DT Asia Pacific No. 7+8, 2014

Asia News / Opinion / “A bite inflicted by a human can have serious health implications” / Business / Challenging but poised to grow / Clinical guidelines for the use of ProTaper Next instruments (Part I) / Infiltration with a resin material / Preventing carious lesions / today HKIDEAS

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DTAP0714_01-03_News 14.08.14 15:54 Seite 1

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DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

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

PUBLISHED IN HONG KONG

www.dental-tribune.asia

Cochrane review
New report questions
superiority of implants
(DTI/Photo Im Perfect Lazybones)

4Page

(DTI/Photo esfera)

NO. 7+8 VOL. 12

Poised for growth
Chang-Hong Whitney on
the dental market in China

Carious lesions
How to treat them with
help of dental sealants

4Page

India extends public dental
health care with 2014 budget
Daniel Zimmermann

DT Asia Pacific
NEW DELHI, India: In his 2014
budget speech presented to the
parliament in New Delhi, India’s
Minister of Finance Arun Jaitley
has proposed multimillionrupee funding for the establishment of a number of new
government-run hospitals. The
12 institutions that he has said
will be established in cities
throughout the country will
include treatment facilities for
oral health care.

Fluoridation
under review
The National Health and
Medical Research Council
(NHMRC) has called for submissions from the Australian
public on evidence regarding
the health effects of water
fluoridation. The council is
preparing a review of its current
recommendations on the subject to ensure that its advice
is based on the latest scientific
evidence.
On behalf of NHMRC, a team
at the University of Sydney will
undertake a systematic review
focused on scientific studies
submitted by the Australian
community that examine the
effects of water fluoridation on
human health published from
1 October 2006. Once the review
is complete, NHMRC will prepare a draft information paper
summarising the findings, on
which the public will have the
opportunity to comment.

In addition to increased funding for public dental services,
a new research and referral institute for higher dental studies is
to be set up in one of the existing
dental schools. The minister did
not provide details, however, on
where or when the institute will
be established.
The measures are just two
of a number of initiatives intended to improve access to
health care for a large part of
the Indian population. The additional investment in this sector

Union Minister for Finance, Corporate Affairs and Defence, Shri Arun Jaitley (left) on his way to present the General Budget
2014/2015. (DTI/Photo: Press Information Bureau, India)

for the next fiscal year will
amount to 500 million rupees
(US$8.3 million), according to
Jaitley.

Commenting on the budget,
which will also see tax reductions for low-income households
and seniors, Prime Minister

Narendra Modi said that the new
budget will be a ray of hope for
‡ DT page 3

Currently, the council recommends that water be fluoridated at the level of 0.6 to 1.1. mg/l,
a level that is believed to help
reduce tooth decay among Australian people without causing
dental fluorosis. DT
AD

New caries
initiative
in the
Philippines

MH17 records
delivered

Mukherjee joins
FDI AWDC

A newly established chapter
of the Alliance for a Cavity-Free
Future in the Philippines is
aiming to improve the country’s
devastating state of oral health.
Its goals presented to the public
at the recent 105th annual convention of the Philippine Dental
Association (PDA) in Pasay City
include the development and
nationwide implementation of
caries prevention and management systems by 2020.

Malaysia has confirmed that
the dental records of all of the
Malaysian victims of MH17 have
been collected and sent to Europe for forensic identification.
Forty-three Malaysian passengers were on board the flight,
which is believed to have been
shot down by pro-Russian rebels
over the Ukraine in early July. DT

The president of India Pranab
has accepted an invitation from
the Indian Dental Association
in Mumbai to inaugurate the
opening ceremony of the FDI
Annual World Dental Congress.
The annual event will be held at
the India Expo Centre in Greater
Noida near New Delhi from 11 to
14 September. DT

While the declaration was lacking in details, the initiative aims for
every child born after 2026 to be
cavity free. It said it will first target
schools in particular in order to
heighten awareness in the education sector that caries is a preventable disease and can result in a
lower quality of life if untreated. DT

Photo showing Ashik Gavai, an Indian teenager who recently had over
200 tiny teeth extracted from his mouth owing to abnormal growth affecting
his right mandibular second molar. (DTI/Photo courtesy of IANS, India)

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

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Ivoclar Vivadent AG
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DTAP0714_01-03_News 14.08.14 15:54 Seite 2

U P C O M I N G

DENTAL TRIBUNE

Asia News

WEBINARS Cochrane reports no evidence
for superior long-term success
of dental implants
DT Asia Pacific

DENTAL TRIBUNE AMERICA IS AN ADA CERP RECOGNIZED PROVIDER

SOFT AND HARD TISSUE
SURGERY WITH MUCODERM®

OCT

Henriette Lerner
06:00 PM (CEST)

Stable implant integration and functionality, along with aesthetic outcome are important aspects in modern implantology. The anatomical situation, however, rarely supports
optimal implant insertion. To ensure a predictable and aesthetic treatment outcome, specific principles for the augmentation should be considered.
Today, soft tissue surgery together with modern materials and
techniques (mucoderm®, etc.) permit minimally invasive treatments with improved aesthetic results. Already in 2007, membranes were developed to improve the width and strength of
the keratinized gingiva as well as change the gingiva typology.
Over the last years, specific materials and techniques have been
established for improved and more predictable results of plastic
peri-implant surgery. These concepts may be supported with
other modern technologies, such as the PRF-technique, aiming
to further improve and accelerate hard and soft tissue healing.

MELBOURNE, Australia/
MANCHESTER, UK: Promising
superior clinical outcomes,
plenty of new dental implants
are launched to markets each
year. A report by researchers
from the Cochrane Oral Health
Group in Melbourne and Manchester has recently suggested
that there may be no differences
in terms of long-term success,
regardless of the shape of the
implant or the material used.
The researchers reviewed
randomised clinic trials conducted around the world from
the group’s own database. From
this, the only statistically significant difference observed was in
relation to surface preparations,
with smoother (turned) surfaces
being found to be less prone to
bone loss associated with periimplantitis than were rougher
surfaces.
Smoother surfaces, however, appeared to fail early more
often, according to the analysis.
Similar results were reported by the group in a series
of earlier reviews, of which
the first was published in 2002.
In the most recent update, two
of the review authors independently compared 38 different implant types, which had

been placed in 27 trials involving more than 1,500 patients,
ranging from the early 1980s to
early 2014. They said that, while
their report provided no evidence that one specific type of
implant proved superior in
terms of long-term success to
other types of implants with
different characteristics, the results would have to be evaluated
carefully owing to the low number of participants and short follow-up periods, which ranged
from one to ten years.

A representative of Straumann
also cautioned against the results, saying that the review
reflects the fact that there is very
little or no published clinical
data on the majority of commercially available dental implants,
since they have not been clinically tested.

Overall, more than half of
the reviewed trials proved to be
at high risk of bias, they said.

“With regard to our own
implants, the review excluded
studies that we and others feel
are important. Furthermore,
it did not consider the large body
of bench tests and preclinical
trials that demonstrate significant differences in some cases,”
the representative told Dental
Tribune Asia Pacific.

He emphasised that of all
the implants available today
only 38 tested in randomised
controlled clinical trials were
considered worthy of review.

“One well known weakness
of such a meta-analysis of
several small studies is that it
cannot predict the results of
a larger study,” remarked Prof.
Stefan Holst, Global Head of
Research and Science at Nobel
Biocare, one of the global market leaders in dental implantology, on the report’s findings.
“With 38 different implant types
with highly diverse geometries,
surfaces, prosthetic superstructures and clinical protocols applied—several of which are no
longer in use—there are many
variables. The meta-analysis
dilutes any potential effect of
a single relevant implant surface or implant characteristic in
clinical practice today.”

According to the Cochrane
Collaboration, there are more
than 1,300 different dental implants available on the market
today. The total value of fixed
tooth replacements was estimated to be US$3.4 billion in
2011, a figure that some analysts
expect to almost double in the
next five years owing to the
increasing demand of an ageing
population and more dentists
starting to place dental implants. DT

DIAGNOSIS AND MANAGEMENT
OF ORAL LESIONS

Prof. Cesar Migliorati
08:00 PM (EST)
The presentation will guide the clinician on how to proceed
when an oral mucosal lesion is found. The discussion will include aspects of importance such as distinguishing benign
and malignant lesions, infections, ulcers, lumps and bumps
and the diagnostic procedures. The presentation will inform
the clinician about the mechanism of building a differential
diagnosis, achieving a definitive diagnosis, and managing the
case. The most common oral lesions and conditions will be
presented.
Participants will learn:
• The importance of oral examination
• Building a differential diagnosis of oral lesions
• Understanding diagnostic procedures
• Understanding basic management of common
oral lesions and conditions
• What to tell a patient when an oral lesion is found?

NOV

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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Magda Wojtkiewicz

Online Editors

Yvonne Bachmann
Claudia Duschek

Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
Dr George Freedman, Esthetics, Canada
Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany

The World’s Dental Newspaper · Asia Pacific Edition

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

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DTAP0714_01-03_News 14.08.14 15:54 Seite 3

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

Asia News

Patients in Australia favour receiving rapid HIV testing
DTI

SYDNEY, Australia: Despite
the necessary technology having been available for a number
of years already, rapid HIV testing is not yet widely offered
in dental settings around the
world. A study, which included
521 dental patients from Sydney
in Australia, now found that
more than 80 per cent of oral
health patients are willing to
undergo such tests during dental appointments. Seventy-six

ﬂ DT page 1

the poor. Despite the trying
times, he added, his government
is committed to extending every
possible assistance to the less off,
the neo-middle and the middle
classes.

per cent of those willing to receive rapid HIV testing at the
dentist’s office preferred an oral
swab, 15 per cent a pin prick test,
and 8 per cent a traditional blood
test, it also showed.
“Dentists are well placed to
offer rapid HIV testing because
they are located throughout the
community, have ongoing relationships with their patients, and
have the necessary training and

expertise to recognise systemic
diseases that have oral mani festations, such as HIV/AIDS,”
said Dr Anthony Santella, a public health scientist who led
the study. He added that about
45 per cent of dentists are currently willing to conduct rapid
HIV testing.
The new findings of the study
were presented at the HIV Testing Symposium, which was held

on 16 July at the university’s
Western Sydney Sexual Health
centre.
According to the 2014 Annual
Surveillance Report, a comprehensive analysis of HIV, viral
hepatitis and sexually transmissible infections in Australia
provided by the Kirby Institute,
approximately 14 per cent of
all HIV cases in Australia are
undiagnosed. The institute esti-

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The measures would be welcome in the country, where the
majority of the population is
still unable to access even basic
dental treatment. According to
a report published last year
by researchers from the Gian
Sagar Dental College in Rajpura
near Delhi in northern India,
the current dentist-to-patient
ratio ranges from an already
low 1:10,000 to a devastating
1:150,000 in some rural areas,
despite the ten thousands of students graduating from the country’s approximately 300 dental
schools each year. Lead author
Dr Ramandeep Singh Gambhir
therefore doubts that the proposed budget concessions will
have any long-term effect.

According to reports, most
Indians are still unaware of the
benefits of oral health measures
that are common in other parts
of the world. In a 2011 study
conducted in public schools in
Mumbai, for example, it was
found that 40 per cent of students
still used their finger instead of
a toothbrush to clean their teeth.
Even worse results were found
with regard to flossing and the
use of mouthwash. DT

Moreover, patients in Australia will soon be able to buy
rapid oral HIV tests over the
counter. At the beginning of
the month, the government removed restrictions preventing
the manufacture and sale of HIV
home self-tests. Now, companies
can sell such tests directly to
consumers. DT
AD

Honorary General Secretary
of the Indian Dental Association
Dr Ashok Dhoble commented:
“IDA has been championing the
cause and has undertaken several initiatives to improve oral
health and with it the quality
of life of people in the country.
Setting up a research and referral
institute for higher dental studies
on a national level as proposed in
the budget is the need of the hour,
if we are to usher in a new dawn
in oral health care.”

“The budget means no reform for the existing problems,
as it only concentrates on dental
research which is already being
conducted in postgraduate dental institutions,” he explained.
“Setting up dental clinics in
medical hospitals won’t solve the
problem either, unless there are
programmes which can raise the
awareness level of the Indian
population.”

mates that 24,500–30,900 people
are living with HIV in Australia.

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

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DTAP0714_04-05_News 14.08.14 15:56 Seite 1

Opinion

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

Dear
reader,

The Ebola
virus
epidemic:
A concern
for dentistry?

“Is it budget time again?”

Daniel Zimmermann
DTI

Implants are probably a topic
in dentistry that has the potential
to spark vigorous debate among
clinicians. Whenever I talk to
dentists in interviews or casually
at congresses, I almost certainly
encounter two opposing viewpoints: those who are passionate
advocates of the devices or those
who believe implants signal the
doom of dentistry.
The truth, as always, lies
somewhere in the middle, but
there is certainly a corporate influence in dental implantology
nowadays that cannot be ignored.
Or to quote a well-known implantologist I recently had the
opportunity to interview: “I am
afraid these companies own us.”
With an increasing number
of dentists expected to start
placing implants, this issue will
become ever more important.
I wonder what your viewpoint
on the debate is. 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.

Prof. Lakshman
Samaranayake
Australia

The risk of extinction
Dr Sebastian Saba
Canada

During the past few years, there
appears to have been an increase in
the continuing education courses
being offered. Many of the courses
cover implant dentistry, but the
conventional courses that form the
basis of learning the skills to save
teeth have been fewer in number.
Apparently, everybody wants to
learn how to place a dental implant
surgically.
In the past, dentists spent four
to five years in dental school learning many of the skills needed to
save teeth. These skills involve
different forms of dentistry, not
limited to periodontics, operative
dentistry or endodontics. They
spent countless hours learning to
negotiate root surfaces in debridement and root canal curvatures in

endodontics, as well as multiple
techniques in operative dentistry
to preserve teeth. But all that has
changed overnight. Why spend so
much time saving teeth when you
can remove them and place a dental implant in half the time? Is this
really better for the patient? Why
burden the patient with multiple
periodontal procedures to save
teeth when the alternative is here?
This approach appears to be
widespread in the thinking of clinicians today. Many are concerned
that dentists are not promoting the
correct approach to preserving the
integrity of the natural dentition.
The attitude is so contagious that
even some endodontists are learning to place dental implants. Is this
not a clear conflict of interest? What
is their motivation? Are we doing
enough to teach dentists to diagnose and prognose the ailing dentition? When does an ailing dentition
become a failing dentition? When
is it appropriate to choose implant
dentistry over conventional, time-

proven and predictable conventional dentistry?
The removal of key aspects of
dental training creates dentists
who are not confident to diagnose
or render the necessary procedures
to save teeth adequately. Their clinical skills in recognising and managing ailing dentition are limited.
Their ability to recognise when and
where dental implants may be used
may be influencing their ability or
motivation to save teeth. Are we
not creating a conflict of interest for
our patients? The true need should
be to return to the basics and learn
to save teeth first, so patients are
able to keep the most natural dental
implant of them all. DT

Contact Info
Dr Sebastian Saba is Editorin-Chief of Dental Tribune
Canada. He can be contacted at
sabpros@sympatico.ca.

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Twenty-two years ago, a seminal report from the Institute of
Medicine (IOM) in the US titled
Emerging Infections: Microbial
Threats to Health in the United
States warned of the dangers of
so-called newly emerging and
re-emerging diseases. The concept of “emerging infectious diseases”, introduced then by the
IOM is now well entrenched, and
to our chagrin we have witnessed
many such diseases over the last
two decades. These include variant Creutzfeldt–Jakob disease/
bovine spongiform encephalopathy, severe acute respiratory
syndrome, and Middle East res piratory syndrome, and above
all the pandemic of acquired
immune deficiency syndrome
(Aids), which has claimed millions of lives the world over. The
re-emerging infectious diseases
we have seen include diseases
caused by meticillin-resistant
Staphylococcus aureus, and multidrug-resistant and extensively
drug-resistant tuberculosis.
Interestingly, the concept of
“emerging infectious diseases”
is not new. Indeed ancient Greek,
Roman and Persian writers documented the emergence of many
new epidemics. In more recent
times, the scientist Robert Boyle
presciently observed in 1865 that
‡ DT page 5

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DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014
ﬂ DT page 4

“there are ever new forms of epidemic diseases appearing […]
among [them] the emergent variety of exotic and hurtful […]”.
Arguably though, the most noteworthy relatively new emerging
infectious disease with the greatest impact on the dental profession has been the human immunodeficiency virus and Aids.
And now we have a severe
epidemic of Ebola virus infection. It is back with a vengeance,
this time in West Africa, with over
380 cases and a 69 per cent case
fatality ratio at the time of writing.
The culprit is the Zaire ebolavirus species, the most lethal
Ebola virus known, with case
fatality ratios up to 90 per cent.

“...we cannot afford to let
our guard down...”
patients die owing to the profound systemic haemorrhage or
its complications. The incubation period of EVD is 2 to 21 days.
Up to now, there have been no
reported cases of transmission
of EVD in any dental settings.
However, the fact that it is transmitted through human secre-

tions, which includes saliva, and
that the incubation period could
last up to 21 days implies that
dental care workers in the endemic areas of the virus, such as
West Africa and sub-Saharan
Africa, may run the risk of acquiring the disease if strict standard
infection control measures are
not routinely followed.

EVD is a severe acute illness
characterised by the sudden onset of fever, intense weakness,
muscle pain, headache and sore
throat. This is followed by vomiting, diarrhoea, rash, impaired
kidney and liver function, and
both internal and external bleeding in some cases. Oral mani festations, such as acute gingival
bleeding, have been reported.
The mortality rate of EVD is very
high and 50 to 90 per cent of

In dentistry, we are constantly exposed to these emerging and re-emerging infectious
threats and we cannot afford to
let our guard down. Vigilance,
awareness and good clinical
practice with standard infection
control at all times are fundamental to prevention, as yetunimagined new diseases surely
lie in wait.
Although we have made spectacular technical and scientific
advances since the release of
the original IOM report some

two decades ago, it appears that
humans are still defenceless in
the face of the relentless march
of our microbe foes. DT

Contact Info
Prof. Lakshman Samaranayake
is head and Professor of Oral
Microbiomics and Infection at
the University of Queensland
School of Dentistry in Brisbane
in Australia. He can be contacted
at l.samaranayake@uq.edu.au.
AD

According to the IOM report,
there are many reasons that new
diseases emerge and re-emerge.
These include health care
advances with the attendant
problems (e.g. transplantation,
immunosuppression, antibiotic
abuse, and contaminated blood
and blood products) and human
behaviour, including injectable
drug abuse and sexual promiscuity. Societal occurrences, such as
economic impoverishment, war
and civil conflict, too are critical
according to the IOM. The current outbreak of Ebola virus
infection is a perfect storm created by a lethal combination of
these factors, including rampant
deforestation, poverty and the
war-stricken situation in many
African countries.

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Images: Dr. Marie Clément (France)

So how does Ebola spread?
According to World Health Organization reports, Ebola virus
disease (EVD) is introduced into
the human population through
close contact with the blood,
secretions, organs or other bodily fluids of infected animals. Human-to-human transmission is
through direct contact (through
broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids, such as saliva, of infected
people, and indirect contact with
environments contaminated
with such fluids. Transmission
through the air has not been documented in the natural environment, nor have there been any
case reports of transmission
through saliva contamination.
Infection in health care settings
has been due to health care
workers treating patients with
suspected or confirmed EVD,
especially when infection control precautions were not strictly
practised. Reports indicate that
those who recovered from the
disease could transmit the virus
through their semen for up to
two months after recovery.

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World News

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

“A bite inflicted by a
human can have serious
health implications”
An interview with former FIFA-appointed
dentist Dr Dietrich Fischer-Brooks
During the last two months,
32 football teams from around
the globe were competing for
the World Cup trophy in Brazil.
Dental Tribune Group Editor
Daniel Zimmermann had the
opportunity to speak with Dr
Dietrich Fischer-Brooks from
Germany, a former FIFA-appointed dentist who also provides
dental care for German Bundesliga club Eintracht Frankfurt,
about the oral health of players
and why the infamous bite inflicted
by Uruguay superstar Luis Suárez
during his team’s match against
Italy could have rather serious
implications for his opponent.
Uruguayan football player Luis Suárez bit an Italian defender during
a World Cup match in Brazil. (DTI/Photo AGIF)

Daniel Zimmermann: Dr
Fischer-Brooks, the biting inci-

dent involving Luis Suárez has
made headlines during this
year’s World Cup tournament.
In addition to a long-term ban,
could this incident have any
implications for his oral health?
Dr Dieter Fischer-Brooks:
Only for his Italian opponent,
Giorgio Chiellini. A wide variety
of harmful bacteria live in the
oral cavity and a bite inflicted by
a human can have serious health
implications. I know of some severe infections that have resulted
from such bites.
Suárez appeared to have
suffered from pain directly
after the incident. Was this real
or just an act?
I believe that this was just an
act. Upon realising that he had
been bitten, the Italian would
likely have struck out at Suárez,
but whether he really hit Suárez
is subject to speculation.
Would you have recommended that Suárez visit a
dentist after the game?
Only if he had really been
struck on the mouth. Shortly afterwards, I saw him giving an interview, however, which indicates
that it could not have been that bad.
Are elbow impacts a frequent
cause of dental injuries in football?
Definitely. Many of the players
I treat here in Frankfurt on a regular basis have sustained injuries
to their anterior teeth at some time
in their career. Therefore, many
players wear mouth guards while
playing. One often sees them
during post-match interviews.
Do players have to undergo
dental check-ups during a tournament like the World Cup or
is oral health considered their
personal responsibility?
This really depends on the professionalism of the staff. As a principle, players should be checked
in advance of the tournament for
any signs of infections in the
mouth, or in the jaw and face area.
Cases of players suffering sudden cardiac death on the pitch are
not uncommon. In many of these
cases, the cause was a serious infection, which may have resulted
from dental problems, including
infected third molars, severe periodontitis or infections in endodontically treated teeth, to name a few.

EXPERIENCE OUR ENTIRE COLLECTION ONLINE

What impact can these problems have on the health or the
performance of players?
Bacteria migration from anywhere in the human body can
affect the heart valves. Moreover,
it can lead to inflammation in
joints like the knee. I remember

a case here in Frankfurt in which
a player, who also played for the
Czech national team, was unable
to wear football shoes for months
owing to a fistula on his small toe.
We were finally able to attribute
this to an infected third molar.
When we removed the molar, the
fistula disappeared within days,
allowing the player to resume
training.
Team physicians often struggle with these symptoms because
they are not able or trained to
recognise such associations. This
example demonstrates clearly
that bacteria in the mouth can migrate to distant parts of the body.
In most cases, the heart primarily
is affected.
Football players have celebrity status and pay significant
attention to their body image.
How important are good teeth
in this regard?
Straight and attractive teeth
have become a symbol of success.
I have to say, however, that some
players have developed a downright tooth fetish, as they visit me
every two or three months to have
their teeth checked. In many
foreign players, particularly those
from Eastern Europe, it is evident
that they did not receive adequate
dental care while they were children. Consequently, I usually have
to perform extensive dental treatment on them.
During the 2006 tournament
in Germany, you were responsible for dental treatment for
the teams from England and
Saudi Arabia. Did you observe
any differences with regard to
their oral health?
There are significant inequalities internationally. Dental care
(similar to general health care) in
England, for example, is not the
best. This is evident in the poor
state of dentition, including de fective fillings and other signs of
second-rate dentistry. High-quality oral health care as practised
in Germany or Switzerland, for
example, is not common.
Owing to your work, do you
pay more attention to the teeth
of footballers, and are there
any players whose teeth have
impressed you lately?
I am really fascinated by James
Rodríguez from Columbia. This
young player has very attractive
teeth. At the moment, I have also
been paying attention to the teeth
clenching that one commonly
sees in players during interviews.
Aesthetics is one thing, but there
are also medical aspects to this.
Thank you very much for the
interview. DT

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DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

Business

Ivoclar Vivadent discusses
monolithic restorations in London
Overall, Ivoclar’s latest expert
event drew over 750 delegates
to London. Organised in collaboration with King’s College
London Dental Institute, one of
the most prestigious dental institutions in the UK, it was the
second edition of a series that
started in Berlin in Germany
two years ago. A follow-up event
has already been scheduled for
2016 and will be held in Madrid
in Spain, Chief Sales Officer at
Ivoclar Vivadent Josef Richter
said.

DTI

LONDON, UK: For over 150
years, the Westminster Hospital
in London took care of the
sick and disabled until making
way for the Queen Elizabeth II
Convention Centre in 1994.
One of the most high-profile
convention venues in the British
capital today, this modern flatroofed building opposite Westminster Abbey now stages over
350 events each year.
Recently, dental manufacturer Ivoclar Vivadent from
Liechtenstein hosted hundreds
of professionals from all over the
globe at the prestigious venue to
discuss the latest in monolithic
restorations. Following the principle that dental restorations
should always mimic the natural
dentition, prominent clinicians
from Europe and the Americas
presented a number of clinical
cases that demonstrated what
can be achieved with dental
ceramics. Impressive restorative
work was shown by German
dental technician Oliver Brix and
the UK’s own Dr James Russell,
among others, who discussed
clinical cases treated using

Delegates can look forward
to a number of new products to
be launched by Ivoclar Vivadent
during the year, including the
much-anticipated IPS e.max
Press multi, which will allow
horizontal pressing for longlasting clinical success.
US dentist Dr George Eliades (second from right) in discussions with other experts. (DTI/Photo Daniel Zimmermann)

Ivoclar Vivadent’s IPS e-max.
While it is still not able to reproduce nature entirely, the restorative system, along with other
modern dental materials, has
not only changed how cosmetic
dentistry is performed, but also
allowed it to be increasingly less
invasive, Russell said.

The use of CAD/CAM technology, was further shown
by Italian technician Michele
Temperani to achieve higher
aesthetic outcomes when combined with all-ceramic materials. Issues in the field were also
addressed, including the correct bonding technique, which,

Improved zirconia
announced by
Kuraray Noritake
DT Asia Pacific

TOKYO, Japan: Kuraray Noritake
Dental has said it has developed
a new kind of zirconia that,
according to the Japanese company, features higher flexural
strength and fracture toughness
than any other material of its
kind. The material demonstrated significantly improved
flexibility in a three-point flex-

ural strength test when compared with results from a test
conducted with a conventional
zirconia.
Fracture toughness was even
found to be twice as high in the
new material, the company reports. More importantly, unlike
in most conventional zirconia,
the crystal structure of the new
material does not appear to

change to a monoclinic phase
under high pressure and temperatures. This process usually
makes materials more prone to
damage by inducing stress.
According to Kuraray Noritake
Dental, the material also does
not need to be subjected to hot
isostatic pressing, an industrial
process for improving physical
or chemical characteristics of
ceramics and metals.
The yet unnamed material
is intended to be used in the
production of a new generation
of durable and more resistant
dental materials. In addition, it
will offer benefits for the development of prosthetic joints and
other industrial applications.
In the next step, the company
said it will ready the material for
launch to dental markets and
other commercial industries.

Photo showing a side view of the material being subjected to a three-point flexural
strength test. (DI/Photo courtesy of Business Wire)

The material is the first joint
development announced by the
company, which was formed
from a merger of dental material
manufacturers Kuraray Medical
and Noritake Dental Supply two
years ago. DT

according to Belgian presenter
Bart van Meerbeek, depends
on functional monomers. While
research has shown that selfetching is often the most effective approach, the etch and rinse
technique is still required in many
cases, he explained.
During a round-table discussion held on the first day, all
experts agreed that a thorough
diagnosis and a good working relationship between the clinician
and dental technician are still
among the most important criteria for achieving the best results.

Also announced were new
furnaces in Ivoclar Vivadent’s
Programat line with a new
design that will offer guided
pressing, among other features,
to make restorations easier and
faster.
In response to increasing
demand, Wieland Dental, part
of Ivoclar Vivadent since 2012,
will be launching a new version
of its compact CNC milling system Zenotec that will allow wet
pressing. The company’s offering of Zenostar zirconia, as well
as abutment solutions, will also
be extended. DT
AD

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DTAP0714_10_Whitney 14.08.14 15:59 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

10 Business

Challenging but poised
for growth
An introduction to the dental market in the People’s Republic of China
(DTI/Photo esfera )

Chang-Hong Whitney

USA
With its long history, rich culture and large population,
China has been the focus of
attention for centuries. Par ticularly its rapid economic
growth in the last two decades
has triggered increasing interest from Western businesses,
who have sought to participate
in this vast market. After having experienced all the highs
in the initial days, as well as the
disappointing lows as China’s
realities set in, many have
found themselves wondering
whether the Chinese market is
still as attractive as it appeared
at first, and how to ultimately
succeed in the market. There
are many successful foreign
companies in the market now.
Whitney Consulting is a reg ulatory consulting company exclusively focusing on Chinese
regulatory affairs, including
product registration, regulatory
strategies and regulatory compliance. Its sister company,
Whitney Research, is a market
research company specialising
in Chinese market research,
competitive analysis, reimbursement research, business strategies and investment advice. Both
companies also work closely
with international trade groups
to bring international suppliers
and their advanced medical
products into the Chinese market.
In 20 years of operating in
China, we at Whitney Consulting
and Whitney Research have seen
the ups and downs of this exciting market, and weathered the
economic and political storms.
This feature article is an attempt
to share our knowledge, experiences and observations on
market trends with readers of
Dental Tribune Asia Pacific.
It is first necessary to consider
background information to the
Chinese dental market. Currently, it is estimated that China
has a population of 1.3 billion
people, of whom more than
two-thirds are under 54 years of
age, with the number of men
slightly exceeding the number
of women. In contrast to many
developing countries, the elderly
demographic is relatively small,
with less than 10 per cent over
the age of 65. The country is the
largest economy in Asia and the
second largest in the world after
the US. According to the National
Bureau of Statistics of China,
the national average disposable
income of urban residents in
2013 was ￥26,955 (US$4,383),
which at the current (11 August)

Chinese manufactures who have traditionally served the medium and lower end of the market, are gaining ground.

exchange rate (US$1 = ￥6.15)
equals a net growth of 7 per cent
compared with the year before.
The top five municipalities and
provinces ranked by disposable
income level in 2012 were the
Shanghai Municipality, Beijing
Municipality, Jiangsu Province,

found that adults between the
ages of 35 and 44 had cavities,
and only 8.4% of the teeth with
cavities had been treated. Periodontal disease was rather rare
and only affected 14% of the population. Tooth loss affected more
than every third person between

ever, are still the thousands of
state-run dental hospitals, which
offer the full range of dental services and rely on their long history,
reputation, experience and large
number of patients. In recent
years, small private clinics have
sprung up in large numbers, tak-

“...annual imports of dental X-ray
systems have been growing in double
digits each year, as have the imports
of dental materials and equipment...”
Tianjin Municipality and Shandong Province.

An underdeveloped market
Dental diseases are tradi tionally considered non-acute
illnesses (i.e. not life/death situations). Therefore, knowledge
of dental care and treatment is
generally lacking. According to
the Third National Oral Health
Epidemic Investigation Report,
published in 2008, 94 per cent of
the population had some form
of dental problem, of which the
most prevalent were calculus
(97 per cent), caries (88 per cent)
and periodontal disease (85 per
cent). Dental sensitivity, plaque
and malocclusion were also
highly prevalent. The report also
found that 66 per cent of children
aged five had cavities. Almost onethird of children aged 12 also had
cavities in the permanent teeth.
In the adult population, it was

the ages of 35 and 44 and almost
one in ten people between the
ages of 65 and 74. Between 10
and 42.6 per cent of adults wore
dentures.
Despite the obvious demand
for dental care services in the
population, the Chinese market
remains under-developed. For
every one million people, there
are only 100 dentists, compared
with 500–1,000 dentists in the
US or EU countries. Even Brazil,
another developing nation, has
a better dentist–patient ratio.
Chinese dental schools produce 15,000 new dentists each
year, a number that is expected
to accelerate through newly established dental hospitals and
clinics. There are approximately
300 dental specialty hospitals in
the country. The major providers
of dental care to the public, how-

ing advantage of the relaxed government regulations for private
health care centres. Over 50,000
of these are estimated to be in
operation to date. As the private
health care market is still largely
in its infancy and relatively unorganised, these clinics will face
difficulties and probably losses
in the near future.
The medical device market
in China is dominated by inter national high-end suppliers.
Lately, the annual imports of
dental X-ray systems have been
growing in double digits each
year, as have the imports of
dental materials and equipment,
such as chairs. While Chinese
manufactures have traditionally
served the medium and lower
end of the market, they are
now gaining ground owing to
improvements in technology,
higher product quality, and fi-

nancial and policy support from
the government, among other
factors.
International companies
looking to enter the Chinese
dental market typically use
trade shows as avenues to showcase their products, meet with
prospective dealers and customers, as well as obtain an
overview of the competitive
landscape. One of the newest
shows in China, the China Dental Show, which is co-sponsored
by the Chinese Stomatological
Association and will be held in
Shanghai from 25 to 28 September this year, will focus on
dental implants and feature the
best products, suppliers and
customers in this field around
the world.
The information provided
above offers only a very brief synopsis of this challenging market.
Other important subjects, such
as the changing public view on
dental care, the business culture,
regulations, policies, reimbursement and medical treatment,
which many companies find
difficult to understand and to
navigate, will be explored in
future articles.
It is evident that China is
poised for high growth in the
dental industry because it has
the health needs, number of
patients, financial availability
and increased awareness of
the benefits of good oral health.
In order to be successful and
survive in China, businesses
must have the tenacity to undertake prolonged processes, the
ability to adapt and the determination to overcome obstacles,
while fulfilling the expectations
of the public concerning health
benefits. DT

Contact Info
Born in China,
Chang-Hong
Whitney has lived
in the US for
24 years. She
is President of
Whitney Con sulting Ltd in Littleton, Mass.,
in the US, and Beijing in China.
Mrs Whitney is a member of the
Regulatory Affairs Professionals
Society and a certified regulatory
affairs professional. She also
teaches Chinese regulatory affairs as an adjunct professor at
Regis College, Weston, Mass., and
works with government agencies,
such as the US Department of
Commerce, providing regulatory
and business consulting services
to companies wishing to enter
China. She can be contacted at
changhong@whitneyconsulting.net.

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DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

12 Trends & Applications

Clinical guidelines for
the use of ProTaper Next
instruments (Part I)
Fig. 1

Fig. 2

Fig. 4

Fig. 8

Fig. 9b

Fig. 9a

According to Bird, Chambers
and Peters,1 rotary nickeltitanium (NiTi) instruments
have become a standard tool
for shaping root canal systems.
Compared with conventional
stainless-steel instruments,
these instruments offer several
advantages. For instance, they
are more flexible and have
increased cutting efficiency.2–4
They can also create centred
preparations more rapidly,5, 6 as
well as produce tapered root
canal preparations that tend to
have less canal transportation.7, 2
However, NiTi instruments
appear to have a high risk of
fracture8, 9 mainly because of
flexural and torsional stresses
during rotation in the root canal
system.10, 11
When there is a wide area of
contact between the cutting edge
of the instrument and the canal
wall during rotation, the instrument will be subjected to an increase in torsional stress.12 The
preparation of a reproducible

Fig. 10

glide path, a smooth passage that
extends from the canal orifice in
the pulp chamber to its opening at
the apex of the root,13 can reduce
the torsional stress on root canal
instruments. This way, a continuous and uninterrupted pathway
for the rotary NiTi instrument
to enter and to move freely to the
root canal terminus is provided.
The main purpose of a glide path
is to create a root canal diameter
the same size of the first rotary
instrument used or ideally a size
larger than that.14–16
Another way to reduce torsional stress is to incorporate multiple progressive tapers into the instrument design, as the ProTaper
Universal system (DENTSPLY
Maillefer) does, for example. According to West,17 the progressive
taper allows for only small areas of
dentine to be compromised. This
design concept also contributes to
maintaining the original canal
curvature.18
The ProTaper Next system was
recently launched on the dental
market. Although it comprises five
instruments, most canals can be
prepared by using only the first

Fig. 13b

Fig. 7

Fig. 6

Fig. 5

Prof. Peet J. van der Vyver &
Dr Michael J. Scianamblo
South Africa & US

Fig. 13a

Fig. 3

Fig. 14a

Fig. 12a

Fig. 11

two. Each file comes with an
increasing and decreasing percentage tapered design on a single
file.19 This multiple progressive
taper concept helps to reduce
contact between the cutting flutes
of the instrument and the dentine
wall, thus reducing the possibility
of taper lock (screw-in effect).
It also increases flexibility and
cutting efficiency.20
The first instrument in the system is the ProTaper Next X1 (Fig.
1) with a tip size of 0.17 mm and
a 4 % taper. This instrument is
used after a reproducible glide
path has been created by means
of hand instruments or rotary
PathFiles (DENTSPLY Maillefer).
The ProTaper Next X2 (0.25 mm
tip with 6 % taper; Fig. 2) can be
regarded as the first finishing file
in the system, as it leaves the prepared root canal with adequate
shape and taper for optimal irrigation and root canal obturation.
Both the X1 and X2 have an increasing and decreasing percentage tapered design over the active
portion of the instruments.
The last three finishing instruments are the ProTaper Next X3

Fig. 14b

(0.3 mm tip with 7 % taper; Fig. 3),
ProTaper Next X4 (0.4 mm tip with
6% taper; Fig. 4) and ProTaper
Next X5 (0.5 mm tip with 6 % taper;
Fig. 5). All three have a decreasing
percentage taper from the tip to the
shank. They can be used to either
create more taper in a root canal or
prepare larger root canal systems.

Fig. 12b

cross-section in the last 3 mm segment to give the instrument a bit
more core strength in the narrow
apical part.

Another benefit of this system
is that the instruments are manufactured from M-Wire and not
from a traditional NiTi alloy.
Johnson et al.21 demonstrated that
the M-Wire alloy can reduce cyclic
fatigue by 400 % compared with
similar instruments manufactured from conventional NiTi alloys. This allows for instruments
that are more flexible, increased
safety, and protection against
fracture of the instruments.22

This design feature results in
a rotational phenomenon known
as precession or swagger,23 which
further minimises the engagement between the instrument and
the dentine walls for reduced taper
lock, screw-in effects and stress on
the file. The removal of debris occurs in a coronal direction (Fig. 7)
because the off-centre cross-section allows for more space around
the flutes of the instrument. This
leads to improved cutting efficiency, as the blades remain in
contact with the surrounding dentine walls. This way, root canal
preparation is faster and requires
less effort.

The last major advantage of
root canal preparation with the
ProTaper Next system is that most
of the instruments have a bilateral
symmetrical rectangular crosssection (Fig. 6)offset from the central axis of rotation (except in the
last 3 mm of the instrument,
D0–D3). The exception is the ProTaper Next X1, which has a square

The swaggering motion of the
instrument initiates the activation
of the irrigation solution during
canal preparation, further improving debris removal. Every instrument is capable of cutting a
larger envelope of motion (larger
canal preparation size; Fig. 6)
compared with an instrument of
similar size with a symmetrical

Fig. 15a

Fig. 15b

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Fig. 16a

Fig. 18a

Fig. 18b

Fig. 16b

Fig. 18c

mass and axis of rotation. This
allows the clinician to use fewer
instruments in preparing a root
canal, as well as adequate shape
and taper for optimal irrigation
and obturation. Moreover, there is
a smooth transition between the
different sizes of instruments as
the instrument sequence itself
expands exponentially.

each root canal system. However,
in this clinical case, there was still
a dentine triangle obscuring direct
access to the distobuccal root
canal system (Figs. 9a & b). The #3
Start-X tip (DENTSPLY Maillefer)
was used to remove some of this
dentine on the pulp floor (Fig. 10)
for more direct access to the distobuccal root canal orifice.

Clinical guidelines for
ProTaper Next instruments

A micro-opener (10.06) was
used to locate and enlarge the distobuccal and mesiobuccal canal
orifices (Fig. 11). For improved
radicular access, the SX instrument from the ProTaper Universal
system was employed (Fig. 12a).
Introducing the file into the coronal portion of the root canal is
recommended to ensure that the
file can rotate freely. Restrictive
dentine is then removed by using
a back stroke outward brushing
motion. This step will also relocate
the canal orifices more mesially or
distally (away from furcal danger)
and pre-flare the canal orifices
to provide complete straight-line
access to the root canal system
(Fig. 12b).

The clinical technique for
ProTaper Next will be discussed
in the following case reports. The
first example will outline the basic
guidelines for the use of ProTaper
Next instruments.

Case report 1
The patient, a 64-year-old
male, presented with a previously
conducted emergency root canal
treatment on his maxillary left first
premolar. A periapical radiograph
showed evidence of three separate
roots and a large periapical lesion
(Fig. 8). According to the patient,
the tooth was left open to allow for
drainage by his dentist who had
performed the emergency root
canal treatment.
Guideline 1:
Create straight-line access
and remove triangles of dentine
It is very important to prepare
an adequate access cavity that will
allow straight-line access into

Fig. 22a

Fig. 22b

Guideline 2:
Negotiate the canal to patency and
create a reproducible glide path
The authors of the article prefer to negotiate the root canal with
size 08 or 10 K-files until apical
patency is established (Fig. 13a).
This is the ability to pass small

Fig. 22c

Trends & Applications 13

Fig. 16c

Fig. 19

Fig. 17a

Fig. 20

K-files (0.5–1.0 mm) passively
through the apical constriction
and beyond the minor diameter
without having to widen it.24
Length determination should be
performed with a Propex Pixi apex
locator (DENTSPLY Maillefer).
Predictable readings can be
achieved by using two size 10 K-files
in the mesiobuccal and distobuccal root canals, and a size 20 K-file
in the larger palatal root canal.
The results have to be confirmed
radiographically (Fig. 13b).
After working length determination, a reproducible glide path
should be established. It is recommended that the stainless-steel
K-files be used in an in-and-out
motion vertically with an amplitude of 1 mm, gradually increasing
the amplitude as the dentine wall
wears away and the file advances
apically.13 West also recommends
a super-loose size 10 K-file as the
minimum requirement. In order
to confirm that a reproducible
glide path has been established,
the size 10 file should be taken to
full working length (Fig. 14a). The
file is then withdrawn 1 mm and
should be able to slide back to
working length by applying light
pressure with the finger. Then, the
file is withdrawn 2 mm and should
be able to slide back to working
length using the same protocol.
Once the file can be withdrawn
4–5 mm and slides back to working

Fig. 23

Fig. 24

Fig. 17b

Fig. 21a

length (Fig. 14b), a reproducible
glide path has been established.25
The reproducible glide path
should then be enlarged by using
rotary PathFiles. The #1 PathFile
(0.13 mm tip size) should be taken
to full working length while operating at 300 rpm and 5 Ncm torque
(Fig. 15a). Once the file has
reached working length, the authors recommend brushing lightly
outwards against one side of the
canal wall. The file should then be
pushed back to working length
and brushed outwards against
another part of the canal wall. This
procedure should be repeated four
times (touching the canal wall in
a mesial, distal, buccal and lingual
direction). Then, the #2 PathFile
(0.16 mm tip size) should be used
in accordance with the same protocol (Fig. 15b). In most cases,
it is only necessary to enlarge the
glide path to the second PathFile
(0.16 mm), as the X1 has a tip size
of ISO 17. However, using the
#3 PathFile (0.19 mm tip size) for
more challenging root canal systems is recommended.
Guideline 3: ProTaper Next
preparation sequence
Sodium hypochlorite (NaClO)
and the ProTaper Next X1 instrument should be introduced into
the root canal. The authors found
that there are five scenarios with
the X1: easy root canals, more

Fig. 25

Fig. 17c

Fig. 21b

difficult and longer root canals,
very long and severely curved root
canals, as well as large-diameter
root canals and root canals for
retreatment for which the use of
the X1 is not necessary and canal
preparation can be initiated with
the ProTaper Next X2, X3, X4 or X5.
The last two scenarios will be
discussed later in the article.
In the case of easy canals
(a mesiobuccal root canal in this
case report), the X1 (operating at
300 rpm and torque of 2.8 Ncm)
should slide down the glide path
up to working length (Fig. 16a).
If this is possible, the instrument
should be pulled back to approximately 2–3 mm short of working
length, followed by a deliberate
back stroke outward brushing
motion, away from any external
root concavities, to create more
space in the coronal aspect of the
root canal (Fig. 16b). Finally, the
file should be taken to full working length and touch the apex.
Brushing outwards (coronally)
with the file in the apical third of
the root canal is recommended.
This touch-and-brush sequence
can be repeated up to three or four
times (Fig. 16c).
For more difficult and longer
canals (a distobuccal root canal in
this case report), the X1 should
‡ DT page 14

Fig. 26

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14 Trends & Applications

Fig. 27a

Fig. 30a

Fig. 27b

Fig. 30b

ﬂ DT page 13

slide down the glide path until
it meets resistance (Fig. 17a).

Fig. 27c

Fig. 27d

Fig. 30c

Fig. 28a

Fig. 31a

A deliberate back stroke outward
brushing motion removes restrictive dentine at this level, away
from any external root concavities.

Fig. 28b

Fig. 31b

This motion will create more lateral space, enabling the file to slide
a few more millimetres down the
root canal towards working length

Fig. 29a

Fig. 31c

(Fig. 17b). If the file ceases to
progress apically, the file should be
removed. After cleaning the flutes,
the canal should be irrigated, recapitulated and re-irrigated before
continuing with the shaping. This
procedure should be repeated
until the file reaches full working
length. In order to complete
the canal preparation, the file
should be taken to full working
length (Fig. 17c), followed by the
touch-and-brush sequence, which
should be performed up to three to
four times.
After the use of the X1, it is
recommended that the canal be
irrigated with NaClO, recapitulated with a small patency file
to dislodge cutting debris and
re-irrigated to flush out all of the
dislodged debris from the root
canal (Figs. 18a–c).

ProTaper Next X2
The instrument (25.06) should
be taken to full working length
using the same protocol discussed
above. However, using the touchand-brush sequence in the apical
part of the root canal only two to
three times is recommended as
a final step (Fig. 19), as excessive
use can lead to transportation of
the root canal. The root canal
should again be irrigated, recapitulated and re-irrigated.

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Over three and a half days, highly acclaimed International and Australian speakers supported by contemporary
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by hands on workshops, Lunch and Learn sessions, specific programmes for members of the dental team.
Social activities will be available for relaxation purposes.
The Brisbane Convention and Exhibition Centre is adjacent to the Southbank Precinct on the banks of
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Gauging of the apical foramen
to determine whether
the preparation is complete
A 25.02 NiTi hand file
(DENTSPLY Maillefer) should be
introduced to full working length
(Fig. 20). If the file is snug at
working length, it indicates that
the apical foramen has been prepared to ISO 25 and the canal is
adequately shaped.
The palatal root canal in the
present case report was prepared
with the X1 and X2. In this case, it
was found that the 25.02 NiTi hand
file was loose at length and it could
be pushed past working length
(Fig. 21a) after canal preparation
with the X2. This indicated that the
apical foramen was still larger
than 0.25 mm. In these situations,
gauging the foramen with a 30.02
NiTi hand file (Fig. 21b) is recom-

Fig. 29b

Fig. 31d

mended. If the 30.02 file is snug at
length, the shape is complete.
If the 30.02 instrument fits
tightly but is short of full working
length (Fig. 22a), continuing with
canal preparation with the X3
(30.07; Fig. 22b) and gauging
again with the 30.02 NiTi hand
instrument (Fig. 22c) is recommended.
Guideline 4:
Shaping recommendations for
the ProTaper Next X3, X4 and X5
The X3, as well as X4 and X5,
if necessary, is used in the same
manner as the X1 or X2, with the
exception that the apical preparation is performed using the touchand-brush sequence only once
or twice in the apical third of the
root canal. Apical gauging is performed according to the protocol
using a 30.02, 40.02 or 50.02 NiTi
instrument. The 30.02 instrument
fitted snugly at working length in
the palatal root canal in the present
case report. The canals were obturated with X2 gutta-percha points
in the mesiobuccal and distobuccal root canals and an X3 guttapercha point in the palatal root
canal as master cones using the
Calamus Dual obturation unit
(DENTSPLY Maillefer). Figure 23
demonstrates the result after
canal obturation.
Preparation sequence for very
long and curved root canals
In selected clinical cases,
the clinician might find that
the ProTaper Next X1 does not
progress to full working length
even after several coronal circumferential brushing motions. The
authors then recommend creating
more coronal shape using the X1,
followed by the X2 up to twothirds of the canal length. This
preparation sequence will create
enough lateral space in the coronal two-thirds of the root canal to
ensure that the X1 can be taken
to full working length without any
difficulty.

Case report 2
The patient, a 50-year-old
female, presented with pain in
‡ DT page 16

[15] => Standard_300dpi

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3/3/14 2:04 PM

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DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

16 Trends & Applications
ﬂ DT page 14

her mandibular right first molar,
which had a history of emergency
root canal treatment. The temporary restoration had broken down
and was leaking, possibly resulting in coronal leakage.
A periapical radiograph revealed very long and curved
mesial roots. Also visible on the
radiograph was evidence of dentine triangles that prevented
straight-line access to the mesial
root canals (Fig. 24).

The defective temporary
restoration and caries were removed before the tooth was
restored with composite and
a new access cavity was prepared.
The dentine triangles on the
mesial aspect of the canal orifices
(Fig. 25) were removed with the
ProTaper Universal SX instrument.
Figure 26 shows the radiographic
view of the length determination,
confirming straight-line access
to the root canals.
As mentioned before, the clinical protocol in cases with very

long and curved root canals
would be to allow the X1 to
progress to about two-thirds of
the canal length (Fig. 27a). This
is followed by the irrigation, recapitulation and re-irrigation
sequence with NaClO. The X2 is
used in the same manner (with
circumferential outstroke brushing motions) to the same length
(Fig. 27b). The canal preparation
is then continued with the X1
to full working length (Fig. 27c)
using the previously mentioned
touch-and-brush sequence. Final ly, the X2 is taken to full working

length (Fig. 27d) after irrigation,
recapitulation and re-irrigation of
the root canal.

sponding GuttaCore obturators.
Figure 28b shows the result after
obturation.

The canals were gauged
according to the technique described before and final preparation was performed up to the X2
in the mesial root canals and up
to the X3 in the distal root canal.
GuttaCore verifiers (DENTSPLY
Tulsa Dental Specialties) were
fitted (Fig. 28a) to working length
to confirm the size of the obturator
for each canal before the canals
were obturated with the corre-

Shaping recommendations
for large-diameter root canals
or retreatment of root canals
If the first file to working
length is a size 20 K-file and it is
loose up to working length, the
shaping procedure can be initiated using the X2 (25.06). If the
first file to length is a 25/30, 30/35
or 40/45 and it is found to be loose
in the canal up to working length,
the shaping procedure can be
initiated with the X3 (30.07), X4
(40.06) or X5 (50.06), respectively.

Case report 3

Ret
in t racti
he on
USA Pas
! te
2

The patient, a 44-year-old
female, presented with pain and
discomfort in her maxillary right
central incisor. The radiographic
examination revealed that previous root canal treatment had
been conducted poorly. There
was also evidence of a large periapical area (Fig. 29a).
After removing the guttapercha, it was possible to take a
size 35 K-file to working length
(Fig. 29b). Root canal preparation
was initiated by preparing the
root canal to working length with
the X4 (40.06; Fig. 30a). Apical
gauging with a 40.02 NiTi hand
file established that the tip of the
file was loose at length and able to
travel past the predetermined
working length (Fig. 30b) and
that a 50.02 NiTi hand file was unable to reach full working length,
penetrating to about 2 mm short
of working length (Fig. 30c). This
indicated that the apical foramen
size was between 0.40 and 0.50 mm.
The root canal was enlarged with
the X5 (50.06; Fig. 31a) and
gauged again with a 50.02 hand
NiTi file. It was found that the
50.02 instrument fitted snugly
at working length (Fig. 31b),
indicating that the shape was
complete. The prepared canal
was obturated with a ProTaper
Next X5 gutta-percha point
using the Calamus Dual. Figures
31c & d show the result after
obturation. DT

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Editorial note: A complete list of references is available from the publisher.
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[17] => Standard_300dpi

DTAP0714_17_Clement 14.08.14 16:03 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

Trends & Applications 17

Infiltration with a resin material
A micro-invasive approach to the treatment of white fluorosis spots
Dr Marie Clement
France

Owing to the increasing demand
for cosmetic treatment in dentistry, it has become essential
to provide patients with the best
possible therapies. Fluorosisrelated colour changes on the
anterior teeth are a reason that
many patients visit their dentist
for aesthetic treatment. In the
worst-case scenario, these fluorosis spots may result in severe
psychological complications for
patients.
For the treatment of lesions that
appear as white spots, the infiltration method is recommended. This
very mild approach was originally
developed to treat early carious
lesions.1 As a side-effect, it has been
found to transform the tooth’s optical properties, making it suitable
for masking white spots. The original principle is based on the use
of an infiltrating substance, which
penetrates the carious lesion after
it has been conditioned with an acid
and dried.2, 3
White fluorosis spots form
owing to fluorosis-related hypomineralisation that produces a
refractive index that differs from
that of healthy tooth enamel. As the
lesions do not absorb any wavelength of light, they appear to be
white.4 By infiltrating a porous lesion with a highly fluid resin material with a refractive index comparable to healthy enamel, however,
it is possible to restore the enamel’s
translucency.5 The following case
report demonstrates how this treatment can be carried out with maximum protection of tissue.6, 7
A young female patient presented at our practice with the request for anterior tooth veneers to
mask her fluorosis spots (Fig. 1).
It is likely that her fluoride consumption had exceeded the prophylactic dose for many years, as
no other prior exposure to fluoride
was determined. While the patient’s fluorosis was confirmed and
classified as Class II, the clinical
examination showed no carious
lesions. According to Hattab’s
classification,8 a Class II fluorosis
is characterised by symmetrical
opaque discoloration.
External whitening was performed by means of a vacuumformed splint, which was worn
overnight, and a 10 % carbamide
peroxide gel. The treatment took
21 days, during which the results
were examined once a week. By
increasing the overall brightness
of the teeth, whitening masks the
smaller white flaws in the enamel.
Although the visual results after
whitening may be satisfactory, they
are often insufficient. In this case,
the opaque fluorosis spots were not
sufficiently masked by brightening
the rest of the teeth (Fig. 2). For this
reason, it was decided to perform
infiltration one month after the
end of the whitening treatment.
In order to remove the biofilm and

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

saliva proteins, an initial prophylactic cleaning was carried out
using a brush and prophylactic
paste (Fig. 3). A dry operating area
was established with the help of
a rubber dam. This way, moisture
can be avoided. Furthermore, the
soft tissue is protected from hydrochloric acid.
The next step was to gain access
to the hypo-mineralised fluorosis
lesions6, 9 through the removal of
heavily mineralised aprismatic
enamel on the surface. This was
achieved by etching the surface
with a 15 % hydrogen chloride gel
(Icon-Etch, DMG) for 120 seconds10
using an applicator tip (Fig. 4).
In order to prevent uneven etching
results caused by bubbles forming
in the gel, the surface was mechanically activated with a micro-brush.
The gel was then suctioned off.
The surface was then rinsed with
a water spray for 30 seconds and
blow-dried with oil-free and waterfree air.
After the etching had been
completed, it was important to remove the water in the microporous
parts of the fluorosis lesions before

starting the infiltration with the
resin material. The lesions therefore were dried thoroughly using
a 95 % ethanol solution (Icon-Dry,
DMG), which was applied to the
surface of the lesion with a blunt
cannula for 30 seconds.
At this stage, it was possible to
monitor whether the white spots
had disappeared or been significantly reduced and to draw conclusions about the potential outcome of the treatment (Fig. 5). If
the brightness of the lesions has
not regressed sufficiently, this indicates that the lesions’ micropores,
covered with a hyper-mineralised
layer, are not yet completely accessible. Should this be the case,
the etching process should be repeated over a period of 120 seconds
(Fig. 6).
Etching a third time should be
considered if the white lesions are
still recognisable after the second
application of Icon-Dry, followed
by the final drying process with oilfree and water-free air to allow the
ethanol to evaporate. After drying,
the lesions will appear more pronounced (white-opaque, bright),

which can be explained by the
refractive index of air.
After rinsing, drying and reapplication of the ethanol solution, the lesions appeared less bright this time
to the extent that they seemed to have
almost disappeared (Fig. 7). At this
stage, the infiltration was carried out,
after the interdental matrices had
been fitted. The resin material (IconInfiltrant, DMG) was applied with
the applicator tip supplied (Fig. 8).
Owing to capillary forces, the
highly liquid hydrophobic resin
penetrates the porous parts of the
lesions. This process usually takes
about three minutes. Since the
resin is light curing, this step has to
be carried out away from light.
The solvents were removed
with an air spray. Excess material on
the vestibular surface was removed
with dental floss. The material was
then polymerised for 40 seconds.
Repeating the infiltration helped to
reduce the porosity of the surface.
At the end of the session, the rubber dam was removed and the surface was polished to prevent external

discoloration in future. The excess
material in the proximal area was
removed with dental floss and finegrit polishing strips. The vestibular
areas were polished with silicone
tips. The final polish was performed
with silicone carbide brushes, diamond pastes used with a goat’s hair
brush (Fig. 9) and aluminium oxide
paste used with a felt wheel.
As a result, an immediate improvement in the aesthetic appearance of the patient was achieved
(Fig. 10), which has led to significant
changes in her personal and social
life. Checks were carried out every
six months to evaluate the ageing
of the resin material over time. DT
Editorial note: A complete list of references is available from the publisher.

Contact Info
Dr Marie Clement is Associate
Professor of Prosthetic Dentistry
at the University of Lyon in
France. There, she also maintains a private practice. Dr
Clement can be contacted at
clement.marie@ymail.com.

[18] => Standard_300dpi

DTAP0714_18_Richter 14.08.14 16:04 Seite 1

18 Advertorial

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

REFLECT celebrates its
10-year anniversary
An interview with Josef Richter, Chief Sales Officer, Ivoclar Vivadent
Ten years ago, REFLECT
magazine was published for
the first time. Today, it ranks
among the highest-circulation dental publications. The
magazine’s concept is straightforward. It offers dental professionals a platform to present
in detail their treatment solutions using Ivoclar Vivadent
products. On the occasion
of its 10-year anniversary,
Mr Josef Richter, Chief Sales
Officer at Ivoclar Vivadent
and intellectual father of
REFLECT, talked about the
magazine’s beginnings, development and future.
Mr Richter, you brought
REFLECT magazine into being.
How did it all start?
It all started with customers
asking for a medium which
would allow a professional and
interdisciplinary exchange of
ideas. They suggested that
Ivoclar Vivadent provides a
platform to promote the professional exchange of clinical
and technical day-to-day experiences. Then, and as I believe
even today, customers were
particularly interested in treatment solutions of individual
patient cases, especially when
complications had to be overcome. Furthermore, readers
continue to be interested in
learning more about the potential of materials in successfully
mastering the various restorative and prosthetic challenges
—all for the benefit of the
patient.
How was the first edition
received by its readers?
At that time, it was rather
unusual for a manufacturer of
dental materials and equipment to publish a primarily
scientific and factual magazine
on its own initiative, because
this would prevent the publication from being impartial.
As a result, the first edition was
received very critically and
cautiously.
Since then, approximately
200 user reports from authors

debated with colleagues in the
field—and the publication of
a patient case provides the
basis for such intensive discussions.

Josef Richter came up with the idea for a scientific magazine.

throughout the world have
been published. How is the
magazine positioned today?
In my opinion, REFLECT has
evolved into something more
than just a prestigious dental

successful restoration or prostheses, which would be worth
publishing in REFLECT. Unfortunately, I have no or only
limited influence on the articles
which will be published in the

The name “REFLECT” has
a double meaning: “to think
about” and “to mirror”. Has
the name been deliberately
chosen based on this double
meaning?

“REFLECT is generally not a commercial
medium, which might be the reason for its
popularity among dental professionals.”
magazine. It has established itself as a reference medium for
dentists and dental technicians
who would like to call attention
to their work in order to discuss
their approach with their colleagues and enter into critical
debate. When visiting the different markets, I am often asked
to assess the work of dentists or
dental technicians who believe
that their work might represent
a “best practice” example of a

magazine due to the fact that
I am neither a dentist nor a
dental technician and therefore
lack the ability to pass a qualified
judgment. Furthermore, I am not
a member of the editorial team
—simply because I am working
in sales and not in the scientific
sector. This proves again that
REFLECT is generally not a commercial medium, which might
be the reason for its popularity
among dental professionals.

Yes, exactly. Even the best
result can motivate someone to
further improve certain things
next time. Nature is so fascinating because it can be imitated in
so many different ways. Dental
professionals who look at their
completed work, who examine
it and who reflect on it will
surely ask themselves this one
question: How can I succeed in
better imitating nature next
time? This question can be

An anniversary not only
presents the perfect occasion
for a review of the past but
also for a look into the future.
Which trends will leave a
mark on the dental market
and which types of user reports will dominate REFLECT
magazine in the future?
The ongoing boom in the
area of digital technologies,
i.e. the ”digital workflow”, is
currently the centre of attraction on the dental market.
Most likely, we will see an increasing number of articles
on the processes and the materials used in digital workflows.
Furthermore, I expect that the
subject of a monolithic approach, i.e. the fabrication of
prosthetics or restorations made
of one piece, will increasingly
be presented in the publication.
Articles focusing on the clinical
use of individually fabricated
abutments will also be given
special attention.
You have been involved in
the dental sector for more
than 20 years. What attracts
you personally to this industry?
Actually, the dental sector
has been home to me for even
a little longer. However, I try
to make light of this as I do
not want to be counted among
the industry’s old dinosaurs yet!
I feel privileged to be pursuing
an occupation which serves
the health and well-being of
people. Firstly, dentistry is able
to help human beings to solve
dental-related problems and
secondly, to regain their sense
of well-being and natural vibrancy to a large degree. It
makes me feel very good to be
able to provide the high-quality
materials and equipment required to achieve all of this.
Thank you very much for
the interview, Mr Richter. DT

[19] => Standard_300dpi

DTAP0714_19-20_Brinker 14.08.14 16:05 Seite 1

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

Trends & Applications 19

Preventing carious lesions
A clinical case describing the use of a dental sealant

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 13
Shannon Pace Brinker
USA

Dental caries has long represented a significant oral health issue
for children and adults. In the
1980s, however, the prevalence of
coronal caries in children steadily
declined in segments of the
population after the implementation of fluoride supplements
and toothpastes, increased public
oral health education, and the
application of dental sealants.1
Since they were first utilised
in dental offices in the 1970s, dental sealants (resin based or glass
ionomer cement) have been effective in caries prevention. Acting as
a barrier, they are typically applied
to the premolars and molars where
decay is most likely to develop.
They have been proven effective in
preventing pit and fissure caries,2
as well as caries on the occlusal
surfaces of permanent molars and
in high-risk cases.3
Over the years, sealants have
been implemented in public programmes as a way to reach children
of low socio-economic status, who
are most susceptible to and often
have a high prevalence of caries.
Studies regarding the retention
rates and clinical benefits of community sealant programmes conducted by county health departments determined that children
who received sealants had a 71 per
cent successful retention rate and
considerable protection from occlusal decay up to fifth grade.4
Other studies indicated that
sealants are more effective when
placed in patients with established
risk factors for occlusal caries,5
while others have suggested that
knowledge gaps remain regarding
the costs and benefits of sealing lowversus high-risk populations.6–8
That may partially explain why
the success of early sealants was
a grey area. A cost–benefit and costeffectiveness analysis regarding
preventive dental programmes in
a hypothetical community examined four popular dental preventive
programmes (community water
fluoridation, school water fluoridation, weekly school-based mouth
rinsing, and school-based sealants)
to evaluate maximum caries reduction over a 20-year period. The

analysis found that community
water fluoridation was the most
cost effective and beneficial, while
school-based dental sealants resulted in negative net benefits.9
Further, studies evaluating the
use and effectiveness of placing
sealants on first and second permanent molars in children over a fiveyear period indicated that sealant
placement was only minimally
beneficial in preventing carious
lesions.5, 10 Therefore, there has
been a lack of agreement among
clinicians regarding the benefits
and use of caries-preventive agents,
including sealants.11
The low incidence of dental
sealant use is a direct result of a lack
of public awareness and patient
education, as well as a disproportionate reimbursement for sealants
by third-party insurers, as is the
case in the US.12 In 1988, the average percentage of patients 18 years
old and younger who had received
dental sealants was only 18.7 per
cent. Many dental patients had not
received sealants at all.13
This trend continued over the
years, even though the American
Dental Association widely advocated the use of dental sealants as
a recommended component of
maintaining good oral health.2 In
fact, children who do not receive
sealants have a greater probability
of developing carious lesions and
needing restorative dental care in
the future, costing the health care
system more in the long-term.14
Perhaps that explains why research
regarding caries risk assessment
and the use of preventive techniques in children aged 6 to 18 years
found that dental sealants and in-office fluoride are the most frequently
used caries preventive regimens.11
Currently, new and improved
dental sealants that are beneficial
and cost effective are available for
use. They reflect an evolution in
which sealants have advanced to
become more cost effective, and research now suggests that properly
placed and retained sealants can
decrease the occurrence of carious
lesions and avoid restorative costs.

Characteristics
of dental sealants
The earliest generations of
sealants were vulnerable to fis-

Fig. 1: Pre-op photograph.—Fig. 2: The tooth was cleaned with pumice and a prophy angle.—Fig. 3: Ultra-Etch 35% phosphoric acid solution was placed for 20 seconds.—Fig. 4: The teeth were thoroughly rinsed and dried.—Fig. 5: The tooth
should have a frosty appearance.—Fig. 6: A small drop of UltraSeal XT hydro was expressed from the brush tip prior to intra-oral application.—Fig. 7: Sing a painting action, UltraSeal XT hydro was applied to pits and fissures.—Fig. 8: Resin
was applied to deep fissures and light cured. It is important to avoid pooling the resin.—Fig. 9: The margins were checked
and the occlusion adjusted.—Fig. 10: Post-op photograph of the tooth sealed with UltraSeal XT hydro.

sures, bubbles and failure to adapt
to dentition, which contributed
to earlier wear. As a result, they
required replacement over time,
which is an essential component of
caries prevention to avoid bacterial
infiltration that can lead to carious
lesions. Early sealants typically
lasted six months to a year.15
First- and second-generation
sealants demonstrated a high resistance to flow and low viscosity,
causing the material to run over
the margins of the tooth and other
surfaces. These sealants were usually clear and resembled caries in
subsequent radiographs. Additionally, early generations of sealants
were incompatible with moisture

and required application in a dry
environment to prevent contamination and sealant failure caused
by a weakened sealant bond.
Although third-generation
sealants showed improvements,
they still had some shortcomings.
These sealants were more viscous
and easier to handle, and as a
result the sealant remained on
the tooth surface until it was light
cured. However, research showed
that light-emitting diodes or
halogen lights were insufficient
for curing 2 mm-thick opaque
sealants or sealants with a high
filler content, potentially causing
microleakage and insufficient
microhardness.16

Adhesion is one of the most
important features of a dental
sealant. Studies have shown that
self-adhesive sealants do not have
as defined an etching pattern as do
etch-and-rinse adhesives.17 A pretreatment conditioning protocol
with an appropriate acid is necessary to obtain adequate penetration
of a sealing material.18
Newer generations of sealants
can be cured in a moist environment and do not require complete
drying of the tooth surface after
etching. This is possible owing to
the hydrophilic agents in today’s
sealants. Nowadays, dental profes‡ DT page 20

[20] => Standard_300dpi

DTAP0714_19-20_Brinker 14.08.14 16:40 Seite 2

DENTAL TRIBUNE Asia Pacific Edition No. 7+8/2014

20 Trends & Applications
ﬂ DT page 19

sionals have sealant materials that
are easy to apply, long lasting and
radiopaque for subsequent dental
procedures, and contain fluoride.
The process of sealing teeth has
been simplified with the introduction of syringes with disposable
tips that allow clinicians to apply
the sealant directly to the pits and
fissures of the tooth surface.
Sealants today can last up to as
long as ten years if regularly cared
for after application.15 This dura-

bility is facilitated by modern technology that permits dentists to view
risk factors, and monitor sealant
application and overall retention.19
Additionally, contemporary sea lants are radiopaque, making
dental procedures easier; radiolucent materials could mimic caries
in subsequent radiographs and,
therefore, be problematic.

UltraSeal XT hydro
This 53 per cent highly filled and
light-curable pit and fissure dental
sealant (Ultradent) is radiopaque,
methacrylate based and thixo-

tropic. It also contains diurethane
dimethacrylate, tri-ethylene glycol
dimethacrylate, and methacrylic
acid. Its adhesive properties increase the bond strength of the
material to the enamel, enhancing
marginal retention and reducing
microleakage. The thixotropic nature of the material, combined with
its hydrophilic chemistry, prevents
sealant failure by pushing moisture
deep into the pits and fissures of the
tooth on a microscopic level. This
prevents moisture-related sealant
failure common with earlier generations of hydrophobic sealants.

THE NEW LUTING FAMILY

Solutions for every
challenge

Additionally, the traditional step of
pre-treating teeth with a drying
agent is eliminated, resulting in
faster and more efficient procedures.

UltraSeal XT hydro is available
in two shades, Opaque White (clear)
and Natural (tooth-coloured material), and is applied using a syringe
and Inspiral Brush tip (Ultradent).

The sealant’s fluorescent properties enable visual verification
of the sealant’s margins under a
UV black light, making it easier to
verify and view marginal retention
at the time of placement and subsequent examinations. The chemical composition contains and releases fluoride, so no additional
treatments are necessary.

Unlike previously introduced
sealants, UltraSeal XT hydro seals
and is retained by dentition for
long-term results, similar to its
predecessor.20 Additionally, it is
free of bisphenol A, as tested by an
independent third-party laboratory
that confirmed levels of less than
0.00000 per cent.21

Case study
A 9-year-old patient presented
with deep pits and fissures upon
examination. It was determined
that applying UltraSeal XT hydro
to deep pits and fissures would be
the best course of preventive treatment. The tooth was cleaned with
pumice and a prophy angle to remove any debris prior to sealant
placement. The brush tip was attached to the Ultra-Etch etchant
syringe (Ultradent) containing a
35 % phosphoric acid solution.
The Inspiral Brush tip was attached
to the UltraSeal XT hydro syringe
for later application of the sealant.
The fissures of the teeth were
cleaned using a micro-etcher from
Ultradent. The selected teeth were
isolated with cotton rolls to avoid
saliva contamination. Etchant was
applied to the fissures of the teeth
for 20 seconds. The teeth were thoroughly rinsed with a water spray
unit and dried with an air abrasion
unit. It was necessary to repeat etching and rinsing in cases in which
sodium bicarbonate was used.

With SoloCem and DuoCem we have two cements which,
together with ParaCore, create the COLTENE bonding family.
No matter which technique you prefer, the matching product
is available for every indication.
SoloCem
reliable cementation in one step – no separate bonding required.

DuoCem
Strong and durable bonding due to proven ParaBond adhesive. At the same
time, the 5ml Automix syringe offers convenient application.

ParaCore
3 indications - 1 material. Core build-up material suited for cementing root
posts and indirect restorations.

001733

www.coltene.com/contact

Prior to applying the sealant,
a small drop of UltraSeal XT hydro
was expressed on to the Inspiral
Brush tip. In order to prevent
premature polymerisation of the
dental sealant, the overhead light
was redirected, and the sealant was
applied using a painting action,
followed by light agitation. The
sealant was light cured using the
VALO LED curing light (Ultradent)
for 10 seconds. It is recommended
that clinicians and patients wear
UV protective eyewear when the
sealant is cured to prevent injuries.
The sealant margins were examined
with a Black Light lens (Ultradent)
to verify marginal retention visually. The occlusion was examined
and appropriately adjusted.

Conclusion
Sealant placement remains an
integral component of preventive
dentistry. UltraSeal XT hydro is an
innovative dental sealant that is easy
to use, cost effective, and clinically
proven to help prevent the formation
of cavities in pit and fissure areas. DT
Editorial note: This article originally
appeared in Australasian Dentist,
March–April 2014. A complete list of
references is available from the publisher.

Contact Info
Shannon Pace
Brinker is a dental assistant in
a private practice
in Virginia Beach
in Virginia in
the US. She can
be contacted at
shannonlpace@aol.com.

[21] => Standard_300dpi

DTAP0714_21-22_today 14.08.14 16:06 Seite 1

HKIDEAS · Hong Kong · 22–24 August, 2014

Official news for visitors and exhibitors

A platform for learning & exchanging ideas
Invitation from Dr Nelson Wong, Vice-President of the Hong Kong Dental Association and chairman of the organising committee of HKIDEAS‘14

HKIDEAS
4rd Hong Kong
International Dental
Expo and Symposium
Date:
22–24 August, 2014

Organiser:

Hong Kong Dental Association

Venue:
Hong Kong Convention and
Exhibition Centre, 1 Expo Dr

Dr Nelson Wong

n On behalf of the Hong Kong
Dental Association and the organising committee, we warmly invite
you to the Hong Kong International Dental Expo and Symposium
(HKIDEAS) 2014, which will be
held on 22 to 24 August 2014.
We strongly believe that
HKIDEAS 2014 will once again
provide an opportunity to foster
advancement, and exchange knowledge and skills in the field of dentistry.

Opening times
of the exhibition:
9:00–18:30

It is the fourth time that we are
hosting HKIDEAS since it was first
launched in 2010. Under the theme
“Commitment to excellence”, this
year’s congress will offer a platform for learning and exchanging
ideas with internationally distinguished speakers in a cutting-edge
scientific programme.

Official language
of the congress:
English
Information provided in this
section are subject to change.

Held concurrently with the
symposium, the trade exhibition

Workshop at HKIDEAS 2013. (DTI/Photo courtesy of HKDA, Hong Kong)

offers a perfect opportunity for
exhibitors to showcase their upto-date, sophisticated products
and devices to all HKIDEAS par ticipants.
We believe that the great diversity of sightseeing attractions in
Hong Kong will impress, and offer
participants a memorable and interesting experience.
I sincerely look forward to seeing you at HKIDEAS 2014. Your participation will certainly help make
this event another success.

About the Publisher
Editorial/
Administrative Office
Phone
Fax
Internet
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 HKIDEAS appears at the Hong Kong International Dental Expo
and Symposium, 22–24 August, 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.

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

[22] => Standard_300dpi

DTAP0714_21-22_today 14.08.14 16:06 Seite 2

news

22

HKIDEAS Hong Kong 2014

Overview of scientific session and workshops
Friday, 22 August, 2014
9:00–10:30
Treatment Planning
in Periodontics and
its Relevance to implant Patients,
Hall 3F
Speaker: Prof. Greg Seymor

Big changes in Paediatric Dentistry,
Hall 3G
Speaker: Dr Justin Lee

11:15–12:45
Patient-Centred Approach
in Management of Dentin
Hypersensitivity, Hall 3F
Speaker: Prof. Stephen Wei

Surgical complication:
Prevention and Management,
Hall 3G
Speaker: Dr Surakit Visuttiwattanakorn

Prosthetic Complications:
Prevention and Management, Hall 3G
Speaker: Dr Chatchai Kunavisarut

Team Approach in Complicated
Cases, Hall 3G
Speakers: Drs Chatchai Kunavisarut
& Surakit Visuttiwattanakorn

16:30–18:00

14:15–15:45
Modern Management of Caries as
Dynamic Disease Process, Hall 3F
Speaker: Prof. Domenick Zero

Modern Management of Caries
as a Dynamic Disease Process,
Hall 3F
Speaker: Prof. Domenick Zero

Saturday, 23 August, 2014
9:00–10:30
Endodontic Solutions: Strategies
for Performing Endodontic
Treatment Predictably,
Profitably and Painlessly, Hall 3F
Speaker: Dr Gary Glassman

AD

CBCT Imaging-Application Beyond
Implantology, Hall 3G
Speaker: Dr Sharad Sahai

11:15–12:45
Endodontic Solutions: Strategies
for Performing Endodontic
Treatment Predictably, Profitably
and Painlessly, Hall 3F
Speaker: Dr Gary Glassman
CBCT Imaging-Application Beyond
Implantology, Hall 3G
Speaker: Dr Sharad Sahai

14:15–15:45
Etiology, Diagnosis and Treatment
of Peri-Implant Diseases, Hall 3F
Speaker: Dr Jörg Meyle

International Dental Exhibition Africa
THE DENTAL INDUSTRY GOES TO AFRICA!

Orthodontics is Beyond Just
Braces, Hall 3G
Speaker: Prof. Gang Shen
Workshop on Endodontic
Solutions, Meeting Room S428
Leader: Dr Gary Glassman

16:30–18:00
Etiology, Diagnosis and Treatment
of Peri-Implant Diseases, Hall 3F
Speaker: Dr Jörg Meyle
The Management of Adults with
Intellectual Disability Who Had
Previous Bad Dental Experience, Hall 3G
Speaker: Prof. Shun-Te Huang
Workshop on Endodontic
Solutions, Meeting Room S428
Leader: Dr Gary Glassman

Sunday, 24 August, 2014
9:00–10:30
Creating a Five-star Dental
Practice, Hall 3F
Speaker: Dr William Cheung

The reference
event for
the African
dental sector

Workshop on CBCT, Meeting Room S428
Leader: Dr Sharad Sahai

9:30–12:45
1st Cross-Strait Elderly Dental Forum

11:15–12:45
Teeth with Periodontitis:
Treat or Extract?, Hall 3F
Speaker: Prof. Thomas Flemming

14:45–18:00
Chinese Dentist Forum in Oral
and Maxillofacial Surgery, Hall 3F

For further information please
contact us at info@ideadakar.com

w w w.ideadakar.com

Winning from Detail—Application of
Damon System in the Clinic, Hall 3G
Speaker: Prof. Wei Lin
Integration of D-Gainer Passive
Self Ligation Applicance (PSL) in
Interceptive Orthodontics, Hall 3G
Speaker: Dr John Ling

[23] => Standard_300dpi

DTAP0714_23_Exhibitors 14.08.14 16:07 Seite 1

business

HKIDEAS Hong Kong 2014

23

HKIDEAS 2014—Floor plan
Registration: Hall 3F&G Concourse, Level 3, Old Wing, HKCEC
Exhibition: Hall 3G, Level 3, Old Wing, HKCEC

Opening Ceremony of
Trade Exhibition

Entrance / Exit

Registration

HKIDEAS 2014—Exhibitors list
Company Confirmed Booth No.

Company Confirmed Booth No.

Company Confirmed Booth No.

Company Confirmed Booth No.

Company Confirmed Booth No.

A.R. Medicom Inc (Asia) Limited

Dental Clinic Management

GlobalHealth (INTL)

KaVo Kerr Group

G03

Sirona

System

Dental Supply Co., Ltd.

Keenworld Technology Limited

D11

Dental Systems (HK) Ltd.

G01–G02

Green Paradise International Ltd. J02

Logic Tech HK Limited

A01

Soaring International Ltd.

F09

Dental Tribune International GmbH E07

Healthcare Dental Limited

maxill hong kong limted

F08, F10

Tesco Dental (H.K.) Ltd.

C06, C08

DENTSPLY International Inc. K04–K05

Henry Schein

Dentz HK Ltd. & Vanguard

Hong Kong Limited

Comuter Assisted Laboratory J03, J13

Hong Kong Council on Smoking

DIO Asia Pacific Limited

and Health

J01

Advance Dental
Consulting Ltd.
Bauhinia Dental Limited

D08, D10, D12
C05, C07

Biomate Medical Device
Technology Co., Ltd.

G05–G06

Carestream Health
Hong Kong Limited

A04

J09–J10, J19–J20

Dental News Philippines

Carl Zeiss Far East Co., Ltd. C03–C04

Faculty of Dentistry,

Colgate-Palmolive (H.K.) Ltd. F01–F06

The University of Hong Kong

Cooper

Focus Medical

Trading Company
Dental Asia

J12
A02

Instrument Ltd.
GlaxoSmithKline Limited

F07

K02

G04

B01, B03
C09–C10

D09

E08–E12

A05, B05–B08

Medi-dent International Ltd.

A03

The College of Dental Surgeons

Medicinus Limited

J14

of Hong Kong

K03

MIS (Hong Kong) Limited

J08, J18

The Royal Australasian College

K07

Nobel Biocare Asia Ltd.

C01–C02

of Dental Surgeons

Hong Kong Dental Association

K08

Pacific Blossom HK Limited

D07

Truly

ID Infinity Limited

J04

Pioneer of Dentistry Column

J11

Dental Material Co., Ltd.

B02, B04

Interdental Limited

J05, J06

TWL Limited

J07, J17

Johnson & Johnson (Hong Kong)
Limited

E01–E06

Procter & Gamble HK Ltd.

D01–D06

QST Technologies (HK) Co., Ltd.
Singapore Dental Association

J16

J15
K06

Floor plan and exhibitors list are subject to change.
Last update was 7 August, 2014.

[24] => Standard_300dpi

SIRONA.SG

GET THE MOST OUT OF YOUR CBCT,
DIGITAL PANORAMIC AND
DIGITAL INTRA-ORAL SCANS.
TRAINING
Training 1: 2D Digital Radiography in Dentistry (1 day course)
09/08/2014
Course Fee
1100 $
Early Bird Registration
before 24th August

550 $

Training 2: Considerations and Advanced Treatment Options for the Use
of CBCT (2 day course)
09/09/ – 09/10/2014
Course Fee

2200 $

Early Bird Registration
before 24th August

1100 $

Dr. Joerg Neugebauer graduated from the University of Heidelberg in 1989 and received the
certification as a dentist by the local government in Germany by 1990. Up to then he
worked for several years in the dental device industry, and had his final position as the
director of R&D departement of implantology with the specialization of oral surgery. After
that he turned into a consultant Interdisciplinary Outpatient Dep. for Oral Surgery and
Implantology at Cologne University. Since August 2010 he is working as a dentist in the
private dental clinic Dres. Bayer, Kistler Elbertzhagen and colleagues, Landsberg am Lech,
Germany and is teaching at the University Cologne.

FOR REGISTRATION PLEASE GO TO SIRONA.SG
OR SEND AN EMAIL TO JOEY.LOW@SIRONA.COM
DAY 1 - TRAINING 1

DAY 2 - TRAINING 2

TIME

TOPIC

TIME

TOPIC

9:00 – 10:30 AM

Understanding modern 2D digital imaging technology
n Necessary equipment
n Digital 2D imaging
n Detectors, acquisitions
n Enhancement and clinical imaging diagnosis

9:00 – 10:30 AM

Understanding the technology behind 3D imaging for
Dental Applications and how it differs from 2D Imaging

11:00 – 12:30 PM

Indications for Cone Beam Computer Tomography in
Dentistry

01:30 – 02:30 PM

Identifying Pathology of the Maxillofacial Region with
CBCT scans

03:00 – 05:30 PM

Hands-On Training 3D Scan Reading

11:00 – 12:30 PM

01:30 – 05:00 PM

Intraoral Digital Radiography
n Principles, Techniques and Error Correction
n Identifying Diseases of the Teeth and Oral Cavity
through Intraoral Radiography
Panoramic Radiography Technique
n Indications for Panoramic Imaging
n Clinical Diseases Identification
n Image evaluation: features of an ideal Panoramic
Radiograph (exposure settings and anatomically
representative)
n Identifying Panoramic Errors

VENUE: Sirona Dental Academy Singapore
6 Battery Road #15-06
Singapore 049909

CDE: y
da
r
e
p
6

DAY 3 - TRAINING 2
TIME

TOPIC

9:00 – 10:30 AM

3D visualization and CAD/CAM Integration for Implant
Treatment and Surgical Guides

11:00 – 12:30 PM

Clinical Cases: Bone Graft, Complex Rehabilitation,
Immediate Loading

01:30 – 02:30 PM

Hands-On Training

03:00 – 05:30 PM

Outlook

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[cover] => DT Asia Pacific No. 7+8, 2014

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Table of contents

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