Asia-Pacific news / Opinio: Tools of the trade / World news / Business / Opinio: Short-term gains...long-term problems? / Bisphosphonates: A threat or an option? / Achieving a nuanced interplay of colours in four easy steps / Vertical reconstruction of soft peri-implant tissues / What do our teeth betray about us?—Part I
Asia-Pacific news
01 - 03 viewOpinio: Tools of the trade
04 - 04 viewWorld news
05 - 06 viewBusiness
09 - 10 viewOpinio: Short-term gains...long-term problems?
11 - 12 viewBisphosphonates: A threat or an option?
14 - 14 viewAchieving a nuanced interplay of colours in four easy steps
16 - 20 viewVertical reconstruction of soft peri-implant tissues
21 - 21 viewWhat do our teeth betray about us?—Part I
22 - 23 viewArray
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DTAP1115_01-02_Title 20.11.15 14:30 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
www.dental-tribune.asia
Published in Hong Kong
Vol. 13, No. 11
ORTHODONTICS
BISPHOSPHONATES
TALKING TEETH
DT contributor Aws Alani, London,
discusses the emergence and
future implications of short-term
orthodontics in general practice.
Theoretical reasoning and experimental data suggest that local
application of the drugs is safe
and effective.
Dr Stanislav Cícha explains how
tooth position and damage to
individual teeth reflect emotional
and health status.
” Page 11
” Page 14
” Page 22
Digital world meets in Singapore GICs
Third CAD/CAM and Digital Dentistry International Conference to open at Suntec in December
By DTI
While they have been improved
over time, glass ionomer cements
(GIC) are still lacking in toughness
and other requisite properties to be
considered the material of choice
for permanent implants, for example. This could soon change, according to scientists from England and
Wales, who have recently gained
new insights into how the material
sets inside the tooth in real time.
SINGAPORE: After two successful
congresses, the Centre for Advanced
Professional Practices (CAPP) in Singapore is inviting dental professionals to its third Asia Pacific edition of
the CAD/CAM and Digital Dentistry
International Conference. The event
will be held from 3 to 5 December at
the Suntec Singapore Convention
and Exhibition Centre and present
the latest developments and innovations in the field.
Organised in partnership with
the Singapore Dental Association
and the American Academy of Implant Dentistry, the show is aimed
at providing an overview of the use
of digital technology in dentistry
and its integration into treatment
processes and the practice workflow.
The organisers have invited prominent experts from around the world
to Singapore to give presentations
on a wide range of topics, including
computer-guided implantology, intra-oral scanning, and smile design.
decoded
Parallel sessions aimed at dental
technicians and laboratory owners
will also be held. Participants will be
able to earn up to 28 CE points by attending the programme.
As a complement to the extensive
education offering, international
dental suppliers will be exhibiting
all of the very latest products, technologies, materials and services in
the industry. These will include
Planmeca, 3Shape, Ivoclar Vivadent/
Wieland, Sirona, Amann Girrbach
and VITA.
” Page 2
Using intense beams of neutral
subatomic particles from the Science and Technology Facilities
Council’s neutron and muon
source at the Rutherford Appleton
Laboratory near Oxford, they
looked at the surface between the
hard glass particles and surrounding polymer as the strength of the
cement develops. Instead of the
material hardening continuously,
they found what they termed
“sweet points”, at which the material suddenly regains elasticity
as it approaches the toughness of
the tissue and then hardens indefinitely.
AD
Cosmetic
dentistry
market
Layer structure of an artificial tooth developed by researchers from Switzerland
under the electron microscope.
” WORLD NEWS Page 5
World Oral Health
Day 2016
Singapore Service
extended
The FDI World Dental Federation
and Dental Tribune International
have renewed their collaboration
agreement for the 2016 World Oral
Health Day campaign. DTI will be
serving as the official WOHD16
media partner and help promote
awareness of the importance of
oral health on a global scale.
The National University of Singapore has incorporated oral health
checks for the first time in its annual Public Health Service screenings. Sixty dental students from
the university joined the programme in order to provide free
dental screenings and oral health
education to residents in need.
According to a new report published by market research firm
MarketsandMarkets, the global
market for cosmetic dentistry is
expected to grow at a compound
annual rate (CAGR) of 6.8 per cent
from 2015 to 2020 to reach US$22.4
billion by 2020. Owing to the intensifying focus on technological
innovations and the increasing
trend of research and development
investments, various new products, such as dental implants and
equipment, are being launched on
the cosmetic dentistry market and
are expected to propel further
market growth. However, a lack of
reimbursement and the high cost
of dental imaging systems are expected to restrain the growth of
this market to a certain extent, the
reports states.
Distinguished by innovation
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www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
[2] =>
DTAP1115_01-02_Title 23.03.16 17:24 Seite 2
ASIA PACIFIC NEWS
02
Dental Tribune Asia Pacific Edition | 11/2015
Second-hand smoke increases
risk of tooth decay in children
Researchers from the Graduate
School of Medicine and Public Health
at Kyoto University analysed data for
76,920 children born between 2004
and 2010. All of the children attended
routine health check-ups at 0, 4, 9
and 18 months and at 3 years of age.
Information on second-hand smoke
exposure from pregnancy to 3 years
of age and other lifestyle factors, such
as dietary habits and oral care, was
obtained through questionnaires.
By DTI
KYOTO, Japan: Although some studies have suggested an association
between second-hand smoke and
caries, it is still uncertain whether
reducing passive smoking among
AD
children would contribute to caries
prevention. However, a Japanese
study has now found that infants exposed to smoking at 4 months of age
showed an increased risk of tooth decay at age 3 compared with children
from a smoke-free family.
The findings showed that 55.3 per
cent of children in the study were
exposed to second-hand smoke by
family members in the household
at 4 months and 6.8 per cent had
evidence of tobacco smoke exposure.
The latter was defined as smoking in
front of the infant by the researchers.
Overall, 12,729 incidents of dental
caries, mostly decayed teeth, were
found in the study group.
Compared with having no smoker
in the family, exposure to tobacco
smoke at 4 months of age was associated with an approximately twofold increased risk of caries at age 3.
The risk of caries was also increased
among those children exposed to
household smoking, whereas the
effect of maternal smoking during
pregnancy was not statistically significant.
Although these findings cannot
establish causality, they support
extending public health and clinical interventions to reduce secondhand smoke, the researchers concluded.
Health statistics show that the
level of dental caries in primary dentition remains high in developed
countries. In Japan, one-fourth of
all 3-year-old children experience
caries, whereas 20.5 per cent of children aged 2 to 5 are affected in the
US, according to the researchers.
The study, titled “Secondhand
smoke and incidence of dental caries
in deciduous teeth among children
in Japan: Population based retrospective cohort study”, was published on 21 October in The BMJ.
IMPRINT
PUBLISHER:
Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT AP & UK:
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Magda WOJTKIEWICZ
ONLINE EDITOR:
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AD PRODUCTION:
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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
¯
Page 1
Dr Marius Steigmann, Implantology, Germany
Published by DT Asia Pacific Ltd.
CAPP Managing Director Dr
Dobrina Mollova remarked that
the growth of CAD/CAM dentistry
alongside new technology, materials and equipment has seen rapid
integration into dental offices and
laboratories.
“Without a doubt, digital technology is becoming essential for every
dental practice and laboratory,” she
said. “The question is: are we prepared to keep up to date with this
growing industry, and are we able to
implement this pool of information
in our practices without the proper
expertise? This will be the main
challenge for us.”
A spin-off of CAPP’s event series
in Dubai, the CAD/CAM and Digital
Dentistry International Conference
was first held in Singapore in 2012.
Over 400 dental professionals attended the last edition, which took
place at the Marina Bay Sands hotel
two years ago.
Those interested in registering
for the upcoming congress can still
do so in advance on the official
event website at www.capp-asia.com.
Alternatively, professionals will be
able to register on-site.
Discounts are available for dental students, auxiliaries and group
registrations.
DENTAL TRIBUNE INTERNATIONAL
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responsibility for the validity of product claims,
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[3] =>
DTAP1115_03_News 20.11.15 14:30 Seite 1
ASIA PACIFIC NEWS
Dental Tribune Asia Pacific Edition | 11/2015
03
New method to preserve carious teeth
By DTI
OTAGO, New Zealand: Dental decay
is one of the most prevalent
chronic diseases in New Zealand
and the rest of the world. Now,
researchers at the University of
Otago have developed a new
method that could help preserve
Gagging
for
evidence
caries-infected teeth and prolong
the life of dental fillings in the
future.
While caries-inhibiting products use silver that can cause
significant discoloration of teeth,
the new technology uses specifically formulated, non-staining
silver particles to arrest caries
and render teeth more resistant
to decay. According to the researchers, the product has to be
applied after caries removal but
before filling. It diffuses into the
tooth, where it can kill remaining
bacteria that may cause further
decay.
“We believe that our non-staining formula will be an important
step forward for oral care and public health,” said Dr Don Schwass,
senior lecturer and prosthodontist
at the university’s Department of
Oral Rehabilitation. “The result will
be that recurrent caries will be significantly reduced and dental fill-
ings will last longer, providing both
economic and health benefits.”
Otago Innovation, the university’s technology transfer office,
has recently licensed the rights to
this formula to a global dental materials manufacturer for further
product development.
AD
Tetric N-Ceram Bulk Fill
®
The nano-optimized 4-mm composite
By DTI
MELAKA, Malaysia/MANCHESTER, UK:
The use of sedatives, acupuncture or
behavioural therapies are just some
of the strategies recommended to
dental practitioners for managing
the gagging reflex that can occur in
patients during treatment. A widescale review conducted by clinicians
from the Melaka Manipal Medical
College’s Department of Dentistry
in Melaka and published by the
Cochrane Oral Health Group in
Manchester has recently found no
evidence that any of these strategies
are in effective at preventing or managing the condition.
Discover the new
time-saving
composite
After a search for randomised
clinical trials evaluating strategies
for managing the gag reflex, the
researchers only found one study,
from Brazil, on the effects of
acupuncture at Point P6 versus
placebo acupuncture, to be eligible
for the review. Of the other 256 studies they took into consideration,
none qualified to be included in the
paper owing to bias, irrelevance and
several other reasons.
For their review, the Malay researchers consulted Cochrane’s registration database and other medical search engines for clinical trials
spanning from 1980 to the present
day. Owing to the inconclusive results, they recommended that more
studies be conducted on both pharmacological and non-pharmacological interventions, with special emphasis on behavioural modification
techniques. Future research should
also take into account a more varied
population range and factors such
as patient satisfaction, they stated.
Moreover, more comparable
studies are needed in contrast to
only trials involving a dummy or
a placebo technique.
Although little is known about
its prevalence, an exaggerated gag
reflex during dental treatment is
a problem encountered by many
dental practitioners, often during
denture try-in sessions. The response
can be triggered by a variety of procedures, including third molar removal or intra-oral image taking.
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[4] =>
DTAP1115_04_Opinion 20.11.15 14:32 Seite 1
OPINION
04
Dental Tribune Asia Pacific Edition | 11/2015
Tools
of the
trade
By Dr Les Kalman, Canada
As I think back to my younger days,
I used to love to take things apart and
try to put them back together. That
progressed into a hobby as a bike mechanic. Cable replacement, greasing
the bearings, wheel truing…I loved
it all. I had minimal tools, but I had
the know-how of how to get the job
done. When I got my dream job as
a shop mechanic, I was amazed that
there was actually a proper tool for
every job. The wrenches and ratchets
were literally the tools of the trade.
It occurred to me, the mechanic
needed to understand what the
tools were for, how to use them and
especially how to care for them. I realised and appreciated the importance of the tools, but did not want
them to be the limiting factor.
Dentistry is experiencing a truly
remarkable period with many
‘tools’ of digital dentistry available
to the clinician and technician.
These tools are not only providing
increased accuracy and improved
efficiency, but are also improving
the experience for the patient, clinician and technician.
Communication has also been
expanded with digital dentistry,
allowing for easier translation of
information to the patient, the
insurance company, colleagues
and the laboratory. With an opensource approach, the technologies
have the opportunity to be merged
and shared. Add in the advances in
mobile technology, the portability
and the utilisation of technology
becomes even more appealing.
From an academic and research
perspective, I can attest that I am
truly a tech junkie. I love gadgets.
Technology seems to improve
every aspect of my day. I find the
technological solution to a problem
a unique driving force that harnesses limitless passion. It appears
to be an exciting time!
The spectrum of digital dentistry has become quite overwhelming. There are technologies that
provide numerous approaches
for image acquisition, easy-to-use
design packages, milling/printing
solutions, implant stability assessment and even real-time guided
implant surgery. The technologies
seem to represent every aspect of
diagnoses, treatment planning
and treatment delivery. It appears
to be a very exciting time!
But let’s not let the excitement
overwhelm us. In dentistry, we have
the privilege of improving the oral
health of our patients. There can
be little comparison to a bike mechanic, as the human body presents
a unique set of complex systems.
However, the technologies in
digital dentistry represent tools.
These tools have a purpose and we
must be able to understand what
the tools are for and how to use
them. The tools cannot act as substitutes to fundamental principals.
As clinicians and technicians,
we must rely on our knowledge,
skills and evidence-based experience to act as our guide. From the
subjective aspect of patient informed consent, to the rigorous
protocols of implant surgery, let us
exercise what our comprehensive
training has taught us. The tools
are merely there to assist us on our
mission.
As we, clinicians, technicians,
educators and researchers, look to
advance dentistry in a modern
technological world, let’s keep the
digital dentistry toolbox open to
more tools. Let’s always pose the
question ‘why’ and try to find a
solution to ongoing problems. Let
us keep the aspect of accessibility
in mind, with the development of
open-source and affordable technologies. Lastly, let us merge our
knowledge, skills and experience
with the tools of digital dentistry to
propel our profession as leaders in
healthcare simulation.
Dr Les Kalman
is an assistant
professor at the
Division of Restorative Dentistry and chair
of the Dental
Outreach and
Community Service programme
at the Schulich School of Medicine
and Dentistry at Western University in
London, Canada. He can be contacted
at lkalman@uwo.ca.
AD
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[5] =>
DTAP1115_05_News 20.11.15 14:32 Seite 1
Dental Tribune Asia Pacific Edition | 11/2015
WORLD NEWS
05
Swiss researchers create artificial tooth
that mimics natural microstructure
By DTI
ZURICH, Switzerland: Materials researchers from ETH Zurich (the
Swiss federal institute of technology) have developed a new procedure that allows them to mimic
the structure of biological composite materials, such as teeth and
seashells.
Using the new technique, they
produced an artificial tooth whose
surface is as hard and structurally
complex as a real tooth, while the
layer beneath is softer, just like
natural dentine.
Natural tooth in its gypsum mold, artificial tooth (sintered but not yet polymer
infiltrated), finished artificial tooth embedded in a “puck” to enable polishing.
“Our technique is similar to 3-D
printing, but ten times faster and
much more cost-effective,” said
Dr Florian Bouville, a postdoctoral
researcher from the ETH study
group. The new method, called
magnetically assisted slip casting
(MASC), allows for the creation of
complex composite materials that
are almost perfect imitations of
their natural models.
In order to demonstrate the
technique’s potential for future
applications in dentistry, the researchers produced an artificial
tooth. “The profile of hardness and
toughness obtained from the artificial tooth corresponds exactly
with that of a natural tooth,” said
lead researcher Dr André Studart,
Professor of Complex Materials at
ETH, pleased with the results.
In the MASC process, a plaster
cast is filled with a suspension
containing magnetised ceramic
platelets. In order to achieve the
unique structure of the natural
models, in which numerous microplatelets are joined together in
different layers, a magnetic field is
applied during the hardening process and its orientation changed
at regular intervals. The ceramic
platelets align to the magnetic
field, resulting in layers with differing material properties in a single
object.
Although the MASC results are
promising, the appearance of the
material has to be significantly improved before the technique can be
used for dental prostheses, Studart
remarked. For the time being, the
results offer proof that the natural
fine structure of a tooth can be reproduced in the laboratory.
Although other methods exist to
imitate nacre or tooth enamel, up
to now it was a challenge to create
a material that mimics the complex structure of the entire seashell
or tooth.
As reported on the EHT website,
the magnetisation and orientation
of the ceramic platelets in the
MASC process has already been
patented.
The study, titled “Magnetically
assisted slip casting of bioinspired
heterogeneous composites”, was
published online on 21 September
in the Nature Materials journal.
AD
[6] =>
DTAP1115_06_Schimmel 20.11.15 14:33 Seite 1
WORLD NEWS
06
Dental Tribune Asia Pacific Edition | 11/2015
“Age per se is not a contra-indication”
An interview with University of Bern professor Dr Martin Schimmel, Switzerland
By Daniel Zimmermann, DTI
State of health and risk factors differ
distinctly among individuals, especially the elderly. In an interview with
Dental Tribune, Prof. Martin Schimmel,
Head of the Division of Gerodontology
at the University of Bern, spoke about
ethical and financial challenges regarding implant treatment of the elderly and the importance of offering this
vulnerable population the benefits of
implant therapy.
Dental Tribune: Implant manufacturers seem to be exclusively targeting
younger age groups nowadays. Do you
think the silver generation is being
overlooked when it comes to implant
therapy and, if so, what could be the
reasons for this?
Prof. Martin Schimmel: I do not
think that statement is true. Tooth
loss is increasingly associated with
elderly people. In my opinion, most
AD
manufacturers of dental implants
are aware of the fact that people in
the Western world are retaining their
own teeth for longer owing to the
successful implementation of preventive measures.
The treatment of trauma cases in
younger people is rather limited.
At the same time, the clientele for
implant treatment is becoming increasingly older. Data from the Department of Oral Surgery and Stomatology at the University of Bern’s
dental clinic clearly demonstrates
this. Narrow-diameter implants are
also explicitly marketed as “Gero” implants nowadays.
Why do older patients benefit from
implant therapy in particular?
Particularly fully edentulous patients and those with an edentulous
Dr Martin Schimmel
mandible benefit the most. Stabilising mandibular complete dentures
with the help of endosteal implants
is one of the greatest achievements
in dentistry. Scientific studies have
found many positive effects, including improved quality of life, satisfaction with dentures, masticatory
functionality and reduced bone
atrophy.
Partially edentulous patients can
benefit from fixed implant prostheses functionally, as well as structurally.
Conventional removable dentures
have proven to be inferior, especially
in free-end situations.
During a panel discussion at the EAO
congress last year in Rome,it was found
unanimously that there is no age limit
for implant therapy. What is the maximum age at which dental implants
could reasonably be used?
Age per se is not a contra-indication.
Even in palliative care, implants may
still play a valid role. Excluding people
from the benefits of this therapy owing to their statistically lower remaining lifespan is unethical. However,
one must consider exactly the point
at which implants in the mouth do
more harm than good—primum non
nocere [above all, do no harm]—particularly in situations where cleaning
is no longer possible and implants
become merely a surface to which
biofilms adhere. Furthermore, the possibility of medical contra-indications
does increase with old age.
What factors play a crucial role in the
implant treatment of elderly patients,
and what factors do clinicians need to
consider compared with treatment of
other age groups?
Of course, the interindividual variability between patients increases
with age, meaning that the older
the patient, the more personalised
treatment strategies have to be. The
planning and implementation need
to be constantly adjusted to medical,
psychological and social individualities. Minimally invasive surgical
approaches and prosthetic treatment methods that take the reduced
adaptability and other physiological
changes due to age into account have
proven successful in this respect.
InWestern countries,the gap between
rich and poor is ever widening. Elderly
people are increasingly falling into the
latter group. What measures can help
to ensure their access to dental implant treatment?
The only path to broad access to
these therapies for financially less
well-off patients lies in private or
public insurance systems. These are
political issues. However, dentists,
dental technicians and the industry
are constantly working on industrial
production structures and thereby
reducing costs. Digital developments in dentistry will surely help to
provide patients with otherwise expensive treatments for a much more
reasonable price. Nevertheless, oversimplified production methods are
often not suitable for the complex
treatment needs of the elderly.
You have pointed out the benefits of
digital production methods. What
other measures could also facilitate
access to dental implants for the
elderly?
Nowadays, the bulk of the costs
incurred is due to the hours of work
performed by the dental team and
technicians. Digital processes can
help to shorten treatment times
through innovative workflows. Moreover, quasi-industrial production
methods can be used in less-complex
cases, thus reducing costs further.
It is important to note that implant
manufacturers have maintained or
even lowered their price levels for
quite some time. However, it remains
important to evaluate the economic
value of using low-cost implants, because they can have a much higher
failure rate, as demonstrated by a
recent Swedish study (Editorial note:
Derks et al. 2015).
From a health policy standpoint, do
you see any deficits in the subsidisation of dental implants for the elderly?
This might differ from country to
country. In Switzerland, for example,
the subsidisation of patients with
low income is evaluated individually
by local authorities. The treatment of
persons who receive social security
benefits or needs-based minimum
benefits is subsidised if implant therapy can be performed in a simple,
economical and appropriate way.
Two inter-foraminal implants, for example, will be reimbursed if conventional prosthetic treatment is not able
to restore a patient’s chewing ability.
In the statutory health insurance
system, there is an obligation to perform the therapy if the loss of teeth
was due to the occurrence or treatment of a severe disease, or to an accident or birth defect. There is certainly
room for other indications, but one
also has to consider the burden for
the social security systems. In my
opinion, Switzerland has established
a sufficient and balanced system.
Thank you very much for the interview.
[7] =>
[8] =>
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[9] =>
DTAP1115_09_Business 20.11.15 14:33 Seite 1
Dental Tribune Asia Pacific Edition | 11/2015
BUSINESS
09
Over 1,650 attend Ivoclar Vivadent
aesthetic symposium in Vienna
By Georg Isbaner, OEMUS MEDIA AG, Germany
VIENNA, Austria: On 13 and 14 November, Ivoclar Vivadent hosted
the Competence in Esthetic (CIE)
symposium, an annual international event for dentists and dental
technicians that focuses on dental
aesthetic solutions, including digital smile design, CAD/CAM dentistry and implant therapies. Over
1,650 participants attended the
symposium, where a considerable
number of distinguished international speakers updated attendees
on the latest developments in dental aesthetics. Attendees also had
the opportunity to earn 16 continuing education credits.
According to the company, the
symposium aimed to provide firsthand expert knowledge of everyday clinical and laboratory practice. The symposium programme
was enhanced by various work-
shops and live demonstrations of
Ivoclar Vivadent products.
Martina Jakob, Head of Marketing for Austria and Eastern Europe;
Gernot Schuller, Managing Director for Austria and Eastern Europe,
and Armin Ospelt, Head of Global
Marketing, opened the symposium
on Friday morning. Jakob particularly spoke about the recently
opened International Center for
Dental Education (ICDE) in Vienna,
which offers state-of-the-art education facilities.
Ivoclar Vivadent’s perpetual success can, in particular, be attributed
to their continuous product and
service innovations, which meet
actual demand. Therefore, it is not
surprising that, even at a regional
event such as the CIE that focuses
on Austria and Eastern Europe, the
company presented various new
products. Among these product innovations were the IPS-style metalceramic material, which promises
greater efficiency thanks to optimised shrinkage behaviour and
aesthetics through brighter colours
because of the integration of
oxyapatite crystals. In addition, the
IPS e.max CAD portfolio was also
extended. Furthermore, the new
MT blocks with medium translucency are suitable cases that require
enhanced brightness and the IPS
e.max blocks with low translucency
are now also available in size A14.
Their new range of stains and glazes,
IPS Ivocolor is now also available for
users of IPS ceramics and Wieland
Zenostar. According to the manufacturer, dental technicians will
only need one assortment for the
individualised characterisation of
laboratory-fabricated restorations.
At a temperature of 1,600°C, the new
sinter furnace Programat S1 1600
produces zirconium oxide crown
frameworks in 75 minutes.
Another topic that was discussed
at the symposium was “digital dentures”, which Ivoclar Vivadent presented in anticipation of this year’s
International Show. The company demonstrated that significant
progress has been made in this
area. The increasing digitisation of
diagnostics, design and construction of dentures, as well as large
automated databases for dental
geometries have facilitated the
manufacturing of aesthetically
appealing CAD/CAD prostheses.
MIS Global Conference: Company calls
for clinical case submission
By DTI
BARCELONA, Spain/BAR LEV INDUSTRIAL PARK, Israel: In anticipation
of its global conference, to be held
from 26 to 29 May 2016 in
Barcelona in Spain, dental implants manufacturer MIS Implants
Technologies has announced an
opportunity for young clinicians
to present clinical cases and techniques focusing on challenging sit-
uations in implantology. The best
cases submitted will be presented
on the first day of the conference.
Clinicians up to the age of
40 may submit their case documentation in English via e-mail by
15 February 2016. All submitted
cases will be reviewed and preapproved by the conference scientific committee and the best case
presentations will be awarded.
The first-prize winner will be
invited to a course by implant specialist Dr Eric Van Dooren, including flights and accommodation.
The second-prize winner will be
invited to a course by Prof. Stefen
Koubi (who lectures internationally on the topics of aesthetic
dentistry, smile design, and wear
and erosion), including flights and
accommodation.
The third-prize winner will be
invited to a course at the MIS headquarters, including flights and accommodation, or will receive MIS
products worth US$1,000 (€920).
The 2016 MIS Global Conference,
subtitled 360° Implantology, aims
to expand knowledge and introduce
true innovation under the theme
of “VCONCEPT: Set the volume of
bone and soft tissue”, and will in-
clude lectures, clinical case presentations and hands-on workshops.
Experienced professionals will
explore the VCONCEPT by providing a broad background on the
current evidence-based therapeutic trends in implant dentistry and
presenting the latest treatment
modalities that fulfil MIS’s philosophy of “Make it Simple”, particularly the V3 implant system.
Faster scanning than ever with
Planmeca FIT, now also with colour
By DTI
HELSINKI, Finland: The Planmeca
FIT system for chairside CAD/CAM
dentistry provides clinics with a
completely digital workflow from
start to finish. It seamlessly integrates intra-oral scanning, 3-D
designing and on-site milling into one system. Scanning within
Planmeca FIT is now faster than
ever before, and colour scanning is
featured for the first time.
The Planmeca FIT system is all
about integrated efficiency. Consisting of the Planmeca PlanScan
scanner, Planmeca PlanCAD Easy
software and Planmeca PlanMill 40
milling unit, it allows clinics to
produce perfectly fitting restorations in a single visit.
The system has made great
strides lately in both scanning
speed and accuracy—intra-oral
scans can now be performed with
unprecedented quickness. Colour
scanning too has been newly introduced, enhancing diagnostics and
making differentiating between
soft and hard tissue easier. Colour
scans also improve communication and increase case acceptance,
as they are easier for patients to
comprehend.
Planmeca FIT workflow steps are
easily controlled through the Planmeca Romexis software platform.
clinics to dental laboratories and
other external partners.
Treatment data
is immediately
viewable on all
workstations,
and the soft-
ware’s flexible licensing allows
scanning, designing and milling
The Planmeca Romexis Clinic
Management module provides
remote real-time usage information on Planmeca PlanMill 40, enabling clinics to locate resources
and monitor ongoing milling
processes.
to take place
simultaneously. In addition, images and data can be sent from
Planmeca FIT is a completely integrated approach to high-quality
dental care. It helps clinics utilise
their resources to the full and treat
more patients in less time. Instead
of two appointments, patients
can be treated in one visit—without temporary crowns or physical
dental models.
[10] =>
DTAP1115_10_Morton 20.11.15 14:34 Seite 1
BUSINESS
10
Dental Tribune Asia Pacific Edition | 11/2015
“We developed Invisalign G6 specifically to
provide treatment to the Asia Pacific market”
An interview with John Morton, R&D Director Align Technology
spoke today, are treating patients
with substantially atypical malocclusion. They are very difficult cases to
treat. These doctors give us fantastic
insights into treatment.
At the International Orthodontic Conference in London, Align Technology
showcased the latest generation of its
Invisalign system, which now offers
clinicians a solution for first premolar
extractions. Dental Tribune sat down
with the company’s R&D director, John
Morton, to discuss the philosophy behind the product and how it can benefit
orthodontics.
Dental Tribune: Malocclusion requiring
the extraction of a first premolar affects only 20 per cent of patients in
Europe and an even lower percentage
of patients in North America. Why was
Invisalign G6 developed with this specific orthodontic condition in mind?
John Morton: Looking at all the different types of malocclusions that exist, treatment by premolar extraction
can be difficult and considered the gold
standard for evaluating an orthodontic
appliance. Premolar extraction may be
less prevalent in the Western hemisphere than in the Asia Pacific region,
where 50 per cent of cases are treated
with first premolar extraction with
maximum anchorage. We developed
Invisalign G6 specifically to provide
treatment to the Asia Pacific market.
In your presentation, you emphasised
the way in which technology has
changed the development process.
We now have highly advanced
sensors to measure the force systems produced by Invisalign aligners. As I said in my presentation, the
design process used to be quite long,
but technology has miniaturised the
sensors significantly. With this type
of technology, we can measure every
force and movement on every tooth,
and we are able to build shapes and
attachments that doctors have not
dreamed of. Moreover, we can do it
all in the virtual world, fabricate in
the laboratory and have our measurements within an hour to see if
the design is better or worse than
previously used.
John Morton
When we launched the Invisalign
system in China in 2011, we knew
we needed this type of treatment. It
took four years to develop, balancing
movement of the canines and the
anterior and posterior of the arch.
Part of the goal of this project was
to make clear in the minds of orthodontists that Invisalign aligners are
a true orthodontic appliance capable
of well-controlled movements required for extraction space closure
and not just a piece of plastic.
Invisalign clear aligners have extended the user base significantly with
each generation of innovation. How
important is feedback from clinicians
in the development process?
It is very important, but there is a
difference between us as a company
and orthodontists in general. Orthodontists solve their treatment problems per patient in the chair on an
individual basis. We have to do this
on a large scale. Some clinicians, like
Dr David Couchat from France, who
We can try many different things
in the computer programmes and
learn from our mistakes without ever
touching a patient. Ten years ago,
we would have to put each design
through a clinical trial for six months
or so, only to find that it is the wrong
design and have to start over. Today,
the design process is down to hours
instead of years.
With the latest generation, does the
Invisalign system or clear aligners
offer a complete solution for orthodontists?
The Invisalign system is a complete orthodontic appliance today,
yet there is always room for further
development. We can certainly design new materials, new parts or
different ways of treating patients.
There are all sorts of improvement
we can do. The appliance is unlimited, as has been shown by our expert
clinicians. There is some resistance
still because building experience
and confidence takes time and effort. Our task as a company is to provide more education and support to
doctors and to give them the opportunity to become confident in using
Invisalign aligners.
Thank you very much for the interview.
AD
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[11] =>
DTAP1115_11-12_Alani 20.11.15 14:34 Seite 1
OPINION
Dental Tribune Asia Pacific Edition | 11/2015
11
Short-term gains…long-term problems?
The emergence of STO and its future implications in general practice
By Aws Alani, UK
The provision of orthodontics can be
a life-changing experience for young
patients whose “crooked” teeth can
affect their confidence and self-esteem. Indeed, where mature patients
present with a history of malalignment, equally beneficial and fulfilling
results can be achieved. In government-funded systems, patients with
congenital abnormalities receive
treatment that is essential to their
ongoing oral health. Restorative dentists work closely with orthodontists,
who can appreciate how small details
can aid in achieving positive restorative outcomes.
As a young dentist, I corrected
a tooth in crossbite with a simple
T-spring appliance. It was enjoyable
and brought a different type of delayed gradual satisfaction to the more
cerebral but tenuous molar endodontics or the more artistic and instant
composite build-up. I was not a specialist, but I managed to do some orthodontics. In contrast to my experience, general dental practitioners are
now more routinely providing tooth
movement with the emergence of
short-term orthodontics (STO). This
has resulted in some conjecture as to
the methods of achieving “straighter”
teeth. Indeed, some may consider
STO as an emerging entity competing with specialist orthodontics, but
should it be?
The specialist training pathway for
orthodontics involves a competitiveentry three-year full-time course
linked with the achievement of a master’s level qualification that many may
feel daunted by. Indeed, navigating
the pathway from start to finish can be
difficult academically and financially
when factoring in fees and loss of earnings during training. Once qualified,
the majority of these specialists reside, like the majority of all specialists,
in the south-east of England. With
this skewed distribution of specialists
and assumed need for access, it might
seem prudent for general dental practitioners to contribute to meeting the
need for orthodontics.
Indeed, the long-cited managed
clinical networks have yet to be fully
realised, although all planning and
documentation related to managed
clinical networks identify general
dental practitioners as integral to the
function of the network. The number
of orthodontic therapists has gradually increased over the last ten years
or so since inception of the first
courses in Wales and Leeds. Therapists are allegedly more cost-effective to train and employ in a large
orthodontic practice; however, unlike their hygiene or therapy colleagues, they cannot practise without a specialist’s treatment plan and
supervision.
Patients who qualify for orthodontic treatment under the UK government-funded system need to be as-
sessed according to the index of orthodontic treatment need. There will
be an obvious shortfall of adults or
adolescent patients with minor malocclusions who do not meet the criteria who would like their teeth
straightened. This cohort may have to
seek treatment privately from orthodontic specialists or general dental
practitioners. As such, these minor or
straightforward cases may be managed in a number of different settings
utilising various techniques with the
advent of STO. This may have resulted
in some territorial paranoia between
the two camps of traditional orthodontics versus STO systems. Conversely, it may be that differing scientific, technical and ethical ethos on
managing the same problem is the
source of the debate.
Quick and easy?
Commercialisation has modified
the provision of orthodontics in the
UK. Indeed, there are now orthodontic
brands with courses attached and a
faculty of individuals who promote
AD
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contemporary issues in the field of dentistry.
Robert Edwab, USA
Treating Medical
Emergencies in the
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Elif Keser, Turkey
PiezocisionTM for Rapid
Orthodontic Therapy:
A Multi-disciplinary Team
Approach
Walter Dias, Germany
Clinical Excellence in Aesthetic
Restorations - Hybrid and Indirect
Techniques Using Smart Composites
Ian Meyers, Australia
Full Day Symposium:
Towards the PostAmalgam Era
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Chairperson of the Full
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Cell to Cell Communcation:
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[12] =>
DTAP1115_11-12_Alani 20.11.15 14:34 Seite 2
OPINION
12
their particular product. Companies
tend to boast that their product is the
best with limited complications and
treatment being low risk, predictable
and easy. Somewhat surprisingly,
courses are being run on how to convert patients into orthodontic clients.
There are books describing strategies
on promoting and increasing revenue. They outline detailed strategies
on attracting more patients than
one’s local competitor—or is that colleague? Sounds more like capitalism
than commercialism to many interested observers.
The rapid development of STO has
not escaped the venture (or some
may say vulture) capitalists. In the
same vein as DIY whitening and sports
guards, one can now have one’s teeth
straightened via online companies
using products delivered by Her
Majesty’s Royal Mail and so cut out
the middleman (i.e. the dentist). To
my knowledge, STO has yet to make
it on to the price list of Samantha’s,
a beauty salon in Peckham.
AD
Dental Tribune Asia Pacific Edition | 11/2015
What may cause fear and worry is
that the provision of tooth movement
set against a backdrop of a focus on
increasing revenue and patient conversion may detract from the real reasons we are providing the treatment.
The risk and benefit of treatment
must remain balanced or be rebalanced in favour of the patient.
The best things in life are rarely
quick, easy and without reflection.
While learning or training, one gains
stature from one’s mistakes and
learns by way of osmosis from those
of individuals one hopes to emulate.
Becoming an expert in many a field
requires time, effort and experience.
Orthodontics is a complicated discipline that is difficult to deliver optimally and efficiently. Treatment planning should be performed in person
not only to appreciate the challenges
the patient presents with but also to
develop a lasting patient rapport.
Equally important, patients need to be
diligent during treatment and forever
more for purposes of retention. Is it
contact here, a rotation there or a
space distal to a canine who are unlikely to be waiting in earnest for the
next voucher deal alert on their
iPhones. Inducing misgivings or raising concerns about the patient’s tooth
position where the teeth are otherwise healthy and the patient presents
with no concerns could be considered
unethical and worryingly dishonourable.
Relapse of confidence
possible that a one- or two-day course
with a treatment plan lasting half
a year or less can provide equally optimal results to a specialist orthodontist utilising traditional means?
In any case, placing a time limit on
any treatment could be considered
contentious. Patients ask me all the
time‘How long is this treatment going
to take Doc?’ I always reply ‘Ill tell you
when its finished’. As such I am rarely
wrong.
Advertising cosmetic
treatments the fair
dinkum way
The Australian health ministry
recently examined the provision of
cosmetic procedures and in particular the modes of promoting the treatments. The working group found
that advertising and promotion
more often than not focused on the
benefits to the consumer, downplaying or not always mentioning risks.
The group went on to identify advertising practices that were not driven
by medical need and where there was
significant opportunity for financial
gain by those promoting these. They
identified the need to regulate promotion and advertising ethically
with factual, easily understood information from a source that is
independent of practitioners and
promoters. This is unfortunately not
always readily available. In some
Australian jurisdictions, there are
specific guidelines that need to be adhered to for promotion of cosmetic
treatments and they specifically
cover before and after treatment adverts, which we know in the UK is a
popular practice among the cosmetically driven. This is commonly one
ideal, perfect case showcased on the
front end of the practice website with
no mention of any problems, either
acute or chronic. Another aspect of
the report detailed prohibition of
time-limited offers or inducing potential customers through free consultations for the purposes of treatment uptake. The latter is something
that has seen STO promoted by way
of voucher deals on the Internet or
via smartphone applications. Others
may consider such a practice as loss
leading; one could ask who is losing
and who is gaining and at what price?
One important aspect of the report
identified the wider social impact of
cosmetic procedures in that people
may become increasingly dissatisfied
with themselves and their appearance, culminating in deeper concerns
for the person and reducing scope for
individuality. Many dentists throughout the country may have a slipped
In a recent publication from an indemnity provider, orthodontics was
identified as an emerging area for
claims against their clients. This is
likely to be the tip of the iceberg, whose
size will probably continually grow as
more and more orthodontics is provided and the repercussions of which
may only become apparent gradually
in the future.
In the now highly litigious arena of
UK dentistry, the failure of orthodontic treatment against the backdrop
of Montgomery v. Lanarkshire Health
Boardis likely to result in increased litigation. The movement of teeth into
what the patient and the dentist feel is
the correct position may be possible
in the short term, but in the long term
complications may arise owing to a
variety of soft- and hard-tissue factors
that cannot accommodate this new
and supposedly “right” position. Indeed, orthodontics requires the appreciation of detail where symmetry
and alignment are “king”, but longterm stability is the likely “empress”.
Relapse of position is a common complaint and where patients have paid
handsomely for a result they may
have been happy with at the time of
the cheque clearing, over time tiny
tooth shuffles can result in disproportionate and vehement dissatisfaction.
Where teeth are moved indiscriminately, recession in the labial segment
is a complication difficult to explain
and remedy in the high lip line of
a conscientious and ambitious corporate female patient. Indeed, more
haste, less speed may result in a case
being etched longer in the memory
of the patient and the clinician for
the wrong reasons.
Clear steps to
business building
A cornerstone of a successful business is the repeat customer who values the dentist and his or her service
and returns with no qualms or misgivings about what the dentist feels
should be provided. A successful business relies on patients returning in
the long term owing to their positive
experiences. Focusing on short-term
gains without due consideration of
quality or reliability of the treatment
provided has potential repercussions
for patients, the business of dentistry
and perception of the profession.
Aws Alani is a
Consultant in Restorative Dentistry at Kings College Hospital in
London, UK, and
a lead clinician for
the management
of congenital abnormalities. He
can be contacted at awsalani@hotmail.com.
[13] =>
&21)Ζ'(1&(/Ζ(6
%(1($7+7+(685)$&(
Dental health is the cornerstone of your well-being.
Restorations created with Planmeca FIT™ have
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Mill
Design
Scan
)LQGPRUHLQIRDQG\RXUORFDOGHDOHU
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Open CAD/CAM workflow
3ODQPHFD2\$VHQWDMDQNDWX+HOVLQNL)LQODQG7HO ID[ VDOHV#SODQPHFDFRP
[14] =>
DTAP1115_14_Aspen 20.11.15 14:35 Seite 1
TRENDS & APPLICATIONS
14
Dental Tribune Asia Pacific Edition | 11/2015
Bisphosphonates: A threat or an option?
Prof. Per Aspenberg, Sweden
lous bone—bisphosphonates reduce the resorptive response to
the trauma without impairing the
bone formation response, therefore having a net anabolic effect.
This explains why both local and
systemic bisphosphonates have
been shown to improve the early
fixation of knee and hip replacements in randomised blinded clinical trials.3
Most dentists will be familiar with
bisphosphonates mainly as a cause
of osteonecrosis of the jaw (ONJ).
ONJ is a complication of systemic
treatment. In contrast, locally applied bisphosphonates have been
proven efficacious for improving the
fixation of dental implants. Theoretical reasoning, experimental data,
and small clinical trials suggest that
local application of bisphosphonates is safe and effective in periodontology and implant surgery.
Bisphosphonates have positive
effects on many conditions in
bone and few and rare side-effects.
Their efficacy in osteoporosis is
well known, and there is evidence
for improved implant fixation in
an increasing number of applications. In dentistry, however, bisphosphonates are often regarded
negatively, owing to the small risk
of ONJ.
ONJ is indeed a problem. However, there is theoretical and clinical
evidence to suggest that the risk of
ONJ can be avoided by local treatment. Local bisphosphonate treatment has shown beneficial effects
without complications in randomised blinded clinical trials in
periodontology and dental implant
surgery.1 How can this be? Here is an
explanation:
AD
Bisphosphonates either bind to
bone mineral or are quickly excreted. Normally, they do not enter
cells and are therefore not toxic.
Only osteoclasts can resorb bone,
and when they do so, the dissolved
bone material passes through the
cell. Therefore, bisphosphonates
can reach the intracellular space of
osteoclasts. Once inside the osteoclast, they will inactivate the cell
and thus reduce bone resorption.
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When bone is infected, the bone
surrounding the infection will be
quickly resorbed. The infected bone
will therefore become surrounded
by richly vascularised soft tissue
that demarcates the infected area.
Thus, a good resorption capability
is important for preventing the
spread of bony infection. This protection mechanism can be impaired if resorption is reduced by
any potent anti-resorptive, leading
to the spread of infection and established osteomyelitis. In dentistry,
this kind of osteomyelitis is called
osteonecrosis. Thus, from a pathophysiological perspective, ONJ is
a somewhat misleading term. The
already well-known anti-osteoclastic
effects of bisphosphonates are sufficient to explain ONJ without suppositions about other, less known,
mechanisms.2 Moreover, the theory fits with the observation that
non-bisphosphonate anti-resorptives are associated with ONJ too.
When implants are inserted into bone, numerous studies have
shown that—especially in cancel-
Because bisphosphonates bind
strongly to bone, local treatment
will stay local. Bisphosphonates
applied to a bone surface will stay
there more or less forever, and thus
not impair the resistance to infection anywhere else. In an animal
model of dental implants (at sites
compromised by local wounding),
the author’s group showed that
systemic bisphosphonate treatment induced osteomyelitis (ONJ),
whereas implants with a bisphosphonate coating improved implant
fixation without problems in spite
of the compromised insertion site.4
Moreover, if an implant site in humans were infected, only the bone
about one millimetre away from
the implant surface would contain
bisphosphonate and could be removed if necessary.
In a randomised blinded controlled trial of dental implants
coated with a protein layer loaded
with bisphosphonates, improved
fixation was demonstrated.5 The
resonance frequency was 6.9 ISQ
units higher for the coated implants compared with the controls
(p = 0.0001; Cohen’s d = 1.3). Radiographs showed less marginal
resorption both at two months
(p = 0.012) and at six months
(p = 0.012). The patients were followed for five years without complications.
To conclude, systemic antiresorptives may impair protection
against osteomyelitis, thereby increasing the risk of ONJ in patients
with other risk factors. Local bisphosphonates seem not to confer
this risk, and improve implant fixation by their net anabolic effect.
Local bisphosphonate treatment
could become an important tool
in dentistry and maxillofacial
surgery.
Editorial note: A list of references is
available from the publisher.
Conflict of interest declaration: The
author has shares in AddBIO.
Dr Per Aspenberg
is Professor of
Orthopaedic Surgery at Linköping
University in Sweden with two decades of experience in research
and clinical trials
on the use of
bisphosphonates to treat orthopaedic
conditions. He can be contacted at per.
aspenberg@liu.se.
[15] =>
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some ways, A-dec saved me.”
–Keith Henderson, D.D.S.
No pain,
All Gain
The discomfort while treating patients was so
debilitating, Dr. Henderson nearly quit dentistry.
After years of suffering—and expense—caused
by poor ergonomics, he found a solution in A-dec.
The rest is history. Dr. Henderson transformed a
life of chronic pain into sustainable good health.
Invest in you. See how Dr. Henderson went
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All rights reserved.
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[16] =>
DTAP1115_16-20_Spiegel 20.11.15 14:35 Seite 1
TRENDS & APPLICATIONS
16
Dental Tribune Asia Pacific Edition | 11/2015
Achieving a nuanced interplay
of colours in four easy steps
Processing the polychromatic IPS e.max Press Multi ingot
By Michael Spiegel, Liechtenstein
For some time,IvoclarVivadent has been
offering a polychromatic, that is multicoloured, ingot for the press technique:
the IPS e.max Press Multi ingot. These
innovative ingots integrate a smooth
shade progression. Nuanced shade gradients from the enamel to the dentine
allow multicoloured restorations to be
pressed in a single sequence. The polychromatic press technique is surprisingly simple, as can be seen below.
Investing
(Fig. 1). This ingot features a smooth
shade progression, similar to the
shade gradation of the natural
tooth. Only one press sequence is
required to achieve a high level of
chroma in the cervical and dentine
areas and the desired level of
translucency in the incisal region.
Restorations that impress with their
nuanced, lively appearance are the
result.
suitably prepared for the placement
of a ceramic restoration, the tooth
shade is determined. As the shade of
the remaining tooth structure has a
substantial effect on the final aesthetic outcome, the shade of the
preparation should also be determined, for instance by means of the
IPS Natural Die Material Shade Guide.
If, additionally, photographs of the
preparations are taken, important
1
2a
2b
3
4
5
6
7a
7b
mum thickness available for the
restoration. As the Multi ingots are
mainly used for monolithic restorations, the layer thicknesses specified
for the staining technique should be
observed. If a veneer is to be created,
the layer thickness of the central area
should be 0.3–0.6 mm, and the incisal third should be between 0.4 mm
and 0.7 mm. Excellent results can
be attained in anterior crowns using
7c
Fig. 1: IPS e.max Press Multi features a smooth shade progression.—Figs. 2a & b:Wax-ups are invested using IPS e.max Press Multi Wax Patterns (Form A and B).—Fig. 3:The IPS Multi
investment ring base contains four openings, which are congruent with the shape of the Wax Pattern.—Fig. 4: Sprued wax-up attached to the investment ring base.—
Fig. 5:A template (IPS e.max Press Multi Sprue Guide) assists in verifying the position of the wax-up in the investment ring.—Fig. 6:Loaded investment ring base.—Figs. 7a–c:Investing
is carried out using the conventional method. Once the investment ring has been filled, the IPS Ring Gauge is mounted and the investment ring is allowed to set in a quiet place.
The press technique is a proven
method for creating monolithic allceramic restorations in the dental
laboratory. Many technicians enjoy
the efficient procedure that allows
them to choose between using their
artistic manual skills or the digital
wax probe, depending on their
preference. Impressive results can
be achieved, especially in conjunction with lithium disilicate glassceramics (IPS e.max Press). Exact
accuracy of fit, high strength, homogeneity and an efficient procedure
are the advantages offered by this
method. Refinements of morphology and function can be applied
in a targeted fashion. For several
months now, the multicoloured IPS
e.max Press Multi has been available
The marginal areas should not be
over-contoured to avoid the need for
time-consuming and risky adjustments. It should also be borne in
mind that the restoration will be
characterised with stains and/or
glaze after the press procedure and
may therefore slightly, but only just
slightly, fall short of the stipulated
thickness in the occlusal area.
The Multi ingot enhances the
family of the proven IPS e.max Press
lithium disilicate materials. It is supplied in nine A–D shades and a bleach
shade. The natural shade progression of the ingot allows users to
create polychromatic restorations
using an efficient procedure, whether
veneers, crowns or hybrid abutment
crowns. Customisation is optional
and is achieved with the staining
technique, very much in keeping
with the spirit of many technicians.
Contouring
The preliminary work is not essentially different from the known procedures used in the press technique.
Before or after the teeth have been
information can be transferred from
the practice to the laboratory with virtually no loss of data. On the basis of
this information, the shade of the ingot is selected. An impression is taken
and a working model fabricated—
usually a model with detachable segments. Generally, the spacer coating
on the die plays an essential role in the
accuracy of fit of the pressed ceramic
restoration, as the investment material (Ivoclar Vivadent) is coordinated
with precisely specified parameters.
The procedure for applying the spacer
is essentially no different from the
procedure applied for monochromatic restorations.
After the dies have been prepared,
we recommend checking the mini-
relatively little space: a thickness of
1.5 mm is required in the central area
and a minimum thickness of 1.2 mm
in the incisal region. In posterior
crowns, the layer thickness should
not be less than 1.5 mm.
Contouring is performed following the conventional guidelines on
shape, morphology and function.
Contouring represents another fundamental aspect of the efficient
manufacture of high-quality restorations. The more accurate and
detailed the contouring of the restoration, the less reworking will
be required later on. Once pressed,
the restoration generally only needs
to be glaze fired or, optionally, it
may be customised with stains.
The Multi ingots are clearly more
chromatic in the lower area than in
the upper third. This gradation follows the gradation found in natural
teeth. The question arises as to how
the shade layers of the ingot can be
transferred to the restoration so that
they are positioned in the correct
place. From this point onwards, the
procedure is different from the conventional press technique. A special
wax-up technique and processing accessories have been developed for
the polychromatic press ingots.
The waxed-up object is laterally
sprued on the investment ring. In
contrast to the conventional procedure, no wax sprues are used.
Instead, prefabricated precision
wax parts (IPS e.max Press Multi Wax
Pattern), which resemble small wax
platelets, are utilised for sprueing.
Depending on the restoration, either
Form A or B is employed. Form A is
indicated for large wax objects, such
as maxillary anterior crowns (Fig. 2a),
and the smaller Form B for delicate
restorations (Fig. 2b). After the appropriate size has been chosen, the Wax
Pattern is sprued to the wax-up. The
waxed-up restoration should be left
on the model die while sprueing to
avoid damaging the restoration margins. A drop of wax is applied on the
side of the Wax Pattern without altering its geometry. The conical side of
the Wax Pattern is aligned towards
the incisal area of the wax-up and the
wax-up is carefully pressed against
the wax. It is recommended to align
the wax-up to the centre of the
Wax Pattern in the investment ring.
Since the shade gradation of the
Multi ingot should be transferred
to the visible part of the restoration,
the vestibular surfaces of the wax-up
have to be aligned accordingly. Posterior crowns are sprued on the
mesiobuccal surface. Finally, the gap
between the Wax Pattern and the
wax-up is closed with a small quantity of modelling wax.
The IPS Multi Investment Ring
Base has been especially designed for
the polychromatic press procedure.
The Multi investment ring contains
four openings, which are congruent
with the shape of the IPS Multi
wax platelets. As a result, the sprued
wax-up can be accurately positioned
in the investment ring (Figs. 3 & 4).
A drop of positioning wax is applied
into the opening to be used. The Wax
Pattern is then inserted into the investment ring base. The incisal edge
and/or occlusal surface of the waxup should face the investment ring
base. Unused openings in the investment ring base are sealed with wax.
Another accessory of the IPS Multi
system then comes into play: the
IPS e.max Press Multi Sprue Guide.
Similar to a template, the Sprue
[17] =>
PRINT
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I
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O
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T
A
EDUC
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The DTI publishing group is composed of the world’s leading
dental trade publishers that reach more than 650,000 dentists
in more than 90 countries.
[18] =>
DTAP1115_16-20_Spiegel 20.11.15 14:36 Seite 2
TRENDS & APPLICATIONS
18
Dental Tribune Asia Pacific Edition | 11/2015
Guide is held against the loaded investment ring to check the correct
sprueing (Fig. 5). The wax-up to be
pressed should be positioned within
the marked area. The distance to the
investment ring base must not be
less than 3 mm (Fig. 6).
The investment materials (IPS
PressVEST or IPS PressVEST Speed)
are applied using a conventional
method. Once mixed, a small quantity of investment material is
brushed on to the occlusal surface
8
9
10
Fig. 8: With the blank side facing downwards, the cold Multi ingot is placed in the preheated investment ring.—Fig. 9: Once pressed and cooled, the restoration is carefully
divested.—Fig. 10: Careful removal of the investment material with polishing beads.
AD
and/or on to the screw channel of
hybrid abutment crowns, and the
insides of the crowns are filled with
investment material using a suitable
instrument to prevent air from being
trapped. After the IPS Silicone Ring
has been placed on the investment
ring base, the investment material is
slowly poured into the investment
ring up to the marking on the silicone
ring. The IPS Investment Ring Gauge
is positioned with a slightly hinged
movement and then pressed into
position. The investment material is
allowed to set in a resting environment (Figs. 7a–c). Once set, the investment ring is preheated using a
conventional method.
ju
,U
.
Dr
Bi
K
Pressing
K ris h n a
n
The IPS e.max Press Multi system
includes the IPS e.max Press Multi
One-Way Plunger, a single-use
plunger, which is used in addition to
the IPS e.max Alox Plunger. With the
appropriate programme having
been selected on the press furnace,
the cold IPS e.max Multi ingot is
placed into the preheated investment ring with the blank side facing
downwards. Next, the cold One-Way
Plunger and the Alox Plunger are
positioned (Fig. 8). The loaded investment ring is placed in the preheated press furnace and the press
programme is started. As known
from the conventional press technique, the investment ring should
be immediately removed from the
furnace after the press process has
ended and allowed to cool slowly.
Divesting is performed in the familiar way. The investment ring is
separated using a separating disc and
carefully broken apart at the predetermined breaking point (Fig. 9).
Blasting with polishing beads at 4 bar
(58 psi) pressure and then at 2 bar
(29 psi) is recommended for removing the investment material (Fig. 10).
The reaction layer is removed using
IPS e.max Press Invex Liquid. The
pressed object is immersed in Invex
Liquid in a plastic cup, cleaned in an
ultrasonic cleaner for 10–30 min and
then rinsed under running water.
The white reaction layer can then
be completely removed with aluminium oxide (100 μm) at 1–2 bar
(14.5–29 psi) pressure without leaving any residue (Fig. 11).
Staining
Finishing is performed with grinding tools suitable for high-strength
glass-ceramics. Work is carried out
at low speed and light pressure.
Overheating of the ceramic must be
avoided. The restoration is tried in
on the die (without a spacer) and
the occlusion and articulation are
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[20] =>
DTAP1115_16-20_Spiegel 20.11.15 14:36 Seite 3
TRENDS & APPLICATIONS
20
checked. The press technology usually transfers even the finest structures to the ceramic. In most
favourable cases, filigree fissures,
accentuated cusp slopes and macrotextures are reproduced one to one
in the ceramic. If preferred, certain
macro-textures can be adjusted by
grinding to give them additional emphasis. Once cleaned, the restoration
shows a smooth shade progression
from the cervical to the incisal region and, as a result, the shade of the
restoration looks very natural.
11
Dental Tribune Asia Pacific Edition | 11/2015
12
13
Fig. 11: Pressed restoration after divesting.The smooth shade progression from the cervical to the incisal is clearly noticeable.—Figs. 12 & 13:Work in progress.The natural shade
progression of the two crowns is the result of the IPS e.max Press Multi ingot. If required, the restorations can be additionally customised with stains.
AD
At this stage, the restoration can
be prepared for the glaze-firing (or
optional stain-firing) cycle. IPS e.max
Ceram Shades and Essences are used
for this step. The procedure is the
same for both polychromatic and
monochromatic restorations. For
better wettability of the stains, a
small quantity of Stain or Glaze
Liquid is applied to the grease- and
contamination-free ceramic surface.
The stains are then applied to characterise the restoration according
to individual requirements. The
characterisations can be intensified
by repeating the staining and firing
procedure. Even before the stains are
applied, the incisal area appears
clearly more translucent than the
other parts of the restoration. This effect can be intensified by brushing on
a small quantity of IPS e.max Ceram
Shades Incisal.
The Dental Tribune International
C.E. Magazines
www.dental-tribune.com
If required, the dental technician
will customise the restoration. However, this is not desired in all cases,
and even without stains, the restoration appears natural and closely resembles a layered crown. Glaze firing
is the final step in the procedure.
I would like to subscribe to
CAD/CAM
implants
cone beam
cosmetic dentistry*
laser
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DT Study Club (France)***
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We recommend using fluorescent
glaze material. The glaze is applied in
a thin, but covering, coating. If minor
adjustments are required after the
glaze firing, they may be applied
using IPS e.max Ceram Add-On materials.
Conclusion
IPS e.max Press Multi affords a
streamlined procedure that supports the need for economic efficiency in the dental laboratory and
yet does not entail sacrifices in aesthetic quality. What is so delightful
about this material is that it allows
you to do all, but does not require
you to do everything. With or without stains, the restorations exhibit
a natural variation of shade and
translucency from the dentine to
the incisal region (Figs. 12 & 13). High
aesthetics and high efficiency are
combined with the proven material properties of lithium disilicate
(IPS e.max Press), such as high
strength. These properties are incorporated into the IPS e.max Press
Multi ingot.
Michael Spiegel is
Product Manager
of All-Ce ra mics
—CAD/CAM at
Ivoclar Vivadent
in Schaan in Liechtenstein. He can
be contacted at
michael.spiegel@
ivoclarvivadent.com.
[21] =>
DTAP1115_21_Linkevicius 20.11.15 14:37 Seite 1
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 11/2015
21
Vertical reconstruction of soft
peri-implant tissues
By Dr Tomas Linkevičius, Lithuania
Crestal bone stability around dental implants remains one of the
most important features of successful implant treatment. Besides
major clinical advantages for the
patient, stable marginal bone provides the clinician with psychological comfort and satisfaction, because of the positive long-term outcome (Fig. 1). Therefore, we all need
to be aware of possible causes of
loss of crestal bone stability and
exercise every method to prevent
bone resorption.
For almost one decade, platform
switching has been considered
to be the most effective way to
achieve this outcome. It is so effective that almost all implant
companies have implemented
platform switching as an essential
feature of implant manufacture.
It has generally be concluded that
implant design is more important
than the biology itself. However,
recent clinical research conducted
by our group has found that softtissue thickness is an important
factor in preserving crestal bone
stability around implants. It was
determined that if vertical softtissue thickness is 2 mm or less,
there will be crestal bone resorption of 1.5 mm in extent during
formation of a biological seal between the soft tissue and the implant, abutment or restoration
surfaces (Fig. 2).
Furthermore, it was clearly
shown that even implants with
platform switching could not
maintain bone if at the time of
implant placement vertical soft
tissue was thin (Fig. 3). That returns
us to the discussion of whether
biology or implant design is more
important. Well, we need to understand that vertical soft-tissue
thickness is a prerequisite of the
biological width around implants.
Biological width around implants
starts to form at the time of healing abutment connection and is
complete after eight weeks. This
biological seal is the only barrier
protecting the osseointegrated
implant from the contaminated
intra-oral environment and hence
most important. Thus, there is
a direct connection between the
peri-implant mucosa of an edentulous alveolar ridge and periimplant soft tissue.
It seems that the soft-tissue
thickness required to protect the
underlying bone around implants
is approximately 4 mm, which is
longer than the biological width
around teeth. There are two ways
in which biological width around
implants is formed: with crestal
bone loss or without bone resorption. Which one would you like
your patient to have? Or which
one would you like your mother
to have? That is the question we
all as clinicians should answer
sincerely.
So if we diagnose thin vertical
tissue at the time of implant placement, what should we do? There
are no current guidelines to follow; however, we need to do some-
1
considering the prosthetic superstructure and implant–crown ratio. Some implant manufacturers
have launched implants of 4 mm
in length, making soft-tissue
thickness even more important
for users of these products.
So what should the approach be?
There are several options, some of
sure, which usually follow bone
resorption. It is well known that
the exposure of the rough implant
surface enhances plaque accumulation and the development of
peri-implantitis. In other words,
the future of such an implant
would only depend on the scrupulous cleaning abilities of the patient,
what is usually not the case.
3
2
4
5
6a
6b
Fig. 1: Crestal bone stability around the implant and abutment (Tapered, BioHorizons).—Fig. 2:Thin vertical soft tissue measured
at the crest (≤ 2 mm).—Fig. 3: Crestal bone loss around an implant with platform switching.—Fig. 4: Sub-crestal placement of
an implant (Tapered Plus, BioHorizons).—Fig. 5: Flattening of the ridge for the regular matching connection implant (green)
will increase soft-tissue thickness. The implant is placed supra-crestally to isolate the microgap and thin polished collar.—
Figs. 6a & b: Original vertical soft-tissue thickness (a); soft-tissue thickness after augmentation with an acellular dermal matrix (b).
thing, because crestal bone resorption will otherwise result.
This is especially important for
short implants, which are increasingly being used. Today, an implant of 8 mm in length is no
longer considered short, and we
have sufficient data to determine
that implants of 6 mm in length
work as well as longer ones do in
the posterior of both jaws. However, imagine the outcome if a
6 mm implant is placed in the
posterior mandible, where thin
vertical soft tissue is frequently
present. We would have approximately 2 mm of bone resorption,
due to biological width formation,
leaving only two-thirds of the
implant surface to become osseointegrated. Such a circumstance
poses a risk of implant failure,
them already researched clinically
and some based on clinical experience without any objective evidence. An initial thought may be
to place the implant deeper subcrestally (Fig. 4). Firstly, there must
be adequate distance from the alveolar nerve to position the implant
sub-crestally in a safe manner. It is
advised that the implant stop at
least 1 mm from the nerve.
Extensive sub-crestal positioning of the implant, of course, does
not prevent crestal bone loss, as
the microgap at the implant–
abutment interface will form an
inflammatory infiltrate, which
will cause bone resorption anyway; however, it is likely that the
implant will not have soft-tissue
recession or rough surface expo-
Another option might be recontouring of the bone during basic
implant bed preparation, especially if a narrow ridge is present.
Careful reduction and smoothening of the narrow ridge will not
only provide a flat bone surface
and a sufficiently wide area of
bone for implant positioning, but
will increase soft-tissue thickness
as well (Fig. 5). While the concept of
bone removal to preserve the bone
might be acceptable to some clinicians, there is no strong clinical
evidence that this procedure increases soft-tissue thickness and
reduces crestal bone remodelling.
Consequently, we might think
in another direction and consider
a third option, vertical reconstruction of the soft-tissue thickness,
which in my opinion is the most
logical approach. Increasing softtissue thickness vertically compensates for the lack of vertical
tissue. Already in a 2009 paper,
we suggested that clinicians
“consider the thickening of thin
mucosa before implant placement”;
therefore, this concept is not entirely new.1 The idea is to place
some sort of autogenous, allogeneic or xenogeneic material
over the implant to increase softtissue thickness after healing.
A connective tissue graft is
considered the gold standard for
soft-tissue augmentation around
implants. However, this technique
has some serious disadvantages,
such as donor site morbidity and
the difficulty of the harvesting
procedure. Therefore, allogeneic
substitutes might be considered a
viable option to replace autogenous grafts in vertical soft-tissue
reconstruction. The use of an acellular dermal matrix is thus far
the only approach backed by solid
clinical research, including a controlled clinical prospective study.2
In this study, implants were placed
in three groups of patients with (a)
thin vertical tissue, (b) thick vertical
tissue or (c) thin vertical tissue augmented with an acellular dermal
matrix material (AlloDerm, BioHorizons). Radiographic assessment showed a reduction of crestal
bone loss from 1.74 mm in the
thin-tissue group to 0.32 mm in
the augmented group. In addition,
soft-tissue thickness increased by
2.33 mm, from 1.50 mm to 3.83 mm,
after augmentation with the allograft (Figs. 6a & b). This research
proves that the lack of vertical softtissue thickness required for biological width formation without
crestal bone loss can be compensated for by the use of an acellular
dermal matrix material at the time
of implant placement.
In conclusion, it must be emphasised that diagnosis of thin vertical
soft tissue is very important in implant treatment. Only by acknowledging that tissue thickness is an
important factor can we follow protocols that allow us to reconstruct
vertical peri-implant tissue and
reduce crestal bone loss.
Editorial note: A list of references is available from the publisher.
Dr Tomas Linkeviçius is an Associate Professor
at the Institute
of Odontology
at Vilnius University in Lithuania. He can
be contacted
at linktomo@
gmail.com.
[22] =>
DTAP1115_22-23_Chicha 20.11.15 14:38 Seite 1
TRENDS & APPLICATIONS
22
Dental Tribune Asia Pacific Edition | 11/2015
What do our teeth betray about us?—Part I
By Dr Stanislav Cícha,
Czech Republic
Our wishes
Right maxilla
The aim of this article is to offer readers information on a topic that is discussed very rarely in dental journals:
how tooth position and damage to
individual teeth reflect emotional
and health status.
In 2000, I read a book by French
dentist Dr Michèle Caffin, Quand
les dents se mettent à parler (When
the teeth talk).1 Because I was most
intrigued by the findings of my
French colleague, I started to observe these relationships and document them. I encouraged my
patients to talk about their troubles
and problems that did not appear
to be overtly dental. In this manner,
psychosomatic medicine2, 3 has inconspicuously become part of
treatment. It helps patients who are
healthy biochemically, radiologically, etc., but who still exhibit dental problems.
In order to avoid constantly flipping through my records, I created
convenient one-page diagrams
mapping the significance of individual teeth. The colours correspond to acupuncture pathways.4
The relationship of acupuncture
pathways to different groups of
teeth will be discussed in Part II of
this article. In Part I, I seek to convey
an unconventional perspective of
teeth as a mirror of emotional and
health status in patients based
on my more than ten years of experience.
If we look at the jaws from this
unconventional perspective, then
the upper jaw firmly attached to the
skull represents our wishes (Fig. 1).
Particularly its width and regular
tooth alignment in the jaw indicate
Left maxilla
Future
Past
Right mandible
Left mandible
Our actions
1
2
3
Central incisors
Our wishes
Express ourselves outwardly +
Problem with inclusion in society
Realisation of concrete matters +
Problem with concrete life situations
+ Express our feelings
Problem with realisation of personal wishes
Mother
the female figure
+ Focus on our feelings
Lack of recognition by and affection from the family
Our actions
4
Father
the male figure
5
7
Importance of parents in daily life
8
that the patient is able to express
his or her wishes and therefore
communication with him or her
will be trouble-free (Fig. 2). A narrow
jaw with incisors and canines in
anterior crossbite, in contrast, signifies a passive individual with
whom communication will be
more difficult. Such difficulties
with expressing wishes and feelings throughout life are signalled
by a complete maxillary prosthesis, for example (Fig. 3).
The lower jaw loosely attached to
the skull by the mandibular joint
represents our actions. The chin,
6
9
especially, is a symbol of energy
and will. Heroines in novels do not
have bird profiles.
The right quadrant relates primarily to the future and the left to
the past. The positive and negative
expression of the status of individual quadrants is illustrated in
Figure 4.
Regarding individual teeth, the
fundamental consideration is the
position of the tooth in the dental
arch. If the tooth is located vestibular from the dental arch, the characteristic is significant.
If the tooth is located orally, is
displaced beyond the adjacent
teeth, is in anterior cross-bite or
is missing, the characteristic is repressed. Large areas affected by
caries, dental fillings, and pulpless
teeth are equally negatively assessed.
Central incisors represent the
male and female figures: the father,
the right maxillary central incisor;
and the mother, the left maxillary
central incisor (Fig. 5). People with
a prominent left maxillary central
incisor (this tooth often overlaps
the right one) had and often still
Lateral incisors
Right maxilla
Temperament of the person
reactions to archetypes
Right mandible
10
13
11
14a
Left maxilla
I usually see diastemas (Fig. 9) in
patients whose parents may live
together, but who essentially lead
separate lives. Patients with diastemas usually have difficulties
in their relationship with a partner.
Of course, one does not usually
gain such information from the
persons concerned, but one gains
insight into these secret corners of
the family when one is a family
dentist for many years.
Left mandible
Temperament of the person
reactions to archetypes
12
Mandibular central incisors
(Fig. 10) predicate the importance
of the patient’s parents in daily life.
The informative value of maxillary incisors is, however, far greater
according to my observation.
14b
Canines
Our outward presentation
of ourselves
15a
15b
have in their adulthood a much
stronger maternal influence than
paternal influence during their
lives (Fig. 6). Once one is aware of
this, one will observe that this is very
common. The opposite (a stronger
influence of the father) is in the minority (Fig. 7). If both of the incisors
are aligned symmetrically, it signifies the balanced influence of both
parents. An example from real life:
Figure 8 shows the fracture of both
central incisors. It was ultimately
necessary to extract the left incisor
owing to a root fracture. The patient’s parents divorced and she was
given over to the care of her father
by the court and her sibling to her
mother. Thus, she lost her mother
and symbolically tooth #21.
16
What we wish to achieve
outwardly
All changes a person has
undergone
Our inner attitude
to change
Expression of our
inner transformation
Lateral incisors represent the
temperament of the person and
his or her reactions to archetypes
(= attitude towards parents; Fig. 11).
If the right maxillary lateral incisor
is in protrusion, it means the person is able to defend his or her freedom in the family, but is usually
in dispute with the father (Fig. 12).
[23] =>
DTAP1115_22-23_Chicha 20.11.15 14:39 Seite 2
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 11/2015
23
Similarly, on the left side (tooth
#22), this position indicates opposition to the mother (Fig. 13), as was
confirmed by both of the patients
shown in the figures. If both teeth
#12 and 22 are in protrusion and
overlap the central incisors, the patient tends to have an edge over his
or her parents.
17
In contrast, retrusion, microdontia or total anodontia (Fig. 14a) of
these teeth is an indication of subordination, often both in the family and in society. For example, my
questions directed at the child in
Figure 14b with anterior crossbite
of the primary lateral incisors were
always answered by his mother
and the child did not interject.
Thus, orthodontic, prosthetic or
implant treatment allows these patients a much better start in current
society (Figs. 15a & b) and a stable
position in the family.
18
the fixed appliance or does not
have his or her teeth fixed by some
kind of splint, the teeth will quickly
relapse apparently without cause.
Dr Stanislav Cícha
is working as a
dentist in Prag
in the Czech Republic. He can
be contacted at
mojezubysro@
gmail.com.
Editorial note: This is the first of a two-part
article which first appeared in Cosmetic
Dentistry 2/15. A complete list of references
is available from the publisher.
AD
Minimally invasive,
maximally effective
Canines reflect the changes
through which a person has gone.
They erupt in times of great growth
and at the beginning of adolescence
(Fig. 16). The right maxillary canine
represents the presentation of personality outwardly. The left maxillary canine represents attitude
towards change (Fig. 17). The right
mandibular canine is an expression
of what we wish to achieve outwardly. The left mandibular canine
is a reflection of our internal transformation (Fig. 18). The canines are
generally perceived by others as a
symbol of vitality and superiority.
People with small canines or canine
in managerial positions often have
in its place an implant, or a dental
restoration to rebuilt the tooth.
I have also observed in these teeth
the retroactive effect of tooth position evident in a change in the patient’s emotional behaviour, as with
the lateral incisors. A shy girl with
a retracted right maxillary canine
completely blossomed and gained
confidence after orthodontic treatment. Of course, she made her parents anxious because they suddenly
had a completely different child at
home. It was probably not the only
cause, but in my practice I often see
similar examples of the retroactive
effect of tooth alignment.
When a patient has his or her
teeth aligned through orthodontic
treatment, the original information
is lost (Fig. 19). However, if the underlying issue is not resolved, for
example a mother still dominates
her daughter, who did not manage
to disappear into world (tooth #21
overlapped tooth #11) or, conversely, the daughter of this mother
unconsciously does not want to
grow up to be a woman because she
likes fulfilling the role of the good
child, when such a patient stops
wearing retainers to maintain the
tooth position after removal of
19
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BONE & TISSUE DAYS
HONG KONG
05. – 06.11.2015
The new force in bone surgery:
The new Piezomed offers extremely high performance, yet is
gentle on soft tissue. In addition, it includes automatic instrument
recognition and LED handpiece illumination. The handpiece with
the cable is thermo washer disinfectable and sterilizable!
Now available from your dental supplier or via wh.com
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[title] => Asia-Pacific news
[page] => 01
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[1] => Array
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[title] => Opinio: Tools of the trade
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[title] => World news
[page] => 05
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[title] => Business
[page] => 09
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[page] => 11
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[title] => Bisphosphonates: A threat or an option?
[page] => 14
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[6] => Array
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[title] => Achieving a nuanced interplay of colours in four easy steps
[page] => 16
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[7] => Array
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[title] => Vertical reconstruction of soft peri-implant tissues
[page] => 21
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[page] => 22
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[toc_html] =>
Table of contents
-
Asia-Pacific news
01 - 03
view
-
Opinio: Tools of the trade
04 - 04
view
-
World news
05 - 06
view
-
Business
09 - 10
view
-
Opinio: Short-term gains...long-term problems?
11 - 12
view
-
Bisphosphonates: A threat or an option?
14 - 14
view
-
Achieving a nuanced interplay of colours in four easy steps
16 - 20
view
-
Vertical reconstruction of soft peri-implant tissues
21 - 21
view
-
What do our teeth betray about us?—Part I
22 - 23
view
[toc_titles] => Asia-Pacific news
/ Opinio: Tools of the trade
/ World news
/ Business
/ Opinio: Short-term gains...long-term problems?
/ Bisphosphonates: A threat or an option?
/ Achieving a nuanced interplay of colours in four easy steps
/ Vertical reconstruction of soft peri-implant tissues
/ What do our teeth betray about us?—Part I
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