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First vaccine for treating gum disease / Asia News / Caricature / World News / Worldental Communiqué December 2009 / Minimally invasive cosmetic dentistry / Complete maxillary implant prosthodontic rehabilitation utilising a CAD/CAM fixed prosthesis / Interview: 'HIV tests should be offered in every dental practice'

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DTAP1209_01-03_TitleNews

15.12.2009

11:40 Uhr

Seite 1

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

www.dental-tribune.asia

NO. 12 VOL. 7

MICD explained

HIV tests

Extra politics

A new treatment protocol
for general practice

An interview with Dr Austin,
VIP Smiles, USA

The latest news from
FDI head office

Page

dental
First vaccine for treating gum disease Asian
markets show

Daniel Zimmermann
DTI

potential

HONG KONG/LEIPZIG, Germany:
Scientists at the University of
Melbourne, Australia, have announced that they have partnered
with CSL Limited and Sanofi Pasteur, the country’s largest biopharmaceutical companies, to further
develop and commercialise a vaccine for the treatment of gum disease. The programme, which has
been ten years in development,
involves bacterial peptides and
proteins that trigger the immune
response to periodontal inflammation. The vaccine is currently being
tested in mouse models and is expected to progress to clinical trials
soon, the researchers said.
The new vaccine approach
is targeting the ‘ring leader’ of
a group of pathogenic bacteria
called P. gingivalis that cause
periodontitis. According to a USbased consortium for P. gingivalis
research, elevated levels of the
organism were found in the majority of periodontal lesions, as well
as in low levels in healthy sites.
In addition, the organism also produces a number of enzymes that
have been shown to interact with
and degrade host proteins.

A new report by Research
and Markets, a market analyst
company from Dublin in Ireland, has found that dental
markets in the Asia-Pacific region exhibit a huge potential
for growth due to low market
penetration and high demand
for modern and sophisticated
technology and equipment.

A new vaccine could help to replace traditional periodontal treatment methods. (DTI/Photo Dmitry Naumov)

Although the bacterium can be
eliminated through periodontal
therapy, it is often found in recurrent infections.
“Periodontitis is a serious disease and dentists face a major challenge in treating it, because most
people will not know they have the
disease until it’s too late and the infection has progressed to advanced
stages,” says Prof. Eric Reynolds,

CEO of the Cooperative Research
Centre for Oral Health Science and
the Head of the University of Melbourne’s Dental School. “This new
approach will provide dentists and
patients with a specific treatment.”

infection. Reynold said their new
line of vaccine products will possibly prevent the progression of
the disease, rather than managing
its symptoms and damaging consequences.

Traditional periodontal therapy involves manual scaling and
cleaning, and even surgery with
instruments or dental lasers in
an effort to contain the bacterial

Sanofi Pasteur has an option to
an exclusive worldwide licence
to commercialise the intellectual
property associated with these
products. DT

An increasing aging population coupled with a rising
awareness for oral health,
high aesthetics and improved
dental treatments have also
boosted the growth in this segment, the report states. In addition, a growing disposable income, an increasing edentulous population and rising
numbers of retired baby
boomers have impacted the
growth of the industry positively.
Overall, the dental industry
remained one of the most
attractive segments of the
healthcare industry with an estimated size of about US$18.8
billion in 2008, according to
the report. DT
AD

Aussi dentists
oppose
dental scheme
reform

Prof John McDevitt from Rice University in Houston is working on a new affordable device
for detecting oral cancer in the dental office.(DTI/Photo Jeff Fitlow)WORLD NEWS,Page 5

India to extend
BDS courses

US dentists delay
new acquisitions

The Dental Council of India
has announced to introduce
a five-year Bachelor of Dental
Surgery course as well as Post
Graduate diploma courses. The
extended offering is supposed
to help internationalise dental
education in India and solve
the faculty problems in dental
colleges. DT

More than 80 per cent of
dentists in the US indicate to
have delayed new acquisitions
because of the recession, a survey by the American Dental
Association has found. While
almost 50 per cent delayed buying new equipment, only 3 to
9 per cent reported to have laid
off personnel. DT

Dentists in Australia are
reported to lob the federal
government to dump plans for
Denticare, a US$3.37 billion
universal dental scheme developed by the Australian
National Health and Hospitals
Reform Commission earlier
this year. The scheme would
entitle patients to receive cover
either free through public dental services or one of a series
of private plans.
Instead, the Australian Dental Association (ADA) is pushing for a targeted scheme modelled on the Commonwealth
Dental Program dumped by the
Howard government in 1996.
It is supposed to be funded
through a new tax on sugar,
sugary sweets and soft drinks,
ADA officials said. DT

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Tel. +423 / 235 35 35 | Fax +423 / 235 33 60

[2] => untitled

DTAP1209_01-03_TitleNews

AD

15.12.2009

11:41 Uhr

Seite 2

Asia News

Countries in Asia less than
average in health care spending
Daniel Zimmermann
DTI

The latest edition
of Health at a Glance
demonstrates that all
the countries observed
LEIPZIG, Germany: Asian
could do better in procountries have been found
viding good quality
to spend less of their GDP’s
health care. Key indifor health care than most
cators presented in the
other countries in Europe
report provide inforand the US. According to
mation on health staa new health care report
tus and the determiby the Organisation for
nants of health, includEconomic Co-operation
ing the growing rates
and Development (OECD)
of child and adult obein Paris, only New Zealand
sity, which are likely to
provided more money for
drive higher health
health care than the averHealth care spending has improved in Asia but still is below
spending in the comage of all observed coun- average. (DTI/Photo Sean Prior)
ing decades.
tries. Japan, Korea and
Australia, however, spent less
average of US$2,984, adjusted for
than the OECD average of 8.9 per
Based on new data on access
purchasing power parity. Luxemcent of GDP.
to care, the report demonstrates
bourg, France and Switzerland
that all OECD countries provide
also spend far more than the
universal or near-universal
OECD average. At the other end of
The US currently spends more
coverage for a core set of health
the scale, health-care expenditure
on health care than any other
services, except the US, Mexico
in Turkey and Mexico is less than
country—almost two and a half
and Turkey. DT
one-third of the OECD average.
times greater than the OECD

Malaysians reject
public dental services
Claudia Salwiczek
DTI

HONG KONG/LEIPZIG, Germany:
Kuala Lumpur’s Deputy Director
of Health Dr Ahmad Bujang has
urged Malaysians to have their
teeth checked once or twice a
year and children at least every
six months, despite the present
problems in government dental
services. Given the current dental status of Malaysians, dental
checks are important, as early
detection of dental diseases like
caries or gingivitis allows for
more effective treatment, he said.

Dr Bujang was responding
to a statement released by the
Ministry of Health in November
claiming that only 6 per cent of
adults in the country use government dental services.
Public dentistry in Malaysia
falls short compared to other
countries in the region, especially in rural areas, where only
60 per cent of dental officer
posts are filled. According to
latest government figures, the
current ratio of public dentists to the population is only
1:15,243, while the ratio for

both public and private dentists combined is 1:7,941. This
leaves patients to wait for long
periods for treatment, as public
dental clinics operate according to appointments.
The Ministry of Health has
announced that it will address
the problem by employing retired and foreign dental officers,
while also improving the service scheme of public dental officers in order to retain those already employed in government
service. In the long run, the
government aims to achieve the
projected target ratio of 1:4,000
by facilitating dental education
in Malaysia and abroad. DT

International Imprint
Licensing by Dental Tribune International

Publisher Torsten Oemus

Group Editor/Managing
Editor DT Asia Pacific

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

Copy Editors

Sabrina Raaff
Hans Motschmann

Editorial Assistant

Claudia Salwiczek
c.salwiczek@dental-tribune.com

President/CEO

Torsten Oemus

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

Dental Tribune International
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49-341/4 84 74-302 Fax: +49-341/4 84 74-173
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
Room A, 26/F, 389 King’s Road, North Point, Hong Kong
Tel.: +852-3113-6177 Fax: +852-3113-6199
The Americas
Dental Tribune America, LLC
213 West 35th Street, Suite 801, New York, NY 10001, USA
Tel.: +1-212-244-7181 Fax: +1-212-224-7185

[3] => untitled

DTAP1209_01-03_TitleNews

15.12.2009

13:01 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

Asia News

Asia will assure future growth, 3M’s Buckley says

Waiting lists in
dental clinics
trouble S’pore

downturn in 80 years, the company’s US sales suffered significantly this year.
Despite the outlook of a slow
economic recovery, Buckley
outlined his company’s ongoing
commitment to investing in its
core businesses while continuing to focus on cash generation
in light of the still uncertain

global economy. 3M, with US
headquarters in St. Paul in
Minnesota, offers a wide array
of dental products through its
division 3M ESPE, including
adhesives, dental cements and
products for restorative and
aesthetic dentistry.
According to latest estimates, 3M sales are expected

to reach between US$24.5 and
US$25.5 billion in 2009, with
organic sales volumes growing by 5 to 7 per cent and currency effects adding 2 to 3 per
cent to sales for the year. The
company also expects that
2010 earnings will be between
US$4.85 and US$5.00 per share,
a slight increase compared to
2009. DT
AD

e.max

NEW YORK, NY, USA/LEIPZIG,
Germany: George Buckley,
Chief Executive Officer of 3M,

has announced that his company intends to take advantage
of more overseas opportunities
in regions like Asia Pacific in the
coming business year. Speaking to investors in New York in
early December, he said that
he expects revenues to grow by
11 to 13 per cent in emerging
markets like China and India.
Owing to the worst economic

Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
Representatives of the Ministry
of Health and the National
Dental Centre (NDC) in Singapore have rejected criticism
about long waiting lists for
special dental procedures in
governmental dental clinics. In
a public letter posted on the
Singapore Dental Association’s
website in December, Dr Kwa
Chong Teck, Executive Director of the National Dental Centre, and Chief Dental Officer
Patrick Tseng said that for patients seeking elective specialist treatment, the NDC generally offers an appointment
within two weeks. They admitted, however, that there is
a waiting list of patients requiring elective crown and bridge
work, root canal treatment or
dentures.
In Singapore, special dental
treatments are subsidised only
when patients are referred
from governmental dental clinics. The national medical saving scheme, called Medisave,
which is supposed to help individuals set aside part of their
income to meet future personal
or immediate family’s hospitalisation, only covers one-day
surgical procedures.

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The Ministry of Health has
rejected demands to extend
the scheme for private clinics to
reduce waiting times. Recent
feedback on delayed procedures came from patients asking for non-emergency elective
treatments, such as braces and
dentures, a government official
said. She added that heavy
subsidy without means-testing
for these procedures will inevitably lead to long queues.
“Medisave should be treated
as a financial reserve so that
treatment needs are met,” Dr
Ansgar Cheng, a consultant
dental surgeon at a private
dental clinic in Singapore, told
Dental Tribune Asia Pacific.
“The key is to identify those
dental treatments that should
be regarded as needs versus
the non-urgent optional treatments like tooth whitening,
which should be taken out of
the equation. There is no doubt
that governmental clinics will
be able to cope with the public
demand with time.” DT

IPS

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amic
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1
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[4] => untitled

DTAP1209_04-07_News

4

15.12.2009

11:43 Uhr

Seite 1

Opinion

We wish all our readers
a successful
new year 2010...

DENTAL TRIBUNE Asia Pacific Edition

[5] => untitled

DTAP1209_04-07_News

15.12.2009

11:43 Uhr

Seite 2

DENTAL TRIBUNE Asia Pacific Edition

World News

Rice University to work
on oral cancer test
Daniel Zimmermann
DTI

NEW YORK, NY, USA/LEIPZIG,
Germany: Researchers at the
BioScience Research Collaborative at Rice University in Houston
in the US have received a US$2

can be performed in the dental
million grant from the US Naoffice. Additional tests for the
tional Institutes of Health for
detection of cardiovascular disthe development of a new test for
eases and HIV are also in develdetecting oral cancer. The test,
opment, the researchers said.
which utilises latest LED and
nano microchip technology,
aims to provide an accurate diagOral cancer affects about
nosis in less
than
30 minutes
and Ad.ai
300,000
people
per year
worldIDEM10
210x297mm
DTI Implants
8/6/09
10:37:48
AM

wide, and most cases are diagnosed in the late stages. If oral
cancer is detected early, the
prognosis for patients is excellent, with a five-year survival rate of more than 90 per
cent. Unfortunately, the actual
five-year survival rate for oral
squamous cell carcinoma is
only about 50 per cent, amongst
the lowest rates for all major
cancers.
“We want to provide an accurate diagnosis for oral cancer
using a minimally invasive test

that requires no scalpels or offsite lab tests,” said principal investigator Prof. John McDevitt,
Rice’s Brown-Wiess Professor
of Chemistry and Bioengineering. “The payoff for this could
be tremendous because oral
cancers today are typically diagnosed much too late in their
development.”
According to McDevitt, the
test is being developed in collaboration with other scientists
from universities in the US and
the UK. DT
AD

www.idem-singapore.com

To the Editor
Re: Editorial, ( Dental Tribune
Asia Pacific No. 11,Vol. 7,page 4)
In the UK at least the number of female graduates in dentistry has outnumbered male graduates for some
time.In terms of new graduates there
is certainly no longer a problem with
the gender balance. The problem
with the well-known opinion leaders
is partly that they are further through
their career, therefore many of them
graduated at a time when more men
were graduating than women. What
is more of a long term problem is that
in order to be a well-known opinion
leader in dentistry you need to devote
an enormous number of hours to
a combination of higher training, attending and lecturing at courses all
over the world, usually in addition
to running a practice. This is pretty
much incompatible with the home
life of many women who want to be
able to have children who are raised
with lots of parental input. Until society changes so that fathers feel both
more willing, and able to take a part
in flexible and part time working, and
spend more time in the home, most
women will sacrifice career glory for
the emotional needs of their children.
We need changes in all professions
and industries so that men who want
to can take on more childcare responsibilities, and allow their female
partners to be leaders in their professions, where they want to be, without
being forced to put their children into
long hours of childcare.

THE BUSINESS OF DENTISTRY

INTERNATIONAL DENTAL
EXHIBITION AND MEETING

April 16-18, 2010

The Sourcing & Education Platform in the Asia Pacific
Join a turnout of over 6,000 manufacturers and distributors, potential partners, visitors and
delegates from across the globe. IDEM Singapore 2010 is enriched with opportunities from
trading and showcasing of high-quality dental equipment to learning and development in
the field of dental practice. This event is a “must-attend” for every dental and associated professionals.

Lucy Nichols, UK, 12. Dec. 2009

Uniquely Singapore: Where Great Things Happen
Re:“Experts discuss future of
implantology in Gothenburg”,
( Dental Tribune Asia Pacific
No. 10,Vol. 7,page 1)
This is exactly what I have been
thinking.We are pricing ourselves out
of the dental implant market. What
good is the invention, innovation or
treatment when only the elite population can afford it. The concept of
treating the patient with only a small
number of implants is not correct.
We need to replace all missing roots
with implants, rather than performing different ways of unproven
restoration for the sake of cost.

Now ranked among the world’s top cities for meetings, Singapore is also a country
with one of the most sophisticated dental markets. Come discover a world of unique
contrasts in Singapore and sample an exciting weekend in this beautiful multi-cultural garden city.
Endorsed By:

Supported By:

Held In:

Norman Kwan, Canada, 6 Dec. 2009

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

In Cooperation With:
International
Ms Sharon Ng
Tel: +65 6500 6722
Fax: +65 6296 2771
s.ng@koelnmesse.com.sg

Europe Only
Ms Daniela Basten
Tel: +49 221 821 3267
Fax: +49 221 821 3671
d.basten@koelnmesse.de

Organizers:

Singapore Dental Association

[6] => untitled

DTAP1209_04-07_News

6

15.12.2009

11:43 Uhr

Seite 3

DENTAL TRIBUNE Asia Pacific Edition

World News

Global centre for laser education installed in the US
Fred Michmerhuizen
DTA

NEW YORK, NY, USA/LEIPZIG,
Germany: The US-based manufacturer of soft-tissue dental lasers AMD LASERS has
announced the launch of its
new International Center for
Laser Education (ICLE) in Indianapolis in the US. The centre,
which is headed by laser expert

Dr Glenn van As, will offer education for the most popular
lasers in dentistry through
video, hands-on courses, and
an interactive laser forum.
ICLE claims to be the first laser
company to offer affordable
laser education to dentists
worldwide.
Several variants of dental
lasers are already in use, with

the most common being diode
lasers, carbon dioxide lasers,
and yttrium aluminium garnet
lasers. Latest studies have
proven that laser applications
for dentistry range from surgery to cosmetic procedures
and even treatment of periodontal and peri-implantitis
infections. The cost of a dental
laser is between US$8,000 and
US$50,000.

“Until now, most laser
courses have been expensive
and not specific enough in content to really assist dentists in
understanding the safety, efficacy, and proper use of dental
laser technology,” said Dr van
As. “Just as AMD LASERS has
made cutting-edge laser dentistry a reality for dentists,
ICLE intends to revolutionise
laser dental education through

courses of unprecedented quality, accessibility, and affordability.”
According to Dr van As,
ICLE’s courses will be suitable
for both experienced clinicians
and dentists new to laser dentistry. The forum will allow
dentists to ask questions, post
technique videos, and share
laser experiences, he added. DT

AD

Genes
drive
gingivitis
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Researchers at the University
of North Carolina (UNC) in
Chapel Hill in the US have discovered that almost one third of all
human genes is involved in the
inflammation of gingival tissue.
By observing gum samples at
molecular level collected from
fourteen individuals with mild
gingivitis, they found that more
than 9,000 genes are expressed
differently during the onset and
healing process of the condition.
According to latest figures of the
International Human Genome
Sequencing Consortium, the
estimated number of genes in
the human body ranges from
25,000 to 30,000.
The study, supported by the
US National Institutes of Health
and oral health-care manufacturer Procter & Gamble, is the
first to identify gene expression
and the biological pathways involved in the onset and healing
process of gingivitis successfully,
including those associated with
immune response, energy metabolism, neural processes, vasculature, chemotaxis, wound
healing and steroid metabolism.
“The study’s findings demonstrate that clinical symptoms
of gingivitis reflect complicated
changes in cellular and molecular processes within the
body,” said Dr Steven Offenbacher, the study’s lead researcher and director of the UNC
School of Dentistry-based Center
for Oral and Systemic Diseases.
“Understanding the thousands
of individual genes and multiple
systems involved in gingivitis
will help explain exactly what is
occurring in a person’s body at
the onset of the disease and how
it relates to their overall health.”
Gingivitis is commonly attributed to lapses in simple oral hygiene habits. If untreated, it can
lead to periodontal disease, which
has been studied extensively
for its possible relation to heart
disease, diabetes and pre-term
birth. The researchers said that
understanding the way gingivitis develops and resolves at
a molecular level could provide
critical insights into gum disease prevention, as well as new
treatments. DT

[7] => untitled

DTAP1209_04-07_News

15.12.2009

11:43 Uhr

Seite 4

DENTAL TRIBUNE Asia Pacific Edition

World News

Directa presents new solutions for
Class II cavity preparations
Daniel Zimmermann
DTI

LEIPZIG, Germany: Placing
a matrix band to attain a good

US dentist
develops
Face Lift
Dentistry
PR Newswire

After 30 years of cosmetic
and bite reconstruction dentistry
in Los Angeles, Beverly Hills and
Santa Monica, Dr Sam Muslin
has perfected and trademarked
Face Lift Dentistry, an advanced
procedure to ensure lasting results in health, comfort and appearance. Non-surgical, it is supposed to optimise dental health
and idealise the bite to augment
the specific facial features of the
patient. Dental patients can look
ten years younger just from work
on the teeth that lengthens and
supports the face, Dr Muslin says.
As a person ages, teeth become worn down and uneven
due to wear and tear and different kinds of dental work in the
mouth. Patients who have short
faces, narrow cheeks, aging lips,
and facial wrinkles usually have
worn down teeth and a form of
bite collapse. Because the tooth
wear is gradual, the person usually does not realise how much
deterioration has occurred.
“The teeth are the foundation
of the face, but most doctors do
not understand how much the
teeth can enhance the facial
features,” says Dr. Muslin, who
is a Master of the US Academy
of General Dentistry. “Cosmetic
face lifts and cosmetic dentistry
often cannot produce optimal
results for the patient.”
According to Dr Muslin, the
Dental Face Lift is done with
a high level of coordination and
efficiency. During the first appointment, poor crowns, loose
teeth, gum disease, bad bite and
facial collapse are taken care of
and the patient receives temporary crowns, veneers and fillings.
On the second visit, all of the new
crowns, porcelain veneers and
fillings are bonded to achieve
a complete reversal of bite collapse, permanent facial support
and lengthening of the patient’s
face, Dr Muslin says.
“Face Lift Dentistry goes beyond cosmetic dentistry and cosmetic surgery to completely treat
both health and facial appearance.
Either alone or combined with
a surgical face lift, it will achieve
superior results,” he adds. DT
(Edited by Daniel Zimmermann)

contact point and avoiding interproximal overhang after excavation for Class II fillings has always been a time consuming and
laborious procedure. Directa has
announced to offer a unique and
easy solution for this procedure
by combining a separating plastic wedge with a stainless steel

matrix. The Fendermate is available in regular and narrow width
and for left or right application
and will be colour coded for better identification.
According to the Swedish company, the combined matrix and
wedge are inserted as one piece.

A new technology contours and compliments the
curvature of the
patients tooth and
holds its shape without
having to use a retentive ring that
inhibits access to a cavity. The

contact point is created by the dual curvature of FenderMate so that further burnishing
will not be necessary.
With the
combination of
FenderMate and
FenderWedge, Directa also offers a tissue friendly approach for
the preparation and filling of
Class II cavities. DT
AD

[8] => untitled

DTAP1209_08_Chile

15.12.2009

11:45 Uhr

Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

The unprecedented success of Dental Salon Chile
Javier Martínez de Pisón
DT Hispanic and Latin America

SANTIAGO DE CHILE, Chile:
The sixth annual edition of
Dental Salon Chile has nothing
to envy from the best Asian,
American or European expos in
terms of quality and professionalism. Lodged now for the
first time in the modern fairgrounds of the Espacio Riesco,
the Dental Salon offers ample
quarters, modern facilities and
many comforts to the visitor.
But probably the most surprising feature is the high quality design of spaces, isles and booths,
an influence that expo organizer Miguel Wechsler says he
has assimilated from attending
shows such as IDS in Germany
and GNYDM in New York.
Wechsler has radically
changed the look and feel of
Dental Salon Chile, which until
2008 took place in cramped
grounds. The Espacio Riesco by
comparison, ten minutes away
by car from downtown Santiago
and for which Wechsler now
provides free buses every
15 minutes, is a large concrete
structure from which huge,
colourful billboard-size banners promoting the Salon hung
outside welcoming the visitor.
AD

Fig. 1: Miguel Wechsler—Fig. 2: The Chilean dental market is growing at an annual rate of 12 per cent. (DTI/Photos Javier Martínez de Pisón)

The Chilean businessman
says that he has invested a lot
of time and resources in organising this 2009 Salon, but
that the projected growth statistics for the dental industry
in Chile support his effort.
Chile is actually a small country, but has developed a quality infrastructure, and its economy is one of the most prosperous in all of Latin America.
Wechsler says that the dental
market in Chile is growing
between 20 and 30 per cent per
year.
Chilean dentists and researchers are renowned in

Latin America as high-standard
professionals, with a tendency
to buy expensive, high-quality
American and European instruments, products and equipment, which is not the case with
other colleagues in the region.
It is estimated that there are
over 11,000 practicing dentists
in the country today, a number
that increases by 12 per cent
every year.
The reason for this increase
is that until recently state-controlled universities graduated
a reduced number of dentists,
but the new private universities
have radically changed this

dynamic, churning out large
numbers of dentists every year.

ganising expos in Peru, Bolivia,
Paraguay and Argentina.

Wechsler says that the 2010
Dental Salon will have an international German Pavilion,
and that he’s in negotiations
with the Swiss industry for
the same purpose. At the IDS
in Germany he was talking
with representatives of the
American Pavilion, who are
also interested in the Chilean
market.

“When the international industry sees the quality of this
Dental Salon Chile they are
happily surprised,” Wechsler
says. “Because they recognise
that it has been modelled after
successful American and European expos. They recognise that
it is a highly organised and
professional effort, and many
ask me if I would consider doing
something similar in other
countries of the region.” DT

Actually, the director of the
Dental Salon is so confident in
the Chilean market that he is
exploring the possibility of or-

Read the full interview with Marc
Wechsler at www.dental-tribune.com.

[9] => untitled

DTAP1209_09-10_FDI

15.12.2009

11:46 Uhr

Seite 1

Photo courtesy of Jon Crail, FDI World Dental Federation

Message from the president FDI supporting member:
In September I was bestowed
the great privilege—and responsibility—of representing the international voice of dentistry as its
elected leader. Throughout the last
few months, I have met FDI members and delegates at their national
and regional events around the
world, such as the Annual Meeting
of the Portugese Dental Association
and International Association for
Dental Research (IADR) World
Congress on Preventive Dentistry.
In doing so, I am struck by the vast
reach of this great organisation.
Whether it’s collaborating with
fellow Council and Committee volunteers on the many FDI projects
in development, participating in
important international governmental meetings, or spending time
with staff at the head office to better
understand the day-to-day workings of the organisation, I am continually impressed with how each
one of FDI’s many parts contributes
to our achievements as a whole.
One of the questions I am asked
repeatedly when meeting people
for the first time as Dr Roberto
Vianna, FDI President—as opposed
to Dr Roberto Vianna the dentist,
professor, dean or entrepreneur—
is about my vision for the FDI during
this upcoming two-year term. My
answer to this question is that my
vision for the FDI is to be true to
the FDI vision: bringing together
the world of dentistry, representing
the dental profession of the world,
and stimulating and facilitating the
exchange of information across all
borders with the aim of optimal oral
health for all people. The FDI vision
is a collective one, developed by and
for our members, and should serve
as the guiding light to our representatives, elected delegates, partners and supporters, and individual

students to get involved in volunteer and advocacy activities related
to oral health promotion promises
a bright future for dentistry.

volunteers that dedicate time and
energy to advancing the profession,
whether technologically, scientifically, educationally or socially.
Volunteer commitment is an essential component of a strong FDI.
I hope you will join me in recognising the contribution of long-standing FDI volunteer, Dr Peter Swiss.
Dr Swiss will be “retiring” from
the FDI next year, after more than
40 years of tireless service in a variety of roles across the organisation.
His spirit of giving time through volunteerism is an example for others
to follow. His work is greatly appreciated and will be missed. And as we
say thank you to Dr Swiss and reflect
on the years he has dedicated to FDI,
we welcome seven new and one
returning member(s): Barbados
Dental Association, Association Burundaise des Chirurgien-Dentistes,
Sociedad Dental de El Salvador, European Federation of Orthodontics,
European Dental Students’ Association, National Children’s Oral Health
Foundation, Mundo a Sorrir and the
Guam Dental Society. This month
we take a closer look at the European Dental Students Association:
the eagerness of this group of dental

As the sum of many diverse
parts, FDI is only as strong as its
relationships and in this respect,
I hope that my service as FDI President can help strengthen existing
bonds and build new bridges for the
organisation. Such bridges might
come through increased crossCommittee collaboration, external
partnerships with neighbouring
Geneva-based NGOs dedicated to
health promotion, or a forum for
intra-member communication and
exchange. In November, FDI took
part in a significant meeting cohosted by the World Health Organization and United Nations Environmental Programme and participated in the 2009 Greater New York
Dental Meeting, with a progressive
continuing education programme
entitled, Dental Caries: Can the
Paradigm of Care Shift?
Looking ahead to 2010 there
are many exciting opportunities on
the horizon, starting with our own
FDI website. I invite you to watch for
the new front page and user features, coming this January. Then in
February the FDI Committees will
convene for mid-year meetings at
our beautiful head office in Geneva.
In the meantime, my warmest
wishes to you and your loved ones
for a happy and fulfilling New Year.

Dr Roberto Vianna
FDI President

The European Dental
Students’ Association
The European Dental Students’ Association (EDSA) was accepted
as an FDI Supporting Member at General Assembly during the 2009 Annual
World Dental Congress in Singapore. EDSA Executive Committee member
and Magazine Editor, Andrew Sullivan, discusses what membership
to the FDI means for EDSA.
the number of
The European
members to the
Dental Students’
organisation. We
Association (EDSA)
feel this is critical
was founded more
for moving in the
than 21 years ago
right direction,
in Paris and now
and embracing
has a reliable netnew and fresh
work of more than
65,000 dental stu- Participants at the 44th EDSA Meeting ideas. Additionin Helsinki, Finland
ally, we will condents from 182
tinue to work on existing projects,
dental schools in 26 countries.
such as the “Prevention Program”,
EDSA delegates from each of its
designed to help students promote
member countries gather twice
the importance of oral health, the
a year in a different European
“Volunteer Program”, which aims
city for EDSA events.
to increase knowledge and awareness about the value of volunteer
We felt honoured to have been
work, and the EDSA Magazine,
accepted as an FDI Supporting
currently published twice a year
Member at the Annual World Denby Wiley-Blackwell.
tal Congress in Singapore last September. Our direct involvement
with FDI is of great importance to
We look forward to working
us as an organisation: we are eager
closely with FDI, building a strong
to learn from established dentists,
and beneficial partnership for both
gaining knowledge from their exgroups. In particular, I would like
periences and expertise. We will
to thank Dr Gerhard Seeberger,
also be able to learn more about
President-Elect of the FDI-ERO
the dental field and what the future
for encouraging this connection.
holds for us as dentists. The relaFDI members are welcome to join
tionship between EDSA and FDI
us for the 45th EDSA Meeting &
will be beneficial for organising
8th EDSA Congress, from 7–14
or overseeing common projects,
March 2010 in Bucharest, Romania.
as well as creating opportunities to
More information about EDSA,
network in the dental field, which
including the contact details for
can sometimes be difficult when
the members of our Executive
working in the private sector.
Committee and information about
the upcoming meeting and conSo what does the future hold
gress, can be found on the EDSA
for EDSA? Our plan is to increase
website (www.edsaweb.org). FDI

issues regarding dental amalsigned to inform future intergovernFDI participates at WHO/ UNEP meeting on and
gam, were universally represented
mental discussions on the subject.
in
UNEP
discussions.
This
task
meeting attendees included
future use of materials for dental restoration team includes Dr Eduardo Ceccotti Other
Professor David Williams, President
FDI World Dental Federation
participated in a joint meeting
of the World Health Organization (WHO) and United
Nations Environmental Programme (UNEP) on 16–17 November in Geneva, Switzerland.
Experts from around the world
were invited to the meeting
to assess the scientific evidence available on the use
of restorative materials, including dental amalgam, and
the implications of using alternatives to amalgam in dental
restorative care.

FDI President, Dr Roberto
Vianna, and Executive Director,
Dr David Alexander, attended the
meeting, presenting a unified position for dentistry based on the resolution on amalgam drafted and
passed at General Assembly during
the 2009 FDI Annual World Dental
Congress (AWDC) in Singapore.
In a presentation entitled “Dental
restorative materials in clinical
practice - views of the dental profession”, Drs Vianna and Alexander argued that no ban or phase-down of
mercury used in the dental profession should occur before a true

alternative to dental amalgam is
widely available in all communities. This FDI position is based upon
several FDI policy statements and
was jointly crafted under the leadership of the Science Committee.
FDI has been closely monitoring developments with regards to
the global regulation of mercury
as a member of the UNEP Global
Mercury Partnership. Following
the 2009 FDI AWDC, the Science
Committee recommended the formation of a task team to ensure the
international dental community,

(CMSC), Dr Peter Cooney (WDDHPC), Dr Stuart Johnston (DPC),
Dr Derek Jones (SciC), Prof Masaki
Kambara (Council), Dr Orlando
Monteiro da Silva (ExecC), Dr
Sarkis Sozkes (EduC) and Dr Martin
Tyas (contributing expert). Dr
Johnston was at the FDI head office
in Geneva during the WHO-UNEP
proceedings to represent dental
practitioners and provide leadership in the preparation of an official
FDI Statement of Position.
The recent WHO-UNEP meeting
is part of a two-phase approach de-

of the International Association for
Dental Research (IADR), Dr Daniel
Meyer, Senior Vice-President, Science/Professional Affairs at the
American Dental Association (ADA),
and Dr Benoit Soucy, Director of
Clinical and Scientific Affairs at the
Canadian Dental Association (CDA).
More information about the
UNEP Global Mercury Partnership and FDI’s official Statement
of Position following the WHOUNEP meeting in Geneva is
available at the FDI website
(www.fdiworldental.org). FDI

[10] => untitled

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Seite 2

Worldental Communiqué

FDI website undergoes
“makeover”
The FDI website (www.fdi
worldental.org) will have a
new look beginning January
2010, featuring a simplified
navigation structure and
menu tabs so that FDI’s members and partners can access
relevant information about
the organisation’s history,
structure, projects, activities,
and Annual World Dental
Congress more easily, and in
fewer clicks.
Some features of the new
FDI front page will include:
• Direct links to current FDI
projects and activities
• Quick Links to the members
section, latest news stories,
FDI publications and a sign

up form for the Worldental
Communiqué
• Updated front page menu (to
simplify website navigation)
• Expanded Congress & Events
section, including a section
to highlight FDI members’
events
• Media section, with a direct
link to press releases, archives and press contact information
• Improved Search functionality
• Contact Us tab in the front
page menu with FDI’s address
and phone number in Geneva
For more information,
contact the FDI at media@
fdiworldental.org. FDI

Inside the FDI
By Dr David Alexander, FDI Executive Director

DENTAL TRIBUNE Asia Pacific Edition

Members’ corner:

The spirit of volunteerism
FDI World and turned to Dr
Swiss, who agreed to take on
the role for two years. Later,
in 2006, when the FDI was seeking a part-time Dental Practice
Committee Coordinator, once
again it turned to Dr Swiss for his
assistance. Dr Swiss has brought
an invaluable amount of support
to the FDI and the Committee.
He ended his contract with the
FDI earlier this year, but has
agreed to continue volunteering his time to the Committee
until after the 2010 mid-year
meeting.

Dr Peter Swiss, Chairman of
the Working Group on Ethics
& Dental Legislation, and
volunteer support staff to the
Dental Practice Committee,
will retire from his FDI activities next year after more than
40 years of service to the FDI.
Dr Swiss has been affiliated
with the FDI since his student
days, when in 1966, he was Treasurer of the International Association of Dental Students (IADS),
an organisation strongly supported by the FDI. A year later
Dr Gerald Leatherman, then FDI
Executive Director, appointed
Dr Swiss as the first FDI Student
Liaison Officer. One of Dr Swiss’s
responsibilities in this role was to
attend IADS annual congresses
on behalf of the FDI and to chair
its General Assembly. Dr Swiss’s
interest in international organised dentistry developed as a result of this role and was further
strengthened when he was appointed a member of the British
Dental Association Organising
Committee for the 1974 FDI Annual World Dental Congress
(AWDC) in London.
Following the AWDC in 1974,
Dr Swiss was invited by Dr
Leatherman to assist with the
organisation of future FDI congresses. He also continued his
commitment with the FDI as

Dr Peter Swiss

a speaker at several FDI congresses and as a member of the
Commission on Dental Education & Practice (1983) and the UK
delegation, becoming National
Secretary in 1994. His particular
interest in international dental
ethics developed in the 1980s,
following his appointment as
Dental Secretary of the Medical
Defence Union in 1982. Dr Swiss
became a member of the FDI
Ethics Committee, and in 2000,
was elected Chairman. In 1998
he chaired the 3rd International
Congress on Dental Law & Ethics
and in 2007 he coordinated the
production of the FDI Dental
Ethics Manual.
In 1999 the FDI became urgently in need of an Editor of

In contemplating his involvement with the FDI, Dr Swiss said
he has seen the FDI develop and
improve. “Until about 20 years
ago, the focus of the FDI was
largely on the interests of the
developed countries and its congresses were attended predominately by participants from
these member associations,”
said Dr Swiss. “More recently,
however, the FDI has expanded
its work to cover a much wider
area of the world and now has
some of its major influence in
the developing countries”. Over
the years, Dr Swiss has attended
27 FDI congresses, beginning
with Sydney, Australia 1973.
He feels the time has now come
for him to stand back and watch
others to continue the great work
of the FDI. FDI

Save the date:

2010 Annual World
Dental Congress

FDI staff at head office in Geneva

The FDI saw some significant
changes at the head office in
2009 and as we settle into our
new home in Geneva, Switzerland, FDI is now entering a new
phase in the organisation’s
history.
The relocation from FerneyVoltaire (France) to Geneva ran
smoothly thanks to the notable efforts of FDI staff and in particular,
Ms Laurence Jocaille, who managed the logistics of the move,
ensuring that no small detail was
overlooked. In an effort to off-set
the very significant costs associated with the relocation, the
FDI created the Sponsor-a-Window Programme, whereby participants could adopt one of the
54 windows that offer a 360-degree view from the Geneva office.
Thanks to the generosity of numerous donors, FDI has raised
a total of 250,000 euros to date
(more details coming soon).
As with many businesses and
activities around the world, FDI
has been struggling to weather
the economic storm. We face particular challenges—as a non-governmental, charitable organisation—to maintain existing channels and develop new avenues of

revenue at a time when budget
cuts and belt-tightening are standard practice. Nevertheless, we
are well poised to move into 2010
under the financial discipline of
our new Finance and Operations
Director, Mr Jérôme Estignard.
Finances are at the heart of every
FDI project and Jérôme brings a
strategic approach that translates
to clear management accountability of FDI finances together
with greater outcomes’ evaluation of what we achieved for
what we spent. This position is vital to our future and it gives me
much pleasure to welcome
Jérôme to the team.
I am also pleased to announce that Mr Bio Khaw has
joined our permanent staff as Senior Accountant. And beginning
January 2010, Dr S.D. Shantinath
will join us as Head of Public
Health. Of course, when welcoming additions to staff, goodbyes
must sometimes also be said:
Ms Heather Sheppard and Ms
Berit Pedersen, both of whom
were part of the FDI family for
more than six years, have decided
to leave us to pursue new and exciting opportunities elsewhere.
We wish them well in their endeavours. FDI

The 2010 FDI Annual World Dental Congress will be held
from 2-5 September in Salvador da Bahia, Brazil.
FDI World Dental Federation
and the Local Organising
Committee of the 2010 FDI
Annual World Dental Congress
(AWDC) are busy preparing
for next year’s event, which
will be held in Salvador da
Bahia, Brazil, from 2 – 5 September.
Located on the northeast
coast of Brazil, Salvador is
the country’s third-largest city,
boasting 34 km of beaches, a

blend of Amerindian, African
and European cultures, and an
historical centre designated an
official UNESCO World Heritage
Site in 1985. As the country’s
first capital (from 1549 to 1763),
Salvador has a long and rich
history, evident in the distinctive
architecture, cuisine and culture
that continue to define the city,
drawing visitors from around
the world and making Salvador
one of Brazil’s top tourist destinations.

The FDI Annual World Dental
Congress provides a unique
gathering place for dentists to
explore the profession’s latest
technological, political and social developments through a
World Dental Exhibition, FDI
General Assembly and business
meetings, the Scientific Programme (including limited attendance courses), and locallyinspired social events.
FDI World Dental Federation
and the Brazilian Dental Association (ABO) have been collaborating closely with local
organisations and representatives to bring you a world-class
event next September. More information about the Salvador
congress is available on the FDI
website. FDI

About the publisher
Publisher
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 Communications Manager
Aimée DuBrûle

Salvador da Bahia, Brazil

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.

[11] => untitled

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Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 11

Minimally invasive cosmetic dentistry
A concept and treatment protocol for general practice
Dr Sushil Koirala
Nepal

Increased media coverage and
the availability of free web-based
information has lead to heightened public awareness and thus
to a dramatic increase in patients’
aesthetic expectations, desires
and demands. Today, a glowing,
healthy and vibrant smile is no
longer the exclusive domain of the
rich and famous and most general
practitioners are forced to incorporate various aesthetic treatment modalities in their daily
practices to meet this growing
demand.
The treatment modalities of
any health-care service are aimed
at the establishment of health and
the conservation of the human body
with its natural function and aesthetics. The concept of minimally
invasive (MI) treatment was initially
introduced in the medical field
and was adapted in dentistry in the
early 1970s with the application of
diamine silver fluoride.1 This was
followed by the development of
preventive resin restorations (PRR)2
in the 1980s and the atraumatic
restorative treatment (ART) approach3 and Carisolv4 in the 1990s.
The major components of MI dentistry are the risk assessment of the
disease with a focus on early detection and prevention; external and
internal re-mineralisation; use of
a range of restorations, bio-compatible dental materials and equipment; and surgical intervention
only when required and only after
any existing disease has been controlled.5–11
Current basic treatment protocols (TPs) and approaches in MI
dentistry are the use of air abrasion,

laser treatment or sono abrasion to
gain cavity access and excavate infected carious tooth tissue through
selective caries removal or laser
treatment;12,13 cavity restoration by
applying ART, PRR, or sandwich
restoration; and the use of computer
controlled local anaesthesia delivery systems14 with emphasis on the
repair of a failed restoration rather
than its replacement.15 Thus far, the
focus of MI dentistry has been on
caries-related topics16 and has not
been comprehensively adopted in
other fields of dentistry. Dr Miles
Markley, one of the great leaders of preventive dentistry,
advocated that the loss of
even a part of a human
tooth should be considered
a serious injury and that
dentistry’s goal should be
to preserve healthy and
natural tooth structure. His
words are much more relevant in today’s cosmetic dental
practice, in which the demand
for cosmetic procedures is rapidly increasing. With the treatment
approach trend towards the more
invasive protocols, millions of
healthy teeth are aggressively prepared each year in the name of
smile makeovers and instant orthodontics, neglecting the long-term
health, function and aesthetics of
the oral tissues.

The need for a new concept
Contemporary aesthetic dentistry demands well-considered concepts and TPs that provide a simple,
comprehensive, patient-friendly
and MI approach with an emphasis
on psychology, health, function
and aesthetics (PHFA; Fig. 1). The
need for a holistic concept and
basic treatment guidelines was expressed by concerned practitioners,
aesthetic dentistry associations and

academics around the world for the
following basic reasons:
• Owing to an increased aesthetic
demand, aesthetic dentistry is becoming an integral part of general
dentistry. The aesthetic outcome
of any dental treatment plays a vital role in the patient’s treatment
satisfaction criteria.

aesthetic needs and the characteristics of the patient.
• Social trust in dentistry is degrading, owing to the trend of fulfilling
the cosmetic demands of patients
without ethical consideration and
sufficient scientific background
(the more you replace, the more
you earn; more is more mentality).
In this article, I introduce a concept and TP for minimally invasive
cosmetic dentistry (MICD), in order
to address these facts properly
and integrate the evidencebased MI philosophy and its
application into aesthetic
dentistry.

Defining MICD

Fig. 1

• MI dentistry currently focuses on
prevention, re-mineralisation and
minimal dental intervention in
the management of dental carious
lesions. It has failed to give the necessary attention to the problems
that negatively affect smile aesthetics, for example non-carious
dental lesions, or developmental
defects and malocclusion.
• The treatment modalities of contemporary cosmetic dentistry are
trending towards more invasive
procedures with an over-utilisation of crowns, bridges, thick full
veneers, and invasive periodontal
aesthetic surgeries, while neglecting long-term oral health, actual

As the perception of
aesthetics and beauty is
extremely subjective and
largely influenced by personal beliefs, trends, fashion, and input from the media, a universally applicable
definition is not available.
Hence, smile aesthetics is a multifactorial issue that needs to be adequately addressed during aesthetic
treatment.17 MICD deals both with
subjective and objective issues.
Therefore, in this article I define
MICD as “a holistic approach that
explores the smile defects and
aesthetic desires of a patient at an
early stage and treats them using
the least intervention options in
diagnosis and treatment technology
by considering the psychology,
health, function and aesthetics of
the patient.”18
The core MICD principles are:
1. application of the-sooner-the-better
approach and exploration of the
patient’s smile defects and aesthetics desires at an early stage in

order to minimise invasive treatments in the future;
2. smile design in consideration of
the psychology, health, function
and aesthetics (Smile Design
Wheel18) of the patient;
3. adoption of the do-no-harm strategy in the selection of treatment
procedures and the maximum
possible preservation of healthy
oral tissues;
4. selection of dental materials and
equipment that support MI treatment options in an evidencebased approach;
5. encouragement of the keep-intouch relationship with the patient to facilitate regular maintenance, timely repair and strict
evaluation of the aesthetic work
performed.
The main MICD benefits include:
1. promotion of health, function and
aesthetics of the oral tissues and
positive impact on the quality of
life of the patient;
2. preservation of sound tooth structures (banking the tooth structure), while achieving the desired
aesthetic result;
3. reduction of treatment fear and
increased patient confidence;
4. promotion of trust and enhancement of professional image.

The MICD treatment
protocol
In my experience, the TPs that
are currently in use in aesthetic dentistry are mostly based on more invasive techniques and procedures.
With the use of such protocols,
cosmetic dentists are knowingly,
or unknowingly, heading towards
the over-utilisation of invasive
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[12] => untitled

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Seite 2

DENTAL TRIBUNE Asia Pacific Edition

12 Trends & Applications
DT Page 11

technologies in their practices,
which is becoming a professional
and ethical concern. The basic aim of
the MICD TP is to guide practitioners
in achieving optimum results with
as little intervention as possible.
The intervention level of the treatment in MICD depends on the type of
smile defects and the aesthetic needs
(objective measurement and subjective perception) of the patient.
The basic framework and pathway of the MICD TP are illustrated
in Figures 2 and 3. It is to be noted
that the TP in medical and dental
sciences must be dynamic in nature
and should be flexible to incorporate evidence-based facts. I have
therefore outlined the MICD core
principles that are required to
achieve the optimum result in terms
of health, function and aesthetics
with minimum intervention and optimal patient satisfaction. However,
it is the practitioner’s duty to incorporate all the necessary guidelines,
protocols and regulations of the au-

thority concerned (state or affiliated
professional organisations) into the
MICD TP.
Phase I: Understand
In the first step of Phase I, the
perception, lifestyle, personality,
and desires of the patient are explored. The primary goal of this first
step is a better patient–dentist understanding. As the aesthetic perceptions of the dentist and the patient may differ, it is imperative to
understand the subjective aesthetic
perception of the patient. Various
types of questions, personal interviews and visual aids can be used
as supporting tools. In this step,
the practitioner should ask the
patient to complete the MICD self
smile-evaluation form. The information obtained will help estimate
the perceived smile aesthetic score
(a-score) and will be used as the
base-line data in the evaluation step.
Next, diseases, force elements
and aesthetic defects of smile
are explored. Information on the
medical and dental history, general

Cleaning and disinfection
of surfaces

With the aid of this simple
grading system, any practitioner
can determine the complexity of the
treatment involved for the accomplishment of a new smile design for
an individual patient and can plan
for the necessary multidisciplinary
support.

Fig. 2

health and specific health (oralfacial) of the patient is collected and
complete dental and periodontal
charting is performed. In order to
understand the force elements, the
existing occlusion, comfort, muscular activity, speech and phonetics
are thoroughly examined with the
evaluation of para-functional and
other oral habits, comfort during
mastication and deglutition, and
temporo-mandibular joints (TMJ)
movements. The necessary diagnostic tests, photographic documentation and the diagnostic study
models are prepared during this
step for the further exploration of
existing diseases, force elements
and aesthetic defects.
In the following step, the data
collected is analysed in relation to
the accepted normal values of a patient’s sex, race and age (SRA) factors. The aesthetic components of
the smile are analysed in detail
grouped into macro- (facial and
dental midline relation, facial profile, symmetry of the facial thirds
and hemi-faces), mini- (visibility of
upper anterior teeth, smile arc,
smile symmetry, buccal corridor,
display zone, smile index and lip
line) and micro-aesthetics (dental:
central dominance, teeth proportion, axial inclination, incisal embrasure, contact-point progression,
shade progression, surface texture;
gingival: shape, contour, embrasure
and zenith height). The practitioner
can now grade the smile in terms
of the patient’s health, function and
aesthetics as follows:
• Grade A: The established parameters of oral health, function and
aesthetics are within normal limits
and aesthetic enhancement is
required only to fulfil the patient’s
cosmetic desires.
• Grade B: The established parameters of oral health and function are
within normal limits; however, the
aesthetic parameters are below
the accepted level. Aesthetic enhancement can further improve
the aesthetic parameters.
• Grade C: The established parameters of oral health or function or
both are below the normal limits.
An establishment treatment is
mandatory prior to aesthetic enhancement.
From the above, the practitioner
will obtain a smile aesthetic grading
in terms of the patient’s health, function and aesthetics, as well as a complete overview over the smile aesthetic problems and the macro-,
mini- and micro-smile defects.
The patient’s PHFA factors are
the four fundamental components

of aesthetic dentistry18 and must
be respected to achieve healthy,
harmonious and beautiful smiles.
The design step depends on the
information obtained from exploration and analysis. The information on psychology is subjective in
nature; however, health, function
and aesthetic analysis provides the
objective information that will
guide the design with the various established and basic principles of
smile aesthetics and also the feasible and practical extent of the
aesthetic desires of the patient. The
aesthetic mock-up, manual tracing,
digital makeover and smile catalogues are some of the popular tools
used in this step. A new smile, alternative designs, types of treatments
involved, complexity, possible risk
factors and complications, treatment
limitation, and tentative costs should
be established during this step.

The last step of this phase is
the most important in MICD TP
because in this step the patient is
presented with an image of his or
her future smile. Visual aids, such
as a smile catalogue, aesthetic
mock-ups, manual sketches, modified digital pictures, computerdesigned makeovers or animations
can be used as presentation tools.
The results of the design step are
systematically presented to the
patient with professional honesty
and ethics. All pertinent queries of
the patient related to the proposed
smile need to be addressed during
presentation. The treatment complexity, its limitations, the risks
involved, possible complications,
treatment cost estimation and
maintenance responsibility must
properly be explained to the patient. The patient is thus involved
in finalising the treatment plan
and will sign the written informed
consent form before proceeding to
Phase II.
Phase II: Achieve
As per the TP, which is finalised
during the presentation step, all
necessary preventive interceptive
and restorative (curative) dental
treatments are conducted in order
to establish the proper health and

Fig. 3

For easy application, the aesthetic treatments in MICD are categorised as follows:
• Type I: Micro-aesthetic components;
• Type II: Mini-aesthetic components; and
• Type III: Macro-aesthetic components: facial and dental midline
relation, facial profile, symmetry
of facial thirds and hemi-faces.
As the treatment modality depends on the professional capability
and experience of the practitioner,
simple and practical methods are
used to categorise the MICD treatment complexity:
• Grade I: Treatment that may require consultation with a specialist (preventive, simple oral surgery/endodontics/periodontics/
implants, short orthodontics);
• Grade II: Treatment that requires
the procedural involvement of
other dental specialists (complex
endodontics/periodontics/orthodontics) but not oral and maxillofacial surgery or plastic surgery;
and
• Grade III: Treatment that requires
the procedural involvement of
oral and maxillofacial surgery or
plastic surgery.

function of the oral tissues. Owing
to the complexity of the treatment,
a multidisciplinary approach may
be necessary for a good result. Once
the case is stable in terms of health
(controlled disease) and function
(balanced force elements) with good
oral habits, the patient is requested
to re-evaluate his or her smile in
terms of aesthetics with the help of
the MICD self smile re-evaluation
form. This is important, because in
some cases the patient is fully satisfied with the results of the establishment step alone and may modify his
or her idea of further aesthetic enhancement. In MICD TP it is considered unethical should the practitioner not collect self smile re-evaluation information from the patient.
The enhancement step of MICD
is focused on the fulfilment of the
patient’s aesthetic desires, which
can be grouped into two categories
based on the patient’s needs and
wants. Even though it is sometimes
difficult to draw a clear line between
the two and their related treatment,
in MICD they are categorised as
follows:
• needs: objective restorative needs
of the patient in harmony with
DT page 14

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DENTAL TRIBUNE Asia Pacific Edition

14 Trends & Applications
aesthetic enhancement procedures.
Hence, MICD emphasises the keepin-touch concept and encourages
patients to go for regular follow-up
visits. Responsibility for maintenance is grouped into two categories:

Fig. 4a: Gummy smile with lack of upper central dominance.—Fig. 4b: Harmonised smile with proper central dominance. Treated with MI approach.

Fig. 5a: Smile after establishment treatment.—Fig. 5b: Smile aesthetic enhancement with non-invasive veneers treatment.
DT Page 12

the SRA factors and due emphasis
on health and function of oral
tissues (naturo-mimetic smile
enhancement)
• wants: subjective desires of the
patient, which may not be in
harmony with the SRA factors
(cosmetic smile enhancement)
During any want-based aesthetic treatment, where healthy oral
tissue is treated with no direct benAD

efit to health or function, the treatment modalities should be within
the scope of non-invasive (NI) or
MI procedures.19 The patient’s
cosmetic desires alone should not
be the rational for the treatment.20
Do no harm! should always be
the credo pertinent to all dental
treatment procedures.
Phase III: Keep in touch
Regular maintenance, compliance and timely repair play a crucial
role in the long-term success of

• Self-care: Patients are advised
to continue their normal oral
hygiene procedures. If necessary, special care and precautionary methods are given, as well
as protective devices. Self-care
should focus on regular tooth
brushing, flossing, the use of prescribed protective devices and
other pertinent professional advice for maintaining general
health.
• Professional care: The oral habits,
health of the oral tissues, and the
functional and aesthetic status of
the work preformed are well documented during each follow-up
visit, and necessary maintenance
repair jobs are carried out.
Evaluation is the final step of
MICD TP. Any ‘completed’ treatment without a proper evaluation
is considered incomplete in MICD
protocol. The following components need to be evaluated:
• Global patient satisfaction: After
receiving aesthetic dental treat-

MICD treatment options
NI treatment options
Smile training
Tooth whitening
Re-mineralisation of white spots
Short orthodontics (sectional)
Non-preparation veneers
Enamel augmentation
Adhesive pontic
(long-term temporary restoration)
Oral appliance

MI treatment options
Micro- and macro-abrasion
Selective contouring (gums/teeth)
Direct restorations
with minimal tooth preparation
Minimal Preparation
Adhesive Brigdes
Veneers, inlays and onlays
MI implants

Table 1

ment, the patient is requested to
complete the MICD exit form, in
which the patient evaluates his
or her new smile, gives a second
perceived smile aesthetic score
(b-score), and indicates his or
her global satisfaction score. The
b-score is compared with the previous a-score. This process helps
determine the patient’s actual
satisfaction status. In MICD, this
is the main parameter for evaluating a patient’s aesthetic satisfaction.
• Clinical success: Clinical success
is a multifactorial issue. Selection
of proper cases (the patient),
restorative materials, TPs and
their correct and skilful application are the key factors for clinical
success. Therefore, MICD TP
suggests self-evaluation of the
following four factors (4Ps) using
the MICD clinical evaluation
form:
– Patient factors: regular maintenance status, compliance issues
and attitude of the patient towards aesthetic treatment;
– Product factors: bio-compatibility, mechanical and aesthetic
quality of the products used for
the treatment;
– Protocol factors:TP used in terms
of its simplicity, predictability
and its evidence-based nature;
– Professional factors: existing
knowledge and skills, and attitude towards developing these.
Detailed clinical documentation of the case during maintenance and evaluation can provide
various cues to the practitioner in
the evaluation of his or her clinical
success in terms of case planning,
material and protocol selection, as
well as his or her existing restorative skills. I believe that a thorough
evaluation can support any practitioner in initiating practice-based
research and keeping up-to-date
with the recent trend of evidencebased dentistry (Figs. 4a–5b).

Conclusion
MI dentistry was developed over
a decade ago by restorative experts
and founded on sound evidencebased principles.21–30 In dentistry, it
has focused mainly on prevention,
re-mineralisation and minimal
dental intervention in caries management and not given sufficient attention to other oral health problems. I believe that the MI philosophy should be the mantra adopted
comprehensively in every field of
the dentistry. For this reason, I have
explained the MICD concept and its
TP, which integrates the evidencebased MI philosophy into aesthetic
dentistry, in the hope that it will help
practitioners achieve optimum results in terms of health, function and
aesthetics with minimum treatment
intervention and optimum patient
satisfaction.

Acknowledgements
In formulating the MICD TP,
I discussed the concept with several
national and international colleagues in order to ensure that it is
simple, practical and comprehensive. I would like to extend my gratitude to Dr Akira Senda (Japan),
Dr Didier Dietschi (Switzerland),
Dr Hisashi Hisamitsu (Japan),
Dr Oliver Hennedige (Singapore),
Dr Dinos Kountouras (Greece),
Dr Mabi L. Singh (USA), Dr Ryuichi
Kondo (Japan), Dr So-Ran Kwon
(Korea), Dr Prafulla Thumati (India),
Dr Vijayaratnam Vijayakumaran
(Sri Lanka), as well as Dr Suhit R. Adhikari, Dr Rabindra Man Shrestha,
Dr Binod Acharya and Dr Dinesh
Bhusal of Nepal, for their valuable
comments, advice and feedback. DT
Editorial note: A complete list of references
and the MICD forms are available from
the publisher.

Contact Info

MICD treatment
modalities
Various types of treatment
modalities are available in MICD.
Their effective use depends on
the level of smile defects, type of
smile design, proposed treatment
type and the treatment complexity
grade. There is only one principle
in selecting treatment modalities
in MICD: always select the least
invasive procedure as the choice of
the treatment.
The two categories of MICD
treatment are NI and MI treatment
(Table 1). However, conventional
invasive treatment modalities may
also be required, depending on the
complexity of the case.

Dr Sushil Koirala is the founding
president of the Vedic Institute of
Smile Aesthetics and maintains
a private practice focusing primarily on MI cosmetic dentistry
(MICD). He can be contacted at
skoirala@wlink.com.np.

[15] => untitled

Anschnitt_DIN A3

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16:11 Uhr

Seite 1

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[16] => untitled

DTAP1209_16_18_TeeKhin

15.12.2009

11:48 Uhr

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DENTAL TRIBUNE Asia Pacific Edition

16 Trends & Applications

Complete maxillary implant
prosthodontic rehabilitation
utilising a CAD/CAM fixed prosthesis

Fig. 1: Pre-treatment intra-oral frontal view: A large space was noted between the intaglio surface of the prosthesis and the maxillary tissue, and there was significant tissue resorption on the labial surface of
the implant over the maxillary right canine area. The patient was asymptomatic.—Fig. 2: Full thickness flap revealed the advanced bone loss on the labial surface of the implant. In spite of the tissue damage,
this implant was clinically firm.—Fig. 3: Maxillary prosthesis before the application of tooth-coloured porcelain: Excessive crown length was noted at this stage.

Fig. 4: Completed maxillary prosthesis with gingival-coloured porcelain applied to provide adequate lip support: Excessive crown height was reduced.—Fig. 5: Anterior view showing the CAD/CAMfabricated full-ceramic implant abutments at the approximated vertical dimension of occlusion.—Fig. 6: Occlusal view of the maxillary arch before insertion of the maxillary prosthesis: Favourable anteriorposterior spread allowed the replacement of posterior teeth with distal cantilevering.
Dr Neo Tee-Khin, Dr Ansgar C. Cheng,
Dr Helena Lee & Ben Lim
Specialist Dental Group
Singapore

Endosseous implant treatment
has been widely reported as
a highly predictable treatment
modality with a low percentage
of clinical complications. PruAD

dent clinical judgement and
careful consideration of the risks
and benefits of various treatment options are essential for
the treatment planning and
long-term success of prosthodontic treatment.1
Traditional implant prostheses
are commonly fabricated using

acrylic resin teeth supported by a
metal framework. Significant space
is designed at the tissue surface
of the prosthesis to enhance oral
hygiene maintenance. However,
application of this prosthetic design
in the maxillary arch is occasionally aesthetically inadequate
and speech may be compromised.
Conventional porcelain-fusedto-metal-restorations require the
placement of labial restoration
margins below the free gingival
margin in order to mask the hue
and value transition between the
sub-gingival implant sub-structures and the supra-gingival crown
restorations. From a periodontal
point of view, sub-gingival placement of restoration margins is related to adverse periodontal tissue
response.2–5 As a result, restoration
margins are best placed coronally
from the free gingival margin.4,5
Porcelain-fused-to-metal restorations are commonly used
in the posterior teeth because of
their well-documented long-term
clinical track record.6–13 CAD/
CAM ceramic-based materials are
prescribed nowadays, owing to
their demonstrated promising
physical properties14,15 and clinical
longevity.16
This article describes the clinical application of high-strength
zirconium oxide restorations in
the prosthodontic management
of an edentulous maxilla with a
failing implant prosthesis.

Clinical report
A 62-year-old female with
an implant-supported maxillary
prosthesis was evaluated at the

Specialist Dental Group in Singapore. She presented clinically with
a maxillary fixed complete denture supported by six endosseous
implants (NobelReplace, Tapered
Groovy, Nobel Biocare). The prosthesis had acrylic resin teeth supported by a gold alloy metal framework. The implant at the patient’s
maxillary right canine area was
exposed. No symptoms were reported by the patient (Fig. 1).
An occlusal examination revealed a stable maximal inter-cuspation position with insignificant
centric relation to maximal intercuspation slide at the teeth level.
A canine-guided occlusal scheme
was noted. No para-functional
habits were reported. Sub-optimal
maxillary lip support was noted.
A significant amount of dead space
was identified between the intaglio surface of the prosthesis and
the maxillary soft tissue.
Upon removal of the maxillary
prosthesis, all the maxillary implants were found to be osseo-integrated. The patient desired to
correct the failing implant, restore
lip support, masticatory function
and facial aesthetics.
The overall treatment plan
included removal of the implant
at the maxillary right canine area,
replacement of a new implant at
the maxillary right canine region
and fabrication of a full-arch,
zirconium oxide-based ceramic
restoration in the maxilla.
Under local anaesthesia, the
implant at the maxillary right canine area was removed surgically
(Fig. 2) and a new 13 mm-long reg-

ular platform implant was placed
(NobelReplace, Tapered Groovy).
The new implant was submerged
and primary wound closure
achieved. Her existing prosthesis
was re-inserted during the healing
period to serve as a provisional
prosthesis. Once osseo-integration was achieved a few months
later, the new implant was exposed
and the maxilla was ready for
prosthodontic rehabilitation after
a few weeks of soft-tissue healing.
Six implant-level impression
copings (NobelReplace) were
placed onto the maxillary implants. High-viscosity, vinyl polysiloxane material (Aquasil Ultra
Heavy, DENTSPLY DeTrey) was
carefully injected around all the
impression copings. A stock tray
loaded with putty material (Aquasil Putty, DENTSPLY DeTrey) was
seated over the entire maxillary
arch to make the definitive impression. A jaw-relation record
at the treatment vertical dimension was made with a vinyl polysiloxane material (Regisil PB,
DENTSPLY DeTrey). The maxillary and mandibular definitive
casts were mounted arbitrarily in
the centre of a semi-adjustable articulator (Hanau Wide-vue, Teledyne Waterpik) using average settings.17,18 The custom zirconium
oxide abutments with gold-alloy
fitting surface (Procera, Nobel Biocare) were CAD/CAM fabricated
according to the prosthesis design.
The development of the
planned definitive maxillary restoration was carried out using a
CAD/CAM process. The maxillary
DT page 18

[17] => untitled

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[18] => untitled

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DENTAL TRIBUNE Asia Pacific Edition

18 Trends & Applications
DT Page 16

Fig. 7: Completed maxillary implant-supported prosthesis; note the placement
of the supra-gingival margins.

definitive cast with the custom
full-ceramic abutments were
scanned (Zeno Scan, WIELAND
Dental+Technik), and the prosthesis framework was designed
using a software program (D700,
3Shape). The framework was
milled in zirconium-base material
(Zeno Zr Bridge, WIELAND Dental+Technik) with a milling machine (Zeno 4030 M1, WIELAND
Dental+Technik). The prosthesis
framework was sintered according to the manufacturer’s recom-

mendations. Subsequently, overlaying low-fusing, tooth-coloured
porcelain material (IPS e.max,
Ivoclar Vivadent) was manually
applied onto the exterior to create
proper anatomic form (Fig. 3).
Low-fusing, gingival-coloured
porcelain material (IPS e.max)
was applied to create proper lip
support (Fig. 4).
During the delivery clinical
session, the old prosthesis was removed and the new custom abutments were torqued to 32 Ncm
(Fig. 5). The new prosthesis was

FDI Annual World Dental Congress

2-5 September 2010
Salvador da Bahia, Brazil

tried-in to verify colour, occlusion,
lip support, teeth form, and comfort. Upon confirmation of the
patient’s acceptance, the implant
abutments were sealed in guttapercha (Fig. 6) and the prosthesis
was cemented in resin-modified
glass-ionomer luting agent (RelyX
Unicem, 3M ESPE).
The patient was evaluated two
weeks post-operatively. Anterior
guided occlusal schemes were
verified intra-orally before and
after prosthesis cementation
(Fig. 7). The patient reported
no discomfort and she had been
functioning well with the new
restorations. No abnormal clinical
signs were noted.

Discussion
Osseo-integration is a welldocumented and predictable clinical treatment option. On the other
hand, management of implant
failure is also a clinical reality.
In this clinical report, the failure of
one implant at a crucial location indicated the need for re-fabrication
of the whole implant prosthesis.
As the patient desired a high
level of aesthetics, full-ceramic
restorations were selected. By
prescribing tooth-coloured ceramic abutments and full-ceramic
restorations, prosthesis margins
were made at the gingival level
and gingival retraction procedures were eliminated during impression and prosthesis insertion.
Full-arch prosthodontic rehabilitation using fixed prostheses
usually requires longer-term
provisional restoration in order
to facilitate a predictable treatment outcome. In this patient,
the existing maxillary prosthesis
served as a long-term provisional
restoration for verifying her adaptability and multiple professional
clinical adjustments of provisional
restorations were not required. This
treatment sequence increased the
margin of safety in the execution of
the definitive full-ceramic restoration. Intra-oral verification of the
new treatment occlusal scheme
and detailed in situ clinical adjustment of the restorations on the day
of prostheses insertion still formed
the essential foundation for proper
treatment execution. In any major
prosthodontic treatment, the patient should be informed of the
potential financial and time implications should the need for re-fabrication of the restorations arise.

Conclusion
The functional management
of an edentulous maxilla using
a full-ceramic implant-supported
maxillary prosthesis has been
reported. New CAD/CAM-based
restorative materials were used
in treating this case. The use of
high-strength full-ceramic restorations enhances overall aesthetic
predictability and long-term functional outcome. DT

congress@fdiworldental.org

www.fdiworldental.org

Editorial note: A complete list of references is available from the publisher.

Contact Info
Dr Ansgar C. Cheng can be
contacted at drcheng@specialist
dentalgroup.com

[19] => untitled

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15.12.2009

11:50 Uhr

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DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 19

“HIV tests should be offered in every dental practice”
An interview with Dr Catrise Austin, VIP Smiles, New York
unaware that they are HIV/
AIDS infected. Do you think
that regular checks in dental
practices could help to create
more awareness of the disease?
That is something I would
like to see happening as more
dentists begin administering
the test. It is time to recognise
that we should be concerned
with the patient’s holistic
health not only his or her oral
health.

like HIV/AIDS or Tuberculoses in the first place?
My opinion is that HIV tests
should be offered in every dental practice because the oral
cavity is one of the first places
that shows signs of HIV infection. You can detect signs
of herpes and other sexually
transmitted diseases in the
mouth as well, and so we look
for lesions and other signs or
symptoms of the disease.

Dr Catrise Austin

According to the latest figures from the United Nations
Organisation UNAIDS, more
than 34 million people worldwide are currently living
with the HIV virus. Since it
can take up to ten years before progressing to AIDS,
early testing can be a life-saving factor. New tests for HIV
checks in dental practices
have recently been developed. Dental Tribune Asia
Pacific met with Dr Catrise
Austin, who maintains a dental practice on 57th Street in
New York City, to speak about
HIV testing in her practice
and how such testing could
help to create a heightened
awareness of the disease
amongst patients.
Dental Tribune Asia Pacific:
Dr Austin, could you tell our
readers the reason you decided to offer free HIV tests to
your patients?
Dr Catrise Austin: The
idea for offering free HIV tests
to my patients arose earlier
this year once I had learnt that

I am currently not aware of
other tests that may diagnose
diseases other than HIV/AIDS;
it would be fantastic if we were
able to diagnose everything
through the mouth.
How does the test work?
The test is called OraSure
Quick and it tests for antibodies
in the blood system. It uses an
oral swab, which we take under the upper and lower lips
and place in a developing solution directly at the beginning
of our dental appointments.
The results are available
within 20 minutes and we can
start with normal treatment
immediately after we have
done the test.
Unfortunately, I often encounter scepticism from some
of my colleagues about the
comfort level and the way to
introduce the test to a patient
in a dental setting. I tell them
every time that the test is very
easy to apply without making
the patient feel uncomfortable.
I guess that like most new ideas
it takes some getting used
to, but it will be successful
because we are helping to
save people’s lives. So, we hope
to get more dentists all over

“It is time to recognise that
we should be concerned with
the patient’s holistic health
not only his or her oral health”
doctors other than medical
doctors can offer HIV testing in
their practices. I said to myself
why not add another service to
our existing checklist of lesions or cavities and give patients the opportunity to know
their status in a different
setting. I saw this as a unique
opportunity for me as a dentist
to diagnose HIV in its early
stages.

the world interested in offering
the test because it is easy for
the patients and takes only
a little bit of time.

Unfortunately, the virus is
still highly prevalent. In New
York City alone, there are
94,000 confirmed cases and
it seems that the number of
infections is not improving in
2009/2010.

Is the test optional?
The test is completely optional and we offer it to all our
patients, from teenagers who
are in high school and probably
sexually active to those in
their 60s and older. We do not
discriminate because the virus
does not discriminate. Since
we began administering the
test in August, we have offered
it to about 150 patients of which
about 60 per cent have taken it.
Fortunately, we did not have
any positive testing so far.

Why should dental offices
test for infectious diseases

What happens if a patient
tests positive?

Patients have to fill out a consent form before taking the test. (DTI/Photo Daniel
Zimmermann)

We are fully trained and
prepared in case a test is positive. If a patient tests positive,
we counsel him or her immediately and help him or her call
their primary health physician
to schedule a confirmatory
test. It is important to note
that the test that we offer is
a screening test only and not

a confirmed test. If a patient
does not have a physician, we
usually refer him or her to one
of the clinics in the New York
City area with which we have
a partnership.
There are thousands of
people in the US and more
around the world who are

I am the first dentist in
New York to offer the test and
I would love to be the trailblazer and help to make the
test the standard of care in
dental practices around the
world. The greatest joy for
me is when a patient says that
he or she would have never
undergone this test if it were
not for me.
Thank you very much for
the interview. DT
AD

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Anschnitt_DIN A3

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10:07 Uhr

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• Fully accredited, with 25 years of experience
teaching Ortho and 10 yrs of experience in
Internet Assisted Training (IAT) Program
• You will be able to do a wide variety of
cases, including the most difﬁcult, with our
comprehensive training
• Lifetime Free Retake policy in either live or
internet format for the rest of your career...the
best support in the industry
• Study at your own pace, on your own time, from
anywhere in the world = less time away from
your practice
• Regional Locations allow students from all
areas of the world access to live portion

Internet
Assisted Training
300 Hours Self Study
+
10 Days Live Seminars in 3 modules
IAT MODULE 1 LOCATIONS & DATES

Hong Kong
June 4-7, 2010

Vietnam
Early 2010
Beijing, China June 18-21, 2010
Sacramento, CA, USA February 19-22, 2010
Ceasarea, Israel April 26-29, 2010
Dubai, UAE March 23-26, 2010

High Tech Teaching
At Progressive, we use technology to give us every
advantage in the classroom and the clinic
• IPSoft™ diagnostic software (included free with series):
get the best diagnosis every time
• Online Case Diagnosis: get instructor help at any time
• Clinical Videos: help you visualize our concepts
• Online Forum: discuss ortho with thousands of colleagues

Aliso Viejo, USA • San Jose, USA • Sacramento, USA • Seattle, USA • Phoenix, USA • Houston, USA • Detroit, USA • Atlanta, USA • Miami, USA • Washington DC, USA • New York, USA • Bilbao, Spain • Madrid, Spain
Amsterdam, Holland • Vienna, Austria • Germany • London, England • Tel Aviv, Israel • Dubai, UAE • Singapore • Sydney, Australia • Melbourne, Australia • Auckland, New Zealand • Hong Kong • Beijing, China

INFO@POSORTHO.NET
WWW.POSORTHO.COM

+1 714 973 2266 (USA)
+61 2 8883 2122 (Australia)

+65 6444 0546 (Singapore) +31 20 647 2272 (Holland)
+34 94 636 1096 (Spain)
+43 7259 32028 (Austria)

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