DT Asia Pacific

Australia: Oral health at stake in federal election / / News & Opinion / Asia News / World News / Xerostomia discussed at UK hygiene forum / Worldental Communiqe / Crown preparation techniques utilising the dental operating microscope

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DTAP0710_01_Title 02.09.10 12:26 Seite 1

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

www.dental-tribune.asia

World News
Xerostomia: Unlocking
the secrets of saliva
4Page

NO. 7+8 VOL. 8

Extra
The latest news from the
FDI head office

4Pages

Crown preparation
Dr Barrington on how to
utilise a microscope

13/14

4Pages

15/16

Australia: Oral health at stake in federal election France and
Health experts demand better access to public dental services
HONG KONG/LEIPZIG, Germany:
Health experts in Australia have
urged all political parties to
make oral health a greater priority in the upcoming federal
election. In a statement released
by the National Oral Health
Alliance, a non-governmental
body comprised of several dental
and health organisations, they
also called for the development
of a sustainable dental workforce to allow people better access to oral health-care services.
Currently, Australians who
are in need of public dental
health-care services have to wait
for long periods before they
receive treatment. In some parts
of the country, patients have to
wait between one to two years.
As a consequence, figures suggest that one in three Australians
decide to delay or avoid dental
treatment altogether.
The incumbent Labor Party
led by Prime Minister Julia
Gillard claimed to have delivered more than 850,000 dental
check-ups to teenagers under
the 2008 Medicare Teen Dental
Plan, but failed to implement
a new universal dental scheme

the US go
digital fast
Dental markets in France and
the US are worldwide leaders in
the adoption of digital sensors,
according to a US market report.
While France has a high penetration rate of almost 75 per cent, US
practices are undergoing a rapid
transition from analogue film to
digital technology, which will
have a dramatic impact on the US
dental imaging market, the report states.

PM Julia Gillard (middle) at a rally in Tamworth, New South Wales. (DTI/Photo courtesy of DPMC, Australia)

as promised in the 2007 federal
election. Their US$3.37 billion
scheme called DentiCare, developed by the National Health and
Hospitals Reform Commission,
has been opposed by the Coalition members in the Senate in
favour of Medicare, an existing
dental care scheme for patients
with chronic conditions intro-

duced by opposition leader Tony
Abbott in 2007, when he was
Minister for Health and Ageing.
Labour recently established a
taskforce to investigate dentists’
compliance with the Medicare
scheme, which they say found
that a substantial number of
them failed to comply with the
requirements.

Abbott has announced that
he will seek to retain Medicare in
case of an electoral win.
Australia will be able to vote
for a new government on 21 August. Latest polls have predicted
a tie between Labor and the
Coalition of the Liberal Party and
National Party. DT

Intraoral X-ray procedures
are the most common type of
dental X-ray nowadays as they
are typically performed in annual checkups. Dental practitioners can choose between
analogue film, photostimulable
phosphor and digital systems.
Digital sensors are able to
take and upload X-ray images of
teeth to a computer immediately,
which eliminates the labour
necessary for the development of
physical film. By reducing film
loss, digital imaging also reduces
the total number of X-rays taken
and in turn decreases patient
exposure to radiation. DT
AD

Malpractice
bill dismissed
by Thai doctors

Terminal 2 at Frankfurt Airport. According to plans of the European Union, patients
in Europe will soon be able to receive the same health-care services in all member states.
(DTI/Photo courtesy of Fraport AG, Germany) 4WORLD NEWS, page 5

FDI congress adds
to Singapore title

Best teeth whitener
is fruit, study say

Singapore has recently been
claiming the position of best city
and country to hold business
meetings in Asia for the third
consecutive year. In 2009, the
city hosted over 600 meetings
that met international criteria,
including the Annual World
Dental Congress of the FDI World
Dental Federation. DT

A recent study by Harvard
University in the United States
has revealed that eating fruit
daily is the best way to whiten
teeth. Through a three-month
clinical study, it was found
that strawberries, orange peels,
and lemon juice have a natural
enzyme that removes tooth
stains. DT

Medical and dental professionals in Thailand are opposing
a new law that aims to give victims of malpractice more rights
without having to go to court. In a
public letter to Prime Minister
Abhisit Vejjajiva, doctors and
dentists stated that the committee that developed the law did not
fairly represent all stakeholders
in the issue and that the law
would give victims the right to
sue even after they have received
compensation.
According to national patients’
rights organisations, there are
between 10,000 and 50,000 cases
of malpractice every year in Thailand, of which only a small percentage ends up in court. Over
97 per cent of these registered complaints were filed against state
hospitals last year, according to
figures from the National Health
Security Office in Bangkok. DT

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[2] => untitled

DTAP0710_02_News 02.09.10 12:29 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

News & Opinion

Current ethical guidelines in India are deficient
An interview with Assistant Prof. Saurab Bither, Christian Dental College, Ludhiana, India
The first handbook on ethical
and legal issues for dentists in
India was recently released by
the Christian Dental College in
Ludhiana in India. Dental Tribune
Asia Pacific spoke with author
Assistant Prof. Saurab Bither
about the book and its discussion
of ethical issues in dental practice.
DT Asia Pacific: Ethical guidelines for dentistry already exist.
Why did you decide to publish a
handbook on the issue?
Assistant Prof. Saurab Bither:
Ethical guidelines for dentistry
have indeed been formulated by
regulatory bodies like the Dental
Council of India (DCI) and Indian
Dental Association (IDA). What this
handbook offers is legal guidelines
because ethical issues that arise in
the delivery of any health-care serv-

Assistant Prof. Saurab Bither

ices are usually accompanied by
legal issues. In this handbook, we
also sought to highlight the concept
of dental negligence and the relevant provisions of legislation pertaining to this matter in our country.
Forensic odontology and the need
for expert witnesses in the field are
discussed in the book as well.

What are the central issues in
dental ethics in India and have
they become of greater concern?
Dentistry is flourishing in India
thanks to technology, education and
stringent measures adopted by regulatory bodies like the DCI and IDA.
Unfortunately, there are members
of the dental fraternity who resort
to unethical practices and flout all
norms, guidelines and ethics of
practice in order to make a quick
buck or just out of financial need.
The image of the entire dental profession may suffer as a result of the
unethical actions of those few.
With increasing dental tourism
in India, it is also very important that
ethical guidelines are followed and
implemented in dental practice.
Should this not be done, we might
fail to benefit from an increasing

number of foreign patients in the future.
What are the
main conclusions of
your book and what
are their implications in practice?
The current ethical principles in
Indian dentistry are
helpful guidelines
regarding dentistry’s professional
obligations, but are deficient in that
they do not address the reciprocity
of the relationship between dentists
and their patients or the principle
of self-determination. Professional
ethical codes, however, are important in developing higher standards
of conduct, as they are based upon
what are considered to be the correct attitude and procedure.

Dental professionals
must recognise and deal
with ethical issues in their
interaction with their patients and society in a rational and principled manner as defined by a code of
ethics. For example, they
must be aware of the legislation concerning malpractice, primarily the Consumer
Protection Act, in order to
prevent litigation. Dentists also
have a duty to maintain and regularly update their level of knowledge
and skills, as well as to participate in
the professional community, maintain cordial relations with fellow
professionals and share the burden
of professional self-regulation.
Thank you very much for this
interview. DT

Politics, but no policy discussion on oral health
when they open their mouths in
front of others.
For the last two years, there has
been a battle underway, with the
Labour Government attempting to
abolish the previous Coalition Government’s scheme that allows complex and chronic conditions to be
treated, and reintroduce a national
dental programme along the lines
of Labour’s previous programme, in
order to provide treatment for lowincome earners. This has twice been
blocked by Senate. The DentiCare
plan proposed by the National Health
and Hospitals Reform Commission,
intended to provided universal access to oral health care through a
new tax, has not transpired either.

Prof. Jenny Lewis
Australia

The Australian federal election
is currently characterised by a focus on the current Prime Minister’s
(Julia Gillard) hair and the Opposition Leader’s (Tony Abbott)
swimwear. Were attention to be
shifted to their teeth instead, perhaps we could move onto policy
substance. Both of the contenders
for Australia’s top job have socially
acceptable mouths with no missing
or crumbling teeth, poor gums or
bad breath. However, this is not the
case for many low-income earning
Australians who cannot afford private dental care, and so wait years
for treatment in public clinics, often
in pain, and suffer embarrassment

At issue is a difference in views
about policy. Should public dental
care be universal or residual? In
Australia, where medical and hos-

pital cover is universal, it remains
acceptable to distinguish between
groups in the case of oral health
because it is not seen as integral to
health but as an optional extra. An
important policy debate about this
should be taking place during this
election, and some have attempted
to engage in such a debate. But there
are considerable political difficulties in introducing a new tax to fund
a universal scheme, finding a sufficient number of professionals to
provide timely services, and (an inevitable consequence of workforce
shortages) allowing auxiliary staff
to provide more services directly.
These conspire to make policy discussions difficult, but that is no reason not to have them. Avoiding them
merely perpetuates the situation for
those who have no choice but to continue using pharmaceuticals and
their hands to cover their painful
and embarrassing mouths. DT

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[3] => untitled

DTAP0710_03_News 02.09.10 12:32 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Asia News

Heraeus acquires majority in Korean dental dealer
Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
The dental division of the German
Heraeus Group is reinforcing its
market position in Asia. As part of
a capital increase, the company
recently acquired a majority share-

EMS device
targets
sub-gingival
biofilm

holding in Huden, a South Korean
dental dealer based in Seoul. The
acquisition, which will focus on the
sale of materials and equipment
for restorative and implant procedures, gives Heraeus direct access
to customers in one of the fastest
growing dental markets in Asia.
Founded in 1851, family-owned
Heraeus has been active in business sectors such as industrial

precious metals, sensors, quartz
glass and biomaterials. Its dental
division, which includes casting
materials, composites, alloys and
ceramics, reported a turnover of
€ 288 million in 2009.
Company officials told Dental
Tribune that the capital increase
was decided upon by shareholders
earlier this year, and will be used
to extend Huden’s sales and dis-

tribution team in the short and
mid-term. In addition, Heraeus
aims to extend cooperation with
local thought leaders and universities to advance product approvals
and enhance brand recognition
in the country. The company aims
to double its current market share
in the next few years.
The financial terms of the transaction were not disclosed. DT

Daniel Zimmermann
DTI

LEIPZIG, Germany: The Swissbased company EMS is now offering
its latest portable Perio handpiece
Air-Flow handy Perio to dentists in
the Asia Pacific region. The device,
which is based on the company’s
award-winning Air-Flow Master
and Air-Flow handy 2+ series, was
developed for rapid removal of
biofilm from the sub-gingival area.
It comes with a single-use Perio
nozzle for easy access to pockets of
up to 10 mm and the air-polishing
powder Air-Flow powder Perio.

According to
some studies, sub-gingival
biofilm is one of the main factors
that contribute to the growing
number of peri-implantitis cases
amongst dental implant patients.
To prevent the penetration of the
sub-gingival area with bacteria and
microbes, the human body triggers
a bone deterioration process as an
“emergency response”, which can
cause dental implants to fail. As subgingival biofilm efficiently protects
bacteria against pharmaceuticals,
conventional treatment with antibiotics is very difficult. EMS says that
their new handpiece provides clinicians with an ergonomic solution
that offers complete removal of the
biofilm even on implant surfaces
and without damaging the cement
or the tooth.
The Air-Flow handy Perio device
is available in white. It will be available through EMS and through the
company’s local dealers in Asia. DT

“THE FUTURE
BEGINS TODAY – WITH
LITHIUM DISILICATE.”
Oliver Brix, Dental Technician, Germany.

Be a visionary: Think about tomorrow, but act for
today. IPS e.max lithium disilicate offers efficient
and flexible solutions – without compromising
esthetics.

Correction
In Dental Tribune Asia Pacific No.5
Vol. 8, the interview titled “Dental
caries is … not easily prevented
or treated in the most susceptible
children” on pages 15/16 misstated the surname of an interviewee. The correct surname is
Lim, not Kim.
In Dental Tribune Asia Pacific No. 6
Vol. 8, the article “Aesthetic and
functional restorations with Panasil impression materials“ on
pages 15/16 misstated that the
authors were DTI editors. Dr Ugo
Torquati Gritti and and Giancarlo
Riva are freelance authors and
not affiliated with Dental Tribune
International.

Hereaus dental laboratory (DTI/
Photo Heraeus Holding, Germany)

amic
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Ivoclar Vivadent Marketing Ltd. Singapore
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[4] => untitled

DTAP0710_04_News 02.09.10 12:35 Seite 1

4

DENTAL TRIBUNE Asia Pacific Edition

Asia News

Malaysian govt admits to public health crisis
Daniel Zimmermann
DTI

Datuk Rosnah Rashid Shirlin (second
from right) at a visit to Hospital Kuala
Lumpur. (DTI/Photo HKL, Malaysia)

HONG KONG/LEIPZIG, Germany:
The government of Malaysia has
released new figures that underline a significant shortage in
the country’s public health care
sector. Speaking to senators at
a parliamentary question time in
August, Deputy Health Minister
Datuk Rosnah Rashid Shirlin said

new figures show that an average
of 360 medical officers have resigned from public service annually since 2005.
Malaysia currently faces a
shortage of 5,000 physicians and
dentists, a situation that has left
thousands of patients in rural
areas especially without access
to affordable health or dental
health care.

The Deputy Health Minister
promised to seek keeping officers in public service through
various initiatives, including the
increase of medical, dentistry
and pharmacy graduates in the
public service. She added that
the government is also planning
to provide more career development opportunities for public
officers and to improve their incentives and allowances.

Asian bug
causes
trouble
worldwide

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Earlier this year, the Ministry
of Health considered extending
the compulsory public service
for doctors to five or ten years
from the current three. Since
1971, doctors in Malaysia have
been required to serve with the
government. DT

With its new Air-Flow handy Perio,
Air-Flow has assigned its latest family
member to combat –
right on target for
subgingival prophylaxis in your
practice.

For more information >
welcome@ ems-ch.com

Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
The emergence of a bacteriaresistant genetic mutation in
Asia and other countries poses
a significant threat to global
health, a multinational team of
researchers has reported. According to their study, published
in the current issue of The Lancet
Infectious Diseases, evidence
of increased prevalence of New
Delhi metallo-beta-lactamase
(NDM-1), an enzyme that makes
bacteria resistant to antibiotics,
was detected in Enterobacteriaceae isolated in India, Pakistan
and the UK. The researchers
called for co-ordinated international surveillance of the
enzyme to prevent its spread
through medical and dental
tourism.
NDM-1, which was first identified by UK Prof. Tim Walsh in
a hospital in India last year,
has been found to be resistant
to a wide range of antibiotics,
including penicillin and amoxicillin, which are commonly used
after dental procedures. In addition, it also affects the efficiency
of carbapenems, a group of antibiotics reserved for use in
emergencies when other antibiotics have failed.
Prof. Walsh told the magazine New Scientist that due to
travelling and medical tourism
throughout the region, bacterial
mutations like NDM-1 increasingly find their way into other
countries. He said the gene,
which was rarely observed just a
few years ago, is now to be found
in between 1 and 3 per cent of
all Enterobacteriaceae-involved
infections. Mutated genes have
recently been isolated in the US,
Sweden, Turkey, Israel, Greece
and the UK, he said.
Infectious disease experts in
the US and the UK have warned
clinicians to be aware of the
possibility of NDM-1-producing
bacteria in patients who have
received medical care in India
and Pakistan. They should also
specifically enquire about this
risk factor when carbapenemresistant Enterobacteriaceae are
identified. DT

[5] => untitled

DTAP0710_05_News 02.09.10 12:39 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Tea not necessarily beneficial for teeth
Daniel Zimmermann
DTI

Whitford found that tea leaves
accumulate not only fluoride, but
also large amounts of aluminium.

When the leaves are brewed,
both substances form insoluble
aluminium fluoride, which cannot be detected by common
fluoride detection methods. By
breaking the aluminium fluoride bond through diffusion, he
found that the amount of fluoride
in all cases was 1.4 to 3.3 times
higher. Dr Whitford said that
this additional fluoride does not
contribute to fluorosis when consumed moderately but heavy

drinkers should be aware of the
danger.
Fluorosis affects more than ten
million people worldwide. It is
found to be most severe in countries like China and India, where
more then 60 million people are
at risk. Besides the consumption of
tea, common causes of excessive
intake of fluoride are the inhalation
of fluoride fumes in the chemical
industries and drinking water. DT

Photo: vicspacewalker

BARCELONA, Spain/LEIPZIG,
Germany: Britons may need to
rethink their national habit of
afternoon tea, as new research
presented at the IADR meeting in
Barcelona in Spain suggests that
the world’s most-consumed beverage contains more fluoride than
previously thought. According to
a study led by Dr Gary Whitford

from the Medical College of Georgia, USA, the concentration of fluoride in black tea can be as high as
9 mg/l compared to 1–5 mg/l found
in earlier studies. The findings
could explain the occurrence of
advanced skeletal and dental fluorosis, a health condition that affects
the stability of teeth and bones.

Woman picking tea leaves in Sri Lanka.
AD

Europe to
improve
patient rights
Daniel Zimmermann
DTI

LEIPZIG, Germany:The European
Union is advancing the rights of
medical and dental patients in
all its member states. In a new
cross-border health-care directive
developed by presidency holder
Spain and adopted by the ministers
of the European Council in June,
patients resident in an EU member
state will be entitled to reimbursement for medical services obtained
in another member state. The draft
directive is expected to become
legal once the European Commission, Council and Parliament begin negotiations on a final version
later this year.
The decision of the Council
comes as a surprise, as Spain opposed an earlier draft, fearing that
it would have to bear the costs of
many Northern Europeans currently living in retirement on
Spanish coasts. The new directive,
which offers a compromise to an
original proposal by the European
Commission, shifts the obligation
for reimbursement from the country of residence to the country of
origin. It also aims to strengthen the
recognition of medical prescriptions and cooperation between
member states, for example, in the
digital exchange of patient data.
Members of the European
Commission, which is responsible
for implementing the decisions of
the Council, have criticised the directive’s requirement that patients
are to seek prior authorisation
from health-care authorities if
their treatment involves hi-tech
equipment or a hospital stay of
more than one night. They claim
that the Council version of the
directive falls short of their original proposal and creates more
confusion for patients.
Cross-border health care between members states of the EU
already exists, but this is usually
regulated by domestic law and
transnational agreements. Rulings
by the European Court of Justice
over the last ten years had established that patients have the right
to obtain health care in other EU
countries, but the European Commission desired greater legal certainty so that patients did not have
to go to court every time they
wished to go abroad for an operation or other medical procedure. DT

[6] => untitled

DTAP0710_06_Straumann 02.09.10 12:41 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Advertorial

New information material from Straumann Asia Pacific
Show your patients that you can offer an attractive long-term solution to enjoy a new quality of life

Fig. 2a: Leaflet

Fig. 1: Brochure

For Straumann, “Simply Doing
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of Patient Communication.
The newly available patient information material supports
dental professionals in their
daily endeavors to inform their
patients that it is possible to

Fig. 2b: Leaflet

mation on dental implants. Sometimes they simply fear the pain
caused by the surgical procedures. In order to bring patients
one step closer to choosing implant-based tooth replacement
solutions, they need to be provided with all the necessary facts.
With well-balanced and factbased information material, patients will find answers to their
most frequently asked questions
like, “Where and when can im-

is available which can be used
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a 1 : 1 sample implant (Straumann® Standard Plus) and a
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Fig. 3: Leaflet Holder

the advantages of dental implantology (Fig. 1).

Leaflet & Leaflet Holder
Suited for patients who
request basic information.
Provides information on
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implantology, an overview
about materials, the function of dental implants as
well as different indications and treatments. For
distribution at your reception or waiting room (Figs.
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Poster
Provides information
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dental implantology at your
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Fig. 4: Poster

Flipchart
Fig. 5a: Flipchart

More detailed information
and clinical explanations for
the dentists to explain to the pa-

Fig. 5b: Flipchart

available which can be used to
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In-Clinic patient video
Fig. 6a: Passport

replace tooth roots almost entirely with dental implants.
Moreover, it presents implant
treatment therapy as a modern
dental method that has been
scientifically tested and used
for over three decades. It shows
patients that qualified dentists
and oral surgeons can offer
them an attractive long-term
solution to enjoy a new quality
of life1 despite missing teeth.

There is a need for patient
information
As a German market survey
indicates, 97% of those who have
received implant therapy confirm that they feel happy with
their newly regained quality of
life. However, out of all suitable
cases, only 46% decide to be
treated with implants. This ratio
suggests that many potential
candidates for this treatment are
still not very well-informed and
that, accordingly, there is a need
for patient information and appropriate material.

Fig. 6b: Passport

plants be used in tooth restorations?”, “What are the benefits?”,
“What is the difference from
conventional procedures?” and
“What are the costs/the long-term
savings?”. The print material can
be displayed in the waiting room
or handed out to patients after the
initial discussion on treatment
options. The content is presented
in an emotionally appealing way
and includes patient testimonials,
scientific data and graphics visualizing the situation before and
after implant treatment.

Dental Implants
“Get back your natural smile”

These items are available:
• Brochure (A5)
• Leaflet (A6)
• Leaflet holder
• Poster (A3)
• Flipchart (Calendar table-top)
• Implant passport (Credit-card
size)
• 3 : 1 Premium Illustration model
• In-clinic Patient video

Brochure
“Get back your natural smile”
Will help and support you
actively in pre-operative discussion to convince your patients of

tients in the consultation room.
Easy to use tabs to find the relevant info, easy handling size and
sturdy calendar table-top base
(Figs. 5 a & b).

Implant Passport
Records information about
your patient’s treatment flows.
Hand it over after the implant
procedure (Figs. 6 a & b).

To be played in the clinic’s
waiting room, LCD screen, consultation room and patient seminars/open houses. Flash version
with more clinical animation
e.g. implant process, how to
make an implant choice, 3 indications of single tooth missing,
multiple teeth missing, edentulous jaw etc. DT

Reference

In addition to the print material, a premium 3 : 1 model is

1 “Quality of life” refers to an improved
quality of life with a dental implant
compared to no treatment. Award
M.A. et al, Measuring the effect of
intra-oral implant rehabilitation on
health-related quality of life in a
randomized controlled clinical trial.
J dent Res. 2000 Sep; 79(9): 1659–63.
2 Riegl Survey 2009, Germany.

Fig. 7b: 3:1 Premium Illustration Model

Fig. 7c: 3:1 Premium Illustration Model

3 : 1 Premium Illustration
Model

The “Dental Implants” information package (brochure, patient flyer and post-op flyer,
posters, implant passport) contains basic information on dental
implants, the surgical procedures and the costs, and the difference from and advantages
over conventional methods are
explained.

Helping patients decide

3 : 1 Premium
Illustration Model

Patients may have only superficial knowledge or wrong infor-

In addition to the print material, a premium 3 : 1 model

Fig. 7a: 3:1 Premium Illustration Model

[7] => untitled

25.03.2010

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[8] => untitled

DTAP0710_08_News 02.09.10 12:44 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Xerostomia discussed at UK hygiene forum
Lisa Townshend
DT UK

Prof. Mike Lewis (DTI/Photo courtesy
of Dentoptix, USA)
AD

GLASGOW/LONDON, UK: The
rising occurrences of Xerostomia
(dry mouth) in patients was one
of the most talked-about issues
at the International Symposium
on Dental Hygiene, recently held
at the Scottish Exhibition and
Conference Centre in Glasgow.
So it was unsurprising that it was
a packed room for Prof. Michael

Lewis’ presentation The role of
the dental hygienist in the diagnosis and management of dry mouth
in association with GSK.
Lewis is Professor of Oral
Medicine in the School of Dentistry, Associate Dean for Postgraduate Studies and Dean of the
Dental Faculty at Cardiff University. He is also Vice-President of
the Royal College of Physicians
and Surgeons of Glasgow.

The lecture began with Prof.
Lewis setting the scene for the
lecture with his alternative title
Unlocking the secrets of saliva.
His aim was to inform delegates of
the production of saliva, its components, the effects of reduced
salivary production, and what can
be done to help patients with this
condition.
Prof. Lewis explained that
there are three major paired

glands that produce 95 per cent
of saliva: the parotid (60 per cent),
the submandibular (30 per cent)
and the sublingual (5 per cent).
The rest is produced by more than
600 minor or accessory glands
mainly found in the lips, cheek
and palate.
Prof. Lewis detailed the manner in which salivary flow rate is
neurally controlled—it is excited
by taste and mechanical stimuli
but inhibited by feelings such as
anxiety. Owing to its importance
in speech, as a buffer against acid
attack, cleansing antimicrobial
actions etc., a reduced flow rate
soon manifests as a problem.
Symptoms often mentioned by
patients include a lack of taste,
difficulty in swallowing, and increased effort when speaking.
Immediate signs in the mouth
observed by clinicians include no
saliva pooling in the mouth, frothy
or cloudy saliva, sticky/erythematous mucosa, atrophic tongue
dorsum, candidosis, and angular
cheilitis. One big marker for
xerostomia, explained Prof. Lewis,
is the occurrence of cervical
caries and failed restorations.
Xerostomia is a complaint that
is often the result of an underlying
cause, including drugs, Sjögren’s
Syndrome, radiotherapy, undiagnosed or poorly controlled diabetes, dehydration and absence
of salivary glands.
Moving from theory to practice, Prof. Lewis then discussed
what clinicians can do for patients
presenting with dry mouth. He
stressed the importance of investigation into the causes of dry
mouth for each patient, to ensure
any underlying condition has
been identified and medication
use explored.
Means of investigation can
include clinical exam (discussion
with patient; appearance of patient, i.e. face, hands, gait; appearance of saliva; ‘mirror sticks
test’—a dental mirror will often
stick to the buccal mucosa if there
is reduced saliva), salivary flow
rate tests, haematological tests,
sialography and labial gland
biopsy.
Once the cause of the condition has been identified, both the
clinician and patient can focus
on the way in which to manage
it, commented Prof. Lewis. For
example, it may be possible to
suggest a change in medication
to one that does not list dry mouth
as a side effect; or a diagnosis of
diabetes should see improved
glycaemic control on behalf of the
patient and subsequent resolution of dry mouth symptoms.
There are many salivary substitutes that can be recommended. Prof. Lewis described a few
of these, as well as the benefits
and disadvantages of using them.
The most graphic disadvantage
was of Salinum, described as “like
licking a cricket bat”! Owing to
their formulation and ease of use,
oral care systems such as the
Biotène range have proved very
popular with patients. DT

[9] => untitled

Think all
toothpastes
work the same?
Colgate Total is proven to help prevent gingival inflammation
.
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Colgate Total contains a Triclosan + Copolymer formula
that helps fight gingival inflammation in two ways: 1, 2, 4
TM

Kills plaque bacteria for a full 12 hours 2
to help reduce plaque by up to 98%
and gingivitis by up to 88%. 3

2.

0.25
0.2
0.15

Triclosan reduces inflammatory
mediators, such as PGE2,4 that may
be associated with systemic health.

3.0
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88%
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+ In vitro.

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Refer to Colgate Total for approved uses

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Better Oral Health as Part of Better Overall Health.
References: 1. Panagakos F et al. J Clin Dent. 2005; 16 (Suppl): S1-S20. 2. Amornchat C et al. Mahidol Dent J. 2004; 24: 103- 111. 3. Garcia-Godoy F, et al. Am J Dent.1990;3 (special issue): S15-S26. 4. Modéer T, et al. J Clin Periodontol. 1996; 23: 927-933.

YOUR PARTNER IN ORAL HEALTH
www.colgateprofessional.com

[10] => untitled

THE DENTAL PROFESSION & PATIENT PARTNERSHIP

Issue 4

ORAL CARE LINK

July, 2010

COLGATE PROFESSIONAL INFORMATION CENTER

Antibacterial toothpastes

WHY do we need to use them?

N.V. Bulkina
Head of Department,
Therapeutical dentistry department,
PhD, DMS, professor.
Russia

Nowadays there is a wide range of medical and preventive
toothpastes in the market. These toothpastes differ in their
composition, mechanisms of action and, thus, have a
definite application.

Fluoride-containing toothpastes are generally used for
reducing dental enamel solubility and assists in straightening. They are primarily indicated as prophylaxis for caries.
Low abrasive toothpastes contain specific ingredients that
prevent the pain impulse and are used for dental hypersensitivity.
Toothpastes preventing inflammation of the gums
contain antibacterial ingredient to fight against the
main source of gum diseases i.e. germs. Bacteria in the
plaque is the key reason for both inflammations of the
gums and caries, so antibacterial toothpastes have
effective complex exposure providing protection of gums
and teeth. A clear example is Colgate® Total toothpaste
containing triclosan as an antibacterial ingredient and sodium
fluoride for providing protection over caries.
Daily mechanical removal of plaque at home and the
resulting effects on the growth of bacteria in the
plaque are the significant components of a comprehensive treatment thereby preventing inflammations of the gums and periodontium. Antibacterial
ingredients of the toothpastes used for therapy and
prophylaxis of the given diseases have bacteriostatic
and/or bactericidal effects, thus, reducing pathogen
and opportunistic plaque bacteria counts. The
numerical reduction is accompanied by the reduction of
bacteria-derived inflammatory mediators causing dental
and gum tissue lesions.

Toothpaste containing triclosan and
copolymer has shown to be highly
effective in treatment and prevention
of inflammation of the gums. Its unique
formulation was patented under the brand
name Triclogard™ and is included in
Colgate® Total toothpastes.
Triclosan has a wide range of antibacterial
activity. It is effective at low concentrations
and has anti-plaque effect. Moreover,
triclosan has a direct influence on the
inflammatory process by suppressing
inflammatory mediators. Triclosan is
safe, with low allergenic capacity and
no occurrence of pigmentations of the
dental enamel. However, it was shown
that triclosan in its pure form is washed
out of oral cavity in 1.5-2 hours. The
copolymer, included in Triclogard™
complex, retains triclosan on the dental
surface and gums up to 12 hours and thus

prolongs its antibacterial activity. Thus,
Colgate® Total toothpaste may control
plaque bacteria growth throughout the day
and night, arresting the main source of the
appearance and progression of the
periodontal diseases. Moreover, long-term
application of Colgate® Total toothpaste
does not result in derangement of the
natural balance in the oral cavity microflora,
so it has shown to be safe and clinically
proven for daily oral hygiene. Additionally,
this toothpaste contains fluoride needed for
dental enamel strengthening.
In conclusion, Colgate® Total toothpaste
due to its unique formulation has a
complex effect on the main reasons for
inflammations in the oral cavity - dental
and gum diseases. It may also be used as
preventive measures as well as for complex
treatment of inflammatory diseases and is
considered to be a justified choice for daily
oral hygiene.

YOUR PARTNER IN ORAL HEALTH
}>ÌiÊ*>ÛiÊÀi>ÌiÀÊÃ>Ê ÛÃÊ>ÀiÊ>VÌÛiÊÊ\Ê}Ê}ÊUÊ

>ÊUÊ/>Ü>ÊUÊ`>ÊUÊ/ >>`ÊUÊ* ««iÃÊUÊ>>ÞÃ>ÊUÊ-}>«ÀiÊUÊ6iÌ>ÊUÊ,ÕÃÃ>ÊUÊ1À>iÊUÊ/ÕÀiÞÊUÊ>â> ÃÌ>ÊUÊiÀ}>ÊUÊÀi>ÊUÊâiÀL>>

www.colgateprofessional.com

[11] => untitled

THE DENTAL PROFESSION & PATIENT PARTNERSHIP

Issue 4

ORAL CARE LINK

July, 2010

COLGATE PROFESSIONAL INFORMATION CENTER

Antibacterial toothpastes

WHY do we need to use them?

N.V. Bulkina
Head of Department,
Therapeutical dentistry department,
PhD, DMS, professor.
Russia

Nowadays there is a wide range of medical and preventive
toothpastes in the market. These toothpastes differ in their
composition, mechanisms of action and, thus, have a
definite application.

YOUR PARTNER IN ORAL HEALTH
}>ÌiÊ*>ÛiÊÀi>ÌiÀÊÃ>Ê ÛÃÊ>ÀiÊ>VÌÛiÊÊ\Ê}Ê}ÊUÊ

>ÊUÊ/>Ü>ÊUÊ`>ÊUÊ/ >>`ÊUÊ* ««iÃÊUÊ>>ÞÃ>ÊUÊ-}>«ÀiÊUÊ6iÌ>ÊUÊ,ÕÃÃ>ÊUÊ1À>iÊUÊ/ÕÀiÞÊUÊ>â> ÃÌ>ÊUÊiÀ}>ÊUÊÀi>ÊUÊâiÀL>>

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[12] => untitled

Only Colgate Total® has
a unique Triclosan plus
Copolymer formula
delivering 12-hour
antibacterial protection1

A powerful combination

s The Copolymer helps ensure the delivery and retention
of triclosan on the surface of teeth and gingiva for
clinically proven 12-hour antibacterial protection1,4
s Extensively Researched: Proven effective over a range
of patient benefits in more than 60 well-controlled clinical
studies with over 16,000 patients5
s Brushing with Colgate Total® is more effective in
reducing plaque and gingivitis than brushing with regular
fluoride toothpaste2,3

Greater reduction in gingival bleeding vs
regular fluoride toothpaste3

0.6
Gingival Bleeding Index

s Triclosan is an effective broad-spectrum antibacterial
that helps prevent and reduces plaque, a cause of
periodontal inflammation2,3

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7 Months
Colgate Total®

References: 1. Amornchat C, et al. Mahidol Dent J. 2004;24:103-111. 2. Panagakos FS, et al. J Clin Dent. 2005;16(suppl):S1-S20. 3. Garcia-Godoy F, et al. Am J Dent. 1990;3(suppl):S15-S26. 4. Nabi N, et al. Am J Dent.
1989;2(special issue):197-206. 5. Data on file. Piscataway, NJ: Colgate-Palmolive Company.

YOUR PARTNER IN ORAL HEALTH
www.colgateprofessional.com

[13] => untitled

DTAP0710_13-14_FDI 02.09.10 12:47 Seite 1

Members’ Corner: Dr Stuart Johnston Spotlight on World Dental

Dr Stuart Johnston

In this issue of WDC, we are
pleased to have FDI Dental
Practice Committee and Dental
Amalgam Task Team (DATT)
member, Dr Stuart Johnston discuss his involvement with FDI
World Dental Federation and
share his vision for oral health.
WDC: As a practicing dentist, what made you decide to
devote your time to addressing
issues affecting dental practice
at an international level?
Dr Stuart Johnston: I initially became involved with organized dentistry at the local
level because I was dissatisfied
with the system of dentistry in the
UK. After some time, I became
Chairman of the local body and
went on to represent the UK at
the national level.
People gave me jobs to do
and I didn’t say “no”. I enjoyed it
… I enjoyed learning and actively
making a better future for myself
and colleagues in UK.
“Accidently” I had the opportunity to attend the FDI Congress
in New Delhi, in 2004, as a representative of the British Dental
Association. I wasn’t sure what to
make of it at first, it seemed very
complex. But after this experience, I reflected on the opportunities FDI involvement presented and quite liked it—the
complexity of it, it was something
completely new, I wanted to understand FDI, what we could do,
how I could help raise the profile
of my home association there.
There is a symbiotic relationship, representing BDA at FDI
and bringing benefits back to
dentists in the UK.
You were recently invited
to join FDI Dental Amalgam
Task Team (DATT). What is the
rationale behind the formation of DATT?
It is fascinating work—the
way these colleagues have communicated with one another

around the world, all cooperating,
and the quality of debate is superb. The FDI Council mandated
that a Dental Amalgam Task
Team (DATT) be established to
ensure that the international
dental community and issues
regarding dental amalgam were
properly and accurately represented in United Nations discussions regarding mercury and
would be based on the best
available science. For details see
UNEP Intergovernmental Negotiating Committee www.unep.org/
hazardoussubstances/Mercury/
Negotiations/INC1/tabid/3324/
language/en-US/Default.aspx
The DATT consists of a representative from each of the
FDI standing committees, three
Council representatives and
where required be supplemented
with subject matter experts.
Where does the DATT stand
now and what role does it play
in FDI overall mission?
At the UNEP meeting in
Stockholm, 7–11 June 2010, I was
privileged to represent FDI Dental Amalgam Task Team. This
meeting saw a continuation of
the process begun in November
and we had the opportunity to
lobby delegates to our position
to avoid an all-out amalgam
ban. DATT is looking to develop
information for member NDAs
to take back to their countries
to communicate with their governments directly. It will be
governments who vote on this,
so we require a team effort to
achieve the desired result.
In regards to dental amalgam, it is not a health issue because the dental profession has a
significant body of evidence that
the use of amalgam as a restorative material is safe with respect
to human health. However it is
the broader considerations with
regards to mercury that the intergovernmental negotiating committee is addressing.
Is FDI developing a position
on environmental waste?
We must be seen as doing
everything we can, including:
• Make sure all waste is collected
properly in dental surgery and
properly disposed of and recycled wherever possible, to
avoid contamination
• Move away from bulk mercury,
which can be misappropriated
for small scale gold mining, towards capsule mercury, which
avoids spillage.

What does the FDI World
Dental Federation offer to the
dentist?
The world is changing and
FDI helps us to understand this
change at international or global
level. For example, amalgam is
prime issue. FDI can represent
this at the world level for the dental profession. Another example
is GCI and how it fits together,
there is serendipity—the strategy
for dealing with caries sees a reduction in need for amalgam.
There is a huge opportunity to
make a real difference through
FDI. For some associations from
more advanced countries, part
of FDI’s work is the duty to help
colleagues in developing areas.
There is a global responsibility
which is enhanced now by amalgam issue—this shows that we
are one world, working together
for better oral health.
What plans does the FDI
Dental Practice Committee
(DPC) have for 2010?
I have been a Member of DPI
for just over a year. It is nice to meet
with colleagues and see how we
approach problems differently. It
can be difficult to produce the consensus statements due to different
legal systems and philosophies of
care, so when we produce a statement it is even more satisfying.
Benefits of being part of the DPC
include meeting more of the people involved in FDI work, and feeling more that I am part of the team.
Looking at purpose of the
committee, there will be fewer
but more focus projects with the
DPC collaborating with other
committees to contribute to FDI
strategic objectives. We are looking at the dental team, risk management in dental practice, indemnity, infection control and
waste management.
Also we have been approached
by colleagues at the Indian Dental Association, which is a positive development.
Where do you see your work
taking you with FDI?
I am enjoying what I am doing
now. It means a juggling act with
FDI involvement, the BDA where
I am chair of the Representative
Body, running dental practice,
and European work. FDI
Dr Stuart Johnston qualified in
1972 from Cardiff Dental School
and has worked in his own practice for the last 32 years. He is the
DPC member on the FDI Dental
Amalgam Task Team (DATT).

Development Fund

Photo: FDI WDDF

For more than a decade, the
FDI’s World Dental Development Fund (WDDF) has made
a difference to the lives of
disadvantaged people in many places around the globe
through its support of oral
health education and outreach
programmes.
Established in 1998, the
World Dental Development Fund
aims to improve oral health
primarily in disadvantaged populations through education, oral
health promotion, disease prevention and primary health care.
The variety of projects that
are funded highlights different
approaches to better oral health
in contrasting settings. Current
projects range from capacity
building in Africa, to improving oral health in rural India,
through to integrating oral
health in primary health care
in northern Pakistan, and oral
cancer awareness and HIV/AIDS
awareness training for dentists in
Latin America.
The World Dental Development and Health Promotion
Committee, the body responsible
for the management of the
World Dental Development Fund
within FDI, recently completed
a project in Cambodia. Here, the
prevalence of HIV/AIDS and
hepatitis is one of the highest in
South-East Asia. Due to the lack
of established standards and
training materials regarding

infection control for dental personnel, the Cambodian Dental
Association proposed a project to
develop a national cross infection
control programme in collaboration with the World Health
Organisation.
The successful completion of
this project has benefitted the
dental team and the entire Cambodian population. A training
manual on cross-infection control (CIC) for dental practitioners
has been developed. Also, as a result of this project, knowledge
and behaviour of dentists in relation to infections has improved.
The World Dental Development Fund accepts applications
on a continuous basis. To improve oral health and oral health
care services in developing countries, educational projects delivered in collaboration with governmental, non governmental
agencies and individuals, and
supported by the FDI member
association are encouraged. The
numerous applications received
from community organisations
and initiatives highlights the
enormous need for effective oral
health programmes.
FDI invites well-wishers to
support this very important work
by making donations to the WDDF,
so that we are able to expand
and sustain the funds successful
activities. For more information:
www.fdiworldental.org/es/node/109 FDI

FDI Revisits Suntec
Center, Singapore
Eight months after the successful 2009 FDI Annual World
Dental Congress at the Suntec
International Convention and
Exhibition Centre, Singapore,
FDI returned to Singapore to
participate in the biennial International Dental Exhibition
and Meeting (IDEM) that took
place from 16 to 18 April 2010.

Dr Roberto Vianna, FDI President, was present at IDEM Singapore to promote FDI and to extend
FDI’s spirit of partnership among
participating stakeholders.
“IDEM Singapore brings together many facets of FDI’s work
‡ FDI page 14

[14] => untitled

DTAP0710_13-14_FDI 02.09.10 12:47 Seite 2

Worldental Communiqué

DENTAL TRIBUNE Asia Pacific Edition

Initiative pilots adaption of
a province-wide oral health
programme in the Philippines

ﬂ FDI page 13

towards improving oral and
general health. Together with
the Singapore Dental Association, FDI develops outstanding
Continuing Education programmes—based on relevant
and timely topics for the profession—which not only play an important role in the development
of dentistry and dental professionals, but also in advocating the
importance of oral healthcare to
the population,” said Dr Vianna at
the IDEM opening ceremony.
Organised by Koelnmesse
and the Singapore Dental Association (SDA), in cooperation with
FDI World Dental Federation,
the 2010 edition of IDEM Singapore delivered cutting-edge
insights into the very latest in
dental technology, techniques
and patient treatment. The 2010

Scientific Conference at IDEM
Singapore, which featured 18 international thought leaders in
their respective fields, brought to
the fore new protocols in patient
treatment. Moreover, the most
recent innovations that help
dentists minimize the risks involved in advanced procedures,
while enhancing the results for
patients, were showcased by
352 exhibitors from 31 countries.

hour. Participants went away
with valuable insights into the
challenges and limitations of
dental implant procedures.

Participants equally benefited from a Consumer Education
Forum, organized by the Singapore Dental Health Foundation,
in conjunction with IDEM Singapore. The forum sought to update
the public beyond the basic principles of good oral care, exploring topics such as the relative
advantages and disadvantages of
implants, what patients should
ask their dentists about implants
and the intriguing Teeth-in-an-

Looking forward, the theme
and speakers for IDEM 2012
Scientific conference have been
chosen. IDEM 2012 will focus
on ‘Advances and Controversies’.
It will have the following personalities as keynote speakers:
Dennis Tarnow from the Columbia School of Medicine, New
York; and Dr Michel Magne and
Dr Pascal Magne from the University of Southern California,
Los Angeles. FDI

IDEM Singapore 2010 also
saw the introduction of ‘Let’s
Talk Business seminar’ in which
participants deliberated on how
they can leverage technology to
transform the delivery of dental
treatments.

During the 1 March 2010
ceremony marking the
end of the three-year
Live.Learn.Laugh. Philippines demonstration
project, Governor of the
province of Batangas,
Vilma Santos-Recto, affirmed her plans to expand the Batang May K
(BMK) project to ten
more municipalities of
the Province of Batangas.
Batang May K—Empowering children to Healthy Habits, was a project under the
Live.Learn.Laugh. partnership
of FDI World Dental Federation
and Unilever Oral Health in
association with the Philippine
Pediatric Dental Society and
Philippines Dental Association
(PDA).
The BMK project aimed at
improving the oral and overall health status of pre-school
children in day care centres
in Batangas through tooth
brushing, hand-washing, fingernail-cutting, healthy diet,
mass de-worming and waste
management.

During the ceremony, outstanding day care centers and
workers in the province received awards for good implementation of the project’s
components, improvement in
their centers and their promise
to sustain the project.
As a catalyst for the threeyear Live.Learn.Laugh. Philippines project, following a
National Oral Health Survey reported that 97.1% of six year old
children suffered from dental
caries and 84.7% from dental
infections, the Philippine Pediatric Dental Society instigated
a project to empower children
to healthy habits. FDI

Grand opening of FDI head office in Geneva, Switzerland
Friday 23 April 2010 saw the
official opening on the new FDI
World Dental Federation head
office and the start of a new
chapter in FDI’s evolution. FDI
secretariat have been settling
in to the new location since the
move from Ferney-Voltaire,
France, last September immediately following Congress.
The move from France to
Switzerland reflects the diversity
of FDI membership. Geneva is
international crossroads with
its multicultural population, in
a country with four official languages, located in heart of Europe and well connected to rest
of the world. Also significant is

the fact that Geneva is a Capital
of Health, with FDI neighbours
including the World Health Organization, World Heart Federation, International Federation
of Red Cross, and Medecins
sans frontiers. Furthermore the
consolidation of FDI businesses
under a single entity provides
more simplified management
and a favourable taxation environment.

organizations—has found a new
home in this city, with neighbours
including the World Health Organization, United Nations, and
World Trade Organization.”
“…From our new home in
Geneva, we are well positioned
to collaborate with our many
partners in health, continuing to
serve as the worldwide, unified
voice for oral health; to promote
oral health globally; and to deliver excellence in continuing
professional education and access to care to communities
worldwide.” FDI

Attending the ceremony were
FDI Council members and
staff, FDI members, corporate
sponsors, partners and other
NGO’s. Mr Stéphane Graber,
Délégué au Service de la Promotion Economique du Canton de
Genève, and Mr André Klopmann, Chargé des ONG internationales, Canton de Genève, represented the Canton de Genève.

Social Events Schedule for FDI
2010 Congress now available
The social programme for
the 2010 FDI Annual World
Dental Congress which will be
held from 2–5 September in Salvador, Brazil, is now accessible
for participants to familiarise
themselves of what awaits them

in the exotic Bahia state. The
programme has been carefully
developed to show the various
aspects of the local culture.
Visit the FDI website to access the social programme. FDI

A ribbon-cutting ceremony
was performed by FDI President,
Roberto Vianna; FDI Executive
Director, David Alexander; and
for the Canton de Genève, André
Klopmann. Guests enjoyed a
brief tour of the office on the
5th floor having a sneak peak of
FDI’s new “home” and FDI’s
colourful windows.
The Grand Opening ceremony coincided with FDI Coun-

cil meeting. Despite the Iceland
volcanic ash incident which
made traveling difficult, a good
number of guests could still
attend the ceremony. However,
some aspects of the event were
postponed, such as the bidding for the 2013 congress. This
has now has been scheduled
to take place in September in
Salvador.

Excerpt from FDI President’s
speech
Roberto Vianna: “I feel proud
that FDI World Dental Federation—one of the world’s oldest
international health profession

About the publisher
Publisher
FDI World Dental Federation
Tour de Cointrin, Avenue Louis Casai 84,
Case Postale 3
1216 Cointrin – Genève
Switzerland
Phone: +41 22 560 81 50
Fax: +41 22 560 81 40
E-mail: media@fdiworldental.org
Web site: www.fdiworldental.org
FDI Worldental Communiqué is published by the FDI World Dental Federation.
The newsletter and all articles and illustrations therein are protected by copyright. Any utilisation without prior consent
from the editor or publisher is inadmissible and liable to prosecution.

[15] => untitled

DTAP0710_15-18_Barrington 02.09.10 12:50 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 15

Crown preparation techniques utilising
the dental operating microscope
Dr Craig Barrington
USA

Successful crown preparations
start at the diagnosis. Early
detection of the need for a
full-coverage restorative can
minimise many difficulties associated with the preparation
of a tooth for a crown, obtaining an accurate impression,
and the achievement of a
precise fitting, long-lasting,
aesthetic restoration. Proper
diagnosis is the all-important
first step.
The second most important
component is vision. The dental
operating microscope (OM) has
proven to be valuable in endodontics but it is just as valuable
—or more valuable—for restorative efforts. High magnification above 4x is necessary to
impose/create good finish lines
that are easy to impress and
temporise. Magnification of 2 to
24x is available with the OM.
Management of gingival health
and biological width is important to the overall final look of
the crown and the cleanability
for the patient. A poor finish line
and a poorly positioned finish
line not only result in poor impressions and final restoration
fit, but also make for poor-fitting
provisionals.
If the finish line cannot be
found, one cannot properly trim
and fit the provisional restoration and remove any temporary
cement properly. When patients
return, gingival tissues can be
irritated, making the placement
of the final restoration challenging. If by chance one does
achieve a good fit, then, when
the soft tissue heals, the junction
of the final restoration and the
tooth may be visible, ruining
the overall aesthetics.

Good patient management
Working at high magnification with the OM requires good
patient and procedural management. If the patient moves
about or is uncomfortable, the
operator cannot concentrate on
proper reduction or the task of
placing a solid, conservative
finish line on the tooth. Therefore, the third most important
component in crown preparation success is the dental rubber
dam.
For most using a dental dam
for a crown preparation is a
widely misunderstood concept.
Simply put, the rubber dam is
the most under-utilised, inexpensive and simple piece of
equipment an operator can incorporate into his/her crown
preparation protocol. With a little training, dentists and assistants can learn techniques that
will benefit all individuals involved in the restoration of a
tooth. (Please note that in all of
the figures 1–10, a dental dam
is in place before and after.)

Fig. 1a

Fig. 1b

Fig. 2a

Fig. 2b

Fig. 3a

Fig. 3b

Fig. 4a

Fig. 4b

Figs. 1–10: Before and after photographs of crown preparations.

Tissue management is the
fourth concern and it points
back to the number one concern
of early diagnosis versus waiting
until a tooth is severely decayed
or broken down. Working deep
subgingivally and in irritated
tissues exponentially complicates the task of crown preparation. Haemorrhagic areas, or
those that are deep subgingivally, can be difficult to visualise
and control. Early diagnosis can
minimise these tissue complications. Good tissue management
protocol is paramount to the
success of the final restoration.

Radiosurgery:
A useful instrument
Lasers have been used in
dentistry for quite some time
but their cost and other fundamental limitations make them
difficult to acquire and use.
However, radiosurgery has been
in use for years and is an affordable and useful instrument that
can solve many problems regarding finish-line visualisation,
finish-line exposure and haemorrhage control. In addition, this
simple, conservative instrument can make cord placement
quick and simple by preserving
the gingival architecture.
The Parkell unit with a #118
tip allows the creation of a very
conservative trough or trench
around a tooth. In combination
with good visualisation using
the OM and good patient and
procedural management with
the rubber dam, we can reliably
create a finish line, expose it,
place a cord if necessary and
impress it.
With a radiosurgical unit,
inflamed tissue can be removed
such that the healthier tissue
is exposed to our haemostatic
agents. Healthy haemorrhagic
tissue responds better to haemostatic agents than inflamed
haemorrhagic tissue does. When
inflamed tissue is encountered,
use of high magnification and
the radiosurgical tip to conservatively contour or remove
this nuisance tissue can provide a predictable result. Reducing tissue thickness but

not modifying tissue height can
leave the gingival tissue in
proper position such that we
achieve nice aesthetics in our
final result.

Handpiece and bur choices
The final item and of least
concern in this protocol are
handpiece and bur choices.
There is existing debate be-

tween electric versus air-driven
handpieces and regarding
which bur is best for which task.
Specifying a particular handpiece or bur would be similar to
directing an artist regarding
which paintbrush to use. What
works in one’s hands is the
most important factor and that
changes from individual to individual and situation to clinical
situation. If a practitioner follows the diagnosis, magnification, isolation and tissue management protocol, then bur and
handpiece choices will fall into
place on their own with time
and experience. I typically use
an air-driven handpiece and
an assortment of Axis turbo
diamonds.
In a stepwise fashion for an
individual crown preparation,
the primary concern is achieve‡ DT page 16
AD

[16] => untitled

DTAP0710_15-18_Barrington 02.09.10 12:51 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

16 Trends & Applications

break contact from the buccal to
palatal direction. The difficult
area to prepare in an upper left
tooth is the disto-palatal/lingual
line angle. The difficulty varies
according to the tooth being
treated and/or the patient’s
tooth limitations.

ﬂ page 15

ment of proper anaesthesia such
that the patient is comfortable in
all capacities. Once this is done,
the rubber dam is placed. I use
a split- or slit-dam technique.
The key to success with this rubber dam technique and crown
preparation is the distance at
which the holes are placed apart
from each other. Generally
speaking, holes are punched too
close together for this technique. It is best to punch the
holes at a distance from each
other on the dam that essentially
matches the true anatomical
distance between the teeth to be
isolated.

Next step:
Occlusal reduction
Once the tooth has been isolated and the patient is confirmed to be comfortable, the
next step is the occlusal reduction. This makes the tooth
shorter and allows better access
and visualisation for the axial
reduction. If there is an existing
restoration in the form of an
alloy or composite filling, it is
removed and the tooth is reduced to the level of the depth of
AD

Fig. 5a

Fig. 5b

Fig. 6a

Fig. 6b

Fig. 7a

Fig. 7b

Fig. 8a

Fig. 8b

this restoration. Existing restorations usually provide a good
guide to achieving nice occlusal
clearance without having to
verify prior to the next step.
Hopefully, I have not diminished
the importance of this step, as
I know this can make or literally
break a final restoration.
Completing the occlusal reduction first allows me to warm
up and work out any kinks in
terms of patient issues, patient

positioning, handpiece water
flow or bur choice etc., before
moving to the more complicated
axial reduction. On the upper
arch, the full-crown preparation
is done with a mirror and indirect vision. The OM places us in
an ergonomic position for doing
this and the rubber dam creates
a nice situation for a high volume suction to create an air flow
that will keep our mirrors
clean(er) of the water spray
from the handpiece. On the

lower arch, I conduct threequarters of the procedure with
direct vision and then finish
certain corners through indirect
vision. Indirect vision on the
lower arch is not a common
technique but with understanding and desire, it is an easy technique to master.
The axial surface reduced
first depends on which tooth is
being treated. For example, I am
right-handed, so on an upper
right first molar I reduce the
palatal side first and then move
to the interproximals. On that
same molar, I break contact on
the mesial first, moving from the
palatal side, breaking the contact towards the buccal side.

Fig. 9a

Fig. 9b

The lower arch is different
to the upper arch in that direct
vision can be utilised for most of
the preparation. The buccal reduction is initially done on both
lower arches and interproximal
contact is broken in a buccal to
lingual direction, starting with
the mesial contact. Once both
mesial and distal contacts have
been broken, the lingual reduction has been accomplished. For
a lower tooth, the disto-lingual
line angle tends to be the most
difficult area to visualise, so this
is the part that is refined using
indirect vision.

Tissue management
and cord placement
Once all occlusal and axial
reduction has been accomplished, the next step is tissue
management and cord placement. I start with the radiosurgical unit with a #118 tip to create
a conservative trough around
the tooth, mostly removing tissue thickness and/or reducing
any volume of inflamed tissue.
This is a very conservative step
under the OM. The OM allows
precise and accurate tissue

Fig. 9c

This is the easier of the two
surfaces to break. First, it is further forward in the mouth and
therefore easier to reach; and,
second, it is a shorter contact
as it is against a premolar. Following the mesial contact break,
I continue around the tooth
through the mesio-buccal line
angle onto the buccal surface.
I then break the distal contact,
also moving from the palatal
side to buccal direction. The
most challenging area to prepare on an upper right first
molar is the disto-buccal (DB)
line angle. Therefore, I prepare
the tooth as far as I can through
the distal contact and around the
DB line angle. I then complete
the buccal reduction and connect the buccal finish line at the
DB line angle.

removal, and increases tactile
sense and the steadiness of our
hands.

Mirror position is critical in
achieving a solid finish line on
the entire tooth including the DB
line angle. These steps, for me,
remain true for most upper right
teeth, with difficulties being
increased as we move more posteriorly and considering patient
limitations in anatomy, patient
attitude, tooth anatomy and existing restorations or decay.

Now the sharpness and position of the finish line can be
re-evaluated and refined. An
ultrasonic unit is used, with
the irrigation on, to clean the
crown preparation of calculus
and/or other debris. Occasionally, a BUC-1 endodontic tip
(Ultradent), which is about the
same size and shape as a 1DT
diamond bur, can be used in
the ultrasonic unit to refine the
crown preparation finish lines.
This is done with the irrigation
feature turned off on the ultrasonic unit. To sharpen, slightly

Axial reduction
The steps for axial reduction
on the upper right arch mirror
themselves on the upper left
arch. On the upper left arch,
I initially reduce the buccal and

A size 00 cord is placed in
a haemostatic agent to soak at
the start of the procedure. Literature supports that a cord
soaked for 15 to 20 minutes in
a haemostatic agent works better than any other alternative
cord/haemostatic agent combination or method.1 Personal
clinical experience and ob servations find this to be true.
With the radiosurgical gingival
trough in place, the cord placement is a simple, pressureless
and quick, followed by copious
air/water syringe rinsing. In the
time that it takes to place the
cord and rinse most haemorrhage will be controlled, if any.

‡ DT page 18

[17] => untitled

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[18] => untitled

DTAP0710_15-18_Barrington 02.09.10 12:51 Seite 3

DENTAL TRIBUNE Asia Pacific Edition

18 Trends & Applications
ﬂ DT page 16

refine, or minimally move a finish line, I occasionally run the
handpiece at a very low speed
without water.

Rinsing and drying
Once all refinements have
been accomplished, the preparation is rinsed and dried and
for the first time, the entire
preparation is evaluated in one
view. The uniformity of the axial
reduction and the position of
the gums in relation to the cord,

Fig. 10a

Fig. 10b

and the cord in relation to the
finish line are all evaluated. The
axial reduction should have
uniform thickness throughout
the different positions, as differ-

Fig. 10c

ent areas need more reduction,
while others need less, based on
material and aesthetic demands.
There should be no areas where
the gingiva is over the cord. If

Fig. 10d

this does occur, that area is
refined with the radiosurgical
unit to ensure a full view of the
cord 360° around the tooth of
tooth-tissue-cord.

VITA MFT – no simpler way to set up teeth!

Fig. 10e

One of the main reasons
we use polyvinyl-siloxane impression materials is because
they are repourable. If adequate strength and thickness of
this material are not obtained
through the proper radiosurgical troughing technique, then
the impression may tear upon
separation of the model. Having
an impression tear after the first
pour limits the ability to fabricate a well-fitting restoration.

When a clear tooth-tissuecord and a visible, sharp finish
line are present, the rubber dam
is removed and the preparation
is evaluated in all dimensions
with the naked eye. At times
the OM can create a ‘cannotsee-the-forest-for-the-trees’ type
of situation, so it is always valuable to take another look from
a different perspective without
the OM. This can allow one to
identify sharp angles or irregularities in the preparation.

Find the correct centric quickly and precisely with the new "Multi Functional Teeth"

Full-arch impressions
A full-arch impression is
taken with a single tray for the
arch that contains the prepared
tooth. For the opposing arch,
a full-arch alginate impression
is taken. With full-arch impressions, a bite registration is usually not required. Most often,
one chairside assistant is utilised for the entire procedure,
but for difficult and challenging
impressions, a second assistant
may be utilised for saliva or
tongue control.
Once all the impressions
have been taken, a provisional
is fabricated, refined, polished
and cemented. Shades are taken
and the patient is released with
post-operative instructions. DT

3365 E

Reference
1. Csempesz F, Vág J, Fazekas A. In
vitro kinetic study of absorbency of
retraction cords. J Prosthet Dent.
2003 Jan;89(1):45–9.

Contact Info

Simply no-one can resist VITA MFT. Thanks to the 'easy-centric ®'

provides ideal static alignment plus many other beneficial fea-

setup concept, even those new to setting up acrylic denture

tures. VITA MFT are universally applicable, highly esthetic and

teeth can achieve optimum occlusion almost automatically –

suitable for every indication. The compact shade and mould

thanks to their pre-abraded occlusal wear facets that minimize

assortment is a further guarantee for optimum productivity.

the horizontal shear forces, their specially molded cusps which

What an attractive prospect! / www.vita-zahnfabrik.com

Dr Craig M. Barrington practices general dentistry in Waxahachie, USA, with his wife,
and has a particular interest in
endodontics and microscope
dentistry. He can be contacted
at cbdds002@prodigy.net

[19] => untitled

webinar_asia_esthetics_AD_final_A3_27.8.10.qxd:Layout 1

30.8.2010

9:22 Uhr

Seite 1

Saturday, 16 October 2010 at 4 pm Indian Standard Time (IST)

INTERNATIONAL FREE LIVE WEBCAST
sponsored by Ivoclar Vivadent

Smile Design and Ceramic
Restoration in Esthetic
Restorative and Implant Dentistry

SPEAKER

Dr Christian Coachman received his

CE
1 ADAdit
cre

+ ate
Attend this online webcast and
c
certifi
get 1 ADA CE credit plus a certificate.

dental degree from the University of
São Paulo and his dental technology
certificate from Rocha Marmo School
(São Paulo, Brazil). He completed a dental ceramic specialization program and
opened his own laboratory in 1996.
Dr Coachman was an instructor at the

Date
Time
Duration
Link
Target group
Language
Required

Saturday, 16 October 2010
4 pm Indian Standard Time (IST)
1 hour plus questions & answers
www.DTStudyClub.com
Dentists and Technicians
English
Computer with audio capabilities and
high-speed internet access

Ceramoart Ceramic Training Centre
(São Paulo, Brazil) in 2001. From 2001
to 2004, he worked as a technical consultant at Oraltech, São Paulo. He is a
founder of and has been a lecturer at
the Insight Group Ceramic Training
Centre (Bauru, Brazil) since 2003. He
is a member of the Brazilian society of
esthetic dentistry.
From 2004 to 2008, Dr Coachman was
the head ceramist of Team Atlanta consisting of Dr Ronald Goldstein, Dr David
Garber and Dr Maurice Salama. He lec-

Replacing missing teeth within the esthetic zone in an esthetically satisfactory fashion
has been and still is a major challenge in dentistry. High esthetic expectations and the
addition of implant therapy have only increased the challenge. It is, therefore, necessary for clinicians and technicians to fully understand all the available options and
limitations as well as where, when and how to best utilize them.
The goal is to design a smile that fits the patient’s functional, biological and emotional needs. Modern techniques and materials can be useless if the final outcome does
not live up to the patient esthetic expectations.
The protocol that is presented will improve the esthetic diagnosis, the communication and the predictability of anterior ceramic restorations.

www.ivoclarvivadent.com

tures and publishes internationally in
the fields of cosmetic dentistry, oral rehabilitation, dental ceramics and dental
implants.

[20] => untitled

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[cover] => DT Asia Pacific

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