DT Asia Pacific No. 5, 2012

Singapore eases registration of devices / Australian dentist sets graduation record / Asia News / Opinion / World News / “A common language for all stakeholders to communicate about caries” / IDEM 2012 review / Un-cosmetic dentistry / Aestethic guidelines for dentures that are natural-looking

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DTAP0512_01_Title 14.05.12 16:15 Seite 1

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

www.dental-tribune.asia

IDEM 2012 review
A look back on Asia’s
largest dental show
4Page

NO. 5 VOL. 10

Un-cosmetic dentistry
Reducing dependence
on porcelain restoration

4Page

Aesthetics
Guidelines for dentures
that are natural-looking

4Page

Singapore eases registration of devices Shorter service
period for
Malay grads

Daniel Zimmermann
DTI

SINGAPORE: Manufacturers of
dental impression materials,
surgical instruments or abutments breathed a sigh of relief when the Singapore Health
Science Authority (HAS) recently
announced that it would lower
its regulatory requirements for
low risk medical devices, Dental
Tribune Asia Pacific has learned.
Registration fees for Class B
products like dental abutments
and scaling systems will also be
lowered soon, the government
agency responsible for medical
product regulation said.
Beginning in May, manufacturers of Class A devices will only
be required to register their devices with HAS for the purposes
of market monitoring. The registration fees for approximately
3,600 Class B products will be
reduced from S$2,300 to S$1,400
from September.
According to the HSA, about
70 per cent of all medical devices
registered in Singapore currently fall under Classes A and B.
The organisation said that it
will look into revising fees for

Owing to the increasing number of dental professionals graduating from universities, the
Malaysian Dental Council has
recently approved a reduction
in the period of the compulsory
national service for dental graduates in the country.
Instead of three years, graduates will have to serve the government for only 24 months in
the future, Ministry of Health officials said during the launch of
Colgate Oral Health Month 2012
in Bandar Utama last month.

The restructured regulations will benefit dental manufacturers. (DTI/Photo courtesy Koelnmesse, Singapore)

Special Authorisation Route registrations and regulations for
higher risk Class C and D devices.
“These changes reflect a flexible and responsive regulator
that is willing to listen to the
teething issues faced by the industry with the introduction
of medical device regulation
in Singapore, without compromising patients’ well-being,” Dr

Amy Khor Lean Suan, Minister of
State at the Ministry of Health,
said. “I am confident that these
enhancements, for lower risk devices in particular, will address
the concerns of the industry and
that HAS will continue to enhance the framework to facilitate
access to safe medical devices.”
Since 2008, medical devices,
including dental equipment, have
had to be registered with the HSA.

Prior to that, regulation was voluntary and followed international regulatory standards, like
those of the US Food and Drug
Administration. The guidelines
have continuously sparked unrest among importers and doctors over the past few years
who blamed the regulations for
preventing medical and dental
professionals from using stateof-the-art equipment and for
increasing health-care costs. DT

According to statistics released by the Ministry of Health
earlier this year, the number of
dental graduates has increased
by 400 per cent in the last decade.
In 2011, 415 graduates registered
with the Malaysian Dental Council. With the shorter period, the
government hopes to keep graduates enrolled in government
service.
Of the more than 4,000 dentists currently practising in Malaysia, almost 60 per cent work
in the public sector. DT
AD

High hopes
for regulatory
head

Former dentist Allan Stewart from Port Stephens in Australia has recently
gained his fourth degree—with the age of 97. (DTI/Photo courtesy of Southern
4ASIA NEWS, page 2
Cross University/Sharlene King)

First vitamin B12 GC, Unison buys
Showa Yakuhin
toothpaste
A German natural cosmetics
manufacturer has launched a
toothpaste that could benefit
people unable to absorb vitamin
B12 from food. Developed in
partnership with the German
Vegetarian Union, the toothpaste
allows the absorption of the
essential nutrient through the
oral mucosa. DT

One of Japan’s largest dental
products manufacturers GC has
acquired Showa Yakuhin Kako
through private equity firm Unison capital. The Tokyo-based
pharmaceutical company was
put on sale by majority shareholder Tokyo Marine Capital last
year and is currently estimated
to be worth US$ 650 million. DT

The Australian Dental Industry Association (ADIA) has called
on the Therapeutic Goods Administration (TGA) in Canberra
to free the industry from unnecessary regulatory burden with
regard to dental goods. In view
of the recent appointment of
Dr John Skerritt as new head of
the country’s body for medical
device regulation, ADIA emphasised that future regulatory reform should not be implemented
at the cost of patients.
TGA is in charge of the regulation of most of the goods
available on the country’s AUS$4
billion (US$4.14 billion) dental
market. Skerritt, who currently
holds an administrative position
in the Victorian government, was
appointed new national manager by the organisation’s board
last month. He will assume duties
at the end of May. DT

Distinguished by innovation
Healthy teeth produce a radiant smile. We strive to achieve this goal on a daily basis. It inspires
us to search for innovative, economic and esthetic solutions for direct filling procedures and
the fabrication of indirect, fixed or removable restorations, so that you have quality products
at your disposal to help people regain a beautiful smile.

www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60

[2] => DTAP0512_01_Title

DTAP0512_02_News 14.05.12 16:15 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Australian dentist sets
graduation record
Dental Tribune Asia Pacific

LISMORE, Australia: At the age
of 97, most people probably consider learning to be the very least
of their priorities. Not Dr Allan
Stewart from Australia. The former dentist from Port Stephens
just received his fourth degree
—Master of Clinical Science
(Complementary Medicine)—
surpassing his own world record
of being the World’s Oldest Graduate set in 2006.
A father of six children and
with 12 grandchildren, Stewart
gained his first academic title
with a Bachelor of Dentistry from
the University of Sydney during
the 1930s. After completing postgraduate studies in dental surgery in the US, he practised
dentistry in Australia and the UK
for more than 40 years.
Things took an unusual turn
in the late 1980s, when Stewart
decided to study law at the
University of New England in
Armidale at an age when most of
his dental colleagues were already enjoying their retirement.
Not having completed the programme, he took it up again in
2001 and completed it in only
four and a half years, making him
then the oldest living person to
have ever graduated from university.
According to Stewart, his latest academic endeavour, which
ended successfully last Friday
with a graduation ceremony in
East Lismore near Brisbane, was
sparked when one of his daughters began studying arts at Southern Cross University at the age

Dr Allan Stewart is the oldest living person to have ever graduated. (DTI/Photo
courtesy of Southern Cross University, Australia)

of 70. He enrolled at the same institute in 2009 in spite of his original intention never to go to university again.
“I must say that although it’s
been a tremendous challenge,
I have recently enjoyed it immensely,” Stewart told reporters.
“I would strongly encourage any
older person to go back to studying.”
University supervisors said
that despite his advanced age, he
used modern tools of communication, like Skype, during his
studies and was actively involved
in online discussions and forums.
Besides Stewart, so far only
a handful of people worldwide

have obtained academic qualifications so very late in life. In
2010, for example, Hazel Soares
from the US earned her first college degree from Mills College
in Oakland, California, at the
age of 94. Three years before,
95-year-old fellow countrywoman Nola Ochs also graduated
with a general studies degree
with emphasis in history from
Fort Hays State University in
Hays, Kansas.
Stewart, who is said to like
boating, fishing and playing
bridge in his spare time, announced that he would finally
hang up his academic robes after
having graduated from Lismore.
He remains a member and Fellow of the Royal Australasian
College of Dental Surgeons. 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

President/CEO

Torsten Oemus

Editorial Assistant

Yvonne Bachmann

Marketing & Sales

Matthias Diessner
Vera Baptist
Peter Witteczek

Director of Finance & Controlling
Marketing & Sales Services
License Inquiries
Accounting
Product Manager
Executive Producer
Ad Production
Designer

Dan Wunderlich
Nadine Parczyk
Jörg Warschat
Manuela Hunger
Bernhard Moldenhauer
Gernot Meyer
Marius Mezger
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.
© 2012, 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] => DTAP0512_01_Title

DTAP0512_03_News 14.05.12 16:15 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Asia News

Market report forecasts extensive
growth of Korean implants in AP
Daniel Zimmermann
DTI

TORONTO, Canada: Dental
implants produced in the Republic of Korea have gained significant market shares in recent
years. Now a report by the Millen-

nium Research Group (MRG) in
Canada has predicted that manufacturers from that country could
dominate dental implant markets in the Asia Pacific region as
early as 2016 owing to their price
advantage.
Implants from Korea are also
catching up in terms of clinical

data, the report states, a fact that
will make them increasingly
adoptable for implant specialists
in the region.
The total regional market for
dental implants is expected to
exceed US$800 million by 2016
with the key driving market being Australia, which was histori-

cally underdeveloped and is now
expected to grow by 10 per cent
annually, according to MRG.
Japan, the largest national
market in the region, will experience slower revenues despite
an overall rise in implant procedures.
Alongside Germany and Israel, South Korea currently has
one of the highest rates of dental
implants per capita worldwide.
This market saturation has recently forced many manufactur-

ers to pursue sales markets overseas. While exports to Western
countries have remained relatively slow, Korean manufacturers like OSSTEM already rival
established implant providers,
such as Straumann or Zimmer
Dental, in Asian countries like
Pakistan, Malaysia or Hong
Kong.
Other significant market
players in the region include
DIO Implants, a company partly
owned by DENTSPLY, as well as
MegaGen and Shinhung. DT
AD

Research
suggest old
folks should
clean teeth
Dental Tribune Asia Pacific

TAIPEI, Taiwan: Data analysis
of patients with public health
insurance in Taiwan has backed
up the claim that oral health and
heart disease might be associated later in life. People over the
age of 50 who had received at
least one tooth scaling showed
slightly lower incidence of myocardial infarction, other cardiovascular events and strokes
than those who had received
none, according to a paper recently published in the American
Journal of Medicine.
In the study, which took
seven years to complete, the
records of more than 22,000 patients selected from the country’s National Health Insurance
Research Database were analysed.
According to the researchers
at the Taipei Veterans General
Hospital and National YangMing University’s Cardiovascular Research Center, the results
made public this month revealed less heart disease in
those people who had had their
teeth cleaned.
The incidence of stroke was
1.1 per cent higher among those
whose teeth had not been
cleaned, and acute myocardial
infarction occurred in only 0.6
per cent more people who had
not undergone tooth scaling.
Lead researcher Dr Zu-Yin
Chen told Reuters Health in London that the results, although
convincing, did not prove that
better oral hygiene can lower
the risk of heart disease but that
dental problems like gum disease most likely increase the
risk of these conditions.

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Chen said that the new study
followed research that suggested that there might be a link
between heart disease and oral
health.
The association itself and the
way in which bacterial inflammation in the mouth contributes
to heart disease is still highly
debated in the dental community. DT

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[4] => DTAP0512_01_Title

DTAP0512_04_News 14.05.12 16:16 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Opinion

The way
forward

Dear
reader,

Prof. Urs Belser
Switzerland
Daniel Zimmermann
DTI

Being a dental trade journalist, I usually come to visit a lot
of trade shows during the year.
On many occasions I have heard
Western manufacturers to complain about the registration of
dental products in Asia.
While things have somehow
improved in this regard, the regulatory situation here is still far
from being perfect. Companies
producing high-end equipment
in particular find it difficult to
roll-out their product simultaneously throughout the region and
dentists are being forced to import devices by themselves for
which they have to pay larger
fees.
Unfortunately, the situation is
unlikely to change in the years to
come, despite efforts to establish
common regional standards. It
will hinder Asian professionals to
keep up with international dentistry. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International

Correction
In Dental Tribune Asia Pacific
No.1+2, Vol. 10, the article on
page 15 about IDEM included
incorrect information. This year
was the seventh time that the International Dental Exhibition &
Meeting was held in Singapore.

A keener eye on post-market activities
Ing Loong Yang
Hong Kong/Singapore

The recent sweeping changes
to the medical device regulations in
Singapore are certainly a welcome
relief for many medical practitioners and industry players. But the
changes might not necessarily be
good news for all those involved, in
particular, diligent companies who
had taken the initiative to have their
products registered before these
new rules were first announced.
Firstly, there will be no refund of
application fees in respect of nonsterile Class A devices registered
before 1 May 2012. It remains to
be seen whether the registered
non-sterile Class A devices, which
now enjoy the exemption scheme,
will be required to be de-registered.
An immediate question that arises

is whether the registrants are still
subject to the registration conditions and duties, as prescribed in
the medical device regulations.
For instance, must these registrants ensure that the devices comply with the prescribed safety and
performance requirements, or notify HSA of any change that may
affect the safety, quality or efficacy
of the devices? Technically, the answer is yes, until HSA decides to
amend the law.
For Class B devices, industry
players may have learnt to bide their
time, as it has been announced that
the registration fees for this risk
class of devices will be reduced
from September this year.
No news has been published yet
regarding the potential issues HSA
might see a need to address. In any
case, the recent changes do not
mean that dealers manufacturing
and importing products that enjoy
the product registration exemption

or reduced registration fees can afford to be complacent. The HSA has
already made it clear that dealers
will continue to be required to declare the list of such products in
the manufacturer’s and importer’s
licences and update this list biannually. “We will manage risk by
putting more emphasis on postmarket vigilance, compliance, audit
and enforcement,” said Associate
Professor John Lim, CEO of HSA.
The message is clear: while
premarket approval requirements
for medical devices have been relaxed, HSA will be casting a keener
eye on post-market activities. DT

Contact Info
Yang Ing Loong is a Hong Kongbased partner of Sidley Austin, a
global law firm with approximately
1,700 lawyers in 18 offices. He can be
contacted at iyang@sidley.com.

Several
Exhibitions

high quality glass ionomer cements

SINO-DENTAL
09.–12.6.2012
Beijing, China

German Pavilion
Booth D68

FDI Dental World Congress
28.08.– 01.09.2012
Hong Kong, China

Light-curing micro-hybrid composite
s UNIVERSAL RANGE OF APPLICATION
s HIGH FILLER CONTENT
s EXCELLENT PHYSICAL PROPERTIES
s FAST AND EASY APPLICATION

first class composites
innovative compomers
modern bonding systems
materials for long-term prophylaxis
temporary solutions
bleaching products …
All our products convince by

Glass ionomer filling cement
s perfect packable CONSISTENCY
s excellent DURABLE AESTHETICS
s ALSO AVAILABLE AS APPLICATION CAPSULES

excellent physical properties
perfect aesthetical results

PROMEDICA Dental Material GmbH
phone: +49 43 21/5 41 73 · fax +49 43 21/5 19 08 · eMail: info@promedica.de · Internet: www.promedica.de

Dental desensitising varnish
s TREATMENT OF HYPERSENSITIVE DENTINE
s FAST DESENSITISATION
s FLUORIDE RELEASE
s EASY AND FAST APPLICATION

General dentistry has undergone major changes during the
last 20 years, not just in the way
clinicians treat their patients, but
particularly in the way patients
request treatment and their increased expectations of outcomes.
In particular, the practice of
restoring patients’ compromised
teeth has become less complex
in some ways, yet more challenging in others. Tooth replacement
is increasingly being performed
through the use of restorations
supported by dental implants,
and numerous elegant and predictable clinical approaches to this
have been developed.
The increase in the use of
dental implants is also partly due
to the developments in the design of the implants themselves
and of the components available
to complete the restoration.
All of these advances, however, would be of little use without well-defined decision-making criteria when considering
treatment in the context of either
damaged or missing teeth. Accurate diagnosis is essential, and
the clinicians involved must always have the aesthetic aspects of
the treatment foremost in mind
when dealing with sites located
within the appearance zone. DT

Contact Info
Prof. Urs Belser is professor at the
University of Geneva’s School of
Dental Medicine. He can be contacted
at urs.belser@medecine.unige.ch.

[5] => DTAP0512_01_Title

DTAP0512_05_News 15.05.12 12:07 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Implant failure may be related to bisphosphonate use
DTI

NEW YORK CITY, NY, USA:
The results of a study conducted
at the New York University College of Dentistry seem to confirm

Teeth
equally
perceived
by dentists
DTI

BERLIN, Germany: Several
morphometric studies have
proven sexual dimorphisms in
human teeth, for example that
women’s teeth are smaller than
men’s teeth. The German Society
for Sex-Specific Oral and Maxillofacial Surgery recently reported on a study that found no
obvious differences between
male and female teeth.
Headed by Prof. Ralf J. Radlanski from the Centre for Oral
and Maxillofacial Surgery at
the Benjamin Franklin Campus
of Charité Universitätsmedizin
Berlin, the researchers explored
whether the sex of an individual could be identified if only
the front teeth were considered.
This was tested by having participants evaluate 50 images of
the anterior oral region of men
and women aged between seven
and 75. The lip area was not
shown.
The participants included dentists, dental technicians, dental
students and dental professionals, as well as 50 people who had
no professional dental background.
The results overall demonstrated that sex could be detected
in only about 50 per cent of the
images. Although there are anthropological studies that claim
to prove measurable morphometric differences, the study proved
that those are not even visible to
experts’ eyes.
While some tooth positions
were correctly assigned by 70 per
cent of the participants, others
were wrongly assigned by the
same number of participants.
The assumption that women
tend to have rounded teeth and
men rather angular ones could
not be confirmed by the study.
Furthermore, contrary to what
was expected by many of the participants, shape, size and colour
of the canines were not meaningful indicators of sex.
“In everyday practice, it is relevant whether the restoration fits
the patient’s face but not whether
the patient is male or female,”
Radlanski said. “Recognisable
typical male teeth or female teeth
do not exist.” DT

the hypothesis that the use of
oral bisphosphonate is connected
to dental implant failure. In the
case-control study, more than
300 middle-aged female patients
with failed dental implants were
compared with woman from the
same age group whose implants
were still intact.
Clinical evaluations at the
Department of Periodontology
and Implant Dentistry were

conducted between 1997 and
late 2004. According to the researchers, the clinical data gathered from these examinations
showed that in women whose
implants had failed the odds
of having taken bisphosphonate orally were almost three
times higher. Dental implant
failure related to the use of oral
bisphosphonate also seemed to
be more likely to occur in the
maxilla.

Neither the quantity nor the
duration of bisphosphonate use
was evaluated.
Although the risk of implant
failure is low, the researchers concluded that oral bisphosphonate
could pose a risk to the success of
dental implant therapy and should
be prescribed with caution.
Earlier research on the association remains ambiguous, as

results from Sweden and Australia have not found increased
risks for implant failure when
bisphosphonate was taken by
patients before or after implant
placement.
However, the majority of clinical organisations still recommend that long-term users stop
taking bisphosphonate before undergoing dental implant procedures to avoid complications. DT
AD

[6] => DTAP0512_01_Title

DTAP0512_06-07_Pitts 14.05.12 16:16 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Dr Nigel Pitts at IDEM 2012. (DTI/Photo Claudia Duschek, DTI)

“A common language for all stakeholders
to communicate about caries”
An interview with IDEM presenter Dr Nigel Pitts, UK
At this year’s IDEM, Dr Nigel
Pitts from the UK presented
a lecture focusing on dental
caries as a public-health issue,
as well as the epidemiology
and importance of under-

standing the science behind
primary and secondary caries
prevention. Dental Tribune
Asia Pacific spoke with him
about evidence-based approaches to planning care that

can be utilised in dental practice.
Dental Tribune Asia Pacific:
Caries is increasingly considered a serious public-health

FDI World Dental Federation
Leading the World to Optimal Oral Health

issue. Has the perception of the
disease changed during the
last few years and if so, what
are the indications of this development?
Dr Nigel Pitts: Yes, the perception has changed, but in what
way, very much depends on
which country one is considering. There is a growing awareness in many “developed” countries, where caries has been
declining dramatically for decades, but there are still vulnerable groups, particularly young
children, with a very high burden of preventable disease.
In other countries, caries in
young children is thought to be
increasing. In yet other traditionally low-caries “developing”
countries, there are real concerns that changes in diet and
lifestyle may be accompanied
by an increasing caries problem
for society and for individuals.
You are one of the developers of a caries classification
and management system endorsed by dental organisations
like the FDI World Dental Federation. What is the concept
behind it and what is its potential for decreasing the burden of tooth decay in the world
today?
ICDAS (International Caries
Detection and Assessment System) is a simple, logical, evidence-based, detection and assessment system that classifies
the stages of the caries process.
It is designed for use in dental
education, clinical practice, research and public health. It provides a common language for
all stakeholders to communicate about caries, and facilitates
valid, consistent comparisons of
lesions at single and multiple
time points.

2012 Hong Kong
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through a new and innovative programme;
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3. Discover the newest technology,
equipment, products and materials;
4. Interact with renowned world
specialists;
5. Empower yourself through FDI
sessions on policy and public and oral
health;

9. Marvel at the breathtaking views of
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10. Uncover the riches and mysteries of
mainland China.

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congress@fdiworldental.org

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10 reasons to join FDI in Hong Kong,
World Oral Health Capital 2012

ICDAS has evolved to comprise a number of approved,
compatible formats for different
needs and applications, including simplified forms for those
wanting to work with fewer
stages of caries. The potential
for decreasing the burden of
caries ranges from helping the
transition to a more preventive
approach to caries, helping in
assessing health needs more
realistically for populations and
individuals, helping evaluate
preventive programmes and
helping to deliver more preventive caries control and better future products through research.
Apart from classification,
what other advantages does
such a system offer?
ICDAS leads to better quality
information, derived from the
assessment of caries severity
and activity, to support decisions
about diagnosis, prognosis and
clinical management at both
the individual and public-health
levels. As we know more about

[7] => DTAP0512_01_Title

DTAP0512_06-07_Pitts 14.05.12 16:16 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

World News

the complexities of the caries
process, informing sound clinical decisions is increasingly important for providing appropriate and high-quality caries care.

“I do see this move from a purely operative
towards a more preventive-based approach.”

How can these concepts be
applied to dental practice?
ICDAS has created the International Caries Classification and Management System
(ICCMS), an open system developed specifically to meet the
needs of those seeking a preventively orientated framework to
support and enable comprehensive clinical caries management
in the dental practice situation.
This framework will help the
dental team secure improved
long-term outcomes for their
patients.

What approaches to primary and secondary caries
prevention are the most promising and what evidence do
we have with regard to their
clinical effectiveness?
The strongest evidence on
caries prevention comes from
high-quality systematic reviews
of fluoride, whether in water,

salt, toothpaste, varnish or other
forms. In addition, there is strong
evidence of the efficacy of sealants.
There are also some promising new developments with remineralisation, but it will inevitably take time to accrue further
evidence of clinical effectiveness.

There is evidence that a
purely restorative approach
is not efficient but preventive
caries control has been adopted rather slowly in many countries. Do you see a move from
an operative towards a more
preventive approach?
I do see this move from a
purely operative towards a more

preventive-based approach gathering pace. It has been a very
slow change in some countries,
despite the profession talking
about it for decades. However,
there are a number of countries
that have been controlling caries
in this way for years and an
increasing number of countries
that are in transition. Reform of
payment systems and changes in
patient expectations are important components of this change.
Thank you very much for
this interview. DT
AD

There are improved means
of detecting and assessing
risks for early carious lesions.
Has technology changed how
we look at them?
The clinical visual detection
and assessment of early lesions
(using ICDAS-style approaches)
is the foundation for planning
care, but there is a continuing
need for detection aids to help
identify lesions that are difficult
to detect visually and for effective risk assessment tools.

THE WORLD SPEAKS e.max.

Examples of some of the
newer approaches on the market for detection are enhanced
electrical, optical and radiographic detection aids. These
should be considered prudently
as aids to preventive caries care,
not just finding more cavities
to fill.

SO DOES THE SCIENCE.
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40 MILLION RESTORATIONS.**
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Concerning the management of early carious lesions,
you promoted a study in 2010
on the best way to manage decay in children’s teeth called
FICTION (Filling Children’s
Teeth, Indicated or Not?). The
study to be finished in 2018
is examining the different approaches (conventional restoration, preventive method
and the Hall technique) to
children of ages three to seven.
Is there a tendency towards
any of these approaches so
far?
As you indicated, this exciting study will not be completed
for some years. The feasibility
stage is finished and the muchneeded back-to-back comparison is getting underway—it is
too soon to see results yet. The
mounting evidence we do have
(from multi-year randomised
controlled trials in general practice) is that the approach of
biological, preventive management with reduced surgical
intervention (such as with the
Hall technique) is showing results that are better than those
achieved by the more conventional methods.

There are also developments
in risk assessment systems, such
as CAMBRA, to accompany older
established systems, such as
cariogram. All of the information derived from these useful
detection and risk assessment
tools needs to be integrated into
a holistic and personalised preventive treatment plan for each
patient.

mic
a
r
e
c
all
ed
e
n
u
all yo

* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is
now available at: www.ivoclarvivadent.com/science_e

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[8] => DTAP0512_01_Title

[9] => DTAP0512_01_Title

DTAP0512_09_IdemReview 14.05.12 16:39 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

IDEM Review

Booming dental industry
drives IDEM Singapore
Organiser Koelnmesse announces changes
for 2014 edition of Asia dental show
marketing of dental care or the
use of digital management systems, and future developments
in dentistry, Dreyer said.

Daniel Zimmermann
DTI

SINGAPORE: The International Dental Exhibition &
Meeting in Singapore will be
more integrated and even
more comprehensive in future. According to Koelnmesse’s Asia Pacific VicePresident, Michael Dreyer,
his organisation plans to
bring the exhibition and congress together in 2014, which
will then both be held in close
proximity on levels 4 and 6 at
the Suntec Singapore International Convention & Exhibition Centre.
The range of topics covered by the congress programme will also be extended
by issues concerning practice
management, such as the

which was affected by air travel
restrictions caused by a volcanic
ash cloud in Europe.

The next IDEM Singapore
will take place from 4 to 6 April
2014.

Attendance by regional and
overseas manufacturers and
dealers also went up by 20 per
cent this year.

This year’s edition has been
the most successful since the first
IDEM was held in Singapore
in 2000. According to figures
of Koelnmesse, participation by
dental professionals increased
by 20 per cent compared to 2010,

Dreyer said that in order to
facilitate this growth, his organisation is aiming at creating
regional communities to attract
more buyers from key countries
in South-East Asia to future
meetings. For this year’s show,

More visitors than ever were swarming the aisles of the Suntec exhibition hall
on Saturday. (DTI/Photo courtesy of Koelnmesse, Singapore)

he said that Koelnmesse has
been working closely with professional dental associations in
countries like Thailand and
Vietnam, who also brought
more attendees to IDEM
Singapore.

IDEM Singapore also
collaborated with the Asia
Pacific Students Dental Association this year. For the
first time, fifteen students of
dentistry from across the region were given the opportunity to come to Singapore
and interact with exhibitors, speakers and attendees.
Extra sessions moderated
by Prof. Urs Belser, Switzerland, and Prof. Robert Boyd,
USA, gave first-hand insights into the intricacies
Michael Dreyer (right) talking to Singapore’s Minister of Health Gan Kim Yong. (DTI/Photo behind sophisticated patient
treatment.
courtesy of Koelnmesse, Singapore)

“Once again, we recorded an
increased number of exhibitors
and visitors, establishing IDEM
Singapore as an important event
in the region’s calendar of dental
events. As markets across the
region prepare to embrace the
globalization of dentistry and its
opportunities, IDEM Singapore
will continue to play a strategic
role to facilitate this growth,”
Dreyer concluded.
“This year’s event provided
an all-round experience for participants with a good mix of trade
exhibitions, scientific sessions
and hands-on workshops. The
knowledge and insights gained
by participants over these three
days will help accelerate the
progress of the industry, probably resulting in more sophisticated dental offerings and a more
robust dentistry market.” DT

“We are looking for high-end clinics and the
distributors selling high-quality products to them”
An interview with Sabine Nahme and Philip Y. K. Teng, Abrasive Technology
sector, especially in Asia. How
are you going to approach the
market?
Sabine Nahme: Although we
have covered many other areas
like optical, medical and aerospace applications in the last
decades, we actually started out
in dentistry. Now we would like
to focus more intensively on our
dental business by expanding
our own quality line, Two Striper,
which is manufactured through a
unique P.B.S. diamond-particle
bonding process, to the Asian
market.

Sabine Nahme (right) and Philip Y. K. Teng, who will manage Abrasive’s operations in Singapore. (DTI/Photo Claudia Duschek, DTI)

Global manufacturer Abrasive
Technology has set up a new
direct sales office in Singapore.
Dental Tribune Asia Pacific
spoke with Sabine Nahme, who
was recently appointed to
Abrasive Technology’s busi-

ness development team, and
Philip Y. K. Teng, the General
Manager for Asia Pacific.
Dental Tribune Asia Pacific:
Abrasive Technology is aiming
at expanding into the dental

Philip Y. K. Teng: We are also
very confident that we will be able
to achieve this goal in a short time.
How will you approach
sales in Asia?
Sabine Nahme: At the moment, we are looking for highend clinics and the distributors
selling high-quality products to
them, in particular.

Philip Y. K. Teng: To do effective networking, we are attending trade shows, conducting
webinars and seminars, and collaborating with highly respected clinicians. At IDEM, we have
already made good contacts in
Korea, India and Singapore.
Thank you both for this
interview. DT

I was recently hired to support Abrasive Technology’s international growth, and I will
assist Philip with sales in Asia.
What are your expectations
of the Asian market?
Sabine Nahme: The East
Asian market is growing every
year. There are a couple of large
markets, with the biggest in China. We are also expecting a large
increase in sales in this region.

Abrasive Instruments (DTI/Photo courtesy of Abrasive Technology)

[10] => DTAP0512_01_Title

DTAP0512_10_IdemUS 14.05.12 16:17 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

10 IDEM Review

US dental exports in Asia prosper
Greater participation at IDEM to support export initiative
plant-retained crowns and temporary cementation of provisional
restorations for which long-term
or increased retention is desired.

SINGAPORE: Exports of medical and dental equipment from
the US to the ASEAN region continue to increase. Imports of dental equipment to Singapore alone
amounted to US$105 million in
2011, according to the latest figures from International Enterprise Singapore. Realising the
potential that the city-state has
to offer, more US companies than
ever participated at the US pavilion this year, making them one of
the largest groups of manufacturers from one single country at
IDEM Singapore.
Vice-President of Sales and
Marketing for Temrex Jackie
Prather declared that the show
was well staged and had good
participation. “For Temrex specifically, IDEM was an excellent
venue for meeting dealers and
seeking expansion into new markets,” she commented. Prather
said that, among others, Doc’s
Best, Temrex etching gels and
TNE cement garnered the most
attention during the event.
Also at IDEM Singapore, Whip
Mix, based in Louisville, Kentucky, introduced its Esthetic
CrossRef, which allows the vertical and horizontal bars to be

More than 25 companies are currently exhibiting at the US pavilion. (DTI/Photo Claudia Duschek, DTI)

aligned after the bite-registration
material sets. According to the
company, the apparatus enables
laboratories to do a final check of
the completed crowns or veneers
by removing the upper bite material and placing the lower impression on the articulated models.

CrossRef (DTI/Photo courtesy of WhipMix, USA)

With Traxodent, a retraction
and hemostatic system used
prior to impression taking, cementation, bonding procedures
or wherever hemostasis and
retraction is required, was on
display. Manufactured and distributed by Premier Dental, it

provides predictable tissue management for accurately detailed
impressions with less retakes.
In addition, the company introduced its new value pack for
its non-eugenol resin cement,
Implant Cement, designed for im-

Traxodent (DTI/Photo courtesy of Premier Dental, USA)

Commercial Counselor at the
US Embassy in Singapore Patrick
Santillo told Dental Tribune Asia
Pacific that the increase in US
companies is in line with the
National Export Initiative introduced by President Barack
Obama two years ago in order to
double US exports worldwide
over the next five years. He said
that overall exports to Singapore
have increased by an average of
15 per cent annually since the
program was launched in 2009.
“There are significant opportunities and we see a really high demand across the region for these
kinds of products and technologies,” Santillo commented. “As
the dental market here and
throughout the South-East Asia
region is growing, I consider our
industry very well positioned.”
The US is one of the three leading suppliers of dental equipment
to Singapore, alongside Japan and
Germany. According to industry
estimates, more than 30 per cent
of dental imports to Singapore
currently come from the US. DT

Implant Cement (DTI/Photo courtesy of Premier Dental, USA)

Hybrid CAD/CAM system launched at IDEM
Dental Tribune Asia Pacific

With Ceramill Motion 2, laboratories of every size will be
able to digitally fabricate prosthetics and frameworks almost
entirely in-house, AmannGirrbach said. Launched in dental

(DTI/Photo Daniel Zimmermann, DTI)

SINGAPORE: A new high-end
device for digital framework
fabrication is now available to
Asian dentists and dental laboratories with AmannGirrbach’s
new Ceramill Motion 2 milling
unit. The hybrid dental CNC
machine was presented by the
Austrian company to dental professionals from South-East Asia
for the first time at IDEM 2012 in
Singapore.

markets earlier this year, the unit
has a fifth axis for greater flexibility and wider range of indications that includes full-denture
prosthetics, splints or occlusally
screw-retained bridges.

Judith Zwenger (left) demonstrating the CeraMill Motion 2.

Owing to its hybrid technology, the machine is supposed
not only to be used both for
milling and grinding but also for
wet and dry milling processes
of zirconia, among others materials.
AmannGirrbach announced
to offer full support and training
for the device through their new
Singapore office that according
to the company was set up in July
last year in order to serve cus-

tomers in Asia and Middle East
region better.
“The mere fact that we can
offer training and react to regional customer needs makes it
easier for us to realize the idea
of being a full-service provider,“
Regional Director for the Asia
Pacific region Judith Zwenger
told Dental Tribune Asia Pacific
in Singapore.
Zwenger said that the Motion 2 is supposed to help increasing revenues by 30 per cent
this year. She added that it will
be on display at more upcoming
trade shows including those in
Dubai, Beijing, Taipei and Hong
Kong. DT

[11] => DTAP0512_01_Title

[12] => DTAP0512_01_Title

DTAP0512_12_IdemSondaz 14.05.12 16:19 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

12 IDEM Review

“Definitely the best event in the
region for the industry”
An interview with Ultradent’s General Manager for Asia Pacific Nicolas Sondaz
vides the information necessary
to help the sales representative
become very good in the field. We
have been running this successfully for the past three years and
it has become part of our identity.

Last year, the dental company
Ultradent set up a new regional office for the Asia Pacific
region in Kuala Lumpur in
Malaysia. During IDEM Singapore, Daniel Zimmermann,
Managing Editor of Dental
Tribune Asia Pacific, had the
opportunity to speak with
Nicolas Sondaz, General Manager for Asia Pacific, about the
company and its future plans.
Daniel Zimmermann: IDEM
Singapore seems to be continuously expanding. What is your
impression of this year’s show
in view of business, as well as
quantity and quality of visitors?
Nicolas Sondaz: We have
participated in a number of exhibitions across the APAC region

Last year, you also announced plans to expand the
Kuala Lumpur office with administrative, marketing and
support divisions. How far
have you come in this respect?
Quite far actually. We have a
new administration/marketing
coordinator, who contributed to
several key projects, including
a Chinese product catalogue and
website, which is a first in the
history of our company.

Nicolas Sondaz (left) in talks with DT Asia Pacific Managing Editor Daniel Zimmermann. (DTI/Photo Claudia Duschek)

in the past and IDEM has always
stood out in terms of organisation, as well as quality of visitors.
This year, for example, we recognised increasing interest by dentists from countries like Indonesia, Philippines and Malaysia.
In our opinion, it is definitely
the best event in the region for
the industry and, therefore, we
have already booked for 2014.

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* Survey of 333 dentists who have used Traxodent at least once in their practice

Many Western companies
are managing their operations
in Asia from Singapore. What
was behind the decision for
setting up your regional office
in Malaysia?
While Malaysia does not offer
all the safety aspects of Singapore, the country offers the perfect infrastructure for running a
business. The cost of living in
Malaysia is extremely competitive and network communication is up to Western standards.

How has the new HQ in
Kuala Lumpur changed operations of your company in the
region?
Our regional office has
helped us to be closer to our
customers and anticipate their
needs more actively. Most regional decisions are made on
the spot, without having to run
through lengthy reporting processes, which is still common in
many other dental companies.
One of the accomplishments
we are very proud of is our certified product training. Our
distributors’ sales force goes
through a full multilevel educational process (bronze, silver and
gold). Each level entails a threeto four-day programme and pro-

We also hired an international regional manager, who
will be responsible for the East
Asia region. To respond to the
growing demand for our VALO
curing light, we will also be expanding our customer support
with an after-sale service in
Kuala Lumpur in the upcoming
months.
You mentioned the VALO
curing light. Which products
have been the best received so
far, and what are the main
differences in the markets you
currently serve?
While our Opalescence Whitening and Tissue Management
techniques continue to be our
bestsellers, demand for VALO,
the only true broadband curing
light with a wand-type design,
has increased significantly. Our
endodontic and restorative product range has also continued to
do very well in the market owing
to the recent launch of a new line
of cement material.
The success of a product usually depends on factors like the
purchasing power of dentists and
the regulatory framework of the
country, but the most important
factor is the level of involvement
of our distributors in promoting
our line locally. Fortunately, we
are blessed with one of the best
distributor networks in the region. All our partners perform
to their best and demonstrate
their dedication to our brand via
marketing, sales and education
programmes.
Where do you see further
potential in the future?
Last year, we opened subsidiaries in India and China and
these are the countries in which
we expect our highest growth in
Asia. Other markets with huge
potential are Thailand, Indonesia and South Korea. Achieving
market approval and penetration there will key to our future
success.
Thank you very much for
the interview. DT

[13] => DTAP0512_01_Title

DTAP0512_13_IdemGmi 14.05.12 16:20 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

IDEM Review 13

Global Medical Implants
takes on new markets
European implant manufacturer sets up in Singapore,
Eyes markets in China and South-East Asia
Daniel Zimmermann
DTI

SINGAPORE: According to industry estimates, dental implants
is going to be the largest growth
sector for dental equipment in
the years to come, particularly in
emerging markets like China and
India. With more and more companies entering promising markets in Asia, not only is competition
increasing, but the range of products available to dental professionals desiring reliable tooth replacements is also increasing.

Hong Kong, which, according to
Gamboa, offer similar market conditions to Singapore, as well as
the Philippines. During the latest
IDEM in April, much interest was

expressed by dentists from Vietnam, Malaysia and Indonesia,
which the company intends to
target after establishing itself in
Singapore. DT

Javier Gamboa Gil de Sola (right) posing with Clinical & Product Manager
Jaime Franco (left) and Scientific Director Dr Alberto Moreno Pelluz.
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Global Medical Implants is the
latest player to announce its upcoming market entry to the region.
Operating from a new office in Singapore, the company intends to fill
a gap with its moderately priced
and scientifically supported range
of dental implants.
“South-East Asia is a very
price-sensitive region. While dentists in Western Europe commonly
go for brand names, people here
tend to look at every single dollar,”
the Director of Global Medical
Implants Asia, Javier Gamboa,
told Dental Tribune Asia Pacific
recently in Singapore. “Our advantage is that we can position
ourselves as a quality European
brand, while at the same time being able to offer prices that are
competitive with those commonly
charged by manufacturers from
South Korea.”

Post cementation

As a spin-off of Spanish prosthodontics manufacturer Ilerimplant
group from Barcelona, Gamboa’s
company has gained wide marketing and sales experience in Europe, Latin America and the Middle East during the last decade.
Its implants are currently available in Germany, Poland, Argentina and Dubai, among other
countries. GMI’s titanium-based
product range, comprising three
brands (Phoenix, Insider and
Frontier), is claimed to offer high
stability and good osseointegration through a self-developed
surface called Advanced DoubleGrip, which combines a white
corundum micro-bubble treatment with acid etching for maximum contact between implant
and bone.

1 material – 3 indications
Optimal monoblock interface
Outstanding sealing and protection
Excellent retention & durable strength

“Clinical studies on our implants found a success rate of over
98 per cent, which is quite remarkable,” Gamboa said. “As they are
also compatible with most other
brands available on the market,
they offer professionals a lot of
versatility in terms of clinical use.”

www.coltene.com
001239

Gamboa commented that Singapore was considered a good
testing ground for the company’s
expansion into South-East Asia
owing to its favourable market
environment, which promotes
medical research and innovation.
GMI next intends to expand into

Core build ups

Crown & Bridge cementation

[14] => DTAP0512_01_Title

DTAP0512_14_IdemMectron 14.05.12 16:20 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

14 IDEM Review

New mectron device premiers in Asia Pacific
DTI

Norbert Emmerich.

SINGAPORE: Mectron’s PIEZOSURGERY® touch device, which
was presented at IDEM to a professional audience of dental professionals from Asia for the first
time, comes with new inserts for a
wider range of indications including mini dental implants or new
applications in prosthetics related to the finishing of the cervical margin in crown preparation.

The Italian dental manufacturer also said to have developed
a customized enzymatic solution called ENZYMEC® that efficiently removes organic residuals from parts like the hand piece,
tubings or inserts.
Launched at IDS 2011 in
Germany, the PIEZOSURGERY®
touch is supposed to offer intuitive controls through an improved hand piece and a black

coloured glass touch screen resembling those of state-of-theart electronical devices such as
smartphones. With the recent
market launch in Asia, the device will be widely available for
dental surgeons throughout the
region except in Japan and China, Regional Manager Norbert
Emmerich said.
Mectron introduced the very
first generation of its PIEZO-

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During the last decade, the surgical technique has become a
standard in many clinical indications including dental extractions, endodontic and periodontal surgery, as well as implant site
preparation.
The company says that many
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evidence based technology for
piezoelectric bone surgery to
date. DT

Orthodontic
offering
extended by
Leibinger
DTI

SINGAPORE: At IDEM 2012,
Otto Leibinger from Germany
was presenting a number of new
products that were developed to
complement its range of orthodontic pliers and accessories.
According to the company, there
are now three new patterns of
the Universal Weingart Pliers
available including one with ultraslim jaws, one with short jaws
for better transmission of force,
as well as one with delicate jaws
and tungsten carbide inserts. All
pliers are being preferably used
in the permanent technique, the
manufacturer said.

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The product offering was
completed by special combination instruments as there are two
different types of ligature instruments; a band pusher and scaler,
as well as a combined explorer
and ligature instrument.
“South-East Asia is one of our
most important growth markets
and, therefore, being at IDEM
is essential for getting in contact with existing and potential
new clients,” said Chief Executive Officer Tina Leibinger-Toth.
“For years, customers have been
rushing to our booth in order to
see and experience what new
products we have to offer. We
were able to establish plenty of
new business contacts.”
“IDEM has been a successful show and therefore, we will
most certainly come back again
in two years,” Leibinger-Toth
added. DT

[15] => DTAP0512_01_Title

DTAP0512_15-17_Zuk 14.05.12 16:20 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 15

Un-cosmetic dentistry
Are you ready to reduce your dependence on porcelain restorations?
Dr Michael Zuk
Canada

While there are some occasional references to concern about
the overuse of porcelain, many
articles in dental trade publications show off before and after dental makeovers that from
my perspective were quite satisfactory prior to expensive intervention. I will not argue that
there are people who truly have
displeasing smiles and they can
benefit greatly from cosmetic
dentistry, but all too often people with body-image issues related to a distorted perception
of their teeth seem to be easy
victims.
“Smilorexia” is the fanciful
term I coined for this disorder,
which appears to affect attractive
young women more than others.
If you open the pages of any journal published by the American
Association of Cosmetic Dentistry, you will no doubt find at
least one or two of these patients
having extensive veneer treatment that could easily have been
avoided with unbiased professional advice. The problem is
that too many dentists have dedicated their lives to pure cosmetic
dentistry, which is often based on
using porcelain as a cure-all.
Sadly, many of the cosmetic
dentists recognised as the top
tier appear to use their standing
as a licence to drill. It is time to
adopt a significant change in philosophy if the dental profession
wishes to maintain any level of
integrity. Lip service to conservative cosmetic dentistry means
nothing. To truly practise “uncosmetic dentistry”, a dentist
must back away from ceramics
and make use of composite to restore worn edges in combination
with orthodontics to correct
alignment.
This style of treatment does
not have to be unprofitable. It
does not have to be only for the
simplest of cases either; actually, very complex cases can be
treated to a high standard when
multiple disciplines are employed together. The collaboration of specialists can be one
alternative, but for patients on a
budget or in areas with lower access, a general dentist trained in
advanced therapies can offer
comparable results for a fraction
of the fee.

Biggest bang for the buck—
The STO combo
Let’s cut to the chase: if you
are a general dentist and want to
knock your practice out of the
park with new opportunities,
look at venturing into the realm
of advanced shorter-term braces.
I specifically say “shorter” because your goal needs to be always trying to be faster because
people hate being in braces, and

Anterior alignment is completed in extremely short periods of time, as in this example the lateral incisor was proclined in only 3 1/2 months. (DTI/Photos M. Zuk, Canada)

aligners are often too slow or they
do not give the dentist enough
control of tooth movement.
There are a number of dentists who promote STO, but I developed my own system before

since few of them agree on anything. The reality is that the
schools of thought in orthodontics are as polarised as the holy
war between the myo-centric
doctors and the centric relation
believers.

nique on their own children or
grandchildren. The studies always seem to conclude with a
recommendation for long-term
data, but the device has been
used for 100 years already.
Mandibles are not stimulated to

“It is time to adopt a significant change
in philosophy...”
I had heard of any others so I have
some different ideas. Frankly,
levelling and aligning simple
orthodontic cases is easy and can
be learned through just a short
course, which these dentists (Drs
Swain, Barr or De Paul) appear
to teach very well. I would rather
remain on the fringe of even
these trend-setters, and offer
my twisted perspective with less
corporate influence.

As an example, the use of the
Herbst appliance forces the TMJ
forward, in an attempt to correct
a deficient mandible. This is like
someone standing on the balls
of her feet to be taller. While the
practice appears to be commonplace, there are orthodontists
who would never use this tech-

grow after all, and patients may
be holding their jaw forward in
a Sunday bite simply to get their
uncomfortable braces off.
Orthognathic surgery may
be vastly underutilised in some
cases and overused in others.
The use of TADs appears to offer

As hugely popular as these
STO courses are, there is however some potential for abuse by
dentists who simply have a weekend course and no other training
in orthodontics. While I would
rather see a dentist do more
orthodontics than veneering, orthodontists are partially justified
for their concerns about GP orthodontics.

BIAS: A particular tendency
or inclination, especially one that
prevents unprejudiced consideration of a question; prejudice
So this article is obviously biased towards expanded skills for
the general dentist, but I do respect the need to pick your battles
in treatment and refer when the
case demands it. I essentially do
not believe in putting up with any
rubbish from specialists who
want to dictate what a general
dentist can and cannot do. If you
do not like my ideas, tough luck
because the ones you have may
not stand up under close scrutiny.
I do not want to waste my time
justifying anything I choose to do
and if I am taking a course beside
an orthodontist who is snivelling
that he will start doing fillings
and extractions, that is awesome;
I may have an opening for an
associate.
As excited as I am about STO,
I think a two-day course is only
a taste of what you need to know.
It is like taking a two-day selfdefence class and then thinking
you can enter mixed martial arts.
The problem is not what you
learn, but the cases that you attempt that are actually much
more complex than you realise
(you will be defeated!). You
MUST take a full orthodontic
course such as the one taught by
Dr Richard Litt, and you are insane not to take a series of oral
rehabilitation courses from Dr
Frank Spear or Dr John Kois.

Taking courses alongside orthodontists and reading their
journals, it is apparent that there
is negative sentiment directed
towards general practitioners
who dare to bracket teeth. I do
feel that a united profession is a
favourable concept but, having
experienced extreme levels of
sabotage in my local area, I now
refer less than in the past. Some
other general dentists have mentioned similar problems (on online forums) with turf protection
that appears oddly focused on
orthodontics.
An article recently used the
term “soft science” to describe
orthodontics, and I would certainly agree that it is difficult to
claim that orthodontists know the
“right way to straighten teeth”,

some promise, and while an oral
surgeon may find it a nuisance to
bother with placing them, a general dentist may be able to get
them in place with little difficulty.
Orthodontists often tremble at
the thought of using a needle
(like I did in dental school), so the
price goes up as the patient heads
to the oral surgeon.

Adult orthodontics is fullmouth reconstruction, and the
treatment of worn dentition is
too important to overlook. In
fact, orthodontists have a very
Dr Zuk is also known as the crazy dentist who bought a tooth from John Lennon.
(DTI/Photo courtesy of Sandra Olson, Canada)

‡ DT page 16

[16] => DTAP0512_01_Title

DTAP0512_15-17_Zuk 14.05.12 16:20 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

16 Trends & Applications
ﬂ DT page 15

difficult time trying to treat
adults with worn dentition, so
I consider this a very good niche
for doctors ready to invest in
cross-training.
I have seen an orthodontist
try to treat an advanced wear situation with full orthodontics,
and the result was all wrong. Instead of allowing for the restorative material, the practitioner
moved the short teeth into place
as if they were full size, so when

“I know, NOT ALL cosmetic dentists
are Veneer Nazis, ...”
we wanted to lengthen the worn
incisors the result was a posterior open bite. The easier way
to treat the case would have been
to build up the teeth with composite prior to starting the orthodontics.
Cosmetic dentists have a
tendency to veneer everything.

They veneer teeth straight because they claim braces take
three to four years. They veneer
teeth to get rid of wrinkles and
headaches. They veneer teeth
to whiten and straighten them.
They veneer teeth because the
old veneers break. Exaggerated
times in braces are often lies that
need to be corrected as soon as

possible to stop the abuse that is
going on. Cosmetic dentists need
to reprogramme to back off and
get some air. And orthodontists
need to give a little elbow room
to their referring dentists who
want to offer some orthodontics.
The smart ones maintain a positive relationship and often
see referrals from the primary

care dentist increase. I know,
NOT ALL cosmetic dentists are
Veneer Nazis, and NOT ALL
orthodontists tell patients that
GP orthodontics causes root resorption.
My suggestion for breaking
an aesthetic obsession is “cosmetic detox”, which is very difficult if you have focused your
training on aesthetic dentistry.
The easiest way to do this is to
take porcelain veneers off the
table in the treatment planning
stage. Composite resin can be
used conservatively with orthodontics to provide a nearcomplete medium- to long-term
solution.
Any time you stick to a single
series of training programmes,
you start to pick up biases that
warp your thinking. You will find
that the ideas within the dental
profession are as extreme as
the religions and political beliefs
around the world. The proponents of the various philosophies can be very convincing, but
I think each doctor needs to take
a step back and make up an individual philosophy that puts the
patient first.

See four times more
The new Synea range with LED+

If you take the average patient, this means that you will
offer fast, affordable, reversible
and conservative treatment. Millions has been spent to make
people think veneers are better
than real teeth; I challenge that
idea. Porcelain is not as good as
healthy enamel, not now and not
ever. Of course, it is a material
that serves a purpose but often it
is used simply to line the dentist’s
pockets.
So to recap this approach
to care, I suggest you take an
STO course from one of the two
6-month braces programmes, add
a full orthodontic programme
(ideally taught by an orthodontist
who has taught orthodontics
grad students), take a full-mouth
reconstruction programme (or at
least a worn dentition component), then if you want you can
take a composite technique
course.

Optimal
illumination

Small
head

High
colour rendering
index

I personally do not get fancy
with composite, since my patients do not have loupes or want
to pay double for advanced microscopic cosmetics. What patients do hate is composites that
chip/stain. This brings me to use
Clearfil AP-X PLT (Kuraray—no
endorsement money yet!). Freehand composite bonding is the
best way to be able follow the
contours of the teeth, so scrap
the idea of using a wax-up as an
instant makeover if orthodontics
would be helpful.

Perfect
LED positioning

The Clearfil shade XL appears to have a chameleon effect that works for most shades
of teeth. If a lighter shade is desired, then a cut-back technique
can be employed to modify the
final appearance with another
shade/material like 3M Supreme
(3M ESPE).

One light – four advantages, the perfect combination. Optimal illumination;
a colour rendering index of more than 90; a perfectly positioned LED; and a
small head: Four reasons why you should use the new Synea turbines with LED+.
Ready for imitation.

From my review of the CRA/
Clinicians Report literature, this
brand of composite is particularly strong in clinical use, and

[17] => DTAP0512_01_Title

DTAP0512_15-17_Zuk 14.05.12 16:59 Seite 3

DENTAL TRIBUNE Asia Pacific Edition
I have heavily restored cases that
are still holding up after five
years of service. The composite
does not polish very well, so
I have started using G-Coat as a
final glaze, especially for smokers. I simply tell the patient
that if he breaks the fillings, there
is a 50 per cent warranty for the
first 12 months, regardless of
how they were broken.
With orthodontic treatment,
you should, as mentioned earlier,
try to rebuild any worn teeth before starting braces. Since you
will be able to move teeth in three
dimensions, you simply build up
the teeth to full size and then you
move directly into orthodontic
records to get started. The occlusion should be left “high” and
finalised with the braces.
The change in vertical dimension (VDO) appears to be
another handicap that paralyses
some dentists. If the patient does
not have muscular problems and
headaches, there may be no need
to move into splint therapy to test
a bite change. Simply by looking
at the effect enamel replacement
would have on the bite and considering how orthodontics could
manage the result may be sufficient without an articulator.
A less deep overbite and a less
trapped mandible appear to be
desirable within most schools of
training.
The cosmetic training really
will begin to come into play with
incisal displays, tooth proportions and fuller arches. The arch
form after orthodontics usually is
very pleasing and mimics the
technique of overlaying ceramic
on the facial surfaces of the upper
bicuspids. The term for this has
faded from my memory because
I tend to avoid courses that push
the use of porcelain.
When I attended the UCLA
Aesthetic Continuum, Dr Jimmy
Eubank took a few moments to
talk about a case in which a
young teen had had her teeth
disfigured with bulky veneers.
He was forced to retreat her teeth
but she had been compromised
for life. As dentists, we are subject
to many sales presentations disguised as courses and we rarely
get the truth. The truth is dentistry is not easy and taking one
weekend course will not be
nearly enough. No guru is going
to tell you all that you need to
know.
At a recent course on anterior
aesthetics taught by Dr Gerald
Chiche at the Seattle Study Club,
I was forced to prepare a number of veneers on plastic teeth.
The burning smell reminded me
of dental school, which brought
back mixed emotions. I took
away the idea of additive cosmetic strategies and the use of
minimal reduction if choosing to
use ceramic. Bonding to enamel
instead of dentine still seems
to be the better plan. (I also gave
Dr Chiche a few photographs of
John Lennon’s decayed molar
and he shared the fact that he had
an original photo of the Beatle
that was lost in Katrina—I hope
he finds the copy sometime
soon!)

Trends & Applications 17

“...the market is shifting towards dentists
who are ready to mix up their training.”
As one of the first dentists
to combine STO concepts with
advanced treatment planning of
the worn dentition, I can honestly say that if you can set aside
the use of porcelain veneers and
substitute some of the treatment
modalities mentioned in this article, you will eventually find a
way back to ceramic usage with

a better empathy for patient care.
The public is becoming wiser
and the market is shifting towards dentists who are ready to
mix up their training.
As my UK dentist colleague
Dr Martin Kelleher, who lectures on “veneerial” disease,
would say, use the daughter test

before you do anything irreversible.
I would add that you owe it
to your patients to learn from
the best in the profession, and
cross-training in continuing education may be the best investment you can make in dental
practice. DT

Contact Info
Dr Michael Zuk is
the author of the
book Confessions of
a Former Cosmetic
Dentist. As a consultant to several
marketing programmes, including HighSpeed
Braces.org and KillerToothache.com,
the dentist has cultivated unique
niches as alternatives to the veneerbased practice model. He can be
contacted at drz@bowerdental.com.
AD

[18] => DTAP0512_01_Title

DTAP0512_18-19_Maier 14.05.12 16:21 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

18 Trends & Applications

Aestethic guidelines for dentures
that are natural-looking

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 1: The triangular tooth shape.—Fig. 2: The rectangular tooth shape.—Fig. 3: The oval tooth shape.—Fig. 4: When looking at the marginal ridges or line angles, the square tooth shape is recognisable.—Fig. 5: When looking at the marginal
ridges or line angles, the triangular tooth shape is recognisable.—Fig. 6:When looking at the marginal ridges or line angles,
the oval tooth shape is recognisable.

corresponding characteristics of
tooth shape through a systematic
approach suitable for each case.

Björn Maier
Germany

Natural-looking dentures have
always been a great challenge
for the dental technician or prosthetist. With so many different
brands of acrylic tooth systems
on the market, it can be easy to
overlook the basics of tooth shape
and its relation to the physiology
of the face.
In this article, I consider the
morphology of the anterior teeth
in particular. Tooth shapes vary
enormously between individuals
and to the untrained eye, a system
of defining these shapes probably
seems remote. However, if you
look at the face as a whole, you will
very quickly understand how nature constitutes the relationship
between tooth shape and facial
physiology through human genetic
development (Figs. 1–3). This article will help you to identify the

First of all, it may help to peruse
the illustrations in order to understand the system and the connections between the illustrations.
Consider general anterior tooth
morphology and you will recognise,
in addition to the obvious characteristics, further specific individual features, like the difference
between a central incisor and a
canine. Although the variety of different shapes of the anterior teeth
appears to be immense, this can be
quiet deceiving. If one leaves aside
the tooth positions and the colour of
the tooth, the general morphology
consists of two factors (Figs. 4–6):
1. the basic shape of the tooth, i.e.
definitive width; and
2. the marginal ridges or line angles
of the tooth, which defines the
optical width.

This correlation of optical width
and definitive width leads to the
different shapes of teeth. This morphological variety can be subdivided into three basic principles.
These three fundamental archetype shapes are square (athletic),
tapering (leptosome) or ovoid
(pyknic). All other tooth shapes are
considered to be hybrid shapes.
In 1914, Leon Williams suggested a now famous classification system of tooth shape, theorising that these three fundamental
shape types are reflected in the
“Kretschmeric Construction Types”
(facial outline types). The shape of
the tooth is equal to the horizontally
flipped shape of the face (Figs. 7–
18). For example, an athletically
built person with an angular face
would have square-shaped teeth
(Figs. 7, 8, 13 & 16). A thin person
with a peaked chin (leptosome)
would have triangular-shaped teeth
(Figs. 9, 10, 14 & 17).

Fig. 19

Fig. 20

Fig. 21

Fig. 22

Fig. 23

Fig. 24

Fig. 19: Twelve-year-old patient with nicely indented incisal edges.—Fig. 20: Comparison of a 30-year-old patient with
abraded incisal edges ...—Fig. 21: ... and a 50-year-old patient with strongly worn incisal edges.—Fig. 22: Mandibulary anteriors of a 12-year-old patient with strong mamelons.—Fig. 23: Mandibulary anteriors of a 30-year-old patient.—Fig. 24:
A set of lower anteriors with strong occlusal wear facets.

Fig. 25

Fig. 26

Fig. 27

Fig. 25:The nose base determines the width of the upper anterior teeth (Gerber).—
Fig. 26: The average nose type correlates with the average width of anterior
acrylic teeth.—Fig. 27: A narrow nose base is an indication of slender anteriors.

Fig. 7

Fig. 9

Fig. 11

Fig. 8

Fig. 10

Fig. 12

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 7 & 8: An athletically built person with an angular face (square). The labial
tooth shape resembles the reversed shape of the face.—Fig.9 & 10: The leptosome
tooth shape of a thin or skinny person with the individual characteristics of the
marginal ridges.—Fig. 11 & 12: Person with a rounded (ovoid) form of the face
(pyknic) and the ovoid tooth shape with the individual characteristics of the marginal ridges.—Fig. 13: Even from the incisal aspect, the respective shape characteristics are visible.—Fig. 14: The triangular type (leptosome) with an introverted labial surface.—Fig. 15: The ovoid type (pyknic) with an extroverted
labial surface.—Fig. 16: Detailed characteristics when viewed from the approximal.—Fig. 17: Detailed characteristics of the triangular tooth shape.—Fig. 18:
Detailed characteristics of the ovoid tooth shape.

Today, this classification of the
tooth shapes based on the shape of
the face is considered to be antiquated. Hence, it only serves as a
very rough general guide when
selecting a set of anterior acrylic
teeth for a patient case. In the fifties,
the “dentogenic concept” by Frush
and Fisher spread across the US
and then to other parts of the world.
According to this concept, a “personality spectrum” can also be
added to help obtain the shape of the
tooth. Next to clinical, intra-oral and
facial relation considerations, the
age, sex, and other characteristics
of the patient are also considered.
Today, taking all of these factors into
account, one will most likely derive
some sort of hybrid shape based

Fig. 28

Fig. 29

Fig. 30

Fig. 31

Fig. 28–31: These images show just a few of the many dento-facial varieties that
can be found in nature.

on one of the three original basic
shapes.
The concept of the three basic
shapes with regard to the labial effect of a tooth can be demonstrated
when viewed from the incisal perspective. A study by Yammamoto
demonstrates this well (Figs. 13–
15). From the incisal perspective,
the relative flatness of the square
shape, the concavity of the triangular shape and the convexity of the
ovoid shape is apparent.
Another decisive aspect of a
successful natural reproduction is
the design of the marginal ridges or
line angles, which has an effect on
the 3-D appearance of the tooth.
Besides the shape and the width
of the tooth crown, the width of the
root is also a decisive factor. Up to
now, I have restricted the consideration of the tooth to the labial and
incisal view. In order to be able
to replicate the 3-D appearance of
the tooth, we must also consider
the labial curvature of the tooth
(Figs. 16–18). From this point of
view, the incisal triangle features
can also be divided into the three
basic components. For each individual case, it is then necessary to
derive the respective hybrid shape.

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DTAP0512_18-19_Maier 14.05.12 16:21 Seite 2

DENTAL TRIBUNE Asia Pacific Edition
After this has been considered,
the following types can be derived
from the mesial view:
The oval anatomy type
• The two well-developed labial
marginal ridges are the key characteristic feature of this anatomy
type.
• A strong labial depression and
a wide labial transitional surface
are present. The difference between the mesio- and the distoapproximal surface is noticeable.
The distal face is wider than the
mesial.
• The growth lobes are generally
not very prominent with this tooth
shape type.
The three-angled anatomy type
• The mesial and distal marginal
ridges are again distinct but not
as strong as with the oval anatomy
type.
• The labial surfaces are relatively
wide, without a noticeable difference in width between the mesial
and the distal.
• The labial and proximal growth
lobes are prominent.
The square anatomy type
• The characteristic feature of this
anatomy type is the indistinct
marginal ridges, which can sometimes cause a rather plain look.
• A well-developed central marginal ridge is present, which appears quite prominent when
viewed from the incisal edge.
• The labial and approximal depressions are somewhat strongly developed, although not as
strongly as with the triangular
type.
The marginal ridges or line angles develop in the sulcus and run
parallel to the basic outer shape of
the tooth towards the incisal edge.
At the incisal aspect, the progression of the marginal ridges differs
between unabraded juvenile teeth
and worn aged teeth (Figs. 19–24).
These different morphological
characteristics are evident in the
case of adjacent teeth, which
makes the reconstruction of a single tooth quite easy. A great deal of
information is needed in order to
rebuild the shape of a tooth and to
recreate a natural, harmonious
look. It becomes more complicated when it is necessary to replace
the whole anterior segment or
the dentition in an entire jaw. For
this reason, the knowledge of the
anatomical features of the single
tooth is very important.
A further aid for determining
the definitive width of the teeth is
the width of the nose base, which
agrees in most cases with the width
of the front teeth (Figs. 25–27).
In his theory, Gerber suggests,
amongst other things, that from an
embryogenetic view the proportion of the nose base and the width
of the nose root can be determined
(Figs. 28–31).
When it comes to determining
the length of the anteriors, some
clues can be derived from the age of
the patient. The lip type is of great
importance here. In vertical perspective, we distinguish between
a full and thin lip and/or between
a long and short upper lip (Figs. 32–
34). Patients with short upper lips
expose more of their teeth than
patients with longer upper lips. The

Fig. 32

Trends & Applications 19
Fig. 33

Fig. 34

Fig. 32: Very full lips suggest long upper anteriors.—Fig. 33: The standard lip
type.—Fig. 34:The shallow lip type suggests relatively short anteriors. This is also
due to the small distance between the nose and the upper lip.

lips outline the space that is subdivided by the arrangement of the
teeth, which typically determines
certain aesthetic key factors. One
can achieve harmony with the remaining parts of the oral region by

weakening or intensifying the visible tooth areas.

Conclusion
In this article, I have only paid
attention to the upper anteriors. The

main reason for this is that the upper
anteriors are aesthetically much
more significant than the lower anteriors. The different shapes of teeth
can be observed on both the upper
and lower anteriors from the facial,
mesial and distal aspects.
This method for achieving aesthetic harmony can be summarised
as:
1. analysis of the facial parts, i.e.
face shape type;
2. analysis of the dento-facial parts,
i.e. lip–nose type; and

Contact Info
Björn Maier is a
Master Dental Technician at the Polyclinic of Prosthodontics,
Ludwig-MaximiliansUniversity. He can be
contacted at info@bjoern-maier.com.

3. analysis of the intra-oral area,
i.e. bite situation and remaining
dentition. DT
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