DT India (Archived)

Dear Readers of Dental Tribune India / Mectron expands in India / Opinion / Dental Tribune International: A global approach to dental media / Interview with Graeme Milicich - New Zealand / News & Events / Solving esthetic dilemmas with direct composite bonding / Treatment acceptance: could have - should have - would have / Interview with Assoc. Prof. Lars Hylander - Uppsala University - Sweden / Interview with Prof. Van B. Haywood - USA / Dentine hypersensitivity: From diagnosis to treatment / Ancient skeleton in India bears evidence of leprosy / The continous wave obturation technique for enhanced precision / Miniscrews-a focal point in practice / ALARa = ALARming: It’s time to rehabilitate dentistry

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DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 1

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DENTAL TRIBUNE
The W orld’s Dental Newspaper  Ind ia Edition

PUBLISHED IN INDIA

www.dental-tribune.com

News in brief

Clinical
Solving esthetic
dilemmas with direct
composite bonding

Dental trade events

VOL. 1 NO. 1
Trends & Application
Hands-on Endo
The continuous wave
obturation technique

Interview
With Assoc. Prof. Lars
Hylander

Dental trade events in India for
the year 2009 kickstart with the

4Page

10

4Page

14

4Page

19

Famdent Show at the capital,
Delhi, which begins on July 24.
This will be followed later by
India’s premier international

Dear Readers of Dental Tribune India

dental exhibition, The World
It’s my great pleasure to welcome

tional publishing group is com-

Dental Tribune India to the Dental

posed of some of the world’s

Tribune International (DTI) pub-

leading academic publishers. Its

lishing network. DTI is proud to

combined portfolio includes more

traders, distributers and exhi-

collaborate with India’s largest

than 100 academic, clinical and

bitors from all over world will

medical publisher, Jaypee Broth-

trade publications that reach

assemble at these events. In

ers, to bring the Indian dental

over 600,000 dental professionals

addition, these events will also

profession the latest global and

in more than 90 countries and

host a large number of seminars,

regional dental news.

25 languages. DTI’s collective

Dental Show staged from October
9-11 and IDEM from October
23-25, both going to be held in
Mumbai. Dental manufacturers,

workshops and poster sesions

Torsten R. Oemus
Chairman & Publisher DT Group

the dental professionals. These

Jitendar P. Vij
Chairman, Jaypee Brothers Medical
Publishers

three events are expected to at-

I am extremely happy to see the

tract dentists, nurses and dental

launch of Dental Tribune India

Easier plaque detection with Inspektor TC

technician from accross the

Edition, through our group, in an

In collaboration with Inspektor

ble, and so this device will show

country to enrich the knowledge

association with Dental Tribune

Research Systems BV in the

people the parts of the mouth

ceived

and enhance practice skills.

International.

India has a large

Netherlands, scientists at the

that they are neglecting when

Inno-vation Award that acknowl-

number of dentists in the private

University of Liverpool have

they brush their teeth, enabling

edges significant innovation in

practice who constantly strive to

developed a new product for

them to remove plaque before

science for the product. “We

upgrade their skills and practice.

identifying plaque build-up in

it becomes a problem,” said

now hope to work with industry

I have sincerely believed that,

the mouth before it becomes

Prof. Sue Higham, Director of

partners to develop this proto-

we, as publishers, must encourage

visible to the human eye. The

Research at the University of

type, so that people can use it

opportunities to bring newer and

toothbrush-sized device has a

Liverpool’s School of Dental

in the home to identify plaque

valuable academic content to

blue light at its tip that allows

Sciences.

is

before any serious dental work

these professionals. DT India, as

plaque to be easily seen as a

designed, so that people can

is needed,” Prof. Higham added.

part of the DTI network, is one

red glow when shone around

easily incorporate it into their

DT

such initiative, through which we

the mouth and viewed through

daily dental hygiene routine.”

Bad breath worries women

plan to bring contemporary global

yellow glasses with a red filter.

Women are more worried about

content in dentistry from 2009

Dentists currently use disclosing

having bad breath than about

onwards. Because the content will

agents in tablet form to indicate

their partners disliking their

be shared in the DTI network,

tooth decay and plaque, but

appearance. Toothpaste manu-

Dental Tribune India, as a news-

these often stain the mouth and

facturer Macleans found that 78

paper, also allows our own frater-

taste

percent of women worry about

nity of dentists to contribute their

product, known as Inspektor

having smelly breath, while

article, views, opinions and case

TC, has been designed for every-

only 4 percent said they were

studies for readers across the

day use in the home and will be

concerned about what under-

world. In the near future, I also

particularly useful for those

wear to wear.

anticipate a warm response by

who are vulnerable to dental

our readers to the forthcoming

diseases, especially children

media of magazines and the DT

and the elderly.

for the continued education of

Simulation helps students
learn dental implant
procedures

Study Club. DT

unpleasant.

The

new

“Early stage plaque is invisi-

A realistic computer game will
soon be used to help dental
students, worldwide, learn and
reinforce dental implants. The
virtual dental implant training
simulation program is designed
by the faculty and students of
Medical College of Georgia
School of Dentistry, US, to aid
diagnostics,

decision-making

and treatment protocols.

Representatives from Inspektor and the University of Liverpool show the new
device at the Medical Futures Award in London last year.(DTI/Medical Futures)

The Dental Tribune Interna-

“Inspektor

TC

‡ page 3

Her team has already rea

Medical

Futures

[2] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 2

DeNtal tribuNe | July-September, 2009

News

India approves new
dental schools
Daniel Zimmermann
DTI

Officials have justified the
large number of approvals by

HONG K ONG/LEIP ZIG, Ger-

the many applications that had

many/ NEW DELHI,

India:

been pending approval for sev-

The Minister of Health and

eral years and numerous public

Family Welfare in India, Shri

complaints of undue delay in

Ghulam Nabi Azad, has approved

the processing of cases. How-

150 educational institutions,

ever, the approvals come at a

including a significant number

time when there is growing

of medical and dental colleges.

concern for the future employ-

He also directed the country’s

ment of dental graduates. Ac-

Medical and Dental Councils to

cording to a Times of India

take up pending recommen-

report, many dental graduates

dations of colleges as soon as

in India are forced to quit

possible so that semesters could

dentistry and work in other,

application. He asked for com-

implemented,”

Prof.

Raman

begin by 1 August, the newspaper

more lucrative jobs.

plaint boxes to be placed at his

Bedi,

Chief

Dental

Dental education in India

office and residents to receive

Officer in the UK and founder of

has grown in recent years and

Education regulators have

complaints against any person

the new Indian dental commu-

India now ranks first in the

In India, each institute offer-

also been said to turn a blind

seeking illegal endorsement,

nity Dentalghar, told Dental

world in having the highest

ing medical or dental education

eye to quality in their haste to

either in medical councils or

Tribune Asia Pacific. “With

number of dental schools. The

needs annual clearance from

recognise private professional

in the Ministry.

higher demands for quality

country has 280 dental institu-

the Ministry of Health and

institutions. Azad made clear

dentistry by local people, dental

tions, which produce between

Family

that no intermediaries would

“What is needed in India is

tourism, postgraduate training

15,000 and 20,000 Bachelor of

recommendation by the two

be tolerated in his ministry for

a national workforce strategy

opportunities etc., many dentists

Dental Surgery graduates every

councils.

clearing any medical institute

that is carefully devised and

will stay in India instead of

year. DT

the Times of India reports.

Welfare

based

Shri Ghulam Nabi Azad (third from left) during the celebration of the International Day against Drug Abuse and Illicit
Trafficking on 26 June in New Delhi. (DTI/Photo: Viney Bhushan)

former

going abroad.”

Americans support dental coverage in health care reforms
Over 60 per cent of Americans

health care in the on-going

consider dental coverage part

health-policy debate. “Acknowl-

of an overall health care reform

edging that the majority of

by the Obama legislation, a

Americans have access to excel-

new public opinion survey has

lent and relatively affordable

shown. The poll released at the

dental care […], we are com-

launch of National Smile Month

pelled to point out that too

in June and commissioned by

many low-income Americans

Oral Health America revealed

still suffer needlessly from dental

that four in five adults agree that

disease,” the letter states. “More

dental benefits are as important

must be done to ensure that

as general medical benefits

all Americans have access to

in an overall health care benefit

quality oral-health services.”

US President Barack Obama at the annual
convention of the American Medical Association
in June. (DTI/ Photo Ted Grudzinski, AMA)

package.
The

ADA

recommends

the introduction of a public

back in 1994.

who say that the realisation

Many poor and lower-middle

increasing funding to the na-

health insurance plan, a concept

The government’s health-

would cost a total of US$1

class families in the US currently

tionwide Medicaid health pro-

similar to the failed health

care reform proposals are op-

trillion over the next decade

do not receive enough dental

gramme, rebuilding the public

care plan developed by his

posed by the US Congress and

and

care, in part because dentists

dental-health infrastructure &

current Secretary of State and

other organisations like the

people in the US uninsured. DT

prefer patients who have private

supporting

former First Lady Hillary Clinton

American Medical Association,

insurance or can pay in cash.

prevention measures, such as

The lack of dental care is also

fluoridation or school-based

not restricted to the poor, recent

education programmes.

community-based

data shows. Experts on oral
health say that about 100 million

Obama’s health care reform

Americans have no access to

nitiative aims to extend health

adequate care.

coverage to 45 million uninsured people in the US, as well

Executive Vice President
Marketing & Sales

DENTAL TRIBUNE

choice and lower rising health

American Dental Association

care costs, by cutting more

(ADA), which represents over

than US$200 billion in reim-

157,000 dentists in the US,

bursements to hospitals over

recently urged the government

the next decade. He has also

to pay more attention to dental

announced

Dental Tribune India 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.

preserve

his

support

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

The W orld’s D ental Newspaper  Ind ia Ed it ion

president Barack Obama, the

millions

Peter Witteczek
p.witteczek@dental-tribune.com

Published by Jaypee Brothers Medical Publishers (P) Ltd., India

leave

International Imprint

consumer

In a recent letter to US

still

Chairman DT India
Jitendar P. Vij
jaypee@jaypeebrothers.com

Editor
Dr. Isha Goel
isha.goel@jaypeebrothers.com
Editorial Consultants
Dr. Gurkeerat Singh
Dr. Amit Garg

Dental Tribune India

Published by : Jaypee Brothers Medical
Director
Publishers (P) Ltd.
P. N. Venkatraman
4838/24 Ansari Road, Daryaganj,
venkatraman@jaypeebrothers.com New Delhi 110002, India
Chief Editor
Phone: 43574357
Dr. Naren Aggarwal
e-mail:jaypee@jaypeebrothers.com
naren.aggarwal@jaypeebrothers.com Website: www.jaypeebrothers.com

[3] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 3

DeNtal tribuNe | July-September, 2009

News 3

 DT page 1

Implants,

Dentistry,

excellent online education awaits

dental community to contribute

forward to making many new ones

activities also include the organi-

Ortho & Laser. Given India’s global

you as a registered member of

to the Dental Tribune platform as

in the years to come. I am very

zation of continuing education

prominence in information tech-

the Dental Tribune Study Club at

reporters, bloggers, presenters,

thankful for the overwhelming

programs as well as congresses

nology, I am certain DTI’s state-of-

www.dtstudyclub.com. This ADA/

reviewers, opinion makers, mod-

interest and trust we have experi-

and exhibitions. The World Dental

the-art ePublishing & eLearning

CERP accredited eLearning plat-

erators or lecturers no matter

enced from the Indian dental

Federation (FDI) & regional dental

plat-forms will generate a lot of

form offers live interactive courses

whether you are a researcher,

community thus far.

associations, such as the Asia

interest among dental profession-

that are also archived for viewing

clinician or politician. The global

Pacific Dental Federation (APDF)

als as well. Please visit www.den-

at a later time, discussion groups,

dental industry wants to hear

and the Latin American Dental

tal-tribune.com for daily news

video product reviews and peer-

more from India, and Dental

Federation (FOLA) have chosen

feeds, clinical updates, product

reviewed case studies, and all

Tribune will serve as your gateway.

Dental Tribune International as

and company directories, print

of it is available 24/7. Finally,

Dental Tribune already has

their official media partners.

archives and ePapers. In addition,

I would like to invite the Indian

many friends in India, and looks

DTI’s presence within the
realm of Indian dentistry has been
long overdue & eagerly anticipated.

However,

establishing

DTI’s broad media & educational
portfolio in India required an
outstanding publishing house that
is experienced, professional, innovative, committed to quality, and
highly regarded within the Indian
academic community. There is no
question that among medical
publishers, Jaypee Brothers not
only meets these requirements,
but also has a global reach and
is well on its way to becoming
an essential partner for the dental
profession in India. In addition
to the Indian Edition of Dental
Tribune, “The World’s Dental
Newspaper,” & its related specialty
newspapers, Jaypee will bring
you clinical journals such as Root,

Washington cracks
down on tobacco,
and ADA approves
The American Dental Association (ADA) is applauding new
legislation to regulate tobacco.
The Family Smoking Prevention
and Tobacco Control Act gives
the U.S. Food and Drug Administration (FDA) the express authority to regulate the manufacture,
marketing

and

distribution

of tobacco products.
The ADA has a long-standing
policy that nicotine is a drug
and that cigarettes and other
tobacco products are nicotine
delivery devices and, therefore,
should be regulated. “Dentists
are the first line of defense in
the war against oral cancer and
many

other

tobacco-related

diseases,” said ADA President
Dr. John S. Findley. “About nine
out of 10 people who will die
from oral and throat cancers
use tobacco.” “Tobacco products
are also associated with higher
rates of gum disease, one of
the leading causes of tooth loss
in adults,” Findley said. DT

Cosmetic

Sincerely,

Torsten R. Oemus
Chairman & Publisher
Dental Tribune Group DT

[4] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 4

4

DeNtal tribuNe | July-September, 2009

News & Opinions

Mectron expands in India
Bangalore facility to host new showroom for dental products

HONG K ONG/LEIP ZIG, Ger-

company, which revolutionised

2007. Bangalore was chosen to

biotechnology. The number of

tment to Mectron India’s distri-

many/BA NG ALO R E,

India:

dental surgery with their devel-

host the new facility because of

employees in the Bangalore

bution partners and shows the

The Italian manufacturer Mec-

opment of piezoelectric bone

its highly educated workforce

facility will be increased from

confidence Mectron has in the

tron has opened a new produc-

surgery, currently distributes a

and the nearby Bengaluru Inter-

4 to 60, Radhakrishnan said.

potential of the Indian dental

tion and administration facility

number of well-known dental

national Airport. With an eco-

Besides new offices and mee-

market,” told Wolf Narjes, Area

in Bangalore in India. Inaugu-

brands from Germany and Italy,

nomic growth of 10.3 per cent,

ting rooms, the new building

Manager

rated with a big opening night

such as Cavex, Euronda, Her-

the city based in southern India

will feature a showroom to

Tribune Asia Pacific. Mectron

back in May, the facility will be

aeus Kulzer, KaVo, K-Driller,

is one of the fastest growing

exhibit the company’s product

has been active in India since

under the direction of M. Rad-

Schulz and Villa. According to

economic centres in India and

range to its customers from

2004. It has also branches in

hakrishnan, a co-founder of

Radhakrishnan, initial planning

host of a number of important

India. “This investment certainly

Delhi and Mumbai. DT

Mectron’s India branch. The

for the new facility began in

industries, such as IT and

demonstrates a strong commi-

for

Asia,

Dental

Experts quarrel over mouthwash

ethanol allows carcinogenic sub-

The Australian government

stances, such as nicotine, to per-

said although the study was “very

Study in Australian dental journal pushes oral cancer debate

meate the lining of the mouth.

interesting”, it lacked definite

Top-selling mouthwashes con-

proof that these products would

tain as much as 26 per cent alco-

increase the risk of cancer. Min-

hol, which is used to kill the bac-

istry of Health dental officer,

teria responsible for tooth decay.

Robin Whyman, recommended

It is also necessary as a solvent

people speak to their dentists

for different flavour oils.

when using mouthwash long
term.

Michael McCullough, Asso -

A young woman buys mouthwash in a supermarket. (DTI/Photo Daniel Zimmermann)

ciate Professor of Oral Medicine

In a written statement sent

at the University of Melbourne

to Dental Tribune in January,

in Australia, who led the study

Johnson & Johnson rejected the

said: “We see people with oral

claims: “Leading cancer scien-

cancer who have no other risk

tists, as well as the US Food and

factors than the use of mouth-

Drug Administration and re-

wash containing alcohol, so

searchers in dentistry, have

what we’ve done is review all

found no evidence that alcohol-

the evidence. Since the article,

containing mouthwashes, if used

further evidence has come

properly, lead to increased risk

out, too.”

of developing oral cancer.” The

“We believe there should be

company, which is behind the

warnings. If it was a facial

Listerine brand, holds 25 per

cream that had the effect of

cent of the global mouthwash

Daniel Zimmermann
DTI

vealed that the long-term use of

formation, which was released

reducing acne but had a four-

market and claims to have con-

mouthwash containing alcohol

after a scientific review was pub-

to five-fold increased risk of

ducted more than 100 scientific

LEIPZIG, Germany: New evi-

can lead to an increased risk of

lished in the Australian Dental

skin cancer, no-one would be

evaluations of its top-selling

dence from Australia has re-

developing oral cancer. The in-

Journal, reports on evidence that

recommending it,” he added.

brand. DT

[5] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 5

[6] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 6

6

DeNtal tribuNe | July-September, 2009

Opinion

Dear reader, Planning for the future
Daniel Zimmermann
DTI

Do you remember sending your

Friedrich Herbst
Germany

capital goods, however, manu-

not be managed by knowledge

facturers of equipment, such as

alone. Human spirit & emotional

all respects. In spite of this, the

practice fittings, dental units,

intelligence paired with ethics

main topic at the assembly of the

imaging devices, & CAD/CAM,

give rise to a socially responsible

international dental manufac-

as well as manufacturers of

trade. Persistence, hesitation,

turers (idm) in Cologne was the

dental implants have noticed a

know-it-alls or daring do not

present shifting in the finance

clear purchase restraint and the

elicit the desire to undertake new

first e-mail? I see myself in 1995

The famous German philo-

markets and its possible effect

need for cutbacks in staff in order

ventures. Only something com-

sitting in a dark basement in my

sopher Friedrich Nietzsche once

on the future. After the gloom at

to cope with current market

pletely new will give rise to new

first year at university, exchan-

said, “We have already gone

the Chicago Midwinter Meeting

circumstances. In addition, com-

values and prosperity. DT

ging short messages with a friend

beyond whatever we have words

in February, the members of the

panies that focus on dental tech-

next to me, on a 486 PC that was

for.” Have we already overcome

Dental Trade Alliance from the

nology have noticed the shift of

state-of-the-art at the time. Since

the current global crisis that

US were particularly surprised

the time-consuming & high-cost

then so much has changed. What

dominates in the media? If you

by the positive feedback at IDS.

production of dentures to coun-

was just fooling around back

happened to visit the 33rd IDS

The momentary mood and facts,

tries where labour and material

then has become an everyday

in Cologne in Germany this year,

however, are two sides of the coin

costs are cheaper. Markets will

commodity that most of us can-

you would have been under the

and apply to any prognosis in

not grow if the services offered

not imagine living without.

impression that this was the

the dental sector. Manufacturers

are too expensive. Competence

case. The floors & booths were

of consumables have reported

and knowledge especially will

Some experts have claimed

crowded, filled with happy faces,

stable or marginally increasing

be required to plan for the future.

that the Internet is one of the

and the show broke records in

sales figures. In the area of

But the future is complex & can-

Contact Info
Friedrich Herbst is the Executive
Director of international dental
manufacturers (idm), an independent umbrella organisation
that globally represents the
common interests of the dental
trade. He can be contacted at
idm-vox@t-online.de.

most significant inventions of the
last 50 years and, indeed, some
projects have changed our lives
to various levels. With the Inter-

Dental care in Australia

the specific range of services
for Denticare. We acknowledge
Professor Spencer’s eminence

net, it has never been easier to
access and share information

C, in which Medicare would be

and oral health promotion, so

as an epidemiologist but believe

all around the world within just

replaced by federally funded

our response to the Commission

experienced senior clinicians

social health insurance. Impor-

on these points is confined to

and clinical academics would

tantly, the Commission has

relatively minor suggestions,

have provided better advice.

proposed the establishment of

including the expansion of in-

We also do not believe the public

a few seconds. Today, we are able

Hans Zoellner

to buy goods or talk to people

Australia

around the globe with just the
click of a mouse. Giants like

Australians enjoy equitable ac-

Denticare universal insurance

ternships to two years. In addi-

sector can expand sufficiently

Google offer so many services

cess to medical services sup-

similar to Option C. The 0.75 per

tion, we support the intent of

to accommodate those without

that we can hardly escape them

ported by universal Medicare

cent Denticare levy would be

Denticare.

health insurance, representing

in our everyday lives. However,

insurance, an effective Pharma-

distributed directly to private

in dentistry, especially in dental

ceutical Benefits Scheme, com-

health insurance companies

However, there are signifi-

order to support Denticare

publishing, the race for revolu-

munity-rated private insurance,

rather than as patient rebates.

cant difficulties with the Denti-

adequately as currently planned.

tionary projects is still on. Many

as well as the provision of both

Notably, federal Denticare pay-

care model suggested. In par-

Moreover, Medicare has worked

publishers, including ourselves,

intern training & service beyond

ment to insurers would be risk

ticular, Denticare is currently

well for medicine in Australia,

have long underestimated the

private sector capacity by public

adjusted breaking the Australian

planned to exclude many impor-

and we would prefer dentistry

many possibilities that the Inter-

hospitals. When the Australian

convention of community rating.

tant dental services, including

to be brought into the proven

net has to offer, sometimes be-

government

the

People without private insur-

multi-canal endodontics, lower

Medicare system, rather than

cause we were afraid of neglect-

National Health and Hospitals

ance would receive Denticare

partial dentures, and crowns.

see oral health experimented

ing our print offers & therefore,

Reform Commission in 2008 to

via federally funded expansion

Also, the restrictive Denticare

with in an untried Option C

our main business model for

inform structural health reform,

of public dental services. The

list would have the effect of con-

model. Indeed, comprehensive

the last 100 years. But this is

it correctly identified exclusion

Commission has also recom-

straining the skills of new gradu-

dental services supported by

changing. Dentists have often

of dentistry from some of these

mended the introduction of a

ates during internships, rather

Medicare have already been

been conservative when it comes

structures as a core problem.

one-year dental internship, as

than expanding their skills. Price

successfully trialled for 132,000

well as additional funding for

water house Coopers, commis-

Australians with chronic dis-

established

to adapting new technologies

55 per cent of Australians, in

but now the age structure is shift-

The Commission’s interim

oral health promotion and the

sioned by the Commission to

ease, through the Enhanced Pri-

ing in many countries, making

recommendations for the entire

expansion of school dental

cost Denticare, makes special

mary Care Program established

way for a new generation of

health system range from Option

services. The Association for

note in its document that Profes-

in November 2007. We suggest

dentists who have grown up with

A, which proposes minimal

the Promotion of Oral Health

sor John Spencer of the Univer-

progressive expansion of current

Internet technologies & are open

change, to a contentious Option

has long sought internships

sity of Adelaide recommended

dental Medicare arrangements

to their many opportunities. With

eventually to include the entire

our new website & the DT Study

population. This could be con-

Club online education platform,

The sunny side of life

verted to Option C–Denticare

both successfully launched in

but only if the rest of the Aus-

early March, Dental Tribune is

tralian health-care system is

striving to take the lead. On these

similarly modified. We are en-

platforms, we do not only offer

couraged by the Commission’s

news that will help you to stay

approach and hope it modifies

ahead in the profession but also

its recommendations in accor-

a number of tools that will give

dance with our suggestions. DT

you the chance to interact with
colleagues and international
experts. We invite you to join us
in this endeavour. DT
Daniel Zimmermann
Group Editor
Dental Tribune International

Contact Info
Hans Zoellner is Chair of the Association for the Promotion of Oral
Health based in Sydney in
Australia. He can be contacted at
h.zoellner@usyd.edu.au.

[7] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 7

DeNtal tribuNe | July-September, 2009

education

Dental Tribune International: A global approach to dental media

Claudia Salwiczek
Editor DTI

LEIP ZIG, Germany: In the last
5 years, the Dental Tribune International (DTI) media group has
grown from a rather small endeavour to a significant global
publishing network. Publishers
and editors in more than 20
countries now deliver the latest
news & trends in dentistry
to over 600,000 professionals
worldwide. At present, Dental
Tribune

International—with

head quarters in Leipzig, New
York & Hong Kong—has a worldwide network of licensed publishing houses in 23 countries.
Local issues of DTI publications
are currently available in all
relevant

markets,

including

Germany, the UK, Italy, Russia,
China, Japan, the US and—new
this year—France and India.
With their numerous publications magazines, newspapers
and handbooks—the group provides essential dental media as
a reliable & easy-to-read source
for current dental news and research. The DTI flagship publication Dental Tribune is the first
worldwide newspaper aimed at
dentists in private practice and
published in the local language
of the country in which it appears. As the official media partner of the World Dental Federation (FDI), the Asia Pacific Dental
Federation (APDF) & the Latin
American Dental Federation
(FOLA), Dental Tribune keeps
its members abreast of the
newest trends & developments
in

dentistry.

The

specialist

magazines—cosmetic dentistry,
implants, ortho, roots & laser—
present the most significant
international developments &
clinical experiences to practitioners & specialists around the
world. The high gloss English
language magazines are published four times a year, sent
to a database of 50,000 dentists
worldwide & distributed at all

major international congresses

specialty articles, clinical stud-

While DTI’s print sector is

a clear, concise design & prima-

& exhibitions.

ies, research news, interdis-

showing sustainable growth, the

rily focuses on news in dentistry

ciplinary concepts, case reports,

company recently expanded its

with regard to science, politics

While each publication is

industry reports, reviews (meet-

Web presence. The revamped

and the industry. The site is

supported by a distinguished

ings, products, etc.), and lifestyle

website

www.dental-tribune.

currently available in English

international advisory board,

articles. Dental professionals

com and the DT Study Club, a

and German. Additional web-

the magazines are also the

from around the world are in-

worldwide online platform for

sites for the more than 25 local

official publications of various

vited to submit their manuscripts

advanced training, were intro-

editions in different languages

renowned academies and asso-

for publication, which are then

duced to the public at this year’s

are under development. DT

ciations. The content of the

reviewed by the respective advi-

International Dental Show in

magazines is a combination of

sory boards.

Cologne, Germany. The site has

[8] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:47 PM Page 8

8

DeNtal tribuNe | July-September, 2009

interview

“The multiple applications of lasers are only
going to expand in the future”

the tip, allows the operator to
finesse ablation rates to create
very smooth contours.
The final concept is the

Interview with Graeme Milicich, New Zealand

clinically observable ablation
conventional rotary instrumen-

continue to improve. For new

hurdle a dentist faces when

threshold. Many new users

tation. For example, you could

diagnostic technology to be read-

beginning with laser is the differ-

focus on power settings and

run into problems with soft tissue

ily implemented in general

ence between rotary instru-

how far the tip should be from

contours or bone levels associ-

practice, it has to be both cost

mentation and lasers. When

the surface, depending on what

ated with a deep cavity while

effective and time efficient.

this is understood, a new laser

they want to do. Absolute dis-

dentist can become competent in

tances in relation to operating

cutting tooth structure. With a
laser you can remove both

What are the chances of treating

a very short time. If these con-

parameters are impossible to

bone and soft tissue by simply

peri-implantitis with lasers?

cepts are not well taught, then

give because there are so many

changing a setting, and are

There are many case studies

the new user will become

variables involved, including

therefore able to complete the

showing excellent results when

frustrated and may fail to inte-

the tip being used, the state of

procedure in one appointment—

treating peri-implantitis with

grate their new laser into their

the tip, the air/water ratios,

something that cannot really

a laser. The laser’s use for

treatment regimes.

and the surface being ablated.

be done with a high-speed

debridement and disinfection

drill. Generally speaking, what

gives the competent clinician

The first concept is that

tooth, it reaches a point where

Lasers have been used in differ-

can be done with a drill, scalpel,

a tool that previously wasn’t

lasers are end cutting. We have

the operator can begin to see

ent medical fields for many

or bone bur can also be done

available. The laser is safe to

all become very competent

the commencement of ablation.

years and have revolutionised

with a laser. Additionally, many

use around implants with little

using rotary instrumentation

This then gives a reference

many treatments, notably eye

patients have a fear of dentistry

risk of damage to the implant.

and

reflex

maximum operating distance in

surgery and hair removal. The

based on the sounds and vibra-

Personally, I have only treated

motions as a result. The natural

relation to the current settings

technology is also an established

tions associated with rotary

one case of peri-implantitis so

tendency is to apply these

and tip being used. New users

aspect of modern dentistry

instruments. These sensations

far, and it was a complete

‘reflexes’ when using a laser

are taught to start out of focus

and is widely used in Europe

do not occur with the laser,

success.

and this leads to frustration

and move towards the tooth u

and the USA. DTI editor Anke

meaning

for the new user. When using

ntil the clinically observable

Schiemann had a chance to

treatment much more accept-

The use of laser in fields like

a high-speed bur, we tend to

ablation threshold is reached.

speak

able.

endodontics or periodontology

move the bur laterally to extend

This distance can range over

is highly controversial. What are

a cut. This does not work with

several millimetres, depending

Graeme Milicich

to

Graeme

Milicich,

the

patients

find

who is a fellow, diplomate, and

As a tip is moved towards the

have

developed

founding board member of the

What role does laser fluorescence

the main issues here?

a laser because it is end cutting,

on the various parameters. Un-

World Congress of Minimally

detection currently play in the

Once again, competent laser

not side cutting. Therefore, the

derstanding the concept helps

Invasive Dentistry (WCMID),

prevention of oral diseases?

clinicians are ahead of the

operator needs to learn a new

new users avoid inadvertent

prior to the recent FDI Congress

With the advent of the KaVo

research in these fields. Clinical

way of pointing the laser directly

high fluence effects at the

in Stockholm in Sweden.

DIAGNOdent more than ten

results are being achieved that

in the direction where a cut

ablation surface.

years ago, the first general

are now only beginning to be

needs to be extended. Anyone

Anke Schiemann: In a nutshell,

dentistry application of laser

validated by research, until the

who has become competent in

There are two other issues

what are the benefits of using

fluorescence was introduced.

research results are available,

the use of air abrasion masters

that will be dealt with as separate

laser in clinical dentistry today?

Like with any new technology,

use of lasers in these fields is

the use of a laser very quickly

topics in the lecture in regard to

Graeme Milicich: Lasers have

it had to be understood first,

going to remain controversial

because the same concepts

ablation rates in enamel. This

many applications in clinical

in order to achieve the best

for many. Those that are using

apply to both technologies.

is the area that new users find

dentistry. My research in the last

results.

lasers & are observing the clini-

four years focused on the clinical

most frustrating, because they

cal outcomes, have little doubt

The second concept is that

tend to use rotary cutting move-

applications of hard tissue Er-

In order to provide patients

as to the efficacy of their treat-

slow is fast. Once again, this

ments

bium lasers. The broad range of

with accurate treatment re-

ments. Personally, I have been

concept is associated with our

device. Firstly, because laser

laser applications has benefits

commendations based on the

involved in research using the

reflex motions associated with

ablation is a non-contact tech-

for both the patient and the den-

results of early cavity detection,

Waterlase (Er,Cr: YSGG) in

using high-speed hand pieces.

nique, magnification is essential.

tist. Many hard and soft tissue

an understanding of minimally

endodontics. The ability for

We tend to use a fast painting

Secondly, enamel ablation rates

laser treatments are much less

invasive concepts is essential.

complete debridement of the

motion on the surface when

are related to the orientation

invasive compared with conven-

Otherwise, the profession can be

canals following conventional

contouring a cavity. Exactly the

of the long axis of the enamel

tional approaches. I do not

open to claims of over treatment.

canal preparation using radial

opposite applies when using a

prisms in relation to the plane

think there is another piece of

These charges often derive

firing tips in a non-ablative mode

laser. Ablation rates are stalled

of the ablation face. Ablation

technology in dentistry that has

from a lack of understanding

is significant, and addresses the

by this rapid painting motion,

rates are 40 per cent greater

the ability Erbium lasers have to

of the technology, its accurate

issues of air and fluid entrapment

and initially it requires a mental

when enamel prisms are ablated

treat soft tissue, bone, and tooth

application, and the concepts

at the apex that are associated

awareness to slow the motion

from their sides, rather then on

structure, simply by changing

and applications of minimally

with conventional techniques

of the tip, to allow ablation to

their ends. This requires an un-

laser-operating parameters.

invasive

used for final canal debridement

occur. As competence increases,

derstanding of the orientation

and rinsing.

this phenomenon is used to

of the long axis of enamel prisms

control ablation rates, without

in different surfaces of a tooth.

techniques.

Often,

astute clinicians are at the fore-

with

an

end-cutting

What is the advantage of lasers

front of the application of new

over rotary cutting instruments,

technology and techniques, and

In your FDI lecture you talked

having to alter laser settings,

The culmination of this under-

and are there limits to what a

the research literature struggles

about new concepts associated

by increasing or decreasing the

standing is epitomised in the

laser can do?

to keep up with the clinical pio-

with laser therapy. Can you give

motion of the tip.

time it takes a new user or a

Yes, there are some limitations

neers. This leads to a period

our readers a brief overview and

as to what can be done with a

with a shortage of validation for

explain these concepts?

laser, like the removal of metal

what eventually becomes a new

restorations and crowns. But if

competent laser clinician to
The third concept is focusing

cut a slot preparation, with a new

The most common complaint

and defocusing the beam, to

user often taking more than

and accepted standard of care.

from a new user is that it will

alter ablation rates without

three times as long to complete

you consider the totality of the

Further developments in the

not cut fast enough. The most

having to change power settings

the same procedure.

types of treatments offered by

field are occurring and, as they

significant contributor to slow

on the laser. This technique,

general dentists, these limitations are far less compared to

filter into general practice, the
standards of diagnosis will

ablation rates is the user, not the
technology. The single biggest

in combination with slowing
or speeding up the motion of

‡ DT page 9

[9] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:48 PM Page 9

DeNtal tribuNe | July-September, 2009

News & events

Stains mistaken as tooth decay British Asian
kids avoid
The research suggests that
stained teeth may result in
the dentist

International Dental
Events 2009

Penny Palmer
DT UK

9

dentists drilling unnecessarily.
LO NDON, UK : Stains on teeth

Children of Bangladeshi, Indian

July 2009

E-mail: annualsession@
ada.org
Web site: www.ada.org

are often mistaken for signs

Dr Robin Horton, from the

and Pakistani origin in the UK

of decay, according to new re-

Wayside Dental Practice in

visit the dentist less frequently

search. A study of 200 private

Harpenden in Hertfordshire,

than any other ethnic group,

dental patients in the UK found

who co-led the study, claimed

according to recent research.

that in over 60 % of cases, stains

that “traditional dental check-

Three-quarters of all children

August 2009

that were hard to remove were

ups have led to unnecessary

under 16 in England have

mistaken for decay. The stains

dental treatment for millions

been for a check-up in the last

were only identified using an

of patients.” The CrystalAir

year, but for all British Asian

advanced device that cleans

abrasion device blasts away

groups the statistics are low.

teeth with a blast of fine abrasive

dirt, debris and stains using a

The government claims that

particles.

narrow stream of aluminium

Bangladeshi children from de-

34th Annual AAED Meeting and
IFED 2009
Where: Las Vegas, NV, USA
Date: 02–05 August 2009
Tel.: +1 312 981 6770
E-mail: info@estheticacademy.org
Web site:www.estheticacademy.org

oxide particles propelled by

prived backgrounds, who often

September 2009

Dental researchers exam-

helium. It is used in conjunction

have a high amount of sugar

ined a particular ‘premolar’

with a laser probe that can

in their diet, are the worst

situated between the front and

detect deeply hidden decay by

affected. The Department of

back teeth and found signs of

shining a light beam through

Health is developing guidance

decay in 78 per cent of cases.

the tooth. The research found

notes for all Primary Care

Dentech China 2009
Where: Shanghai, China
Date: 28–31 October 2009
Tel: +86 21 6294 6966
E-mail: mail@showstar.net
Web site: www.dentech.com.cn

But 63 per cent of them turned

that using the two systems

Trusts, aiming to provide ideas

FDI Annual World Dental Congress
Singapore 2009
Where: Singapore, Singapore
Date: 02–05 September 2009
Tel.: +33 4 50 40 50 50
E-mail: congress@fdiworldental.org
Web site: www.fdiworldental.org

out to be false alarms when they

together was 70 % more accurate

on promoting oral health care

were examined again, using

in picking up decay than tradi-

to the British Asian community.

the CrystalAir abrasion device

tional techniques. DT

DT

World Congress on Preventive
Dentistry
Where: Phuket, Thailand
Date: 07–10 September 2009
Tel.: +1 703 548 0066
E-mail: research@iadr.org
Web site: www.iadr.com

BDTA Dental Showcase 2009
Where: Birmingham, UK
Date: 12–14 November 2009
Tel: +44 1494 782873
E-mail: admin@bdta.org.uk
Web site: www.dentalshowcase.com

instead of mirrors and scrapers.

Dental snapshots in 3-D

FAMDENT SHOW 2009
Where: New Delhi, India
Date: 24-26 July 2009
Web site:www.famdent.com

2009 China Dental Exhibition
International
Where: Tianjin, China
Date: 16–18 September 2009
Tel.: +86 10 6216 4099
E-mail: info@globalstar.org.cn
Web site: www.globalstar.org.cn

World Dental Show
Where: Mumbai/India
Date: 09–11 October 2009
Tel.: +91 22 26590001
Web site: www.wds.org.in
IDEM India 2009
Where: Mumbai, India
Date: 23–25 October 2009
Tel.: +49 221 821 3267
E-mail: idem-india@koelnmesse.de
Web site: www.idem-india.com

November 2009

FDI Continuing Dental Education
Programme
Where: India
Date: 21–22 November 2009
Contact: Dr. William Cheung
Email:wcheung@dentalmirror.com

Under contract by the German

taken in the patient’s mouth,”

Two camera optics provide the

dental company Hint-ELs, an

says Dr Peter Kühmstedt, Group

sensor chip with image informa-

expert team at the Fraunhofer

Manager for 3-D Measurement

tion from different measurement

Society in Jena, Germany, has

Technology at the Fraunhofer

perspectives. After the pixel-

developed a new optical digitisa-

Institute for Applied Optics

precise comparison of various

tion system that scans the oral

and

Engineering

camera images, the evaluation

cavity and captures 3-D data of

IOF. “After an all-around meas-

programme identifies any image

the teeth, using camera optics.

urement, it is even possible to

faults and removes them from

The system is designed to faci-

represent the complete jaw arch

the complete image.

litate the production of dental

as a virtual computer image.”

prostheses, in order to supersede

In order to obtain precise

Since patients are moving

the intricate and laborious route

results, the researchers have

while the images are being,

from bite impression and plaster

utilised fringe projections in

the researchers have ensured

mould to model scanning in

which a projector shines strips

that the process is quick. “The

dental laboratories.

of light on the tooth area to be

image

measured. From the phase-

measurement position is cap-

“The 3-D coordinates of the

shifted images, a evaluation

tured in less than 200 millisec-

tooth surface can be determined

software determines the geo-

onds,” explains Dr Kühmstedt. DT

on the basis of measurements

metric contour data of the tooth.

ADA 2009
Where: Honolulu, HI, USA
Date: 01–03 October 2009
Tel.: +1 312 440 2876

 DT page 8

becomes cost effective and will

increases, costs will decrease,

cations. If we look back over

laser out of the equation, it is

become a common part of gen-

making it more attractive to

60 years to the initial introduc-

very easy to visualise a laser

Recent research on shorter wave-

eral dentistry. The main issue is

more of the profession.

tion of the high-speed hand

in every practice in the near

length lasers or the so-called

that laser effects are frequency

piece, there was initial and sig-

future.

blue lasers has shown them to be

specific, & as applications de-

Do you expect lasers to be an

nificant resistance to the tech-

effective in diagnosing cancer

velop, this will lead to a plethora

essential part in every dental

nology, and it took over 10 years

Thank you very much for the

cells. With this in mind, how do

of technology that becomes

practice in 10 to 15 years?

before it was readily accepted

interview. DT

you see the use of the laser in

difficult for the clinician to

The multiple applications of

into general practice. Lasers

general dental practice develop-

incorporate into a practice. I

lasers are only going to expand in

have had a slower journey,

ing in the years to come?

envisage, in the near future,

the future. At the moment, the

mainly because of the need for

Many dentists focused on mini-

a diode-based laser that will

lasers with the most clinical ap-

advanced technology to make

mal intervention have embraced

have multiple, switchable fre-

plications

are

them more applicable in the field

laser fluorescence in the diagno-

quencies that will allow one unit

the Erbium family, and many

of dentistry and the associated

sis of demineralisation of tooth

to accomplish varied tasks that

dentists have embraced this

research & development costs

structure. With these new appli-

require different frequencies.

technology and are constantly

that are reflected in the price of

cations, such cancer screening

As uptake of laser technology

expanding its clinical appli-

lasers. Taking the cost of a

Precision

sequence

in

one

for

unit

CEDE 2009
Where: Poznan, Poland
Date: 24–26 September 2009
Tel.: +48 42 632 28 66
E-mail: cede@cede.pl
Web site: www.cede.pl
Dental Expo 2009
Where: Moscow, Russia
Date: 08–11 September 2009
Tel.: +7 495 155 7900
E-mail: info@dental-expo.ru
Web site: www.dental-expo.com

each

October 2009

SAAAD Aesthetic Dental Conference
Where: Kathmandu, Nepal
Date: 21–22 November 2009
Tel.: +977 142 425 64
Email: skoirala@wlink.com.np
ADF 2009
Where: Paris, France
Date: 24–28 November 2009
Tel.: +33 01 58 22 17 10
E-mail: adf@adf.asso.fr
Web site: www.adfcongres.com
Greater New York Dental Meeting
2009
Where: New York, NY, USA
Date: 27 Nov.–02 Dec. 2009
Tel.: +1 212 398 6922
E-mail: info@gnydm.com
Web site: www.gnydm.com DT

[10] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:48 PM Page 10

DeNtal tribuNe | July-September, 2009

10 Clinical

Solving esthetic dilemmas with direct
composite bonding

solution that can satisfy their
needs and desires. It has been
my experience that a non-threatening consultation approach
builds

By Bruce J. LeBlanc, DDS

tremendous

trust

of

nano-hybrid resin and bonded
to the adjacent teeth (Fig. 10).

As an old saying goes, “we often

The completed case satisfied

miss the forest for the trees.” In

the desires & needs of the patient

our practice, it is easy to get

within her existing financial

lost in the concept that we do

limitations.

veneers, crowns or whatever
Conservative

and lose our focus on the call

minimally

to help patients solve problems

invasive options using bleaching

that affect their comfort, esthet-

techniques to remove tooth

ics or function. These problems

discoloration combined with

can range in the effect they have

creative

on a patient’s daily life, from

techniques can create a variety

minor irritations to what I call

of solutions to the dental prob-

composite

bonding

dental disabilities. When a pa-

showing the present condition

Although there is an obvious

composite to be layered for

lems patients encounter. For

tient fractures a front tooth, the

and the outcomes of similar

financial reward to providing

color balance & reinforcement.

many patients experiencing fi-

effect includes an emotional

cases from other patients. The

treatment this way, the spiritual

component that can be disabling.

solution

rewards

Solutions we are able to offer
may be truly life changing.

nancial challenges in the present

from

A recall photo at 6 months

national economy, direct com-

composite restorations as well

providing such a service are

(Fig. 7) shows a very durable

posite dentistry can provide an

as a root canal for tooth #9.

of significant value to how we

esthetic result achieving proper

affordable solution that can

view ourselves in the work that

color matching of the centrals.

satisfy their needs and desires.

chosen

was

direct

we

receive

We approach these patients

My technique utilized a

we do. Notice in the picture

An emotionally disabled patient

with the concept of “How can

fourth generation multi-bottle

that we took at one year post

was now restored and excited

we help you?” using visual tools,

bonding agent that has provided

treatment (Fig. 3) the relaxed

about her smile.

including digital photography

me exceptional predictability

smile of the patient that indicates

and radiographs, to discover

and longevity over many years,

the emotional component of the

The final case was a seven-

dous trust with our patients as

problems

communicate

and without sensitivity issues.

disability has been resolved. We

teen year old patient with a

we communicate appropriately

solutions, & allowing patients

Micro- and nano-hybrid compos-

have not only restored her teeth,

retained deciduous tooth in

to them that we want to help

to choose what fits their socio-

ites offer the strength of hybrids

but her psyche as well. Very few

place of #10 (Fig. 8) that had min-

them make choices that serve

economic situation and needs.

while retaining a high gloss

professions have the ability to

imal root remaining and was

them best in solving their prob-

I have found this approach to

polished finish. Silicone polish-

impact their clients this way.

about to exfoliate. The patient

lem. As patient trust and satis-

be nonthreatening in a way

preferred not to do an implant

faction increases, so do the

that shares the responsibility

and crown, so with the abut-

financial and spiritual rewards

with the patients so that they

ment teeth being non carious, a

that we receive in return, which

own the outcome.

fixed bridge was unacceptable.

allows us to build a practice

The decision was made to re-

climate that is a joy to return

lab

place the primary exfoliated

to each day. DT

processed restorations done

tooth with a direct bonded

meticulously to generally have

pontic in place of #10 splinted

the highest potential for long-

to teeth 9 and 11. When the

evity of service, direct compos-

occlusion scheme is favorable

ites offer a tremendous service

and sufficient area of bonding

with sufficient longevity to be

can be gained on the virgin

and

Although

I

consider

It has been my experience
that a non-threatening consultation approach builds tremen-

About the author

of great value. Additionally,
because solutions can generally
be accomplished in one visit
with the most conservative tooth
preparations, patients consider
it an excellent choice.
For example, a college student had recently fallen and

ing points, abrasive discs and

The second case involved

abutment teeth, this solution

broken several upper incisors.

polishing brushes were used to

an emergency patient with a

can easily last for 10 years or

She was a very pretty girl who

properly shape and create a

fractured upper central incisor

longer. For this patient, that was

identified strongly with the ap-

highly polished surface. The

(Fig. 4). The incisal half of the

an exciting option that left

pearance of her smile. If you

unique aspect of completing a

tooth had broken clean in one

open the possibility of an implant

will notice in her pretreatment

case like this in one visit is the

piece and fit like a puzzle

and crown at a future date. The

smile picture (Fig. 1), there

reaction of the patient to have

perfectly back in place (Fig. 5).

tooth was extracted (Fig. 9) and

was a real strain in her face

such

Definitive treatment included

a direct bonded pontic was

that indicated the problem had

resolved so quickly.

root canal treatment with a

fabricated ety of solutions to

fiber post and core with the

the dental problems patients

a

traumatic

situation

become as much emotional
as it was physical (Fig. 2 is a

To walk into our office dis-

broken half of the tooth ce-

encounter. For many patients

pre-treatment close-up). With

abled as she was and leave

mented into place as though it

experiencing financial chal-

the clinical photographs, we

restored is an amazing accom-

was veneer (Fig. 6). Minimal

lenges in the present national

were able to discuss solution

plishment to the patient that

preparation of the facial allowed

economy, direct composite den-

options

creates tremendous gratitude.

a direct veneer of nanofilled

tistry can provide an affordable

in

consultation

by

Dr. Bruce J. LeBlanc provides
seminars nationally on adhesive
dental techniques. His practice
offers adhesive and cosmetic solutions that minimize tooth removal.
He is a product consultant to dental
manufacturers and has published
internationally on his adhesive
technique. He is course director
and presenter for “Mastering
Posterior Esthetics” at LSU School
of Dentistry as well as a presenter
for the LSU Cosmetic Continuum.
He is also the president of the F.
Harold Wirth Foundation established at LSU School of Dentistry
to enhance the dentist/patient
relationship and the enjoyment
of practicing dentistry. LeBlanc
may be reached via e-mail at
bjleb@cox.net.

[11] => DTAP0109_01-02_TitleNews

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[12] => DTAP0109_01-02_TitleNews

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DeNtal tribuNe | July-September, 2009

12 Practice Management

Treatment acceptance: could
have, should have, would have

verbalize those desires without

pled with kind words can

prompting. Others have con-

build trust and respect.

cerns, but don’t want to appear

•

Explain alternatives to the

foolish in raising them. Yet, if

treatment. Make sure the

new and existing patients feel

benefits and the possible

It’s a matter of trust

for you to be frank about what,

that the dentist and dental team

risks to the procedures are

Certainly, patients trust you

if anything, they might be faced

are sincerely interested in their

understood. Informed con-

When it comes to treatment ac-

enough to come in for routine

with as a result of the treatment.

needs, wants and concerns, they

sent in writing is necessary

ceptance — or lack thereof — it

appointments. But when the

If they are given advantages

are far more likely to be open to

when there are risks and

seems as though a lot of time

patient needs or wants care

and disadvantages, research

the treatment recommended.

when the outcome could be

and energy are wasted on that fa-

that goes beyond “routine” pro-

shows that patients are more

miliar trio “could have, should

cedures, have you and your

willing to trust you to deliver

have and would have.” You

team instilled in the patient the

their care. Patients always feel

Encouraging
acceptance

spend hours analyzing how

confi- dence, the dental educa-

better when they know the

Follow these steps to set the

Sit at the same level as the

things could have been if you had

tion and the necessary trust in

benefits and risks of proposed

tone

patient and lean slightly

just used a different approach.

you and your practice overall

treatment.

acceptance.

How things should have been

for him or her to accept the

if you had just taken more time

treatment recommended?

By Sally McKenzie, CMC

patient

•

Look the patient in the eye
when discussing treatment.

treatment

forward to show interest
and care. You will be able to

Always speak at the patients’
level of understanding.

to educate the patient on why

for

less than favorable.

•

Create a comfortable, non-

listen to and observe the

rushed environment when

patient’s
readily.

response

more

the treatment was necessary.

In some cases, patients are

Jargon and “$10 words” can

explaining treatment. Don’t

How things would have been if

motivated to pursue treatment

confuse patients and make them

have the schedule booked

you had listened more carefully

merely because they seldom

uncomfortable because they

so tight that you are perceived

understanding as the patient

to the patient.

question

don’t understand, but they likely

as being in a rush. Patients

responds to the presentation.

won’t ask you what you mean.

need to feel that they are

This is proof to the patient

important and worthy of your

that you are truly listening

time.

to each word said.

recommendations

from their health care providers.
Oftentimes, dental teams

But those patients are growing

mistakenly view the treatment

fewer and farther between each

presentation as a one-time event

year.

Exhibit clear confidence in
your recommended course of
treatment.

•

that is a makeit- or-break-it

Explain in simple language

•

•

Smile and nod your head in

Never turn away from the

the reasons the procedures

patient

while

she/he

is

situation. You either win or you

Most patients today base

A personal testimonial about

are necessary. Choose lan-

speaking. Not only is this

lose based on that 15 minute

major decisions, such as exten-

recent treatment for another

guage that fits the patients

rude, but it also shows that

song and dance. In reality,

sive dental treatment, on multi-

patient and the results obtained,

educational level of under-

you are not listening to what

patient treatment acceptance

ple factors: full comprehension

for example, underscores that

standing and speak slowly,

the patient is telling you.

begins long before you sit across

of the need for treatment; the

sense of security. It demonstrates

using pictures to illustrate.

from him or her eager to present

importance of the procedure to

that you have no doubt that

the best that your dentistry has

them in terms of quality of life,

to offer. Consider our patient,

esthetics or health; possible

Mary, who goes to Dr. Smith’s

Explain the steps of the

Certainly, presenting treat-

you will get a good result for this

procedures and how many

ment to patients requires skill

patient.

appointments and how long

and understanding of patients’

•

“don’t make the patient feel that
his mouth is a mess”

office.
“Dr. Smith’s office is great
for cleanings and that, but he

needs. Many people learn these
skills by trial and error, which
can be quite costly. If treatment
acceptance is a struggle among
either new or existing patients,
or both, it’s time to find out

always seems so rushed. He
Be aware of the perception of
“fairness.”

each appointment will take.

exactly

Explain to the patient how

system is breaking down. DT

tive procedure; and how they

Many issues having to do with

you will make her/him com-

want to ask about veneers, but

feel

trust are linked to the patients’

fortable during treatment

I never feel like I should bother

a whole.

perception of the value they

and what options are avail-

are receiving. Studies show that

able, such as anesthetic.

takes a quick look at my teeth

ramifications if they choose to

after the hygienist cleans them

procrastinate or elect an alterna-

and sends me on my way. I

him with questions,” Mary says.
Dr. Smith, meanwhile, is

about

the

practice

as

R ecommendation
acceptance

patients avoid dental treatment

•

due to cost more than pain.

detemine if she/he has any

When it comes to treatment

Yet, if they feel that the costs

false ideas about treatment.

accept recommended treatment.

presentation, we find that most

measure up to the service

(Many patients still think

Yet he gives little thought to

dentists and teams understand

received, there is no complaint.

that root canal therapy in-

the manner in which he and

the fundamentals of the con-

Many patients will not question

volves removing the roots.)

his team build or erode, the foun-

cept,

that

fees if the practice has demon-

Use educational tools, such

dation upon which successful

patients base their recommen-

strated that they can deliver

as chairside videos or other

treatment acceptance is based.

dation acceptance on multiple

superior service. From the first

visual aids. When using

factors.

phone call to dismissal, consis-

video or other educational

tently demonstrate the “value”

aids, summarize what the pa-

for services that the patient

tient has viewed and ask if

is receiving.

there are any areas that

they

forget

In Mary’s case, Dr. Smith
doesn’t realize that he is under-

In addition to always treating

mining Mary’s trust in his care.

every patient as if she or he is

Mary will be far less likely to

the most important person in

proceed with recommended

the room with you, and always

treatment because Dr. Smith

taking the time to solicit ques-

has created the impression that

tions from the patient, consider

he is always in hurry to get to

need further explanation.
Many patients today expect more
than just a routine visit.

•

this

critical

About the author

Ask the patient questions to

befuddled when patients don’t

but

where

Sally McKenzie is CEO of McKenzie
Management, which provides
success-proven management solutions to dentistry nationwide. She
is also editor of The Dentist’s
Network Newsletter, www.thedentistsnetwork.net; the e-Management Newsletter from www.
mckenziemgmt.com; & The New
Dentist™ magazine, www.thenewdentist.net. She can be reached at
(877) 777.6151 or sallymck@mckenziemgmt.com.

Be empathetic to the patient’s
concerns about the condition

Fight oral cancer!

They are smart, savvy and are

of the teeth. Don’t make the

a few other ways in which you

much more aware of recent

patient feel that his/her

the next patient, which makes

build trust with every patient

advances in dental care and

mouth is a “mess.” Patients

her feel uneasy and unimpor-

and at every opportunity.

treatment options than patients

who have postponed dental

20 years ago. Numerous patients

care are often embarrassed

Did you know that dentists are one
of the most trusted professionals to
give advice? Prove to your patients
just how committed you are to
fighting this disease by signing up
to be listed at www.oralcancerselfexam.com. The new Web site
was developed for consumers in
order to show them how to do selfexaminations for oral cancer.

tant. Worse yet, Mary is interested in a certain procedure

Be candid. Most patients are

would love to change something

and don’t want to be per-

but doesn’t even feel comfortable asking about it.

aware of some general risks in
treatment so they are waiting

about their smile or improve
their oral health, but few will

ceived as neglectful or hopeless. Encouragement cou-

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[14] => DTAP0109_01-02_TitleNews

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DeNtal tribuNe | July-September, 2009

14 interview

“Amalgam separators must be mandatory”

travels two or three times around

Interview with Assoc. P rof. Lars Hylander, Uppsala University, Sweden

One of the things that could be

the earth before it settles down.
done by practically all countries

Severe mercury pollution oc-

made to introduce regulations,

mittee on Emerging and Newly

is simply to remove amalgam

curred in Minamata in Japan,

but they haven’t been successful

Identified Health Risks—work-

fillings before bodies are burned

in the 1960s. Unfortunately, the

so far.

ing on these matters and, in my

in crematoria. But there are also

opinion, both did a very poor

alternatives, such as to freeze-

children were the ones that

Prof. Lars Hylander

Mercury has been used for

were the most affected. Many

You recommend amalgam sepa-

job. They looked at the situation

dry bodies and then collect the

were born crippled, blind, deaf,

rators, but only a few countries

in Sweden, where amalgam

fillings. The mercury-containing

or paralysed, or had spasmodic

in Europe require their instal-

separators are practically mand-

remains should be put in con-

cramps. A special hospital was

lation. Should there be more

atory, and assumed this was

tainers and securely stored,

built for the victims of this disas-

political pressure to make this

the case for all countries in

preferably in deep bedrock

ter. I met many of those patients

technology mandatory for dental

the European Union.

repositories, such as abandoned

during my time in Japan. Some

offices?

of them have always been in

It must be mandatory, otherwise

The conclusion was that no

suggested because these mines

a wheelchair, because they

people will not use it. I also

further legislation is needed.

typically have no humidity, an

were born paralysed owing to

recommend including the costs

I was astonished when I saw

environment

the effects of methylmercury.

for amalgam separators and

that they made this decision

corrosion. However, their geo-

the cleaning costs at crematoria

without any proper scientific

logic characteristic does not

millennia in many applications,

mines. Salt mines have been

that

excludes

primarily in artisanal mining

How much does amalgam con-

into the price for the amalgam

evaluation. Even the authorities

gua-rantee

& as an electrode in the chlor–

tribute to the entire amount of

fillings. In Sweden, for example,

here in Sweden got quite upset

stability. The abandoned mer-

alkali industry. Today, for many

mercury that is released into the

the taxpayers pay for the clean-

about it, but their protest was

cury mine in Spain is a safer

people exposure to mercury

environment?

ing, and though we are quite a

not given consideration.

option for a sound, final disposal.

results from their amalgam fill-

About 300–500 kilograms of

ings. With new regulations on

mercury from dental amalgam

amalgam use in Europe and the

are released in Sweden per year.

United States, environmental

Exact numbers are hard to get,

aspects of the toxic metal have to

because a large amount of mer-

be taken into consideration. DTI

cury from fillings goes into the

rich country, we find it too

The Federal Drug Administration

Others say that preventive meas-

editors Daniel Zimmermann

air from crematoria and mixes

expensive to put cleaning de-

in the United States has recently

ures are the solution because the

and Claudia Salwiczek spoke

up with mercury that is released

vices on all crematoria. This

changed

better oral health status is, the

with Lars Hylander, Associate

into the air from other countries.

is not very responsible. Many

the health effects of dental

fewer fillings will be needed.

Professor at the University of

Emissions from Sweden, for

varieties of amalgam- or mer-

amalgam. Do you think that

That’s true. I remember when I

Uppsala, Sweden, about how

example, go to Finland & Russia,

cury-free fillings are available

this will have an impact on

went to the dentist for the first

today, and they are more expen-

how we look at the whole

time. All doctors came to see me,

sive than amalgam, if aesthe-

amalgam issue?

because it was rare that a seven-

tical aspects, the risk of cracked

Definitely. I guess that with

year-old had teeth with no caries.

teeth in large amalgam fillings

such a statement, the American

Nowadays, the situation is the

and environmental costs are

Dental

cannot

opposite. I have no statistics for

not considered.

continue with their pro-amal-

seven-year-olds today, but it is

gam attitude, which they have

known that in the adolescents

Why isn’t this topic on the political

proclaimed for more than 100

group (18–19 years) about 30–45

agenda?

years. They didn’t even recom-

per cent have no caries at all. Pre-

There is much lobbying to avoid

mend

separators,

ventive measures in Sweden

bringing this topic into the

but only screens on the chair

have been quite successful, but

political agenda. For example,

side that collect particles larger

we are experiencing a down-

Prof. Hylander demonstrates an amalgam separator, Photo: DTI.

I recently received a statement

than 0.6 or 0.7 mm. However,

ward trend again. The amount

amalgam waste affects the envi-

and we get many emissions

from the Swedish authorities

due to the high-speed drills

of

ronment and how it could be

from Germany.

stating that they will not admit

we use today, most of the parti-

increasing

to health problems caused by

cles are much smaller than

drinks, sweets, and a lack of

Nowadays, dental offices and

amalgam, because they fear

that and settle in the tubing

regular meals. There should

DTI: Dentists have been using

clinics are the top point contri-

that people will start to claim

or the sewage system.

clearly be more emphasis on

amalgam as filling material for

butors to mercury pollution

reimbursements from the gov-

prevented.

a long time, but it seems that they
do not know that much about
its effects on the environment.
Prof. Hylander: The problem

their

long-term

“Nowadays, dental offices and clinics are the top point
contributors to mercury pollution of water.”

their

position

Association

amalgam

on

decay

in

youngsters

because

of

is
soft

preventive measures in develo-

“...mercury that is released into the air typically travels
two or three times around the earth before it settles down.”

ping countries, because people
there are more exposed to soft
drinks and sweets advertising.

What

with amalgam is that the meta-

should

we focus on:

llic mercury, which is part of

of water. Previously, the main

ernment, because they once

Norway enforced a ban on amal-

preventive measures or the use

the filling, is transformed into

sources were the chlor-alkali

said it was safe. I was also quite

gam at the beginning of this year.

of separators?

methylmercury by bacteria in

industry & some other industries

disappointed by the European

Do you think that more countries

The formula is quite simple: stop

water. Methylmercury is a toxic

that use mercury in one form or

Commission hearing last year

are to follow?

using amalgam, start using

substance that bioaccumulates

another. On a global scale, fossil

on how to handle amalgam

Yes,

will

amalgam separators, and put

in fish, especially those we like

fuel is the main contributor.

and whether it should be man-

follow. The question is, when? It

more efforts into preventive

to eat such as tuna. Once the mer-

There are ways to limit the

datory for all member states

is not reasonable to allow the

measures.

cury is in our system, it can be

mercury emissions from crema-

to have amalgam separators.

emission of such a toxic metal

transported to the brain, where

toria & fossil fuel, but countries

There were two different com-

that will always remain in the

Thank you very much for the

it can result in mental conditions,

like China or even the United

mittees—the Scientific Commit-

environment. To give you an

interview. DT

especially in children, whose

States find them much too expen-

tee on Health and Environmental

example,

brains are still in development.

sive. Various attempts have been

Risks and the Scientific Com-

released into the air typically

more

countries

mercury

that

is

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DeNtal tribuNe | July-September, 2009

Clinical 15

“The tooth’s response to bleaching is individualistic and
can only be determined by starting treatment”
Interview with P rof. Van B. Haywood, USA

that is quite open to molecules
of a certain size. Once it is under-

Patients must be counselled

stood how easily the peroxide

on the frequency of application

penetrates the tooth, the result-

and the appropriate concentra-

ant pulpal response of sensitivity

tion of bleaching agent. They

may be considered a reversible

need to be aware that applica-

pulpitis.

tions more than once a day or
higher concentrations of blea-

Can bleaching sensitivity cause

ching agent can increase the

damage in the long term?

likelihood of sensitivity. Patients

Although penetration of perox-

with pre-existing tooth sensi-

ide through the tooth to the pulp

tivity must be cautioned that

can produce sensitivity, the pulp

increased sensitivity, albeit tran-

remains healthy and the sensitiv-

sitory, may occur & that manage-

Dr Van B. Haywood is a Professor

ity is completely reversible when

ment of the sensitivity may

in the Department of Oral Reha-

treatment is terminated. No

require a longer time span for

bilitation in the School of Den-

long-term sequelae remain after

bleaching as a result of the addi-

tistry at the Medical College of

the sensitivity has abated.

tional time to treat the sensitivity.

Prof. Van B. Haywood

Georgia. In 1989, Dr Haywood

What treatment objectives are

& Prof. Harald Heymann co-

Research has shown that pa-

authored the first article in

tients have tooth sensitivity even

available?

the world on nightguard vital

when using non-bleaching agent

No bleaching treatment should

bleaching (NGVB). He has com-

in a tray, or just wearing a tray

be initiated without a proper

pleted over 90 publications on

alone. Hence, it is not possible to

dental examination, which gen-

the NGVB technique and the

have all patients be sensitivity

erally includes radiographs and

initiation. Wearing the tray alone

show reduction in sensitivity,

topic of bleaching & aesthetics,

free because of the mechanical

determines a diagnosis for the

or with potassium nitrate before

and greater effect develops with

including the first papers on

forces of the materials and occlu-

cause of the discolouration. The

bleaching can also minimise pa-

continued use. The patient

treatment of bleaching sensitiv-

sion, & some plans must be made

examination should include an

tients’ perceived pain responses.

should be advised in accordance

ity with potassium nitrate, direct

to address potential problems.

explanation to the patient of all

thermoplastic tray fabrication,

Sensitivity avoidance and treatment involves potassium nitrate in a variety
of delivery vehicles and techniques. (DTI/Image courtesy of Prof. Van
B. Haywood)

with the manufacturer’s instruc-

their treatment options, consid-

How effective are the desensi-

tions, typically to be applied by

extended treatment of tetracy-

How can bleaching sensitivity

ering existing restorations—

tising toothpastes available on

brushing twice daily as a part of

cline stained teeth and primary

be prevented?

which will not bleach—and other

the market & how do they work?

the regular oral hygiene regime.

teeth bleaching. Dental Tribune

“No bleaching treatment should be initiated
without a proper dental examination”

Editor Claudia Salwiczek spoke
with Dr Haywood about bleaching sensitivity.

What is your recommendation
to dentists performing bleaching
procedures?
The biggest challenge in aes-

Claudia Salwiczek: Tooth sensi-

Reliable methods for complete

aesthetic needs. It should be

The most common, profession-

thetic dentistry is to maintain the

tivity is the single most significant

prevention have not yet been

noted that there are several

ally endorsed, self-applied ap-

ethics of the dental profession,

deterrent to the very popular

established. However, a history

causes of discolouration (ab-

proach to treating sensitive

and to place patient care ahead

dental bleaching. How well do we

of sensitive teeth & the patient’s

scessed teeth, caries, internal or

teeth is the use of desensitising

of financial gain. Patients should

understand this condition?

response during examination

external resorption) for which

toothpastes,

contain

be presented with all options

P rof. Haywood: Tooth sensitiv-

can be reasonable predictors.

bleaching will mask the indica-

potassium salts (nitrate or chlo-

for treatment, including the

ity is the most common side effect

The tooth’s response to bleach-

tion of pathology but not resolve

ride). Potassium ions pass easily

cost/benefit ratio and the risk/

of bleaching. Whereas all of the

ing is individualistic & can only

the problem. Other treatments

through the enamel and dentine

benefit ratio, based on research

typical causes of dentine hyper-

be determined by starting treat-

will be required before or instead

to the pulp in a matter of minutes.

where possible. Conservative

sensitivity generally involve the

ment. Most reports of sensitivity

of bleaching.

Potassium is believed to act by

treatment that preserves enamel

hydrodynamic theory of fluid

occur within the first two weeks.

interfering with the transmi-

and tooth structure is always

flow, the sensitivity associated

Often, these report a single day

Sensitivity may be treated

ssion of the stimuli, by depolaris-

preferred. My credo, which has

with bleaching seems to have

of sensitivity, followed by no

actively or passively, but at-home

ing the nerve surrounding the

worked well for me AND my

a different origin. In bleaching

problems the next day.

treatment is most favourable.

odontoblast process. Most potas-

patients in the past, is: “Do unto

Passive treatment involves re-

sium-base desensitising tooth-

others as you would have them

sensitivity

ducing the frequency of applica-

pastes also contain fluoride for

do unto you.”

no cracks, exposed dentine, or

mainly depends on inherent

tion or the duration of treatment,

cavity protection, and some

deep restorations, but following

patient sensitivity, frequency of

or interrupting continuous appli-

offer an array of flavours and

a few days of bleaching, the tooth

application and concentration

cation. Active treatment involves

the whitening, tartar-control,

may experience severe sensitiv-

of the material, a history of

using a material with potassium

and baking soda benefits found

ity. This seems to be related to

sensitivity should be determined

nitrate in the product, applying

in most regular toothpastes.

the easy passage of hydrogen

during examination. Existing

potassium nitrate instead of

peroxide and urea through the

sensitivity can be determined

bleaching material in the tray

In clinical trials, the de-

intact enamel and dentine in the

from the preoperative exam by

for 10 to 30 minutes when

sensitising effect of brushing

interstitial spaces into the pulp

simple methods of explorer

needed, and pre-brushing with

with anti-sensitivity tooth-paste

within 5 to 15 minutes. The tooth

contact with areas on the teeth

potassium nitrate toothpaste for

generally takes about two weeks

is a semi-permeable membrane

or air blown on the teeth.

two weeks before bleaching

of application twice per day to

situations, the teeth may be
in an excellent condition, with

Because

tooth

which

Thank you very much for the
interview. DT
Editorial note: This interview was
supported by an educational grant
from GlaxoSmithKline. For more
information on sensitivity please
read Pashley DH, Tay FR, Haywood
VB, Collins MA, Drisko CL: Dentin
Hypersensitivity: Consensus-Based
Recommendations for the Diagnosis
& Management of Dentin Hypersensitivity. Inside Dentistry, October
2008, Vol. 4, N0. 9 (Special Issue).

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DeNtal tribuNe | July-September, 2009

16 Clinical

Dentine hypersensitivity
From diagnosis to treatment

All available treatments appear
to work; however, in recommending a treatment to patients,
dental professionals should consider the needs of the individual,
in order to maximise compliance.

Prof. Hien Ngo
Singapore

for the patients and can lead to

tains space around the crystals

hygiene and subsequent plaque

Nerve desensitisation

modification of behaviour, such

and prisms (Fig. 3), which is

accumulation on root surfaces.

There is much evidence to indi-

Dentine hypersensitivity is de-

as avoiding brushing of the

normally filled with organic

It could be possible that stagnant

cate that products containing po -

fined as pain arising from

affected areas, which in turn has

materials.

plaque leads to demineralisation

tassium nitrate are effective in

exposed dentine in response to

a negative impact on oral health.

hypersensitivity caused by vital

with a smear layer and opening

controlling dentine hypersensi-

bleac-hing, the organic plugs

of dentinal tubules. These early

tivity. Tarbet et al. (1980; 1981;

thermal, chemical, tactile or

the

case

osmotic stimuli, which cannot be

Dentine is a very permeable

are removed by the hydrogen

demineralised areas tend to be

1982) demonstrated in well-con-

explained as arising from any

tissue, it contains a dense net-

peroxide, exposing the underly-

softer and more discoloured than

ducted clinical trials that, with

other form of dental defect or

work of dentinal tubules, which

ing dentine to external stimuli.

the surrounding areas (Fig. 4).

daily use, a toothpaste contain-

pathology (Addy and Urquart

are essentially highways con-

Thus far, three theories for den-

1995). Such hypersensitivity is

necting the external environ-

tine hypersensitivity have been

common: in a 1987 survey of a

ment to the pulp. In a young

proposed:

group of patients in the UK,

person, odontoblasts send pro-

ing 5 per cent potassium nitrate is

Treatment options

effective in desensitising for up to

The treatment options for den-

four weeks and that potassium

tine hypersensitivity can be

nitrate does not induce changes

broadly grouped into the desen-

in the pulp. It was suggested that

Orchardson found that 74 per

cesses deep into tubules (Fig. 1),

Odontoblast transduction theory

cent suffered from some form of

with the remaining space filled

When odontoblast processes

sitisation of nerve endings and

the potassium (K+) ion blocks

hypersensitivity. He also noted

with extracellular fluid. A pre-

are stimulated by chemical and

the plugging or covering of the

nerve impulses by interfering

a very early peak of prevalence

condition of dentine hypersensi-

mechanical means neurotrans-

dentinal tubules. These options

with the sodium (Na+) pump and

between 20 and 25 years. How-

tivity is the exposure of dentinal

mitters are released, which

ever, Addy (1992) reported a peak

tubules,

patent

transmit these signals to nerve

Mode of action

Active ingredient

Mode of application

between 20 and 40 years, and

orifices (Fig. 2), to the oral

endings residing in the pulp.

Nerve desensitisation

Potassium nitrate

Self-application, daily use

Fisher (1992) reported a peak

environment.

These neurotransmitters have

with

their

between 40 and 49. The teeth

not been identified; thus, the

Potassium oxalate
Dentine surface cover

Glass ionomer

Professional application

Dentine bonding agent

Professional application

Fluoride varnish

Professional application

CPP-ACP

Self-application, daily use

most commonly affected were

Dentine is normally covered

the canines and upper premo-

by enamel or cementum, which

lars, followed by the upper first

can be removed by attrition,

molars. It was also reported

abrasion or erosion. It can

Nerve endings are present in the

Plugging of

Minerals/Salts

that in patients with periodontal

also be removed by aggressive

dentinal tubules, so mechanical

dentinal tubules

Fluoride:

disease, molars were more

tooth brushing or root planing.

and chemical stimuli trigger the

Sodium fluoride,

frequently affected.

One

pulpal nerve fibres directly.

Stannous fluoride, MFP

Self-application, daily use

Strontium chloride

Self-application, daily use

can

explain

the

high

validity of this theory is in doubt.
Neural theory

incidence of sensitivity after
It has been suggested that the

periodontal treatment with ex-

Hydrodynamic theory

Ferrous oxide

Self-application, daily use

incidence of hypersensitivity

posed dentine as due to both

This theory was proposed by

TCP

Self-application, daily use

will

humans’

gingival recession and aggres-

Brannstrom and co-workers and

Protein precipitants

longevity increases and they re-

sive root planing. Another reason

is the most supported theory. The

Formaldehyde

Professional application

tain their teeth until ever more

for exposed dentine is a develop-

dentinal tubules are fluid filled

Glutaraldehyde

Professional application

advanced ages; however, this is

mental anomaly in the cervical

and when the fluid is disturbed by

Silver nitrate

Professional application

not supported by epidemiologi-

region when enamel and cemen-

thermal, physical and osmotic

Physical

cal studies. It is true that gingival

tum do not meet during the

changes on the surface of den-

Laser

recession and loss of cementum

development stage. However,

tine, the baroreceptors are stim-

are more common in older indi-

dentine hypersensitivity is often

ulated, which leads to discharge

viduals, but aged dentine is also

the result of a combination

of nerve endings. Accordingly,

with their relevant active ingre-

depolarisation of nerve cell

less permeable, owing to the

of the above factors.

dentine hypersensitivity can be

dients are listed in Table 1. The

walls.

treated by minimising move-

high prevalence of dentine hy-

increase

deposition of sclerotic & second-

Professional application

Table 1

ary dentine. Dentine hypersensi-

It is a common belief that

ment of intra-tubular fluid. Den-

persensitivity led to the develop-

In the case of potassium

tivity, while not a serious dental

enamel is an impermeable

tine hypersensitivity is multifac-

ment of a surprisingly large num-

oxalate, it is postulated that in

problem, can be an uncomfort-

tissue; however, a study of its

torial in nature. One factor that

ber of products designed to

addition to the effect of K+ there

able and unpleasant experience

microstructure shows that it con-

tends to stand out is poor oral

alleviate this clinical problem.

is also some plugging of the
dentine tubules with calcium
oxalate salt, which decreases
dentine’s permeability.
Nerve desensitisation works
best in patients with generalised,
mild to severe dentine hypersensitivity. As the active ingredient is
built into a toothpaste, compliance is normally high because no
extra step is added to the daily
oral-care routine.
Dentine surface cover
When dentine hypersensitivity is

Fig. 1: Odontoblast process in a dentinal tubule (the process is normally bathed in extracellular fluid).—Fig. 2: Dentine hypersensitivity can only occur
|when dentinal tubules are exposed to the external environment.

severe and localised, patients
may not be able to brush the

[17] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:48 PM Page 17

DeNtal tribuNe | July-September, 2009
affected

areas

well.

Clinical 17

important to protect these areas
temporarily with a physical
barrier, such as a varnish or
thin glass ionomer, in order to
desensitise and allow better
cleaning. This method should
also be combined with the use
of a product containing potassium nitrate.
The use of a dentine bonding
agent has been advocated, as it
can provide short-term relief, but
the seal provided by a dentine
bonding agent, especially the
single-bottle version, does not
last

long.

Dentine

bonding

Fig. 3: Enamel is composed of crystals organised into prisms. The arrows are pointing at the inter-prismatic space, which is normally sealed with organic
materials.—Fig. 4: Early demineralised cervical dentine due to poor oral hygiene and diet.

agents are not designed to be exposed to the oral environment

protective physical barrier over

hyde or glutaraldehyde should

ing toothpaste containing potas-

and should not be utilised in an

exposed dentine.

be done with caution, as these are

sium nitrate/potassium oxalate

strong tissue fixatives and much

as the active ingredient. Potas-

Plugging of dentinal tubules

safer alternatives for the treat-

sium nitrate, stannous fluoride

CPP-ACP-containing prod-

There is evidence to support

ment of dentine hypersensitivity

and strontium chloride are active

ucts, such as Tooth Mousse or

the use of the various active

are available.

ingredients specifically designed

MI Paste, are also good desensi-

ingredients listed under the

tisers. These products work

minerals/salts

instantly after direct application

off-label fashion.

for

dentine

hypersensitivity.

Conclusion

Only in severe and localised

Most of the products containing

Dentine hypersensitivity is a

cases should in-office-proce-

to the affected areas. The

these ingredients are for daily

common dental problem that

dures be used to complement at-

mechanism of action has not

home use, and compliance

can be managed successfully,

home treatment. DT

been elucidated, but it has

is thus an issue that clinicians

using a wide range of in-office

been suggested that the protein

will need to manage.

procedures & at-home products.

sub-heading.

When it is mild and generalised,

component of CPP-ACP, case
in phospho-peptide, forms a

The application of formalde-

the condition can be treated us-

About the author

Editorial note: This article is supported by an educational grant from
GlaxoSmithKline.

Prof. Hien Chi Ngo is an Associate
Professor in the Department of
Restorative Dentistry in the Faculty
of Dentistry at the National
University of Singapore. He can
be contacted at rsdhcn@nus.edu.sg.

[18] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:48 PM Page 18

DeNtal tribuNe | July-September, 2009

18 education

Ancient skeleton in India
bears evidence of leprosy

Alexander’s army had brought
leprosy back from its campaigns
in India.
Leprosy is still common in
many countries, especially in
temperate, tropical, and subtropical climates. India has the
largest number of leprosy pa-

middle-aged adult male skeleton

tients in the world. The number

demonstrating signs of leprosy

of new cases of leprosy recorded

in skeletal material, such as

by official services was 138,000

tooth loss and root exposure.

in 2007, but there are some two

Historians have long consid-

to three million people who

ered the Indian subcontinent to

have had to endure the disabili-

be the source of the leprosy that

ties caused by leprosy through-

was first reported in Europe in

out their lives.

the fourth century B.C., shortly
after the armies of Alexander
the Great returned from India.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects

The 4,000-year-old skeleton

almost 250,000 people world-

was found near Udaipur in north-

wide. It is not very contagious

western India. The authors say

and has a long incubation

their find confirms that a passage

period, which makes it difficult to

Anterior view and inferior view of the cranium demonstrating signs of leprosy. (DTI/Photo Robbins et al. PLoS ONE)

Claudia Salwiczek
DTI

been found in India and may

Professor Gwen Robbins, an an-

LEIP ZIG, Germany: The oldest

help unravel the myth of where

thropologist

known skeleton showing signs

the disease originated. In the

State University in the US, and

journal PLoS One, Assistant

researchers in India describe a

leprosy

has

recently

Appalachian

Anterior view of the mandible demonstrating root exposure, alveolar resorption,
ante-mortem tooth loss, & a small apical abscess at the left third premolar.
(DTI/Photo Robbins et al. PLoS ONE)

in the Atharva Veda, a set of San-

determine where or when the

skrit hymns written around 1550

disease was contracted.

B.C., indeed refers to leprosy.
The bacterium that causes lep-

Leprosy has two common

rosy seemed to have spread

forms, tuberculoid and leproma-

worldwide from a single clone,

tous. Both forms produce sores

biologists reported three years

on the skin, but the lepromatous

ago. But because of insufficient

form is the most severe, produc-

samples, they could not deter-

ing large, disfiguring nodules

mine whether the bacterium was

(lumps and bumps).

disseminated

when

modern

All forms of the disease even-

humans first left Africa about

tually cause peripheral neuro-

50,000 years ago or spread from

logical damage, which results in

India in more recent times.

sensory loss in the skin and muscle weakness. People with long-

Other biologists have con-

term leprosy may lose the use of

tended that because the bac-

their hands or feet, owing to re-

terium is not easily transmissi-

peated injury resulting from a

ble, requiring prolonged inti-

lack of sensation.

mate contact between people, it
would not have started to spread

Effective medications exist,

until around the third millen-

and isolation of victims in ‘leper

nium B.C., when people started

colonies’ is unnecessary. The

living in dense populations in

emergence of drug-resistant

cities and long-distance trade

Mycobacterium leprae and an

sprang up.

increased number of cases
worldwide have led to global

Dr Helen D. Donoghue, an

concern about this disease.

infectious disease specialist at
University College London, said
the finding was fascinating
and fits in with the theory that

Editorial note: For the original article, please go to: http://www.plos one
.org/article/info%3Adoi%2F10.1371
%2Fjournal. pone.0005669. DT

[19] => DTAP0109_01-02_TitleNews

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DeNtal tribuNe | July-September, 2009

trends & applications 19

The continous wave obturation technique
for enhanced precision

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

L. Stephen Buchanan
USA

binding

This single

CW hand plugger can be introduced,

the needle to reheat after being

can be coated with sealer and

down-pack stroke should take

and with pressure, the clinician

cooled by contact with the den-

moved in and out of the empty

Step 1: Down pack

1.5 to 3.5 seconds,

but never

should confirm that the apical mass

tine. After the 5-second pause,

backfilling space three to four

Once the cone fit has been ac-

more than 4 seconds for safety.

of gutta-percha has not dislodged,

with the needle lightly held in

times to ensure that the sealer

complished and radiographi-

The CW plugger will slow its api-

and that it has cooled and set. In

place, one of the handpiece

material coats the backfill space.

cally confirmed, the Continuous

cal movement & stop about 1 mm

medium & large canals, the plugger

toggle switches (back button for

The area left by the plugger will

Wave (CW) plugger that matches

short of the binding point. At this

should not be buried in the apical

medium speed, forward button

exactly match the shape of the

the gutta-percha cone is fitted in

point, any previously cleaned

mass of gutta-percha, as it will

for faster speed) should be acti-

backfill cone (Fig. 12). The cone

the canal. The tip should be fitted

lateral & accessory canals will

create a tubular space—the primary

vated in order to extrude the

can then be seared off at the orifice

within 5 mm from the canal

be filled. Firm apical pressure

cause of backfill voids. The canal

gutta-percha (Fig. 8).

level with the System-B/Elements

terminus and never closer than

should be maintained for a full 5-

is now ready for the backfill by

3 mm. The canal is dried and

second sustained push to take up

any means preferred. If post space

After the extruded material fills

measured one last time with

any shrinkage that might occur

is required, this has been achieved

the backfill space ahead of the

The rigid stainless-steel end of

feather-tipped GT Series X paper

upon cooling of the apical mass of

(Fig. 7). The backfill can be accom-

needle, the back pressure of the

the hand plugger can then be placed

points. The cone is trimmed to be

gutta-percha. The System-B/El-

plished using one of two methods:

extruded gutta-percha will move

against the gutta-percha and with

.5 mm short, coated with sealer,

ements unit will sound a click

a syringe-backfill technique, using

the needle back out of the canal.

a firm sustained pressure, the coro-

& cemented in the canal (Fig. 1).

signal 5 seconds after the switch

the extruder function of the System-

At this point, it is important that

nal mass can be condensed at the

is released (Figs. 3 & 4).

B/Elements unit or an optional

the clinician resist the temptation

orifice level. This technique is also

single-cone technique for backfill-

to pull the needle out of the canal.

ideal for removing voids created

ing medium and large canals.

The extruded gutta-percha should

during an extruder backfill. The

be allowed to back the needle out.

stop on the CW electric heat plugger

The cone can then be seared
at the orifice with the tip of the

point.

Step 2: Separation burst

unit electric heat plugger (Fig. 13).

pre-heated CW plugger at an an-

Still maintaining apical pres-

gle to the cone, and the butt end

sure, the button should again be

Step 3a: Syringe-backfill option

Care should be taken to allow

should simply be adjusted so that it

can then be removed. The larger

activated for a full 1 second in

The speed of extrusion is set on

approximately 5 to 10 seconds for

will reach beyond the existing void.

stainless-steel end of a CW hand

order to heat the plugger fully

the control panel of the System-

the needle to reach the orifice

The heated plugger can then be

plugger is used to compact the

(Fig. 5). When the button is

B/Elements unit. After pre-heat-

level (Fig. 9). Using the rigid stain-

thrust through the void, cooled for

softened gutta-percha at the

released, the clinician should

ing is completed (45 sec.), the

less-steel end of the appropriate

10 seconds, then removed so the

canal orifice (Fig. 2). The cold

pause for another full second

forward toggle switch on the

CW hand plugger, a very firm

backfill can be completed using the

CW electric heat plugger is

and then slowly withdraw the

handpiece is pressed until mate-

condensation push should be given

steps outlined above (Fig. 14).

pushed against the gutta-percha,

plugger (Fig. 6).

rial extrudes out of the needle tip

to the warm gutta-percha. A void

The opposing canal was filled

to prime the needle. The heated

of 4 mm can be eliminated if enough

with a GT Series X carrier-based

pressure is applied (Figs. 10 & 11).

obturation technique. DT

Step 3b: Single-cone backfill option (ideal for medium and large
canals)

Contact Info

then the heated plugger is driven
smoothly through the gutta-

After removal of the CW plugger,

needle can then be placed into

percha, to with in 3 mm of the

the small, flexible NiTi end of the

the canal for 5 seconds, allowing

While the filler material should
be down-packed through the
master cone as usual, the 1-second separation burst is not necessary. Instead, the plugger
Fig. 9

Fig. 10

Fig. 11

should be allowed to cool in the
canal for approximately 10 seconds (two clicks from the unit).
The plugger can be removed by
rotating it back and forth with
apical pressure, and the stillcold plugger can be teased out
during rotation. An AutoFit Back-

Fig. 12

Fig. 13

Fig. 14

fill cone (the same size as the
plugger used for the down pack)

A leading expert in the field of
endodontics, Dr Buchanan is re nowned for his multi-media presentations, 3-D anatomic research,
writings on procedural techniques
and revolutionary instrument designs. He can be contacted at info@
endobuchanan.com and through his
website www.endobuchanan.com

[20] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:48 PM Page 20

trends & applications

Miniscrews-a focal point in
practice
Six-part series by Dr Björn Ludwig, Dr Bettina Glasl, Dr Thomas Lietz
& P rof. Jörg A. Lisson—P art I

In view of the plethora of publi-

1. minimum anchorage;

elastic bands).

cations, courses, and advertising

2. medium anchorage; and

2. extra-oral support:

material on this subject, it would

3. maximum anchorage.

•

headgear; and

•

face mask.

seem that miniscrews are widely

These three categories can be

used. Once some candid ques-

described using the example of a

3. enossal support:

tions have been asked and an-

conventional canine retraction

•

swered, however, it becomes ap-

after removal of a first premolar

parent that the reality is quite dif-

(Figs. 1.1).

implants, miniscrews, etc.
This article only deals with

anchorage in bony structures.

ferent. It seems evident that

The terms skeletal or cortical

there are valid reasons that

In the case of minimal an-

miniscrews are not yet in daily

chorage, the support is provided

use in many practices. With this

by the individual teeth. Figure

series, the authors intend to en-

1.1a shows that a single premolar

courage those practitioners who

is not sufficient as an abutment

are hesitant to use miniscrews to

to distalise a canine. The premo-

Bony anchorage has its roots

use them routinely, by providing

lar is clearly mesialised in reac-

in Gainsforth’s unsuccessful at-

a compendium of experiences

tion to the application of force.

tempt to insert screws into the

and new findings in this field.

Figure 1.1b shows how two,

jawbone as load anchors in

equally strong, anchorage seg-

1945. Many later experiments

ments are formed. Action and

were

reaction are comparable in this

method had become obsolete by

case; the result is reciprocal

the late 1970s. From 1980 on-

tooth movement. In the case of

wards, various research groups

Moving a body requires anchor-

maximum anchorage (Fig. 1.1c),

(such as Creekmore, Roberts,

age in the form of a counter sup-

the posterior group of teeth

and Turley2–7) took up the subject

port. The force required for the

is secured and held stationary

once more. Creekmore pub-

movement acts on both body and

by using a miniscrew. The canine

lished the first, clinically suc-

abutment. In his Third Law

can be retrac-ted by the complete

cessful patient treatment case.

(1687), Newton specified that

force vector, as the reactive

There are now numerous

every action has an equal and

force is completely absorbed

options for cortical anchorage

opposite reaction. In dentofacial

by the anchorage block formed.

(Fig. 1.2), including (artificial or

orthopaedics, this means that the

Apart from anchorage quality,

pathologically) ankylosed teeth

force acts on all teeth involved in

the basis, ie, the type of anchor-

on the basis of miniplates

the case of the dental support of

age location, plays a role:

normally used in cranio-maxillo-

The basis and history
of anchorage: the
selection of screws
Anchorage in general

anchorage

are

used

inter-

changeably in this case.
History and overview of skeletal
anchorage

unsuccessful

and

the

facial surgery and the use of pros-

a tooth movement. Thus, both

thetic implants. Wehrbein and

bodies ultimately move. The

1. dental

extent of movement and coun-

support:

Glatzmaier were the first to pres-

termovement does, however,

•

use of additional intra-oral

ent an implant system specifi-

devices (nance, palatinal

cally designed for jaw or-

strength of the individual teeth,

arch,

thopaedics (Orthosystem, Strau-

ie, on the number and length

bumper);

mann8–10). These orthopaedic

modification of fixed appli-

jaw implants, which also in-

the structure of the surrounding

ance (buccal root torque,

cluded Midplant (HDC), are

bone.

blocking); and

mainly inserted into the palate.

incorporation of the teeth of

This method has been found

the other jaw (Class II or III

to be both safe and successful.

depend

the

anchorage

of the roots, the root surface, and

Anchorage quality can be
divided into three categories:

•

desmodontal

lingual

arch,

lip

Figs. 1.1: After removal of the first premolar, the canine is to be retracted; results for a) minimum, b) medium or reciprocal and
c) maximum anchorage.

[21] => DTAP0109_01-02_TitleNews

DTI ISSUE 1:DTAP0109_01-02_TitleNews 18/07/09 1:48 PM Page 21

DeNtal tribuNe | July-September, 2009

trends & applications 21

Figs. 1.3: Clinical example of two typical miniscrew treatment applications: a): gap closure, b): straightening of tooth No. 7.

Fig. 1.2: Overview of the range of cortical anchorage options.

Fig. 1.4: One-sided gap closure in the left lower jaw. Miniscrews prevented the expected reactive side effect of subsequent
shifting of the middle line.

In recent years, the require-

nition an implant: “An implant is

nadium. The biocompatibility of

refer to its outer diameter, ie,

ments for cortical anchorage

an artificial material implanted

such materials, the metal surface

the size of the shaft, including

Length of the miniscrew

techniques have been defined in

into the body, which is to remain

of which is in direct contact with

the thread. For secure and

The length of the miniscrews on

the literature. However, upon

there either permanently or for

the bone, has been firmly estab-

primarily mechanical anchor-

the market varies between

age, a certain amount of bone is

5 and 14 mm. Length specifica-

required around the screw. To

tions of a miniscrew usually

closer

inspection,

only

or-

an extended period.”

11–14

lished.

thopaedic mini-implants met

More than thirty different

these requirements favourably,

terms for orthodontic screws are

Osseo-integration

date there have been no studies

refer to the shaft, ie, the threaded

in terms of:

used in the international litera-

Brånemark was the first to

on the amount of bone actually

section.

•

biocompatibility;

ture. The most common of these

define the concept of osseo-inte-

required;

•

small size;

are mini-implant and miniscrew,

gration, which he described as

available suggests 0.5 to 2 mm. At

Like the diameter, the length

•

simplicity of insertion and

while the terms minipin or pin

“a direct functional and struc-

an interradicular level, the

of the screw selected depends

use;

are preferred when speaking to

tural link between living bone

amount

available

on the amount of bone available.

•

primary stability;

patients. At present, there are

tissue and the surface of a force-

prescribes the maximum diame-

Depending on the region, the

•

immediate load capacity;

over thirty manufacturers of

absorbing implant.”15–17 Sev-

ter of the screw.

total thickness of the bone is

•

adequate resistance against

miniscrew systems (Fig. 1.5).

eral authors, such as Costa and

orthodontic forces;

The number of screws per sys-

Maino, view anchoring a minis-

Poggio et al.22, Schnelle et

length of a screw is of secondary

tem ranges from two to 154 dif-

crew not as osseo-integration,

al.23, and Costa et al.24–25 provide

importance to the diameter

ortho-paedic appliances;

ferent types. In order to assist

but as a skeletal resistance

some suggestions as to the

when it comes to secure anchor-

independence

practitioners in selecting such

block.18,19 In the opinion of Cope

vertical space required, ie, the

age, as mentioned above. Various

co-operation;

devices according to their prac-

and Bumann, miniscrews are an-

space between the enamel/

studies have shown that it is the

clinically superior results in

tice’s needs, the most important

chored by mechanical stabilisa-

cement

the

thickness of the cortical section

comparison with standard

decision-making criteria for

tion and not by osseo-integra-

mucogingival line. These inves-

that plays a more important

alternatives;

choosing implant systems are

tion.20,21

tigations clearly indicate that

role.29–31 As far as the distribution

ease of removal; and

discussed below.

•
•
•

usability

with

standard
of

patient

the

information

space

between 4 and 16 mm.28 The

interface

and

the diameter of a miniscrew

of force over the body of the

Diameter of the miniscrew

should not exceed 1.6 mm. It

screw is concerned, FEM analy-

The diameter of the miniscrews

should be noted that the stability

ses have shown that the load is

All miniscrews are made from

on the market varies between

of a miniscrew in the bone

applied only in the region of the

Any form of skeletal anchorage,

pure titanium or from an alloy of

1.2 and 2.3 mm. Diameter speci-

depends on its diameter and

cortical bone.32–33

including miniscrews, is by defi-

titanium with aluminium or va-

fications of a screw normally

not on its length.26–27

•
•

cost-effectiveness.

Mini-implants

Material

Figs. 1.5: Eight examples of the over 700 different forms of miniscrews currently available (from left to right): Ortho easy (FORESTADENT),
Dual-Top (Jeil Medical), LOMAS (Mondeal), Osas (Dewimed), Spider Screw (HDC), and tomas-pin SD (DENTAURUM).

Aarhus Mini Implant (Medicon),

AbsoAnchor (Dentos),

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DeNtal tribuNe | July-September, 2009

22 trends & applications

Fig. 1.6: The stress resistance (fracture level in Ncm) depends on the diameter of the miniscrew (according to Kyung,
modification by the authors).

Figs. 1.7: Interradicular X-ray image showing spatial ratios.

Figs. 1.8: For practical reasons, it is advisable to use systems that offer only one, universally applicable head variant. This single head should allow for the attachment all types of coupling elements
(threads, elastic chains, round wires, square wires).

known as the gingival neck,

Conclusions

hook tops;

is the most vulnerable part of

The correct method of anchor-

•

ball-shaped heads;

an implant or a miniscrew.

age with regard to shape and

diameter through colour-coding

•

eyelets;

Perforation of the gingiva pro-

quality is crucial for successful

layer depth of 1.25 mm. Thus, the

of the screws can be accom-

•

simple slots;

vides a potential access point

treatment. Maximum anchorage

ratio between the length of the

plished by means of anodisa-

•

cross-shaped slots; and

for micro-organisms, posing

is not necessary in all cases,

head (the part of the screw out-

tion, using for example, Ortho

•

universal heads (Figs. 1.8).

the risk of peri-mucositis or

and thus, neither is the use of a

side the bone) and the length

easy (FORESTADENT). A posi-

peri-implantitis. This is one of

miniscrew necessarily essential.

of the threaded section (the

tive side effect of this is that

The screw head should be

the main causes of the prema-

From an historical point of

part of the screw inside the

the oxide layer formed results

very small and compact, to en-

ture loss of miniscrews.35–36 Dur-

view, the cortical anchorage

bone) should be at least 1:1.

sure that the patient experiences

ing the immediate post-opera-

system is, in common with other

minimal discomfort. However, it

tive phase, the mucosa should

jaw

must be large enough for the cou-

be as close as possible to the

not new at all. The idea was

When selecting the length

This has been confirmed by

of the screw, the depth of the

numerous clinical studies. Easy

•

gingiva must also be taken

identification of length and

into account, with an average

Poggio

al.

recommend

firmer

anchorage

the implant in the bone.

lengths of 6 to 8 mm. Costa24,25

orthodontic

techniques,

suggests miniscrews with a

Screw head

pling elements to be securely fas-

screw, to seal the area.37 The

conceived more than 75 years

length

and

Some suppliers have a special

tened to it (Figs. 1.9).

most

shape

ago. Of all forms of skeletal an-

10 mm. Based on these studies,

head variant for each potential

transgingival collum is that of a

chorage, the mini-implant is

it would appear that it not

application

cone, as this shape naturally

the most universally used and

necessary to use longer screws.

such as:

results in safe sealing without

is the most suitable for routine

a pressure zone. This

use. However, before practition-

makes it more diffi-

ers can select the most appropri-

cult for microorgani-

ate miniscrew for use in their

sms

penetrate,

practice from the large range

thus preventing in-

on offer, they will need to review

fections. The cone

the literature thoroughly. DT

between

their

range,

Transgingival portion
The transgingival portion, also

advantageous

shape also seals the
perforation wound,
as a cork would seal
a bottle, thus reducing bleeding.

Figs. 1.9: Height difference of the screw head in two clinical situations.

Editorial note: A complete list of
references is available from the
publisher. The next edition of
Dental Tribune India will feature
Part II – Basic information on the
insertion of miniscrews.

[23] => DTAP0109_01-02_TitleNews

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DeNtal tribuNe | July-September, 2009

technology 23

ALARa = ALARming:

Figure 3 demonstrates the
amount of noise due to the increased radiation from a med-

it’s time to rehabilitate dentistry

ical CT scanner when compared to a dental cone beam
3-D CT scanner taken on the
same patient. Note that the

Alan A. Winter, DDS
USA

badges for our staff, reduce

image as compared to 3-D im-

ALARA are applied. Isn’t it time

area of interest (the dental im-

scatter radiation with im-

aging from the cone beam com-

the state boards of health and

plants in the maxillary right

proved X-ray heads, and we get

puterized tomographic New-

licensure, plus national gov-

premolar area) is more easily

Ask any recent dental school

our

Tom 3G scanner by AFP and

ernmental agencies, institute

seen with less “noise” than in

graduate what the acronym

tested. But is that enough?

that of the i-CAT by Imaging

measures to reduce this un-

the equivalent image in the

Sciences Inc. What is critical to

necessary health risk to the

medical scanner.

machines

periodically

ALARA stands for, and he or she is
sure to know. Ask most practicing

Consider the following: No

note is not the absolute num-

public if dental colleagues re-

dentists with a bit of unwanted

less an authority than Gordon J.

bers in the chart—different

main entrenched in mindsets

girth around their waists and

Christensen, DDS, in JADA vol

published studies yield slightly

from another era?

graying at the temples, and they

135, Number 10, 1437–1439,

different amounts—but the

will most likely be uncertain.

2004, “Why Switch to Digital Ra-

ALARA is cryptic for “As Low

diography,” cited the many

Achievable.”

valuable benefits of switching

When applied, the ALARA princi-

from conventional dental film

ple mandates that exposure to

to intraoral digital sensors, not

dental radiation should be at the

the least of which was the X-ray

lowest level possible to obtain the

reduction of up to 80 per cent.

information necessary to diag-

Naturally, digital radiography

nose and/or treat a patient. Is

applies the ALARA principle.

ALARA one of those hot topics

Yet, in the “Wall Street Journal,”

that comes and goes if you wait

Rhonda L. Rundle wrote about

long enough? Is it an issue to be

the “Shifts to Digital Systems

concerned about, or is it one

Cuts

more thing to tuck away in our

times…” Nov. 29, 2005, stating

memory banks hoping it will go

that according to the most re-

underground and attention need

cent data from dental manufac-

only be paid to it when outside

turers, 15–25 per cent of den-

forces make it too hard to ignore?

tists used digital radiography.

Reasonably

Discomfort

and

Wait

In summary, as patient outcomes become paramount in
aesthetic and implant den-

Fig. 1: Data from the International Commission on Radiological Protection, 2005.

Fig. 2: The benefits of dental cone beam scanners outweigh
those of a medical CT machine.

That was more than 30 months
ALARA is here to stay. It is on

ago. Maybe the number has in-

the legislative books of nearly

creased to 30 per cent, if that

all states in the United States.

much. The question needs to be

It is embraced as protocol by

asked, why haven’t the other

the European Dental Commu-

70 per cent or more converted

nity as well as part of Radiation

their dental practices to digital

Protection Codes of Canada

radiography since it was first in-

and taught in every US dental

troduced in the early 1990s?

Fig. 3: Scatter or “noise” generated from a medical CT scanner on top, when compared with a dental cone beam scanner
taken on the same patient on the bottom.

school. And as ubiquitous as
the ALARA principle is in or-

While an obvious answer

ganized and academic den-

is related to the cost of convert-

relative low radiation by these

While the scope of this arti-

tistry, accurate diagnoses, pre-

tistry, its doctrine is not widely

ing to digital, when does the

two CBCT manufacturers that

cle focuses on the profession’s

surgical planning and judg-

practiced nor seemingly en-

grea ter good supersede the

yield accurate 3-D imaging for

need to outwardly embrace the

ments made with the benefits

forced by any state or national

return on investment? When

implant insertion, removal of

principles of ALARA, it is criti-

of more radiological informa-

regulatory agency.

do ethics and doing the right

impacted third molars close to

cal for dentists to understand

tion should always be per-

thing kick in? And if radiation

the alveolar nerve, and so ma-

the benefits of cone beam 3-D

formed against the risks in-

Does non-enforcement di-

hygiene is so important—and

ny more clinical applications

CT scanners when compared

volved with exposing patients

minish ALARA’s importance?

all the experts agree it is due

when compared to medical CT

to medical machines.

to X-rays while insuring that all

Only in application, not in con-

to the potential of irreversible

machines.

cept—and therein lies the rub.

cell death—why doesn’t the

While dentistry has concerned

government intervene with tax

The telling numbers are at

only take one dental arch at a

itself with major issues over

breaks to soften the financial

the bottom of the chart com-

time. They do, however, have

the years such as fluoride,

blow so all dentists can provide

piled by the ICRP—the Inter-

greater contrast as a result of

OSHA, caries reduction, sys-

what should be a mandated pol-

national Commission for Radi-

the increased radiation. Dental

temic links to untreated peri-

icy for the public’s greater good?

ological Protection. Patients

cone beam 3-D CT scanners,

requiring both a mandibular

on the other hand, are more

odontal disease, proper dis-

radiological imaging adheres
Medical CT machines can

posal of chemicals, and lately

ALARA applies to 2-D and

and maxillary CT scan taken

accurate because they take the

the complications of bisphos-

3-D imaging. No greater appli-

on a medical scanner are ex-

entire “volume” of data in the

phonates, to name a few, there

cation of the ALARA principle

posed to the equivalent radia-

field without gaps of missing

has been little or no effort at the

can be applied when compar-

tion of 265 panoramic images.

data points due to the spiral he-

grass roots or public level for

ing the radiation from a med-

With so many cone beam 3-D

lices of medical CT machines,

dentists to incorporate and

ical CT scanning machine to

dental scanners abounding, is

take both arches at the same

practice radiation hygiene.

most dental cone beam 3-D CT

it reasonable to continue to

time, use exponentially less ra-

Yes, there are the lead shields,

scanners. Figure 1 highlights

send patients to medical radio-

diation, and have less noise as

and yes, there are the thyroid
collars. And we use radiation

the effective dose in microSieverts of radiation of a panoramic

logical offices for 3-D imaging?
Not when the principles of

a result of a “softer” X-ray.

to the principles of ALARA. DT

Contact Info

Dr Alan Winter can be reached
at info@i-dontics.com

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[cover] => DT India (Archived)

[toc] => Array ( [0] => Array ( [title] => Dear Readers of Dental Tribune India [page] => 01 ) [1] => Array ( [title] => Mectron expands in India [page] => 04 ) [2] => Array ( [title] => Opinion [page] => 06 ) [3] => Array ( [title] => Dental Tribune International: A global approach to dental media [page] => 07 ) [4] => Array ( [title] => Interview with Graeme Milicich - New Zealand [page] => 08 ) [5] => Array ( [title] => News & Events [page] => 09 ) [6] => Array ( [title] => Solving esthetic dilemmas with direct composite bonding [page] => 10 ) [7] => Array ( [title] => Treatment acceptance: could have - should have - would have [page] => 12 ) [8] => Array ( [title] => Interview with Assoc. Prof. Lars Hylander - Uppsala University - Sweden [page] => 14 ) [9] => Array ( [title] => Interview with Prof. Van B. Haywood - USA [page] => 15 ) [10] => Array ( [title] => Dentine hypersensitivity: From diagnosis to treatment [page] => 16 ) [11] => Array ( [title] => Ancient skeleton in India bears evidence of leprosy [page] => 18 ) [12] => Array ( [title] => The continous wave obturation technique for enhanced precision [page] => 19 ) [13] => Array ( [title] => Miniscrews-a focal point in practice [page] => 20 ) [14] => Array ( [title] => ALARa = ALARming: It’s time to rehabilitate dentistry [page] => 23 ) ) [toc_html] =>

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