DT Asia Pacific No. 11, 2011
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DTAP1111_01_Title
DTAP1111_01_Title 29.11.11 15:24 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG
www.dental-tribune.asia
Profile implants
In interview with Anders
Holmén from Astratech.
4Page
11
NO. 11 VOL. 9
A clinical challenge
Restoring severely
discoloured anterior teeth
Extra
The latest news from the
FDI head office
16
4Page
4Page
9
Study finds DNA vaccine to inhibit caries formation Taiwan implants
receive recognition
Daniel Zimmermann
DTI
Dental implant maker Hung
Chun Bio-S from Southern Taiwan
has been given a product award for
its Ti-one 101 implants by the Institute for Biotechnology and Medicine Industry at the recent National
Innovation Awards in Taipei.
HONG KONG/LEIPZIG, Germany:
A research group from the Chinese
Academy of Sciences in Beijing
has reported a vaccine containing
genetically modified DNA to be effective in preventing tooth decay
in animals. By injecting lab rats
with a protein derived from the
Salmonella bacterium, they found
evidence that it promoted the formation of antibody molecules that
have the potential to inhibit the
colonization of Streptococcus mutans and the development of caries
lesions.
Being a relatively new concept,
nucleic acid vaccines have been
under examination for their use
in forming antibodies against a
number of diseases and systematic
conditions including cancer. It’s
potential to influence the formation
of caries lesions was first examined by scientists almost 30 years
ago. The new results build on
previous research from the Beijing
research group with the so-called
pGJA/VAX vaccine and are the
most convincing so far in having
found an effective mucosal adjuvant candidate for intranasal immunization of an anti-caries vaccine, the authors said.
Operating from Taiwan’s major
port city Kaohsiung, Hung Chun
Bio-S has been active in the national and international implant
markets since early 2011. Director
of Research and Development Lui
Ching-Chieh told reporters that his
company, which invested US$10
million in its implant portfolio, has
gained a five per cent market share
within the last 11 months.
Researchers from China haven taken another step towards development of a caries vaccine. (DTI/Photo Diego Cervo)
The admitted that low immunogenicity which is the ability to
provoke an immune response is
still relatively low in the vaccine.
“Animal experimentation with
this vaccine and route of administration have been reported over
the past several years, “explains
Dr Daniel Smith, an immunology
specialist and member of the
Forsyth Institute in the US, to DT
Asia Pacific. “The new feature here
is the use of flaggellin as an adjuvant which seems to give a modest
improvement in antibody levels.”
Other substances currently in
pre-clinical experimentation for
use as a caries vaccine are other
recombinant proteins and glucanprotein conjugates. According to
Smith, human trials however
cannot be expected to be realised
anytime soon. DT
Taiwan’s US$50 million dental
implant market is still dominated
by companies from Europe, Korea
and the US. In 2008, for example,
Nobel Biocare entered the market
with the acquisition of its Taipeibased distributor Implant Master.
National industry sources estimate that the number of implants
placed is growing by almost 20 per
cent each year.
Besides Hung Chun Bio-S, local
competition includes bio-ceramics
manufacturer Coho Technology in
Taiyuan. DT
AD
Better oral health
for Vietnam
US Navy Chief Petty Officer Nick Hall looks at flooded neighborhoods north of Thailand’s capital Bangkok, 28 October, 2011. Owing to the catastrophy, French dental
manufacturer Acteon cancelled a seminar on bone management. (DTI/Photo DOD, USA)
Human jaw
Fortis buys
shrinks with age Singapore unit
The size of the human jaw decreases with age, research conducted at the Malmö University
Faculty of Dentistry in Sweden
has found. According to study,
which followed 30 participants
over a timespan of 40 years, less
room was available for teeth in
the jaw of each individual with
increasing age. DT
India’s largest provider of
health care clinics and services
has agreed to pay more than half
a billion US Dollar to buy Singapore-based Fortis Healthcare
International PTE from RHC in
Mauritius. The record deal is expected to be completed by-mid
of December depending on regulatory approval. DT
The Vietnamese government
is doing well in its efforts to improve the oral health of school children, Minister of Health Nguyen
Thi Kim Tien has said. Speaking
at the Sixth Asian Conference on
Oral Health Promotion for School
Children last month in Hanoi, she
revealed that 10 million school
children are now receiving regular dental care through the country’s national oral health programme.
According to results of the last
National Oral Health Survey conducted in 2001, more than 85 per
cent of six-year-olds in the country
suffer from tooth decay. Tien said
that although the programme has
achieved good results, still only
30 per cent of hospitals nationwide
offer dental services.
Most dental professionals are
also based in cities, making it difficult for people living in rural areas
to get any dental treatment at all,
she said. DT
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Tel. +423 / 235 35 35 | Fax +423 / 235 33 60
[2] =>
DTAP1111_01_Title
DTAP1111_02_News 29.11.11 15:24 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
AD
Disagreement brews over use
of botox in Australian dentistry
(DTI/Photo Bork)
From news reports
MELBOURNE, Australia: The
use of botulinum toxin (botox)
in dentistry is causing debate
amongst the dental community
in Australia. The discussion
came to a head recently after the
Australian Academy of DentoFacial Aesthetics (AADFA) issued
a letter to the Dental Board of
Australia (DBA), the governmental agency that oversees standards, registration and training
in dentistry, requesting the retraction of an interim policy that
allows only dentists trained in
the treatment of TMJ disorders
to administer the toxic protein.
Put in place originally in November 2010, this policy also
announced the review of the use
of botox in dentistry but has not
introduced any changes thus far.
In a public letter, the DBA’s chairperson John Lockwood, however, said that the Board is currently working on establishing
a panel of national experts who
will review several policies, including those on the possession,
administration, supply and prescription of restricted drugs such
as dermal fillers or botox.
Dr Myles Holt, head of the
AADFA, a private organisation of
dentists that promotes facial injectable treatments throughout
Australasia, said that the current
guidelines are causing confusion
amongst dentists and should
therefore be retracted in order to
make way for a better regulatory
framework. He blamed the DBA
for having set up its policy with-
out the proper research or scientific consultation.
Based in Melbourne, the
AADFA claims to have trained
more than 150 dentists in Australia and New Zealand in facial
aesthetic treatment since 2009.
On its website, the Australian
Dental Association confirmed
that it has received some enquiries by dentists requesting
clarity on the issue and advises
its members to comply with the
current DBA guidelines.
Cosmetic dentistry procedures like tooth whitening, veneers or invisible braces have
become a thriving business in
Australia, with clinics specialised in aesthetic procedures reporting an increase in patients of
up to 60 per cent in recent years.
According to the latest figures
from the Cosmetic Physicians
Society of Australasia, Aussies
are also currently spending more
than AUS$300 million (US$291
million) on non-invasive cosmetic procedures, with botox being
the most requested in 91 per cent
of clinics.
The use of botox and dermal fillers by dentists is currently allowed in some countries in
Asia, as well as the USA and Europe. DT
International Imprint
Licensing by Dental Tribune International
Publisher Torsten Oemus
Group Editor/Managing
Editor DT Asia Pacific
Daniel Zimmermann
newsroom@dental-tribune.com
Tel.: +49 341 48474-107
Copy Editors
Sabrina Raaff
Hans Motschmann
Editors
Claudia Salwiczek
President/CEO
Torsten Oemus
Editorial Assistant
Yvonne Bachmann
Marketing & Sales
Matthias Diessner
Vera Baptist
Peter Witteczek
Director of Finance & Controlling
Marketing & Sales Services
License Inquiries
Accounting
Product Manager
Executive Producer
Ad Production
Designer
Dan Wunderlich
Nadine Parczyk
Jörg Warschat
Manuela Hunger
Bernhard Moldenhauer
Gernot Meyer
Marius Mezger
Franziska Dachsel
International Editorial Board
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
Dr George Freedman, Esthetics, Canada
Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
Published by Dental Tribune Asia Pacific Ltd.
© 2011, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information
and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility
for product names or claims, or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International.
Dental Tribune International
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302 · Fax: +49 341 48474-173
Internet: www.dental-tribune.com E-mail: info@dental-tribune.com
Regional Offices
Asia Pacific
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd, 20A, Harvard Commercial
Building, 105-111 Thomson Road, Wanchai, Hong Kong
Tel.: +852 3113 6177 · Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
116 West 23rd Street, Suite 500, New York, NY 10001, USA
Tel.: +1 212 244 7181 · Fax: +1 212 224 7185
[3] =>
DTAP1111_01_Title
DTAP1111_03_News 29.11.11 15:25 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Asia News
3
Dental students in New Zealand borrow most, pay back early
Daniel Zimmermann
DTI
HONG KONG/LEIPZIG, Germany:
Students of Medicine and Den-
Singapore
pushes
dentistry
tistry are not the ones to blame for
the hundreds of millions of loans
overdue under the Student Loan
Scheme, New Zealand’s Tertiary
Education Minister Steven Joyce
said on Monday. In its 2011 report, released in October, the
Ministry of Education found that
there are over 2,600 students
with piling debts of more than
NZ$100,000 (US$81,300) each,
with pilots and serial students
being the worst payers.
Although in the group with
the highest loans, medical and
dental graduates are usually the
ones who are able to pay back
their loans quickly, Joyce commented. He said that almost one
million students have received
money from the government
since the implementation of
the scheme in 1992. The total
amount of debt currently exceeds NZ$600 million (US$488
million), almost 0.5 per cent of
the country’s gross domestic
product.
the UK who have not made any effort to pay back their dues, he said.
Joyce announced initiatives to
amend the scheme in order to reduce the amount of debt of groups
who owe the ministry the most, especially those living overseas. The
loan amount of borrowers there
has increased by 27 per cent within
the last 12 months. Legal action
will be also taken against some
borrowers living in Australia and
With NZ$80,000 (US$65,000),
dentistry tops the list of occupations with the highest average
starting salaries, according to
latest figures from Careers New
Zealand, a government agency
based in Wellington. This amount
can almost double within five
years of practice to NZ$150,000
(US$121,900). DT
AD
From news reports
SINGAPORE: Singapore’s new
Minister for Health Gan Kim Yong
has announced further investment into the city-state’s dental
infrastructure. Speaking at this
year’s Dentist’s Pledge Affirmation Ceremony of the Singapore
Dental Council, he said that his
ministry will look into the possibility of enhancing its capacity
to better support dental research
and training. As a first step, the
annual intake of students at the
National University of Singapore’s
Faculty of Dentistry will be raised
from 48 to 80 by the year 2020.
®
VITA Easyshade Advance – To err was human!
More precise than the eye: digital determination and verification of all tooth shades
Gan Kim Yong (DTI/Photo courtesy of
Ministry of Health, Singapore)
Earlier this month, the ministry announced an initiative to
encourage private practices to
publish their average fees for
several kinds of dental treatment,
a practice the ministry has followed for fees charged by public
institutions for years.
Yong, who is a member of the
governing People’s Action Party,
took over office after the general
elections from long-term Minister
for Health Khaw Boon Wan, who is
currently serving as the country’s
Minister for National Development. After he was sworn in, Yong
launched a campaign for reviewing the physical capacities of the
ministry, amongst other issues. DT
3421 E
During his speech, Yong
pointed to the Primary Care Partnership Scheme, which was recently expanded and now subsidises tertiary dental procedures
like crowns and root-canal treatment in private practices for an
estimated additional 700,000 Singaporeans. He said that a working
group has also been established
to strategise the development
and implementation of a new
specialty, including geriatric and
special needs dentistry, a field of
care that according to him needs
development owing to the citystate’s rapidly ageing population.
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Easyshade Advance. / www.vita-zahnfabrik.com
[4] =>
DTAP1111_01_Title
DTAP1111_04_News 29.11.11 15:45 Seite 1
Opinion
DENTAL TRIBUNE Asia Pacific Edition
Dear
reader,
Myth or reality?
4
Dr KM Shivkumar
India
Dental caries is one of the
most common infectious and
non-life-threatening diseases
known to affect us. It also appears
to be a major public health problem, which if left untreated can
cause considerable pain and discomfort, as well as require huge
amounts of money and time to
treat. The WHO has estimated
that more than five billion people
have suffered from tooth decay.
Daniel Zimmermann
DTI
Last year one these pages I already talked much about Asia’s
prospects in dentistry. Looking
back at the last 12 months, nothing could be more relevant today.
With debts soaring and markets
plunging in almost all developed
markets, established systems of
social and health care are getting under increasing financial
stress. This development will
have an effect not only on many
people but also on the industry,
which is already looking at the
Far East for profits.
With the majority being only
at the beginning of their development cycle, however, Asian
countries should carefully watch
the crisis that is currently unfolding in the West in order to
avoid repeating the same mistakes. There is no doubt that
growth is important for the survival of every society but it also
has become quite clear that
uncontrolled distribution of resources and wellfare only leads
to turmoil. Asians should be
aware that all our future will
depend much on how seriously
they are willing to take these
principles.
With this in mind, the Asia
Pacific editorial team wishes
you a happy and successful year
2012! DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International
There are various preventive
measures for dental caries, of which
immunisation is one. The vaccination can be given subcutaneously,
orally, or intranasally by activating
gut or nasal lymphoid tissues.
Use of botox is a medical procedure
Prof. Laurence J. Walsh
Australia
The use of botox for treating
TMJ dysfunction and spasms in
the muscles of mastication is a
well-accepted part of clinical
practice, particularly for oral and
maxillo-facial surgeons, with a
growing evidence base supporting safety and efficacy. Severe
bruxism or jaw-closing dystonia
unresponsive to other treatments can be treated by injecting
Botox-A into the masseter muscles.
The Dental Board of Australia’s interim policy on the
use of botox permits the use of
botulinum toxin by registered
dentists with the necessary education, training and competence
for the treatment of TMJ disorder or dysfunction. A general
dentist is not sufficiently conversant with the indications for
using Botox-A to treat wrinkles
as opposed to other skin treatments such as laser resurfacing, dermabrasion or Retin-A
therapy.
The arguments against allowing use of botox for wrinkle
reduction and other cosmetic
treatments are threefold. Firstly,
the principles of pharmacology
that underpin the use of botox
are covered in dentistry programmes at a very basic level,
which is not a sufficient foundation for clinical use because of
the lack of detailed pharmacology and therapeutics (dosages,
side-effects, etc.). Secondly, the
detailed anatomy of the midface, orbit, upper face and neck
is not covered in dental training
at a level sufficient for the safe
use of botox. The fact that we as
dentists are experienced at administering injections of local
anaesthetic solutions into the
oral and peri-oral regions does
not mean it is appropriate for
dentists to inject botox across
the neck and face. Finally, the
use of botox for cosmetic purposes is part of cosmetic medicine (or beauty therapy) and
does not form part of the practice
of dentistry. Its use for cosmetic
purposes should be confined to
appropriately trained medical
practitioners, and should be
considered a medical procedure. DT
Contact Info
Prof. Laurence J. Walsh is head
of the University of Queensland
School of Dentistry in Brisbane,
Australia. He can be contacted at
l.walsh@uq.edu.au.
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Over the last four decades,
many successful animal experiments have been conducted on
mice, rats and monkeys for effective immunisation against antigenic components of S. mutans
or S. sobrinus in dental plaque.
Despite the scientific evidence,
no dental caries vaccine for humans exists today, primarily because paediatric vaccine approval
boards are reluctant to add such
a vaccine for a normally non-lifethreatening disease to their catalogues. Another reason is strong
economic interests that hinder
the development of such a vaccine
for release onto the market. DT
Contact Info
Dr KM Shivkumar is associate
professor at the Department of
Public Health Dentistry, Sharad
Pawar Dental College & Hospital,
Datta Meghe Institute of Medical Sciences University, Sawangi, India. He can be contacted at
kmshivakumar@rediffmail.com.
[5] =>
DTAP1111_01_Title
DTAP1111_05_News 29.11.11 15:46 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
World News
5
New study targets dental drills for hearing loss
Daniel Zimmermann
DTI
NEW YORK CITY, USA/LEIPZIG,
Germany: An audiology student
who is investigating the effects of
noise from dental drills on dentists
has won a National Hearing Conservation Association 2011/2012
research award. In her study,
Krisztina Busci Johnson from the
East Tennessee State University in
Johnson City seeks to determine
whether rotating instruments
used in dentistry take their toll on
dentists’ hearing function.
Johnson is not the first scientist
to look into a possible connection
between dental drills and hearing
loss in dental professionals. Research on this topic dates back to
the early 1980s, when a study published by the “American Journal of
Public Health” found a cause and
effect relationship between hearing loss and the use of the highspeed dental handpieces.
ciated with permanent inner hear
damage. This level of noise is typically created by subway trains driving at high speeds or heavy traffic.
Being a dental assistant for
eight years herself, Johnson intends to measure and compare data
on the hearing threshold of dentists
drilling without hearing protection
over a period of a working day. She
is currently seeking participants in
the Johnston City area, who will
also receive a free clinical hearing
evaluation during the process. If
successful, she hopes to be able to
persuade dentists to use better
hearing protection and to widen the
study by including dental assistants
or hygienists.
“Another possibility is that the
data could persuade dental drill
manufacturers to produce drills
that are safer for the human ear,”
she said.
Manufacturers of modern dental drills usually do not recommend using ear protection during
operations, saying that the technology has become quieter over
the years and their running time
has significantly decreased. According to the NHCA, a second research award went to a University
of Florida research assistant who
is investigating hearing threshold
changes induced by digital audio
players.
The annual trophy comes with
prize money of $5,000. DT
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Tetric N-Collection
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A complete nano-optimized restorative system
Results, however, remain inconclusive, as a recent study conducted by the Institute for Evaluation in Cologne in Germany found
that noise from rotating instruments did not go beyond 85 to 90
decibels, the limit commonly asso-
2012 WDF
to be held in
Hong Kong
From news reports
BELLEVUE, Wash., USA: Modern Dental Laboratories has announced that registration for its
second World Dental Forum in
Hong Kong in 2012 is now open to
dentists in the United States. The
event will be held in conjunction
with the centennial anniversary
of the University of Hong Kong
and feature educational offerings in English ranging from
subjects like dental restorations
to endodontics, implant dentistry
or sleep medicine.
With its Shenzhen dental lab
north of Hong Kong, Modern
Dental Laboratory says to be one
of the largest global providers of
ISO 13485:2003 certified dental
work. It also maintains one of the
largest dental technology school
worldwide with a staff of 3,000.
The company’s first congress
was held in fall 2009 and saw
more than 200 dentists from
Europe, North America and Asia
learning and discussing new
trends in the global dental industry. Next year’s event has confirmed presentations from US
dental researchers Drs John
Burgess and Jack Ferracane and
will be held at the Grand Hyatt
hotel from 31 May to 3 June.
Participants will be also able to
earn up to 16 AGD approved CE
credit hours, the company said. DT
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[6] =>
DTAP1111_01_Title
DTAP1111_06_News 29.11.11 15:54 Seite 1
6
DENTAL TRIBUNE Asia Pacific Edition
World News
A durian a day keeps caries away,
research from Asia suggests
From news reports
LAS VEGAS, Nev., USA: A sugary
gel covering the thorn-covered
husks of the durian fruit is currently being investigated by researchers for its potential as a
mouth disinfectant. Students
from the Faculty of Dentistry at
the Chulalongkorn University in
Bangkok, Thailand, recently presented their initial findings at the
Annual Meeting of the American
Dental Association in Las Vegas,
the website drbiscus.com has reported.
They found that the substance made of polysaccharides
was able to reduce the number of
Streptococcus mutans bacteria in
lab rats hours after use, which
would make it as effective as
0.2 % chlorhexidine, a common
formula used in mouth rinses.
Studies on human subjects also
showed a reduction of hydrogen
sulphide, methyl mercaptan, and
dimethyl sulphide, compounds
responsible for halitosis or bad
AD
Cavex Alginates
Superior in
strength, control
and balance
breath. No evidence of treatmentrelated gross toxicity or deaths
caused by exposure to mouth
rinsing with durian polysaccharide gel was observed, the researchers stated.
Durian is popular in many
Southeast Asian countries, including Thailand and Malaysia,
which are the world’s largest importers of the fruit. Its roots and
leaves are often used in traditional medicine.
Earlier research conducted
on durian polysaccharide gel
confirmed the antibacterial properties of the gel. DT
Caries
investigated
by nanotech
From news reports
BASEL/VILLIGEN, Switzerland:
Researchers at the University of
Basel and the Paul Scherrer Institute, the largest research centre
for natural and engineering sciences within Switzerland, have
successfully demonstrated how
caries affects human teeth at a
nano-level. Their study offers
new possibilities for the treatment of tooth damage.
Your impression is our concern!
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Dentine consists mainly of
inorganic elements but a fifth is
composed of organic material.
It was previously hypothesised
that these organic components—
especially certain endogenous
structural proteins (collagen)—
were unaffected by damage to
the dentine and that their structure could offer a basis for remineralisation. To test this hypothesis, the research team, led by
Prof. Bert Müller at the Biomaterials Science Center at the University of Basel, used X-ray scattering to compare the density of
collagen in healthy and carious
tooth spots.
The researchers cut both
healthy and carious teeth into thin
slices of 0.2 to 0.5 mm and examined them using small-angle
X-ray scattering, a technique
used for the structural characterisation of solid and fluid materials in the nanometre range.
They observed that carious
bacteria initially destroy the ceramic components of the outer
enamel and the subjacent dentine. In contrast, in the early to
mid-carious state, a significant
part of the dentinal collagen
network, remains practically unaffected.
Hence, the researchers suggest that in the future their
method will allow the development of biometric dental fillings
and cavity treatments that are
based on an undamaged dentinal
collagen network, and allow the
remineralisation of damaged
dentine, for example, with nanoparticles. DT
[7] =>
DTAP1111_01_Title
DTAP1111_07_News 29.11.11 15:56 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
World News
Forsyth starts commercialization of blue light
gum treatment technology
From news reports
BOSTON, Mass., USA: The Forsyth Institute in Boston has signed
an exclusive licencing agreement
with a US-based start-up for the
commercialisation of a recently
patented blue-light based technology for use in dentistry. Under
the terms of the contract, Lexing-
ton-based PhotOral will be allowed to support the development
and marketing of an intraoral
cleaning system working against
bacteria that cause gingivitis.
The promising technology
was developed and first documented by Forsyth researchers
Nikos Soukos and Max Goodson.
They found that light with a
particular wavelength, typically
used in teeth whitening procedures, did also eradicate so-called
“black-pigmented bacteria” that
are responsible for the inflammation of gum tissue. In addition,
their study showed that the proportion of other healthy bacteria
increased.
“This suggests that it might
one day be feasible to use light to
restore a healthy bacterial balance in the mouth,” Soukos told
the university paper Harvard
Gazette in 2005.
According to PhotOral CEO
Stamatis Astra, a Boston University business graduate and radio
7
talk show host, a prototype of the
device is expected to be available
within the next 12 to 18 months.
He said that it will be targeted at
the consumer market and be
priced at US$90 dollars. His company would now be in the process
of raising a sum of US$10 million
for financing first clinical trials,
production and marketing.
Astra told the New England
technology journal Mass High
Tech that the technology could
also be used in the future to disinfecting wounds. DT
AD
Birth after
oral cancer
treatment
Lisa Townshend
DT UK
LEAMINGTON SPA, UK: A
British mother has made medical history after successfully
giving birth having had chemotherapy cancer treatment during her pregnancy. Thirty-yearold mum-to-be Sarah Best from
Leamington Spa was diagnosed
with mouth cancer when she
was four months pregnant and
was told that if she did not opt
to have radiotherapy the cancer
was sure to spread.
®
Panasil initial contact.
Precise, even in extreme situations.
As Best underwent radiotherapy and chemotherapy treatment to treat the mouth cancer,
two five-cm thick lead shields
were used to protect baby Jake
from the radio waves. Best unexpectedly gave birth to a healthy
baby boy just hours after receiving her last course of radiotherapy.
“I was devastated when I
was told I had cancer,” Best, who
had an operation to remove a
tumour from her tongue, was
quoted saying in The Telegraph.
“The surgeons managed to remove most of it but they said
they saw specks of cancer cells
on my lymph nodes. I thought
pregnancy was supposed to be
the happiest time. You are supposed to feel wonderful. I was
really worried about the effect
the radiotherapy could have
on the baby but the doctors said
the lead shield would protect
him.”
Meanwhile, she has been
given the all clear from cancer.
Consultant oncologist Lydia
Fresco, who helped design and
build the lead guard for Sarah,
said in The Telegraph: “Sarah’s
case was extremely rare. As far
as published cases go she was
the only woman with mouth
cancer in the world to have this
combination of chemotherapy
and radiotherapy while pregnant.” DT
021087_0911
Best said she was expecting
to have Jake at least a month
after her treatment ended but
suddenly went into labour on the
last day of her treatment.
If people were satisfied with just good solutions, only small advancements would be made. This applies to dental impressions
as well. The modern A-Silicone Panasil® initial contact features not just good, but remarkable initial hydrophilicity. Following
the usual sulcus preparation, it flows directly onto the moist tooth surface and thoroughly wets it - plus it retains the moisture
through the entire process.The result: impressions with utmost detail accuracy of the preparation, even in extreme situations.
Whether you are performing a two-step putty-wash impression technique, a one-step double mix technique or a one-step puttywash impression technique, A-Silicon Panasil® initial contact will provide optimum results. Together with Panasil® tray materials,
we offer the ideal system for any of these techniques. For more information, please visit our website: www.kettenbach.com
[8] =>
DTAP1111_01_Title
[9] =>
DTAP1111_01_Title
DTAP1111_09-10_FDI 29.11.11 15:57 Seite 1
The 2011 FDI Annual World FDI Hong Kong
Dental Congress in figures 2012 briefing
112 scientific sessions facilitated by more than 128 speakers
from 29 different countries.
Sessions covered a wide
range of issues, from oral health
and noncommunicable diseases to caries management,
from patient safety to salivary
diagnostics and from to oral and
maxillofacial surgery to orthodontics—in fact full coverage of
the today’s key areas of interest
and discussion in dental art,
science and practice.
With entry free-of-charge,
just under 5,300 square metres of exhibition space, some
27,000 visitors, 200 exhibitors
and nearly 1,000 exhibition
staff, 2011 proved to be the
largest FDI World Dental
Exhibition in recent years.
Jointly organized by FDI and
the Mexican Dental Industry
(AMIC), it was held alongside
the 2011 FDI Annual World
Dental Congress at the Centro
Banamex Convention Centre,
Mexico City, from 14–17 September 2011.
Over 5,000 individuals, principally dental practitioners, but
also hygienists and students,
participated in the sessions and
meetings scheduled in and
around the event. The four-day
Scientific Programme, held under the theme ‘New horizons
in oral health care’, featured
In addition, 121 scientific
posters were on display and
59 free communications were
presented. The three winners
of the 2011 FDI Poster Award
Competition were announced
during the VIP reception on
14 September. They are Assoc.
Prof. Josimeri Hebling from
Brazil, Assoc. Prof. Aziza Eldarrat from the United Arab Emirates and Prof. Hyun-Duck Kim
from South Korea.
In all, 98 nationalities were
represented at the 2011 FDI Annual World Dental Congress. FDI
FDI recently held a site visit
and briefing in Hong Kong
for an audience comprising
members of the dental industry, representatives from
the Hong Kong
Dental Association, and key
providers. The
aim was to detail
the numerous
opportunities at
the 2012 Annual
World Dental
Congress as well
as respond to
questions.
Those present
included sponsors from 19 companies, of which 8
are current FDI corporate
partners —in all some 60 industry representative, mainly
from China but also from Australia, France and Singapore.
The briefing, which took place
on 17 October, also allowed all
parties to familiarize themselves with the venue.
“We outlined our plans for
new sessions and products
envisaged for the 2012 Congress and feedback was very
positive,’ said FDI Executive
Director JeanLuc Eiselé. “I
really picked
up on an interest and willingness to invest
in the event.”
“Success,
as they say, is
measured by
attention to detail and understanding needs
and expectations,” added
Dr. Eiselé. “And
that is exactly the approach
FDI plans to adopt for the
AWDC 2012.”
Meanwhile, the Congress
website will soon be open,
with a preliminary programme
online by the end of November. FDI
FDI President: high-level meetings on India visit
There he once again had the opportunity of carrying out a presentation of FDI and outlining its
vision and activities to members
of the local chapter of IDA, officials from the regional government, and deans from local universities.
On his first official visit—at the
invitation of one of FDI’s members and valued partner in
‘Leading the world to optimal
oral health, the Indian Dental
Association (IDA)—FDI President Orlando Monteiro da Silva
addressed local events, consolidated links with regional
branches of IDA and held highlevel meetings with government officials.
The trip took in three of the
country’s major cities. His first
stop, 23 September, was in Chennai, where he addressed a vast
audience of dentists and dental
students at the opening ceremony
of a ‘Dental-medical interaction
Symposium’, organized by IDA’s
Greater Chennai Branch and the
Sri Ramachabdra University.
IDA President Dr. George
Thomas was present as guest of
honour. Other dignitaries present included Dr Gunaseelan Rajan and Dr S. Murukesan, respectively President and Hon. Secretary of the IDA-Greater Chennai
During the course of Dr da
Silva’s visit, IDA officials expressed their keen support for
FDI to launch a Continuing Education Accreditation System and
outlined their intention of presenting a specific proposal.
Branch, and Dr R. Suresh, Dean
of the Dental Faculty Sri Ramachandra University. The visit
included a view of the University’s medical, pharmaceutical
and nurse training facilities.
The following day, Dr da Silva
was in Kolkata, where he briefed
a highly receptive audience,
among them Mr Sudip Bandhyopadyay, Minister of State
(Health), on FDI advocacy and
activities in the field of noncommunicable diseases. As well as
IDA representatives, the audience comprised government officials from all over India, mem-
bers of the Indian Dental Council, notably IDC President Dr
Dibyendu Mazumber and Vicepresident Dr Mahesh Verma,
and faculty from a number of
universities.
Mumbai, 25 September, was
Dr da Silva’s last port of call.
Commented Dr da Silva on
his return: “I was genuinely
moved by the warm reception
I received everywhere I travelled
and by the enthusiasm of IDA,
local politicians and academia on
FDI’s work and what it is trying
to achieve.”
“More specifically, I received
very clear signals from a major
FDI contributor: we really need
to move forward on continuing
education.” FDI
[10] =>
DTAP1111_01_Title
DTAP1111_09-10_FDI 29.11.11 15:57 Seite 2
10
Worldental Communiqué
DENTAL TRIBUNE Asia Pacific Edition
Oral diseases are obstacles FDI + NDAs =
to development, says UNDP success at UN Summit
The Administrator of the United Nations Development Programme, Helen Clark, has
called oral diseases “obstacles
to development”.
She was speaking at a side
event on 19 September, organized
around the United Nations Summit on noncommunicable diseases held 19–20 September in
New York. The theme of the vent
was ‘Putting the teeth into noncommunicable diseases: encouraging priority actions for noncommunicable diseases’. “Something as preventable as tooth decay can impair people’s ability to
eat, to interact with others, attend
school, or work. These consequences all detract from human
wellbeing, economic potential,
and development progress,”
noted Ms Clark, who is also former New Zealand Prime Minister.
In her address, ‘Intersectoral
Collaboration to Advance SocioEconomic Development and
Achievement of the Millennium
Development Goals’, she high-
lighted the development impact
of oral diseases.
“Low and middle income
countries face variously alarmingly high and/or rapidly increasing rates of oral diseases,
including tooth decay, cancers,
and Noma. These challenges can
be exacerbated by weak health
system capacity, and by a lack of
focus on oral health- despite its
importance for sustaining overall health.”
“The result,” said Ms Clark,
“is unnecessary death and disability on a large scale from oral
diseases.”
Deep concern
The 19 September UN Summit
side event was sponsored by the
United Republic of Tanzania and
co-sponsored by Australia and
Sweden. In his keynote address,
Tanzanian President Jakaya M.
Kikwete expressed his deep concern over the burden of oral diseases for Tanzania and other resource-constrained countries.
The event was moderated by
Ali Velshi, Anchor and Chief Business Correspondent for CNN and
included discussion of the ‘Global
Burden of Oral Diseases: Common Risk Factors’, ‘Connecting
Oral Diseases to Non-Communicable Diseases’ and ‘Integrating
Oral Health into Primary Health
Care-Practical Solutions’. Present
at the event, FDI President Orland
Monteiro da Silva, said: “I was very
impressed by the debate and discussion and learned a lot about the
impact of oral diseases on developing countries. I certainly came
away with a much better sense of
the extent of the problem and possible solutions.”
“Now it is up to us to monitor
how the elements of the political
declaration—which now, as we
had hoped, contains specific references to oral diseases—are integrated into national health
strategy and what kind of support
our profession needs to provide.”
FDI President Dr Orlando
Monteiro da Silva and Executive
Director Jean-Luc Eiselé attended the Summit to hear pre-
She called the Summit “a wake
up call for governments” and
cautioned that NCDs “are the
diseases that break the bank”,
which, left unchecked, “have the
capacity to devour the benefits
of economic gain” delivering “a
two-punch blow to development”.
Elsewhere, FDI participated
in seven New York side events to
the UN Summit, and distributed
some 350 WHPA NCD Toolkits.
The NCD Action Toolkit, in particular its Health Improvement
Card, can help individuals and
health professionals develop
strategies to address risk factors
and actively improve the health
and well-being of patients and
members of the general public.
The Toolkit describes how to:
on NCDs held in New York on
16 June.
In the wake of this, FDI sent
its landmark ‘Write to your
Minister’ email to its NDAs on
5 July, encouraging them, first,
to make sure their head of government or state would be attending the Summit and, second, to make contact with their
Health Minister, Chief Dental
Officer and, possibly, public
health authorities “to alert
them to the fact that oral health
is not included in the ‘Draft outcome document’.”
It attached a special advisory document on the main
points to raise as well as a template letter, based on a model
from the American Dental Association, to provide an
opener for face-to-face dialogue.
FDI followed this up on
10 August with a direct
appeal to UN General Assembly Chair, H. E. Joseph
Deiss, with copy to Sir
George Alleyne, former
PAHO Director General
and chairman of the drafting committee for the outcome document, indicating specific changes FDI
was requesting.
More information: WHO Global Status
Report on Noncommunicable diseases
2010—www.who.int/nmh/publications/
ncd_report_full_en.pdf
Following the two-day event,
Dr da Silva said the experience
had been both intense and rewarding. “It was a huge opportunity to view the NCDs issue from
a number of different perspectives. As the Summit progressed,
I was increasingly convinced of
the vital and unique contribution
that dental medicine can make
to NCD prevention and education.”
sentations from ministers of
health and a number of international dignitaries, including
WHO Director General Dr Margaret Chan.
Thanks to its own lobbying
and direct action by FDI member national dental associations (NDAs), as well as to the
sustained efforts of a number of
other governmental and nongovernmental stakeholders,
the Declaration’s Article 19
now recognizes that “renal,
oral and eye diseases pose a
major health burden for many
countries and that these diseases share common risk factors and can benefit from common responses to non-communicable diseases.”
Also present, FDI Executive
Director, Jean-Luc Eiselé, added:
“This is knowledge that FDI very
much needs to have at its fingertips. It will inform and advise our
current strategy on Africa.” FDI
FDI omnipresent during
United Nations Summit
FDI was omnipresent in New
York during the two-day United Nations Summit on noncommunicable diseases both
to attend the Summit and to
promote and disseminate the
newly-published World Health
Professions Alliance WHPA
Action Toolkit.
FDI’s bid for oral diseases to
be mentioned specifically in
the Declaration from the United Nations Summit on Noncommunicable Diseases has
been crowned with success.
This reflects a view that FDI
has long expressed. Yet, in early
July, FDI had to admit in a letter
to its NDAs that “the feedback
we have received indicates that,
at this point, oral health still has
little support and is unlikely to
figure in the Final Declaration
unless at the specific request of
member governments.”
This was despite two interventions, the first at the World
Health Assembly in Geneva on
21 May, the second, by Executive Director Jean-Luc Eiselé,
at a UN Civil Society Hearing
• avoid tobacco use and harmful
alcohol consumption
• improve diet and maintain a
healthy weight
• undertake regular sufficient
physical activity
• screen for preventable illness.
FDI World Dental Federation developed the WHPA toolkit
in partnership with the World
Medical Association, the International Pharmaceutical Federation, the World Confederation of Physical Therapists, and
the International Council of
Nurses. FDI
Commenting FDI’s
successful campaign, FDI
President Orlando Monteiro da Silva, said “We
could never have achieved
our goals without the timely action of some NDAs who took our
advice and alerted their health
authorities to the problem. This
whole NCD campaign illustrates the very real strengths of
FDI as an international Federation working directly through
its member associations to advocate health policy and getting
the results it wants!” FDI
Political Declaration of the High-level
Meeting of the General Assembly on
the Prevention and Control of Noncommunicable Diseases—www.un.org/
ga/search/view_doc.asp?symbol=A%
2F66%2FL.1&Lang=E
About the publisher
Publisher
FDI World Dental Federation
Communications Manager:
Christopher Simpson
Tour de Cointrin, Avenue Louis Casaï 84,
Case Postale 3
1216 Cointrin – Genève
Switzerland
Phone: +41 22 560 81 50
Fax: +41 22 560 81 40
E-mail: media@fdiworldental.org
Web site: www.fdiworldental.org
FDI Worldental Communiqué is published by the FDI World Dental Federation.
The newsletter and all articles and illustrations therein are protected by copyright. Any utilisation without prior consent
from the editor or publisher is inadmissible and liable to prosecution.
[11] =>
DTAP1111_01_Title
DTAP1111_11-12_Holmen 29.11.11 15:57 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Business 11
Implants for a neglected
clinical situation
An interview with Dr Anders Holmén, Astra Tech
The Swedish implant manufacturer Astra Tech AB recently presented OsseoSpeed TX Profile,
an implant for sloped ridge situations, at the annual congress of
the European Association for Osseointegration in Athens, Greece.
Dental Tribune Asia Pacificspoke
with former dentist and Astra
Tech Head of Product & Therapy
Management, Dr Anders Holmén,
about its indications, clinical benefits and why it is mainly targeted
at experienced users.
DT Asia Pacific: After the
Academy of Osseointegration
congress in Washington, DC, in
May, you presented the OsseoSpeed TX Profile implant at a
major European implantology
meeting for the first time. What
has the feedback been from specialists so far?
Dr Anders Holmén: The EAO
congress has always been a positive forum for Astra Tech AB to
present new products with related
concepts and the scientific background that is behind it. By exhibiting at congresses like the EAO you
as a company also establish your
presence and demonstrate your
level of expertise. This year, we
again have had an extremely good
response from congress participants, including those who visited
our EAO satellite symposium
where they had the opportunity to
discuss aspects of the new profile
implant with various clinicians
from the Europe and the US.
The new implant was designed for a specific clinical situation. How common is this problem in dental implantology?
I would say that sloped ridges
are not so much a problematic but
rather neglected clinical situation.
We have noticed that implant cases
where the alveolar ridge has a slope
are quite frequent, and that regular
implants with a flat profile do not
offer good adaptation to this bone
contour. When a flat implant is
placed in line with the buccal aspect in such a case, then the lingual/palatal and proximal bone
have no support and will eventually
resorb and disappear. The risk for
soft tissue dehiscence and compromised aesthetic results is a reality.
Another way to place a flat implant that supports all surrounding
bone is to position it in level with the
lingual/palatal aspect of the bone.
The disadvantage with this is the
risk for discolouration of the buccal
soft tissue owing to the implant
sticking out of the buccal aspect of
the bone. What we have done with
the OsseoSpeed TX Profile implant
is a very simple thing from a conceptual point of view. By giving the
implant a sloped profile, in harmony with the bone profile, we are
able to maintain the bone around
the implant and provide support for
long term aesthetic results.
How many cases do you estimate could be treated with this
kind of implant?
Initial calculations indicated
that 5 to 10 per cent of clinical situations will be suitable for treatment with this implant. However,
after the launch in March and
looking at the experienced from
our clinical research programme,
we see the need becoming more
frequent. Clinicians are also communicating that this is something
they will use more often, so we
foresee that in the future it will be
‡ DT page 12
AD
[12] =>
DTAP1111_01_Title
DTAP1111_11-12_Holmen 29.11.11 15:57 Seite 2
12 Business
DENTAL TRIBUNE Asia Pacific Edition
Acteon cancels seminar over floods
The company has been doing
business in Bangkok since 2004.
It’s current staff comprises 38 people. General Manager of Acteon
Thailand and seminar project
leader Junichi Wakabayashi said
that participants who have completed the registration procedure
for the seminar will receive a full
refund of their registration fees.
Daniel Zimmermann
DTI
French dental manufacturer said
in a statement.
pon Dental University in Japan, to
hold lectures and hands-on courses.
HONG KONG/LEIPZIG, Germany:
Dental Tribune Asia Pacific has
learned that Acteon has stopped
organisation efforts for a seminar
on bone management to be held
in the capital of Thailand in early
2012. Owing to the floods that are
still affecting Thailand’s capital,
a safe environment for holding
such an event is compromised, the
The seminar was to be held
from 10 to 11 January at the Grand
Millennium Sukhumvit, a five-star
hotel located in Bangkok’s central
Watthana District. The company
had invited a number of international speakers, including renowned oral surgeon Dr. Fred
Bergmann from Germany and Prof.
Fumihiko Watanabe from the Nip-
“As the Thai government is still
very concerned about inhabitants’
safety and of hygiene conditions,
we do not want the attendees to
take any risk,” International Marketing Director Robert P. Gregoire
told Dental Tribune Asia Pacific.
“Our priority is to support our Thai
office and our personnel there to
repair the damages and move on.”
AD
UNIVERSAL DUO-SHADE NANO COMPOSITE
According to the latest figures
from the Department of Disaster
Prevention and Mitigation in Thailand, more than 500 people have
died since the flooding began in
July. The catastrophe could also
have a severe impact on the country’s already strained political and
economic system, experts say. DT
fl DT page 11 Holmén
used in 30 to 40 per cent of all implants being placed.
Do you have clinical results
available to back up the new
profile implant?
First results from studies were
presented and discussed at the AO
and the EAO meetings. We have
one-year data available from implants placed in healed ridges and
are about to start another trial
looking at implants placed in extraction sockets. The scientific basis however for the Profile implant
is the well documented Astra Tech
BioManagement Complex which
in total applies to this new evolution of our implant assortment.
The implant is mainly targeted at experienced users. What
are the main challenges that
come with this new profile?
There is definitely a learning
curve attached to this implant and
clinicians who want to use it have
to have good diagnostic experience and be knowledgeable in
implant surgical procedures. The
problems here are that beginners
might miss in planning for and performing correct dimension and direction of the drilling which does
not necessarily result in severe
complications but could mean
negative feedback from the patient. It is easy to understand the
concept but we have installed a
process where our customers
have to do some actual hands-on
training to make sure that they understand the critical and important parts of the handling before
doing the first clinical case.
BRILLIANT™NG
simply natural
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The TX Profile has already
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available in the rest of the
world?
This is a global launch, so dentists in countries where we have
distributors or own subsidiaries
should be able to obtain this implant depending on the local regulatory processes.
The OsseoSpeed TX Profile
will probably be a topic at your
next World Congress in Gothenburg in May 2012. Apart from
this, are there more products that
you are currently working on?
With our implant system, we
already have a scientifically supported solution that offers predictable long-term results. What
we constantly do, nevertheless, is
to try to identify those situations
where we can improve on products and make it easier to work
with for our customers. The new
profile implant is a perfect example
for existing scientific documentation to meet a clinical situation
through a minor product modification. We certainly have more
things in the pipeline and some
of them will be discussed at our
World Congress next year in May.
Thank you very much for
this interview. DT
[13] =>
DTAP1111_01_Title
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3/10/2011 8:27:06 AM
[14] =>
DTAP1111_01_Title
DTAP1111_14-15_Olivi 29.11.11 15:58 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
14 Trends & Applications
Laser in endodontics (Part I)
Prof. Giovanni Olivi et al.
Italy
One of the main goals of endodontic treatment is the effective cleaning of the root-canal
system. Traditional endodontic
techniques use mechanical instruments, as well as ultrasound
and chemical irrigation to shape,
clean and completely decontaminate the endodontic system.
in DT Asia Pacific 12/11, will present the state-of-the-art effectiveness of these instruments in the
cleaning and decontamination of
the endodontic system and take a
look at the future, presenting recent preliminary studies on new
methods of utilising laser energy.
radial and stripped tip in combination with EDTA irrigation results
in effective debris and smear layer
removal without any thermal damage to the organic dentinal structure.13
Lasers in endodontics
Lasers are classified according
to their location on the electromagnetic spectrum of light. They can be
Laser technology was introduced to endodontics with the goal
Fig. 1: Lasers and the electromagnetic spectrum of light.
Electromagnetic spectrum of
light and laser classification
The lasers considered here for
endodontic applications are the
near infrared laser—diode (810,
940, 980 and 1,064 nm) and Nd:YAG
(1,064 nm)—and the medium infrared lasers—Erbium, Chromium:
YSGG (Er,Cr:YSGG; 2,780 nm) and
Erbium:YAG (2,940 nm). A brief introduction to the basic physics of
laser–tissue interaction is essential
for understanding the use of lasers
in endodontics.
Fig. 2: Laser–tissue interaction.
continuous wave mode
gated mode
pulsed mode
Fig. 4: Methods of laser light emission.
Fig. 3: Coefficients of tissue absorption.
The complexity of the rootcanal system is well known. Numerous lateral canals, of various
dimensions and with multiple morphologies, branch off from the principal canals. A recent study found
complex anatomical structures in
75 % of the teeth analysed. The
study also found residual infected pulp after the completion of
chemo-mechanical preparation,
both in the lateral canals and in
the apical structures of vital and
necrotic teeth associated with periradicular inflammation.1
The effectiveness of the debridement, cleaning and decontamination of the intra-radicular
space is limited, given the anatomical complexity and the inability of
common irrigants to penetrate into
the lateral canals and the apical
ramifications. Therefore, it appears advisable to search for new
materials, techniques and technologies that can improve the
cleaning and decontamination of
these anatomical areas.
The use of lasers in endodontics
has been studied since the early
1970s, and lasers have been more
widely used since the 1990s.2–7 In
this regard, Part I of this article will
describe the evolution of laser techniques and technologies. The second part, which will be published
of improving the results obtained
with traditional procedures through
the use of light energy by increasing
cleaning ability and the removal of
debris and the smear layer from the
root canals and thus improving
the decontamination of the endodontic system.
Different wavelengths have
been shown to be effective in significantly reducing bacteria in infected canals and studies have
confirmed these results in vitro.8
Further studies have demonstrated
the efficiency of lasers in combination with commonly used irrigants,
such as 17 % EDTA, 10 % citric acid
and 5.25 % sodium hypochlorite.9
The action of the chelating substances facilitates the penetration
of laser light, which can penetrate
into the dentinal walls up to 1 mm
in depth and have a stronger decontaminating effect.8,9 Other studies
have investigated the ability of certain wavelengths to activate the irrigating solutions within the canal.
This technique, which is termed
laser-activated irrigation, has been
shown to be statistically more effective in removing debris and the
smear layer in root canals compared with traditional techniques
and ultrasound.10–12 A recent study
by DiVito et al. demonstrated that
the use of the Erbium laser at subablative energy densities using a
visible and invisible, near, medium
and far infrared laser. Owing to
optical physics, the function of the
various lasers in clinical use differs
(Fig. 1). In the visible spectrum of
light, the green light laser (KTP, a
neodymium duplicate of 532 nm)
was introduced in dentistry in recent years. There have been few
studies concerning this wavelength. Its delivery through a flexible optical fibre of 200 µ allows its
use in endodontics for canal decontamination and has shown positive
results.14,15
Near infrared lasers (from
803 nm to 1,340 nm) were the first to
be used for root decontamination. In
particular, the Nd:YAG (1,064 nm),
introduced at the beginning of the
1990s, delivers laser energy through
an optical fibre.5 The medium infrared lasers, the Erbium (2,780 nm
and 2,940 nm) laser family, also produced at the beginning of the 1990s,
have been equipped with flexible,
fine tips only since the beginning of
this century and have been used
and studied in endodontic applications. The far infrared laser CO2
(10,600 nm) was the first to be used
in endodontics for decontamination
and apical dentine melting in retrograde surgery. It is no longer used in
this field with the exception of vital
pulp therapy (pulpotomy and pulp
coagulation).
Scientific basis for the use
of lasers in endodontics
Laser–tissue interaction
The interaction of light on a target follows the rules of optical
physics. Light can be reflected, absorbed, diffused or transmitted.
• Reflection is the phenomenon of
a beam of laser light hitting a target and being reflected for lack
of affinity. It is therefore obligatory to wear protective eyewear to
avoid accidental damage to the
eyes.
• Absorption is the phenomenon of
the energy incident on tissue with
affinity being absorbed and
thereby generating its biological
effects.
• Diffusion is the phenomenon of
the incident light penetrating to a
depth in a non-uniform manner
with respect to the point of interaction, creating biological effects
at a distance from the surface.
• Transmission is the phenomenon
of the laser beam being able to
pass through tissue without affinity and having no effect.
The interaction of laser light
and tissue occurs when there is
optical affinity between them. This
interaction is specific and selective based on absorption and diffusion. The less affinity, the more
light will be reflected or transmitted (Fig. 2).
Effects of laser light on tissue
The interaction of the laser
beam on target tissue, via absorption or diffusion, creates biological
effects responsible for therapeutic
aspects that can be summarised as:
• photo-thermal effects;
• photomechanical effects (this includes photoacoustic effects); and
• photochemical effects.
The diode laser (from 810 nm to
1,064 nm) and the Nd:YAG (1,064 nm)
belong to the near infrared region
of the electromagnetic spectrum
of light. They interact primarily
with soft tissue by diffusion (scattering). The Nd:YAG laser has a
greater depth of penetration in soft
tissues (up to 5 mm), while the
diode laser is more superficial (up
to 3 mm). Their beam is selectively
absorbed by haemoglobin, oxyhaemoglobin and melanin, and has
photo-thermal effects on tissue.
Therefore, their use in dentistry is
limited to the vaporisation and incision of soft tissue. They are also
used for dental whitening with a
laser beam, by thermal activation of
the reagent. In endodontics, they
currently represent the best system
for decontamination, owing to their
ability to penetrate the dentinal
walls (up to 750 µ with the 810 nm
diode laser; up to 1 mm with the
Nd:YAG)8 and for the affinity of
these wavelengths with bacteria,
destroying them through photothermal effects.16
The Erbium lasers (2,780 nm
and 2,940 nm) belong to the
medium infrared region and their
beam is primarily absorbed superficially by soft tissue between
100 and 300 µ and up to 400 µ by the
dentinal walls.8,17
The chromophore target is
water, which is why their use in
dentistry extends from soft to hard
tissue. Owing to the water content
of the mucosa, gingiva, dentine
and carious tissue, Erbium lasers
vaporise and affect these tissues
thermally. The explosion of the water molecules generates a photomechanical effect that contributes
to the ablative and cleaning process
(Fig. 3).18–20
Parameters that influence
the emission of laser energy
Laser energy is emitted in different ways with various instruments. In diode lasers, the energy is
emitted in a continuous wave (CW
mode). A mechanical interruption
of the energy emission is possible
(properly called ‘gated’ or ‘chopped’
and improperly called ‘pulsed’), allowing for better control of thermal
emission. The pulse duration and
intervals are in milliseconds or microseconds (time on/off).
The Nd:YAG laser and the
Erbium family emit laser energy in
a pulsed mode (also called freerunning pulse), so that each pulse
(or impulse) has a beginning time,
increase and an end time, referred
to as a Gaussian progression. Between pulses, the tissue has time to
[15] =>
DTAP1111_01_Title
DTAP1111_14-15_Olivi 29.11.11 15:58 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
The Erbium lasers also work
with an integrated water spray,
which has the double function of
both cleaning and cooling. In the
pulse mode, a string of pulses is
emitted with a different pulse repetition rate (improperly called ‘frequency’) referred to as the Hertz
rate (generally from 2 to 50 pulses)
per second. The higher emission
repetition rate acts in a similar way
to the CW mode, while the lower
repetition rate allows for a longer
time for thermal relaxation. The
emission frequency (pulse repetition rate) influences the average
power emitted, according to the
formula shown in Table I.
Another important parameter
to consider is the ‘shape’ of the
pulse, which describes the efficiency and the dispersion of the
ablative energy in the form of thermal energy. The length of the pulse,
from microseconds to milliseconds, is responsible for the principal thermal effects. Shorter pulses,
from a few microseconds (<100)
to nanoseconds, are responsible
for photomechanical effects. The
length of the pulse affects the peak
power of each single pulse, according to the formula in Table I. Dental
lasers available on the market today are free-running pulsed lasers,
the Nd:YAG with pulses of 100 to
200 µs and the Erbium lasers with
pulses of 50 to 1,000 µs. Furthermore, diode lasers emit energy
in CW that can be mechanically
interrupted to allow the emission
of energy with pulse duration of
milliseconds or microseconds depending on the laser model.
Effects of laser light on bacteria
and dentinal walls
In endodontics, lasers use the
photo-thermal and photo-mechanical effects resulting from the interaction of different wavelengths
and different parameters on the
target tissues. These are dentine,
the smear layer, debris, residual
pulp and bacteria in all their various aggregate forms.
Using various strengths, all the
wavelengths destroy the cell wall
owing to their photo-thermal effect. Owing to the structural characteristics of the different cell walls,
gram-negative bacteria are more
easily destroyed with less energy
and radiation than gram-positive
bacteria.16 The near infrared lasers
are not absorbed by hard dentinal
tissue, having only a thermal effect
and not an ablative effect. They
penetrate deeper, allowing for a
decontaminating effect on deeper
dentine layers.8 The medium infrared lasers have an ablative effect
on dentine walls but are also well
absorbed by the dentinal walls and
thus have an equally effective, although more superficial, decontaminating effect in this regard.8,16
The thermal effect of the lasers,
utilised for its bactericidal effect,
must be controlled to avoid damage
to the dentinal walls. Laser irradiation at the correct parameters
vaporises the smear layer and of
the organic dentinal structure (collagen fibres) with characteristics of
superficial fusion and melting. Only
the Erbium lasers have a superficial
P
E
R
Pd
F
P(W)
PP(W)
power (in W)
energy (in J)
pulse repetition rate (in Hz)
power density or density of power (in W/cm2)
fluence or density of energy (in J/cm2)
average power = E x R
peak power = E; length of single pulse (in seconds)
Table I: Laser light emission parameters.
ablative effect on the dentine, which
appears more prevalent in the intertubular areas richer in water than
in the more calcified peri-tubular
areas. When incorrect parameters
or modes of use are employed, ther-
mal damage is evident in the extensive areas of melting, recrystallisation of the mineral matrix (bubble),
and superficial microfractures concomitant with internal and external
radicular carbonisation.
With a very short pulse length
(less than 150 µs), the Erbium laser
reaches peak power using very low
energy (less than 50 mJ). The use
of subablative energy minimises
the undesirable thermal effects on
dentinal walls while the peak
power offers the advantage of the
phenomena of water molecule excitation (target chromophore) and
the successive creation of the photomechanical and photoacoustic
effects (shock waves) of the irrigant
solutions introduced in the root
canal on the dentinal walls. These
effects are extremely efficient in
cleaning the smear layer from the
dentinal walls, in removing the
bacterial biofilm and in the canal
decontamination, and will be discussed in Part II.10–13 DT
Editorial note: A complete list of references
is available from the publisher.
Contact Info
Dr Giovanni Olivi practises
aesthetic, restorative and paediatric dentistry in Rome. He can
be contacted at olivi.g@tiscali.it.
AD
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Trends & Applications 15
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[16] =>
DTAP1111_01_Title
DTAP1111_16-17_Edelhoff 29.11.11 15:58 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
16 Trends & Applications
Restoring severely discoloured anterior teeth
How to achieve an impressive outcome with minimally invasive procedures
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Prof. Daniel Edelhoff & Oliver Brix
Germany
Endodontically treated incisors present a challenge for
the restorative team. Often,
they also entail serious aesthetic deficiencies in the form
of severe discolouration. The
objective of the treatment presented in this case was to reconstruct the biomechanical
and optical properties of the
affected teeth, while compromising as little natural dental
tissue as possible.
By following a clearly coordinated procedure, the treatment
team may achieve satisfactory
results with an internal bleaching method, an adhesive post
build-up and a preparation technique that suits the requirements of the restorative material. The invasiveness of this approach is considerably reduced
compared with conventional
restorative techniques.
This article discusses the rehabilitation of two upper central
incisors by placing fibre-reinforced composite posts, using
Fig. 14
build-up materials and subsequently restoring the teeth with
360° veneers made from lithium-disilicate ceramic. A 28year-old male patient presented
at the practice with the wish to
have his endodontically treated
and severely discoloured upper
central incisors restored. He
said that he had not had any
problems since the resection of
the root was done years ago.
However, he was dissatisfied
with his impaired aesthetic appearance caused by the affected
teeth (Figs. 1–3).
The clinical and radiological
evaluations revealed tight and
properly executed root-canal
obturations in teeth #11 and 21.
There were no signs that indicated the presence of root-canal
posts, but the extensive composite restorations in both teeth
were leaking and showed secondary caries (Fig. 4). At the
time of the clinical evaluation,
five years had passed since the
restorations. The specific challenges that the treatment team
had to face were the patient’s
wish to have the aesthetic appearance of his teeth restored
Fig. 1: The pronounced discolouration and the inadequate tooth position of the upper central incisors impaired the
aesthetic appearance.—Fig. 2: The severe discolouration of tooth #11 also caused discolouration of the marginal
gingival area.—Fig. 3: The asymmetrical tooth axes of the central incisors are clearly visible.—Fig. 4: Leaking composite restorations and secondary caries in the endodontically treated teeth #11 and 21.—Fig. 5: The root-canal fillings were checked prior to the internal bleaching procedure, and the cemento-enamel junction was sealed. The cavities were then ready for the application of the bleaching agent.—Fig. 6: Two weeks later, the severe discolouration
had almost entirely been removed by the internal bleaching treatment.—Fig. 7: The build-up and prepared incisors.
Given the severe degree of discolouration, adhesively cemented fibre-reinforced composite posts combined with
mouldable composite materials were used.—Fig. 8: Lithium-disilicate-based 360° veneers made of IPS e.max Press.
In order to mask the dental structure better with a minimum layer thickness, an MO ingot was selected.—Fig. 9: The
optimum masking of the extensively build-up abutment teeth achieved by an MO ingot coping and a try-in paste in
the white-opaque shade became evident already during the try-in of the veneers.—Fig. 10: Frontal view of the veneers
during try-in. The use of lithium disilicate as the basis of the restoration ensured a homogeneous appearance regardless of the substructure.—Fig. 11: The 360° veneers were seated with the luting cement that corresponded to the tryin paste used; a multistep dentine adhesive system was used. Thus, an excellent aesthetic outcome could be achieved
reliably and predictably.—Fig. 12: The restorations in transmitted light. By combining translucent build-up materials and glass-ceramic veneers, a light transmission that matched the properties of natural teeth was achieved.—
Fig. 13: Post-op view with mandible in protrusion. The final check of the functional and aesthetic parameters was
satisfactory. The tooth shade excellently matched the adjacent teeth.—Fig. 14: Portrait image of the final outcome.
The discolouration had been removed, the tooth position corrected and the tooth proportions adjusted.
in a timely fashion. The patient
required that his natural tooth
shade and position be restored
and the remaining tooth structure be stabilised to the highest
possible extent in the long term.
Treatment planning
Before we proceeded with
the planning for the permanent
restoration, the inadequate fillings of the anterior teeth and the
secondary caries were removed.
This allowed us to assess the
extent of damage to the teeth.
In addition, a possible contamination of the two root canals
with micro-organisms, resulting
from the inadequate fillings—
which had been in place for
years—had to be ruled out.
Both root-canal fillings had
been tightly sealed at the cemento-enamel junction with
separate fillings and therefore
the canals did not have to be reopened. Internal bleaching of
the crown portions of both teeth
using the walking bleach technique was planned. After an initial technical and clinical evaluation, the following treatment
plan was determined. First, the
tooth position and proportions
were to be corrected by means of
an analytic wax-up. The brightness of the affected teeth was
then to be adjusted by internal
bleaching to match the brightness of the neighbouring teeth
during a preliminary treatment
phase. Owing to the extensive
lesion, we opted for a direct
adhesive build-up following
endodontic treatment with cemented fibre-reinforced composite posts. For the final restoration of the severely discoloured anterior teeth, we decided to use 360° veneers based
on a lithium-disilicate material.
In order to achieve an optimum
aesthetic outcome, the veneers
were to be fabricated in the cutback technique.
Preliminary treatment
and preparation
After the coronal pulp chamber of the two incisors had been
cleaned, another seal was placed
at the cemento-enamel junction
using a small amount of phosphate cement. This procedure
ensured that the bleaching agent
that would be applied later did
not diffuse into these sensitive ar-
eas (Fig. 5). For the internal
bleaching, a mixture of sodiumperborate powder and distilled
water was applied using the
walking bleach method. The
palatal access to the coronal pulp
chamber was sealed with cotton
pellets soaked in bonding agent
(Heliobond) and a low-viscosity
composite (Tetric EvoFlow, both
Ivoclar Vivadent).
The next appointment was
scheduled for one week later.
The desired tooth shade had not
yet been achieved, and therefore
fresh bleaching agent was applied. After another week with
the bleaching agent in place, a
satisfactory brightness value was
observed on both abutment teeth
(Fig. 6). A calcium-hydroxide
preparation (CalciPure, Drugtech) was inserted into the pulp
chamber and left in place for a
week in order to neutralise the
bleaching agent.
After the neutralisation phase,
we proceeded to the post-endodontic build-up of the abutment
teeth. For this purpose, the coronal sealing of the root-canal fillings was removed and standard-
[17] =>
DTAP1111_01_Title
DTAP1111_16-17_Edelhoff 29.11.11 15:59 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
ised holes for the fibre-reinforced composite posts were
drilled. The posts were luted with
Variolink II (dual-curing, low viscosity, white-opaque shade) and
a multistep adhesive (Syntac,
both Ivoclar Vivadent). After the
posts had been covered with a
low-viscosity composite (Tetric
EvoFlow), a bright, highly filled
viscous composite (Tetric EvoCeram, Bleach XL) was applied to
create the direct build-up (Fig. 7).
A high-power curing light (bluephase G2, Ivoclar Vivadent, with
> 1,000 mW/cm2) was used for
the final polymerisation of the cementation and build-up materials. A diagnostic pattern, fabricated on the basis of the wax-up,
was employed for the minimally
invasive preparation, containing
all information relating to the
correction of the tooth position
and the outer contour of the final
restoration.
Temporisation and fabrication
of the final veneers
shade 0 (MO 0). The IPS e.max
Press frameworks were veneered with the IPS e.max Ceram
veneering ceramic in shade A2
(both Ivoclar Vivadent; Fig. 8).
Try-in and seating
After removal of the temporary restorations, residue of the
bonding agent was removed
with cleaning brushes and a fluoride-free cleaning paste. In order to check the shape and shade
of the veneers in the patient’s
mouth, the restorations were
tried in with a shaded glycerine
Trends & Applications 17
gel (Try-in Paste, Variolink II,
white-opaque). A perfect masking of the abutment teeth had
already been achieved at this
stage and the resulting situation
showed a harmonious appearance regardless of the substructure (Figs. 9 & 10).
The inner aspects of the
glass-ceramic veneers were
etched with a hydrofluoric acid
gel (< 5% IPS Ceramic Etching
Gel, Ivoclar Vivadent) for 20 seconds. Subsequently, a bonding
agent (Monobond Plus, Ivoclar
Vivadent) was applied. Only the
multistep dentine adhesive system Syntac was applied to the
tooth. The restorations were
luted into place with the Variolink II system in white-opaque
(Fig. 11).
Conclusion
A light transmission that
corresponded to that of natural
teeth was achieved by using
translucent build-up materials
in conjunction with glass-ceramic lithium-disilicate veneers
(Fig. 12). The final outcome with
regard to functional and aesthetic parameters was found to
be very satisfactory at the final
evaluation. The tooth shade was
in perfect harmony with the surrounding dentition. In addition
to removing the severe discolouration of the hard and soft
tissues, we were able to correct
the tooth position and adjust the
tooth proportions (Fig. 13). The
patient was fully satisfied with
the outcome and did not have
any phonetic problems resulting
from the correction of the tooth
position (Fig. 14). DT
AD
80 Ncm
Powerful for surgery
The diagnostic template was
also used for creating the direct
veneer temporaries. The temporary restorations could thus be
fabricated in a fairly straightforward manner using a Bis-GMAbased temporary material (Telio
C&B, A2; Ivoclar Vivadent). Heliobond was applied to the finished, non-etched preparation
surfaces and to the inner side
of the temporaries and lightcured after removal of excess
material.
After a four-week evaluation
phase of the tooth shape and
position, which both were determined by the wax-up and transferred to the temporaries, a
precision impression of the prepared teeth and an impression of
the antagonist jaw were taken.
This information was sent to the
laboratory together with the face
bow, the registration of the jaw
relation and an image of the prepared abutment teeth. The image of the preparations helped
the laboratory to assess the required degree of opacity for the
framework structure. Given the
different levels of translucency
and the different build-ups of
the abutment teeth and to ensure
an improved masking capability
in case of a relapse of the discolouration, the treatment team
chose to use press ceramic ingots
with a medium opacity level in
Contact Info
Prof. Daniel Edelhoff is working as
a tenured associate
professor at the Department of Prosthodontics, LudwigMaximilians-University, Munich, Germany. He can be contacted at daniel.
edelhoff@med.uni-muenchen.de.
Contact Info
Oliver Brixis working as a dental technician in Wiesbaden,
Germany. He can be
contacted at OliverBrix@t-online.de.
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[18] =>
DTAP1111_01_Title
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Fax: +1 732 741 6437
f.balve@koelnmessenafta.com
International
Stephanie Sim
Koelnmesse Pte Ltd
Tel: +65 6500 6723
Fax: +65 6296 2771
s.sim@koelnmesse.com.sg
[19] =>
DTAP1111_01_Title
DTAP1111_19_Straumann 29.11.11 15:59 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Advertorial 19
The importance of implant-abutment connections
Clinical success of implant-borne restorations is not only a matter of osseointegration
Successful implant therapy is
not only a result of a well-osseointegrated implant with beneficial
effects on the bone and soft tissue.
A large degree of success, especially in terms of aesthetics, quality of life and patient satisfaction,
depends on the prosthetic elements.1 In particular, the connection between the implant and the
abutment may be of great importance when it comes to long-term
stability and the successful outcome of a restoration.2,3
The following article illustrates properties of an implantabutment connection in terms of
handling, stability, strength, biological aspects, clinical aspects
and success of a restoration. The
right balance in connection design, materials used, precise stateof-the-art manufacturing, rigorous quality controls as well as
many years of experience from
Straumann provides prosthetic
components with reliability and
gives confidence to the patient and
the restorative dentist.
1. The right materials and
characteristics, a pre-requisite
for optimal properties
The materials used in prosthetic components play an important role. The use of state-of-the-art
materials for abutment, screw and
implant result in adequate ultimate
and fatigue strength properties of
the prosthetic component. Therefore, the right selection of materials
is essential for parts with optimum
material properties. Another essential aspect is the use of highquality materials. Straumann has a
very high-standard quality system
and therefore performs thorough
inspections of raw materials before
they undergo the manufacturing
process.
2. Smart tolerances are essential
for the engagement and
functionality of the parts
In addition to the design, the tolerances of the abutment, screw and
implant also play a major role in
an implant-abutment connection.
Tolerance means the permissible
limit or limits of variation in a physical dimension deviating from a
nominal dimension. Dimensional
tolerances, for instance, define the
possible space between two connecting components (e.g. outer diameter of an abutment and inner
diameter of an implant as shown
in Fig. 1). Geometric tolerances
define the shape of a feature to be
within a certain tolerance.
Smart tolerances on the design
as well as high-precision manufacturing are essential for the engagement and the functionality of the
parts. The accurate fit of abutment,
screw and implant is achieved by
harmonizing and matching tolerances for the performance of the
parts. It is necessary to specify appropriate tolerances to maintain
proper functionality. Straumann
abutments and screws on Straumann implants are designed to
function together as intended over
time by following a controlled production and inspection process.
Harmonised and matched tolerances minimise the possibility of
displacements of abutments in implants with and without applied
forces, resulting in a connection
with minimal wear and stability.
Tolerances which are not aligned on
an implant-abutment connection
in its intended use may negatively
impact on the stability and durability of the restoration. Therefore
Straumann recommends the exclusive use of original Straumann
components for all engaging
parts as competitors do not know
Straumann’s tolerances. Combining Straumann products with parts
from different manufacturers voids
the Straumann warranty.
maintenance of crestal bone and
long-lasting aesthetics.2 Therefore,
Straumann recommends the exclusive use of original Straumann
components for all engaging parts
as competitors do not know Straumann’s dimensions and features.
The design of basal and occlusal
screws is crucial for stability and
long-term reliability
The design of the screw plays
an essential role in the stability and
long-term reliability of a connection.9 A design with a conical section on the screw head and the abutment increases the surface area to
keep the screw from rotating and
thereby minimizes the possibility of
the proper seating of the prosthetic
components. This is a key requirement for the restorative dentist, as
visibility in a patient’s mouth can
be limited.
Geometry: Connecting surfaces
One aspect of the design is the
geometry of the connection. Connecting surfaces (highlighted in
green in Fig. 3) do not allow the
abutment to rotate within the implant and can therefore only be
assembled in its correct orientation. This feature provides precise orientation, precise repeated
abutment placement and a stable
connection of the prosthesis to the
implant.
tween abutment and implant)
to ensure that the connection is
sealed tight to avoid the creation of
a micro-gap.15
Material biocompatibility:
Not to be neglected
Straumann only uses materials
where biocompatibility has been
assessed. Biocompatibility of the
material and compatibility with
other materials are also crucial.
Bio-incompatibility of restorative
parts can have an affect on adverse
tissue reactions and inflammation
of bone and soft tissue in patients.
Material compatibility is important
for components which come into
contact with each other, such as
3. Design matters
An adapted connection design
ensures tight connection and
excellent load distribution
The shape of the load bearing
surface is of great importance.4–7
It is designed to allow for the connection to be sealed tight15 and
reduce sensitivity to lateral forces.
A conical shape provides excellent
load distribution of abutments onto
implants,6,7 good sealing properties, a defined seating position of
the abutment and is designed to
avoid micro-gaps.15 The conical
shape of the connection allows for
uniform stress distribution and
prevents the occurrence of peak
stresses within the implant, abutment and respective screw.6,7
Not only the shape of the load
bearing surface, also the engagement of the part within the implant
plays a significant role.3 In the
Straumann Bone Level implants,
for instance, the CrossFit connection (Fig. 2) was designed to provide guidance during assembly and
distribute loading forces to the implant. In the Straumann Soft Tissue
Level implants, the synOcta abutment was designed to provide guidance during assembly and to absorb loading forces to minimize
movement of the coping.
Fig. 1
screw loosening.9,10 In addition, the
cone on the screw and the cone on
the connection (only with titanium
abutments) between implant and
abutment are engineered to be parallel to ensure optimal clamping
force between the engaging parts.
The screw is also required to bear
axial loads that occur through the
tightening process, thus a balance
between design features and dimensions is important to prevent
screw loosening and breakage.
4. A high surface quality helps
to minimise wear
Smooth surfaces on components in contact seal the engaging
surfaces and reduce wear.11 This
results in a connection with minimised wear and thus good stability.
A smooth surface can also reduce
or minimise the occurrence of wear
debris.11
Harmony of design between the
engaging parts is highly relevant.
A restoration is only as strong as
its weakest link; therefore it is very
important to design features and
dimensions in terms of the restoration as a whole and not just looking
at one component, e.g. only the implant or only the abutment.
5. Smooth handling for both
restorative dentists and dental
technicians
Handling characteristics are
another important factor, both for
the restorative dentist (in terms of
assembly of the prosthetics components on the implant) as well as
for the dental technician (in terms
of assembly of the restoration on
the master model).
Harmonized designs between
abutment, screw and implant strive
to achieve optimal strength and
load distribution throughout the
entire construct,6,7 providing a
strong and reliable connection
engineered for great stability and
durability. Components manufactured for precise fit and ideal load
distribution help to ensure the
Assembly: Good guidance and
tactile feedback
During the assembly process,
good guidance and tactile feedback
(on when the assembly process is
complete) are important. The result is a hassle-free assembly procedure which helps to save time,
compensates for low visibility and
does not require X-rays to confirm
Straumann Implant-abutment connections are designed to:
• ensure optimal load distribution to reduce peak stresses; 6,7
• minimize the infiltration of bacteria and contamination in micro-gaps;15
• have a design harmony between abutment, screw and implant to provide optimum mechanical
performance and long-term stability of a restoration;2
• ensure good handling of abutments and screws during the assembly process; e.g. with genuine
Straumann parts, the user receives tactile feedback when an abutment is placed correctly and
when a screw is tight.
Table I
Fig. 2
6. Biological aspects
Control of bone and soft tissue
growth: The influence of the
implant-abutment interface
Individual oral hygiene of the
patient is a relevant biological aspect that can influence the successful outcome of restorations.16 How
the implant-abutment interface
influences bone growth and surrounding soft tissue growth is an
important success factor in restorations.14 A gap between abutment
and implant, caused for example by
dimensions and tolerances that are
not harmonized and matched, may
cause bacterial infiltration and accumulation, and may subsequently
impact on the success of treatment.12
Biological width: As big as possible
A smart design of the connection as described in an earlier section of this article reduces bacterial infiltration into microgaps, the
origin of bacterial contamination.8
In this regard, consideration of the
biological width–the distance from
the bone crest to the micro-gap
(point on surface at implant-abutment connection)–plays a crucial
role when designing abutments
and implants.8 The biological width
should be as big as possible,12,13
therefore, the connection should
be moved as far away from the
bone as possible. This can be
achieved with an implant design
emerging at the level of soft tissue
(vertical offset) or with an implant
design emerging at the level of
the bone crest with so-called platform switching (horizontal offset
through internal connection). A
design according to these requirements avoids the infiltration of
bacteria, which is important as it
avoids bacterial contamination and
related inflammation and bone
loss.14,15
Straumann designs abutments
and implants with specific tolerances on the conical section (load
bearing and sealing surfaces be-
Fig. 3
the abutment, screw and implant.
Engaging parts made of different
materials may trigger galvanic
corrosion,17 a process that can be
triggered when two or more different sorts of metal come into contact
in the presence of an electrolyte
(e.g. saliva). The resulting corrosion products from the surfaces of
the metals involved may contaminate the surrounding bone and
soft tissue and leak into the mouth
of the patient. 17
7. Peace of mind through
clinical evidence
The best possible long-term
reliability of implant-based restorations can be proven through
clinical data. Clinical evidence provides tremendous confidence for
the patient as well as the restorative
dentist and confirms that the design, tolerances and materials of
Straumann products contribute to
the best possible long-term care for
the patient.
Conclusion: Only Straumann
on Straumann ensures the
best possible performance
The combination of Straumann
abutments on Straumann implants
is designed to achieve the best possible performance of the implantabutment connection and therefore of the entire restoration.2,3
Straumann abutments with screws
and Straumann implants are designed for each other to ensure
harmony between design (shapes
and features), tolerances, surface qualities and materials used*.
Straumann delivers products built
on innovation, precision, reliability
and simplicity. Straumann parts
have undergone mechanical testing and have been engineered
precisely to function in a particular
mechanical configuration. DT
A complete list of references are available
from Straumann.
* Combining parts from different manufacturers voids the Straumann warranty.
In the event of complications due to combining parts from different manufacturers,
Straumann disclaims all responsibilities.
[20] =>
DTAP1111_01_Title
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