DT Canada No. 4, 2015

Denturists from across the globe gathering in D.C. / News/ Events / TiN-engineered instruments match high-tech advancements seen in restoration materials / Industry

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DENTAL TRIBUNE
The World’s Dental Newspaper · Canada Edition

September 2015 — Vol. 9, No. 4

www.dental-tribune.com

feedback loop spreads Oral cancer

Doing well by doing good

routine full prosthesis on implants

University of Toronto
Faculty of Dentistry
researchers show that
neutrophil and cancer cell
‘crosstalk’ underlies oral
cancer metastasis.

Henry Schein Canada, as
part of its Calendar of
Caring program, shines the
spotlight on the many ways
that its customers are
‘giving back.’

Dental lab’s detailed
case study documents
overdentures as viable
choice among restoration
options for edentulous
patients.

” page A2

” pages A6–A7

” pages A8–A10

Denturists from
across the globe
gathering in D.C.

World Symposium
on Denturism,
Sept. 16–19

Publications Mail Agreement No. 42225022

(Source: National Denturist Association, USA)

• Neutrophil and cancer cell
‘crosstalk’ underlies oral cancer
metastasis.
• Get green in Vancouver: 2016 Pacific
Dental Conference to incorporate St.
Patrick’s Day festive spirit.
• VOCO event combines C.E. with the
ultimate driving experience.

Industry

Canadian management expert to deliver keynote
at World Symposium on Denturism gala dinner
he Denturist Association of Canada and other national denturist organizations around the world, as members of the International Federation of Denturists (IFD), are encouraging their members and other dental professionals
to attend the Ninth Annual World Symposium on Denturism, Sept. 16–19.
The meeting is being presented by the National Denturist Association USA in partnership with the IFD. The host site is the Hilton Alexandria Mark Center, in historic
Alexandria, Va., five miles from Washington, D.C., and its many monuments, museums and other attractions.
Included among the educational offerings on the agenda for this year’s meeting are
sessions on ethics, pathology, social media, office management, clever techniques,
radiograph recognition, flexible partials, cranial nerve function, designing options
for implants, digital solutions for removable dentures, creating the beautiful denture, dental prosthetic identification and patient centered occlusion for fully edentulous functional dentures.
The symposium includes a three-day exhibit
hall, Thursday through Saturday, Sept. 17–19,
which are also the core days for the educational
sessions.
The keynote speaker at a gala dinner event on
Friday is Janice Wheeler, president and co-owner
of The Art of Management practice management
consulting firm, which is dedicated to helping
health care professionals reach their full potential. As a speaker, she has a reputation for enthusiastic and motivational performances. She is
also an author whose articles appear regularly in
several professional magazines including The National Denturist, USA and The Journal of Canadian
Denturism.
Wheeler also presents an educational session
on Friday afternoon, “How to Create Your Ideal
Practice.” Other speakers at the symposium include: Eugene Royzengurt with “Gengival Customization,” which covers the steps needed to create high-end restorations and life-like removable
prosthetics; the always popular Thomas Zaleske,
sharing his high-value insights on “Removable
Prosthetics”; and Jonathan Bill, RDTUK, part of the
research team at Loughborough University in the
United Kindgom, sharing his insights as one of the
primary developers of the CQR denture technique.

NEWS/EVENTS A2

The Ninth Annual World Symposium on
Denturism will be in historic Alexandria, Va.,
five miles from Washington, D.C., and its
many monuments, museums and other
attractions, including Thomas Circle, above.
Photo/Jason Hawke, www.washington.org

a3–a11

• TiN-engineered instruments from
American Eagle match the high-tech
advancements the industry has seen
in restoration materials.
• Single-bottle adhesive from
VOCO self-cures without any light
activation: Futurabond M+ needs
only one coat and 35 seconds.
• Temporary luting material delivers
natural appearance.
• Doing well by doing good: Henry
Schein Calendar of Caring honors
dentists’ humanitarian work.
• Photoacoustic shockwave with
irrigant debrides where files can’t.
• Implant-supported total prosthesis
(daily routine).
• From Rhein’83: Smallest
dimensional attachment system
designed to be compatible with all
implants.
• Position yourself for long career
with Posiflex Free Motion Elbow
Supports.

[2] =>

NEWS/EVENTS

Dental Tribune Canada Edition | September 2015

Neutrophil and cancer
cell ‘crosstalk’ underlies
oral cancer metastasis
An abnormal immune response or
“feedback loop” could very well be the
underlying cause of metastases in oral
cancers, according to Dr. Marco Magalhaes, assistant professor at the University
of Toronto’s Faculty of Dentistry and lead
researcher in a study published in the
journal Cancer Immunology Research.
Magalhaes has unearthed a significant
connection between the inflammatory
response of a very specific form of immune cells, neutrophils, and the spread
of this deadly disease.
“There’s a unique inflammatory response with oral cancers,” explains
Magalhaes, citing the growing body of
evidence between cellular inflammation
and cancer, “because the oral cavity is
quite unique in the body. A great many
things are happening at the same time.”
Magalhaes focused attention on
neutrophils, immune cells commonly
found in saliva and the oral cavity but
not widely researched in relation to oral
cancer. Like other immune cells, neutrophils secrete a group of molecules, including TNFa, that regulates how the
body responds to inflammation.
The study noted that oral cancer
cells secreted IL8, another inflammatory mediator, which activates neutrophils, effectively establishing a massive
immune-response buildup or “feedback
loop.”

Ultimately, the researchers found, the
immune-response loop resulted in increased invasive structures known as
“invadapodia,” used by the cancer cells
to invade and metastasize.
“If we understand how the immune
system interacts with the cancer, we
can modulate the immune response to
acquire an anti-cancer response instead
of a pro-tumor response,” Magalhaes
argues.
While the study points to the possibility of one day creating targeted, personalized immunotherapies for patients
with oral cancer that could effectively
shut down the abnormal immune response, the team is currently expanding
upon their study of inflammation and
oral cancer.
Approximately 3,600 cases of oral cancer are diagnosed in Canada every year,
yet the survival rates — 50 to 60 percent
over five years — have remained stagnant for decades while other cancer survival rates have dramatically improved.

About the Faculty of Dentistry,
University of Toronto
Combining the rigours of biological and
clinical research with a comprehensive
educational experience across a full
range of undergraduate and graduate
programs — with and without advanced
specialty training — the Faculty of Dent-

.
.

President/Chief Operating Officer
Eric Seid e.seid@dental-tribune.com
Group Editor
Kristine Colker k.colker@dental-tribune.com
Editor in Chief
Dr. Sebastian Saba feedback@dental-tribune.com
Managing Editor
Robert Selleck r.selleck@dental-tribune.com

Product/Account Manager
Will Kenyon w.kenyon@dental-tribune.com
Product/Account Manager
Humberto Estrada h.estrada@dental-tribune.com
Product/Account Manager
Maria Kaiser m.kaiser@dental-tribune.com
BUSINESS DEVELOPMENT MANAGER
Travis Gittens t.gittens@dental-tribune.com

Oral squamous cell is shown invading the
extracellular matrix of a healthy cell.

Education Director
Christiane Ferret c.ferret@dtstudyclub.com

Photo/Provided by Dr. Marco Magalhaes,

Accounting Coordinator
Nirmala Singh n.singh@dental-tribune.com

University of Toronto Faculty of Dentistry

istry at the University of Toronto has
earned international respect for its dental research and training.
Whether focused on biomaterials and
microbiology, next-generation nanoparticles, stem-cell therapies or groundbreaking population and access-to-care
studies, the mission is to shape the future of dentistry and promote optimal
health by striving for integrity and excellence in all aspects of research, education
and clinical practice. You can learn more
at www.dentistry.utoronto.ca.
(Source: University of Toronto)

For most attendees, C.E. credit is given
for general attendance (up to five hours)
and individual courses (up to 20 C.E.
credits).
Online registration opens Oct. 15 at
www.pdconf.com. Special hotel rates are
available now.

Tribune America, LLC
Phone (212) 244-7181
Fax (212) 244-7185
Published by Tribune America
© 2015 Tribune America LLC
All rights reserved.
Tribune America strives to maintain the utmost accuracy in its news and clinical reports. If you find a factual error or content that requires clarification, please
contact Managing Editor Robert Selleck at r.selleck@
dental-tribune.com.
Tribune America cannot assume responsibility for the
validity of product claims or for typographical errors.
The publisher also does not assume responsibility for
product names or statements made by advertisers.
Opinions expressed by authors are their own and may
not reflect those of Tribune America.
Editorial Board
Dr. Joel Berg
Dr. L. Stephen Buchanan
Dr. Arnaldo Castellucci
Dr. Gorden Christensen
Dr. Rella Christensen
Dr. William Dickerson
Hugh Doherty
Dr. James Doundoulakis
Dr. David Garber
Dr. Fay Goldstep
Dr. Howard Glazer
Dr. Harold Heymann
Dr. Karl Leinfelder
Dr. Roger Levin
Dr. Carl E. Misch
Dr. Dan Nathanson
Dr. Chester Redhead
Dr. Irwin Smigel
Dr. Jon Suzuki
Dr. Dennis Tartakow
Dr. Dan Ward

Tell us what you think!

(Source: Pacific Dental Conference)

C.E. and ultimate driving experience
VOCO has partnered with BMW and its
Performance Driving Center to offer a
unique continuing education experience.
On Sept. 25, participants can learn
about trends and technologies in dentistry from G. Franklin Shull, DDS, FAGD,
combined with the thrill of BMW’s ultimate driving experience.
Attendees will be able to spend about
five hours driving the newest models of
the 1, 4, 5, 6, 7, Z, M and X series, on and

Publisher & Chairman
Torsten Oemus t.oemus@dental-tribune.com

Managing Editor
Sierra Rendon s.rendon@dental-tribune.com

2016 Pacific Dental Conference to incorporate St. Patrick’s Day festive spirit
and international speakers will present
150 open sessions and 36 hands-on
courses covering a variety of topics. Attendees also will be able to explore Canada’s largest two-day dental tradeshow
(with more than 300 exhibitors), getting
the year’s first chance in Canada at seeing the latest in dental equipment and
services.

The World’s Dental Newspaper · Canada Edition

Managing Editor
Fred Michmershuizen
f.michmershuizen@dental-tribune.com

Get green in Vancouver
With opening day of next year’s Pacific
Dental Conference falling on St. Patrick’s
Day, attendees will get to experience the
Irish holiday with a Western Canada flavor — while also earning C.E. credits.
The PDC, which typically attracts more
than 12,500 dental professionals, will be
from March 17–19 in Vancouver.
More than 130 local, North American

DENTAL TRIBUNE

off the racetrack. After Shull’s two-credit
(ADA/CERP) lecture, “The Changing Face
of Restorative Dentistry,” attendees will
be able to learn from BMW professional
driving instructors on the track in timed
events and elimination races.
For more information and to register,
contact Russ Perlman at Russ.Perlman@
voco.com or visit www.goo.gl/LG0zXC.
(Source: VOCO America)

Do you have general comments or criticism you would like to share? Is there
a particular topic you would like to see
articles about in Dental Tribune? Let us
know by emailing feedback@dentaltribune.com. We look forward to hearing from you!
If you would like to make any change
to your subscription (name, address or
to opt out) please send us an email at
database@dental-tribune.com and be
sure to include which publication you
are referring to. Also, please note that
subscription changes can take up to six
weeks to process.

[3] =>

Dental Tribune Canada Edition | September 2015

INDUSTRY

TiN-engineered instruments match high-tech
advancements seen in restoration materials
Non-porous, wear-resistant surface ends material pullback often seen when sculpting with stainless steel
By Cappy Sinclair, DDS
Coastal Cosmetic Dentistry
Virginia Beach, Va.

n the era of adhesive dentistry, there are constant and continual advancements in the
areas of the materials that are used to restore
teeth. Bonding agents have gone through
several generations in attempts to decrease
chair time and increase strength, and composites are constantly adjusting the ratios
of various particle sizes to gain that perfect
harmony of functionality and esthetics.
However, through all of these changes, very
little has been changed about the instruments with which the items are placed. In
a dentist’s composite armamentarium the
instruments are often the weakest link,
which, in some cases, can lead to a compromise of the final composite restoration.
In this case I’m talking about the pullback phenomenon that many dental composites can exhibit when sculpting. This
pullback occurs when the composite material sticks to the micro-scratches in the
surface of commonly used stainless steel
instruments. These scratches, which can
occur from just daily ultrasonic and sterilization processes, create a rough surface
for the composite to grab onto and thus
be pulled away from the preparation area.
This pullback effect can end up creating
voids in the final restoration and can also
create the need for spending unnecessary
time finishing the restoration to proper
contours. This is ultimately true in direct
anterior composite cases where a majority
of the contours should be created through
the material placement prior to finishing.
The ability to have a composite instrument with a smooth surface then becomes
paramount to not only save time, but to
have a predictable restoration. American
Eagle has applied a multilayered TiN/Ti
surface-engineering process that creates a
non-porous and wear-resistant surface to
its line of composite instruments.
This TiN process gives you the final element of control that is needed for perfect sculptability of your composites.
There is no pullback effect from the TiN
instruments, enabling the composite to
be sculpted to the proper anatomy either
in the anterior or posterior before curing
and thus saving time during the finishing process and creating an esthetic and
void-free restoration. The instruments
are lightweight and easy to maneuver
with the stainless steel EagleLite™ handle.
Also, with TiN Engineered instruments,
you know that you will still have the same
composite handling ability from the first
restoration to the 500th due to the corrosion resistance of the TiN/Ti surface engineering.
American Eagle has created composite
instruments that match the technology
of the composites in use today. Make sure
that you don’t stay stuck using those old
stainless-steel instruments. Let TiN engineering help take your composite restorations to the next level. Learn more by visiting www.am-eagle.com, phoning (800)
551-5172 or faxing (406) 549-7452.

American Eagle composite
instruments provide the
long-lasting, non-stick
control needed for
efficient, esthetic
sculpting of today’s
constantly improving
composites and
bonding materials.
Photos/Provided by
American Eagle
Instruments

[4] =>

INDUSTRY

Dental Tribune Canada Edition | Semptember 2015

Single-bottle adhesive self-cures
without any light activation
Futurabond M+ needs only one coat and 35 seconds
By VOCO Staff

VOCO recently introduced Futurabond M+, a universal single-bottle adhesive. Futurabond M+ versatility enables it to be used in self-, selective- or total-etch
mode without any additional primers on virtually all
substrates. Futurabond M+ achieves total-etch bond
strength levels with all light- self- and dual-cure resin
based composites, cements and core buildup materials.
With a dual-cured activator, Futurabond M+ will self-

cure without any light activation, which, according to
the company, offers a big advantage for endodontic applications such as post cementation where it avoids the
pooling effect, a problem with light-cured adhesives.
Futurabond M+ also adheres well to metal, zirconia and
ceramic making extra primers unnecessary.
Futurabond M+ needs only one coat and takes 35
seconds from start to finish. Its low film thickness of
9 microns makes bonding margins invisible (i.e. no
“halo” effect) and prevents pooling problems. Additionally the material does not need to be refrigerated.

Futurabond M+ achieves total-etch bond strength levels with
all light-, self- and dual-cure resin-based composites, cements
and core buildup materials. Photos/Provided by VOCO

Further Futurabond M+ benefits include its indication
as a desensitizer for use under amalgam restorations or
on hypersensitive tooth necks, as a protective varnish
for glass ionomers as well as an intraoral repair of ceramic restorations.
For more information on Futurabond M+ you can visit
the VOCO website at www.voco.com.

Temporary luting material delivers natural appearance
VOCO’s Bifix Temp offers high esthetics with a simple
application that provides users with visually pleasing
results. The translucent and tooth-like universal shade
blends with highly esthetic temporaries, does not shine
through and promotes natural appearance of
temporary restorations. Thanks to Bifix
Temp’s low film thickness, temporaries can
be cemented to fit without adjustment.
As a composite-based dual-cure materiAs a composite-based dual-cure material, VOCO’s Bifix Temp offers
al, Bifix Temp offers 90 seconds of working
90 seconds of working time and sets in four minutes.
AD

time and sets in four minutes. The light-cure mode offers the
user control and easy removal of excess material via a “tackcure” technique that activates an initial elastic gel phase. Any
unwanted residues are easy to locate and remove as Bifix
Temp’s universal shade stands out well against the gingiva.
Bifix Temp comes in an auto-mix syringe with very short
tips, making application precise and economical. To learn
more, you can visit www.voco.com.
(Source: VOCO America)

[5] =>

[6] =>

INDUSTRY

Dental Tribune Canada Edition | September 2015

Doing well by d
By Robert Selleck, Managing Editor

The people at Henry Schein Canada, in
the spirit of the company’s philosophy of
“Doing Well by Doing Good,” created its
Calendar of Caring to spotlight the many

charitable programs it supports. The initiative also gives Henry Schein customers the
opportunity to contribute a portion of their
purchases to help the charitable causes that
Henry Schein supports.
This extra support expands the help the
company provides, and in appreciation,

participating customers receive a plaque
that can be displayed in the office.
In recent efforts, Henry Schein has distributed more than 1,000 backpacks filled
with school supplies and clothing to underprivileged children and provided winter
holiday gifts to families in need across

Canada. It supplied more than $500,000 of
health care products to underserved people
across the globe, planted more than 4,000
trees as part of its Go Green program and
backed charitable causes fighting breast,
oral and prostate cancer.
At Henry Schein, according to the com-

Robert McFarlane, DDS
Five years ago, after Mount Forest, Ontario, dentist Dr.
Robert McFarlane’s wife, Donna, retired from her teaching
career, the couple’s already expansive volunteer work took
flight — literally — to Africa and India.
The McFarlanes were well known for supporting local students, the Mount Forest United Church and the area’s hospital. But now — with Donna retired and Bob able to more
easily step away for two-week stretches from the 11-chair
dental practice he built over the preceding 30 years — the

On a recent Free The Children trip, Dr. Robert and Donna
McFarlane with several Masai men near the community of
Osenetoi, Kenya. Photo/Provided by Dr. Robert and Donna McFarlane

couple found themselves ready to broaden their volunteer
perspective. The broader effort was realized through a fitting symmetry: The local community they had given so
much to over the years returned that generosity with the
same spirit, contributing time and dollars to support the
couple’s efforts in Kenya and northwestern India.
Bob McFarlane had never imagined his varied community service work would ultimately take on a global trajectory. His earliest projects with fellow Kinsmen Club members focused on new baseball diamonds, park pavilions and
other such amenities for the immediate community. Those
successes prompted him to take on a bigger challenge 10
years ago — leading a building restoration effort for the
150-plus-year-old Mount Forest United Church. Under Mcfarlane’s leadership, fundraising goals were quickly met
and more than $1.4 million in restoration work has been
completed on the historic structure.
More recently, McFarlane took on the campaign chair
position in a capital development project for the community’s Louise Marshall Hospital. McFarlane and a core group
of other community leaders successfully coordinated the
raising of $5 million in less than two years to upgrade the
hospital’s emergency services and ambulatory care physical plants and equipment.
Five years ago, Donna’s post-retirement research prompted the couple to align with Free The Children the Ontariobased organization founded by then-12-year-old Craig
Kielburger in 1995 to fight child labour around the world.

Kielburger would later by joined by his brother Marc,
and today their global organization remains dedicated to
improving the lives of children and families overseas — as
well as across Canada.
For their first Free The Children trip, the McFarlanes put
together a team that spent two weeks in the rural community of Osenetoi near the Masai Mara National Game Reserve
on the Serengeti Plain at Kenya’s border with Tanzania.
On that 2010 trip, the group of 21 people helped expand
the community’s school and health clinic, which primarily serves the area’s Masai nomadic communities, totaling more than 300,000 people. Since then, they also have
helped fund a deep-water-well drilling project. The McFarlanes already have another group of 19 (including two more
dentists) committed to another two-week trip in 2016 to
follow-up with more assistance, including providing basic
dental care.
Two years ago, the McFarlanes participated in another
Free The Children “Adopt a Village” program, this time in
India, in the Udaipur and Rajsamand district in the northern desert state of Rajasthan. There, their team of 13 volunteers from Mount Forest helped worked with local schools
on building expansion projects.
“It’s been an interesting and rewarding venture,” McFarlane said. “Giving back to the local community, and now the
local community helping to fund a lot of the work we have
been able to do in Africa and India. This outreach really has
been from our community as a whole.”

Matthew Orzech, DDS
When Dr. Matthew Orzech hit the 20-year mark with his
practice in Toronto’s Forest Hill neighborhood, he and his
wife, Shawna, the practice’s marketing manager, wanted
to celebrate the anniversary in a way that would benefit
the immediate community. Shawna started checking into
Toronto-based organizations that were locally focused in
their outreach efforts — and that were using virtually all of
their funding in direct support of the people being served.
The process ended up revealing a set of neighbors who
were a relatively invisible presence in a community known
as one of Toronto’s most exclusive: There was a homeless
population in the shadows being watched over by Ve’ahavta,
which identifies itself as a “Jewish humanitarian response
to poverty.”
The Orzechs liked the fact that a high percentage of
Ve’ahavta’s funding was going directly to the people being
assisted — plus the organization had a strong local focus.
So, partnering with Ve’ahavta, the couple launched a “Keep
Smiling” program at Orzech’s Forest Hill practice (Orzech
also has a practice in Toronto’s Greektown neighborhood),
and the office set a goal of raising $2,000 to support shifts
on the organization’s mobile outreach van — with the Orzechs promising to match every dollar raised.
Another big part of the appeal of partnering with
Ve’ahavta: The Orzechs, their staff and even their patients
were welcome to ride in the van on outreach shifts to dir-

ectly participate in the work, which is exactly what they did.
“This is an affluent area, with large homes,” Orzech said,
describing the upscale enclave. “We’d like to believe there
are no homeless people, so it was eye-opening.” The van
stays on a known route, and the outreach service has been in
place long enough that stopping points and times have become commonly known. Shortly after the van pulls up, Orzech said, a surprising number of people seemingly emerge
from nowhere to approach it. The Orzechs contributed
toothbrushes, toothpaste and floss to distribute in addition
to the organization’s standard selection of supplies: socks,
T-shirts, sweatshirts and other essentials.
The Keep Smiling campaign ran for the entire year, and
the $2,000 goal was exceeded. Ve’ahavta used the contributions to buy supplies for distribution from the van. The
organization also provides pre-employment training, life
skills training, social-networking access and workshops that
provide outlets for self-expression and creativity.
Orzech’s practice got deeper into the spirit of supporting
the organization by not just raising funds but by also sponsoring a sock drive, which was enthusiastically supported
by many of the practice’s patients. The effort was so well received, the office is planning on another sock drive prior to
the approach of this winter. “Socks are among the items the
organization is always in need of,” Orzech said. The outreach
van covers its route four to five evenings per week as well as

Dr. Matthew Orzech, far right, distributing dental-hygiene
supplies and other essentials to service users of the Ve’ahavta
mobile-outreach van, which Orzech and his practice supported
with a ‘Keep Smiling’ fundraising campaign.
Photo/Provided by Dr. Matthew Orzech

one day on the weekend. “It really is impressive to see them
work,” Orzech said of the outreach workers. “They really
know how to connect with people and find out what people
need, especially when the cooler months are approaching.
We really appreciate their work.”

[7] =>

INDUSTRY

Dental Tribune Canada Edition | September 2015

doing good
pany, “giving back” happens 365 days a year,
and the Calendar of Caring initiative opens
the door to expanding the help the company is able to provide.
Briefly profiled below are a few examples
of some of the charitable and community
service work being performed by Henry

Schein customers across Canada, many of
whom receive donations of Henry Schein
supplies in support of the noble efforts.
To learn more about or get involved with
Henry Schein Cares, you can contact Peter
Jugoon, vice president, special markets and
planning, at peter.jugoon@henryschein.ca.

Sponsored by

My Care Dental, Niagara Falls, Ontario
Even before ripples from the global economic downturn
of 2008 began being felt in their city, the partners at My
Care Dental in Niagara Falls, Ontario, were becoming aware
of a growing population in the area with unmet oral health

People typically start lining up between 5 and 5:30 a.m. for My
Care Dental Day (formerly Mcleod Dental Day). Everybody gets
a number and an estimated time for when a treatment slot will
be available. Nobody is turned away. Pictured is the 2014 day.
The 2015 day marked the practice’s seventh year for the
free-treatment event. Photo/Provided by My Care Dental

care needs. Various factors were in play, including the lack
of fluoride in the municipal water supply and big gaps in
insurance coverage. “Caries is rampant in this area,” said
Frank Bojcic, DDS, one of the partners in the practice. “You
don’t need to look too hard to find it.”
Bojcic and the practice’s other three partners, Robert
MacInnis, DDS, Ian Cheng, DDS, and Joe Rogers, DDS, and
associate Habib Tarzi, DDS, all wanted to do something to
address the community’s needs. Inspired by Bojcic’s membership in the charity Knights of Malta and by a Florida
practice that was providing a free-care day for the underserved in its community, the partners decided they should
provide a similar free-treatment day in Niagara Falls.
They opted for a Saturday in May, clear of winter/spring
weather challenges but before Mother’s Day and summer
travel. That first free day, seven years ago, attracted about
65 patients. Virtually all of the practice’s staff of 40 volunteered their time to make the day happen. The event
was so well received, it prompted the staff and dentists to
enthusiastically repeat it every year since. The number of
patients treated now typically exceeds 100.
“We work almost like a MASH unit,” Bojcic said. “We approach it like triage and keep the paperwork minimal. We
try to see as many people as possible.” People typically
start lining up between 5 and 5:30 a.m. in anticipation
of the initial “triage,” which includes X-rays, starting at
6:30 a.m. Through that process, everybody in line gets a
number and an estimated time for when a treatment slot

will be available. That system continues throughout the
day as other patients arrive. First step is usually a cleaning,
then, if needed, time with one of the dentists. “Nobody gets
turned away,” Bojcic said.
It’s mostly restoration work, lots of fillings, with some
veneers and composite work on chipped teeth. Typically,
even a few root canals are performed. “We have a great
team,” Bojcic said of the staff and dentists’ efforts. “It really
is a well-oiled machine.”
The practice’s 14 operatories stay busy all day. Refreshment stations are set up for patients and staff. The goal
is to start winding down around 2 p.m., but that’s rare.
Depending on the turnout and demand, the treatments
typically finally wrap up closer to 3:30 or 4 p.m. “It’s definitely the busiest day of the year,” Bojcic said. “But our staff
really knows how to keep things moving, turning over
rooms really quick. It’s a great way for us to give back to
our community and set a positive example for others. We
just really want to spread that sort of good vibe and pay it
forward. I think everybody — the patients and the staff —
really enjoy the day. I am very thankful for everyone’s efforts. We could not do this without such a fantastic team.”
Bojcic said the practice has closely tracked the value of
the care cumulatively delivered across the seven annual
free days to date. It adds up to $287,000.
“It’s a lot of hard work and takes a lot of effort,” Bojcic
said. “But we all feel good about it. I don’t see us ever stopping. I look forward to seeing us hit $1 million in care.”

Ramzi Haddad, DDS
Ramzi Haddad, DDS, made his first Health Outreach trip
to Guatemala five years ago. He immediately realized that
practicing such “pure dentistry” in relatively primitive
conditions for extremely appreciative patients was highly
gratifying — and he knew he would be back. On his second
trip the following year, the team of dental professionals he
was with treated 380 patients in one week, breaking the
organization’s record. On his third trip Haddad served as
project leader, coordinating the organization’s first boatbased mission. His team staffed a dental clinic on a donated
houseboat in Guatemala’s Rio Dulce region. The floating
clinic (and a satellite shore-based operatory they would set
up nearby) enabled the team to extend care deep into the
rain forest, treating primarily children in remote villages
that are home to Guatemala’s Mayan indigenous population. The area has minimal access to even basic health and
dental care — and few formal education resources.
Also for the first time on that river trip, the Health Outreach team partnered with a Guatemalan organization
experienced with serving the area population to enable a
more efficient operation from the moment the volunteers
arrived. The local organization working with Haddad’s
team was Asociación Ak’ Tenamit, an indigenous community development group that promotes long-term solutions
to poverty through education, health care, income generation and cultural programs. The staff and volunteers run

a boarding school serving 523 students from 100 villages.
They also run a 24-hour clinic that serves more than 25,000
people — as well as the dental-care boat that was staffed by
Haddad’s team.
Health Outreach viewed the riverboat clinics and local
partnership as a big success and committed to continue
with both, as did Haddad, who shortly after his return was
already planning another week-long trip for 2015.
Thirteen volunteers from Canada participated in that
January 2015 trip, including five dentists (one, an oral surgeon), four assistants (including Anita Lassak, Nasha Zaheer
and Lorena Ramirez-Maldondo, from Haddad’s offices) a
physician and a hygienist. On four of the five clinic days,
the team staffed three operatories in the boat, with a triage chair on the deck. A ground clinic with two chairs was
set up near the boat, enabling the sharing of generators to
power five ADEC compressors — and an instrument sterilization station. (On one of the treatment days, operatories
were trucked from the boat to a high-mountain village.)
In total, the team treated 405 patients, 80 percent of them
children. (Each day, after all the children had been seen, the
team would treat parents in need of care.) Most of the work
involved restorations and extractions. Haddad was able to
perform four root canals between two patients, saving central incisors of two 13-year-old girls. Because two of the clinics were held at the Ak’ Tenamit school, Haddad was able

Dr. Ramzi Haddad, third from right in back, led 13 volunteers (and
their translator, far left) on a riverboat dental outreach trip on
the Rio Dulce in Guatemala (the deck pictured held the clinic’s
triage chair). The 2015 trip was Haddad’s fourth to Guatemala
with Health Outreach. Photo/Provided by Health Outreach

to start the root canals on Tuesday and have the patients
return Friday for completion. “Our volunteers worked tirelessly and endured risks to see more patients than ever
before in the 13-year history of Health Outreach,” Haddad
wrote in his field report on the 2015 trip. And, of course, he
is already deeply involved in planning a 2016 return.

[8] =>

INDUSTRY

Dental Tribune Canada Edition | September 2015

Photoacoustic shockwave with irrigant debrides
areas files can’t reach
By Enrico Divito, DDS

Successful endodontic treatment depends upon maximal debridement and
disinfection of the entire root canal
system. The root canal system must be
shaped to a convenience form that permits adequate cleaning and disinfection
by elimination of microbes.1
The literature is clear that as much as
35 percent or more of the root canal system remains untouched by any instrumentation technique. Essentially no filing
technique allows instruments to sculpt all
canal walls and remove infected dentin.2
To decrease the bacterial load and achieve
better debridement, irrigation protocols
are used prior to obturation.
The efficacy of the irrigants to decontaminate canal walls has seen significant
improvements recently. Both negative and
positive apical pressure irrigation techniques have been surpassed by ultrasonically activated irrigants, photo-activated
disinfection and laser-activated irrigants
in their ability to improve cleanliness of
the canal system.3,4
In particular, the Er:YAG (Lightwalker
Er:YAG& Nd:YAG dental laser, National
Dental Inc., Barrie, Ontario) has shown to
be effective at removing debris and the
smear layer from canal walls.3,4 A final application of the Er:YAG laser to the sodium
hypochlorite already present within the
canal, after standardized instrumentation,
can result in improved cleaning of the
canal walls with a higher quantity of open
tubules (Fig. 1) compared with results without the use of the laser. 3,4
A new application of laser-activated irrigation (LAI), Photon Induced Photoacoustic
Streaming (PIPS™), uses an Erbium 2,940
laser to pulse extremely low energy levels
of laser light to generate a photoacoustic shockwave, which streams irrigants
throughout the entire root canal system.5
Using extremely short bursts of peak
power, laser energy is directed down into
the canal and the action actively pumps
the tissue debris out of the canals while
cleaning, disinfecting and sterilizing each
main canal, lateral canals, dentinal tubules
and canal anastomoses to the apex. This
movement of irrigant is achieved without
the need to place the radial and stripped

laser tip (PIPS tip, Fig. 2) into the canal itself, unlike with other conventional hand and ultrasonic systems.
The tip is held stationary in the
coronal aspect of the access preparation only. With the irrigant occupyFig. 1: Left, apical third of root treated with PIPS shows
Fig. 2: Left, tapered and stripped PIPS tip
ing the entire root canal system, the
clean surfaces, no thermal damage. Right, SEM of
used for laser-activated irrigation. Right,
shockwave travels in all directions
apical third shows clean dentin tubules post PIPS with
position of laser tip in PIPS technique: in the
during activation and effectively
no thermal damage. Photos/Provided by Enrico Divito, DDS pulp chamber and not in canal.
debrides and removes organic tissue remnants. Through this laseractivated turbulent flow phenomenon,
reducing method — and
clinicians following the PIPS protocol are
has demonstrated its abilnot required to place the tip into each
ity to decontaminate and
canal, thus eliminating the need to endebride areas that files and
large and remove more tooth structure to
instrumentation
cannot
deliver standard needle irrigation to the
reach — success rates rise
smaller and more delicate apical anatomy,
and retreatment for past
Fig. 3: Left, pre-treatment. Right, post-treatment obturation
commonly seen in the apical one third.
failures is possible.7
after PIPS. Tooth instrumented to a #25/06 taper. Note the
The results are canal convenience forms
PIPS is also helpful in loconservative convenience form maintaining more original
that are more conservative, minimally incating and helping negotianatomy of root canal system and reducing the need to use
vasive and biomimetic (Fig. 3).
ate calcified canals. PIPS is
larger file sizes, conserving more dentin tooth structure.
Unlike other laser-activated irrigant
a valuable additional tool in
techniques, PIPS is not a thermal event,
the treatment of endodonbut rather subablative. Properly executed,
tics regardless of the shaping
PIPS creates turbulent photoacoustic agiand obturation system used.
tation of irrigants that move fluids three
Laser technology used in
dimensionally throughout the root canal
endodontics during the past
system even as far as the apical terminus,
20 years has undergone an imdistant from the radial stripped tip locaportant evolution. Research in
Fig. 4: Left, mandibular molar canal system shows
tion. By activating the tip in the access cavrecent years has been directed
isthmus before (A, red canal) PIPS laser-activated
ity and outside the root canal system, the
toward producing laser techirrigation. Areas of organic tissue and debris from
extremely low energy needed to activate
nologies (such as impulses of
instrumentation completely eliminated, as highlighted
the unique PIPS tip (20 mJs or less) is below
reduced length, radial-firing
by post-PIPS image (B, green canal). Right, mandibular
the threshold of ablation for dentin. Ledgand stripped tips) and techmolar with canal preparation to a size 30/.04 (A, green
ing and thermal effects that have plagued
niques (such as LAI and PIPS)
canal) obturated with nano-particle BC Sealer (Brasseler
the widespread use of other laser systems
that are able to simplify laser
USA, Savannah, Ga.) and single cone obturation (B, blue).
is completely avoided at the energy levels
use in endodontics and mini5,6
used by the PIPS technique.
mize the undesirable thermal
effects on the dentinal walls, using lower
Recent testing, performed at the UniDr. Enrico DiVito pracenergies in the presence of chemical irritices in Scottsdale, Ariz. In
versity of Tennessee by Dr. Adam Lloyd,
gants. EDTA has proved to be the best solu2004, he formed the Arizona
chairman of the department for endodontion for the LAI technique that activates
Center for Laser Dentistry.
tics, objectively confirmed the improved
the liquid and enhances its cleaning of
He is the founder and direccleaning and debridement of organic and
the smear layer. The use of a laser (PIPS) to
tor of the state-accredited
inorganic tissue left by instrumentation.
activate sodium hypochlorite increases its
Arizona School of Dental
Microcomputed tomography scans were
antimicrobial activity.
Assisting (ASDA). In addiused to assess before-and-after volumetFinally, using the correct protocol, the
tion to teaching at ASDA, DiVito is also a
ric change in the internal intaglio of lower
PIPS technique reduces the thermal effects
clinical professor at the Arizona School of
first molars treated with PIPS protocol
and exerts both a stronger cleaning and
Dentistry and Oral Health. He is a graduate
(Fig. 4). Sequential slicing beginning at
bactericidal action, because of its streamof the University of the Pacific, Arthur A.
6 mm from the apex and moving down to
ing of fluids initiated by the photonic
Dugoni School of Dentistry with honors. He
the last 2 mm demonstrated that all slice
energy of the laser. Further studies are curcan be reached at edivito@azcld.com.
images showed significant improvements
rently underway to validate LAI and PIPS
after PIPS.
technique as innovative technologies in
Because PIPS is a less techniqueList of references is available from the
modern endodontics.
sensitive, minimally invasive and timepublisher on request.

Implant-supported total
prosthesis (daily routine)
By Dr. E. Veralli and Odt. Luca Ruggiero

In this clinical case, we demonstrate how the
use of overdentures are a viable choice among
the restoration options for edentulous patients.
The clinician must carefully assess the suitable
number of implants to support an overdenture
to identify the ideal restoration solution.

Fig. 1

Fig. 2

Figs. 1, 2: Upper/lower master models. Photos/Provided by E. Veralli and Luca Ruggiero

A systematic review of the literature reveals
a lack of information about the ideal number
of implants for a removable restoration in an
edentulous patient; however, most studies propose to insert two to four implants in the mandible.
We will illustrate all laboratory clinical stages
” PROSTHESIS, page A9

Fig. 3

Fig. 4

Figs. 3, 4: Wax rims leveled and individually adapted.

[9] =>

Dental Tribune Canada Edition | September 2015

INDUSTRY

Smallest dimensional attachment system
designed to be compatible with all implants
Rhein’83 OT Equator has a reduced vertical
profile of 2.1 mm and diameter of 4.4 mm
Rhein’83, a global producer of precision
attachments on removable prosthesis,
describes its OT Equator as the smallest
dimensional attachment system on the
market. It has a reduced vertical profile
of 2.1 mm and diameter of 4.4 mm (metal
housing included). It is compatible with
any implant brand.
Because of its shape, Equator provides
superior stability when compared with

traditional attachments, according to the
company. It corrects divergence of up to
25 degrees, the company reports. Functionality is guaranteed by coupling of attachment and cap.
Caps are available in four colors, based
on levels of retention — from a minimum
of 0.6 kg to a maximum of 2.7 kg.
Caps should always be used with metal
housing.

Photo/Provided by Rhein’83

To learn more about OT Equator, you
can contact the company by email at
info@rhein83usa.it or by telephone at
(877) 778-8383.
You can visit the company online at

www.rhein83usa.com to learn more about
all of its products and services, including
the OT Equator.
(Source: Rhein’83)

Fig. 5
Fig. 5: Analysis of the edentulous ridges
vestibular masks.

“ PROSTHESIS, page A8
according to Prof. Gerber’s methods.
These steps will lead to the production of
an overdenture with OT Cap attachment
and OT SpheroBlock abutments on four
implants in the lower jaw and complete
prosthesis with mucous support for the
upper.

Introduction
In a total edentulism, the prosthesis with
a mix of implant support and mucous
support represents the boundary between the resilient prosthesis (mucosal
supported) and the rigid prosthesis (implant supported).
The prosthesis retained with OT Cap attachments or OT Equator is a hybrid prosthesis that must comply with a set of parameters typical of traditional prostheses.
Numerous scientific studies demonstrate
that two implants are sufficient to stabilize mandibular complete dentures and
to improve significantly the edentulous
patient’s quality of life. Four implants
can noticeably improve the prosthesis
retention.

Clinical case
In an initial interview, the patient asked
for a more stable and esthetic prosthesis
that would help improve social- and
private-life interactions by removing the
fear that the lack of teeth — or the prostheses — would be noticeable.
After evaluating with the patient the
costs and benefits of the therapeutic options, we chose a solution with SpheroBlock Abutments. Two implants of 3.5 mm
and two of 3.0 mm diameters convinced
us to abandon the option of a bar because
of insufficient implant support.
” PROSTHESIS, page A10

[10] =>

INDUSTRY

A10
“ PROSTHESIS, page A9
We placed four implants in the mandibular arch; and after osteo-integration,
the clinician proceeded with the preliminary and final impressions.
After the master models (Figs. 1, 2) were
created, in the laboratory two resin basis
with occlusal rims were used for registration of intermaxillary relations.
In the dental office, the occlusal rims
were leveled and adapted individually,
establishing a first provisional DVO
with the use of conventional methods
(Figs. 3, 4). Then the models were mounted in the articulator, taking as reference
the Bonwill and Balkwill triangles.
We analyzed the shape of the jaw, as
well as the three-dimensional interalveolar relationships, as is usually performed for a full dental prosthesis with
mucous support.
We traced on the exterior face of the

model the trend of the ridge, to ensure
proper implant placement according to
the method of Prof. Gerber, using rulers
and a compass profilometer. With the latter we also drew the trend of both upper
and lower wax rims (Fig. 5).
A silicone key was used to record all information concerning the position and
dimensions of the upper wax rim, previously set up in the office. Only with the
silicone key complete were we ready to
remove the wax from the basis.
Using the CRS 10 set, we decided to
give support to the basis with the same
self-curing resin. Our concern was that
recording the intraoral relation with conventional hard wax could introduce minor deformations. We delivered this set to
the dental office together with a new upper rim basis for taking of the face bow.
The patient’s movements of protrusion and laterality were tracked on the
bottom plate, which was smeared with

Dental Tribune Canada Edition | September 2015

a suitable marker to record the relative
trajectories. With appropriate material,
we blocked the final centric relationship,
and we placed the face bow (Fig. 6) for the
orientation of the models.
The articulator was mounted with
the universal face bow accessory (KaVo,
Quick, Ivoclar, Sam).
We first fixed the upper model and
then the lower (Fig. 7). Next, guided by
the silicone keys, we assembled the teeth
respecting the upper front esthetic references and phonetic.
Particular attention was given to the
lower front teeth to ensure a tooth-totooth relationship starting from the canines to enable mounting of the posterior teeth according to the method of Prof.
Gerber.
We drew a vertical line in the upper
premolar, which started at the mesial fossae and continued on the vestibular surface. We drew a vertical line on the lower

Fig. 6
Fig. 6: Registration with the face bow.

Fig. 7
Fig. 7: The final setup in the articulator.

Fig. 8
Ad

Fig. 8: Steel housings for OT cap micro.

Fig. 9
Fig. 9: Prostheses cured, before polishing.

Fig. 10

Fig. 11
Figs. 10, 11: Sferoblock positioned and patient
with new prostheses.

PDC

premolar that started at the cuspid and
continued to vestibular. The two lines
needed to overlap one another perfectly.
We completed the assembly of the
molars, and the prostheses were sent to
the dental office for routine checks.
We chose four OT micro Sferoblock
with the appropriate transgingival
height (Fig. 8), and the lower model was
duplicated with the OT Cap’s analogues.
The prostheses were then cured with
resin using traditional techniques and
the flasks JST, eventually placed in the
articulator for selective grinding (Fig. 9).
The prostheses were finished and polished, the abutments screwed and prosthetic delivered to the patient (Figs. 10,
11).

Conclusion
Dentures with mucous support and retained by attachments still must respect
all of the prescriptions and principles
followed to create the rational basis of a
conventional full denture.
Materials and equipment: Candulor articulator; Teeth Physioset ct and ct Condyloform Candulor; flasks JST Candulor;
Resin C-plast Candulor; esthetic resin
Candulor; CRS set Candulor; OT Sferoblock micro Rhein’83; Cuff Height measurer Rhein’83; OT Cap micro Rhein’83;
Parallelometer key for OT Cap Rhein’83;
Waxlectric Renfert; Waxprofi Renfert.

[11] =>

INDUSTRY

Dental Tribune Canada Edition | September 2015

A11

Position yourself for long career

To learn more on ergonomics in the dental clinic, visit
entists, hygienists and dental assistants face
www.posiflexdesign.com. The source for some of the staon a daily basis all of the top conditions needtistics in this article is “Prevention of Work-Related Mused to develop musculoskeletal disorders.
culoskeletal Disorders in Dental Clinics,” by Rose-Ange
Dental work requires precision and control
Proteau. It is available free at www.asstsas.qc.ca.
in movement — so static positions can result in fatigue
in the muscles of the neck, the back and the shoulders.
(Source: Posiflex Design)
After a few years or even months, the muscle fatigue may
cause ailments, pain or even more severe
conditions, such as tendinitis, bursitis,
Factors contributing to development of musculoskeletal disorders:
neck pain, disk herniation and others.
If I work with my arms close to my body, can
I avoid muscle tension?
Even when your arms seem relaxed along
your body, the shoulder and upper back
muscles have to be contracted to keep the
stability required for the precise work of
your hands. These muscle contractions can
reduce the blood flow up to 90 percent,
which causes fatigue to accumulate and
weaken your muscles and articulations.
Why use mobile elbow supports?
The Posiflex mobile elbow support system
was developed to diminish the charge to
the upper body in order to favor a good
bloodstream. A scientific study demonstrated that using the Posiflex system
contributes to achieving a more secure
and comfortable work posture while significantly reducing muscle contractions in
the shoulders, neck and upper body. This
unique concept follows body movements.
The elbow rests offer an appropriate support of the arms while preserving the freedom of movement.
Precision work requires concentration
and effort. We forget ourselves when we are
concentrated on a task. The elbow supports
enable practitioners to keep a good posture
as they keep you in line.
Do I have to always be on the supports to get
the benefit?
It is not possible to be on the supports 100
percent of the time. The studies demonstrated that with 50 percent of the time on
the support, bloodstream is sufficient to
prevent and diminish tension. After a short
learning curve, the majority of users are on
the supports 80 to 90 percent of the time.
Why invest in a dental stool?
Dental professionals can easily spend eight
to 12 hours a day on a stool. In fact, it is the
piece of equipment you use the most and,
generally, it is also the most neglected. You
pay attention to your patient comfort, so
what about your comfort and that of your
employees?
The investment is modest and quickly
profitable compared to costs created by
medical treatments or leave from work. Do
you have to plan long procedures early in
the week because your body can’t do it on
Thursdays?
How should the patient chair be adjusted to
keep the practitioner in good posture?
Eyes-to-task distance is the key for good
posture. When the patient chair is placed
low it forces you to bend your neck, even
with loupes, creating tensions. Furthermore, because of lack of leg room, the operator must straddle the chair or worse sit on
the tip of the seat. This position does not
provide lumbar support or a safe position.
Many speakers and authors favor a higher
position of the patient chair with the patient laying flat. The arms stay close to the
body and the forearms are flexed.

Repetition.

Tempo.

Force.

Michelle Fontaine, RDH, was able to continue practicing by
changing her position and by using the Posiflex Free Motion
Elbow Supports. Photos/Provided by Posiflex Design

Awkward movements
and posture.

Inadequate rest.
Ad

[12] =>

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[cover] => DT Canada No. 4, 2015

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Table of contents

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