio and
plans to achieve a list of 17 journals by next year. The International Journal of Clinical
Pediatric Dentistry and the
International Journal of Clinical
Implant Dentistry are already
in active circulation. New titles
in orthodontics and cosmetic
dentistry are under development.
With Dental Tribune as our
new title for general practitioners, we hope to benefit from
an already existing network of
25 international publishers and
look forward to bringing their
expertise to our large readership in India. DT
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[8] => untitled

DTAP0509_08-11_Wamser

8

29.05.2009

16:44 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Eye on India

“India has much going for it”
Interview with Dr Johannes Wamser and Mike Batra, Dr Wamser + Batra GmbH, Germany
say that this has become very
successful.

The Indian market with a population of more than 1 billion
people and an emerging middle class offers enormous
potential for all kinds of industries. Dentistry is one of
them. Editor Claudia Salwiczek spoke with Dr Johannes
Wamser and Mike Batra from
German consulting company
Dr Wamser + Batra GmbH
about the current market conditions in India and why foreign manufacturers of medical and dental equipment
should start to invest now.
Claudia Salwiczek: Dr
Wamser, you offer consulting
services to companies that
are interested in setting up in
India. Why are you focusing
on dentistry?
Dr Wamser: We are not exactly focused on dentistry and
offer our services to many industries. The common denominator is simply India. In our
company, you will find a number of professionals that have
much experience in doing business there, such as managers
from German companies who
worked and lived in India for
a couple of years. The reason
that we are dealing with dentistry now is trivial. India has
much going for it!
Could you please explain
this to us?
Dr Wamser: Sure. Currently, a small but powerful
social class is developing in
India that is influenced by international media and is able
to fly to London or Dubai occasionally to do shopping. This
developing part of the population is placing high demands on
the Indian health care system,
which unfortunately is still
underdeveloped in most parts
of the country. India is still
a classical example of a developing nation with low standards in clinics and the education of medical personnel.
This is changing now only in
a small segment that offers
high-quality products and services, but not throughout the
country.

It is also not a secret that
many Indian dentists who have
practised in England or the
US are now using the opportunities that these clinics offer
and return to practise in India
for a while.

Claudia Salwiczek (right) talks to Dr Johannes Wamser (middle) and Mike Batra (left). (DTI/Photo Daniel Zimmermann)

So there is no mass market
for medical or dental equipment in India?
Dr Wamser: I have to agree
because the number of doctors
and clinics that want to purchase advanced technology and
are able to use it is manageable.
However, the number is sufficient to make the market attractive for foreign manufacturers.

companies that were focusing
on private clinics, which have
multiplied in the big cities
like Delhi, Mumbai and Bangalore. As these clinics are brand
new, the risk of infection with
Methicillin-resistant Staphylococcus aureus is minimal or
non-existent, which is something these clinics regularly
exploit for their advertising.

out of pocket and this is where
street dentists usually come
into play. We focus mainly on
the private sector, which has
experienced quite an upswing
in the last four to five years.
In this sector, the technological standard, the dentist–
patient ratio and the quality
of bedside care is comparable
to Western countries. At the

moment, a number of private
clinics with capacities of 1,000
to 1,500 beds are being built
that are aimed primarily at
dental tourists.

India is often compared
to China when it comes to
economic development. What
potential does the Indian dental market really have?
Dr Wamser: On the one
hand, we have a mass of people
that offer dental services on the
streets but who have never had
any dental education. On the
other hand, we have a small
segment of well-educated and
foreign-trained dentists who
work in many of the private
dental clinics. The group of
street dentists or those with
small practices are not able
to buy expensive equipment;
therefore, it falls upon the private sector and hospital chains
to invest in new equipment.
Meeting this growing demand
is a significant opportunity for
foreign manufacturers of dental equipment.

And these clinics mainly
treat foreign patients...
Dr Wamser: They do at
a very high level of quality
but also at a reasonable price.

What should be done?
Dr Wamser: India needs
a big leap forward to reach
the same level of technological development that Western

“There is a large gap between what is
currently available there and what people
are willing to pay for good health care”
There is a large gap between
what is currently available
there and what people are willing to pay for good health care.
In my opinion, foreign manufacturers would be able to sell
their technologies in India at
a price range comparable to
Europe or the US.
Could you please briefly
explain the health care system in India?
Mr Batra: Similar to other
markets, the health care system
in India is divided into the
public and private sectors. In
the past, we accompanied a
number of German medical

I suppose the conditions
in public hospitals paint a
different picture?
Mr Batra: Indeed. Public
hospitals are generally uninteresting for most foreign manufacturers of medical equipment because the price and
quality levels are different from
what they offer in their markets. For example, it is common for 300 people to share
a room that only has the capacity of 100 beds. Syringes are
re-used twice or even three
times, which makes these hospitals perfect breeding grounds
for diseases like hepatitis C.
Patients also have to bring
or buy wound dressing material from the clinics, and
bedside care is often provided
by a family member instead of
a nurse.
Is medical treatment free?
Dr Wamser: In most cases,
the treatment is free and patients only have to pay for materials and medicine. The public
health care system is state subsidised and financed, but as you
can imagine, these financial
means are not sufficient for
the 1.2 billion people living on
the subcontinent.

Modern dental clinics have multiplied in India. (DTI/Photo Courtesy of Meera
Dental Hospital)

What about dentistry?
Mr Batra: There are certain
basic procedures like normal
check-ups that are free. Dentures, however, must be paid

What’s the price range of
these clinics?
Dr Wamser: Dental services are 60 to 70 per cent cheaper than in Europe or North
America but the cost of materials is more or less the same.
These clinics are independent
and can offer less expensive
services because they do not
have to pay opportunity costs,
for example.

Street dentist in Bangalore, India. (DTI/Photo Matthew Logelin)

Many private clinics have
dental departments that were
established especially for
overseas patients, which help
them with travel arrangements, such as booking flights,
transport from the airport
and getting visas. I have to

countries have achieved in
two decades. This includes all
sectors, such as high-quality
equipment, sterilisation methods and hygiene standards.

 DT page 10

[9] => untitled

Anschnitt_DIN A3

04.03.2009

10:53 Uhr

Seite 1

2009
Greater New York Dental Meeting
85th
Annual Session

The
Largest Dental
Convention/
Exhibition/Congress
in the United States

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Tel: +1 (212) 398-6922
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visit our website: www.gnydm.com for more information.

[10] => untitled

DTAP0509_08-11_Wamser

29.05.2009

16:44 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

10 Eye on India
DT Page 8

India is in need of—and certainly wants—foreign expertise
and this can only be achieved
through the purchase of new
products. However, merely
selling advanced equipment
will be not enough: doctors in
India have to be trained in new
methods and technologies.
In most Asian countries,
manufacturers often struggle with the various regisAD

“Manufacturers that enter the
market early will be able to shape
the market conditions there”
tration procedures for their
products. What is the case in
India?
Dr Wamser: I have to admit
that India is a country with a

very high level of bureaucracy.
The system introduced by the
British in the 19th century was
taken over and even extended
by the Indians. Therefore, prod-

uct registration is a requirement in India and will become
a problem when industry players try to achieve it under time
pressure. Companies that plan

and provide all the necessary
documentation will face no
problems.
Mr Batra: We found out that
it took many German companies actually longer, sometimes years, to register a product in China than in India, even
though they had been on the
market there for quite some
time. There is certainly the risk
that guidelines and regulations
change and extend the registration process, but usually it goes
smoothly. As far as dental products are concerned, we have
learned that the registration of
implants takes more time than
the registration of dental units.
How competitive is the
dental market in India?
Dr Wamser: To answer that
question we have to look into
other industries. There certainly is competition and the
market in India is not necessarily uncharted territory. If
you compare it with China once
again, private business has
been allowed in India for
decades and small- and medium-sized enterprises have
been producing and selling
dental equipment for years.
Their products, however, usually do not meet the requirements for quality and technology that we have here in Europe
or the US.
Sounds promising...
Dr Wamser: Well, not really.
Foreign manufacturers still try
to enter the Indian market by
dumping technology that was
state-of-the-art 20 years ago.
Doing so is a big mistake and
will definitely backfire because
the low-price sector clearly is
and will be dominated by Indian
companies.
So what are your recommendations?
Dr Wamser: There are not
many standards in India as
far as technology is concerned
and this gives companies the
chance to influence the future
of dentistry in India. Manufacturers that enter the market
early will be able to shape the
market conditions there.
Being the first is the key?
Dr Wamser: If we talk about
dentistry in India, we do not
only look at the present state
and today’s market potential
but at development that will
last for the next two or three
decades. Manufacturers can
choose to enter the market now
as pioneers or later when the
market will be fully developed.
Also keep the persistence effect in mind. Dental graduates
who practised on one particular
device are likely to use that
device or its successors for the
rest of their professional lives.
Being the first in the market
can mean successful business
for decades to come. Entering
the market later means more
competition or breaking into
an already established market
or system.
Thank you very much for
the interview. DT

[11] => untitled

DTAP0509_08-11_Wamser

29.05.2009

16:45 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

Eye on India 11

Mumbai prepares for major dental show
IDEM to address growing dental market opportunities in India
LEIPZIG, Germany/MUMBAI,
India: Preparations for the
first International Dental
Meeting & Exhibition (IDEM)
in Mumbai are in full swing.
According to preliminary reports from the organiser
Koelnmesse, more than 60 per
cent of the available booth
space at the Bombay Exhibition Center has been booked.
The organisers have confirmed that countries like
Switzerland, Italy, Korea,
Germany and the US will
have joint booth participation
at the show. IDEM India is
scheduled to take place from
23 to 25 October 2009.
IDEM India’s show concept
is based on a major dental event
that is organised by Koelnmesse in Singapore and takes
place every two years. The last
show in 2008 drew more than
6,000 trade visitors to the South
Asian city-state and confirmed
its role as a pivotal dental meeting in the Asia Pacific region.
A survey revealed that more
than 20 per cent of the exhibitors there are already serving Indian customers or are
looking for a similar platform
to address the Indian market
directly.
Amongst Asia’s emerging
market countries, India remains one of the countries with
sustainable growth. The country currently has at least 40,000
practising dentists and a market volume of around US$440
million, which is three times
higher than that of China. However, the tempo has slackened
somewhat in India too, owing
to the current situation in the
global financial markets. For
the current fiscal year 2008/09,
analysts from the Centre for
Monitoring Indian Economy
corrected expectations from
8.2 per cent to 7.4 per cent after
9.0 per cent the previous year.
The Office of Statistics in India
is reckoning on only 7.1 per
cent, which was confirmed in
the most recent report by the
company Germany Trade and
Invest. However, compared
with recent growth forecasts of
only 2 per cent for countries in
the EU or the US, the opportunities for making an entry into the
Indian market are excellent.

successful trade shows in
emerging markets,” said Oliver
P. Kuhrt, Executive Vice-President of Koelnmesse. “The
Indian market has enormous
potential and we hope that
IDEM India will become an important platform for the dental

trade in the country, where they
can contact existing and future
customers.”
Kuhrt said that visitor advertising, which was begun during
IDS Cologne in March and is
targeted at dealers and profes-

“With the IDEM show in Singapore we have proven that we
are able to set up international

Traffic scene in Mumbai. (DTI/Photo Dana Ward)

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[12] => untitled

DTAP0509_12_Shukla

29.05.2009

16:45 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

12 Eye on India

Medical tourism in India
is growing by 20–30 per cent

thing to everyone. You need to
know the spectrum of your offerings and the market segments that
you will target. The American
market, for example, is very different to the Nigerian market. Patient needs and expectations are
also different.

Interview with Vivek Shukla, India

The next step is to equip yourself at the internal and operational
level to deliver what you are about
to promise.

or later equivalent quality at
cheaper prices will be considered
as an option.
Also, the number of private
health-care players has grown
significantly, especially in India.
In search for higher revenue and
footfall, these players will certainly look beyond their borders.

Vivek Shukla

Vivek Shukla is a health care
marketing professional from
New Delhi in India. With a Master of Business Administration
from the Lal Bahadur Shastri
Institute of Management in
New Delhi, he joined the health
care business in 1998 and has
since helped more than 20 hospitals around India in terms
of management and business
development. Dental Tribune
Group Editor Daniel Zimmermann spoke with him about the
growing health care market in
India and the effect of medical
tourism on its future.

What are the cost differences
between hospitals and dental
offices in India and other countries in Asia, and how do the
costs compare with Europe,
Australia or the US?
In India, general costs, like
rent for office space and the cost
of equipment, are considerably
lower compared with Europe or
the US. Therefore, the price of
treatments can be considerably
lower.
Overall, a good standard of
living can be maintained in India
at a lower cost than in developed
countries. For example, groceries
cost about 20 times less here than
in Germany or France.
India is already a significant
player in the field of medical
tourism. Can you tell us how
big the market in India currently is?

Top 5 medical tourism destinations in Asia
Country
Thailand
India
Malaysia
Singapore
Phillipines
and especially the health-care
system in India?
A large health-care system
helps the economy to grow. In
fact, there are signs of an increased number of medical
tourists flying in because of the
global economic slowdown. It
is a kind of Giffen’s Paradox that
we studied in Economics, which

Number of arrivals (Year)
900.000 (2007)
450.000 (2007)
370.000 (2008)
348.000 (2007)
150.000 (2007)
thing that you need. You need to
back it up with a lot of PR work.
Speaking of PR work: you
consult doctors and hospitals in
terms of management and business development. How well are
physicians and dentists in Asia
prepared for the influx of patients from abroad?

Medical tourism in Europe
and Asia is booming. In your
opinion, what is the reason for
this growth?
Treatment costs have risen
consistently. It does not matter if
you are paying out of your pocket
or your insurance company is paying for you. As long as someone is
paying for the treatment and the
treatment costs increase, sooner

There are initiatives in the
European Union that aim to give
patients seeking cross-border

“Patient rights and legal protection
are very important issues”
implies that the demand for
cheaper goods and services goes
up during inflation. Medical
tourism is good for various allied
industries including airlines,
hotels, travel agencies, and the
pharmaceutical and medical
equipment industry.

Lately, many physicians and
dentists have woken up to the new
trend. They are accumulating
knowledge not only about soliciting international patients, but also
about servicing them. Treating a
patient from the rural areas in India is not the same as treating an

Daniel Zimmermann: You
recently spoke at the 2nd European Congress on Health Tourism in Budapest in Hungary.
Is the medical tourism market
in Europe similar to that of Asia
or did you note major differences?
Vivek Shukla: Medical tourism in Asia has two types of
patients. On the one hand, there
are patients from developed countries like the US, who are looking
for high-quality treatment options
that are cheaper than in their
home countries. On the other
hand, there are patients from underdeveloped countries looking
for treatment options that are not
available in their countries.
I believe many Europeans
travel ‘within the continent’. In
Asia, apart from patients travelling ‘within the continent’, a number of health tourists also comes
from America, Africa, and other
continents. The number of patients travelling from Europe to
Asia is significantly lower compared with the health tourists
coming from North America or
Africa.

Do Indian doctors compete
more with their Asian counterparts or with their colleagues in
the industrialised world?
The environment is fairly competitive, as India has about 650,000
doctors. Most of them deal with
high patient numbers, as the country has a large population. These
doctors compete mostly with other
doctors in Asia, and medical
tourists have a choice between India, Thailand, Singapore, and other
destinations in Asia. This is where
direct competition takes place.

health care more rights. Will we
see similar developments in Asia
in the future through, for example, bilateral or multilateral
free trade agreements?
Sooner or later this will happen. It is just a matter of someone
taking the lead and introducing
these initiatives. Patient rights
and legal protection are very important issues. Countries that are
flexible and open to these concepts will have advantages in the
long run.
What role will employers
and insurance companies play
in these developments?
I think they will play a major
role. Patients will demand more
security and rights. This will put
pressure on the insurance companies and employers. In order to
save costs and payouts, the insurance companies and employers
will have to heed the demands of
the patients. Low cost should not
result in low quality.

(DTI/Photo Paul Prescott)

There is much speculation
about the size of the market. The
Indian government claims that
about 200,000 people visited India
last year for medical treatment.
One report suggested that the
medical tourism market is growing by 20 to 30 per cent per year
and will reach US$2 billion by the
year 2012.
The Indian government recently introduced a medical travel
visa, in order to track the number
of medical travellers to the country. This will help in drawing conclusive evidence for the inbound
numbers.
Can you already see the impact the medical tourism industry will have on the economy

In India, the medical tourism
initiative is driven by players
from the private sector. There
has been a continual rise in the
number of private health-care
ventures since 1990. Hence, the
medical tourism business is going to grow further as the number
of private health-care businesses
increases. Currently, the Compound Annual Growth Rate of the
industry is estimated to be about
13 to 15 per cent per year, in spite
of the slowdown.
Countries like the Philippines are currently running big
campaigns on medical tourism.
I think they could be instrumental in attracting patients, if
well executed. However, an advertising campaign is not every-

American or a European patient.
Dentists and physicians are realising the need to give more information, build web sites, respond
to e-mails, etc.
Doctors in India enjoy a good
reputation globally, and they are
well trained and educated. New
challenges will arise when it
comes to managing the experience of patients and creating operational health-care systems.
What is your foremost recommendation to doctors or
dentists who want to become involved in the medical tourism
market?
They need to be very clear
about what they are offering and
to whom; you cannot give every-

Let us take a look into the future. How big will the medical
tourism sector in Asia be in 10 to
15 years?
This depends on many factors.
Some of the most important factors include the cost of treatment
in the Western world, political
stability in Asia and the legal rights
of medical tourists.
There is a high probability that
the medical tourism market will
grow further in the Asian region.
I sense that in the long run, the
number of players will be reduced. At the moment, everyone is
trying to jump on the bandwagon.
After a while, only those with robust plans and government backing will survive.
Thank you very much for the
interview. DT

[13] => untitled

A_dec_300_A3_E

09.03.2009

10:47 Uhr

Seite 1

Introducing
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[14] => untitled

DTAP0509_14_Haywood

29.05.2009

16:49 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

14 Special Feature

“The tooth’s response to bleaching
is individualistic and can only be
determined by starting treatment”
Interview with Prof. Van B. Haywood, USA
stitial spaces into the pulp within
5 to 15 minutes. The tooth is a
semi-permeable membrane that
is quite open to molecules of a
certain size. Once it is understood how easily the peroxide
penetrates the tooth, the resultant pulpal response of sensitivity
may be considered a reversible
pulpitis.

Prof. Van B. Haywood

Dr Van B. Haywood is a Professor in the Department of Oral
Rehabilitation in the School
of Dentistry at the Medical
College of Georgia. In 1989,
Dr Haywood and Prof. Harald
Heymann co-authored the
first article in the world on
nightguard vital bleaching
(NGVB). He has completed
over 90 publications on the
NGVB technique and the topic
of bleaching and aesthetics,
including the first papers on
treatment of bleaching sensitivity with potassium nitrate,
direct thermoplastic tray fabrication, extended treatment
of tetracycline stained teeth
and primary teeth bleaching.
Dental Tribune Editor Claudia
Salwiczek spoke with Dr Haywood about bleaching sensitivity.
Claudia Salwiczek: Tooth
sensitivity is the single most
significant deterrent to the
very popular dental bleaching. How well do we understand this condition?

Can bleaching sensitivity
cause damage in the long
term?
Although penetration of peroxide through the tooth to the
pulp can produce sensitivity, the
pulp remains healthy and the
sensitivity is completely reversible when treatment is
terminated. No long-term sequelae remain after the sensitivity has abated.
Research has shown that patients have tooth sensitivity
even when using non-bleaching agent in a tray, or just wearing a tray alone. Hence, it is not
possible to have all patients be
sensitivity free because of the
mechanical forces of the materials and occlusion, and some
plans must be made to address
potential problems.
How can bleaching sensitivity be prevented?
Reliable methods for complete prevention have not yet
been established. However, a
history of sensitive teeth and the
patient’s response during examination can be reasonable predictors. The tooth’s response to
bleaching is individualistic and
can only be determined by starting treatment. Most reports of
sensitivity occur within the first

and the appropriate
concentration of
bleaching agent.
They need to be aware
that applications more
than once a day or
higher concentrations
of bleaching agent can
increase the likelihood of sensitivity.
Patients with pre-existing tooth sensitivity
must be cautioned that
increased sensitivity,
albeit transitory, may
occur and that management of the sensitivity may require a
longer time span for
bleaching as a result of
the additional time to
treat the sensitivity.
What treatment
objectives are available?
No bleaching treatment should be initiated without a proper
Sensitivity avoidance and treatment involves potassium nitrate in a variety of delivery vehicles
dental examination, and techniques. (DTI/Image courtesy of Prof.Van B. Haywood)
which generally inbefore bleaching can also mintivity, and greater effect develcludes radiographs and deterimise patients’ perceived pain
ops with continued use. The pamines a diagnosis for the cause
responses.
tient should be advised in acof the discolouration. The examination should include an explacordance with the manufacturer’s instructions, typically to
nation to the patient of all their
How effective are the debe applied by brushing twice
treatment options, considering
sensitising toothpastes availdaily as a part of the regular oral
existing restorations—which
able on the market, and how
hygiene regime.
will not bleach—and other aesdo they work?
thetic needs. It should be noted
The most common, profesthat there are several causes of
sionally endorsed, self-applied
What is your recommendiscolouration (abscessed teeth,
approach to treating sensitive
dation to dentists performcaries, internal or external reteeth is the use of desensitising
ing bleaching procedures?
sorption) for which bleaching
toothpastes, which contain
The biggest challenge in
will mask the indication of
potassium salts (nitrate or chloaesthetic dentistry is to mainpathology but not resolve the
ride). Potassium ions pass easily
tain the ethics of the dental
problem. Other treatments will
through the enamel and dentine
profession, and to place pabe required before or instead of
to the pulp in a matter of mintient care ahead of finanbleaching.
utes. Potassium is believed to
cial gain. Patients should be
presented with all options
for treatment, including the
cost/benefit ratio and the
risk/benefit ratio, based on
research where possible. Conservative treatment that preserves enamel and tooth
structure is always preferred.
My credo, which has worked
well for me AND my patients
act by interfering with the transSensitivity may be treated
in the past, is: “Do unto others
mission of the stimuli, by depoactively or passively, but atas you would have them do
larising the nerve surrounding
home treatment is most
unto you.”
the odontoblast process. Most
favourable. Passive treatment
potassium-base desensitising
involves reducing the fretoothpastes also contain fluoquency of application or the duThank you very much for
ride for cavity protection, and
ration of treatment, or interthe interview. DT
some offer an array of flavours
rupting continuous application.
and the whitening, tartar-conActive treatment involves using
Editorial note: This interview was
trol, and baking soda benefits
a material with potassium nisupported by an educational grant
found in most regular toothtrate in the product, applying
from GlaxoSmithKline. For more
pastes.
potassium nitrate instead of
information on sensitivity please
read Pashley DH, Tay FR, Haywood
bleaching material in the tray
VB, Collins MA, Drisko CL: Dentin
for 10 to 30 minutes when
In clinical trials, the deHypersensitivity: Consensus-Based
needed, and pre-brushing with
sensitising effect of brushing
Recommendations for the Diagnopotassium nitrate toothpaste
with anti-sensitivity toothsis & Management of Dentin Hyperfor two weeks before bleaching
paste generally takes about two
sensitivity. Inside Dentistry, October
initiation. Wearing the tray
weeks of application twice per
2008, Volume 4, Number 9 (Special
alone or with potassium nitrate
day to show reduction in sensiIssue).

“No bleaching treatment should be initiated
without a proper dental examination”
Prof. Haywood: Tooth sensitivity is the most common side effect of bleaching. Whereas all of
the typical causes of dentine hypersensitivity generally involve
the hydrodynamic theory of fluid
flow, the sensitivity associated
with bleaching seems to have
a different origin. In bleaching
situations, the teeth may be
in an excellent condition, with no
cracks, exposed dentine, or deep
restorations, but following a few
days of bleaching, the tooth may
experience severe sensitivity.
This seems to be related to the
easy passage of hydrogen peroxide and urea through the intact
enamel and dentine in the inter-

two weeks. Often, these report a
single day of sensitivity, followed
by no problems the next day.
Because tooth sensitivity
mainly depends on inherent patient sensitivity, frequency of
application and concentration
of the material, a history of
sensitivity should be determined during examination. Existing sensitivity can be determined from the preoperative
exam by simple methods of explorer contact with areas on the
teeth or air blown on the teeth.
Patients must be counselled
on the frequency of application

[15] => untitled

A3-out.pdf

C

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CM

MY

CY

CMY

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4/14/09

5:16:05 PM

[16] => untitled

DTAP0509_16_Skeleton

29.05.2009

16:52 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

16 Eye on India

Ancient skeleton in India
bears evidence of leprosy
Claudia Salwiczek
DTI

LEIPZIG, Germany: The oldest known skeleton showing
signs of leprosy has recently
been found in India and may
help unravel the myth of where
the disease originated. In the
journal PLoS ONE, Assistant
Professor Gwen Robbins, an anthropologist at Appalachian
State University in the US, and
researchers in India describe a
middle-aged adult male skeleton demonstrating signs of leprosy in skeletal material, such
as tooth loss and root exposure.
Historians have long considered the Indian subcontinent to

tions in cities and long-distance
trade sprang up.
Dr Helen D. Donoghue, an
infectious disease specialist at
University College London,
said the finding was fascinating
and fits in with the theory that
Alexander’s army had brought
leprosy back from its campaigns in India.
Leprosy is still common in
many countries, especially in
temperate, tropical, and subtropical climates. India has the
largest number of leprosy patients in the world. The number
of new cases of leprosy
recorded by official services
was 138,000 in 2007, but there
are some two to three million
people who have had to endure
the disabilities caused by leprosy throughout their lives.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects
almost 250,000 people worldwide. It is not very contagious

Anterior view and inferior view of the cranium demonstrating signs of leprosy. (DTI/Photo Robbins et al. PLoS ONE)
AD

FDI Annual World Dental Congress

2 -5 September 2009

Singapore
Anterior view of the mandible demonstrating root exposure,alveolar resorption,
ante-mortem tooth loss, and a small apical abscess at the left third premolar.
(DTI/Photo Robbins et al. PLoS ONE)

be the source of the leprosy that
was first reported in Europe in
the fourth century B.C., shortly
after the armies of Alexander the
Great returned from India.
The 4,000-year-old skeleton
was found near Udaipur in
north-western India. The authors say their find confirms
that a passage in the Atharva
Veda, a set of Sanskrit hymns
written around 1550 B.C., indeed refers to leprosy. The bacterium that causes leprosy
seemed to have spread worldwide from a single clone, biologists reported three years ago.
But because of insufficient
samples, they could not determine whether the bacterium
was disseminated when modern humans first left Africa
about 50,000 years ago or
spread from India in more recent times.

congress@fdiworldental.org

www.fdiworldental.org

Other biologists have contended that because the bacterium is not easily transmissible, requiring prolonged intimate contact between people, it
would not have started to
spread until around the third
millennium B.C., when people
started living in dense popula-

and has a long incubation period, which makes it difficult to
determine where or when the
disease was contracted.
Leprosy has two common
forms, tuberculoid and lepromatous. Both forms produce
sores on the skin, but the lepromatous form is the most severe,
producing large, disfiguring
nodules (lumps and bumps).
All forms of the disease eventually cause peripheral neurological damage, which results in
sensory loss in the skin and
muscle weakness. People with
long-term leprosy may lose the
use of their hands or feet, owing
to repeated injury resulting
from a lack of sensation.
Effective medications exist,
and isolation of victims in ‘leper
colonies’ is unnecessary. The
emergence of drug-resistant
Mycobacterium leprae and an
increased number of cases
worldwide have led to global
concern about this disease. DT
Editorial note: For the original article,
please go to: http://www.plosone.org/
article/info%3Adoi%2F10.1371%2F
journal.pone.0005669.

[17] => untitled

090227_WH_AD_LED_297X420:Layout 1 27.02.09 14:22 Seite 1

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[18] => untitled

DTAP0509_18-20_Ivoclar

29.05.2009

16:53 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

18 Eye on India

Creating ultimate direct anterior
restorations with the help of
nanotechnology composite
Dr Arun Rajpara
India

Creating consistent results
in aesthetic dentistry is certainly the ultimate goal that
every clinician wants to
achieve. However, achieving
this result and patient satisfaction can be elusive at times.
Because aesthetic restorative
dentistry is artistic in nature,
there is much subjectivity in
fabricating the final aesthetic
result.
Creating beautiful direct
resin restorations requires the
clinician to perform equally
well on a range of tasks. The
clinician has to consider all
aspects present in the patient’s
smile zone, from gingival ar-

Fig. 1

chitecture to tooth contour,
from colour to surface texture,
in order to create the ideal
result. On a conceptual level,
having an understanding of the
final result is one thing, choosing the ideal technique and executing the process is another.
In all circumstances, the direct
resin application technique is
so versatile that the clinician
can add, reduce, polish and repolish the composite veneering material until the desired
outcome is achieved.
Clinicians have seen the
revolution in composite material science and techniques
since the advent of the acid
etch technique in 1955. The
development of hydrophilic
dentine bonding agents has

Fig. 2

further added to restorative
possibilities. The significant
advantage of modern direct adhesive composite systems is
that they allow clinicians to
preserve sound tooth structure
during the removal of caries
and preparations compared
with traditional restorative
procedures.
The new composite restorative Tetric N-Ceram (Ivoclar
Vivadent) features aspects of
nanotechnology: ‘nano additives’ that help material sustain
a good viscosity and polishability have been incorporated.
Further organic pigments covalently bonded to silicon dioxide particles in a nanoscale
range enable an outstanding
colour match with natural

tooth structure, and thus give
outstanding aesthetic results
clinically. Tetric N-Flow (Ivoclar Vivadent) with nano-optimised technology complements this composite resin,
helping the clinician to achieve
a predictable aesthetic result
clinically. The nano-filled,
light-cured, single-component
total-etch adhesive Tetric
N-Bond (Ivoclar Vivadent) ideally complements the Tetric
N-Family products.
The objective of this article
is to introduce the clinical application of the new Tetric
N-Ceram, Flow and Bond. The
rationale behind the clinical
technique and intricate application methods is also discussed.

Clinical case
A young patient, a 16-yearold boy, presented with large
cervical and proximal carious
lesions on all maxillary and
mandibular anterior teeth.
(Figs. 1 & 2) All these lesions
were surrounded by white
hypocalcified enamel lesions.
The patient presented a history
of restorations on these in past
that failed over time. Clinically,
it was also observed that there
was chronic gingival inflammation, evidenced by hyperplastic gingiva with bleeding
from marginal areas.
After proper evaluation, the
priority was to achieve good
gingival health and contour.
DT page 20

Fig. 3

Fig. 1: Initial situation of carious lesions on maxillary and mandibular anterior teeth, showing inflammation on surrounding gingival tissue with compromised smile aesthetics.—Fig. 2: A close-up view of
maxillary incisors, showing a need for aesthetic restorations.—Fig. 3: Following tooth preparation, which included placing a shorter bevel at the DE junction area and a long facial bevel.

Fig. 4

Fig. 5

Fig. 6

Fig. 4: Application of gel etchant Total Etch.—Fig. 5: A hydrophilic single component adhesive (Tetric N-Bond) was applied on etched surfaces.—Fig. 6: First increment of Tetric N-Ceram shade A3.5 dentine
composite, which was lightly feathered onto the short and long bevels with contouring instruments and artist brushes.

Fig. 7

Fig. 8

Fig. 9

Fig. 7: Further increments of Tetric N-Ceram composite enamel shades A2 and A1 were placed with the OptraSculpt instrument.—Fig. 8: Finishing with the three-step polishing system Astropol (grey, green,
pink). In the figure, the last step (pink) is shown.—Fig. 9: Final polishing was completed with Astrobrush.

[19] => untitled

Anschnitt_DIN A3

11.05.2009

11:49 Uhr

Seite 1

[20] => untitled

DTAP0509_18-20_Ivoclar

29.05.2009

16:54 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

20 Eye on India
DT Page 18

After thorough prophylaxis
under local anaesthesia, deep
gingival scaling and gingival
re-contouring was done. The
patient was instructed regarding proper brushing and
plaque control measures, using Cervitec Gel (Ivoclar Vivadent) at home to achieve good
gingival health.
A
reasonable
gingival
health was achieved after
about ten days and a restorative treatment was scheduled.
After gingival retraction, complete caries was excavated
with high-speed diamond burs
and slow-speed round burs.
Soft hypocalcified enamel was
removed as well. A flameshaped, high-speed diamond
bur and coarse polishing discs
were used to prepare the margins in the cervical area, extending to the complete labial
surface of the tooth. On the
labial surface, about 0.8 to
1 mm of enamel was reduced,
in order to preserve the natural
enamel left on the tooth. A
short bevel was placed on the
cervical preparation and on
AD

Fig. 10

Fig. 11

Fig. 10: Final restorations after completing the finishing and polishing.The completed restorations were harmoniously integrated with the surrounding dentition.—
Fig. 11: Post-restoration close-up view of the restored maxillary incisors, revealing the anatomy and surface texture.

the Class III preparation at the
DE junction area. Preparations
were thoroughly rinsed with
water (Fig. 3).

Restorative technique
The restorative plan included restorations of the involved carious lesions (Class V
and Class III restorations), followed by direct veneering with
Tetric N-Ceram composite
material. Shade selection was
done, and two maxillary cen-

tral incisors were chosen for
the restoration. Preparations
were etched with 37% phosphoric acid gel Total Etch
(Ivoclar Vivadent) for 15 seconds (Fig. 4). Neighbouring
teeth surfaces were protected
by covering them with Teflon
tape. The teeth were rinsed
and air-dried but not to the
point of desiccation.
Next, the bonding agent
Tetric N-Bond was applied on

enamel and dentine (Fig. 5).
After about 20 seconds, the
preparation surfaces were airdried with a gentle blast of air
and light-cured for 10 seconds
using the bluephase C8 LED
light (Ivoclar Vivadent) in LOP
mode. A small layer of flowable
composite Tetric N-Flow was
placed in the deep proximal
and cervical areas where dentine was exposed and was
spread with a thin brush, followed by light curing for
20 seconds using the bluephase C8 curing light in SOF
mode.
Tetric N-Ceram composite
restorative shade A3.5 dentine
was placed in the proximal
and on the cervical areas, to
replace the natural dentine
(Fig. 6). This dentine shade
composite material was also
manipulated over the short
bevel area, to hide the margin between the enamel and
dentine. This was light-polymerised for 20 seconds using
the bluephase C8 light in SOF
mode. Next Tetric N-Ceram A2
enamel shade was placed
on top of this dentine shade
of composite and contoured
properly (Fig. 7), followed by
light curing for 20 seconds. The
A1 enamel shade was placed
from the middle third of the
preparation until the incisal
third and spread well with
OptraSculpt (Ivoclar Vivadent)
and light-cured for 20 seconds.
After this, a final transparent
layer of Tetric N-Ceram composite shade T was placed in
the middle third and spread as
a very thin layer on the entire
labial surface and the incisal
surface with a one-way brush.
The whole surface was given
a smooth anatomy with a sable
brush. This layer of composite
was light-cured for 20 seconds.
Finally, the entire restoration
was subjected to final polymerisation for 10 seconds
each on the labial, palatal and
proximal surfaces using the
bluephase C8 light in HIP
mode.
After completing the primary anatomy of the two central incisors, all the remaining
lateral incisors and canines
were restored with the same
technique. Subsequently, all
mandibular anterior teeth
were restored in the same way.
For this case, as gingival
health was comparatively poor

initially at the time of developing this restoration (because of
the presence of caries and no
control over the accumulation
of plaque), the final finishing
and polishing, in order to develop the secondary anatomy,
was delayed until the following
appointment a week later.

Finishing and polishing
For finishing and polishing,
12-fluted carbide and diamond
finishing burs were used.
Thereafter, the Astropol (Fig. 8)
and Astrobrush System (both
Ivoclar Vivadent; Fig. 9) were
employed to impart a high lustre, whilst maintaining the existing created texture and surface anatomy. Astrobrush was
used with a slow-speed motion
without pressure. The whole
procedure was repeated after
modifying the restoration according to the patient’s requirements.

Conclusion
When done properly, composite restorations can be long
lasting and beautiful, appearing as real as nature intended. Today’s technological advances of materials, such as
Tetric N-Ceram’s shade variety
and strength, and the polishability of composite resin allow
clinicians to close spaces,
transform spaces and enhance
colours with minimal removal
of tooth structure, as we can
appreciate in the Figures 10
and 11. DT

Contact Info

Dr Arun Rajpara is a dental
surgeon at the Soham Dental
Clinic in Valsad in India. He can
be contacted at arunrajpara@
gmail.com.

[21] => untitled

DTAP0509_21-22_Bedi

29.05.2009

16:55 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Eye on India 21

“You can take someone out of India but
you can never take India out of them”
Interview with Prof. Raman Bedi, United Kingdom

Prof. Raman Bedi

Prof. Raman Bedi is one of
many dentists of Indian origin that live and work in the
UK. As Chief Dental Officer
(CDO), he helped shape
British dentistry between
2002 and 2005. We spoke to
him about his latest project
Dentalghar and dentists of
Indian origin working in
other parts of the world.
Daniel Zimmermann:
Prof. Bedi, you were Chief
Dental Officer for the UK
from 2002 to 2005. What are
you doing at the moment?
Prof. Raman Bedi: I consider my time spent as CDO
a real privilege and loved the
job but have also never looked
back. When I was asked to be
CDO, I was thrilled and keen
to meet the challenge. But in
2006, when the opportunity
came for me to lead the Global
Child Dental Health Taskforce,
whose mission is supported by
the World Health Organization
(WHO), the choice was simple.
I am now living out the dream
I had at the start of my career
and this is very satisfying and
fulfilling.
I knew that I would be a paediatric dentist from my second
undergraduate year. I remember writing to David Barmes,
then head of the Oral Health
Unit at WHO in Geneva, asking
him for a job. He was kind
enough to take the time to respond and pointed out that if
this was a career option then I
should gain postgraduate qualifications and about 20 years
experience before applying to
WHO—quite daunting feedback for a 21-year-old dental
student!
The current CDO, Barry
Cockcroft, recently said in
an interview with our sister
publication in the UK that
public dentistry has improved significantly in Britain. Do you agree with him?
It is not easy to be a public
figure and a spokesperson for
Government policy. There are
deep-rooted constraints and

few in the profession understand the extent of these; Barry
is doing a good job. It is certainly true that dental caries
levels in all, except the under
five-year-olds, have improved
in the past few decades. More
individuals are retaining their
teeth. So yes, in general terms,
oral health has improved. But
still about 50 per cent of our
children have cavities, and the
long list of children waiting
for a general anaesthetic to
have decayed teeth extracted
is more than a concern; it is
blight on the public policy
landscape.

nity whose physical links with
the subcontinent—but not emotional ones—were severed.
There is a saying in India: you
can take someone out of India
but you can never take India
out of them.
I noticed that our medical
colleagues were organising
themselves and linking up with
their counterparts in India.

people of Indian origin have
settled.
We are creating a platform
through which to bring together many groups into one
global community. There is
no set agenda that one has to
buy into; it is simply an arena
in which to meet, discuss issues and create opportunities,
whereby many of us outside

They have established joint
ventures, conferences and collaborative training opportunities. In dentistry, proportionately speaking, we have
more dentists of Indian origin
worldwide than our medical
colleagues, and so this factor
gave rise to the drive to start
Dentalghar. It is, if you will,
a response to a need.

I will simply say that dental
care is much influenced by the

Are there any requirements for joining the group?

India can think about how we
can give something back to our
country of origin. I don’t know
where this will take us, but it is
full of exciting prospects and
an opportunity to engage.
Your partner in this project is Smile-on, a UK-based
provider of dental education. What is their role in the
project?
I can just about navigate
around my PC by myself but
(DTI/Photo Regien Paassen)

You are the founder of
Dentalghar, a new worldwide community for dentists
of Indian origin. What is the
purpose behind this community?
It is simply responding to
a global movement that is occurring within the Indian Diaspora. I was born in India, but
my parents migrated when
I was two years of age. Similar
to me, there is a large commu-

What I have noticed is that
many dentists are asking how

“What is needed in India
is a national workforce strategy”

It is also fair to point out that
this is not just true of England
but of nearly every developed
country. Oral health has improved but the gap in inequalities remains, and to the question are we doing enough for
children, the answer has to be
no. If the question is about dentistry as a whole, then yes this
has improved but to the same
level as it has done in other
countries?

market in which it is provided,
so the remuneration of dentists
is critical.

The organisation is not a
campaigning one, and the particular issue of work permits
has not been discussed by
members. We simply bring
people together and if certain
issues come up then members
might want to respond as individuals.

Let me also say at this stage
that everyone is welcome to
join this virtual community,
irrespective of race, ethnic
background, religion or gender—in fact, we would welcome a multifaceted community. The focus is on the subcontinent (Pakistan, India,
Nepal, Bangladesh and Sri
Lanka) and the diverse ‘Asian’
dental communities that have
sprung up in regions as far
apart as the US, Canada,
UK, South Africa, Singapore,
Middle East and Australia—
the list goes on wherever

after that, I am out of my depth.
This is a virtual community
engaging through the Internet; thus, I needed to have partners who had IT expertise and
understood the dental market
and publishing. Smile-on had
this combination and I had
worked with the company before, so it was an obvious
choice for me to team up with
them.
Does the organisation
also help dentists from India
with work permits, visas
etc.?

they can help or volunteer in
India. Others are reconnecting
with their roots (that is, the
towns where their families
originated) and asking what
dentistry is like there. So in
fact, the interest is reversed
and directed towards India.
How many dentists of Indian origin are currently
working abroad?
This is very difficult to determine, as there has not been
a global census. We do know
that India has over 25 per cent
of all dental schools in the
world and that in the UK, US
and Australia, a sizable proportion of dental students have
their ancestral roots in the
subcontinent. The Ministry of
Indian Affairs estimates that
there are over 1 million healthcare professionals worldwide
who have Indian origins, a proportion of which are dentists.
At Dentalghar, we conservatively estimate that 20 per cent
of dentists worldwide have Indian origins.
You are of Indian origin
yourself but as I understand,
you became involved in dentistry here in the UK.
Indeed, my parents were
part of the large migration
from India to the UK that occurred in the late 1950s and
1960s. They had little experience of Higher Education, and
so my brothers and I entered
university life with very little
background information or
guidance as to what subjects
we should chose. It was also at
a time when professional career advice was hard to obtain.
And thus, I drifted into dentistry with very little understanding about what to expect.
In spite of this somewhat disadvantaged position, I loved
my time at Bristol Dental
School and have never regretted the choice I made to study
dentistry.

DT page 22

[22] => untitled

DTAP0509_21-22_Bedi

29.05.2009

16:55 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

22 Eye on India
DT Page 21

The newspaper the Times
Of India recently reported
that many dental graduates
in India have to leave dentistry to work in more lucrative jobs, such as in the
Business Process Outsourcing sector (BPOs). With more
than 250 dental institutions
in the country, is there an
overflow of dental professionals in India right now?

“We have more dentists of Indian origin worldwide
than our medical colleagues”
The outsourcing sector attracts professionals from all
sectors; dentistry is just one of
them. Many new graduates
work in dental practice but
supplement their income by
working at BPO centres for
a few hours each week.

I was in India two months
ago and met 50 deans of dental
schools, who came to engage
with the Global Child Dental
Health Taskforce project. They
shared their concerns about
dental employment for their
future graduates. What is

needed in India is a national
workforce strategy that is carefully devised and implemented.
What are the main reasons that dentists leave the
country?

Are dentists from India
sufficiently trained for service in regions like the UK?
It is difficult to answer this
question. There are many dental schools in India that are excellent, whilst others require
modernisation. One thing is
certain: the dentists who sit entry exams in regions such as
the US or the UK do very well.
From my personal experience,
the postgraduates I have supervised who trained in India
have been outstanding.

J
J

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In the past, it was for employment and training. Now,
for many, India is an attractive
place to live and work, with increasing potential. Overseas
postgraduate education is still
a strong pull factor for dentists.
But, the situation over the next
10 to 15 years will change
dramatically. With higher demands for quality dentistry by
local people, dental tourism,
postgraduate training opportunities etc., many dentists will
stay in India and some may
even return.

Date/Signature

Fax form to: +49 341 484 74 173 or subscribe online at www.dental-tribune.com

Last year, the House of
Lords abandoned guidelines
that discriminate against
overseas medical graduates.
Did this also concern dentistry and, if so, has this decision improved working conditions for Indian dentists in
the UK?
The House of Lords’ ruling
was on a very specific case
taken up by the British Association of Physicians of Indian
Origin (BAPIO). It has more of
an impact on those who are
medically trained than on
those seeking dental training.
BAPIO was courageous in
making this appeal and in time,
it will be seen as a landmark
event in race relations within
the National Health Service
here in the UK. For a minority
ethnic organisation to challenge government in the High
Court is remarkable and even
more so for them to have their
case upheld—well unbelievable! But it was the right thing
to do. I am proud to have been
asked to be the Chairman of
BAPIO.
Regions like the UK rely
heavily on dentists from
abroad to sustain their services. What impact do and will
foreign doctors have on dentistry in the country?
Historically, we have relied
on overseas-trained doctors
and dentists. In 2004, England
published a dental workforce
strategy to build a home-grown
workforce, which is why our
dental schools increased their
undergraduate numbers by
25 per cent in 2006. If in
20 years’ time, we got the numbers wrong, then we know who
to blame: I chaired the review!
Thank you very much for
the interview. DT

[23] => untitled

DTAP0509_23_Buchannan

29.05.2009

16:57 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 23

File selection: Why geometry matters most
L. Stephen Buchanan
USA

Shortly after the excitement
of the rotary file revolution wore
off, the next frontier in shaping
technology became the search
for faster cutting efficiency. This
is logically similar to our continuing search for increasingly
faster computers.

However, experienced clinicians started seeing overfills
from transportation, shortened
canals, apical ripped canal termini, over-shaped coronal regions and cyclic fatigue failures
that hadn’t occurred with their
safer, slower files. The firstorder question in file selection
became: safe or fast? Landedblade instruments with radiused-tip geometry were much
safer, in terms of avoidance of
transportation, but non-landed
blades with aggressive cutting
tips were faster cutting.
The advent of GTX Files with
M-Wire has eliminated the difficult decision between safety and
speed. They are the first rotary
shaping instruments that deliver
speed of cutting with safety from
transportation and breakage
(Fig. 1).
M-Wire, a new rhombohedral-phase NiTi metal used in
GTX Files, has radically improved the files’ resistance to
cyclic fatigue. While R-phase
(the sweet spot between austenite-phase and martensite-phase
NiTi) will become the new industry standard for addressing cyclic
fatigue, it will never solve the
problem of dangerous file
geometries.

Fig. 1: GT Series X File. Note the maximum shank diameter at 1 mm, the radiused tip, the consistent, wider blade
angle and the variable-width lands.At
the tip and shank ends,the land widths
are half the size of the lands in the middle region of the flutes, allowing rapid
cutting without transportation.

The radial lands on GTX Files
have been optimised by varying
the width of these lands along the
length of the file. This geometrical change vastly improves cutting efficiency without derangement of the canal path, a claim
that no file set without lands can
make (Fig. 2). Furthermore, the
decreased flute angle has significantly increased GTX File’s
flexibility compared with other

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Offering the translucency desired for the aesthetically demanding anterior region of the
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Abutment can be used for single
and multi-unit, cement-retained, all-ceramic restorations.
Instead of an implant-level
impression, clinicians will be
able to make a direct impression
of the Encode Healing Abutment,
the company said. Codes embedded on the occlusal surface of the
healing abutment communicate
the implant depth, hex orientation, platform diameter and interface. An impression of the Encode Healing Abutment and the
opposing arch, with a bite registration and the shade selection, is
the only information the labora-

tory will need to deliver a patientspecific final restoration. According to the company, the Encode Zirconia Abutment allows
angle correction up to 30 degrees
and will be available in MicroMiniplant 4.1 and 5 mm Certain
Implant restorative platforms.
BIOMET 3i recently announced that it has established
direct operations to serve markets in Korea and Japan. These
new offices will operate under
the leadership of Ulf Sewerin,
BIOMET 3i’s Business Area Director for Asia Pacific operations.
“These are exciting times for
BIOMET 3i,” Sewerin said in a
company press release. “I look
forward to working with our
country managers to ensure that
our customers in Japan and Korea have access to our innovative
products with the best levels of
customer service possible.” DT

landed instruments, simultaneously doubling the chip space
between the flutes for a longer
cutting time before clogging.

Fig. 2: Micro-CT reconstruction of
curved canals shaped in a mesial root
of a mandibular molar, comparing
outcomes in the apical third with
rotary files of radiused vs. aggressive
tip geometry. Note the canal on the
right showing severe transportation
(aggressive tip) and the canal on the
left following the original canal path
as the canal terminates (radiused tip).

Another important design
feature of GTX Files is their limited maximum flute diameter.
Keeping the cutting flute diameters limited to 1 mm controls the
amount of coronal enlargement
during the shaping procedure,
which is critical to the maintenance of the structural integrity
of roots and to the avoidance of
strip perforation.

one to three instruments and in
as little time as 30 to 45 seconds
(Figs. 3 & 4). That’s why geometry matters. DT

Contact Info

All of these innovations in
design geometry have resulted
in a file set that typically cuts the
ideal shape in most canals with

Figs. 3 & 4: Maxillary and mandibular molar shaped using 1-3 GTX files in each
canal. Notice the fidelity to the original canal path.

A leading expert in the field of
endodontics, Dr Buchanan
is renowned for his multi-media presentations, 3-D anatomic research, writings on
procedural techniques and
revolutionary instrument designs. He can be contacted
at info@endobuchanan.com
and through his website
www.endobuchanan.com

[24] => untitled

DTAP0509_24-26_Ludwig

29.05.2009

16:57 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

24 Trends & Applications

Miniscrews—a focal point in practice
Six-part series by Dr Björn Ludwig, Dr Bettina Glasl, Dr Thomas Lietz & Prof. Jörg A. Lisson—Part IV

Fig. 1a

Fig. 1c

Fig. 1b

Fig. 1d

Figs. 1a–d: The uprighting of a second molar with simultaneous reshaping of the dental arch. The problem is clearly visible in the X-ray. The uprighting spring is fixed to a miniscrew (a, b). Status after five
months without reactivation of the arch section (c, d).

Clinical examples (2)
Repositioning
individual teeth
The uprighting of molars
The straightening of mesially
tipped (second) molars in a full
dentition represents a therapeutic challenge. The treatment is
further complicated if the tooth is
not only tipped but also partly impacted. The presence of a nonerupted third molar does not simplify the process (Fig. 1a). When
planning the required appliance,
it is important to consider
whether it is necessary, for example, to reshape the entire dental
arch (Figs. 1a–d) or just upright
the tipped tooth. If miniscrews
with bracket heads are used,
it is possible to employ a special
NiTi uprighting spring (such
as the Memory Titanol spring,

FORESTADENT). A standard
multi-bracket appliance can be
used to reshape the dental arch.
At the same time, a second force
element can be applied with the
aid of a miniscrew and an uprighting spring (Figs. 1b–d). This
avoids the loss of anchorage that
inevitably occurs when only an
uprighting spring is fixed to the
multi-bracket appliance (Fig. 2).
The straightening of an individual tooth may become necessary
for periodontological, prosthetic
or orthodontic reasons. This is a
very simple procedure if a miniscrew and uprighting spring are
used, and the appliance remains
invisible to the observer. The
tooth need only be fitted with an
appropriate attachment system
that makes it possible to fix this
to the uprighting spring. Depending on how the spring is set, it is
even possible to achieve intru-

sion or extrusion of the tooth.
This form of treatment is inexpensive for the patient and the
orthodontist will find it highly
effective.
Alignment of retinated teeth
The alignment of retained or
displaced teeth, particularly in
the case of canines, is one of the
most common forms of surgical
intervention in the field of orthodontic techniques. Numerous
appliances are available—rubber bands, springs, orthodontic
chains—that are effective to a
greater or lesser extent. All these
mechanisms have the same underlying problem: the neighbouring teeth must be used—directly or indirectly—to provide
an anchorage, so that the required traction forces can be applied. Ideally, the neighbouring
teeth will offer the greater resist-

Fig. 2: The uprighting spring fixed to the main arch not only affects the molars,
but also causes displacement of the premolars (loss of anchorage). (Photo: Prof.
Dominguez, São Paulo, Brasil)

chorage for the alignment of displaced teeth (Figs. 3a–c). If sufficient space is available, brackets
will not be needed in the initial
phase of treatment.

Fig. 3c

Fig. 3b

Fig. 3a

Fig. 2

Figs. 3a–c: The alignment of a displaced canine using a miniscrew. After the canines have been exposed, they are attached to a bracket by means of a miniscrew (a).
After removal of the screw, the dental arch can be reshaped using a conventional technique (b, c)

Fig. 4a

Fig. 4b

Fig. 4c

Fig. 4d

anchorage technique—with dental support only—has several disadvantages. The most significant
is the risk of tipping the anchor
teeth. Many appliances have
been described that distribute
the force over more than one
tooth. A further problem is apparent here: as it is necessary to
leave the appliance in place for
a longer period after the active
phase, it is only possible to commence further corrective treatment for teeth in the anterior
region. It is possible to overcome
these problems by using the
‘hybrid RPE’ (Figs. 4–6). Bands
are employed as usual in the molar region. In the anterior region,
the RPE appliance is fixed using

Fig. 4e

Figs. 4a–e: Obtaining additional transverse space by means of ‘hybrid RPE’. The initial diagnosis is an asymmetrical narrow jaw with insufficient space for tooth 13 (a). After fixture of the brackets, two miniscrews (OrthoEasy) were inserted during the same session (b). The hybrid RPE appliance was attached to the miniscrews and molar bands using laboratory abutments (FORESTADENT; c). The diastema
shows the effect of the appliance after ten days’ use (d). Status after transverse expansion and concurrent reshaping of the dental arch (e).

Fig. 5

Fig. 5: The hybrid RPE appliance with adjuvant anterior hooks for the attachment of a Delaire mask.

ance so that only the retained
tooth moves. Realistically, however, both components tend to
move towards each other. In the
worst-case scenario, only the
group providing anchorage is
displaced from its original position. This can occur if there is
ankylosis of the retinated tooth,
something that is difficult to evaluate during initial examination.
If an attempt is made to move an
ankylosed canine towards insufficient dental anchorage, the result will be the worst-case scenario. This can lead to an open
bite in the region of the anterior
teeth and premolars. Miniscrews
provide the definitive form of an-

Skeletal adjustments
Palatine suture expansion
Rapid palatal expansion (RPE)
is one of the most effective and
stable methods of acquiring
more transverse space in the upper jaw. The targeted screw rate
should be in the range of 0.2 to
0.6 mm/day. As a rule, the appliance is fixed by means of bands
to the molars and premolars.
The desired transverse width can
generally be achieved within
10 to 20 days. Thereafter, a threemonth stabilisation phase should
be observed, in order to allow
ossification of the ruptured
palatine suture. The standard

two miniscrews. These should be
placed on a notional transverse
line connecting the canine/premolar contact points paramedially. Distraction is achieved using the same method as in standard techniques. There are several advantages to hybrid RPE.
Preparation of the apparatus is
much simpler and cheaper, whilst
the dental arch, including the
premolars, is accessible for additional tooth correction measures.
Class II corrections
In the case of patients with
Class II malocclusion who have
DT page 26

[25] => untitled

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[26] => untitled

DTAP0509_24-26_Ludwig

29.05.2009

18:25 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

26 Trends & Applications

Fig. 6a

Fig. 6c

Fig. 6b

Fig. 6d

Figs. 6a–d: Bilateral cross-bite in a seven-year-old boy (a). X-ray of the hybrid RPE appliance in situ (b). Status after ten days’ use: cross-bite has disappeared and vertical bite has remained stable (c, d).

Fig. 7a

Fig. 7b

Fig. 7d

Fig. 7c

Figs. 7a–d: Anchorage of the canine using a miniscrew avoids protrusion of the anterior teeth when using a fixed Class II correction appliance (here: Williams appliance, FORESTADENT).

Fig. 8b

Fig. 8a

Figs. 8a & b: The miniscrew stabilises the position of the molars to which the Kinzinger FMA is attached. This counteracts any protrusion of the premolars and
anterior teeth (a). Class I dental status on completion of treatment (b).
DT Page 24

completed or are near completing their growth phase, simple techniques for the forward
positioning of the lower jaw
are usually ineffective. Following a thorough initial examination and diagnosis, there
are three possible therapeutic
approaches: camouflage, fixed

Class II correctional appliances
(Herbst splint, Sabbagh Universal Spring, FMA, Jasper
Jumper etc.) or orthognathic
surgery. The patient must be
informed of the advantages
and disadvantages of each
approach. All fixed Class II correctional appliances—irrespective of whether these use the
Herbst splint or canted plane

Fig. 9

Fig. 9: The use of miniscrews to attach intermaxillary rubber traction bands
means that no other attachments to the teeth are necessary.

Fig. 10a

diate prosthesis is problematic.
As an alternative, particularly
where additional anchorage
is required, miniscrews can
be used. A longer screw (8 or
10 mm) can be inserted in
the centre of the dental ridge
(Fig. 10b). There should be at
least 1 mm of bone to the mesial
and distal sides of the miniscrew. The hole for the insertion
of a miniscrew (1.6 mm) should
thus be at least 2.6 mm. A provisional crown can then be mounted onto the head of the miniscrew. If necessary, a bracket can
be fixed to this crown (Fig. 10c).

Fig. 10b

principle—have the same problem and the same undesirable
side effects. There is a risk of
protrusion of the lower frontal
teeth and/or distalisation of the
upper molars. By means of passive stabilisation with the aid
of two miniscrews (Figs. 7 & 8),
these effects can be readily
avoided.

the question arises of whether, in
the era of the miniscrew, it is necessary to involve the other jaw in
the stabilisation of the surgical
effect. If miniscrews are used
in the opposing jaw (Fig. 9), the
same effect is achieved—but
with considerably less restriction from the point of view of the
patient.

Orthognathic surgery

Pre-prosthetics

After surgical intervention to
relocate or reposition the jaw (for
orthodontic or traumatological
reasons), it is important to maintain a stable correlation between
bone fragments and the jaw in
the postoperative phase. This
promotes healing and prevents
relapse. The occlusion appliance
is fixed intra-orally, using intermaxilliary elastic or wire ligatures, depending on the situation. It is essential to use the appropriate fixing options, whether
this is a splint (Schuchardt splint)
or a multi-bracket appliance.
Where these are really only
needed in one jaw or jaw section,

It is the aim of pre-prosthetic
orthodontics to position the
teeth optimally for the subsequent prosthesis. This can include intrusion, uprighting, and
the opening or closing of gaps,
amongst other techniques. As
this series and many other publications have already shown,
miniscrews are particularly
useful in this context. Miniscrews can also be used as anchoring elements for a provisional prosthesis. Where teeth
are missing (particularly the
second canines, Fig. 10a) and
the growth phase is not yet completed, the fitting of an interme-

Fig. 10c

Outlook
The clinical use of miniscrews supports a wide range of
tasks. Dental repositioning that
was previously deemed impossible becomes achievable, whilst
possible repositioning techniques are improved and supported. In order to achieve this,
miniscrews alone are not sufficient; an appropriate range of
equipment is also necessary.
Several suppliers of miniscrews
offer, in addition to screws and
insertion tools, a number of devices that facilitate the use of
miniscrews. The fifth part of this
series will focus on the wide
range of useful auxiliaries that
are available. DT

Contact Info
Dr Björn Ludwig
Am Bahnhof 54
56841 Traben-Trarbach
Germany
Tel.: +49 65 41 81 83 81
Fax: +49 65 41 81 83 94
E-mail: bludwig@
kieferorthopaedie-mosel.de

Fig. 10d

Figs. 10a–d: Missing tooth 12 is to be replaced by an implant-based crown. The initial phase of treatment involves widening the gap (a). The head of the vertically inserted OrthoEasy screw (b) is used to
anchor a provisional crown (including bracket), which serves to widen the gap further (c).

[27] => untitled

Anschnitt_DIN A3

24.04.2009

11:06 Uhr

Seite 1

[28] => untitled

Anschnitt_DIN A3

19.03.2009

9:30 Uhr

Seite 1

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[cover] => DT Asia Pacific

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