Thirty two-year old dentist is the fi rst Thai woman to climb Mount Everest / First special needs dental clinic opens in Singapore / World News / Business / But it’s different here - An international perspective on the business of dentistry / Non-ablative melanin depigmentation / Interview: “There certainly is a learning curve to technology” / Single-use hand instruments / Ortho Tribune Asia Pacific Edition
Thirty two-year old dentist is the fi rst Thai woman to climb Mount Everest
01 - 01 viewFirst special needs dental clinic opens in Singapore
02 - 02 viewWorld News
03 - 03 viewBusiness
04 - 07 viewBut it’s different here - An international perspective on the business of dentistry
08 - 08 viewNon-ablative melanin depigmentation
10 - 12 viewInterview: “There certainly is a learning curve to technology”
14 - 14 viewSingle-use hand instruments
16 - 16 viewOrtho Tribune Asia Pacific Edition
17 - 24 viewArray
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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
Published in Hong Kong
www.dental-tribune.asia
Why it is important for clinicians
to gain a global perspective when
observing best practise in dentistry.
SINGLE-USE INSTRUMENTS
Robert Jagger, University of Bristol, explains why their use can
provide significant advantages in
general dental practice.
” Page 08
” Page 16
ORTHO TRIBUNE
© Alexis Photo/Shutterstock.com
© Rawpixelcom/Shutterstock.com
BUT IT’S DIFFERENT HERE
Vol. 14, No. 7+8
Read the latest news and clinical
developments from the field of
orthodontics in our specialty section included in this issue.
” Page 17
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Thirty two-year old dentist is the first
Thai woman to climb Mount Everest
By DTI
© Facebook/Thai Everest 2016
BANGKOK, Thailand: As the first
woman from Thailand to do so, a
dentist from Prachuap Khiri Khan
has successfully summited Mount
The 32-year-old’s achievement
follows that in May 2008 of her
fellow-countryman Vithitnan
Rojanapanich, who was the first
person from the South East Asian
country ever to reach the summit.
Chumnarnsit is one of the
latest of almost 7,000 climbers to
have ascended Everest since the
first successful attempt by New
Zealand mountaineer Edmund
Hillary and the Nepalese Sherpa
Tenzing Norgay in 1953. In 2016,
over 400 people successfully
reached the summit, according to
figures from the Nepalese Ministry of Culture, Tourism and Civil
Aviation.
ing from Nepal to Tibet, Mount
nearby Kangchenjunga at the
Everest is the world’s highest
India–Nepal border. Every year,
mountain with a height of 8,848 m.
hundreds of climbers from all
It overtops K2, which is approxiover the world attempt to scale
mately
250 m lower, and 1the
the 17:10
giant Seite
peak.1
IV_Image_Anz_102x128_Layout
01.12.11
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This year’s climbing season
was overshadowed by the death of
six people, most notably Australian climber Maria Strydom, who
began suffering severe symptoms
of altitude sickness 15 minutes
away from the peak and died soon
thereafter.
Photo of Napassaporn Chumnarnsit at the summit as featured on Thai Everest
Facebook page.
Everest. Napassaporn Chumnarnsit, who works at the provincial
hospital in the southern town,
reached the peak of the world’s
highest mountain already on the
morning of 23 May as part of the
Thai Everest 2016 expedition.
Chumnarnsit successfully climbed
Everest through the popular
southern route starting in Nepal.
The mountain can also be accessed from a northern route in
China, as well as sixteen other
routes.
In total, the mountain has
claimed 265 lives over the last
70 years. Only two years ago,
16 Nepalese climbers died in an
avalanche in the Khumbu Icefall,
which resulted in the mountain
being closed for most of the 2015
climbing season.
Also notorious was the 1996
disaster, which took eight lives
and was documented in a book
and feature film.
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[2] =>
02
ASIA PACIFIC NEWS
Dental Tribune Asia Pacific Edition | 7+8/2016
First special needs dental clinic
opens in Singapore
SINGAPORE: The first dental centre
functionally designed to cater for
the elderly and people with special
needs was recently opened at the
National Dental Centre of Singapore in Outram. The Geriatric
Special Care Dentistry Clinic offers
a full range of oral health services
customised for patients with
complex medical needs, including
a wheelchair-tilting device that
allows patients to remain in the
wheelchair during dental treatment.
The National Dental Centre
opened the clinic in response to
Singapore’s rapidly ageing population and growing demand for
these services. Customised for
health conditions that are not
easily managed at primary care
clinics, the special needs unit has
wider walkways, larger waiting
areas and dental chairs, as well as
handrails and low counters. More-
PUBLISHER:
Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT AP & UK:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
to better serve our seniors and undertake more research in disease
trends in geriatric dentistry,” Gan
stressed. In addressing this issue,
the clinic will serve as a training
ground for the next generation of
oral health professionals who are
specialising in this field.
© NDC, Singapore
By DTI
IMPRINT
Wheelchair-bound patient being treated on wheelchair titling unit.
over, every treatment room is furnished with dental radiographic
equipment so that patients do not
need to be transferred to another
room to obtain radiographs.
During the opening ceremony,
health minister Gan Kim Yong
stressed that oral health and dental care must be incorporated as
part of the government’s overall
strategy for ensuring good health
among seniors. Although critical,
oral health is an often underestimated component of the overall
well-being of geriatric and special
needs patients, he said.
“We must also invest in training dental healthcare professionals
As reported by Channel NewsAsia, the Ministry of Health is
already offering scholarships for
dentists who are keen to take up
the challenges of geriatric and
special needs dentistry. So far, four
dental professionals have completed specialty training under
this programme in the clinic.
Being the first of its kind in
Singapore, the clinic has seen
more than 4,000 patients to date.
A second geriatric and special
needs dentistry clinic is being
planned at the upcoming Centre
for Oral Health at the National University Health System and is expected to open for service in 2019.
King’s College London collaborates
with China’s largest dental group
By DTI
– live and interactive webinars
– a focused discussion forum
– interaction with colleagues and
experts across the globe
– a growing database of
scientific articles and case reports
– ADA CERP-recognized
credit administration
BYBO Dental Group, one of China’s
largest dental providers, over the
upcoming months. The collaboration started in July with a distance
learning programme that will
offer BYBO staff across China
training and information on the
management of tooth wear and
occlusal change.
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Join the largest
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in dentistry!
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
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INTERNATIONAL EDITORIAL BOARD:
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Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Marius Steigmann, Implantology, Germany
Published by DT Asia Pacific Ltd.
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Dr Edward Lynch, Restorative, Ireland
Institute is extending its international reach with the launch
of a number of activities that will
see the institute partner with
© Chris Dorney/Shutterstock.com
BEIJING, China & LONDON, UK:
King’s College London Dental
CLINICAL EDITOR:
Magda WOJTKIEWICZ
In addition to the distance/
blended learning programmes,
face-to-face lectures by King’s
academics, including Profs.
Raman Bedi, Martyn Cobourne
and Francis Hughes, at various
sites in China began in June and
will continue until the end of
the calendar year, the university
said in a press release. All information will be available to
BYBO staff in both English and
Mandarin.
In addition to continuing professional education, the partnership will include staff exchange,
as well as the transfer of clinical
expertise and protocols, over the
next three years.
Estimated to be worth £3.6
million, the collaboration agreement was first announced at the
end of 2015.
“King’s Dental Institute’s commitment to improving oral health
knowledge and provision in practice around the world shines
through in this collaboration,”
commented Prof. Dianne Rekow,
Executive Dean of the Dental
Institute, on the partnership. “Not
only is it a fantastic opportunity
to share our world-leading expertise with BYBO, but it also offers us a unique chance for us to
learn from one of China’s most
renowned dental providers.”
Founded in 1993, BYBO consists of 200 chain dental clinics
with approximately 6,000 employees across China, according to
its figures.
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Opinions expressed by authors
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[3] =>
WORLD NEWS
Dental Tribune Asia Pacific Edition | 7+8/2016
03
World Hepatitis Day:
Infection increases mouth cancer risk
© Dmitry Lobanov/Shutterstock.com
hepatitis C-related liver diseases.
The most affected regions are
Africa and central and east Asia.
The hepatitis C virus is bloodborne and thus mainly spread
through blood-to-blood contact.
In rare cases, it can be transmitted
brated each year on 28 July. Millions of people across the world
now take part to raise awareness
about viral hepatitis and to call
for improved access to treatment,
better prevention programs and
government action.
through certain sexual practices
and during childbirth. There
is currently no vaccine for hepatitis C.
The WHO introduced World
Hepatitis Day in 2010, to be cele-
The study, titled “Association
between hepatitis C virus and
head and neck cancers,” was
published in the August issue of
the Journal of the National Cancer
Institute by Oxford University
Press.
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HOUSTON, USA: World Hepatitis
Day is one of four official disease-specific World Health Organization (WHO) health days. It aims
to raise awareness about viral
hepatitis, which can be transmitted through unsafe injection
practices and inadequate sterilization in the health care setting.
Hepatitis C is associated with liver
cirrhosis and other diseases. For
example, a new study has shown
that individuals infected with the
hepatitis C virus are at a greater
risk of developing oral cancer.
55%
on time
*
In the study, researchers at the
University of Texas MD Anderson
Cancer Center investigated medical records of 409 patients with
new-onset primary oropharyngeal or nonoropharyngeal head
and neck cancers, as well as 694
controls with smoking-associated
cancer of the lung, esophagus
or urinary bladder, who were all
tested for the hepatitis C virus
from 2004 through 2014 at the
center.
WHO estimates that about
130–150 million people globally
have chronic hepatitis C infection
and approximately 700,000 people worldwide die each year from
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[4] =>
04
WORLD NEWS
Dental Tribune Asia Pacific Edition | 7+8/2016
Henry Schein completes Asia investment
By DTI
of dental consumables, implants
and equipment.
KYOTO, Japan/MELVILLE, USA: Last
week, Henry Schein announced the
completion of a 50 per cent equity
investment in One Piece Corporation, a subsidiary of J. Morita.
Henry Schein first entered the
Japanese market in October 2014,
with an investment in Iwase Dental Supply, a full-service provider
“We are delighted to move forward with our partnership with
Henry Schein,” said Haruo Morita,
President and CEO of J. Morita. “We
share a devotion to innovation,
the ability to adapt to changing
market conditions, and a strong
commitment to industry leader-
ship that will enhance our efforts
to help practicing dentists in
Japan deliver quality oral health
care.”
approximately 6,000 dental clinics and had aggregate sales of
approximately US$125 million in
the 2015 fiscal year.
Japan, we look forward to a strong
partnership that will bring new
services and solutions to the
Japanese dental community.”
With the partnership, Henry
Schein has expanded its presence
in Japan, the second-largest dental
market in the world. One Piece is
composed of eight dental dealers
throughout Japan, which serve
Commenting on the partnership, Henry Schein CEO Stanley M.
Bergman said: “We are committed
to the Japan dental market and
with Kenichiro Iwase, assuming
the leadership of Henry Schein
Japan has approximately
90,000 dentists and about 64,000
dental clinics. With the addition of
One Piece, Henry Schein Japan will
serve approximately 20 per cent of
Japan’s dentists.
Red and white aesthetic harmony
By DTI
as well as stable shades, the company said.
SINGAPORE: In order to help clinicians to create lifelike direct
resin restorations, dental materials
company SHOFU has introduced
Beautifil II Enamel and Gingiva.
Developed as complementary extensions to Beautifil II, both are
made from specially modified
multifunctional organic fillers
and nano-fillers, providing them
with exceptional handling characteristics, longer working time,
high abrasion and wear resistance,
Moreover, effortless and superior polishing with sustained polish
retention achieves lasting aesthetics.
SHOFU’s proprietary S-PRG fillers
release fluoride and exert an antiplaque effect on the restoration surface. A special one-push syringe ensures controlled dispensing of the
smooth and creamy material that
is easy to sculpt into fine details to
recreate the surface textures seen
in natural teeth and gingivae.
Beautifil II Enamel is available
in four naturally translucent and
opalescent shades that facilitate
lifelike shade reproduction and
value adjustment in the final
restoration to meet individual
clinical needs. Beautifil II Gingiva
offers five natural shade variations of pink to easily mimic
the patient’s gingivae while restoring areas with receded or
missing gingivae or papillae,
cervical defects, root caries or erosion, or exposed porcelain-fusedto-metal margins and abutments
to achieve red and white aesthetic
harmony.
Straumann: Controlling stake in MegaGen
By DTI
BASEL, Switzerland: Straumann
has announced that is exercising
its conversion right and call option to acquire a controlling stake
in South Korean implant manufacturer MegaGen. The option
was obtained in March 2014, when
Straumann agreed to purchase
convertible bonds from MegaGen
for a total of US$30 million (€27
billion).
The bond agreements between the two companies provide
Straumann with the right to convert them into MegaGen shares.
An additional agreement with the
main shareholders of MegaGen
entitles Straumann to purchase
an additional number of shares in
MegaGen to obtain a controlling
stake in MegaGen.
Straumann’s decision to exercise the conversion right and call
option has triggered the process
in the agreements to determine
the conversion rate and the price
of the additional shares. MegaGen
has disputed the conversion price
and calculation procedure and
has initiated arbitration in Seoul
in South Korea under the International Chamber of Commerce
rules. Expediency is in the best
interests of all parties involved,
and Straumann is in the process
of responding in order to close
the deal as soon as possible. This
could take up to two years, depending on the progress of the
arbitration.
Straumann CEO Marco Gadola
explained: “Our investment has
helped MegaGen to drive its
growth strategy and to achieve
good results in 2015. However,
with its domestic market highly
penetrated and our industry consolidating rapidly, we are firmly
convinced that it is in the best
interest of MegaGen’s employees,
customers and shareholders to
have a strong global partner who
can help the company to provide
complete solutions and to expand
internationally. At the same time,
MegaGen complements our portfolio with differentiated products
and could help us to address the
value segment more effectively
particularly in the Asia-Pacific
and Middle East regions.”
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[5] =>
Dental Tribune Asia Pacific Edition | 7+8/2016
BUSINESS
“The journey of innovating the
clinical workflow has just begun”
An interview with Nobel Biocare and Digital Imaging President Hans Geiselhöringer
From 23 to 26 June, Nobel Biocare
held its global symposium in the
world metropolis of New York in
the US. The company staged a truly
exceptional event with a high-class
educational programme at the
Waldorf Astoria in Manhattan. As
the official media partner of the
event, Dental Tribune International
had the opportunity to meet with
Hans Geiselhöringer, President of
Nobel Biocare and Dental Imaging,
at the symposium for a short interview.
Dental Tribune International: Has
the global symposium met your
expectations?
Hans Geiselhöringer: We are
extremely happy with the symposium because it has exceeded our
expectations in every sense, from
the record number of participants
to the motivation of our team and
customers to engage in discussions, as well as the quality of the
speakers and their presentations.
We have always had high standards at our meetings, but I must
say that I was really thrilled by
the way innovation was presented
not only by our company but also
by the clinicians and experts
themselves.
In addition, I found the NEXT
GEN forum in particular incredible, as it gave us confirmation that
we are on the right track to doing
more for the younger generation
“I believe
that even
experts cannot
predict the
impact of the
Brexit on
the industry.”
of implantologists. I was positively
surprised to see how enthusiastic
and open our young clinicians are
to working hard with us to move
this project forward.
Overall, we have seen at this
symposium that the future is
bright, and I strongly disagree
with some critical voices that suggest that there will no longer be
real innovations in implantology.
In my opinion, the journey of
innovating the clinical workflow
has just begun.
With regard to training of the next
generation of dental professionals,
what kind of role can or should
Nobel Biocare play in implant education?
” Page 23
Hans Geiselhöringer
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[6] =>
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[7] =>
Dental Tribune Asia Pacific Edition | 7+8/2016
BUSINESS
07
To continue leading the value market
By DTI
BARCELONA, Spain: Founded in
1995, MIS Implants Technologies
started out as a small implant
company in the discount segment, but has developed into a
successful global business over
the past 20 years. At a press conference held during the MIS Global
Conference in Barcelona in May,
the management team gave a detailed outlook on the company’s
future strategic developments,
product innovations and potential growth markets.
In order to pursue considerable growth and address challenges
in the implant market, MIS made a
number of organisational changes
to the company structure several
years ago. One of these was integrating research and development functions into the marketing and sales department, a move
that transformed the department’s
way of working.
China, where MIS only recently
opened a new subsidiary.
“Despite the vast number of
dentists, the number of implants
sold in China today is similar to the
number in Israel. However, we believe that the situation will change
when we train more dentists on how
to use dental implants. Therefore,
we are investing in education in particular,” Peretz told Dental Tribune.
“...dentists will no
longer accept low-value
discount implants.”
MIS management identified
three markets offering opportunities for considerable growth,
namely Germany, the US and
He further explained: “Today,
the dental implant market is
divided into the premium, the
value and the discount segment.
Doron Peretz, Senior Vice President of Marketing and Development.
We predict that about five years
from now this will no longer be
the case. The main reason is that
dentists will no longer accept lowvalue discount implants. MIS is
currently leading the value segment and will continue to do so.”
Peretz also disclosed that the
company is planning to bring
a number of new products to
market over the next three years,
© Claudia Duschek/DTI
Since 2013, Doron Peretz, Senior
Vice President of Marketing and
Development, has been guiding
the R & D division at MIS.
“The key to continuous growth
is innovation. However, it is not
easy to drive innovations from
in-house. Therefore, our marketing team, who is most exposed to
the current opportunities of the
market, has contributed a lot to
exploring and bringing new ideas
to research and development, and
we are progressing rapidly in expanding our portfolio with this
approach,” he said.
© Claudia Duschek/DTI
Dental implant manufacturer MIS announces future strategies
MIS CEO Idan Kleifeld added:
“Today, it is crucial to offer complete solutions and in line with
our philosophy ‘Make it Simple’,
our primary principle is to simplify every stage of the implantology process. The combination
of mechanical design of the V3,
biological properties of the new
B+ implant surface, and digital
technology with the MGUIDE, allows us to provide clinicians with
highly effective solutions that
produce safe and predictable results.”
“We want to become the most
innovative company in implant
dentistry and we are now close
to fulfilling this aim with our
latest developments,” Kleifeld
concluded.
MIS Implants Technology presenting its new B+ implant surface treatment at its Global Conference in Barcelona.
“ Page 21
Education is key. We believe
that it is very important that clinicians start the thought process
for the clinical workflow early. We
have some programmes in place
already and will promote these
programmes to help and support
universities in the education of
young dentists in implantology.
For example, we support academic institutions and dental students through the provision of
NobelClinician Software licences
for implant planning and patient
communication.
including the next generation
of the V3 Implant System, which
will be launched at the upcoming
International Dental Show in
March 2017. With some of these innovations, MIS is aiming to offer
its customers products in the premium range. “In order to really
grow, we have to participate in
the premium segment, which currently accounts for about 70 per
cent of the global implant market. We have to develop solutions
and services that can compete
against other products and bring
added value in this segment,” he
said.
Only recently, voters in the UK decided that the country should leave
the European Union. How could the
Brexit affect the dental industry
and are there any immediate concerns for Nobel Biocare?
This is a question that is really
difficult to answer, as the shortand long-term consequences of
the Brexit remain unclear. I believe that even experts cannot
predict the impact of the Brexit
on the industry. From a personal
point of view, I believe it is never
a good thing to have many separate markets. However, whether
the Brexit will affect us as Nobel
Biocare directly, I do not yet know.
How has the acquisition by the
dental platform of the Danaher
Corporation, which occurred at
the end of 2014, affected Nobel
Biocare’s business?
We have seen only positive
effects. The transition into the
dental platform has given us new
opportunities to develop resources
for innovation, marketing and
sales that we would not have had
without this partnership. Collaboration with other brands within
the platform has opened up expertise that is allowing us to lead
innovation in dentistry. We are
learning from our colleagues and
have gained tools that are helping
us to refine our processes and
accelerate results.
The new home of Nobel Biocare
is a very good one.
The next big occasion in the dental
event schedule is the International
Dental Show in March next year.
Are there even more innovations to
come from Nobel Biocare?
I cannot disclose anything yet.
However, I can tell you already that
there will be significant innovations presented. The potential that
we are going to bring to the market
will be of the same magnitude as
that experienced at the symposium over the past few days.
Nobel Biocare will accelerate
its delivery of significant and
meaningful innovations, each developed with the well-being of the
patient in mind.
Thank you very much.
[8] =>
08
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 7+8/2016
But it’s different here
An international perspective on the business of dentistry
By Chris Barrow, UK
© Rawpixel.com/Shutterstock.com
As a business consultant, I have
been providing training, coaching
and mentoring services to UK and
Irish dentists and their teams for
the last 23 years. Additionally, I have
had the opportunity to work with
clients in a number of European and
other countries, including Turkey,
India, the US, Canada and Australia.
I consider myself a bit of a rebel and
love to talk about innovation in
business and how it applies in dentistry and the wider health care
environment.
In this article for Dental Tribune I want to take you back to the
mid-1990s and my first experience of working with UK dentists,
providing team training workshops all across the country. InAD
evitably, there would come a point
in one of those early workshops at
which an attendee would raise his
or her hand and, instead of asking
a question, make a statement that
came down to something like
“Chris, this is all very good and exciting, but you need to understand
that here in [insert place name]
things are different.”
Candidates for “insert place
name” ranged from the valleys of
southern Wales to the West End
of London, from north to south,
from crowded to thinly populated
areas; references were made to
cosmopolitan, suburban and rural
communities. The speaker would
elaborate and suggest that whatever idea I was proposing would
fall on stony ground because of
the idiosyncrasies of the local
population or macro- and microeconomic circumstances.
As a speaker, one learns to deal
with such objections and concerns
with empathetic listening and
compassion, but I gradually realised that, in each of these locations, there were dentists who
were just getting on with the job
and enjoying great success, because they were either oblivious of
or immune to those self-limiting
beliefs. Now, do not get me wrong
here, if your dental practice is situated in a town where a significant
proportion of the population is
dependent on one major employer
that then closes down, even the
greatest optimist and positive
thinker would have to take a reality check and respond. Thankfully,
such economic disasters are relatively few in number. Most of
the time, the aforementioned
statements of difference are a selffulfilling prophecy on the part of
the conference questioner.
The caring speaker will try to
engage the attendee in meaningful dialogue, but experience shows
that, sadly, the critic rarely wants
to be persuaded away from his
or her unfalsifiable hypothesis.
Bringing this phenomenon into
the second decade of the twenty-first century, the most frequent
use of the phrase “ah, but it’s different here” relates to the digital
marketing landscape. Whenever
I comment in writing or at a conference on the explosive growth of
digital, there will inevitably be a
listener who wants to tell me that
people in his or her postcode are
not on the Internet, do not use social media and do not have e-mail
addresses. Mirroring my earlier
experience, I then meet dentists in
the same location who are happily
generating digital sales.
A recent internal survey of my
top clients (located across diverse
geographical and economic locations) revealed the startling fact
that almost 66 per cent of their
website visits were from mobile
devices—smartphones and tablets—
thus demonstrating that website
appearance on a 27-inch iMac
screen is no longer as important as
how it looks on mobile.
If I now refer back to the international locations in which I have
had the opportunity to work, I can
think of not one of the listed countries in which I would argue that
the situation is different. Perhaps
the most notable of these is Pune
in northern India, where I was
privileged in February to deliver
a two-day workshop to 50 dentists
list of countries, there is not one
excluded from the information
and connection revolution that is
reshaping all of our lives.
People are people. The independent traveller of 50 years ago
would have commented on diverse cultures. In 2016, the same
traveller will comment on similarities, whether good or bad. The
global village contains dental patients and they have similar needs
and expectations of value. So if
you are looking for tips on how to
improve your dental business, you
now gain a global perspective
when observing best practise.
“The global village contains
dental patients and they
have similar needs and
expectations of value.”
from that city and nearby Mumbai.
Halfway through the morning
on my second day there, an attendee rose to his feet and requested a hand mike and I knew
what was coming: “Chris, we have
all enjoyed your lecture so far, but
you need to understand that here
in India things are different,” he
said.
I have visited and worked with
the best in all of the countries
listed and found that no nation is
behind the curve when it comes
to innovation in the business of
dentistry and we can all learn from
each other. Except, of course, in
your place—if it’s different?
I listened, acknowledged and
then simply carried on, in the
knowledge that Mumbai is now regarded as the health care tourism
capital of the world, that technology is influencing society as rapidly as anywhere and that the traditional Indian business model of
sole-trader dentists with no nurse,
no hygienist and no associate is
rapidly being replaced by dental
corporates and retailers, as is the
case everywhere. In my original
Chris Barrow
is the founder
of 7connections
business coaching. An active
consultant,
trainer and
coach to the
UK dental profession, he regularly
contributes to the dental press, social media and online. Chris Barrow
can be contacted at coach.barrow@
7connections.com.
[9] =>
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Tribune Group GmbH is an ADA CERP provider. ADA CERP is a service of
the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not
approve or endorse individual courses or instructors, nor does it imply
acceptance of credit hours by boards of dentistry.
100
C.E.
CREDITS
Certificates will be
awarded upon completion
Tribune Group GmbH is designated as an Approved PACE Program Provider by the Academy
of General Dentistry. The formal continuing dental education programs of this program
provider are accepted by AGD for Fellowship, Mastership and membership maintenance
credit. Approval does not imply acceptance by a state or province board of dentistry or AGD
endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.
[10] =>
10
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 7+8/2016
Non-ablative melanin depigmentation
By Dr Kenneth Luk, Hong Kong
Melanin depigmentation of gingiva
using various laser wavelengths have
been reported for over ten years.1–5
Layer by layer, the mucosa is ablated
to the basal layer of the epithelium
where the melanocytes are located.
Lasers have been compared with
the use of scalpel and diamond bur
(Fig. 1).6–9 By incorporating the optical
properties and absorption characteristics of 810 nm together with specific
power parameters, a non ablative
technique was developed (Fig. 2).10, 11
1
3
2
4
5
6
Fig. 1: Depigmentation by ablation.—Fig. 2: Depigmentation by absorption of melanin and haemoglobin.—Figs. 3–6: Depigmentation on upper arch using 810 nm at 30 W, 20 kHz, 16 µs, pre-op, immediate
coagulation, three weeks post-op and eight years post-op.
Another similar non-ablative
technique described as microcoagulation was also reported using
a 20 W 980 nm diode laser.12 The
445 nm blue wavelength was introduced in the dental market in 2015.
By using 320 µm uninitiated fibre
delivering 1 W continuous wave of
445 nm, the same non-ablative
procedure and result can also be
realized.
Background with
non-ablative technique
Diode laser at 810 nm is poorly
absorbed in water, but it is well absorbed by pigment such as haemoglobin and melanin. The use of
high power, short pulse duration
concentrated the thermal energy
on the surface over deep tissue
thermal conduction with lower
power and long pulse.13, 14 The author has used the 810 nm wavelength (elexxion Claros 810 nm
diode laser, elexxion AG, Singen,
Purpose
Germany) with the power parameters of 30 W, 20 kHz, 16 µs giving
an average power of 10 W. Under
local anaesthesia, a non-initiated
600 µm fibre was used. The fibre
was placed at a distance of 2 mm to
5 mm from the pigmented mucosa.
Coagulation can be observed with
immediate effect upon irradiation.
A constant movement must be performed in order to avoid thermal
damage deep into the tissue. Water
irrigation can be used as coolant
during the treatment.
There is no surface ablation of
the pigmented mucosa but rather
the haemoglobin and melanin
absorbing the laser energy (Fig. 2).
This technique (Figs. 3–6) showed
a treatment time of two minutes
compared to the ablative technique time up to 30 minutes in an
area of first premolar to first premolar of one dental arch. The wavelength of 445 nm is much better
absorbed by melanin and haemoglobin than 810 nm (Fig. 7). Hence,
Pigment removal in the requested sites was discussed using
445 nm diode laser. The same
technique would be used and the
patient consented to the treatment.
Material and method
SIROLaser Blue (Dentsply
Sirona) with an emission wavelength of 445 nm was used at 1 W,
CW delivered through a 320 µm
fibre.
7
Fig. 7: Absorption Spectra of biological materials. (Courtesy of J. Meister)
a much lower power density may
be used to produce the same effect.
Case outline
A 26-year-old female patient of
Chinese ancestry presented with
melanin pigmentation in 2007.
Congenital melanin pigmentation
of the labial gingiva was diag-
nosed. Depigmentation on the
upper arch using 810 nm at 30 W,
20 kHz, 16 µs was carried out.
Eight years post-op showed mild
relapse of pigmentation, but the
patient was satisfied with the cosmetic appearance (Figs. 3–6). She
now wanted the melanin pigment
on her lower anterior segment to
be removed (Fig. 8).
8
9
10
11
12
13
Procedure
Depigmentation technique is
the same as described with the
810 nm wavelength (above). Under
local anaesthesia, a non-initiated
320 µm fibre delivers the energy
at a distance of 2 mm to the pigmented area with constant movement. Immediate change to pink
colour without surface ablation
of the pigmented mucosa was ob-
Figs. 8–11: Depigmentation of lower arch using 445 nm at 1 W CW, pre-op, immediate post-op, one day post-op and one day post-op laser peel between 31, 41.—Fig. 12: Three days post-op (photo taken by
patient on holiday).—Fig. 13: Two weeks post-op.
[11] =>
[12] =>
12
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 7+8/2016
served. The procedure took approximately 40 seconds to complete between lower left and right
canine region.
Results
In this case, the mucosa turns
pink without any signs of surface
mucosal ablation except one spot
between teeth 41, 42 (Fig. 9).
Sub-surface coagulation of blood
vessels gave a pink coloured appearance. There was very mild
15
14
Fig. 14: Diagram 3.—Fig. 15: Diagram 4.
AD
post-op discomfort for about one
hour after loss of the anaesthetic
effect. No analgesics were required as the discomfort feeling
disappeared fast.
Laser peeling of mucosa between 31 and 41 was noted during
photograph taking at one day
post-op review (Figs. 10 & 11). The
three day post-op photo taken by
the patient showed that the laser
peel disappeared with new gingival mucosa formation (Fig. 12). Two
weeks post-op showed complete
recovery of the gingival mucosa
without melanin pigmentation
(Fig. 13).
Discussion
There has not been much information on this new wavelength. From Fig. 7, the absorption
coefficient for haemoglobin is
estimated at 7 x 10²/cm–1 and
10³/cm–1 for melanin. Penetration
depth for haemoglobin is calculated at 140 µm and 10 µm for melanin. The penetration depth of
haemoglobin and melanin with
810 nm are 2 mm and 0.1 mm
respectively. Furthermore, scattering curve showed less tissue
scattering effect with 445 nm
than 810 nm.
In view of the low scattering
effect together with high absorption of haemoglobin and melanin
to 445 nm, 1 W CW was used. Power
density of 88 W/cm² (Fig. 14) delivering at 88 J/cm² fluence at 2 mm
distance was calculated. Although
the power density of 1,697 W/cm²
(Fig. 15) delivering 543 J/cm² fluence used by 810 nm is higher
than 445 nm delivered, the eight
years post-op showed stable gingival contour with no recession
(Fig. 16). The understanding of the
optical properties of the wavelength, power parameters and
laser tissue interaction are important information for the clinician
to achieve the desired treatment
outcome.
Conclusion
The use of 1 W CW 445 nm blue
diode laser is effective in non-ablative depigmentation of oral mucosa. This non ablative technique
provide immediate aesthetic result with very short procedure
time. To the author’s knowledge,
this is the first case presented
using 445 nm for melanin depigmentation.
01
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03
Wi-Fi
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Editorial note: A list of references is
available from the publisher.
04
Smooth
external
design
Dr Luk reports no potential conflicts of
interest.
Dr Kenneth
Luk is a dental surgeon
from Hong
Kong. He can
be contacted
at laserdontic
@me.com.
[13] =>
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[14] =>
14
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 7+8/2016
“There certainly is a learning curve
to technology”
An interview with dental technician Lee Culp, CEO of Sculpture Studios
Dental Tribune: Although dentistry
is evolving towards the digital
world, the dental community still
seems divided when it comes to
acknowledging the relevance of
digital dentistry.
Lee Culp: Yes, we have those
who embrace digital technology
and there is the group that is still
concerned about, confused about
or fearful of digital technology,
but there is also the group in the
middle, which is the largest one.
They have bought the equipment, but not made the change
yet. For example, they have a
scanner, but they do not really do
anything with it. One could say
that they have not fully commit-
© Kristine Huebner/DTI
Having been at the forefront of
the digital evolution in dentistry
for 20 years now, Lee Culp can be
considered a true digital pioneer.
At this year’s International Expert
Symposium hosted by Ivoclar
Vivadent in Madrid in Spain, he
lectured on the impact of digital
restorative dentistry for improving communication and teamwork in daily practice. Dental
Tribune had the opportunity to
speak with him about his fully digitally operated dental laboratory,
Sculpture Studios, and when he realised that the future of dentistry
is digital.
new technology, I have the case
digitised in the computer. I can
move it around, invite the dentist
to view the screen and discuss
everything while I change something on the computer. The dentist understands my challenges
and sees the situation from my
perspective, and I do not have to
verbalise it over the phone.
This facilitates long-distance communication too, for example if
specialists or patients live in remote areas.
Yes, we have had cases from
all over North America, Great
Britain, Denmark and Australia,
to name a few, and apart from
the time difference, the digital
technology enables one to work
closely together on cases wherever one is in the world. It also
makes the workflow much easier
because everybody involved is on
the same page.
Lee Culp
ted yet to using the technology
to its fullest.
As software and fabrication processes continue to evolve, practitioners need advanced training.
Do you think there are enough
educational opportunities available
today and are they adequate?
AD
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Approved by: Ministry of Science and Technology of the People’s Republic of China
Organized by: China International Conference Center for Science & Technology /
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Co-organized by: Shanghai Stomatological Association / College of Stomatology, Shanghai Jiao Tong University / Shanghai Research Institute of Stomatology /
School of Stomatology, Tong Ji University / Shanghai Stomatological Disease Center
Shanghai World Expo Exhibition and
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October 26~29, 2016
There certainly is a learning
curve to technology, and from
my point of view, the digital companies do not necessarily do the
greatest job of training. They are
good at basic training upon sale,
but there is just not a great deal of
advanced training out there. We
run a digital academy back in the
US and we offer a large number of
courses. However, there need to
be more in each country, because
more people want to know how
to accomplish advanced things,
such as smile design, implant
placement, surgeries—all of those
things. There is a great need for
education but not enough education providers.
I know exactly when that was.
CEREC (Sirona) hired me as a consultant to help create a laboratory system. When I started with
CEREC, it could not produce a 3-D
representation of a tooth. It produced many lines on the screen
and one had to interpret those
lines to make out a tooth.
It was incredibly difficult. So,
the aha moment was when the
engineers and marketing people
came over from Germany and
they hooked up the computer to
a projector and a screen and I saw
a tooth moving. I knew right
away: this is it!
What is the focus of your company?
For one, it is a dental laboratory where we create dental restorations, but we also conduct
a great deal of research, both
on materials and on technology
for many different companies.
For example, I have served on a
number of development teams
for several of the major Ivoclar
Vivadent products. In our laboratory, we assisted in the development of the product Empress
Esthetic, as well as the Ivocler
Denture teeth. We are hired as
consultants to work on projects
from companies, and we provide
education to dentists and laboratory technicians—all digitally
based.
With all the digital possibilities
available, will traditional expertise and technical skills become
somewhat obsolete?
Whatever design is produced
on the computer and by machine, the final 25 per cent has to
be done by hand. One still has
to mould, carve, glaze, colour—
whatever we do. We do not lose
this; we just get to the artistic
part faster and more efficiently
now, but one still has to be a
very well-trained technician or
dentist. A bad technician is not
going to be a good digital technician. Similarly, as a dentist, if
one cannot take an impression
with vinyl, one is probably not
going to be able to take an impression with digital technology
either.
You are a certified dental technician and probably trained only
the analogue way. Was there a
moment when you knew there
was no stopping the digital development in dentistry?
In your lecture, you spoke about
how digital technology can improve communication. Could you
please explain that aspect?
It is mainly about the amazing visual possibilities. With the
From your perspective, what are
the next developments to expect
in the digital field?
If one imagines diagnosis and
treatment planning to be on the
far left of a scale and the process
of making the restoration on the
right, digital technology is already very advanced on the manufacture side. However, it has not
progressed as much in terms of
the planning process, except for
implants maybe—but implant
planning does not consider the
overall picture, the entire mouth;
it is just planning software to
put something somewhere surgically.
Right now, we have software
for the last 50 per cent; now we
need software for the first 50 per
cent. Companies like 3Shape are
starting to respond, as they are
starting to realise the importance
of the diagnosis and treatment
planning process.
Another development is predictive software. I believe that
every child, once the permanent
dentition starts to erupt, should
be given a full-mouth scan every
six months. With each scan, we
would know what to be aware of
in terms of tooth movement,
tooth wear, bone and tissue
changes. In dentistry today, we
mostly do not act before there
is an obvious problem. Therefore, we need to have predictive software to change that,
namely processes and technologies that can sound the alarm
before something is seriously
wrong.
Thank you very much for the interview.
[15] =>
[16] =>
16
TRENDS & APPLICATIONS
Dental Tribune Asia Pacific Edition | 7+8/2016
Single-use hand instruments
Making a case for their use in general dental practice
By Robert Jagger, UK
A wide range of single-use disposable dental and surgical instruments is now produced by a number
of manufacturers. Instruments are
available for purchase either singly
or as procedure kits and are priced
to be a realistic alternative to decontaminating reusable instruments.1
Paradoxically, single-use instrumentation is rarely seen as a viable alternative by dental professionals, who
typically associate single-use instruments with cheap unreliable plastic
devices and a very limited product
range. In reality, there are mirrors,
probes, restorative instruments, endodontic instruments, minor oral
surgical instruments and extraction
forceps for both adult and paediatric use.
Dental Practices).2 Dangers posed
by prion diseases, such as variant
Creutzfeldt–Jakob Disease (vCJD),
remain even with the most effective dental sterilisation processes.
The prion associated with vCJD is
able to survive steam autoclaving
under standard exposure conditions,2 suggesting that some reusable surgical instruments are potentially being utilised in a contaminated state. Use of single-use
disposable instruments ensures
that instruments are not contaminated, protecting patients and
clinical staff alike.
forecast true procedure costs accurately, as there are no hidden costs
associated with the decontamination, sterilisation and packaging of
reusable instrumentation.
Convenience
Among other applications,
single-use packs allow rapid and
efficient management of dental
extractions that become complicated by, for example, crown fracture. Contingency stock of single-use surgical packs (comprising
integral single-use scalpel handles
prevention concerns associated
with the reprocessing of reusable
instruments.
Single-use dental scalers are an
efficient solution for dentists, dental hygienists and dental therapists,
since every instrument is guaranteed to be sharp for every procedure, enabling reduced treatment
times and less patient discomfort.
The Instrapac Periodontal Microsurgery Pack (Robinson Healthcare)
is designed to facilitate complex
periodontal surgical procedures in
a cost-effective way, ensuring that
Quality
Single-use instruments can
be of extremely high quality and
may be almost indistinguishable
in use from reusable instruments.
Clinicians often comment that
they are impressed by their quality
and functionality and that they
appear far too good to throw away
after just one use. These instruments are a significant step forwards from the poorer quality
equipment that was previously
available.
Before selecting a supplier of
single-use instruments, however,
it is critical to ensure that they
comply fully with all relevant
British and European medical device regulatory standards and that
they are manufactured from medical-grade surgical steel and undergo rigorous in-process quality
assurance checks and batch testing. Purchasing instruments from
a supplier approved by the British
Dental Industry Association will
provide practitioners with assurance that they are dealing with
an appropriately regulated manufacturer.
Sterilisation
One of the most significant
changes to have affected the dental profession in recent years has
been the adoption of rigorous
sterilisation and cross-contamination procedures (HTM 01-05:
Decontamination in Primary Care
© Romas_Photo/Shutterstock.com
Procedure packs too are available for specific procedures and contain all of the necessary instruments. Examples of packs include
those for dental and periodontal
examination, restorative procedures, maxillofacial biopsy, minor
oral surgery, and periodontal microsurgery. This article seeks to
challenge current clinician perceptions of single-use instrumentation by examining the potential
benefits of high-quality single-use
instruments in daily practice.
Costs
Most general dental practices
are now equipped with HTM
01-05-compliant equipment. Reprocessing dental instrument
trays, however, inevitably leads to
significant wear and tear and ultimately instrument damage. Regular sharpening (and replacement)
of reusable instruments too is
necessary for instruments such as
luxators, chisels and elevators.
This can add substantial costs to
the reprocessing of reusable instruments. Reprocessing protocols
dictate that a dental practice must
hold significant stock of expensive
reusable instruments, much of
which often lies redundant at any
given point in time.
Single-use instruments can
provide a cost-effective contingency to cover unexpected emergency situations in which reusable
instruments may be unavailable,
for example when managing unplanned surgical complications or
when washer disinfectors or sterilisers are inoperable and significant clinical time may be lost while
waiting for the arrival of a skilled
service engineer. Single-use instruments enable clinicians to
are designated as a specialist clinical waste stream and as such must
be disposed of in accordance with
UK and European clinical waste
management regulations. Historically, this has meant that they
were disposed of alongside clinical
sharps waste and ultimately conveyed to incineration and landfill.
This has previously raised concerns over their adverse environmental impact.
However, a recent innovative
partnership between Robinson
Healthcare and one of the country’s largest specialist health care
waste management companies,
Healthcare Environmental Group
(HEG), has led to the development
of a unique UK-wide recycling
programme for single-use surgical-steel instruments. Under this
initiative, HEG is now able to provide dental practices with a unique
reusable Healthcare Sharps waste
container. The company has a
fleet of dedicated, regulation-compliant, purpose-designed vehicles
and the capacity to service individual dental practices and clinics
with scheduled waste container
collections and deliveries. Containers are tracked from practice to
recycling station using GPS track
and trace technology. Depending
on the annual volume of steel recycled, HEG is potentially able to
offer a payback to dental practices
that use the Healthcare Sharps
recycling service. Overall, HEG
operates nine processing and energy recovery sites across the UK,
providing an energy recovery
programme that maximises the
environmental benefits.
Conclusion
and blades, tissue retractors, periosteal elevators, dental elevators
and suture packs) enables highly
convenient, efficient and costeffective management of complications.
Single-use conservation and examination packs provide a costeffective means of extending the
length of daily clinic treatment sessions, especially towards the end of
the day, when access to sterile reusable instruments may be compromised owing to sterilisation equipment downtime or cleaning routines (when nursing staff are therefore unavailable for clinical duties).
In endodontics, clinicians can
more effectively identify and control procedure costs and maximise
their return on time-consuming
and costly procedures with the
use of single-use rubber dams and
root canal obturation packs. Safety-conscious patients are increasingly requesting that single-use instruments be used for their treatment because they feel more comfortable if the hand instruments
used to perform their procedure
are brand new and have never been
used on another patient. Single-use
instruments eliminate infection
instruments are always functional
and sterile. Robinson’s soft-tissue
biopsy packs provide an off-theshelf sterile, cost-effective solution
for performing intra-oral tissue biopsies, particularly in general practice, where these procedures are
often performed infrequently.
In implant dentistry, single-use
periotomes and microsurgery packs
provide a cost-effective solution
for procedures that require precision and speed.
Moreover, single-use conservation and surgical packs offer benefits when managing medically vulnerable patients, including those
with immunocompromising conditions and those requiring dental
treatment before elective cardiac
and renal surgery and pre- and
post-head and neck radiotherapy
and chemotherapy.
Environmental impact
It is often forgotten that decontamination and sterilisation procedures consume large amounts of
energy, water, cleaning fluids and
consumables, with associated significant environmental impact.
Single-use surgical instruments
The use of high-quality single-use instruments can provide
significant advantages to dentists
in general dental practice, particularly in terms of sterility, convenience, efficiencies and reduced
operating costs. Packs, such as surgical, restorative, periodontal and
implant packs, can be particularly
helpful. The purchase costs of the
single-use instrument option are
less significant when the substantial hidden costs of reusable instruments are considered, and their
cost in use is typically significantly
less than the reusable instrument
option. Furthermore, recent advances in the way that these instruments may be recycled have
effectively addressed environmental concerns.
Editorial note: A list of references is
available from the publisher.
Robert Jagger
is a consultant
in restorative
dentistry for the
University of
Bristol Dental
Hospital and
a senior clinical lecturer at the School of Oral and
Dental Sciences. He can be contacted
at R.Jagger@bristol.ac.uk.
[17] =>
ORTHOTRIBUNE
The World’s Orthodontic Newspaper · Asia Pacific Edition
Published in Hong Kong
www.dental-tribune.asia
Vol. 14, No. 7+8
Short-term gains…long-term problems?
The emergence of STO and its future implications in general practice. By Aws Alani, UK.
The provision of orthodontics can
be a life-changing experience for
young patients whose “crooked”
teeth can affect their confidence
and self-esteem. Indeed, where
mature patients present with a history of malalignment, equally beneficial and fulfilling results can be
achieved. In government-funded
systems, patients with congenital
abnormalities receive treatment
that is essential to their ongoing
oral health. Restorative dentists
work closely with orthodontists,
who can appreciate how small details can aid in achieving positive
restorative outcomes.
As a young dentist, I corrected
a tooth in crossbite with a simple
T-spring appliance. It was enjoyable and brought a different type of
delayed gradual satisfaction to the
more cerebral but tenuous molar
endodontics or the more artistic
and instant composite build-up.
I was not a specialist, but I managed to do some orthodontics. In
contrast to my experience, general dental practitioners are now
more routinely providing tooth
movement with the emergence of
short-term orthodontics (STO). This
has resulted in some conjecture
as to the methods of achieving
“straighter” teeth. Indeed, some
may consider STO as an emerging
entity competing with specialist
orthodontics, but should it be?
The specialist training pathway for orthodontics involves
a competitive-entry three-year
full-time course linked with the
achievement of a master’s level
qualification that many may feel
daunted by. Indeed, navigating
the pathway from start to finish
can be difficult academically and
financially when factoring in fees
and loss of earnings during training. Once qualified, the majority
of these specialists reside, like the
majority of all specialists, in the
south-east of England. With this
skewed distribution of specialists
and assumed need for access, it
might seem prudent for general
dental practitioners to contribute
to meeting the need for orthodontics.
Indeed, the long-cited managed clinical networks have yet
to be fully realised, although all
planning and documentation related to managed clinical networks identify general dental
practitioners as integral to the
function of the network. The number of orthodontic therapists has
gradually increased over the last
ten years or so since inception of
the first courses in Wales and
Leeds. Therapists are allegedly
more cost-effective to train and
employ in a large orthodontic
practice; however, unlike their
hygiene or therapy colleagues,
they cannot practise without a
specialist’s treatment plan and
supervision.
Patients who qualify for orthodontic treatment under the UK
government-funded system need
to be assessed according to the
index of orthodontic treatment
need. There will be an obvious
shortfall of adults or adolescent
patients with minor malocclusions who do not meet the criteria who would like their teeth
straightened. This cohort may
have to seek treatment privately
from orthodontic specialists or
general dental practitioners. As
such, these minor or straightforward cases may be managed in
a number of different settings
utilising various techniques with
the advent of STO. This may have
resulted in some territorial paranoia between the two camps of
traditional orthodontics versus
STO systems. Conversely, it may
and learns by way of osmosis
from those of individuals one
hopes to emulate. Becoming an
expert in many a field requires
time, effort and experience.
Orthodontics is a complicated
discipline that is difficult to
deliver optimally and efficiently.
Treatment planning should be performed in person not only to appreciate the challenges the patient
presents with but also to develop
a lasting patient rapport. Equally
important, patients need to be diligent during treatment and forever
more for purposes of retention.
Is it possible that a one- or two-day
course with a treatment plan lasting half a year or less can provide
equally op-timal results to a specialist ortho-dontist utilising traditional means?
© Alexis Photo/Shutterstock.com
be that differing scientific, technical and ethical ethos on managing
the same problem is the source of
the debate.
Quick and easy?
Commercialisation has modified the provision of orthodontics
in the UK. Indeed, there are now
orthodontic brands with courses
attached and a faculty of individuals who promote their particular
product. Companies tend to boast
that their product is the best with
limited complications and treatment being low risk, predictable
and easy. Somewhat surprisingly,
courses are being run on how to
convert patients into orthodontic
clients. There are books describing strategies on promoting and
increasing revenue. They outline
detailed strategies on attracting
more patients than one’s local
competitor—or is that colleague?
Sounds more like capitalism than
commercialism to many interested observers.
The rapid development of STO
has not escaped the venture (or
some may say vulture) capitalists.
In the same vein as DIY whitening
and sports guards, one can now
have one’s teeth straightened via
online companies using products
delivered by Her Majesty’s Royal
Mail and so cut out the middleman (i.e. the dentist). To my knowledge, STO has yet to make it on
to the price list of Samantha’s,
a beauty salon in Peckham.
What may cause fear and
worry is that the provision of
tooth movement set against a
backdrop of a focus on increasing
revenue and patient conversion
may detract from the real reasons
we are providing the treatment.
The risk and benefit of treatment
must remain balanced or be rebalanced in favour of the patient.
The best things in life are rarely
quick, easy and without reflection.
While learning or training, one
gains stature from one’s mistakes
In any case, placing a time limit
on any treatment could be considered contentious. Patients ask me
all the time ‘How long is this treatment going to take Doc?’ I always
reply ‘Ill tell you when its finished’.
As such I am rarely wrong.
Advertising cosmetic
treatments the fair
dinkum way
The Australian health ministry—recently examined the provision of cosmetic procedures and
in particular the modes of promoting the treatments. The working group found that advertising
and promotion more often than
not focused on the benefits to the
consumer, downplaying or not always mentioning risks. The group
went on to identify advertising
practices that were not driven by
medical need and where there
was significant opportunity for financial gain by those promoting
these. They identified the need to
” Page 18
DT launches new international ortho mag
By DTI
HONK KONG: The orthodontic
segment has grown significantly
within the past 20 years owing
to new technologies and products,
as well as an increase in adult
patients requesting orthodontic
treatment. In response to this
trend and to update dentists on
the most significant developments in the field, Dental Tribune
International (DTI) has added
ortho—international magazine
of orthodontics to its portfolio.
The 2016 issue includes articles on
clear aligners, vibration therapy
and rapid maxillary expansion,
as well as the latest product information and event previews.
The new high-gloss Englishlanguage magazine adopts an
interdisciplinary approach involving orthodontics, oral surgery,
periodontics and restorative den-
tistry, and aims to serve as
an educational tool, providing
comprehensive knowledge and
information on the newest technology that can profitably be integrated into treatment concepts.
The publication, which will be distributed at all major international
orthodontic congresses and exhibitions, presents the latest research and case studies, as well as
trends in procedures and techniques.
In order to connect with orthodontic specialists, the DTI team
is scheduled to attend a number
of orthodontic events around the
globe in 2016, including the 92nd
Congress of the European Orthodontic Society, which will take
place between 11 and 16 June in
Stockholm in Sweden; and the
fourth Scientific Congress for
Aligner Orthodontics, to be held
on 18 and 19 November in Cologne
in Germany. DTI will be providing
comprehensive live coverage of
these and other events on its
website. In addition, e-newsletters
about the respective events will be
sent to orthodontists worldwide.
From 2017, a new issue of the
ortho magazine will be published
twice a year with a print run of
4,000 copies. An e-paper edition
of the magazine is available free
of charge via the DTI online print
archive.
[18] =>
18
ORTHO NEWS
“ Page 17
regulate promotion and advertising ethically with factual, easily
understood information from
a source that is independent of
practitioners and promoters. This
is unfortunately not always readily available. In some Australian
jurisdictions, there are specific
guidelines that need to be adhered
to for promotion of cosmetic treatments and they specifically cover
before and after treatment adverts, which we know in the UK is
a popular practice among the
cosmetically driven. This is commonly one ideal, perfect case
showcased on the front end of the
practice website with no mention
of any problems, either acute or
chronic. Another aspect of the
report detailed prohibition of
time-limited offers or inducing
potential customers through free
consultations for the purposes of
treatment uptake. The latter is
something that has seen STO promoted by way of voucher deals on
the Internet or via smartphone
applications. Others may consider
such a practice as loss leading; one
could ask who is losing and who is
gaining and at what price?
One important aspect of the
report identified the wider social
impact of cosmetic procedures in
that people may become increasingly dissatisfied with themselves
and their appearance, culminating in deeper concerns for the person and reducing scope for indi-
Ortho Tribune Asia Pacific Edition | 7+8/2016
viduality. Many dentists throughout the country may have a
slipped contact here, a rotation
there or a space distal to a canine
who are unlikely to be waiting in
earnest for the next voucher deal
alert on their iPhones. Inducing
misgivings or raising concerns
about the patient’s tooth position
where the teeth are otherwise
healthy and the patient presents
with no concerns could be considered unethical and worryingly
dishonourable.
AD
International Magazines
ortho
international magazine
of orthodontics
www. dental-tribune.com
Relapse of confidence
In a recent publication from
an indemnity provider, orthodontics was identified as an emerging
area for claims against their clients.
This is likely to be the tip of the
iceberg, whose size will probably
continually grow as more and
more orthodontics is provided
and the repercussions of which
may only become apparent gradually in the future.
In the now highly litigious
arena of UK dentistry, the failure
of orthodontic treatment against
the backdrop of Montgomery v.
Lanarkshire Health Board is likely
to result in increased litigation.
The movement of teeth into what
the patient and the dentist feel
is the correct position may be
possible in the short term, but
in the long term complications
may arise owing to a variety of
soft- and hard-tissue factors that
cannot accommodate this new
and supposedly “right” position.
Indeed, orthodontics requires the
appreciation of detail where symmetry and alignment are “king”,
but long-term stability is the likely
“empress”. Relapse of position is
a common complaint and where
patients have paid handsomely
for a result they may have been
happy with at the time of the
cheque clearing, over time tiny
tooth shuffles can result in disproportionate and vehement dissatisfaction. Where teeth are moved
indiscriminately, recession in the
labial segment is a complication
difficult to explain and remedy in
the high lip line of a conscientious
and ambitious corporate female
patient. Indeed, more haste, less
speed may result in a case being
etched longer in the memory of
the patient and the clinician for
the wrong reasons.
Clear steps to
business building
Vol. 1 • Issue 1/2016
issn 1868-3207
ortho
international magazine of
orthodontics
1
2016
EUR 22 per year (2 issues per year; incl. shipping and VAT for customers in Germany) and EUR 23
per year (2 issues per year; incl. shipping for customers outside Germany).
Your subscription will be renewed automatically every year until a written cancellation is sent to Dental
Tribune International GmbH, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to the renewal date.
Shipping Address
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Address
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practice management
Short-term gains…
long-term problems?
Country
trends & applications
Vibration therapy in orthodontics:
Realising the benefits
E-mail
industry report
From straightforward
to complex cases
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SUBSCRIBE NOW!
A cornerstone of a successful
business is the repeat customer
who values the dentist and his or
her service and returns with no
qualms or mis-givings about what
the dentist feels should be provided. A successful business relies
on patients returning in the long
term owing to their positive experiences. Focusing on short-term
gains without due consideration
of quality or reliability of the
treatment provided has potential
repercussions for patients, the
business of dentistry and perception of the profession.
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Aws Alani is
a Consultant
in Restorative
Dentistry at
Kings College
Hospital in
London, UK,
and a lead clinician for the management of congenital abnormalities. He can be contacted at awsalani@hotmail.com.
[19] =>
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This course consists of 2 intensive days in Dubai
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Curriculum fee: €1,350
tel.: +49-341-484-74134 | email: request@tribunecme.com
Tribune Group GmbH is an ADA CERP provider. ADA CERP is a service of
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credit. Approval does not imply acceptance by a state or province board of dentistry or AGD
endorsement. The current term of approval extends from 7/1/2014 to 6/30/2016.
Provider ID# 355051.
[20] =>
DTUK0116_21_OTCraven 28.07.16 13:45 Seite 1
ORTHO TRENDS
20
Ortho Tribune Asia Pacific Edition | 7+8/2016
Individuals play the game, but teams
win championships
What it takes to build the ultimate practice unit
By Lina Craven, UK
do attitude makes the impossible
possible.
It is said that all teams are groups,
but not all groups are teams. What
separates the two is interdependence. A true team is focused on a
common purpose; team members
support one another and enhance
each other’s work and contribution. Andrew Carnegie captured
this accurately when he said,
“Teamwork is the ability to work
together toward a common vision.
It is the fuel that allows common
people to attain uncommon results.”
I know that achieving the ultimate team is possible, because
when I was a dental nurse many
years ago in America, I was part of
an ultimate team. What made us
great was our leader, Dr Derick
Tagawa. He and his partner had
a very clear vision and they knew
exactly what was needed from
each one of us to ensure the
practice achieved its desired results. In turn, each one of us
knew that every challenge we
faced was an opportunity for personal, professional and practice
growth.
Practices with a motivated,
focused and empowered team
produce excellent results; consequently, patient satisfaction is
high and practitioners realise
increased financial rewards.
Achieving such a team is not pie
in the sky, but it does require complete commitment from the
whole team. Based on my own experience of being a part of a highperforming team and my observations as a consultant to practices, here are my key principles
for the creation of an ultimate
team.
Do not confuse being the boss
with being a leader. Leaders set
the tone for the practice. They
lead by positive example. Successful teamwork starts at the top
with leaders who provide strategic vision and establis h team
goals. Effective leaders clearly define their vision and share it with
their team to establish a common
purpose.
Any successful relationship can
only survive if values are shared,
believed and agreed upon; values
like honesty, respect, integrity,
commitment to each other, commitment to the practice success.
Shared values help to build an
effective team and to establish
its culture, conduct, rules and
policies. The key is to ensure
the entire team agrees on the
same values and is prepared to
work by them. According to the
Consistency is critical to creating the ultimate team; it fosters credibility and trust. Ken
Blanchard and Sheldon Bowles
wrote in their book Raving Fans,
“customers allow themselves to
be seduced into becoming raving
fans only when they know they
can count on you time and time
again”. This is also true for teams:
just replace the word “customers”
with “team members”. I often
hear people say things like “one
day we’re instructed to something and the next day it becomes
something else”. If you want to
be part of the ultimate team, be
consistent.
world’s finest flight demonstration team (the Blue Angels, US
Navy), “without shared values,
peak performance isn’t possible”
and “a team’s values must align
with its purpose, mission, and
actions”.
Every team member, from the
leader to the cleaner, must learn
to communicate clearly and effectively. Successful relationships
are built on positive, honest and
open feedback. Is information
shared openly and honestly in
your team? Does gossip or negative chatter exist in your practice?
Team members must learn to address concerns, deal with conflict
and accept responsibility for the
success of other team members.
When conflict occurs, it must be
dealt with honestly, directly and
openly as soon as possible and
in line with the team’s adopted
values. Foster positive attitudes
and creative thinking—attitudes
can either make or break the team
dynamics, so there is no place for
negative people.
Do all your team members have
clear and up-to-date job descriptions? Are they all qualified to
undertake their roles? Are there
written procedures for every area
of the practice? I often hear team
me mbers say they are not sure
who is responsible for something,
or they do not have a job description, or they were promised
training when they started, but
have not yet received any owing
to the practice being too busy.
Empowerment results from clearly defined roles and practice
procedures and a shared understanding of one another’s roles.
Cross-training increases efficien-
cy and makes each person more
productive and valuable to the
team.
Each team member is a cog in
the practice’s wheel of success.
However, many are often underutilised to his or her full potential
where staff were expected to be
(from the rota) and anyone off
that day. It only took 5 minutes for
the update and 5 minutes more to
review the day before regarding
what had worked well and what
had not. It helped us to focus on
the day ahead.
It is said that what motivates individuals the most is recognition
—a pat on the back or a word of
praise here and there for a job well
done. Embrace this principle and,
although it may feel awkward at
first, if it is done often enough
it becomes a habit. Sam Walton,
founder of Wal-Mart Stores, said:
“Appreciate everything your associates do for the business .
Nothing else can quite substitute
for a few well-chosen, well-timed,
“Successful leaders embrace the power of
teamwork by tapping into the innate
strengths each person brings to the table.”
Blue Angels, US Navy
and thus become bored or complacent. Dr Tagawa believed in
providing the best training for his
staff. He also recognised that he
may lose some individuals who
desired greater career progression than the practice could offer.
He knew nevertheless that those
who remained would perform at
their peak and more than justify
his investment.
Every morning in Dr Tagawa’s
practice as part of our commitment to the team, we would meet
10 minutes prior to the start of
the day to prepare for the show.
The head receptionist had a simple but effective system for updating us with vital information,
including how many patients we
would be seeing, special recognitions (like patients’ birthdays),
identifying difficult patients,
Walt Disney once famously
said, “You can dream, create, design and build the most wonderful place in the world, but it
requires people to make the
dream a reality.” Imagine a girl
visiting Disney World hoping to
see Cinderella, but when she
encounters her, Cinderella is
chewing gum and has a can’t-do,
won’t-do attitude. Is Cinderella
playing her role? It takes the right
attitude and focused commitment from every member of the
team to turn the vision into a reality. When that patient your practice dreads is due to arrive, how
do you all respond? With “I will
not take any nonsense from this
patient today!” or “I’ll show her
who’s right!”? When we choose
the right attitude and choose to
stay true to our purpose, we will
help others to do the same. A can-
sincere words of praise. They’re
absolutely free and worth a fortune.”
Building the ultimate team
does represent a challenge, but
once achieved it is hugely rewarding. There is no point implementing one principle in isolation.
It is like baking a cake without
the eggs.
Lina Craven is
founder and Director of Dynamic Perceptions,
an orthodontic
m a n a g e m e nt
consultancy and
training firm in
Stone in the UK,
and has many
years of practice-based experience. She
can be contacted at info@linacraven.com
[21] =>
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[22] =>
DTUK0116_22-23_OTChayah 28.07.16 13:51 Seite 1
DTUK0
ORTHO TRENDS
22
Ortho Tribune Asia Pacific Edition | 7+8/2016
Conservative smile design
for the general dentist
This article discusses the advantages of short-term anterior tooth
alignment using the Inman Aligner
system, particularly for general dentists. The article will give a brief description of the Inman Aligner appliance and its use in short-term orthodontics, and it will answer three major
questions the general dentist should
ask himself or herself during the treatment planning process. In support of
this treatment modality, three case
scenarios general dentists see daily
will be given as examples.
Treatment
concept
and case
presentation
1
By Dr Rami Chayah, Lebanon
Abstract
and should look for any skeletal discrepancies. Compromises
must be signed off.
treatment or Class II or III treatment.
Only certain types of movements are
possible and some patients will still
need conventional orthodontic treatment or indirect restorations. Certain
criteria should be met before treat-
ment proceeds. At consultation, other
orthodontic alternatives should be offered. The dentist must quote for the
long-term retention maintenance
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Dentists need to consider three
questions about treatment during the
treatment planning process. The first
question: can the patient’s teeth be
Introduction
General dentists face the daily challenge of performing instant veneers
for patients with misaligned anterior
teeth who refuse orthodontic treatment, many of whom regard fixed
orthodontic treatment as too long
a commitment for achieving their
desired aesthetic results. In today’s
fast-paced life, some patients are not
prepared to wait or to go through
long treatments.1, 2 One of the greatest
benefits of short-term anterior alignment is that many people who would
refuse comprehensive orthodontic
treatment may accept short-term removable alignment techniques such
as the Inman Aligner system.
The Inman Aligner is a simple removable appliance, a modification
of the removable spring retainer. It
uses super-elastic coil springs to apply
highly efficient light and consistent
forces on both the labial and lingual
surfaces of the anterior teeth (Figs. 1 & 2).
The appliance is fabricated on a cast
on which, based on a surgical model,
the anterior teeth needing correction
have been removed and reset in the
ideal position in wax on the working
cast.3 When the patient wears the appliance, the built-in forces generated
by the spring coils will correct the
misaligned anterior teeth (Fig. 3).
What distinguishes the Inman
Aligner appliance from other shortterm orthodontic systems such as
Invisalign (Align Technology) and
Six Month Smiles is its low cost, low
risk and short learning curve for general practitioners. Only one appliance
is used from the start to the end of
the treatment. Sometimes, several
clear aligners may be used to de-rotate
resistant canines. The system is well
received by patients because it is fast
and relatively cheap. It also accommodates today’s active lifestyle. Usually,
most cases take from six to 16 weeks.
Patients can take the appliance out
during meals or work meetings.
As with any other treatment techniques, the Inman Aligner has its
limitations. Hence, case selection is
imperative, as the Inman Aligner is
not suitable for posterior orthodontic
Fig. 1: Inman Aligner appliance.—Fig. 2: Illustration of the Inman Aligner showing the appliance components.—Fig. 3: Inman Aligner appliance in the mouth. Case 1—Fig. 4:
Frontal view with the teeth in occlusion before treatment.—Fig. 5: Frontal view with slightly open bite showing the status of the teeth before treatment.—Fig. 6: Frontal view
with the teeth in occlusion after alignment and bleaching.—Fig. 7: Close up frontal view of the maxillary teeth after ABB.—Fig. 8: Right side view of the maxillary teeth before ABB.
—Fig. 9: Right side view of the maxillary teeth after ABB.—Fig. 10: Left side view of the maxillary teeth before ABB.—Fig. 11: Left side view of the maxillary teeth after alignment
and bleaching.—Fig. 12: Full face before treatment.—Fig. 13: Full face after treatment.—Fig. 14: Frontal view showing the patient’s natural smile before treatment.—Fig. 15:
Frontal view showing the patient’s natural smile after treatment.—Fig. 16:Full face showing the patient’s natural smile before treatment.—Fig. 17:Full face showing the patient’s
natural smile after treatment.—Fig. 18: Occlusal view showing the maxillary arch before treatment.—Fig. 19: Occlusal view showing the maxillary arch after treatment.
[23] =>
DTUK0116_22-23_OTChayah 28.07.16 13:51 Seite 2
ORTHO TRENDS
Ortho Tribune Asia Pacific Edition | 7+8/2016
fixed without orthodontic treatment
in a very short period? In order for the
general dentist to answer this question, he or she should first establish
whether the patient does not wish
to pursue orthodontic treatment because of the time commitment and
cost. Would he or she also refuse
short-term anterior tooth alignment?
Would the occlusion be improved
even though a Class I molar or Class I
canine relationship may not be
achieved? Patients may prefer shortterm alignment techniques because
of the shorter treatment time and
the lower cost.
Case 1
The first case presented is a good
example of a scenario relevant to
the question above. The patient was
a young woman at college who presented at my office requesting a full
smile makeover of 20 veneers; she
desired a “Hollywood smile” as expressed in her own words. Her complaint was the retracted maxillary
right and left central incisors, the incisal edge wear on the maxillary central incisors and mandibular anterior
teeth, the pointy shape of the maxillary and mandibular canines, and
the yellow colour of her teeth overall
(Figs. 4 & 5). It could be argued that it
would be highly unethical to prepare
the sound enamel, transforming her
ten maxillary teeth into stumps, for
the rest of her life, especially at this
young age. After long discussion and
explanation of the disadvantages of
the shortcut route of preparing her
teeth for ceramic veneers, this option
was excluded. Several other options
were available and discussed with her,
but because she wanted a smile enhancement in a short period of time,
conventional fixed orthodontic treatment was also excluded. After checking her bite, it was observed that there
was insufficient interocclusal space
to shift the maxillary central incisors
forwards without opening the bite.
However, the patient accepted use of
the Inman Aligner system owing to its
short treatment time and flexibility
regarding being able to take the appliance off during the day while eating.
The treatment plan was to follow
the ABB protocol (alignment, bleaching and bonding). This concept still
constitutes a smile makeover but in
a very conservative manner. Taking
into consideration her age and her
sound enamel tissue, this was agreed
to be the most progressive means of
carrying out her smile enhancement.
First, her maxillary teeth were aligned
using the Inman Aligner with an
expander for nine weeks. Two extraclear aligners were used in the last
two weeks of treatment to de-rotate
the maxillary left lateral. Once the
maxillary teeth had been aligned
and in the last two weeks of treatment,
the teeth were bleached with customfitted super-sealed trays (Fig. 6). Now
that the teeth had been straightened
and whitened, the patient became
more aware of the differential wear
on the incisal edges of her anterior
maxillary and mandibular teeth.
Incisal edge bonding using composite was completed using a simple
direct technique. The patient was
very happy with the final result
(Figs. 7–19).
23
Case 2
The second question to be considered regarding treatment: would
some of the teeth be aggressively
prepared or end up with root canal
treatment if treated with restorative
dentistry without alignment and
would the overall outcome be better
with alignment rather than without?
This question addresses the ethical
dilemma general dentists face every
day. We often have cases with overlapping anterior central incisors in
our office.
The patient presented in this case
was bothered by the look of his overlapping maxillary central incisors
(Figs. 20 & 21). His mandibular teeth
were also crowded, but for some reason, his concern was only with his
maxillary teeth. He had started to
hide his smile in front of his friends,
feeling embarrassed to show his
maxillary teeth. After the full orthodontic examination and discussion
about all of the treatment options,
including comprehensive orthodontic treatment, the patient chose the
removable Inman Aligner system
owing to its flexibility in that the
wearer is able to remove the appliance for several hours a day and
because of its short treatment time.
The maxillary left central incisor
would have been aggressively prepared had it been treated restoratively.7–9 By using a simple anterior
alignment technique, the treatment
took only eight weeks to straighten
the teeth and a great deal of sound
enamel tissue was preserved by conservatively resolving the unattractive appearance of the maxillary
teeth (Figs. 22 & 23).
25
20
21
22
23
24a
24b
Case 2—Fig. 20: Frontal view showing the overlapping central incisors before treatment.—Fig. 21: Side view showing the overlapping
central incisors before alignment.—Fig. 22:Frontal view showing the teeth after alignment.—Fig. 23:Side view showing the teeth after
alignment.—Figs. 24a & b: Side views showing the moderately crowded and worn teeth before treatment.
dentine of the incisal edges (Fig. 25).
The patient initially requested instant
veneers to resolve his smile problem,
but after mocking up the design directly in his mouth, he was discouraged from pursuing this option owing
the amount of tissue that would be
lost. The aggressive preparation of
The treatment plan was to align
the teeth first and then to reassess the
restorative work needed (Fig. 26). The
appliance was used for 12 weeks and
only worn for 16 to 18 hours a day. During the last three weeks of alignment,
the patient began to bleach his teeth.
By week 12, the teeth were straight and
loss. This clinical approach guarantees that the strength of bonding to
the enamel is much greater.
Conclusion
The goal of this article is to encourage general dentists to reflect
on the importance of considering
short-term tooth alignment alone
or in conjunction with restorative
dentistry when treating patients.
Hopefully, these three questions and
cases will prompt readers in thinking
through the process of this treatment modality.
Disclosure: Dr Chayah is the trainer for
Inman Aligner Training in the Middle East.
He provides hands-on full-day certificate
courses to general practitioners.
26
Acknowledgement: I wish to thank Dr Tif
Qureshi, the founder and Director of Inman
Aligner Training in London, for his mentoring and sharing the last case in this article.
Editorial note: A complete list of references
is available from the publisher.
27
28
Case 3—Fig. 25: Occlusal view showing the tooth misalignment.—Fig. 26: Occlusal view showing the result of treatment.—Fig. 27: Maxillary
teeth after alignment to reassess the restorative work needed.—Fig.28:Natural-looking thin maxillary veneers owing to aligning the teeth first.
Case 3
The third question to be considered: will the teeth require restorative
work anyway, even after alignment?
The case presented serves to
demonstrate the necessity of aligning
the teeth even before placing ceramic
veneers.10–13 The patient in this case
exhibited moderate misalignment
with major anterior edge wear due to
occlusal trauma. In addition, the teeth
were darkened through years of stains
being absorbed through the worn
the tissue was explained to him using
the occlusal image of his maxillary
teeth. After an extensive orthodontic
examination and discussion of the
options, the patient refused fixed orthodontic treatment, as well as clear
aligners. He refused the first option
because he did not want anything
fixed in his mouth, and he refused
the second option because of the
proposed time involved. The Inman
Aligner system was introduced to the
patient, and he quickly accepted this
option owing to the short treatment
time and removability.
white (Fig. 27). At this point, a direct
mock-up was done to show the
patient the smile design that could be
achieved with composite. He felt that
the teeth were still flat and wanted a
fuller smile. Because we had aligned
the teeth, only minimal preparation
was needed as evident from the waxup and the decision was made to fabricate ceramic veneers instead (Fig. 28).
This case shows that for complex situations and considering patients’ high
aesthetic demands, pre-alignment is
essential to produce minimally invasive veneers with minimal enamel
Dr Rami Chayah
runs a cosmetic
dental practice
in Lebanon with
an emphasis on
minimally in vasive dentistry.
He seeks to share
his passion for
photographic and
video production and believes that
through his personalised dental approach, he can demonstrate a more
positive way of practising dentistry,
helping other dentists to view the
dental domain in a different way.
You can reach Dr Chayah through his
social media: facebook.com/ramichayah
and http://instagram.com/ramichayah
www.inmanalignertraining.com
[24] =>
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Table of contents
-
Thirty two-year old dentist is the fi rst Thai woman to climb Mount Everest
01 - 01
view
-
First special needs dental clinic opens in Singapore
02 - 02
view
-
World News
03 - 03
view
-
Business
04 - 07
view
-
But it’s different here - An international perspective on the business of dentistry
08 - 08
view
-
Non-ablative melanin depigmentation
10 - 12
view
-
Interview: “There certainly is a learning curve to technology”
14 - 14
view
-
Single-use hand instruments
16 - 16
view
-
Ortho Tribune Asia Pacific Edition
17 - 24
view
[toc_titles] => Thirty two-year old dentist is the fi rst Thai woman to climb Mount Everest
/ First special needs dental clinic opens in Singapore
/ World News
/ Business
/ But it’s different here - An international perspective on the business of dentistry
/ Non-ablative melanin depigmentation
/ Interview: “There certainly is a learning curve to technology”
/ Single-use hand instruments
/ Ortho Tribune Asia Pacific Edition
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