DT Asia Pacific No. 5, 2014

Australian researchers transform teeth into early-stage brain cells / Opinion / World News / “The trend towards the medium- price range has accelerated” / Business / Using the same material for different cases

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DTAP0514_01-03_News 16.05.14 15:05 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

18 News & Opinions

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

PUBLISHED IN HONG KONG

www.dental-tribune.asia

ITI congress
Singapore research wins
implantology award
4Page

NO. 5 VOL. 12

Asia investment
An interview with
Straumann’s Frank Hemm

Anterior restorations
Using the same material
for different cases

4Page

Australian researchers transform
teeth into early-stage brain cells

First 3-D
dynamical
virtual mouth

New findings could aid in the therapy of stroke victims

Scientists from Melbourne in
Australia have recently presented the world’s first dynamic
virtual mouth that includes 3-D
representations of the anatomical features of teeth, gingivae,
tongue, cheeks and palate. Using
a technique called smoothedparticle hydrodynamics, it was
developed on real data on the
physics of chewing at the Commonwealth Scientific and Industrial Research Organisation,
the Australian national science
agency.

DT Asia Pacific

ADELAIDE, Australia/LONDON,
UK: After almost a decade of
research, the University of
Adelaide’s Centre for Stem Cell
Research has recently announced
another breakthrough discovery
in the use of dental stem cells for
regenerative therapy. By exposing stem cells from mouse teeth
to different growth factors present in the brain during early embryonic development, they were
able to create complex networks
of cells that resembled neurons,
the cells in the brain that are
responsible for transmitting and
processing information.
While the cells are still missing features, such as ion channels, necessary to support the
kind of communication that
neurons conduct, they could be
a major step in developing new
therapies to help patients who
have suffered a stroke, according
to lead researcher Dr Kylie Ellis,
a doctoral graduate in Physiology

According to the researchers,
the new mastication model will
help to predict how a particular
food breaks down and how
flavour is released into tie saliva
to the taste buds. In addition,
it will show the distribution
and interaction of components
such as salt, sugar and fat, they
said.
The neuronal-like appearance of a mouse-derived dental pulp stem cell. (DTI/Photos University of Adelaide, Australia)

and Commercial Development
Manager of the university’s commercial arm, Adelaide Research
& Innovation. She said that other
methods of induction using a dif-

ferent composition of factors
may be necessary to support the
full transition of the stem cells
into neurons. Her team is now investigating the time window af-

ter a stroke in which these stem
cells will be useful in helping aid
recovery and how they may have
this effect.
‡ DT page 3

The invention holds important implications for getting a
better understanding of food
structures and the sensory experience of consumption as well as
for other areas like oral health. DT
AD

A standard
for dental
records

Dr Mahesh Verma (left) recently received the Padma Shri Award, one of the highest
civilian awards in India, for his contribution to the field of dentistry. Verma is
currently president of the Indian Dental Association. (DTI/Photo Dr Mahesh Verma)

NextGen
materials

Sterilisation
ineffective

Researchers at the Vienna
University of Technology have
reported to have developed a new
generation of photoactive materials based on the element germanium in partnership with dental manufacturer Ivoclar Vivadent.
Initial tests have shown that it
considerably reduces the duration of the hardening process for
fillings. DT

Using disposable rather than
non-disposable syringe tips
could potentially decrease the
risk of cross-infection between
dental procedures, even when
the latter kind have been thoroughly sterilised several consecutive times, researchers from
New Zealand have suggested in
the latest issue of the Australian
Dental Journal. DT

The Niigata division of the
Japan Dental Association is
planning to standardise dental
records nationwide to improve
the identification of bodies in
emergency situations such as
large-scale disasters.
In order to increase identification efficiency, the association
said it wants to implement an
optical mark recognition sheet
with 26 check items, including
past treatment, that has shown
to expedite the matching process
of dental remains dramatically.
The initiative, which is part
of a larger project by the Japanese Ministry of Health, Labour
and Welfare, was successfully
tested last year with dental information gathered from over
1,700 patients from the Niigata
prefecture. DT

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DTAP0514_01-03_News 16.05.14 15:05 Seite 2

AD

U P C O M I N G

DENTAL TRIBUNE

Asia News

WEBINARS Research from
Singapore wins
implantology award
lous and cortical bone
allocrafts. These are
layered on the implant
surface and protected
by a bovine pericardium
membrane, mimicking
native human bone structure. The technique has
demonstrated several
advantages compared to
the method of harvesting
block grafts, such as reduced surgical trauma
and treatment time.

DT Asia Pacific

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28

SINUS LIFT PROCEDURES
IN THE DAILY PRACTICE

APR

Daniel Rothamel
06:00 PM (CEST)

Sinus grafting procedures are an established therapy to gain
bone height in the posterior maxilla. Depending on the remaining bone height, they can be performed with simultaneous or
two-stage implant placement using osteotomes, a trans-alveolar
or lateral-window approach.
Numerous studies have shown predictable results using autogenous bone but also bone substitute materials. However, within
the last decade, the role of autogenous bone as the "golden
standard" for sinus grafting procedures has been increasingly
discussed, since same results can be obtained using bone substitute materials without additional donor-site morbidity and
additional stress for the patient.
In the webinar, different approaches of sinus grafting procedures, the selection of different bone substitute materials,
clinical and histological results and a sufficient complication
management will be discussed.

REGISTER ON WWW.DTSTUDYCLUB.COM

21

ORAL HEALTH CARE FOR
HIV+ PATIENTS

MAY

David Reznik, DDS
08:00 PM (EST)

It has been 32 years since the first reports of Acquired Immunodeficiency Syndrome (AIDS) were reported to the
United States Centers for Disease Control and Prevention.
The dental team has been and continues to be an important
part of HIV primary care since the early days of the epidemic
when up to 80% of all HIV+ patients would present with an
oral manifestation related to disease progression. Recognition of the oral manifestations of HIV infection are important
tools in accessing a patient’s overall well-being as they are
important indicators of disease progression for those known
to be HIV positive. For those with unknown HIV status, the
presence of these lesions may signify HIV infection or other
systemic conditions.
This presentation will enable the participants to accurately
diagnose and manage the most common oral opportunistic
infections seen in association with HIV disease. Topics to be
covered will also include proper dental management for people living with HIV disease including a discussion of important
lab values and when, if ever, premedication prior to invasive
dental procedures is required.

SINGAPORE/GENEVA,
Switzerland: For her
research on the clinical
efficacy of the sandwich
bone augmentation technique, Dr Jia-Hui Fu from
the National University
of Singapore’s Faculty
of Dentistry has just
been awarded the André
Schröder Research Prize
by the International
Team of Technology (ITI)
in Geneva in Switzerland. In her paper, published in the journal
Clinical Oral Implants
Research, she and a team
of researchers were able
to show that the technique provided predictable results in the
regeneration of buccal
bone on dental implants.

Internationally-educated Fu, who is currently working as Associate
Professor at the National
University of Singapore,
is the first dental professional from Singapore
and the second from Asia
to have won the Prize,
which has been awarded
since 1992 to researchers
who contributed signifiFu was recognised for Dr Jia-Hui Fu, winner of the André Schröder Research Prize. cantly to the area of dental implantology and oral
the first part of her study
tissue regeneration, according
“We observed that implant
during which she was collecting
to the ITI. Named after the organdesign affected bone regeneraclinical and radiographic paisation’s founder, a Swiss protion at the platform level and will
rameters between 2009 and 2011
fessor and pioneer in fixed tooth
explore the influence of implant
as part of an overseas scholarship
replacements, it is endowed with
macro- and micro-designs on the
at the University of Michigan in
the sum of 20,000 Swiss Francs
stability of regenerated bone in
the United States. Follow-up re(US$22,500).
subsequent studies,” she said.
search, which has recently been
submitted for review, according
In addition to its award, the
First reported about a decade
to Fu, will focus on the biological
ITI says to provide 2 million Swiss
ago, sandwich bone augmentaand structural phenotypes of the
Francs (US$ 2.25 million) annution utilises the different healing
bone that has been regenerated
ally to research in both fields. DT
properties of particulate cancelvia the technique.

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

Clinical Editor

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Online Editors

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Claudia Duschek

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

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Published by Dental Tribune Asia Pacific Ltd.
© 2014, Dental Tribune International GmbH. All rights reserved.

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DTAP0514_01-03_News 16.05.14 15:05 Seite 3

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

Asia News

3

Dental curriculum in Bangladesh revamped
DT Asia Pacific

DHAKA, Bangladesh: Students
planning to take up an education
in dentistry in Bangladesh this
year will have to study longer, as
the country’s Medical and Dental Council in the capital Dhaka
has approved a new curriculum
at its general meeting which
was held in early May. Among
other things, it will see Bachelor

of Dental Surgeon (BDS) programmes extended to five years.
Timelines for the annual examinations will also be changed
in order to give students more
time to focus on practical learning when the new guidelines will
become effective later this year.

required BDS students to study
for four years which, according to representatives of the
Bangladesh Dental Society,
proved insufficient for remaining competitive with students
from other countries where students often have to complete
longer programmes.

The previous dental curriculum, implemented in 2007,

Similar rules were already
implemented successfully with

new guidelines for academic
degrees in medicine and general surgery last year, they told
the newspaper Dhaka Tribune
last week.
The update for dental programmes will become valid
for students who enroll for the
next academic year 2014–2015
starting in fall. All graduates
who have started under the

previous curriculum will not
be affected by the changes, the
Council said. Bangladesh has
currently 1,700 seats available
in 23 dental colleges nationwide,
of which over 90 per cent are
operating privately, according
to figures from the Directorate
General of Health Services, an
agency working under the
country’s Ministry of Health and
Family Welfare. DT
AD

ﬂ DT page 1

“Should our results continue
to be as successful as they have
been, we hope to see this work
entering clinical trials within the
next five years,” she told Dental
Tribune Asia Pacific.

N-Cement Collection
Luting materials from Ivoclar Vivadent

The centre, a collaboration
of academic and medical institutions at the university, has
been working on brain therapies
based on dental stem cells since
2005. Among other findings, it
has discovered that treatment
with stem cells after a stroke
can lead to improved cognitive
and motor skills in rodents. The
recent findings published in the
Stem Cell Research and Therapy

Dr Kylie Maree Ellis

journal were part of wider research on developing a laboratory-based model for actual
treatment in humans.
“Ultimately, we want to be
able to use a patient’s own stem
cells for tailor-made brain therapy that doesn’t have the host
rejection issues commonly associated with cell-based therapies,” Ellis said. “Dental pulp
stem cell therapy may also provide a treatment option available
months or even years after the
stroke has occurred.”
According to research, dental
stem cells derived from the pulp of
primary or adult teeth hold great
potential for future regenerative
therapies. For example, they have
been successfully transformed
into a variety of tissues, including
blood, bone and nerves, by researchers. In comparison with
stem cells extracted from bone
marrow and other sources, they
are easier to collect and pose
fewer ethical problems. DT

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DTAP0514_04_News 16.05.14 15:06 Seite 1

Opinion

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

Dear
reader,

Perfect
restorations

“I’ve been to the dentist.”

Dr Munir Silwadi
UAE

Daniel Zimmermann
DTI

Restoring damaged or missing teeth has always been a tough
challenge, since ancient Egypt
until the present time. Rapid
developments in the field of
CAD/CAM systems in the last
decade are bringing us closer
to our goal of achieving the perfect restoration. Computers are,
beyond doubt, far superior to
humans in determining such
critical parameters as evaluating
dimensions, angles or spaces.
Furthermore, what we see on the
screen is often what the milling
unit or 3-D printer produces.

These really must be exciting
times for anyone doing research on
dental stem cells because in addition to its potential for successfully
treating dental and craniofacial
diseases, these cells have also been
found to be useful in the therapy
of a number of general conditions
such as inflammatory or neural
diseases, as recently demonstrated
by researchers from Australia.
Cell populations with stem
cell characteristics however cannot only be found in dental pulp.
Scientists have identified them
in five other dental tissues including the periodontal ligament
or the apical papilla.
This knowledge puts the
mouth right in the forefront of
efforts to fight existing and future diseases. If the therapeutic
potential of these cells is finally
unleashed, the saying “oral health
is important for general health” will
have an entirely new meaning. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International

Dental Tribune welcomes comments,
suggestions and complaints at
newsroom@dental-tribune.com.
For quick access to
our contact form,
you may also scan the
following QR code.

Developing hand skills
knowledge and skills in simple
case management first.

Dr Sushil Koirala
Nepal

In general dental practice,
simple to moderate restorative
cases dominate the total workload in the practice and the financial gain ratio is comparatively
high in simple cases compared
with full mouth rehabilitation or
other complex treatment. However, it is interesting to note that
our young dentists in dental practice are focusing on complex case
management and not giving due
priority to Class V restorations, inlays, onlays, mild anterior crowding, maintaining optimal oral
hygiene, enhancing tooth colour,
etc. Globally, the focus is on implant and full mouth restorations,
which requires in-depth clinical

Personally, I always advise
my trainees to develop hand skills
in direct composite resin restorations, as a good dentist must
have artistic hands. Once we
understand the minute details
(texture, colour, anatomy and
effects) of natural teeth using
direct restorations, it is easy to
obtain quality work from the laboratory and achieve high clinical
results. In order to treat complex
cases, such as cosmetic full mouth
rehabilitation, temporomandibular joint dysfunction (TMD)
and sleep medicine, one must
complete the required continuing education and learn clinical
skills at quality training centres.
MiCD and TMJA harmony
dentistry are becoming quite
popular because of their do no

harm approach to clinical practice and simplicity in training
approach that focuses on skill
acquisition.
As a practising clinician and
presenter of various international
training programmes, I feel that
every good clinician should
participate in a clinical teaching
programme, if possible, because
this will help clinicians to remain
updated and promote personal
happiness by sharing their
knowledge and skills for better
patient care around the word. DT

Contact Info
Dr Sushil Koirala is Editorin-Chief of Dental Tribune Asia
Pacific’s sister publication cosmetic
dentistry. He can be contacted at
skoirala@wlink.com.np.

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We are certainly coming
closer to our goal. The perfect
restoration appears to be just
around the corner. DT

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It is the obligation of every
one of us to join this fast-moving
industry. We owe it to our patients, as well as to ourselves,
to become acquainted with and
put to use all available technology to offer the best possible
treatment. I believe that digital
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They are precise, predictable
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Dr Munir Silwadi is specialist
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msilwadi@eim.ae.

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DTAP0514_06_News 16.05.14 15:06 Seite 1

6

World News

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

International organisation aims to redefine
nickel-free label in dental products
DTI

GENEVA, Switzerland: The
International Organization for
Standardization (ISO), one of the
world’s largest developers of voluntary international standards
for products and services, is currently revising its recommenda-

tion for metallic materials for
restorations and appliances. The
revision will bring about a modification of labels that proclaim
a dental product nickel free.
As reported by the American
Dental Association at the beginning of April, ISO aims to clarify

and redefine the term “nickel
free” in its ISO 22674 standard.
The norm classifies metallic
materials that are suitable for the
fabrication of dental appliances
and restorations, and specifies
requirements with respect to the
packaging and marking of prod-

ucts and to the instructions to be
supplied for the use of these
materials. It further allows manufacturers to employ the term
“nickel free” if a product contains
less than 0.1 per cent nickel.
The revision to the standard
would oblige manufacturers to

account for trace amounts of
nickel in metal alloys with a label
change, including the statement
“nickel free: contains less than
0.1 per cent nickel”, similar to
food product labels that indicate
traces of substances that are associated with allergic reactions,
such as peanuts, ADA stated. DT

AD

A SILICONE IMPRESSION MATERIAL

US adults
stay away
from dentist
DTI

WASHINGTON, USA: The latest
figures released by US research
company Gallup indicate that almost one-third of Americans do
not visit the dentist once a year,
although this is generally recommended. In large-scale public
opinion polls conducted in 2008
and 2013, only about 65 per cent
stated that they had visited the
dentist at least once in the previous
year.
The survey also showed that
more women than men visited
the dentist. In 2013, 67.2 per cent
of the female participants but
only 62 per cent of their male
counterparts reported visiting
the dentist annually.

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With regard to ethnic variation, the investigators observed
that in 2013 about 55 per cent of
black and Hispanic participants
said that they had visited the
dentist in the past year, compared with about 70 per cent of
white and Asian participants.
According to Gallup, similar results were observed in 2008.
However, there was a slight decline in the black population.
In 2008, the percentage of black
participants who visited the dentist in the past year was still at 58.
Participants’ dental care-seeking patterns appeared to differ
according to marital status too.
The investigators said that in 2013
married participants (70.9 per cent)
visited the dentist more often than
single individuals did (60.7 per
cent). In addition, the survey
showed that those who were separated visited the dentist the least
often. The rates dropped the most
among this group: from 52.4 per
cent in 2008 to 46.6 per cent in 2013.
Data for the survey was obtained through telephone interviews with 178,072 US adults
conducted during 2013 and with
354,645 adults conducted during
2008 as part of the Gallup–
Healthways Well-Being Index,
a research project to track and
understand the key factors that
drive well-being commissioned
by Gallup and health services
provider Healthways. DT

[7] => Standard_300dpi

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DTAP0514_08_Business 16.05.14 16:18 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

Business

“The trend towards the mediumprice range has accelerated”
An interview with Straumann executive board member Frank Hemm
about the company’s recent investment in MegaGen
strate the extent of the potential
of our innovative technologies.

Following previous investments in Brazil, Germany and
Spain, Straumann recently
announced that it has bought
convertible bonds worth US$30
million from MegaGen, one of
the largest dental implant solution providers in South Korea.
At the recent World Symposium
of the International Team for
Implantology in Geneva in
Switzerland, on behalf of
Dental Tribune Asia Pacific,
implants magazine Managing
Editor Georg Isbaner had
the opportunity to talk with
Frank Hemm, a member of
Straumann’s executive management board, about the investment and how it will affect
his company’s position in the
Asia Pacific region.
DT Asia Pacific: According
to analysts, South Korean manufacturers are expected to dominate the market for dental
implants in Asia in the years to
come. Is this projected development the main reason for your
investment in MegaGen?
Frank Hemm: South Korea
is one of the largest markets for
implants in terms of volume.
More than two million implants
are placed every year and local
manufacturers are looking to
expand into other Asian markets
with high potential. China is a
good example, where the market

Achieving a leading position
in Asia will certainly have a
positive influence on our global
position.

Georg Isbaner (left) in talks with Frank Hemm. (DTI/Photo Henrik Schröder, Germany)

is still comparatively small but
under-penetrated and growing
quickly.
In these markets, the premium
implant segment, where Straumann has been and still is very active, is growing less dynamically
than the medium- and low-price
segments are. We see the same
trend in other markets, like Brazil,
where companies like Neodent
sell higher volumes than premium providers do. Two years
ago, we had to ask ourselves

Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry

whether we could address the
non-premium segment with our
existing brand or whether we
needed a second brand. We decided on the latter and purchased
a 49 per cent stake in Neodent. As
an established brand in the region,
MegaGen gives us a foothold in
the Asian “value” (medium-price)
segment. The convertible bond
approach means that we have the
option to gain a majority stake in
2016 with a managed low risk.

only synergies we see are in
supporting the value brand
companies to enter selective
markets, and in sharing backoffice functions, like infrastructure, information technology or
accounting. Everything else is
handled by each company independently. Straumann products are certainly produced in
Straumann facilities and this
will continue to be the case in
the future.

What requirements will
have to be fulfilled for you to
exercise the option to convert
and acquire a majority stake
in MegaGen in 2016?
We are keeping a close eye
on the company’s development.
MegaGen is a relatively new
enterprise. It is growing dynamically and has many ambitions
that still have to be realised. We
also want to see how the market
develops and the extent to which
MegaGen can penetrate certain
areas. The company’s valuation
is another item on our radar.
If our expectations are met,
we can convert the bonds into
shares in 2016 or require repayment with interest. That is
the flexibility that this option
allows us.
Should you decide to convert the bonds into stock,
another large international
implant conglomerate would
be created. Is it only possible
to survive in the long run as
a large market player?

“Unlike in some industries,
scale in the dental implant industry
does not have inherent returns.”

www.dental-tribune.com

Straumann has always provided premium dental implants
backed by solid scientific evidence and service excellence.
These key differentiators make it
necessary to use a separate brand
strategy to address customers
who are willing to accept lower
standards and who want to pay
less for implants. The value segment is growing exponentially
and developing a new brand
from scratch would simply take
too much time and too many resources, which is the reason we
chose to invest in other established companies.
Both companies have said
that they will continue to operate separately. Still, do you
expect any synergies to arise
from this partnership?
It is important to keep both
businesses completely separate
to ensure that customers do
not think that Straumann is
MegaGen and vice versa. The

Is there the risk that you
might be creating more competition for yourself with this
investment?
We would not have taken this
step if the market situation had
not required it. The trend towards products in the mediumprice range has accelerated and
there is already strong compe tition, even without MegaGen.
We are not adding more competition; rather, we are competing
where we could not compete as
Straumann.
What position is your company generally aiming for in
the Asia Pacific region?
We aspire to market leadership in the region. We are not there
yet, partly because our Roxolid
implants with the SLActive surface are not yet available in
the larger markets. We recently
received approval for SLActive
Tissue Level implants in Japan
and the sales figures demon-

The implant market is still
very fragmented and the market
share of larger corporations is actually declining. There are hundreds and hundreds of smaller
providers, often founded by dental clinicians, that come and go
because they do not have the capability to expand internationally. Few companies succeed in
making this jump and remaining
in the market for a longer period.
Unlike in some industries,
scale in the dental implant industry does not have inherent returns.
What we are seeing is a consolidation in a larger context, as many
distributors have started to include implants in their portfolios
with the aim of becoming one-stop
shops. This development needs
careful scrutiny because implants
involve other factors that only we
as specialists can deliver.
Thank you very much for
the interview. DT

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DTAP0514_09_Business 16.05.14 15:08 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

Business

Sirona unveils new unit for new markets
INTEGO treatment centre meant to offer premium quality at affordable prices
Daniel Zimmermann
DTI

to Executive Vice President of
Sales Walter Petersohn.

BENSHEIM, Germany: Checking the latest investment figures,
Jeffrey T. Slovin looks relaxed
and pleased with himself. Minutes ago, the 49-year-old CEO
of Sirona was still rocking the
stage in front of 400 guests in
a specially prepared production
room at the company’s site in
Bensheim in Germany for what
he says is probably one of
the most important product
launches in his company’s recent
past.

Balancing this stretch, however, made it necessary to offer
two versions of the unit, named
BASIC and PRO, that can serve
practitioners with normal treatment requirements as well as
specialists who want to perform
advanced procedures like implantology or endodontics. For
the latter group, the PRO version
will offer enhanced features
such as an automatic disinfection
device or the possibility to add
an apex locator. Moreover, it will
be equipped with a touch screen
panel and a four-way footswitch
for more intuitive control. Both
versions of the INTEGO will be
available with hanging hoses
or whip arms in a variety colours
to fit different practice environments. Emphasis was also on
improved ergonomics with the
unit featuring a thinner backrest, more comfortable upholstery, and flexible height adjustment.

Developed to fill a gap between its C8+ and SINIUS dental
chairs, the new INTEGO treatment unit was developed to be
a door opener to new markets
in which the Germany company
took significant investments—
markets such as Asia where
Sirona opened a new regional
headquarters at the end of last
year. Excluding the Germanspeaking countries, however, it
will also be supplied in established markets like Scandinavia
and Southern Europe, according

“We are proud to still be able
to offer a product which is a hundred per cent made in Germany
but for which we were able to
significantly reduce production
costs,” he said.

Jeffrey T. Slovin presenting the new INTEGO unit. (DTI/Photo Daniel Zimmermann)

depending on the specific configuration—significantly less when
compared to some of the company’s current flagships which
sell for up to €30,000. However,

Peterson made an assurance
that the lower price tag does not
mean a compromise in the quality the company is known for
around the globe.

While the BASIC version of
the INTEGO is scheduled to
launch in July, the PRO version
is anticipated to follow later
this year. However, it will take
at least until the next IDS in
Cologne before registration is
received in all target regions
and for it to be available in all
markets, Petersohn added. Asked
about the company’s existing
dental chair portfolio comprising four major brands, of which
the latest was launched only
four years ago, he assured that
all will continue to stay for the
time being.
“We will let the market decide
what the future of each unit will
look like,” he said. DT
AD

The units are going to sell
between €15,000 and €25,000,

Roland DG
reorganises in
Asia Pacific
to the company’s operations in
China were also announced,
including the naming of former
President of East Asia Sales
Michael Man as President of the
Roland DG (China) Corporation
in Shanghai.
According to the company,
the restructuring, which is part
of its Global One reorganisation
efforts that began last year,
are intended to strengthen its
leadership position in one of
the fastest-growing regions in
the world.
Marc Margetts. (DTI/Photo courtesy of
Roland DG, Japan)
DT Asia Pacific

SYDNEY, Australia/HAMAMATSU,
Japan: As part of its global restructuring plans, Roland DG has
recently made public leadership
changes for several of its Asia
Pacific operations. Beginning this
month, Marc Margetts, currently
CEO of Roland DG Australia, will
take over responsibility as pres ident for the region.
While Margetts will maintain
his current position, the company said, the role of president
of its subsidiary in Sydney will
be assumed by former general
manager John Wall. Alterations

In addition to its headquarters in Japan and its offices in
Australia and China, Roland DG
currently maintains direct business operations in South Korea
and Taiwan. It also operates
through dealers in markets like
India and Hong Kong.
A provider of digital solutions
for a variety of industries, the
company manufactures and distributes mills for the production
of dental prostheses, including
crowns, bridges and abutments,
under its DWX brand. In Australia, it recently opened a new
3-D and dental creative centre
in Sydney that offers live demonstrations, as well as interactive
training sessions and seminars,
to dental professionals. DT

EXPERIENCE OUR ENTIRE COLLECTION ONLINE

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DTAP0514_10-12_Tirlet 16.05.14 15:09 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

10 Trends & Applications

Using the same material
for different cases
Anterior ceramic restorations placed with the adhesive luting technique
Dr Gil Tirlet, Hélène Crescenzo
& Didier Crescenzo
France

In many clinical situations,
a combination of full and partial restorations is indicated.
In order to fulfil (bio-)mechanical, functional and aesthetic
requirements, it is of utmost
importance for clinicians to select the most suitable ceramic
materials for each individual
case. A thorough knowledge of
the latest ceramic systems and
adhesive luting techniques is
all it takes to fabricate partial
restorations according to biomimetic principles.
In our case, a 28-year-old female patient consulted our practice with the request to improve
her smile. She was particularly
concerned about the appearance
of her four maxillary anterior
teeth. Orthodontic treatment
would have been an elegant solution to realigning both the maxillary and the mandibular arches,
but the patient declined this option. Another approach therefore
had to be taken to meet her needs.
Teeth 11 and 21 had previously been restored with porcelainfused-to-metal (PFM) crowns.
Besides them appearing very
bulky, teeth 12 and 22 (the
two lateral incisors) appeared
to have been pushed back (Figs.
1 & 2). The patient also had very
bright teeth, which would have
to be correctly imitated by applying internal highlights (Fig. 3).
On the basis of the aesthetic
treatment plan, a mock-up of the
restoration was fabricated with
a tooth-coloured composite resin.
This anterior matrix, as we call it,
was used to discuss the desired
outcome with the patient.
The pushed-back position of
the lateral incisors was to be
restored with veneers, followed
by minimal preparation and new
crowns for the central incisors.
The lateral incisors were minimally prepared according to
the anterior matrix (Figs. 4 & 5).
The space available for the new
restorations was shown to be
ideal after the PFM crowns were
removed from teeth 11 and 21.
The remaining amount of tooth
structure was adequate to provide biomechanical reinforcement for the two central incisors
(Fig. 6), which is also known
as the ferrule effect. Therefore,
we decided to place the new ceramic restorations according to
an adhesive luting protocol.
Based on the information
that was available about this
case (the colour of the enamel

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 13

Fig. 14

Fig. 15

Fig. 1: Pre-op situation (front view).—Fig. 2: Pre-op situation (side view).—Fig. 3: The exceptional luminosity and brightness of the anterior teeth were established
during shade selection.—Fig. 4: The tooth-coloured mock-up gave an indication of how the two lateral incisors would have to be prepared.—Fig. 5: The margins
were finished after minimally invasive tooth preparation.—Fig. 6: View of the four prepared teeth.—Figs. 7 & 8: The chroma of the prepared teeth 11 and 21 was
determined (IPS Natural Die Material shade guide; Ivoclar Vivadent). The selection of the appropriate press ingot required considerable care and deliberation,
since the thickness varied between the restorations. The difference in the preparation depth of the lateral and central incisors is clearly visible in the photographs.—
Fig. 9: A sketch of the aesthetic features served as a guideline for the restoration build-up.—Fig. 10: The layering scheme taking aesthetic planning aspects into
consideration.—Fig. 11: Creation of the tooth shape and the surface texture on the model.—Fig. 12: The surface texture of the restorations was checked by applying
a fine layer of powdered gold.—Fig. 13: The four anterior restorations were seated with adhesive luting composite. As a result of the existing occlusal conditions, the
incisal edge was relatively easy to create and imparted considerable personality to the smile.—Fig. 14: A photograph of the final situation on which it is evident that
the crowns and the veneers have the same colour.—Fig. 15: The black-and-white photograph allowed the four ceramic restorations to be assessed in terms of value.

and the tooth core etc.), the laboratory technician selected a suitable press ingot (IPS e.max Press,
Ivoclar Vivadent; Fig. 7). The
challenge was to select an ingot

that would accommodate both
the crowns for the highly chromatic and luminous central incisors and the thin veneers for
the light lateral incisors (Fig. 8).

When maximum brightness
is desired in restorations on
intensively coloured bases like
the two incisors in this case,
a medium opacity ingot is the

first choice, as it provides a
medium level of opacity, as well
as good masking properties and
‡ DT page 12

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DTAP0514_10-12_Tirlet 16.05.14 15:09 Seite 2

12 Trends & Applications

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

ﬂ DT page 10

a high degree of fluorescence.
The minimally prepared teeth
did not provide a binding colour
for the partial restorations.
Therefore, a more translucent
type of ingot would impart a
greyish appearance to the relatively thick lithium disilicate
veneers. Owing to this, we usually prefer a fluorescent (me dium opacity) ingot to ensure
the appropriate brightness of
the restored teeth.

Fig. 17

Fig. 16

Figs. 16 & 17:The situation six months
after treatment.

2014

HKIDEAS
Hong Kong International Dental
Expo And Symposium

www.hkideas.org

22 – 24 August 2014
Hong Kong Convention and Exhibition Centre

The restorations were finally
fabricated using the well-known
press technique. Since the patient had very intensively coloured gingival tissue and dark
red lips, the tooth necks had to be
saturated with IPS e.max Ceram
Occlusal Dentin brown and Deep
Dentin A1, in addition to the
selected A1 shade (Figs. 9 & 10),
for a smooth transition between
the tooth necks and the restorations. A large amount of information, which was extremely helpful in the finishing, was provided
for the laboratory by means of
close-up photographs of the
teeth and gingival tissue, as well
as the patient’s face showing various natural facial expressions.
The surface texture and the
shape of the teeth (Figs. 11 & 12)
were carefully recreated. Finally,
the restorations were prepared
for placement.

Conclusion
Upon seating the restorations,
it was evident that our treatment approach had been successful and the teeth blended in
smoothly with the dentition. The
overall impression was harmonious (Fig. 13). The ingot that
had been selected was shown to
be ideal for this case. There was
no difference in shade between
the two crowns on the central
incisors and the adjacent veneers (Figs. 14 & 15). A highly
aesthetic solution was achieved
with minimally invasive tooth
preparation (Figs. 16 & 17). DT

Call for Abstracts:
Deadline: 30 April 2014
Early-bird Registration:
Deadline: 31 May 2014

Contact Info
Dr Gil Tirlet
practises as a
dentist in Paris
in France. He can
be contacted at
gtirlet@me.com.

Contact Info
Hélène Crescenzo
maintains a dental laboratory in
Cogolin in France.
She can be contacted at contact@
estheticoral.fr.

Contact Info
Organizer

Didier Crescenzo
maintains a dental laboratory in
Cogolin in France.
He can be contact ed at contact@
estheticoral.fr.

[13] => Standard_300dpi

Honored
The recognition is inspiring. Every year since
the inception of the Townie Choice awards,
doctors have voted A-dec best in class
across multiple dental-equipment categories.
That’s more than a vote of confidence. It’s a
testament to A-dec quality from those who
know best.
To learn more, call 1.503.538.7478 or
visit a-dec.com/DentistsChoose.

Best
Patient
Chairs
(2003-2013)

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(2003-2013)

©2014 A-dec Inc.
All rights reserved.

A-decTownie2013_DentalTribune.indd 1

3/3/14 2:04 PM

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DTAP0514_14-15_Advertorial 16.05.14 15:10 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014

14 Advertorial

Seven ways to increase dentin
bond strengths
Dr Dan Fischer
USA

of durable service if attention
to detail is followed.

If you battle with debonding restorations, post-op sensitivity, or microleakage,
weak adhesion to dentin
could be your problem. There
are multiple factors that can
impact the quality of dentin
bonding, many of which
are overlooked or unknown.
It can be difficult to see the
impact of these factors in
a clinical setting. The Research and Development
team at Ultradent has performed tens of thousands of
lab tests, introducing dif ferent variables to find the
most fool-proof process for
effective dentin bonding. Before approaching these steps,
however, it is critical to ensure that some fundamentals
are in place.

Tissue management is paramount. The clinician must
be in control of all oral fluids
before bonding begins.2 Rubber dam can be a great help
but sometimes it simply isn’t
practical. Control of bleeding,
saliva and sulcular fluid are
paramount to predictably bond.
I can’t imagine performing
adhesive dentistry near or under soft tissues without Vistostat or Astringedent X and the
Dento Infusor.

Bonding can only be predictably performed on hard

Dr Dan Fischer, CEO and president
Ultradent

mineral dentin.1 All soft, affected tooth structure must be
removed to achieve adequate
and maximum bond values.
Adhesive or minimally invasive dentistry is not dictated by
cavity prep design, but rather
by simply excising the lesion.
Quality adhesive reconstruction will last for many years

A clean and dry air source
is required for quality bonding
to occur. It is recommended
that clinicians use a dedicated
air syringe in each operatory
to avoid water leakage, which
is common in air/water combination syringes.
The most important element to assure quality ad -

hesion, assuming a quality
bonding agent is used, example Peak Universal by Ultradent or Clearfil SE by Kuraray,
is to prevent contamination.
My definition of adhesion is
that “any substance which
comes between mineral mother dentin and your adhesive
is a contaminant”.
Laser-prepared surfaces on
both dentin and enamel do
not create the ideal surface for
bonding. In fact, laser preparation can contribute to a 20 per
cent reduction in bond values,
on average, due to microscopic
fracturing of the surface. To
regain the highest bond value,
it is imperative to freshen
every laser-prepared surface
with a diamond bur prior to
etching.1, 2, 3, 4, 5, 6
With these bonding “best
practices” in place, clinicians
can increase bond strengths
even further by incorporating
insights from Ultradent’s lab
testing. These lab tests result ed in eight simple, controllable
steps for ensuring the highest
quality bond strengths.

Step 1: Etch for the
appropriate length
of time be it with “self-etch”
or phosphoric acid etch.
Most phosphoric acid etch
preparations can etch too deep
if left too long on the surface.
A fumed silicate type phosphoric like UltraEtch is more
forgiving in this regard.

Step 2: Ensure ideal dentin
moisture conditions.
Manufacturers use solvents
(acetone, ethanol, water) in
adhesives to thin resin chem istries, allowing the adhesive
resins to flow into the depths
of the etched zone. Since the
solvents used are hydrophilic
(water-loving), they will actively carry the primer or adhe sive into moist dentin better than
dry dentin. Each solvent type
works differently with moisture
levels, with ideal conditions for
each described below.
Acetone-Containing
Adhesive Systems
Ensure the dentin surface is
glistening with moisture. This
can be easily achieved by using
a cotton pledget and dabbing
off the excess moisture. Ad hesives that contain acetone
are particularly sensitive to
over drying. If the tooth surface
is not moist prior to adhesive
application, a substantial loss
in bond strength will result.
Tel: +1 424 744 0608 / email: c.ferret@tribunecme.com / www.TribuneCME.com

Ethanol-Containing
Adhesive Systems
Adhesives that contain
ethanol do not require as much
moisture. Leave the dentin
surface damp by using the air
syringe for no more than one

second, blowing off visible
surface moisture. Do not direct
any substantial sustained air
at the surface. A chalky white
or over-dried surface will decrease bond values.
Self-Etching Adhesive Systems
(Water-Containing)
Systems that contain water
can be placed on slightly drier
surfaces. The water in the
self-etch adhesive is the carrier for its acid. Thin for one to
three seconds prior to adhesive
application.

Step 3: Pay attention to
application time & technique.
It is quite important to leave
adhesives in place as long
as suggested by the manufacturer. In a busy dental office, it
is easy to count too fast; watch
the clock instead. It is crucial
to give the adhesives time to
penetrate or wet the deepest
etched zones created.
With self-etch adhesives
being less acidic than phosphoric acid, it is important to
leave the adhesive in place
long enough to properly etch
and penetrate the dentin and
enamel.
Also, be sure to scrub in the
adhesive if the manufacturer
recommends it. Usually, scrubbing adhesives into dentin
will increase bond strengths by
a few per cent and allow for
a much more consistent and
reliable bond. On the other
hand, scrubbing enamel will
slightly decrease bond strengths.
When possible in the same
preparation, treat enamel
more delicately and dentin
more aggressively.

Step 4: Thin and dry
the adhesive properly.
All adhesives should be
dried before they can poly merize properly. This means
that all adhesives need to be
aired so they’re paper thin
(in the case of Peak) and then
air dried. The best way to accomplish this is with a gentle
air stream, using half air at
1 to 2 inches from the surface.
A properly thinned adhesive will look uniformly glossy
without pools; pooled product
contributes to a substantial
decrease in bond strength due
to trapped solvents. Leave the
air on long enough in a gentle
stream so that there’s no movement in the resin, just drying,
to finish volatilizing the solvents. This allows monomers
to polymerize properly for the
highest strengths possible.

Step 5: Light cure close
to the surface
with a compatible light.
Place the curing light as
close to the restored surface

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DTAP0514_14-15_Advertorial 16.05.14 15:10 Seite 2

DENTAL TRIBUNE Asia Pacific Edition No. 5/2014
as reasonably possible. This
ensures that the materials are
exposed to sufficient energy
for a proper cure. At a distance
of one inch, most lights will
only produce ten per cent or
less of the energy that they do
at one millimetre.
Only a few of the newest
generation of LED lights produce a “broadband” wavelength, meaning they actually
emit more than one colour of
blue. This is important due to
the fact that many dental materials contain initiators (light
sensitive chemicals) that react
to deeper blue and violet
colours of light. Manufacturers
use multiple formulations for
their product lines, with incisal enamel shades often
containing different amounts
or even different initiators
than the dentin/body shades.
“Broadband” LED curing
lights inspire more confidence
in those situations, since they
emit several wavelengths,
similar to how quartz halogen
lights function. An unsurpassed quality broadband LED
is Ultradent’s VALO.

Step 6: Place the first
increment of composite
in a super thin layer.
In order to achieve a “mono
block” restoration (tooth, adhesive and composite acting
as one), it is important to place
the first layer of composite at
a depth no greater than 0.2 mm
thick so that thorough and
complete adaptation can occur. If a thicker first layer is
applied, it is likely that slight
voids will result beneath the
composite, which can be a
point of failure over time.
After the first layer is
adapted, place the standard
increments of one to two millimetres in thickness. Another
way to improve adaptation to
the adhesive layer is to use
a flowable composite for the
first layer. However, avoid
“bulk filling” due to stress
build-up issues.

Step 7: Never use
expired product.
Since all restorative mate rials contain reactive components, it is important to refrigerate materials that are not
used on a daily basis in order to
slow the degradation process.
The higher the temperature,
the faster the chemistry will
react and become unsuitable
for use. Manufacturers recommend expiration dates because
of data that shows when the
product becomes unacceptably degraded.
At Ultradent, we typically
set that marker at not less than
90 per cent of “new” performance, meaning that the product’s performance has not
decreased by any more than
ten per cent since its manu facture. Typically, it’s even less
than that. When the expiration
date arrives, it doesn’t mean
that the product suddenly went
bad, but it means the product
has reached a “marker” set by
that manufacturer.

Products that contain solvent are subject to problems
with evaporation. Securely
tighten all lids to reduce the
risk of solvent loss, which
could lead to poor product performance.

Conclusion
Many clinicians will have
the opportunity to increase
dentin bond values in their
practice by incorporating a few
simple practices into their
bonding procedures. It is important to start with a solid

understanding of bonding
fundamentals. After this base
is established, eight controllable factors contribute to
the final bond value achieved;
in combination, this increase
or decrease can be dramatic. DT

References
1. Takabatake Y, et al. Bonding to
Demineralized Dentin All-inOne Adhesive Systems. Japanese
Journal of Conservative Dentistry
2005;48(2):227–233.

Advertorial 15
2. Bailey JH, Fischer DE. Procedural
Hemostasis and Sulcular Fluid
Control: A Prerequisite in Modern Dentistry. Pract Periodontics
Aesthet Dent. 1995 May; 7(4):65–
75.
3. Martinez-Insua A, et al. Differences
in bonding to acid-etched or
Er:YAG-laser-treated enamel and
dentin surfaces. J Prosthet Dent
2000;84(3):280–8.
4. Gorgul G, et al. Effects of Nd:YAG
Laser Irradiation on the Adaptation of Composite Resins to Root
Dentin. Journal of Contemporary
Dental Practice 2005;6(4):116–123.
5. Ceballos L, Toledano M, Osorio R,
Tay FR, Marshall GW. Bonding to

Er:YAG-laser-treated Dentin. J
Dent Res 2002;81(2):119–122.
6. Yazici AR, Frentzen M, Dayangac B.
In vitro analysis of the effects of acid
or laser etching on microleakage
around composite resin restorations. J Dent 2001; 29:355–61.
7. De Munck J, Van Meerbeek B, Yudhira R, Lambrechts P, Vanherle G.
Micro-tensile bond strength of two
adhesives to Erbium:YAG-lased vs.
bur-cut enamel and dentin. Eur J
Oral Sci 2002; 100:322–9.
8. Yazici AR, Frentzen M, Dayangac B.
In vitro analysis of the effects of
acid or laser etching on microleakage around composite resin restorations. J Dent 2001; 29:355–61.
AD

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29.04.2013 11:20:50

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[cover] => DT Asia Pacific No. 5, 2014

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Table of contents

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