DT Asia Pacific

Implant dentistry in Singapore gets boost / Asia News / The politics of a dental plan for Australia / World News / Business / “We are committed to investing and supporting the development of implant dentistry in China” / Removal of a fractured instrument: Two case reports / All-ceramics encounter PFM ceramics / A simplified method for the removal of cemented implant prosthetics / Discover the small world of ToothVille / APDF Newsletter

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DTAP0910_01_Title 04.10.10 15:13 Seite 1

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AP

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

PUBLISHED IN HONG KONG

www.dental-tribune.asia

Spalinger speaks
Straumann’s CEO about
the step into China
4Page

NO. 9 VOL. 8

Endodontics
How to remove
a fractured instrument
4Page

Off time
Discover the strange
world of ToothVille

11/12

4Page

Implant dentistry in Singapore gets boost Stem cell
University of Washington endorses six-month course in surgical training
Daniel Zimmermann
DTI

Health care consulting company Gencoval Strategic Services
in India has announced its partnership with a French biomedical institute to open the first
dental stem cell bank in Mumbai.
The new company Stemade
Biotech will use a patented technology from Institute Clinident
BioPharmain Aix-en-Provence
in France to extract and preserve
Dental Pulp Stem Cells derived
from primary and wisdom teeth
under cryogenic conditions for
various therapeutic applications
in the future, company officials
said.

HONG KONG/LEIPZIG, Germany:
A dental implant training programme currently run by Singapore’s largest private dental care
centre T32 has been accorded
recognition by the University of
Washington (UW) in Seattle in the
US. The programme, which saw
its first students graduate in late
September, was set up last year
in partnership with Arrail Dental
Group in China to offer dentists
from both countries advanced
training in key techniques required for dental implant surgery.
While dental education programmes between Singapore
and other countries already exist, this is the first time that a US
university has endorsed a training programme offered by a private dental clinic in the country.
Besides consultation on the programmes, UW will also provide
training and assessment on UW’s
main campus in Seattle for the
final part of the course.
“Singapore is hugely important and recognised as a key

bank opens
in Mumbai

Dr Wong Keng Mun, Managing Director of T32 Dental Centre (middle), surrounded by staff. (DTI/Photo courtesy of Max PR, Singapore)

dental and health hub for Asia
and we are delighted to partner
T32 Implant Dental Training
Centre to provide a robust
course for dentists to continue
their specialist postgraduate
training, post graduate which in
turn will benefit patients in Singapore and across the region,”
commented Dr Ariel Raigrodski,
Associate Professor and Director
of Graduate Prosthodontics at

UW’s Department of Restorative
Dentistry.
Singapore’s Chief Dental Officer Prof. Patrick Tseng hailed the
new partnership, which he said
would provide more opportunities for dentists to update their
knowledge and offer better quality dental care. Patients who may
not be able to afford treatment
with the latest dental techniques

will also benefit from the new programme, as they will be given
treatment at a reduced cost treatment by qualified dentists under
the guidance of the T32 Centre’s
trainers, he added.
Singapore has seen an upswing
in the numbers of placed implants
placed lately due to rising income
and higher oral-health awareness
amongst the population. DT

The latest research has indicated that adult stem cells,
which can also be extracted from
bone marrow and other parts of
the human body, have the potential to treat non-communicable
diseases like cancer or heart
disease and to repair or regenerate entire organs. Dental Pulp
Stem Cells have been found to
form at least 29 different unique
tissues, including dental enamel,
dentine, blood vessels and nerve
cells. DT
AD

UAE kids
miss out on
dental checks

Tan Jing (China) performing at a Spring Festival concert in Beijing. The 33-year old
celebrity singer has been appointed ambassador for a new oral health awareness
campaign by the Chinese government. (DTI/Photo courtesy of Xinhua News, China)

Dental corp sends
help to Pakistan

NZ reptile tested
for use in dentistry

Henry Schein, the largest
dental company in the world,
has donated health care supplies to the flood victims in Pakistan. The effort is part of the
company’s global social responsibility programme that supports non-governmental organisations during humanitarian
emergencies. DT

UK researchers have started
to investigate the sophisticated
interplay between jaws, muscles
and the brain through skull and
teeth of a NZ reptile species
called Tuatara. Their studies
could help to prevent damage to
dental implants and jaw joints
that occur after loss of periodontal ligament. DT

The head of Dubai Dental
Services of the United Arab Emirates’ (UAE) Ministry of Health
Dr Aisha Sultan has called on
the central government in Abu
Dhabi to increase spending
on preventive oral-health programmes. She said that while
other Middle Eastern countries
like Bahrain have successfully
implemented such programmes,
the UAE still lacks political will to
introduce regular dental checks
of schoolchildren, especially in
the country’s neglected Northern
rural areas.
According to the results of
a national oral health survey
conducted in early 2010, caries is
highly prevalent in the primary
dentition of most five year-old
children living in the UAE. It also
found that only 17 per cent of all
children were complete caries
free. DT

Distinguished by innovation
We shape the future of dentistry with our innovative products and systems. They
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Tel. +423 / 235 35 35 | Fax +423 / 235 33 60

[2] => DTAP0910_01_Title

DTAP0910_02_News 04.10.10 15:14 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Aussi coalition agrees on
more spending for dental care
parties to come up with
new ideas regarding improving access to dental
health care services in
the country. (Please see
‘Australia: Oral health
at stake in federal election’, Dental Tribune Asia
Pacific, No. 7+8, 2010: 1).

Claudia Salwiczek
DTI

HONG KONG/LEIPZIG,
Germany: The new coalition between the Australian Labor Party and
the Australian Greens is
giving greater priority to
dental services. In a policy
Australian Dental Asagreement signed by the
sociation (ADA) leader
new Prime Minister Julia
Dr Neil Hewson has welGillard (Labor) and Green
comed the new agreeSenator Bob Brown in
ment as an overdue step
September, party leaders
agreed to raise more Prime Minster Julia Gillard (left) greeting members of the to improving federal
funding for dental care.
money for dental services new Parliament. (DTI/Photo courtesy of ALP, Australia)
He said that his organiin the 2011 federal budget.
sation will be open to discussing
The commitment is seen as a
of Green Members of Parliament
new initiatives like the ADA’s own
first step in establishing a univerto form a minority government
DentalAccess scheme that aims
sal dental health care scheme,
against the Liberal–National
to improve access to dental servwhich has been in high demand
Coalition. During the federal
ices for disadvantaged groups
by dentists and patients alike.
election campaign, senior Ausand people living in neglected
tralian dental officials had critirural areas, where patients often
cised the lack of political commitAfter two weeks of political
have to wait weeks or months for
ment to oral health across the
deadlock, Labor recently rea dental appointment. DT
political landscape and urged all
gained power by winning support

Malaysia opens advertising
market for health professionals
Daniel Zimmermann
DTI

and dentists were only allowed to
advertise through health care-related newspapers or magazines.

HONG KONG/LEIPZIG, Germany:
Malaysia is currently liberalising
provisions under the Sales and
Advertising Act that will allow
health care providers to advertise
their services in all media. Restrictions placed on advertising
abroad are also to be removed,
according to the Ministry of
Health. Under the previous act,
promulgated in 1965, physicians

Malaysia’s Health Minister
Datuk Seri Liow Tiong Lai told
reporters that the government
had decided to remove the ban to
promote the country’s growing
medical tourism market and
raise the number of foreign patients from the current 330,000
to over 350,000. He said that although medical advertisements

still require approval from the
ministry’s Medicines Advertising
Board (MAB), waiting times will
be shortened from six weeks to
approximately a few days.
Currently, all medical advertisements, including websites,
have to receive prior approval by
the MAB. Advertisements containing false information can be
rejected or even incur a penalty of
up to RM3,000 (US$725), or imprisonment of one or two years. 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 48474-107

Copy Editors

Sabrina Raaff
Hans Motschmann

Editorial Assistant

Claudia Salwiczek
c.salwiczek@dental-tribune.com

President/CEO

Torsten Oemus

Marketing & Sales

Peter Witteczek

Director of Finance & Controlling

Dan Wunderlich

Marketing & Sales Services

Nadine Parczyk

License Inquiries

Jörg Warschat

Accounting

Manuela Hunger

Product Manager

Bernhard Moldenhauer

Executive Producer

Gernot Meyer

Ad Production

Marius Mezger

Designer

Franziska Dachsel

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.
© 2010, 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.

Dental Tribune International
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302 · Fax: +49 341 48474-173
Internet: www.dental-tribune.com E-mail: info@dental-tribune.com

Regional Offices
Asia Pacific
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd, 20A, Harvard Commercial
Building, 105-111 Thomson Road, Wanchai, Hong Kong
Tel.: +852 3113 6177 Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
116 West 23rd Street, Suite 500, New York, NY 10001, USA
Tel.: +1 212 244 7181 · Fax: +1 212 224 7185

[3] => DTAP0910_01_Title

DTAP0910_03_News 04.10.10 15:16 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Asia News

3

India sets new World Record in oral health, heads for another
Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
Indians have set a new World
Record for the Most People using
Mouthwash at the same time.
Guinness World Records recently
acknowledged the achievement
that saw over 300 people line up and
rinse their teeth simultaneously
during a World Oral Health Day
charity drive in Mumbai.

turer of dental products, to set a new
record for the most dental checkups delivered in one day. The event
will take place during Oral Health
Month in dental camps around
New Delhi and Mumbai, and will be
joined by Indian actresses Karisma
Kapur and Shriya Saran. DT

Indian Dental Association (IDA)
officials, who organised the event
in cooperation with dental products manufacturer Listerine, said
that the successful record attempt
was held to carry oral health messages around the country, where
most people only use a toothbrush
but avoid additional oral care
measures such as mouthwash or
dental floss. They said that the organisation has also teamed up with
Colgate, another large manufac-

Guinness World Records Executive Adjudicator Jack Brockbank (middle)
poses with participants in Mumbai.
(DTI/Photo courtesy of Guinness World
Records, UK)
AD

Philippine
government
investigates
lab closure

POWERFUL
BONDS
POWERFUL
OPTIONS

Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
The Philippine Department of
Labor and Employment has started
investigations into the sudden closure of a dental facility in the capital Manila that left over 400 workers
jobless. The lab, which has been
operating under the name Skytech
International Dental Laboratories,
was allegedly shut down due to
bankruptcy over e-mail by its
American owner in late August and
without prior notice to management and staff, Filipino newspapers report.
Skytech has produced dental
replacements, including crowns,
bridges and dentures for clients in
the Philippines and abroad.
The Department took up investigations after members of the
leftist Bayan Muna party filed a
resolution during a September parliamentary session that urged the
government to immediately look
into the matter and “craft measures
to prevent similar incidents and ensure the protection of workers’
rights in this age, where major management decisions are relayed and
implemented via electronic means.”

®

VARIOLINK N

Department of Labor and Employment Secretary Rosalinda Baldoz announced it would request
domestic and US governmental
support to file legal action against
the missing owner, who currently
resides in the US. She also said that
her Department would provide
financial compensation to former
Skytech employees and discuss
measures regarding resuming operations, including the formation
of a workers’ cooperative to handle
unprocessed local and foreign
orders.
Canadian investor Frontier
Corporation is rumoured to have
an interest in taking over Skytech’s
business operations in the Philippines.
Besides other countries in
Southeast Asia, the Philippines
have become an important hub for
the production of dental replacements that cost a minimum there to
make, compared to laboratory work
produced in Europe or the US. DT

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Bendererstr. 2 | FL 9494 Schaan | Liechtenstein | Tel.: + 423 / 235 35 35 | Fax: + 423 / 235 33 60
Ivoclar Vivadent Marketing Ltd. (Liaison Ofﬁce) India
503/504 Raheja Plaza | 15 B Shah Industrial Estate | Veera Desai Road, Andheri (West) | Mumbai 400 053 | India
Tel.: +91 (22) 2673 0302 | Fax: +91 (22) 2673 0301 | E-mail: info@ivoclarvivadent.ﬁrm.in
Ivoclar Vivadent Marketing Ltd. Singapore
171 Chin Swee Road | #02-01 San Centre | Singapore 169877 | Tel.: +65 6535 6775 | Fax: +65 6535 4991

[4] => DTAP0910_01_Title

DTAP0910_04_News 04.10.10 15:16 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Opinion

Dear
reader,

“2000 years of Italian dentistry”

Claudia Salwiczek
DTI

Daniel Zimmermann
DTI

Continuing education (CE)
has become essential for dentists
across the globe to stay competitive and to be able to deliver
quality dental care to their patients.

Are you looking for a new
dental lab? Well, just step into
your front yard and you will find
plenty of them.
There is no doubt that denture
making has become a flourishing
business in the region, particularly in South East Asia. In countries like the Philippines, Thailand
and Vietnam, there are now large
facilities producing huge amounts
of low-cost dental work not only
for dentists in Singapore or Japan
but, increasingly, overseas.
However, low prices often
come at a high cost. In this case,
it’s the technicians who do not
only earn significantly less for
doing exactly the same work as
their Western counterparts but
who also have to cope with poor
working conditions. Dentists
should remember this next time
they consider sending an order to
Manila or Hanoi.
Don’t get me wrong, dental
work made in Asia CAN be
a thriving business. However,
dentistry should not repeat the
mistakes that other industries
have already made in this part of
the world. A recent study from
Canada found that dentists increasingly put quality over price.
Let them be an example to the
whole profession. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International

Education
reloaded

The politics of a dental plan for Australia
Prof. John Spencer
Australia

Two separate worlds of dentistry exist in Australia. Readily accessible, high quality dental services for high-income Australians
are supported by over a billion
dollars of federal spending via
insurance rebates and uncapped
programmes for baby boomers
with the personal resources to negotiate medical funding for those
with chronic diseases. Middle and
low income Australians, the majority of the population, face either
affordability barriers for private
dentistry or a scarcity of resources
for public dentistry barely maintained by state and territory governments. This is an unfair and
unjust situation.
Policy directions have been
proposed, not the least by the
National Health and Hospitals
Reform Commission in 2008 and
2009. The boldest proposal was

a universal social insurance
scheme for dental services. While
its costs, community or professional support might be debated,
what seems irrefutable is the need
to decide on a long-term direction
for financing reform and make an
immediate start on an incremental implementation. The insurance proposal was accompanied
by policy on a dental graduate
residency year, a revitalisation of
dental services for children and
an investment in oral health promotion, which have all been less
controversial, but also stalled.
While the universal dental
insurance scheme seemed to be
stalled by professional opposition
and its full implementation cost,
the recent Australian federal
election has brought all the
former proposals back to life.
Specifically the Australian Labor
Party has been forced to agree to
“urgent further action on dental
care … in the context of the 2011
Budget” in an agreement with the
Australian Greens so as to form
the new Gillard minority government. Similar interest in dental

care has been shown by the
‘cross-bench Independents’ who
have also been crucial in determining who governs Australia.
The hope is that the Gillard
Government will pursue a similar
approach to other contentious
policy areas and form a ‘working
group’ under the Federal Cabinet
with all parties, the Independents
represented and a small number
of experts to drive policy in the
lead up to the 2011 Budget. It is
not beyond Australians to develop
detailed policy that could steer
a path through competing selfinterests and arrive at improved
oral health and fairer access to
dental services in Australia. DT

I am proud to inform you that
Dental Tribune will broaden its
CE portfolio in 2011 and start to
include ADA CERP accredited articles in most of its international
magazines, including cosmetic
dentistry, roots and CAD/CAM.
These articles will be available in the magazines and on the
Dental Tribune Study Club platform (www.dtstudyclub.com),
where readers will be also able to
go through the accreditation
process.
A minimum of one ADA CERP
credit will be awarded per article. For subscribers to the print
editions, access to the CE quiz
will be free. Non-subscribers can
also access the article via the DT
Study Club website for a small
fee.
I invite you to participate in
this new endeavour and hope
you will benefit from it. DT

Contact Info
Contact Info
Dr John Spencer is Professor of
Social and Preventive Dentistry at
The University of Adelaide in Australia and Director of the Australian
Research Centre for Population
Oral Health. He can be contacted at
john.spencer@adelaide.edu.au.

Claudia Salwiczek is working as
specialty editor for Dental Tribune
International in Leipzig in Germany. She can be contacted at
c.salwiczek@dental-tribune.com.

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DTAP0910_05_News 04.10.10 15:21 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

One in five Italian dentists not qualified to practise
Daniel Zimmermann
DTI

be over 1,000 bogus dentists in
Rome alone.

LEIPZIG, Germany: A large
number of dentists and dental
technicians in Italy are practising illegally. According to estimates from the National Association of Italian Dentists (ANDI),
approximately one in five or a total of 15,000 dentists are not qualified to practise. The organisation admitted that there might

Practising dentistry without
being qualified to do so is common in Italy, with many clinics
and practices operating undetected for many years—even
decades. In September, police
raids in Palermo and three other
cities found at least seven clinics
that employed dentists who were
not qualified to practise den-

tistry. However, only very few
unqualified dentists are prosecuted. Last year, fewer than
500 people were charged with
the unauthorised practice of the
dental profession, according to
police reports.
ANDI said that most illegal
dentists are able to practise dentistry through diplomas gained
from countries that recently
entered the EU or from South

American countries, where educational standards are generally
lower. The penalty for the unau-

thorised practice of dentistry in
Italy is six months’ imprisonment
or a fine of € 500 to 600. DT
AD

Nano paint
fights off
superbacteria
Claudia Salwiczek
DTI

NEW YORK, USA/LEIPZIG, Germany:
The emergence of antibioticresistant bacteria is becoming
a major challenge in the fight
against hospital-related infections. Researchers from New
York and Albany in the US have
now reported the successful testing of a new nanoscale coating
that can be used for surgical
equipment or hospital walls and
that kills even super-resistant
bugs like Methicillin-resistant
Staphylococcus aureus (MRSA)
within 20 minutes of contact.
MRSA is a bacteria strain
usually found on the skin and
sometimes nasal passages of
healthy people from where it
can make its way into the body
through cuts or medical equipment accessories like catheters
and breathing tubes. Infections
caused by MRSA are difficult
to treat because they do not
respond to antibiotics used to
treat staphylococcus infections,
such as penicillin or cephalosporin. In countries like Australia, more than 700 patients die
of MRSA-related infections each
year.
The new coating, which is
based on a natural enzyme
called lysostaphin, can be used
with any type of surface finishes,
the researchers said. It is only
toxic to MRSA and works by first
attaching itself to the bacterial
cell wall and then killing it by
slicing it open.
“It’s very effective. If you put
a tiny amount of lysostaphin in
a solution with Staphylococcus
aureus, you’ll see the bacteria
die almost immediately,” said
Prof. Ravi Kane, Department of
Chemical and Biological Engineering at the Rensselaer Polytechnic Institute in Troy, New
York. “At the end of the day,
we have a very selective agent
that can be used in a wide range
of environments—paints, coating, medical instruments, door
knobs, surgical masks—and it’s
active and it’s stable.”
Kane added that the coating
has a dry storage shelf life of up
to six months and can be washed
repeatedly without loss of effectiveness. DT

Distinguished by innovation
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[6] => DTAP0910_01_Title

DTAP0910_06-07_WorldNews 04.10.10 15:22 Seite 6

DENTAL TRIBUNE Asia Pacific Edition

World News

Experts discuss dentine
hypersensitivity at forum
Daniel Zimmermann
DTI

Salvador da Bahia
AD

SALVADOR DA BAHIA, Brazil/
LONDON, UK: Experts in the
field of dentine hypersensitivity
gathered last month at the FDI’s
Annual World Dental Congress
in Salvador da Bahia, Brazil, to

discuss the latest developments
and updates in managing the
condition.
Prof. Martin Addy, lecturer
at the University of Bristol’s
School of Oral and Dental Sciences in the UK, set the scene
by considering the accepted

definition of hypersensitivity
and possible reasons for the
condition. He described the history of the profession’s knowledge of dentine hypersensitivity
as “An enigma being frequently encountered but ill-understood”, quoting Johnson et al.
(1982). Although there has been
an awareness of the condition
for more than 100 years, much is
still unknown about it.
To define dentine hypersensitivity, Prof. Addy looked to
Holland et al. (1997): “Dentine
hypersensitivity is characterised by short, sharp, pain arising from exposed dentine in
response to stimuli, typically
thermal, evaporative, tactile,
osmotic or chemical and which
cannot be ascribed to any other
form of dental defect or pathology.” He commented that it is
very difficult to diagnose sensitivity clinically, as sensitive
and non-sensitive dentine look
similar at the level at which
a clinician sees dentine.
Prof. Addy described the
most accepted theory for hypersen sitivity—hydro dy na m ic
theory. Explaining the hydrodynamic mechanism in relation to the teeth, he referred
to a study in which a sensitive
tooth and a non-sensitive tooth
were analysed. It demonstrated
that the sensitive tooth had
eight times the number of
tubules, and that the tubules
themselves were twice the diameter of those in the nonsensitive tooth.
Next to speak was Prof.
Nicola West from the University
of Bristol Dental Hospital. In
her presentation, Dentine hypersensitivity: The importance
of patient factors, she looked at
the aetiological factors for hypersensitivity. She highlighted
the behavioural effect of dentine hypersensitivity on patients
whose quality of life is impaired
by the condition. Prof. West focused on the issue that dentine
needs to be exposed to cause
hypersensitivity and that the
exposure is mainly caused by
gingival recession, compromise
of gingiva by periodontal disease or enamel erosion.
Gingival recession is often
caused by trauma to the margins, usually by the vigorous
brushing of the sufferer. Prof.
West advised looking at patients’ toothbrushes and their
brushing methods when seeking a cause for hypersensitivity,
but did caution that this may be
difficult, as patients will modify
their behaviour when being
observed.
Prof. West also discussed
enamel erosion at length. She
explained the difference between intrinsic (i.e. gastrooesophageal reflux disease) and
extrinsic (i.e. acid challenges

➟

[7] => DTAP0910_01_Title

DTAP0910_06-07_WorldNews 04.10.10 15:22 Seite 7

DENTAL TRIBUNE Asia Pacific Edition
➟
caused by food and drink) erosion. In considering extrinsic
erosion, she focused on the
acidic challenges to teeth as
a result of the diet of a hypersensitivity sufferer. Many of the
problems appear to stem from
the number of acidic drinks
available. According to 2009
sales figures for soft drinks in
the UK, a staggering 229.1 litres
of soft drinks are consumed per
person per year; that’s 0.65 litres
a day! For a person susceptible
to erosion, this can present
a significant acidic challenge to
teeth.
Prof. West called for routine
screening for tooth wear and
erosion, especially in face of
the rise in patient and tooth
longevity and the availability of
treatments to help reduce the
severity of the sensitivity for
patients. She also listed some
recommendations for patients:
reduce frequency of acid exposure; avoid acidic foods and
drink at night-time; no swishing
or frothing drinks around the
mouth; avoid brushing teeth directly after an acidic challenge.
The next presentation was
by Dr Stephen Mason. His presentation, Sensodyne Rapid Relief—instant and long-lasting
protection, detailed the latest
GSK product offering to combat
sensitivity. Dr Mason detailed
the different formulations of
Sensodyne in the past using
strontium chloride and the particular challenges this presented, namely a taste many
consumers disliked and noncompatibility with fluoride.
Strontium chloride was then
surpassed by strontium acetate
because of its compatibility with
fluoride, non-staining properties and improved taste. This
has now been developed into a
marketable product called Sensodyne Rapid Relief. Dr Mason
discussed some of the clinical
research that has been conducted for the Rapid Relief product, first against a fluoride control toothpaste and then against
a competitor brand using 8%
arginine calcium carbonate.
The studies demonstrated that
there was a marked reduction in
pain felt by the subjects both after immediate application with
a pea-sized amount directly to
the tooth, and after set periods of
time brushing twice a day. In
nearly every study, the group
using Rapid Relief demonstrated the most improvement.
The final speaker at the
symposium was Prof. Eduardo
M.B. Tinoco, Associate Professor at Rio de Janeiro State University. His presentation, Practical approaches to management
of dentine hypersensitivity in
practice, considered the diagnosis and management of sufferers in practice. After a brief
overview of the prevalence,
possible causes and definition
of dentine hypersensitivity,
which Prof. Addy had already
covered in more depth, Prof.
Tinoco then posed the question “Dentine hypersensitivity:
How do I treat this?”

A good starting point for
managing hypersensitivity in
practice once a correct
diagnosis has been
made and other
causes have been
excluded or treated,
said Prof. Tinoco, is
the identification of
aetiological factors and
their exclusion by means of
diet modification or oral-health
instruction. Other factors he discussed beyond those already
mentioned in previous presentations included occupational

World News
factors, such as the damage
sustained by competitive swimmers and professional
wine-tasters. Obviously,
wine piqued the attention of many attendees!

Prof. Tinoco explained the way
in which to taste wine properly:
“To experience the taste of a wine
fully, swirl a little bit of it in your
mouth to cover all your taste-

buds. Take a moment to enjoy
the flavour before either swallowing or spitting out the wine.
n addition to the initial taste,
you will find there is also an
aftertaste to the wine, usually
referred to as the finish.”
Prof. Tinoco then discussed treatment adjuncts,
both for patients at home
and clinical interventions in
surgery. Clinical treatments
included the use of varnishes
and primers; the use of glass
ionomers to cover the affected

area; laser treatments or mucogingival surgery.
He concluded that there
should be proactive screening
of all patients to help with correct diagnosis. Advising patients about diet modification
etc. should help remove or modify the severity of the sensitivity,
and the recommendation of
brushing with a desensitising
toothpaste twice daily, as well as
rubbing it on affected areas is an
extremely efficacious, low-cost,
non-invasive treatment. DT
AD

[8] => DTAP0910_01_Title

Anschnitt_DIN A3

04.12.2009

9:11 Uhr

Seite 1

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[9] => DTAP0910_01_Title

DTAP0910_09_Business 04.10.10 15:22 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Business

Daniel Zimmermann
DTI

TORONTO, Canada/LEIPZIG,
Germany: Fewer dentists in
Canada are having their denture
prescriptions fabricated in the
US or offshore in countries like
China, a new survey by the
Dental Industry Association of
Canada (DIAC) has revealed.
Of the 1,000 dentists who participated in the survey in 2009,

only 2.3 per cent sent their prescriptions outside the country—
a decline of 4.6 per cent compared with the 2008 survey.
Dentists who responded to
the DIAC questionnaire saw
“consistent quality” and “better
communication” as the main
factors in choosing dental labs.
Pricing as a factor ranked second
place after being a leading factor for two consecutive years.

(DTI/Photo: Alexander A.Trofimov)

Canadian dentists in favour of local labs
Faster case turnaround was the
third highest ranked factor in
the survey.
According to the Canadian
Dental Association, there were
slightly over 2,000 dental technicians working in the country’s
couple of hundred dental labs
in 2009. Despite a drop in the
number of tooth extractions performed by dentists and the promotion of dental health, the num-

ber of dental technologists, technicians and laboratory bench
workers has increased slightly in

recent years, owing to the development of new types of prostheses that require more work. DT
AD

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nano hybrid
restorative
launched by
VOCO
LEIPZIG, Germany: The German manufacturer of dental materials VOCO is launching a new
universal nano hybrid restorative
for all cavity classes in October.
Grandio®SO can be used for a
wide range of indications including class I to V restorations, the
reconstruction of traumatically
injured anterior teeth or the
correction of shape and colour to
enhance aesthetic appearances.
Interlocking and splinting of
loosened teeth, core build-up for
crowns, and the fabrication of
composite inlays are other indications covered by the material, the
company said in a press release.

According to CEO for Marketing and Sales, Olaf Sauerbier,
Grandio®SO is currently the most
tooth-like material on the market
due to its physical parameters
and their interaction. He said that
the composite’s very high filler
content, low shrinkage, as well
as high compressive and flexural
strength will dentists help to
achieve durable and, at the same
time, aesthetic restorations. The
material is also offering improved
thermal expansion behaviour, a
very high surface hardness as well
as an optimal balance of translucence and opacity, he added.
Grandio®SO has shown to
combine exceptionally long
workability under exposure to
light with very short setting times
(10 seconds per 2 mm increment)
during subsequent polymerization. It also exhibits good plasticity without tending to stick to
the instruments.
Grandio®SO comes in 16 different shades including two new
shades (VCA3.25, VCA5), which
according to Sauerbier have been
in demand for a long time. It is
available in the form of rotating
syringes and caps. DT

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[10] => DTAP0910_01_Title

DTAP0910_10_Straumann 04.10.10 15:23 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

10 Business

“We are committed to investing and supporting
the development of implant dentistry in China”
An interview with Beat Spalinger, President and CEO of Straumann, Switzerland
The Swiss-based dental manufacturer Straumann recently
announced that it is extending its reach into the Chinese
dental market. At Sino-Dental 2010 in Beijing, Dental
Tribune China Senior Editor
Edward Chen spoke with the
new President and CEO Beat
Spalinger about the company’s plans and commitment
to China.
Edward Chen: Mr Spalinger,
your company is planning to
set up a sub-division in China.
What lies behind this decision
and will it influence your
business strategy there?
Beat Spalinger: China is
currently the key growth market in Asia for dental implants or
any type of restorative dentistry.
There is increasing demand
for top quality dental solutions

quarters in Singapore. So far,
the Chinese dental community
has responded very positively
to this.

Beat Spalinger, President and CEO of
Straumann, Switzerland

combined with education and
service in the country and we
have been committed to supporting our customers in the
region through our Asian head-

However, with the rapid
growth of implant dentistry in
China, we need to get closer to
our customers and strengthen
our local presence. Therefore,
we have decided to not only
continue the partnership with
Beijing Focus Medical, but also
open our own subsidiary within
this business year. Having our
own local representation will
allow us to understand the
needs of our Chinese customers
better and to play a more active
role in key professional activities such as educational programmes and workshops.
Owing to the global economic slowdown, some den-

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tal markets have experienced
a decline in the past two years.
Why do you consider China as
holding good prospects?
Even though China is still at
a relatively early stage in implant dentistry, the continuous
growth of public institutions,
together with the rise of the private sector, give us reason to

Could you tell us more
about SLActive and your new
Bone Level Implant?
Both products have been
highly successful in Europe and
North America, where more
than a million SLActive implants
have been sold since 2005. Since
October 2009, SLActive has
also been available in China.

“China will be one of the
top three markets globally
in the next ten years.”
believe that China will be one
of the top three markets globally
in the next ten years.
We are committed to investing and supporting the development of implant dentistry
in China, focusing on scientific
evidence, training and educational activities. This commitment is also reflected in the
establishment of Straumann
China.
Do you have a long-term
commitment to the Chinese
market?
Straumann has gained some
considerable market share in
the past two years that has been
driven by our innovative and
clinically proven line-up of
products and technologies. I am
proud to say that we are one of
the very few companies, if not
the only company, to have an
implant system on the market
that is supported by ten years of
clinical data.
We also believe that our
commitment to training and
education such as sponsoring
implant training centres in
Beijing and Hong Kong, or the
recently held First International Periodontology Congress
in Hangzhou has contributed
significantly to our success in
China.
Together with Beijing Focus
Medical we will continue to
seek to gain the trust of dental
professionals who wish to offer
their patients optimum treatment solutions.
What is Straumann’s current product line and do you
plan to launch new products
this year in China?
We recently launched our
third-generation implant surface technology SLActive, as
well as our new generation
Bone Level Implant range. We
also have other offerings like
the high performance material
Roxolid and our digital solutions portfolio, which have just
been launched in initial markets and are to be rolled out
globally as soon as possible.

According to head-to-head preclinical studies, SLActive has
been shown to increase treatment predictability by enhancing osseointegration and reduce healing times from 6–8
to 3–4 weeks, which makes it
superior to other major competitor implant surfaces.
The Straumann Bone Level
Implant offers new confidence
at bone level through optimised
crestal bone preservation, simplified handling (thanks to the
new CrossFit Connection), and
excellent aesthetic results due
to improved soft-tissue management. It complements our
highly successful Tissue Level
range and enables us to offer
a complete system for all indications that can be used with the
same surgical kit. We expect the
full launch of the Straumann
Bone Level Implant later this
year in China.
An increasing number of
Chinese dentists seem to be
incorporating implant dentistry into their practice. How
do you think Straumann could
support them?
To help dental professionals
achieve predictable long-term
aesthetic outcomes, Straumann
engages in a wide range of educational activities across all
specialisations. Last month, for
example, we held the ITI Education Week at the University
of Hong Kong, a unique event
organised in partnership with
the International Team for
Implantology (ITI) network in
Switzerland. ITI will also hold it
first Congress in China in Inner
Mongolia in August next year.
In addition, Straumann and
ITI are supporting their customers by educating patients
through various educational
material and scholarships that
are intended to enable young
dentists to study at universities
abroad for a semester. The ITI
also funds research currently
being conducted at Chinese
universities.
Thank you very much for
the interview. DT

[11] => DTAP0910_01_Title

DTAP0910_11-12_Michiels 04.10.10 15:24 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 11

Removal of a fractured instrument: Two case reports
Dr Rafaël Michiels
Belgium

Fractured instruments pose a
challenge to every endodontist.
The difficulty in the retrieval of
these instruments ranges from
surprisingly easy to downright
impossible. The clinical outcome of cases with fractured
instruments depends on several
factors, such as the position of
the instrument in the canal, the
type of material, the instrument
size and canal anatomy.¹ Failure in retrieval of the fractured
instrument does not automatically result in failure of the
case.² One can still try to bypass
the instrument, choose a surgical approach, or even wait and
see. However, if we bear ‘nothing ventured, nothing gained’
in mind, then we should always
at least try to retrieve the fractured instrument.

Case I
A 27-year-old female patient
was referred to our practice.
She was in good health and had
an American Society of Anesthesiologists (ASA) score of 1. The
patient had some mild clinical
symptoms on tooth #30 due to
apical periodontitis. She had been
told, by the referring dentist, that
there was a fractured instrument
in her tooth and that the instrument had to be removed first in
order to allow for decent retreatment.
Before starting with the treatment, a new diagnostic radiograph was taken. In this case,
the diagnostic radiograph (Fig. 1)
showed not one but two broken
instruments in the mesial root,
one in each mesial canal. Thereafter, the tooth was isolated with
the rubber dam and the coronal
filling was removed. Straight-line
access was established, as this
is imperative in order to be able
to reach and see the fractured
instruments. Gates-Glidden burs
(DENTSPLY Maillefer) were used
to enlarge the mesial orifices
coronally.
After reaching the instrument
in the mesio-buccal canal, I modified a size 3 Gates-Glidden bur
by removing the tip of the bur
(Fig. 2). In this manner, one gains
an aggressive bur that allows one
to create a platform above the
instrument. At this moment, the
instrument could be clearly visualised (Fig. 3). Ultrasonics were
then used to loosen the fragment.
ProUltra tips (DENTSPLY Maillefer), both zirconium nitride and
titanium, were used for this purpose.
One-and-a-half hours after
starting the treatment, the fragment had been loosened but
was still stuck in the canal. We
decided to leave it in place for
the time being and made a new
appointment. Calcium hydroxide
paste (UltraCal XS, Ultradent)
was put into the coronal part of
the mesial canals and the tooth
was sealed with glass-ionomer
cement (Fuji IX GP Fast, GC) and
a cotton pellet.

Fig. 1

Fig. 2

Fig. 7

Fig. 8

Fig. 13

Fig. 14

Fig. 3

Fig. 4

Fig. 9

Fig. 10

Fig. 15

Fig. 6

Fig. 5

Fig. 11

Fig. 16

Fig. 12

Fig. 17

Fig. 1: Diagnostic radiograph, showing two separated instruments in the mesial root.—Fig. 2: A modified Gates-Glidden bur used for creating a plateau above the instrument.—
Fig. 3: One of the separated instruments.—Fig. 4: Gutta-percha cone fitting.—Fig. 5: The pulp chamber after obturation with gutta-percha.—Fig. 6: Final radiograph (parallel).—
Fig. 7: Final radiograph (angled).—Fig. 8: Diagnostic radiograph, showing the separated instrument at approx. 5 mm from the apex.—Fig. 9: The separated instrument.—
Fig. 10: The separated file after retrieval.—Fig. 11: Working length determination.—Fig. 12: Deep apical split.—Fig. 13: Gutta-percha cone fitting.—Fig. 14: Apical obturation with
gutta-percha.—Fig. 15: The pulp chamber after complete obturation with gutta-percha.—Fig. 16: Final radiograph (parallel).—Fig. 17: Final radiograph (angled).
AD

During the next visit, the tooth
was again isolated and opened.
The calcium hydroxide paste was
removed, using 10 % citric acid
and passive ultrasonics with the
IRRISAFE tip (Satelec). Again,
ultrasonics were used to retrieve
the instrument. After five minutes, the fragment in the mesiobuccal canal was removed. Another five minutes later, the instrument in the mesio-lingual
canal was also removed. While
removing the instrument in the
mesio-buccal canal was very
time-consuming, removing the
instrument from the mesio-lingual canal was surprisingly easy.
This clearly highlights the abovementioned difficulty range of
instrument retrieval.
After the removal of both instruments, working length was
determined in both mesial canals
with the electronic apex locator
(Root ZX Mini, Morita). A glide
path was established and the
mesial canals were initially
shaped with a ProTaper S1
(DENTSPLY Maillefer). Copious
irrigation was performed using
3% sodium hypochlorite. Next,
the gutta-percha in the distal
canal was removed with a size
25.06 ProFile (DENTSPLY Maillefer), which was rotated at
500 rpm in an X-smart Easy endodontic motor (DENTSPLY
Maillefer). No chemical was required for gutta-percha softening. The canals walls were
scraped with Micro-Debriders
(DENTSPLY Maillefer) in order to
remove the last remnants of
gutta-percha. All canals were
shaped to a size 40.06 ProFile. Final apical shaping was performed
with K-Flexofiles (DENTSPLY
Maillefer). Smear-layer removal
was carried out by irrigating the
canal with 10% citric acid. A final
wash of the canal was performed
with sterile saline. Tapered
gutta-percha cones were then fit‡ DT page 12

[12] => DTAP0910_01_Title

DTAP0910_11-12_Michiels 04.10.10 15:24 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

12 Trends & Applications
ﬂ DT page 11

ted (Fig. 4) and tug-back was confirmed. Topseal (DENTSPLY
Maillefer) was used as a rootcanal sealer.
Obturation was performed
according to the continuous wave
of condensation technique with
the Elements Obturation Unit
(SybronEndo). After obturation
(Fig. 5), a temporary restoration
of glass-ionomer cement was
placed (Fuji IX GP Fast). Final

radiographs (Figs. 6 & 7) were
taken, both parallel and angled.
The radiographs show two completely separated mesial canals;
hence, instrument removal in
both canals was favourable. The
prognosis of this case was good
and the patient was referred to
her general dentist for a definitive coronal restoration.

Case II
A 19-year-old male patient
was referred to our practice. He
was in good health and had an ASA

score of 1. The referring dentist
had fractured a small instrument—most likely a size 10 or
15 K-file, according to his referral
letter—while performing rootcanal treatment on tooth #4. The
root-canal treatment was necessary because of a trauma that
the patient suffered. The buccal
cusp had fractured and the pulp
was exposed.
A new diagnostic radiograph
(Fig. 8) was taken, which showed
the fragment approx. 5 mm from

the apex. The tooth was isolated
with a rubber dam and access was
gained through the temporary
restoration, which was placed by
the referring dentist.
After opening, the remnants
of calcium hydroxide paste were
removed with 10 % citric acid
and passive ultrasonics. The fractured instrument could be visualised immediately (Fig. 9), because the canal was very large in
the middle and coronal part. This
allowed a very conservative and

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tissue-saving approach. Given
the position in the canal and the
shape of the canal, a deep apical
split of the canal was suspected.
After probing with small K-files,
a patent palatal was confirmed.
The instrument was fractured
in the buccal canal. A titanium
ProUltra tip #8 (DENTSPLY Maillefer) was used to loosen the
instrument. In the meantime, copious irrigation with 5% sodium
hypochlorite was performed.
The fractured instrument was
retrieved (Fig. 10) and after determining working length (Fig. 11),
shaping with rotary nickel-titanium instruments (Twisted Files,
SybronEndo) was started. Both
canals were shaped to a size 25.08
Twisted File. The master apical
file was kept small due to the deep
split (Fig. 12) and the tension felt
while shaping, thus minimising
new instrument fracture. Apical
finishing was carried out with
size 25 K-flexofiles. Smear-layer
removal was performed with a
rinse of 10 % citric acid. A final
wash of the canal was carried
out with sterile saline. Tapered
gutta-percha cones were then fitted and tug-back was confirmed
(Fig. 13). Topseal was used as
a root-canal sealer. Both canals
were obturated according to the
continuous wave of condensation
technique with the Elements
Obturation Unit. After obturation (Figs. 14 & 15), a temporary
restoration in glass-ionomer cement was placed together with a
cotton pellet, which was soaked
in an alcohol and chlorhexidine
mixture first and then air-dried
after it had been placed in the
access cavity. Final radiographs
(Figs. 16 & 17) were taken, both
parallel and angled. The prognosis of this case was good and
the patient was referred to his
general dentist for a definitive
coronal restoration.

Conclusion
In the end, removal of a fractured instrument can be very difficult and it may take a long time
to accomplish. Dr Marga Ree once
said on the ROOTS forum that
she was being taught that endodontics is all about the three
P’s: Passion, Persistence and Patience. This hits the nail right on
the head as far as instrument
retrieval is concerned. DT
Editorial note: A list of references is
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beneﬁt from a system that is unique in

ﬂexibility and breadth of application.
Nobel Biocare is the world leader in
innovative evidence-based dental
solutions.
For more information, contact a
NobelBiocare Representative
or visit our website.
www.nobelbiocare.com

Nobel Biocare Asia Ltd. 14/F, Cambridge House, Taikoo Place, 979 King’s Road, Quarry Bay, Hong Kong; Phone +852 2845 1266; Fax +2537 6604
Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales office for current
product assortment and availability.

Dr Rafaël Michiels works in
two private practices limited
to Endodontics in Belgium.
He can be contacted at rafael.
michiels@gmail.com

[13] => DTAP0910_01_Title

DTAP0910_13-14_Jelinkova 04.10.10 15:24 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 13

All-ceramics encounter PFM ceramics

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 1
Hana Jelínková
Czech Republic

Obtaining harmonious aesthetic results with two different veneering materials is a
considerable challenge that
is not without risks. Situations in which dental technicians are forced to use several
different veneering materials to satisfy the needs of their
customers are determined
by biological factors and the
financial means of the patients. All the ceramic veneering materials on the market
differ in their chemical composition, which is responsible
for the final appearance of the
restoration. In addition, the
influence of the framework
material should not be underestimated. If it hinders the
transmission of light, the aesthetics of the restoration will
be compromised.
So, how do we obtain truly
perfect results?
We tend to choose products
that can be combined on the
basis of their optical compatibility. For this purpose, we often have to rely on the many
years of experience we have
gained working with materials
from different manufacturers.
However, we have also found
that we can achieve optical
compatibility by using products from manufacturers who
supply materials that are coordinated in terms of their
shade. Manufacturers who
focus their efforts on solving
the problem of optical compatibility amongst their different
materials strive to offer their
products in integrated systems.
On the basis of the following
case, we would like to demonstrate the manner in which two
different materials can be successfully combined. The patient’s teeth #14, 15, 16, 17, 26
and 27 were restored with
provisional crowns. For the
permanent restoration of these
teeth, a combination of allceramics (IPS e.max, Ivoclar
Vivadent) and PFM ceramics
(IPS InLine, Ivoclar Vivadent)
was chosen: metal frameworks
veneered with the leucitebased feldspathic ceramic IPS

InLine were combined with
lithium-disilicate glass-ceramic
frameworks veneered with
the nano-fluorapatite glassceramic IPS e.max Ceram.
The patient chose this solution for financial reasons. In
the fabrication of the restorations, the specifications of the
shade diagram and the recommended layer thicknesses of
the individual materials were
observed. The latter aspect
was of particular importance
due to the different shrinkage
characteristics of the two ceramics.
The individual IPS InLine
and IPS e.max Ceram veneering materials (for example,
Dentin, Incisal and Effect materials) not only have consistent designations, but also coordinated shades. Before the
metal frameworks in the present case were veneered with
IPS InLine, the substrate had
to be completely covered with
an opaquer layer to mask the
metal. The IPS e.max lithiumdisilicate frameworks did not
require this coating, as the
materials for the fabrication of
the substructures are available
in many different shades and
levels of translucency.
Nonetheless, we were able
to follow the same shade diagram once we had placed the
layer that would mediate the
required adhesive bond (after
foundation and opaquer firing,
respectively). This enabled
us to obtain the desired harmonious appearance of the
restorations. IPS InLine and
IPS e.max Ceram differ slightly
with regard to their translucency. However, this aspect is
quite useful in the subsequent
layering procedure. We attenuated and masked the opaqueness of the metal frameworks,
while we enhanced the translucent properties of the lithium
disilicate by applying the IPS
e.max Ceram all-ceramic.
The veneering steps for the
two different types of restorations are very similar. In the
case at hand, the teeth were
waxed up according to the
‡ DT page 14

[14] => DTAP0910_01_Title

DTAP0910_13-14_Jelinkova 04.10.10 15:24 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

14 Trends & Applications
ﬂ DT page 13

instructions of the manufacturer: the IPS e.max Press
lithium-disilicate frameworks
with a minimum final thickness
of 0.8 mm and the metal frameworks (Cr-Co alloy) with a
thickness of minimum 0.4 mm.
Both types of restorations were
built up anatomically, that is,
with supported cusps and
crown margins, in order to obtain an even thickness of the ve-

“Coordinated materials and shade systems make it easy
to use different types of ceramics in one restoration”
neers. This detailed wax-up
provides the basis for creating
restorations with maximum
aesthetics and function. Next,
the sprues were attached to the
wax-ups (Fig. 1).
After the press and casting
procedures, the substructures

were coated with a wash and
opaquer layer respectively in
preparation for the subsequent
layering procedure. The metal
frameworks were completely
masked with opaquer (Fig. 2)
and shoulder powders were
evenly sprinkled onto this
layer. The excess was carefully

removed. This step improves
adhesion and optimises light
refraction through the crystals
of the Margin material.
This effect attenuates the
opaqueness of the PFM restoration. It is clearly visible in
the finished restoration.

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
CE
1 ADAdit
cre

+ ate

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

SPEAKER

Dr Christian Coachman received his
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
Saturday, 16 October 2010
Time
4 pm Indian Standard Time (IST)
Duration
1 hour plus questions & answers
Link
www.DTStudyClub.com
Target group Dentists and Technicians
Language
English
Required
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
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
sisting of Dr Ronald Goldstein, Dr David
Garber and Dr Maurice Salama. He lec-

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.

In the present case, the
metal-reinforced crowns were
built up first. Owing to the
versatility of all-ceramics, the
desired harmony with regard
to shades and opaqueness is
easier to achieve with these
materials than with PFM materials. In order to obtain an overall aesthetic result, therefore,
the all-ceramic restorations
were fabricated last (Fig 3).
Figures 4 and 5 show the finished crowns on the model
with the gingival contour. The
adhesive luting composite
Multilink Automix (Ivoclar
Vivadent) was used to cement
all the crowns. This luting
composite is suitable for the
cementation of PFM and allceramic restorations.

founder of and has been a lecturer at

the head ceramist of Team Atlanta con-

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.

We followed a similar procedure for the all-ceramic substructures. If the framework
had to be (partially) shaded,
we used IPS e.max Ceram
Shades instead of the opaquer.
The remaining surfaces were
coated with a thin layer of
glazing liquid. Then we used
the sprinkle technique to
distribute IPS e.max Ceram
Dentin over the frameworks.
In the fabrication of restorations with lithium-disilicate
substructures, the achievement of light scattering is
secondary. Rather, the focus
for this type of restoration is on
adhesion. After firing, the surfaces are slightly rough, which
mediates the desired bond between the framework and the
layering material.

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

The present case demonstrates that the combination
of PFM ceramics and all-ceramics can produce excellent
aesthetic results. Coordinated
materials and shade systems
make it easy to use different
types of ceramics in one restoration and allow materials
such as the Effect materials to
be used to their fullest effect.
With the help of conventional
shade diagrams, the desired
results can be achieved quickly
and easily. DT

Contact Info

www.ivoclarvivadent.com

Hana Jelínková is a dental
technician working and living
in Písek in the Czech Republic. She can be contacted at
hanula.jelinkova@gmail.com.

[15] => DTAP0910_01_Title

25.03.2010

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[16] => DTAP0910_01_Title

DTAP0910_16_Davis 04.10.10 15:24 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

16 Trends & Applications

A simplified method for the removal
of cemented implant prosthetics

Fig. 1a

Dr Scott Davis
Australia

There are times when it becomes necessary to remove the
cemented prosthetic restoration
from one or more implants and
the prosthesis is not amenable
to conventional crown and
bridge removal devices. In order to remove these prostheses,
we need to gain access to the
abutment screws by drilling
through the crown or bridge.
The challenge is to create the
smallest possible access holes
and to do this with a minimum of clinical time and effort.
This article will describe a
simple method for constructing

Fig. 4

Fig. 1b

and using a device to guide
the development of appropriate access holes in the implant
prosthesis.
I was lucky enough not to
have a patient with a loose or
damaged bridge to use for this
presentation, so I used a patient
education model to provide the
images to facilitate the description of the technique (Figs. 1a & b).
Figure 2 shows the location of
the implants.

Constructing the device
The master cast that was
used for the construction of the
implant prosthesis is the central
element for this technique (Fig. 3).

Fig. 5a

Fig. 2

Long screws from impression
copings (Fig. 4) or long laboratory screws are inserted into the
implant analogues (Figs. 5a & b).
The cast is blocked out with periphery wax to act as formwork
for the construction of the device
(Figs. 6a–c). The wax should
extend for at least one tooth on
either side of the prosthesis.
If no tooth is present distal to
the prosthesis, then additional
teeth are covered anteriorly to
maximise stability of the device.
The wax should also block out
the full dimensions of the prosthesis. I like to construct the
mesial aspect of the device to be
sufficiently wide and robust for

Fig. 5b

Fig. 3

a finger or thumb to be readily
placed on this area for stabilising
the device during preparation of
the access holes.
The model and the screws are
lubricated with either petrolatum or a water-based lubricant.
Auto-polymerising or light-curing resin is adapted to the cast
to cover the adjacent occlusal
surfaces and encompass the
screws in the implant analogues
(Figs. 7a & b).
I prefer to use GC pattern
resin and in the later stage of
polymerisation, I remove the
screws before they potentially
become locked in the resin. Once
the material sets, it is trimmed
and polished (Figs. 8a & b) then
checked for stability on the
model. Additional material can
be added if required.
If a stone model of the prosthesis is available, it is convenient to confirm the stability of
the device and to assess that
there is no contact between the
prosthesis and the device (Fig. 9).
The intaglio surface is adjusted
as required to ensure appropriate adaptation.

In the clinic

Fig. 5c

Fig. 6a

Fig. 6b

Fig. 6c

Fig. 7a

Fig. 7b

Fig. 8a

Fig. 8b

Fig. 9

Fig. 10

Fig. 11a

Fig. 11b

The chairside process is simplified by the use of this acrylic
resin guiding device that provides a visual aid for the appropriate position for drilling the
access holes. Ideally, porcelain
should be removed using a
diamond high-speed bur with
copious irrigation. I prefer to use
a round diamond bur for this purpose, as it is less likely to cause
porcelain chipping. If the prosthesis is metal ceramic, the metal
substructure is first penetrated
with a small round carbide bur.
Subsequently, a metal-cutting
tungsten carbide bur is used to
widen the access as required.
Figure 10 shows a screwdriver
passing through the guide into
the abutment screw. Figures 11a
and b show the precision of the
preparation without over-preparation.
Once the access hole has
been debrided of obturating
materials, an appropriate screwdriver is inserted. In order to
prevent ceramic delamination,
it is important to ensure the
driver is not contacting any
porcelain before significant
torque is applied. I initially insert
the driver and inspect for lack

of contact with the porcelain.
Following, I apply light hand
torque to the driver in order to
determine that it is fully seated
before a second inspection to
ensure no porcelain contact.
Finally, the screw and the prosthesis are removed.

Discussion
Drilling free hand into the
prosthesis with no guide can
result in oversized access holes
and wasted chairside time. The
primary goal of the method
described here is to maximise
laboratory procedures in order
to reduce chairside time. We also
minimise the size of the access
holes, which reduces the damage to the prosthesis.
Delegation of the construction
of the device to a technical assistant can further reduce cost, for
both the patient and us. Thereby,
a task to which we look forward
with trepidation can be reduced
to a minor inconvenience.
By minimising the diameter
of the access holes, we increase
the probability that the prosthesis can be returned to the patient
after dealing with the reason for
removal. Once the prosthesis has
been removed from the mouth,
there are two options. Firstly,
we could consider the abutment/
prosthesis as a single item. After
inspection and cleaning, the
prosthesis can be replaced. Had
the abutment screw become
loose, then the grain structure
of the screw may have become
elongated and the screw should
be replaced.
The second option is separating the abutment from the crown
or bridge. When they cannot be
separated by mechanical means,
they can be separated by gentle
heating in a furnace. Slowly
heat to less than 200 °C for five
minutes, then the abutment
and prosthesis should separate
very easily. Allow to cool to room
temperature slowly, then inspect
porcelain for defects before returning to the patient. DT

Contact Info
Dr Scott Davis works in a private prosthodontics practice
in Port Macquarie in Australia.
He can be contacted at scott@
davisdental.com.au.

[17] => DTAP0910_01_Title

Projekt1_Stand_Satzspiegel_DIN A3 05.03.10 12:38 Seite 1

[18] => DTAP0910_01_Title

DTAP0910_18_ToothVille 04.10.10 15:25 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

18 Off time

Discover the small world of ToothVille

AD

Laura Hatton
DT UK

meeting with the builders to discuss that cavity restoration.

LONDON, UK: Gummy bear attacks? Scuba-divers treating root
canals? Decorators performing
tooth-whitening sessions? Sound
like an ordinary day at the dentist?
Invite the miniature world of
ToothVille into your waiting room
and your ordinary day will
be transformed—not forgetting

Being a keen photographer,
London-based dentist Dr Ian Davis
has combined his two passions—
dentistry and photography—to create ToothVille, a world of mouth
moulds in which various dental
treatments are carried out by miniature figurines. Inspired firstly by the
artwork of Slinkachu (slinkachu.com)

and the thought of what it would
be like if teeth were large, Dr Davis
has created a storm of creative inspiration for the dental world using
the power of these little workmen.
The ToothVille sculptures include
decorators carefully whitening a
set of teeth, scuba-divers carrying
out root-canal treatments, emergency teams rescuing broken teeth
and workmen guarding teeth from
a sugar attack from three scary-

looking Gummy Bears! ToothVille
could be the perfect answer to the
serious need to turn teeth and
dentistry into accessible and approachable subjects for the public.
Patients at Dr Davis’s surgery are
experiencing a waiting room quite
unlike any other; children and adults
alike are being drawn into the unique
world of ToothVille, describing the
experience as anything from “amazing and funny” to “quirky”. From
laughing and giggling as they see the
Gummy Bear attack, to cringing at
the implant photographs, ToothVille
“demystifies the treatment”, teaching patients about cavity prevention
and restoration in a way that no other
product has yet achieved.
Having placed pictures along
corridors and throughout his waiting room, Dr Davis has also produced a book, mainly aimed at
the younger generation, although
adults also can’t seem to put it down.
The picture book, aiming to inspire
prevention in all areas of tooth decay, begins with the least invasive
treatments of cavity preparation
and restoration and leads onto emergency dentistry, before embarking
on photographs of miniature model
scuba- divers recreating root-canal
treatments. Whilst tiny workmen
defend another set of teeth from
sugar attacks, the book comes to an
end with further photographs, carried out in pure ToothVille style,
recreating the invasive treatment
of an implant; the final destination
that all teeth want to avoid.

Originally encouraged by his
photography hobby, Dr Davis’s passion for combining dentistry and
photography is certainly becoming
that of a business. Future models
of ToothVille will see regular sugar
attacks and further creations will
be modelled on orthodontic treatment and tooth loss. Like existing
ToothVille models, future photographs of the moulds will visually
demonstrate different treatments,
casting a brighter light on orthodontic treatments and expressing
the manner in which tooth loss can
be avoided, and in serious cases,
repaired. Even though Dr Davis is
focused on improving the models
that he has already created, the
“icing on the cake” would be to publish a children’s book, providing the
younger generation with a chance
to learn about dental health in an
entertaining and interesting way.
With the miniature workmen as visual metaphorical representations
of the “small things” in dental care,
the models are fast becoming a useful way of conveying the message
of maintaining good oral health.
Commenting on ToothVille,
Dr Davis said, “ToothVille is quirky
and makes the patients smile in
the waiting room.” DT

[19] => DTAP0910_01_Title

DTAP0910_19_APDF 04.10.10 15:26 Seite 1

page

From the Editor’s Desk
Newsletter to him and his beloved
family for giving me this opportunity
to prepare my maiden Newsletter.

Dr How Kim Chuan
Malaysia

First of all, I beg your pardon for
taking a little bit longer in coming
out this issue of APDF Newsletter.
I have just taken over the duty
from my respectable countrymen
Dr Suresh Nair on 16 May 2010. Dr
Suresh has done a very good job during his tenure and hence naturally
this has imposed an invisible pressure on me to match his standard so
as not to let him down. Suresh has
also been a good friend and a great
help to me guiding me along to this
Newsletter. I wish to dedicate this

The response and contribution
of articles from member national
dental associations (NDA) has not
been encouraging. However, I view
this as my inexperience in presenting to them the nature of articles
I needed for this Newsletter. The
onus is on me to present an outline
and then followed by requesting
for the necessary information to
achieve this end. I would take this
as a learning curve and hopefully I
could be better in the coming issues.
It was once said, “The future is
here; it’s just not widely distributed
yet.”

My thoughts on the
ADTA Study
Nearly two years ago, the American Dental Trade Association
(ADTA) undertook a rigorous study
to better understand the market

trends for the dental industry.
I thought it would be helpful to
share the highlights of the ADTA
study with all of you. These highlights point to a considerable degree
of change—changes in technology,
changes in the marketplace, and
changes in the economic trends of
dental care. These changes would
have a considerable impact on the
subject topic of Continuing Professional Development (CPD).
From an economic context,
the ADTA report suggests future
changes will move at a considerably
different pace. Today, more than
half of the economic value of dental
care comes from procedures and
treatments that were not available
20 years ago. With shifting interests
on the part of patients, evolving
technology, and new delivery factors
continuing to emerge, it seems reasonable to expect a future marked by
additional—if not revolutionary—
change. Future trends promise to reflect the momentum of the past in

A brief history of the APDF
Dr Oliver Hennedige
Singapore

Many have requested that
I should give a brief history of the
Asia Pacific Dental Federation/Asia
Pacific Regional Organisation
from its inception to its present day
structure.
Way back on October 13, 1955,
a small organization with ambitious

Imprint
Asia Pacific
Dental
Federation
Asia Pacific
Regional
Organisation of
the Federation
Dentaire
Internationale
President
Prof. Prasad Amaratunga
Secretary General
Dr Oliver Hennedige
Editor APDF/APRO
Dr How Kim Chuan
Editorial Board
Advisor
Dr T. S. Jeyalan
Members
Dr James Chih-Chien Lee
(Chinese Taipei)
Dr Munir Amro (Jordan)
Assoc. Prof. Dr Seow Liang Lin
Editor’s Office
S-067A Mid Valley Megamall,
58000 Kuala Lumpur, Malaysia
Tel.: +60 3 22873782 / +60 3 22843482
Fax: +60 3 22843482
E-mail: drhowkimchuan@gmail.com
Secretary General’s APDF/APRO Office
242 Tanjong Katong Road
Singapore 437030
Tel.: +65 63445315 / +65 63442116 /
+65 67347590 / +65 67347591
Fax: +65 63442116 / +65 67349117
E-mail: bibi@pacific.net.sg
Publisher
Asia Pacific Dental Federation
www.apdfederation.org

ideas held its inaugural session in
Tokyo, Japan, attended by 32 delegates from Japan, Philippines, Indonesia, Malaya (made up of dentists from Singapore and Malaya),
Thailand, South Vietnam, Hong
Kong and the Republic of China.
These 8 countries’ representatives
decided to form the Asia Dental
Congress (the fore-runner of the
Asia Pacific Dental Federation) and
the meeting in Tokyo became the
First Congress. Owing to the vision
of these 32 dentists in the early days
the organization grew steadily. By
the 3rd congress again held in Tokyo
(second congress was in Manila),
the organization became officially
affiliated to the World Dental Federation which at that time was known
by its French name—Federation
Dentaire Internationale (FDI).
By the 5th congress which was
held in Seoul 1967 some 12 years
later it was officially named the
Asia Pacific Dental Federation with
a new constitution reflecting its regional representation. Australia became its eleventh member followed
by New Zealand its 12th member. Because of its regional outlook the
APDF became effectively the Regional Organisation of FDI and
hence the double name Asia Pacific
Dental Federation/Asia Pacific Regional Organisation (APDF/APRO).
The official meeting of delegates in 1967 after some debate decided on this double name rather
than changing it to just Asian Pacific Regional Organisation when it
joined the world body. It wanted to
reflect and retain its original objectives of representing this vast Asia
Pacific region where two thirds of
humanity lived and at the same
time be the official regional representative of the world body. The
double name reflects its commitment to the development of dentistry, dental health and education

in this region as its top most priority. (Incidentally the world body
has 5 regional organisations and
APDF/APRO is one of them.)
The Federation steadily grew
with Congresses being held approximately every 3 years interval.
Getting member countries to host
the congress was a daunting task
and the intervals between congresses had to be stretched out. By
the 10th Congress held in Singapore
in 1981 the Asia Pacific Dental Congress became a major dental event
in the Asia Pacific Dental calendar
of events. That congress held in Singapore recorded the participation
of 1,780 delegates from 34 countries
and a large dental trade exhibition
call “Expodent Asia 81” which had
168 international exhibitors and
manufacturers from 19 countries
in a floor space of 55,000 sq feet
(approx 5,100 sq meters). Additionally another 2,300 trade visitors
came to view the latest in the dental
industry at Expodent Asia ’81. It was
a resounding success and changed
the outlook of the organization
with many countries now wanting
to host this event.
From then on APD Congresses
really took off and today congresses
and dental trade exhibitions are
held yearly in member countries
with no lack of associations wanting to host this prestigious event.
As for the International College
of Continuing Dental Education
(ICCDE) the educational component
of APDF/APRO it was set up during
the 19th Asia Pacific Dental Congress
held in Manila, Philippines in 1995.
It was conceptualized not as a bricks
and motar edifice but a virtual college linked to APDF/APRO to serve
the profession and the people in this
region by focussing on upgrading the
professional skills and expertise of
general dentists and specialists in the

combination with the less clear
forces of the future, such as consumer behaviour and technology.
While it is clear that change is occurring—and that change will continue throughout our industry—the
systemic nature of the supply and
demand forces make for a complex
and dynamic picture. Technology
will interact with disease patterns;
dental workforce issues will interact
with patient behaviour; practice
models will interact with service
choices; and demographics will interact with capacity issues. All together, whether gradual or radical,
change is certain. Both providers
and the industry as a whole can influence this evolution by encouraging new service choices, practice
models, technologies, access points,
and staffing concepts.

The ADTA report predicts
a very optimistic future
All told, the range of scenarios
available can take the dental indus-

try from gradual erosion to extraordinary growth. With leadership
at the provider and industry level,
the ADTA report predicts a very optimistic future. In fact, the study concludes that the dental-care system
will evolve more in the next 20 years
than in the previous 50 years! Market activity in the aggregate could
more than double—even triple.
For that reason, the next quarter century might best be described
as “transitional”. While the ADTA
report supports a positive future,
it also adds the qualifier that the
market must be willing to embrace
growth and change. Better policy
moves and focused leadership at
every level, in every sector, can
ensure the promise of effective, innovative dental-care services for
the entire population.
That said, I leave you with the
words of Mahatma Gandhi: “We
must become the change we want
to see.” APDF

New APDF Council
President
Prof. Prasad Amaratunga

Dental Education
Dr Anil Kohli

President Elect
Dr Hermogenes Villareal

Public Dental Health
Dr Zaura Anggraeni

Vice Presidents
Dr Munir Amro
Dr James Chih Chien Lee
Dr Bhagwant Singh
Dr Sigmund Leung
Dr Asif Niaz Arain

Oral Diseases
Dr Gamini De Silva

Secretary General
Dr Oliver Hennedige
Treasurer
Dr Keki Mistry
College Chairman
Dato Dr Ratnanesan
Editor
Dr How Kim Chuan

various fields of dentistry. It aimed
to undertake this task by continuing
dental education programmes, specific courses and to bring continuing
dental education to every corner of
this vast region. It has the task of
upgrading practice and competency
of dentists and specialists.
To this end the College has conducted joint scientific programmes
in member countries. Organised
workshops and is responsible for all
the scientific programmes in the
Asia Pacific Dental Congresses for
1995 onwards. The College also
awards Fellowship based on dedicated service to the profession and
organized dentistry through their
individual Associations or through
activities of APDF/APRO. Fellowship could also be gained by attending accredited courses and having
satisfied in attendance, knowledge
gained etc the candidates become
eligible to sit for an examination
conducted by the College. On passing a Fellowship will be awarded.
Today the Federation (APDF/
APRO) serves its member associa-

General Dental Practice
Dr Leo De Castro
Defence Forces Dentistry
Col. Chomquan Sangbuakaew
Immediate Past President
Dr Jeffrey Tsang
Organising Chairmen
Dr Hermogenes Villareal,
Philippines (33rd APDC)
Dr James Lee,
Chinese Taipei (34th APDC)
Dato Dr Ratnanesan,
Malaysia (35th APDC)

tions well and is a truly useful umbrella organization of this region.
Its annual congresses are leading
events in the region attracting both
the industry and delegates. The
College has continued to evolve
with a number of continuing dental
education programmes being conducted in the region. It maintains
a high standard in the scientific programmes of the Asia Pacific congresses.
From a beginning of 32 dentists
from 8 countries today Asia Pacific Dental Federation/Asia Pacific
Regional Organisation and its
educational component the ICCDE
officially represents 27 countries
with annual congresses attracting
thousands of dentists each time it
is held. There are no lack of hosts
and countries’ invitations extend to
5 consecutive years ahead of time.
Both the APDF/APRO and its
educational component ICCDE
are well structured organizations.
They are truly the voice of dentistry
and dental health and continuing
dental education in this region. APDF

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[toc] => Array ( [0] => Array ( [title] => Implant dentistry in Singapore gets boost [page] => 01 ) [1] => Array ( [title] => Asia News [page] => 02 ) [2] => Array ( [title] => The politics of a dental plan for Australia [page] => 04 ) [3] => Array ( [title] => World News [page] => 05 ) [4] => Array ( [title] => Business [page] => 09 ) [5] => Array ( [title] => “We are committed to investing and supporting the development of implant dentistry in China” [page] => 10 ) [6] => Array ( [title] => Removal of a fractured instrument: Two case reports [page] => 11 ) [7] => Array ( [title] => All-ceramics encounter PFM ceramics [page] => 13 ) [8] => Array ( [title] => A simplified method for the removal of cemented implant prosthetics [page] => 16 ) [9] => Array ( [title] => Discover the small world of ToothVille [page] => 18 ) [10] => Array ( [title] => APDF Newsletter [page] => 19 ) ) [toc_html] =>

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