Novel biosensor for use on teeth / Asia News / Opinion / “Evidence for risk factors related to a specific form is still weak” / Conical internal connections will fuel future growth in European dental implant market / Business / Extending the boundaries of feasibility in direct restorative procedures / “Lecture theatre”—a new interactive concept—on chairside CAD/CAM dentistry
Novel biosensor for use on teeth
01 - 01 viewAsia News
02 - 03 viewOpinion
04 - 04 view“Evidence for risk factors related to a specific form is still weak”
06 - 07 viewConical internal connections will fuel future growth in European dental implant market
09 - 09 viewBusiness
10 - 10 viewExtending the boundaries of feasibility in direct restorative procedures
12 - 14 view“Lecture theatre”—a new interactive concept—on chairside CAD/CAM dentistry
15 - 15 viewArray
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DTAP0612_01_Title
DTAP0612_01_Title 05.06.12 14:30 Seite 1
DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG
www.dental-tribune.asia
Periodontitis
Dr Tomasi on aggressive
vs. chronic periodontitis
4Page
6
NO. 6 VOL. 10
Direct restorations
A challenging case
in the anterior region
4Page
CAD/CAM congress
An interview with
Dr Michael Dieter
12
Novel biosensor for use on teeth
Daniel Zimmermann
DTI
PRINCETON, NJ, USA: Princeton University researchers have
successfully tested a special kind
of biosensor that could help to
prevent disease by detecting
even small amounts of harmful bacteria more quickly than
conventional methods. Using a
“tattoo” made from silk and gold
and attached to a cow’s tooth, they
were able to transmit a signal
wirelessly to a nearby receiver.
With the method, developed
in collaboration with the US Air
Force and the American Asthma
Foundation, the researchers hope
one day to be able to detect not
only bacteria but also DNA or
particular viruses. In lab tests
conducted at Princeton’s School
of Engineering and Applied Science this year, they were able to
detect pathogens responsible for
surgical infections and stomach
ulcers, among others.
The signals are received from
a gold antenna on a tattoo that
is attached to an array of graphene—very small particles of
carbon—that triggers a signal
when in contact with bacteria
4Page
15
Biomaterial
stimulates
healing
A group of researchers from
South Korea, Switzerland and the
US has found that blood platelet biomaterial significantly improves the healing process after
placement of dental implants. In
a case study conducted in Italy,
they observed beneficial shortand long-term results after the
replacement of a fractured central incisor.
The sensor consists of a graphene layer printed onto a bioresorbable silk substrate. (DTI/Photo Princeton University, USA)
through attached proteins called
peptides. Therefore, the device
does not require any power supply, the researchers said.
The sensor is held in place by
a water-soluble silk base derived
from insect cocoons. In this way,
the researchers said, the sensor
can be used on different kinds of
biomaterials, like teeth or skin,
and washed away or dissolved by
body enzymes after use.
According to the researchers,
there is still a long way to go before such a biosensor could be
in regular use, since the sensor
is still too large to fit on human
teeth and its lifetime and trans-
mission distance are short. They
admitted, however, that a few
modifications to the design of the
sensor could increase its transmission distance in the future.
Most traditional biosensors
are based on substrates like silicon, which makes them heavy
and uncomfortable to wear. DT
The material seems to act as a
bio-membrane that protects the
implant from the oral environment. It also appears to stimulate
the growth of cells and to accelerate gingival healing and maturation. After seven days, they
found that the gingival aesthetic
profile was well defined. At six
months, they reported a satisfactory final result that was still stable and aesthetic after two years.
According to the researchers,
L-PRF is simple, inexpensive and
easy to prepare in only 15 minutes. Moreover, it is free of additives, such as anticoagulant,
a substance that prevents the
clotting of blood, or chemicals for
activation, they said. DT
AD
Astra Tech
backs up
implant line
US Marines prepare for the deployment of military forces during the PacificPartnership mission in 2011. The annual campaign provides medical and
dental relief to more than 20,000 people in South-East Asia. (DTI/Photo courtesy
4ASIA NEWS, page 2
of US Navy/Kristopher Radder, USA)
Australian dentistry Geistlich celebrates
gets boost
market entry
The Australian government
has announced to provide over
AUS$500 million to oral health
care services in the country over
the next four years. The cash injection is supposed to lower waiting lines for public dental services and help dentists to relocate
to remote or underserved areas,
among other measures. DT
The Swiss company Geistlich
has recently celebrated the successful registration of Bio-Oss in
Japan. Besides the bone substitution material, the company also
aims for the market approval of an
indication extension of Bio-Oss for
implantology as well as its collagen
membrane for bone regeneration
Geistlich Bio-Gide in 2012. DT
Astra Tech has presented
new clinical data confirming the
clinical effectiveness of its dental implant system. The results
gathered through the company’s global research programme
show almost 100 per cent survival rates for the company’s
OsseoSpeed implants in sites like
the posterior mandible.
Recent multicentre studies
have also demonstrated the safety
and predictability of OsseoSpeed
3 mm narrow implants and OsseoSpeed Profile implants, company
officials said at the Astra Tech
World Congress in May.
Since 2011, Astra Tech has
been part of DENTSPLY, a US dental company that manufactures
and distributes the ANKYLOS and
XiVE implant systems through
its German-based subsidiary
DENTSPLY Friadent. 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] =>
DTAP0612_01_Title
DTAP0612_02_News 05.06.12 14:30 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
AD
Dentists take part in military-led
aid mission to Asia Pacific
International humanitarian campaign aims to
provide treatment for more than 20,000 people
WASHINGTON, DC, & SAN
DIEGO, CA, USA: In one of the
worst natural disasters in recent
times, the Boxing Day tsunami
killed more than 200,000 people
in South-East Asia. Following the
catastrophe, humanitarian missions organised by the Pacific
Partnership have been conducted in the region each year since
2006. Recently, the first support
troops including military dental
providers were deployed from
around the world for this year’s
campaign.
According to Mission Commander US Navy Captain James
Morgan, who spoke to reporters before embarking, the joint
exercise will see repeated visits
to regions and islands in Indonesia, the Philippines, Cambodia and Vietnam during the
next two months. Up to 100
dental providers will be taking
part in the mission, which is
budgeted at US$20 million and
expected to resume in early
August.
“While at a host nation, I expect we’ll see anywhere from
60 to 100 patients daily, and
sometimes, patients need more
than one procedure performed,”
commented William Robinson,
a US Air Force major and dental
provider from San Antonio.
Besides dental services like
teeth cleaning and extraction,
military personal will also provide other medical and engineering aid, as well as training to local
medical professionals.
US Sailors stand in ranks at a promotion ceremony during Pacific Partnership
2011 onboard the amphibious transport dock ship USS Cleveland in the Arafura
Sea. (DTI/Photo courtesy of US Navy, USA/Michael Russell)
Approximately 1,000 professionals, both military members
and civilians, are expected to join
the mission, which, according
to Captain Morgan, is supported
by non-governmental organisations such as the San Diego
Pre-Dental Society and intended
to enhance international cooperation, as well as regional capability for future emergency
response. Several countries, including France, Singapore and
South Korea, are participating
for the first time, he said. Besides
the US, Canada, Japan, New
Zealand and Australia have contributed resources regularly
since the beginning.
The last mission in 2011 provided treatment to more than
21,000 patients.
The Partnership is hosted by
the US Navy, which also provides
major transportation and logistic support through the USNS
Mercury, one of its two currently
operating hospital ships. According to Captain Morgan, it will
offer capacity for between 100 to
150 surgeries per day offshore
and on land.
With almost 200 ships and
more than 300,000 troops in the
region, the US Pacific Fleet is currently the largest naval military
power in the Asia Pacific region.
During a visit to the region in
November last year, US president
Barack Obama announced his intentions to strengthen US–AP relations to promote stability in the
region, of which the Partnership
is considered an essential part. 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] =>
DTAP0612_01_Title
DTAP0612_03_News 05.06.12 14:31 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Asia News
3
Elexxion signs new distributor for Asian markets
Dental Tribune Asia Pacific
“With Global Dental Supplies
we have a strong partner that
gives us the opportunity to systematically expand our sales
and marketing activities in Asia,”
commented elexxion CEO Per
Liljenqvist.
Besides elexxion dental
lasers, Global Dental Supplies
also distributes products from
the German implant company
BEGO, Sunstar, Bisco and GC,
among others.
He said that his company
could benefit from the agreement
in terms of product registration
and exhausting new distribution
channels in the region.
The latest elexxion product
offering includes the delos 3.0,
a novel Er:YAG/diode laser combination indicated for a wide
range of dental applications.
In addition, the company distributes the pico mobile diode
laser and duros, an Er:YAG dental laser device claimed to facilitate efficient hard-tissue surgical
preparation and bone ablation
tasks. DT
(DTI/Photo Leung Cho Pan)
HONG KONG/RADOLFZELL,
Germany: Dental laser specialist elexxion has reported that
it has signed a new distribution
agreement with Global Dental
Supplies in Hong Kong. The fiveyear contract will give the dental
distributor the exclusive rights
to distribute elexxion’s laser
technology for use in dentistry in
several Asian countries.
Japan. The distribution rights
for Hong Kong and Macau were
previously held by Healthcare
Dental, which did not renew its
contract with elexxion after 2009,
company officials said.
View of Hong Kong harbour.
AD
Currently, the German company sells its products through its
subsidiaries and dealers in selected markets, such as India and
THE WORLD SPEAKS e.max.
Regulation in
Malaysia gets
revamped
Daniel Zimmermann
DTI
PUTRAJAYA & KUALA LUMPUR,
Malaysia: Medical device regulations are being stepped up in
Malaysia with the upcoming
launch of a new governmental
agency that will require local
manufacturers and importers to
have their products officially registered before they enter the
market. The Medical Devices
Authority, which will replace the
current Medical Device Control
Division, will operate under the
authority of the Ministry of
Health and be led by the country’s
Director-General of Health.
To date, the registration of
medical devices in Malaysia has
been voluntary and imports have
been largely uncontrolled.
Speaking to Dental Tribune
Asia Pacific, Ultradent’s General
Manager for Asia Pacific, Nicolas
Sondaz, said that no official information had yet been communicated by the ministry with regard
to dental devices. His company,
which sells restorative materials
and tooth-whitening kits, among
other products, opened its Asian
headquarters last year in Kuala
Lumpur.
*
SO DOES THE SCIENCE.
From left: G. Ubassy, Dental Technician, France | M. Roberts, Dental Technician, USA | M. Temperani, Dental Technician, Italy | D. Hornbrook, Dentist, USA |
O. Brix, Dental Technician, Germany | U. Brodbeck, Dentist, Switzerland | G. Gürel, Dentist, Turkey | C. Coachman, Dentist, Ceramist, Brazil |
A. Shepperson, Dentist, New Zealand | A. Bruguera, Dental Technician, Spain | S. Kataoka, Dental Technician, Japan | S. Kina, Dentist, Brazil
As part of the 2011 Medical
Device Act ratified by the Malaysian parliament late last year,
the regulatory changes are intended to protect domestic businesses from patent infringement
and patients from the health risks
posed by low-quality devices.
From November, all products
will be classified into four risk
categories, ranging from low to
high, Ministry of Health officials
commented. They said that noncompliant companies will be
fined a maximum of RM200,000
(US$63,600).
UP TO 10 YEARS OF CLINICAL EVIDENCE.
1
2
98.2 % CROWN SURVIVAL RATE.
40 MILLION RESTORATIONS.
1 PROVEN SYSTEM:
IPS e.max
3
* The IPS e.max Scientific Report Vol. 01 (2001 – 2011) is now available at:
www.ivoclarvivadent.com/science_e
mic
a
r
e
c
all
ed
e
n
u
all yo
1
M. Kern et al. “Ten-year results of three-unit bridges made of monolithic lithium disilicate ceramic“;
Journal of the American Dental Association; March 2012; 143(3):234-240.
2
Mean observation period 4 years IPS e.max Press, 2.5 years IPS e.max CAD.
See the IPS e.max Scientific Report Vol. 01 (2001 – 2011).
3
Based on sales.
www.ivoclarvivadent.com
“The process of product registration has been quite slow in
Malaysia,” he said. “We hope that
the Ministry of Health will consider the size of the market and
place the fee for each product
registration accordingly.” DT
Ivoclar Vivadent AG
Bendererstr. 2 | FL-9494 Schaan | Liechtenstein | Tel.: +423 / 235 35 35 | Fax: +423 / 235 33 60
Ivoclar Vivadent Marketing (India) Pvt. Ltd.
503/504 Raheja Plaza | 15 B Shah Industrial Estate | Veera Desai Road, Andheri (West) | Mumbai 400 053 | India
Tel.: +91 (22) 2673 0302 | Fax: +91 (22) 2673 0301 | E-Mail: india@ivoclarvivadent.com
Ivoclar Vivadent Pte. Ltd.
171 Chin Swee Road | #02-01 San Centre | Singapore 169877 | Tel. +65 6535 6775 | Fax +65 6535 4991
[4] =>
DTAP0612_01_Title
DTAP0612_04_News 05.06.12 14:31 Seite 1
Opinion
DENTAL TRIBUNE Asia Pacific Edition
Dear
reader,
Microbiological
infections
4
Wim Crielaard
The Netherlands
Modern molecular analyses
and in particular next-generation
sequencing(NGS) techniques have
revolutionised oral microbiology.
Being able to analyse all oral bacteria, the oral microbiome, is of
particular relevance and importance because it is well known
that micro-organisms cooperate
collectively in a polymicrobial
ecosystem, causing chronic oral
infections, such as periodontitis.
Daniel Zimmermann
DTI
When you are reading this
words, I will have already departed to cover the 7th congress
of the European Federation of
Periodontology in Vienna. Thousands of professionals involved
in periodontology and dental
implantology are expected to
gather in the Austrian capital in
June to discuss latest research
results and concepts to fight periodontal diseases.
Studies of cultivable sub-gingival micro-organisms had already
shown that the predominant bacteria in periodontally healthy sites
are Gram-positive facultative rods
and cocci. In periodontitis, there
is a decrease in the number of
these “healthy” organisms and an
increase in the number of “pathogenic” Gram-negative rods and
spirochetes.
Although occasionally overlooked, the prevalence of those
diseases remains one of the
biggest challenges that all professionals in every field of dentistry have to face nowadays in
daily practice. From orthodontic
treatment to long-term maintenance of dental implants, almost
every clinical success depends
on a healthy periodontium.
Owing to deteriorating trends
in health like the obesity epidemic with its side effects in large
parts of the US and Europe, this
challenge is expected to rise considerably in the years to come,
since periodontal inflammation
and gum disease have been
proven to be closely related to
the general state of health.
Unfortunately, in many countries, periodontology still plays a
minor role when it comes to dental education as well as the number of chairs and positions established at universities and dental
schools.
In addition, interdisciplinary
cooperation between periodontists and other fields of dentistry
is still lacking, despite the fact
that dental professional organisations recommended to check
the periodontal status before
starting any treatment.
The participation of many
dental implant specialists at this
Europerio is a ray of hope that the
dental community is beginning
to understand that their future is
not only depending on teeth but
also on the tissue that surrounds
them. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International
Dental Tribune
welcomes comments,
suggestions and
complaints at feedback@
dental-tribune.com
Vaccination against periodontitis
Professor Lior Shapira
Israel
Prevention of disease, in this
case chronic periodontitis, is always better than cure. Developing a vaccine for periodontitis has
been a hot subject for periodontal
researchers. The old dogma was
that the role of vaccination is to
induce a humoral immune response, meaning protection by
the production of memory B cells
and antibodies against the
from Seattle was the leader in periodontal vaccination research.
They vaccinated primates with
whole-cell P. gingivalis, and
demonstrated partial protection
against experimental periodontitis. Interestingly, they found
that the levels of specific antibodies against P. gingivalis were
high in all animals that were exposed to the bacteria, immunized
and non-immunized, and antibody production was not able to
explain the protection achieved.
From then on, significant efforts were made in identifying
molecules that are virulence fac-
taining the code for the adhesive
part of an important cysteine protease of P. gingivalis, rgpA. The
vector in bacteria was expressed
by our own Dr. Asaf Wilensky,
who produced a recombinant
peptide and used it in vaccination
experiments with mice, in which
periodontitis was induced by
inoculation of P. gingivalis, and
bone loss was assessed using
micro-CT.
A recent hypothesis is that
targeting P. gingivalis may have
a community-wide impact on the
flora, and may be important for
preventing chronic periodonti-
“...we still lack data from clinical trials in animals...”
pathogen. This dogma however
is too simple. Recent evidence
suggests that immunization can
modulate the host response and
shift the response, a key element
in successful protection. The nature of the cellular response and
which molecules are secreted to
the site by these cells are critical
to disease processes, as well as
protection.
What is the process of developing a vaccine? First, we have to
identify the key pathogens, and
then identify and isolate virulence factors from the pathogens
as candidate antigens. The candidate vaccine should be tested
first in preclinical models followed by safety and efficacy tests
in humans.
Eighteen years ago, a research group headed by Roy Page
tors and may serve as good candidates for vaccine development,
with most researchers concentrating on molecules derived
from P. gingivalis. Some of its
proteins were isolated and used
for immunization studies. Many
investigators focused on a specific group of important enzymes
—cysteine proteases, which are
considered to be essential for
P. gingivalis survival and for disease pathogenesis.
Modern molecular biology
offers new approaches to making
vaccines by cloning genes from
bacteria, expressing the protein
antigen in other bacteria in culture and isolating the pure protein in the laboratory. This makes
the preparation safer and easier
to prepare. Professor Mike Curtis
from the Queen Mary, University
of London has cloned a gene con-
tis. So, how close are we to developing a periodontitis vaccine
in 2012? Well, we still lack data
from clinical trials in animals
and there is not enough preclinical data. Therefore, we are still
far from phase III experiments
in humans.
Indeed, culturing sub-gingival
micro-organisms has provided
considerable knowledge on the
pathogenic bacteria associated
with periodontitis, but unfortunately this approach is limited by
the fact that it focuses (by definition) on cultivable micro-organisms. As has been underlined frequently in the past, many oral
bacteria cannot be cultivated and
therefore conclusions are drawn
on an incomplete picture. With
this in mind, and because scientists started to realise that the
polymicrobial ecosystem actively
sustains oral health, even before
NGS, molecular microbial analyses had been developed, which
give a better, more complete
overview of the oral microbial
ecology in health and during disease.
Many molecular microbial
analyses have been targeted at a
selection of (pathogenic) microorganisms, but only open-ended
approaches, where there is no
selection for specific species to
be detected, can be used for oral
microbiome studies.
Yet, there is hope. Better understanding disease pathogenesis in animal models will help us
in developing the right vaccine
for the right target. DT
The open-ended approach that
has been most widely used for oral
microbial communities and oral
infections is the 16S rRNA gene
clone-library approach. Indeed,
by using this technique, several
uncultivated bacteria were found
to be associated with periodontitis,
but after the first NGS study in
which several orders of magnitude
(i.e. millions) bacterial 16s DNA
codes were analysed, it became
clear that so far we had only explored the tip of the iceberg. DT
Contact Info
Contact Info
Prof. Lior Shapira is Chair of the
Department of Periodontology,
Faculty of Dental Medicine, Hebrew University—Hadassah in
Jerusalem, Israel. He can be contacted at shapiral@cc.huji.ac.il.
Wim Crielaard is Professor at
the Academisch Centrum Tandheelkunde Amsterdam (ACTA)
University of Amsterdam, the Netherlands. He can be contacted
at w.crielaard@acta.nl.
[5] =>
DTAP0612_01_Title
[6] =>
DTAP0612_01_Title
DTAP0612_06-07_Tomasi 05.06.12 14:32 Seite 1
6
DENTAL TRIBUNE Asia Pacific Edition
World News
“Evidence for risk factors related
to a specific form is still weak”
An interview with Dr Cristiano Tomasi, Sweden,
on aggressive vs. chronic periodontitis
Dr Cristiano Tomasi
Aggressive and chronic periodontitis share many clinical
features yet are also different
in terms of development and
progression. On occasion of
Europerio 7 in Vienna this
month, Dr Cristiano Tomasi
from the University of Gothenburg in Sweden spoke
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with DTI Group Editor Daniel
Zimmermann about the importance of early identification
and why the identification of
risk factors associated with
both forms of periodontal disease remains difficult.
Daniel Zimmermann: Both
chronic and aggressive periodontitis are complex infections. What is the basic microbiology underlying this disease?
Dr Cristiano Tomasi: Probably the most important microbiological feature is the establishment of a sub-gingival
biofilm. The evidence suggests
that periodontal disease is not
related to a specific micro-organism but rather to a complex
environment of many different
species that live in symbiosis.
In a susceptible subject, the
biofilm challenge will prompt
a host response that will lead to
the destruction of periodontal
support.
It is estimated that between ten and 15 per cent of
adults in developed countries
suffer from chronic periodontitis. Are there any figures
available for the aggressive
form?
This question is not easy
to answer. In fact, even for
chronic periodontitis, prevalence differs significantly, depending on disease definition
and the population studied.
Furthermore, most epidemiological studies have only addressed the prevalence of periodontitis, with no distinction
between the aggressive and
chronic forms.
The range in prevalence
when mild cases are included
may reach 40 per cent in a population. The prevalence of the
aggressive form, according to
one study, was four per cent for
localised forms and two per
cent for generalised forms in a
population ranging between
the ages of 18 and 30. Other
studies have suggested prevalence of severe cases in a young
population of up to eight per
cent.
Generally speaking, we still
lack epidemiological data from
studies that directly address
this question.
One of the main differences between both forms appears to be the age group in
which they commonly occur.
Age remains an important
parameter for distinguishing
the two forms. While severe
cases at age 20 are commonly
recognised as aggressive, those
at 60 are mainly diagnosed
as chronic. The diagnosis of
[7] =>
DTAP0612_01_Title
DTAP0612_06-07_Tomasi 05.06.12 14:32 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
both forms, however, is clinical
and basically follows the same
steps.
A problem is that in many
cases it is not actually possible
to identify the age at which the
periodontal disease started, so
it is not easy to draw conclusions on clinical features related to age of onset.
What are the main challenges in differentiating between both forms?
I really think that the most
important thing is to diagnose
and intercept periodontitis as
early as possible. A screening
probing can reveal initial periodontal destruction and signs
of inflammation quite easily, allowing for an early and effective
intervention.
World News
“If we are successful in our
treatment, is it really important
how what we call the disease?”
How important would
these be considered to be?
Unfortunately, it is still not
clear. Some risk factors are
related to the establishment of
the disease, while others are
related to the progression rate.
As I said before, the evidence
for risk factors related to a specific form is still weak and the
evidence not as strong as we
would like it to be.
You have presented at the
7 congress of the European
Federation of Periodontology.
What can participants expect
to take home from the presentation?
th
I hope to clarify the similarities and differences between
the two forms of periodontitis.
We will go through the most recent published results on those
issues and try to sort things out
as much as possible.
I see this as a real challenge.
I will share my thoughts and my
doubts on some questions that
every clinician has to face on a
daily basis.
Thank you very much for
this interview. DT
AD
T
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ork
Marking the fine distinction
between aggressive and chronic forms could be another step,
but the implications of these
studies would be more interesting for researchers than for clinicians. If we are successful in
our treatment, is it really important what we call the disease?
And if we are not successful, do
we blame the name of the disease?
One clinical consideration
may be that the systemic use of
antibiotics as adjunctive treatment is supported by studies
on aggressive cases, but I think
that with regard to the problem
of microbial resistance induced
by excessive use of antimicrobials, this approach should
never be the choice for initial
treatment, but be considered
after re-evaluation to accompany mechanical retreatment
of the remaining diseased sites.
This view, however, is not
shared by some periodontologists, who view the first treatment attempt as the important
one.
Both forms of periodontitis share risk factors. What
are the most common?
Periodontal disease is clearly the result of an unbalanced
host response to the microbial
challenge. It is therefore obvious that the genetic set-up of
the host and the microbial
composition of the biofilm are
recognised as risk factors for
the development of the disease.
Environmental factors like
smoking and stress have also
been correlated with the progression of the disease and its
most severe forms.
It is a more difficult task to
determine risk factors that are
clearly associated with one of
the two forms of the disease.
A few studies have shown specific bacteria to be associated
with aggressive forms, but others have also reported aggressive forms without the presence
of those bacteria. The same
thing happened with specific
genetic polymorphisms. New
insights are expected to come
from epigenetic studies, in
which the activation of specific
genes is related to local environmental factors.
7
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[8] =>
DTAP0612_01_Title
FDI World Dental Federation
Leading the World to Optimal Oral Health
2012 Hong Kong
FDI Annual World Dental Congress
29 August - 1 September 2012
1. Celebrate the uniqueness of FDI at its
100th Annual World Dental Congress;
6. Enjoy exclusive face-to-face encounters
with your peers worldwide;
2. Learn about the latest developments
from international and regional experts;
7. Develop your knowledge and skills
through a new and innovative programme;
8. Sample some of the best cuisine
in Asia: one restaurant for every 600
inhabitants!
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
Hong Kong and Macau;
10. Uncover the riches and mysteries of
mainland China.
Leading the world into a new century of oral health
www.fdicongress.org
congress@fdiworldental.org
Design: b’com · +33 (0)6 50 46 60 70
10 reasons to join FDI in Hong Kong,
World Oral Health Capital 2012
[9] =>
DTAP0612_01_Title
DTAP0612_09_Zamanian 05.06.12 14:32 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Business
9
Conical internal connections will fuel future
growth in European dental implant market
Dr Kamran Zamanian & Ian van den Dolder
iData Research Inc., Canada
rapidly developing the quality
of the medical services they
offer.
The dental implant and bone
graft substitute market is the
most rapidly advancing segment of dental technology,
and leading competitors in
this market must consistently
develop new products supported by research from scientific and academic organisations to remain competitive.
Recent cases have demonstrated that when companies
lose a segment of support
from the scientific community, their market shares tend
to suffer significantly.
The European dental implant and bone graft substitute
market has been further challenged by recent economic
instability and the eurozone
crisis, which has created a consistent demand for lower-cost
dental implant products. As a
result, many lower-priced competitors have begun to seize
larger market shares in almost
every European market. In
many segments, these competitors are either regional or
sourced from overseas markets such as Brazil, Korea and
Israel. Regenerative products
and barrier membranes have
been particularly affected by
consumer austerity, as these
products are discretionary in
many cases.
However, a growing number of consumers continue to
demand high-quality products,
guarantees of service and scientific improvements, which
only premium manufacturers
are equipped to offer. Conical
internal connections is one
such recent innovation, and
currently constitute the fastestgrowing connection type in the
dental implant industry.
Many dental implant and
bone graft substitute companies have looked to expand
their product portfolio or create
new markets while they create
package deals to offset competition from rapidly emerging
lower-priced competitors. Significantly, many European and
US companies involved in this
market have begun to invest
in rapidly emerging periphery
markets such as Turkey.
Increasing prevalence of
conical internal connections
Dental implants are connected to final abutments in
one of three ways: internal connections, external connections
or single-unit devices in which
the implant and abutment are
already attached. Furthermore,
internal connections have two
sub-segments: butt-joint in ternal connections and conical
internal connections.
Research has shown that a
lack of intimate fit of the im-
The UK features one of the
highest rates of outbound dental tourism, as patients are
unaccustomed to large out-ofpocket costs for procedures,
owing to the legacy of the National Health Service. Whereas
rich patients from developing
countries used to come to prestigious hospitals in the UK and
elsewhere for treatment, outbound medical travel from the
UK has been growing far faster
than inbound over the past
decade, as UK patients are increasingly traveling abroad for
lower-cost care. Figures suggest more than 50,000 citizens
of the UK go abroad for treatment annually. The number
of outbound medical tourists
from the UK rose by 170 per cent
from 2002 to 2009.
View of Istanbul at sunset. Turkey is expected to become one of the major growth markets for dental implants in Europe.
(DTI/Photo Tatiana Popova)
“...this market is expected to overshadow
butt-joint internal connections increasingly...”
plant in the abutment or movement of the implant can provide
an area for bacterial growth.
Conventional butt-joint connections provide a connection
that can result in micro-movement between the implant and
the abutment, creating a pump
effect for bacteria into the connection area. When bacteria
are present in the micro-gap,
they can cause inflammation,
tissue recession and bone loss.
Recent clinical studies have
demonstrated that, on average,
conical connections offer a
smaller micro-gap than buttjoint connections, in addition
to a greater mechanical level
of stability. As a result, conical
connection types have become
hugely successful in the dental
implant market, and the majority of leading dental implant
manufacturers have introduced
conical internal connection
products. Conical connection
types will continue to represent
one of the fastest-growing segments of the dental implant
market.
nies to establish domestic subsidiaries or local distribution
partners, fuelling options for
consumers. Turkey is also a
popular destination for dental
tourism, especially among patients from more expensive European markets. From 2008 to
2018, the Turkish dental implant, final abutment and computer-guided surgery market
is expected to grow at a compound annual growth rate of
20.4 per cent.
that will offer lower-priced
products to compete domestically and later internationally
with larger implant companies.
EU medical tourism
to strongly impact dental
implant market
The EU directive on crossborder healthcare that comes
into force in 2013 will have a
strong impact on the European
dental implant market. This
directive will target the medical
Turkey one of the fastest
growing markets in the world
Turkey is one of the fastestgrowing dental implant markets, congruent with strong
economic growth that weathered the recession far better
than the US and nearly any region in Europe. The technology of dental implants in this
country has advanced rapidly,
as most of the major players in
the European market moved
quickly to gain a strong market
share in Turkey. Additionally,
this market benefits from low
labour costs, which adds to the
incentive for implant compa-
Fig. 1: Unit share by connection type, Dental Implant Market, Europe, from 2008
to 2018. (Image courtesy of iData Research Inc.)
In May 2011, AGS Medikal
Ürünleri, the first major Turkish company to produce dental
implants, commenced operations in the province of Trabzon,
on the coast of the Black Sea.
The company was established
with an initial 5 million Turkish
lira investment. Market experts
predict that the company will
soon be joined by other Turkish
dental implant manufacturers
tourism market, which is significant, as dental treatment procedures account for nearly half
of medical tourism in most
major markets. The directive
gives patients the right to be
reimbursed for treatment they
receive in other EU countries.
This could lead to more Western Europeans traveling to
Eastern Europe, including Poland and Bulgaria, which are
Dental implant companies
follow success of conical
internal connection
Internal connection types as
a whole are becoming increasingly dominant in the dental implant market. Conical internal
connections and butt-joint internal connections represented
83.4 per cent of implants with
an internal connection in 2011.
Conical internal connections is
the fastest-growing segment of
the market and expected to increase at a compound annual
growth rate of 10.1 per cent by
2018.
NobelActive (Nobel Biocare)
was one of the foremost early
successes of conical connection
types, and was rapidly adopted
by consumers owing to clinical results demonstrating its
greater stability and smaller micro-gap between implant and
abutment. The majority of large
companies now offer a conical
connection, as this market is
expected to overshadow buttjoint internal connections increasingly owing to the greater
stability and perceived smallerdiameter micro-gap offered by
conical internal connections.
Many companies are combining
these connection types with tapered shape and surface treatments as the current generation
of premium products. DT
The information contained in this article was taken from two detailed and
comprehensive reports published by
iData Research (www.idataresearch.net),
entitled “European Markets for Dental Implants, Final Abutments and
Computer Guided Surgery” and “European Markets for Dental Bone Graft
Substitutes, Dental Membranes and
Tissue Engineering.”
iData Research is an international market research and consulting firm focused on providing market intelligence
for the medical device, dental and pharmaceutical industries. For more information and a free synopsis of the above
report, please contact iData Research
at dental@idataresearch.net.
[10] =>
DTAP0612_01_Title
DTAP0612_10_Business 05.06.12 14:32 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
10 Business
3Shape scanner bundled with Dental System software
Dental Tribune International
COPENHAGEN, Denmark:
The D500 scanner series
from 3Shape has been bundled with the company’s
Dental System Standard software. According to the Danish
manufacturer, the package provides a range of scanning and
designing tools that dental labs
need for entry to CAD/CAM for all
the basic dental indications. This
AD
includes 3Shape’s flexible Sculpt
Tools, the new telescope design
workflow, 3Shape Communicate and the TRIOS Inbox,
which connects the lab directly to the dentist using
TRIOS digital impression
taking.
The software is upgradable to Dental System Premium, which covers a number of
additional indications. It can also
be extended with the company’s
wide range of add-on modules
such as Adaptive Impression
Scanning, the company said.
The D500 3-D scanner series
has been developed for use in
small to medium-sized labs that
are looking for an easy and
fast entry into digital processing.
The compact device is built on
3Shape’s market-proven scanning technologies, including the
three-axis motion system for
complete capture of impressions,
deep inlays and full undercuts.
According to 3Shape, the D500
is one of the fastest entry-level
scanners on the market and a
cost-efficient choice without compromising quality and speed.
3Shape offers different pricing models for the D500 bundle
to meet the requirements of any
lab in any market. Lab professionals are advised to contact
their local 3Shape reseller for
pricing information. DT
Equity fund
acquires
Aussi lab biz
Dental Tribune Asia Pacific
SYDNEY, Australia: Southern
Cross Dental Laboratories is seeking new growth opportunities in
the Pacific and European markets
with a deal that will leave private equity firm Ironbridge with a
60 per cent majority stake in the
Australian company. The major
transaction has a reported value
of A$95 million (US$93.4 million)
and is Ironbridge’s first investment in the dental industry.
The acquisition is also the closing investment in Ironbridge’s
second investment fund, worth
A$1 billion, through which the
firm has already acquired a waste
disposal business and service
provider to the offshore gas and oil
industry. In addition, the company
has stakes in the private health
care market, including hospital
operations and pharmaceuticals.
Founded by Dr David Penn,
a dentist and developer of dental appliances such as the Penn
Composite Stent, Southern Cross
currently provides laboratory
services (including crowns, bridges and invisible braces) to dentists
in Australia, New Zealand, Ireland
and the UK. It also offers courses
on dental procedures, including
Invisalign and intra-oral scanning. In its home market, Southern
Cross is estimated to have a market
share of almost 30 per cent.
Penn told the Australian Financial Review that he will be leading
the new holding together with
Ironbridge’s Chief Executive Neil
Broekhuizen. He said that, while
Ironbridge will have a 40 per cent
stake in Southern Cross’s previous
business in Europe, it will be fully
responsible for operations in Australia and New Zealand.
“We are growing nicely and
there are some incredible opportunities,” Dr Penn was quoted as
saying. “It was time to bring in a
partner to help take the company
to its next stage of growth.” Southern Cross’s business has grown by
20 per cent a year lately, according
to Penn. DT
[11] =>
DTAP0612_01_Title
[12] =>
DTAP0612_01_Title
DTAP0612_12-14_Weisrock 05.06.12 14:33 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
12 Trends & Applications
Extending the boundaries of feasibility
in direct restorative procedures
A clinical case combining a high-performance material and clearly defined protocol
Dr Gauthier Weisrock
France
Modern high-performance composite materials and standardised treatment protocols have
led to more direct composite
restorations being fabricated
in the anterior region than
ever. Even extremely challenging cases may now be
treated chairside with predictable results and minimal
loss of tooth structure.
A 24-year-old female patient
presented at our practice with a
request regarding aesthetics.
She disliked the appearance of
tooth #11, which showed severe
discolouration after endodontic
treatment. A clinical examination revealed that the root had
been extirpated after an accident and that a fractured piece
had been reattached with a
composite material (Figs. 1 & 2).
Upon radiological examination,
it was found that the root-canal
treatment had been performed
correctly. However, a post had
not been used.
Owing to the fact that approximately half of the original
tooth structure had been lost,
we opted for a direct composite restoration, provided that
a tooth-whitening procedure
could be successfully completed. Along the spectrum of
possible treatments, this approach is located between “conventional” composite restoration and ceramic veneering
and, therefore, appeared to be
clinically appropriate.
The patient, whose primary
concerns were a natural tooth
shade and minimal loss of tooth
structure, agreed to the recommended procedure. We decided
to use the nano-hybrid composite IPS Empress Direct (Ivoclar
Vivadent) to fabricate the restorations. In addition to dentine and enamel materials, this
product is also available in an
opalescent material version.
Preliminary treatment
First, internal bleaching was
performed on the tooth, on
which the success of treatment
Fig. 5
Fig. 1
Fig. 2
Fig. 1: Severely discoloured tooth#11.—Fig.
2: The shape of tooth #11 appeared to be harmonious with tooth #21. The substance loss
amounted to somewhat less than half of the
tooth.—Fig. 3: After the bleaching procedure,
the shade of tooth #11 was optimal.—Fig. 4:
Prepared tooth #11 with vestibular chamfer
and straight, right-angle palatal margin.
the dentine for 15 seconds. Both
were then thoroughly rinsed
and dried.
Fig. 3
Fig. 4
would depend. Access to the
endodontic chamber was created through the old restoration.
The gutta-percha increment
was removed up to 3 mm below
the cemento-dentinal junction.
At the bottom of the cavity, a plug
with a thickness of 2 mm made of
glass ionomer cement was inserted to prevent the bleaching
agent from accessing the sensitive areas. We used a mixture of
sodium perborate and distilled
water for the bleaching procedure. The access to the cavity
was then sealed with a temporary material.
Since the desired tooth
shade was not achieved upon
initial bleaching, the entire procedure had to be repeated after
one week. After another week,
the result was finally optimal
(Fig. 3). In order to neutralise
the bleaching agent, calcium
hydroxide was placed into the
cavity and left in place for at
least one week. (An adhesive
may only be applied 15 days after conclusion of the bleaching
procedure, in order to ensure
optimum adhesion and stable
shade.)
Aesthetic diagnosis and
shade determination
After tooth-shape analysis,
we concluded that the propor-
Fig. 6
tions were harmonious compared with tooth #21. In order
to avoid a misinterpretation of
the shade owing to dry adjacent teeth, the tooth shade was
determined prior to any intervention and in daylight. The
IPS Empress Direct shade guide
was used for the determination
of the enamel and dentine materials. We determined the dentine shade based on the cervical
third and the enamel material
based on the incisal third of the
adjacent tooth. Particular attention was paid to the anatomical structure of the adjacent
tooth and the various opalescent reflections visible on the
incisal surface, since it was our
aim to imitate these features.
A layering diagram detailing all
the materials that we planned to
use was prepared. In this case,
only four shades were used:
A3/A2 Dentin, A2 Enamel and
Trans Opal.
Subsequently, we created
a palatal silicone key on tooth
#11 with the appropriate shape
and occlusion. Once in place
intra-orally, this key helped to
create the palatal wall of the
restoration in one step. The key
included the teeth adjacent to
the tooth that needed to be restored and covered the incisal
area.
Preparation and application
of the adhesive
The existing restoration was
removed with the help of both
rotary and ultrasonic instruments and with care to prevent
any damage to the adjacent
teeth. During the preparation
of the tooth, the mechanical
properties of the material used
and the aesthetic integration
needed to be taken into account. In the case of IPS Empress Direct, the ideal preparation design involved a vestibular chamfer and a straight,
right-angle proximal and palatal margin (Fig. 4).
Before proceeding with the
adhesive cementation, it was
necessary to protect the operatory field from saliva or blood
in the oral cavity. Therefore,
we isolated the anterior teeth,
including the canines, with
a rubber dam. The expanded
treatment area allowed us to
assess the incisal line, and the
size and shape of the adjacent
teeth.
We checked whether the
silicone key could be positioned
exactly. (If required, interfering areas can be adjusted using
a scalpel until a precise fit is
achieved.) The enamel areas
were etched for 30 seconds and
Subsequently, the adhesive
was applied, while the adjacent
teeth were protected with a
metal matrix. We used the
ExciTE F total-etch adhesive
(Ivoclar Vivadent) for this step.
Owing to the non-retentive
preparation design and the fact
that most of the restoration
would be created on enamel,
this type of adhesive proved superior to self-etching products.
In order to facilitate penetration
into the dentine tubules, the adhesive was gently massaged into
the cavity walls. (After the adhesive has dried, the cavity must
exhibit a glossy appearance. If
this is not the case, the procedure needs to be repeated.)
The adhesive was then lightcured for 10 seconds with a
bluephase curing light (Ivoclar
Vivadent).
Building up the palatal
and proximal walls
As a first step, the palatal
enamel was built up. A thin layer
of enamel material (shade A2)
of less than 0.5 mm was applied
to the palatal key and smoothed
out with a brush. Then the key
loaded with composite material
was placed in the mouth and the
fit was checked again. If necessary, the material may be modified before it is polymerised for
10 seconds.
Fig. 7
Fig. 5: Creating the palatal wall with enamel material (A2 Enamel).—Fig. 6: Designing the proximal area and the transition lines.—Fig. 7: Building up the palatal and proximal areas, or transforming a complex preparation
into a simple one.
[13] =>
DTAP0612_01_Title
DTAP0612_12-14_Weisrock 05.06.12 14:33 Seite 2
DENTAL TRIBUNE Asia Pacific Edition
Fig. 8
Fig. 9
Trends & Applications 13
Fig. 10
Fig. 8: Application of dentine material in shade A3.—Fig. 9: Application of dentine material in shade A2. The previous layer was entirely covered with this material.—Fig. 10: Application of a covering layer of enamel material in shade A2.
AD
The palatal wall created in
the process showed the exact
desired shade and did not touch
the adjacent teeth (Fig. 5).
Applying a thin layer of
enamel material (A2) to the
proximal walls changed the
complex cavity into a simple
one. In order to create the thin
layer, we fixed a transparent
matrix in place with a wooden
wedge, which allowed us to
create the transition lines (the
convex area that separates the
proximal from the vestibular
area)—the restorative outcome
is influenced by the successful
design of these transitional areas because it is not possible to
design them with rotary instruments. We then applied composite material from the distal
side of tooth #11, while tightening the matrix from the opposite
side and polymerising the material in this position (Fig. 6).
Thus, sufficient composite material could be added until the
desired transition area was
achieved. The mesial side was
built up in the same manner
(Fig. 7).
More reliable
caries detection
Building up the dentine core
Using dentine materials, a
restoration is created that
shows decreasing saturation
from the cervical to the incisal
and from the palatal to the
vestibular area. In order to
achieve this, a 3-D layering
technique is applied, using
materials with different levels
of saturation. In our case, a material with a saturation one
degree higher than the desired
final tooth shade was applied.
Therefore, dentine material in
shade A3 was used in the area of
the cervical margin.
The layer was applied to the
palatal wall using a flat spatula
suitable for composite resins
(Fig. 8). Subsequently, a layer
consisting of dentine material
with a lower saturation was applied (shade A2). A pointed silicone instrument was used to
design a slightly wavy margin
covering half of the chamfer up
to 1 mm below the incisal edge
(Fig. 9). (If this technique is applied, the translucency of the
enamel material becomes visible in the area of the incisal
edge and the transition from
tooth structure to composite
material is masked.)
Each layer was polymerised
with the bluephase curing light
for ten seconds.
‡ DT page 14
Scan the QR code
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[14] =>
DTAP0612_01_Title
DTAP0612_12-14_Weisrock 05.06.12 14:33 Seite 3
14 Trends & Applications
DENTAL TRIBUNE Asia Pacific Edition
fl DT page 13
Designing the enamel portion
The opalescence effect was
enhanced by applying a thin
layer of Trans Opal material
in the area of the incisal edge.
Since the visible effect of this
material is very intense, only
a small amount could be used.
An enamel layer (shade A2)
was applied in several steps to
the vestibular area, then contoured with brushes and cured
for ten seconds. This enamel
AD
Fig. 11
Fig. 15
Fig. 11 & 12: The restored tooth #11 exhibits a harmonious appearance, achieved with a minimal loss of tooth structure.
material covered the entire restoration (Fig. 10).
Finishing and polishing
The patient’s teeth exhibited a very pronounced macroand microtexture (vertical pits
and horizontal streaks, respectively). Imitating these features
to achieve a lifelike reflection
on the restorative surfaces was
a challenging task.
This step was similarly important to determining the
appropriate shade. We imitated
the surface texture with finegrain diamond-coated burs,
using flame- and lens-shaped
instruments (first with the red
and then with the yellow colour
code). The burs were used in
the red handpiece without water irrigation.
Another important step was
the finishing of the transition
lines and the interproximal
areas. It is advisable to use
abrasive strips for this purpose
because rotary instruments
may produce flat areas that
cause inappropriate reflections.
OptraPol Next Generation polishers (Ivoclar Vivadent) with
water irrigation were used for
the polishing process. We always take great care to polish
restorations perfectly whilst
avoiding any damage to the surface texture we design. The polishing was greatly facilitated
as a result of the extraordinary
polishability of this composite
material (Fig. 11 & 12).
Conclusion
Owing to high-performance
materials such as IPS Empress
Direct, which are consistently
improving, and a clearly defined approach, we may use
direct restorations for more
indications than ever before,
thus constantly extending the
boundaries of feasibility. The
advantage of direct restoration
procedures is that they are time
saving and conservative. Nevertheless, it may happen that
directly restored teeth show
discolouration again in spite of
the perfect aesthetic outcome.
In this case, another treatment
is inevitable. DT
Contact Info
Dr Gauthier Weisrockis a dental surgeon from Marseille
in France. He can
be contacted at
gauthier.weisrock
@gmail.com.
[15] =>
DTAP0612_01_Title
DTAP0612_15_Dieter 05.06.12 14:35 Seite 1
DENTAL TRIBUNE Asia Pacific Edition
Trends & Applications 15
“Lecture theatre”—a new interactive
concept—on chairside CAD/CAM dentistry
An interview with Dr Michael Dieter, Ivoclar Vivadent, Liechtenstein
To be held for the first time in
South-East Asia, the seventh
CAD/CAM & Computerized
Dentistry International Conference in Singapore in October will offer a detailed
overview of the latest CAD/
CAM technologies that are
aimed at helping dentists
achieve aesthetic and longlasting all-ceramic restorations chairside. During a presentation in Cape Town, South
Africa, Dental Tribune Asia
Pacific had the opportunity to
speak with Ivoclar Vivadent’s
Dr Michael Dieter, head of
the International Center for
Dental Education, who will
be hosting the lecture theatre
together with Jörg Vogt, international CEREC trainer for
Sirona.
Dental Tribune Asia Pacific:
Dr Dieter, your joint presentation with Mr Vogt in Singapore
will be held in form of a lecture
theatre. What is behind this
concept?
Dr Michael Dieter: Jörg
Vogt and I developed this concept two years ago. When the organiser’s managing director, Dr
Dobrina Mollova, saw our performance at the sixth CAD/CAM
& Computerized Dentistry International Conference in Dubai
last year, she named it a “lecture
theatre” because of its truly interactive nature. Jörg and I present in continuous dialogue with
each other, which makes the lecture more interesting, not only
for the audience but also for us.
Additionally, case demonstrations with the CEREC AC will be
performed live on stage.
Primarily, our lecture is
aimed at dentists who are interested in minimally invasive
aesthetic treatment solutions or
who simply want to get into dental CAD/CAM technology. Our
goal is to provide a guideline
clinical treatment sequence for
predictable treatment using
chairside CAD/CAM technology. However, the lecture is also
suitable for any dentist who is
interested in all-ceramics as a
modern restorative treatment
option.
From my experience, I can
say that many practitioners still
have little knowledge of what
all-ceramic material they are
supposed to use for various
clinical situations. With our lecture theatre, we aim to demonstrate the main differences in
terms of aesthetics, particularly
for use in the anterior dentition, and the physical properties or strength of the various
all-ceramic systems.
What do you think the reason is for this lack of knowledge?
ferent preparation design compared with the commonly used
metal alloys or metal ceramics.
If mistakes are made at the beginning, fracture of the restoration becomes much more likely.
Therefore, preparation techniques for all-ceramics with regard to CAD/CAM application
will be in focus as well.
Dr Michael Dieter
Recently, we have seen the
rapid development of materials
and technologies. For the practitioner, it is sometimes difficult
to keep up with all these new
developments. This is why con-
What impact has CAD/CAM
technology had on the usage
of aesthetic restorations in
the dental practice?
With CEREC, CAD/CAM
technology has been available
for chairside application for
more than 27 years. So this is
a well-documented procedure
with long-term clinical success.
Today, there are approximately
34,000 CEREC units in use,
which demonstrates impressively that this technology is
still driving aesthetic dentistry
in the clinical practice.
sents the aesthetic limitation of
chairside CAD/CAM.
Have restorations become
more complex with chairside
CAD/CAM?
On the one hand, yes, the
procedure has become somewhat more complex because
the dentist is also responsible
for the design, milling and surface finishing of the restoration.
On the other hand, impressions
and temporaries are no longer
necessary, which makes restoration easier for both the dentist
and the patient.
What are the critical factors for achieving successful
long-term clinical outcomes?
In addition to the factors
described above, cementation,
particularly for glass-based ceramic restorations, is a clinical
step of paramount importance
for long-term clinical success,
“...cementation is a very important
factor and still underestimated
by many dentists.”
tinuous education is becoming
more and more important.
If we look at the increasing
number of all-ceramic systems
on the market that manufacturers claim to be aesthetic,
we can in fact perceive significant differences. The questions
remain: what does “aesthetic”
mean, and how suitable are
these materials in clinical reality? This is exactly what we
will be discussing in our lecture: translucency, opalescence
and fluorescence—these optical properties of the natural
tooth can be reproduced in
the patient’s mouth with select modern all-ceramic materials.
While I will focus on the
treatment sequence from a
clinical perspective, Mr Vogt
will provide insights into the
CAD/CAM process using the
CEREC AC and the latest software (version 4.03). He will
demonstrate live, step-by-step,
how to design the restorations
and I will illustrate the related
clinical cases.
What are the most common mistakes when choosing
materials?
Selecting the right material
is not the only difficulty. The
correct tooth-preparation technique remains a challenge for
many dentists because all-ceramics require an entirely dif-
The main indications are
inlays, onlays, partial crowns,
full crowns and veneers. In addition, up to four-unit posterior
bridges are now possible, either
as a temporary solution with
polymer blocks (e.g. Telio CAD,
Ivoclar Vivadent) or as a permanent restoration with a highstrength zirconium dioxide/
lithium disilicate material (e.g.
IPS e.max CAD-on, Ivoclar
Vivadent).
What are the aesthetic limitations of chairside CAD/
CAM?
Generally, posterior restorations like inlays, onlays and
crowns can be realised with
good aesthetic results. With anterior restorations like crowns
and veneers, the aesthetic outcome largely depends on the
adjacent teeth that we have
to match intra-orally. Highly
aesthetic colour gradients for
CEREC restorations can be
achieved with polychromatic
blocks (e.g. IPS Empress CAD
Multi, Ivoclar Vivadent) or by
shading and staining monochromatic lithium disilicate
blocks (e.g. IPS e.max CAD,
Ivoclar Vivadent).
since it is directly linked to the
aesthetic outcome and the fracture strength of the final restoration. Which ceramics have
Many speak of CAD/CAM
technologies as the next revolution in dentistry. Do you
agree?
I would say that the revolution will continue. I am still
fascinated by the materials and
the manufacturing process. Allceramic restorations are not
only aesthetically pleasing but
also minimally invasive. Therefore, patients benefit not only
from better looking teeth, but
also from the fact that much less
natural tooth substance has to
be removed compared with traditional restorative techniques
and materials.
The next few years will show
what CAD/CAM manufacturers
have kept in reserve, both
chairside and labside. Materials manufacturers like Ivoclar
Vivadent will continue to develop highly aesthetic and userfriendly all-ceramic systems
that aim to further reduce the
minimum material thickness—
requiring even less invasive
tooth preparations—to the benefit of the patient.
Thank you very much for
this interview. DT
AD
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[title] => Novel biosensor for use on teeth
[page] => 01
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[page] => 09
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Table of contents
-
Novel biosensor for use on teeth
01 - 01
view
-
Asia News
02 - 03
view
-
Opinion
04 - 04
view
-
“Evidence for risk factors related to a specific form is still weak”
06 - 07
view
-
Conical internal connections will fuel future growth in European dental implant market
09 - 09
view
-
Business
10 - 10
view
-
Extending the boundaries of feasibility in direct restorative procedures
12 - 14
view
-
“Lecture theatre”—a new interactive concept—on chairside CAD/CAM dentistry
15 - 15
view
[toc_titles] => Novel biosensor for use on teeth
/ Asia News
/ Opinion
/ “Evidence for risk factors related to a specific form is still weak”
/ Conical internal connections will fuel future growth in European dental implant market
/ Business
/ Extending the boundaries of feasibility in direct restorative procedures
/ “Lecture theatre”—a new interactive concept—on chairside CAD/CAM dentistry
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