DT Asia Pacific No. 12, 2011
Array
(
[post_data] => WP_Post Object
(
[ID] => 56573
[post_author] => 0
[post_date] => 2011-12-13 13:31:20
[post_date_gmt] => 2011-12-13 13:31:20
[post_content] =>
[post_title] => DT Asia Pacific No. 12, 2011
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => dt-asia-pacific-no-12-2011-1211
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 20:56:08
[post_modified_gmt] => 2024-10-21 20:56:08
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/epaper/dtap1211/
[menu_order] => 0
[post_type] => epaper
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56573
[id_hash] => 0e8788faa01e6e654e5a6766c8674d92a8075d79452754cff68824544a8aff76
[post_type] => epaper
[post_date] => 2011-12-13 13:31:20
[fields] => Array
(
[pdf] => Array
(
[ID] => 56574
[id] => 56574
[title] => DTAP1211.pdf
[filename] => DTAP1211.pdf
[filesize] => 0
[url] => https://e.dental-tribune.com/wp-content/uploads/DTAP1211.pdf
[link] => https://e.dental-tribune.com/epaper/dt-asia-pacific-no-12-2011-1211/dtap1211-pdf-2/
[alt] =>
[author] => 0
[description] =>
[caption] =>
[name] => dtap1211-pdf-2
[status] => inherit
[uploaded_to] => 56573
[date] => 2024-10-21 20:56:02
[modified] => 2024-10-21 20:56:02
[menu_order] => 0
[mime_type] => application/pdf
[type] => application
[subtype] => pdf
[icon] => https://e.dental-tribune.com/wp-includes/images/media/document.png
)
[cf_issue_name] => DT Asia Pacific No. 12, 2011
[contents] =>
)
[permalink] => https://e.dental-tribune.com/epaper/dt-asia-pacific-no-12-2011-1211/
[post_title] => DT Asia Pacific No. 12, 2011
[client] =>
[client_slug] =>
[pages_generated] =>
[pages] => Array
(
[1] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-0.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-0.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-0.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-0.jpg
[1000] => 56573-0b49c070/1000/page-0.jpg
[200] => 56573-0b49c070/200/page-0.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56575
[post_author] => 0
[post_date] => 2024-10-21 20:56:02
[post_date_gmt] => 2024-10-21 20:56:02
[post_content] =>
[post_title] => epaper-56573-page-1-ad-56575
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56573-page-1-ad-56575
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 20:56:02
[post_modified_gmt] => 2024-10-21 20:56:02
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56573-page-1-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56575
[id_hash] => d3897347a785f3cf8d82c8eb1b90f9be97a72be027918515193a19e9e18425ca
[post_type] => ad
[post_date] => 2024-10-21 20:56:02
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/2628
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56573-page-1-ad-56575/
[post_title] => epaper-56573-page-1-ad-56575
[post_status] => publish
[position] => 60.24,65.03,33.94,30.6
[belongs_to_epaper] => 56573
[page] => 1
[cached] => false
)
)
[html_content] =>
)
[2] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-1.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-1.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-1.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-1.jpg
[1000] => 56573-0b49c070/1000/page-1.jpg
[200] => 56573-0b49c070/200/page-1.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-2.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-2.jpg
[1000] => 56573-0b49c070/1000/page-2.jpg
[200] => 56573-0b49c070/200/page-2.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56576
[post_author] => 0
[post_date] => 2024-10-21 20:56:02
[post_date_gmt] => 2024-10-21 20:56:02
[post_content] =>
[post_title] => epaper-56573-page-3-ad-56576
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56573-page-3-ad-56576
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 20:56:02
[post_modified_gmt] => 2024-10-21 20:56:02
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56573-page-3-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56576
[id_hash] => f31d8d9cdac298777706578df6a30c09138ca53d9c644afa4ab9aa42e75840a3
[post_type] => ad
[post_date] => 2024-10-21 20:56:02
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/25/code/wh_dentalwerk_buermoos_gmbh_austria
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56573-page-3-ad-56576/
[post_title] => epaper-56573-page-3-ad-56576
[post_status] => publish
[position] => 23.96,25.41,70.22,69.95
[belongs_to_epaper] => 56573
[page] => 3
[cached] => false
)
)
[html_content] =>
)
[4] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-3.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-3.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-3.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-3.jpg
[1000] => 56573-0b49c070/1000/page-3.jpg
[200] => 56573-0b49c070/200/page-3.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[5] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-4.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-4.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-4.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-4.jpg
[1000] => 56573-0b49c070/1000/page-4.jpg
[200] => 56573-0b49c070/200/page-4.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[6] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-5.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-5.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-5.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-5.jpg
[1000] => 56573-0b49c070/1000/page-5.jpg
[200] => 56573-0b49c070/200/page-5.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56577
[post_author] => 0
[post_date] => 2024-10-21 20:56:02
[post_date_gmt] => 2024-10-21 20:56:02
[post_content] =>
[post_title] => epaper-56573-page-6-ad-56577
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56573-page-6-ad-56577
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 20:56:02
[post_modified_gmt] => 2024-10-21 20:56:02
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56573-page-6-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56577
[id_hash] => f31c1542a8833d675af021e7e0006d06b18b6579bc8aa0b42013b9d83d124278
[post_type] => ad
[post_date] => 2024-10-21 20:56:02
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/2628
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56573-page-6-ad-56577/
[post_title] => epaper-56573-page-6-ad-56577
[post_status] => publish
[position] => 6.21,25.41,70.24,69.95
[belongs_to_epaper] => 56573
[page] => 6
[cached] => false
)
)
[html_content] =>
)
[7] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-6.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-6.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-6.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-6.jpg
[1000] => 56573-0b49c070/1000/page-6.jpg
[200] => 56573-0b49c070/200/page-6.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[8] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-7.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-7.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-7.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-7.jpg
[1000] => 56573-0b49c070/1000/page-7.jpg
[200] => 56573-0b49c070/200/page-7.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[9] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-8.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-8.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-8.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-8.jpg
[1000] => 56573-0b49c070/1000/page-8.jpg
[200] => 56573-0b49c070/200/page-8.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[10] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-9.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-9.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-9.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-9.jpg
[1000] => 56573-0b49c070/1000/page-9.jpg
[200] => 56573-0b49c070/200/page-9.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[11] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-10.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-10.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-10.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-10.jpg
[1000] => 56573-0b49c070/1000/page-10.jpg
[200] => 56573-0b49c070/200/page-10.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[12] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-11.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-11.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-11.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-11.jpg
[1000] => 56573-0b49c070/1000/page-11.jpg
[200] => 56573-0b49c070/200/page-11.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[13] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-12.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-12.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-12.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-12.jpg
[1000] => 56573-0b49c070/1000/page-12.jpg
[200] => 56573-0b49c070/200/page-12.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[14] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-13.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-13.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-13.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-13.jpg
[1000] => 56573-0b49c070/1000/page-13.jpg
[200] => 56573-0b49c070/200/page-13.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[15] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-14.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-14.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-14.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-14.jpg
[1000] => 56573-0b49c070/1000/page-14.jpg
[200] => 56573-0b49c070/200/page-14.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[16] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-15.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-15.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-15.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-15.jpg
[1000] => 56573-0b49c070/1000/page-15.jpg
[200] => 56573-0b49c070/200/page-15.jpg
)
[ads] => Array
(
)
[html_content] =>
)
)
[pdf_filetime] => 1729544162
[s3_key] => 56573-0b49c070
[pdf] => DTAP1211.pdf
[pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/56573/DTAP1211.pdf
[pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/56573/DTAP1211.pdf
[should_regen_pages] => 1
[pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/epaper.pdf
[pages_text] => Array
(
[1] =>
DTAP1211_01_Title
DTAP1211_01_Title 12.12.11 15:30 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG
www.dental-tribune.asia
A year in review
Our dental specialists
look back at 2011
4Page
NO. 12 VOL. 9
Endodontics
New guidelines for
the use of lasers
4
Full ceramics
How to restore extensive
coronal lesions
4Page
10
4Page
13
Researchers bite into spinal cord injury rehab Award given
Daniel Zimmermann
DTI
to Specialist
Dental Group
HONG KONG/LEIPZIG, Germany:
In recent years, dental stem cells
have increasingly been investigated for their use in medical
applications, including the rehabilitation of lost or damaged
biological function. Scientists
from the Nagoya University in
the Nagasaki Prefecture in Japan
have reported that they could
possibly help to repair injuries of
the spinal cord, a leading cause of
paralysis and disability.
Specialist Dental Group has
won a “Promising Brands” Award
at this year’s Singapore Prestige
Brand Award organised by the
Association of Small and Medium
Enterprises (ASME) and the country’s largest Chinese-language
newspaper Lianhe Zaobao. The
annually trophy recognises up and
coming brands in the city state that
have been developed and managed effectively through various
branding initiatives.
Having transplanting human
dental pulp stem cells into lab
rats with severe spinal cord injury (SCI), they found that the
animals regained significantly
more limp function than through
a transplant of human bone marrow stromal cells or skin-derived
fibroblasts. According to the researchers, the cells not only inhibited the death of nerve cells,
but also promoted the regeneration of severed nerves and
replaced lost support cells with
new ones, two main factors essential for functional rehabilitation.
Prior to the winning the SPBA,
Specialist Dental Group was already selected as one of three finalists
for “Best Healthcare Experience”
at the Singapore Experience
Awards for the second year in a row.
“Spinal cord injury often
leads to persistent functional
One in 50 people are living with paralysis due to injuries of the spinal cord. (DTI/Photo Alexander Raths/Germany)
deficits due to the loss of neurons
and glia and to limited axonal
regeneration,” they stated in the
study published in the Journal of
Clinical Investigation last week.
“Our data demonstrate that toothderived stem cells may provide
therapeutic benefits for treating
SCI through both cell-autonomous and paracrine neuroregenerative activities.”
Investigating different types
of stem cells for their potential
in SCI rehabilitation has a long
track record in science. This
September, for example, researchers from the Medical College
of Wisconsin reported that they
had begun to implant foetal neural cells into SCI patients. The
Nagoya study is the first to have
shown a rehabilitation effect in
SCI cases with stem cells derived
from dental tissue.
Classified by the grade of impairment, SCI can have mild to
severe health effects on patients,
including total loss of biological
function. Common therapies include surgery, long-term physical
therapy and other rehabilitation
efforts. DT
Founded in 1979, the group has
grown into one of the largest multispeciality dental practices in Singapore employing dental specialist
who offer treatment in areas such
as prosthodontics, orthodontics,
periodontics, oral maxillofacial
surgery and paedodontics. According to SDG, their signature treatments include dental implants,
braces, Invisalign, gum treatment,
oral surgery, crowns/veneers and
dentistry for children. DT
AD
Imprint
Licensing by
Dental Tribune International
Managing Editor
Daniel Zimmermann
newsroom@dental-tribune.com
Tel.: +49 341 48474-107
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
Colonel William R. Bachand, former Commander of the Pacific Regional
Dental Command of the US Army, spoke to Dental Tribune recently about his
new post in Europe. (DTI/Photo Annemarie Fischer)4WORLD NEWS, page 6
Korea sees new Scaling is good
dental laser
for you
Dental laser specialist Biolase has announced to have
gained regulatory approval for its
Waterlase iPlus all-tissue dental
laser system in South Korea. According to the US manufacturer,
the system will be available beginning of December through
the company’s dealer MJ DMT in
Seoul. DT
A study from Taiwan has found
that scaling teeth at least once
year can reduce the risks of suffering from a heart attack by
more than 20 per cent. Presented
at the Scientific Session of the
American Heart’s Association
in the US, the study followed
100,000 people over the period of
seven years. DT
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.
Distinguished by innovation
Healthy teeth produce a radiant smile. We strive to achieve this goal on a daily basis. It inspires
us to search for innovative, economic and esthetic solutions for direct filling procedures and
the fabrication of indirect, fixed or removable restorations, so that you have quality products
at your disposal to help people regain a beautiful smile.
www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
[2] =>
DTAP1211_01_Title
DTAP1211_02_News 12.12.11 15:30 Seite 1
2
DENTAL TRIBUNE Asia Pacific Edition
Advertorial
Early osseointegration to hydrophilic and
hydrophobic implant surfaces in humans
Prof. Niklaus P. Lang
Switzerland
The surface characteristics of
titanium implants influence
the rate and degree of osseointegration. Moderately rough
surfaces such as SLA® have
demonstrated superior boneto-implant contact (BIC) than
surfaces such as titanium
plasma-sprayed (TPS), Al2O3blasted or machined surfaces. Chemical modification, such as with the
hydrophilic SLActive®
surface, can further enhance the osseointegration process.
tromolar region of 28 healthy
volunteers. A healing cap with
an internal screw assembly
was attached to the coronal
part of the implant. After submerged healing periods of 7, 14,
28 and 42 days, the implants
were removed using a specially
designed trephine, which removed the implant and circumferential tissue of 1 mm thickness.
Investigations comparing osseointegration
with various implant surfaces have been performed, but tend to be in
vivo animal studies. No
data are available from
human studies, and the
healing sequence of the
early osseointegration
process in man and how
it compares to the process–seen in other in vivo
investigations–is relatively unknown.
The aim of this investigation, therefore, was
to evaluate the rate and degree
of osseointegration at two different implant surfaces (SLA®
and SLActive®) during the early
phases of healing in a human
model.
Materials and methods
A total of 49 specially designed titanium implants (length
4 mm, outer diameter 2.8 mm)
with either a SLA® or SLActive®
surface were placed in the re-
imens. Artifacts were present on
a number of specimens—these
areas were excluded from analysis so that only artifact-free regions were evaluated. The percentages of new bone-to implant
contact after 7, 14, 28 and 42 days
are shown in Table 1.
After seven days, no differences were observed between
the SLA® and SLActive® specimens. BIC was approximately 6 %, and some
early bone apposition
was noted in places
where existing bone was
in close contact with the
implant surface; bone
therefore bridged a gap
between old bone and
implant in these situations. The majority of the
space between bone and
implant was filled with
soft tissue comprising
primitive matrix with
various bone debris particles.
Results
BIC increased to
12.2 % and 14.8 % for
SLA® and SLActive®, respectively, after 14 days.
Bone formation was
noted on the existing
bone, extending partly
onto the implant surface. The beginning of new bone
apposition was evident over
large areas of the surface of
the SLActive® implants. Larger
bone particles were seen to be
surrounded by osteoid, which
helped trabecula formation.
Healing was uneventful at all
sites. Of the 49 implants placed,
30 were available for histological/histometric analysis; difficulty in harvesting the biopsies
resulted in the loss of some spec-
BIC increased in both sample
types by day 28, but was significantly higher with SLActive®
(48.3 %) than with SLA® (32.4 %).
A bony coating was observed
Histological sections were
prepared and histometric analyses performed for amounts of
new bone, old bone, bone debris,
soft tissue and BIC.
Fig. 1: Light micrograph of the implant-tissue interface at a SLA® surface after
28 days (arrows indicate new bone).—Fig. 2: Light micrograph of the implanttissue interface at a SLActive® surface after 28 days (arrows indicate struts of woven
bone trabeculae extending from old bone, or OB, towards the implant surface).
with both specimen types (Fig. 1
and Fig. 2), but almost complete
BIC was observed within some
threads of the SLActive® implants
(Fig. 2), and new mineralized
bone trabeculae were observed
extending into the provisional
matrix.
After 42 days, BIC increased
further to 62 % for both SLA® and
SLActive®. An advanced stage of
bone maturation was observed
with both surfaces, and the formation of Osteons was observed
away from the implant surface.
The osteocoating was noted to
be thick and extensive, and was
frequently connected via trabeculae, extending onto new
bone.
Conclusions
Similar healing patterns were
observed for both SLA® and
SLActive® implants. Osseointegration (BIC) was greater after
AD
NE W
SHA
DE
Highest quality made in Germany
high quality glass ionomer cements
first class composites
innovative compomers
modern bonding systems
u s at s –
t
e
e
n
M
ib it io
h
x
e
ral
ca . d e
i
seve
d
e
rom
p
.
w
ww
Glass ionomer FILLING cement
s PERFECT packable consistency
s EXCELLENT durable aesthetics
s also available as application capsules
s NOW AVAILABLE IN SHADE !
materials for long-term prophylaxis
temporary solutions
bleaching products…
All our products convince by
excellent physical properties
perfect aesthetical results
PROMEDICA Dental Material GmbH
Tel. + 49 43 21 / 5 41 73 · Fax + 49 43 21 / 5 19 08
Internet: http://www.promedica.de · eMail: info@promedica.de
Innovative luting system
s SUITABLE FOR ALL MATERIAL CLASSES
s NO ETCHING AND NO BONDING
s FAST AND EASY CEMENTATION OF ENDODONTIC POSTS
s DUAL CURING FOR FLEXIBILITY AND SAFETY
Dental desensitizing varnish
s TREATMENT OF HYPERSENSITIVE DENTINE
s FAST DESENSITIZATION
s FLUORIDE RELEASE
s EASY AND FAST APPLICATION
14 days and significantly greater
after 28 days for SLActive®. The
rate of osseointegration was
substantially slower (approximately double the healing time)
in humans than that observed
in animal studies. This is the
first study to demonstrate histologically the osseointegration
process with SLActive® in humans. DT
This article first appeared in Clinical
Oral Implants Research, 2011, 22,
pages 349–356.
Contact Info
Prof. Niklaus P. Lang is working
as professor at the Department of
Periodontology and Implant Dentistry, Prince Philip Dental Hospital, The University of Hong Kong.
He can be contacted at info@straumann.com.
[3] =>
DTAP1211_01_Title
DTAP1211_03_News 12.12.11 15:32 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Asia News
Philippines comes out tops in DENTSPLY
Asia Student Clinician Competition
From news reports
SINGAPORE/MANILA, Philippines: A dental student enrolled
at the Centro Escolar UniversityMalolos School of Dentistry in
Manila in the Philippines has won
DENTSPLY’s 2011 Student Clinician Competition for Southeast
Asia. Twenty-two-year-old Kime
Calbaquinto was recognised for
her outstanding research in the
field of dentistry.
Aussies
spend more
on dental
services
This is the first time that a
Filipino dental student has won
the annual competition. During
a first attempt to win the trophy in
2009, representatives from the
Southeast Asian country only
finished third place. As the winner, Calbaquinto will become a
member of the Student Clinician
American Dental Association
and receive travel funding to represent the International Association for Dental Research SouthEast Asia division at next year’s
session of the American Dental
Association in San Francisco,
university officials said.
This year’s competition was
held in conjunction with the 25th
Convention of the International
Association for Dental Research
and 22nd Annual Meeting of the
South East Asia Association for
Dental Education in Singapore
and joined by winners of national
student clinicians competitions
held in countries like Malaysia,
Singapore, Vietnam and Indonesia.
US-based dental equipment
manufacturer DENTSPLY has
organised the annual contest for
undergraduate students in the
USA since 1959 and has since ex-
ported the concept to more than
35 countries worldwide. DT
AD
80 Ncm
Powerful for surgery
Daniel Zimmermann
DTI
HONG KONG/LEIPZIG, Germany:
Australians incurred more out-ofpocket expenses on dental services last year, a new report on oral
health and dental care released by
a government agency has found.
According to the paper, the overall
dental expenditure in 2009–2010
increased by more than 10 per cent
to AUS$7.6 billion (US$5.67 billion).
The report published by the
Australian Institute of Health and
Welfare (AIHW) in Canberra
gathered information from surveys conducted and managed by
the Australian Research Centre
for Population Oral Health. It
also found that over two-thirds of
adults in the country had to pay
for various dental treatments outof-pocket, despite having insurance and nine per cent had to pay
for their dental expenses fully.
The results could fuel demands for the creation of a universal Denticare scheme by the
Green party, who made improved
access to dental care a condition
for a coalition with the Labor
party in last year’s federal elections. Both parties have clashed
repeatedly over the issue in the
last twelve months.
As a basic commitment, the
government recently announced
that it would provide additional
funding of AUS$55 million (US$56
million) for dental care next year
and set up a National Advisory
Council on Dental Health in order
to develop recommendations on
the reform of the deficient public
dental health care system. Prior
to that, Labor angered its coalition partner with plans of scrapping dental funding from its 2012
budget entirely.
According to the AIHW report, almost 30 per cent of adult
Australians had untreated tooth
decay in 2006,. It also found that
every second teenager had caries
in their permanent teeth at the
age of 15. DT
3
The new Elcomed from W&H: logical and easy to use. Uncompromising
in performance: with a torque of up to 80 Ncm on the rotating instrument,
the surgical drive unit guarantees smooth usage, which can be completely
documented at no further cost thanks to an integrated USB interface.
These are just three of the many advantages of the new W&H Elcomed.
wh.com
Captivation and precision
[4] =>
DTAP1211_01_Title
DTAP1211_04_News 12.12.11 15:33 Seite 1
4
DENTAL TRIBUNE Asia Pacific Edition
Opinion
A leap for endodontics A specialty cemented in biology
Prof. Beena Rani Goel
India
The single most important
development that was a giant
leap for endodontics is microcomputed tomography, by giving
us a 3-D view of the area in which
we have to work. Without this
technology, the basis for many
endodontic procedures was just
empirical. For example, enlarging the root canal three sizes
beyond the first file that binds, or
arbitrarily deciding the final apical size with tapered rotary use
during hand instrumentation
does not have any scientific basis
at all.
The work of Prof. Marco A.
Versiani on the root-canal anatomy project has provided us
with a micro-CT study guide that
has demystified many old concepts. Now we know that all root
soon with a number of applications in access preparation, rootcanal shaping, and decontamination of the root-canal system.
The improved technology has
introduced endodontic fibres
and tips of a calibre and flexibility that permit insertion up to
1 mm from the apex. Laterally
emitting conical fibre tips were
found to be safe under defined
conditions for intra-canal irradiation without harmful thermal
effects on the periodontal apparatus.
The EndoVac irrigation system (Discus Dental) is one of the
best things that has happened to
endodontics in recent years.
While sodium hypochlorite is the
only endodontic irrigant capable
of significantly eliminating the
biofilm associated with endodontic infections, it has the
tendency to cause catastrophic
tissue damage when extruded.
With EndoVac, fortunately, it
can now be safely delivered to
“...it is heart-warming to see
that recent developments in
endodontics can maintain the
tooth in a functional state.”
canals are curved, apical diameters are not as small as perceived,
and root canals do not have large
tapers.
Regenerative endodontics,
though in the infant stage, can
hold significant implications for
the management of necrotic immature teeth. This applies to the
advances in tissue engineering
and the regeneration of the
pulp–dentine complex.
Multiple studies have shown
that continued root development can be accomplished after
disinfection of the root-canal
system, evoked bleeding inside
the root canal, and adequate
coronal seal. These treatment
protocols can result in radiographic and clinical evidence
of healing and subsequent root
development that has been attributed to regeneration of tissue.
Until recently, the clinical
presence of stem cells in the
canal space after this procedure
had not been proven. New findings by Tyler W. Lovelace et al.
demonstrated that the evokedbleeding step in regenerative
procedures triggers the significant accumulation of undifferentiated stem cells in the canal
space, where these cells might
contribute to the regeneration of
pulpal tissues. Future developments may see wider application
of these tissue-engineering principles, which have the potential
to revolutionise the field of endodontics.
The use of lasers in endodontics may be common procedure
full working length. A SEM image taken at 0.75 mm from the
apical termination demonstrates
completely clean walls at this
level, which has not been achievable with other irrigation systems. Research has also shown
that the use of EndoVac can result in a significant reduction of
post-operative pain levels in
comparison with conventional
needle irrigation.
According to the latest microCT studies, the apical thirds are
not cleaned with tapered systems of small tip size. In addition,
they showed that instruments
with a flat widened tip determine
apical cross-sectional diameter
better than round tapered instruments. The coming years are
bound to see an increased acceptance of LightSpeed LSX instruments (Discus Dental) to obtain
biologically optimal preparations.
At a time when dental professionals have a choice between
root-canal treatment and implant placement after extraction,
it is heart-warming to see that
recent developments in endodontics can maintain the tooth
in a functional state for many
years, if incorporated into the
surgery. DT
Contact Info
Prof. Beena Rani Goel is President
of the International Academy for
Rotary Endodontics and a wellknown endodontist from India.
She can be contacted at profgoel@
gmail.com.
Dr Young-Guk Park
South Korea
The ultimate goal of any orthodontic treatment is to obtain better
aesthetics of the dentition and the
face, and the health of the periodontium, TMJ and longevity of
the dentition throughout life by
means of accurate diagnosis and
mechanotherapy upon malocclusion and dento-facial disharmonies. Bringing all these propositions together requires discarding
empirical and conceptual orthodontic planning by adopting 3-D
movement algorithms for each
tooth and, accordingly, design of
corresponding biomechanics.
Orthodontic tooth movement
results from forces that evoke cellular responses in the teeth and
their surrounding tissues, including the periodontal ligament, alveolar bone and gingiva. It is advantageous for the orthodontist to
control the details of the biological
events that unfold during tooth
movement, as some of these details
may differ from one person to another owing to variables such as
sex, age, psychological status, nutritional habits or drug consumption. Biological variations may be
the foundation of the differences
that are frequently observed in the
outcomes of orthodontic treatment
between patients with similar malocclusions but identical treatment.
Principles of orthodontic biomechanics are usually taught with
the help of a typodont, consisting of
artificial teeth embedded in wax.
This set-up ignores entirely the biological aspect of tooth movement.
However, in the clinical setting,
living patients are encountered,
and mechanical forces mobilise
their teeth. These movements result from the development of
strains in dental and para-dental
tissues, followed by modelling and
remodelling of these tissues.
In some patients, systemic conditions may exist, evoking complications such as root resorption,
dehiscences and fenestrations of
the alveolar bone. Hence, clinical
orthodontics must be viewed as a
specialty cemented in biology, all
the way down to the molecular
level. As a clinical profession, it
must be based also on profound
knowledge of mechanics, biology,
physiology, and pathology.
The usual rate of tooth movement by conventional protocols
of mechanotherapy is approximately 1 mm per month. The suggested minimal intervention, surgically assisted orthodontics is
a minimally invasive peri-orthodontic procedure without flap
elevation, which accelerates tooth
movement with an enhanced
turnover rate of surrounding
structures. This milieu is clinically
expedient with sound biological
foundation, and makes the orthodontic outcome more stable and
less prone to complications. It has
elucidated the evidence that minor surgical procedures by orthodontists obtained accelerated
rates of tooth movement with impunity, and enhanced the rate of
bony and periodontal response,
thereby shortening the duration of
treatment.
Clinical orthodontics has seen
innovative change with the rise of
digital dentistry as these applications have brought cutting-edge
technology to diagnosis and treatment. Laser scanning, structure
photo-imaging, and surface image
analysis have almost superseded
the stone model in the clinical
environment. In addition, these
technologies enable clinicians to
achieve an intended treatment result through individual custom appliances made possible by robotics
that allow sophisticated individual tooth positioning, a procedure
that was not possible with conventional preformed appliances.
These diverse technologies
bring the prospective adjustment
in fundamental framework of the
conventional treatment, and consequently improve the accuracy of
the orthodontic correction. DT
Contact Info
Dr Young-Guk Park is Professor
of Orthodontics at Kyung Hee University in Seoul in South Korea.
He can be contacted at ygpark@
khu.ac.kr.
Harmonic teeth, muscles and joints
Dr Sushil Koirala
Nepal
Since I have been involved in
cosmetic dentistry, the field has
been dominated by the Hollywood
concept of wide and symmetrical
white smiles regardless of age,
sex and ethnicity. Cosmetic orientation has also been influenced for
many years by fashion and the media that have been encouraging
clinicians to compromise biological function in favour of the cosmetic desires of the patients.
Fortunately, public taste in
smile aesthetics is moving towards
the naturo-mimetic concept and
the one-fit-for-all smile design concept is slowly fading. Nowadays,
an increasing number of clinicians
are adopting a customised smile
design approach that respects patients’ actual needs, age, sex, ethicality and financial resources.
With an increased advocacy
of ethical cosmetic dentistry on
a global scale, clinicians are becoming much more aware about
the loss of biological function in
the treatment they are providing.
It has been very encouraging to
see that during the recent IFED
meeting in Brazil, many of the
speakers discussed concepts like
minimally invasive cosmetic den-
tistry (MICD), which they are applying in their practices. With this
in mind, I can clearly foresee that
in the years to come cosmetic dentistry will fully embrace the MICD
concept and treatment protocols
that promote healthy, functionally
balanced and aesthetic smiles.
criteria by which to evaluate clinical success in cosmetic dentistry.
The value of function will be much
better understood by cosmetic
dentists and the concept of TMJ
harmony will be implemented to
promote naturally pleasing and
functionally balanced smiles.
With new digital diagnostic
and restorative tools, accuracy and
the period necessary for treatment
are becoming important factors in
cosmetic dentistry. Treatment using high magnification and good
illumination combined with digital case documentation could become mandatory clinical protocol
in the years to come.
As far as restorative materials
are concerned, the field will see a
rising demand for healing effects,
for example, to prevent hard and
soft tissue loss. Restorative technologies will also more likely
move towards direct restorative
processes.
Another area of change will be
case finishing. Currently, the field
focuses primarily on micro-aesthetic components such as colour,
optical properties, shape, proportion, texture, and surface and margin finish, while neglecting biological factors like individual tooth
contact forces and timing, which
are key to achieving a functionally
balanced bite. This lack of force
finishing in cosmetic dentistry
can result in frequent restoration
fractures or myofascial pain dysfunction syndrome, a condition
that often occurs after treatment.
Cosmetic dentists will most likely
adopt the force finishing concept
in their finishing protocol.
Harmonic teeth, muscles and
joints (TMJ) will become major
It is difficult to predict what
technologies will shape the field of
cosmetic dentistry in the future, but
in my view, technology in general
will be more focused on decreasing
the loss of biological function,
while minimising financial costs
and time spent on treatment. It will
be more focused on the holistic goal
to achieve overall health, function,
aesthetics and positive psychological impact after treatment. DT
Contact Info
Dr Sushil Koirala is the Founding
President of the Vedic Institute of
Smile Aesthetics and maintains a
private practice that focuses primarily on MICD in Kathmandu,
Nepal. He can be contacted at
skoirala@wlink.com.np.
[5] =>
DTAP1211_01_Title
DTAP1211_05_News 12.12.11 15:33 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
World News
5
Ban on HIV dentists in the UK could be lifted
From news reports
LONDON, UK: HIV-positive dentists and doctors in the UK could
soon be allowed to practise again,
provided they are taking antiretroviral drugs and are being
monitored, British media report.
According to newspaper The
Independent, the UK Department
of Health is to announce that the
automatic ban on dentists and
doctors with HIV carrying out
procedures that might potentially lead to blood contamination
could soon be lifted.
The newspaper has learnt
that ministers are planning to
hold a consultation before Christmas to obtain views from across
the medical and dentistry professions, as well as from experts and
members of the public. A final decision will probably be made in
2012.
The possible regulation change
comes after a study of the evidence
presented to the Chief Medical
Officer Dame Sally Davies, which
concluded that the risk of transfer
during any medical procedure is
now negligible and the likelihood
of any infection to be as low as one
case every 2,400 years.
The prohibition, which has
been in place for 20 years, forbids
health workers in the UK who are
infected with HIV to perform exposure-prone procedures. Hospitals and dental surgeries have
long followed a “don’t ask, don’t
tell” policy with regard to HIV
positive practitioners, sources in
the medical profession told the
newspaper. They believe that—
regardless of the emotive nature
of HIV—the policy can no longer
be justified on public health
grounds and that it is therefore
clearly discriminatory. DT
According to latest news reports, HIVpositive dentists and doctors in the
UK could soon be allowed to practise
again. (DTI/Photo lenetstan )
AD
To the Editor
Re: “Editorial: Use of botox
is a medical procedure”
(Dental Tribune Asia Pacific
Vol. 9, No. 11, page 4)
Pretty well everything about dentistry was covered at a basic level to
enable graduation, just as medical
practitioners graduate with very basic
information. The test for medical and
dental practitioners is how conscientiously they pursue CPD throughout
their careers. If the dental or medical
practitioner has attended approved
courses in botox therapy, and has
taken the subject seriously, there
should be no problem with him/her
administering botox. I’m a dental
practitioner, and choose not to administer botox for cosmetic purposes.
Currently, I would regard myself as
requiring further information and
training before using it in any form.
However, I feel confident that under
the right tutors I would acquire the
skills required quickly. My colleague
is very experienced and is “only a
general dentist”, but he has spent considerable time and money to acquire
the necessary education, training and
competence. Use of botox is a medical
procedure. Dentistry is a medical specialty. Dentists are more than competent to administer botox if trained
properly.
S
SIMPLY
IMPLY B
BETTER
ET TE R
S
TR AUM ANN ® SL
SLActive
STRAUMANN
Active
The next generation in sur
surface
face technology designed to deliver:
1, 2
Higher security and faster osseointegration for ever
everyy indication1,2
down to 3
– 4 weeks3
3–4
Reduced healing times from 6
6–8
– 8 weeks
Increased treatment predictability in critical protocols1
More information on www.straumann.com
Dr Martin Edwards, 01 Dec. 2011
“Secondly, the detailed anatomy
of the mid-face, orbit, upper face and
neck is not covered in dental training
at a level sufficient for the safe use
of botox”— I don’t know where you
went to dental school but I was trained
A LOT on head and neck anatomy.
I completed a dermatology rotation
in my residency. The pharmacology
coursework taught me to evaluate
new drugs, not just memorise the
properties of existing drugs. Cosmetic
dentistry and cosmetic medicine
don’t overlap? Get a grip; your arguments are very weak.
Dan, 01 Dec. 2011
Ganeles
G aneles e
ett a
al.
l. C
Clin.
lin. O
Oral
ra l IImpl.
m p l. RRes.
e s. 2
2008;19:1119-1128
0 0 8;19:1119 -1128
Bornstein
B o rn st e in et
e t al.
a l. J Periodontol.
Pe rio d o n t o l. 2010
2010 Jun;81(6):809-819
J u n;81(6):8 0 9 - 819
3
Oates
O a t e s et
e t al.
a l. TThe
h e IInternational
n t e rn a tio n a l Journal
J o u rn a l of
o f Oral
O ra l & Maxillofacial
M a xi l l o f a ci a l
Implants.
2007;22(5):755-760
I m p l a n t s. 20
07;22(5):755 -76 0
For
more
details
SLActive
Fo r m
o re d
e t ail s ssee
e e ssummary
ummar y S
L A ctive ® Scientific
S cie ntifiicc S
Studies.
t u die s.
1
2
Dental Tribune
welcomes comments,
suggestions and
complaints at feedback@
dental-tribune.com
[6] =>
DTAP1211_01_Title
DTAP1211_06-07_Warriors 13.12.11 10:24 Seite 1
6
DENTAL TRIBUNE Asia Pacific Edition
World News
Warriors of oral health
DTI’s Group Editor Daniel Zimmermann recently gained an exclusive insight
into the European Headquarters of the US Army Dental Corps.
LEIPZIG/HEIDELBERG, Germany:
The spirit of General Patton is
greeting patients at the door. Only
a few metres away from the hospital room where one of America’s
most famous war heroes regrettably died in 1945, Lieutenant
Colonel Cathleen Labate has just
begun her daily shift. The dental
provider from New Hampshire is
one of almost 100 army dentists
currently serving in the Europe Regional Dental Command (ERDC) at
the Nachrichten Kaserne in Heidel-
berg, a small German town idyllically situated along the edge of
the Odenwald forest. There she is
jointly responsible for the oral
health of several hundred soldiers
and their family members in the
surrounding Army communities.
Labate was recently assigned
to another Army dental clinic in
Vicenza in Italy. Prior to that, the
descendant of German-Italian
immigrants worked in private
practice in the US for almost
20 years. The oral health of sol-
AD
Tetric N-Collection
®
A complete nano-optimized restorative system
diers she sees at the base on a daily
basis is often better that those of
the patients she treated during
her career as a dentist in rural
America. Consequently, the most
common procedures here are
regular dental exams and emergency work like the removal of the
periodontal abscess of a retired
army officer who has just left her
office. “Generally speaking, the
oral health of people in the military is good,” she says. “Although
I have to admit that missions
like those in Iraq and Afghanistan
can seriously take their toll on soldiers’ teeth.”
Colonel William R. Bachand
could not agree more. The 58-yearold Commander of the ERDC has
been with the Army Dental Corps
for more than 32 years. In stressful
situations like armed conflicts, he
says, oral hygiene quickly declines
with every single soldier. Along
with the high in-take of acid and
sugar-rich fluids, especially in hot
climates like Afghanistan, this negligence often leads to major dental
problems, a phenomenon that Army
dentists experienced in earlier conflicts like Korea or Vietnam. At the
beginning of the last two US engagements in Iraq, for example, statistics showed a 30 per cent increase
in returning soldiers with signs of
rampant caries or gingivitis.
Bachand currently commands
over 20 army dental clinics, spread
over US bases in Germany, Italy and
Belgium. Worldwide, the military
employs over a thousand dental officers in three major regions—the
US, Europe and the Pacific. Before
he took command of the ERDC
from Colonel Randall Ball last year,
Bachand served as the commander of the Pacific Regional Dental
Command in Hawaii, a post very
different in many aspects to that in
Europe.
“In the Pacific you have a
smaller population but huge distances to cross between each base
and clinic,” he says. “In Europe,
everything is conveniently reachable at a driving distance.”
EXPLORE OUR LATEST COLLECTION
Tetric N-Collection
®
®
-Ceram |
®
-Flow |
®
-Bond |
®
-Bond Self-Etch
www.ivoclarvivadent.com
Ivoclar Vivadent AG Clinical
Bendererstr. 2 | FL 9494 Schaan | Liechtenstein | Tel.: + 423 / 235 35 35 | Fax: + 423 / 235 33 60
Ivoclar Vivadent Marketing (India) Pvt. Ltd.
503/504 Raheja Plaza | 15 B Shah Industrial Estate | Veera Desai Road, Andheri (West) | Mumbai 400 053 | India
Tel.: +91 (22) 2673 0302 | Fax: +91 (22) 2673 0301 | E-mail: india@ivoclarvivadent.com
Ivoclar Vivadent Marketing Ltd. Singapore
171 Chin Swee Road | #02-01 San Centre | Singapore 169877 | Tel.: +65 6535 6775 | Fax: +65 6535 4991
Bachand’s scope of duty could
soon become even smaller, as the
US Army is in the process of significantly pulling back troops from
Europe. According to the latest
plans of the US Department of Defense, over 4,000 soldiers are to be
relocated to the US mainland over
the next two years. For the ERDC,
this would mean the closure of
several clinics and the relocation
of dental personnel. In Germany,
the clinics in Heidelberg and
nearby Mannheim in particular
will be closed by 2013, a process
that comes with numerous challenges, says Bachand.
“This transformation will be
complex because owing to the
closure of Army bases, large numbers of soldiers are moving within
Europe. In addition, we’ll try to
minimise job losses of our civilian
[7] =>
DTAP1211_01_Title
DTAP1211_06-07_Warriors 13.12.11 10:24 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
World News
to stay in touch with the latest
technology-driven changes like
CAD/CAM or cone-beam computed tomography,” Bachand
comments. “Compared to when I
started in the service over 30 years
ago, almost every aspect of our
field has now become computerised, beginning from the
workload reporting to the scheduling system, diagnosis or treatment.”
seem to be an option for Bachand
anymore.
“What I like especially about
military dentistry is the group
practice approach and the possibilities to really focus on the
clinical needs of every individual patient. Even though we have
to be responsible financial stewards, we do not have to worry
so much about the business aspects in regard to specific treatment for patients,” he concludes.
“I would never trade that experience.” DT
Despite the more stable lifestyle, switching places with dentists in the civil world does not
AD
contractors like German dental
technicians we usually hire from
the nearby areas,” he tells Dental
Tribune.
Cavex ImpreSafe
Serving for more than
100 years
Dentists have always been
part of US military forces. Before
Congress signed the bill for the
establishment of a commissioned
Dental Corps in 1911, dentists and
other health care professionals
had been working for the Army
on a contract basis since the Revolutionary Wars of the 18th century.
Full financial and operating autonomy, however, was not achieved
until 1977 when the dental command was finally separated from
the medical service, a command
structure that had previously led
to low morale and retention rates
amongst dental officers.
B
LA
TO
RINSE AND SEND
SSIO
N
Most CE courses in Europe,
however, are organised with local
providers such as the Kopf clinic
at the Heidelberg University’s
Faculty of Medicine, which has
collaborated with the ERDC for
many years.
RE
According to Bachand, the
Corps is currently short a few hundred officers worldwide, despite
the fact that Army dentists are
much on par with their civilian
counterparts and enjoy several
advantages like paid education or
a concise career development
plan. Each year, for example, the
Army provides them with 30 hours
of continued education and even
sends specialists back to the States
for conferences like the recent
annual congress of the American
Dental Association in Las Vegas.
P
IM
Most army dentists enter the
service through the Health Professions Scholarship Program, a
competitive one- to four-year paid
educational programme available
for several medical-related posts
throughout the military forces.
Others are directly recruited by the
Army, including many older dentists who often want to do a last
service for their country.
FAST, SAFE, EFFECTIVE AND ECONOMIC
E
NS
RI
Nowadays, the dental service
in Europe alone has an annual
budget of US$18 million, of which
the most part is spent on personnel
and dental equipment. In terms
of dental supplies, the Army rides
the patriotic train, with all chairs
being provided solely by US manufacturers like A-dec and Pelton
& Crane. Long-term contractor
Henry Schein also just closed another exclusive US$172 million
contract with the service for 2012.
3
min.
DISINFECT
PREVENT CROSS CONTAMINATION
2011
Top Infection
Control Product
CAVEXYOUR IMPRESSION IS OUR CONCERN
Cavex ImpreSafe is an alginate, polyether and silicone disinfectant. In only 3 minutes Cavex ImpreSafe kills
bacteria, viruses and fungi without damaging the surface of the impression. Cavex ImpreSafe is a concentrate.
1 litre = 33 litre ready-to-use disinfectant = 33 weeks disinfected impressions!
As a result Cavex ImpreSafe is economical, cost effective and uses little storage space.
Cavex Holland BV, P.O. Box 852, 2003 RW Haarlem, The Netherlands. Tel +31 23 530 77 00 Fax +31 23 535 64 82 dental@cavex.nl www.cavex.nl
“Even more like our civilian
colleagues, Army dentists have
7
[8] =>
DTAP1211_01_Title
DTAP1211_08_Caricature 12.12.11 15:39 Seite 1
[9] =>
DTAP1211_01_Title
DTAP1211_09_Calender 12.12.11 15:39 Seite 1
[10] =>
DTAP1211_01_Title
DTAP1211_10-12_Olivi 12.12.11 15:40 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
10 Trends & Applications
Laser in endodontics (Part II)
Fig. 5
Fig. 6
Fig. 11
Fig. 12
Fig. 16
Fig. 17
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 13
Fig. 14
Fig. 15
Fig. 18
Fig. 19
Fig. 20
Fig. 5: Localisation to 1mm from the apex of the near infrared laser fibre and different penetration of the dentinal wall with Nd:YAG laser and diode 810 nm (on the right).—Fig. 6: Radial firing tips for
Er,Cr:YSGG laser.—Fig. 7: Undesirable thermal effects: during the retraction movement of the fibre of an Nd:YAG laser in a dry canal, contact with the dentinal wall can cause burns.—Fig. 8: Undesirable
thermal effects: during the retracting movement of an Er,Cr:YSGG laser tip used according to a traditional method, the tip contacting the dry dentinal wall causes burns, ledging and transportation of canals.
—Figs. 9 & 10: SEM images of radiated dentine with Nd:YAG laser (dry, 1.5 W, 15 Hz). Note the extensive areas of dentinal melting and bubbles. (Figures 9–16 courtesy of Prof Vasilios Kaitsas, Aristotle University of Thessaloniki, Greece.)—Figs. 11 & 12: SEM images of radiated dentine with diode 810 nm laser (dry, 1.5 W, 15 Hz) with 50 % ton-toff and 200 µm fibre, showing evidence of thermal effects, with detachment and smear layer.—Figs. 13 & 14: SEM images of irradiated dentine with Er,Cr:YSGG laser (1.0 W, 20 Hz, 1 mm to the apex), spray off and canal irrigated with physiological solution, showing evidence
of smear layer and thermal damage.—Figs. 15 & 16: SEM images of irradiated dentine with Er,Cr:YSGG laser (1.5 W, 20 Hz) with air/water spray of 45/35 %, showing open dentinal tubules without evidence
of a smear layer. Note the typical pattern of laser ablation, both on the organic and inorganic dentine.—Fig. 17: Localisation 1 mm from the apex of the fibre and tips of the near and medium infrared lasers.
According to the LAI technique, the tip must be localised in the middle third of the canal, approximately 5mm from the apex (on the right).—Figs. 18–20: PIPS tip, radial firing, in quartz, 400 µ. The 3 mm
terminals were deprived of their outer coating to increase the lateral dispersion of energy.
Prof. Giovanni Olivi et al.
Italy & USA
After explaining the basic physics of the laser and its effects on
both bacteria and dentinal surfaces, the second part of this article series will analyse some of
the most important research in
the international literature today
and the new guidelines for the
use of laser as a source of activation of chemical irrigants.
Laser-assisted endodontics
Preparation of the access cavity
The preparation of the access
cavity can be performed directly
with Erbium lasers, which can
ablate enamel and dentine. In this
case, the use of a short tip is recommended (from 4 to 6 mm), with diameters between 600 and 800 µm,
made of quartz to allow the use of
higher energy and power. The importance of this technique should
not be underestimated.
Owing to its affinity to tissues
richest in water (pulp and carious
tissue), the laser allows for a minimally invasive access (because it
is selective) into the pulp chamber and, at the same time, allows
for the decontamination and removal of bacterial debris and pulp
tissue. Access to the canal orifices
can be accomplished effectively
after the number of bacteria has
been minimised, thereby avoiding the transposition of bacteria,
toxins and debris in the apical direction during the procedure.
Chen et al. demonstrated that bacteria are killed during cavity
preparation up to a depth of 300
to 400 µm below the radiated surface.20 Moreover, Erbium lasers
are useful in the removal of pulp
stones and in the search for calcified canals.
Preparation and shaping of canals
The preparation of the canals
with NiTi instruments is still the
gold standard in endodontics today.
In fact, despite the recognised ablative effect of Erbium lasers (2,780
and 2,940 nm) on hard tissue, their
effectiveness in the preparation of
root canals appears to be limited
at the moment and does not correspond to the endodontic standards reached with NiTi technology.21–23 However, the Erbium,
Chromium: YSGG (Er,Cr:YSGG) and
dentinal surfaces compared with
traditional rotary techniques.24
In a preliminary study on the effects of the Er:YAG laser equipped
with a microprobe with radial emission of 200 to 400 µm, Kesler et al.
found the laser to have good capability for enlarging and shaping in a
faster and improved manner compared with the traditional method.
The SEM observations demonstrated a uniformly cleaned dentinal surface at the apex of the coro-
Stabholz et al. presented positive results of treatment performed
entirely using a Er:YAG laser and
endodontic lateral emission microprobes.28,29 Ali et al., Matsuoka et al.
and Jahan et al.used the Er,Cr:YSGG
laser to prepare straight and curved
canals, but in these cases, the results of the experimental group
were worse than those of the control
group. Using the Er,Cr:YSGG laser
with 200 to 320 µm tips at 2 W and
20 Hz on straight and curved canals,
they concluded that the laser radia-
Fig. 21
Fig. 22
Fig. 23
Fig. 24
Fig. 25
Fig. 26
Figs. 21–23: SEM images of radiated dentine with radial firing tip, at 20 and 50 mJ, 10 Hz for 20 and 40 seconds, respectively, in a canal irrigated with EDTA, showing noticeable cleaning of debris and smear layer from the dentine and exposure of the collagen structure. (Figures courtesy of Dr Enrico DiVito, USA.)—Fig. 24: SEM images of radicular dentine
covered with bacterial biofilm of E. faecalis before laser radiation.—Figs. 25 & 26: SEM images of radicular dentine covered with bacterial biofilm of E. faecalis after radiation with Er:YAG laser (20 mJ, 15 Hz, PIPS tip) with irrigation (EDTA),
showing destruction and detachment of bacterial biofilm and its complete vaporisation from the principal root canal and
from lateral tubules. (Figures 25–29d courtesy of Drs Enrico DiVito and David Jaramillo, USA.)
the Erbium:YAG (Er:YAG) lasers
have received FDA approval for
cleaning, shaping and enlarging canals. A few studies have reported positive results for the efficacy of these
systems in shaping and enlarging
radicular canals. Shoji et al. used an
Er:YAG laser system with a conical
tip with 80 % lateral emission and
20 % emission at the tip to enlarge
and clean the canals using 10 to 40 mJ
energy at 10 Hz, obtaining cleaner
nal portion, with an absence of pulp
residue and well-cleaned dentinal
tubules.25 Chen presented clinical
studies prepared entirely with the
Er,Cr:YSGG laser, the first laser to
obtain the FDA patent for the entire
endodontic procedure (enlarging,
clearing and decontaminating),
using tips of 400, 320 and 200 µm
in succession and the crown-down
technique at 1.5 W and 20 Hz (with
air/water spray 35/25 %).26,27
tion is able to prepare straight and
curved (less than 10°) canals, while
more severely curved canals demonstrated side-effects, such as perforations, burns and canal transportation.21–23 Inamoto et al. investigated the cutting ability and the
morphological effects of radiation
of the Er:YAG laser in vitro, using
30 mJ at 10 and 25 Hz with a velocity
of extraction of the fibre at 1 and
2 mm/seconds, again with positive
results.30 Minas et al. reported positive results using the Er,Cr:YSGG
laser at 1.5, 1.75 and 2.0 W and 20 Hz,
with water spray.31
The surfaces prepared with the
Erbium laser are well cleaned and
without smear layer, but often contain ledges, irregularities and charring with the risk of perforations
or apical transportation. In effect,
canal shaping performed by Erbium laser is still a complicated procedure today that can be performed
only in large and straight canals,
without any particular advantages.
Decontamination of the
endodontic system
Studies on canal decontamination refer to the action of chemical
irrigants (NaClO) commonly used
in endodontics, in combination
with chelating substances for better
cleaning of the dentinal tubules (citric acid and EDTA). One such study
is that of Berutti et al., who reported
the decontaminating power of
NaClO up to a depth of 130 µm on
the radicular wall.32 Lasers were
initially introduced in endodontics
in an attempt to increase the decontamination of the endodontic system.2–7 All the wavelengths have a
high bactericidal power because of
their thermal effect, which, at different powers and with differing
ability to penetrate the dentinal
walls, generates important structural modifications in bacteria cells.
The initial damage takes place in
the cell wall, causing an alteration
of the osmotic gradient, leading to
swelling and cellular death.16,34
Decontamination with near
infrared laser
Laser-assisted canal decontamination performed with the near infrared laser requires the canals to be
prepared in the traditional way (apical preparation with ISO 25/30), as
[11] =>
DTAP1211_01_Title
DTAP1211_10-12_Olivi 12.12.11 15:40 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
this wavelength has no affinity and
therefore no ablative effect on hard
tissue. The radiation is performed at
the end of the traditional endodontic
preparation as a final means of decontaminating the endodontic system before obturation. An optical
fibre of 200 µm diameter is placed
1 mm from the apex and retracted
with a helical movement, moving
coronally (in five to ten seconds according to the different procedures).
Today, it is advisable to perform this
procedure in a canal filled with endodontic irrigant (preferably, EDTA
or citric acid; alternatively, NaClO)
to reduce the undesirable thermal
morphological effects.9,35–38
these bacteria.44 However, these
systems do not have a bactericidal
effect at depth in the lateral canals,
as they only reach 300 µm in depth
when tested in the width of the
radicular wall.8 Further studies
have investigated the ability of the
Er,Cr:YSGG laser in the decontamination of traditionally prepared
canals. Using low power (0.5 W,
10 Hz, 50 mJ with 20 % air/water
spray), complete eradication of bacteria was not obtained. However,
better results for the Er,Cr:YSGG
laser were obtained with a 77 % reduction at 1 W and of 96 % at 1.5 W.42
Trends & Applications 11
A new area of research has investigated the Erbium laser’s ability
to remove bacterial biofilm from
the apical third,46 and a recent in
vitro study has further validated the
ability of the Er:YAG laser to remove
endodontic biofilm of numerous
bacterial species (e.g. A. naeslundii,
E. faecalis, L. casei, P. acnes or F. nucleatum), with considerable reduction of bacterial cells and disintegration of biofilm. The exception to this
is the biofilm formed by L. casei.47
Ongoing studies are evaluating
the efficacy of a new laser tech-
nique that uses a newly designed
both radial and tapered stripped tip
for removal of not only the smear
layer, but also bacterial biofilm.13
The results are very promising. The
Erbium lasers with “end firing”
tips—frontal emission at the end of
the tip—have little lateral penetration of the dentinal wall. The
radial tip was proposed in 2007 for
the Er,Cr:YSGG, and Gordon et al.
and Schoop et al. have studied the
morphological and decontaminating effects of this laser system
(Fig. 6).48–50 The first study used a
tip of 200 µm with radial emission
at 20 Hz with air/water spray (34
and 28 %) and dry at 10 and 20 mJ
and 20 Hz (0.2 and 0.4 W, respectively). The radiation times varied
from 15 seconds to two minutes.
The maximum bactericidal power
was reached at maximum power
(0.4 W), with a longer exposure
time, without water in dry mode
and with a 99.71 % bacterial eradication. The minimum time of radiation (15 seconds) with minimum
power (0.2 W) and water obtained
94.7 % bacterial reduction.48
‡ DT page 12
AD
Using an experimental model,
Schoop et al. demonstrated the
manner in which lasers spread their
energy and penetrate into the dentinal wall, showing them to be physically more efficient than traditional chemical irrigating systems
in decontaminating the dentinal
walls.8 The Neodymium:YAG (Nd:
YAG; 1,064 nm) laser demonstrated
a bacterial reduction of 85 % at 1 mm,
compared with the diode laser (810
nm) with 63 % at 750 µm or less. This
marked difference in penetration is
due to the low and varying affinity of
these wavelengths for hard tissue.
The diffusion capacity, which is not
uniform, allows the light to reach
and destroy bacteria by penetration
via the thermal effects (Fig. 5).
Many other microbiological studies
have confirmed the strong bactericidal action of the diode and Nd:YAG
lasers, with up to 100 % decontamination of the bacterial load in the
principal canal.39–43 An in vitro study
by Benedicenti et al. reported that
the use of the diode 810 nm laser in
combination with chemical chelating irrigants, such as citric acid and
EDTA, brought about a more or less
absolute reduction of the bacterial
load (99.9 %) of E. faecalis in the
endodontic system.9
®
Panasil initial contact.
Precise, even in extreme situations.
The 3-D decontamination of the
endodontic system with Erbium
lasers is not yet comparable to that
of near infrared lasers. The thermal
energy created by these lasers is in
fact absorbed primarily on the surface (high affinity to dentinal tissue
rich in water), where they have
the highest bactericidal effect on
E. coli(Gram-negative bacteria), and
E. faecalis (Grampositive bacteria).
At 1.5 W, Moritz et al. obtained an
almost total eradication (99.64 %) of
021087_0911
Decontamination with medium
infrared laser
Considering its low efficacy in
canal preparation and shaping,
using the Erbium laser for decontamination in endodontics requires
the use of traditional techniques in
canal preparation, with the canals
prepared at the apex with ISO 25/30
instruments. The final passage with
the laser is possible thanks to the use
of long, thin tips (200 and 320 µm),
available with various Erbium instruments, allowing for easier reach
to the working length (1 mm from
apex). In this methodology, the traditional technique is to use a helical
movement when retracting the tip
(over a five- to ten-second interval),
repeating three to four times depending on the procedure and alternating
radiation with irrigation using common chemical irrigants, keeping the
canal wet, while performing the procedure (NaClO and/or EDTA) with
the integrated spray closed.
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
[12] =>
DTAP1211_01_Title
DTAP1211_10-12_Olivi 12.12.11 15:40 Seite 3
DENTAL TRIBUNE Asia Pacific Edition
12 Trends & Applications
fl DT page 11
The second study used a tip of
300 µm diameter with two different
parameters of emission (1 and
1.5 W, 20 Hz), radiating five times for
five seconds, with a cooling time of
20 seconds for each passage. The
level of decontamination obtained
was significantly high, with important differences between 1 and
1.5 W, with a thermal increase contained between 2.7 and 3.2 °C.49 The
same group from Vienna studied
other parameters (0.6 and 0.9 W)
that produced a very contained thermal rise of 1.3 and 1.6 °C, respectively, showing a high bactericidal
effect on E. coli and E. faecalis.50
presence of a smear layer, but with a
reduced area of melting, compared
with the carbonisation seen with
dry radiation. The best results were
obtained when radiation followed
irrigation with EDTA, with surfaces
cleaned of the smear layer, with
open dentinal tubules and less evidence of thermal damage.35–38 In the
conclusion of their studies on the
Erbium laser, Yamazaki et al. and
Kimura et al. affirmed that water is
necessary to avoid the undesirable
morphological aspects markedly
present when radiation with the
Erbium lasers is performed dry.56,57
The Erbium lasers used in this way
result in signs of ablation and thermal damage as a result of the power
and conical tips) with the external coating chemically removed—
were used to increase the lateral
diffusion of energy. The study was
designed to irradiate the root canals
that were prepared internally with a
dense smear layer grown experimentally. Comparing the results of
the groups that were laser radiated
with the groups that were not, the
study concluded that the laser activation of irrigants (EDTAC, in particular) brought about better cleaning and removal of the smear layer
from the dentinal surfaces.65 In a
later study, the authors reported
that this procedure, using power of
1 and 0.75 W, produces an increase
in temperature of only 2.5 °C with-
lasers (940 and 980 nm) with 200 µm
fibre to activate the irrigants at
powers of 4 W and 10 Hz, and 2.5 W
and 25 Hz, respectively. Considering the lack of affinity between
these wavelengths and water,
higher powers were needed which,
via thermal effect and cavitation,
produced movement of fluids in the
root canal, leading to an increased
ability to remove debris and the
smear layer.71 In a later study, the
authors also verified the safety of
using these higher powers, which
caused a rise in temperature of
30 °C in the intra-canal irrigant
solution but of only 4 °C on the external radicular surface. The study
concluded that irrigation activated
Fig. 27a
Fig. 27b
Fig. 27c
Fig. 27d
Fig. 28a
Fig. 28b
Fig. 28c
Fig. 28d
Fig. 29a
Fig. 29b
Fig. 29c
Fig. 29d
Figs. 27a–d: Confocal microscope images of the dentine of the root canal covered with biofilm (a). View in fluorescent light of bacterial biofilm (in green; b). Dentine
autofluorescence (in red; c). 3-D view superimposed (d).—Figs. 28a–d: Confocal microscope images of the dentine of lateral tubules covered in biofilm (a). View
in fluorescent light of bacterial biofilm (in green; b). Dentine autofluorescence (in red; c). 3-D view superimposed (d).—Figs. 29a–d: Confocal microscope image of
dentine (a). Autofluorescence with no sign of bacteria (b & c). 3-D view superimposed (d).
The need to take advantage of
the thermal effect to destroy bacterial cells, however, results in
changes at the dentinal and periodontal level. It is important to evaluate the best parameters and explore new techniques that reduce
the undesirable thermal effects
that lasers have on hard- and softtissue structures to a minimum.
Morphological effects on the
dentinal surface
Numerous studies have investigated the morphological effects
of laser radiation on the radicular
walls as collateral effects of rootcanal decontamination and cleaning performed with different lasers.
When they are used dry, both the
near and medium infrared lasers
produce characteristic thermal effects (Figs. 7 & 8).51 Near infrared
lasers cause characteristic morphological changes to the dentinal
wall: the smear layer is only partially removed and the dentinal
tubules are primarily closed as a
result of melting of the inorganic
dentinal structures. Re-crystallisation bubbles and cracks are evident
(Figs. 9–12).52–55
Water present in the irrigation
solutions limits the thermal interaction of the laser beam on the
dentinal wall and, at the same time,
works thermally activated by a near
infrared laser or directly vaporised
by a medium infrared laser (target
chromophore) with its specific action (disinfecting or chelating). The
radiation with the near infrared
laser—diode (2.5 W, 15 Hz) and
Nd:YAG (1.5 W, 100 mJ, 15 Hz)—
performed after using an irrigating
solution, produces a better dentinal
pattern, similar to that obtained
with only an irrigant.
Radiation with NaClO or chlorhexidine produces a morphology
with closed dentinal tubules and
used. There is evidence of ledge
cracks, areas of superficial melting
and vaporisation of the smear layer.
A typical pattern arises when
dentine is irradiated with the Erbium laser in the presence of water.
The thermal damage is reduced and
the dentinal tubules are open at the
top of the peri-tubular more calcified and less ablated areas. The inter-tubular dentine, which is richer
in water however, is more ablated.
The smear layer is vaporised by
radiation with Erbium lasers and
is mostly absent.58–64 Shoop et al.,
investigating the variations of temperature on the radicular surface in
vitro, found that the standardised
energies (100 mJ, 15 Hz, 1.5 W) produced a measured thermal increase
of only 3.5 °C on the periodontal surface. Moritz proposed these parameters as the international standard
of use for the Erbium laser in endodontics, claiming it as an efficient
means of canal cleaning and decontamination (Figs. 13–16).14,16
Even with Erbium lasers, it is advisable to use irrigating solutions.
Alternatively, NaClO and EDTA
can be utilised during the terminal
phase of laser-assisted endodontic
therapy with a resulting dentinal
pattern, with fewer thermal effects.
This represents a new area of research in laser-assisted endodontics. Various techniques have been
proposed, such as laser-activated irrigation (LAI) and photon-initiated
photo-acoustic streaming (PIPS).
Photo-thermal and
photomechanical phenomena
for the removal of smear layer
George et al. published the first
study that examined the ability of
lasers to activate the irrigating liquid inside the root canal to increase
its action. In this study, the tips of two
laser systems—Er:YAG and Er,Cr:
YSGG (400 µm diameter, both flat
out causing damage to the periodontal structures.66 Blanken and
De Moor also studied the effects of
laser activation of irrigants comparing it with conventional irrigation
(CI) and passive ultrasound irrigation (PUI). In this study, 2.5 % NaClO
and the Er,Cr:YSGG laser were used
four times for five seconds at 75 mJ,
20 Hz, 1.5 W, with an endodontic tip
(200 µm diameter, with flat tip) held
steady 5 mm from the apex.
The removal of the smear layer
with this procedure led to significantly better results with respect
to the other two methods.67 The
photomicrographic study of the
experiment suggests that the laser
generates a movement of fluids at
high speed through a cavitation effect. The expansion and successive
implosion of irrigants (by thermal
effect) generates a secondary cavitation effect on the intra-canal fluids. It was not necessary to move the
fibre up and down in the canal, but
sufficient to keep it steady in the
middle third, 5 mm from the apex.68
This concept greatly simplifies the
laser technique, without the need
to reach the apex and negotiate
radicular curves (Fig. 17a).
De Moor et al. compared the
LAI technique with PUI and they
concluded that the laser technique,
using lower irrigation times (four
times for five seconds), gives results comparable to the ultrasound
technique that uses longer irrigation times (three times for 20 seconds).69 De Groot et al. also confirmed the efficacy of the LAI technique and the improved results
obtained in comparison with the
PUI. The authors underlined the
concept of streaming due to the
collapse of the molecules of water
in the irrigating solutions used.70
Hmud et al. investigated the
possibility of using near infrared
by near infrared lasers is highly effective in minimising the thermal
effects on the dentine and the radicular cement.72 In a recent study,
Macedo et al. referred to the main
role of activation as a strong modulator of the reaction rate of NaOCl.
During a rest interval of three minutes, the consumption of available
chlorine increased significantly after LAI compared with PUI or CI.73
Photon-initiated photoacoustic
streaming
The PIPS technique presupposes the use of the Erbium laser
(Powerlase AT/HT and LightWalker AT, both Fotona) and its interaction with irrigating solutions
(EDTA or distilled water).13 The
technique uses a different mechanism from the preceding LAI. It
exploits the photoacoustic and
photomechanical phenomena exclusively, which result from the
use of subablative energy of 20 mJ
at 15 Hz, with impulses of only 50 µs.
With an average power of only
0.3 W, each impulse interacts with
the water molecules at a peak
power of 400 W, creating expansion
and successive “shock waves” and
leading to the formation of a powerful stream of fluids inside the canal,
without generating the undesirable thermal effects seen with other
methodologies.
The study with thermocouples
applied to the radicular apical third
revealed only a 1.2 °C thermal rise
after 20 seconds and 1.5 °C after
40 seconds of continuous radiation.
Another considerable advantage is
derived from the insertion of the
tip into the pulp chamber at the
entrance to the root canal only,
without the problematic insertion
of the tip into the canal or 1 mm
from the apex required by the other
techniques (LAI and CI). Newly
designed tips (12 mm in length, 300
to 400 µm in diameter and with
“radial and stripped” terminals)
are used. The final 3 mm are without coating to allow a greater lateral
emission of energy compared with
the frontal tip. This mode of energy
emission makes better use of the
laser energy when, at subablative
levels, delivery with very high peak
power for each single pulse of 50 µs
(400 W) produces powerful “shock
waves” in the irrigants, leading to
a demonstrable and significant mechanical effect on the dentinal wall
(Figs. 18–20).
The studies show the removal of
the smear layer to be superior to the
control groups with only EDTA or
distilled water. The samples treated
with laser and EDTA for 20 and
40 seconds show a complete removal of the smear layer with open
dentinal tubules (score of 1, according to Hulsmann) and the absence
of undesirable thermal phenomena,
which is cha racteristic in the dentinal walls treated with traditional
laser techniques. With high magnification, the collagen structure
remains intact, suggesting the hypothesis of a minimally invasive
endodontic treatment (Figs. 21–23).
The Medical Dental Advanced
Technologies Group, in collaboration with the Arizona School of
Dentistry and Oral Health (A. T. Still
University), the Arthur A. Dugoni
School of Dentistry (University of
the Pacific), the University of Genoa
and the University of Loma Linda’s
School of Dentistry, is currently investigating the effects of this rootcanal decontamination technique
and the removal of bacterial biofilm
in the radicular canal. The results,
which are forthcoming, are very
promising (Figs. 24–29).
Discussion and conclusion
Laser technology used in endodontics in the last 20 years has
undergone an important development. The improved technology
has introduced endodontic fibres
and tips of a calibre and flexibility
that permit insertion up to 1 mm
from the apex. Research in recent
years has been directed towards
producing technologies (impulses
of reduced length, “radial firing
and stripped” tips) and techniques
(LAI and PIPS) that are able to
simplify the use of laser in endodontics and minimise the undesirable thermal effects on the dentinal
walls, using lower power in the
presence of chemical irrigants.
EDTA has proved to be the best
solution for the LAI technique that
activates the liquid and increments
its chelating capacity and cleaning
of the smear layer. The use of
NaClO increases its decontamination activity. Finally, the PIPS technique reduces the thermal effects
and exerts a potent cleaning and
bactericidal action thanks to its
streaming of fluids initiated by the
photonic energy of the laser. Further studies are necessary to validate these techniques (LAI and PIPS)
as innovative technologies for
modern endodontics. 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.
[13] =>
DTAP1211_01_Title
DTAP1211_13-14_Stoboran 12.12.11 15:42 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Trends & Applications 13
Restoring extensive coronal lesions
A clinical case using IPS e.max from Ivoclar Vivadent
Fig. 1
Fig. 2
Fig. 3a
Fig. 3b
Fig. 3c
Fig. 3d
Fig. 4a
Fig. 4b
Fig. 4c
Fig. 4d
Fig. 4e
Fig. 5a
Fig. 5b
Fig. 5c
Fig. 5d
Fig. 6
Fig. 7
Fig. 1: Initial situation: extensive and deep lesion after endodontic treatment.—Fig. 2: The canine was used for shade determination. The antagonist served as comparison.—Figs. 3a–d: For the wash firing,
the framework was wetted with glaze liquid and sprinkled with dentin powder (B3).—Fig. 4a–e: Characterisation with stains and shades.—Figs. 5a–d: Anatomical layering with various ceramic materials.—Fig. 6: The result after the final firing cycle and polishing.—Fig. 7: The fully anatomically pressed restoration is ready for the staining technique.
Florin Stoboran
Romania
Laboratory-fabricated ceramic
in- and onlays and tabletops
offer dental technicians the
possibility to design a detailed
morphology and create a lifelike shade design. In this sense,
they are a good alternative to
direct restorations of posterior
teeth with composite resin.
This article will discuss the fascinating possibilities offered by
IPS e.max Press and IPS e.max
Ceram (Ivoclar Vivadent) for
the fabrication of all-ceramic
inlays.
With IPS Empress 2 and the IPS
Eris layering ceramic from Ivoclar
Vivadent, I discovered a special allceramic system seven years ago.
Back then, the company was praising the highly aesthetic results
that dentists were able to achieve
with this system, particularly with
regard to shade design in single
crowns, as well as in- and onlays.
I was interested to find out for myself and so I tested the system.
Although the material generally met my expectations, I found
that its strength was still not optimal for the fabrication of inlays
and onlays. Great care had to be
taken while sand-blasting the
thin restoration margins in order
to prevent them from breaking.
The entire processing therefore
became rather time-consuming.
However, this problem did not
keep me from continuing to work
with the material, as the aesthetic
results made all efforts worthwhile.
Meanwhile, the IPS e.max
Press lithium disilicate (LS2)
glass-ceramic ingots provide
dental technicians with a range
of materials that allows them to
meet all requirements in terms of
mechanical properties and aesthetics. Chipping, as it tended to
occur under time pressure, is a
thing of the past, thanks to an outstanding strength of 400 MPa.
The IPS e.max Press range
comprises five ingot types with
different translucencies. I currently use the LT, HT and Impulse
ingots for inlays and onlays (LT
= low translucency, HT = high
translucency).
Shade determination
Shade determination is crucial in the fabrication of ceramic
restorations. I usually take the canine as a reference, as this tooth
shows a very high dentine portion. In this clinical case, an LT ingot in the shade B3 was selected
owing to the size and depth of the
lesion (Figs. 1 & 2).
The shade of the cervical area
of the tooth was B3, and a brighter
shade was selected for the cusps
(B2). I wanted the restoration to
show a shade saturation from the
inside. Owing to the depth of the
defect, an LT ingot with lower
translucency and a lifelike brightness value and chroma was selected instead of an HT ingot. An
inlay of this size might have
shown a greyish shade effect if an
HT ingot had been used.
After the shade group had
been determined on the basis of
the canine, all following work
steps were completed within this
shade group, in this case shade
group B. To illustrate this: the canine in this case had the shade B3;
consequently, all the work was
planned to lighten up or darken
this shade according to the specific requirements.
To document this patient case,
two different approaches were
pursued. On the one hand, a cutback IPS e.maxPress framework
was layered with IPS e.max Ceram, and on the other hand, a fully
anatomical inlay was pressed and
characterised during the glaze
firing.
The layering technique
At the beginning, residues of
the investment material were removed from the framework with
aluminium oxide (110 µm, 2 bar/
29 psi). Subsequently, the surface
of the framework was sand-blasted with glass polishing beads.
Owing to the excellent strength of
the LS2 material, the risk of restorations breaking at the margins is
extremely low.
After the sand-blasting, glaze
liquid was applied in a thin layer
and dentine powder in the sameshade as the ingot was sprinkled
onto the framework. This procedure improves the bond between
the layering ceramic and the LS2
material and additionally creates
a “diamond effect” under incident
light (Figs. 3a–d).
After the initial firing cycle at
750 °C a stain firing was conducted, in the course of which fine,
more detailed characterisations
were designed. For this purpose,
highlights were created with stain
materials. Darker colours were
used in the deeper areas of the
restorations (central fossae) and
lighter colours in the elevated
areas (cusp tips; Figs. 4a–e).
The layering diagram applied
after stain firing was fairly
straightforward: dentine (B2) for
the cusps, some Opal Effect 2
(OE2) between the cusps towards
the central fossae (depth effect)
and some Transpa Incisal (TI1) to
imitate the anatomy of the posterior tooth. This layer, however,
was restricted to 0.2 mm below
the final restoration outline in
order to leave some room for
OE4 material, which is capable of
reflecting light to some extent
and, therefore, used often to imitate the whitish effect seen on the
cusp tips (Figs. 5a–d). After the
layering and another firing cycle
at 750 °C, I focused on the design
of the surface textures, which I
‡ DT page 14
AD
[14] =>
DTAP1211_01_Title
DTAP1211_13-14_Stoboran 12.12.11 15:42 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
14 Trends & Applications
fl DT page 13
Fig. 8a
Fig. 8b
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Figs. 8a & b: Characterisation with stains and glaze material.—Fig. 9: Result after the glaze firing and polishing.—Fig. 10: Try-in of the fully anatomically pressed and stained inlay.—Fig. 11: Try-in of the
ceramic layered inlay.—Fig. 12: The inlay in place.
created with rotary grinding instruments and sealed by means of
a glaze firing conducted at 715 °C.
Finally, the restoration was polished with rubber polishers and
a diamond paste (Fig. 6).
The staining technique
All morphological properties
of this molar, including the sur-
face texture, were already designed in the wax-up. After the
ceramic inlay had been pressed
AD
and divested, the surface was
slightly ground and the contact
points and the occlusion were
checked (Fig. 7).
The same stains as the ones
used in the layering technique
were applied and subsequently
fired in a stain and characterisation firing (Figs. 8a & b).
®
VITA VMK Master
Brand new, yet still a classic!
The new VITA metal ceramic with the familiar layering you’re accustomed to.
Av
ail
an able
d V in
ITA VI
cla TA S
ss YS
ica TE
lA M
1– 3D
D 4 -M
sh AS
ad TE
es R ®
!
It is advised not to apply the
stains too excessively in order
to prevent a mirror effect. If too
much material is applied, the
light is reflected from the restoration surface and cannot penetrate it. As a result, the desired
translucency cannot be achieved.
The shape and the marginal
adaptation were checked with
silver powder before and after
the glaze firing. Finally, the restoration was polished to a high
gloss with a rubber polisher and
diamond paste (Fig. 9).
Comparison
Both restorations were tried
in intra-orally and showed a
nearly perfect marginal fit. As a
consequence, the restoration
that was actually to be cemented
into place had to be selected on
aesthetic criteria. The monolithic structure and the fact that
only pressed LS2, the strongest
pressable ceramic tested to date,
was used would have been a reason to use the stained restoration
(Fig. 10).
3400 E
With regard to mechanical
and functional properties, this
restoration would have been first
choice; however, it did not show
the desired translucency. When
the two restorations were compared, the layered restoration
clearly showed a superior shade
effect (Fig. 11), and thus was permanently seated (Fig. 12).
VITA shade, VITA made.
1968: The world is in motion and VITA revolutionizes the world of
Master is especially well suited for the veneering of non-precious
dentistry with its VMK 68 metal ceramic. In 1995, VITA inspires the
metal alloy frameworks. Furthermore, the traditional layering con-
world of dentistry again – with the original VMK 95. And in 2009?
cept continues to provide simple handling. Equally simple and
VITA goes one step further: VITA VMK Master. Thanks to its firing
highly aesthetic is being able to choose between the two VITA
temperature, chemical and physical characteristics, VITA VMK
original shade systems. www.vita-zahnfabrik.com
Conclusion
IPS e.max Press and Ceram
in combination with an adhesive
cementation protocol represent
a valuable asset for dental technicians. The system allows the
fabrication of highly aesthetic
inlays with an excellent strength
and many advantages for patients and clinicians alike, thus
providing a highly attractive
alternative to direct inlay restorations. DT
Contact Info
Florin Stoboran
is a dental technician from Oradea
in Romania. He
can be contacted at
florinstoboran@
yahoo.com.
[15] =>
DTAP1211_01_Title
DTAP1211_15_Mahony 12.12.11 15:46 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Trends & Applications 15
The problem of white spot lesions
A new method for remineralisation post-orthodontic treatment
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Dr Derek Mahony
Australia
Demineralised white spot lesions occur frequently after
orthodontic treatment. Some
teeth are more prone to demineralisation, typically the
maxillary lateral incisors and
the mandibular canine teeth.
The disto-gingival area of the
labial enamel surface is the
area most commonly affected
(Fig. 1). In the first few weeks
after removal of the fixed appliances, there is a reduction
in white spot lesion size and
appearance, possibly due to the
action of saliva (Fig. 2).
Various treatment methods
have been proposed to assist the
process of remineralisation. It is
important to note that fluoride
should not be used in high con-
Fig. 6
Fig. 5
Fig. 7
Fig. 1: Typical white spots: C-shaped or irregular.—Fig. 2: Smooth surface caries lesion.—Fig. 3: Clinical image of an incipient caries lesion.—Fig. 4: Clinical image
of an incipient caries lesion.—Fig. 5: Pore system of an incipient caries lesion.—Fig. 6: The first treatment to bridge the gap between prevention and restoration.
—Fig. 7: Smooth surface procedure.
white spot lesions have fallen
short is that fluoride therapy is
not always effective in the advanced stages, and the use of
restorative fillings usually sacrifices significant amounts of
healthy tooth structure. Instead
of adopting a wait and see approach, Icon has been shown
to arrest the progress of early
enamel lesions up to the first third
of dentine in one simple
procedure (Fig. 6), without unnecessary loss of
healthy tooth structure.
the Icon product when attempting to remineralise white spot
IDEM12 210x297mm DTI US Ad.ai
Fig. 8b
One of the reasons that earlier
approaches to the treatment of
2:40:28 PM
AD
www.idem-singapore.com
THE BUSINESS OF DENTISTRY
INTERNATIONAL DENTAL
EXHIBITION AND MEETING
Figs. 8a & b:Lesions before and after Icon treatment.
This article will describe a
revolutionary new approach to
the cosmetic treatment of white
spot lesions (Figs. 3). With Icon,
a microinvasive technology from
German manufacturer DMG, demineralised enamel can be filled
and reinforced without drilling or
anaesthesia (Figs. 4 & 5).
invasive dentistry; it is microinvasive dentistry. DT
In the procedure described here, the surface
area of the white spot lesion iseroded with a 15 %
HCl gel, which opens the
pore system of the lesion.
This is then dried with
ethanol, followed by the
application of Icon onto
the lesion with the application aid. The extremely high penetration coefficient enables it to
penetrate into the lesion
pores. Excess material is
then removed, and the
material is light-cured.
The total treatment time
should be about 15 minutes (Fig. 7).
Fig. 8a
centration, as it tends to prevent
demineralisation and can lead
to further unsightly staining.
Low concentrations of fluoride,
however, may assist remineralisation, such as thosefound in
casein calcium phosphate materials. Additionally, stimulation of
salivary flow by chewing sugarfree gum is helpful.
9/7/11
lesions post-orthodontic treatment. This is not just minimally
The cosmetic treatment of cariogenic white spots
in one visit can be very appealing, especially to young patients
and their parents (Figs. 8a & b).
No drilling or anaesthesia is required and those patients who
have already demonstrated poor
compliance with their brushing
can be treated earlier. I would
recommend that clinicians try
APRIL 20 - 22, 2012
Limited space available. Secure your booth now!
We Bring the Asia Pacific Markets to You. IDEM Singapore connects you with
over 6,000 dental traders, distributers and practitioners from the Asia Pacific region.
Enriched with opportunities from the trading and showcasing of high-quality
dental equipment to learning and development in the field of dental practice,
this event is a “must-attend” for every dental and associated professional.
Contact Info
Endorsed By
Derek Mahony
is a world re nowned Specialist Orthodontist
from Randwick
in Australia. He
can be contacted
at info@derekmahony.com.
Supported By
Held In
In Co-operation With
Co-organiser
Singapore Dental Association
North America
Franz Balve
Koelnmesse Inc
Tel: +1 732 933 1117
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
[16] =>
DTAP1211_01_Title
Dental Tribune for iPad –
Your weekly news selection
Our editors select the best articles and videos from around the world for you
every week. Create your personal edition in your preferred language.
ipad.dental-tribune.com
)
[page_count] => 16
[pdf_ping_data] => Array
(
[page_count] => 16
[format] => PDF
[width] => 884
[height] => 1233
[colorspace] => COLORSPACE_UNDEFINED
)
[linked_companies] => Array
(
[ids] => Array
(
)
)
[cover_url] =>
[cover_three] =>
[cover] => ![DT Asia Pacific No. 12, 2011]()
[cached] => true
)
)
[2] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-1.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-1.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-1.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-1.jpg
[1000] => 56573-0b49c070/1000/page-1.jpg
[200] => 56573-0b49c070/200/page-1.jpg
)
[ads] => Array
(
)
[html_content] =>
)
[3] => Array
(
[image_url] => Array
(
[2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/2000/page-2.jpg
[1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/1000/page-2.jpg
[200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/56573-0b49c070/200/page-2.jpg
)
[key] => Array
(
[2000] => 56573-0b49c070/2000/page-2.jpg
[1000] => 56573-0b49c070/1000/page-2.jpg
[200] => 56573-0b49c070/200/page-2.jpg
)
[ads] => Array
(
[0] => Array
(
[post_data] => WP_Post Object
(
[ID] => 56576
[post_author] => 0
[post_date] => 2024-10-21 20:56:02
[post_date_gmt] => 2024-10-21 20:56:02
[post_content] =>
[post_title] => epaper-56573-page-3-ad-56576
[post_excerpt] =>
[post_status] => publish
[comment_status] => closed
[ping_status] => closed
[post_password] =>
[post_name] => epaper-56573-page-3-ad-56576
[to_ping] =>
[pinged] =>
[post_modified] => 2024-10-21 20:56:02
[post_modified_gmt] => 2024-10-21 20:56:02
[post_content_filtered] =>
[post_parent] => 0
[guid] => https://e.dental-tribune.com/ad/epaper-56573-page-3-ad/
[menu_order] => 0
[post_type] => ad
[post_mime_type] =>
[comment_count] => 0
[filter] => raw
)
[id] => 56576
[id_hash] => f31d8d9cdac298777706578df6a30c09138ca53d9c644afa4ab9aa42e75840a3
[post_type] => ad
[post_date] => 2024-10-21 20:56:02
[fields] => Array
(
[url] => http://www.dental-tribune.com/companies/content/id/25/code/wh_dentalwerk_buermoos_gmbh_austria
[link] => URL
)
[permalink] => https://e.dental-tribune.com/ad/epaper-56573-page-3-ad-56576/
[post_title] => epaper-56573-page-3-ad-56576
[post_status] => publish
[position] => 23.96,25.41,70.22,69.95
[belongs_to_epaper] => 56573
[page] => 3
[cached] => false
)
)
[html_content] =>