DT Asia Pacific No. 5, 2011

India to get stand-alone dental insurance / Australia commits to dental health care reform - sets up taskforce / Nepalese teeth to uncover origins of birth defects / Opinion / World News / Business / More flexibility and treatment options with Roxolid® / Improved longevity and aesthetics in Class IV restorations / “There seems to be no limit to what tissue we can regenerate” / 50 years of Sensodyne® innovation (1961–2011)

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DTAP0511_01_Title 25.05.11 15:37 Seite 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG

www.dental-tribune.asia

NO. 5 VOL. 9

Facial birth defects
Origins to be uncovered
by Nepalese teeth

Class IV restorations
Improved longevity
and aesthetics

4Page

Dental stem cells
An interview with
researcher Dr Mao

4Page

India to get stand-alone dental insurance Geistlich takes

over Korean
New oral health care scheme expected to be launched in June
distributor
Daniel Zimmermann
DTI

The Swiss dental manufacturer
Geistlich Pharma has announced
that it has acquired 100 % of the
shares of Jungsan Biomed, its current distribution partner in South
Korea. The new company will be
based in the capital Seoul and focus
exclusively on the distribution of
Geistlich’s biomaterials for bone replacement and tissue regeneration
in dental and cranio-facial surgery.
Financial details were not disclosed.

NEW DEHLI, India/HONG KONG/
LEIPZIG, Germany: The Insurance Regulatory and Development Authority in India has approved a stand-alone insurance
scheme that could help millions
of patients throughout the country gain access to much-needed
dental care, Indian newspapers
have reported. The scheme,
which is said to be implemented
in June, will cover basic dental
procedures, such as check-ups,
fillings and extractions, as well as
treatment for oral cancer.
Proposed by the Indian Dental
Association in 2003, the plan
has been under review since then.
It has been announced that the
General Insurance Corporation,
an insurance company owned by
the government, and three other
public insurance companies will
form part of the scheme. Two
insurance options will be offered
for a premium of Rs 1,000 (US$22)
and Rs 2,000 (US$44) per year.
Currently, most dental fees in
India are paid out of pocket and in-

An Indian girl smiling. Like millions of her countrymen she could soon benefit from a new dental scheme. (DTI/Photo Kailash K Soni)

surance is mainly offered through
general health insurance, which
often stipulates certain requirements, such as hospitalisation.
Stand-alone dental schemes exist, for example, through private
companies like Unilever but they
are not utilised by the masses.
Dr Ravi Sher Singh Toor, a
senior lecturer in the Depart-

ment of Pedodontics & Preventive Dentistry at Luxmi Bai
Dental College & Hospital in
Punjab, said that a good dental
insurance scheme should include preventative services and
give patients the freedom to
choose their own dentist. They
should also allow the option to
refer the patient to a specialist,
he added.

While the costs for basic dental procedures in India start from
as low as US$10, complex treatments like bridgework or implants can add up to US$500.
The average annual income in
India dropped to approximately
US$1,200 last year, according
to a recent study by the ET
Intelligence Group consulting
group. DT

According to a Geistlich representative, the Jungsan acquisition
is one of the most recent steps in the
company’s long-term strategy for
international expansion. It is also
intended to strengthen the market
presence in one of the most dynamic and competitive dental
markets in Asia. The company will
retain the staff and facilities of
Jungsan Biomed in Seoul, the representative said.
GeistlichPharma is part of the
larger Geistlich Group conglomerate, which includes activities in the
production of adhesives, fat for animal feeds and real estate. Besides
South Korea, the company also has
a subsidiary in Beijing in China. DT
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predicts new
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In a study on animal teeth, Prof. Paul Sharpe (picture) and colleagues found that blood
cells can trigger cell growth in teeth. (DTI/Photo KCL, UK)4WORLD NEWS, page 5

New hope for facial Unilever to expand
rehabilitation
China business
An exercise programme involving devices used by dentists
has shown prospects for the
rehabilitation of facial nerve
damage. The treatment uses
an instrument associated with
measuring tongue strength and
the so-called Perry appliance to
increase the strength of impaired
facial muscle regions. DT

Owing to its growth in emerging markets, Unilever, the AngloDutch manufacturer of toothpaste and other consumer products, has announced to expand
its business in China with a new
production site. The plant will
be located in Tianjin and have
an annual production output of
100,000 tons. DT

A new report released at the
Annual Meeting of the Asian
Development Bank in Vietnam
has forecast that the region
could account for half of the
world’s economic output by 2050,
provided that it sustains growth
and overcomes challenges like
urbanisation and social wellbeing.
Under these assumptions,
more than 3 million people could
enjoy living standards comparable with those enjoyed by most
Western countries today. Prospects are high for countries
such as Vietnam, Thailand and
Malaysia, according to the report.
Currently, the continent, led
by high-income developed economies like China, Korea and
Japan, accounts for 27 % of the
world’s economic output. DT

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[2] => DTAP0511_01_Title

DTAP0511_02_News 25.05.11 15:38 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

AD

Australia commits to
dental health care reform,
sets up taskforce
Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
In a last minute effort to commit
to dental health care reform, the
Australian government has decided to provide additional funding of AU$53 (US$56 million) to
public dental services over the
next four years. The funding will
be used to establish more dental
internship programmes in order
to reduce waiting times for
dental treatment, government
officials said in May. They also
announced to set up a National
Advisory Council on Dental
Health to plan further steps to
reform the inadequate public
dentistry system.
The Greens have welcomed
the commitment, which they see
as a first step in long-term dental
care reform. They reminded
Labor that dental care also has to
remain top priority in next year’s
budget. The coalition between
both parties has struggled politically over the last two months
regarding how much money
should be spent to improve the
country’s poor public dental
health care system. The Greens’
promotion of a universal dental
care scheme for all Australians
was a key factor for forming a
coalition with Labor in last year’s
federal elections.
In March, Labor Minister of
Health Nicole Roxon announced
that dental care funding would

Australia’s Prime Minister Julia Gillard (second from left) inspecting damage during a recent visit to Japan. Australia’s inadequate public dental health care system also needs her attention, dentists say. (DTI/Photo courtesy of ALP, Australia)

be scrapped altogether from this
year’s budget.
Dentistry representatives
said that although the funding
will help patients nationwide to
access delayed dental treatment,
it will probably not be enough to
cut down waiting times, particularly in rural areas. In addition,
the government should be focusing on ways to entice dentists to
work in underserved areas like
the South.
“Things like scholarships for
dental graduates so that they’re
paid during dentistry and when
they graduate they commit them-

selves to rural areas or relocation
payments like the government
has done for general practitioners,” Dr Angela Pierce, President
of the South Australian Branch of
the Australian Dental Association told the ABC News network.
Waiting times for public dental services in Australia have
remained high over the last few
years owing to the shortage of
dental staff. According to a 2008
report by the Australian Institute
of Health and Welfare, patients
relying on public dental services
are three times more likely to
suffer from dental diseases such
as caries or periodontal disease.

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
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Building, 105-111 Thomson Road, Wanchai, Hong Kong
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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] => DTAP0511_01_Title

DTAP0511_03_News 25.05.11 16:19 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Asia News

Nepalese teeth to uncover origins of birth defects
Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
The remote village of Jiri in Nepal is
just a regular stop-over for trekkers
on their way to Mount Everest. For
Prof. Richard J. Sherwood from
Dayton in the US, however, the small
group of natives living there could
hold the key to understanding the
origin of common birth defects such
as cleft lip or palate. In a field study,
the anthropologist and biomedical
expert is currently examining the
teeth of hundreds of villagers,
which, according to him, could explain why the early development of
facial features can go seriously
wrong.
The reason Prof. Sherwood
chose such a remote place for his
study was pragmatic. The population of Jiri has been part of several
biomedical studies since the 1980s
and, therefore, much of the groundwork, including genotyping by
blood sampling, has already been
done. In addition, the local ethnic
group in Jiri, the Jirels, have a homogeneous diet and have never received orthodontic care, which are
two factors important for studying
natural variations in the craniofacial apparatus, Prof. Sherwood says.

Prof. Sherwood intends to publish preliminary results next year.
Through the study of normal variation, he hopes to determine the
chromosomal regions that could
explain why cleft palates develop
differently, as well as gain new insights into other dental conditions,
such as crowding.
According to the American
Speech-Language-Hearing Association, one out of every 700 new-

borns (more than 6,000) in the
US is affected by cleft lip and/or
palate each year. In less developed
countries like China, reports suggest that tens of thousands are
affected, most of which are left
untreated, leading to death or, in
the majority of cases, lifelong
impairments. Besides genetics, the
condition has also been linked to
the mother’s poor health habits,
such as smoking, or environmental factors, including exposure of

the foetus to drugs, pesticides or
radioactivity.
“Abnormalities can be thought
of as the extreme ends of the normal
distribution in a trait but even relatively minor conditions, for example
malocclusions, may have a significant impact on the psychological
well-being of individuals if they
feel self-conscious about how they
look,” Prof. Sherwood concludes. “If
we are able to identify the genetic

Jiri is located in the Himalayas.

influences on normal variation it
will, of course, have implications on
the study of facial abnormalities.” DT
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Prof. Richard J. Sherwood examining
a dental cast in the Jiri Dental Study lab.

ol d !

tive

nt
ss

SLAc
ann
®

A pilot study back in 2005 produced 200 impressions, however,
Prof. Sherwood told Dental Tribune
Asia Pacific that he is aiming to take
samples from at least one-fifth of
Jiri’s current population―about
1,500 people―until funding runs out
in 2012. His study has received more
than US$2 million from the National
Institute of Dental and Craniofacial
Research, a US federal agency based
near Washington, DC, and part of
the National Institutes of Health,
which supports research with the
potential to improve oral, dental or
cranio-facial health.

Stra
o
...

In order to obtain data quickly,
he set up a small dental clinic in the
village in January last year, where
local staff takes traditional dental
casts and sends them to the US regularly. At Wright State University in
Dayton, they are digitally scanned
and examined further. Prof. Sherwood visits the site himself two or
three times a year. According to him,
there are over 15 people working on
the project including a dentist, dental assistant and physician in Nepal.
“Before we established the dental
clinic, there was no local dentist
and most people had never seen
a dentist in their life,” he says. “Participants are given a tooth cleaning
and general oral exam as part of our
study. We also provide some services, such as fillings, free of charge.”

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[4] => DTAP0511_01_Title

DTAP0511_04_News 25.05.11 15:34 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Opinion

Dear
reader,

“Please choose a stem
cell of your liking.”

In contrast to their medical
colleagues, dental stem cell researchers have been working
‘under the radar’ for quite some
time. The recent conference on
dental and craniofacial stem
cells in New York could be the
first sign that experts in this field
have become fully aware of the
potential regenerative technologies can hold for the future of
dentistry and oral health.

Much will depend on the cooperation between the medical
and dental field, as non-dental
cells have been proven to be able
to re-build tooth cells and vice
versa. With the recent conference and another already on the
horizon, dentists have definitely
taken a giant leap. DT

Dr Harold Loe, then Director of the
National Institute of Dental Research in
the US, stated in the 2003 September
edition of the Dental Products Report
that: “first filling is a critical step in the
life of a tooth. Using amalgam for the
first filling requires removing a lot of
the tooth substance, not only diseased
tooth substance but healthy tooth
substance as well.

A dental insurance for India
Dr Ravi Sher Singh Toor
India

Considering the growth of
the Indian economy, prospects
for dental insurance remain unexplored. Unlike most Western
countries, specific dental insurance plans are not common and
oral health insurance is usually
integrated within general health
insurance schemes. This type is
provided by insurance companies as part of their own general
health insurance schemes, such
as a health advantage policy or
student medical policy.

Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International

Re: “No-drill restorations and
amalgam equally successful”
(Dental Tribune Asia Pacific,
Vol. 9, No. 1+2, page 5)
Mercury is toxic to poor and rich
alike. The mercury in “silver” fillings is
the largest contributor to the human
body burden of this highly toxic heavy
metal.

Daniel Zimmermann
DTI

With the current state of research, however, it will still take
years, probably decades, before
even first human trials will receive approval by regulatory
agencies but help could come
from the fact that dental stem
cells hardly raise any ethical outrage, a discussion that commonly
restricts research with stem cells
derived from other sources like
human embryos. So ironically,
we might be able to see clinical
applications in dentistry first before they are even introduced to
general medicine.

To the Editor

In a comprehensive survey of
3,120 people from all parts of
Indian society, our department
found that none of those sur-

veyed had any kind of dental
insurance. This indicates the urgent need for such a scheme.
Over three-quarters (78%) said
that they would make use of dental insurance if offered, if the plan
was suited to their needs. None of
the respondents knew of a dental
insurance company.
The Indian Dental Association
has been trying to establish an allinclusive dental health-care insurance scheme since 2003. Until
now, however, the organisation
had been unable to achieve anything substantial in this regard.
Once introduced in June, the policy may not be well received, as
there has been no advertisement
campaign or press coverage of the
scheme and no public announcements have been made.
If well received, the scheme
may offer many benefits, such as

oral health-care workers being
able to reach every class and village across the country. In addition, the scheme would serve as
a good motivation to visit a dentist regularly and to complete
their treatment, as they will not
need to pay for further treatment.
If the government creates
awareness of the benefits of dentistry for longevity of teeth across
society, insurance policymakers
should support it by offering beneficial dental insurance schemes
for the masses. DT

Contact Info
Dr Ravi Sher Singh Toor is Senior
lecturer in the Department of Pedodontics and Preventive Dentistry
at Laxmi Bai Dental College and
Hospital, Patiala, India. He can be
contacted at toor2k@gmail.com.

So, in making the undercut you
sacrifice a lot, and this results in a
weakened tooth. The next thing you
know the tooth breaks off, and you
need a crown. Then you need to repair
the crown … and so it continues to the
stage where there is no more to repair
and you pull the tooth.
With the first filling you should
do something that can either restore
the tooth or retain more healthy tooth
substance. Use new materials-composites or materials you can bond to
the surface without undercuts. You can
do this with little removal of the tooth
substance so that the core of the
tooth is still there.”
ART has been tested for years with
excellent results. It is the answer to
getting rid of amalgam even for the
poor, despite the FDI and ADA claim
that poor children will not have their
cavities filled if mercury fillings are
banned.

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[5] => DTAP0511_01_Title

DTAP0511_05_News 25.05.11 15:36 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Blood vessel cells aid tissue repair in teeth
Daniel Zimmermann
DTI

NEW YORK, USA/LEIPZIG, Germany:
New research presented at the recently held first International
Conference on Dental and Craniofacial Stem Cells in New York
in the US could mean a breakthrough in future tissue and organ
repair. In an experiment involving incisors from rodents, a mammal species that includes mice

and squirrels, researchers from
the UK, Brazil and the US found
that connective tissue cells can
transform into specialised cells to
repair damaged tissue in teeth.
Their results have been published in the latest issue of Proceedings of the National Academy
of Sciences of the USA.

found in small blood vessels, have
the potential to transform into
different cells. This new study is
the first claiming to have found
genetic evidence that they can
also act as stem cells to regenerate
lost or damaged tissue. In the experiment, they were transplanted
into the tooth, where they transformed into dental pulp cells.

Previous research suggested
that so-called pericytes, usually

“This is the first time perivascular cells have been shown to

differentiate into specialised cells
during a natural repair process,”
says Prof. Paul Sharpe from the
Department of Craniofacial Development at the Dental Institute
at King’s College London, who
led the study. “In addition to the
obvious significance for understanding the cellular mechanisms of tissue repair, it also
has wider implications for areas
of regenerative medicine/dentistry directed towards stimulat-

Blood vessel cells inside a tooth. (DTI/
Photo Kings College London, UK)

ing natural repair following tissue damage or disease.” DT
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From news reports

PENNSYLVANIA & CHICAGO,
USA: US dentists are more likely to
offer emergency dental care to children enrolled in private insurance
schemes than those with Medicaid,
the country’s health programme
for the poor. These alarming findings are the result of an undercover
study of 85 dental practices in the
state of Illinois. Researchers at the
University of Pennsylvania posed
as mother of a fictional 10-year-old
boy with an acute oral injury.

Today you can go further than treating
the pain of dentine hypersensitivity.
Today you have new Sensodyne®
Repair & Protect containing NovaMin®

According to the study, only six
dentists offered an appointment
to children with public health insurance. All dentists offered an
appointment to privately insured
children. However, chances increased significantly when dentists
were enrolled in Medicaid.

calcium phosphate technology.
NovaMin® builds a reparative
hydroxyapatite-like layer over exposed
dentine and within the tubules1-5

The findings confirm earlier
studies that have painted a sad
picture of the country’s dental
health-care system for disadvantaged children. According to a 2010
study by the Pew Research Center,
one in five children in the US lack
access to dental care owing to low
income and poor resources.
“Lack of funding is among the
greatest barriers to better oral
health in America. But funding
alone will not ‘fix’ Medicaid. Patients need help navigating an
often complicated bureaucracy
and overcoming other barriers,”
said Raymond F. Gist, President of
the American Dental Association
(ADA), commenting on the results
of the study. “These programmes
cannot reach their potential without other significant reforms.
These include reducing unnecessary red tape for dentists and
patients, and helping patients overcome such related barriers as the
needs for transportation, child care
or permission to take time off from
school or work to receive treatment.”
The ADA has been lobbying for
increased Medicare funding for
years. The association recently
launched a pilot programme to
train health workers to provide
treatment to people experiencing
barriers to access of oral healthcare services. DT

Starting to form from the first use,5 this reparative
layer creates an effective and lasting barrier to the
pain of dentine hypersensitivity6-8

Explore the new layer of opportunity
with Sensodyne Repair & Protect

Visual representation of dentine cross-section
and dynamic reparative layer

Specialist in dentine hypersensitivity management
References: 1. Burwell A et al. J Clin Dent 2010; 21(Spec Iss): 66–71. 2. LaTorre G, Greenspan DC. J Clin Dent 2010; in press. 3. Efflant SE et al. J Mater Sci Mater Med 2002; 26(6):557−565. 4. Clark AE et al.
J Dent Res 2002; 81 (Spec Iss A): 2182. 5. GSK data on file. 6. Du MQ et al. Am J Dent 2008; 21(4): 210−214. 7. Pradeep AR et al. J Periodontol 2010; 81(8): 1167−1113. 8. Salian S et al. J Clin Dent 2010; in
press. SENSODYNE® and the rings device are registered trademarks of the GlaxoSmithKline group of companies. Prepared November 2010. Z-10-175.

[6] => DTAP0511_01_Title

DTAP0511_06_News 25.05.11 15:38 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Business

Ortho-specialist appoints former J&J exec as CEO
Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
Former Johnson & Johnson executive David N. Edwards will replace Dr Mervyn Fathianathan
as CEO of BioMers, a Singapore-based company specialising in orthodontic appliances.
Edwards, who has also worked
for Bausch & Lomb and Nestlé,
will take over the responsibilities

for the company’s
global business, starting immediately. Dr
Fathianathan will remain Chief Technical Officer and oversee future development and research
activities, the company said.
Founded in 2005,
BioMers is a National

David N. Edwards (DTI/
Photo courtesy of Nanostart, Germany)

University of Singapore spin-off focusing on products
based on polymer
composite for biomedical applications. Their core
products include the
recently launched
SimpliClear, a highly
translucent customisable braces system, and an ortho-

dontic retention solution called
ASTICS.
According to Dr Fathianathan, Edwards is expected to help
the company expand into new
markets. In his previous position as President of Bausch
& Lomb’s Asia-Pacific division,
he managed several successful
product launches in the ophthalmic market, Dr Fathianathan
said.

BioMers currently distributes
its products in Singapore and the
US only. The company is partially
owned by Nanostart, a Germanbased venture fund with representation in Singapore. DT

New standard
launched
by ISO
From news reports

Experience peace of mind.

GENEVA, Switzerland: Around
1.5 million different medical
devices are available worldwide.
Every year, thousands of new
products are launched. The
International Organization for
Standardization (ISO) has introduced a new International Standard that aims to assess the safety
and performance of such devices
and to improve patient safety.
ISO is a global network that
identifies international standards that are required by businesses, governments and society.
The non-governmental organisation develops these standards
in partnership with the sectors
that will put them to use, adopts
them by transparent procedures
based on national input and delivers them to be implemented
worldwide.

Rely on quality-assured and
long-lasting restorations.

Select from a full range of
high-quality biocompatible
solutions.

According to ISO, the new
standard ISO 14155:2011 will
provide a technical basis for regulation and minimise technical
barriers to trade. It was developed to encourage medical manufacturers to guarantee that their
products do not compromise
patient safety.

Access tools for effective
patient communication.

In 2007, the World Health
Organization reported that more
than one million accidents attributable to medical devices occur
annually in the US. Furthermore,
in some developing countries,
half of the medical equipment
was found to be unusable or only
partly usable.
NobelProcera Implant Bridge

It’s called NobelProcera. A single system that lets you
provide your patients with individualized prosthetic
solutions for every indication. Gain the peace of mind
that comes with complete coverage including extensive
warranty, quality assurance and material certification.
Prescribe a wide selection of individualized restorations,
all in biocompatible materials, that yield a consistent fit

and natural-looking esthetics. As a pioneer in CAD/CAM
dentistry, NobelProcera uses innovative digital technology and centralized precision milling for tooth- and
implant-based copings to full-arch bridges and implant
bars. Partner with Nobel Biocare and make a real and
lasting difference to the well-being of your patients.
Their smile, your skill, our solutions.

nobelbiocare.com/digital

Nobel Biocare Asia Ltd. 14/F, Cambridge House, Taikoo Place, 979 King’s Road, Quarry Bay, Hong Kong; Phone +852 2845 1266; Fax +852 2537 6604 3
© Nobel Biocare Services AG, 2011. All rights reserved. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of
Nobel Biocare. Disclaimer: Some products may not be regulatory cleared/released for sale in all markets. Please contact the local Nobel Biocare sales ofﬁce for current product assortment and availability.

The new standard addresses
good clinical practice for the
design, conduct, recording and
reporting of clinical investigations carried out on humans to
assess the safety or performance
of medical devices for regulatory
and other purposes. This International Standard specifies general requirements intended to
protect the rights, safety and
well-being of humans and to
ensure the scientific conduct of
the clinical investigation and the
credibility of the clinical investigation results.
The requirements are also
intended to define the responsibilities of the sponsor and principal investigator, as well as assist
sponsors, investigators, ethics
committees, regulatory authorities and other bodies involved in
the conformity assessment of
medical devices. DT

[7] => DTAP0511_01_Title

DTAP0511_07-09_Straumann 25.05.11 15:39 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications

More flexibility and treatment
®
options with Roxolid
Straumann’s small-diameter implants in clinical use

Fig. 1

Fig. 2a

Fig. 2b

Fig. 3a

Fig. 3b

Fig. 4

Fig. 5a

Fig. 5b

Fig. 6

Fig. 7

tric in relation to the prosthetic
axis and the emergence profile.
The gutta-percha spot on the
DentaScan was in a more buccal
position than the available bone
(Figs. 5a–19). The root of the
adjacent #43 was also placed very
buccally (Figs. 5a–21). A vestibular bone concavity was clinically
visible on #44 (Fig. 5b). After
preparing the implant bed for
a Ø 3.3 mm implant, the buccal
bone wall thickness was up to
1 mm and the lingual wall thickness was over 2 mm.

Fig. 8a

Fig. 8b

Fig. 9a

Fig. 9b

Fig. 10a

Fig. 10b

Fig. 10c

Dr Didier Blasé
Belgium

ity. In non-aesthetic regions, it
may allow avoidance of GBR procedures and less time-consuming treatment.

was in the right prosthetic axis.
As there was not much space,
the drilling had to be precise.
The bone walls were very thin
and the implant shimmered
through slightly. A small dehiscence of 1 mm was visible at the
buccal plate of #45 and #44, but it
did not need any augmentation
(Figs. 2a & b), as there was no
aesthetic issue (Fig. 4).

there was sufficient bone to place
a Ø 4.1 mm implant. However,
the bony substance was eccen-

Narrow implants are very beneficial in reduced width crests, as
they may avoid systematic horizontal bone augmentation if
the remaining bone is in the correct prosthetic axis. Roxolid®
small-diameter implants from
Straumann also offer more flexibility and can provide dentists
with new treatment options.
Depending on the specific case,
they can be placed more lingually or buccally than a regular implant which helps to
adjust possible eccentricity of the
remaining bone (see Case 2).
Originally, I did not use smalldiameter implants frequently
because I did not feel confident
doing so, owing to the higher risk
of fracture reported for narrow
implants in the literature. Another concern was the reduced
surface for osseointegration
compared with regular-diameter implants.
The combination of higher
strength and excellent osseointegration properties of Roxolid
compared with the features of
commercially available pure titanium implants gave me new
confidence. Roxolid implants allow me to benefit from all the
specific advantages of smalldiameter implants but with the
necessary degree of predictabil-

Another reason was Straumann’s approach in launching
the product. I saw a slow and
safe product introduction, based
on extensive testing and clinical
data. The strength of the material was proven by laboratory
tests. Various clinical and preclinical studies ultimately convinced me. It will be interesting
to observe the long-term behaviour of this new material and
the clinical data it generates.
We have to remain cautious,
however, even if the results of
the mechanical testing are very
promising.

Case 1: Partially edentulous
patient with a narrow bone
ridge in a non-aesthetic zone
(premolar)
Two implants had to be
placed in positions #44 and #45.
In the region of #45 there was
sufficient bone height over the
VIII canal. By contrast, the ridge
width was very narrow (Fig. 1).
An augmentation procedure was
needed as a prerequisite for the
placement of a regular-diameter
implant (e.g. Ø 4.1 mm). In this
case, the Ø 3.3 mm Roxolid® implants were a valuable alternative in order to use the existing
bone substance better—particularly as the remaining bone

The polished implant neck
was intentionally placed above
the crest in order to avoid bone
loss around the neck. A two-element bridge was placed on the
implants (Figs. 3a & b). The implant neck was slightly visible
clinically on the vestibular side.
The inter-implant papilla was
absent. Even when the patient
smiled broadly (Fig. 4), the border of the implant neck was
not visible, as this region was
hidden. It is very important to
analyse the smile line of the patient before placing implants in
this way.
In this case, Roxolid® allowed
less complicated surgery to be
performed by avoiding a larger
augmentation in a non-aesthetic
zone. The patient benefited from
a shorter treatment time.

Case 2: Partially edentulous
patient with eccentric bone
The X-ray measurement in
region #44 showed a crestal
width of over 7 mm. Therefore,

The choice of a Straumann
Standard Plus Ø 3.3 mm Roxolid®
implant instead of a regulardiameter implant allowed place‡ DT page 9
AD

[8] => DTAP0511_01_Title

110331_WH_AD_LISA_LINA_A3_AEN:Layout 1 31.03.11 15:17 Seite 1

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[9] => DTAP0511_01_Title

DTAP0511_07-09_Straumann 25.05.11 15:39 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

Fig. 11

ﬂ DT page 7

ment of the implant in an ideal
position, particularly when anticipating the future prosthetic
restoration and avoiding vestibular bone augmentation (Fig. 6).
The small dehiscence of 2 mm
was not compensated for. Thanks
to an initial lingually displaced
incision, a large and thick band
of keratinised gingiva was preserved buccally (Fig. 7) at the
end of the surgery to prevent
further buccal recession of the
gingiva. Prior buccal gingival
recession on #43 could be observed. The preoperative scan
(Figs. 5a–21) offered an explanation in form of a large bony dehiscence of the buccal plate on this
tooth. The patient did not want
any muco-gingival surgery for
root coverage. Eight weeks after
surgery, a three-unit premolar
bridge was seated on implants
at teeth #44 and #46.

Fig. 12

Trends & Applications

Fig. 13b

Fig. 13a

with a thick and wide band of
keratinised gingiva around the
implants. The panoramic X-ray
(Fig. 13a) demonstrated that

there was enough bony substance around the implants to
prevent the risk of a mandibular
fracture.

Even though there was sufficient bone height, the ridge
was very thin in this case. Therefore, Roxolid® small-diameter

implants were a valuable solution in order to avoid a more
traumatic and more invasive
solution. DT
AD

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A Roxolid® Ø 3.3 mm implant,
in this case, made it possible
to place an implant in an ideal
position without performing an
augmentation procedure, allowing for a less complicated surgical procedure. The patient
received an aesthetic solution
that would not have been recommended in the anterior aesthetic zone (teeth #13 to #23),
where a bone augmentation procedure would have been a prerequisite.

Case 3: A bone-preserving
solution for an elderly,
fully edentulous patient
A fully edentulous 83-yearold patient was to be given an implant-retained removable denture. Two implants were to be
placed inter-foraminally in the
#43/42 and #33/32 regions. There
was sufficient bone height, but
the crest was very thin, which
would have required a larger
augmentation (bone block) or
major grinding of the ridge (Figs.
9a & b).

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The placement of Ø 3.3 mm
implants allowed the vestibular dehiscence defect in region
#33 to be limited to 3 mm
(Fig. 10a) and to 1 mm in region
#43 (Fig. 10b). Two small flaps
were elevated in order to
minimise the surgical trauma.
Two Straumann Standard Plus
Roxolid® implants (L 12 mm)
were placed.
The initial lingually displaced incision preserved a nice
amount of keratinised gingiva
that was repositioned buccally
around the polished implant
necks and the healing screws
(Fig. 11). After a six-week healing period, two LOCATOR® abutments were placed. The clinical
check at three months showed
good healing of the soft tissues,

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[10] => DTAP0511_01_Title

DTAP0511_10-12_Ivoclar 25.05.11 15:42 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

10 Trends & Applications

Improved longevity and aesthetics
in Class IV restorations
A clinical case involving Tetric N-Ceram and FRC Postec Plus from Ivoclar Vivadent

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 1: Initial situation after endodontic treatment completed on teeth #11 and 21.—Fig. 2: Wax mock-up done on a stone plaster model.—Fig. 3: Tooth preparation with a long wave bevel and a short bevel.—
Fig. 4: FRC Postec Plus post cemented with Multilink Automix after following a proper adhesive protocol, also a chamfer prepared on the palatal surface.

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 5: Etching of the enamel and dentine surfaces with N-Etch.—Fig. 6: Adhesive bonding application with Tetric N-Bond using the VivaPen for 20 seconds.—Fig. 7: Silicone putty matrix prepared from the
wax-up on the stone model placed and Tetric N-Flow in shade A1 applied on the palatal surface.—Fig. 8: The first layer of Tetric N-Ceram in shade T placed on putty matrix and the completed scaffolding.

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 9: A layer of Tetric N-Ceram in dentine shade A 3.5 is placed.—Fig. 10: A layer of Tetric N-Ceram in shade T is placed between the mamelons and in the incisal area.—Fig. 11: A layer of Tetric N-Ceram in
enamel shade A1 is placed to replace missing enamel and sculpted with OptraSculpt.—Fig. 12: The final layer of Tetric N-Ceram in shade T is placed, spread and smoothened with a sable one-way brush.
Dr Arun Rajpara
India

Traumas and injuries in anterior teeth are common in young
people and those active in
sports and other physical activities. Treating such injuries
with predictable, conservative
and natural looking restorations is of primary concern for
aesthetically conscious dentists. A new generation of nanocomposite restorative materials and adhesives is helping
clinicians to place composite
restorations in Class IV fractures conservatively. These
materials provide restorations
that closely resemble the form,
function and aesthetic properties of natural teeth.
Many factors contribute to the
appropriate design and material
choice for the restoration of
an anterior tooth, such as the patient’s age, occlusion, habits and
aesthetic preferences.1, 2 Laboratory-fabricated restorations and
chairside direct restorations offer unique advantages, which
should be considered by both the
patient and dentist.1, 2
This article presents a clinical case in which Tetric N-Ceram
(Ivoclar Vivadent), a modern
nano-composite resin restorative, was used in conjunction
with FRC Postec Plus (also

Ivoclar Vivadent), a glass-fibrereinforced composite post, to
achieve enhanced longevity,
composite retention and superb
aesthetics in an extensive Class
IV restoration in a 15-year-old
male patient. The young man
presented with a large fracture of
the right and left maxillary central incisors after a sports injury
(Fig. 1). Intra-oral, peri-apical
radiographic findings revealed
pulp exposure. Immediate endodontic treatment was planned
and completed in the same visit
to relieve the patient of pain.
In addition, impressions of both
arches were taken to restore the
patient’s smile line.
As the patient was young,
the practitioner considered the
patient’s aesthetic appearance
to be of particular concern.
Consequently, different treatment options such as direct and
indirect restorations were discussed.
After the models had been
prepared, a diagnostic wax-up
was created (Fig. 2) and a high
viscosity, silicone putty matrix
was prepared. The putty matrix,
once placed in the patient’s
mouth, was used for spatial
reference as a volumetric, 3-D
guide for the placement of the
composite restoration and to
preserve the facial/lingual line
angles.3, 4

Treatment procedure
The patient opted for a
restoration involving a direct
composite layering technique
and glass-fibre post placement
for better composite retention.
The composite shade was selected and a shade map for the
layering technique was designed. In addition, the length
and size of the glass-fibre post
FRC Postec Plus were determined using post-operative, intra-oral radiographs.
The putty matrix was tried in
the patient’s mouth for lingual
and incisal fit. A bevel was prepared along the fracture line in
the dentine using high-speed
diamond burs and extended as
a chamfer preparation on the
palatal surface. A short bevel
was prepared along the fracture
line in the enamel on the labial
surface (“wave bevel”; Fig. 3).
In order to achieve an additional
blending of margins and increase the micromechanical
bonding, the bevel was extended
further to roughen the enamel.
Under local anaesthesia, a size 2
FRC Postec Plus post was placed
after completing the drill protocols to remove the gutta-percha
material and widen the root
canal to allow proper fit of the
post. An intra-oral radiograph
was taken to ensure optimum
fit of the determined post length.
After using 38% phosphoric acid

(N-Etch, Ivoclar Vivadent) for
better retention of the post,
silanising it with Monobond-S
(Ivoclar Vivadent) and applying
Multilink Primer A and B (Ivoclar
Vivadent) to the root, the post was
cemented in place using Multilink Automix resin cement
(Ivoclar Vivadent; Fig. 4).
Following this procedure,
N-Etch was applied to the enamel for 20 seconds and to the dentine for 5 to 10 seconds (Fig. 5).
The acid etchant was then removed with copious amounts of
water and the moisture with a
slow stream of air. The adhesive
Tetric N-Bond (Ivoclar Vivadent)
was applied using the VivaPen
(Ivoclar Vivadent) and brushed
in for at least 10 seconds. (Fig. 6).
The solvent of the bonding agent
was removed with a gentle
stream of air and light-cured
with a bluephase C8 curing light
(Ivoclar Vivadent) using the low
start programme.
The silicone putty matrix was
placed on the teeth and a first increment of a flowable composite
resin, Tetric N-Flow in shade A1,
was applied to the palatal chamfer area in order to achieve a tight
seal (Fig. 7). Then, the material
was polymerised. A thin layer of
Tetric N-Ceram composite resin
in shade T was placed on the putty
matrix and polymerised using the
Soft Start Mode of the bluephase

C8 light in order to reconstruct
the missing palatal and incisal
shelf. A further thick layer, 1 to
1.5 mm of the same shade T,
was placed on the entire incisal
edge to create a halo effect in the
incisal area of the final restoration.
The silicon putty matrix was
removed, as the scaffolding had
been prepared on the palatal
and incisal morphology (Fig. 8).
Tetric N-Ceram in dentine shade
A 3.5 was placed on the entire
fracture line. This opaque dentine layer helped to hide the demarcation line between the tooth
surface and artificial composite
resin restoration. After lightcuring this layer, another substantial layer of dentine shade
A3.5 was applied in the shape of
the natural dentine mamelons
using OptraSculpt instruments
(Ivoclar Vivadent) to replace the
lost dentine structure in this area
and light-cured (Fig. 9). Tetric
N-Ceram in shade T was placed
in a thin layer between the mamelons and spread evenly with the
OptraSculpt tips and a single-use
brush. After polymerising this
layer, a subtle amount of Tetric
Color in shade blue (Ivoclar
Vivadent) was placed between
the mamelons with a thin 0.8 mm
endodontic file and spread evenly with a fine single-use brush.
‡ DT page 12

[11] => DTAP0511_01_Title

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[12] => DTAP0511_01_Title

DTAP0511_10-12_Ivoclar 25.05.11 15:42 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

12 Trends & Applications

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 13: Initial finishing for the composite with Astropol grey cups at slow speed.—Fig. 14: Finishing with the Astropol green cup.—Fig. 15: Final finishing with the Astropol pink cup.—Fig. 16: Polishing of
the restoration with Astrobrush at slow speed.—Fig. 17: Finished restorations.
ﬂ DT page 10

This material was polymerised
for 20 seconds using the SOF

mode of the bluephase to achieve
incisal edge characterisation
and natural translucency in the
enamel area (Fig. 10). Tetric

N-Ceram in enamel shade A1
was prepared in the shape of a
ball and placed over the middle
third area, spread evenly with

OptraSculpt and blended smoothly again using a single-use brush
(Fig. 11). After light-curing the
last layer, Tetric N-Ceram in

shade T was prepared, placed at the
centre of the labial surface, spread
evenly and smoothened with the
single-use brush (Fig. 12).
While contouring the last two
layers, the mesial and distal line
angles, as well as incisal margin
were reconstructed. Furthermore, the practitioner took care
of the contact points and embrasures. Final light-curing was performed on both the labial and
palatal surfaces using the intensity programme of the bluephase
C8 light for 20 seconds each time.

Mucopren soft Delivers
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Excess composite was removed with a #12 scalpel blade.
The labial and palatal surfaces
were contoured with mediumgrit discs, diamond finishing
burs and interproximal finishing
strips. At this stage, special care
was taken to preserve the contours and surface characteristics.
Proper occlusion was verified in
centric occlusion and excursive
movements. Final finishing and
polishing were achieved with the
Astropol three-step finishing system (Ivoclar Vivadent). Astropol
grey cups were used at slow speed
with water-cooling to ensure an
improved natural texture (Fig. 13).
In the next step, Astropol green
finishing points were used at slow
speed with water-cooling for initial polishing (Fig. 14). Finally, the
pink Astropol finishing cup was
used at slow speed without watercooling to impart a shiny lustre
to the final restoration (Fig. 15).
The final ultimate gloss on the
restoration was achieved using
Astrobrush (Ivoclar Vivadent) at
slow speed (Fig. 16).

Conclusion
Traumatically damaged teeth
can be restored effectively with
beautiful and natural-looking
restorations. In this case, good results were achieved by combining the excellent physical and
aesthetic properties of the latestgeneration nano-composite, Tetric
N-Ceram, with an FRC Postec
Plus glass-fibre post (Fig. 17).
Proper planning by the clinician
in selecting compatible materials
and meticulous execution of the
treatment plan yielded highly
aesthetic results. The patient was
amazed to see his beautiful smile
restored in just a few hours. DT

020915_2011

A list of references is available from
the publisher.

Denture relining material with permanently soft A-silicone. Reliable, efﬁcient
and comfortable. Mucopren soft - a denture reliner of assured
quality that has many advantages. Mucopren soft is guaranteed to bond
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surface makes it very difﬁcult for bacteria to settle. A very promising
material indeed! For further information please call +49 (0) 2774 70599 or visit
our website:
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Contact Info
Dr Arun Rajpara
currently works at
the Soham Dental
Center for Cosmetic & Advanced
Dentistry in Valsad, India. He can be contacted at
arunrajpara@gmail.com.

[13] => DTAP0511_01_Title

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[14] => DTAP0511_01_Title

DTAP0511_14_Mao 25.05.11 15:42 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

14 Trends & Applications

“There seems to be no limit to what
tissue we can regenerate”
An interview with Dr Jeremy Mao, Columbia University, New York, about dental stem cell research
ing in dental stem cell research?
As far as research is concerned, people tend to look at
the US first but as the conference
has shown, there are quite a
number of researchers in Europe and Asia working on dental and craniofacial stem cell
research, including some countries where you would not expect such research to be conducted, like Malaysia.

Research has proven that dental stem cells hold potential for
the successful regeneration of
dental and other body tissues.
In May, experts from around
the globe gathered in New York
for the first time to discuss the
latest concepts and scientific
breakthroughs at the International Conference on Dental
and Craniofacial Stem Cells.
Dental Tribune Asia Pacific
Editor Daniel Zimmermann
spoke with Columbia University professor and co-organiser
Dr Jeremy Mao about the conference and when the first
clinical applications might be
available for dentists.
Daniel Zimmermann: Dr
Mao, re-growing teeth or parts
of it could mean an end to dentistry as we know it. When will
this concept become reality?
Dr Jeremy Mao: Research in
the area of dental tissue regeneration and engineering is developing rapidly. Different parts
of the tooth like the dental pulp,
dentine and cementum have
been already successfully regenerated in animal models.
These techniques are not ready
for clinical use yet but they will
be available in a few years from

article that demonstrated that
clones of mononucleated stem
cells of dental pulp can transform into myoblasts and help
with the formation of muscle tissue. This, and other research,
suggests that dental stem cells
can be used to treat not only
dental diseases, but also other
medical conditions.

Stem cell tissue regeneration will obviously have a
significant impact on dental
practice. Do you expect dental
professionals to be open to this
concept?
I think, as dental professionals we are quite used to new inventions and innovations. I have
had the opportunity to lecture to
various members of the profession, such as oral surgeons and
paediatric dentists, and with a
few exceptions they were quite
enthusiastic about the potential
of dental stem cells for tissue
regeneration and engineering.
In acknowledging that regenerative endodontics could be the
next evolution in root-canal
treatment, the American Association of Endodontists has set
up a special committee that will
provide funding for research
projects in this area in future.

Is there collaboration between scientists that work with
dental and medical stem cells?

Edentulism, particularly
amongst the elderly, is a major problem in countries with

Dr Mao posing with delegates. The conference in New York was the first international gathering of researchers working
with dental stem cells. (DTI/Photo courtesy of Columbia University, USA)

is little controversy regarding
dental stem cells. Why is that?
This is true. There is not
much ethical discussion because
unlike embryonic stem cells,
which can only be obtained by
destroying the fertilised embryo,

Theoretically, there seems to
be no limit to what tissue we can
regenerate, so you can expect the
whole range of dentistry fields
to benefit from these techniques.
It is only a matter of time until
we have learned enough about

“Science is only one part
of this process.”

Dr Jeremy Mao speaking to conference delegates in New York.

“There are quite a number of researchers
in Europe and Asia working on dental
and craniofacial stem cell research. ”
now, depending on approval by
regulatory agencies like the
Food and Drug Administration
in the US. Science is only one
part of this process.
In contrast with embryonic stem cell research, there

dental stem cells are harvested
from what clinicians refer to as
“dental waste” such as extracted
teeth or teeth that have fallen out.
What fields of dentistry
will probably benefit most
from this research?

these cells to be able to use them
to regenerate all kinds of tissues.
Can dental stem cells be
used for medical applications
as well?
Very likely. Earlier this year,
for example, we published an

To some degree, but not to the
extent that we would like. Let me
give you an example. Two years
ago, I attended a conference
organised by the International
Society for Stem Cell Research in
Barcelona in Spain, and there
was not one single presentation
on dental stem cells. Realising
that this was an understudied
area, the idea of an international
conference on dental and craniofacial stem cell research was
born. With it, we also hope to promote collaboration between scientists working in these areas.
How did the congress in
New York turn out, in general?
Looking back, it was quite an
intense conference. We had over
200 attendees and 30 presentations over the course of three
days. The feedback was extremely positive and there are
already plans for a second conference. However, we have not
decided on a location yet.

mass populations such as
India or China. Could dental stem cell research offer
the ultimate solution to this
problem?
It would certainly not be
right for any scientist or company working in this field to
ignore these regions because
there is such a strong clinical
need. I am certain that as the
technology develops, it will also
be available to some of the populous regions in the world such
as India, China or Africa. Of
course, there is the problem of
affordability, which was also
discussed at the conference in
New York. Stem cell therapies
will be higher priced at the beginning but with a larger variety
of products I am sure the price
will come down. Considering
the high costs of current restorative procedures, such as dental
implants, I am sure stem cell
regenerating tissue will be a
strong contender.

Which other regions or
countries are currently lead-

Thank you very much for
this interview. DT

[15] => DTAP0511_01_Title

DTAP0511_15_Gsk 25.05.11 15:43 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Advertorial 15
the same patented bioactive
material used in advanced bone
regeneration techniques.7, 8 It
acts as a reservoir to build a
new reparative layer over exposed dentine and within the
tubules.9–13 This layer has a similar chemical composition to
hydroxyapatite mimicking the
tooth’s natural composition and
strongly binding to the collagen
in dentine.14–16

50 years of Sensodyne
innovation (1961–2011)

For the last 50 years Sensodyne
has been at the forefront of
scientific innovation into the
aetiology, treatment and prevention of dentine hypersensitivity and erosive tooth wear. In
January 2011, GlaxoSmithKline
celebrated 50 years of Sensodyne innovation by hosting a
50th anniversary symposium in
Madrid in Spain. Experts in the
field of dentistry and dental
research discussed the past,
present and most importantly
the future of oral health, each
presenting a prospective from
their own field of specialism.

“Traditionally, there has been
a lack of understanding of the
aetiology of hypersensitivity and
gingival recession. For dentists
to offer advice they need to be educated and Industry has a role,”
Prof. Martin Addy4. Prof. Addy
called for further research that
is fully scientifically founded.
“Many clinical trials on treatments for dentine hypersensitivity belong in the realms of testimonials. Areas for improvement

includes employing experts not
only in dentistry but also in fields
outside to expand the understanding of dentine hypersensitivity. Linking aetiology, research and patient needs has
resulted in toothpastes that deliver specific patient benefits.
Up until now pain measurement was subjective and could be
influenced by a number of variables. Research for an objective

Dr Jonathan Earl, Principal
Scientist Sensodyne, using his
expertise in material science
and engineering has applied
electron microscopy techniques
to the visualisation & characterisation of the tooth structure and
how treatments work in vitro.
This work was carried out in
conjunction with UK universities Cambridge, Leeds and
Manchester, and uses various
methods including Scanning
Transmission Electron Microscopy (STEM), Environmental
Scanning Electron Microscopy
(ESEM) and Focussed Ion Beam
Scanning Electron Microscopy
(FIB SEM).
The research shows the
transformation of Novamin in
saliva-changes are not only
seen in structure but can also be
measured in changes in chemical composition. This dynamic
reparative layer is harder than
natural dentin15,16; it is able to
withstand daily oral challenges
such as tooth brush abrasion, and

last 50 years both internally and
externally. “The next 50 years
will be even more exciting for
GSK Sensodyne with continued
investment into leadership in
oral care through science. We are
living in exponential times,”
Teresa Layer. DT

References
1. Professor Francis Hughes, Periodontology, Kings College London Dental Institute—“Past, Present and Future: Towards
periodontal Health for all”
2. Professor J.M (‘bob’) ten Cate, Head of
Preventive Dentistry at the academic
Center for Dentistry Amsterdam (ACTA)
—“Past, Present and Future: Toothpastes
in Caries prevention”
3. Professor David Bartlett, Head of Prosthodontics, King’s College London Dental Institute—“Past, Present and Future:
Erosive Tooth wear”
4. Professor Martin Addy, Division of
Restorative Dentistry (Periodontology)
University of Bristol—“Past, Present and
Future: Dentine Hypersensitivity”
5. GSK data on file. Ipsos Healthcare Professional Mouth Care full year 2010
6. United States Patent No. 5,735,942; Title:
Compositions Containing Bioactive Glass
and Their Use in Treating Tooth Hypersensitivity, issued April 7, 1998
7. David C. Greenspan NovaMin® and Tooth
Sensitivity—An Overview (J Clin Dent
2010;21[Spec Iss]:61–65)
8. Greenspan DC, Burwell A, Jennings D,
Muscle D. NovaMin®and Dentine Hypersensitivity – In Vitro Evidence of Efficacy.
Journal of Clinical Dentistry Special Issue, Nov 2010
9. LaTorre G,Greenspan DC. Role of ionic
release from NovaMin® (calcium sodium
phosphosilicate) in tubule occlusion: Invitro analyses. Journal of Clinical Dentistry, Special Issue, Nov 2010
10. Efflant S E, Magne P, Douglas W H, Francis L F. Interaction between bioactive
glasses and human dentin,. J Mater
Sci.Mater Med, 26[6]:557-565 (2002)
11. Clark AN E, LaTorre G, McKenzie K
Dentin Surface Morphological and Chemical Changes Produced by Treatment with
a Bioactive Prophylaxis Agent. J Dent
Res 81 (Spec Iss A): 2182. 2002
12. GSK Data held on file (2010)

The principal speakers at the
symposia included Prof. Francis
Hughes,1 Prof. J.M (‘bob’) ten
Cate,2 Prof. David Bartlett3 and
Prof. Martin Addy.4
All speakers agreed that dentistry had come a long way in
50 years, however, good oral
health for all is a challenge and
can only be achieved by linking
treatment to patient needs. “Research into genetic profiling
holds many possibilities,” Prof.
Francis Hughes1.
Oral health prevention, a relatively neglected area of global
health, is now key and commitment is needed by policy makers
to prevent chronic diseases. “The
effectiveness and contribution of
fluoride toothpastes are undisputed, however in the future priorities should include ‘Better’ or
‘Smarter’ products that improve
compliance, availability and affordability. Every one can learn
to brush̶however a paradigm
shift in prevention needs to occur, as caries prevention is very
dependent on fluoride,” Prof.
J.M (‘bob’) ten Cate2.
“In the future, there will be
reduced government funding for
dentistry practice and research,
therefore, there is a need for
industry and university collaboration with research focused
on clinical needs and realistic
outcomes. Prevention of erosion
needs changes to formulation of
toothpastes which actively protect enamel and dentine from
acids,” Prof. David Bartlett3.

Prof. Barlett and Drs Mason, Earl and Barlow.

include Objective Evaluation
Criteria, better controls and evidence of stimulus response and
therapeutic action. There is a
need to be able to really magnify
and visualise dentine either as
a replica or in-situ.”
The speakers all agreed that
industry has a key role to play in the
continuing research and development of preventative dental care.
Through collaboration with
the dental health care professional
and by researching patient’s
needs, truly significant advances
have been made. Sensodyne was
first made available in 1961 by
Block Drug. Since GlaxoSmithKline’s acquisition of the brand,
it has rapidly grown globally and
become the dentists’ sensitivity
toothpaste of choice in many
markets.5
GlaxoSmithKline’s significant investment in Sensodyne

Prof. J.M (‘bob’) ten Cate. (DTI/Photos courtesy by GSK, UK)

measure for pain using fMRI
(functional Magnetic Resonance
Imaging) to map brain activity
was presented by Dr Ashley Barlow, GSK Principal Clinical Scientist, in collaboration with the University of Zurich using a multidiscipline team including experts
in medical, clinical, engineering,
psychology, statistics and data
management. Future GSK investment into pain measurement will
bring advances into understanding dentine hypersensitivity and
hence more targeted modes of
treatment and prevention.
In early 2011, GlaxoSmithKline will be launching the world’s
first daily fluoride toothpaste
with Novamin, Sensodyne Repair
and Protect, a development that
clearly illustrates why Sensodyne has become synonymous
with dentine hypersensitivity.
Novamin, advanced calcium
phosphate technology, employs

dietary acid challenges.9,13,16,17
With regular use two times
a day,16,18,19 it helps maintain
lasting protection to deliver clinically proven relief from the pain
of dentine hypersensitivity.18,19,20
GlaxoSmithKline are working with DENTSPLY, a global
leader in professional dental
products, to develop the new
Sensodyne NUPRO Professional
Range also utilising NovaMin®
technology. The in-office Prophy
Paste is the only prophylaxis
product containing the unique
patented ingredient, NovaMin®.
Dr Teresa Layer, Vice President
Oral Healthcare R&D, is hugely
excited about forging a relationship with DENTSPLY to work on
taking the brand forward.
Sensodyne’s strengths lie in
its dental and clinical heritage.
GlaxoSmithKline acknowledges
it owes a lot to all the people who
have worked on Sensodyne in the

13. Zhong JP et al. The kinetics of bioactive
ceramics Part VII: Binding of collagen
to hydroxyapatite and bioactive glass,
Zhong J P, LaTorre G P, Hench L L, in Bioceramics 7 Ed O H Andersson and A YliUrpo. Proceedings of the 7th International
Symposium on Ceramics in Medicine,
Turku, Finland, July 1994
14. Burwell AK and Greenspan DC. Quantitative Tubule Occlusion in an In Vitro Remineralization/Demineralization Model.
J Dent Res 85 (Spec Iss C):0568 (PEF), 2006.
15. GSK Data held on File (2010)
16. Zhejun Wang, Yue Sa, Salvatore Sauro,
Hao Chen , Wenzhong Xinga, Xiao Ma, Tao
Jiang, Yining Wang, Effect of desensitising
toothpastes on dentinal tubule occlusion:
A dentine permeability measurement and
SEM in vitro study Journal of Dentistry
38 ( 2010) 400–410
17. Pradeep AR, Sharma A, Comparison of the
Clinical Efficacy of a dentifrice containing
Calcium Sodium Phosphosilicate with a
Dentifrice containing potassium nitrate
and a placebo on dentinal hypersensitivity: A randomized clinical trial. J Periodontal. Aug;81(8):1167-73 (2010)
18. Salian S, Thakar Kulkarni S, LaTorre G.
A Randomized, Controlled, Clinical Study
Evaluating the Efficacy of Two Desensitizing Dentifrices. J Clin Dent. Special Issue,
accepted for Publication (2010)
19. Du M Q, Bian Z, Jiang H, Greenspan DC,
Burwell AK, Zhong J, Tai BJ, Clinical evaluation of a dentifrice containing calcium
sodium phosphosilicate (NovaMin) for
the treatment of dentin hypersensitivity.
Am J Dent. 21(4); 210-214 (2008)

[16] => DTAP0511_01_Title

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[cover] => DT Asia Pacific No. 5, 2011

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