DT Asia Pacific No. 12, 2017

Asia Pacific News / World News / Business / “Advanced knowledge and a supporting community via the Internet” / JADR annual meeting stands out with diverse and broad scientific programme / A fracture load study on implant-supported crown restorations / New materials for a classic indication - Cementation of all-ceramic restorations using Variolink Esthetic / Lab Tribune Asia Pacific Edition

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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

NEW EDITION

Vol. 15, No. 12

INTERVIEW

New: Dental Tribune International welcomes Dental Tribune
Japan, which was introduced
at the Tokyo Dental Show in
November.

LAB TRIBUNE

Dr Mikko Nyman about his new
portal, QAdental, and how it aims
to improve dental treatment in remote areas though shared information and consultation services.

” Page 02

Read about the new Awrel Partner Portal, through which labs
can offer their customers voiceguided ordering services for implants, supplies and equipment.

” Page 09

” Page 17

By DTI

DARWIN, Australia: Unreasonably long waiting times in public
dentistry have been an issue in
Australia for some time. Now,
new figures disclosed in a senate
estimates hearing in Canberra in
October show that the problem
worsened in most states in 2016,
especially in the Northern Territory. Here, the waiting period
i ncreased dramatically from
30.8 months to 45.7 months—almost four years—in just a year.

Blood pressure and periodontitis

Long waiting
times

GUANGZHOU, China: Treatment
of periodontitis significantly lowered blood pressure among Chinese patients at risk of developing
high blood pressure, according to
a preliminary study. The research
was presented at the American
Heart Association’s Scientific Sessions 2017, a premier global exchange of the latest advances in
cardiovascular science for researchers and clinicians.

In new research, intensive treatment of periodontitis was associated with a significant decrease in blood pressure among
patients at risk of developing high blood pressure.

served in diastolic blood pressure.
Three months after treatment,
systolic blood pressure was nearly
eight points lower and diastolic
pressure was nearly four points
lower in the same patient group.

The study compared blood
pressure levels after standard and
intensive treatment for periodontal disease among 107 Chinese
women and men aged 18 years and
over with prehypertension and
moderate to severe periodontitis.
Through random assignment,
half of the participants received
standard treatment and half received intensive treatment. One
month after treatment, systolic
blood pressure was nearly three
points lower in participants receiving intensive treatment, but
no significant difference was ob-

Prof. Yu Guang Yan, Modern Dental Group CEO Godfrey Ngai and Prof. Thomas
Flemmig (from left) kicking off a traditional dragon dance performance at the
World Dental Forum in Beijing in China.
” News Page 07

Five million
patients

Anti-cariogenic
herb

Align Technology has announced that its five millionth Invisalign patient has begun treatment.
“It’s very rewarding to see how rapidly Invisalign treatment is growing
around the world. I can’t believe
our first ‘million’ took ten years to
achieve, while our fifth ‘million’ only
took one year,” said Joe Hogan, Align
Technology President and CEO.

A research team from China
and the Netherlands has found that
extracts of the Chinese herb Galla
chinensis demonstrated anti-cariogenic properties. The herb inhibited dental caries by favourably
shifting the demineralisation/
remineralisation balance of enamel
and curbing the biomass and acid
formation of dental biofilm.

Six months after treatment, systolic blood pressure was nearly 13
points and diastolic blood pressure almost ten points lower in
these patients. “The present study
demonstrates for the first time that

intensive periodontal intervention
alone can reduce blood pressure
levels, inhibit inflammation and
improve endothelial function,”
said study lead author Dr Jun Tao
from the University in Guangzhou.

According to a report by
the NT News, the national average waiting time in 2016 was
12.05 months, with Victoria having the second longest wait in
the country with 16 months and
Western Australia the shortest
with 2.5 months. Compared with
the previous year, the figures
show deterioration of the situation in most states. Waiting
times increased in Victoria (from
12.77 to 16.01), New South Wales
(from 12.92 to 14.20), the Australian Capital Territory (from 5.56
to 5.95) and South Australia
(from 12.45 to 14.70).

IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1

Dental
benefits
After plans to terminate the
Australian Child Dental Benefits
Schedule (CDBS) in 2016, the government finally decided that it was
to be saved and increased efforts to
raise public awareness of the benefits programme. Apparently, this has
paid off. According to new figures
disclosed by Department of Health
official Mark Cormack, 859,714 children had utilised the CDBS by September this year. According to Cormack, this is a higher number than
the same time last year, although
he did not provide actual September-to-September data for comparison of the 2016/2017 period. In
total, 1,036,920 children out of about
2.9 million made use of the CDBS
in 2016, the figures further showed.
In 2018, the scheme, which allows
low-income families to claim a rebate of up to A$1,000 per child every
two years for dental care, will be
continued with minor amendments.

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
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[2] =>

ASIA PACIFIC NEWS

02

Dental Tribune Asia Pacific Edition | 12/2017

Malaysia: Dental Bill 2017
proposes stricter regulation
© Zerb

terstoc
or/Shut

k.com

By DTI
KUALA LUMPUR, Malaysia: Malaysia’s new Dental Bill 2017, which
had its first reading in Parliament
on 27 November, will see significant changes made to the regulation of the dental profession and
the organisational structure of the
dental workforce. Among other
measures, the bill aims to appoint
the Malaysian Dental Council and
the Malaysian Dental Therapist
Board to control and regulate the
profession. The existing dental
council, established under the Dental Act of 1971, will consequently be
dissolved.

Originally the intention was to only amend the Dental
Act 1971, but due to the many
amendments that were proposed,
it was decided that it was necessary to table a new law altogether.
The proposed bill allows for more
effective regulation of dentistry,
puts stricter disciplinary procedures in place for dental professionals and introduces fees and
charges for registration and licensing.
Only accredited and registered dental surgeons, from both
the public and private sector, who
have been practicing as dental
surgeons for at least seven years
in Malaysia would represent the
newly-proposed Dental Council.

The council will have the
power to approve or reject the registration applications of dental
practitioners and
specialists. The Dental Therapist Board
will register and
issue certificates to
dental therapists and postgraduate dental therapists based
on the conditions and restrictions
of the new law and will be responsible for regulating the registration examinations and ethical
and professional conduct of the
professionals in the group.
The imminent revision of the
regulatory framework comes as no
surprise, as the country has seen a
string of incidents related to fake
dentistry practices and persons
delivering dental services and
treatments without valid licensing. In this regard, the Dental Bill
2017 aims to ensure the safety of
dental patients and maintain high
standards of dentistry in the country. The proposed law will also empower the council and the board to
conduct disciplinary proceedings

Together with Yoshimitsu Teraoka, representative of Dental Tribune International (DTI) in Japan,
delegates from the company’s
head office attended the trade
show not only to meet clients, but
also to introduce DTI’s new publishing partner in Japan, Medical
Net. DTI and the listed Tokyo-based
company officially joined forces already in July. In October, the first
print issue of Dental Tribune
Japan was launched, which reaches
20,000 dentists and 10,000 dental
hygienists in Japan.
“Japan is the third-largest economic power in the world and
there are many good dental companies in the country,” commented
Medical Net President and Chief
Operating Officer Yuji Hirakawa.
“We want to be a bridge between
Japan and the rest of the world.”

Complimenting the launch
of the Japanese-language edition,
DTI Business Development Manager Claudia Salwiczek-Majonek
said: “Our partners here in Japan
have not only published an out-

standing first edition of Dental
Tribune Japan, but also perfectly
represented DTI at the Tokyo Dental Show. We are very proud to be
partnering with Medical Net and
have high expectations for the

MANAGING EDITOR AP:
Kristin HÜBNER

EDITOR:
Yvonne BACHMANN

While the Malaysian Dental
Association (MDA) has welcomed
the first reading of the new bill,
the association has also raised
concerns that stricter regulations
might cause unwanted limitations to the profession, the New
Straits Times reported. Therefore,
MDA President Dr Ng Woan Tyng
stressed that any clause that limits the freedom of practice of dentistry by the general dentist will
reduce the accessibility of many
dental procedures by the general
public, especially in the rural
areas, resulting in monopolies
driving up prices. This may cause
less-informed members of the
public to resort to illegal dentistry
that will ultimately endanger their
health.

PUBLISHER/PRESIDENT/CEO:

Among the many other exhibiting companies that presented
their products and services at the
two-day event were Asahi Roentgen, Dentsply Sirona, GC, Ivoclar
Vivadent, KaVo Kerr Group, Kuraray Noritake Dental, Lion, Mokuda
Dental, Morita, Nishika, NSK,
Osada, Planmeca, SHOFU, Sunstar,
Takara Belmont, Tokuyama Dental,
Tokyo Giken and Yoshida Dental.

Atsushi Saito, Division Director Dental Tribune Japan, and DTI Business Development Manager Claudia Salwiczek-Majonek.

Daniel ZIMMERMANN
newsroom@dental-tribune.com
Tel.: +44 161 223 1830

EDITOR/SOCIAL MEDIA MANAGER:

launch of our entire portfolio, including our www.dtstudyclub.com
education platform, in this thriving and promising market.”

TOKYO, Japan: Almost 20,000 visitors celebrated the latest in dentistry in Tokyo in November. Held
at Tokyo Big Sight, the city’s international exhibition centre, the
Tokyo Dental Show featured more
than 190 local and international
manufacturers and dealers.
Among the new products introduced to the Japanese market was
the first issue of Dental Tribune
Japan.

GROUP EDITOR:

and impose punishment on their
members who violate the conditions and terms that are set out in
the bill, theSundaily reported. According to the news website, the
current legislation does not allow
for disciplinary action to be taken
against illegal dentists or unregistered practitioners who work in
registered practices.

First Dental Tribune Japan issue
By DTI

IMPRINT

At the show, two trends in dentistry were obvious. One was the
ongoing advancements in the digital field, with ever-more precise
dental tools, such as intraoral
scanners, milling machines and
devices for a digital workflow,
showcased at the industry exhibition. The second indicated a
longer-term transformation of
the profession. While prevention
and preservation have conventionally been a part of dentistry,
there is an increasing shift towards these two aspects becoming the foundation of dentistry—
not least owing to population
ageing, a phenomenon especially
prevalent in Japan. This change
from mainly providing treatment
to implementing a more holistic
approach to oral healthcare was
evident at the Tokyo event.

Monique MEHLER

MANAGING EDITOR &
HEAD OF DTI COMMUNICATION SERVICES:
Marc CHALUPSKY

TEAM ASSISTANT:
Julia MACIEJEK

COPY EDITORS:
Sabrina RAAFF
Ann-Katrin PAULICK

CLINICAL EDITORS:		
Magda WOJTKIEWICZ
Nathalie SCHÜLLER
Torsten R. OEMUS

CHIEF FINANCIAL OFFICER:
Dan WUNDERLICH

BUSINESS DEVELOPMENT MANAGER:
Claudia SALWICZEK-MAJONEK

PROJECT MANAGER ONLINE:
Tom CARVALHO

JUNIOR PROJECT MANAGER ONLINE:
Hannes KUSCHICK

E-LEARNING MANAGER:
Lars HOFFMANN

MARKETING SERVICES:
Nadine DEHMEL

SALES SERVICES:
Nicole ANDRÄ

ACCOUNTING SERVICES:
Anja MAYWALD
Karen HAMATSCHEK
Manuela HUNGER

MEDIA SALES MANAGER:
Antje KAHNT (International)
Barbora SOLAROVA (Eastern Europe)
Hélène CARPENTIER (Western Europe)
Maria KAISER (North America)
Matthias DIESSNER (Key Accounts)
Melissa BROWN (International)
Peter WITTECZEK (Asia Pacific)
Weridiana MAGESWKI (Latin America)

EXECUTIVE PRODUCER:
Gernot MEYER

ADVERTISING DISPOSITION:
Marius MEZGER

DESIGNER:
Nora SOMMER

Published by DT Asia Pacific Ltd.
DENTAL TRIBUNE INTERNATIONAL
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
info@dental-tribune.com
www.dental-tribune.com

Regional Offices:
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c/o Yonto Risio Communications Ltd,
Room 1406, Rightful Centre,
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Fax: +852 3113 6199

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DENTAL TRIBUNE AMERICA, LLC
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Tel.: +1 212 244 7181
Fax: +1 212 224 7185
© 2017, 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. Scan this code
to subscribe our weekly Dental
Tribune AP e-newsletter.

[3] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 12/2017

Almost all Myanmar mouth cancer
patients chew betel quid, study finds
By DTI
TOUNGOO, Myanmar: A study
has found that almost all of the
mouth cancer patients investigated used smokeless tobacco in
the form of betel quid, researchers
have reported at the European Society for Medical Oncology Asia
2017 Congress, held in Singapore
from 17 to 19 November.
This observational study investigated the lifestyle behaviours of
head and neck cancer patients that
may have contributed to their disease. The cross-sectional study was
conducted in the medical oncology
unit of Toungoo General Hospital
in 2016. All head and neck squamous cell carcinoma (HNSCC) patients who came to the hospital for
treatment were included in the
study. Participants were asked
about their habits regarding betel
quid chewing, smoking and alcohol
consumption. Of the 307 cancer patients who visited Toungoo hospital that year, 67 (22 per cent) had
HNSCC and were included in the
study. Of those, 41 were male and 26
were female. The mean age was 59.2
years (range: 36–81 years) for men
and 58.7 years (range: 19–86 years)
for women. The most common cancer site was the oral cavity (34.3 per
cent), followed by the larynx (25.4
per cent), oropharynx (11.9 per
cent), nasopharynx (11.9 per cent),
hypopharynx (10.4 per cent), lip
(4.5 per cent) and nose (1.5 per cent).
Regarding lifestyle habits of
the entire study population, 20
patients (30 per cent) chewed
betel only; 19 patients (28 per cent)
chewed betel and smoked tobacco;
19 patients (28 per cent) chewed
betel, smoked tobacco and consumed alcohol. Two patients
smoked tobacco and drank alcohol, two smoked tobacco only, two
had none of the risk factors, and
information was unavailable for
three patients. All oral cavity cancer patients were betel quid
chewers. In addition, 48 per cent
smoked tobacco and 44 per cent
consumed alcohol. The majority
(87 per cent) of mouth cancer patients said they held betel quid in
the buccal cavity most of the time.
Lead author Dr Khin Khin Nwe,
a medical oncologist at the Toungoo General Hospital, said: “According to previous studies the incidence of oral cancer, also called
mouth cancer, in Southeast Asia
has been disturbingly high for
many years. It has also been shown
that smokeless tobacco use is common in this region—for example,
in Myanmar more than 50 per cent
of men use betel quid. Commenting on the topic, Dr Makoto Tahara
from the National Cancer Center
Hospital East in Chiba in Japan,

said: “Given the number of health
issues associated with chewing
betel quid, particularly oral cancer

and precancerous conditions such
as leukoplakia and oral submucous
fibrosis, understanding ways to

reduce betel quid chewing is of
global public health importance. In
the last decade, betel quid has been

classified as a group 1 carcinogen
by the International Agency for Research on Cancer.”
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[4] =>

WORLD NEWS

Dental Tribune Asia Pacific Edition | 12/2017

Parrotfish tooth research may ring in
new era of biomaterial development
© J.S. Lamy/Shutterstock.com

By DTI
SINGAPORE/BERKELEY, USA: The
achievements of science are
evolving constantly. However,
there are many natural wonders
that humanity has not been able
to mimic yet. Among these are
parrotfish teeth, which are one of
the strongest and most abrasion-resistant in the animal world.
Investigating their structural
make-up, a team of researchers
has now determined the underlying properties that make the fish’s
teeth strong enough to even bite
stony corals.
“Parrotfish teeth are really
good all-round biters of hard
things, and few other teeth in nature are harder or stiffer,” said lead
author Dr Matthew Marcus from
the Lawrence Berkeley National
Laboratory in California. To feed,
the investigated steephead parrotfish Chlorurus microrhinos bite
off corals and assimilate the organic material within it. To do so,
these fish have two sets of teeth:
one for biting corals and a pharyngeal set for grinding and chewing
the bitten-off material.
Aiming to find out what makes
the fish’s teeth so resistant, the re-

assemble into bundles interwoven like the warp and weft threads
in fabric. The fibres gradually decrease in size from 5 μm at the
back to 2 μm at the tip, and according to Marcus, it is this size decrease that makes the tooth structure so hard.
“The results also show that in
nature, complex structures have
evolved to carry out specialised
extraordinary functions, like biting coral, using simple, unsophisticated materials,” Marcus told nanotechweb.org. “Man-made materials, in contrast, usually do the
opposite—that is, we use hightech materials with a very basic
structure.”

Parrotfishes are named for their unique dentition, which forms a parrot-like beak. Their teeth contain fluorapatite, which is
among the stiffest and hardest biominerals known and can also be found in human teeth that have been exposed to fluoride.

searchers first measured their mechanical properties in nano-
indentation experiments. Afterwards, they performed chemical
analysis with a variety of techniques, including scanning elec-

tron microscopy with energy-dispersive X-ray analysis and electron probe micro-analysis.
As reported by nanotechweb.
org, the results showed that it is

not the material of parrotfish
teeth that is special, but the arrangement of the crystals of the
teeth. Studying the structure, the
researchers found that the enameloid nanocrystals co-orient and

According to the researchers,
the techniques used in the study
could be employed to study
human bone and teeth more
thoroughly and help in the development of new biomimetic
materials.
The study, titled “Parrotfish
teeth: Stiff biominerals whose
microstructure makes them
tough and abrasion-resistant to
bite stony corals”, was published
online ahead of print on 20 October in the ACS Nano journal.

Dental radiographs can reveal
vitamin D deficiency
By DTI

McMaster University researchers Prof. Megan Brickley,
Lori D’Ortenzio and their colleagues had previously discovered

HAMILTON, Canada: Human teeth
hold vital information about vitamin D deficiency, and Canadian
anthropologists have now found
that this serious but often hidden
condition can be detected on a
simple dental radiograph. Identifying individuals who may have

experienced vitamin D deficiency
has significant potential for further understanding of the factors
that may have compromised the
health of people in the past.

Radiograph showing vitamin D deficiency: Chair shaped, constricted pulp horns
in the left first mandibular molar and a second mandibular molar (black circles).

that human teeth hold a detailed
and permanent record of serious
vitamin D deficiency. This appears
as microscopic deformities in dentine and can be extremely valuable for understanding precisely
when people, even those who
lived centuries ago, were deprived
of sunlight, necessary for the
body’s production of vitamin D.
The record is preserved by
enamel, which protects teeth from
breaking down, unlike bones,
which are subject to decay. The
problem with looking for such deformities is that a tooth must be cut
open to observe the patterns that
form a lifetime’s vitamin D record,
and the supply of post-mortem
teeth available for study is limited.
To avoid wasting precious
specimens, the researchers looked
for a way to isolate teeth for further investigation. By using radiographs to study the readily observable shapes of the pulp horns,
the researchers found a consistent, recognisable pattern that
could prove helpful both to their

studies of archaeological teeth, as
well as to people who may not realise they are suffering from vitamin D deficiency.
The pulp shape in a healthy
person’s tooth resembles an arch
topped by two cat ears, but in a
person who has had a severe deficiency of vitamin D is asymmetrical and constricted, typically looking like the profile of a hardbacked chair.
D’Ortenzio and Brickley’s previous research had suggested
such a recognisable pattern, and
their examination of both historic
and current teeth proved that radiographic images are consistent
and reliable indicators of prior
deficiency.
“It was a real Eureka! It wasn’t
just that it looked different. It was
different,” remembered Brickley,
who holds the Canada Research
Chair in Bioarchaeology of
Human Disease. “I think it’s really
important. It was a piece of work
that aimed to look more at past in-

dividuals, but it has the potential
to contribute to modern healthcare as well.”
Since the consequences of
vitamin D deficiency can be severe—especially in terms of bone
health—knowing who has had a
deficiency can help identify people who may have ongoing issues
to prevent worse damage, the researchers said. If regular dental radiographs show a problem, blood
tests can confirm whether there is
a current deficiency.
Knowing more about ongoing
vitamin D deficiency can also help
to determine what is the best balance between protecting people
from harmful UV rays and making sure they get enough sun to
maintain a healthy level of the
vital nutrient.
The study, titled “The rachitic
tooth: The use of radiographs as a
screening technique,” was published online on 7 November in
the International Journal of Paleopathology.

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BUSINESS

Dental Tribune Asia Pacific Edition | 12/2017

“A truly open solution”
By DTI
At the Greater New York Dental Meeting (GNYDM), global dental imaging
technology specialist 3DISC showcased its newly developed Heron IOS
scanner. Dental Tribune had the opportunity to speak with Sigrid Smitt
Goldman, CEO and Executive Chairman of the 3DISC group, about the
company’s entry into the intraoral
scanner market and what sets the device apart from competing products.
After a two-year development process, you showcased the marketready Heron IOS in New York. What
were priorities in the development
of the scanner?
The Heron’s lightweight design
and ability to update in real time
make it an essential tool in the contemporary dental practice. In development, we focused on ergonomics
for the dentist and comfort for the
patient. Recognising that size and
flexibility in scanning are essential,
we developed a small, lightweight
hand- and mouthpiece with a 360°
rotating tip for maximum flexibility and comfort when scanning the
upper and lower arches.
Were there any challenges you had
to overcome in the development
process?
During the development process, we took initial concepts to
dentists early on in the design
phase and were quite surprised to
find that they had very different
approaches to some basic things,
like how they would pick the unit
up. Some used a pen grip, others
lifted it from the top. This feedback
led to several changes to the shape
of the unit and drove the design of
the 360° rotating tip that allows
the scanner to be comfortably held
and used in every situation.

When will the device be available
to customers and in which markets?
We open for sales in Europe
and USA in the first quarter of 2018
and the first scanners will be in
clinics early in the second quarter.

with solutions other than those of
3DISC too?
Yes, the scanner output is entirely open, providing both STL
and PLY format, and expected to
be compatible with most open
dental CAD systems.

“The 360° rotating tip allows the scanner to be
comfortably held and used in every situation.”
ning, validation, commenting and
order submission to the laboratory.
The Heron offers an all-in-one
application accessible from one
interface—a truly open solution
with what we believe is one of the
market’s best-optioned CAD integrations.

Sigrid Smitt Goldman, CEO and Executive Chairman of the 3DISC group, with the company’s Heron IOS scanner during the 2017 Greater
New York Dental Meeting.

Increasingly, dental manufacturers are introducing open solutions. Is Heron IOS compatible

Our QuantorClinic software is
a combination of our own scan
software and exocad’s DB soft-

ware, with dentalshare as the primary laboratory sharing tool. It facilitates order management, scan-

Have you already planned any updates, such as introducing a wireless Heron IOS version in the future?
Naturally, the development of
the solution does not end with the
upcoming launch. We primarily
expect updates on the software
side, such as improvements to the
free QuantorClinic software license that comes with the scanner. This means that dentists that
order the first-generation software now will automatically get
the updates with their software at
no extra charge.
Editorial note: The scanner will be
available to customers in Asia soon, a
company representative told Dental
Tribune. Currently, 3DISC is in the process of obtaining market approval for
Heron IOS in China and Japan.

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[7] =>

07

BUSINESS

Dental Tribune Asia Pacific Edition | 12/2017

Chinese market in focus at 2017
World Dental Forum in Beijing
AD

By DTI
BEIJING, China: Held for the fourth
time in 2017, this year’s edition of
the World Dental Forum proved to
be a great success for its organiser, dental prosthesis provider
Modern Dental Group. Bringing
together over 800 dental professionals from around the world in
the Chinese capital city, the event
increased the exposure of the
country’s growing dental market
by engaging local market players
and dentistry experts.

VITA original shade guides
Reliable shade determination for a perfect match.

Complemented by a smallscale exhibition, which was held
alongside the congress programme,
the two-day forum covered a
broad range of topics in lectures
delivered by a line-up of international speakers who mainly focused on industry developments
in the fields of digital dentistry,
implantology and aesthetic dentistry. The opening speeches were
delivered by Prof. Thomas Flemmig, Dean of Dentistry at the University of Hong Kong, and the
President of the Chinese Stomatological Association Prof. Yu
Guang Yan, and were followed by
traditional Chinese dance performances.

Under Ngai, the Hong Kongbased company has extended its
services to mainland China, training thousands of dental technicians and driving the development of the dental laboratory industry in China. Therefore, as part
of the World Dental Forum’s social
programme, attendees had the
chance to visit the Modern Dental
Laboratory in Shenzhen, which
employs over 4,000 technicians
and is the largest state-of-the-art
laboratory in the world.
According to Ngai, the company will continue to nurture the
emerging Chinese market by delivering knowledge, technologies
and skills to the country. “We are
confident that in the near future,
the Chinese market will grow and
develop into one of the leading
dental prosthetic markets in the
world.”

3471E

Commenting on the event’s
regional focus, Modern Dental
Group CEO Godfrey Ngai said:
“Founded in Hong Kong, and
being one of the major global players who has strong presence in five
continents, it is our obligation to
contribute towards the Chinese
market through education and
introducing international standards.”

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16.11.17 09:14

[8] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 12/2017

Sophisticated solutions tailored for the
Indian market

Fig. 1: Fast and lightweight: Planmeca’s new intraoral scanner, the Planmeca Emerald was the focus of some of the product presentations.—Fig. 2: With a series of roadshows, W&H India and Planmeca India updated
attendees on their latest product solutions.

“[...] we offered an optimal platform for a lively exchange of experiences and know-how [...].”
By DTI
BANGALORE, India: Kicking off a
series of events to increase their
brand awareness in India, cooperation partners Planmeca and
W&H have hosted exclusive roadshows in six of the country’s
metropoles. At the evening events
that were specifically tailored to
the demands of the Indian dental
market, attendees had the opportunity to familiarise themselves
with the two companies’ comprehensive product portfolios during

interactive expert discussions and
live demonstrations.
“Our aim was to maintain the
direct contact with dentists, institutional heads as well as corporate
hospital heads on site and to establish W&H India and Planmeca
India as an important local partner for advanced dental solutions,” said Raghavan Radhakrishnan, General Manager of the
companies’ joint office in Bangalore, which was officially opened
in April.

Radhakrishnan announced
that the roadshows were just the
start of their broader action plan
for the country’s dental market.
Inviting dental experts from all
over India to be introduced to the
latest solutions offered by the
two family-run businesses, the
roadshows were held in Chandigarh, New Delhi, Mumbai, Pune,
Cochin and Bangalore from 8 to
14 November. According to the organisers, approximately 60–70 dental professionals attended each
event, including dental special-

ists, such as implantologists, prosthodontists, oral surgeons and radiologists.
During the product presentations, special focus was placed
on W&H’s new implantology device Implantmed, an automatic
handpiece maintenance device
Assistina TWIN and the company’s Primea Advanced Air Turbine. Planmeca highlighted its
Planmeca Emerald intraoral scanner and the Planmeca PlanMill 40 S,
a chairside CAD/CAM milling

unit. After an introduction, attendees had the opportunity to
experience and discuss the innovative functionalities of the products during hands-on demonstrations.
“The aim of our roadshows
was not only to present our product innovations and our product
know-how, but also to support active networking among the Indian experts. For our product success and brand awareness the
personal contact to our customers and target groups is decisive,”
Radhakrishnan stressed.
“With the current series of
events we offered an optimal
platform for a lively exchange of
experiences and know-how,
which offered an added value for
the daily practice to the participants.”

J. Morita to distribute TRIOS in Japan
By DTI
TOKYO, Japan: Starting in spring
2018, J. Morita will distribute Danish
digital solutions provider 3Shape’s
award-winning TRIOS 3 intraoral
scanner as part of its line of dental
products in Japan, the two companies announced in November.
“The 3Shape TRIOS 3 is renowned for its documented high accu-

racy and amazing speed. J. Morita’s
expert sales teams and strong service network make them an excellent partner for Japanese doctors
seeking a smooth entry into digital
dentistry,” commented Hiroyuki
Nishiya, 3Shape Country Manager
for Japan, on the agreement.
Since its launch in 2011, the
TRIOS range has received numerous awards. In October, the device

was given the 2017 Cellerant “Best
of Class” Technology Award for the
fifth consecutive year in recognition of its accuracy, scanning
speed and ease of use.
Earlier this year, 3Shape introduced TRIOS 3 Wireless at

the International Dental Show
in Germany. This device is the
latest model in the TRIOS portfolio and the only wireless digital impression solution on the

market. The newest model links
to a PC via a point-to-point
wireless connection to eliminate the need for cables in the
operatory.

[9] =>

Dental Tribune Asia Pacific Edition | 12/2017

SCIENCE & PRACTICE

“Advanced knowledge and a supporting
community via the Internet”
© Messukeskus Helsinki

An interview with Dr Mikko Nyman, developer of new dental consultation portal QAdental

Will your product be globally available?
QAdental is open to all dental
professionals globally and membership is free. Dentists can register at www.qadental.com.

QAdental is open to all dental professionals globally and membership is free. – Dr Mikko Nyman at the 2017 Finnish Dental Congress and Exhibition in Helsinki.

By Benito Gründer, DTI
In November, QAdental won the
Innovation Award at the Finnish
Dental Congress and Exhibition in
Helsinki. Developed by Dr Mikko
Nyman and Teddy Grenman, Chief
Dentist and Chief Engineer at NUOVO
NORDIC Healthcare Services, respectively, the platform offers
dental professionals the opportunity to e-consult with dental specialists, serves as a database for
learning material and patient cases,
and enables forum discussions.
Dental Tribune spoke with Nyman
about this pioneering solution and
the expertise it brings to remote
areas and developing countries.
Congratulations on winning the
award. How did this come about?
This has been quite a year. We
piloted QAdental in Namibia this
spring. It wasn’t easy to obtain permission from the local ministry of
health and it wasn’t easy to get people excited about something totally new. We visited the country
twice. However, we managed to
conduct the pilot successfully.
Did you have a team to support you
in the development process?
QAdental was developed by a
team. Teddy Grenman and I were
the main architects, but without
the rest of the team—CEO Jani
Korpela, Chief Medical Officer
Jarkko Saramäki and Project Coordinator Teemu Tanninen—we
wouldn’t have been able to conduct the pilot successfully in Namibia. Steve Jobs’s famous quote
applies to QAdental also: “Great
things in business are never
done by one person. They’re done
by a team of people.”
Did you expect to win the award?
We knew that big Finnish players such as Planmeca and Hammasväline would take part in the
contest with their new great, innovative products, but we were quite
sure that there were not many service providers who would be taking part, so we made the decision
to participate in the contest. Certainly, we didn’t expect to win. We

didn’t even have any marketing
material ready. We built QAdental
based on the [Eric Ries’s] lean
start-up principles. Validated
learning was and will be the base
for our development process.

and learning experiences are
shared with several practitioners
at the same time, so QAdental

dental forums, QAdental focuses
solely on consultation and learning material. There’s always a dentist on duty taking care of maintenance, and to make sure that the
appropriate QAdental professional
answers to the corresponding
consultations. The officer on duty
is also the quality controller when
it comes to official answers.

serves as a kind of reverse innovation when it comes to Western
countries. Compared with other

Thank you very much for the interview.
AD

How do the features of QAdental
help practitioners in particular?
In Finland and many other
countries, specialist services are
not available in remote areas. This
means dental professionals located there are obliged to work beyond their scope. QAdental brings
to them advanced knowledge and
a supporting community via the
Internet. This way, clinicians can
perform more challenging procedures more safely and discuss patient cases with their peers. The
growing international database of
questions and answers and learning material is available for all
members. With the help of the
advanced search function—or
maybe artificial intelligence in
the near future—clinicians may
find answers to their questions
from previous questions and answers.
What sets QAdental apart from
other dental community platforms?
This kind of consultation or
support service might be very
significant in enhancing patient
safety and healthcare quality.
Our plan was to export Finnish or
Western expertise to developing
countries. One challenge was
that these countries cannot afford to pay for Western dental
specialist consultation. That’s
why we wanted to develop a way
to share the knowledge. The solution was quite obvious: we had to
create a place where all consultations, answers and learning material are available for all members so that the learning experience wouldn’t be limited to one
person.
During the pilot project, we
learnt that there’s a need for specialist e-consultations also in Finland, especially in remote areas.
In Finland, there’s no tele-consulting platform where information

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[11] =>

Dental Tribune Asia Pacific Edition | 12/2017

SCIENCE & PRACTICE

JADR annual meeting stands out with
diverse and broad scientific programme

Fig. 1: Dr Harry-Sam Selikowitz during his presentation.—Figs. 2a & b: Well-attended poster session: 183 abstracts, 54 of which were
submitted by international researchers, were presented at the Japanese Association for Dental Research annual meeting in Tokyo.

By DTI
TOKYO, Japan: On 18 and 19 November, the Japanese Association
for Dental Research (JADR), the Japanese division of the International
Association for Dental Research
(IADR), concluded the 2017 edition
of its annual meeting held at Showa
University in Tokyo. This year’s
event particularly stood out with a
diverse and broad scientific programme, offering the 350 local and
international participants a wide
choice of topics, such as advances in
stem cell research, aetiology of periodontitis and life science in space.
According to congress President
Prof. Ryutaro Kamijo, Chairman of
the Department of Biochemistry at
the School of Dentistry at Showa
University, novel and interdiscipli-

nary communication is needed to
fully understand the issues society
is facing today in order to provide
solutions that further advance dental research in the future. Therefore,
the theme of this year’s meeting,
“Forefront of dental science—Toward a global standard in medical
science”, was chosen to further spur
worldwide progress in dentistry.
The international speaker lineup included Prof. Angus William G.
Walls from Scotland (IADR President), Dr Seong-Ho Choi from
Korea (President of the Korean Division of the IADR), Dr Harry-Sam
Selikowitz from Norway (FDI World
Dental Federation) and Prof. Irma
Thesleff from Finland (University
of Helsinki). They held special lectures on topics such as geriatric
dentistry, oral and non-communi-

cable diseases, techniques for the
regeneration of damaged periodontal tissue, and conserved signalling pathways in tooth development and regeneration.
Among the highlights of the
programme were the lectures under
the topic of “Life science in space—
Biomedical research performed in
the international space station”,
which addressed vital issues faced
by dental researchers throughout
the world. Currently, several studies
are underway that are investigating
complex matters related to longterm biological gravitational effects, as well as bone loss and muscle
atrophy—comparable to those found
in the ageing population.
“I am confident that the participants were able to take home sev-

eral new ideas that will help to enhance dental science research in
Japan and throughout the world,”
concluded Kamijo about the successful event.
The JADR promotes a wide variety of research related to dentistry
and serves as a gateway to the global
development of dental science in
Japan, with JADR members providing primary contributions to progress in dentistry throughout the
world. The meeting and its mission
were widely supported by the Japanese industry. Among the 54 spon-

sors were companies such as publisher Dental Tribune International
and its Japanese partner Medical
Net, Nobel Biocare Japan, Straumann, Lion Dental Products and
Asahi Kasei Pharma.
The 66th JADR meeting is
scheduled for 17 to 18 November
2018 and will be held in Sapporo in
Japan under the theme “Back to the
tangible—The symbiosis of basic
research and clinical dentistry”.
More information can be found
www.kokuhoken.jp/jadr66/

Dental Tribune International

ESSENTIAL
DENTAL MEDIA
www.dental-tribune.com

[12] =>

SCIENCE & PRACTICE

Dental Tribune Asia Pacific Edition | 12/2017

A fracture load study on
implant-supported crown restorations
An interview with Dr Nadja Rohr, Switzerland

Fig. 1: Dr Nadja Rohr.—Fig. 2: The crowns were loaded until fracturing occurred.—Fig. 3: Measurement results for the fracture load of the crowns (ten test samples for each restoration and luting material)
made of hybrid ceramic and feldspathic ceramic, which were attached with different luting composites.—Fig. 4: Correlation between the fracture load of the crowns and the pressure resistance of the luting
composites.—Fig. 5: Attaching the crowns to the zirconium dioxide implants.

By DTI
Owing to the rigid ankylotic anchoring of the implant in the bone, high
forces act on the superstructure,
and this can lead to chipping and
fractures in the case of restorations
made from conventional, brittle ceramics. Owing to its dual ceramic–
polymer network structure, the
VITA ENAMIC hybrid ceramic (VITA
Zahnfabrik) has a comparatively
high, dentine-like elasticity. This
elasticity allows the material to absorb masticatory forces. In this interview, Dr Nadja Rohr from the
University of Basel’s centre for dental medicine in Basel in Switzerland
reports on her findings in fracture

without cement

load tests of implant-supported
crowns.
In an in vitro study, you examined
the fracture load of crowns made of
hybrid ceramic and conventional
ceramic seated on one-piece ceramic implants. What process did
you follow?
Standardised molar crowns
made of hybrid ceramics and feldspathic ceramics were attached to
zirconium dioxide implants (ceramic.implant, ø 4.0 mm, VITA
Zahnfabrik) using four different
attachment composites. After
being stored in water for 24 hours
at 37 °C, the crowns reached their
breaking point. The luting materi-

Harvard Implant

Panavia SA

Maxcem Elite

High fracture load values for
hybrid ceramics and feldspathic
ceramics were achieved with luting composites that had high pressure resistance.

als used were also characterised according to their flexural strength,
elastic modulus, tensile strength
and pressure resistance.
What were the differences between
restorations made of VITA ENAMIC
hybrid ceramic and conventional
ceramic in the fracture load tests?
With the use of hybrid ceramics, significantly higher fracture
load values were achieved compared with feldspathic ceramics.

How relevant is the pressure resistance of a luting composite in daily
clinical practice?
High pressure resistance luting
composites can increase the stability of the overall system. In the
molar area, there are maximum
masticatory forces of up to about
1,000 N. Choosing the right luting
composite can have a positive effect on the clinical success of hybrid and feldspathic ceramic restorations.

In your test series, the crowns were
bonded with self-adhesive and conventional composites. Did that affect the fracture load values determined?

Multilink Automix

Maxcem Elite

Multilink Automix

Panavia SA
Harvard Implant semi-permanent

without cement

What should be considered when
choosing the luting composite, and
what should be taken into account
during the integration process?
Dentists should choose a luting
composite that meets the specific
clinical requirements of the case.
For attaching hybrid ceramic
crowns to zirconium dioxide implants, this would be an adhesive
luting composite with high pressure resistance. Furthermore, it is
important for the conditioning to
be performed according to the
manufacturer’s instructions.
Editorial note: This interview was first
published in Dental Barometer, Issue
7/2017.

[13] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2017

New materials for a classic indication
Cementation of all-ceramic restorations using Variolink Esthetic

Fig. 1: Pre-op situation.—Fig. 2: Situation after composite build-up (Tetric N-Ceram
Bulk Fill) and preparation.— Figs. 3a & b: Crown design in the software suite (inLab) and try-in before crystallisation firing (IPS e.max CAD).—Fig. 4: Characterised
and glazed crown.—Fig. 5: Etching and silanating with Monobond Etch & Prime.

By Drs Eduardo Mahn & Juan
Pablo Sánchez, Chile
Zinc phosphate cements are seen
as classic luting materials for the
cementation of metal–ceramic
crowns. Along with all-ceramic
materials, glass ionomer cements
(GICs) and resin-modified glass
ionomer cements (RMGICs) were
introduced. Generally, luting cements are expected to meet certain requirements: they should
provide an optimum bond to the
tooth structure and restorative
material, must not be soluble in
water, should be suitable for application in thin coatings and should
offer long-term stability. This is in
contrast to the properties of classic cements, which are water soluble and do not establish an adhesive bond to the enamel or dentine

www.idem-singapore.com

(zinc phosphate cements) or establish only a minimally adhesive
bond and only to the dentine (GICs
and RMGICs). Nonetheless, these
cements show reasonable survival
rates if used for the appropriate indication even if they have certain
limitations.

Problem 1: Opacity
The opacity of the luting material is a critical issue for all-
ceramic crowns, as well as ceramic inlays and onlays. Almost
any colour can theoretically be
reproduced with ceramics by exploiting their natural translucent properties. Using an opaque
luting material appears to be
counter-productive in achieving
this. Further critical issues are
the limitations involved in the
anterior region and the location of the cement line
in the visible area for inlays and onlays. For instance, if a tooth is restored with a veneer, the
basic shade of the tooth is
maintained; only the
enamel is replaced, usually by using a translucent
ceramic that covers the
natural dentine. In such a
case, it is essential to use a
translucent luting material to achieve a favourable
result.

Problem 2:
Adhesion

The comparatively low
bond strength of conventional cements is also problematic. Classic preparations around the tooth create a high degree of friction

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[14] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2017

Fig. 6: Enamel etching prior to application of the adhesive.—Fig. 7: Applying Variolink Esthetic DC into the crown.—Fig. 8: Placing the crown.—Fig. 9: Excess removal is easily achieved owing to the new
technology based on the Ivocerin photoinitiator.—Fig. 10: Final curing. Excess luting material was removed beforehand (quarter technique).—Fig. 11: Seated crown after excess removal.—Figs. 12a & b: Lateral
and occlusal views of the completed restoration.

“Almost any colour can theoretically be
reproduced with ceramics by exploiting
their natural translucent properties.”
and retention. However, the retention is significantly reduced
with partial crowns, veneers or
onlays. It is therefore advisable to
use a luting material that is capable of providing a strong adhesive
bond. Both problems led to the
widespread use of luting composite materials. Perhaps their only
disadvantage is the removal of
excess material. These luting materials are hard and solid and not
water soluble, and they have a
high adhesive strength, making
removal of excess difficult. Early
luting composites were equipped
with a self-cure mechanism.
Users had to wait a few minutes
until the composite was almost
fully set before they could remove the excess material. This
period was risky because of the
moisture in the mouth. Blood or
saliva could come into contact
with the non-polymerised composite and cause damage.

12a

Dual-curing luting
composites
These issues led to the rise of
dual-curing composites for the cementation of all-ceramic crowns.
Dual-curing luting composites are
usually delivered in double-push
syringes with a mixing tip. During
extrusion, the base and catalyst
are automatically mixed. The material can be applied directly. The
main advantage is that the curing
process can be accelerated with
light and excess material can easily be removed. At the same time,
the self-cure mechanism ensures
a reliable cure, even with relatively thick or opaque ceramic layers. Nonetheless, there are some
situations in which excess material cannot be removed all that
easily because the setting reaction
takes place too quickly or the material does not cure down to the
depth of the composite layer. After

one second of light curing, the surface is set and excess can be broken off, but the material is still
paste-like at the interface to the
crown or tooth.
Excess can be polymerised en
bloc and pulled off as a ring in one
go with no uncured material left
in contact with the tooth or
crown. In addition, the luting
composite does not contain
amine, which is another advan-

tage, since amine may be implicated in discoloration of the cement line over time.

One material,
five shades
Variolink Esthetic (Ivoclar
Vivadent) is based on the value
shade concept. The shades are
classified according to the effect
to be achieved with the cement.
Five shades are available: Light+,
Light, Neutral, Warm and Warm+.
In this way, the shade spectrum
ranges from an opaque white
tone (Light+) to an opaque yellow-brownish shade (Warm+). In
between lie shades such as a coconut water white and a neutral
tone (very translucent) and a
warm tone (comparable to A3). In
addition, the luting composite is
available in an LC (light-curing)
and a DC (dual-curing) version.
The LC version is designed for rel-

atively thin restorations, such as
inlays, onlays and veneers. The
DC version is suitable for more
extensive and opaque restorations. The luting composite is
used in conjunction with the
light-curing single-component
Tetric N-Bond Universal (Ivoclar
Vivadent).

Clinical case
A 45-year-old male patient
presented to the practice with a
restoration on tooth #46. The
tooth had been endodontically
treated and temporised with a filling (Fig. 1). The temporary was removed, the tooth built up with
Tetric N-Ceram Bulk Fill (Ivoclar
Vivadent) and then prepared for
the crown restoration (Fig. 2). An
impression was taken with a onestep, two-phase impression technique using a putty and lightbody silicone. After scanning the
model, the crown was designed in

“[…] the self-cure mechanism ensures a
reliable cure, even with relatively thick
or opaque ceramic layers.”

12b

[15] =>

13a

Figs. 13a & b: Radiographic control images before and after the treatment.

the software suite (inLab, Dentsply
Sirona) and milled from an IPS
e.max CAD lithium disilicate block
(Ivoclar Vivadent; Figs. 3a & b).
After the crystallisation firing, the
crown was stained and glazed
(Fig. 4). The next step was to etch
and silanate the ceramic crown
with the new glass-ceramic primer
Monobond Etch & Prime (Ivoclar
Vivadent). This primer combines a
ceramic etching and silanating
component in a single material
and therefore eliminates the need
for the ceramic to undergo hydrofluoric acid etching (Fig. 5). After
the etching and silanating step,
the crown was rinsed with water
and dried. The isolated enamel
was then etched (Fig. 6). The adhesive (Tetric N-Bond Universal) was
applied and dispersed with a
strong stream of air. The dual-curing version of the Variolink Esthetic luting composite was used
for seating owing to the thickness
of the crown and the low translucency of the ceramic material
(Fig. 7). The luting composite was
applied into the crown. The restoration was then seated (Fig. 8) and
light-cured from each side for
two seconds. Excess composite
was easy to remove owing to the
Ivocerin photoinitiator (Ivoclar
Vivadent), which provides a fast
and thorough cure with a minimum amount of energy (Fig. 9).
For final polymerisation, the restoration was light-cured from
each quarter for 20 seconds
(Fig. 10). Figures 11 and 12a & b show
the oral situation after placement
of the crown. Although the cement line was located above the
gingival margin, it was not visible owing to the favourable tone
and opacity of the luting composite. Figures 13a & b show radiographic control images of the restoration: the radiopaque build-up
material and cement can easily
be distinguished from the tooth
structure. This aspect is particularly important in situations
where excess cement cannot be
seen with the naked eye.

Conclusion
The cementation methods
used in conjunction with all-
ceramic materials have changed
for single-crown restorations.
Variolink Esthetic is a protagonist
of the latest generation of luting
composites. Excellent bond
strength values, coupled with userfriendly handling characteristics
and highly aesthetic properties,
make this material an asset in
day-to-day dental restorative care.

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 12/2017

13b

Dr Eduardo Mahn
is a certified implantologist and
the Director of
Clinical Research,
and the Director
of the Program
of Esthetic Dentistry at the Universidad de los Andes in
Santiago in Chile. He can be contacted
at emahn@miuandes.cl.

Dr Juan Pablo
Sánchez is a
dental surgeon.
He holds a postgraduate degree
in oral rehabilitation from the
Universidad de
los Andes and lectures on this field at
the university. He can be contacted at
drjpsanchez@gmail.com.
AD

[16] =>

[17] =>

Lab TRIBUNE
The World’s Event Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

Vol. 15, No. 12

Ivoclar Vivadent hosts successful
Competence in Esthetics symposium
By DTI

sion of the program is already available and was
shown at the event.

VIENNA, Austria: Digitalisation has changed the dental industry and new technologies have entered dental practices and laboratories faster than predicted.
Following the dynamics of
this development, dental
manufacturer
Ivoclar
Vivadent highlighted this
topic at its Competence in
Esthetics symposium recently held in the Austrian
capital of Vienna.
For the third time, Gernot Schuller, Senior DirecDigitalisation in focus: New state-of-the-art software was introduced at the event.
tor for Austria and Eastern
Europe at Ivoclar Vivadent,
Many speakers at the symposium
and his team succeed in drawing
dental technicians to overcome
were pioneers in terms of digitaliparticipants from all over the
the barriers of time and space was
sation and have used several generworld to the symposium. More
proven by a number of presenters
ations of devices and technologies
who work as a team across differthan 1,400 participants from 36
and shared their experiences via
ent countries, among them Dr Stecountries registered for the event,
numerous clinical cases that they
fan Koubi from France and dental
which is traditionally hosted at the
technician Hilal Kuday from TurAustria Center Vienna conference
treated using either a fully or
key, as well as Dr Florin Cofar from
venue. An additional 100 people
mixed digital approach.
Romania and dental technician
joined as day visitors to attend the
What changed with the advent
presentations of the 21 speakers.
Lorant Stumpf from Ireland.
of CAD/CAM? What are the
In his opening speech, Ivoclar
strengths and weaknesses of this
At the symposium, new stateVivadent CEO Robert Ganley extechnology? At the event, there was
of-the-art software was introduced
plained why it is important for the
a general consensus that CAD/
that in the future will allow users
company to focus on digitalisaCAM is an intelligent tool rather
to see different versions of their
tion, a megatrend that has been
than a solution in itself. That CAD/
restoration in a virtual mirror and
predicted by reputable futurolomodify it with a swiping motion,
CAM facilitates day-to-day work
gists and not only for dentistry.
like on a smartphone. A demo verand makes it easier for dentists and

At present, treatment
teams may use mock-ups
that are milled or printed to
give their patients a clearer
sense of what their prospective smiles may look like. Dr
Irena Sailer and dental technician Vincent Fehmer presented a case in which they
offered their patient three
different mock-ups to try-in:
a perfect aesthetic version, a
version with a diastema and
another one in which teeth
#12 and 22 were rotated
around their axes. These
digitally prepared mock-ups
facilitated the conversation with the
patient and made it possible for her
to choose her own prospective
smile. The mock-up of her choice
was then finalised using digital
technology. “This is as easy as
copy and paste,” said Fehmer.
Dental technicians can expand
their digital library with every clinical case by storing scan data. Over
time, this results in an extensive collection of tooth shapes that can be
used in the planning of other cases.
The Cofar–Stumpf team knows how
to use the library to their advantage.
Both team members have studied
the dentition of many patients and

have turned the basics of aesthetics
upside down when it comes to shape
and symmetry: their result proves
that the shape of the face does not
always conform to the shape of the
tooth and some asymmetry may be
present—especially in the case of
smiles that appear natural or beautiful. “It’s all about harmony and individuality and not about perfection
in form and symmetry,” explained
Cofar. When the team members use
their library of nature in the digital
planning process, they blend the anterior and posterior teeth of different cases. In the process, the teeth
are scaled in size but never distorted,
because that would affect the optical
result adversely.
Especially for Ivoclar Vivadent
events and lectures, the company
developed the IV Events app. During the Competence in Esthetics
2017 symposium, the app provided
information about the presentations and speakers, and allowed
users to rate them using the star
system used on social media. The
app also gave participants the opportunity to pose questions to the
presenters, and questions of broad
interest were discussed on stage.
The discussions were moderated
by Drs Thomas Bernhart (scientific chairman of this year’s event)
and Laurent Schenck (Senior Director of Global Communications
and Strategy at Ivoclar Vivadent).

US dental software provider first to
deliver voice-assisted ordering
NEW YORK, USA: The next step in
artificial intelligence advancement within dentistry could be
just around the corner. Awrel, the
dental software solution provider
for web, mobile and voice platforms, has recently unveiled their
Awrel Partner Portal. According to
the company, this new technology
enables dental supply companies
and laboratories to supply their
customers with intelligent, voiceguided ordering services for implants, supplies and equipment.
The capabilities of the new
technology reportedly enable companies to extend their order processing capabilities beyond the current paper-, web- and mobile-based

methods to environments that
deliver next-generation, conversational voice experiences. Additionally, companies will be able to custom label their offerings, define
unique workflows and create company- and product-specific conversational exchanges.
“We’re very pleased to be the
first dental software provider to
deliver voice-assisted, hands-free
ordering,” said Dr Arnold Rosen,
Awrel founder and CEO. “With this
technology, dental care providers
will see improved productivity
and quality while suppliers and
labs will accelerate their sales processes. This is a definite win-win.”
The system is designed so
that the person placing the order

can respond to product-specific
prompts from a voice-powered
agent or chat-bot. Each subsequent interaction follows an intelligent, protocol-based conversational flow. After the order is
completed, it can be sent via
message to the supplier or laboratory, or the system can be customised so that it can flow directly into an existing electronic
ordering system.
“We soon realise that dentistry could logically benefit
from next-gen voice assistants.
This is a logical extension of our
offerings,” said Rosen. “As a
prosthodontist, my hands serve
as the tools of my trade. I’d rather
they be working to create a great
smile than typing orders into a

computer or cellphone. With
voice technology, my hands are
free to work and puts my focus
where it belongs—on the patient.”
Companies using
Awrel’s voice capabilities can also
provide their
customers with
Awrel’s readyto-download
texting and
collaboration tool for
HIPAA-compliant sharing
and the storage of messages,
images, documents and scans.

By DTI

[18] =>

BUSINESS

Lab Tribune Asia Pacific Edition | 12/2017

Stay CALM! Planmeca algorithm
improves imaging quality

Fig. 1: Planmeca 3-D imaging specialist Mikko Lilja participated in the development of the algorithm. CALM analyses and compensates for patients’ movement during the scanning process, making dental imaging
safer and quicker for patients and dentists alike. —Fig. 2: A Planmeca representative introducing the CALM algorithm at the Finnish Dental Congress and Exhibition in Helsinki in November, were the solution
received a honourable mention.

By DTI
HELSINKI, Finland: Patient movement is among the most significant challenges to CBCT imaging, producing artefacts that can
compromise the quality of the
image.
According to Finnish manufacturer Planmeca, an end-user
solution to this problem was in
the company’s sights for some
time and has now finally been addressed with Planmeca CALM.

The algorithm analyses and
compensates for patients’ movement, eliminating the need for retakes and thus improving the
quality of and the time needed for
imaging in dentistry. Recounting
the development process of CALM
(Correction Algorithm for Latent
Movement), Planmeca 3-D imaging specialist Mikko Lilja explained the mechanism of the
solution: “In tomographic reconstruction, the assumption is that
the measurements—in this case
the CBCT x-ray projection im-

ages—are geometrically consistent with one another, but when a
patient moves, the data no longer
adds up, which shows in the reconstruction.”
To avoid these disruptions,
Planmeca CALM restores the consistency of the X-ray measurements by tracking the movement
of the patient. The algorithm
works with all volume and voxel
sizes and adds only between 10
and 60 seconds to the overall reconstruction time, the company

stated. The function can be run either after the scan is complete or
before exposure to ensure that
the volumes are already corrected
when they are accessed in the
Planmeca Romexis software.
“In the past, dentists would
send their unsatisfactory images
to the manufacturer for reconstruction or just redo the entire
scan, but with Planmeca CALM
this is now a thing of the past. We
are proud to be the first dental
manufacturer to provide a solu-

tion for motion artefact correction to the end-user,” Lilja said.
For dentists, the CALM feature is especially valuable when
imaging restless or livelier patients, such as children, individuals with special needs or elderly
patients. “Even in cases where
you might not typically think
there has been significant movement, Planmeca CALM can noticeably enhance the image and
enable seeing more details,” Lilja
concluded.

ity of dental practitioners in
Western Australia. However, this
regulatory framework is set to
change, according to the Australian Dental Industry Association
(ADIA).
Although each state and territory takes a different regulatory
approach to owning CBCT equipment, in terms of outcomes, there
is broad alignment across all of
them—with the exception of
Western Australia.

By DTI
PERTH, Australia: CBCT imaging is changing the way dental

practitioners can visualise the
oral and maxillofacial complex,
as well as teeth and the surrounding tissue. Despite being regarded

as beneficial for practitioners and
patients alike, owing to a restrictive licensing policy, the technology is only available to a minor-

“ADIA welcomes news that the
Radiological Council of Western
Australia looks set to remove the
restrictions on CBCT ownership in
that state,” said ADIA CEO Troy
Williams. Owning and operating
CBCT equipment in Western Australia is currently limited to dentists registered with the Australian Health Practitioner Regulation
Agency (AHPRA) in the specialty
of dentomaxillofacial radiology
—a criterion that only very few
dentists fulfil. In a senate committee hearing on 9 November, the
ADIA CEO pointed out that, of the

about 1,780 registered dentists in
the state, almost none satisfy the
requirement to own and operate
CBCT equipment.
Once in force, the regulatory
changes will allow AHPRA-registered dentists who have successfully completed a recognised CBCT
course to be eligible for a licence to
own and operate CBCT equipment. According to the ADIA release, the requisite courses are offered by the dental schools at the
University of Queensland and the
University of Adelaide and by a
private provider.
“This outcome is entirely consistent with what ADIA has argued
for over many years. It’s actually
five years ago this month that
ADIA met with the then Minister
for Health to progress this reform
and we’ve naturally discussed it in
the past with the current Minister,
Roger Cook,” Williams commented.
It has not yet been announced
when the new legislation will be
put into force.

[19] =>

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[20] =>

TRENDS & APPLICATIONS

Lab Tribune Asia Pacific Edition | 12/2017

Fixed and removable implant
restorations: A solution for every arch
By Dr Paresh B. Patel, US

Figs. 1a–c: Pre-op condition of the patient. Note the high lip line, severe cervical caries present on the patient’s remaining teeth and lack of gingival support.—Fig. 2: The pre-op panoramic radiograph demonstrated periodontal disease, cervical caries, the terminal state of the patient’s dentition and the compromised state of the surrounding periodontium, which had rendered the teeth mobile.—Fig. 3: Maxillary
implants with parallel pins in place exhibiting the axial placement of the anterior implants and the tilted angulation of the posterior implants.—Fig. 4a: Inclusive Tapered Implant.—Figs. 4b & c: The implants were threaded into place, achieving excellent initial stability.—Fig. 5: Multi-unit abutment with carrier in place illustrates correction of the implant’s angulation to establish a uniform prosthetic platform around the arch.

Introduction
When a patient presents with an
edentulous arch or terminal dentition, implant treatment can be
provided that improves not only
form and function, but also quality of life. For patients desiring
better masticatory capability,
stability, aesthetics and comfort
than a conventional denture can
offer, both removable and fixed
implant restorations are superior
alternatives.1 While the appropriate implant solution can vary de-

pending on the patient’s oral
health, anatomy, quality and quantity of bone, and financial resources, full-arch prostheses have
progressed to the point where virtually every patient can have his
or her teeth restored.
Although fixed implant-supported restorations offer the
highest levels of stability, function and patient satisfaction, removable overdentures also offer
a dramatic improvement over

conventional complete dentures. 2 Both treatment options
effectively mitigate the bone resorption that occurs after the
loss of teeth, helping to preserve
the oral and facial structures
and, by extension, the self-confidence of the fully edentulous
patient.
Determining which solution
is appropriate requires a careful
evaluation of the individual patient’s circumstances and de-

sires. Even when an implant
overdenture is delivered, the
prosthesis can eventually be
converted to a fixed restoration.
As evidenced by the case that
follows, in which one arch is restored with an implant overdenture and the other with a BruxZir Full-Arch Implant Prosthesis,
practitioners today have a great
deal of clinical flexibility.
Whatever prosthetic approach is adopted, immediate,

life-changing relief can be provided to patients suffering from
terminal dentition or an uncomfortable, poorly functioning conventional denture. Furthermore, the dramatic overhaul of this patient’s oral health
demonstrates the life-changing
capabilities of implant therapy,
which helped him overcome severe functional and aesthetic
challenges that affected practically every facet of his life prior
to treatment.

“Whatever prosthetic approach is adopted, immediate, life-changing
relief can be provided to patients suffering from terminal dentition
or an uncomfortable, poorly functioning conventional denture.”

[21] =>

TRENDS & APPLICATIONS

Lab Tribune Asia Pacific Edition | 12/2017

10a

10b

11a

11b

11c

12a

12b

13a

Fig. 6: Conventional dentures were fabricated in advance of the surgical appointment so that they could be immediately converted to serve as temporary appliances during the healing phase.—Figs. 7a & b:
Same-day conversion of the maxillary denture to an immediate fixed prosthesis was achieved by adding multi-unit temporary cylinders using self-curing acrylic and trimming the appliance into a horseshoe shape.—Figs. 8a & b: Note the dramatic change in the appearance of the patient, who left with chairside-converted dentures in place on the same day as surgery, including a screw-retained fixed
provisional for his upper arch.—Fig. 9: Post-op panoramic radiograph illustrates all-on-4 configuration of maxillary implants and axial placement of the mandibular implants, which would facilitate a
passive fit of the mandibular overdenture.—Figs. 10a & b: The patient returned 14 weeks after implant surgery, and healing of the peri-implant tissue had progressed nicely.—Figs. 11a–c: Transfer copings were attached to the maxillary multi-unit abutments, and an open-tray impression was made to serve as the basis for the working cast the laboratory would use to begin designing the restoration.
Note that a closed-tray impression was taken for the mandibular implant overdenture.—Figs. 12a & b: For the recording of jaw relations, a mandibular wax rim was designed to seat over the Locator
attachments, while a screw-down wax rim was created for the maxilla.—Figs. 13a & b: The maxillary wax rim was screwed into place through the temporary cylinders, while the mandibular wax rim
was seated over the Locator impression caps.

Case presentation
A 47-year-old male presented
with terminal dentition in both
arches resulting from periodontal
disease and severe caries (Figs. 1a–c).
The patient had already lost many
of his teeth, and the dentition that
remained had been rendered unstable by his periodontal condition
(Fig. 2). He had saved up enough
money for a fixed implant restoration for his upper arch, for which
he desired the most functional,
lifelike prosthesis possible. While
he could not afford such a restoration for both arches, he wanted a
retentive appliance for his mandible, with the option of later upgrading to a fixed prosthesis.

from monolithic zirconia would
ensure maximum long-term durability. This was important considering the relatively young age
of the patient, who would not have
to worry about his maxillary prosthesis succumbing to fractures,
chips or stains. His mandibular
appliance would be held in place
by connecting to the implants via
Locator attachments (Zest Dental
Solutions), which are an economical means of improving prosthetic
retention and stability. The overdenture caps that connect to the
Locator attachments would be incorporated in the prosthesis chairside—though it should be noted
that many clinicians elect to have
the laboratory handle this step.

The patient accepted a treatment plan in which his maxilla
would be restored with a BruxZir
Full-Arch Implant Prosthesis and
his mandible with an Inclusive
Locator Implant Overdenture. Fabricating his maxillary restoration

The surgical phase of treatment called for the extraction of
the patient’s remaining teeth, followed by the immediate placement of eight dental implants.
Cone beam computed tomography (CBCT) scans were taken to

help determine the optimal placement of the implants within the
available bone and away from the
patient’s vital oral anatomy. Evaluation of the CBCT scan determined that there was sufficient
height, width and quality of bone
to place the implants in the appropriate locations and angulations via freehand surgery. Four
ø 3.7 mm Inclusive Tapered Implants (Glidewell Direct) would be
placed in each arch to support the
fixed maxillary restoration and
the removable mandibular prosthesis. At the surgical appointment, the patient’s remaining
teeth were removed, and a flap
was raised to visualise the socket
sites and areas of implantation.
Bone levelling was performed on
the patient’s upper arch to elevate
the patient’s smile transition line
above the upper lip.
The maxillary osteotomies
were positioned to facilitate an
a ll-on-4 configuration, with the

posterior implants tilted to maximise the anterior–posterior spread,
avoid the sinuses and accommodate
the patient’s bone limitations
(Fig. 3). Osteotomies were created
for the placement of four mandibular implants, as opposed to the minimum of two required for a Locator
overdenture. This would enhance
retention of the overdenture while
affording the possibility of upgrading to a fixed restoration at a later
time. After the creation of the osteotomies, the implants were placed
(Figs. 4a & b).

13b

Inclusive Multi-Unit Abutments (Glidewell Direct) were attached to the maxillary implants,
correcting for the divergent angulation of the implants. This would
both position the restorative platform in a manner that would situate the screw access holes of the
eventual prosthesis toward the lingual aspect and allow for a molar–
molar restoration (Fig. 5). Note that
patients with terminal dentition
presenting for treatment are commonly anxious about losing their
teeth and the effect this will have

[22] =>

TRENDS & APPLICATIONS

Lab Tribune Asia Pacific Edition | 12/2017

15a

15b

15c

16a

16b

16c

17a

17b

17c

18a

18b

Fig. 14: A PVS wash impression was made of the mandibular arch, capturing the positions of the Locator attachments and the gingival contours and vestibules.—Figs. 15a–c: The laboratory produced wax set-ups for
try-in. The maxillary set-up included temporary cylinders so that the set-up could be attached to the implants during evaluation. The mandibular set-up included recess wells so that it could be seated over the Locator attachments and soft tissue.—Figs. 16a–c: The maxillary and mandibular wax set-ups were tried in to evaluate fit, aesthetics, occlusion and function.—Figs. 17a–c: Individual sections of the implant verification
jig were seated and luted together before being picked up in the open-tray final impression, which was made using a custom tray and Capture PVS material (Glidewell Direct).—Figs. 18a & b: The final mandibular
implant overdenture was designed to seat over Locator attachment analogues situated in the mandibular cast. This would allow the overdenture caps that engage the Locator attachments to be picked up chairside.
—Figs. 19a & b: CAD software was used to design the definitive prosthesis for the patient’s maxilla based on the final impression and approved wax set-up. Access holes were created in the precise positions needed
for passive fit.—Figs. 20a & b: The provisional implant prosthesis was milled and seated on the master cast to verify proper fit, as well as the interocclusal relationship with the opposing implant overdenture.

on their speech and masticatory
capabilities. For this reason, it is
important to make every effort to
ensure that the patient leaves with
functional appliances in place.
Thus, conventional dentures were
fabricated from preliminary impressions in advance of the surgical appointment for modification
and delivery after placement of the
implants (Fig. 6).
Sufficient primary stability
having been achieved, the Inclusive Tapered Implants placed in
the patient’s maxilla could be immediately loaded. Thus, the maxillary denture was trimmed and
modified chairside to connect to
the multi-unit abutments through
temporary cylinders (Figs. 7a & b).
This would satisfy the patient’s desire to leave the surgical appointment with a fixed, fully functional
maxillary prosthesis in place.
Note that the two most distal molars were removed to minimise
the cantilevers and the forces
transmitted to the implants during osseointegration. Healing abut-

19a

ments were placed on the mandibular implants to begin developing
the transmucosal passages.
The mandibular immediate
denture was then modified and
relined to seat over the implants
during healing. This approach
provided the patient with sameday temporary restorations, and
he walked out of the office with
properly functioning teeth for the
first time in many years. The effect this had on the patient’s comfort, function and appearance
was immediate and profound
(Figs. 8a & b). The final radiograph
taken after seating the temporary
appliances confirmed excellent
positioning of the implants (Fig. 9).
The patient returned after
14 weeks of healing for stability
of the implants and health of
the soft tissue to be evaluated.
Removal of the temporary appliances revealed excellent tissue
health around the healing abutments of the mandible and multi-unit abutments of the maxilla

19b

(Figs. 10 a & b). Polyvinylsiloxane
(PVS) impressions were taken to
begin the restorative process
(Figs. 11a –c).
Because multi-unit abutments
and healing abutments were placed
on the day of surgery, the restorative process began above the tissue
level, without any need for secondary surgery or anaesthesia. The restorative protocol for both prostheses included wax rims and setups, which the laboratory produced
on the working casts fabricated
from the impressions (Figs. 12a & b).
The maxillary wax rim incor
porated temporary cylinders
through which screws could connect to the dental implants. The
mandibular wax rim was designed
to seat over Locator attachments.
At the next appointment, the
wax rims were seated, the jaw relationship was recorded using a conventional denture technique and
a bite registration was taken
(Figs. 13a & b). A PVS wash impression of the mandibular arch was

20a

also taken with the wax rims and
Locator impression caps in place
(Fig. 14). This would aid the laboratory in designing an overdenture
that fully rested on the tissue instead of the implants. The case
was returned to the laboratory,
and wax set-ups were produced
(Figs. 15a–c). During the try-in appointment, the wax set-ups were
evaluated to confirm the vertical
dimension of occlusion, interocclusal relationship, phonetics, aesthetics, midline, arrangement of the
teeth, tooth colour and shape, incisal edges and function (Figs. 16a–c).
After final approval of the wax
set-ups, the restorative protocols
for the two prostheses diverged, as
the laboratory moved directly to
the final implant overdenture
from the approved wax set-up,
while the process for the BruxZir
Full-Arch Implant Prosthesis included an implant verification jig,
custom final impression and provisional implant prosthesis. These
extra measures were taken to
make absolutely certain that the

20b

definitive prosthetic design was accurate before milling the final restoration from monolithic zirconia.
The implant verification jig was attached to the implants so that a
precise final impression could be
taken (Figs. 17a–c). The custom tray
provided by the laboratory was
filled with PVS material and seated
over the implant verification jig. As
the PVS material set, the relative
positions of the implants represented by the verification jig remained fixed, ensuring an extremely accurate final impression.
The approved wax set-ups and
final maxillary impression were
returned to the laboratory so that
the final mandibular implant
overdenture and maxillary provisional implant prosthesis could be
produced. The final mandibular
appliance was fabricated on the
master cast and included recess
wells in which metal housings
with overdenture caps would be
cured chairside (Figs. 18a & b).
These denture caps provide retention and stabilise the pros-

[23] =>

TRENDS & APPLICATIONS

Lab Tribune Asia Pacific Edition | 12/2017

21a

21b

22a

23a

22b

23b

Figs. 21a & b: After seating of the final mandibular implant overdenture, the maxillary provisional implant prosthesis was tried in to verify fit, form and function.—Figs. 22a & b: The interocclusal relationship
was verified with the final mandibular and provisional maxillary appliances in place.—Figs. 23a & b: The metal housings of the overdenture caps were seated over the Locator attachments.—Fig. 24:
Quick Up self-curing acrylic was used to pick up the metal housings in the overdenture and fill in the minor voids between the denture caps and recess wells of the prosthesis. Note that, in many cases,
the dentist elects to have the overdenture caps processed by the laboratory.—Fig. 25: The black processing inserts were replaced with the appropriate retentive caps, which are colour-coded according
to strength.—Fig. 26: The patient with the final Locator overdenture and the maxillary provisional implant prosthesis in place.—Fig. 27: The definitive maxillary restoration was milled from BruxZir Solid
Zirconia, incorporating the slight adjustments that were made to the PMMA provisional appliance.—Figs. 28a & b: The final BruxZir Full-Arch Implant Prosthesis completed a dramatic oral reconstruction for a patient who presented with terminal dentition, restoring form, function and quality of life.

thesis by seating over the Locator
attachments and keeping the appliance in place during function.
A new master cast of the maxilla was produced based on the
custom open-tray final impression. The new master cast and
final approved wax set-up were
scanned. A virtual model was generated, upon which the fixed monolithic prosthesis was designed
using CAD software (Figs. 19a & b).
Because this digital model was
based on the final impression with
the verification jig, screw access
holes were created in precise
alignment with the positions of
the maxillary implants. The resulting design was used to mill a
provisional implant prosthesis
from polymethyl methacrylate
(PMMA; Figs. 20a & b). This appliance was tried in and worn for a
trial period, thus ensuring an accurate prosthetic design.
The provisional implant prosthesis is an essential element of
the restorative process, as signifi-

cant adjustments cannot be made
to the final restoration once it has
been milled from BruxZir Solid
Zirconia. At the following appointment, the Inclusive Locator Implant Overdenture was seated and
checked for proper fit, function
and support from the soft tissue.
The provisional implant prosthesis was then screwed into place,
and its tooth positioning, function and aesthetics were verified
(Figs. 21 a & b). With both appliances in place, the interocclusal relationship was checked
(Figs. 22a & b). Minor occlusal adjustments were made directly to
the maxillary provisional implant
prosthesis, as PMMA is easily modified. Slight alterations were also
made to the mandibular implant
overdenture. Block-out shims and
the retentive overdenture caps
were then seated over the Locator
attachments (Figs. 23a & b). Quick
Up self-curing material (VOCO
America) was added to the recess
wells of the overdenture before
seating the appliance over the
metal housings. After allowing the

28a

material to set for approximately 3
minutes, the overdenture was removed, picking up the denture
caps in the prosthesis. The minor
voids surrounding the denture
caps were then filled with Quick
Up light-cured pink composite
(Fig. 24). The appropriate retentive
inserts, which are available in a variety of strengths, depending on
the functional capabilities of the
patient and the number of implants, were swapped into the
metal housings (Fig. 25). The implant overdenture was reseated,
providing excellent retention, stability and function for the patient.
With the final mandibular restoration in place, the patient wore
the provisional full-arch implant
prosthesis for a trial period of two
weeks (Fig. 26). This opportunity to
wear the appliance during actual
day-to-day function instilled a
high degree of confidence in the
prosthetic design for the patient
and dentist alike. After patient approval, the provisional implant
prosthesis was returned to the lab-

oratory so that it could serve as the
blueprint for the final restoration
and the minor adjustments made
to the appliance could be included
in the definitive prosthetic design.
The final BruxZir Full-Arch
Implant Prosthesis was digitally
fabricated with precision (Fig. 27).
As an exact reproduction of the
test-driven provisional, the definitive prosthesis fitted perfectly and
offered the aesthetics and function the patient had come to expect (Figs. 28a & b). The final restoration effectively addressed the
unique circumstances of the case,
providing the most durable, stable
prosthesis possible for his maxilla
and a mandibular restoration
that greatly improved prosthetic
retention and could be upgraded
to a fixed prosthesis should the
patient’s situation change.

Conclusion
Practitioners now have the
clinical flexibility to offer patients
a wide range of treatment options,

28b

from entry-level, economical restorations like the Inclusive Locator
Implant Overdenture to the fixed,
highly durable BruxZir Full-Arch
Implant Prosthesis. There is a viable means of treating nearly all patients, whatever their oral health,
needs and finances. Given the
life-changing benefits of implant
therapy and the straightforward
restorative protocols of today, all
patients should be offered this service to confront the challenges presented by complete edentulism.
Editorial note: This article was first published in CAD/CAM international magazine of digital dentistry No. 2/17. A list of
references is available from the publisher.

Dr Paresh B. Patel is a co-founder of
the American Academy of Small Diameter Implants and has worked as a
lecturer and clinical consultant on dental implants for various companies. He
has been in private practice in Lenoir
and Mooresville in North Carolina in
the US since 1996 and can be contacted
at pareshpateldds2@gmail.com.

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[cover] => DT Asia Pacific No. 12, 2017

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