Asia News / World News / Business / Physiological healing patterns: What clinicians need to know about tooth extractions / Secular trends in dental development / Clinical guidelines for the use of ProTaper Next instruments (Part II) / today ICOI World Congress XXXI ·Tokyo · October 3.-5. 2014
Asia News
01 - 04 viewWorld News
05 - 06 viewBusiness
09 - 09 viewPhysiological healing patterns: What clinicians need to know about tooth extractions
10 - 10 viewSecular trends in dental development
12 - 12 viewClinical guidelines for the use of ProTaper Next instruments (Part II)
13 - 16 viewtoday ICOI World Congress XXXI ·Tokyo · October 3.-5. 2014
17 - 23 viewArray
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
(DTI/Photo Paul Prescott)
PUBLISHED IN HONG KONG
www.dental-tribune.asia
Oral cancer crisis in India
An interview with Dr Pankaj
Chaturvedi, Mumbai
Business
UK’s Prima Dental opens
Indian operations
2
4Page
4Page
NO. 10 VOL. 12
Trends & Applications
Secular trends in dental
development
9
4Page
12
DTI
launches
FDI closes record meeting in India new edition
for South Asia
(DTI/Photo Daniel Zimmermann)
DT Asia Pacific
GREATER NOIDA, India/GENEVA,
Switzerland: While the official
figures are still to be confirmed
by the organiser in India, initial
estimates suggest that the FDI
World Dental Federation held its
most successful annual congress
ever this month. As the organisation reported in mid-September,
an estimated 17,000 visitors
overall attended the four-day
event in Greater Noida near New
Delhi, which also saw the first
ever visit by Indian President
Pranab Mukherjee to the state of
Uttar Pradesh.
Seventy-eight-year-old Mukherjee, who attended the opening
ceremony at the India Expo Centre and Mart as guest of honour,
said that his government is well
aware of the poor standards of
oral health in the country. Several programmes and projects
conducted by his government
and organisations like the Indian
Dental Association are underway
to raise awareness of the importance of good oral health and
hygiene among different segments of the Indian population,
with the FDI congress being one
of them.
Pranab Mukherjee addressing delegates of the FDI Annual World Dental Congress in Greater Noida, New Delhi.
The ceremony also saw the
launch of a new oral health campaign driven by the Indian Dental Association called “Happy
Muskaan”, which will be supported by dental consumables
manufacturer Colgate. It will
conduct volunteer-based programmes throughout the country to help raise awareness of
the importance of oral hygiene
in daily life among the Indian
population.
On behalf of the FDI, several
new policy statements were
adopted by its General Assembly,
including statements on oral radiation, the detection of HIV and
care of HIV-infected patients, as
well as perinatal and infant oral
health. Furthermore, the feder -
ation announced the launch of
the FDI Data Hub for global oral
health, a new online source for
oral health statistics and indicators. Developed under the guidance of the FDI Oral Health Atlas
Task Team, it aims to provide a
one-stop shop for all information
pertaining directly or indirectly
to global oral health, according
to the FDI. DT
With the launch of the new
edition of its flagship publication
Dental Tribune for the South Asia
region at the FDI Annual World
Dental Congress in Greater
Noida near New Delhi, the Dental
Tribune International Publishing Group is celebrating another
addition to its extensive portfolio
of international dental media.
The new edition will cover countries such as India, Sri Lanka,
Nepal, Bangladesh, Burma and
Bhutan, and is anticipated to
reach an audience of approximately 100,000 dentists.
“The market in this specific
region has been growing in many
sectors and people are constantly
embracing new technologies,”
said publisher Ruumi Daruwalla,
explaining the incentive behind the new edition. “What has
really been missing, however,
is a publication that offers high
quality and can reach the maximum number of dental professionals.”
According to Daruwalla,
Dental Tribune South Asia will be
available in print and online. DT
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FDI partner
Picture showing visitors of the FDI Annual World Dental Congress in India posing
with Dr Strong Teeth, a new mascot developed by the Indian Dental Association
to promote good oral health. (Photo courtesy of IDA, India)
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The results of a recently published study from Japan indicate
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which has strong antimicrobial activity against bacteria, fungi and
viruses, and thus does not induce
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A new web-based education
programme, developed and trialled by researchers at the University of Melbourne, Australia, could
help maintain healthy and natural
teeth into older age. People who
took part in the trial embraced the
new technology and made positive
changes to their dental care routines, the researchers said. DT
Dental consumables manufacturer GlaxoSmithKline will be
the first organisation to collaborate with FDI for the comprehensive scientific training its oral
healthcare representatives undergo. In a rigorous and ongoing
process, independent FDI scientists are both examining and optimizing 5 training modules that
correspond with GSK’s portfolio
of specialist products in oral
health, dentine hypersensitivity
and other areas, the company
announced at the FDI Annual
World Dental Congress in India.
According to GSK representatives, the three-year agreement
will ensure a consistency of scientific training among the 1,500
GSK brand representatives worldwide, preparing them to communicate the science behind the company’s products in an approved,
standardised way that resonates
with dentistry leaders. DT
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AD
U P C O M I N G
DENTAL TRIBUNE
Asia News
WEBINARS “A very large burden
for the country”
An interview with head and neck cancer surgeon
Dr Pankaj Chaturvedi, Mumbai, about oral cancer in India
lated products have successfully
developed and implemented
new marketing tactics to lure
in younger demographics and
make them use their products.
Therefore, we are facing a
major health crisis as tobacco
consumption is continuously
increasing amongst youth.
Daniel Zimmermann
DTI
DENTAL TRIBUNE AMERICA IS AN ADA CERP RECOGNIZED PROVIDER
06
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Today, soft tissue surgery together with modern materials and
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the keratinized gingiva as well as change the gingiva typology.
Over the last years, specific materials and techniques have been
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peri-implant surgery. These concepts may be supported with
other modern technologies, such as the PRF-technique, aiming
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REGISTER ON WWW.DTSTUDYCLUB.COM
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DIAGNOSIS AND MANAGEMENT
OF ORAL LESIONS
Prof. Cesar Migliorati
08:00 PM (EST)
The presentation will guide the clinician on how to proceed
when an oral mucosal lesion is found. The discussion will include aspects of importance such as distinguishing benign
and malignant lesions, infections, ulcers, lumps and bumps
and the diagnostic procedures. The presentation will inform
the clinician about the mechanism of building a differential
diagnosis, achieving a definitive diagnosis, and managing the
case. The most common oral lesions and conditions will be
presented.
Participants will learn:
• The importance of oral examination
• Building a differential diagnosis of oral lesions
• Understanding diagnostic procedures
• Understanding basic management of common
oral lesions and conditions
• What to tell a patient when an oral lesion is found?
Oral cancer is the most rapidly growing dental condition
worldwide. On the Indian subcontinent, it is now one of the
most common types of cancers,
causing 48,000 people to die
from the disease per year.
Dental Tribune Asia Pacific
spoke with congress presenter
Dr Pankaj Chaturvedi, a head
and neck cancer surgeon
from the Tata Memorial Hospital in Mumbai, at the recent
FDI World Dental Congress in
Greater Noida in India about
awareness among the Indian
population, risk factors and
what is being done to fight the
epidemic.
Dental Tribune: Oral cancer cases are growing worldwide in double digit rates.
How prevalent is the disease
in the Indian population and
what demographics are mostly
affected?
Dr Pankaj Chaturvedi: Oral
cancer currently ranks amongst
the three most common cancers
in India and accounts for almost
40 per cent of total cancer deaths
in some areas. In most regions
of the country, the condition is
the second most common malignancy diagnosed among men,
accounting for up to 20 per cent of
cancers, and is the fourth most
common among women.
To make things worse, approximately 70,000 new cases are
In addition to tobacco, established risk factors for oral cancer
are the heavy consumption of
alcohol, as well as the presence
of an oral premalignant disease.
Other contributory or predisposing factors include dietary deficiencies, particularly of vitamins
A, C and E and iron, as well as
viral infections, particularly induced by HPV which is known to
be of high oncogenic potential.
Dr Pankaj Chaturvedi
added to the already high number
of oral cancer patients each year.
Prevalence is highest in rural
areas and vulnerable populations, such as among people with
a low socio-economic status.
According to figures of
the World Lung Foundation,
the direct medical costs of
treating tobacco-related diseases including oral cancer in
India amounted to more than
US$1 billion in 2010/11. Do patients have general access to
treatment?
As the available treatment
centres are mainly located in
the cities and have very few
resources, patients usually have
limited access to treatment.
Unfavourable socio-economic
determinants like low literacy
and low per capita income also
hinder effective disease management.
The most common etiological agents for oral cancer have
been identified to be tobacco,
alcohol, and increasingly the
human papillomavirus (HPV).
Does this pattern also apply to
your country?
The real concern in India is
tobacco as it is one of the leading
causes of premature death and
disability. Its use here is rather
complex because it is consumed
in a variety of ways, such as being
smoked, chewed, and snuffed
orally. Patterns of consumption
also differ significantly throughout the whole country. Manufacturers of tobacco and its re-
Since the aetiology of oral
cancer in India is predomi-
NOV
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
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Online Editors
Yvonne Bachmann
Claudia Duschek
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
The World’s Dental Newspaper · Asia Pacific Edition
Published by Dental Tribune Asia Pacific Ltd.
© 2014, Dental Tribune International GmbH. All rights reserved.
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
nantly tobacco-related, should
prevention strategies primarily
focus on people overcoming
traditional habits? How realistic is that scenario in your
opinion?
In the last decade, huge resources have been put into prevention as well as the control of
tobacco and its related diseases.
In the current scenario, prevention will hold the key for changing the age old customs and traditions into more healthy habits.
This requires intervention at
individual, community and national levels. Right now, there are
a number of initiatives provided
by the government in terms of
policy making and implementation. Non-governmental organisations have also started to reach
out to communities to raise
awareness and refer people for
early screenings. There are lot of
challenges though, that we have
to deal with.
What strategies do you recommend?
Tobacco control needs ongoing commitment from all parts of
society. While as an individual you
have the choice to use or not to use
it, society has to advocate generally for a more healthy way of life.
The government’s role in this is
to firmly check the production,
distribution and sale of tobacco.
Strict enforcement and vigilance
are required to effectively implement tobacco control laws.
Studies have demonstrated
that most Indians, particularly in
rural areas, are not even aware of
the benefits of basic oral health
measures like tooth brushing.
Owing to its diversity, traditional practices in India significantly differ. Of course, oral
hygiene practices still have to
be considered primitive in most
parts of India but this depends
largely on education and financial resources. Most people are
definitely aware of the benefits
of good oral health but the lack of
Asia News
supportive environments makes
them vulnerable, so they resort
to more primitive habits.
The need is to renormalise
the habit, advocate for effective
public health campaigns and focus on the ability to self-examine
the oral cavity for early signs and
symptoms of oral cancer. Community participation and involving youth to bring in change can
be an effective strategy.
Thank you very much for
the interview. DT
Workers enjoying a cigarette. The consumption of tobacco in India is on an
all-time high. (DTI/Photo Paul Prescott)
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India’s health ministry and
doctors have recently asked the
Ministry of Finance to raise taxes
for consumption of cigarettes
and tobacco products.
“...we are facing
a major health
crisis...”
In your mind, could this
lead to less consumption?
Raising taxes on tobacco
products is certainly one of the
evidence-based strategies to
reduce consumption of tobacco.
Promising results have been
achieved in states which have
already seen an increase in taxation.
Prevention first starts with
awareness. Is the medical and
dental profession in your
country sufficiently aware of
the issues related to oral cancer?
Health care professionals
are the major contributors in
addressing the problem to the
general public. Lobbying for
evidence-based policy making to
the implementation and continuation of tobacco cessation services are just few of the initiatives
that should be supported by
them. The real challenge however is to develop a more sustainable model for remote and rural
areas, where poverty and illiteracy are high and an adequate
preventive health infrastructure
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
Asia News
Far East meets Europe in Rome
Experts from South Korea presented clinical innovations in dental implantology
at annual scientific meeting of the European Association of Osseointegration
dental implantology in the Eastern
Asian country.
“Expectations have been high
since the EAO accepted the proposal by our Chairman Dr Je-Uk
Park to host a parallel session at
the 2014 congress in Rome,” he
told Dental Tribune Asia Pacific
in an interview. “I am sure that attendants will enjoy the knowledge
that our experts, under the motto
‘Cutting edge of implant dentistry’,
will bring to the table.”
Lee said that, while implantology in South Korea was considered inferior compared to Western
Standards not long ago, the specialty has taken a big leap forward
in recent years.
Prof. Bu-Kyo Lee
DT Asia Pacific
ROME, Italy: For the first time in
the history of the annual scientific
meeting of the European Association of Osseointegration (EAO),
clinical experts from a country
outside Europe have participated
in a special parallel guest country
session organised by the association in partnership with the
Korean Academy of Osseointegration. As part of this year’s scientific
congress programme, clinicians
and educators from dental schools
in South Korea presented on
a wide range of implant-related
topics including computer-guided
flapless implant surgery or surgical intervention in case of periimplantitis.
According to Prof. Bu-Kyu Lee,
professor of Oral and Maxillofacial
Surgery at Asan Medical Center in
Seoul and director of International
Affairs of the Korean Association of
Oral and Maxillofacial Surgeons,
the session also provided a comprehensive insight into the state of
“Most of what we know about
implantology today has its roots
in developments that began in
Europe,” he said. “Now we have
been given the opportunity to give
something back by presenting
clinical knowledge and methods
which have been developed in our
country and could benefit implantology worldwide.”
“It is a honour to have been invited by the EAO ahead of other important markets such as Japan or
the US. We hope that the presentations have been up to par with what
attendees expected in terms of content and clinical skills,” Lee added.
Dental implants have come
a long way in South Korea since
they were introduced to the country four decades ago. Back then,
US and European products wholly
dominated the still young market.
Now, with 225 implants per 10,000
people, the country has one of the
highest implants per capita rates in
Crowded street in Seoul, the capital of South Korea. The country has now the highest rate of dental implants per capita in
the world. (DTI/Photo TungCheung)
the world, ranking after Germany
and Israel. According to a report
published by the Korean Health
Industry Development Institute,
the regional market exceeded
US$320 million in 2013. That year,
forty South Korean companies
manufactured approx. 12 million
dental implants. Later, in June, the
Korean National Health Insurance
Corporation announced that it
would expand the coverage of dental implants in patients aged 70 and
older beginning in 2015, and those
aged 65 and older in 2016; domestic competition is thus expected to
increase even further.
The market saturation has
recently forced many manufacturers to increasingly pursue
sales markets overseas. Owing to
their price advantage, implants
“Made in Korea” have started to
gain more market share overseas.
In the Asia Pacific, a recent report by the Millennium Research
Group (MRG), a market intelligence provider in Canada, has predicted that manufacturers from
South Korea could dominate dental implant markets in that region
as early as 2016. By that time, the
total regional market is expected
to exceed US$800 million.
While exports to Western countries have remained relatively slow,
South Korean manufacturers like
OSSTEM already rival established
implant providers such as Straumann
or Zimmer Dental in Asian countries like Pakistan, Malaysia and
Hong Kong. Other significant market players in the region include
DIO Implants, a company partly
owned by DENTSPLY, as well as
MegaGen and Shinhung.
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Implants from Korea are also
catching up in terms of clinical
data, the report stated, a fact that
will make them increasingly
adoptable for implant specialists
in that region. Manufacturers now
offer seminars focusing on basic
and advanced implant placement
training and the advancement
of restoration skills to dentists.
Having recognised the increasing
financial limitations provided by
dental implants, a growing number of South Korean dentists has
also taken part in seminar programmes that focus on how to
remain competitive. This led to an
increase in the number of dentists
who are able to perform implant
surgery procedures. Demand for
implants has been also driven by
a new trend among South Korean
dentists to promote aesthetic treatment through dental implants. DT
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
World News
5
DTI
SANTIAGO DE COMPOSTELA,
SPAIN: According to reports, an
increasing number of people tend
to look for health-related infor mation on the Internet. In the field
of dentistry, dental implants currently rank among the top three
most searched topics after amalgam and aesthetic treatment. The
findings of a Spanish study suggest
that results for this search term
provided by common search engines do not lead to either easily
comprehensible or useful information for users.
as well as forums or discussion
groups, were not included, according to the researchers.
The study, which was recently
published in the Clinical Oral
Implants Research journal, was
conducted by the OMEQUI research group at the University
of Santiago de Compostela’s
School of Medicine and Dentistry. DT
(DTI/Photo antb)
Search engines of little use
for people seeking information
on implants online
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From the 100 highest-ranked
results listed for the search term
“dental implants” by the two most
popular search engines, Google
Search and Yahoo! Search, in
autumn 2013, the researchers
from the University of Santiago de
Compostela found that the overall
majority scored low in accessibility and usability. The information
provided on the remaining websites, which were evaluated by the
group over the course of the study,
was also seriously lacking in terms
of both of these criteria. The results on the Yahoo search engine
scored slightly higher in terms of
relevance and usability in comparison with Google. No significant difference could be detected
between the two search engines’
results in terms of accessibility
however.
The poor outcome in terms of
quality in even the highest-ranked
results could be a reason that patients considering dental implants
are misinformed about the device
or have overly high expectations
for the treatment, the researchers
suggested. “E-health information
on dental implants in the English
language is difficult to read for the
average patient and poor in terms
of quality,” they said in the report.
“Therefore, it is necessary to
generate websites that provide
reliable, high-quality information
about dental implants, with content that is both independent
from commercial interest and
easy to understand by the average
patient.”
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According to a quick web
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listed slightly over 1.7 million results for “dental implants” in early
September, while Google listed
around twice that number. With
approximately one billion users a
month, the market leader remains
the most popular English-speaking search engine worldwide,
followed by Yahoo, which is estimated to have 300 million users.
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001205
Overall, the study only included 32 websites, of which the
majority were affiliated to nonprofit organisations, or medical
or dental institutions. Only five of
these websites were listed among
the results on both search engines.
Websites hosted by companies,
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
World News
Tooth loss expected to decline
significantly in the US
DTI
Less people in the US will have missing teeth by 2050. (DTI/Photo aastock)
CHAPEL HILL, USA: The number of edentulous people will
decline significantly, a study has
found. Researchers at the University of North Carolina at
Chapel Hill followed edentulism
over the last hundred years and
predict that the number of people
with tooth loss will be 30 per cent
lower in 2050 than it was in 2010.
The researchers investigated
population trends in edentulism
among US adults at least 15 years
of age by creating time-series
data from five national cross-
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sectional health surveys: 1957
to 1958 (100,000 adults), 1971
to 1975 (14,655 adults), 1988 to
1998 (18,011 adults), 1999 to 2002
(12,336 adults) and 2009 to 2012
(10,522 adults). Birth cohort
analysis was used to isolate age
and cohort effects. Geographic
and socio-demographic variation in prevalence were investigated using a sixth US survey
of 432,519 adults conducted in
2010. Prevalence through 2050
was projected using age cohort
regression models with simulation of prediction intervals.
Across the five-decade observation period, edentulism prevalence declined from 18.9 per
cent in 1957 to 1958 to 4.9 per cent
in 2009 to 2012. The single most
influential determinant of the
decline was the passing of generations born before the 1940s,
whose rate of edentulism incidence (5 to 6 per cent per decade
of age) far exceeded that of later
cohorts (1 to 3 per cent per decade
of age). High-income households
experienced a greater relative
decline, but a smaller absolute
decline, than did low-income
households.
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By 2010, edentulism was a
rare condition in high-income
households and had contracted
geographically to states with disproportionately high poverty.
With the passing of generations
born in the mid-20th century,
the rate of decline in edentulism
is projected to slow, reaching
2.6 per cent (95 per cent prediction
limits: 2.1 per cent, 3.1 per cent)
by 2050. The continuing decline
will be offset only partially by
population growth and population aging, such that the predicted number of edentulous
people in 2050 (8.6 million;
95 per cent prediction limits:
6.8 million, 10.3 million) will be
30 per cent lower than the 12.2 million edentulous people in 2010.
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“While it’s encouraging to
know that this study by Dr Gary
Slade illustrates a steep decline
in US edentulism over the past
five decades, these health gains
in absolute terms have not been
distributed equally,” said American Association for Dental
Research President Dr Timothy
DeRouen. “Additional public
health measures must be taken
to reduce tooth loss in low-income populations.”
The paper, titled “Projections
of U.S. Edentulism Prevalence
Following Five Decades of Decline,” was published online on
August 21 in the Journal of Dental
Research ahead of print. The journal is a publication of the International Association for Dental
Research (IADR) and the American
Association for Dental Research,
a division of the IADR. The IADR
is a non-profit organization dedicated to advancing research and
increasing knowledge for the improvement of oral health, among
other objectives. DT
[7] =>
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50 Years Strong
Being dental’s top choice for decades* is only the beginning.
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• 62 Townie Choice Awards® during the last 11 years have
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[*] Based on research by Strategic Data Marketing.
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© 2014 A-dec Inc.
All rights reserved.
A-dec_50thAnniversary_DentalTribune.indd 1
3/10/14 12:29 PM
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DTAP1014_09_Business 18.09.14 17:51 Seite 1
DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
Business
9
“This step has long been an ambition of ours”
the products. This has helped us
to determine a range that really
addresses the market here.
With a full range of sophisticated
dental burs on display at the
2014 FDI Annual World Dental Congress, UK-based dental
manufacturer Prima Dental has
launched its new business its new
business-to-business operation in
India. Dental Tribune Asia Pacific
met with sales manager Dan
Hodgson and managing director
Richard Muller to discuss the
relevance of this market to the
company and Prima Dental’s plans
for its activities in the region.
Dental Tribune Asia Pacific:
Why did you decide to launch
your business operations in
India at the FDI AWDC above
all other events?
Richard Muller: The FDI
congress is an event that holds
international implications. As
you may know, we export to 85
countries around the world.
While we certainly look forward
to extending our business on
the Indian subcontinent, we also
expect to meet relevant business
contacts from overseas. The FDI
congress is a particularly good
event for that.
Did you have any history in
India?
Richard Muller: Actually,
we have been operating actively
in the Indian market through
presentations at trade shows,
like the World Dental Show in
Mumbai, since the mid-1990s.
After almost 20 years, we are
now here with our own business.
This step has long been an ambition of ours.
Will your products be available nationwide?
Dan Hodgson: Here at the
FDI congress, we are launching
with our northern distributors,
but we are also seeking distribution partners in the south and in
the east during the show. We will
soon have clarity in this regard.
Dan Hodgson and Richard Muller (second and third from left) with the New Delhi sales team. (Photo Daniel Zimmermann, DTI)
Compared with the other
markets you operate in, what
particular challenges does the
Indian market pose?
Each country has its own tax
regime and legal system. It took
us a while to understand the complexities of the Indian system and
we have had to navigate through
a great number of technical issues. In terms of the dental profession, there is clear potential in
both the public and private sectors. While the latter is not large
in percentage, it is certainly large
in numbers. The public sector is
still relatively under-developed
and we expect it to take a little
bit longer, probably two to three
years before we can achieve substantial sales in the sector.
Nobel Biocare
to join Danaher
dental business
DTI
ZURICH, Switzerland/CHARLOTTE,
USA: Danaher, a US health care
conglomerate of brands from
various industries, and Swiss dental manufacturer Nobel Biocare
announced that the two companies have entered into a definitive
transaction agreement. In order
to further expand its global dental
business, Danaher has offered to
buy Nobel Biocare, which is the
second-largest supplier of dental
implants worldwide, for CHF2 billion (US$2.1 billion).
Earlier this year, Nobel Biocare
confirmed that it had been approached at the end of July by
third parties with a potential interest in acquiring the business. Now,
the company’s board of directors
has unanimously decided to recommend that Nobel Biocare’s
shareholders accept the offer,
which includes the acquisition of
at least 67 per cent of all shares.
According to Danaher, it
reaches about 99 per cent of dental practices worldwide through
an extensive network of dealers
and direct sales. With the acquisition of Nobel Biocare, the company
will become one of the largest consumable and equipment competitors in dentistry, especially in the
premium segment of dental implants, with expected sales of US$3
billion. Danaher also stated that it
is planning more investments.
Both companies disclosed that
the transaction is scheduled for
completion by late 2014 or early
2015. Once the acquisition has
been completed, Nobel Biocare
will operate as a stand-alone company within Danaher’s dental
business, maintaining its own
brand and identity.
Since 1984, Danaher has acquired more than 400 companies.
KaVo Kerr Group, which unites
leading dental consumable, equip ment, high-tech and specialty
brands under one platform, was
formed at the beginning of this
year. The group includes KaVo,
Kerr, Axis, SybronEndo, Instrumentarium Dental, SOREDEX,
i-CAT and Implant Direct. DT
What in your opinion makes
your products particularly
suitable for the Indian market?
Dan Hodgson: The core of
our products is that they are reliable and very precise. They have
a number of special features that
add to their strength and durability. The burs we are introducing in
India are particularly focused on
the needs of the market. We have
conducted a great deal of research
with local dentists to understand
their product requirements and
the purposes for which they use
What further plans do you
have for the region?
Richard Muller: We will certainly use our new Indian base to
explore the whole subcontinent.
Asia has a growing share of our
total market, although the predominant share is the North
American and the UK markets.
We also have significant business in South Korea, Japan and
Indonesia, where we recently established a new distribution network. We will be concentrating
our efforts on India, however.
Thank you very much for
the interview. DT
AD
Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry
www.dental-tribune.com
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10 Trends & Applications
DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
Physiological healing patterns:
What clinicians need to know
about tooth extractions
0.4 mm-wide layer of connective
tissue, similar to that described
in the previously mentioned
study.11 Only in the apical 1.8 mm
of the defects was new bone integrated on to the implant surface, leaving the coronal 3.2 mm
occupied by connective tissue
attached to the implant surface.
Daniele Botticelli
Italy
After a tooth has been extracted,
a series of processes are set in
motion that ultimately results
in the healing of the alveolus.
As demonstrated in animal1, 2
and human studies,3, 4 intraalveolus healing usually starts
with the formation of a coagulum in the alveolus immediately after the tooth has been
extracted. This clot is then progressively replaced by a provisional matrix, which functions
as a scaffold for the woven bone
that will form from the lateral
walls and the bottom of the
alveolus to fill the extraction
socket eventually. Subsequent ly, the immature bone becomes
mature alveolar bone.
After two months, 1 mm more
was gained coronally, leaving
a remaining defect of 1.9 mm.
After four months, bone healing
was finally complete (Fig. 2).
Similar patterns of healing
have been described for implants
placed immediately into extraction sockets,14, 15 demonstrating
again that bone formation originated from the lateral bony
walls, rapidly filling the defect.
Osseointegration on the surface,
however, started apically within
the defect from the site of contact
between the implant and the
native bone, and took a longer
time to complete (three to four
months) compared with the
physiological healing of an extraction socket (one month).
In this time, intra-alveolus
processes continue. Extra-alveolus healing occurs concomitantly
and will result in vertical and
horizontal resorption of the
walls of the extraction sockets, a
process that is more pronounced
at the buccal than at the lingual
aspects.5, 6
A recent systematic review on
post-extraction alveolar dimensional changes in hard and soft
tissue in humans7 reported a horizontal dimensional loss of 29 to
63 per cent and a vertical dimensional loss of 11 to 22 per cent
six months after tooth extraction.
Moreover, it reported that the reduction of alveolar crest dimensions was faster during the first
six months of healing and continued after that. In a clinical study,
the width of the alveolar crest at
the buccal and lingual aspects
was measured in edentulous
sites and compared with the dentate contralateral sites in 149 cast
models.5 A reduction of the alveolar crest of about 3.5 to 3.6 mm
at the buccal aspect and 1.7 to
2.0 mm at the lingual aspect was
observed. Another study found
a total reduction of the width of
the alveolar crest of about 30 per
cent after 3 months and of 50 per
cent after 12 months.8
When an implant is placed
immediately into an extraction
socket, the physiological healing patterns of the alveolus are
different from those described
above. In order to better understand these processes, it is important to mention two processes
that have been proposed as explanations for osseointegration,
namely distance and contact
osteogenesis.9, 10 While new bone
is formed on the surfaces of the
native bone in distance osteogenesis and the bone will come
into contact with the implant surface as a result, new bone forms
first on the implant surface in
contact osteogenesis.
An experiment was conducted on animals to test these
processes11 by preparing cylindrical defects in the alveolar
bone and implants (smaller in dimension than that of the defects
and with a moderately rough surface) placed and stabilised by devices to guarantee their stability
despite the absence of primary
contacts with the native bone.
After implant placement, gaps of
≥ 0.7 mm were obtained between
the implant surface and the bony
walls. After three months of healing, very little osseointegration
was observed at the defect sites
(0.3 to 5.3 per cent) compared
with the control sites (46.1 per
cent), in which implants were
placed in full contact with the native bone (Fig. 1). Moreover, the
defects were found to be filled
with newly formed bone, which,
however, did not reach the implant surface along its entire
length. A space of 0.4 to 0.5 mm
in width between the front of
the new bone and the implant
surface was observed, occupied
by connective tissue that surrounded almost the entire body
of the implant. Proper osseointegration may be difficult to
achieve when there is no primary
contact with the native bone.
In order to study this supposition, a series of experiments
on animals were conducted.12, 13
Recipient implant sites of 10 mm
in depth were prepared in the
alveolar crest according to the
usual protocol. The marginal
5 mm of the sites was subsequently
widened with a drill so that a marginal gap of 5 mm in depth and
1.25 mm in width was obtained
between the rough
surface implant and
the bony walls after
implant placement.
All of the experimental sites were
covered with collagen membranes.
The fully submerged and his tological outcomes
were evaluated after
one, two and four
months. It was observed that the defects had filled with
newly formed bone
after one month
(Fig. 2). However,
the bone was separated from the implant surface by a
Another important factor to
be considered is osteoconduction,10 which can be defined as
the process during which bone
grows on to a surface.16 It is a
well established that moderately
rough surfaces provide higher
osteoconductivity and induce a
higher degree of osseointegration compared with turned surfaces.17 While this difference in
osteoconductivity may have limited clinical significance,18 more
attention should be paid to marginal defects present at implant
placement. In fact, experimental
studies have demonstrated incomplete healing of marginal defects with implants with turned
surfaces.19, 20 This may be related
to the lower osteoconductive
potential and capacity of turned
surfaces to maintain this property over time compared with
rough surfaces. This may be
relevant when implants with a
turned surface are placed into
extraction sockets or placed at
the same surgical stage of sinus
floor elevation, for example. DT
Editorial note: A complete list of references is available from the publisher.
Contact Info
Dr Daniele Botticelli is head of
the oral surgery
division at the
Ariminum Research & Dental
Education Center in Rimini in
Italy. He can be contacted at
daniele.botticelli@gmail.com.
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DTAP1014_12_Jayaraman 18.09.14 17:52 Seite 1
DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
12 Trends & Applications
Secular trends in dental development
FDI presenter and paediatric dentist Dr Jayakumar Jayaraman, Hong Kong,
about the evidence and why it should be applied to clinical practice
dentition, this finding was verified by research involving children in Finland, Germany and
Hong Kong.
Dental panoramic radiograph showing development of permanent teeth in a 11-year-old chinese boy.
Secular trends are phenomena
in physical maturation that
are not cyclical or seasonal but
develop over a relatively long
period. An analysis of these
patterns is of interest because
they help us to understand the
relationship between human
development and the environment, as well as physiological
aspects of intergenerational
relationships in growth.
average age of menarche was
12.53 years.2 Another positive
trend was observed with regard
More importantly, secular
trends can serve as indicators of
developments in public health
as it changes over time.1 To give
an example: the average age of
menarche was 17.5 years during
the 1800s and since then has
decreased progressively at a
rate of two to three months
per decade. In 2006, a study on
Irish females found that the
to average body height: a study of
Dutch males found that their
height had increased from 165 cm
in 1860 to 181 cm in 1990.1
dental arch or facial dimensions
and other orofacial structures.
They can be attributed to several
Dental development is a
sequential process that varies
substantially between the sexes
and between populations with
different ethnicities. For example, many studies have reported
advanced dental development
in females compared with
males, a finding that is prevalent in all population groups.
Similarly, advanced dental
emergence has been observed
in African-American children
compared with Chinese and
Japanese children.
Various secular trends have
also been found in maxillary and
mandibular dentition. There is
“…serve as indicators of
developments in public health…”
In addition to skeletal development, secular changes have
been reported with regard to
body weight, body mass index
and other physiological aspects
of the human body, such as the
AD
D E N TA L I N S T R U M E N T S –
MADE IN GERMANY
at
S e e u s KO H A M A
O
W D S NYo. D -68
Booth
factors, including changes in genetic pattern, socio-economic
status, as well as nutrition, health
and climatic conditions. Unlike
skeletal development, however,
dental maturation remains relatively unaffected by other maturation phenomenon.3 The secular changes observed in dental
development, which includes
dental maturation and emergence, are reflections of these
minor changes that have been
occurring over several years.
While dental maturation is
the development of the anatom ical components of a tooth, a
process that starts with the initiation of crown formation in utero
and continues until closure of the
root apex in the early twenties,
dental emergence is the eruption
of a tooth into its relative position
in the arch.
There is evidence that secular trends exist for both of
these processes. For example,
research has demonstrated delayed dental maturation in the
remains of eighteenth-century
children compared with dental
records of children living in
modern England.4
By analysing the maturation
of a permanent tooth, Nadler also
found that children living in the
1990s showed advanced maturation compared with children
born two decades earlier.5
Bodenseeallee 14-16 • 78333 Stockach Germany
Tel. +49 7771 64999-0 • Fax +49 7771 64999-50 www.kohler-medizintechnik.de
A similar trend was observed
in dental emergence in a study
that found advanced emergence
in Japanese children from the
1980s compared with children
in 1934.6 Detected mostly in
the permanent dentition, and to
a minimal extent in the primary
wide agreement that the latter
is more advanced in dental maturation, as well as emergence,
since mandibular teeth are the
Hong Kong, we found accelerated
maturation of permanent teeth
in children born in 2001 compared with children born in 1981.
However, this trend was observed
only in the maxillary dentition.
As agreed by other investigators,
in both year cohorts, females
showed advanced development
compared with males.7
With such strong evidence,
we need to bring the applicability
of common dental atlas charts,
such as those developed by
Schour and Massler, whose tables and charts are based on
institutionalised American Caucasian children in the 1920s,8 to
the current population into question. A recent study conducted
in London tested the applicability
of old and modern dental charts
and found that the older charts
were inaccurate.3 However, most
clinical textbooks in dentistry still
reproduce these charts, mainly
because few other populationspecific dental charts exist.
There is a need for evidencebased dental charts created from
modern and healthy samples
identified by sex and ethnicity.
Once created, they could not only
serve as an eminent tool in forensic dentistry for estimating the
age of subjects with undocu-
Interdisciplinary management of missing left lateral incisor and impacted
canine of a chinese girl aged 12 years.
first to erupt in the oral cavity in
both the primary and permanent
dentition.
Nadler reported advanced
dental maturation based on
evaluation of only the growth
pattern of a mandibular canine.
The reason for this approach
comes from an earlier study that
found a correlation between the
maturation of mandibular canines and ossification centres in
the hand. This study also concluded that a strong relationship
exists between dental and skeletal development.5 The use of
a single tooth type to analyse
secular trends has been criticised by several authors for
ignoring that each tooth type
exhibits different patterns of
maturation. It has been suggested that all developing teeth
must be included in the analysis
in order to confirm a secular
change. In our own study of
5- and 6-year-old children in
mented birth records, but also
provide insight on current dental development standards that
could be utilised for appropriate
time-related management of
dental conditions. DT
A list of references is available from
the publisher.
Contact Info
Dr Jayakumar
Jayaraman is a
paediatric dentist
from Hong Kong
with special research interests in
dental anthropology, forensic dentistry, legal medicine and human biology. His area of expertise is dental
age assessment and, for this reason, he started the Date of Birth
Foundation, the world’s first charity
organisation to promote accurate
birth records. He can be contacted at
drjayhk@hotmail.com.
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
Trends & Applications 13
Clinical guidelines for the use of
ProTaper Next instruments (Part II)
Fig. 1a
Fig. 1b
Fig. 1c
Fig. 2a
Fig. 2b
Fig. 2c
Fig. 1a: Preoperative radiograph of a maxillary right second premolar.—Fig. 1b: Length determination radiograph. Note the ‘S’-shaped canal configuration.—Fig. 1c: Postoperative radiograph after canal
obturation with Guttacore obturators (DENTSPLY Maillefer).—Fig. 2a: Preoperative radiograph of a maxillary right first molar.—Fig. 2b: Length determination radiograph. Note the ‘S’-shaped canal
configuration in the distobuccal root canal.—Fig. 2c: Postoperative radiograph after glide path preparation with Pathfiles and canal preparation with ProTaper Next X1 and X2. Obturation was done
with Guttacore obturators. Note maintenance of ‘S’-shaped curvature in the obturated distobuccal root canal system.
Prof. Peet J. van der Vyver &
Dr Michael J. Scianamblo
South Africa & US
Recently, the ProTaper Next system (DENTSPLY Maillefer) was
launched into the dental market.
In part I of this series, published
in the July/August edition of
Dental Tribune Asia Pacific, the
authors outlined the clinical
guidelines for the use of the
ProTaper Next instruments. There
are five instruments in the system
but most canals can be prepared
by using only the first two instruments. The first instrument in the
system is the ProTaper Next X1,
with a tip size of 0.17 mm and a
4 % taper. This instrument is used
after creation of a reproducible
glide path by means of hand
instruments or rotary Pathfiles
(DENTSPLY Maillefer).
The ProTaper Next X1 is always
followed by the ProTaper Next X2
(0.25 mm tip and 6 % taper). This
instrument can be regarded as the
first finishing file in the system,
as it leaves the prepared root canal
with adequate shape and taper for
optimal irrigation and root canal
obturation. The ProTaper Next X1
and X2 have an increasing and
decreasing percentage tapered design over the active portion of the
instruments.
The last three finishing instruments are the ProTaper Next X3
(0.30 mm tip with 7 % taper), ProTaper Next X4 (0.40 mm tip with 6 %
taper) and the ProTaper Next X5
(0.5 mm tip with 6 % taper). These
instruments have a decreasing percentage taper from the tip to the
shank. The ProTaper Next X3, X4
and X5 can be used to either create
more taper in a root canal or to prepare larger root canal systems.
There are several advantages
related to the ProTaper Next system:
• The instruments are manufactured from M-Wire that contributes towards more flexible instruments, increased safety and
protection against instrument
fracture,1 allowing the clinician to
treat more complex root canal systems with a high level of success
• The instruments have a bilateral
symmetrical rectangular cross
section with an offset from the
central axis of rotation (except in
the last 3 mm of the instrument,
D0-D3) creating an asymmetric
rotary motion. The exception is the
ProTaper X1, which has a square
cross section in the last 3 mm to
give the instruments a bit more
core strength in the narrow apical
part. The asymmetric rotary motion allows the instrument to experience a rotational phenomenon
known as precession or swagger.2
According to Van der Vyver and
Scianamblo,3 the benefits of this
design characteristic include that
it further reduces (in addition to
the progressive tapered design)
the engagement between the instrument and the dentine walls
because only two cutting points
make contact with the canal wall at
any time. This will contribute to
a reduction in taper lock, screw-in
effect and stress on the file. It also
ensures debris removal in a coronal direction because the off-centre cross-section allows for more
space around the flutes of the
instrument. This will lead to improved cutting efficiency, as the
blades will stay in contact with
the surrounding dentine walls.
Root canal preparation is done in
a very fast and effortless manner.
Furthermore, the swaggering
(asymmetric) rotary motion of the
instrument initiates activation of
the irrigation solution during
canal preparation, improving debris removal. The design also reduces the risk of instrument fracture because there is less stress on
the file and more efficient debris
removal. Every instrument is capable of cutting a larger envelope
of motion (larger canal preparation size) compared to a similarlysized instrument with a symmet rical mass and axis of rotation.
This allows the clinician to use
fewer instruments to prepare a
root canal to the adequate shape
and taper to allow for optimal
irrigation and obturation. Finally,
there is a smooth transition between the different sizes of instruments because the design ensures
that the instrument sequence itself
expands exponentially.
The aim of this article is to illustrate the use of ProTaper Next in struments in complex and challenging endodontic cases. The preparation technique for minimally
invasive root canal preparation with
ProTaper Next instruments will also
be discussed.
‘S’-shaped root canals
A major challenge in endodontics is the treatment of ‘S’-shaped
or bayonet-shaped root canals. This
type of root canal configuration can
be present in root canal systems
of maxillary laterals, canines and
premolars, as well as mandibular
molars.4 The authors would recommend using Pathfile no. 3 (ISO tip
0.19 mm) (after Pathfiles no. 1 and 2)
in these challenging root canal
systems as the final glide path preparation file. This will increase the
glide path size before introducing
the ProTaper Next X1, resulting in
less engagement as the file travels
down the canal curvatures.
Case report one
The patient, a 41-year-old female, presented with irreversible
pulpitis on her maxillary right second premolar (Fig. 1a). The length
determination radiograph revealed
an ‘S’-shaped canal configuration
(Fig. 1b). The canal was negotiated
and glide path enlarged using
Pathfiles no. 1, 2 and 3. Canal preparation was done with ProTaper
Next X1 and X2.
In this case, emphasis was
placed on using a backstroke, outwards brushing motion with the
ProTaper Next instruments to remove restrictive dentine in the
canal, allowing the instruments
to progress apically. The canal was
obturated (Fig. 1c) with a size 20
Guttacore obturator to working
length followed by another X2 Guttacore obturator to ensure adequate
obturation of the oval coronal part
of the root canal system.
Case report two
A 45-year-old male patient presented with severe pain on his maxillary right first molar. A preoperative periapical radiograph revealed
placement of a deep amalgam
restoration (Fig. 2a). The length
determination radiograph revealed
an ‘S’-shaped canal configuration in
the distobuccal root canal (Fig. 2b).
The root canals were negotiated to
working length and the glide paths
enlarged using Pathfiles no. 1 and
no. 2. Pathfile no. 3 was used in the
distobuccal root canal. Canal preparation was done with ProTaper Next
X1 and X2 in all three root canals.
After gauging with a size 25
nickel titanium hand instrument, it
was decided to enlarge the palatal
root canal to a ProTaper Next X3.
All three root canals were obturated
with matching ProTaper Next gutta
percha cones using the Calamus
Dual Obturation Unit (Fig. 2c). Note
the maintenance of the ‘S’-shaped
curvature in obturated distobuccal
root canal system.
Challenging curvatures in
the apical third of root canals
Apical root canal curvatures
must always be respected and never
straightened. According to Catellucci,5 straightening these curves
would mean displacing the apical
foramen from its original position,
which can lead to treatment failure.
Other problems that can be encountered when treating curved
canals include ledge formation,
perforation, zip formation and file
separation.6
It is very important to identify
canal curvatures during initial canal
negotiation in order to avoid the
above mentioned preparation errors. The greater the angle of cur vature and the smaller the radius of
curvature, the more complex the
management and treatment will be.7
Again, the authors would recommend using all three Pathfiles
in these challenging root canal
systems to enlarge the glide path
prior to canal preparation. It is also
important to note that the reduced
apical tapers of the ProTaper Next
instruments (compared to ProTaper
Universal) are ideal for maintaining
apical curvatures or ‘S’-shaped root
canals.
Case report
The patient, a 27-year-old male,
presented with a non-vital mandi ‡ DT page 14
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DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
14 Trends & Applications
fl DT page 13
bular left first molar and an in adequately root canal treated
mandibular right second molar
(Fig. 3a). Access cavities were prepared and the previous gutta percha
was removed from the canals of the
second molar.
A length determination radiograph revealed sharp apical curvatures in the last few millimetres
of the mesial and distal roots of the
mandibular first molar. It was also
noted that the working length was
short in the canals of the second molar (Fig. 3b). A combination of C+
and K-files were used to negotiate
the canals in the mandibular second molar to full working length.
A reproducible glide path was established in all the root canals and the
glide paths enlarged to ISO 0.19 mm
using Pathfiles.
The coronal two thirds of the
canals were prepared with ProTaper
Next X1 and X2 using a backstroke,
outwards brushing motion to remove
restrictive dentine in the canals, allowing the instruments to progress
towards the apical third. The apical
third of the root canals were prepared
with a controlled push-pull motion,
allowing the instruments to progress
up to working length.
Fig. 3a
Fig. 3b
Fig. 3c
Fig. 3a: Non-vital mandibular
left first molar and inadequately root canal treated
mandibular right second molar.—Fig. 3b: Initial length
determination radiograph.
Note that the files were short in
all the root canals in the
mandibular second molar.—
Fig. 3c: Periapical radiograph
demonstrating the fit of the
plastic inserts of ProTaper
obturators to the corrected
working length (mandibular
second molar) after canal negotiation with C+ and K-files
and preparation with ProTaper
Next.—Fig. 3d: Final result
Fig. 3d
Fig. 3e
Fig. 3f
after the canals were obturated
with ProTaper obturators.—
Fig. 3e: Periapical radiograph (30 degrees mesial angulated) demonstrating respect of the original canal anatomy after canal preparation with ProTaper Next
instruments.—Fig. 3f: Six-month follow-up periapical radiograph illustrating periapical healing.
The prepared root canals were
gauged with a size 25 nickel titanium hand file. The file was snug at
working length except in the distal
canal of the lower first molar. This
canal was enlarged with a ProTaper
Next X3 instrument. Figure 3c
shows radiographic confirmation of
the working length and the fit of the
plastic carriers of size 25 ProTaper
obturators (without gutta percha).
All the canals were obturated (Fig. 3d)
with size 25 ProTaper obturators,
except the distal root canal in the
AD
lower first molar that received a size
30 ProTaper obturator. Figure 3e
demonstrates the final result after
obturation and Figure 3f illustrates
healing of the periapical pathology
around the roots on a six-month
postoperative radiograph.
Minimally invasive
canal preparation
According to Gutmann,8 minimally-invasive endodontic (MIE)
procedures can range from diagnosis to making a decision to treat
(or not to treat) the case. They also
include:
• Minimal removal of dentine during access cavity preparation,9
enlarging and shaping of the root
canal system to retain as much as
sound dentine as possible.
• Retention of tooth structure during disassembly and retreatment
procedures.
6 Months Clinical Masters Program
in Aesthetic and Restorative Dentistry
TM
Dubai Session, 12-15 November 2014
On location session, hands on + online learning
and mentoring
Learn from the Masters of Aesthetic and Restorative Dentistry:
Topics
Anterior Composite Restorations Demystifying Anteriors
Posterior Direct Restorations
Conservative Indirect Esthetic Restorations
We have to accept that if access
openings are too restricted it can impact on the final result of treatment.
Gutmann further suggests that efforts should be made to minimise
the excess removal of cervical
tooth structure in the canal orifice
through the use of Peeso reamers,
Gates Glidden burs and orifice
opening instruments. These instruments tend to straighten the canal
and weaken the root canal walls,
predisposing them to cracks and,
in some cases, can even lead to
root canal wall stripping defects.
For some clinicians, it might be an
option not to brush excessively with
ProTaper Next instruments but to
rather use the ‘push-pull’ preparation technique.
Case report
Registration information:
12-15 November 2014
Details on www.TribuneCME.com
a total of 4 days of intensive live training in Dubai (UAE)
Curriculum fee: € 3,450
contact us at tel.: +49 341 48474 302
email: request@tribunecme.com
(you can decide at any time to complete the entire Clinical Masters Program
and take the remaining session)
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on your cases
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of the Pacific
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50
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C.E. CREDITS
*iPad only available for the participants
in the entire Cinical Master Program
Supported by:
Tribune America LLC is the ADA CERP provider. ADA CERP is a service of the American Dental Association to assist dental
professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual
courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
The patient, a 39-year-old male,
presented with non-vital maxillary
first and second molars (Fig. 4a).
He also reported that his previous
dentist, for pain relief, did emergency root canal treatments on
both teeth.
The temporary filling on the
upper first molar was removed
and four root canal orifices located
and explored (mesiobuccal, mesiobuccal 2, distobuccal and palatal).
Figure 4b shows a periapical radiograph confirming the working
lengths that were electronically
measured with the Propex Pixi apex
locator (DENTSPLY Maillefer).
Reproducible glide paths were
established by using a size 10 K-file by
hand, followed by mechanically enlarging the glide paths in all four root
canals using Pathfiles no. 1, 2 and 3.
All four root canals were prepared
with ProTaper Next using the following technique, resulting in minimally invasive canal preparations.
In order to explain the technique, we
will outline the preparation steps for
one of the mesiobuccal root canals.
ProTaper Next X1 was introduced
into the canal and used in a pushpull motion. Restrictive dentine was
removed on the outstroke, pulling
motion. The push-pull motion was
repeated a few times until the instrument progressed approximately
4mm (Fig. 5a). The instrument was
removed from the root canal, the
flutes cleaned and the canal irrigated, recapitulated and re-irrigated.
The file was re-introduced into the
root canal and the same protocol repeated (Fig. 5b). After three cutting
cycles of 4 mm each, the full working
length was reached (Fig. 5c).
ProTaper Next X2 was introduced and used following the same
protocol. After two cutting cycles of
4mm each, full working length was
reached. A size 25/02 nickel titanium hand file was used to gauge the
apical foramen. The file fitted snug
at working length and shaping was
complete.
The mesiobuccal, mesiobuccal
2, and distobuccal canals were prepared up to ProTaper Next X2 and
the palatal canal was prepared up
to ProTaper Next X3. Because the
instruments were used in a pushpull motion instead of a deliberate
brushing motion, the canal shapes
were generally smaller in size and
more conservative. The concept of
larger apical sizes has been advocated to improve bacterial reduction. However, maintaining smaller
sizes (>20<40) would seem desirable for the preservation of radicular dentine in the majority of cases
and to rather focus on improved
methods for cleaning and disinfecting root canal systems.8
‡ DT page 16
[15] =>
Standard_300dpi
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[16] =>
Standard_300dpi
DTAP1014_13-16_Protaper 18.09.14 17:53 Seite 3
DENTAL TRIBUNE Asia Pacific Edition No. 10/2014
16 Trends & Applications
fl DT page 14
Fig. 4b
Fig. 4a
Fig. 5a–c
Fig. 6a
Fig. 6b
Fig. 4a: Preoperative radiograph of
non-vital maxillary left first and second
molars.—Fig. 4b: Length determination radiograph for the maxillary first
molar.—Fig. 5a: ProTaper Next X1 is
introduced into the canal and used in
a push-pull motion. Restrictive dentine
is removed on the outstroke, pulling
motion. The push-pull motion was
repeated a few times until the instrument progressed approximately 4 mm
(arrow). The instrument was removed
from the root canal, the flutes cleaned
and the canal irrigated, recapitulated
and re-irrigated.—Fig. 5b: The file was
reintroduced into the root canal and
the same protocol repeated. The instrument now progressed up to the apical
third of the root canal (arrow).—
Fig. 6a: ProTaper Next X3 gutta percha
cone and three size 20 Guttacore verifiers fitted to working lengths prior
to obturation.—Fig. 6b: Postoperative
result after obturation.
AD
The Dental Tribune International
C.E. Magazines
www.dental-tribune.com
The palatal canal was obturated
with a ProTaper Next X3 gutta percha
cone using the Calamus Dual Obturation Unit (DENTSPLY Maillefer).
It was decided to obturate the two
mesiobuccal and distobuccal canals
with Guttacore crosslinked gutta
percha carriers.
I would like to subscribe to
CAD/CAM
cone beam
cosmetic dentistry*
DT Study Club (France)***
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incl. shipping and VAT for customers
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(4 issues/year; incl. shipping for customers
outside Germany).** Your subscription will
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Editorial note: A complete list of references
is available from the publisher.
Prof. Peet J. van
der Vyver is an
extraordinary
professor at the
Department of
Odontology of the
University of Pretoria’s School of
Dentistry in South Africa. He can
be contacted at peetv@iafrica.com.
Shipping address
City
It must be noted that because
of the more conservative canal
preparations obtained with the
push-pull preparation protocol it
was not possible to passively fit a size
X2 Guttacore verifier (size 025) up to
working length in the prepared root
canals. Only size 20 Guttacore verifiers fitted passively, without resistance to working length (Fig. 6a).
The selected root canals were then
obturated using three size 20 Guttacore obturators. Figure 6b shows
the final result after obturation.
Carrier-based obturation also forms
part of the MIE concept due to the
minimal amount of application
forces involved during the obtu ration process onto the remaining
root structure. DT
Expiration Date
Security Code
fax: +49 341 48474 173 | e-mail: subscriptions@dental-tribune.com
Dr Michael J.
Scianamblo is
an endodontist in
the US and the
developer of Crit ical Path Technology. He can
be contacted at
michael@criticalpathtechnology.com.
[17] =>
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DTAP1014_17_ICOItoday 18.09.14 17:53 Seite 1
ICOI World Congress XXXI · Tokyo · 3–5 October, 2014
Official news for visitors and exhibitors
Are all implants equal?
New products in focus
Plan ahead
A Cochrane report has recently suggested that
there may be no differences in terms of longterm success, regardless of the shape of the
implant or the material used.
The ICOI World Congress XXXI in Tokyo is an
excellent opportunity to see state-of-the-art
technologies in the field of dental implantology.
In our business section, you will find the latest
update of the floor plan and the exhibitors list of
the ICOI World Dental Congress in Tokyo.
»Page 18
»Page 23
»Page 20
(DTI/Photo Im Perfect Lazybones)
ICOI World Congress XXXI
“The Future of
Implant Dentistry”
Date:
3–5 October, 2014
Venue:
Tokyo International Forum
Opening times:
Saturday, 4 October: 8 a.m.–6 p.m.
Sunday, 5 October: 8 a.m.–4 p.m.
Continuing Education:
ICOI is an ADA CERP recognised
provider. Delegates who have registered for the congress can earn
continuing education credits (maximum 18) by attending scientific
sessions during the meeting. All
presentations are in lecture format.
They qualify for AGD Subject Code
690 Implants.
Publisher:
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd, 20A,
Harvard Commercial Building,
105–111 Thomson Road, Wanchai,
Hong Kong
Phone.: +852 3113 6177
Fax: +852 3113 6199
Internet: www.dental-tribune.asia
Publisher:
Torsten Oemus
Director of Finance
and Controlling:
Dan Wunderlich
Managing Editor:
Daniel Zimmermann
Product Manager:
Claudia Salwiczek
Production Executive:
Gernot Meyer
Production:
Franziska Dachsel
This special edition of today international will
appear as a supplement to Dental Tribune
Asia Pacific during the ICOI World Congress
XXXI, Tokyo, 3–5 October, 2014.
The magazine 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. No responsibility shall
be assumed for information published about associations, companies and commercial markets. General
terms and conditions apply, legal venue is Hong Kong.
October marks return of
ICOI World Congress to Japan
Prestigious event for dental implant rehabilitation to take place at Tokyo International Forum
n TOKYO, Japan: Ten years ago,
the International Congress of Oral
Implantologists (ICOI) first held its
World Congress in Tokyo, Japan. In
October, the annual meeting finally
makes its first return to the Japanese
capital, that will be organised by
the ICOI’s Asia-Pacific section. Held
at the Tokyo International Forum,
the three day event will run from
3 to 5 October.
According to Scientific Chairman
Dr Koichi Ito, with which Dental Tribune Asia Pacific had the opportunity
to speak in early September, participants of the congress in Tokyo can
look forward to an impressive line-up
of international and local speakers.
Among other topics, clinicians and
dental implant experts from the US,
Western Europe and Japan have announced that they will present papers on the diagnostic use of cone
beam computerised tomography, the
association between implant surface
and osseointegration, and tooth regenerative therapy as future dental
treatment. The programme is accompanied by an industry exhibition,
where over 50 companies will showcase the latest products and solutions.
“I think we have seen incredible
development in dental implantology
in Japan since the last congress was
held ten years ago,” Ito remarked.
“With the tremendous support from
the ICOI over these years, our membership in Japan has created a clinical environment which is characterised by clinical excellence and
increasing trust from the general
public.”
The overall market for dental
implants has an estimated value at
¥350 billion (US$32.5 million), with
only moderate growth rates to be
expected in years to come. While
Japan is generally considered to have
a surplus of dentists, only few practitioners in the country actually used
to place dental implants. From these
only few place more than ten implants per year, which according to
Tokyo. (DTI/skyearth)
Dr Yoshiharu Hayashi, ICOI diplomat
and prominent implantologist with
practices in Tokyo and the Chiba
provence, is largely due to lack of
knowledge about dental implant rehabilitation in the general public.
He said that although dental clinics
have recently picked up on dental
implants, which has lowered the
prices for this kind of treatment significantly, patients tend to choose
experienced clinicians and cheaper
but lower-quality treatments in order to avoid postoperative problems.
Another problem is implant education which according to Dr Hayashi is
largely provided through corporate
workshops conducted by dental implant manufacturers, which he said
are often not enough to provide clinical techniques appropriately.
“If the quality of the ICOI training
system could be conveyed to more
dentists through the upcoming World
Congress by the ICOI, rather than
through manufacturers, this would
make feel patients more safe when
considering dental implant placement,” he said.
According to the ICOI, up to 1,400
professionals are estimated to attend
the meeting, of which the majority
is expected to come from Japan.
The ICOI Asia-Pacific currently boasts
a membership of over 3,000. The division was founded in 1998.
AD
Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry
www.dental-tribune.com
[18] =>
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DTAP1014_18_Cochrane 18.09.14 17:53 Seite 1
18
news
ICOI Tokyo 2014
Cochrane reports no evidence for superior
long-term success of dental implants
MELBOURNE, Australia/MANCHESTER, UK: Promising superior
clinical outcomes, plenty of new
dental implants are launched to
markets each year. A report by reAD
searchers from the Cochrane Oral
Health Group in Melbourne and
Manchester has recently suggested
that there may be no differences in
terms of long-term success, regard-
less of the shape of the implant or
the material used.
The researchers reviewed randomised clinic trials conducted around the
world from the group’s own database.
From this, the only statistically significant difference observed was
in relation to surface preparations,
with smoother (turned) surfaces being
found to be less prone to bone loss
associated with peri-implantitis than
were rougher surfaces.
Smoother surfaces, however, appeared to fail early more often, according to the analysis.
Similar results were reported by
the group in a series of earlier reviews,
of which the first was published in
2002. In the most recent update, two
of the review authors independently
compared 38 different implant types,
which had been placed in 27 trials
involving more than 1,500 patients,
ranging from the early 1980s to early
2014. They said that, while their report
provided no evidence that one specific type of implant proved superior
in terms of long-term success to other
types of implants with different characteristics, the results would have to
be evaluated carefully owing to the
low number of participants and short
follow-up periods, which ranged from
one to ten years.
Overall, more than half of the reviewed trials proved to be at high risk
of bias, they said.
“One well known weakness of such
a meta-analysis of several small studies is that it cannot predict the results
of a larger study,” remarked Prof.
Stefan Holst, Global Head of Research
and Science at Nobel Biocare, one of
the global market leaders in dental
implantology, on the report’s findings.
“With 38 different implant types with
highly diverse geometries, surfaces,
prosthetic superstructures and clinical protocols applied—several of which
are no longer in use—there are many
variables. The meta-analysis dilutes
any potential effect of a single relevant
implant surface or implant characteristic in clinical practice today.”
A representative of Straumann also
cautioned against the results, saying
that the review reflects the fact that
there is very little or no published clinical data on the majority of commercially available dental implants, since
they have not been clinically tested.
He emphasised that of all the implants available today only 38 tested
in randomised controlled clinical trials were considered worthy of review.
“With regard to our own implants,
the review excluded studies that we
and others feel are important. Furthermore, it did not consider the large body
of bench tests and preclinical trials
that demonstrate significant differences in some cases,” the representative told Dental Tribune Asia Pacific.
According to the Cochrane Collaboration, there are more than 1,300
different dental implants available
on the market today. The total value of
fixed tooth replacements was estimated to be US$3.4 billion in 2011,
a figure that some analysts expect to
almost double in the next five years
owing to the increasing demand of an
ageing population and more dentists
starting to place dental implants.
[19] =>
Standard_300dpi
DTSC_A4_EN_Layout 1 04.02.14 14:23 Seite 1
www.DTStudyClub.com
Y education everywhere
and anytime
Y live and interactive webinars
Y more than 500 archived courses
Y a focused discussion forum
Y free membership
Y no travel costs
Y no time away from the practice
Y interaction with colleagues and
experts across the globe
Y a growing database of
scientific articles and case reports
Y ADA CERP-recognized
credit administration
r
o
f
r
e
t
s
i
g
Re
FREE!
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
[20] =>
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DTAP1014_20-22_Exhibitors 18.09.14 17:54 Seite 1
ICOI Tokyo 2014
ICOI Tokyo 2014—Floor plan
[21] =>
Standard_300dpi
DTAP1014_20-22_Exhibitors 18.09.14 17:54 Seite 2
business
ICOI Tokyo 2014
21
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DTAP1014_20-22_Exhibitors 18.09.14 17:54 Seite 3
business
22
ICOI Tokyo 2014
ICOI Tokyo 2014—Exhibitors list
Company Confirmed Booth No.
Company Confirmed Booth No.
Company Confirmed Booth No.
Company Confirmed Booth No.
Company Confirmed Booth No.
AIDA Chemical Industries Co. Ltd.
11
Bee Brand Medical Dental Co. Ltd. 14
Calypso Int’l Co., Ltd.
5
Corp. Hotline
22
DoWell Dental
Alta-Dent Co.,Ltd
69
Biohorizons
42–43
Citi Card Japan Inc.
9
Corp. Mediart
6
Empower Healthcare K.K.
46
American Express int’l Inc.
32
Biomet 3i Japan, Inc.
77–78
Corefront Co., Ltd.
37
Cross Field Corp.
58
Family Office Association
16
APRO FX
41
Blue Giraffe
25
Corp. GENOVA
4
DENTSPLY International Inc.
51
Fukuoka Dental College
57
Asahi Pretec Corp.
8
Brainbase Corp.
7
Corp. GIKO
45
Dental Promotion
17
GC CORPORATION
36
Hakuho Co., Ltd.
71
Hermans Co., Ltd.
35
Hu-Friedy Japan Co., Ltd.
28
AD
61–62
ICOI/Columbia
Diplomate Program
81
IDREF
83
IMPLATEX Co., Ltd.
53
Ivoclar Vivadent AG
12–13
Iwase Dental Supply Inc.
68
KAWARYO PGM
26
Kentec Corp.
24
Kinki Rentogen
Industrial Co., Ltd.
64
KYOCERA
Medical Corporation
55
Kyoyukai
23
Leading Implant Center
40
Lion Dental Products Co., Ltd.
50
Medical Apex Co. Ltd.
15
Medical Net
Communications, Inc.
66–67
Meikai University
School of Dentistry
18
MetLife
27
The 36th Australian Dental Congress
MOKUDA Ltd.
38
Brisbane Convention and Exhibition Centre - an AEG 1EARTH venue
Wednesday 25th to Sunday 29th March 2015
NHOSA Co., Ltd.
MORITA Coporation
Nobel Biocare Japan K.K.
Invitation from the Congress Chairman
59–60
52
70,75–76
NYU CDE International programs
82
OKABE Co., Ltd.
31
Olympus Terumo
On behalf of the Local Organising Committee of the 36th Australian Dental Congress,
it is with great pleasure that I invite you to attend Congress and enjoy the river city of Brisbane.
Biomaterials Co., Ltd.
39
Oral Inc.
19
Over three and a half days, highly acclaimed International and Australian speakers supported by contemporary
research, will present a wide range of subjects relevant to practice. These presentations will be complimented
by hands on workshops, Lunch and Learn sessions, specific programmes for members of the dental team.
Social activities will be available for relaxation purposes.
OSADA Electric Co., ltd.
34
OSSTEM JAPAN Co., Ltd.
56
Pro-seed Corporation
29
Quintessence Publishing Co., Ltd.
80
RF Co., Ltd.
10
SHOFU INC.
3
The Brisbane Convention and Exhibition Centre is adjacent to the Southbank Precinct on the banks of
the Brisbane River. Nearby is the Queensland Performing Arts Complex, the Queensland Museum and
the Queensland Art Gallery and Gallery of Modern Art. A comprehensive industry exhibition will be
held alongside the Congress enabling delegates access between scientific sessions to view
the latest in equipment and materials.
Come and join us for the scientific programme, the opportunity to meet
colleagues and the experience Brisbane has to offer.
Sirona Dental System K.K.
Titanium sponsor:
Smart Practice Japan
54
Smile US
49
Star Chip Co., Ltd.
47
Straumann Japan K.K.
Dr David H Thomson
Congress Chairman
36th Australian Dental Congress
Educating for Dental Excellence
72–74
41671
Team M Corporation
65
Unicare Biomedical, Inc
48
Ushio Inc.
63
Wavelengths Co., Ltd.
30
Yamato Corporation
25
Yoshida Dental Trade Co., Ltd.
79
Z-System AG
20–21
facebook.com/adacongress twitter.com/adacongress youtube.com/adacongress adc2015.com
Floor plan and exhibitors list are subject to change.
Last update was 17 September, 2014.
[23] =>
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DTAP1014_23_PR 18.09.14 17:54 Seite 1
business
ICOI Toyko 2014
NEW POLYMER BLOCK ALLOWS CUSTOMIZED
IMPLANT RESTORATIONS FOR CEREC AND INLAB
Its new, highly cross-linked polymer block completes the digital workflow to include temporary restorations in implant dentistry, Ivoclar
Vivadent has recently announced.
With Telio CAD A16, for the first time
a block with a pre-fabricated interface is available, which allows the
direct fabrication of hybrid implant
restorations for single-tooth tempori-
sation. Moreover, the block is supposed to enable users of CEREC and
inLab to create customised monolithic
hybrid abutment crowns. The prefabricated interfaces in sizes S and L
are tailored to the requirements of
titanium bases from Sirona. According to Ivoclar Vivadent, the completed restorations can be directly
cemented on the Ti base.
As a result of the industrial production process, temporary hybrid
abutment crowns made of
Telio CAD A16 fit extremely accurately,
reducing the
treatment
time for users
and patients. The hybrid
abutment crown is easy to adjust
and provides a clear idea of what the
permanent restoration will look like.
In addition, a proper emergence pro-
file can be ideally developed and
shaped. The restoration can be incorporated immediately
after the implantation
procedure or after the
healing phase.
Ivoclar Vivadent
said that Telio CAD A16
forms an ideal basis for longterm, implant-supported restorations fabricated with IPS e.max CAD
Abutment Solutions. The self-curing
23
luting composite Multilink Hybrid
Abutment ensures an excellent bond
of the restoration to the titanium
base. The PMMA block is offered in
size A16 and in 6 shades (BL3, A1, A2,
A3, A3.5, B1). Restorations made of
this block are indicated for a wear
period of up to 12 month.
IVOCLAR VIVADENT,
LIECHTENSTEIN
www.ivoclarvivadent.com
Booth 12–13
AD
CBCT IMAGING WITH
LOWER DOSES
Planmeca Ultra Low Dose is
a new imaging protocol that is supposed to allow CBCT imaging with
an even lower patient radiation
dose than standard 2-D panoramic
imaging. It is based on intelligent
3-D algorithms, according to Planmeca, and offers a vast amount of
detailed anatomical information at
a very low patient dose. Two-dimensional imaging, therefore, can no
longer be justified, the manufacturer said.
FDI 2015BANGKOK
Annual World Dental Congress
22 - 25 September 2015 - Bangkok Thailand
The Tampere University Hospital in Finland is one of the facilities
which has changed imaging practices owing to the new protocol.
“We have been using the new
Planmeca Ultra Low Dose protocol
since last summer, and we have
found it to be very useful in many
imaging indications,” a representative said. “These include postoperative follow-up studies, orthodontic cases requiring localisation of
impacted teeth and their effects on
the neighbouring ones, detection
of facial asymmetries, sinus imaging in certain ENT cases where
sinusitis needs to be excluded, pharyngeal airway measurements in
sleep apnoea patients, as well as
many implant cases.”
According to the representative, the protocol also had a significant impact on patients. “We often
found them to be concerned about
radiation exposure, but once they
hear that the dose is even lower
than in traditional panoramic 2-D
imaging, they are always relieved.
Also, referring physicians often
specifically ask us to use the Ultra
Low Dose protocol,” he said.
Planmeca Ultra Low Dose is
available with all Planmeca
ProMax 3D imaging units. Images
taken with the protocol can for
a used for a large variety of clinical
cases, such as postoperative and
follow-up studies in maxillofacial
surgery, orthodontics, implant
planning, as well as ENT studies.
PLANMECA, FINLAND
www.planmeca.com
GC CORPORATION
Booth 36
www.fdi2015bangkok.org
www.fdiworldental.org
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Table of contents
-
Asia News
01 - 04
view
-
World News
05 - 06
view
-
Business
09 - 09
view
-
Physiological healing patterns: What clinicians need to know about tooth extractions
10 - 10
view
-
Secular trends in dental development
12 - 12
view
-
Clinical guidelines for the use of ProTaper Next instruments (Part II)
13 - 16
view
-
today ICOI World Congress XXXI ·Tokyo · October 3.-5. 2014
17 - 23
view
[toc_titles] => Asia News
/ World News
/ Business
/ Physiological healing patterns: What clinicians need to know about tooth extractions
/ Secular trends in dental development
/ Clinical guidelines for the use of ProTaper Next instruments (Part II)
/ today ICOI World Congress XXXI ·Tokyo · October 3.-5. 2014
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