DT Asia Pacific No. 10, 2011
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DTAP1011_01_Title
DTAP1011_01_Title 28.10.11 16:22 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG
www.dental-tribune.asia
Passive income
Methods for exit planning
and retirement funding
4Page
13
NO. 10 VOL. 9
Violence in healthcare
Prof. Shepherd about
prevention strategies
4Page
Anterior restorations
An unconventional method
with press ceramics
14
4Page
16
Dog stem cells
Zimmer reveals Next Gen dental implant
let
bone
grow
design with osseoincorporation functionality
Stem cells derived from dog
teeth and dental pulp have shown
the potential to help re-grow
bone tissue when transplanted
into a parent animal, scientists
from the Nagoya University
School of Medicine in Japan report. Their discovery could pave
the way for stem cell therapy in
oral maxillo-facial surgery and
other medical fields like the reconstruction of bone tissue of the
musculoskeletal system.
Daniel Zimmermann
DTI
ATHENS, Greece: A Tapered
Screw-Vent implant featuring
osseoincorporation was revealed
by US manufacturer Zimmer
Dental at the Annual Congress
of the European Association
for Osseointegration (EAO) last
month in Athens in Greece.
The new design has an osteoconductive midsection made of
Trabecular Metal, a highly biocompatible material with a
structure similar to cancellous
bone, and is compatible with the
company’s Tapered Screw-Vent
Surgical Kit and range of prosthetics.
Trabecular Metal has been
already used for more than a
decade in many of Zimmer’s orthopaedic devices. Made from
tantalum, a rare and highly corrosion resistant metal already
used in the fabrication of dental
implants since the 1950s, it offers
high porosity that allows bone
around implant sites to grow not
only onto the material but also
into it—a process known as osseoincorporation.
The new implant design with the porous osteoconductive midsection made of Trabecular Metal. (DTI/Photo Annemarie Fischer)
Zimmer acquired the technology from an acquisition of the
Implex Corporation in 2003.
Studies on dental implants
containing Trabecular Metal in
canine mandibular models began in 2010 and showed evidence
of ingrowth by maturing bone as
early as two weeks after implantation. According to the company,
data collection from human trials,
is currently being done with the
first long-term results expected
to be available soon.
Zimmer has gained CE approval for the implant in Europe
and anticipates market approval
for the USA through the Food
and Drug Administration in
the upcoming weeks. Information about when the implant
will be first available to implant
specialists in Asian markets
was not disclosed at the EAO
meeting. DT
In their pre-clinical study, the
researchers extracted primary
teeth from puppies and grafted
them onto parent canine jawbones as an allograft. Evaluating
the progress of bone formation
after several weeks, they found
that defects had been repaired
were prepared and demonstrated well-formed mature bone and
neovascularisation.
The findings could mean an
alternative donor source for
autogenous bone grafting, the
researchers said. Common methods use the patient’s own bone
tissue, which can be problematic
owing to a sometimes limited supply of autogenous bone and the
invasiveness of the procedure. DT
AD
Philips divests
Discus unit to
SybronEndo
A woman showing off her false crooked canines. Veneers that make teeth look imperfect
are one of the latest fashion trends in Japan. (DTI/Photo Dental Salon Plaisir, Japan)
Bacteria linked
Beijing teams up
pancreatic cancer with Colgate
Particular types of oral bacteria, some of which are found in
gum disease, are associated with
the development of pancreatic
cancer, a study has reported. According to the US researchers, the
finding might make it possible to
halt the progress of one of the most
difficult cancers to treat by altering the balance of bacteria. DT
The China office of ColgatePalmolive is providing free dental checks for more than one million children in primary schools
through a mobile service. The
tour is organised in partnership
with the Chinese government in
order to improve the nation’s oral
health, Ministry of Health representatives said. DT
SybronEndo has announced
that it has acquired the endodontic business unit from Discus
Dental, a US dental company
currently held by Royal Philips
Electronics. The takeover will
take effect immediately and includes Discus’ entire product
range of irrigation systems and
other products under the Smart
Endo brand, as well as patents
and licenses, the company said in
a press release.
On their websites, both companies advise customers to contact their local SybronEndo representatives for all future Discus
Dental product orders. Further
information were not disclosed.
Discus Dental was acquired
by Dutch consumables manufacturer Philips almost a year
ago. DT
Distinguished by innovation
We shape the future of dentistry with our innovative products and systems. They
distinguish us – in the field of restoratives, all-ceramics and esthetic prosthetic
solutions. A wealth of experience, great commitment and innovative ideas help us
to always find the optimum solution for high-quality products that allow you to
make people smile.
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Principality of Liechtenstein
Tel. +423 / 235 35 35 | Fax +423 / 235 33 60
[2] =>
DTAP1011_01_Title
DTAP1011_02_News 28.10.11 16:23 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
AD
New court ruling could mean end
to fast food in Indian schools
From news reports
NEW DELHI, India: The High
Court in Delhi has ruled in favour
of a public petition that urges the
Indian government to take action for changing food policies in
schools and colleges nationwide.
The directive also suggests a sale
ban on fast food in and within half
a kilometre of school premises.
The consumption of fast food
has dramatically increased in
India with global brands like
McDonalds or KFC slowly replacing food courts selling traditional
favourites like dosa or bonda. At
the same time, its negative effects
have also increased including
obesity, diabetes or tooth erosion
from acids found in fizzy drinks.
A recent study conducted by researchers from the KLES’s Institute of Dental Sciences in Belgaum found that approximately
one in three Indian children aged
A McDonalds fast food restaurant in Dehli. (DTI/Photo paul prescott)
5 to 6 were already suffering from
tooth wear and erosion of enamel.
Representatives of Uday foundation, the Delhi-based organisation who filed the petition, welcomed the decision of the High
Court which they say could help
to enhance the health as well educational outcomes of schoolchildren in the long-run.
Under the directive, the government will have to deliver first
reports about actions taken by
beginning of November. Representatives of the Ministry of
Health told the online news portal
OneIndia that it recently sent out
written requests to all states to follow guidelines for providing safe
and health food in educational
institutions. DT
Liberalisation of health care market
in Malaysia encounters resistance
From news reports
KUALA LUMPUR, Malaysia:
Criticism about a new rule that
will allow foreigners to fully own
hospitals in Malaysia has been
rejected by the country’s Ministry
of Health. The government revealed its intentions to liberalise
the health care market during
their 2012 Budget announcement
last month, which professional
organisations claim could open
the sector for unqualified doctors
or dentists.
At a press conference in Kuala
Lumpur, Health Minister Datuk
Seri Liow Tiong Lai reacted to the
criticism saying the quality of doctors would be assured by the
Malaysian Medical Council, a government body who is responsible
for the registration of medical professionals. He told the reporters
that the liberalisation could bring
long-term benefits for the industry
such as to make the country more
attractive to medical tourist or lure
Malaysian doctors back who are
currently serving overseas.
The Malaysia Medical Association has raised concerns about
the plans by saying that checks for
foreigners are currently inadequate and need revision including
the introduction of a national specialist register to avoid unqualified doctors and dentists to enter
the market. They also said that
such a move was unnecessary and
could penalise local doctors.
The Malaysian Dental Association did not comment on the
matter yet. 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
Editors
Claudia Salwiczek
President/CEO
Torsten Oemus
Editorial Assistant
Yvonne Bachmann
Marketing & Sales
Matthias Diessner
Vera Baptist
Peter Witteczek
Director of Finance & Controlling
Marketing & Sales Services
License Inquiries
Accounting
Product Manager
Executive Producer
Ad Production
Designer
Dan Wunderlich
Nadine Parczyk
Jörg Warschat
Manuela Hunger
Bernhard Moldenhauer
Gernot Meyer
Marius Mezger
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.
© 2011, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information
and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility
for product names or claims, or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International.
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Tel.: +49 341 48474-302 · Fax: +49 341 48474-173
Internet: www.dental-tribune.com E-mail: info@dental-tribune.com
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The Americas
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116 West 23rd Street, Suite 500, New York, NY 10001, USA
Tel.: +1 212 244 7181 · Fax: +1 212 224 7185
[3] =>
DTAP1011_01_Title
DTAP1011_03_News 28.10.11 16:24 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Asia News
3
Oral health challenges remain high in Southeast Asia, expert says
From news reports
SEATTLE, USA: One of Thailand’s leading epidemiologist
Scrutinised
over benefits
has said that oral health issues
remain a burden in most Southeast Asian societies. During a
keynote speech she held on the
occasion of the annual Research
Day organised by the University
of Washington’s (UW) School
of Dentistry in Seattle in the US,
Dr Waranuch Pitiphat pointed
out that many people in the region still lack access to adequate
dental care partly owing to the
insufficient number and poor
distribution of health care workers including dentists.
In addition, infection control
in dental clinics in some of these
countries is still highly inadequate, she said. She urged dental students to consider global
oral health in their research
agenda.
Research Day is an annual
event held by the UW School of
Dentistry to recognise its standing as a US leader in dental research. Besides Dr Pitiphat, this
year’s event also saw participation by UW staffers Dr Tim
DeRouen, Dr Christy McKinney
and Dr Carey Farquhar.
Harvard-educated Dr Pitiphat
who is currently working as
Associate Dean for Research,
graduate Studies and International Affairs for Khon Kaen
University, an international recognised school of higher education in Thailand, has been
cooperating with UW for five
years in order to train oral health
clinical researchers. The programme which also includes
Thammasat University in Bangkok recently received a million
dollar grant from the US National Institute of Health to
continue operations for another
five years. DT
AD
Daniel Zimmermann
DTI
HONG KONG/LEIPZIG, Germany:
Investigations by the Australian
Department of Health and Ageing are currently underway into
the misuse of government funds
for dental services provided to
patients under the Chronic Disease Dental Scheme. It has been
reported that more than 600 dentists nationwide are suspected
to have received money from
Medicaid, a government health
programme, for dental work that
was never done or lacked the
required paperwork.
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everyy indication1,2
The news could mean the final blow for the scheme, which
has been under attack by the
Gillard government for quite
some time to be replaced by a programme targeting mainly pensioners and disadvantaged people. Under the Chronic Disease
Dental Scheme, patients with
chronic illnesses and complex
care needs were able to claim
AUS$4,250 (US$4,000) in benefits
for dental services conducted by
a Medicare-enrolled dentist over
two consecutive years.
down to 3
– 4 weeks3
3–4
Reduced healing times from 6
6–8
– 8 weeks
Increased treatment predictability in critical protocols1
More information on www.straumann.com
Dentist representatives welcomed the government initiative
to detail dental spending from
Medicare but warned about putting dentists under general suspicion because administrative
requirements for the scheme are
unclear and patient eligibility
usually determined by GPs.
“Rather than deal with any
issues around dentists not fulfilling their administrative requirements at the time of the Scheme’s
implementation through an educative or conciliation process,
Medicare has waited two years after the dental care was delivered
to pursue recovery of monies,”
President of the Australian Dental
Association (ADA), Dr F. Shane
Fryer, said. He questioned the motivation behind the government
campaign, which he said could
force dentists into bankruptcy or
having to close their practices.
According to latest Medicare
estimates, the benefits misused
account for AUS$20 million
(US$19.2 million) paid to dentists
since 2007. To date, only 60 investigations have been completed,
the department said.
The branch of the ADA in
New South Wales, where the
majority of dentists believed to
be involved in the fraud practise,
has been reported to be raising
money for a potential lawsuit
against the government. DT
Ganeles
G aneles e
ett a
al.
l. C
Clin.
lin. O
Oral
ra l IImpl.
m p l. RRes.
e s. 2
2008;19:1119-1128
0 0 8;19:1119 -1128
Bornstein
B o rn st e in et
e t al.
a l. J Periodontol.
Pe rio d o n t o l. 2010
2010 Jun;81(6):809-819
J u n;81(6):8 0 9 - 819
3
Oates
O a t e s et
e t al.
a l. The
Th e International
I n t e rn a tio n a l Journal
J o u rn a l of
o f Oral
O ra l & Maxillofacial
M a xi l l o f a ci a l
Implants.
I m p l a n t s. 2007;22(5):755-760
20 07;22(5):755 -76 0
For
Fo r m
more
o re d
details
e t ail s ssee
e e ssummary
ummar y S
SLActive
L A ctive ® Scientific
S cie ntifiicc S
Studies.
t u die s.
1
2
[4] =>
DTAP1011_01_Title
DTAP1011_04_News 28.10.11 16:24 Seite 1
Opinion
DENTAL TRIBUNE Asia Pacific Edition
Dear
reader,
A revolution
4
Dr Ansgar Cheng
Singapore
The new Zimmer implant is
indeed a revolutionary concept because its macroscopic topography
is unique. The presence of screw
thread on the apical and coronal
portion allows this implant to be
used in immediate loading cases
and the non-threaded mid-section
offers a unique 3-D scaffold for
bone ingrowth, which may, in turn,
enhance the long-term bone and
implant contact and stability of
integration.
Daniel Zimmermann
DTI
Dr Pitiphat’s words of concern about the oral health situation in Southeast Asia come
at the right time. Unfortunately,
when I tried to contact her
for an interview, her Bangkok
home was under threat by
the floods that recently swept
through the capital of Thailand.
With no information about her
current situation, I can only
hope that she and her family
have survived the catastrophe
unharmed.
There is no doubt that poor
oral health remains a problem
from the slums in Rangpur to
the Lakes Plains in Western
Indonesia, even though its impact on the population is low
compared with other major
health problems in the region
like HIV/Aids or malaria. Quality of life, however, has many
facets and the ability to speak or
eat well and without pain is one
of them.
Oral health improvements
in boom markets like Singapore or Hong Kong have long
clouded deficits in countries
that have fallen behind the
economic rush. Governments,
health agencies and dentists
alike need to push for more dental programmes and initiatives
in order to close this gap. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International
Low priority for oral health
phasis on those factors that have
an impact on oral health.
Dr Masayuki Ueno
Japan
The devastating oral health
problems in Southeast Asian
countries, such as the lack of national oral health policies, inadequate infection control in dental
clinics, limited access to care,
and spotty distribution of healthcare workers, make investigation of the influence of social and
behavioural factors, as well as
risk factors, extremely urgent.
Growing globalisation and
resulting inequalities have hindered the promise of favourable
changes in oral health. Many
Southeast Asian countries are
facing various demographic and
socio-economic changes. Since
the social. political, cultural and
environmental climate has been
changing rapidly, prompt and appropriate programmes need to be
implemented. The focus should
be moved towards greater em-
Despite the magnitude of personal and community burdens
that oral health problems carry in
many Asian countries, it is apparent that the concerns of the general population about oral health
are relatively low, mainly because most oral diseases are not
serious or life threatening, but
also because oral health is perceived as a lower priority compared with other health and economic concerns. The importance of oral health should be
emphasised more strongly in the
development of health policies
and interventions.
For oral health-related measures to be successful, conventional treatment-oriented procedures are of little value in these
Asian countries, owing to limited
resources and personnel. Health
policies that emphasise health
promotion and prevention, as
well as empowerment and advocacy, are considered to be essential. To improve oral health effec-
tively, strategies that address the
underlying causes of poor oral
health situations by using a range
of additional strategies based on
economic, political and institutional aspects are necessary.
Bone research on similar
non-smooth titanium surfaces
has demonstrated enhanced
areas of bone/implant contact.
Bone ingrowth may also be
speeded up as a result of change in
bone-healing gene expression.
Community-based oral healthpromotion and oral disease-prevention programmes should be
implemented with the cooperation of other community residents,
health-care workers, the government and other health authorities.
It is desirable to integrate such
strategies with other health projects in schools, workplaces, and
communities. Since everyone
needs to be made aware of the
urgent oral health situation and its
consequences, the mass media
could be used to provide adequate
information to the public. DT
The combination of the internal prosthetic connection and new
implant surface probably represents the most contemporary design concept. The trabecular metal
mid-implant segment theoretically allows the maintenance of
osseointegration under high functional stress situations which may
be particularly beneficial in Type IV
bone with low density. Any clinicians with sufficient experience in
placing other screw-type endosseous implants should be able to
handle the clinical procedures.
Further long-term clinical outcome data would certainly confirm
the validity of this new design. DT
Contact Info
Contact Info
Dr Masayuki Ueno is Associate Professor at the Department of Oral
Health Promotion, Tokyo Medical
and Dental University, Japan. He can
be contacted at ueno.ohp@tmd.ac.jp.
Dr Ansgar Cheng is a prosthodontist at Specialist Dental Group in
Singapore. He can be contacted at
drcheng@specialistdentalgroup.com.
AD
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[5] =>
DTAP1011_01_Title
DTAP1011_05_News 28.10.11 16:26 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
World News
5
Tooth movement could be an
alternative to bone transplants
From news reports
GOTHENBURG, Sweden: Researchers at the University of
Gothenburg’s Sahlgrenska Academy have found a way to replace lost teeth without building
up the jaw artificially. With their
method, existing teeth are moved
into the toothless area using
a brace, which offers clinicians
a less complicated and painful
option for giving patients their
lost teeth back.
gitta Lindskog Stokland and her
colleagues also managed to
demonstrate that the same procedure in humans caused only small
changes in the tissue around the
tooth. “X-rays showed some damage to the root known as root
resorption, but this didn’t seem
to cause any lasting problems,”
Stokland said. “What’s more, our
follow-ups a year later showed
that the damage had lessened.”
The original site of the moved
tooth suffers a reduction in bone
mass and dental tissue volume,
though not to the same extent as
when teeth come out for other
The second premolar was moved orthodontically into an edentulous area with
reduced dimension. The final construction was an implant in the area of the original position of the second premolar. From left to right: Clinical situation before
treatment, at retention after orthodontic treatment, and one year after orthodontic treatment. (DTI/Pictures courtesy of Birgitta Lindskog Stokland, Stokland)
reasons. This means that this
area is well suited to implants or
other tooth replacements, without there being any need for bone
AD
UNIVERSAL DUO-SHADE NANO COMPOSITE
When we lose our teeth, because of illness or injury, the jaw
in the toothless area also decreases in volume. This reduction makes it difficult to carry out
dental implants, often leaving
just one option for replacing lost
teeth: building up the jaw with
a bone transplant.
In an experimental study on
dogs, the Swedish researchers
managed to use a brace to move
existing teeth into a toothless area
with limited bone volume, without any reduction in the tooth’s
natural attachment to the jaw.
In a subsequent clinical study,
consultant dental surgeon Bir-
EU regulates
whitening
From news reports
BRUSSELS, Belgium: The Council of the European Union has
adopted an amended directive on
teeth whitening products. The directive sets out differentiated rules
according to the level of hydrogen
peroxide in accordance with advice from the European Scientific
Committee on Consumer Safety.
Tooth whitening or bleaching
products containing up to 0.1 per
cent hydrogen peroxide will continue to be freely available on the
market to consumers. Products
containing concentrations higher
than 0.1 per cent and up to 6 per
cent will only be sold to dentists.
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For each cycle of use of the product, the first use will be by a dentist
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The dentist will then provide access to these products for the remainder of the cycle of use. Persons under 18 years of age will not
be allowed to use these products,
even under the supervision of a
dentist. Products containing more
than 6 per cent have been banned.
The previous European Cosmetics Directive only established
a maximum authorised concentration of hydrogen peroxide—
the main active ingredient in
tooth whitening products—at the
level of 0.1 per cent.
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The Member States will now
have 12 months to implement the
Directive into their national legislations. DT
transplants. “In other words,
many patients can be given more
teeth more easily,” Stokland
stated. DT
[6] =>
DTAP1011_01_Title
DTAP1011_06-07_News 28.10.11 16:26 Seite 1
6
DENTAL TRIBUNE Asia Pacific Edition
World News
Implantology in times of crisis
European Association for Osseointegration
celebrates annual congress in Athens
Daniel Zimmermann
DTI
IDEM12 210x297mm DTI US Ad.ai
9/7/11
2:40:28 PM
ATHENS, Greece/LEIPZIG, Germany:
The 20th annual congress of the
European Association for Osseointegration (EAO) took place
under less-than-ideal conditions.
Huge piles of garbage bags littered the narrow alleys of the
Greek capital, and metro buses
and trains were not running for
most of the time owing to the ongoing public service strikes. Furthermore, air-traffic controllers
in several European countries
AD
www.idem-singapore.com
THE BUSINESS OF DENTISTRY
threatened to stop working during the week in which the congress was to take place. Despite
these unfavourable circumstances, more than 3,000 dental clinicians and researchers in the field
of implantology attended the
dental implant event of the year,
which took place at the Megaron
Athens International Conference
Centre not far from the Presidential Mansion in Athens.
Since 1991, the Brusselsbased EAO has organised congresses in different European
cities annually, for example, in
the Scottish metropolis Glasgow
last year and the Principality of
Monaco in 2009. Despite the prevailing mood of the financial crisis, this year’s congress, organised in partnership with three
Greek dental organisations, went
relatively smoothly, the organiser
said. Speaking to Dental Tribune
in Athens, most visitors and exhibitors also expressed satisfaction with the scientific and
commercial offering. Their only
criticism was the distribution of
Dr Schlee from Germany discussing
Zimmer’s new implant design.
INTERNATIONAL DENTAL
EXHIBITION AND MEETING
APRIL 20 - 22, 2012
Limited space available. Secure your booth now!
We Bring the Asia Pacific Markets to You. IDEM Singapore connects you with
over 6,000 dental traders, distributers and practitioners from the Asia Pacific region.
Enriched with opportunities from the 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 professional.
Endorsed By
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Koelnmesse Inc
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Tel: +65 6500 6723
Fax: +65 6296 2771
s.sim@koelnmesse.com.sg
booths over three levels inside
the venue that seemed to favour
only those companies exhibiting
on the ground level. Improvements in this regard were announced, however, by the organisers for next year’s event.
In advance of the congress,
German professor Wilhelm
Neukam from the University of
Erlangen, who chaired the Organising Committee this year
with Prof. Asterios Doukoudakis
from the University of Athens,
had said that implant treatment
planning would be a major topic,
particularly with regard to new
imaging techniques and computer-assisted implantation. In a
scientific session held on Thursday and moderated by Prof.
Christoph Hämmerle from the
University of Zurich in Switzerland, the latest methods for
computer-aided implant fabrication were discussed by renowned specialists in the field
like Dr Theodorus Kapos (USA)
und Prof. Sandro Palla (Switzerland). In addition, University of
Pennsylvania professor Michael
Bergler presented the latest
‡ DT page 7
[7] =>
DTAP1011_01_Title
DTAP1011_06-07_News 28.10.11 16:26 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
World News
Danish dental surgeon confirmed
as President of EAO
to the EAO website, his current
research interests include oral
implantology, bone biology, bone
regeneration and surgical endodontics.
Prof. Schou took over as interim
president at the last board meeting in June 2011. Amongst other
positions he has held, he served
as Secretary-General of the EAO
from 2008 to 2010. He is also currently Chairman of the EAO Abstract Committee and Associate
Editor of the European Journal
of Oral Implantology. According
The General Assembly in
Athens also saw the current Secretary-General of the EAO, Prof.
Pascal Valentini, Italy, elected as
the new President-Elect. His position will be filled by Prof. Björn
Klinge from the Department
of Periodontology at the Karolinska Institutet in Stockholm,
Sweden. DT
From news reports
ATHENS, Greece/BRUSSELS, Belgium:
Prof. Søren Schou has been
elected President of the European Association for Osseointegration (EAO), the organisation
announced on Saturday. The
49-year-old Dane, who is currently
professor and Chairman of the
Department of Oral and Maxillofacial Surgery and Oral Pathology at the Aarhus University’s
School of Dentistry in Denmark,
will be leading the organisation
until the next General Assembly
in 2012 in Copenhagen.
Owing to medical problems
of past president Dr Paul Stone,
7
Prof. Schou (right) posing with EAO
congress chairmen Profs. Friedrich
W. Neukam (centre) and Asterios
Doukoudakis (left). (DTI/Photo Daniel
Zimmermann)
AD
fl DT page 6
CAD/CAM systems and discussed
their current and future impact on dental laboratories in
Europe.
Smaller and stronger.
Other topics received with
great interest were genetic predictability for dental implant loss
(see the interview on page 19 of
this edition) and the pros and
cons of implant treatment in
adolescents.
In addition to their established product lines, industry
players introduced several innovations at EAO. At a press conference held on the second day of
the congress, for example, the US
implant company Zimmer presented its latest implant design to
dental journalists in Europe exclusively. Several new products
were also revealed by other industry giants like Nobel Biocare
and Straumann. The latter showcased its new small-diameter,
soft tissue-level implant, as well
as a new restorative material
developed in collaboration with
3M ESPE. According to the company, it combines nano-ceramic
components with a highly crosslinked resin matrix for improved
aesthetics and stability in the fabrication of dental crowns, inlays,
onlays and veneers.
Further innovations were
also exhibited by Keystone Dental, Tigran from Sweden, and the
Swiss company CAMLOG.
“We are very pleased with the
high-level presentations and scientific works showcased here,”
remarked Neukam. “However,
we are still facing many challenges in clinical research. The
conclusions of many speakers
were that more research is
needed to be able to generate
consensus statements in the
field.”
According to Neukam, the organisation’s next congress is
scheduled for October 2012 and
will look back at implantology
research over the past 20 years.
It will be held in the Danish capital of Copenhagen. DT
Maximum material strength
and strong sealed connection.
High initial stability and
bone preservation.
NEW
Nobel Biocare announced
NobelClinician, new diagnostic
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for Apple and Windows operating systems, as well as two new
NobelReplace implants with a
complete range of prefabricated
and individualised prosthetic
solutions.
Safe implant placement in
areas with limited space.
3.0 mm for
limited spaces
It’s called NobelActive 3.0. This unique implant is the
ideal solution for narrow spaces in the anterior region.
The drilling procedure is designed to retain as much
bone as possible, while the implant body and thread
design condenses bone during inser tion enhancing
initial stabilit y. The sharp apex and cut ting blades
enable you to adjust the implant position for optimal
restorative orientation. Together with the strong sealed
connection and built-in platform shifting, NobelActive
3.0 allows you to safely produce excellent esthetic
results. After 45 years as a dental innovator we have
the experience to bring you future-proof and reliable
technologies for effective patient treatment. Their smile,
your skill, our solutions.
Visit nobelbiocare.com/active3
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
© Nobel Biocare Services AG, 2011. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of
Nobel Biocare. 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.
[8] =>
DTAP1011_01_Title
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[9] =>
DTAP1011_01_Title
DTAP1011_09_Business 28.10.11 16:27 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Business
9
Mectron “touches” implant specialists
Market approval of PIEZOSURGERY device in Asia in mid-2012
Daniel Zimmermann
DTI
ATHENS, Greece: Italian manufacturer of dental surgical equipment mectron presented its new
generation of PIEZOSURGERY devices to an international professional audience of implantologists
for the first time at the annual
congress of the European Association of Osseointegration (EAO).
Launched at IDS 2011 in Germany,
the PIEZOSURGERY touch is supposed to offer intuitive controls
through an improved hand piece
and a black coloured glass touch
screen resembling those of stateof-the-art electronical devices such
as smartphones.
ten years ago. During the last
decade, the surgical technique has
become a standard in many clinical
indications including implant site
preparation. The company says
that many universities and experts
have contributed in validating
PIEZOSURGERY, making it the
only evidence based technology for
piezoelectric bone surgery to date.
The PIEZOSURGERY touch
presented at this year’s EAO comes
with new inserts for a wider range
of indications including mini dental
implants or new applications in
prosthetics related to the finishing
of the cervical margin in crown
preparation. In addition, mectron
has developed a customized enzymatic solution called ENZYMEC
that, according to the company,
efficiently removes organic residuals from parts like the hand piece,
tubings or inserts.
The device is currently available for dental surgeons in Europe.
Approval for other countries including markets in Asia is expected
by mid-2012. DT
Product Manager Renato Bocchini (left)
demonstrating mectron’s newest piezosurgery unit to visitors of the EAO.
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NEW YORK CITY, USA/HAAG,
Switzerland: The Swiss company
Sulzer Mixpac has filed another
lawsuit at a US District Court in New
York against the Seil Global Corporation based in South Korea. In the
complaint, the manufacturer of the
MIXPAC S-system is accusing Seil
to have infringed patents with their
range of mixing tips suitable for
2-component applications systems
used in dentistry.
P
IM
From news reports
E
NS
RI
Seil sued by
Sulzer over
mixing tips
3
min.
DISINFECT
The lawsuit is the latest in a
year-long juristic battle involving
both companies. Sulzer filed their
first complaint against Seil during
the Greater New York Dental Meeting in November 2008. Other lawsuits have been successfully ruled
in favour of the company in November 2010 and September this year.
Despite a Temporary Restraining
Order issued by the court prohibiting Seil to import and sell their mixing tips in the US as well as adjustments in the tip construction introduced in 2010, Sulzer still claims
their patents to be infringed.
A decision by the court is expected in the upcoming weeks. According to representatives of the
Greater New York Dental Meeting,
Seil has registered again for their
next exhibition to be held from 27 to
30 November in New York City. DT
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[10] =>
DTAP1011_01_Title
DTAP1011_10_Planmeca 28.10.11 16:27 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
10 Business
The Nordic masters of dentistry
In its 40th year, Planmeca closes in on a fully integrated workflow
Daniel Zimmermann
DTI
Planmeca products are currently exported to over 100
countries worldwide. Besides
the company with the same
name and Plandent, the Planmeca group comprises dental
tool maker LM Instruments as
well as Opus Systemer, a practice management software company, and Triangle Future Systems. For more information
about the group and its product
range please visit their website
at: www.planmeca.com
HELSINKI, Finland/LEIPZIG,
Germany: Being a socially responsible company with a clear
vision is one thing. Being at the
top of the trade for more than
40 years is another. The Finnish
dental manufacturer Planmeca
is both. Established in the early
1970s, when computer technology promised to open a new
world in industrial design, the
company was the first to incorporate microprocessors in its dental units. Since then, this idea has
spawned a new age for dental
technology equipment and has
set the standard for a whole industry for decades to come.
Owing to this fact, one might
reduce Planmeca’s expertise
only to dental units, like the slick
and ergonomic Compact i or
their flagship product, Sovereign. But over the years the company has also regularly launched
a number of sophisticated dental
X-ray devices and imaging software onto the market that have
become household names not
only in dental practices worldwide, but also in rather unlikely
places like US military bases.
Overall, the Planmeca Group
with its six affiliates generates a
turnover of €700 million worldwide (according to own estimates), a number that puts them
easily on par with other dental industry giants like Sirona Dental
Systems or KaVo.
into dental units with the new
Planmeca PlanScan scanner,
available as a cart delivery system and with open connectivity,
which was designed to allow
dentists to capture the complete
intra-oral situation of a patient
and save it as a 3-D model for immediate design without the need
for fabricating a physical model.
Planmeca president Heikki Kyöstila demonstrating a panel controlling the new automated warehouse. (DTI/Photo Torsten Oemus)
façade that reflects the Nordic
blue sky on sunny days hides
dent and that of its medical device
subsidiary Planmed ever since,
“Solution-oriented thinking and
passion to achieve a perfect workflow.”
buzzing production facilities
and a fully automated warehouse with robotic forklifts on
the ground level.
envisions a bright future for his
company, especially in view of the
number of new products launched
at the International Dental Show
Outside view of the expanded premises with the large glass façade. (DTI/Photos Planmeca, Finland)
It may seem unusual that all
this success happened to be and
is still generated from a rather
unremarkable site in Herttoniemi, an old industrial district 10 kilometres east of
Helsinki’s city centre. There, the
company recently completed
the expansion of its premises by
more than one third to almost
50,000 square metres, an area so
large that it could now accommodate more than seven football fields. Besides administrative offices, the new shiny glass
Planmeca’s cone-beam volumetric tomography unit ProMax 3D
“Planning the building started
only in April last year, and despite
the extremely rough winter conditions, construction stayed on
schedule,” said Heikki Kyöstila,
President and owner, looking
back on the last 18 months. “With
the new production premises, we
can respond to the increased demand more effectively.”
The 65-year-old Finn and hobby
golfer, who founded Planmeca in
1971 as a small-scale import business and has remained its presi-
that now provides an extended
selection of 3-D volume sizes,
ranging from 34 x 42 mm to 16 x
16 cm, and comes with an inte-
All this is brought together in
the Romexis software, which has
recently been expanded with
a stand-alone application for
iPhone and iPad devices for clinicians to access and share 2-D and
3-D images via mobile networks
worldwide. With the iRomexis
application, for the first time
dentists have also a free native
application with true 3-D surface
model rendering in the palm of
their hands, the company said.
For Kyöstila, however, this is
only the beginning of a new age
in dentistry. According to him, it
The new premises including the warehouse shown here are larger than seven football fields combined.
in Cologne, Germany, this year.
The centrepiece of this recent
market initiative is its Digital
Perfection Integration concept,
which, according to Planmeca, offers a revolutionary means of combining data collected from different 3-D imaging devices to provide
dental surgeons with more detailed clinical knowledge in the
preoperative phase.
Hardware-wise, dental professionals recently saw the
launch of two new versions of
grated 3-D face scan unit called
ProFace, allowing clinicians to
capture a realistic 3-D photo of
the patient’s face both in standalone mode or in combination
with a CBVT scan. According to
the Vice-President of Digital Imaging, Helianna Puhlin-Nurminen, the system does not only reduce radiation exposure to patients, but also assures enhanced
clinical and aesthetic outcomes.
In addition, intra-oral surface data can now be integrated
all comes down to his company’s
solution-oriented thinking and
passion to achieve a perfect workflow for dental surgeries.
“We believe the best way to
design cutting-edge products
that really meet the needs of our
customers is to listen to them
closely,” he concluded. “Observing and learning from their
workflow helps us to understand
the significance of the smallest
details that can make a world of
difference to the user.” DT
[11] =>
DTAP1011_01_Title
Unbenannt-11 1
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[12] =>
DTAP1011_01_Title
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[13] =>
DTAP1011_01_Title
DTAP1011_13_Palmer 28.10.11 16:32 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Trends & Applications 13
The passive income practice
New methods for exit planning and retirement funding of dentists
Dr Phillip Palmer
Australia
provision of service, i.e. clinical
training.
Exit planning has traditionally been a fairly simple task
for dentists. The choices a
dentist faced were either
winding down the number of
days worked, thereby gradually easing into retirement, or
working until three to six
months before wanting to
stop, and then advertising the
practice for sale. After negotiations with the buyer, dentists
would sell and walk away—
much like a house sale. Sometimes there would be a good
handover of patients and staff,
and sometimes this process
would be less than ideal.
There definitely needs to be
more than one clinician. Rarely
is there sufficient profit over
and above the employee dentist’s wage (40% after lab) to
warrant running the practice
as a business with such a small
staff.
More recently, other options
for exit planning have become
available for practice owners.
Over the last three to four years,
for example, many dentists in
Australia having sold their
practices stayed on to work as
employee dentists for the new
owner. This model in particular
has increased in popularity recently with corporate entities
often being the buyer. Another
model is deferred sale/employee with view, whereby a
new dentist (Dr Junior) works
for a year as an employee for
Dr Senior.
If all goes well, a contract is
signed for the purchase of half
(or even all) the practice in
some years hence. The employed dentist continues to
work as an associate, and the
transaction is settled after the
agreed time. This technique assures Dr Senior both a buyer
and extra income from Dr Junior during the years as an employee. Through the incremental percentage technique, after
a similar trial period, the practice contracts are exchanged
and incrementally each year
a further percentage of the
practice changes hands from
Dr Senior to Dr Junior.
In each case, after the practice is sold, the ex-owner commonly takes the money he made
from the sale, goes on a holiday
and then invests whatever is left
in real estate or the stock market to fund his retirement. For
a practice here in Australia
grossing say AUS$800,000 per
year, if sold on the open market
Contact Info
Former dentist Dr
Phillip Palmer is
currently Director of Prime Practice and Dentist
Job Search and
regarded as Australia’s leading
expert in the business of dentistry. He can be contacted at
info@primepractice.com.au.
There are plenty of horror
stories out there, especially
after the global financial crisis,
of retired dentists needing to
return to practice because the
practice sale did not fund
their retirement the way they
expected it to. The never sell
concept represents a new way
of looking at the asset that is
your practice and how it can
bring you returns long after
your clinical career comes to
an end. DT
AD
could bring up to AUS$500,000.
If that entire sum were used
to purchase a residential investment property, one would
be lucky to net more than
AUS$30,000 per year, and probably less, to fund retirement.
Another way to exit plan and
fund a dentist’s retirement is
to establish the passive income
practice, also known as the
“never sell concept”. Using this
method, the practice is set up in
such a way as to be self-managed, with little effort (1 day/
month) needed from the owner
when the practice is mature.
The profit from the practice can
be as high as 30% after payment
of all normal expenses and clinicians’ wages.
If maintained as a going concern and run properly, there is
no reason to expect a return
from the AUS$800,000 grossing
practice of less than AUS$200,000
p.a. (and still maintain an asset
worth at least AUS$500,000).
Obviously, for this option
to work, the practice and the
staff need to be trained to be
self-managed and to provide a
certain level of service and
communication. Basically, they
would need to have a deep
knowledge and understanding
of the systems needed to run
a practice.
Some degree (the more, the
better) of management, leadership and business skills is also
required by the owner, including the ability to look at and
analyse the right numbers or
to motivate key staff members
to manage the practice and outperform through the judicious
use of incentives, including
well-designed bonus systems.
As the owner dentist is no
longer present full-time in the
passive income practice, there
also needs to be regular training in communication and the
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[14] =>
DTAP1011_01_Title
DTAP1011_14-15_Sheperd 28.10.11 16:33 Seite 1
14 Trends & Applications
DENTAL TRIBUNE Asia Pacific Edition
“Changes in the patient’s body language”
An interview with Prof. Jonathan Shepherd, University of Wales College of Medicine,
about violence in health care settings
of Medicine professor and author Jonathan Shepherd, there
are a number of things that
dentists can do in order to
prevent and manage violent
behaviour of patients in their
practice or dental clinic. Dental
Tribune Asia Pacific spoke with
him about the most important
strategies and the role practice
design can play in preventing
those incidences.
Prof. Jonathan Shepherd
Violence aimed at health care
professionals is rare but possible as demonstrated by the latest series of robberies and rape
crimes against female dentists
in the Philippines. According
to University of Wales College
DT Asia Pacific: Prof. Shepherd, statistics on violence in
any form of health care setting
are extremely difficult to find.
Has violence against health
care workers increased or decreased in recent years?
Prof. Jonathan Shepherd:
As you have mentioned, there are
no statistics, at least in Europe,
that I am aware for evaluating the
occurrence of violent behaviour
in health care settings. If we are
AD
talking about crime in general,
we are currently observing a
falling trend in the UK and
throughout the continent. However, there is some evidence that
the recent economic downturn
in Europe is causing more acquisitive crime, particularly house
crimes that include burglary and
robbery, which can also affect
medical or dental practices.
What are the main reasons
for violent behaviour in health
care settings?
Sometimes, stress can be a
trigger, which has become an argument, for example, in dentistry
for keeping stress levels to a minimum, managing pain promptly,
and being sympathetic towards
patients at all times. Mentally
disabled patients or those who
are intoxicated with alcohol or
stimulants such as cocaine may
turn violent, as might psychotic
or obsessive impulsive patients.
A reason that does not apply
so much to dentistry but to medicine is that sometimes people
can be very angry about their set-
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with complaints in this regard
immediately.
Some incidences of violence
could be prevented by being
able to detect the first warning
signs. What are the most common?
Shouting or violent gestures,
for example pointing at someone, are obvious signs of someone possibly turning violent.
However, there are often changes in the patient’s body language that dentists, for example,
should be aware of. First warning
signs could be things like rapid
breathing, flared nostrils, restlessness or repetitive movements.
Staff in the dental team definitely need to recognise their
own body language response to
these signals. It is all too easy to
respond consciously to a hostile
situation in a way that increases
tension without saying a word.
What are the best strategies
you recommend for dealing
with violent behaviour?
“It is all too easy to respond
consciously to a hostile situation
in a way that increases tension
without saying a word.”
tlement, thinking that somebody
should have done more to prevent a disease.
An underestimated thing is
money. If dentists happen to have
an expensive car or advertise expensive valuables in their practice, some people will interpret
those as signals of wealth that
could encourage stealing. Dentists should also estimate treatment costs thoroughly and deal
There are several things
medical or dental professionals
can do both at a physical and psychological level. The most important thing is to be aware that
patients do not realise that they
make the clinician appear incompetent by criticising him or
her. So if a patient becomes hostile and resistant during a procedure or just realises that the procedure is more uncomfortable,
painful or difficult than he or she
[15] =>
DTAP1011_01_Title
DTAP1011_14-15_Sheperd 28.10.11 16:33 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
Trends & Applications 15
thought before a procedure, dentists should explain clearly to the
patient what is involved and what
to expect.
agitated patients can pick them
up because they will use anything at hand as a weapon in
a worst-case scenario.
“... practitioners or dental staff should always try
to get away from a situation and summon help.”
Dentists should always be
courteous and try to find out
what their patients real concerns
are and acknowledge these concerns. It is recommended that
dentists talk calmly to angry
people and pay close attention
to them, while standing outside
their own personal space and
slightly out of their arms reach. If
possible, dentists should always
stand and operate on the nondominant side, which is where
the patients usually wear their
wrist-watches.
Often, dental practitioners,
especially after practice takeovers, have little influence over
the way their practice is laid
out. What can they do?
In this case, it can be useful
to have local police or crime prevention officers around from time
to time to give advice on how to
maximise security through simple measures like good lighting
or door locks, particularly in practices located in poorer areas with
widespread social problems such
as unemployment or drug use.
They often suggest ensuring that
trees and shrubs in the garden in
the front of the practice do not obscure the front, so that a burglar
can be seen when he or she enters
the front door from the road.
However, this could all be
for nothing if the staff are not familiar with the premises and
thus do not know where alarm
buttons or all the exits are.
Therefore, practitioners should
regularly update their existing
and new staff members about
those things. Front-line staff
such as receptionists should
receive training in interpersonal skills but not be assigned
tasks they are not qualified to
do, for example, explaining the
nature of various dental problems. That’s definitely a dentist’s
job!
Thank you very much for
this interview. DT
AD
And physically?
Even when trained in selfdefence measures, practitioners
or dental staff should always try
to get away from a situation and
summon help. If a staff member
becomes trapped, however, he
or she should pick up anything,
even clothing or a towel, in order
to use it as a shield. If someone
is grasped around the neck, for
example, he or she should not
hesitate to defend him- or herself
by kicking, scratching, biting and
using his or her nails.
POWERFUL
BONDS
POWERFUL
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Generally, all incidences of
violence should be reported to
the police and thoroughly documented. In the UK, for example,
about half the violence that leads
to the emergency room is not
known to the police.
In your book, you have dedicated a whole chapter to practice design. Could you explain
how the way practices are laid
out can help to prevent or manage violent behaviour?
Practice design can be indeed
very important. In clinical areas,
for example, furniture should be
arranged in a way that a staff
member is always nearer to the
door than the patient and cannot
be cornered easily. The reception area should create a distance
between patients and the receptionist so that he or she is
out of reach. It is also important
that glassware, scissors or other
sharp items not lie around so that
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Prof. Jonathan Shepherd is author of “Violence in Health Care—
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[16] =>
DTAP1011_01_Title
DTAP1011_16-18_Hant 28.10.11 16:34 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
16 Trends & Applications
Veneer restorations layered onto pressed
ceramic substrates
A new way of approaching anterior dental restorations
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 1: The patient was unhappy about the discoloured composite restorations and the uneven alignment of the teeth.—Fig. 2: A model of the initial situation shows the palatal deviation of the central incisors.
—Fig. 3: Veneers layered on investment dies.—Fig. 4: Veneers after divesting.–Fig. 5: Deep Dentin is applied in layers to achieve an appropriate masking effect.—Fig. 6: Transpa and Opal materials complete
the layering procedure.—Fig. 7: When the veneers were tried in …—Fig. 8: … neither the patient nor the treatment team was satisfied with the outcome.
AD
Szabolcs Hant
Hungary
For a case involving a discerning male patient who desired
the aesthetic correction of
teeth #11 and 21, I describe
two methods of creating an
anterior restoration. With the
first conventional method,
veneers are layered and fired
on an investment die. The
other involves layered veneers on a pressed ceramic
substrate. The patient was
particularly concerned about
the palatal position of the
teeth and the discoloured
composite restorations (Fig. 1).
The goal here was to find a
treatment option that would
preserve as much tooth structure as possible following the
principles of conservative
dentistry.
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An analytical evaluation of
the diagnostic model demonstrated that a minimally invasive aesthetic modification
could only be achieved with
ceramic veneers (Fig. 2). At this
stage, the possibility of using a
totally non-invasive treatment
option was still considered. The
palatal position of the upper
two central incisors provided
sufficient space to accommodate a layered non-prep veneer.
Already at this stage, I decided
to use two different methods, a
conventional one and one relatively unknown in our markets,
and draw comparisons.
Conventional method
A metal-ceramic system
(IPS d.SIGN, Ivoclar Vivadent),
which involves firing of the
veneers in an investment ring,
was used. The veneers were
modelled on investment dies
(GC Orbit Vest) that had been
prepared in advance (Fig. 3–4).
During the application of the
layers, the areas of the composite restoration were masked
with Deep Dentin to prevent it
from shining through the ceramic layers (Fig. 5). The use
of translucent material for the
cervical region is generally
advised, unless the underlying
tooth structure is completely
discoloured. In the case discussed, Transpa Neutral and
Opal Effect 1 materials (both
Ivoclar Vivadent) were applied
(Fig. 6). The advantageous
translucent properties of Transpa
Neutral and the incisor-like
opalescence of Opal Effect 1
provide a suitable combination for this area, allowing the
transition in the cervical region to be effectively camouflaged.
It is essential to work in
small steps when working with
an investment die. The mechanical and chemical bond between the investment material
and ceramic material is not as
strong as the bond between the
opaquer and ceramic material
when a conventional layering
technique on a framework is
used. It is imperative to bear
this in mind because it is very
difficult to mend the restoration
once the ceramic material has
detached itself from the investment die owing to a layer that
has been applied too thickly.
Here, a comparatively thin
layer of dentine material was
sufficient because this restoration did not involve a metal
framework masked with opaquer. Consequently, more space
was available for the enamel
materials.
Upon completion of the firing process, the investment
dies were removed and the
veneers were tried in. An optimal result was achieved in
the cervical region. The use
of a matching try-in paste
(Variolink Veneer Try-In, Ivoclar
‡ DT page 18
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[18] =>
DTAP1011_01_Title
DTAP1011_16-18_Hant 28.10.11 16:34 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
18 Trends & Applications
Fig. 9
Fig. 11
Fig. 10
Fig. 12
The unconventional
method
Fig. 13
Fig. 14
Fig. 9: The incisal area was too bright and the veneers appeared slightly oversized.—Fig. 10: The pressed veneers were
ground down to a thin material thickness and used as a substrate for the subsequent application of ceramic layers.
—Fig. 11: Try-in of the pressed veneers before the layering procedure—Fig. 12: Evaluation of the shade effect after the first
firing.—Fig. 13: The veneers layered onto a substrate made of IPS e.max Press ceramic.—Fig. 14: The veneers in situ.
Both the patient and treatment team were satisfied with the outcome.
fl DT page 16
Vivadent) turned out to be very
helpful. The shade of the incisal
area also appeared to be successful because the tooth’s in-
herent shade shone through
the translucent layers of the
incisal area. Upon close examination, however, we saw that
the incisal was slightly brighter
than that of the neighbouring
teeth (Figs. 7–9), which was
unacceptable for the patient.
In addition, the veneers were
oversized and did not integrate
harmoniously into the surrounding dentition.
AD
Owing to the first disappointing results, a treatment
option had to be found that
would give the patient a satisfactory result. A technique
was finally considered that was
based on a similar approach
but involved different materials, IPS e.max Press ceramics
(Ivoclar Vivadent) with highly
translucent HT ingots. These
materials were originally developed for full-contour in- and
onlays, veneers and crowns, but
their high viscosity and high
flexural strength (400 MPa),
also makes them suitable for
ultra-thin veneers of 0.3 mm
thickness.
In the case discussed, the veneers were pressed from HT A2
ingots and then ground down to
a thickness of 0.3 mm (Fig. 10).
A try-in showed that this material was capable of closely imitating the natural tooth shade
(Fig. 11).
During the application of
the layering ceramic, the existing composite restorations had
to be taken into account. Try-in
pastes to simulate the shade
effect and to check whether the
composite restorations were
sufficiently camouflaged were
used. Sufficient space was
available to design the incisal
tooth, which meant that I was
able to control the translucency
in this area appropriately. In
order to mask the discoloured
areas in the proximal regions
of the restorations, opaque
materials were used.
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With the Deep Dentin and
Mamelon materials, IPS e.max
offers two choices—both of
them are characterised by
comparatively strong masking
capabi lities. However, the
Mamelon materials should be
used only sparingly in this area.
Except for the “light” shade,
these materials demonstrate
fairly distinct shading characteristics and may therefore
have a visible effect on the
restoration. Subsequently, the
Dentin and Transpa materials
were applied in layers in the
customary manner. The restoration in progress could be directly checked in the oral cavity
between the individual firing
cycles and the materials could
be selected accordingly, which
presented a decisive advantage
(Fig. 12).
The first veneers designed
were not satisfactory because
of their shape. Therefore, a
slightly narrower incisal veneer
was created this time (Fig. 13).
The patient approved of the
shape and veneers were applied (Fig. 14).
Incorporation
The use of two different ceramic materials provides a convenient opportunity to point out
the differences in etching techniques. Etching the ceramic
veneers with hydrofluoric acid
(IPS Ceramic Etching Gel,
Ivoclar Vivadent) is an essential
but critical process in adhesive
techniques because the etching
time depends on the ceramic
material. In this case, reaction
times for the individual ceramic materials were different.
According to the manufacturer’s recommendations, the
IPS d.SIGN fluor-apatite ceramic requires an etching time
of 60 seconds and the etching
time for the IPS e.max Press
lithium disilicate ceramic is
only 20 seconds. Users should
not deviate from these recommendations.
After the etchant has been
allowed to react, the surfaces
should be thoroughly rinsed
with water using an ultrasonic
device, for example. While the
etching of the veneer can be
deferred to the dental technician, it is essential to be aware
that surfaces that have been
already etched have to be
cleaned again after the try-in in
the oral cavity and before the
veneer is silanised (Monobond
Plus, Ivoclar Vivadent). Studies have shown that the surface can be contaminated by
the remains of salivary fluids
and adversely affect the bond
strength, particularly when
glycerine-based try-in pastes
are used.
Conclusion
Veneers made of IPS d.SIGN
ceramic materials have been
used to design restorations that
achieve exceptional aesthetic
results that last several years.
However, today’s range of products includes various other materials and methods that enable
dentists to achieve similar or
even better results in specific
cases. The IPS e.max system is
a case in point. It is worthwhile
taking new routes for restoration fabrications depending
on the requirements of each
patient case and allowing some
scope for creativity. In the process, however, the specific
properties and restrictions of
the material in use should
never be ignored. DT
Contact Info
Szabolcs Hant is a
dental technician in
Budapest, Hungary.
He can be contacted at densnatura@
gmail.com.
[19] =>
DTAP1011_01_Title
DTAP1011_19_Donos 28.10.11 16:35 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Off time 19
Completing the puzzle
An interview with Prof. Nikolaos Donos, UK,
on genetic predictability for implant loss
In recent years, an increasing
number of studies have focused
on the association between
gene combinations and their
influence on biological complications that lead to implant failure. A case-control study from
Egypt published in the June
issue of the Journal of Oral
Implantology found that IL-1
polymorphisms, for example,
may affect the outcome of treatment for peri-implantitis in
genotype-positive patients. At
this year’s European Association
for Osseointegration congress
in Athens, DT Group Editor
Daniel Zimmermann spoke
with Prof. Nikolaos Donos from
the University College London’s
Eastman Dental Institute about
the current state of research
and whether gene tests for implant failure are on the way.
can already occur within the first
year or almost immediately after
implant placement.
Are there any gene tests for
implant failure on the horizon?
What we can do is to conduct
significant research in which
we keep identifying different
polymorphisms and do association studies in order to complete the genetic puzzle. Then
we might be able to screen pa-
tients before they receive implants.
At this point, however, we are
far from being able to develop
any genetic tests for implant
failure risks. The only means of
prevention right now is to treat
the diseases that contribute to it,
such as periodontal inflammation and identify groups of patients with high susceptibility to
periodontal disease.
Thank you very much for
this interview. DT
Prof. Nikolaos Donos in Athens, Greece.
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Daniel Zimmermann: Dr
Donos, there are indications
that specific gene combinations could be associated with
biological complications that
cause implant loss.
Prof. Nikolaos Donos: Yes,
there are quite a number of gene
combinations that are being currently looked at, for example the
IL-1 and IL-6. TGF beta and TNF
alpha genes have also been evaluated, mainly because they have
proven to play a role in inflammatory processes.
Does any significant evidence of such an association
exist?
From the studies we have reviewed so far, we have not been
able to find an obvious association between genetic polymorphisms and implant failure, either early or long-term. Owing
to its role in periodontal inflammation, there might be the possibility that IL-1 polymorphisms
could be a risk factor for peri-implantitis but you have to consider
that in order to draw these kinds
of conclusions you need significantly larger studies and those we
have so far are not that large in
number of patients or implants.
That doesn’t mean though that
they do not have an influence.
How common are these polymorphisms?
Itis difficult to say because
some polymorphisms can occur
in many people in one specific
ethinicity or race group yet not be
expressed in other ethnic groups.
How large do studies have
to be in order to be able to draw
any conclusions?
Late implant failure can become evident up to three, four
or even five years after implant
placement, so you would need
to follow a significant number
of patients for several years (at
least 5) before you would be able
to see complications and evaluate all relevant parameters.
Evaluating early implant loss
however is difficult because it
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