DT Asia Pacific No. 4, 2011
Rare oral condition declared an autoimmune disease / Asia News / World News / Business / Trends & Applications / Advertorial
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DTAP0411_01_Title
DTAP0411_01_Title 20.04.11 15:29 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG
www.dental-tribune.asia
Nakanishi speaks
An interview with
the President of NSK
4Page
NO. 4 VOL. 9
MICD approach
Why does it matter
to dentists?
4
Composite resin
Reconstructing an
anterior dentition
4Page
9
4Page
12
Rare oral condition declared an autoimmune disease Ortho study
gives HK people
a bad note
Daniel Zimmermann
DTI
NEW YORK, USA/LEIPZIG, Germany:
Patients suffering from a very
rare condition that affects the
oral mucosa may soon be offered
some relief by new research
conducted in the US. In a recent study, scientists from Tufts
University near Boston claim to
have found evidence that chronic ulcerative stomatitis (CUS),
characterised by recurring and
painful ulcers, is mainly caused
by an autoimmune response by
the body that destroys the binding of cells inside the surface
tissue layer of the mouth.
According to the scientists,
only a dozen cases of CUS have
been reported worldwide since
the condition was first clinically identified in 1989 but the
number may be higher, as patients may remain undiagnosed
owing to the extensive testing
procedure and low awareness amongst dental clinicians.
While it was known that patients with CUS have specific
auto- antibodies, researchers
had not been not able to determine the extent to which these
contributed to the condition.
With help of the new findings,
People in Hong Kong should
brush up on their knowledge of
misaligned teeth (malocclusion).
According to a new survey conducted by the city’s Society of
Orthodontists on more than 1,000
participants, four in five people
did not know that it can lead to
long-term dental complications,
such as temporomandibular disorders or impaired speech and
chewing dysfunction. Most saw
major consequences for their
social life, including loss of attractiveness and self-esteem due
to conditions like crowded teeth,
crossbite or overbite.
CUS chiefly occurs in middle-aged Caucasion women. (DTI/Photo ostill)
CUS could now be classified as
an autoimmune disease in order
to allow better management of
the symptoms.
Owing to its unique resistance to standard medication
like corticosteroids, successful
treatment of CUS has been
achieved only in some cases
through hydroxy-chloroquine,
a prescription drug primarily
used to prevent malaria, as well
as to treat rheumatoid arthritis
and lupus. By better understanding the mechanisms linking the autoimmune response to
ulcerative sores, new approaches could be developed to treat
patients suffering from the condition, the scientists said.
So far, CUS has been found
chiefly in middle-aged Cau-
casian woman. It can only be
diagnosed by surgical biopsy
using immunofluorescent microscopic examination done by
an outside laboratory. In normal clinical settings, it may be
mistakenly identified as oral
erosive lichen planus, another
more common chronic condition affecting mucosal surfaces
and also thought to be an autoimmune disease. DT
The findings confirm results
of earlier studies that showed
that Hong Kongese generally
lack knowledge of the consequences of bad oral health. The
last national survey on the matter
conducted in 2001 revealed that
only 30 per cent of adults seek
regular dental check-ups. Over
50 per cent also considered tooth
loss as a nature eventuality in life.
In terms of oral health, Hong
Kong currently ranks similar to
other developed countries in
the region. DT
AD
Southern
India troubled
by fluoride
The health of residents of
Bangalore and neighbouring villages in India is under threat by
increasing levels of natural fluoride in their drinking water, the
national newspaper The Hindu
reports.
The skull of a Labidosaurus hamatus dinosaur. Biologists from the University of
Toronto in Canada have recently found signs of oral infections in the fossil, making it
practically the oldest toothache ever recorded. (DTI/Photo Prof. Robert Reisz, Canada)
Mouth enzyme
Dental stem cell
could fight caries bank expands
Japanese researchers have
discovered that the FruA enzyme
produced by the Streptococcus
salivarius bacteria, a harmless
inhabitant of the human mouth,
inhibits the development of oral
biofilms or plague. The discovery could lead to more efficient
oral health products to fight
caries. DT
India’s first private dental
stem cell bank has announced
plans to expand into 10 major
cities including Chennai and
Bangalore within this year.
Founded by Stemade Biotech,
a Indian-French joint venture,
the institution currently operates two branches in Mumbai
and New Delhi. DT
According to the latest tests
by the country’s Department of
Mines and Geology, the amount
of the mineral found in water
reservoirs beneath the city recently exceeded the limit for
human consumption by 400%.
If consumed over a long period,
high amounts of fluoride can significantly contribute to skeletal
and dental fluorosis, a condition
that weakens bones and teeth.
Experts said that the fiveyear high may be due to deeper
sunk wells that strike fluoriderich ground water at depths of
300 metres. DT
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[2] =>
DTAP0411_01_Title
DTAP0411_02_News 20.04.11 15:30 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
AD
Australia spends millions
on kids oral health study
Four times more children admitted to dental
hospitals than in the UK
Daniel Zimmermann
DTI
HONG KONG/LEIPZIG, Germany:
As part of a multi-million dollar health funding package,
the Australian Coalition has
granted the University of
Adelaide in South Australia
AU$1.3 million (US$1.36 million) to investigate poor oral
health in children. The study
will be conducted nationwide
over four years and involve
more than 30,000 participants from private and public
schools.
According to a governmental survey, teenage children
in Australia have an increased
risk of developing dental diseases. Every year, over 20,000
children are admitted to hospitals for dental work, a significantly higher number compared with other countries
like the UK, where slightly
over 5,000 admissions were
recorded in 2009.
Researcher Professor John
Spencer from the Australian
Research Centre for Population Oral Health, who will also
lead the study, said that it will
look at the organisation and
delivery of dental services for
children, as well as compare
the use and clinical outcomes
of school dental services and
private dentists. He said that
Children in Australia have an increased risk of developing dental diseases.
(DTI/Photo Shane White, Australia)
his institute will be partnering
with all eight state and territory
public dental authorities, who
will be committing an additional AU$1.7 million (US$1.78
million) to the project.
“Public programmes like
the school dental services are
not reaching as many children,
yet private dental services may
be out of the financial reach of
many families,” Prof Spencer
said. “The challenge is to
identify and eliminate barriers
to dental health services in
Australia, improving service
delivery, reducing risks and
promoting healthy diets.”
Australia currently spends
less than the US and countries
in Asia and Europe on public
health care, a 2009 study by the
Organisation for Economic Cooperation and Development has
found. The funding for a universal dental health scheme, a key
motivation for the Green Party
forming a coalition with Labor
in the last national election, was
recently scrapped from the federal budget by the Ministry of
Health. DT
International Imprint
Licensing by Dental Tribune International
Publisher Torsten Oemus
Group Editor/Managing
Editor DT Asia Pacific
Daniel Zimmermann
newsroom@dental-tribune.com
Tel.: +49 341 48474-107
Copy Editors
Sabrina Raaff
Hans Motschmann
Editors
Claudia Salwiczek
Anja Worm
President/CEO
Torsten Oemus
Editorial Assistant
Yvonne Bachmann
Marketing & Sales
Peter Witteczek
Director of Finance & Controlling
Dan Wunderlich
Marketing & Sales Services
Nadine Parczyk
License Inquiries
Jörg Warschat
Accounting
Manuela Hunger
Product Manager
Bernhard Moldenhauer
Executive Producer
Gernot Meyer
Ad Production
Marius Mezger
Designer
Franziska Dachsel
International Editorial Board
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
Dr George Freedman, Esthetics, Canada
Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
Published by Dental Tribune Asia Pacific Ltd.
© 2011, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information
and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility
for product names or claims, or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International.
Dental Tribune International
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302 · Fax: +49 341 48474-173
Internet: www.dental-tribune.com E-mail: info@dental-tribune.com
Regional Offices
Asia Pacific
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd, 20A, Harvard Commercial
Building, 105-111 Thomson Road, Wanchai, Hong Kong
Tel.: +852 3113 6177 · Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
116 West 23rd Street, Suite 500, New York, NY 10001, USA
Tel.: +1 212 244 7181 · Fax: +1 212 224 7185
[3] =>
DTAP0411_01_Title
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DTAP0411_01_Title
DTAP0411_04_NSK 20.04.11 15:42 Seite 1
4
DENTAL TRIBUNE Asia Pacific Edition
Asia News
“The Japanese people will recover from this disaster quickly”
An interview with Eiichi Nakanishi, President and CEO of NSK Nakanishi, Japan
production four times for a
period of three hours since
then. However, this has only
marginally affected our production output.
Eiichi Nakanishi is relieved.
His company NSK Nakanishi
and its staff were unharmed
by the 11 March earthquake
and subsequent tsunami.
Like most Japanese companies, the manufacturer of
handpieces and other dental
equipment has an obligation
to serve its customers in
any circumstances. This is
the reason Nakanishi says the
company is currently working overtime, despite the
occasional black-outs, which
are still restricting business
operations in the country.
A number of companies have announced or
launched initiatives to help
victims of the disaster. Are
you working on something
similar at the moment?
Our company has donated a total sum of €260,000
to the Japanese Red Cross
Society with the assistance
of Corporate Adviser and
former CEO Mr Takasuke
Nakanishi and Ms Shizu
Established in the 1930s,
Nakanishi, the wife of our
NSK has had to face a number
founder. In addition, we have
of obstacles during its 80-year
history, in addition to natural Eiichi Nakanishi, President and CEO of NSK Naka- collected donations from our
staff that will support people
disasters. Production of dental nishi, Japan. (DTI/Photo by NSK Nakanishi, Japan)
affected by the catastrophe.
handpieces, for example, had
enhance dental treatment and
to be stopped in 1945 owing to
care for professionals and patients.
World War II and was not resumed
How has the disaster influBesides major updates of their core
until 1951. Since then, the small
enced business life in general?
product lines, such as the Ti-Max
company from Tokyo has evolved
We expect to see some effects
Z contra-angle handpieces and
into a major international dental
in our business operations, particS-Max pico turbines, new surgical
player with several business
ularly in the areas most affected by
systems and the iCare+ all-in-one
branches outside of Japan. NSK
the earthquake and the tsunami.
cleaning system were on display.
operates not only in major markets
However, the best we can do right
like the US or Germany, but also
now is to help the population afDental Tribune Asia Pacific had
in China, Dubai, France, Spain,
fected by the disaster and work
the opportunity to speak with Eiichi
Australia and the UK. Recently,
together to recover from these
Nakanishi about the new products
a representative office was estabevents, which have had severe
and the company’s response to the
lished in Singapore to enhance
results.
current situation in Japan.
sales and services to customers in
the Southeast Asian region.
In your opinion, will this
catastrophe have any long-term
DTI: Mr Nakanishi, how have
impact on the dental industry
your business operations been
Since NSK conducts most of its
in Japan?
doing in the aftermath of the natsales overseas, the recession that
ural disasters in Japan?
hit the Japanese economy in 2009
It is too early at the moment to
had little impact on overall busimake predictions about the longEiichi Nakanishi: Fortunately,
ness results. This relative indeterm effects on our industry, as we
our staff were not injured and our
pendence of domestic sales also
are still in the process of recovery.
facilities remained undamaged.
gave the company the opportunity
We believe that the Japanese peoAs soon as we had confirmed that
to invest in new technologies. As
ple will recover from this disaster
all our facilities were safe, we
a result, NSK launched seven new
quickly owing to the Japanese
resumed operations on 14 March,
products at this year’s International
spirit, which embraces such
almost immediately after the diDental Show (IDS) in Cologne
characteristics as endurance, persaster. Owing to the occasional
that, according to Nakanishi, will
severance and dignity.
black-outs, we have had to stop
You have just returned from
this year’s IDS in Cologne. What
are your general impressions
regarding your exhibition there
and the state of the whole industry?
I believe that this year’s IDS
was very successful for us. We had
many visitors to our booth and
received great feedback on our
new products. Unfortunately, we
only met a few visitors from Japan,
probably owing to the current situation in our country.
You exhibited seven new
products, including new handpieces, scalers and hygiene solutions. In your opinion, what
product or products will be
of the most benefit to dental
practitioners?
All our new products are extremely useful but if I had to
choose key products, the Z series
contra-angle handpieces, as well
as the Surgic Pro surgical micromotor with excellent durability,
reliability and great torque accuracy, will be of most benefit to
practitioners.
Are these products already
available worldwide?
We will launch these products
in Europe first and gradually expand to other regions. Customers
will first be able to purchase them
this summer.
You home market, Japan,
was hit hard by the recession.
How important have overseas
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In Europe, we have increased
our business thanks to re-organisation of sales and the establishment of our new headquarters in
Frankfurt/Main, Germany. We recently expanded our sales network
in emerging markets, with new
offices in Dubai, Moscow and
Singapore. We are also improving
our operations in China through
“...the best we can do right now is
to help the population affected
by the disaster...”
AD
All our products convince by
excellent physical properties
easy handling
perfect aesthetical results
markets become to your company?
Historically, our business has
grown steadily all over the globe.
Our overseas operations already
contribute 83% to our overall business and, therefore, the economic
conditions in Japan only had little
impact. Actually, our domestic
business has grown lately in spite
of the recession.
Glass ionomer filling cement
– perfect packable consistency
– excellent durable aesthetics
– also available as handmix version
our subsidiary in Shanghai and
have started to re-organise our
sales network in Latin America.
NSK has been on the market
for more than 80 years. What
business goals do you want to
see accomplished by 2030, for the
company’s 100th anniversary?
In accordance with our corporate philosophy―by offering
high performance and durable
products at reasonable prices,
NSK contributes to the health and
well-being of people throughout the world―our ultimate goal
is to be the No. 1 global dental
company.
Thank you very much for this
interview. DT
[5] =>
DTAP0411_01_Title
DTAP0411_05_News 20.04.11 15:43 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
World News
Bugs threaten health of orthodontic patients
One in two retainers found to host array of harmful bacteria
Daniel Zimmermann
DTI
LONDON, UK/LEIPZIG, Germany:
Orthodontic retainers are a po-
WHO takes
on influenza
threat
tential source of harmful microbes if not properly cleaned,
scientists in the UK have
warned. In a series of tests conducted at the UCL Eastman
Dental Institute in London at
least 50 per cent of all tested
retainers contained species of
Candida and Staphylococcus
micro-organisms, including
MRSA, a multidrug-resistant
bacterium that can be fatal to
patients with a compromised
immune system.
The Candida yeast, found
universally on human skin and
other areas, can also cause infections. Amongst other conditions, it has been associated with
oral candidiasis, a condition often related to ill-fitting dentures.
Both species do not normally
occur in the oral cavity.
The researchers said that the
high number of harmful bacteria found in retainers is most
likely the result of poor cleaning,
allowing microbes to build up
a resistant biofilm and spread
to other areas of the oral cavity
such as interior cheeks and
tongue. The potential for transmission is also high, as retainers
are frequently removed and
replaced in the mouth by the
person who uses it, they added.
They recommend wearers
wash their hands thoroughly
before and after inserting their
retainers.
Proper dental hygiene through
tooth brushing and the use of
mouthwash also helps to keep
harmful bacteria from entering
the mouth. DT
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Germany: Members of a working
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an international framework to
improve preparedness for influenza pandemics that threaten
public health worldwide. The
agreement, which is expected to
provide clear legal regimes and
responsibilities for all stakeholders involved in the prevention and
management of pandemics, is the
result of more than three years of
negotiations. It is expected to be
ratified during the World Health
Assembly in Geneva, Switzerland, in May.
WHO headquarters (DTI/Photo courtesy of WHO, Switzerland)
According to a joint statement,
one of the key elements of the
agreement will be improved cooperation and exchange of information between key players such as
the WHO, national laboratories
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[6] =>
DTAP0411_01_Title
DTAP0411_06_News 20.04.11 15:43 Seite 1
6
DENTAL TRIBUNE Asia Pacific Edition
World News
Periodontal treatment no harm to newborns
From news reports
SAINT PAUL, USA/LEIPZIG, Germany:
Pregnant women with gum disease may undergo non-surgical
periodontal treatment without
fear of consequences for their
baby’s health. In a large trial
involving 400 infants between
the ages of two and three from
different paediatric clinics in
the US, dental clinicians found
that treating periodontitis during
pregnancy did not affect the
children’s cognitive, motor or
language capabilities later in life.
In the study, clinicians from
universities in Minnesota, Kentucky, Mississippi and New York
compared development data of
children born to women who
were treated for gum disease before and after their delivery.
However, the results between the
control and experimental groups
only differed slightly. Higher
motor and cognitive scores were
observed in the children of
women who saw an improvement in their periodontal health.
Earlier studies indicated that
paternal periodontal treatment
may be linked to different medical problems including low birth
weight, preterm birth and longterm development delays, as
bacteria released during treat-
ment may enter the mother’s
bloodstream and harm the baby.
According to research, pregnant
women are prone to gingival
bleeding, which is caused by
a hormonal imbalance that encourages the growth of certain
oral bacteria.
If the new data is verified,
pregnant women throughout
the US could have their gum conditions treated, confident in the
AD
knowledge that it will not have
a clinically significant effect on
their child’s development, the
researchers said. A spokesperson of the American Academy
of Periodontology said that although the data remains inconclusive, the organisation generally recommends women to
maintain their periodontal health
during pregnancy. DT
Renewal of
Brunei
agreement
Lisa Townshend
DT UK
EMS-SWISSQUALITY.COM
LONDON, UK: King’s College
London Dental Institute can look
forward to three more years of
collaboration aimed at the development of the dental workforce
in Brunei Darussalam after the
renewal of the agreement with
the Government of Brunei.
SUBGINGIVAL
WITHOUT
LIMITS
Professor Stephen Dunne,
Head of Dental Practice & Policy
at the Dental Institute, and Mrs
Mabel Slater, Head of Dental
Care Professionals Centre for
Education and Learning, will
take this collaboration forward.
In welcoming the news of the
signing of the renewal of the
agreement, Professor Dunne
said: “I am delighted that we are
continuing this highly successful
collaboration. It is a great pleasure to work with Ministers and
colleagues in Brunei Darussalam. Much has been achieved
during the past three years, in
particular, the establishment of
a Brunei Diploma in Dental Hygiene and Therapy Programme.”
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“In addition, foundations
have been laid for other areas
of workforce development, including Dental Technology and
a Dental Hygiene Therapy Conversion Programme,” he added.
“Discussions are also underway
to establish a National Survey of
Oral Health Brunei Darussalam
to fully inform dental workforce
requirements for the future.
Thus, I am confident that the
next three years of our collaboration will be just as successful
as the last.”
In the meantime, discussions
led by the Dean continue with
the University of Brunei Darussalam in respect of the possibility
of collaboration in respect of
BDS (Bachelor of Dental Surgery)
training.
According to the Brunei Ministry of Health, the country’s dental service is facing a serious
shortage of staff as only 28 dental
officers serve the total population of 381,000 people under
the Primary Oral Health Care
Scheme. There is also a low
number of local graduates as
well as foreign dentists with suitable qualifications for the post of
Dental Officer. DT
(Edited by Daniel Zimmermann, DTI)
[7] =>
DTAP0411_01_Title
DTAP0411_07_News 20.04.11 16:55 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Business
7
China imports caries detection from Europe
Daniel Zimmermann
DTI
LONDON, UK/LEIPZIG, Germany:
Beijing Focus, one of China’s
largest dental dealers, has signed
an exclusive distribution agreement with 3-D Diagnostic Imaging, the UK developer of the CarieScan PRO device, through its
subsidiary Wisdom International
Medical and Science and Technology. The agreement will take
effect immediately and be 3-D’s
first step into the Asian market.
The company, which is based
in Dundee in the UK, is already
distributing the device in North
America and all German-speaking markets through distribution agreements. Beijing Focus
currently represents a number
of Western dental companies,
including Straumann, Bien-Air
(both Switzerland) and SciCan
(Canada).
Manufactured in Scotland,
CarieScan PRO is an awardwinning diagnostic device that
utilises alternating current impedance spectroscopy technology for the early detection of
dental caries. It is claimed to be
more than 92% accurate in detecting sound and carious teeth.
Regulatory approval for CarieScan PRO by Chinese officials is
anticipated in the last quarter of
2011, a company spokesperson told
Dental Tribune Asia Pacific. She said
that the device will be displayed
earliest at the DenTech exhibition
in Shanghai in late October.
3-D’s stocks climbed by 0.25
points on the London Stock Exchange after the agreement had
been announced. DT
Picture showing the CarieScan PRO
in clinical use. Due to a new distribution agreement, the device will be
soon available to dentists in China.
(DTI/Photo courtesy by Buchanan
Communications, UK)
AD
IDEM
executive
resigns
Yvonne Bachmann
DTI
Mr Kuhrt, who has worked
for Koelnmesse since 2000, has
not yet disclosed the details of
his future plans. During his time
at the company, he established
Koelnmesse’s subsidiary Koelnmesse Service GmbH and was
was appointed Executive VicePresident of the parent company
Koelnmesse GmbH. Hemanaged
more than 20 international trade
fairs, including the world’s largest
dental show IDS. “I am looking
back at ten years of very interesting and multifaceted work at
Koelnmesse, for which I am
profoundly grateful. I wish the
group, its management and all
of its employees continued professional success and all the best
for the future,” Mr Kuhrt stated.
Gerald Böse added: “In recent
years, Mr Kuhrt has generated
strong momentum for our trade
fair portfolio and continuously
refined the leading global trade
fairs for which he was responsible. I would like to thank him
for his extraordinary dedication
and wish him every success for
his new challenges.” DT
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The responsibilities of Kuhrt’s
management division will provisionally be taken over by Gerald
Böse, CEO of Koelnmesse. “Gerald Böse has a lot of experience in
the organisation and marketing
of trade shows,” Guido Gudat,
Koelnmesse spokesperson, told
Dental Tribune Asia Pacific. According to Mr Gudat, the company is
looking for a new executive vicepresident, who, amongst other
duties, will take over the marketing for the next IDEM in 2012.
NobelProcera
TM
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in a certain case, trademarks of Nobel Biocare.
LEIPZIG, Germany: Oliver P.
Kuhrt, Executive Vice-President
of Koelnmesse GmbH in Germany and responsible for marketing, has announced that he will be
resigning in order to pursue a new
professional challenge. Mr Kuhrt,
who has overseen the marketing
of five editions of the International Dental Exhibition & Meeting in Singapore and many other
exhibitions, formally informed
the Chairperson of the group’s
Supervisory Board, Jürgen Roters,
of his desire to resign at the Supervisory Board meeting in April.
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[9] =>
DTAP0411_01_Title
DTAP0411_09-10_Koirala 20.04.11 16:57 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Trends & Applications
9
A Vedic Smile approach to dentistry
Dentist Dr Sushil Koirala talks about the Minimally Invasive Cosmetic Dentistry concept
and why it matters to dental professionals
Javier M. de Pisón
DT Latin America
MIAMI, USA: An extremely
skilled clinician with over 17
years of experience in Cosmetic
Dentistry, Dr Sushil Koirala says
that technology should work to
improve health, never to compromise it. His Minimally Invasive
Cosmetic Dentistry (MiCD) treatment protocol is based on consciousness, nature and evidencebased technology that really
respects the patient’s long-term
health and needs.
Koirala, who is the founder and
president of the Nepalese Academy of Cosmetic Dentistry and
of the South Asian Academy of
Aesthetic Dentistry, combines in
his MiCD protocol philosophy and
ethics, scientific research, and
what can be described as a Vedic
Smile or holistic approach to
dentistry.
Worried about the rapid advance in aesthetic procedures,
Koirala began to question if the
aim of many dental techniques
was to improve health or just to offer the patient a quick makeover,
regardless of their long-term consequences. Years of practice led
him to develop his guidelines
for MiCD, a set of principles that
stress early diagnosis, disease intervention, selection of minimally
invasive treatment procedures,
and use of evidence-based materials, taking into account as well
the psychological aspects, ethnic
background, and actual health
needs of the patient.
In a ground-breaking article
entitled “Minimally Invasive Cosmetic Dentistry: Concept and
Treatment Protocol,” Dr Koirala
offered a much needed guide to
minimally invasive cosmetic dentistry, a discipline that up to now
has been more concerned with
appearances than with clinical
evidence. The article, published in
cosmetic dentistry magazine, was
translated in many languages and
attracted many followers eager to
at last have a clinical protocol for
many dental cosmetic procedures
that stressed something that while
obvious was not widely followed
―preserving as much natural
tissue as possible.
The ability to differentiate between what a patient wants and
what he or she actually needs is a
large ethical question in cosmetic
dentistry. In order to address this
issue Dr Koirala has developed
what he calls a simple self-consciousness pre-treatment test,
Patients today are much more educated and demanding regarding dental treatements. Amalgam is a perfect example. A high-percentage
of patients demand not to have amalgam
fillings for cavities, but a tooth-color material. In the past, a restoration with
amalgam required cutting a lot of tissue, but the new direct tooth-colored
restorative materials cause less damage to
the tooth and provide better aesthetics.
Logo of the MiCD Global Network,
a group of professionals who wish to
improve the knowledge of the clinician
and the patient on minimally invasive
aesthetic procedures.
The goal now is achieving good aesthetics with minimally invasive treatment with the support of MiCD instruments and bio-aesthetics material,”
Loke continues.
“We are the official partner of the MiCD
movement, which motto is ‘Preserving Health
Enhancing Smiles.’ We are fully committed
to support their educational events for both
public and dental professionals, such as workshops, lectures and symposia,” he adds.
Cover of Koirala’s book in
Giomers.
Regarding teeth whitening for
instance, Dr Koirala says that
while some people may need it,
“more often than not the coloring
of the teeth is a perfect balance designed by nature. The eyes, teeth
and skin tone should be in harmony. If the teeth are too white,
it may look awkward and unnatural.”
A Pioneer Paper
Preserving Health, Enhancing Smiles
“Many patients are now going
for direct aesthetics restorations, non-prep veneers, minimal tooth preparation indirect
restorations, and mini-implants,
which are less invasive,” says
says Patrick Loke, SHOFU’s General Marketing Manager for Asia
Pacific. “The trend is growing.”
to preserve the definition of
beauty set forth in the cultural
tradition of the patient rather
than following the status quo of a
broad, one-size-fits-all plan.
SHOFU’s advanced restorative materials use
S-PRG Technology (Surface Pre-Reacted
Glass Ionomer), which provides predictable
aesthetics and better function. These are
bio-aesthetics materials that allow fluoride
release and recharge. You can restore a small
cavity removing only the affected area because the S-PRG fillers help re-mineralize
the tooth structure.
S-PGR Technology is effective and is based on eight years of clinical trials.
The new ongoing studies use MiCD protocols and newly developed materials, They were introduced in 2010 at the main dental research venue,
the congress of the International Association for Dental Research (IADR)
in Barcelona, Spain.
Changing the Mindset
While the principles of MiCD
may seem complicated, the protocol is easy to follow and very
practical. The reason is that it
doesn’t require changing clinical
techniques, but using them in
a consciousness way beneficial
for both the patient and the dentist.
Dr Sushil Koirala talking to Dental Tribune. (DTI/Photos Javier M. de Pison,
DT Latin America)
“whereby I ask myself four simple
yet honest questions”:
• How would I treat my own family
members?
• Will the treatment plan remain
the same regardless of who the
patient is?
• Am I competent and happy
enough to take up the case?
• Is the patient happy with the
Biological, Financial and Time
(BFT) cost estimation of the
treatment?
Dr Koirala explains that “what a
patient wants and what a patient
needs are two different things. The
needs are the basic treatments a
dentist can provide. But the wants
are of a different variety, like choosing clothes in a store: you choose
the color of the teeth, the texture of
the teeth, the shape of the smile.”
What is Beauty?
Since the definition of beauty
is different in each culture, it also
affects cosmetic procedures.
“For Western-style contemporary smile aesthetics, beauty is
white long teeth and a straight
smile, but the same parameters
don’t apply in Asia,” he explains.
“In fact, Asian patients don’t mind
having a little bit of overlapping teeth, which they see as natural. So we cannot use the same
formula globally in cosmetic
dentistry.”
Studies have shown that the
dental pulp of Asian patient is generally wider, in comparison with
European or American patients,
and Dr Koirala points out that
“preparations with wide shoulders could be a hazard to the
pulps in Asian patients.” Even so,
many dental technicians follow
Western standards for non-Western patients with different facial
features.
Dr Koirala warns that “you
need clear consciousness while
choosing the right technology for
your practice, as technology may
not always be health-oriented.”
As a sample, he thinks that
CAD/CAM restoration technology
still has to be refined in order to
be adopted fully in restorative
dentistry. “CAD/CAM presently
demands extension for Insertion,
Strength and Aesthetics,” thus,
“we are compromising health for
technology.”
“Clinicians still believe that articulating paper mark gives them
ideal force component in occlusal
adjustment,” he continues. “The
‘big mark big force, small mark
small force’ concept has no scientific evidence, but most cosmetic
dentists relay on articulating paper marks to do occlusal force adjustment. Computerized Occlusal
Analysis System, which can objectively measure occlusal forces
of each tooth with the time sequences of occlusal contact, was
developed almost 15 years ago. It is
hard to understand why clinicians
neglect scientific facts about articulating paper marks and still believe in it for balancing the force
component in smile design. This is
why I advocate consciousness in
dentistry, because technological
information is not enough; you
need consciousness to rightly use
it for mankind.”
This is the background
against which Dr Koirala revolted
and led him to develop the MiCD
treatment protocol, which he
summarizes “as bringing consciousness, nature and technology together”. Rather than inflicting one’s own definition of beauty
on the patient, the dentist must
listen to and understand the personal and cultural desires of the
individual undergoing the dental
work, he says. Dr Koirala strives
“We don’t say, ‘Don’t cut the
tooth this way’, we say, ‘Cut less,’”
explains Dr Koirala. In fact, the
MiCD protocol does not reject any
contemporary procedure, including full crowns or bridges, it just
asks the dentist to use their consciousness properly to think if invasive options can be avoided, and
to use them only as a last resort.
In other words, the only thing a
dentist has to do to comply with
MiCD is to change the priorities
for a given procedure, to alter his
or her mindset.
The framework of MiCD establishes five golden principles:
1. “Sooner the Better”—early exploration of diseases and defects
to minimize possible invasive
treatment in future.
2. “Smile Design Wheel”—follow
these principles, and respect the
psychology, health, function and
aesthetics of the patient.
3. “Do no Harm”—select treatment procedures that maximize
preservation of healthy tissue.
4. “Evidence-Based Approach”
—selection of materials and
equipment must be based on
science.
5. “Keep in Touch”—focus more
on regular maintenance, timely
repair and strict evaluation,
which should be understood by
the patient.
As Dr Koirala says, they are
simple guidelines to accommodate every treatment in a dynamic
protocol because science constantly changes.
“A good protocol should incorporate changes based on scientific
evidence,” he continues. “The
philosophical part may be the most
difficult because it's subjective,
which is why we give a questionnaire to the patient whereby he decides what he wants. We give him
the science and inform him about
‡ DT page 10
[10] =>
DTAP0411_01_Title
DTAP0411_09-10_Koirala 20.04.11 16:57 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
10 Trends & Applications
fl DT page 9
the technique, but he decides what
type of aesthetics he wants.”
High-quality materials
When Dr Koirala published his
MiCD protocol in 2009, he not only
gained a following among dentists, but also the respect of highquality dental manufacturers.
“I met with Mr. Patrick Loke,”
Koirala says referring to SHOFU’s
Asia-Pacific Marketing Director,
210x297
Ad.ai
“who toldIDEM12
me he
liked DTI
the APAC
concept
of MiCD because his company is
concerned with the health of the
patient, and with developing bioaesthetic products in dentistry.”
In SHOFU he seems to have met
his match and you can detect his
dedication and conviction when he
says, “I’m very happy using Giomers
(a bio-aesthetic restorative material), so much so that it inspired me
to write a book,” he adds referring
to a new type of restorative materials whose name is a hybrid of the
words “glass ionomer” and “com4/19/11
4:09:29
PM
posite” (see
Sidebar,
page 9).
Dr Koirala is now conducting
long-term clinical trials using
various dental materials, with a
focus on the MiCD protocol and its
acceptance as a way to accomplish
clinical results.
He believes he has developed a
concept that is good for the patient,
good for the dentist, and good for
society. The MiCD protocol is in its
preliminary stage worldwide, but
the conferences he gave in South
East Asia and South Asia have been
widely accepted. “This is the right
time to come out with this new phi-
Dr Koirala has acknowledged the help of Patrick Loke (right) of SHOFU Asia
Pacific, in expanding the concept of MiCD.
AD
losophy”, he explains, “so that in
four or five years a new generation
can start talking about the preservation of health in the long run.”
www.idem-singapore.com
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Featured Speakers:
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University of Southern California,
Los Angeles
Pascal Magne
Robert Boyd
Associate Professor,
Chair of Aesthetic
Dentistry, University
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Held In
In Co-operation With
Co-organiser
Non-Invasive Health
The medical sciences are
moving towards non-invasive procedures, and adequate ways of
health promotion to avoid oral diseases. In dentistry, however, minimally invasive procedures are being used routinely only in caries
management.
“In the medical sciences it is inherent not to cut tissue,” Dr Koirala
continues. “If patients knew that
to place a crown you need to cut
the tooth’s enamel, they probably
would not accept the treatment.
You need to start at an early age,
like 6 or 7, in order to detect various smile defects like orthodontic
problems, everything that can
affect oral health, including cosmetics, should be thought at an
early age.”
“Dentists may use MiCD or
not,” he adds, “but they all agree
it’s the right approach. I want to
encourage everybody to join the
MiCD mission. Our MiCD Global
Network (a web-based organization) is a group of dedicated professionals who wish to improve
the knowledge of the clinician and
the patient. Information technology can help promote these ideas
through networks of dentists, people, and like-minded companies.
We need to change our mindset.”
Dr Koirala plans to change the
mindset through more international lectures, collaborating with
like-minded clinicians and academicians, creating study clubs to
exchange knowledge, and providing internet-based educational
seminars.
“We are changing protocols
for the health of the patient, and
ultimately, dentists will win too,
because it saves time on procedures and provides aesthetics and
function. The type of material used
is secondary to me, as long as it
preserves health, a harmonious
function (the force component),
and promotes aesthetics. We are
not promoting a company here,
but promoting health. And that is
our first responsibility as clinicians. It is something that can be
the pride of the profession.” DT
Resources
International
Koelnmesse Pte Ltd
Ms. Ziqi Zielinski
Tel: +65 6500 6721
z.zielinski@koelnmesse.com.sg
– www.MiCDglobalnetwork.org
– Koirala S. Minimally invasive cosmetic dentistry: Concept and treatment protocol. Cosmetic Dentistry
beauty & science, Vol. 3, Issue 4/2001,
28–33. (www.dental-tribune.com/
articles/content/id/1749/scope/
specialities/region/international)
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DTAP0411_01_Title
DTAP0411_12-14_Ivoclar 20.04.11 17:07 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
12 Trends & Applications
Reconstructing an anterior dentition with composite resin
A clinical case using IPS Empress Direct from Ivoclar Vivadent
Fig. 2
Fig. 1
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 1: The pre-op situation shows the unattractive restoration on tooth #11.—Fig. 2: An X-ray showing apical periodontitis in tooth #11.—Fig. 3: A close-up of teeth #11 and 21.—Fig. 4: The old filling is removed and tooth #11 is prepared.—Fig. 5: Following the adhesive pre-treatment, a palatal “enamel shell” is created.—Fig. 6: The dentine core is built up generously.
Dr Gabriel Krastl
Switzerland
Re-creating the original tooth
as accurately as possible is a
challenging task for the operator.
It also poses a challenge regarding
the dental material used in the
process. However, modern materials and layering schemes modelled
on the natural structure of the
tooth provide a sound base on
which predictable aesthetic results
can be achieved. This case study
describes the restoration of a
fractured anterior tooth with specific reference to the biomimetic
properties of IPS Empress Direct
(Ivoclar Vivadent).
A young female patient was dissatisfied with the appearance of her
upper teeth, which resulted from an
accident-related injury to tooth #11
a few years prior. After the dental
trauma, the tooth was restored with
composite resin but the patient
wished to have corrective work
done. Compared with the adjacent
teeth, the remaining natural part of
tooth #11 appeared yellowish, while
the composite build-up appeared
greyish and translucent. The clinical examination revealed that the
teeth did not show any signs of decay
and were in good condition overall
in relation to the patient’s age. In
addition, the patient also practised
excellent oral hygiene (Fig. 1).With
the exception of tooth #11, all teeth
reacted to the sensitivity test. The
probing depth of the gingival sulcus
measured less than 3 mm. Tooth #11
also showed minimal percussion
sensitivity. The peri-apical X-ray
revealed traces of an apical lesion
(Fig. 2). The root canal appeared
to be extensively calcified.
After discussions with the patient, root-canal treatment was
planned for tooth #11. Subsequent
internal bleaching was proposed in
preparation for a new composite
build-up. The oral cavity was isolated with a rubber dam before the
root canal was opened. The canal
was difficult to locate, despite using
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ALPRO MEDICAL GMBH • Mooswiesenstr. 9 • 78112 St. Georgen • Germany
+49 7725 9392-0 +49 7725 9392-91 Þ www.alpro-medical.com info@alpro-medical.com
Wipes for ever (y day)
The best cleaning and
disinfection of surfaces
an operating microscope. It was
finally found at a depth of 13 mm.
The root canal was prepared and a
calcium-hydroxide medicated filling placed for a period of two weeks.
Subsequently, the root canal was
filled with thermoplastic gutta-percha points and sealed. The cervical
structure of tooth #11 was internally
bleached with sodium perborate
until the tooth structure acquired
the shade of the adjacent tooth.
Analysis of the tooth shape
and shade
A closer look at the two central
incisors revealed that the teeth were
slightly asymmetrical (Fig. 3), as the
crown of tooth #11 appeared somewhat wider. When the patient was
asked about this, she stated that she
had had a median diastema that was
closed after the restorative work on
her dental trauma had been finished.
The appropriate materials for replacing dentine and enamel were selected
using the shade guide from the IPS
Empress Direct Set. The dentine materials were matched to the cervical
area of the tooth and the enamel material was selected in accordance with
the incisal area of the adjacent teeth.
The build-up of a tooth is a very
sophisticated procedure, which requires careful planning. In order to
ascertain and visualise the desired
result before the tooth is built up, it
is useful to draw up a “map” of the
tooth’s characteristics, which will
show areas that are highly translucent
or opaque. A digital photograph that
captures the pre-operative situation is
of invaluable use in the subsequent
build-up procedure. However, it is
important to note that digital photographs only provide a rough indication of the placement of the different
composite resins and staining materials, as they do not convey true colour.
In this case, A3 Dentin, A2 Enamel,
Trans Opal and Tetric Color white materials were used for building up the
composite resin restorations.
A mock-up was prepared for the
fabrication of a silicone matrix. The
shape and contour of the existing
restoration were largely congruent
with the neighbouring tooth #12.
Therefore, only small adjustments
to the shape were necessary, such as
a slight lengthening of the incisal
edge in the distal region. Silicone
putty was used to record the information provided by the mock-up.
Since only the palatal part and the
incisal edge of the silicone matrix
were needed for the building up
tooth #11, the matrix was correspondingly trimmed with a scalpel.
Preparation, adhesive pretreatment and adjustments
to the adjacent tooth
The old composite resin restoration was removed with rotating
instruments and the enamel margins were bevelled. A wide area
was prepared in the labial region
(approximately 2 mm) to ensure the
invisibility of the final restoration
margin (Fig. 4). A rubber dam was
placed over the anterior teeth (up
to the first premolar) to allow a full
view of the operating area. Ligatures helped to isolate the anterior
teeth requiring treatment and to
displace the rubber dam towards
the gingival margin. A three-step
system, entailing phosphoric acid
etching (e.g. Syntac Classic) was
used for the adhesive pre-treatment of the tooth structure. In order
to make the two anterior teeth
appear symmetrical and to close
the diastema, the mesial region of
tooth #21 had to be widened a bit
with enamel material.
The main aim of the anatomic
layering technique is to create an
artificial “enamel shell”, which establishes the palatal and proximal
contour of the original tooth. In this
case, a small amount of transparent
enamel material (A2 Enamel) was
placed in the trimmed silicone
matrix and thinly distributed with
a spatula. The defect had to be covered as far as possible. Some flowable Tetric EvoFlow was applied to
the palatal defect margin of the prepared tooth #11. Then, the silicone
matrix, together with the enamel
materials, was placed on the anterior teeth from the palatal aspect and
checked for correct fit. If the enamel
material in the silicone matrix has
been properly placed, it will reach
the cervical margin of the defect.
The flowable material on the tooth is
thus displaced and fills out possible
voids. Furthermore, it ensures good
marginal adaptation.
The restoration was initially
polymerised from the labial aspect.
Then, the silicone matrix was carefully removed and the built-up composite resin was polymerised from
the palatal aspect. Small amounts of
excess in the palatal and proximal
areas were removed with a scalpel
(size 12). The palatal surface prepared in this way produced the
desired width in the incisal area.
Nevertheless, the proximal part of
the restoration did not make contact
with the neighbouring tooth at this
stage. The chosen matrix technique
has a decisive influence on the creation of the most natural-looking
proximal contours possible. As the
mesial and distal portions of the defect were located super-gingivally
in this case, transparent matrices
were used, which were held in
place with wooden wedges. The
proximal wall was built up with
utmost precision. After the matrix
and wedges had been removed, the
‡ DT page 14
[13] =>
DTAP0411_01_Title
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[14] =>
DTAP0411_01_Title
DTAP0411_12-14_Ivoclar 20.04.11 17:07 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
14 Trends & Applications
fl DT page 12
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 7: The built-up dentine core provides only very little space for the enamel material.—Fig. 8: The restoration is ready for polishing once it has been formed with translucent and white-opaque materials
and sculpted.—Fig. 9: A natural-looking surface lustre and fine morphological structure is produced with a suitable polishing technique.—Fig. 10: The follow-up examination after four weeks, showing a
normal clinical situation.—Fig. 11: The final X-ray showing the root canal filling and composite restoration.—Fig. 12: The smile of a satisfied patient.
thin composite layer significantly
enhanced the appearance of the incisal, palatal and proximal contours
of the tooth (Fig. 5).
Build-up of the dentine core
The subsequent layers were
placed with opaque dentine material (IPS Empress Direct Dentin, A3)
and the dentine core was built up
(Fig. 6). Compared with natural
teeth, this part of the tooth was
larger. As a result, the space avail-
able for the enamel coating was
very limited, so it made sense to
cover the enamel bevel with dentine material as well. This measure
AD
prevents the restoration margin
from becoming visible as a grey
line. Towards the incisal part, the
dimensions and the morphology of
the dentine core were determined
by the neighbouring and contralateral teeth. In this case, mamelon
structures were created. In the incisal area, enough space was provided for the translucent enamel
materials (Fig. 7). Each increment
was cured for 20 seconds using
a bluephase LED light.
The incisal part between the
mamelons was filled with a special composite resin material (IPS
Empress Direct Opal). A natural
opalescent appearance was created with this technique. In addition,
a white staining material (Tetric
Color white) was selectively applied
in order to re-create the whitish
opaque areas of the enamel.
Str ength
of a Hybrid ...
The restoration was completed
by applying a final thin enamel layer
(IPS Empress Direct Enamel A2)
on the labial side (Fig. 8). While the
resin composite was still soft, the
final surface texture of the restoration was created with a brush. The
tooth shape was modelled such that
it would help to reduce the subsequent finishing work to a minimum.
...Deli v e r
like a flow
Finishing and polishing
BEAUTIFIL Flow Plus
Yet another milestone in the Giomer family of restoratives, BEAUTIFIL Flow
Plus is an injectable hybrid aesthetic restorative that exhibits superior strength,
durability and aesthetics for enhanced applications in direct cosmetic dentistry.
...
The Plus EHQH¿WVIRU\RX
• Ideal density and stackability for effortless sculpting
• Remarkable mechanical properties
• Easy injectable delivery
• Extensive application capabilities including load-bearing surfaces
• Simulates life-like aesthetics with excellent shade match
%HQH¿WVRIÀXRULGHZLWKDQWLSODTXHHIIHFW
Official Partner
For further information, contact your Shofu dealer
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Singapore Branch 10 Science Park Road, #03-12 The Alpha, Science Park ll, Singapore 117684
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Excess material was removed
with a scalpel (size 12). Suitable
finishers and polishers were used
to adjust the surface gloss and micro-morphology of the tooth to that
of the adjacent teeth. Restorative
margins were finished and adjustments to the proximal and incisal
areas were made with flexible
discs. It must be noted that in labial
areas these instruments have to be
used with great care to prevent the
destruction of the morphology and
the accidental removal of enamel
material. Concave areas in the
buccal surface were deepened
with silicone polishers. High-gloss
polishing was performed with silicon-carbide-impregnated brushes
(Astrobrush; Fig. 9).
Four weeks after treatment, the
clinical situation looked healthy.
The restoration in tooth #11 was
virtually invisible and symmetry
was restored in the anterior dentition (Fig. 10). The radiological
follow-up exam did not show any
irregularities (Fig. 11). The patient
was free from complaints and
highly satisfied with the overall
result (Fig. 12). DT
Contact Info
Dr Gabriel Krastl
is the director of
the dental emergency centre at the
Clinics for Dentistry, University
of Basel. He can be contacted at
gabriel.krastl@unibas.ch.
[15] =>
DTAP0411_01_Title
DTAP0411_15_Straumann 20.04.11 15:41 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Advertorial 15
A comparison of Roxolid with Ti Grade 4 implants
A one-year follow-up report on a randomized double-blind multi-center study
Bilal Al-Nawas et al
Germany
Small diameter implants are
beneficial in daily practice but
they have limits based on the
choice of implant material or
surface. In order to increase confidence and enhance the treatment options for narrow diameter implants, an alloy composed
of titanium and zirconium
(Roxolid) has been developed
by Straumann. This material
shows better tensile and fatigue
strength as compared to pure
titanium1, 2 and possesses excellent osseointegration properties3
in combination with the SLActive
surface.
Based on the results of previous studies, a clinical multi-centre study was initiated with the
aim of a direct comparison between pure titanium and Roxolid
implants (Fig. 1).
Materials and methods
A randomized, controlled,
double-blind, split-mouth study
Fig. 1: X-ray picture showing one test and control implant after placement. There
is no visible difference between test and control implant.
was started in the beginning of
2008 in eight centres.
• Indication: Fully edentulous
mandible
• Test: BL implant Ø 3.3 mm
SLActive Roxolid
• Control: BL implant Ø 3.3 mm
SLActive Ti
• Solution: Removable denture
on 2 LOCATOR abutments
• Specific: Double-blind study
for the first year
Each patient was treated with
two implants (one test implant
and one control implant), which
were placed intraforaminally.
Abutment and prosthesis placement was performed 8–10 weeks
after surgery (Fig. 2). Twelve
months after surgery, the following parameters were analysed:
• Crestal bone loss (standardized
X-rays)
• Bleeding on probing
• Plaque index
After full analysis of all
parameters the data was unblinded.
Results
Table I: Bone loss of both materials is around 0.3 mm 12 months after surgery
for both groups (per protocol population).
One year after surgery, the
study was un-blinded and the
data of 89 patients or 178 implants were evaluated respectively. Three early implant failures were recorded. The implant
failures occurred in both implant
material groups (one test implant and two control implants)
and in three different study
centres.
Fig. 2: Treatment plan before un-blinding procedure.
pure titanium implants and may
offer a wider spectrum of clinical
applications. DT
References
1. Data on file, tensile strength of
material used for all Straumann®
titanium and Roxolid® implants
2. Norm ASTM F67 (states min. tensile strength for annealed titanium)
3. Gottlow J, Dard M, Kjellson F,
Obrecht M, Sennerby L ‘Evaluation of a New Titanium-Zirconium
Dental Implant: A Biomechanical
and Histological Comparative
Study in the Mini Pig’ Clin Implant
Dent Relat Res. 2010 Jun 25
LOCATOR® is a registered trademark
of Zest Anchors, Inc
AD
Crestal bone change
Fig. 3: Distribution of the crestal bone loss.
Implant surgery was the
baseline for the crestal bone loss
evaluation. The evaluation was
made for the per protocol population. No statistically significant
differences were found between
the two groups (Table I).
Frequency analysis of the
crestal bone change did not show
any statistically significant difference between the two groups
(Fig. 3).
Plaque index
and sulcus bleeding
Fig. 4a: Not statistically significant in the plaque index between the groups.
The plaque index and sulcus
bleeding data was taken from
the intent-to-treat population.
No differences were found between study implant and control
implant (Figs. 4a & b).
Conclusions
Fig. 4b: Not statistically significant in the sulcus bleeding between the two groups.
This study did not show any
statistically significant differences (bone change, sulcus bleeding, plaque) between Roxolid
and titanium implants. Very low
bone loss (0.3 mm control and
study group) was observed one
year after surgery. Higher mechanical strength and uneventful one-year follow-up indicate
that small diameter Roxolid implants are a valid alternative to
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DTAP0411_01_Title
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CFTUTVQQPSUJOUIFJOEVTUSZ
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INFO@POSORTHO.NET
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ICCDE & CPD
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3/9/11 2:57 PM
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/ Trends & Applications
/ Advertorial
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