DT Asia Pacific No. 10, 2016

News / Business / Interview: “ In the not-so-distant-future - half of all treatments will be done with aligners” / Walking among giants: Marketing dentistry in the global connected economy / Digital complete dentures: First clinical and technical experiences with the Digital Denture System / Implant Tribune Asia Pacific Edition

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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
www.dental-tribune.asia

ALIGNERS

WALKING AMONG GIANTS

An interview with Canadian dentist Dr Sam Daher about how to
turn treatment with the appliance into a business model.
” Page 8

Vol. 14, No. 10

Business consultant Chris Barrow
gives advice on how to market
dentistry in the global connected
economy.

Published in Hong Kong

IMPLANT TRIBUNE

Read the latest news and clinical
developments from the field of
implantology in our specialty section included in this issue.

” Page 10

” Page 17

(866) 999-2635

New Aussie research confirms dental
benefits of water fluoridation
By DTI
SYDNEY, Australia: Anti-fluoride
groups in Australia have repeatedly
asserted that water fluoridation
poses potential health dangers.
However, the findings of two new
research reports reinforce the positive impact of fluoridated water
supplies on people’s dental health.
In Western Australia, for example,
children from non-fluoridated areas
were found to be at 1.6 times the risk
of having one or more decayed,
missing or filled permanent teeth
compared with children who drank
fluoridated water.

young, with children from areas
without water fluoridation having
1.5 times the risk of one or more decayed, missing or filled primary
teeth.
“The bottom line is that water
fluoridation works and remains
our single most important public
health measure to combat tooth
decay,” commented Western Australia Minister for Health Dr John
Day on the findings.

The study, titled “Dental health
outcomes of children residing in
fluoridated and non-fluoridated
areas of Western Australia”, was conducted
among 10,825 children
aged 5 to 12 in 2011 and
2012. In the analysis, the
researchers compared
the dental health of
children who presented
at dental treatment centres in non-fluoridated
areas of the south-west
of Western Australia
and in the Perth metropolitan area, where the
drinking water has been
fluoridated for over
© Pingpao/Shutterstock.com
40 years.

Investigating the effect of water
fluoridation on children’s oral
health, this study also found that
fluoride reduced decay in the very

The findings were supported by
an evidence evaluation review that
was recently published by the National Health and Medical Research

Council (NHMRC). The systematic
review included three relevant reviews and 25 primary studies that
reported on dental caries.
According to the researchers,
the study’s evidence corroborates
the results of the previous NHMRC
review (2007), which found that
water fluoridation at levels comparable to those used in Australia reduced the incidence of caries in the
primary and permanent teeth of
children by approximately 35 per
cent compared with non-fluoridated water. In addition, water
fluoridation was found to increase
the proportion of children with
no dental caries by approximately
15 per cent, they wrote.
While there is evidence that
community water fluoridation at
appropriate levels is a safe and effective means of preventing dental
caries, anti-fluoride groups have
raised concerns about its efficacy
and the potential health risks associated with the measure. In addition to health concerns, community water fluoridation is regarded
as a violation of individual rights, as
people dependent on public water
supplies cannot decide either for or
against it.
In Australia, the fluoride controversy is widespread and anti-fluoride
initiatives have been successful in

in 1953. The Australian Dental Ashaving fluoridation of water supsociation recommends water fluorplies stopped in some areas of
idation across the nation without
Queensland and are now targeting
exception as a critically important
Western Australia. The country first
step in protecting the oral health of
introduced public water fluoridaall Australians.
tion
at Beaconsfield in Tasmania
IV_Image_Anz_102x128_Layout
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17:10 Seite 1
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[2] =>

02

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 10/2016

PD forum discusses oral health
benefits of sugar-free gum
© pikselstock/Shutterstock.com

The findings of the study, titled
“Oral health promotion: The economic benefits to the NHS of increased use of sugarfree gum in the
UK”, were published online on 12 February in the British Dental Journal.
Expanding the study’s approach to a global scale, Dodds introduced new research that will be
published within the next several
months. The results suggest that
Taiwan could save up to NT$89
million annually if every citizen
habitually chewed three pieces of
sugar-free gum per day, Dodds
said at the meeting.

By DTI
TAIPEI, Taiwan: Earlier this year,
the results of a UK study suggested that the British health care
system could save on substantial
costs if chewing sugar-free gum
were to be established as a regular
oral health care intervention. Expanding the scope of the research
to a global scale, the role of sugar-free gum in the prevention of
dental caries has now been discussed at a meeting of the International Association of Paediatric
Dentistry, which took place from
26 to 28 August in Taiwan.
In the past, various studies
have shown that chewing gum
without added sugar, particularly
after consumption of food, can
reduce the development of caries.
For example, acids arising from
plaque that cause tooth decay are

significantly removed from the
mouth through the mechanism of
increased salivary flow. Moreover,
saliva helps to remove food debris
from susceptible tooth surfaces, is
effective for remineralising damaged enamel, and encourages the
remineralisation of early cavities.
At the meeting, which was
the organisation’s first regional
meeting to be held in the country,
a forum of international experts
again took up the discussion
about the potential benefits of
frequent chewing of sugar-free
gum for one’s oral health and the
resulting economic gains for national health systems, the China
Post has reported.
According to Dr Michael Dodds,
lead oral health scientist at the
Wrigley Company Foundation,
which supported the UK research,

AD

the study showed that, if all
12-year-olds in the country chewed
sugar-free gum three times a day,
it could save the health system as
much as £8.2 million (€9.7 million)
annually. In the study, potential
savings on dental care expenditure were estimated by considering the costs of tooth restoration
and tooth extraction caused by
dental decay and performed in
primary care settings and under
general anaesthetic.

Osteology
Symposium goes
Down Under
By DTI

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Although Wrigley, a company
known for its wide range of gum
brands, supported the research, the
new findings are backed by previous scientific results. For example,
researchers from the University
of Groningen found that chewing
sugar-free gum removed up to
100 million bacteria in 10 minutes,
making it a useful addition to oral
hygiene measures such as daily
toothbrushing and flossing.

MELBOURNE, Australia: The Osteology Foundation has announced
that it will be holding a national
symposium in Melbourne themed
“Strategies for predictable regeneration—Today and tomorrow” in
June next year. This will be the
first time an Osteology Foundation event will take place on the
Australian continent.
The scientific programme of
the first Osteology Australasia
Symposium will address different
strategies for predictable hardand soft-tissue regeneration with
the aim of giving practitioners the
relevant knowledge for their daily
practice and the confidence to
provide their patients with the
best possible treatment.
During the two-day event, a
number of distinguished national
and international speakers will
provide insight into the latest research in oral tissue regeneration
and discuss topics based on evidence from research, study data
and master clinicians’ experience.
Besides the lectures, participants
will have the opportunity to try
out the latest techniques and materials in practical workshops.

The Osteology Foundation is
a non-profit organisation. It was
formed as an international, independent science-based forum to
promote research in oral tissue
regeneration and ensure that
knowledge gained from research
is translated into everyday clinical
practice.
Today, the foundation promotes research, education and
collaboration between universities and industry in the field of
oral and maxillofacial tissue regeneration. In following its motto
of “Linking science with practice
in regeneration”, it hosts various
national educational events.
Over the next 12 months, several National Osteology Symposia
will be staged worldwide in various countries, including Ukraine,
Spain, Japan and Russia. Every
three years, the organisation
holds its famous international
symposium in the Côte d’Azur in
Monaco.
The Australasian symposium
will be held on 2 and 3 June 2017 at
the Arthur Streeton Auditorium
in Melbourne. More information
can be found at www.osteologyaustralia-nz.org.

IMPRINT
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Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT AP & UK:
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Marc CHALUPSKY
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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

Published by DT Asia Pacific Ltd.
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All rights reserved. Dental Tribune makes every effort
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[3] =>

WORLD NEWS

Dental Tribune Asia Pacific Edition | 10/2016

03
© DTI

DTI publishers
discuss future
strategies
BERLIN, Germany: The Dental
Tribune International (DTI) publishing group, which consists of
about 30 publishers around the
world, customarily meets once a
year to present its latest products
and introduce new partners. This
year, the 12th Annual Publishers’
Meeting was held from 4 to 6 September at the picturesque Greater
Wannsee lake in the German
capital of Berlin. Over 50 people
from about 20 countries, including partners from Asia, Australia,
Europe, the Middle East and the
US, attended.

In collaboration with its German
licensee OEMUS MEDIA, DTI will
” Page 4

More than 30 publishers from around the globe joined this year’s Annual Publishers’ Meeting in Berlin.

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Over the past 13 years, the
DTI publishing network has grown
significantly. Today, DTI reaches
over 650,000 dental professionals
in 25 different languages in about
90 countries around the globe.
At the meeting in Berlin, the group
welcomed two new partners, from
Israel and Iran, who will be publishing their respective localised
versions of the Dental Tribune
newspaper and providing updates on their particular market
on local websites on www.dentaltribune.com.

55%
on time
*

Furthermore, the publishers
were introduced to one of DTI’s
newest publications, the Journal
of Oral Science and Rehabilitation,
which was launched in 2015. It
originated from the efforts of
a large group of researchers involved in the advancement of
implant dentistry. The aim of the
journal is to promote rapid communication of scientific information. Released quarterly in March,
June, September and December
each year, it publishes original
and high-quality research and
clinical papers in the fields of periodontology, implant dentistry,
prosthodontics and maxillofacial
surgery.

A major topic covered at the
meeting was the International Dental Show (IDS), the most important
trade fair in the dental industry.

Data available on request.

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The publishers had the opportunity to learn more about
the DTI Communication Services
offering. As the importance of
content marketing is growing
rapidly in all industries, including dentistry, DTI established
this new division last year. The
department aims to assist smaller
and mid-sized companies, in particular, in communicating more
effectively with their audiences
through tailor-made targeted
editorial support, video production, event organisation and publishing.

By DTI

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[4] =>

WORLD NEWS

Dental Tribune Asia Pacific Edition | 10/2016

Restorative dentistry has become
a two-class system
An interview with Prof. John Nicolson, UK
cially to composite
Materials scientist
resins. Being nonProf. John Nicholson
adhesive, composfrom London has
ites have to be emconducted extenployed in associasive research on
tion with bonding
glass ionomer ceagents. The funcments and related
tion of bonding
materials over the
agents is to alter
last 30 years. In a
the nature of the
presentation he refreshly cut tooth
cently gave at the
surface from hyFDI Annual World
drophilic to hydroDental Congress in
phobic, and this
Poznan in Poland he
requires careful dediscussed whether
ployment of senmodern dental ma- Prof. John Nicolson, UK
sitive materials in
terials can meet the
accordance with manufacturer’s
world’s oral health needs, among
instructions. Having created a
other things. Dental Tribune spoke
surface for bonding, the composwith him about the shortcomings
ite itself must be placed. This typof modern dental materials, reically requires placement in increstorative dentistry becoming a
ments, with sufficient application
two-class system, and atraumatic
of the curing lamp to ensure
restorative treatment.
depth of cure.
Dental Tribune: In your presentaAll of this manipulation is diftion, you argued that most modern
ficult and requires a high level of
dental materials are characterised
skill on the part of the dentist.
by cosmetic rather than functional
Done correctly, it works well and
aspects. Where do they lack most
the resulting repair is durable and
in your opinion?
aesthetic. However, it is too comProf. John Nicholson: They lack
plicated to be the basis of tooth
ease of use. This applies espe-

“ Page 3
be publishing a new issue of its
well-established today newspaper
on each of the six days, providing
comprehensive coverage of the previous day’s events. For the first
time, the two publishers will be setting up a lecture forum at their

booth—known as the Media Lounge,
a restaurant and meeting area at
which leaders in dentistry conventionally gather during IDS. At the
forum, which will seat up to 200
participants, DTI will be holding
Dental Tribune Study Club lectures
and press conferences through DTI
Communication Services.

repair in poorer countries, owing
to the high numbers of patients,
unreliable electricity supplies and
fewer skilled dentists.
Most technologies seem to become
cheaper over time, except dental
materials. What are the reasons for
this reverse trend?
In dentistry, we have emphasised appearance over performance, a feature that is not so
much of a problem in countries
with large numbers of dentists
able to replace worn-out restorations, that is in richer communities in the developed world. The
dental market therefore does not
favour cheaper solutions, or simpler ones.
With state-of-the-art dental materials only affordable in rich
countries and a select few in poor
countries, has modern restorative
dentistry become a two-class system?
It has indeed, and that twoclass system applies in richer
countries too, where poorer individuals are less likely to be able
to afford the best-looking repair
materials. Specifically, this means

Moreover, the publishers were
informed about DDS WORLD, a
website that was recently launched
by DTI and promises to become the
most comprehensive resource in
dentistry. It is a full-service digital
marketplace for products, news,
e-learning and practice management, and targeted at vendors,

amalgam repairs rather than composites.
Atraumatic restorative treatment
was originally developed to provide
a cost-effective treatment for patients in the world’s poorest countries. What have been the experiences with the technique so far,
and can it offer an alternative for
a population with no access to
modern dental materials?
Reports over the last few years
have shown it to be very successful. A variety of patient groups,
including children, young adults
and even older patients, are benefiting from what is effectively
minimal intervention, low-cost
dental treatment. Furthermore,
the performance of the glass ionomer repair materials in the atraumatic restorative treatment technique is proving to be better than
what might be expected on the
basis of in vitro studies of the
materials’ properties.
Amalgam is still widely used, particularly in poorer countries. Are
we prepared for amalgam-free
dentistry, and what should be done
to ensure there are proper alter-

natives after the phase-down has
been completed?
I think we need to maintain
the use of glass ionomers and
perhaps see how these materials
can be improved for this large
and important group of patients.
We also need to recognise that
acquiring a proper understanding
of the clinical performance of
any material is a time-consuming
process and that it can take years
to obtain a full picture of how
materials really behave in patients.
Should there be greater emphasis
on the issue of dental materials in
oral health campaigns and agendas
around the world?
Yes, there should. We know
that caries is the most widespread
disease in humans, so we can
a safely assume that damage
to teeth is equally widespread.
Consequently, in my opinion, we
should emphasise the role of
appropriate repair materials just
as much as we currently emphasise preventative steps.
Thank you very much for the interview.

dentists, dental technicians and
patients alike.

online marketplaces is growing in
all industries.

Owing to its comprehensive
approach, DDS WORLD has the potential to become the most important platform in dentistry and will
thus help DTI secure its position
in the market, as the importance of

DTI further announced the relaunch of its website, www.dentaltribune.com, which is scheduled
to go live with a completely new
design and layout in spring next
year.

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[5] =>

[6] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 10/2016

I-Max 3D from Owandy helps clinician
to take leap into 3-D imaging
By DTI

ator, the I-Max 3D can be easily
mounted to a wall. According to
the company, the I-Max 3D offers
outstanding performance and excellent image quality to lower purchase, delivery and installation
costs. With its sleek, sophisticated
and slender design, the I-Max
proves to be an attractive and valuable asset for every clinic.

CROISSY-BEAUBOURG, France: Every
dentist can now make the leap
into the 3-D era with the I-MAX 3D
from Owandy Radiology. A realistic diagnostic option for almost
everyone, the new device is the
result of unrivalled technological
and manufacturing expertise,
and like the I-Max before it remains the most comprehensive,
compact and lightweight model
on the market, according to the
French manufacturer.

Equipped with a 3D Cone
Beam sensor, the I-Max 3D enables
clinicians to carry out high definition (87 µm) examinations, making the diagnostic process easier.
Through its ALI-S (Automatic Layers Integration System), the unit
directly and automatically selects
the best sections in order to
display a perfect, high definition
image without any form of oper-

With a weight of just 66 kilograms and an exclusive “Easy to Install” system, this panoramic unit
comes fully assembled, requiring
just one technician to install it in
situ. As with every intraoral gener-

ator involvement. The multi-FoV
system supports examinations in
9 x 9 cm (full mouth) and 9 x 5 cm
(full arch) formats for implantology, with a 5 x 5 cm option for
endodontic diagnostics. The I-Max
3D also offers a wide range of 3-D
programmes for more in-depth
examinations. The combination
of an ultra-sensitive sensor with
an extremely short exposure time
helps to considerably reduce X-ray
dose emissions.
Making the unit more than
just a another 3-D imaging device,
the I-Max 3D also comes with a
range of ingenious programmes
to help clinicians to optimise their
day to day practice needs as well as
to can models and impressions for
implant surgery that’s both safe

nd
and convenient. The combination
of the I-Max 3D and QuickVision
3D software allows to create surgical guides that are ready to
print, without any assistance.
QuickVision 3D further simulates
implant positioning and let operators import STL files from their
laboratory or dental impressions
camera. The functionalities of the
QuickVision 3D software (such as

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oblique MPR mode), together with
its compact 5 x 5 cm format, make
it possible to view images in line
with patients’ teeth, particularly
in endodontics.
For dentists who are not sure
about taking the leap into 3-D imaging, Owandy Radiology offers a
number of tutorial videos on its
YouTube channel.

A solution
for polishing
all-ceramics
By DTI
SINGAPORE: For clinicians frustrated with polishing zirconia restorations, Shofu offers a unique
colour co-ordinated, three-step
diamond impregnated polishing
system. The ZilMaster is the solution to the smoothest surface
finish and high gloss polish on all
modern metal-free ceramics such
as zirconia or lithium disilicate,
the company said.
Designed with an excellent
balance of diamond particle size,
distribution and a resilient silicone binder, ZilMaster polishers
eliminate even the finest scratches
while smoothening hard Zirconia
surfaces to obtain a lustrous polish that lasts.

According to SHOFU, ZiLMaster
is available in a variety of shapes
and shanks for both extra (HP)
and intra-oral (CA) application.

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[8] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 10/2016

“In the not-so-distant-future, half of all
treatments will be done with aligners”
An interview with Dr Sam Daher, Canada
I personally like about this
treatment modality is that
the aligners do not apply a
great deal of force, maybe
10, 20 or 30 grams. Research has shown that this
is the optimal amount of
force; strong forces are not
actually needed. Also, the
clinical achievement is really in the hands of the orthodontist. There is very
little downside to this as far
as I am concerned.

Vancouver orthodontist Dr
Sam Daher is one of the
world’s leading experts in
clear aligner treatment. Having performed more than
4,000 treatments with Invisalign, he currently runs two
practices entirely specialised
in this treatment modality in
addition to his other four
clinics. At the recent British
Orthodontic Conference (BOC)
in Brighton in the UK, where
he presented a paper on
open-bite treatment with
clear aligners, Dental Tribune
had the opportunity to
speak with him about the
benefits of digital technology,
the future of clear aligners
in general and his business
model.

Dental Tribune: Dr Daher,
this is the first time you have
spoken at the BOC. How was
your presentation received?
Dr Sam Daher: I have
never been to the BOC, but
I have spoken in London
many times before. I can recall my first talk to a UK audience a couple of years ago.
Back then, the interest in
Invisalign was not what it is
today, perhaps owing to a
lack of faith in the system.
Today, far more experience
has been gleaned and we
have seen much better results with it, so there is generally more interest from Dr Sam Daher
specialists. The attendance
ClinCheck and digital scanning
of my lecture here in Brighton was
have advanced clear aligner treatamazing. There is clearly much inment. What impact have they had
terest and far greater acceptance
on digital technology in the field?
than before. Also, the questions
posed were far more genuine.
I have been using scanners for
six years and have not taken one
Your presentation here in Brighton
conventional impression since
focused on open-bite treatment
with clear aligners. Could you summarise some of your key points for
our readers?
One of the main advantages
of clear aligners is that with them
we can control the vertical dimension. One of the worst things we
can do in open-bite treatment is to
allow the posterior teeth to push
through. With clear aligners, we
do not only prevent the posterior
teeth from extruding, but actually intrude them a little, when
then. The first thing one notices
needed, allowing us to control the
when one starts using scanners
vertical dimension and close the
is that aligners adapt so much
anterior open bite at a much faster
better to the teeth because the
rate than with any other fixed apscan is far more accurate. Second,
pliance as a matter of fact. Thus,
it allows for an improved pawhat I aim for is to intrude the
tient experience. Using polyvinyl
posterior teeth when there is alsiloxane material is always a
ready an anterior open bite. With
hassle and a discomfort for
both an anterior and posterior
the patient if the material gets
open bite, we create a mandible
into the mouth. Using scanners
that simply autorotates and that
saves a great deal of time and
will help close the anterior open
is more comfortable for the pabite.
tient.

defined by a combination of technology improving quite nicely
and patients requesting it as an
aesthetic treatment modality, for
example. I am sure that in the notso-distant future half of all treatments will be done with aligners.
Where would you personally like
to see aligner treatment heading
in the future?
I think aligner suppliers need
to provide auxiliaries as part of
their systems too. At present, we

“The aligner market
has actually advanced
quite a bit and this
development is based
on science, technology
and experience.”
There are certain shortfalls. For example, patient
compliance and sometimes teeth do not move as
one intended, but that happens with fixed braces too.
Furthermore, with ClinCheck,
which provides 3-D treatment
planning, I am able to plan different approaches and then decide for
myself. If I am still not certain, I can
show the patient what each treatment outcome will look like and

What was obvious here in Brighton
is that orthodontics is at a crossroads. What role will clear aligners
play in the future, in your opinion?
I believe—and I said that already five years ago—that in ten to
20 years, a much larger portion of

“Treatment with aligners is not necessarily
difficult, but it is a bit different...”
then let him or her decide. This way,
it becomes an educational tool that
can enhance patient compliance.
Aligner treatment is not without its
critics. Is there any justification for
this, in your opinion?
The aligner market has actually advanced quite a bit and
this development is based on science, technology and experience.
Aligners are custom made and that
alone should be enough to elicit a
positive response to aligners. What

our patients will be treated with
aligners as opposed to fixed braces.
Braces have allowed us to understand the biomechanics very well
and aligners just take that same
knowledge and apply it to invisible
aligners.
The future role of clear aligners is also determined by patients
asking for this treatment. Dentists
not yet using aligners have had to
learn this treatment modality and
quickly. Thus, its role is definitely

obtain aligners from one company, but have to go elsewhere to
obtain the elastics and miniscrews etc. In a few years, companies will hopefully offer a comprehensive package to allow dentists
to plan much ahead of time.
Another area where clinicians
could benefit is being able to
use different materials for the
start and the end of treatment—
just like in conventional orthodontic treatment where we use
NiTi at the start of treatment
and stainless steel at the end.
However, there is a great deal of
improvement in this regard already.
You run two practices entirely focused on aligner treatment. What
advice would you give a clinician
who would like to switch to that
business model?
It is important to first acquire
the necessary clinical skills and
become really comfortable using
aligners. Treatment with aligners
is not necessarily difficult, but
it is a bit different, so it is necessary to become acquainted with it.
The way to attain confidence is to
treat enough patients—my guess
is 1,000 or so. Once the clinician
has become comfortable working
with aligners, he or she can start
thinking about switching.
Thank you very much for the interview.

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TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 10/2016

Walking among giants
Marketing dentistry in the global connected economy
In an information-rich world, the
wealth of information means a
dearth of something else: a scarcity
of whatever it is that information consumes. What information
consumes is rather obvious: it consumes the attention of its recipients.
Hence a wealth of information
creates a poverty of attention.
These prophetic lines were shared by
Nobel laureate and social scientist
Dr Herbert Simon in 1971. It seems incredible to think that his words predate the Internet by 20 years. Simon
lived in a world in which advertisers
tried to gain our attention with billboards, newspaper advertisements
and television commercials. At the
same time, the local ma-and-pa
business prospered through convenience and human interest.
The connected economy and
growth in population have created
statistics that are beyond our comprehension. There were 60 trillion
websites at the last count and every
year the Internet grows by eight
million new songs, two million
new books, 16,000 new films,
30 billion blog posts and 182 billion
Tweets. Google handles 35 billion
e-mails every day alone, and 1.8 billion photographs are uploaded to
the Cloud from everywhere around
the globe. I speculate as to how
many of those photographs are of
happy, smiling faces.
IBM tells us that we are
“a world awash in data”, 80 % of

By Chris Barrow, UK

which is currently invisible to our
computers; however, with the IBM
Watson project, the company intends to use cognitive computing
to bring that data into a useable
domain. With global health care
data expected to grow by 99 % in
the next 12 months, the search is
on to find a new unified theory
that will bring all of this information to the fingertips of government, business and individuals.
The question is, can we cope
with this? In his book Homo Deus:
A Brief History of Tomorrow, Israeli

author Prof. Yuval Noah Harari
visualises a completely connected
world in which “Data-ism” dominates. There he writes: “Sapiens
evolved in the savannah thousands of years ago and their algorithms are not built to handle
21st Century data flows. We might
try to upgrade the human dataprocessing system, but this may
not be enough. The Internet-of

“The challenge is for the mouse
to gain attention without competing
with the bull elephants.”
all-Things may create such huge
and rapid data flows that even upgraded human algorithms won’t
handle it. When cars replaced the
horse-drawn carriage, we didn’t
upgrade horses—we retired them.
Perhaps it is time to do the same
with Homo Sapiens.”

Dental Tribune International

ESSENTIAL
DENTAL MEDIA
www.dental-tribune.com

Big business has a simple solution to this problem; it is called big
money. Whether it is a Super Bowl
television commercial, a giant
bill-board on a motorway or, nowadays, massive expenditure on
Internet visibility via paid media,
those with the deepest pockets offering the best products and services are the winners in the race to
attract that poverty of attention

1. Use good search engine optimisation (SEO) to optimise your
position in Google’s organic
search. SEO is a technical skill
that has to be delivered by experts. Google changes its own
goalposts regularly and the
savvy SEO guru will know that
and take appropriate action
quickly.
2. Massively encourage the collection of Google reviews, user
reviews via Facebook and critic
reviews via proprietorial sites
like WhatClinic.com, NHS Choices
and Comparethetreatment.com
in the UK. In September 2016,
Google changed the rules twice,
first by including external reviews alongside its own in
searches and second by altering
its own search criteria to favour
businesses with in excess of
100 Google reviews. It is necessary that your marketing activity be adjusted to reflect such
changes.?
3. Connect to your patients
through a well-maintained social media channel like Facebook or Twitter (and deliver
daily human interest content).
Remember that those 1.8 billion
photograph uploads per day include the inevitable selfies.
Many of my clients now take

A rather grim and ominous
suggestion perhaps, but by jolting
our sensibilities, Harari makes us
pause for thought. Let us narrow
our field of vision from these
impossible numbers and facts.
Pundits suggest that you and I are
interrupted by advertising and
brand exposures 5,000 times in an
average day and mentally register
around 350 of these. We note 150,
think briefly about 80 and pause at
12 to think about whether they are
relevant to us at this time. Thus,
the challenge facing the dental
marketer is how to become one of
12 out of 5,000 at the right time, on
the right day, for the right person.

first mentioned in 1971. So where
does this place the independently
owned dental practice? You are a
mouse, wandering between the
legs of a herd of bull elephants,
all trumpeting their mating call.
No matter how loudly you squeak,
at best your sound will be drowned
out and at worst you may be
trampled in the rush.
I have watched the world of
digital marketing in dentistry
very carefully over the last five
years and have reached some conclusions that are likely to land me
in trouble with traditional digital
marketers. However, I did not get
where I am today without stepping on the fenced-off grass every
now and then, running along the
side of the swimming pool and
tearing up the rule book. So, here
is my recommended list of actions
to be taken by the independent
dental practice in order to gain
attention:

a patient selfie at the end of a
course of aesthetic dental treatment. To quote again from
Harari’s new book: “If you experience something—record it.
If you record something—
upload it. If you upload something—share it.”
4. Build a website that engages the
visitor through video and visual
testimonials. Your most powerful marketing collateral is the
stories that your patients can
tell about the difference that
you have made to their lives.
5. Collect visitors’ e-mail addresses
and consent (to e-mail) via white
paper marketing. A coffee shop,
hotel or airport exchanges free
Wi-Fi access for an e-mail address and permission to keep
one informed. You can do the
same by exchanging useful information (free guides).
6. Nurture long-term relationships with patients and prospects by publishing a monthly

[11] =>

Dental Tribune Asia Pacific Edition | 10/2016

Template for
end-of-treatment protocol
So Mr Patient, now that we have
arrived at the end of your course
of treatment, I’d like to ask a
couple of questions:
• Are you happy with the clinical
outcome?
• Are you happy with the customer service that the team
delivered?
If so, I’d like to ask some favours:
1. We are growing the practice at
the moment and we would
like to see new patients and
would love to see more people
like you, because we like you!
Would it be OK to give you
three of my referral business
cards to pass on to any family,
friend or colleague who may
be interested in visiting our
practice?
2. We have noticed that online
reviews are growing in importance and would like to invite
you to submit a review of your
experience on Google, Facebook or any other review site
that you may be connected to.
3. We love to collect testimonials from happy patients. They
are great for our marketing
and can give confidence to
others who may be nervous.
We find that 90% of those
who do consent to a testimonial prefer a written commentary, as they are uncomfortable with a video camera
recording, whereas 10% are
happy to be filmed and photographed. May I ask, are you
a 90%’er or a 10%’er?
4. If a 90%’er, I’d love to organise
a written testimonial from
you.
5. If a 10%’er, we would like to
invite you to one of our quarterly video testimonial evenings here at the practice.
Every three months, we set
aside some time early evening
and invite four to six of our
10%’ers to come along for
some light refreshments and
to have their photograph
taken professionally (at our
expense) and to be filmed for
4 minutes or so. The questions
we ask on video are: How did
you find us originally? What
was it that had you looking?
How was your customer service experience? What difference did the treatment make?
It would be lovely to invite
you to our next event. The
dates are...

human interest e-mail newsletter.
7. Deal with initial enquiries directed through the Internet,
by telephone or in person in a
polished manner.
8. Create a memorable new patient
experience from initial consultation all the way through to
treatment delivery.

9. Employ a strict end-of-treatment protocol to capture reviews, testimonials and social
connections (as well as plan
membership).
I have given you nine marketing actions designed especially for
the smaller business. Actions that
should be avoided by the independent dental practice are seeking to gain attention by paying
through the nose for Google or
Facebook advertising, broadcast-

11

TRENDS & APPLICATIONS

ing non-human interest material
or selling services on price, discount or special offer. This is because every week I hear from dentists and their marketing teams
that advertising to strangers,
using jargon and cutting prices at
best attract nobody and at worst
attract bargain-hunters, priceshoppers and messers.
“A wealth of information creates a poverty of attention.” We
end where we began. The chal-

lenge is for the mouse to gain attention without competing with
the bull elephants. You can only
do that by stepping away from the
herd of elephants and delivering
your story in a different way and
a different place. For me, that
means human interest, personal
service and recommendation, and
so when I am working with clients
on their marketing plans, we focus
on and mobilise their most valuable asset: the goodwill of their
existing patients.

Chris Barrow
is the founder
of Coach Barrow consultancy
practice. An active consultant,
a trainer and
a coach to the
UK dental profession, he regularly
contributes to the dental press, social media and online. Chris Barrow
can be contacted at coachbarrow@
me.com.
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TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 10/2016

Digital complete dentures
First clinical and technical experiences with the Digital Denture System
By Dr Piero Venezia and Pasquale Lacasella, Italy
Only a few years ago, the idea of
using CAD/CAM to fabricate removable dentures seemed scarcely realistic even though such technologies
had already become an indispensable component of the workflow
for fixed superstructures on natural
teeth and implants. Recently, digital
tools that help to provide rapid and
predictable treatment of edentulous patients have become available. This report describes a digital
system (Digital Denture System,
Wieland Dental) that allows complete dentures to be produced in
only three appointments.

A 70-year-old female patient
wearing a complete maxillary denture had suffered an avulsion of
the anterior mandibular teeth four
weeks prior to her first visit. Lack of
support in the posterior mandibular region and continued pressure
in the anterior maxillary region
had led to severe atrophy. The clinical situation was therefore akin to

Figs. 1a–c: An edentulous patient requiring prompt and cost-effective rehabilitation of her maxilla and mandible.

the dental condition described as
combination syndrome (Figs. 1a–d
& 2a–b). Since the patient wanted
a rapid and cost-effective rehabilitation with removable dentures,
we opted for the Digital Denture
System protocol.

First appointment
For the preliminary impression, a prefabricated impression

tray was coated with a tray adhesive (Virtual Tray Adhesive, Ivoclar
Vivadent) and the impression material was mixed with the catalyst
(Virtual Putty Regular Set, Ivoclar
Vivadent). After the primary impression had been taken, the areas
where excessive compression was
present were slightly reduced with
the help of a micromotor handpiece. Next, the secondary impression was taken with a low-viscosity

silicone (Virtual Light Body Regular
Set, Ivoclar Vivadent; Fig. 3).
In order to determine the
preliminary maxillomandibular
relation and occlusal plane, two
reference points, one on the chin
and one on the nose, were marked
and the distance between the two
points was measured. The vertical
dimension of occlusion was determined by subtracting approxi-

mately 2 to 3 mm from the soft
interocclusal rest position, which
corresponds to the freeway space.
A Centric Tray (Ivoclar Vivadent)
was used to record the maxillomandibular relation. Consisting of
an acrylic arch with a retention
rail, this device was loaded with
impression material (Virtual Putty
Regular Set). We asked the patient
to slowly close the jaws to the preliminary vertical height. After the
impression material had set completely, a UTS CAD device (Wieland
Dental) was attached to the handle
to establish the occlusal plane.
This registration device measures
the angle of the occlusal plane in
relation to Camper’s plane (CP) and
the bipupillary plane (BP).
Once measured, the angles
were transferred to the CAD software to reproduce the virtual position of the occlusal plane for the
design of the 3-D bite plate (Digital
Denture Professional add-on software module, Wieland Dental) and
the denture. The Centric Tray was
attached to the adapter of the UTS
CAD and then the lateral braces of
the bow were aligned to CP (Fig. 4).
Next, the front part of the basic
bow was aligned to the BP and the
BP screw was fastened to secure the
registration joint. The angle values
of the patient were recorded on
the order form, and then the form,
impression and Centric Tray record
were forwarded to the laboratory.
In the laboratory, the impressions and the Centric Tray record
(preliminary bite registration) were
scanned using the Digital Denture
Professional add-on—based on the
Denture Digital Design software
(3Shape)—and the ScanIt Impression (3Shape) add-on. CP and BP
angle modifications can be implemented with the latter add-on. The
programme brings the two scans
together and produces two virtual
models of the edentulous jaws,
which are aligned according to the
clinical situation (Figs. 5a & b).
The dental technician created
a 3-D bite plate for the functional
impression and the needlepoint
tracing record. The models were
aligned to each other on the basis
of the preliminary impression.
Next, the dimension of the bite
rims had to be established (Fig. 6).
The 3-D bite plate design allows
for insertion of both the bite rim
supports for functional impressiontaking and the registration plates
of the Gnathometer CAD device
(Wieland Dental) for needlepoint
tracing. The CAD datasets of the 3-D
bite plates were sent to a Zenotec
select ion milling unit (Wieland
Dental) for machining (Fig. 7).

Second appointment
9

Figs. 2a & b: Intra-oral view: resorbed alveolar ridges and a clinical situation similar to combination syndrome.—Fig. 3: Double-mix impression of the maxilla and
mandible.—Fig. 4: The UTS CAD device used to determine the occlusal plane.—Figs. 5a & b: Base for the next design steps: anatomical impression of the jaws
and digitised preliminary registration.—Fig. 6: Design of the 3-D bite plate taking the needlepoint tracing appliance (Gnathometer CAD) into account.—
Fig. 7: CAD/CAM-milled 3-D bite plates ready to be connected to the needlepoint tracing appliance.—Fig. 8: Functional impression with Virtual Light Body.—
Fig. 9: Needlepoint tracing: centric position verified by the patient.—Fig. 10: The exactly aligned impressions (immobilised records) were digitised using a laboratory
scanner.—Fig. 11: CAD tooth set-up: an extensive software library of denture teeth was used in the process.

Before taking of the functional
impression, the bite rim supports
were inserted into the 3-D bite
plates. For the registration, they
were simply replaced with the registration plates. A polyvinyl siloxane material (Virtual Monophase,
Ivoclar Vivadent) was used for

[15] =>

[16] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 10/2016

functional border moulding. For
this purpose, the material was applied to the margins of the maxillary plate. Once the plate had been
seated in the oral cavity, the muscles were activated.
Next, an adhesive varnish (Virtual Tray Adhesive) was dispensed
on to the inner surface of the tray.
Once dried, Virtual Light Body impression material was applied and
the 3-D bite plate was seated in the

Fig. 12: Try-in of the prototype to check the functional parameters.—Fig. 13: Complete dentures created with CAD/CAM.
—Fig. 14: The patient is visibly happy with her digitally produced set of dentures.
14

“Scanning technologies, combined with
CAD/CAM processes, substantially
reduce the workload associated with the
fabrication of complete dentures.”
mouth (Fig. 8). The patient was
asked to carefully close against the

opposing jaw. After that, the UTS
CAD appliance was used to check

the parallelism of the occlusal
plane to the BP and CP.

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The patient was asked to occlude. This allowed us to check
that the centric relation had been
established correctly (Fig. 9). The
3-D maxilla-mandibular record
can be immobilised with a suitable material (e.g. CADbite, Ivoclar
Vivadent). Finally, the patient’s
aesthetic lines (midline, canine–
canine line, smile line, lip closure
line) were marked on the record.
The immobilised record was then
forwarded to the laboratory, together with information about
the tooth selection and CP and BP
values.
In the laboratory, both sides of
the record were digitised in their
exact position using the denture
scan holder (3Shape; Fig. 10). The
digitised jaw models were aligned
with each other on the basis of the
registered relations, and the occlusal plane was established using the
data captured with the UTS CAD.
The dental technician defined the
extension of the denture and selected an appropriate tooth mould
from a software library of denture
teeth (Fig. 11).
The Digital Denture Professional add-on contains several
examples of functional set-ups
for select Ivoclar Vivadent and
CANDULOR denture teeth, saving
considerable time. The functional
parameters and mandibular dynamics can be verified in a virtual
articulator similar to the Stratos
300 (Ivoclar Vivadent) and possible interferences can be identified.

such as corrections to the midline
and reduction of the vertical dimension, were communicated to
the laboratory. There, the denture
design was approved for CNC production. A transfer template was
computed automatically to facilitate the correct placement of the
denture teeth. The CNC milling
machine then finished the denture bases. The dentures were removed from the disc and polished
(Fig. 13).

Fourth appointment
Intra-oral evaluation of the
complete dentures and subsequent modifications were carried
out in the same way as the procedures for conventional dentures.
Hardly any alterations were necessary in this case. The dentures provided a secure and reliable fit and
harmoniously integrated into the
patient’s overall facial appearance
(Fig. 14).

Conclusion
Scanning technologies, combined with CAD/CAM processes,
substantially reduce the workload
associated with the fabrication of
complete dentures. Virtual set-up
and design facilities (CAD) and
denture milling procedures (CAM)
eliminate the lengthy processes involved in model articulation and
flasking. As polymerisation shrinkage does not occur, the dentures
exhibit a high accuracy of fit.
The system described in this
report meets the demographic
and economic requirements for
the production of straightforward,
fast, cost-effective and high-quality
dentures for edentulous patients.

Dr Piero Venezia
is a practising
dentist at Studio Cavalcanti
and Venezia
in Bari in Italy. He can be
contacted at
info@studiocavalcantivenezia.it.

Third appointment

E-mail

PayPal

In order to determine the
maxillomandibular relation, a
Gnathometer CAD was used. This
appliance is designed for taking
needlepoint tracing records in
edentulous patients. The bite rim
supports were removed and the
Gnathometer CAD mounted. Colouring material (crayon, felt tip
pen) was applied to the lower registration plate and the patient was
asked to perform retrusive, protrusive and lateral movements. The
coloured registration plate showed
the typical gothic arch tracing record produced by the tracing stylus. The perforation of the fixing
plate was aligned with the arrow
head of the arch (centric relation)
and secured in position.

Expiration Date

Security Code

A third appointment is purely
optional. In this case, a prototype
was tried in on the patient to check
the aesthetics, phonetics and function of the prospective final dentures (Fig. 12). Fine adjustments,

apuliadigitalab.it.

Pasquale Lacasella is a dental technician
at Apulia
Digital Lab in
Bari. He can
be contacted
at lacasella@

[17] =>

IMPLANT TRIBUNE
The World’s Implantology Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

Vol. 14, No. 10

HONG KONG, China: Investigating
patients’ knowledge and perceptions regarding implant therapy, a
Chinese study has found that an
alarming number of participants
had inaccurate and unrealistic expectations about dental implants.
Moreover, the study determined
that only 18 per cent felt confident
about the information they had
about the treatment.
In the study, the researchers
investigated preoperative information levels, perceptions and
expectations regarding implant
therapy via a questionnaire. Re-

sponses from 277 patients were
obtained during 2014 and 2015 in
three different locations in China
(Hong Kong, Sichuan and Jiangsu).
The analyses established that
about one-third of the participants had mistaken assumptions
about dental implants. According
to the researchers, common misconceptions were that dental
implants require less care than
natural dentition, implant treatment is appropriate for all patients with missing teeth, dental
implants last longer than natural
dentition, and there are no risks or

complications with implant treatment.
Overall, younger respondents
(< 45) and those with higher education (bachelor’s and postgraduate
degrees) tended to have more realistic perceptions and lower expectations of the treatment outcome.
When asked about their level
of knowledge, 63 per cent of the
participants said that they were
generally informed about implants, but only 18 per cent felt
confident about the information
they had.

Explaining implants © racorn/Shutterstock.com

Fundamental implant misconceptions

Taiwan: Excessive implant prices and fees
TAIPEI, Taiwan: Considering the
country’s per capita income, the
cost of undergoing extensive implant treatment in Taiwan is
equivalent to the price of an imported luxury car, the Taiwanese
Consumers’ Foundation (CF) commented in relation to the findings
of its new survey. In addition to
disproportionately high implant
costs, the CF survey found that
Taiwanese implant patients were
often faced with an array of
vaguely labelled associated fees.

for a single implant, while the fee
in Hsinchu County is NT$60,000–
NT$100,000 (US$1,865–US$3,109),
the China Post reported.

Overall, prices for a single implant ranged from NT$40,000 to
NT$150,000 (US$4,663), which is
very expensive when considered

in relation to the nation’s per capita income. According to the CF report, a Taiwanese earning a minimum hourly wage would have to
work between 334 and 1,250 hours
to afford one dental implant,
while a person in Japan would
have to work between 213 and
284 hours, and someone in the US
between 77 and 359 hours.
Based on a Gallup survey,
Taiwan had a median per capita
income of US$6,882 in 2013, compared with US$10,840 in Japan
and US$15,480 in the US.

As its main finding, the survey
identified considerably varying
costs for implant treatment in the
country. For example, it found
that a patient in Chiayi County
is charged around NT$40,000–
NT$80,000 (US$1,243–US$2,487)

Taipei, Taiwan © HTU/Shutterstock.com

The survey further identified
a number of related costs, sometimes ambiguously named, charged
for implant treatment, including
a tooth implantation evaluation

fee, a tooth implantation surgery
fee, artificial tooth root, prosthetic crowns and periodontal
prostheses. In addition, owing to
a general lack of standardisation
for implant treatment, participants reported confusion regarding the surgical treatment options they were offered, what the
treatments actually entailed and
whether the costs would be covered by their health insurance, the
CF stressed.
In light of the findings, the
foundation called on the Ministry
of Health and Welfare and related
government bodies to review current regulations that standardise
the fees charged by medical care
providers. At present, the fee
schedule is not mandatory.

Advancing biocompatibility of implants

When it comes to functionality and compatibility, the
achievements of nature are rarely
matched by science. Mussels, for
example, can attach tightly to
almost any surface owing to a
certain protein, L-dopa, which is
able to bind very strongly even to
smooth surfaces such as that of
ceramics or metals.

Taking their inspiration from
this particular feature, the Japanese scientists sought to imitate
nature in order to enhance biocompatibility in medical applications. “We thought it would be interesting to try to use various
techniques to attach a biologically
active protein—in our case we
chose insulin-like growth factor-1,
a promoter of cell proliferation—
to a titanium surface like those
used in implants,” lead author
Chen Zhang from the RIKEN Nano
Medical Engineering Laboratory
explained.
Using a combination of recombinant DNA technology and
treatment with tyrosinase, the
researchers were able to create a
hybrid protein that contained
active parts of both the growth
factor and L-dopa. In additional
experiments, the team was able

to confirm that the proteins
bound strongly to the titanium
surface and remained attached,
Mussels growing on stone © Kuttelvaserova Stuchelova/Shutterstock.com

WAKÕ, Japan: Mimicking the adhesive properties of mussels, which
are able to form a tight bond with
smooth surfaces, scientists from
the RIKEN research institute in
Japan have successfully attached
a biologically active molecule to a
titanium surface, a metal used in
artificial joints and dental implants, for example. Their findings
may enable the development of
new cell growth-enhancing materials and thus more biologically
beneficial dental implants.

even when the metal was washed
in phosphate-buffered saline, a
water-based solution.

“This is similar to the powerful properties of mussel adhesive,
which can remain fixed to metallic materials even underwater,”
Zhang said. According to Dr Yoshihiro Ito, the team leader of the
Emergent Bioengineering Materials Research Team of the RIKEN
Center for Emergent Matter Science, this universal modification
process could be used with other
proteins too and may allow for the
production of new cell growthenhancing materials, with potential applications in cell culture systems and regenerative medicine.
The study, titled “A bioorthogonal approach for the preparation
of a titanium-binding insulinlike growth-factor-1 derivative by
using tyrosinase”, was published
online ahead of print on 6 July in the
Angewandte Chemie International
Edition journal.

[18] =>

IMPLANT BUSINESS

Implant Tribune Asia Pacific Edition | 10/2016

“We are working hard on targeting new
markets”
An interview with Oliver Klein, BEGO Implant Systems
Dental implantology is in a constant state of change. New implants, surgical protocols and innovative materials present dental
professionals with the challenge
of identifying technically reliable
and high-quality solutions. For the
past 25 years, German dental company BEGO has been well known
for its implant systems. Dental
Tribune spoke with Oliver Klein,
Director of International Sales and
Business Development at BEGO Implant Systems, about the company’s implant solutions and its next
steps into Asia.
Dental Tribune: Your BEGO Semados
RS/RSX 3.0 implants have been available for over a year now. Intended
for the restoration of incisors, they

use an advanced connector design
to ensure optimal stability. This
technology is being used by an increasing number of international
dental implant manufacturers. What
distinguishes RS/RSX 3.0 from competing solutions?
Oliver Klein: The main advantage of the RS/RSX 3.0 is
the true diameter of 3 mm. This
implant line is mainly indicated
for narrow anterior gaps. In addition, the user can select between two different implant
types: a machined collar and
a rough collar for solutions in
the aesthetic zone. The dentist
can choose the most suitable
solution for all prosthetic indications from a wide range of
abutments.

Could you please elaborate on the
Semados range of solutions? What
different types of implants and
prostheses does BEGO offer?
The BEGO Semados implant
family consists of several implant
lines for different indications.
The well-known S-Line, launched
25 years ago, is the global top
seller. Owing to its straight implant shape and the simple surgical procedure, this implant system became a reliable brand on
the market. The tapered, selfcondensing RI- and Mini-Line implants are mainly used in poor
bone qualities and quantities. The
RS/RSX-Line—the implant twins—
are becoming increasingly popular owing to their conical implant
shape and self-tapping thread

Oliver Klein

design. The concept of platform
switching has been adapted to the
RS/RSX-Line and an additional
prosthetic line (PS-Line) has been
developed. The implant family
has been completed with a provisional implant (PI-Line). A complete range of prosthetic components is available, including
screw-retained bridge restorations (MultiPlus) and CAD/CAM
solutions.

Pacific. What has the response
been so far? Which markets will be
targeted next?
We have already been very
successful in China and Taiwan,
and our products are available
in several smaller markets too.
To provide a better service and
strengthen our further growth in
the APAC region, we opened an
office in Hong Kong in February.
We are launching our products in

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Tribune Group GmbH is an 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.

Details on www.TribuneCME.com
contact us at tel.: +49-341-484-74134
email: request@tribunecme.com

15 C.E.

CREDITS

Certificates will be
awarded upon completion

Tribune Group GmbH is designated as an Approved PACE Program Provider by the Academy
of General Dentistry. The formal continuing dental education programs of this program
provider are accepted by AGD for Fellowship, Mastership and membership maintenance
credit. Approval does not imply acceptance by a state or province board of dentistry or AGD
endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.

What is the major purpose of
the BEGO Guide System, and how
does it help dentists to better
plan and place the company’s implants?
With the BEGO Guide Trays
(available for the S- and RS/RSXLine), the user can plan the implant positions properly using
various software programs and
reduce treatment time owing to
predictable implant positioning
and prosthetic rehabilitation. The
convenient handling of the tools,
especially the self-locking spoons,
has more and more implantologists convinced.
BEGO have introduced its implant
technologies in different markets,
such as the Middle East and Asia

Vietnam in the third quarter of
this year and are pursuing market
entry to Thailand and Australia.
We are very pleased to have had
a great response regarding our
product portfolio, quality and service. Products made in Germany
and offered by a family-owned
company are very popular in
these markets. The same applies
to the Middle East, where we are
very active in Turkey, Saudi Arabia
and Iran—just to name some
countries. Also in this region, we
are working hard on targeting new
markets to extend our business
and meet our substantial growth
goals.
Thank you very much for the interview.

[19] =>

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[20] =>

OPINION

Implant Tribune Asia Pacific Edition | 10/2016

“Dentists cannot blindly rely on the
computer-guided approach”
An interview with Prof. Daniel Wismeijer, The Netherlands
Technologies such as cone beam
computed tomography (CBCT),
intra-oral scanners and CAD/CAM
techniques have introduced a computer-guided workflow into dentistry, specifically implantology.
While a computer-guided approach can make treatment more
precise, safe and predictable, it
requires a practised, experienced
and focused practitioner to implement a digital workflow. At
the recent EAO congress in Paris,
Dental Tribune spoke with Prof.
Daniel Wismeijer from the Netherlands about the problems that
implantologists are still facing in
using digital technologies and
the future of computer-guided implant surgery.
AD

Dental Tribune: Prof. Wismeijer,
with the emergence of new digital
technologies, novel treatment approaches have become available to
dentists—particularly in the field
of implant dentistry. While some
implantologists embrace these
new technologies, others are still
sceptical of them. Why do you think
that is?
Prof. Daniel Wismeijer: Novel
technologies do not only affect
implantology; they introduce digitisation into other areas of dental
practice too. Consider the applications of intra-oral scanners
and CEREC (Dentsply Sirona) machines and the use of new technologies in planning and designing
customised implant superstruc-

some cases be more rewarding,
as at least then the practitioner
knows what he or she can expect
and what his or her limitations
are.

tures. While some dentists use
quite a lot of these tools, others do
not use them at all and leave
everything up to the dental technicians. This largely depends on
the dentist and his or her attitude
towards digital technologies and
digitisation in general—be it at
home or in the dental practice.
Then, of course, dentists have
to invest in this sort of technology,
as well as learn it and be prepared
to unlearn their current practices.
This too depends on the dentist:
is he or she ready to use new technologies or would he or she prefer
to stick with what he or she had
learnt previously? On the one
hand, we see many young dentists

Prof. Daniel Wismeijer

start working with these new technologies immediately and thereby
become very experienced in new
treatment approaches. On the
other hand, dentists who are more
experienced in established treatment protocols are, of course, less
inclined to unlearn the old and
start learning the new technologies.
In the “Emerging technologies: Head
to head” session at the EAO congress, you will be talking about
computer-guided implant surgery.
What advantages does such surgery
offer? Has it already proven itself in
research and clinical practice, and
what results can it achieve compared with free-hand surgery?
In my opinion, guided surgery
helps dentists become increasingly precise in our work. Digital
technologies are proving themselves in implant dentistry and
I think that they are improving
with time. If the practitioner can
plan up front where he or she
wants to place an implant and
what sort of superstructure he or
she wants to put on top of that,
and if he or she can also place the
implant in that exact position and
implement a superstructure that
fits precisely, that will show that
we have come a long way.
However, we are not there yet.
There are still certain problems
we have to deal with, problems in
precision, problems in combining
all the tools needed for guided
implant surgery and the limitations of these tools. For example,
in order to plan the position of an
implant and its superstructure
exactly, we have to superimpose
CBCT scans and intra-oral scans
using software. Factors such as
voxel size and the absence of clear
landmarks by which to superimpose the different scans correctly
can affect precision and cause
deviations between the planned
and the realised positions. I am
not saying that free-hand surgery
is more precise; however, the freehand surgical approach may in

So what can dentists do to better
implement a digital workflow in
implant treatment?
Dentists have to know that
they cannot blindly rely on the
computer-guided approach. They
still need to get their heads around
the technology first and stay focused while using it. Moreover,
they have to accept that there is a
learning curve and that computer-guided surgery will not work
100 per cent the first time it is
applied.
In my lecture, I will be discussing the variables that influence
the precision of the guided surgery workflow and what dentists
are able to do to overcome associated problems. Primarily, they
have to become comfortable with
the different tools and software
packages and gain experience in
working with them. In the long
run—and I think that we are not
so far away from that now—computer-guided surgery is a treatment approach that will probably
be much more precise than planning and placing implants without any guidance at all.
How will digital technology further
change implant dentistry in the
future?
One of the tools that I will be
demonstrating during my presentation is a dynamic navigation
system that provides real-time
guidance based on the patient’s
CBCT scan. During surgery, the
dentist sees the planned implant
position on a screen while sensors
track the drill and the patient’s
jaw and the system provides
visual and tactile feedback to ensure that the dentist drills exactly
at the planned osteotomy site.
Dynamic navigation systems
like this one are the next step
towards robotisation in implant
dentistry. From there, it will not
take much to develop a computer-steered robot arm that calculates whether the drill is in line
with the planning and, supervised
and handled by the dentist, drills
the osteotomy. In various surgical
disciplines, for example neurosurgery, operations are already being
performed using robotic technologies, as they are able to perform
much more precisely than the
human hand alone. It is only a
matter of time until these technologies enter dentistry as well.
Thank you very much for the interview.

[21] =>

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Tribune Group GmbH is an 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.

16

C.E.

CREDITS

Certificates will be
awarded upon completion

Tribune Group GmbH is designated as an Approved PACE Program Provider by the Academy
of General Dentistry. The formal continuing dental education programs of this program
provider are accepted by AGD for Fellowship, Mastership and membership maintenance
credit. Approval does not imply acceptance by a state or province board of dentistry or AGD
endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.

[22] =>

TRENDS & APPLICATIONS

Implant Tribune Asia Pacific Edition | 10/2016

Growing a successful dental implant clinic
By DTI
In April 2016, Dr Ian Lane, a managing partner at Queensway Dental
Clinic, together with Richard Elliott,
Managing Director of Queensway’s
Dental Laboratory, presented a webinar to a global audience of over
350 dentists, giving their insights
into what they feel have been the
most fundamental factors of growing a successful dental implant
clinic.
Queensway Dental Clinic
(www.queensway.co.uk) was founded in 1993, when Dr Paul Averley
took over the north-eastern clinic.
At the time, it was at the heart of
an area where the population’s
oral health was significantly lower
than that of the national average.
Over the next 23 years, the practice grew into the award-winning
business it is today—a journey
that Lane believes would not have
been possible without the partners, specialists, nurses, managers, technicians and therapists
who have invested their time and
passion in every step.

tistry: “We focus on holistic care,
meaning there is real choice for
the patient, as well as ensuring
that shared decisions are made,
over which patients have full control.”
“We have always invested in
our team,” continued Lane. “Indeed, the strong foundations of
our clinic have been built on the
knowledge and experience of our
team. To build a truly successful
implant clinic, it is vital to have
the right team in place.”

Furthermore, Queensway understands the importance of investing in the skills of its partners
and takes great pride in the individual achievements of its team
members. Indeed, the partners at
Queensway Dental Clinic have all
graduated from the Kois Centre
in Seattle in the US—five of only
15 practitioners in the UK to have
done so.
“The skills we have learnt at
the Kois Centre have transformed

Elliott too graduated from the
Kois Centre and was the very first
technician in the UK to have done
so. This significant achievement is
mirrored in the way Queensway
invests in the skills and CPD of its
laboratory technicians, representing recognition of the importance
of technicians in the provision of
implant therapy.
Indeed, owing to the training
provided by the Kois Centre, as
well as the benefits of NobelClinician Software, the team at
Queensway has managed to
streamline their case assessment
and treatment planning process.
“We’re all speaking in the same
language now,” said Lane. “We can
provide effective risk assessments
for our patients, deliver effective
and reliable treatment plans for
implant treatments, design our
patients’ smiles, provide diagnostic assessments with models and
photos, and review cases with the
entire team present.”
Vital to all this, Lane went
on to explain, are communication and working alongside colleagues who all have the same
skill and experience. “This is
why,” he said. “We take our train-

Between 1998 and 2013, Queensway Dental Clinic was the largest
referral centre for conscious sedation in the region, and the clinic
treated over 100,000 patients

Dr Ian Lane

Of course, it is not just the
clinical skills that contribute to
the success of an implant practice.
Queensway Dental Clinic has
striven to improve the training of
its front-of-house staff to ensure
that patients receive only the very
highest standard of service from
the moment they enter the practice. This has included sending the
team on lunch-and-learn sessions
with Nobel Biocare representatives, having cue cards developed
to act as prompts on the phone,
and giving each of the staff the
necessary understanding of implant treatment options in order
for them to communicate this effectively to prospective and current patients.

during that time. However, as of
2011, the business model started
to change and the partners turned
their attentions to expanding the
private side of the clinic. By applying the same principles learnt
from building a successful NHS
practice, Queensway Dental Clinic
grew from a four-surgery practice
into a 25-surgery practice over
time.
Lane suggested that this success can largely be attributed to
the Queensway ethos with its patient-centred approach to den-

Working with Nobel Biocare
enables the Queensway team to
use a variety of different techniques, including immediate loading, and provides the opportunity to scan and plan treatments
in full 3-D. It also allows the
clinical staff of Queensway to liaise effectively with the laboratory staff, expediting and improving the process from start to
finish.
This kind of professional knowledge, when brought together effectively with clinical, technical
and management skills, has been
one of the greatest contributing
factors to the success of Queensway’s implant business. “It’s been
a challenge,” admitted Lane. “And
it requires excellent communication from all aspects of our business, but it has certainly paid
dividends—and it certainly would
not have been possible without
the relationship we share with
Nobel Biocare.”
This relationship seems in no
way likely to end soon; indeed, the
team at Queensway Dental Clinic
and laboratory has found working
with Nobel Biocare so effective
that it has seen an 87 per cent
increase in spending on Nobel
clinical products, as well as a 250
per cent increase for laboratory
items since 2011. “Having a single
company solution in our busy
practice has been incredibly useful in boosting our business,” said
Lane.
The figures speak for themselves. Since 2011, Queensway
Dental Clinic has experienced an
increase in its implant turnover of
220 per cent with up to 50 per cent
of all of its private activity originating from its provision of implants. There has also been a concurrent growth of 125 per cent in
its laboratory business and this
can be directly linked to its implant success.

With Gold Standard Investors
in People accreditation, it is clear
that Queensway Dental Clinic
understands the importance of
nurturing the skills of its team.
Investing heavily in the continuing professional development (CPD)
of every single member, it has
seen its nursing teams progress
through the Nobel Biocare basic
and advanced nursing courses, as
well as attain the dental implant
nursing qualification from King’s
College London—and all are experienced to some degree with the
All-on-4 treatment modality.

the way we practise,” said Lane.
“As well as improving the outcomes we can achieve for our patients. Seeing many patients who
have suffered from many different problems with their teeth, it’s
vital that we have the skills—like
those that the Kois Centre teaches
so well—to be able to manage
the complexity of these cases in
a reliable way. Without a doubt,
these skills have also enabled us
to reassure our patients that they
are being treated with the most
up-to-date and predictable procedures and techniques.”

ing and education seriously at
Queensway.”
It is also down to the implant
provider. Since 1993 (with the
exception of a very short departure in 2009), Queensway Dental
Clinic has used Nobel Biocare implants. “It’s the mix of quality
service and quality products,” explained Lane. “We don’t use cheap
products and Nobel Biocare doesn’t
provide them. In all, it helps us
minimise the risk to our patients
and enables us to achieve excellent results.”

However, having the knowledge and the products is just
one part of achieving success.
Putting everything into practice
represents the greatest struggle
for a large and busy centre like
Queensway Dental Clinic. For this
reason, the team strives to follow
five essential tenets to ensure
success.
Firstly, it is important to provide one point of contact. Lane explained that having so many disciplines together under one roof has
created a service in which patients
can feel confident. Rather than
being passed around between different teams, patients at Queensway can conveniently be treated
by one dedicated and well-trained
team.
Furthermore, Queensway invests in progressive treatment

[23] =>

protocols. The team works hard
to ensure patients’ teeth can be
restored in the shortest predictable time. This includes adopting
new technologies and techniques,
as well as learning to communicate effectively with all necessary
services to ensure the optimum
result can be achieved in the
shortest, safest and most nontraumatic manner.
While Lane emphasised the
importance of communication
within the Queensway team, he
also stressed how important it is
to communicate effectively with
patients. By conducting applicable and in-depth research of the
patient demographic in the area,
the Queensway team can target
its treatments to those who need
them most. This information can
then be transferred to triedand-tested marketing campaigns,
such as those used on the practice
website, through Google or via
social media. Queensway also
utilises local advertising, which
can often be the most successful
method of reaching patients in
the area.
Lane explained how crucial
it is to invest in a good website:
“As one of the main points of contact for most patients, a website
has to be responsive; it has to be
image led and easy to navigate.
Our website is both smartphone
and tablet friendly, in recognition
of the massive usage of these
two devices. All of the images on
our website are of our own patients as well—no stock images
are used.”
Another key factor of Queensway’s success is its ability to accept high-end treatments at any
time. This means that whenever
an enquiry is made about any
treatment, it can be answered
succinctly and accurately by a
member of the team who understands precisely what is needed.
Queensway Dental Clinic has a
highly trained treatment adviser
who can answer these queries, and
the clinic offers a free 30-minute
consultation with an implant
dentist.
Lastly, Queensway Dental
Clinic recognises the importance
of delivering patient satisfaction and encouraging patients
to recruit others. According to
Lane, “At Queensway, approximately 80 per cent of all new patient enquiries are made through
word of mouth or recommendations.”
Everything the Queensway
team does is geared towards ensuring that patients receive a service they cannot help but recommend. By carrying out monthly
patient surveys, running patient
forums and open evenings, taking
testimonials and Google reviews,
and building up a strong referral
network, the Queensway team can
collect, review and build upon
patient feedback to ensure that
its service always reaches a high
standard.

TRENDS & APPLICATIONS

Implant Tribune Asia Pacific Edition | 10/2016

“To build a truly successful implant clinic, it is vital
to have the right team in place.”
In conclusion, by investing in
exceptional training, by communicating effectively, by working
with high-quality and supportive

companies, and by maintaining
high levels of service, Queensway
Dental Clinic has achieved a great
deal over the last 20-plus years.

The dedication and hard work
shown by its team are a testament
to its past and continued success
and serve as a shining example

of what an implant business can
achieve today and tomorrow.
www.queensway.co.uk
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[cover] => DT Asia Pacific No. 10, 2016

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