DT Asia Pacific No. 6, 2014

India targets fluorosis problem with new identification system / Asia News / Opinion / World News / Business / Special: Infection Control / Minimally invasive treatment of stained anterior teeth / Endodontic restorations in one single step / A state-of-the-art device for 3-D scanning / today APDC Dubai 2014

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DTAP0614_01-03_News 04.06.14 13:04 Seite 1

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DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

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

PUBLISHED IN HONG KONG

www.dental-tribune.asia

NO. 6 VOL. 12

Mimicking nature
MI treatment of stained
anterior teeth

The Endo-Resto System
Endodontic restorations
in one single step

Special
Practice hygiene
and Infection control
4Page

4Page

India targets fluorosis problem
with new identification system

Anniversary
newspaper
published

DT Asia Pacific

Worldental Daily, the daily
newspaper of the Annual World
Dental Congress (AWDC) of the FDI
World Dental Federation which
will be published by the organisation in partnership with the Dental
Tribune International Publishing
Group (DTI) for the tenth time in
2014. The anniversary edition will
be available at the FDI’s 102nd AWDC
in Greater Noida near New Delhi,
India, in September.

NEW DELHI, India: The Indian
Council of Medical Research
(ICMR) in New Delhi has said that
it has tested a new and simpler
system that could help to identify
dental fluorosis in the population.
The tool is based on photographic
information from patients with the
conditions gathered from several
districts in India, and can be used
by health workers without prior
knowledge in dentistry.
(DTI/Photo Gary Yim, Hong Kong)

First tests conducted with the
new system by an ICMR Task Force
among schoolchildren in the South
Delhi and Hisar districts turned
out successful, with little difference
found in regard to detection rates of
dental specialists and field workers
unfamiliar with fluorosis, the Council said. With this tool, the organisation hopes not only to help health
workers nationwide to detect the
condition its early stages but also to
gather reliable national data on the
prevalence of flourosis, which is considered to be a major public health
problem owing to the excessive intake of fluoride through drinking
water in most parts of India.

Girl in Mumbai getting water from a well. Children in particular are suffering from the negative effects of water fluoridation.

Although representative data in
the country is lacking, results from
different studies suggest a high
prevalence in areas with high water
flouridation. If the condition is not
detected, it can lead to skeletal fluorosis, a condition that causes bone to
lose its flexibility through the accu-

mulation of osseous tissue. It has also been associated with renal failure,
atherosclerosis and other diseases.
Fluorosis is commonly identified through Dean’s Index, a fivestage classification system developed in the late 1930s by H. Trendley

Dean, one of the most prominent
advocates for water fluoridation
in the United States. Alternatives
include the Thylstrup-Fejerskov
Index, developed in Denmark in
the 1970s, and the US National Institutes for Dental Research’s Total
Surface Index of Fluorosis. DT

DTI produced the first edition of
Worldental Daily for the AWDC in
Montréal, Canada, in 2005. Since
then, the newspaper has been available to congress attendees at every
AWDC including those in Dubai,
Hong Kong and Istanbul. Every
edition of the newspaper is made
with support of local partners and
printed overnight, so that visitors
can keep constantly up-to-date with
what is happening during the event.
In addition to Worldental Daily,
DTI publishes daily newspapers
under its today international brand
at almost every major dental event
around the globe, including the
IDS in Cologne or the IDEM in
Singapore. DT
AD

Dental
sector
opened
(DTI/Photo Gerhò, Italy)

Picture shows a new dental application for Google Glasses introduced by the Italian
company Gerhò at Amici di Brugg in Rimini in Italy. The tool allows dentists to
manage their practice via the novel head-mounted internet device. 4BUSINESS, page 6

Pioneers receive
benefits

Bond teeth creator
prosecuted

The government in Singapore has introduced new health
care benefits under the Com munity Health Assist Scheme
for the country’s pioneer gener ation that include subsidies for
selected dental services like
crowns or root canal treatment.
The package will apply to almost
half a million elderly people. DT

The General Dental Council
in the UK has fined Luis Fairman
for unlawfully using the title of
dental technician. Fairman created the iconic metal teeth of
infamous James Bond villain
jaws, which were worn by actor Richard Kiel in the films
“The Spy Who Loved Me” and
“Moonraker”. DT

The Philippines has announced modifications to its
Negative Investment List that,
among other things, will remove
barriers for businesses from the
ASEAN region to invest in specialised dental clinics and other
health care related businesses.
According to the new regulations, which took effect in April,
foreigners are now allowed to
own between 67 and 70 per cent
of a health care related business
that is based in the South East
Asian country.
Foreign direct investments
to Indonesia currently exceed
domestic direct investments by
almost 100 per cent. In 2013,
foreigners invested more than
270 trillion (US$22 million) in the
Philippines economy. DT

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DTAP0614_01-03_News 04.06.14 13:04 Seite 2

U P C O M I N G

DENTAL TRIBUNE

Asia News

WEBINARS Dental routine
practised among early
inhabitants of China
DT Asia Pacific

DENTAL TRIBUNE AMERICA IS AN ADA CERP RECOGNIZED PROVIDER

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.

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.

According to the scientists,
the findings are the first evidence
of the habit ever recorded in
Eastern China. Along with other
Pleistocene fossils from the
country, it also confirms the hypothesis that the earliest use of
tools was by the Homo genus,
they said. To date, it remains
unclear, however, whether the
grooves found in the enamel and
root surfaces of the teeth indicate
a therapeutic purpose.
“It has been suggested that
the use of toothpicks is unique
to the genus Homo, and toothpicking could have accompanied
the dietary shift to heavier reliance on animal protein. Thus,
in Yiyuan teeth, the proposal that
tooth-picking with a hard nee-

(DTI/Photo E.G.Pors)

SINUS LIFT PROCEDURES
IN THE DAILY PRACTICE

JINAN, China/OXFORD, UK:
Early ancestors of humans who
lived in Eastern China almost
half a million years ago might
have regularly used toothpicks,
anthropologists have recently
suggested in the specialist journal Quaternary International.
In several fossil teeth recovered
from a Middle Pleistocene site in
Yiyuan near the capital Beijing,
they found interproximal grooves,
which they believe signifies the
habitual use of sticks made from
hard material to remove residual
food particles from teeth.

Photo shows an artistic depiction of an early homonin eating plants.

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

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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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© 2014, Dental Tribune International GmbH. All rights reserved.

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The remains from the Yiyuan
site, which included cranial
fragments and was excavated
by archaeologists in 1981, have
been assigned to the Homo
erectus species, which is widely
considered to be a direct ancestor of modern humans and
other human species, such as
Neanderthals. Archaeological
findings indicate that the species
inhabited large parts of Asia,
Africa and Europe between
1.8 million and 40,000 years
ago. DT

In total, the researchers examined seven teeth from three
individuals under a binocular
microscope and scanning electron microscope. Two of the teeth
exhibited interproximal grooves
of different depths, which are
characteristic signs of toothpicking. Similar markings on
the teeth of other Homo species
found in different sites around

The World’s Dental Newspaper · Asia Pacific Edition

the world have previously been
reported.

dle-like stick was used to remove
food particles caught between
teeth to relieve gum pressure
is likely to be very plausible,”
the authors commented in the
article.

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.

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DTAP0614_01-03_News 04.06.14 13:04 Seite 3

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

Asia News

Probiotic bacteria found helpful in orthodontic patients
DTI

SONGKHLA, Thailand: A new
study has provided additional evidence that probiotics are beneficial against a number of oral conditions. Researchers in Thailand
recently found that lactobacilli

Australia to
cut dental
spending
DT Asia Pacific

CANBERRA, Australia: The Australian government intends to
scrap over half a billion Australian
dollars worth of subsidies for dental health care from its next federal
budget. Among other cut-backs,
the proposed plans will see the
end of the Dental Flexible Grants
Programme, which was originally
introduced to help dentists set up
in outer metropolitan areas. This
way, the government aims to save
almost A$229 million (US$211.5
million) over the next four years.

in particular could help reduce
levels of mutans streptococci,
which can cause dental caries,
especially in cleft lip and palate
patients with fixed orthodontic
appliances.
The study included 30 cleft
lip and palate patients who had
been undergoing treatment between June and August 2011 with
fixed orthodontic appliances for
at least three months with attach-

ments on at least 20 permanent
teeth. For a period of four consecutive weeks, half of the patients
consumed milk powder with probiotic Lactobacillus paracasei
SD1 in 50 ml of water once a day,
while the remainder received
the same amount of milk powder
in water but without probiotic
bacteria.
From an analysis of participants’ saliva samples, the re-

searchers observed a significant
reduction in salivary mutans
streptococci after the four-week
period in the first group. In addition, a significant increase in
salivary lactobacilli was noted
in this group.
The results suggest that especially orthodontic patients, who
usually need treatment owing to
irregularities in tooth size and
misalignment of teeth, could

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Another A$390 million (US$360
million) is to be put aside by
delaying a federal–state partnership programme that was intended to support local governments in providing public dental
health care services. Dental and
oral health clinic developments
at Charles Sturt University in
Sydney will also be halted.
In return, the government said
it will put A$2.7 billion (US$2.49
billion) into new programmes,
such as the Child Dental Benefits
Schedule.

4 mm

The measures are part of a
larger cut-back of federal medical subsidies that will require
patients to pay more out of pocket
for visiting a doctor or basic
medical services, such as having
an X-ray taken. According to the
government, the savings from
these measures will go into a A$2
billion (US$1.85 billion) medical
research fund to advance therapies for systemic conditions,
such as cancer.
Overall, the government expects to accumulate A$80 billion
(US$73.9 billion) in combined savings from the health and education
sectors over the next ten years.
Representatives from dentist
and patient organisations have
already criticised the plans,
which they think will further
burden the already extensive
waiting list for public dental
treatment. President of the Australian Dental Association Dr
Karin Alexander told ABC News
that she expects that the waiting
list could double or treble owing
to the cut-backs.

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It is estimated that up to half
a million people are currently on
a public waiting list for dental
treatment. DT

benefit significantly from probiotic intervention because fixed
appliances facilitate the colonisation of bacteria such as mutans
streptococci and render this
group more susceptible to dental diseases. However, further
long-term studies with a larger
sample size are needed to clarify
the mechanisms of probiotic
bacteria in reducing oral microbial counts, the researchers
concluded. DT

Ivoclar Vivadent AG
Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel.: +423 235 35 35 | Fax: +423 235 33 60

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DTAP0614_04_News 04.06.14 13:07 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

Opinion

Dear
reader,

It is not
dirty teeth

“At least I know they are
infectious”

Prof. A.K. Susheela
India

India is currently facing a
serious health crisis due to fluoride toxicity, particularly in children. Besides the major forms
of fluorosis that affect teeth,
bones and soft tissue, the disease
has several other ramifications,
such as interfering with thyroid
hormone production. It has also
been found to contribute extensively to mental retardation and
bone deformities. Moreover, it
can hamper oral iron absorption
and haemoglobin production
in pregnant women, resulting in
low birth weight in babies.

Daniel Zimmermann
DTI

As you might already have
noticed, this issue of Dental
Tribune Asia Pacific is dedicated
to the topics of practice hygiene
and infection control. In compiling the material, we have aimed
to provide not only an overview
of all the current issues in this
field but also recommendations
on updating your hygiene routine to prevent cross-infections
in your own practice.
With more patients seeing
their dentist than their regular
GP, the dental profession is
and will remain at the forefront
of every new major outbreak.
Although a cliché, it is the little
things that really make a difference. Most preventative measures do not require the investment of much extra effort or
money if they are practised on
a daily basis.
I wish you an enjoyable and
insightful read. 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.

The world is very small
9 per cent mortality. Only two cases
have been detected in the US, both
of whom had a recent history of
travel to Saudi Arabia.
Dr Raghu Puttaiah
USA

The Middle East Respiratory
Syndrome (MERS) is a respiratory
condition associated with a specific
strain of coronavirus called MERSCoV. The clinical scenario includes
severe respiratory illness, fever,
cough and shortness of breath,
leading to death in about a third of
those infected. While MERS was
first reported in 2012 on the Arabian
Peninsula, cases have now been reported in over three dozen countries, spanning Asia, Europe and
North America. While this disease
has been noted to spread from those
infected to their caregivers or those
living in close contact, it has not yet
been found to spread in community
settings as seen during the severe
acute respiratory syndrome (SARS)
outbreak in Asia that saw over 8,000
people infected, resulting in about

The Centers for Disease Control and Prevention (CDC) and the
World Health Organization (WHO)
are concerned about the potential
of MERS to spread globally and
therefore are providing information and control measures similar
to those provided during the SARS
and influenza A (H1N1) outbreaks.
With respect to dentistry, if there
is a vaccine available for any infectious disease of public health
concern, we must take it before
it affects us. With regard to infection control, if we as dental care
providers feel ill or feel that we are
about to fall ill, we must not go to
work but stay away from people,
including co-workers and patients,
until the symptoms resolve. We
should also inform patients prior
to their appointment that, if they
are not feeling well, they should
reschedule the appointment.

Basic infection control measures, such as frequent handwashing, wearing a mask, and following
standard and additional precautions, the last being specific to
MERS, must be adhered to strictly.
The world is very small with respect to travel and the spread of
disease from one continent to
another can happen within a day.
Keeping abreast with rapidly
changing information on diseases
such as MERS from reliable
sources, such as the CDC, WHO,
Association for Professionals in
Infection Control and Epidemiology, and Organization for Safety,
Asepsis and Prevention, is necessary for the dental team. DT

Contact Info
Dr Raghu Puttaiah is the owner
of OSHA4Dental, a dental safety
and education company based in
Plano in the US. He can be contacted
at rputtaiah@bcd.tamhsc.edu.

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Determining such criteria
could also form a good academic
exercise for students of dentistry
and medicine. DT

Contact Info

China
Dental Show

Overtly visible dental fluorosis is the easiest way to identify
excess fluoride ingestion. In
the mild, moderate and severe
forms, the accompanying discolouration extends away from
the gingivae, is bilaterally symmetrical and horizontally aligned.
Often, however, discolouration
on the enamel surface is still
misdiagnosed as dirty teeth.
While the Dean and Thylstrup–
Fejerskov indices are available
for fluorosis classification, simpler criteria that are easy to
understand could help to address
misdiagnosis.

Dental desensitising varnish
• treatment of hypersensitive dentine
• fast desensitisation
• fluoride release
• easy and fast application

Prof. A.K. Susheela is Executive
Director of the Fluorosis Research and Rural Development
Foundation in New Delhi in
India. She can be contacted at
frnrdf@gmail.com.

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DTAP0614_05_Mers 04.06.14 13:08 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

World News

Association for infection control updates
dentists on new infectious disease
Digital toolkit on MERS Coronavirus available from OSAP
Owing to the sharp increase
in infections during the last two
months, the organisation has advised health care professionals

worldwide to heighten infection
control measures. A strain of the
coronavirus related to the bird flu
bug that wreaked havoc in Asia

a couple of years ago, the new
disease was first identified in
2012. Similar to severe acute respiratory syndrome, it is thought

to have been transmitted from
animals to humans, with the main
source of infection suspected to
be camels. DT
AD

Negatively-stained transmission electron micrograph of a MERS Coronavirus. (Photo courtesy of Center for
Disease Control/Maureen Metcalfe &
Azaibi Tamin, USA)
DTI

ANNAPOLIS, Md., USA/GENEVA,
Switzerland: The Middle East
Respiratory Syndrome (MERS),
a recently discovered highly
transmissible disease, has caused
uncertainty among health care
professionals worldwide. Despite
the World Health Organization
rating the situation as nonepidemic, the Organization for
Safety, Asepsis and Prevention
(OSAP) in the US has launched
a toolkit intended to bring oral
health professionals up to date
with the new threat.
The material, which is available for download on the organisation’s website, is meant to be
a quick reference for information
on the disease. It also gives recommendations on how to identify early symptoms, which are
similar to those of the common
flu, and how prevent it from
spreading to other patients or
health care personnel.
“The MERS situation in the
US represents a very low risk to
the general public at this time.
However, dental clinicians are an
important part of the health care
system and should be knowledgeable of MERS and other trans missible disease,” Executive Director Therese Long commented.
“OSAP will keep its online MERS
toolkit updated and continue to
offer it as a free downloadable tool
for dental health care workers.”
She added that the disease
and its impact on dentistry will
be the focus of the organization’s
upcoming annual symposium,
which will be held next week in
Minneapolis in the US.
To date, more than 600 cases
of infection with the MERS coronavirus have been confirmed by
the WHO, of which the overall
majority was reported to have
occurred in the Middle East, particularly in Saudi Arabia. It also
announced that it has tested an
individual from the US as pos itive, which still needs to be
confirmed by laboratory tests.

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DTAP0614_06_Rimini 04.06.14 13:08 Seite 1

6

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

Business

Rimini show confirms that the future
of dentistry is digital
DTI

RIMINI, Italy: The use of digital
technology seems to be changing
dentistry forever and nowhere
has this been more obvious
than in Italy last month, where
numerous manufacturers from

Italy and abroad showcased their
latest devices and materials to
thousands of dental professionals at this year’s Amici di Brugg
dental show.
Besides Henry Schein’s ConnectDental pavilion, a booth ded-

icated entirely to the company’s
combined portfolio for an allout digital workflow and other
services such as Sirona’s Digital
Dental Academy, a new application
designed for Google Glass draw
special attention from visitors.
Specifically designed to work

on the head-mounted device,
Dental Glass is intended to improve workflow in dental practices by projecting information
directly in the clinician’s field of
view, similar to a pilot’s head-up
display. This way, clinicians can
remotely access patient records,

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among other data, display radio graphic images, or manage
appointments through voice recognition software or a touchpad
located at the earpiece, according
to the Italian developer Gerhò,
a subsidiary of the Breitschmid
group. The manufacturer said
that the app will also allow the
capture of photos and video in
high-definition format through
its built-in camera.
Google Glass is currently only
available in the US. When the device will be released to European
markets is still unclear owing to
some technical limitations and
the lack of distributors, according
to reports. The technology, however, is currently being experimented on for its future use in
general and dental medicine. Last
year, for example, Dental Tribune
reported on the first maxillofacial
surgery broadcast with the device, which took place at Hospital
de Molina in Murcia in Spain.
Completely digital solutions
however are already available in
dental offices. BIOLASE, for example, offers such solutions and
has expended great effort on its
Total Technology Solution in recent years. In addition to its complete range of dental lasers, the
US dental technology company
now offers sophisticated imaging
equipment and CAD/CAM solutions, such as the GALAXY BioMill
System, which allows digital fabrication of restorations chairside.
“The adoption cycle of new
technologies is growing increasingly shorter and more advanced
technologies like the Waterlase
will rapidly find their way into
dental practices. Dentists that
do not upgrade their equipment
will likely begin to lose patients,
become uncompetitive and lag
behind,” CEO Federico Pignatelli
explained to Dental Tribune
International (DTI) at the show.
DTI CEO and publisher
Torsten R. Oemus confirmed this
forward-looking corporate strategy by emphasising the strong
points of the digital revolution:
“Turning dental offices into
high-tech playgrounds is indeed
becoming a global trend, which
reaps rewards for patients and
dentists alike. Technology is what
differentiates a modern dental
office from a conventional one,
increases patient flow, and advances diagnostic and treatment
outcomes, which ultimately leads
to increased revenues.”

Organizer

He invited dentists who are
unsure about how digital technologies could benefit their
practice to attend the Digital
Dentistry Show, the first edition
of which will be held in autumn
2014 at the International Expodental show in Milan in Italy.
Focusing entirely on digital
products and applications for
dentistry, the unique expo format
will not only showcase the latest
products and solutions by leading providers in the field, but also
offer education in the form of
lectures and webinars from 16 to
18 October. Information about
what to expect from the event
and how to register is available
on the events website. DT

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DTAP0614_07-08_Baharin 04.06.14 13:09 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

Special: Practice Hygiene

7

Infection control has never been
more essential
An update on practice hygiene measures and protocols
period, the DHCP inhales about
0.014 to 0.12 µl of aerosolised
saliva, which may contain viable
pathogens that can have a detrimental effect on the health of
susceptible DHCP.

Dr Safura Baharin
Malaysia

Dental professionals are at
high risk of cross-infection.
A report published in 1999 has
shown that in developing countries, for example, the number of
dental staff contaminated during
treatment is increasing by almost
6 per cent each year.1 Research
has shown that infectious microorganisms can be transmitted
by blood or saliva via direct or
indirect contact, aerosols, or
contaminated instruments and
equipment.2 As stated by the US
Centers for Disease Control and
Prevention (CDC) in their 2003
guidelines, the transmission of
infectious disease can occur in
four ways: direct contact with
blood or body fluids, indirect
contact with contaminated objects or surfaces, contact with
bacterial droplets or aerosols,
and inhalation of airborne microorganisms.3
The most likely mode of transmission in dentistry is through
inhalation of bacterial aerosols
or splatters. Their potential
health hazards are well documented and acknowledged.4–9
Both can be host to a large variety
of micro-organisms and viruses,
which can be infectious to
susceptible individuals. During
treatment, the dentist’s face and
patient’s chest are most affected
by splatter, as the majority of the
splatters are radiated towards
them.10, 11 According to studies,
the most contaminated area on
the dentist’s face during treatment is around the nose and
inner corner of the eyes.11
Splatter consists of large particles of greater than 100 µm

Country
Pakistan
Bangladesh
Indonesia
India
Myanmar
Malaysia
Thailand

(DTI/Photo Jasmin Merdan)

Demand for dental treatment
has been increasing in recent
years as people have become
more aware of their oral
health and the benefits of good
dental aesthetics. Maintaining
and practising stringent crossinfection control procedures
therefore have never been
more essential to ensure the
health and safety of dentists,
dental hygienists and assistants, as well as other supporting staff who may be indirectly involved in the treatment
process.

‡ DT page 8

During treatment the most contaminated areas are around the dentist’s nose and his or her inner corner of the eye.

generated during the use of dental equipment, such as turbines,
ultrasonic scalers, or water and
air syringes. Owing to this, splatter tends to travel in a trajectory,
thereby contacting objects in its
path. Aerosol consists of smaller
particles that can remain in
the air for a long time and travel
with air currents. Most dental
aerosols are less than 5 µm in
diameter; therefore, they are
able to penetrate and stay within
the lung, causing respiratory or
other health problems. Among
dental procedures that produce
high aerosol concentration are
ultrasonic scaling, tooth preparation using high-speed handpieces, and dental extraction
involving bone removal via a
dental handpiece.8
The World Health Organization (WHO) has reported a rise in
airborne infections worldwide.
Tuberculosis in particular has increased in the developing world
(Tab. 1).12 It has been stipulated
that the risk of exposure to tuberculosis in susceptible DHCP is
greater than in healthy individuals. Bennett et al. concluded that
dentists and their assistants, who
are exposed for approximately
15 minutes during peak aerosol
concentration, have a slightly
higher risk of exposure to Myco bacterium tuberculosis than the
general public does.9 During this

Estimated # of cases

Estimated rate
(per 100,000 population)

410,000
350,000
450,000
2,200,000
200,000
24,000
80,000

231
225
185
176
377
80
119

Table 1: Tuberculosis in Asia.12

With all of this in mind, it is the
responsibility of DHCP to adhere
strictly to recommended infection control guidelines and policies. Several measures should
be taken to reduce and control
airborne contamination in the
dental clinic. For example, it has
been demonstrated that the use
of a mouthrinse, high-volume
evacuation or a combination of
both methods significantly reduces the number of colonyforming units in aerosols emitted
during ultrasonic scaling.13 Routine use of rubber dam isolation
provides a clean and dry area for
placement of dental restorations,

PPE

Recommendations

Rationale

Surgical mask

• Should cover both nose and mouth
• Change when wet (from sweating,
sneezing, breathing or other contamination)
• Use particulate filter respirators (N95)
when airborne isolation precautions are
necessary (transmission-based precautions
for patients with tuberculosis)

• Splatters and aerosols may contain bacteria
and viruses that can infect a susceptible
person in the dental clinic.
• To protect dentists’ and assistants’ oral and
nasal mucosa from blood and saliva splatter
• Some of these micro-organisms are small
enough to penetrate the mask and are then
then inhaled by the DHCP and infect
the lungs. A special mask may therefore
be needed (N95 and FFP3 respirators).

Protective eyewear

• Should be worn all the time
• Preferably with lateral protection that is
wide enough to cover the eye
• Must be rinsed and disinfected when
contaminated between patients

• Splatters from dental procedures may come
into contact with the conjunctiva
and cause irritation or infection.
• Some materials used during dental
treatment, such as sodium hypochlorite,
may cause severe irritation and damage
if accidentally splashed into
the DHCP’s eyes or face.
• To protect the mucosa of the eyes
from splatters

Face shield/visor

• Select a face visor with acceptable
• Splashes or splatters generated during
visual quality (clear, no reflection or refraction) dental treatment, especially when using an
and no fogging
ultrasonic scaler or high-speed handpiece,
are concentrated towards the dentist’s face.
• Wearing a face shield also reduces the amount
of splatter contaminating the face area.
• To protect the face from splatters and
aerosols during dental procedures

Gloves

• Worn when in contact with blood or body fluids • To prevent transmission of infection
• Double gloving may reduce the risk
from the patient to the DHCP and vice versa
of exposure in high-risk patients
• To prevent the contact of blood and saliva
(HIV, hepatitis B or C virus)
with the dentist’s hands
• Should be worn for the duration of the dental
treatment and changed between patients
• Hands must be washed before wearing gloves

Protective clothing,
such as gowns
or jackets

• Change daily or when visibly contaminated
with blood or oral fluids
• Wash separately from domestic
and non-medical clothing
• Preferably long sleeves with a tight cuff

• To protect daily clothing from
contamination from splatter or aerosols
• High occurrence of blood-contaminated
splashing in the direction of the
dentist during surgical procedures
• Areas commonly contaminated are the
right forearm, abdomen and thorax8

Table 2: Recommendations and rationale concerning personal protective equipment.

[8] => Standard_300dpi

DTAP0614_07-08_Baharin 04.06.14 13:09 Seite 2

8

Special: Practice Hygiene

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014
(DTI/Photo Tyler Olsen)

ﬂ DT page 7

prevents salivary and blood
splatter, and protects the patient’s mouth and airway.
Using personal protective
equipment (PPE), such as surgical masks (with at least 95 per
cent efficiency against particles
3 to 5 µm in diameter; changed
for every patient or every 20 minutes in an aerosol environment
or 60 minutes in a non-aerosol
environment), safety glasses
with lateral protection to prevent contact with eyes, as well as
disposable gowns and gloves to
reduce the penetration of or contact with bacterial aerosols and
splatters, is vital (Tab. 2).
Regular maintenance of the
air-conditioning system is recommended too, as good ventilation has a diluting effect on the
airborne microbial load, especially at night when the clinic
is closed.14 Air samples taken at
different times at a multi-chair
dental clinic showed that bacterial aerosols are more concentrated during treatment and
that there is higher concentration of circulating bacterial
aerosols at the beginning of the
day, which may be related to
reduced ventilation.14 Residual
bacterial aerosols can be removed through air filters or
ultraviolet light.

dental materials and work sent
out to the laboratory, and regular
maintenance of the dental water
lines and equipment, which has
the potential to harbour bacteria.
All dental water lines should be
purged at the beginning of each
day for between 5 and 10 minutes
and flushed thoroughly with
water, as residual water may become contaminated overnight and
biofilm may develop along the
inner side of the tube. Purging
will result in a significant decrease in bacterial counts.15, 16
The Canadian Dental Association recommends running
high-speed handpieces for
20–30 seconds after each treatment to purge all potentially
contaminated air and water. This
procedure has been proven to
reduce the bacterial load in the
water line significantly.17 Blood
cells, as well as bacterial and
viral particles, can survive inside
handpieces even after disinfection. They must therefore be
sterilised between patients.18, 17

ing. Improperly trained personnel, however, may lead to poor
infection control practices. It is
the responsibility of every dentist
to educate and train his or her
assistants in the standard procedures. Furthermore, DHCP
immunisation status should be
up to date.
It remains a difficult task to
eliminate the risk of exposure
to dental aerosols. The best way
to reduce the risks, however, is
to employ routine cross-infection protocols recommended by
the health authorities, such as
the CDC, WHO and ministries of
health. To date, various infection
control reports and procedures
have been published to inform
and educate dental health care
personnel (DHCP) about the importance of practising adequate
infection control. DT
Editorial note: A complete list of references is available from the publisher.

Contact Info
Using personal protective equipment such as surgical masks, safety glasses as
well as disposable gowns and gloves is vital.

As splatters can travel as far
as the door or supply counter in
the middle of a multi-chair dental
clinic,14 all clean, unused instruments and equipment should be
kept in closed cabinets or drawers to prevent contamination.

Other important measures
that must be taken to prevent
cross-infection include adequate
sterilisation of dental instruments, disinfection of work surfaces before and after each dental procedure, disinfection of all

The clinic floor should be disinfected and cleaned with an antimicrobial disinfectant solution
at least twice per day to eradicate
any bacterial residue from splatter or aerosols.
It is a well-known fact that
private dental clinics sometimes
employ dental assistants who
have not received certified train-

Dr Safura Baharin
is Head of Clinical Services at the
Faculty of Dentistry of the National University
of Malaysia near
Kuala Lumpur in
Malaysia. She can be contacted at
safurabaharin@ukm.edu.my.

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[9] => Standard_300dpi

DTAP0614_09_Liberali 04.06.14 13:10 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

Special: Practice Hygiene

Dentistry is not immune to threats
posed by antibiotic resistance
sistance by enhancing infection
prevention and control. Every
member of the dental team must
follow the standard procedures
required to prevent the trans mission of micro-organisms, including hand hygiene, personal
barrier protection, instrument
disinfection and sterilisation
protocols, as well as surface decontamination strategies. Work
surfaces in the dental operatory
that are in the contaminated zone
must be cleaned after every patient by wiping the surface with
a neutral detergent, while work
surfaces outside the contaminated zone must be cleaned after
each session or when they become visibly soiled. The dental
team should be fully aware of the
risk of dissemination of potentially hazardous micro-organ isms and ensure that efficient
cross-infection control procedures are properly maintained. DT

Dr Sharon Liberali
Australia

The administrative aspects of
dentistry continue to become
more demanding with increasing amounts of time spent in
fulfilling mandatory accreditation requirements. It can often
feel overwhelming, taking us
away from the clinical practice
of dentistry, and there is a risk
that, owing to high clinical demand, short-cuts may be taken.
However, infection control
must be considered to be a central part of quality dental care.
A purported commitment to
high standards and the pursuit
of clinical excellence is meaningless when low priority is
given to quality issues in the
field. Failure to address all infection control requirements
increases the risk of disease
transmission, ultimately compromising patient safety.
The importance of infection
control in clinical dental practice
simply cannot be understated.
While the tasks associated with
the decontamination and steril isation processes of reusable
instruments are now routine,
consideration must be given to
the less obvious components of
the infection control process that
can unwittingly compromise the
health of our patients. Identifying
when patients may potentially be
infected with bacteria or viruses,
how these bacteria or viruses may
be transmitted in the health care
setting, and when we need to

Editorial note: A complete list of references is available from the publisher.

Contact Info

Three-dimensional illustration of an MRSA bacterium. (DTI/Photo courtesy of Michael Taylor)

in the WHO report: methicillinresistant Staphylococcus aureus
(MRSA), Escherichia coli and carbapenemase-producing Gramnegative bacteria (e.g. Klebsiella
pneumoniae).

setting, especially when patients
with multi-resistant organisms
are not identified, and compliance with hand hygiene and
surface cleaning or disinfection
is poor.

“Almost everything in a dental clinical
setting can serve as a reservoir
and/or a vector for opportunistic
pathogenic organisms.”
apply transmission-based precautions are increasingly gaining
significance.
The microbial threats facing
us today pose significant health
risks, and the situation is not likely
to improve. The WHO’s first global
report on antibiotic resistance1
was released on 30 April 2014.
It has identified that highly resistant organisms are now commonplace and that antibiotic resistance is a serious worldwide threat
to public health. Dentistry is not
immune to this.
Multi-resistant bacteria are
primarily transmitted either by
direct contact or indirectly via
contaminated surfaces. Currently,
the most problematic health careassociated multi-resistant organisms include those highlighted

Almost everything in a dental clinical setting can serve
as a reservoir and/or a vector
for opportunistic pathogenic
organisms.
This includes, but is not limited to, work surfaces, computer
keyboards, the hands of health
care workers, and dental equipment and/or devices. Surfaces
in particular play a significant
role in the acquisition, persistence and spread of infections.
Clinically important microorganisms that can cause health
care-acquired infections have
been shown to persist in every
health care environment for
considerable periods. This facilitates the spread of the or ganism throughout a health care
facility, including the dental

Viruses from the respiratory
tract (e.g. the influenza virus) can
persist on surfaces for several
days, while blood-borne viruses
(e.g. hepatitis B virus and HIV)
can persist for more than one
week. Herpes viruses (e.g. herpes
simplex virus Types I and II) commonly encountered in the dental
office can persist on surfaces
anywhere from a few hours to
as long as seven days. Bacteria
can persist for much longer.
Most Gram-positive bacteria
(e.g. MRSA) can survive for
months on dry surfaces, and
many Gram-negative species
(e.g. E. coli and K. pneumoniae)
can also survive anywhere from
weeks to months and can thereby be a continuous source of
transmission if no regular preventive surface disinfection is
performed.2

The WHO’s report highlighted that health care workers
can help tackle antibiotic re-

Dr Sharon Liberali
is Director of the
Special Needs Unit
of Adelaide Dental
Hospital, and a
member of the
Infection Control
Committee of the Australian Dental
Association. She can be contacted at
sharon.liberali@health.sa.gov.au.

Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry
www.dental-tribune.com

[10] => Standard_300dpi

DTAP0614_10_Special 04.06.14 13:11 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

10 Special: Practice Hygiene

Non-disposable syringe tips resist sterilisation
DT Asia Pacific

ST LEONARDS, Australia/
DUNEDIN, New Zealand: Owing to their internal construction,
air or water syringes commonly
used in dentistry are generally
prone to bacterial contamination. Using disposable rather
than non-disposable syringe tips
however 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 reported in the latest issue
of the Australian Dental Journal.
Of 68 used non-disposable syringe tips tested for microbiological growth, almost 40 per cent
were found to be harbouring dif-

ferent kinds of bacteria after having been sterilised with a Class B
autoclave. According to the researchers, the level of contamination did not decrease significantly regardless of the number
of additional sterilisation cycles
the tips were run through. Flushing the instruments simultaneously with air and water before
the cleaning and sterilisation
processes also resulted in no

difference to the level of contamination, they said.
While control tips of the disposable kind also showed contamination, the level was significantly lower. The researchers
suggested that one of the main
reasons for the build-up of bac teria or contaminants in nondisposable tips could be corrosion facilitated by continuous

AD

Implant surface after being scaled
with Premier® Implant Scaler

exposure of the instruments to
humidity during treatment,
which increases the roughness
of the surface, allowing potentially harmful micro-organisms
to accumulate over time. While
such micro-organisms might be
harmless, they recommend the
use of disposable tips over nondisposable tips to reduce the risk
of cross-infection.
For the study, new and used
non-disposable syringe tips from
the urgent care unit at the School
of Dentistry of the University of
Otago in Dunedin were investigated. DT

204
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HIV/AIDS
patients
refused
DT Asia Pacific

KOBE, Japan: While compliance with infection control practice in Japanese dental offices
has improved lately, most dentists still seem to be hesitant
to treat patients with HIV/AIDS.
A survey conducted by researchers from the Department of
Health Science at the University
of Hyogo among practitioners in
the Aichi Prefecture has found
that only one in three would be
willing to see patients with the
disease.
It also found that respondents
with a level of infection control
practices that exceeded standard
precautions, such as wearing
a mask or gloves during treatment, were more likely to treat
HIV/AIDS patients.
The researchers conducted
the survey involving 2,100 dentists
in 2011, of which the majority
were male, older than 50 years
and worked in general practice.
The results, while lacking compared with other developed countries, are a step-up from those reported in an earlier survey in 1996,
which found that only 15 per cent
of dentists were willing to treat
patients with the disease.

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The total number of HIV/AIDS
cases in Japan exceeded 20,000
in 2012, with the number of
new infections per year remaining steady, according to figures
from the National Institute of
Infectious Diseases in Tokyo. In
a report published last year, however, the institution reported that
a significant number of new infections appear to go undetected,
labelling the national surveillance system as insufficient. The
Department of Global Health Policy at the University of Tokyo has
predicted HIV/AIDS prevalence
to quintuple by 2040, particularly
in high-risk groups, unless new
measures are introduced to the
country’s public health intervention framework. DT

[11] => Standard_300dpi

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3/3/14 2:04 PM

[12] => Standard_300dpi

DTAP0614_12_Armitage 04.06.14 13:12 Seite 1

12 Special: Practice Hygiene

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

The importance of clean water lines
Jane Armitage

UK
The cleaning of water lines is
something I would not normally write about but this is
going to be a personal article
that I would like to raise awareness to. Last year I received
a telephone call from a chest
consultant who told me that
he thought he knew why I was
having recurrent chest infections, tiredness, and persistent
cough. He had taken three
sputum samples from me and
had grown Mycobacterium
avium and Mycobacterium
intracellulare, otherwise known
as a Mycobacterium aviumintracelluare infection (MAI)
or MAC (Mycobacterium avium
Complex).
These bacteria are found living in house dust and tap water.
They may infect wild or domestic
animals as well as humans. I had
never heard of it and was very
self-composed when he told me
it was a type of lung infection
AD

creased scientific knowledge of
dental unit waterlines (DUWL)
biofilms and their associated
risks, contamination of dental
unit waterlines has become a
prominent infection control issue. Flushing the waterlines for
two minutes at the start of the day
and for 20–30 seconds between
patients reduces the bacterial
count but in DUWL where this
method is used as the sole means
of water quality management
flushing is unlikely to provide
water of drinking water standard
i.e. with a total bacterial count
of 100 CFU/ml, nor will flushing
remove the biofilm.

caused by bacteria from the same
genus as the one which causes
Tuberculosis (Tb), but was noncontagious. Within a matter of
days I was seen by a Tb specialist and commenced treatment
the following day. I was told that
MAC mimics Mycobacterium
tuberculosis (MtB) and is usually
found in thin middle age women
with low immunity. He stated that
he wished I had had full-blown
infectious Tb as this would have
been cleared in six months.
Unlike Tb, it would take a treatment plan of 18–24 months (three
times as long as conventional Tb)
and relapses are common even
after taking what was described
as chemotherapy antibiotics.
I was ok until I saw that word
then I freaked. How can this have
happened? How had I caught it?
Was I going to die? These were all
questions I was throwing at him.
He explained that this form of
non-contagious mycobacterial
infection can be caught from
shower heads, soil, cigarette papers, any form of sprayed water

(DTI/Photo Zhang Xiangyang)

or simply by breathing the bug in.
I was told I had been unlucky and
his guess was I had breathed it
in and slowly it had reached my
lung and started to attack. The

bug was already in the white
blood cells which are responsible for removing infections in the
body. Therefore, it was difficult
to get rid of.
MAC is resistant to many antibiotics; there are limited drugs
that can be given but all come
with extreme side effects which I
was warned about. One drug can
affect the optical nerve in the eye,
the other, your liver. I remember
looking at the medication and
putting it back in the bag as the
mere thought was freaking me
out. I have now been on treatment for a year and can’t wait un-

However, in dental units,
which are not drained down at
night, flushing at the start of the
day will help to reduce the bacterial load caused by overnight water stagnation. Flushing between
patients helps to prevent cross
contamination by removing any
suck-back of oral fluids that have
bypassed the anti-retraction
valve. It is recommended to use
biocides to control the biofilm by
daily draining down and cleaning of the waterlines to reduce
biofilm build up. The biocide
(disinfectant) can be introduced
with a pressurised pump or via
an independent reservoir bottle.
I didn’t catch my illness from
our water lines but since I have
been ill the people around me
have looked not only at their
water lines but at their cleaning
methods at home. Many have

“...some dental units may
harbour opportunistic
respiratory pathogens.”
til I can come off. I have since had
negative results and my X-ray
is clear but I will have to remain
on the drug regime as if there
are any stray MAC bugs they will
multiply and I will become very
ill again.
The consultant was impressed with how I had tolerated
the treatment as many throw
the towel in before completion.
Several times that thought had
crossed my mind, but I wanted
rid; I wanted to be me again. My
reasons for sharing this information is to ask you all to be
aware that this can come from
sprayed water, so please ensure
your water lines are cleaned
with one of the many waterline
cleanser/disinfectants manu factured. Biofilms form rapidly
on dental unit waterlines. The
majority of the organisms in the
biofilm are harmless environmental species, but some dental
units may harbour opportunistic
respiratory pathogens.
Effective infection control is
one of the cornerstones of good
practice and clinical governance. Due to a combination of
negative publicity and an in-

changed their shower heads so
often that I’m thinking of asking
for commission. The Health &
Safety Executive and the Department of Health here in the
UK have issued guidance for
the treatment of DUWL. I urge
you all, wherever you are, to
ensure these means of testing
and cleansing the water lines
are carried out. A risk assessment for managing water lines
should also be carried out.
I would also advise you to look
at your home, clean the showerheads, and run the shower for
a couple of minutes before use.
I have been unfortunate. Don’t
let this opportunistic pathogen
into your life. DT

Contact Info
Jane Armitage
is currently a
practice manager for Thompson & Thomas
Family Dental
Care in Sheffield
in the UK. She can be contacted
at janearm@ tiscali.co.uk.

[13] => Standard_300dpi

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DTAP0614_14_Pr 04.06.14 13:13 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

14 Business

Enamel Pro Prophy Paste available in VanillaMint flavour
calcium phosphate, Enamel Pro
uses innovative technology to
prevent the loss of enamel
through remineralisation. It
removes stains and polishes
quickly without splatter, is
gluten free and rinses off easily.

DTI

PLYMOUTH MEETING, Pa., USA:
Premier Dental has recently
added the VanillaMint flavour
to its Enamel Pro line. The new
prophy paste flavour offers
a subtle splash of vanilla
blended with mild mint, according to the US company.

Available in fine, medium
and coarse grits, and in a box
of 200 single-dose cups, new
VanillaMint is a welcome addition to the current flavours,

The only prophy paste formulated to deliver amorphous

RaspberryMint, mint, strawberry,
cinnamon, grape and bubble gum, the company said.
Premier stated that scientific
data supports that Enamel Pro
provides greater lustre for
whiter, brighter teeth. It said that
patients and dental professionals
will appreciate the unique presentation, as well as pleasant
aroma, flavour and taste of the
product. DT

Maestro 3D ORTHO System
Innovative solutions for dental applications
www.maestro3d.com

New product
generation
from Unident
DTI

GENEVA, Switzerland: Correct
processing of instruments before
and after treatment of dental
patients is of utmost importance,
according to Swiss company
Unident. Developed over a period of two years, its new generation of disinfection and cleaning
concentrated solutions for the
treatment of dental instruments
and burs is claimed to offer superior cleaning power and disinfection properties to ensure
instruments are
safe to handle
prior to sterilisation.

OPEN 3D ORTHO SCANNER
2 Axis - Structured Light

Texture Grey Scale\RGB Color
Superimposition
This module is useful to obtain models with a RGB color texture or
grey scale. For example it helps create very accurate margin lines
as marked on the model.

According to
Unident, Micro 10 Excel reliably
deactivates adenovirus, HIV-1,
bovine viral diarrhoea virus
(surrogate for hepatitis C virus),
pseudorabies virus (surrogate
for hepatitis B virus), herpes
virus, norovirus, vaccinia virus
and rotavirus. The formula displays bactericidal, yeasticidal,
fungicidal and myco-bactericidal activity after just 10 minutes
of soaking.
While most instrument cycles have to be renewed every
24 hours, diluted solutions of
Micro 10 Excel remain stable
for up to seven days, the company said. It can be used as
a holding solution and in an
ultrasonic cleaner to further
enhance the instrument’s cleaning power.
Unident stated that it had
given special attention to instrument care and developed Micro
10 Excel in such a way that it
keeps instruments in perfect
condition and inhibits corrosion. Therefore, the formula was
rigorously tested to ensure compatibility with a wide range of
materials.

AGE SOLUTIONS SRL - www.age-solutions.com - www.maestro3d.com
Viale Rinaldo Piaggio, 32 56025 Pontedera - PI - ITALY
tel: 0039 0587274815 - fax: 0039 0587970038
info@age-solutions.com

Owing to its fresh mint fragrance, Micro 10 Excel does
not come with the unpleasant
odours associated with many
other products, both diluted
and undiluted. It is available in
containers of 1 l and 2.5 l with
a 20 ml dosing cap. DT

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DTAP0614_16-17_Ubassy 04.06.14 13:14 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

16 Trends & Applications

Minimally invasive treatment
of stained anterior teeth
The art of mimicking nature with the use of pressed ceramic veneers

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 8
Fig. 7

Fig. 9

Fig. 12

Fig. 10

Fig. 11

Fig. 14

Fig. 13

Fig. 1: Pre-op view.—Fig. 2: Minimally invasive preparation included the placement of horizontal reference grooves to define the penetration depth in the enamel.—Fig. 3: The silicone matrix, which was
made from the wax-up, on the model. The challenge was to hide the stains effectively, while creating a natural-looking appearance using ultrathin restorations.—Fig. 4: The pressed frameworks
(IPS e.max Press LT) were approximately 0.3 mm thick. We took advantage of the optical properties of the translucent ingots (low translucency).—Fig. 5: The layers were built up on the framework
(optical filter) with different ceramic materials (IPS e.max Ceram).—Figs. 6 & 7: After being polished, the thin veneers showed natural-looking translucency combined with slight opalescence and a lively
interplay of colours. The appearance of the surface was influenced by irregularities in the texture.—Fig. 8: Before the veneers were placed, they were tried in with glycerine-based try-in pastes to simulate
the outcome and to select the suitable luting composite shade (Variolink Veneer).—Fig. 9: The shade of the prepared teeth was taken into consideration in the selection of the luting composite. The whitish
Variolink Veneer High Value +2 paste was chosen. A highly translucent luting cement would have made the restorations appear grey.—Figs. 10 & 11: The veneers were cemented according to a sophisticated
and systematic procedure.—Figs. 12 & 13: The adhesive bond ensures long-lasting adhesion of the veneers.—Fig. 14: The thin veneers blended in smoothly with the orofacial environment. The result was
not compromised by any stained areas. The fundamental principles of biomimetics had been fulfilled.
Dr Stefen Koubi & Gérald Ubassy
France

Today’s patients expect attractive, flawless teeth as a
matter of course rather than
merely functional teeth. The
appearance of teeth has become an integral component
of a person’s well-being. As
a result, dentistry no longer
aims to provide curative and
restorative treatment only,
but to offer aesthetic dental
solutions too.
The demand for minimally
invasive treatment modalities
is growing. As dental pro fessionals, we have the re sponsibility to act according
to ethical principles and to
choose the best possible treat-

ment options. In some cases,
this means questioning entrenched habits and exploring
new possibilities. Do severely
stained teeth always have to
be completely masked with an
opaque material, for example,
or can we find a way of covering
up the stain, but still maintaining the lifelike colour from
within the tooth?
The approach to the case
presented here was to consider
the stained tooth structure an
ally rather than a foe. Lithium
disilicate in the form of IPS
e.max Press (Ivoclar Vivadent)
was used, as the material can
be used to fabricate very thin
veneers that are not much
thicker than contact lenses.
Bonded to the teeth, it allows

the creation of long-lasting
restorations with lifelike characteristics.
A patient consulted our
practice owing to her severely
stained maxillary and man dibular teeth (Fig. 1). After the
diagnosis had been discussed
with the patient, aesthetic
parameters were established.
It is standard practice to document this type of case pho tographically with the jaws at
rest and in a dynamic position.
The treatment plan was based
on a diagnostic wax-up. Morphological criteria were of
minor importance, as the treatment focused on masking the
stains. Only very small adjustments were made, for example, with regard to the position

of tooth 12. The patient also
requested that the narrow diastema between tooth 11 and
tooth 21 be closed.
In our practice, we follow
biomimetic principles whenever we can and aim to cause
minimal harm to healthy tooth
structure. We also try to consider the natural teeth in the
treatment plan. Modern materials provide the tools we
need to meet this challenge.
The properties of many allceramic products are almost
identical to those of dental
enamel; the materials even
mimic the colour of the natural
tooth structure. With the appropriate techniques, a natural
appearance can be imparted
to ultrathin restorations.

In this case, we decided to
make the most out of the excellent optical properties of lithium
disilicate. The low opacity of
pressed ceramic, which is often
considered to be a disadvantage
for veneers, was actually useful
in this case. The conventional
solution would have been to
treat the patient with highly
opaque veneers fabricated on
refractory dies, which is a rather
complex procedure.
Our approach was to diffuse
the stains rather than completely mask them, with the
pressed lithium disilicate veneers working like an optical
filter. This way, they would
allow light to pass through but
would scatter it similar to natural dental tissue.

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DTAP0614_16-17_Ubassy 04.06.14 13:15 Seite 2

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014
The main challenge was to
remove only a minimal amount
of tooth structure and then
mask the teeth to create the
illusion of natural enamel. We
selected a suitable IPS e.max
Press ingot before preparing
the teeth, considering the optical potential of the material.
In cases in which stains have
to be completely covered up,
a highly opaque ingot is recommended.
A considerable amount of
space, however, is required to
imitate the interplay of colours
in this type of restoration.
Therefore, we selected a press
ingot with low translucency
(LT), which may seem unusual. The decision was based
on a careful analysis of the
particular situation and the optical properties of the material.
The idea was to have the veneers act like optical filters that
would change the colour of the
dentine tissue. Dental enamel
is not transparent but translucent. It scatters light and
therefore modifies the colour
of the tooth. We also planned
to characterise the framework
with a subsequent layer.
A silicone matrix (wax-up)
was used as a reference in
tooth preparation. A small but
adequate amount of tooth
structure was removed in the
visible aesthetic part of the
tooth. In order to define the
preparation depth in the
enamel, we placed horizontal
reference grooves (ball-ended
groove bur; Fig. 2). The optimum situation was established
with the help of the wax-up
(Fig. 3).
In the next step, the veneers
were fabricated according to
the customary technique using
IPS e.max Press LT ingots
(Fig. 4). In the subsequent
characterisation procedure,
the translucent properties of
the framework structure were
maintained and the brightness
of the teeth was increased with
a layering ceramic (IPS e.max
Ceram, Ivoclar Vivadent). We
aimed to achieve a masking
(saturated) effect by using
bright and opaque enamel materials. The greatest challenge
in the layering process was to
imitate the structure of the
dentine, the absorption areas,
the opalescent translucency
and the halo effect in the incisal
third of the teeth. When ultrathin restorations are produced,
it is advisable to verify the
shade achieved with IPS e.max
Ceram Essence materials in
the stains firing process.
The pressed frameworks
were approximately 0.3 mm
thick. The cervical areas and
the middle third of the restorations were coated with only
a thin layer of dentine material
(Deep Dentin B1). In order to
achieve an illusion of depth,
we applied an effect material
(Opal Effect 1) to vertical segments of the proximal areas.
We then placed a translucent
dentine layer of unsaturated
Dentin B1 and neutral Dentin
in a ratio of 1:1 between the

Trends & Applications 17

“With the appropriate techniques,
a natural appearance can be imparted...”
proximal areas. We selectively
layered a mixture of Mamelon
material (MM light and MM
yellow-orange) in the upper
third of the restoration. Below
the mamelons, we placed what
we refer to as an absorption
material. We used Opal Effect
violet, a purple powder, which
was mixed and coloured with
50% Impulse Transpa browngrey. The difficult part of this
procedure was placing the
individual materials on the
veneers without increasing
their thickness. Finally, the
layers were coated with an
opalescent ceramic material
(Opal Effect 4) to achieve the
desired aesthetic effect. A successful outcome depended on
the ratio in which the different
materials were used. The layers consisted of a third of the
above-mentioned materials
and two thirds of the opalescent ceramic (Opal Effect 4;
Fig. 5).

We recommend placing a
rubber dam around each tooth.
This isolation has distinct benefits: the dental practitioner
can concentrate on each tooth
individually, the prepared
tooth surfaces can be air
abraded without exposing the
patient to any harmful aluminium oxide particles, and
excess composite can be easily
removed. Isolating the teeth
with a rubber dam does not
hamper the exact placement
of the restorations.
The teeth were air abraded
to remove the bonding agent
used for the provisional restorations (Fig. 10). The teeth
were then etched with 37%
phosphoric acid. The primer
and the bonding agent were
applied within 40 seconds and
the surface was dried (Fig. 11).
The materials were light cured
for 1 minute. The restorations
were etched with hydrofluoric

acid for 20 seconds. They were
also carefully rinsed, conditioned with silane and coated
with a light-curing bonding
agent. The veneers were placed,
excess cement was removed
and the restorations were
light cured for 40 seconds at a
high intensity (1,200 mW/cm2;
Bluephase 20i, Ivoclar Vivadent). Finally, the rubber dam
was removed and the cervical
areas were carefully finished.
We used a #12 scalpel blade
to prevent harm to the ceramic surface. Finally, the
static and dynamic occlusion
was checked.
The results were highly attractive. The stains had been
hidden, but the restorations
had a lifelike shade, translucency and brightness. This
combination of veneer, cementation material and tooth
produced a highly resistant
structure similar to that of nat-

ural dentition (Figs. 12 & 13).
In this case, pressed lithium
disilicate veneers offered an
efficient means of achieving
a natural balance between
opacity (coverage) and translucency (vitality). The restored
teeth exhibited a lifelike in terplay of fluorescence and
brightness (Fig. 14). DT

Contact Info
Dr Stefen Koubi
maintains a private practice in
Marseilles in
France. He can
be contacted at
koubi-dent@wanadoo.fr.

Contact Info
Gérald Ubassy
is Director of
Dental Laboratory and Training
Center International in Roche fort-du-Gard in
France. He can be
contacted at contact@ubassy.com.

AD

The surface morphology
was created according to models, which provided a reference for the tooth shape and
texture. In the finishing step,
we used our established twocoloured pencil technique for
applying the ridges and concavities. In addition, we incorporated very fine, almost
indiscernible structures. The
restorations were then mechanically polished to ensure
their smooth integration in the
patient’s mouth (Figs. 6 & 7).
For improved longevity, ultrathin restorations have to be
placed with the adhesive luting
technique. This treatment step
is a daunting procedure owing
to previous complications with
this technique. Failures can be
avoided, however, if the pro cedures are followed strictly.
Our restorations fully met
the prerequisite of a precision
fit (IPS e.max has a precision
of 50 µm, which is ideal). The
shade of the restorations was
simulated with glycerinebased try-in pastes and a suitable shade was selected for
the luting composite (Variolink
Veneer, Ivoclar Vivadent;
Fig. 8). Since the retention of
veneers depends entirely on
the strength of the bond to
the tooth structure, adhesive
systems that employ acid etching should be used, as they
provide excellent bonding results (ExciTE F DSC, Ivoclar
Vivadent).
Light-curing luting composites are the preferred choice
for the cementation of veneers
owing to their easy handling
and long-lasting aesthetics.
The material, Variolink Veneer
High Value +2 paste, selected
in this case reinforced the desired optical qualities (Fig. 9).
A highly translucent material
would have given the veneers
a greyish tinge.

EXPERIENCE OUR ENTIRE COLLECTION ONLINE

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DTAP0614_18_Schirrmeister 04.06.14 13:25 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

18 Trends & Applications

Endodontic restorations
in one single step
DENTSPLY DeTrey’s Endo-Resto System in clinical practice

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. 1: The baseline radiograph showing a composite restoration in tooth 37, close to the mesial pulp horn.—Fig. 2: The access cavity showing two mesial canals connected by an isthmus.—Fig. 3: The master
points were checked radiographically before the root filling was placed.—Fig. 4: Gutta-percha and AH Plus were introduced into the root cavity and AH Plus residue was left in the access cavity.—Fig. 5:
After cleaning with AH Plus Cleaner, the access cavity was ready for the adhesive procedure.—Fig. 6: First, the enamel was conditioned with 36% phosphoric acid.—Fig. 7: The dentine was conditioned more
briefly.—Fig. 8: After conditioning with phosphoric acid.—Fig. 9: Applying the XP BOND adhesive.—Fig. 10: After application and curing of XP BOND.—Fig. 11: Placing SDR.—Fig. 12: SDR is self-levelling
and thus leaves a smooth surface.—Fig. 13: The Ceram·X capping layer was placed, light cured and polished.—Fig. 14: The final radiograph.
Prof. Jörg Schirrmeister
Germany

The Endo-Resto System by
DENTSPLY DeTrey is a practical
and comprehensive solution for
endodontic restorative treatment. With the exception of
gutta-percha and a conventional
capping composite, the system
includes everything necessary
for placing a root canal filling
and achieving a tight coronal
seal. In addition to AH Plus Root
Canal Sealing Material for the
placement of the root filling and
AH Plus Cleaner to remove excess of the sealer from the access
cavity, it comes with a 36% phosphoric acid for conditioning the
enamel and dentine, as well as
the adhesive XP BOND and the
flowable bulk-filling composite
Smart Dentin Replacement
(SDR).
With the Endo-Resto System,
the endodontic filling and the definitive adhesive cap can be placed
in a single session. Temporary closure is no longer required. Once
the endodontic restoration has
been placed, dentists can reconstruct the occlusal enamel layer
with their composite of choice.
In our case, we use Ceram·X
(DENTSPLY), a nano-ceramic
composite, which achieved ex cellent clinical results in one of
our own studies conducted at the
University of Freiburg.1
Available since 2010, SDR is
the first posterior composite for

dentine replacement that combines the easy handling of a flowable composite with minimal
shrinkage stress.2 This allows
the material to be placed and
processed in increments of up to
4 mm in Class I and II cavities after
the application of a conventional dentine or enamel adhesive.3
SDR is compatible with all
methacrylate-based universal or
posterior composites, which are
used for the capping layer. All this
translates into practical benefits,
allowing high-quality aesthetic
restorations to be delivered at very
reasonable cost.
SDR is characterised by reduced polymerisation shrinkage
stress. A polymerisation modulator changes the viscoelastic behaviour of the material as stress starts
to build up during polymerisation.
Polymerisation stress is therefore
reduced without any adverse effects on either polymerisation
speed or conversion rates, which
gives SDR the necessary physical
and mechanical properties for it
to be used as a flowable posterior
base material in the bulk-filling
technique. These modifications
to the methacrylate chemistry
ensure compatibility with the existing methacrylate-based adhesives and composites with which
dentists are familiar and whose
clinical performance is scientifically documented.
The existing indications for
Class I and II cavities are augment ed by further indications in endo -

dontics. A study by Dr Johannes
Ebert of the University of Erlangen-Nuremberg in Germany has
shown that SDR is highly suitable
and safe for direct adhesive coronal restorations after root canal
obturation.4 Particularly in endodontics, the possibility of using 4 mm
increments offers significant workflow benefits, given the depth of the
access cavity. SDR is self-levelling,
making it easy to introduce and
less technique sensitive.
A study on Class I cavities has
shown that SDR works very well
even in cavities with an unfavourably high configuration factor.5
In this study, SDR was the only
one of the investigated materials
suitable for bulk filling. In Class I
and II cavities, SDR has been
used successfully as well, which
was documented by a prospective
24-month study.7
In our case, a 24-year-old
female patient presented with
pulpal symptoms that had developed several months after a Class II
composite restoration had been
placed. At her first visit, she reported spontaneous nocturnal
pain and a strong sensitivity to
cold. No other clinical symptoms
were found besides those reported. The results of percussion
and bite testing were negative.
There was no apical tenderness
on palpation. No periapical lesion
could be detected on the radiograph (Fig. 1). Irreversible pulpitis was diagnosed based on the
clinical findings.

We discussed the planned procedure with the patient and obtained her consent. She was anesthetised, and the access cavity was
prepared under the dental microscope under rubber dam isolation.
A pronounced isthmus between
the two mesial canals and a
shallower isthmus between the
mesiobuccal and distal canals
were evident (Fig. 2).
Instrumentation was carried
out using PathFiles and ProTaper
Universal files (both DENTSPLY).
The gutta-percha master point
was adjusted to a tight fit in the
apical segment of the root canal
and then checked radiographically
for proper length and fit (Fig. 3).
AH Plus residue (Fig. 4) from the
access cavity was removed with
AH Plus Cleaner (Fig. 5). After conditioning the tissue with 36% phosphoric acid (DeTrey Conditioner 36;
Figs. 6–8), the orange filter was activated on the dental microscope and
XP BOND was applied (Figs. 9 & 10)
and light cured. SDR was then placed
in 4 mm increments (Figs. 11 & 12)
and light cured. Finally, the cavity
was restored with Ceram·X mono+
M2 as an enamel cap (Fig. 13). The
endodontic filling was controlled
radiographically (Fig. 14).

Conclusion
DENTSPLY DeTrey’s EndoResto System offers dentists a
practical and time-saving system
that includes all the materials,
from the sealer to the bulk-filling
composite. The major innovation
in this system is clearly SDR. For

the first time, low polymerisation
stress combined with a high curing depth facilitate the use of
a flowable composite base in the
bulk-filling technique with up to
4 mm increments in Class I and II
cavities.
The excellent sealing properties of the material are crucial
in preventing reinfection, specifically in endodontic access cavities.
The advantages over conventional
composites with regard to handling can help save significant
time. The self-levelling consistency of SDR ensures ideal adaptation to the cavity walls. Compatibility with existing methacrylate
adhesives and composites, and
delivery in one universal shade in
Compula Tips simplify the workflow for economical high-quality
aesthetic posterior restorations.
As far as post-endodontic appli cations are concerned, the system
could only benefit from a slightly
longer metal cannula. DT
Editorial note: A complete list of references is available from the publisher.

Contact Info
Prof. Jörg Schirrmeister maintains
a private practice
specia lised in
endodontics in
Freiburg/Breisgau
in Germany. He
can be contacted
at mail@endodontie-freiburg.de.

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DENTAL TRIBUNE Asia Pacific Edition No. 6/2014

Trends & Applications 19

A state-of-the-art device
for 3-D scanning
Terry Whitty reports on AGE Solution’s Maestro Scanner system
Terence Whitty
Australia

The concept of digital study
models has often been talked
about, particularly in orthodontic circles, as a solution
to the considerable physical
space required to store plaster
models. If a model could be
scanned in three dimensions
to a high degree of accuracy,
stored electronically and then
reconstituted should the need
arise some time in the future,
then the need for physical storage of models could potentially
be eliminated.
While there has been talk of
this, little in the way of real solutions have been available. Study
model scanning services exist
but often if you look at the fine
print in their terms and conditions, you may not even own
the scans of your own models!
A more practical alternative is to
be able to scan study models in
your own laboratory rather than
sending them out to be scanned
by a third party.
Digital models have many advantages. They are easy to make,
inexpensive, very accurate, cost
very little to store and transportation is a breeze. Amazingly, you
can store over 800 sets of models
on one DVD-R disc or an average
500 GB hard drive could hold
a staggering 100,000 sets of models! Much better than rooms and
rooms full of study models.
I have been working with digital models for some time and have
examined several systems on the
market today. I have recently found
a great new digital study model system with a host of very “useable”
features and the best news of all
is that it is very affordable.
The Maestro Scanner system
consists of a digital 3-D scanner
and various software programs
so you can easily scan dental
models, manipulate the data in
various ways and then easily
share this data so anyone anywhere with the viewing software
can visualise the digital models.
The Maestro Scanner is a
smartly designed state-of-the-art
structured light 3-D scanner.
It uses patterns of light and two
digital cameras to measure the
surface of the model in threedimensions. Projecting a narrow
band of light onto a three-dimensionally shaped surface produces a line of illumination that
appears distorted from other perspectives than that of the projector, and can be used for an exact
geometric reconstruction of the
surface shape. This is the basis of
structured light scanning and in
this case, uses no lasers so it’s

Fig. 2

Fig. 1

Fig. 3

Fig. 6

Fig. 4

Fig. 5

Fig. 7

Fig. 8

Fig. 1: Maestro 3D Dental Scanner.—Fig. 2: An example of MMR (Maxillary and Mandibular relationship) scanning.—Fig. 3: An example of impression scanning.—
Fig. 4: An example of multi dies scanning.— Fig. 5: Maestro 3D iPad Viewer.—Fig. 6: Main screen of Maestro 3D Ortho Studio.—Fig. 7: Brackets positioning
in Maestro 3D Ortho Studio.—Fig. 8: Attachments positioning in Maestro 3D Ortho Studio.

completely safe for anyone to
use. It also has great accuracy
and is quite speedy in operation.
This type of scanning is used by
many dental CAD/CAM manufacturers so the technology is
well proven for our market.
The Maestro System comes
with the Maestro Easy Dental
Scan program and I have to say,
the name says it all. Put your
model into the scanner, click a
button or two and you are on your
way to a scanned model. However, diving deeper into the program allows you to uncover more
complex features if you wish. It
even allows you to scan crown
and bridge models and acquire
multiple dies (up to 8) in one scan.
Some of the more advanced C&B
scanners are not able to do this.
Remember, digital study models
are not just for orthodontic purposes but can be used for all dental
models. It’s a great way to diagnose, discuss and store models.
The quality of the scans is
more than impressive with a great
amount of detail once the scans
are processed. Once you scan the

upper and lower models and do
a quick occlusal scan, the registering of the scanned models into
the correct bite relationship is
completely automatic. This is a
feature I really like. You can also
register the models in various
relationships—centric relation;
centric occlusion; protrusive or
construction bite to name a few.
There are also various editing and
measuring tools provided and you
can do adjustments to the scans if
need be. You can save the finished
files in industry standard STL or
a proprietary ORTHO and ORTHO
iPAD file format. File sizes are
quite small and easily emailed to
clients.
One of the additional notable
features of Easy Dental Scan is
the option to batch scan. In many
systems, immediately after the
scan is completed, it is processed
which can take quite a bit of time.
With the batch scan, you can
quickly scan several models and
then complete the processing of
the scans at a later time. You simply walk away and the computer
does all the work while you get
on with something else.

There is also an Ortho Studio
program. This starts with a powerful and cleverly thought out
database section. Sets of models
are sorted by Dental Practice–
Dentist–Patient and this is great
because it’s very easy to find what
you are looking for. It only takes
a few minutes to master this
section. It is just so easy to use.
When a set of models are
loaded, all the information from
the database accompanies it so you
know exactly what you are looking
at. In this section of the program,
you will find tools for adding virtual
orthodontic bases using various
popular angles including ABO
2013, measuring tooth and arch
width, occlusal mapping, multiple
views, snapshot, printing and
much more. It’s extremely easy to
use and you are guided through
each step in a wizard-like interface. The latest version of Ortho
Studio has the ability to perform
complex digital diagnostic set-ups
and the ability to create files ready
for aligner therapy as well as orthodontic bracket placement. This
is a powerful system and a valuable
tool for any practice or laboratory.

A real bonus of the package has
to be the free Ortho Studio Viewer.
This program is a cut down version
of Ortho Studio but is still feature
rich enough for using digital models for diagnosis on an everyday
basis. The viewer includes tools
for measuring tooth and arch
width, occlusal mapping, multiple
views, snapshot, printing and
more. Of course it’s very easy to
use so people will actually use it!
This is a great program to give
away to people you want to share
your digital files with. For example,
you may be a lab scanning models
for various clients. You can distribute the free viewer to these clients
so they can use it to view and diagnose direct from the scans. DT

Contact Info
Terry Whitty runs
a busy laboratory
in Sydney’s Eastern Suburbs, specialising in high
tech dental manufacturing. He
can be contacted
at www.trulinedental.com.au

[20] => Standard_300dpi

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30.05.2014 07:16:02

[21] => Standard_300dpi

DTAP0614_21_today 04.06.14 13:24 Seite 1

APDC · Dubai · 17–19 June, 2014

Independent news for visitors and exhibitors

APDC to be held in Dubai for the first time
Thirty-sixth edition of the Asia Pacific Dental Conference to focus on the improvement of the quality of life through better oral health care
n The emirate of Dubai will become the centre of the Asia
Pacific dental community again
this month, when the Dubai Inter national Convention & Exhibition
Centre opens its to doors to professionals from Asia and the Middle
East for the next edition of the Asia
Pacific Dental Conference. Held in
Dubai for the first time, the event is
not only the largest get-together of
dental players in the region but
also the most prominent showcase
of the latest in science, technology
and products for dentistry.
The show is held for the
36 time this year. According to
latest estimates, up o 50 dealers
and manufacturers from the region
and abroad have registered for the
dental exhibition. Among innovations such as new and improved
dental materials or equipment,
a huge number of advanced digital
solutions will be on display, that
were developed help to improve
the workflow and communication between dental practises and
laboratories for the benefit of
patients.

of botox in dentistry and implants
will also be held.
“This is the first time since its
inception in 1955 that the Asia Pacific Dental Federation is holding
its annual congress in the Middle
East, and Dubai is all geared up
to make the event a memorable
one,” said APDC 2014 Chairperson
Dr Aisha Sultan Alsuwaidi. “Keynote speakers have been invited
to share their knowledge and
expertise in the various fields of
dentistry. In addition to the scientific program, an international
trade exhibition will showcase the
latest trends and technologies in
the dental sciences.”

th

Current issues and methods in
dentistry will be discussed at the

Dubai. (DTI/Ashraf Jandali)

scientific programme, which will
see clinical presentations by more
than 50 local and internationally
renown speakers. A number of

specialised courses also took place
again this year prior to the congress. In addition, a symposium
on regenerative dentistry will be

held this years with presentations
focusing on topics such as stem
cells or regenerative endodontics.
Special events focusing on the use

The Asia Pacific Dental Conference is held from 17 to 19 February. It is organised by the Asia
Pacific Dental Federation in partnership with the United Arab
Emirates Ministry of Health, as
well as the Emirates Medical
Association and Emirates Dental
Society. Last year’s edition in
Kuala Lumpur, Malaysia attract ed more than 3,000 dental pro fessionals from the Asia Pacific
region and abroad, according to
figures of the APDF.
AD

25.–28.09. 2014

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innovative compomers
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materials for long-term prophylaxis
temporary solutions
bleaching products …

Glass ionomer filling cement
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• also available as application capsules

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Dental desensitising varnish
• treatment of hypersensitive dentine
• fast desensitisation
• fluoride release
• easy and fast application

[22] => Standard_300dpi

DTAP0614_22_Schedule 04.06.14 13:26 Seite 1

news

22

APDC Dubai 2014

Scientific Schedule

13:30–14:30

11:00–11:45

New perspectives in sinus floor
elevation techniques, Maktoum D
Speaker: Dr Christian Makary

The selection of biomaterials and
surgical techniques in Periodontal
plastic surgery, Maktoum A
Speaker: Prof. Guilio Rasperini

Tuesday, 17 June

11:00–12:30

09:00–17:00

Systemic diseases, oral mucosal
lesions and the dental practitioner,
Maktoum B & C
Speaker: Dr Abraham Thomas

Regenerative Dentistry
Symposium, Abu Dhabi B

14:15–15:15

11:30–12:30

09:00–09:45

Long term clinical results of
ceramic abutments, Maktoum A
Speaker: Prof. Jung-Suk Han

Maintaining patients
with dental implants:
Strategies for sustainable success,
Maktoum D
Speaker: Dr Nikos Mattheos

09:00–09:45
Challenges in Pediatric Dentistry,
Maktoum A
Speaker: Dr Dina Debaybo

09:00–10:30
From Smile Design to Composite
Veneer, Maktoum B & C
Speaker: Dr Bart Beekmans

9:00–10:00
Cone beam and Orthodontic
treatment, Maktoum D
Speaker: Dr Nael K. Abu Hassan

9:45–10:30
TMJ- Anatomy to Dental MorphologyClinical Application, Maktoum A
Speaker: Prof. William L. J. Fuh

10:00–11:00
Bone Ring Technique, Maktoum D
Speaker: Dr Bernd Giesenhagen

11:00–11:45
Temporo-Mandibular Dysfunction
and Occlusion, Maktoum B & C
Speaker: Dr Ashok Karad

11:00–12:00
Root Canal Irrigation Dynamics—
whats new and whats really true!
Speaker: Dr Gopi Krishna

11:30–12:30
New Horizons in Implant
Prosthodontics: Analogue
vs. CAD/CAM-generated
Superstructures, Maktoum D
Speaker: Dr Peter Uwe Gehrke

11:45–12:45
Introduction to Computerized
Occlusal Analysis, Maltoum B & C
Speaker: Dr Robert Kerstein

12:00–12:45
Computer Guided Implantology
at your fingertips, Maktoum A
Speaker: Dr Philippe Tardieu

13:30–14:15
Comprehensive Esthetic Considerations
for Implant Surgery, Maktoum B & C
Speaker: Dr Michael Chen
Medical Emergencies in Dental
Office, Maktoum A
Speaker: Dr James Rutkowski

13:30–15:30
Implant Esthetics: From
Expectations to Reality, Maktoum D
Speaker: Dr Urs Belser

14:15–15:00
Periodontal inflammation:
from gingivitis to systemic
diseases, Maktoum B & C
Speaker: Dr Roy Abou Fadel
Regenerative Endodontics,
a State of the Art, Maktoum A
Speaker: Dr Zaki Malallah

15:30–16:15
Bone tissue engineering, Maktoum B & C
Speaker: Prof. Saso Ivanowski
Customer Service in the
Dental Practice, Maktoum A
Speaker: Dr William Cheung

16:15–17:00
Must a removable reconstruction
be unaesthetic?, Maktoum B & C
Speaker: Prof. Sandro Palla

16:00–17:00
Simple Aesthetic Orthodontics for
the General Dentist, Maktoum D
Speaker: Dr Tif Qureshi

17:30
Welcome Ceremony

AD

Wednesday, 18 June

The Pulp therapy in primary teeth,
Maktoum B & C
Speaker: Dr Mawlood Kowash

14:15-15:00

14:30–15:30

Soft tissue management around
implants, Maktoum A
Speaker: Dr Zadeh Homa

Bruxism and Temporomandibular
disorders: Is there a causal
relationship?, Maktoum D
Speaker: Prof. Sandro Palla

09:00–10:30

15:30–16:30

Dental Ergonomics:
Evidence-based guidelines for
equipment selection, adjustment
and positioning, Maktoum D
Speaker: Bethany Valachi

Mini Dental Implants, Maktoum B & C
Speaker: Dr Todd Shatkin

Tiny Teeth: Baby’s First Dental
Visit, Maktoum A
Speaker: Dr Anubha Sacheti

15:45–16:30
Digital Prosthodontics: The future
is now, Maktoum A
Speaker: Prof. Shiv Shankar

16:00–17:00

09:45–10:30
Complications and Malpractice in
minor oral surgery, Maktoum B & C
Speaker: Dr Othman Al Tuwairgi

Reminaralization therapy in
Contemporary Esthetic Dentistry,
Maktoum D
Speaker: Dr Andrey Akulovich

Occlusion in Restorative Dentistry,
Maktoum B & C
Speaker: Dr Shankar Iyer

11:45–12:45
Controversies in dental
implantology, Maktoum A
Speaker: Dr Emad El Subehi

13:30–14:15
Clinical Photography:
An essential element of today’s
dental practice, Maktoum B & C
Speaker: Dr Ashok Karad

14:00–14:45
Ergonomics for dental personnel,
Maktoum A
Speaker: Marie Jalkanen
Diversity of Dental Implant
Therapies, Maktoum D
Speaker: Dr Nawaf Al Dousari

16:30–17:15
11:00–11:45

Ridge Augmentation using
autografts & recombinant
technology, Maktoum B & C
Speaker: Dr S.M. Balaji

14:15–15:00

16:30–17:30

14:45–15:30

The Endodontic Glidepath:
“The road to NiTi Rotary Safety
and efficiency”, Maktoum D
Speaker: Dr Rashid Elabed

Hard and soft tissue grafting,
Maktoum A
Speaker: Terry Oto

Dental plaque associated
with self-ligating brackets
during orthodontic treatment,
Maktoum A
Speaker: Dr Saud Al-Anezi

11:00–12:30

Thursday, 19 June

Application of radiology
in Forensic odontological
investigations, Maktozum B & C
Speaker: Prof. Phrabhakaran Nambiar

Full-Mouth Adhesive
Rehabilitation of Severely Eroded
Dentitions: a Novel Treatment
Concept, Maktoum A
Speaker: Dr Urs Belser

11:45–12:30
Resorption of hard dental tissues,
Maktoum B & C
Speaker: Dr Prasad Amartunga

11:45–12:45
Autism and Paediatric Dentistry,
Maktoum D
Speaker: Dr Neeta Chandwani

09:00–10:30
Techniques To Restore Patients
To Normal Contour, Comfort,
Function, Esthetics and Health,
Maktoum B & C
Speaker: Dr Hilt Tatum

How to tame a dragon,
Maktoum B & C
Speaker: Dr Mohammed Mansour

15:15–17:15
No pain, less stress—vision
or reality for dental patients?
Local anesthaesia and pain
pharmacotherapy in dentistry,
Maktoum A
Speaker: Krysztof Gonczowski

15:30–16:15
Clinical impact of new materials
and techniques on fixed
restorative dentistry,
Maktoum A
Speaker: Dr Arun Nayyar

My experiments and experiences
with Inhalation Sedation,
Maktoum B & C
Speaker: Dr Srinivas Namineni

16:00–17:00
09:00–10:00

13:30–14:15
Interdisciplinary Management of
Complex Dental Problems,
Maktoum B & C
Speaker: Dr Mithran Gonnewardene

Regenerative Strategies In Implant
Dentistry; Peri-Implanitis
And Current Trends, Maktoum D
Speaker: Stavros Mastronikolas

10:00–11:00
Conservative, conventional and
unconventional endodontics,
Maktoum A
Speaker: Associate Prof. Patrick S.K. Tseng

The Box Technique:
Aesthetically Guided Bone
Regeneration, Maktoum D
Speaker: Dr Andrea Menoni

Horizontal and Vertical Grafting
Techniques, Maktoum D
Speaker: Terry Oto

16:15-17:00
Porcelain Laminate Veneers:
Prep & No-Prep, Maktoum B & C
Speaker: Lamberto Vilani

17:30
Closing Ceremony

About the Publisher
Editorial/
Administrative Office
Phone
Fax
Internet
Tel: +1 424 744 0608 / email: c.ferret@tribunecme.com / www.TribuneCME.com

Publisher
Director of Finance
and Controlling
Managing Editor

DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd, 20A,
Harvard Commercial, Building,
105-111 Thomson Road, Wanchai, Hong Kong
+852 3113 6177
+852 3113 6199
www.dti-publishing.com
www.dental-tribune.com
Torsten Oemus
Dan Wunderlich
Daniel Zimmermann

Product Manager
Production Executive
Production

Claudia Salwiczek
Gernot Meyer
Franziska Dachsel

today APDC Dubai appears at the Asia Pacific Dental Congress in
Dubai, 17–19 June, 2014.
The magazine and all articles and illustrations therein are protected by
copyright. Any utilisation without prior consent from the editor or publisher is inadmissible and liable to prosecution. No responsibility shall
be assumed for information published about associations, companies
and commercial markets. General terms and conditions apply, legal
venue is Leipzig, Germany.

[23] => Standard_300dpi

DTAP0614_23_Exhibitors 04.06.14 13:27 Seite 1

business

APDC Dubai 2014

23

APDC Dubai 2014—Floor plan
8 A -1

8A-2

8A-3

8A-4

3

3

3

3

3

3

3

3

6

P A R A LLEL SESSION H A LL

8D-18

3

6

ENT R A NCE
8D- 2

8D- 3

8D- 9

8D-17

3

3

3

3

3

8E -10

8E -12

8E -14

8E -16

8E -18

ENTR A NCE
3

3

3

12

8E - 20

6

ENTR A NCE

8E - 9

6

8E -3

8E -13

6

8E -15

3

8E -17

8E -19

6

3

8F -10

8D-14

8D- 20

8F - 2

8F - 9

8F -11

8D-15

8F -18

8D-19

3

3

3

3

6

3

6

8 A - 31

3

3

12

8E -11

3

3

GOODS DOOR

8 A - 27

6

15

3

3

3

6
8 A - 29

6

3

3

6

8 C- 20
8 A - 30
8G -1

8G -3

3

3

8C -10

8C -12

8C -14

8C - 9

8C -11

8C -13

3

8 C-19

3

3

3

8B - 9

8B -11

8D-12

8B -10

8B -12

8D-11

3

3

3

3

6

3

3

6

8D -16

6

3

2

3

8G -18

8C -18

8D-13

8B-17

8B-19

L e gend:
FHR (Fir e Ho s e R eel)
Fir e Es c ape C or r idor
Fir e E x i t
Fir e A lar m Br e ak Gla s s

T he sha de d b o o t hs ha v e be en s old

R e s er v e d

APDC Dubai 2014—Exhibitors list
Company Confirmed Booth No.

Company Confirmed Booth No.

Company Confirmed Booth No.

Company Confirmed Booth No.

Company Confirmed Booth No.

3D Ortholine

8C – 18

Biotek

BC – 10

8A – 3

8F – 2

Cerkamed

8F – 10

GlaxoSmithKline
Consumer Healthcare

Technology Industries Group

3M ESPE Gulf Ltd.

Dental South China
International Expo

8E – 03

NSK Nakanishi Inc.

8A – 31

Acteon

8D – 09

China Tooth Material Exchange 8D – 15

HansBiomed Corp

8E – 13

Pharma Plus Drug Store

8A – 2

Sawhney Trading

8E – 17

Scrubz

8D – 3

Sirona Dental Systems GmbH

8G – 1

Titan Surgical Co

8E – 19

Tri Hawk International

8F – 09

Z- systems AG

8B – 09

AD Dental Solutions
GmbH

8E – 16 + 8E – 18

Al Hayat pharmaceuticals

8B – 17

Amna Industries

8E – 11

Anyang Zongyan

Colgate Palmolive Company

8D – 2

Dental Technology
Middle East—
Zimmer, Salli, AMMCS

CSM Implant

8D – 17

Dentart Instruments MFG

8D – 13

Hong Kong Dental Association 8D – 12
8F – 18
Infodent

8F – 11

CO/Dentaluck

8E – 20

Straumann

8B – 19

8A – 27

DENTSPLY IH GmbH

8G – 3

Johnson and Johnson

8G – 18

Denmat

8E – 14

DTI—

MANI, Inc

8E – 15
8D – 11

Delma Medical Instrument
(Guangzhou) Co., Ltd

Dental Material Co, ltd

8E – 09

Dental Arabia ME

8A – 1

Dental Tribune International

8B – 12

META BIOMED CO, LTD

APDC 2015

8A – 30

Dental Medium

8E – 12

Dubai Convention Bureau

8A – 4

Middle East Dental Laboratory 8D – 18

AsnanPortal

8A – 29

Dental News Philippines

8B – 11

Futudent

8C – 19

North Instrument

Floor plan and exhibitors list are subject to change.
Last update was 28 May, 2014.

[24] => Standard_300dpi

PA N · C E P H · 3 D

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) [page_count] => 24 [pdf_ping_data] => Array ( [page_count] => 24 [format] => PDF [width] => 895 [height] => 1243 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT Asia Pacific No. 6, 2014

[toc] => Array ( [0] => Array ( [title] => India targets fluorosis problem with new identification system [page] => 01 ) [1] => Array ( [title] => Asia News [page] => 02 ) [2] => Array ( [title] => Opinion [page] => 04 ) [3] => Array ( [title] => World News [page] => 05 ) [4] => Array ( [title] => Business [page] => 06 ) [5] => Array ( [title] => Special: Infection Control [page] => 07 ) [6] => Array ( [title] => Minimally invasive treatment of stained anterior teeth [page] => 16 ) [7] => Array ( [title] => Endodontic restorations in one single step [page] => 18 ) [8] => Array ( [title] => A state-of-the-art device for 3-D scanning [page] => 19 ) [9] => Array ( [title] => today APDC Dubai 2014 [page] => 21 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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