DT Asia Pacific No. 9, 2011

Health experts go cuckoo over mental patients / Asia News / Opinion / Da Silva assumes presidency of World Dental Federation / British researchers develop method for filling without drilling / Dental surgeries should think pink - UK designers say / Business / "Our investments in Singapore are developing favourably" / Business / Comparision of titanium and Roxolid implants at three different time points in an animal model / "Oral health often tends to be side-lined as a minor concern" / Not all dental filling materials are equal / Indonesian dentist helps reforest orangutan habitat

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DTAP0911_01_Title 28.09.11 15:59 Seite 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition
PUBLISHED IN HONG KONG

www.dental-tribune.asia

Ortho start-up
Interview with Singapore
investor Nanostart
Page

NO. 9 VOL. 9

Filling materials
The best choice for
posterior restorations

Page

Borneo charity
Dentist helps to reforest
orang-utan habitat

Page

Health experts go cuckoo over mental patients Australia sets
up dental
council

Daniel Zimmermann
DTI

HONG KONG/LEIPZIG, Germany:
People with psychiatric disorders are more likely to suffer
from dental diseases than people
who are mentally stable, a new
report from Australia suggests.
Having reviewed over 20 studies
from Europe, Asia and the US,
researchers from the University
of Queensland (UQ) found that
patients diagnosed with severe
mental illnesses had a three-fold
higher risk of losing all their
teeth.

Dental experts have been
gathered by the Australian coalition to form a new advisory body
on oral health. The National Advisory Council on Dental Health,
which includes the President of
the Australian Dental Association, as well as heads of other national oral health organisations,
is intended to develop strategies
to improve the country’s poor
public dental care system.

Mental patients also had significantly more decayed, filled or
missing teeth, the study shows.
Levels of dental disease however
were lower in countries or regions with water fluoridation.

According to a study, more attention should be given to the oral health status of mentally disabled. (DTI/Photo Refat Mamutov)

The alarming figures were
released on the same day that
new findings from Germany revealed that almost 40 per cent of
Europeans suffer from some
kind of mental health problem.
According to the study, treating
disorders like anxiety, insomnia
or depression costs the Union an
estimated US$394 billion a year,
including costs for dental treatment.

Besides their neglect of oral
hygiene, mental patients often
lack access to oral health care
owing to dental phobia and treatment-related costs, UQ professor
and lead researcher Steve Kisely
said. He added that medication
commonly used to treat disorders, such as antidepressants or
mood stabilisers, can additionally reduce saliva flow, which can
cause xerostomia and increase

plaque formation in these patients.
“Patients with severe mental
illnesses like schizophrenia, dementia or bipolar disorders are
most affected by bad oral health,”
he told Dental Tribune Asia Pacific.
Conversely, Kisely said that
dental diseases can lead to mental disorders like social phobia

caused by the poor anaesthetic
appearance of teeth or other
symptoms, like bad breath.
He recommended including
oral health check-lists in the standard assessment of psychiatric
patients and increasing promotion
of oral hygiene measures amongst
this group. “They should be given
advice on diet, smoking and brushing technique,” he concluded. DT

The decision to set up the
council follows an agreement
on the improvement of public
dental services signed by Labor and the Green party during
last year’s federal elections.
Both coalition partners already
clashed over the issue in early
May, which resulted in additional funding of AU$53 million
(US$56 million) for dental care
by the government over the next
four years.
Public dental services, especially in South Australia, are
poor, with patients having to wait
for months or even years to get
a dentist appointment. DT
AD

Fiji has eyes
on people’s
oral health

Surveying damage caused by the earthquake/tsunami in Japan. In an exclusive
interview, AmeriCares’ Ella Gudwin talks about restoring dental care facilities.
(DTI/Photo AmeriCares/Tammy Allen, USA)TRENDS & APPLICATIONS, page 14/15

Managing bone
with Acteon

New light on
oral leucoplakia

The Thailand subsidiary of
French dental manufacturer Acteon
has announced to hold a seminar
and workshop on the issue of
bone management next January
in Bangkok, Thailand. The seminar will be joined by Drs Fred
Bergmann and Surakit Visuttiwattanakorn as well as Profs. Fumihiko
Watanabe and Lars Sennerby. DT

Chemical luminescence can
aid in the visualisation of oral leucoplakia, new research has found.
Following oral examinations, researchers at King’s College London
Dental Institute evaluated the accuracy of chemiluminescence in
detecting potentially malignant
oral disorders using a commercially available detection kit. DT

A new oral health survey is
being conducted by the Fiji
Ministry of Health to re-evaluate
the prevalence of dental diseases
on the island. Over the next few
weeks, dental checks will be conducted on and questionnaires
distributed to 6,000 individuals
from different parts of the country in collaboration with the Fiji
National University in the capital
Suva, the ministry said.
The last two surveys, done
in 1998 and 2004, revealed that
dental diseases like caries and
periodontal disease plague the
majority of Fijians, especially
young children and adolescents.
It also found that one in ten adults
had decayed, missing or filled
teeth. According to the ministry,
the initial results of the new survey are expected to be released
early next year. DT

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[2] => DTAP0911_01_Title

DTAP0911_02_News 28.09.11 15:59 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Serial robber, dentist rapist
nabbed by Philippine police
PDA president calls for better security measures in dental clinics
Daniel Zimmermann
DTI

HONG KONG: Female dentists
in the Philippines can breathe
a sigh of relief, as the National
Capital Region Police Office has
reported that it has arrested a
man who could be responsible
for a series of robberies and
sexual crimes targeting dental
offices in the Metropolitan Manila area. Police representatives
told reporters that the 32-yearold suspect was seized in early
September in his home in Las
Piñas City, 20 kilometres south
of the capital.
The arrest is a succès d’estime
for the Philippine National Police, which has recently been cast

in a poor light by reports posted
on whistleblower website WikiLeaks, describing the agency
as inefficient and corrupt. It also
ends a manhunt lasting for
months and involving intelligence operatives throughout the
country, as well as the Philippine
Dental Association (PDA), which
it said was cooperating closely on
the matter with the police.
The suspect, who spent five
years in prison on robbery
charges from 2004 to 2009, is accused of robbing over 20 dental
offices and raping or sexually assaulting female dentists over the
last 12 to 14 months. His modus
operandi was to pose as a client
requesting dental treatment and
once having gained access to in-

timidate his victims with a semiautomatic handgun to make
them compliant.
According to the police, he
has confessed to 19 of the robberies, starting in May 2010, but
has denied the charges of rape
and sexual assault.
Another individual suspected
to be involved in two of the crimes
is also in custody, the police said.
PDA President Dr Roberto
Tajonera, a dentist from Manila,
appeared relieved, but said that
better security measures need
to be taken in dental clinics, such
as the installation of CCTV cameras, to prevent further attacks
on dentists. DT

Fibre-optic sensor research
honoured by AP dental student body
From news reports

BANGKOK, Thailand: Research
from Singapore demonstrating
the use of fibre-optic Bragg stack
sensors to measure demineralisation of enamel has taken first
place at this year’s scientific research competition held at the
38th Asia Pacific Dental Students
Association’s (APDSA) annual
congress in Thailand.
High-resistance fibre-optic
sensors are commonly employed

in a wide range of industrial applications in order to measure
temperature, strains, illumination and other physical quantities. In dentistry, they have been
used to study contraction and
setting expansion of composite
materials, amongst other things,
but not to sense the decrease of
minerals in the outer layer of
teeth. The team from the National University of Singapore
hopes to utilise the novel technique for the early detection of
tooth decay.

The APDSA research prize is
awarded to outstanding research
conducted by dental students
throughout the Asia-Pacific region. This year, 14 teams from
universities in Japan, Indonesia,
Malaysia, Taiwan and South Korea took part in the annual contest.
Prizes were also given to students from Indonesia who had
tested the effect of white tea on
tumour cell viability and of mouthwash containing Curcuma xanthorrhiza on caries risk factors. DT

International Imprint
Licensing by Dental Tribune International

Publisher Torsten Oemus

Group Editor/Managing
Editor DT Asia Pacific

Daniel Zimmermann
newsroom@dental-tribune.com
Tel.: +49 341 48474-107

Copy Editors

Sabrina Raaff
Hans Motschmann

Editors

Claudia Salwiczek

President/CEO

Torsten Oemus

Editorial Assistant

Yvonne Bachmann

Marketing & Sales

Matthias Diessner

Director of Finance & Controlling

Dan Wunderlich

Marketing & Sales Services

Nadine Parczyk

License Inquiries

Jörg Warschat

Accounting

Manuela Hunger

Product Manager

Bernhard Moldenhauer

Executive Producer

Gernot Meyer

Ad Production

Marius Mezger

Designer

Franziska Dachsel

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

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

Published by Dental Tribune Asia Pacific Ltd.
© 2011, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information
and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume responsibility
for product names or claims, or statements made by advertisers.
Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International.

Dental Tribune International
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302 · Fax: +49 341 48474-173
Internet: www.dental-tribune.com E-mail: info@dental-tribune.com

Regional Offices
Asia Pacific
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd, 20A, Harvard Commercial
Building, 105-111 Thomson Road, Wanchai, Hong Kong
Tel.: +852 3113 6177 · Fax: +852 3113 6199
The Americas
Dental Tribune America, LLC
116 West 23rd Street, Suite 500, New York, NY 10001, USA
Tel.: +1 212 244 7181 · Fax: +1 212 224 7185

[3] => DTAP0911_01_Title

DTAP0911_03_News 28.09.11 16:00 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Asia News

3

Dental students in India face new regulations
From news reports

NEW DEHLI, India: The Indian
Ministry of Health and Family Welfare recently approved a revision
of course regulations for Bachelor
of Dental Surgery (BDS) programmes, making it mandatory for
dental undergraduates to participate in a paid, rotating one-year internship after four years of theoret-

ical training. The new regulations
will first be applied to students who
started their BDS in 2008/2009 and
be implemented in dental schools
around the country in Autumn.

It also contributed to increased
stress levels amongst dental students owing to the high number of
subjects in the final year, according to a 2009 study.

Internships were temporarily
dropped from BDS courses in 2007
after the Dental Council of India
found out that many students, especially from private schools, had
tried to fake certificates instead of
actually doing hands-on training.

Since then, BDS programmes
have been five-year courses and
consisted of theoretical modules
only.
Reviving the scheme after four
years follows international stan-

dards that require mandatory internships in dental education institutions worldwide, ministry officials said in a statement. They
added that it will also provide for
better opportunities for practical
training and skill development.
It is estimated that India currently has the largest number of
dental schools in the world. However, experts say that the country
is putting too many dentists on the

market, making it difficult for BDS
graduates to find a job. DT
AD

Treatment of
swallowing
disorders

The new generation of NiTi Files

Daniel Zimmermann
DTI

HONG KONG: Magnetic brain
stimulators could help stroke patients overcome life-threatening
swallowing difficulties, Australian
scientists have reported. In a clinical study conducted at the University of Adelaide (UA) in South Australia, researchers are currently
investigating how the process of
trans-cranial magnetic stimulation
(TMS), a non-invasive electromagnetic stimulation of cerebral nerve
cells, could help to regain control of
mouth and throat muscles damaged by cerebrovascular accidents.
According to UA speech pathologist and lead researcher Dr
Sebastian Doeltgen, swallowing
disorders affect more than 50 per
cent of patients suffering from the
effects of a stroke. If untreated, the
condition can lead to severe health
conditions like silent aspiration,
dehydration or even pneumonia,
which can be life threatening, especially for elderly patients. Common therapies to overcome the
problem include physical exercises to improve the coordination
of mouth and throat muscles.

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hoenix from
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iTi FFile!
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The new therapy approach developed by Doeltgen and his team
uses magnetic stimulation to create electric currents in the brain
that could stimulate the nerve cells
that the scientists believe control
the complex process of swallowing.
Similar techniques were successfully used by German researchers
earlier this year to stimulate cerebral nerve cells in rats.

134 ° C

“When people have a stroke,
the parts of their brain that control
the muscles in the mouth and
throat are often damaged and we
have to find ways to reactivate
these regions,” Doeltgen told
Dental Tribune Asia Pacific. “Using
TMS, we can assess to what degree
different cortical motor networks
are involved in swallowing motor
control. This information will
ultimately allow us to develop tailored swallowing rehabilitation
approaches that target specific
motor circuits.”

w w w.hy ﬂex.info
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The initial results of the study,
which has received governmental
funding of AU$300,000 (US$313,000),
are expected to be released in two
to three years. DT

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[4] => DTAP0911_01_Title

DTAP0911_04_News 28.09.11 16:00 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Opinion

Dear
reader,

“Congrats, your treatment was a complete success.”

Re: “Many errors are related
to violation of the biological
width” (Dental Tribune Asia
Pacific Vol. 9, No. 7+8, page 6)

Daniel Zimmermann
DTI

If you ever had to treat a
patient with any kind of mental
disorders, you may be aware of
the fact that it can be quite a
challenging task. Unfortunately,
latest reports from clinicians are
suggesting that most mental
disorders are on the rise among
almost all age groups; from
common forms like depression,
anxiety or dementia, to closely
related conditions like burnout.
As different as these conditions might be on the first look,
they all seem to be connected
to deterioration of oral health.
Therefore, patients suffering
from these illnesses do not only
increasingly require dentists to
follow treatment protocols that
are significantly different to
that commonly used for patients
who fall into the classification
of being “normal” but also pose
a heavy burden to many dental
health care systems around the
globe.
Precaution measures like
additional training in dental
schools or through postgraduate education will have to be
taken to make sure that dental professionals will have the
skills and, more importantly, the
mind-set to be able to cope with
this challenges in the longrun. DT
Yours sincerely,
Daniel Zimmermann
Group Editor
Dental Tribune International

To the Editor

Care for mentally disabled
Dr Kuan-Yu Chu
Taiwan

Many studies have shown
that people with mental illnesses
have poorer oral hygiene and
oral health than the general population. They also have a lower
utilisation of dental care than
other disabled people. Amongst
them, the most frequently observed component of the DMFT
index is missing teeth. This finding indicates insufficient preventive and conservative dentistry in
the community and long-term
care units, and a growing need
for prosthetic treatment aimed at
people with mental disabilities.
The high prevalence of dental
diseases also creates an urgent
need for dental treatments for the
mentally ill.

Most individuals with mental
disabilities are on medication for
long periods, which frequently
leads to increased risk of dental
diseases and to more difficult dental procedures. However, according to the results of an oral health
survey by the National Yang-Ming
University here in Taipei for inpatients with mental disorders, an
important modifiable factor associated with the filling rate of the
DMFT index is prolonged stay in
long-term care institutions.
The results demonstrated that
long-term care institutions and
dental clinics in the community
might have limited capability or
willingness to offer essential oral
health services to people with mental disabilities. Thus, accessibility
to quality care, preventive oral
health programmes and a proper
budget are the three principle issues for enhancing the oral health
of people with mental disabilities.

When conducting comprehensive assessments, psychologists
should take dental problems into
consideration and design effective health care plans for people
with mental disabilities. The present integration of general and
oral health programmes is inadequate. Better cooperation amongst
medical and dental professionals
for long-term care could better
meet the dental needs of the mentally ill. Financial support from
the government could facilitate
the above-mentioned reforms, and
break the economic barrier to
prosthetic treatments for people
with mental disabilities. DT

Contact Info
Dr Kuan-Yu Chu works at the Department of Dentistry, Tao-Yuan
General Hospital, Department of
Health, Taiwan. He can be contacted at kyc0321@yahoo.com.

Indeed education in dental schools
could be improved. But, today this is
only possible by extending the study
period because the programme is
already full. Problems with ceramic
crowns are a concern, as well as occlusion, a subject neglected for years. The
simple interrelation of occlusal form
with chewing force is not respected.
Implant-supported crowns are much
more sensitive to errors and today
overloads on the supra-structures are
common, mainly in fixed prostheses.
With the scientific crash of gnathology
in the ‘70s, today few people want to
expose themselves by talking about
occlusion. As much as gnathological
theories were treated like a doctrine,
we shall not make the same error
today by neglecting the importance of
occlusion.

M. Bossard, 05 Aug. 2011

Re: “Editorial: Goodbye
amalgam?” (Dental Tribune Asia
Pacific Vol. 9, No. 1+3, page 4)
I would really like to see this
“comprehensive research from South
Africa” giving proof that glass-ionomer
crowns are going to outdo amalgam
crowns in molars for a patient who
cannot afford ceramic or gold restorations. What nonsense!

Wajih Jinnah, 19 Aug. 2011

Dental Tribune
welcomes comments,
suggestions and
complaints at feedback@
dental-tribune.com

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[5] => DTAP0911_01_Title

DTAP0911_05_News 28.09.11 16:00 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

5

Da Silva assumes presidency of World Dental Federation
Javier M. de Pison
DT Latin America

MEXICO CITY, Mexico: The
FDI World Dental Federation is
the United Nations of Dentistry,
remarked one of the speakers
at the opening ceremony of the
99th FDI Annual World Dental
Congress in Mexico City. Proof of
this is the intense lobbying, discussions and negotiations that
take place amongst delegations
and committees representing all
the national dental associations
in the world.
The chair of the organising
committee, Dr Víctor Guerrero
Reynoso, said that he was very
proud because 98 different countries were represented at the
congress, which “means it is a
truly global event”. For his part,
the President of the Mexican
Dental Association, Dr Jaime
Edelson, said that “the dentists
are an integral part of the health
system of every country” and
demanded “an end to the separation between oral health and
general health.”
He added that it was a moment to feel proud to be a dentist
and especially Mexican. “It’s also
time to share and learn from
more than 90 foreign dentists
who have come to bring their
knowledge and experiences” to
the FDI congress.

The new FDI President justified the above by saying that,
on the one hand, we are seeing
an increasing number of invasive
dental treatments and, on other
hand, there is a need to help
people achieve optimal dental
health. Other reasons cited were
the ageing population in some
countries, the growing number of
medically compromised patients
and awareness of the importance
of patient safety. Finally, he men-

tioned the relationship between
non-communicable diseases,
such as cancer, cardiovascular
and respiratory diseases and
diabetes, and dental caries and
periodontal disease, which affect
over 90% of people worldwide.
Monteiro da Silva concluded
by saying that one of his goals is
to achieve a better integration
of the Portuguese-speaking communities worldwide in FDI.

The newly appointed Secretary of Health of Mexico, Salomon
Chertorivski, opened the congress as his first official act. Chertorivski said that as he entered
the Centro Banamex he met the
dentist who treated him as a child.
He went on to describe a series
of measures that met with broad
support amongst the practitioners attending. The Health Secretary said that he will implement
steps to reduce red tape eligibility

for dental care now demanded
by the Mexican social security
system. He added that Mexico
agrees with the proposal of Dr
Margaret Chan, director-general
of the World Health Organization,
who stated that oral health is
a neglected area of international
health. Therefore, “Mexico adheres to the FDI initiative to
obtain official recognition by
WHO of dental diseases as noncommunicable diseases.” DT
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Ayub Safar, President of
Mexican Dental Trade Association, agreed that it was a historic
moment to be part of the FDI
World Congress in Mexico. Safar
thanked the foreign and domestic industry for supporting
“this commercial and scientific
event”, which he described as
a great opportunity to update
knowledge and to benefit the
Mexican population.
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Monteiro da Silva said that
when he first attended an FDI
World Dental Congress in Paris
in 2000 “I was far from imagining
that 11 years later I would be
president of the federation. The
president’s job is to lead, strengthen, and update the policy
strategy to address new developments at social, political, economic and technological levels.”
Monteiro da Silva added that
for decades the profession “Or
dental medicina, as it should be
called, had limited its scope to
a restorative approach. Today,
everyone agrees on the need
to embrace the medical field,
especially because some areas
related with traditional dentistry,
such as education, prevention,
treatment, rehabilitation, demand it.”

Stra

... o v e

One of the most emotional
moments of the ceremony was
when outgoing President, Dr
Roberto Vianna, passed the presidency of the federation to Dr
Orlando Monteiro da Silva of
Portugal, who will serve in this
capacity for two years. Vianna
said that his serving in office has
given him great satisfaction and
that he envisions a bright future
for the profession.

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n
i m pla

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[6] => DTAP0911_01_Title

DTAP0911_06_News 28.09.11 16:01 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

British researchers develop
method for filling without drilling
From news reports

LEEDS, UK: The thought of the
dentist’s drill puts many people off
visiting their dentist, even if they
only need a check-up and not
treatment. Researchers at the University of Leeds have announced
that they have discovered a pain-

free way of tackling dental decay
that reverses the damage of acid
attack and rebuilds teeth as new.
The pioneering treatment promises to transform the approach to
filling teeth forever.
Tooth decay begins when acid
produced by bacteria in plaque

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dissolves the minerals in the
teeth, causing microscopic holes
or “pores” to form. As the process
of decay progresses, these micropores increase in size and number. Eventually, the damaged
tooth may have to be drilled and
filled to prevent toothache, or
even extracted.
The researchers have developed a revolutionary new way to
treat the first signs of tooth decay
by arming dentists with a peptide-based fluid that is painted
onto the tooth’s surface. This
peptide technology is based on
knowledge of how the tooth
forms in the first place and stimulates regeneration of the tooth.
“This may sound too good to be
true, but we are essentially helping
acid-damaged teeth to regenerate
themselves. It is a totally natural
non-surgical repair process and is
entirely pain-free too,” said Prof
Jennifer Kirkham from the Leeds
Dental Institute, who led the development of the new technique.
The “magic” fluid was designed by Dr. Amalia Aggeli and
other researchers in the School of
Chemistry. It contains a peptide
known as P 11-4 that assembles
into fibres under certain conditions. In practice, this means that
when applied to the tooth, the
fluid seeps into the micro-pores
caused by acid attack and then
spontaneously forms a gel. This
gel then provides a scaffold or
framework that attracts calcium
and regenerates the tooth’s minerals from within, providing a
natural and pain-free repair.
The researchers tested the
technique on a small group of
adults whose dentist had spotted
initial signs of tooth decay. According to the scientists, the results of
this initial trial suggest that P 11-4
can indeed reverse the damage
and regenerate the tooth tissue.
“The results of our tests so far
are extremely promising,” said
Prof Paul Brunton, who oversees
the patient testing at the Leeds
Dental Institute. “If these results
can be repeated on a larger patient group, then I have no doubt
whatsoever that in two to three
years’ time this technique will be
available for dentists to use in
their daily practice.”

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According to Brunton, the
main reason that people do not
see a dentist regularly is fear. “If
we can offer a treatment that is
completely non-invasive, that
doesn’t involve a mechanical
drill, then we can change that
perceived link between dental
treatment and pain. This really
is more than filling without
drilling, this is a novel approach
that enables the patients to keep
their natural teeth,” he said.
The study is being funded
by Swiss company credentis AG,
which has licensed the technology. DT

[7] => DTAP0911_01_Title

DTAP0911_07_News 28.09.11 16:02 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

World News

Dental surgeries should think pink, UK designers say
From news reports

LONDON, UK: When refurbishing their premises, dentists who
want relaxed patients should
think about how their customers
want to feel when they visit the
dentist. According to a design
team from London, a mid to light
pink helps to relax the muscles
and is an ideal colour for a dental
surgery.

ing of cleanliness. However, it is
extremely important to produce
the correct atmosphere for the
customer or client, which includes considering the psychology of colour; a consumer is not
likely to return on the basis of
liking a brand’s colour palette but
may do so if he/she felt relaxed
and safe in the environment.
When a soothing affect is needed,
a pink in a muted tone can be very
successful, as can a restful green.”

According to Ördög, dentists
are tending to move away from
just the practical to more of the
aesthetic. As design and style filter into all areas of life today, the
environment in which they work
can now reflect this. Also, because
colour plays an important part of
our overall experience when
visiting a building or room, it can
influence mood and our physical
experience to some extent. The
use of colour to improve clients’

Feelings experienced when
entering a new environment can
in part be attributed to colour.
Colour is light that travels in
waves from the sun and the
energy from light is absorbed
through the eyes. It stimulates the
pituitary and pineal glands, which
in turn control some of the body’s
systems, including hormonal
changes. Research suggests that
pink is a calming colour and so
is regularly used in rooms where
a tranquil effect is desired, for example, in hospitals, rehabilitation
centres and even prisons.

When it comes to workclothes, dentists should stick with
white and not experiment with
different colours. “White coats are
universally known and accepted
as garments worn by medical professionals or experts. They also

represent cleanliness and are synonymous with hygiene. It is probably not appropriate to change
this, as the credibility of the dentist
may be compromised,” Ördög told
Dental Tribune Online. “However,
in theory it would be great fun
to see dentists in pale pink or
sunshine yellow coats—perhaps
this would help calm or cheer up
patients and lighten the mood of
children or those who really fear
visits to the dentist.” DT
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However, according to commercial interior designers at
Lima Europe, dental practices
should avoid cerise and hot pinks,
as these could add to an increased
heart rate, respiration and brainwave activity. “Light colours such
as white and cream or pale pastel
shades evoke feelings of freshness and tend to have a calming,
relaxing nature, especially lighter
greens and warm yellows,” Alíz
Ördög, a designer at Lima Europe, told Dental Tribune Online.
“Red in rooms appears brash,
can increase one’s heart rate and
could possibly be even more
alarming to some patients, as it
has obvious connotations of
blood. Orange is also stimulating
rather than calming so unless
used as an accent colour to evoke
a fun element of the brand these
colours would be best avoided for
dental surgeries, as they would
most likely make the majority of
patients feel uneasy or giddy.
Black would be a difficult colour
to work with for practical reasons,
it absorbs light and can hide dirt.
In terms of patient experience, it
can also feel oppressive.”

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“However, it is not necessarily
the case that these colours cannot
be used, more the fact of how
they are used. In small quantities,
black in particular could be incorporated into various design
schemes. Dental surgeries do
not necessarily have to be, and
I personally think should not be,
just white; a sympathetic, well
thought-out design scheme can
feature most colours except
bright pinks, reds and oranges,”
the designer added.
When working closely with
their clients, London interior
designers Ördög and her colleague Zoltán Madosfalvi carefully discuss colour palettes and
the feeling the particular space
is intended to evoke. Zoltán explained: “Some of Lima’s business clients, such as dentists’,
doctors’ and cosmetic surgeries,
come to me wanting their reception area to reflect their brand
identity whilst also creating a feel-

experience, helping to make
them feel at ease, is being given
increasing attention because it
can be viewed as an aspect of
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DTAP0911_09_Business 29.09.11 14:50 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Business

New player to enter Indian dental laser market
From news reports

NEW DEHLI, India/FRANKFURT/
MAIN, Germany: It has been
reported that New Dehli-based
Unicorn Denmart, one of India’s

AmannGirrbach
opens office
in Singapore
Daniel Zimmermann
DTI

SINGAPORE: The city-state has
become host for another prominent dental market player: CAD/
CAM specialist AmannGirrbach
has announced the opening of a
new branch in the Singapore River
Planning Area. With this step, the
Austrian company, which also has a
subsidiary in the US, intends to expand its business in the Asia-Pacific
and Middle Eastern markets.
The new Singapore branch
will support Amann’s distribution
partners in both regions through
logistics and responsive customer
service, the company said. It also
announced plans for a help desk
and company training centre to be
established by the end of the year.

AmmanGirrbach’s new office as seen
from the Coleman Bridge in central
Singapore. (DTI/Photo courtesy of
AmannGirrbach, Austria)

Prior to the establishment of the
new office, the company operated
through individual dealers in Saudi
Arabia, the Philippines, Malaysia
and other countries.
Founded through a merger of
an Austrian and German company
in 2004, AmannGirrbach manufactures laboratory instruments and
CAD/CAM solutions. As one of a
few providers worldwide, they offer
a complete in-house milling solution for dental laboratories with
their Ceramill product line.
Chairman Marco Ratz said that
AmannGirrbach is currently experiencing average growth rates of
30 per cent per year in the combined Asian and Middle Eastern
markets. The company makes €46
million in annual revenue, according to market sources. DT

largest distributors of dental products and services,
has become an exclusive
dealer for German dental
laser company elexxion.
The recent agreement includes the company’s claros
pico, a low-cost, mobile
diode laser indicated for use
in endodontics, as well as
periodontic and soft-tissue
laser surgery.

The agreement is elexxion’s
first step into Asia markets. Its
claros pico laser received market approval in Europe in late
2010 and has since been distributed in countries like Germany,
France and Spain. It will extend
Unicorn’s existing portfolio of

laser dentistry devices, which
includes a mini diode laser system imported from Dilas Diodenlaser in Germany. In addition to
elexxion, the company stocks
products from dental heavyweights such as Cefla Group,
Vatech or NSK in India.

The claros pic diode laser (promotional picture) will soon be available
to dentists in India. (DTI/Photo courtesy of elexxion AG, Germany)

Elexxion shares on the
Frankfurt Stock Exchange in
Germany reacted positively. DT
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[10] => DTAP0911_01_Title

DTAP0911_10_Kroell 28.09.11 16:05 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

10 Business

“Our investments in Singapore are
developing favourably”
An interview with Andreas Kröll, CEO of Nanostart AG, Singapore

Nanotechnology makes the SimpliClear wire almost invisible to the eye.
(DTI/Photos courtesy of Nanostart AG, Germany)

With SimpliClear, the Singapore-based start-up company
BioMers Pte Ltd is setting out to
conquer the growing market
segment of aesthetic orthodontics. Dental Tribune Asia Pacific

spoke with the Managing Director of German investor Nanostart Asia, Andreas Kröll, about
the company and its long-term
prospects in the global market
for orthodontic applications.

Dental Tribune Asia Pacific:
Mr Kröll, your fund is currently
invested in three technologybased companies in Singapore,
including BioMers. What was
the reason behind this investment?
Andreas Kröll: BioMers is a
National University of Singapore
spin-off that was founded about
five years ago. We have had an eye
on the company for quite some
time and finally decided to invest
in the SimpliClear technology in
2009, which in our opinion offered
a very interesting treatment option
that provided a unique combination of clear aesthetics and excellent clinical outcomes. At this time,
the product already existed, but in
a slightly different form, with standardised archwires. A few months

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Endorsed By

Supported By

Held In

In Co-operation With

Co-organiser

Bausch + Lomb, Edwards brings
a lot of experience to BioMers in
terms of developing successful
business strategies, building strong
teams and driving execution. This
complements the excellent technical and industry knowledge of
the founders’ team. With his help,
the team will manage the overall
commercialisation process from
Singapore and gradually develop
structures for global distribution.

Andreas Kröll

later, the product development of
SimpliClear was completed. Since
then, the company has been focusing on the marketing side and
managing its expansion.
How does SimpliClear want
to position itself in the market?
The core proposition behind
the SimpliClear technology is its
unique and almost invisible archwire that is made of a specifically
designed composite that qualifies
the product notably for use within
the aesthetic segment. The aesthetic market is recognised as a
large growth market in which
there are a number of solutions
available. Many of the current solutions, however, have limitations
in terms of the patient cases that
can be addressed, owing to limitations in terms of clinical effectiveness. SimpliClear, with its effectiveness in addressing a broad
range of patient cases, offers a new
standard of care in the aesthetic
segment. The goal is to capitalise
on the opportunity to combine a
product that delivers both aesthetic benefits and predictable
clinical outcomes.
Through the Nanostart Singapore Early Stage Venture Fund,
your company currently owns
25 per cent of BioMers. What is
your role in the company?
As a venture capital investor,
the main focus has to be on the
structures that make a company
work. A vast part of this responsibility is building an functioning
organisation and team. Currently,
about twenty-five people, including company founders Dr Mervyn
Fathianathan and Renuga Gopal,
work for BioMers but we estimate
that staff will almost double by the
end of the year. With David Edwards as the new CEO, we now
also have an experienced executive on board who will help with
the commercialisation of the technology.

Singapore Dental Association

North America
Franz Balve
Koelnmesse Inc
Tel: +1 732 933 1117
Fax: +1 732 741 6437
f.balve@koelnmessenafta.com

International
Stephanie Sim
Koelnmesse Pte Ltd
Tel: +65 6500 6723
Fax: +65 6296 2771
s.sim@koelnmesse.com.sg

What kind of experience will
Edwards bring to the company?
Owing to his previous executive positions in global companies
such as Johnson & Johnson and
eye care products manufacturer

Which advantages does Singapore offer as a development
site for nanotechnologies?
It is common knowledge that
during the last decade the Singapore government has put a lot of
resources into research and development. In fact, the development
of Singapore as a leading hub for
life sciences and med-tech innovation is one of its top economic
priorities. In this regard, the Singapore government provides considerable support to companies such
as BioMers. Through this support,
numerous innovations such as
SimpliClear have emerged that
are now in the process of being
released onto the market.
Moreover, the city-state offers
an excellent market environment
for commercial enterprises including such things as legal security for the protection of intellectual property, ease of doing business and the availability of talent.
On top of this, two of the world’s
largest growth markets, China and
India, are on Singapore’s doorstep.
In which markets is the product already available?
We recently completed the initial test marketing phase successfully. As a result, a large number
of orthodontists in Singapore and
the US are already familiar with
SimpliClear. However, the market
in Singapore, with only approximately five million people, offers
limited opportunities for growth
and so we are planning to expand
further into key markets such as
Europe and the US within the next
12 months. In these areas, we have
received market approval from
the US Food and Drug Administration and the European Union.
Do you intend to invest in
other dental technologies?
We are certainly looking into
two or three other technologies,
but will focus on the current portfolio involving BioMers and three
other companies in the nanotechnology segment. All our investments in Singapore are developing
favourably. At the moment, we
are working on another round of
financing for BioMers for the end
of this year, which will give the
company the financial capacity to
build a larger production site in
Singapore.
Thank you for the interview. DT

[11] => DTAP0911_01_Title

Ivoclar_A3_DTAP7_811 28.09.11 15:49 Seite 1

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[12] => DTAP0911_01_Title

DTAP0911_12_News 28.09.11 16:06 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

12 Business

Duumvirate to lead GC Asia
after director retires
Daniel Zimmermann
DTI

Eddie Balchin (right) being presented with a “Thank You and Enjoy Your Retirement” present by GC Corporation Director Dr Kiyotaka Nakao (middle) and
GC Asia President Dr Tony McLaughlan. (DTI/Photo GC Asia, Singapore)

HONG KONG: GC’s Asia division
has announced the retirement
of its long-time director Eddie
Balchin, Dental Tribune Asia Pacific has learned. The sixty-fiveyear-old Brit who has been with

LED’s be independent

the company for almost 20 years
already took leave during the
company’s anniversary dealer
meeting in May. He will be replaced by a duumvirate of Kazuo
Terada, who will be responsible
for finances and administration,
and sales and marketing executive Dr Pia Trinos.

Having begun his career at
the Royal Army Dental Corps
in the UK, Balchin joined GC in
1994. Prior to that, he had worked
for numerous dental businesses
in the UK and Hong Kong.
In an official statement, Trinos
recognised Balchin’s contribution in setting up the regional
operation for GC and establishing a wider customer base for
the company’s brand products in
South and South East Asia. She
also emphasised his efforts in
establishing positive working relationships with GC’s customers,
dealers and associates over the
years. DT

Mergers
drain
capital
From news reports

LONDON, UK: Business analysts
have warned that the rise of
mergers and acquisitions in the
medical technology industry is
leaving little for early starter companies to sustain their businesses.
According to an Ernst & Young
LLP report released in September, transactions in the industry
accounted for US$47.3 billion so
far this year, a huge increase from
US$30.6 billion recorded in 2010.
In the same period, capital going
to early starter companies has
declined dramatically, the same
report suggests.
This lack of investment in innovation could hinder the market
in generating significant growth
rates over the next few years because industry leaders like Johnson & Johnson, General Electric
and Medtronic are driving consolidation, John Babitt, head of
Ernst &Young’s medical technology practice told Bloomberg.
“With interest rates at basically
zero, there is no desire to do better. That has fuelled merger and
acquisition activity,” he said.
Despite decreasing innovation, Babitt said the trend for acquisitions will continue as companies use them to bolster sales
and diversify their operations
internationally. New capital, however, could flush in from private
equity firms attracted by the sector’s sound fundamentals.

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Recent acquisitions in the dental industry include DENTSPLYs
takeover of AstraZenetec’s dental
unit for $1.8 billion and Philips’ acquisition of tooth-whitening specialist Discus Dental in 2010 for
an undisclosed sum. In the overall medical technology market,
Johnson & Johnson rose to top of
the list this year with the purchase
of US implant maker Synthes for
$21.3 billion in one the largest acquisitions in the last decade. DT

[13] => DTAP0911_01_Title

DTAP0911_13_Thoma 28.09.11 16:08 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 13

Comparison of titanium and Roxolid implants
at three different time points in an animal model

Fig. 1: X-ray showing alternating placement of Roxolid (lime green) and titanium (dark green) implants.
Dr Daniel S. Thoma et al.
Switzerland & USA

Titanium dental implants
with a narrow diameter may
help to overcome some limitations of regular diameter
implants (e.g. cases of narrow ridge width or situations
with small interdental space).

the Roxolid alloy, which is composed of titanium and zirconium. Mechanical tests have
demonstrated higher tensile
and fatigue strength of the
Roxolid material compared
with pure titanium.4, 5
In addition, preclinical data
has indicated a similar or even

Materials and methods
In nine large hound dogs,
54 Straumann Bone Level titanium implants (control) and
54 Straumann Bone Level
Roxolid implants (test) were
placed. All implants had an endosteal diameter of 3.3 mm and
featured the SLActive surface.
Tooth extraction surgery was
performed four months prior to
the implant placement surgery.
The implants were placed in a
randomised manner in all dogs.
In every mandible, 12 implants
(six per hemi-mandible) were
placed by alternating the two
implant types (Fig. 1).

Fig. 3: Values of crestal bone change (negative value corresponds to bone loss) did
not reveal any statistically significant difference between test and control implant.

Standardised X-rays were
taken at surgery (n = 9) and
after two weeks (n = 9), four
weeks (n = 6) and eight weeks
(n = 3) to measure the bone
loss. At each stage, three animals were sacrificed for histological preparation.
The parameters measured
within the histo-morphometric analysis were the first boneto-implant contact (fBIC) and
the bone-to-implant contact
(BIC) in order to evaluate the
osseointegration behaviour of
the two groups.

Fig. 4:The mean BIC values for Roxolid exceeded 80% at all three time points and
were not statistically different to titanium.

The fBIC is the distance between the implant shoulder and
the first bone-to-implant contact. A negative fBIC value indicates that the bone is located
coronally and a positive fBIC
indicates that the bone is apical
to the implant shoulder. The
BIC is calculated by measuring
the distance between the bone
crest and the apical end of the
cylindrical part of the implant.

Fig. 2: Schematic representation of the histo-morphometric parameters assessed.

dy observed for both implant
types at two weeks, with peak
values obtained at four weeks
(Ti) and eight weeks (Roxolid),
as shown in (Fig. 4). The results did not reveal any statistically significant difference in
the BIC in the two materials.
The mean fBIC values did
not reveal any statistically significant difference for the two
implants at any evaluated time
point. There was a pattern of
increasing bone growth at the
implant shoulder over time
(Fig. 5).

level occurred. Mean BIC values of over 80% were reached
at four weeks and eight weeks,
indicating a good anchorage of
the implant. Roxolid implants
show similar osseointegration
behaviour to SLActive titanium
implants and have higher tensile strength than pure titanium. DT
Parts of this article originally appeared online in the Journal of Periodontology, 22 February 2011. A complete list of references is available from
the publisher.

Contact Info

Conclusions
This animal study did not
reveal any statistically significant difference in osseointegration between Straumann
BL Roxolid implants and Straumann BL titanium implants.
From baseline to eight weeks
only minimal change in bone

Dr Daniel S. Thoma is working as
an assistant professor in the Clinic
for Fixed and Removable Prosthodontics and Dental Material Science at the University of Zurich,
Switzerland. He can be contacted
at daniel.thoma@zzmk.uzh.ch.

AD

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fheZkYjh[l_[mi"`eXi"YbWii_Ó[ZiWdZl_Z[ei\ehd[WhboWbbi_jkWj_edi$

Results

Fig. 5: The fBIC values (reversed y-axis) at the three time-points (a negative value
means that the bone is located coronally to the implant shoulder and a positive
value means that the bone is located apically to the implant shoulder).

However, reducing the diameter of titanium dental implants might lead to increased
clinical risks related to a lower
mechanical resistance.1–3
In order to overcome this
issue, Straumann developed

stronger osseointegration of
Roxolid compared with pure
titanium.6 The aim of this study was to determine whether
Roxolid implants exhibit similar tissue integration in comparison with pure titanium
implants.

Radiological analysis
Regarding crestal bone
change there was no statistically significant difference at
any time point between the two
materials. An initial slight bone
loss at two weeks was followed
by bone gain at four weeks, and
at eight weeks bone was nearly at initial placement level
(Fig. 3). This pattern might be
attributed to the bone remodelling process.
Histo-morphometric analysis
Similar BIC values of approximately 80 % were alrea-

mmm$Z[djWb#jh_Xkd[$Yec

[14] => DTAP0911_01_Title

DTAP0911_14-15_Gudwin 28.09.11 16:09 Seite 1

14 Trends & Applications

DENTAL TRIBUNE Asia Pacific Edition

“Oral health often tends to be side-lined
as a minor concern”
An interview with Ella Gudwin, AmeriCares, about dental relief efforts in Japan

Ella Gudwin

With relief efforts in Japan
slowly coming to an end, news
concerning the natural disaster
has become scarce. However,
Dental Tribune Asia Pacific
AD

found that a large number of
relief organisations are still
operating in the affected areas
to help restore much-needed
infrastructure such as dental
clinics. Dental Tribune Group
Editor Daniel Zimmermann
had the opportunity to speak
with Ella Gudwin, Vice-President of Emergency Response
at AmeriCares, Stamford, USA,
about the dental needs of the
population in the aftermath of
the disaster and why organisations like hers are necessary
for a successful reconstruction
process.
Ms Gudwin, you are coordinating the relief efforts of your
organisation in the aftermath
of the earthquake/tsunami disaster in Japan. What is the
current situation there?
AmeriCares personnel delivering aid to evacuation centres in the early days of
the disaster. (DTI/Photo courtesy of AmeriCares, USA)

Ella Gudwin: The last time
I went to the Miyagi Prefecture
was in June and at the time there
were mixed feelings about the
progress. Now, with the country entering the reconstruction
phase, new issues are arising as
decisions are made about where
the communities will be built and
how they will be set up.
While it is good news that
people in the affected areas are
finally being moved from the
shelters to temporary housing
facilities, the process has been
difficult for some survivors, especially many elderly people
who are not very fond of the idea
of being separated from their old
communities.
How was the health infrastructure affected by the disaster in the area you are working
in?
Secondary and primary care
services have definitely been
affected most. To give you a number, none of the six dental clinics

care for people still living in
temporary housing facilities. In
regards to dental care specifically, we are building two dental clinics in Minami Sanriku.
It is the first infrastructure reconstruction project we have
taken on during this transitional
phase.
This is a three-way partnership in which we are providing
US$200,000 for each structure
and clinic interior ($400,000 for
both facilities combined), and
money from the Japanese government is being used to provide
the majority of the equipment
and supplies. We selected the
site for the clinic after consulting
with the Minami Sanriku City
Council, which is in charge of the
long-term reconstruction planning. The Miyagi Dental Association is working with local
dentists to staff and operate the
new facilities.
In terms of scale, we are running a smaller operation than

“Secondary and primary
care services have definitely
been affected most.”
that existed in Minami Sanriku
(a coastal town in the Miyagi
Prefecture) actually survived the
disaster. Currently, there are
only two temporary dental facilities to serve a population of
approximately 10,000 people.
What dental care-related
projects are you currently running in Minami Sanriku?
Throughout Japan we are financially supporting the restoration of health services such as
mobile and home-based medical

many other organisations in the
region but we are very targeted
and help to get money down to
the ground early. We do not know
of any other organisation focusing on oral health services at
the moment, so we are filling a
unique gap there.
How important are oral
health issues amongst the affected population?
In the case of natural disasters, oral health often tends to
be sidelined as a minor concern

[15] => DTAP0911_01_Title

DTAP0911_14-15_Gudwin 28.09.11 16:09 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

Trends & Applications 15

“Japanese people place a high value on
health care and are accustomed to seeing
a doctor more than ten times a year.”
value on health care and are
accustomed to seeing a doctor
more than ten times a year. Each
clinic will have the capacity to
treat a maximum of 20 patients
per day, although, realistically,
we expect them to take care of

approximately ten patients per
day, depending on the staff available onsite.
Our hope is that this project
will help not only to ensure that
survivors maintain good oral

health, but also to keep them
inside the community rather
than relocating elsewhere, including the remaining dentists.
Thank you very much for
this interview. DT

A local relief worker (right) talking to
a dentist in Minami Sanriku, where
AmeriCares is building the dental clinics for survivors. (DTI/Photo courtesy
of AmeriCares/ Ramona Bajema, USA).

but over the time, there is usually
a slow but significant deterioration of oral health. If you take the
demographics of the population
in the area we are serving into
consideration, which consists of
many elderly people with dentures, it has indeed become very
important. In addition, there was
a lack of running water for almost
six months, which had a visible
impact on dental hygiene as a
whole because people stopped
performing daily procedures like
toothbrushing.
How has coordination with
the local authorities been?
Unfortunately, Japan did not
adopt the cluster system established by the United Nations after
the devastating tsunami in 2004,
which was intended to bring
together relief organisations all
active in the same sector, such
as health or food distribution.
Though the country has a very
good mechanism at the macrolevel, coordination at the microlevel, e.g. in towns and villages,
was rather ad hoc and not as
well orchestrated as it could have
been. The further we go now
into the reconstruction phase,
the more resource gaps are beginning to emerge.

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In contrast with other organisations, which have tended to
send money through intermediaries, we have decided to set up
our operational office in Sendai,
where we are close to the communities we are serving, and be
part of the daily dialogue about
what is happening and where the
resource gaps really are.
The issue of radiation was
highly debated over the course
of the disaster owing to inconsistent information provided
by authorities. How does it affect your work?
Fortunately, our staff in Japan
is working outside the no-go
zone. Our colleagues there however carry radiation dosimeters
and iodide tablets as an emergency precaution. There are also
weekly sample checks on water
and food, like milk, beef and
vegetables conducted by local
authorities.
How long do you expect
your help to be required?
The clinics are expected to be
operational for at least two years
—possibly as long as ten years.
As soon as they open, we expect
an upswing of visits because the
Japanese people place a high

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[16] => DTAP0911_01_Title

DTAP0911_16-18_Mahn 28.09.11 16:09 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

16 Trends & Applications

Not all dental filling materials are equal
Selecting the best choice for posterior restorations

Fig. 1

Fig. 2

Fig. 3a

Fig. 3b

Fig. 4

Fig. 1: Pre-op view.—Fig. 2: Proper isolation of the operative field with a rubber dam.—Figs. 3a & b: Application of the self-etching adhesive for 30 seconds.—Fig. 4: Application of a flowable composite resin
as the first layer.
Dr Eduardo Mahn
Chile

Glass ionomer cements (GICs)
and composite resins have
been successfully used for a
variety of indications in direct
filling procedures for many
years. Both materials are considered to be excellent amalgam alternatives, but they both
have their respective strengths
and weaknesses. Over time, the
spectrum of their applications
has grown wider and more sophisticated.

GICs chemically bond to the
tooth structure and release fluoride over time. Moreover, they are
easy to use and biocompatible.
GICs are composed of polyalkenoic acid and glass powder, mainly
aluminium fluorosilicate glass. An
initial acid–base reaction occurs
when the powder and liquid are
mixed. A salt gel matrix is formed
and a completely cross-linked
structure results, which assists in
the setting of the cement.1,2
Conventional glass ionomers
were introduced in 1972,3 fol-

lowed by metal-reinforced GICs
containing either silver or gold.4
In 1992, the first resin-modified GICs appeared on the market.5, 6 Current research efforts
are focused on using acids with a
high molecular weight, which
would heighten the viscosity of
the product and accelerate curing.
The applications of GICs
range from cementation and lining procedures to the placement
of Class V restorations and small
deciduous tooth fillings. Never-

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theless, it is important to note
that the adhesive strength of
GICs is relatively low (only 3 to
7 MPa).6,7 Furthermore, the problem of marginal integrity and
seal must be taken into consideration. Even though GICs demonstrate a thermal coefficient of expansion similar to that of natural
tooth structure,1, 6 glass ionomer
fillings often show marginal
leakage. Several studies have
found that composite resins have
higher success rates with regard
to marginal integrity than GICs
in enamel.8
The most important characteristic of GICs is probably their
ability to release fluoride when
the components are mixed. This
continues gradually without
negatively influencing the mechanical properties of the material.9 Moreover, GICs are capable
of absorbing topically applied
fluoride and releasing this component over an extended period.10 Therefore, GICs are considered to have a cariostatic effect in clinical use.11 However,
carious lesions are often found
along the margins of GIC restorations.
The amount of fluoride to be
released by GICs to inhibit the
development of caries has not
been established yet. The life
cycle of GIC restorations is another concern. Numerous studies have shown that the survival
of these restorations is considerably shorter than those made
with composite resin and amalgam. Therefore, GICs are more
appropriately used in the fabrication of long-term temporaries than permanent restorations. A systematic analysis has
shown that the failure rate of
GICs is above 7 %, while that of
composite resins is lower than
3%.12
Despite these drawbacks,
many practitioners are tempted
to use GICs because they are
easier to use. In addition, their
application protocol is faster
than that of composite resins.
They are also much cheaper and
have therefore gained popularity
in emerging markets.
As a result of developments
in the field of composite resins,
particularly with regard to inorganic fillers13 and monomers
used during the procedure,14
these materials now feature
lower solubility, as well as higher
wear and fracture toughness.
The overall mechanical properties of composite resins have im-

proved significantly. The interaction of the bonding agent and
the tooth structure establishes
micromechanical retention,15–17
which ensures a high level of
resistance.
Nowadays, composite resins
have only two shortcomings
compared with GICs: they take
longer to place and the application protocol is more technique
sensitive. The time difference is
not significant if the entire
restorative procedure, including
examination, diagnosis, anaesthetic, excavation, preparation,
isolation, and finishing and polishing, is considered. The development of self-etching adhesives—irrespective of one-step
or two-step systems—has reduced the entire treatment time
quite considerably. The introduction of self-etching adhesives
has also helped to reduce technique sensitivity and increase
the reproducibility of results.18
The dentine tissue is not etched
and the smear layer is not removed. Instead, infiltration takes
place. As a result, the dentine tissue is easy to dry and post-operative sensitivity is reduced.19
Furthermore, the evaporation of
the solvent after the application
is not a critical issue. As is the
case with many total-etch adhesives, a mixture of different solvents, rather than just one, is
used. In this context, it is important to note that strong adhesion
to dental enamel can only be
achieved with phosphoric acid
etching.20, 21 This step is always
recommended, regardless of the
method used.
In the following case study,
a self-etching adhesive of the latest generation was used (Tetric
N-Bond Self-Etch, Ivoclar Vivadent). Owing to its innovative
pen-shaped delivery form, this
material can be applied directly,
which saves time. Regardless
of these advances and developments, however, composite resin
users must have in-depth knowledge of materials. Operational instructions recommended
by the manufacturer must be
strictly observed.

Case study
A 31-year-old female patient
presented to our surgery after
a lengthy absence. A thorough
examination revealed that several aspects required attention,
in particular a highly opaque,
damaged filling in tooth #47.
The filling in question had the
‡ DT page 18

[17] => DTAP0911_01_Title

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3/10/2011 8:27:06 AM

[18] => DTAP0911_01_Title

DTAP0911_16-18_Mahn 29.09.11 17:34 Seite 2

DENTAL TRIBUNE Asia Pacific Edition

18 Trends & Applications

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 5: View of the distal cusps after light-curing.—Fig. 6: Sculpting of the mesial cusps.—Fig. 7: Occlusal view of the filling before polishing.—Fig. 8: Final polishing in one step with a large “flame” tip.—
Fig. 9: Result of the occlusal inspection.
ﬂ DT page 16

distinct appearance of a GIC.
Secondary caries had formed
AD

in the distal area. According to
the patient, it had been placed
less than two years previously.
Furthermore, we took note of

a filling made of Tetric Ceram
(Ivoclar Vivadent) in tooth #46
that had been placed in our surgery more than eight years ago.

The restoration was clearly worn
out after all this time. Nevertheless, the margins were still intact
(Fig. 1).

We recommended that the
filling in tooth #47 be replaced.
Figure 2 shows the working
field isolated with a rubber dam
(OptraDam Plus, Ivoclar Vivadent)
to ensure clean and safe placement of the restorative material.
The old filling was removed and
carious tissue was excavated.
An adhesive (Tetric N-Bond SelfEtch) was placed directly on
the tooth structure and scrubbed
in for 30 seconds (Figs. 3a & b).
The solvent was evaporated with
a strong stream of air. Then, the
surface was light-cured with a
third-generation LED polymerisation unit for 10 seconds.
First, a layer of flowable composite resin (Tetric N-Flow) was
placed in the cavity (Fig. 4) and
light-cured for 10 seconds. Subsequently, the filling was built up
with shade A2 of the universal
composite resin Tetric N-Ceram.
A non-stick modelling instrument
(OptraSculpt, Ivoclar Vivadent)
was used, with which the cusp
slopes and tips were faithfully
reproduced. This instrument is
supplied with various working
tips to satisfy different clinical
indications. In this case, the chisel
shape with the pointed tip end was
used to sculpt the fissures.
The restoration was built up
in four steps. One cusp was modelled and light-cured at a time.
Figure 5 shows the situation
after the distal cusps had been
polymerised. In Figure 6, a mesial cusp is sculpted. Only as
much composite resin as was
necessary was applied and lightcured.
As a result, very few occlusal
adjustments were necessary.
Figure 7 shows an occlusal view
of the filling before polishing.
The natural-looking anatomy is
clearly evident, as well as the
worn eight-year-old filling in
tooth #46 and its intact margins.
After occlusal grinding, the
restoration was polished with
OptraPol Next Generation rubber tips (Ivoclar Vivadent, Fig. 8),
which have a high diamond
crystal content (72 wt %). This
high diamond content achieved
excellent polishing results in
only one step. Figure 9 shows the
finished filling with the marked
contact points. DT
A complete list of references is available from the publisher.

Contact Info
Dr Eduardo Mahn
is a Chilean specialist for direct
aesthetic dental
restorations with
composite. He can
be contacted at edomahn@gmail.com.

[19] => DTAP0911_01_Title

DTAP0911_19_Borneo 28.09.11 16:10 Seite 1

DENTAL TRIBUNE Asia Pacific Edition

Off time 19

Indonesian dentist helps reforest
orangutan habitat
Yvonne Bachmann
DTI

In May, 30 Forest Guardians
joined the team. Their wages
are paid from the Whitley Award
prize money. “We knew the
money should go towards new
staff that help to protect the
park,” the dentist explained.
“This plan was part of the proposal for the Whitley Award.”

Dr Hotlin Ompusunggu, a
Sumatran dentist, is the cofounder and programme manager of Alam Sehat Lestari
(ASRI), a health-care and conservation charity located in
Sukadana on the Indonesian
island of Borneo. She was recently given the Whitley Award
for her efforts to improve the
health and well-being of rainforest communities, while also
safeguarding a globally important habitat for gibbons, hornbills and orangutans, amongst
many other species.
The Whitley Award is a British
nature conservation prize that
comes with £30,000 (US$47,500)
prize money. Whitley Awards are
made annually at a ceremony in
London, hosted by Princess Ann,
Princess Royal.
Dr Hotlin Ompusunggu (left) receiving the Whitley Award from Anne, Princess Royal. (DTI/Photos Whitley Fund for Nature, UK)

“It feels exciting having won
the award”, Hotlin Ompusunggu
told Dental Tribune in an interview. The 36-year-old dentist,
originally from Sumatra, now
works in Gunung Palung National Park in West Kalimantan,
an Indonesian province on the
island of Borneo. The park is
home to about ten per cent of the
world’s orangutans, as well as
clouded leopards, hornbills,
crested fireback pheasants and
sun-bears. Its twin 1,000 metres
peaks are swathed by tall dipterocarpous forests in their lowlands and montane cloud forests
near their summits. The park is a
watershed for the roughly 60,000
villagers who live on its borders.

Health-care provision
almost impossible
Local people living around
the park are poor, with an average income of US$13 a month.
The provision of good local
health care is almost impossible
in this region. Most people are
subsistence farmers, and local
farming methods are heavily reliant on expensive and dangerous chemical fertilizers and pesticides. Health-care and farming
costs drive villagers into debt,
and illegal logging is one of the
few sources of cash income. Logging and slash-and-burn agriculture are destroying the Gunung
Palung watershed, resulting in
flooding, damage to agricultural
areas, and high rates of waterborne illnesses. And so the cycle
of poor health, poverty and environmental destruction is perpetuated.
The charity’s name ‘Alam
Sehat Lestari’ means ‘Healthy
Nature, Everlasting’ and the abbreviation ASRI, ‘harmoniously
balanced’. ASRI aims to stop
the poverty–poor health–deforestation cycle by working to empower local people to turn from
loggers into forest guardians.
Members work with local com-

munities to integrate high quality, affordable health care with
strategies to protect the threatened rainforests of the park. The
charity enables local people to
access health care that they could
normally not afford, providing
villagers with free contraception, as well as immunisation,
cataract surgery and general
medicine. They are also educated on health, the environment
and the importance of protecting
the links between both. In return,
villagers exchange items used
in conservation work, e.g. seedlings for reforestation or manure
for organic farming, or participate in work like replanting parts
of the park previously damaged
by illegal logging. In this way, the
villagers help ASRI to conserve
Gunung Palung National Park
and, ultimately, the fate of the
park lies in their hands.
The ASRI clinic was born in
2007 when Hotlin Ompusunggu
began working with Dr Kinari
Webb, founder of Health In
Harmony (HIH), a US-based nonprofit organisation that supported the establishment of the
Indonesian ASRI. “HIH supports
ASRI through fundraising, by
coordinating expert volunteers
for ASRI, and providing knowledge resources when they are
needed,” Antonia Gorog, HIH
Programme Director, told Dental
Tribune. “The organisation was
founded on the principle that human health and environmental
health are tightly linked,” she
explained.

Poor dental hygiene
For the people in West Kalimantan poor dental hygiene is a
major problem across the board.
“When I came here in 2007 and
first started treating patients,
I did a survey. The results showed
that 100 per cent of the people
were in great need of dental
care,” Hotlin Ompusunggu said.

“I have worked in many places in
Indonesia and I think with regard
to dental health care this is one
of the worst.”
The dentist does not only
treat patients, but also aims to
educate them. She started informing patients, particularly
children, on dental health care
and environmental conservation
at the same time. “We give out
tooth brushes to children
so they can maintain their
oral health. However,
we quickly learned that
things which have been
given away for free are
not appreciated that
much. So we started
swapping toothbrushes
for bamboo sticks, which
we need to plant trees in
the park. This way the
children will remember
that we planted a tree,
will get to know why we
planted a tree and find out
that it is important. The
children begin to appreciate the fact that, without
trees, they would not
have the water supply to
brush their teeth. Every
time they brush their
teeth they can be grateful
for trees and the fact that
they are contributing to
the cause to save and
replant trees,” Hotlin
Ompusunggu explained
to Dental Tribune.

involve Goats for Widows, a project that provides mated pairs of
goats to severely disadvantaged
members of the community and
receives in return the first kid
goat and sacks of manure for organic composting, and Organic
Farming Training, which helps
farmers improve soil quality and
removes the need for opening
new farmland each year,” Antonia
Gorog said.

According to Antonia Gorog,
the number of staff is no indication of the number of people involved: “Many thousands are
involved. In 2009, first year of
ASRI’s reforestation programme,
4,000 families gave seedlings
and other essentials for the
reforestation work in exchange
for mosquito nets. In the 2010
reforestation effort, hundreds
of people traded seedlings for
toothbrushes. Hundreds more
helped in the planting both years.
Over 100 people have also been
trained in organic farming and
they are training others. Then,
there all the widows who have received goats, and the 14,000 patients that we have cared for in
our clinic and the mobile clinic.”
Even though ASRI was initially received with scepticism
by some local communities, they
have generally had excellent
relations. The charity strives to
be honest and transparent about
the programme’s goals and is
extremely prudent regarding the
use of funds. “ASRI has successfully demonstrated to
local communities that it
really is about helping
them, and is not out for
its own gain,” Antonia
Gorog emphasised.

Support is always
welcome
The organisation is
always grateful for any
support. HIH coordinates
expert volunteers for
ASRI, such as medical
professionals who could
help to train Indonesian
doctors and nurses in the
clinic, or people knowledgeable about organic
farming and reforestation. “Additional expertise in goat husbandry,
construction—ASRI will
soon build a hospital, solar engineering,
and sustainable cooking
stoves would also be welcomed,” Antonia Gorog
told.

Orangutans like this specimen are increasingly threatened
by deforestation.

The cornerstone of
ASRI’s programme is health care,
which is linked to conservation
initiatives in multiple ways. Villagers can receive high quality
health care, including dental
care, at the ASRI clinic on the border of the national park. For local
people, there are many ways
to receive help. “Communities
that cease illegal logging receive
discounts on health care services
at the clinic. Other initiatives

Prize money funds
new employees
ASRI employs 42 staff members, including four doctors, a
pharmacist, conservation education staff, reforestation staff, a
Goats for Widows manager and
14 village women who help to
prevent drug-resistant tuberculosis by ensuring patients take
their medication.

Anyone wishing to
support the project financially can donate money both in
Indonesia and tax-exempt in the
US. Donations will help provide
much-needed medical or dental
equipment, help reforest orangutan habitat and train communities in alternative livelihoods
to illegal logging. Interested
people can contact ASRI and/or
HIH through their websites:
www.alamsehatlestari.org and
www.healthinharmony.org. DT

[20] => DTAP0911_01_Title

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6, 1

d o n t ic C E

Learn World Class

COMPREHENSIVE ORTHODONTICS
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[cover] => DT Asia Pacific No. 9, 2011

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Table of contents

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