News / Industry / Artificial intelligence: A gift to dentists / Industry / A new endo-resto approach in digital dentistry / Help your patients say yes! / Why is Slow Dentistry calling / Six-month evaluation of a sodium bicarbonate-containing toothpaste for the reduction of established gingivitis: A randomised USA-based clinical trial / “Roxolid is one of the most significant advances in the last 20 years” / News
News
1 - 2 viewIndustry
4 - 4 viewArtificial intelligence: A gift to dentists
6 - 6 viewIndustry
8 - 10 viewA new endo-resto approach in digital dentistry
12 - 16 viewHelp your patients say yes!
20 - 20 viewWhy is Slow Dentistry calling
22 - 22 viewSix-month evaluation of a sodium bicarbonate-containing toothpaste for the reduction of established gingivitis: A randomised USA-based clinical trial
24 - 24 view“Roxolid is one of the most significant advances in the last 20 years”
26 - 28 viewNews
30 - 30 viewArray
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[1] =>
LY
N
O
S
AL
N
IO
SS
FE
O
PR
TA
L
EN
D
PUBLISHED IN DUBAI
ENDO TRIBUNE
“Today’s solutions from FKG cater
to the very diverse patient and
dentist population..."
www.dental-tribune.me
LAB TRIBUNE
Digital workflow for 3D-printed
complete dentures
Insertion A
Insertion B
IMPLANT TRIBUNE
Guided maxillary arch implant restoration: Language and crossborder collaboration...
Insertion C
Vol. 13, No. 3
ORTHO TRIBUNE
Kuwait’s dental speakers navigate
evolving sector at exclusive masterclass, hosted by AG
Insertion D
HYGIENE TRIBUNE
Oral health matters: “This toothbrush is perfect, so why should we
change it?”
Insertion E
New comprehensive review of 3D printing
in oral and maxillofacial surgery
By Anisha Hall Hoppe, Dental
Tribune International
BOSTON, US/KARAJ, Iran: The
introduction of 3D printing in medicine has improved outcomes
across surgical applications by decreasing costs, reducing surgical
time and improving reliability of
treatments. Researchers from the
Harvard School of Dental Medicine
and the Alborz University of Medical Sciences in Iran have created a
handy summary of the current ad-
vances of 3D printing in the field of
oral and maxillofacial surgery
(OMFS) that offers clinicians a brief
explanation of 3D printing and a
broader look at how 3D printing
can be used for specific purposes in
OMFS.
Clinicians need not have a
strong understanding of engineering or materials science to be able
to utilise 3D printing in their treatment plans. Indeed, merely under▶ Page 02
3D printing enables surgeons to create surgical plans, implants and protheses that are all tailored to the individual anatomy
and needs of each patient while being cost-effective and reducing surgical time and complications.
(Image: FOTOGRIN/Shutterstock)
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NEWS
02
Dental Tribune Middle East & Africa Edition | 03/2023
◀ Page 01
standing the differences between
the various 3D-printing methodologies is an adequate place to start.
Thanks to high-resolution imaging,
the practitioner need only import
image data and many 3D-printing
software packages will process and
render this information into a printable model, for which the clinician
requires no CAD/CAM knowledge.
In addition, clinicians can even outsource overall virtual surgical planning and surgical implant fabrication to the numerous companies
now offering these services.
In their review, the researchers
give a simple description of CAD/
CAM’s role in realising implants
and surgical solutions bringing implants and surgical solutions to life.
Computer-rendered 3D models
and printed guides advance surgery for maxillofacial trauma and
reconstruction, reducing surgical
time by ensuring bones are repositioned correctly, for example.
Printed cutting guides improve
surgical results, and even before
surgery, CAD programs can calculate symmetry in areas of bone defects for restoration with CAM devices.
The power of visualisation
3D-printed models significantly aid in patient education and
communication, helping clinicians
demonstrate the desired results of
the planned procedure, particularly
when the trauma or area of reconstruction is difficult to understand.
CAD enables clinicians to even
work with parents to prepare for
needed corrections, such as for a
known cleft palate, while their child
is still in utero.
This ease of visualisation is particularly useful in complicated procedures such as those of orthognathic surgery. During the procedure, printed osteotomy guides
ensure that bone segments are
placed correctly, dental roots and
nerves are avoided, and compli-
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IMPRINT
INTERNATIONAL
HEADQUARTERS
PUBLISHER AND CHIEF EXECUTIVE OFFICER:
Torsten OEMUS
CHIEF CONTENT OFFICER:
Claudia Duschek
Dental Tribune International GmbH
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Tel.: +49 341 4847 4302
Fax: +49 341 4847 4173
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Material from Dental Tribune International GmbH that
has been reprinted or translated and reprinted in this
issue is copyrighted by Dental Tribune International
GmbH. Such material must be published with the per-
mission of Dental Tribune International GmbH. Dental
Tribune is a trademark of Dental Tribune International
GmbH.
All rights reserved. © 2023 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written
permission of Dental Tribune International GmbH is
expressly prohibited.
Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’
product news accurately but cannot assume respon-
cated asymmetric movements can
be achieved when desired. Additionally, 3D printing of titanium
plates that are completely customised to patient anatomy ensure ongoing stability and strength of the
bone.
A safer option
3D printing has also meant that
microvascular reconstruction is no
longer necessary in cases of reconstruction, as bone harvesting and
transplantation has become a thing
of the past. In maxillofacial prosthodontics, the risk of infection and
obstruction of anatomical structures, among other issues, are already challenging enough without
having to deal with problems such
as donor site morbidity and added
patient pain. There are a number of
3D-printable materials available for
various reconstruction purposes
that are both biocompatible and
cost-effective, and designated
software can easily remodel defects or completely missing bone
and other facial structures into a
symmetrical, aesthetic and functional result.
Materials of incredible strength
and durability are available for surgical purposes, such as for temporomandibular joint prostheses.
Reconstruction of the fossa and
mandibular component requires
different materials that work together and provide enduring
strength. The advent of 3D-printed
guides has meant that are patients
no longer subjected to multiple
surgeries for a procedure such as a
condylectomy and prosthetic replacement. The authors do note
that more research needs to be
done into the new procedures that
utilise some device or scaffolding
solutions, as there is still a lack of
information on how patient-tailored prostheses affect muscle and
joint function in the long term.
The use of 3D-printed surgical
guides for dental implant placement is well documented and has
been shown to dramatically decrease both the surgery time and
the errors that may arise from freehand drilling. The fabrication of
dental implants too using 3D printing is being increasingly investigated. Some studies on bone healing rates for a variety of structures
and implant materials have indicated high rates of implant success,
but long-term clinical evidence is
lacking.
Bone tissue engineering has
shown significant progress, researchers all over the world having
developed scaffolding solutions
that rely on various combinations
of designs, cell sources and biomaterials, among others, all tailored to
patient-specific anatomy. There is
much more still to be done, and the
sibility for the validity of product claims or for typographical errors. The publisher also does not assume
responsibility for product names, claims or statements
made by advertisers. Opinions expressed by authors
are their own and may not reflect those of Dental Tribune International GmbH
authors note a bright future for research in regeneration of neural
and vascular networks, ensuring
mechanical properties and more. It
is also a field without much medical
regulation and one that would benefit from more clinical studies, particularly considering the advances
expected in bioactive synthetic
materials in the coming years. The
authors cite the success in one
study of a 3D-printed scaffold for a
cleft palate restoration that utilised
bone marrow stromal cells and
achieved new bone growth in 45%
of the defect volume after just six
months.
The need for updated curriculum
The review also highlights the
overarching benefits of utilising
3D-printed models in clinician education, particularly because realistic, easy-to-access models can be
printed anywhere and can be customised to virtually any training situation or patient model. 3D printing using both soft and hard materials can produce a lifelike cleft lip
and palate model in a single print,
for example. Researchers are constantly re-evaluating model creation based on surveys of tactile
and haptic feedback and how realistic a model is compared with the
real thing.
In addition to a list of materials
and their associated applications
across OMFS, the authors include
some associated risks with 3D
printing, including need for further
classification of devices. They also
note that clinicians should take the
time to educate themselves on not
only the associated costs of 3D
printing but also the technology
that they specifically will require.
Not every material is compatible
with every printer, and skilled technicians are essential for the various
steps of the 3D-printing process.
3D printing itself involves the risks
of exposure to chemicals, possibly
lasers or other sources of injury and
should really be undertaken with
proper assistance. Though clinicians should not feel hesitant in
adopting 3D printing, it is not as
simple as printing and implanting.
There are a myriad of sources on
the topic and a number of companies specialising in helping clinicians use 3D-printed surgical solutions immediately, safely and with
efficacy.
The study, titled “The impact of
3D printing on oral and maxillofacial surgery”, was published online
on 14 April 2023 in the Journal of 3D
Printing in Medicine, ahead of inclusion in an issue.
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www.dental-tribune.com
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INDUSTRY
04
Dental Tribune Middle East & Africa Edition | 03/2023
Ultradent introduces J-Temp
temporary resin
By Ultradent Products
Ultradent Products, Inc., a leading developer and manufacturer of
high-tech dental materials, today
released its newest product,
J-Temp temporary resin, a premixed, light-cured temporary resin
designed for multiple use cases
and maximum ease of use—for
dentists, by dentists.
Engineered for maximum usability—offering four solutions in
just one product syringe, dentists
can utilize J-Temp temporary resin
for everything from bite ramps and
temporary occlusal buildups, to
build structure for isolation clamping, for temporary restorations,
and for splinting between implant
copings.
AD
On developing J-Temp temporary resin, Ultradent’s vice-president of clinical affairs, Dr. Jaleena
Jessop says, "J-Temp Temporary
Resin started because there was always a need for something that
didn’t exist. The more I used J-Temp
temporary resin for different procedures, the more I found that it is
really nice to have one product that
can cover a gamut of different
needs, versus needing five of six
different materials that may expire
before you use them next."
Ultradent’s J-Temp temporary
resin features a consistency that’s
viscous enough that it won’t run,
but fluid enough to be self-leveling
and easy enough to manipulate
right in the operatory. Ultradent
(Image: Ultradent Products)
recommends using J-Temp temporary resin with Ultradent’s Black
Mini tip for simple, precise placement. When it comes to removal,
the resin’s light purple color allows
for easy identification— making for
a seamless experience for patient
and dentist, start to finish.
For more information about J-Temp
please contact
sophia.yadi@ultradent.com.
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[6] =>
GENERAL DENTISTRY
06
Dental Tribune Middle East & Africa Edition | 03/2023
Artificial intelligence: A gift to dentists
By Dr Kyle Stanley, USA
The May 2019 edition of The Atlantic magazine contained an article
titled “The truth about dentistry”. In
it, the author visualised dentists—
not a particular dentist but dentists
in the abstract—as sinister authority
figures looming over the helpless
patient’s recumbent form, drill in
hand. Mistrust permeated the scene
like swamp fog. “When he points at
spectral smudges on an X-ray,” the
author pleads, “how are we to know
what’s true?”
Then there was the Dustin Hoffman movie Marathon Man with its
Nazi dentist-cum-torturer, and the
famous—or, if you’re a dentist, notorious—1997 Reader’s Digest article by a writer who visited 50 dentists in 28 states, picking them at
random out of the Yellow Pages, and
was given treatment plans ranging
in cost from under US$500 to nearly
US$30,000. That one really hit a
nerve, so to speak.
Dentists have had their share of
bad rap, but still, the experience of
the Reader’s Digest writer was probably not terribly far from the truth. It
was borne out, with eerie accuracy,
by a 2021 Dental AI Council study intended to quantify the suspected inconsistencies in dental diagnosis
and treatment. The same set of fullmouth radiographs was presented
to 136 dentists, and they were asked
to provide tooth-by-tooth diagnoses and a treatment plan. A person
with confidence in the scientific basis
of dentistry might naturally expect a
limited amount of diversity among
the responses and would assume
that the commonalities would far
outweigh the differences. Not so.
Not once did more than half of the
participants agree about the diagnosis for a given tooth. The variety
of estimated costs was almost comical, ranging from US$300 to
US$36,000—figures strikingly similar to those cited by the Reader’s
Digest author. Worse, the range of
cost estimates did not present as a
bell curve, the majority of responses
clustered together and only a few
outliers at the extremes. Instead, the
distribution was more or less at; the
frequency of a cost estimate of
US$1,000 was about the same as
that of a cost estimate of US$10,000.
Other studies have found that
dentists’ interpretation of radiographs—the very foundation of diagnosis—was far from reliable. Esti-
(Image: flutie8211/Pixabay)
mates of cavity depth and recognition of radiolucencies were wrong as
often as they were right. In another
study, three dentists examined several thousand radiographs; their interpretations were in full agreement
only 4% of the time.
Houston, we have a problem
How should we account for this
lack of precision in a medical field? Is
it due to dishonesty? To greed? To
variations in skill? To honest differences of opinion? Whatever the reason, it gives dentistry a bad name.
But there is a remedy. It comes in the
form of a powerful new technology
that is already transforming many
aspects of our lives: artificial intelligence, or AI for short.
AI is an umbrella term covering
a wide range of computing techniques. They range from “general
AI”—intelligence indistinguishable
from that of a human being, in all
circumstances—to “narrow AI”, specialised programs whose expertise is
limited to a particular class of problem. Most make use of a programming technique called a “neural network” by loose analogy to the structure of the human brain, and all have
in common the property of trainability. They learn by taking in vast
amounts of data of a certain type—
say, photographs of faces or samples of text— and extracting commonalities. Once trained, an AI program can pick out a particular face
in a crowd or write an essay or a love
poem as well as or better than you
can.
General AI is the darling of science fiction writers, but is very far
from realisation. No AI system has
anything like the broad knowledge
of all aspects of the world that a
human being has, and so, for the
time being at least, we do not have
to worry about being taken over by
independent-minded and malevolent robots like the notorious HAL of
2001: A Space Odyssey. Even the
comparatively limited task of safely
operating a car in an urban environment has not yet been mastered,
despite years of effort and oceans of
investment.
Narrow AIs, however, already
easily match or surpass human abilities, and they have become the
tools of choice for performing many
exacting tasks. Many of these involve computer vision, the analysis
and recognition of objects or imagery. More than a decade ago, it was
Dr Kyle Stanley.
found that a trained AI could recognise and categorise nodules in radiographs of cancer patients’ lungs
as accurately as a panel of oncologists could, and much faster. Computer vision and AI are now familiar
parts of the oncological toolkit, and
they are being applied to a widening
array of medical fields. One of those
is dentistry.
Dentists are in an excellent position to take full advantage of AI.
There exists, to start with, a virtually
limitless supply of dental radiographs for training. The radiographic image is the coin of the
realm in dentistry; patients are accustomed to having their pathologies explained to them with reference to the “spectral smudges on an
X-ray” evoked by The Atlantic’s reporter. The range of pathologies to
be detected is relatively narrow, and
the AI program can not only identify
them but also quantify them with
greater than human precision. The
dental radiograph is, therefore, an
ideal application for the sharp focus
of narrow AI.
The second opinion—so to
speak—provided by an AI program
is directly valuable to the practitioner. The computer is hypersensitive to subtle greyscale gradations; it
may detect something the human
reader has overlooked. More importantly, it is never tired, distracted or
rushed and so is not prone to the
types of mistakes and oversights
that people routinely make simply
because they are human. The AI
program may in many cases simply
duplicate the perceptions of the
human, in which case nothing is
gained but confirmation, but it may
add information overlooked by the
human or differ in its interpretation,
leading to a re-examination and
re-evaluation of the evidence.
Even if these benefits may seem
minor to an experienced practitioner confident in his or her abilities, there is another side of the AI
experience to consider: the patient’s. The results of the AI program’s analysis are presented to the
patient in vivid, intuitively understandable form. The radiograph no
longer consists merely of spectral
smudges, but has become graphically compelling, having highlighted
areas, colour-coded outlines and
explanatory labels. For a patient, the
enhanced display conveys a heightened sense of precision, clarity and
objectivity. The diagnosis is no longer just the opinion of one person,
whom a cynic might suspect of ulterior motives. It need not be taken on
faith; it is supported by the unbiased
authority of a digital computer.
While the graphic presentation
of a computed analysis may impress
a patient as something more than
human, the practitioner should be
aware that the AI program is an assistant, not a supervisor. Even
though the accuracy of AI’s radiographic analyses in various medical
fields has been shown to be indistinguishable from that of human interpreters, the AI program actually
knows much less about teeth (or
lungs or livers) than the trained and
experienced practitioner does.
What it does know, and knows very
well, is how a large number of specialists have interpreted a very large
number of radiographs. Its findings
are, in effect, those that hundreds or
thousands of dentists would make if
they were to vote on the content of
a given radiograph. Where there is
not unanimous agreement, majority
opinion prevails, or findings are presented in terms of probabilities. The
practitioner using the AI program
remains entirely free to form a different opinion or to disregard the
advice the program gives, but has
the benefit of knowing what a large
group of peers would have made of
the radiograph in question.
The most significant impact of
dental AI, however, is not that it necessarily brings a superhuman level
of certainty to the data upon which
diagnoses are based—although in
most cases it may—but that it provides, for the first time, an objective
and universally accessible standard
of reference. Objective standards
are precisely the thing that dentistry
has lacked in the past, and their absence has given rise to suspicions
about the candour and consistency
of dental diagnoses. Look at the
Reader’s Digest writer: guided only
by a phone book, he collected a bewilderingly large variety of diagnoses. If he had visited only dental offices using an AI assistant, he would
have been given a much smaller variety, and the differences would have
been due to small variations among
the radiographs made by different
practices rather than to the whims of
individual dentists or the immediate
financial needs besetting them.
Consistency is not the only thing
AI brings to dentistry. It also provides support for insurance claims
and facilitates record-keeping,
tracking of patients’ dental health
and comparison of performance
among multiple practices in an organisation. It trains dentists at the
same time as dentists train it. In the
future, it may reveal connections between dental health and general
health that we do not now suspect.
Those are some of the collateral
benefits. Above all, however, AI will
give patients the reassurance of
knowing that the condition of their
teeth is not merely a matter of opinion.
Dr Kyle Stanley is a specialist in
implantology and a passionate
advocate for mental health in the
dental profession. He is founder and
chief clinical of cer of Pearl, a company transforming patient care through
arti cial intelligence. Dr Stanley maintains a private practice in Beverly
Hills in the US, where he focuses on
implant surgery and prosthetics.
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INDUSTRY
08
Dental Tribune Middle East & Africa Edition | 03/2023
Choose the correct mask
for your daily practice
By HuFriedyGroup
The spread of the pandemic
over the last years has raised more
and more awareness about the importance of wearing personal protection equipment such as gowns,
gloves, caps, drapes and masks
throughout daily routine in dental
practices. During this difficult time,
any type of mask was acceptable
due to the emergency and the supply shortage, but now clinicians
have the possibility to choose
wisely the correct mask to wear
based on the amount of fluid, spray,
aerosol, splashing or spattering of
blood generated and the length of
each procedure: by doing so, they
protect their patients, the dental
staff and the community itself.
The ASTM classification in three
different levels help identifying the
right mask for a particular procedure and our full portfolio of
Crosstex Masks covers all levels
providing the appropriate protection to minimize the spread of potentially infectious diseases.
•
ASTM Level 3 masks: provide
high fluid protection and are
ideal for procedures that generate moderate to high
amounts of fluid, spray and
aerosols, including complex
oral surgery, crown preparation, implant placement, periodontal surgery and the use of
Image: HuFriedyGroup
ultrasonic scalers. Crosstex
Ultra Masks are part of this
group.
•
ASTM Level 2 masks: provide
moderate fluid protection and
can be worn during limited
oral surgery, endodontics,
prophylaxis, restoratives, sealants and others. Crosstex
Procedural Masks are level 2.
•
ASTM Level 1 masks: provide
light fluid protection and are
ideal for patient exams, impressions and orthodontics.
Crosstex Isofluid Masks belong to this group.
Apart from the choice based on
the level of protection, which is
nowadays an essential requirement
for any infection prevention program within the dental practice, clinicians may choose our masks also
thanks to their comfort: unlike the
most common masks available in
the market, Crosstex masks feature
a soft, white medical-grade facial
tissue inner layer that makes the
mask comfortable, other than the
highest quality meltblown filter for
best filtration efficiency and
breathability. The elastic, flat ear
loops, also, minimize pressure to
the ears and are attached to the
outside of the mask to eliminate
skin irritation and providing the
most comfortable fit.
Last but not least, Crosstex
masks have some additional characteristics, among which the most
important one and award-winning:
Secure Fit Technology’s patented
design features flexible aluminum
nose and chin strips for a customized fit that eliminates dangerous
gaps around any face shape. A special option for people with allergic
sensitivity is also available: Ultra-Sensitive is an extra soft white
hypoallergenic inner cellulose
layer. The FogFree strip, lastly, block
and absorb moisture, forming a
strong seal preventing fogging of
eyewear.
Some dental practitioners may
be tired of wearing the standard
white or blue masks and this is why
we have listened to their request
and decided to enlarge even more
our portfolio, already full of colour
options such as pink, yellow, lavender, blue, turquoise, sapphire, etc.,
with the new Ultra Earloop
Facemask with SecureFit Technology, in Black! Belonging to the
ASTM Level 3, they are ideal for
procedures that generate moderate or high amount of fluid, spray
and aerosols and now clinicians can
feel safe during long and complex
procedures while being cool with
their new Black masks!
Scan this QR code to know more:
All company and product names are
trademarks of Hu-Friedy Mfg. Co., LLC,
its affiliates or related companies, unless
otherwise noted.
Follow us on
@HuFriedyGroupMiddleEast
@HuFriedyGroupEurope
@HuFriedyGroup Europe
Hu-Friedy Mfg. Co., LLC.
European Headquarters
Astropark - Lyoner Str. 9
60528 Frankfurt am Main, Germany
Tel.: +49 (0)69 24753640
Fax: +49 (0)69 25577015
Free Call: 0080048374339
AD
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Visit www.promedica.de to see all our products
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* Patel RB, Skaria SD, Mansour MM, Smaldone GC. Respiratory source control using a surgical mask: An in vitro study [published correction appears in J Occup
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HuFriedyGroupEurope
Hu-Friedy Mfg. Co., LLC. • European Headquarters • Lyoner Str. 9 • 60528 Frankfurt am Main, Germany • HuFriedyGroup.eu
All company and product names are trademarks of Hu-Friedy Mfg. Co. LLC., its affiliates or related companies, unless otherwise noted.
©2023 Hu-Friedy Mfg. Co., LLC. All rights reserved. HFL-803GB/0423
[10] =>
INDUSTRY
10
Dental Tribune Middle East & Africa Edition | 03/2023
Irradiance vs. Power: Curing
light performance
By Ultradent Products
As curing light technology improves, dentists are consistently
sold on irradiance (mw per cm2) as
being the defining factor in beam
effectiveness. While there is no
doubt irradiance adds value, it does
not tell the full story of how well a
light will cure various materials. Irradiance tests typically only show
the irradiance of a very small portion of the light. Measuring the
power distributed over the entire
beam tells a more comprehensive
story of its curing capabilities.
When comparing irradiance
and power, think of power as the
overall amount of light being put
out and irrandiance as how much
light is put out over a certain area.
Compare, if you will, polymerizing
a restoration to lighting a room.
There’s a bulb in the center of the
ceiling, and you’re standing below
with a funnel. You can cover the
bulb with the funnel shaped reflector and direct all the light into one
small, bright spot, with most of the
room remaining dark. Or you can
let the bulb’s brightness cover the
room evenly and be able to see everything.
“Dentists need to stop looking
only for the irradiance value, and
instead, look for power value as
well as a good irradiance value,”
AD
says Ultradent VP of Research and
Development, Neil Jessop. “Irradiance isn’t the only metric dentists
should be looking for—they should
be looking for power evenly distributed over the entire surface of
the tooth.”
A beam with a small, superhot
center will unevenly cure a composite. A beam with uniformly dispersed power throughout provides
a superior, more predictable cure.
Equally distributed power allows a
dentist to center the light over a
tooth and fully cure the entire restoration without creating hotspots
and leaving areas under-cured.
Misleading measuring
Many of the misconceptions
built around irradiance stem from
how it’s historically been measured. Traditional light meters,
which remain the most common
found in dental offices, aren’t giving dentists an accurate assessment of their curing light’s capabilities.
“Most meters that are available
in the world measure the center of
the light,” Jessop says. “[Measuring
devices] sample a very small part of
the beam and you may be on a particular hot spot and not realize that
it’s just measuring how dense the
light is, or how much light is sitting
in that particular spot.”
By measuring the center
hotspot only, these meters ignore
significant amounts—if not the
majority of—the actual lens/footprint of the light. The hotspot will
have a curing ability slightly wider
than the hotspot itself, but the
overall target can be missed. Distributing power evenly over a larger
area ensures a more consistent,
quality cure compared to lights
with small hotspots.
Jessop says he frequently sees
ambiguous—if not disingenuous—
marketing materials given to dentists. “The way these companies are
misleading customers is that they’re
measuring the hotspot of their light,
which may have a very high irradiance, but which covers a very small
area, compared to VALO X [light]
which has twice the power evenly
distributed over a much larger area.”
Measuring accurately
Ultradent’s research and development team created a meter to
help dentists measure a light’s
power and irradiance more accurately. “The only way you can accurately measure a curing light is with
a meter that takes into the account
the entire area of the light with a
window that’s bigger than the light,
which is something that we have
and sell.” He adds, “I know it’s technically confusing. Power—which is
how much light your device puts
out, versus irradiance, which is how
much light your device puts out
over a certain sampled area, can
easily be manipulated (without the
right meter.) (The Ultradent meter)
is what you’re going to want when
you’re measuring a light’s power to
get a true power reading,” Jessop
stresses.
Why power matters
A curing light with a large, uniform footprint and good power
output from the entire lens allows
the user to hold the light in place
over the tooth and be assured that
it will polymerize the entirety of the
restoration, every time—compared with having to move the light
around the tooth, worrying and
wondering if the hotspot thoroughly cured every area of the restoration.
“Ultradent’s VALO X curing light
is nearly foolproof in that it doesn’t
have a hotspot, and it distributes
more total power over the entire
footprint, which makes curing the
entirety of the area a lot easier,”
Jessop says. “The goal is to have
every square millimeter of the
tooth get the same amount of light
like with the VALO X curing light.
Where with other lights, they’re
often only covering maybe 50% of
the tooth. Their bright spot may be
tiny. It’s unfortunate because many
doctors are misled to think that the
entire tooth is getting that ‘irradiance measurement’ that the company is claiming, when only a tiny
spot of the light is doing the work,
leaving the rest insufficiently
cured.”
That’s not to say the VALO X
doesn’t provide excellent irradiance and collimation. The difference is, the VALO X evenly distributes it. “It’s all about the beam uniformity and coverage,” Jessop
adds.
When choosing your curing
light
Clinicians in the market for a
quality curing light want something that will completely and dependably polymerize all light cure
dental materials. However, a light’s
purported irradiance doesn’t often
represent the full picture, in terms
of overall power.
Instead of measuring a light’s
irradiance in one hotspot, clinicians
should look at how evenly the
light’s power is spread out. “Generally speaking, dentists should aim
for light with power uniformity. You
want to cover more tooth without
oversaturating any areas,” says Jessop.
For more information about VALO X
please contact sophia.yadi@ultradent.
com.
[11] =>
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[12] =>
GENERAL DENTISTRY
12
Dental Tribune Middle East & Africa Edition | 03/2023
A new endo-resto approach in
digital dentistry
By Dr Simona Chirico, Prof
Massimo Mario Gagliani, Italy
Introduction
The endodontic treatment of
severely compromised teeth and
their restoration represent an everyday challenge in the clinical
dental practice. The advent of increasingly high-performance endodontic instruments, CAD/CAM
technologies by chairside systems
and the related materials drastically reduced the rehabilitation
times of these teeth, allowing the
treatments to be performed in a
single visit.
This procedure might be an interesting alternative to the usual
one; it discloses a new way of thinking in which restorative preparation and digital impression, has
made before the endodontic treatment; in fact, right after a complete
removal of carious tissues or damaged restorations, the clinician
should orient the whole preparation, except the access cavity, to
seal dentin and prepare the tooth
for the indirect restoration. At the
end of this phase a digital impression should be taken and addressed to the milling procedure;
during this period the root canal
treatment might be accomplished
and, at the end, the restoration
could be cemented, sometimes
without removing the rubber dam.
Inclusions criteria consist in:
•
Carious lesions with pulp involvement (need endodontic
treatment);
•
•
•
•
Carious lesions that have
caused the loss of at least one
cusp (need indirect restoration);
Inappropriate
endodontic
treatment (need endodontic
retreatment);
Presence of apical lesions
(need endodontic treatment/
retreatment)
Willingness of the patient to
undergo a long appointment;
Exclusions criteria consist in:
•
Invasion of the supracrestal
attachment during the margins preparation;
•
Acute or chronic periapical abscess;
•
Temporomandibular
disorders (TMD);
•
Vertical root fracture
The potential advantages of this
procedure should be summarized:
•
Immediate Dentin Sealing before theusage of irrigating
solutions might guarantee a
better sealing by the adhesive
systems
•
The access cavity might be
better controlled during the
shaping and sealing steps
•
Adverse effects on adhesion
process generated by any kind
of sealer might be avoided
•
The single visit procedure reduces time for patient and clinician
•
In a single visit procedure, the
restoration might enhance the
overall sealing of the endodontic space
The use of COLTENE endodontic instruments, which have features suitable for this procedure, is
clearly recommended to obtain a
conservative shaping of the root
canal system.
The use of the resin composite
CAD/ CAM block BRILLIANT Crios,
as a material for partial indirect restorations, guarantee excellent performances both for mechanical resistance and aesthetics, with the integration of this with the surrounding tissues.
The luting of the restorations
can be accomplished either with
the BRILLIANT EverGlow composite
in a paste or flow composition,
making the steps of removing the
material and its polymerization
easier.
Case 1
A female 38-year-old patient
had an emergency appointment
due to pain and high sensitivity of
heat and cold in the fourth quadrant. After carrying out the physical
and radiographic examination, the
presence of a large carious lesion
with pulp involvement first lower
molar, which had an old composite
restoration, was clinically and radiographically assessed. A poor
oral hygiene and gingivitis in the
acute phase was also detected
(Figs. 1, 2). Since the patient was
pregnant and would have given
birth after 3 weeks, a single session
procedure was encouraged and the
new protocol "endo-resto approach in digital dentistry" was
chosen.
Fig. 1: Radiographic evaluation of
tooth 46
Phase 1
Isolation and cavity preparation
After applying the rubber dam
to isolate the fourth quadrant, the
removal of the old restoration to
evaluate the extent of the carious
extension
was
accomplished
(Fig. 3). Later a full toilette of the
dentine was completed, the margin
relocation performed and the cavity refined for proceed with the
endodontic treatment (Fig. 4). All
the margins were perfectly visible
and the contour of the future endocrown should not be modified by
the root canal treatment procedures. The root canal system at this
time should be already prepared
(Fig. 4).
Phase 2 – Impression
In this case, to give a little rest
to the patient, the rubber dam was
removed but most of the time it
should be left in place during the
digital impression procedure.
A part of teflon was placed in
the bottom of the pulp chamber,
for a height of about 1.5 mm. This
tool was used to simulate the subsequent covering of the floor with
the flow, after finishing the endodontic treatment. Once the correctness of the canal closure was
verified, the chair-side digital protocol started with the use of CEREC
Primescan. After selecting the
tooth (46), the type of restoration
(inlay/onlay) and the material to be
used (Coltene - BRILLIANT Crios),
the impressions of the upper and
lower hemiarchs and the bite were
recorded (Figs. 5-7).
Fig. 2: Clinical evaluation of tooth 46
In this way the milling machine
was able to produce the endocrown, during the execution of the
endodontic treatment.
Once this procedure was completed, the margin preparation of
46 was drawn (Fig. 8), ready to be
restored with an endocrown, and
the final project previewed (Fig. 9).
When everything was finished, the
process continued with the milling
of the BRILLIANT Crios A2 HT composite block (Figs. 10, 11).
Phase 3
Endodontic treatment
The root canal shaping was carried out with the Hyflex EDM instruments - Shaping set medium
25 mm, alternating the use of
CanalPro sodium hypochlorite at
each step (Figs. 12, 13). After completing the root canal instrumentation and drying the canals using
Paper Points Greater Taper .04
COLTENE paper cones, GuttaFlow
bioseal root canal cement was applied and closed by vertical hot
condensation with Hyflex EDM
Gutta-percha points (Figs. 14-16).
▶ Page 13
Fig. 3: Initial removal of the old restoration on tooth 46 to assess
the extent of the carious lesion.
Fig. 4: Tooth 46 with completed and finished cavity.
Fig. 5: Digital impression (lower hemiarch).
Fig. 6: Digital impression (upper hemiarch).
Fig. 7: Digital impression (buccal bite).
Fig. 8: Drawing of the preparation margin to accommodate the endocrown.
Fig. 9: Preview of the endocrown of 46.
Fig. 10: Preview of the milling phase.
Fig. 11: BRILLIANT Crios A2 HT block.
[13] =>
GENERAL DENTISTRY
13
Dental Tribune Middle East & Africa Edition | 03/2023
◀ Page 12
Phase 4 – Restoration
After the endodontic treatment
(Fig. 17), a layer of BRILLIANT EverGlow Flow (Fig. 18) was applied to
the bottom of the pulp chamber
(Fig. 19). Once the milling of the
block was completed (working time
about 9 minutes), a try-in check was
done. Afterwards, the endocrown
was finished and polished (Figs. 20,
21). We continued with the conditioning phases of the restoration,
carrying out, in the order: sandblasting (Fig. 22), application of the
adhesive ONE COAT 7 UNIVERSAL
(Fig. 23).
After applying the rubber dam
again, isolating the fourth quadrant, the conditioning of tooth 46
was performed: etching (Fig. 24),
ONE COAT 7 UNIVERSAL adhesive
(Figs. 25, 26).
At this point, the luting of the
endocrown took place using the
heated composite BRILLIANT EverGlow A2/B2 (Figs. 27, 28). After removing all the excesses, the polymerization took place for a time of
90 seconds per surface (occlusal,
buccal, lingual). Post luting polishing was performed using the DIATECH
ShapeGuard
Composite
Polisher Kit (Figs. 29, 30).
After removing the rubber
dam, a post-luting clinical check of
the endocrown was performed
(Fig. 31). The execution time of this
new protocol “endo-resto approach in digital dentistry” was
2 hours and 30 minutes.
Ten days after the endo-resto
treatment, the patient will undergo
a clinical and radiographic evaluation to assess the integration of the
restoration with the surrounding
tissues. (Figs. 32, 33).
Case 2
A male 62-year-old patient had
an emergency appointment due to
pain and high sensitivity of heat and
cold in the third quadrant. After carrying out the physical and radiographic examination, the presence
of a large carious lesion with pulp
involvement first lower molar, which
had an old amalgam restoration,
was clinically and radiographically
assessed (Figs. 34, 35). The patient
was offered to treat this tooth in a
single visit with the new protocol
"endo-resto approach in digital
dentistry”, which he accepted.
Phase 1
Initial digital impression
The session began immediately
with the digital impression, concerning the left lower arch, the
upper one and the buccal bite
(Figs. 36-38). It is important to start
with the impression because, after
having prepared the tooth under
the rubber dam and recorded the
new impression, the software is
able to match and recognize the
two components.
Phase 2
Isolation und preparation
After applying the rubber dam
to isolate the third quadrant
(Fig. 39), the amalgam was removed and the mesial margin was
relocated. Then, the cavity was prepared, according to the endocrown, and the pulp chamber was
opened according to the endodontic treatment (Fig. 40).
PHASE 3 – Final digital impression and procedures
Before the digital impression,
teflon was applied on the pulp
floor, with the aim of simulating the
thickness of the subsequent layer
▶ Page 14
Fig. 12: Hyflex EDM files.
Fig. 13: CanalPro (NaOCl 3 %).
Fig. 16: HyFlex EDM Guttapercha Points.
Fig. 17: Endodontic treatment completed.
Fig. 18: BRILLIANT EverGlow Flow.
Fig. 19: Layer of flow applied to the bottom of pulp chamber.
Fig. 20: Resin composite endocrown at the end of characterization
and polishing.
Fig. 21: Resin composite endocrown at the end of characterization
and polishing.
Fig. 22: Sandblasting.
Fig. 23: Application of adhesive ONE COAT 7 UNIVERSAL.
Fig. 24: Etching.
Fig. 25: Application of the universal adhesive.
Fig. 26: ONE COAT 7 UNIVERSAL.
Fig. 27: BRILLIANT EverGlow A2/B2.
Fig. 28: Luting of the endocrown.
Fig. 29: DIATECH ShapeGuard Polishers.
Fig. 30: Endocrown after polishing and finishing.
Fig. 14: ROEKO Paper Points
Greater Taper 0.04.
Fig. 15: GuttaFlow bioseal.
[14] =>
GENERAL DENTISTRY
14
Dental Tribune Middle East & Africa Edition | 03/2023
◀ Page 13
Fig. 31: Clinical view of the endocrown of 46, after removing the
rubber dam.
Fig. 32: Clinical evaluation of endocrown integration.
Fig. 33: Radiographic evaluation of the integration of the restoration and endodontic treatment.
Fig. 34: Clinical evaluation of tooth 36.
Fig. 35: Radiographic evaluation of tooth 36.
Fig. 36: Digital impression (mandibular arch).
Fig. 37: Digital impression (maxillary arch).
Fig. 38: Digital impression (buccal bite).
Fig. 39: Isolation of the third quadrant.
Fig. 40: Tooth 36 after cavity preparation and removal of the pulp.
Fig. 41: With the use of a probe, the thickness of the teflon was measured, which must be between 1 and 2 mm, in order to emulate the
flow layer after the endodontic treatment.
Fig. 42: Applied teflon.
Fig. 43: Digital impression of tooth 36 after the application of rubber dam and cavity preparation.
Fig. 44: Drawing of the dental preparation margin to accommodate
the endocrown.
Fig. 45: Preview of the endocrown of 46.
Fig. 46: Preview of the milling phase.
Fig. 47: BRILLIANT Crios A2 HT block.
Fig. 48: Hyflex EDM files.
Fig. 49: CanalPro (NaOCl 3%).
Fig. 51: GuttaFlow bioseal.
Fig. 52: HyFlex EDM Guttapercha Points.
Fig. 50: ROEKO Paper Points
Greater Taper 0.04.
▶ Page 15
[15] =>
GENERAL DENTISTRY
15
Dental Tribune Middle East & Africa Edition | 03/2023
◀ Page 14
Fig. 53: Endodontic treatment completed.
Fig. 54: BRILLIANT EverGlow Flow.
Fig. 55: Layer of flow applied to the bottom of pulp chamber.
Fig. 56: Resin composite endocrown after characterization and polishing.
Fig. 57: Resin composite endocrown after characterization and polishing.
Fig. 58: Sandblasting.
Fig. 59: Application of ONE COAT 7 UNIVERSAL.
Fig. 60: Application of the universal adhesive.
Fig. 61: ONE COAT 7 UNIVERSAL.
Fig. 62: BRILLIANT EverGlow A2/B2.
Fig. 63: Luting of the endocrown.
Fig. 64: DIATECH ShapeGuard Polishers.
Fig. 65: Endocrown after polishing and finishing.
Fig. 66: Clinical evaluation of endocrown integration.
Fig. 67: Radiographic evaluation of the integration of the restoration and endodontic treatment.
of flow that will be applied at the
end of the endodontic treatment
(Figs. 41, 42).
Once the correctness of the
canal closure was verified, the
chair-side digital protocol continued. Tooth 36 was cut out from the
previous scan, and the preparation
under rubber dam was recorded,
with the adjacent teeth as reference (Fig. 43).
Once this procedure was completed, the margin preparation of
36 was drawn (Fig. 44), ready to be
restored with an endocrown, and
the final project previewed (Fig. 45).
When everything was finished,
I continued with the milling of the
BRILLIANT Crios A2 HT composite
block (Figs. 46, 47) and then the
endodontic treatment.
Phase 4
Endodontic treatment
The root canal shaping was carried out with the Hyflex EDM in-
struments - Shaping set medium
25 mm, alternating the use of
CanalPro sodium hypochlorite at
each step (Figs. 48, 49). After completing the root canal instrumentation and drying the canals using
Paper Points Greater Taper .04
COLTENE paper cones, GuttaFlow
bioseal root canal cement was applied and closed by vertical hot
condensation with Hyflex EDM
Gutta-percha points. (Figs. 50-52).
After the endodontic treatment
(Fig. 53), a layer of BRILLIANT
EverGlow Flow (Fig. 54) was applied
to the bottom of the pulp chamber
(Fig. 55).
Phase 4
Endcrown luting procedure
Once the milling of the block
was completed (working time
about 11 minutes), the endocrown
was tried in, finished and polished
(Figs. 56, 57). We continued with
the conditioning phases both of
the restoration and the tooth. For
the first one it consisted in: sandblasting (Fig. 58), application of the
universal adhesive ONE COAT 7
UNIVERSAL (Fig. 59). For the second one: etching, ONE COAT 7 UNIVERSAL adhesive (Figs. 60, 61).
At this point, the luting of the
endo-crown took place using the
heated
composite
BRILLIANT
EverGlow A2/B2 (Figs. 62, 63). After
removing all the excesses, the polymerization took place for a time
of 90 seconds per surface (occlusal,
buccal, lingual). Post luting polishing was performed using the DIATECH ShapeGuard Composite Kit
(Figs. 64, 65).
After removing the rubber
dam, a post-luting clinical and radiographic check of the endocrown
was performed (Figs. 66, 67). The
execution time of this new protocol
“endo-resto approach in digital
dentistry” was 2 hours and
20 minutes.
Dr Simona
Chirico
is a dentist who
graduated from
the University of
Milan in 2016
and later pursued a Master's
degree in Restorative and Aesthetic
Dentistry at the University of Bologna,
which she completed in 2021. She has
been actively involved in Restorative
Dentistry, Endodontics, and Digital
Dentistry since 2017, and currently runs
a private practice in Milan and Desio
(MB). Additionally, she serves as the
scientific coordinator for "Dentistry33 Edra".
Prof. Massimo
Gagliani
has been actively practicing
Restorative Dentistry and Endodontics
since
1990. He began
his career as a Researcher at the University of Milan in 1992 and was later
promoted to Associate Professor in the
same institution in 2000. He is a member of major international and national
societies for Restorative & Endodontics
and was one of the five founders of the
Digital Dental Academy (DDA). His research work has been widely published
in major international journals. Since
2014, he has served as the Scientific
Coordinator for Editorial Group Edra.
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On average, with the iTero Plus series as compared to the iTero Element 2 and iTero Element 5D, and based on
scan processing time comparison of 40 Invisalign scans and 40 restorative scans with 3 prep teeth processed
by the iTero Element 2/iTero Element 5D computing units and the iTero Element Plus series computing unit.
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Your
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Healthy
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Help keep your patients on a
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AT LEAST
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Gingivitis is often ignored by patients in
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gum health between visits is difficult.
Halitosis
Gingival
recession
Periodontitis
OF ADULTS
Tooth loss
In addition to good oral hygiene and
professional advice, patients may benefit
from the addition of parodont ax ® and
Mouthwash for their optimum gum health.
1
suffer from gingivitis globally,
2
but 2 out of 3 take no action
Patient insight research shows that
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daily life causing anxiety, embarrassment
and affecting social life, especially when
symptoms become noticeable to others.3
INTENSIVE TREATMENT
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Short-term intensive treatment
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We value your feedback. Always follow the product label prior to use. +973 16500404 - Gulf & Near East countries
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[19] =>
Week 2
We value your feedback. Always follow the product label prior to use. +973 16500404 - Gulf & Near East countries
contactus-me@gsk.com, ZINC Code: PM-BH-PAD-22-00007 | Date of preparation: March 2022
References: 1. CDC Perio 2016; Half of American Adults have Periodontal disease. 2. Data on file, GSK, parodontax® Segmentation, August 2015. 3. Data on File, GSK,
Firefish: Putting the patient first. Life impact of gum disease. March 2016. 4. Kakar A et al. Evaluate the Efficacy of Different Concentrations of Sodium
References: 1. CDC Perio 2016; Half of American Adults have Periodontal disease. 2. Data on file, GSK, parodontax® Segmentation, August 2015. 3. Data on File, GSK,
Bicarbonate Toothpastes. IADR General Session and Exhibition, Cape Town, South Africa, 2014. Abstract No: 754. 5. Data on file, GSK, RH01530, January 2013. 6.
Firefish: Putting the patient first. Life impact of gum disease. March 2016. 4. Kakar A et al. Evaluate the Efficacy of Different Concentrations of Sodium
Beiswanger BB, et al. J Clin Dent 1992;3(2):33-38. 7. Sanz M et al. J Periodontol 1989;60(10):570-576. 8. Data on file, GSK, RH02434, January 2015. 9. Pratten J
Bicarbonate Toothpastes. IADR General Session and Exhibition, Cape Town, South Africa, 2014. Abstract No: 754. 5. Data on file, GSK, RH01530, January 2013. 6.
et al. Int J Dent Hyg 14(3):209-214. 10. Todkar R et al. Oral Health Prev Dent 2012;10(3):291-296. 11. Jones CG.
Periodontology 2000 1997;15:55-62. Prepared April 2017. GCGHDM/CHPAD/0069/16
* Compared to a regular toothpaste following a professional clean and 24 weeks’ twice-daily brushing.
We value your feedback. Always follow the product label prior to use. +973 16500404 - Gulf & Near East countries
contactus-me@gsk.com, ZINC Code: PM-BH-PAD-22-00007 | Date of preparation: March 2022
Beiswanger BB, et al. J Clin Dent 1992;3(2):33-38. 7. Sanz M et al. J Periodontol 1989;60(10):570-576. 8. Data on file, GSK, RH02434, January 2015. 9. Pratten J
et al. Int J Dent Hyg 14(3):209-214. 10. Todkar R et al. Oral Health Prev Dent 2012;10(3):291-296. 11. Jones CG.
Periodontology 2000 1997;15:55-62. Prepared April 2017. GCGHDM/CHPAD/0069/16
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p=0.001
0
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1
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Clinically proven to reduce the symptoms of gingivitis10
parodontax® toothpaste
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Mean change from baseline in plaque removal
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3
Clinically proven to reduce plaque, bleeding gums and inflammation8
0
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4
6
8
12
14
16
18
20
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To
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[20] =>
GENERAL DENTISTRY
20
Dental Tribune Middle East & Africa Edition | 03/2023
Help your patients say yes!
(Image: YAKOBCHUK VIACHESLAV/Shutterstock)
By Dr Kübel Özkut, Turkey
The last two years have certainly been challenging times, and
many of us have understandably
been worried about what it all
means for the future of our businesses. The additional weaknesses
of systems that were already struggling prior to the COVID-19 pandemic have become even more
magnified, and that certainly is not
helping us regain our patient numbers.
Since the beginning of the pandemic, we as dental professionals
have put a great deal of effort into
making our patients feel safe and
protected so that they can properly
maintain their oral health by receiving any necessary treatment. However, knowing how to execute excellent dental treatment and having the opportunity to provide
treatment to our patients are two
different things. Getting patients to
schedule the treatment we recommend can be difficult, but it is vital
to our practice's success. The acceptance rate should be greater
than 80% for existing patients and
between 50% and 75% for new patients.1
It is imperative to take the time
to explain to each patient why they
need the particular treatment, and
we must do our best to answer all
their questions. Despite receiving
all the necessary information concerning the proposed treatment,
many patients leave the office without scheduling an appointment for
the treatment, some never to be
heard from again. While this can be
a frustrating situation, it can also be
an opportunity to make improvements to our systems to raise case
acceptance rates.
If we want patients to accept
treatment, we need to fully understand what they really desire. When
we have the same priorities as our
patients, our practice's retention
and case acceptance rates will go
up. Patients will feel more in control
of the process and appreciate that
we have understood their needs
and values, thereby fostering loyalty and trust. 2 They will not feel
pressured into accepting treatment
they do not want, but they will
gladly accept treatment that will
help them meet their oral health
goals.
Engagement with patients
Effective listening is the key to
finding out what motivates patients, what they think about their
smiles, and what they would like to
improve. 3 It is not about selling
dentistry; it is about getting to
know our patients and even partnering with them so that we can
create a win-win situation. Asking
questions, particularly open-ended
ones, can help encourage patients
to
communicate
their
oral
health-related desires. For example:
•
•
•
•
•
On a scale of 1–10 (1 being
poor and 10 being excellent),
what level of oral health would
you like to achieve?
Have you ever encountered
problems with chewing, or
have you had mouth or tooth
pain?
How important is your smile to
you and to your confidence
when interacting with people,
both personally and professionally?
If you had a magic wand, what
would you like to change
about your smile, if anything?
Diet affects oral health. Could
you please tell me about your
diet?
We dentists may be excellent
clinicians and superior at treatment
planning, but presenting treatment
plans to the patient is something
better delegated to a well-trained
staff member. For example, having
a treatment coordinator who goes
over every detail with the patient in
a comfortable, quiet environment,
giving them the opportunity to ask
questions without feeling rushed,
can be very effective.
Conversations supported with
digital tools to demonstrate treatment options visually also help patients understand the benefits of
the suggested treatment and help
them feel more connected to the
practice, which of course makes
them more comfortable about
scheduling treatment. If we want to
improve case acceptance in our
practice, we should ask for the patient’s final decision after the presentation of the suggested treatment and explore any barriers to
acceptance with the patient.
Dental fears
Unfortunately, dental fears are
common and often keep patients
from getting the treatment they
need. When patients look at before
and after photographs of similar
cases we have completed, it can
help to ease their fear and earn
their trust, making them much
more likely to accept the treatment.
It is imperative that the patient understands exactly what the treatment involves and how we plan to
keep them comfortable. This includes enquiring about their concerns, covering the possible consequences of not receiving treatment, and focusing on the advantages of the proposed treatment.
Research has found that nearly
68% of those who avoided or delayed visits to the dentist gave the
expense as the primary reason.4
While multiple reasons were given,
the cost of going to the dentist was
mentioned more than twice as
often as anything else.4 Most patients do not put money away specifically for dental care and have no
idea how they are going to pay for
treatment.5 In my experience, if
they are not in pain, patients often
convince themselves that they do
not need treatment, which inevitably leads to more complicated
problems and additional costs
down the road.
We should take the time to educate patients in detail before
talking about costs, making sure
that they understand the value of
the care we provide. If it is because
they do not really see the value of
the treatment, we should educate
them about their condition and the
possible consequences of not receiving the treatment. Once patients understand why they need
treatment, price becomes less of a
barrier. In our clinic policies, we
should offer different financing options for our patients, showing
them that we are also ready to support them.
Lack of time
Lack of time is a common reason for treatment delay. Like most
people, our patients are often very
busy and may forget to call to
schedule treatment once they leave
the practice, sometimes despite
knowing the importance of their
dental health and the importance
or urgency of the proposed treatment. To overcome this, we can
train our treatment coordinator to
follow up with the patient two days
or a week after the initial case presentation is made. That way, the
conversation is still fresh in the patient’s mind.
We can use these calls as an opportunity to educate patients even
further and address any lingering
concerns. Patients will appreciate
the extra effort and gain a better
understanding of the recommended treatment and why it is
necessary.
Efficient recall and retention
program
Retaining a current patient is
far easier and more cost-effective
than attracting a new patient, so investing time and effort in an efficient patient recall and retention
strategy is essential. In an effective
recall and retention program, patients should visit twice a year.
The recall and retention strategy should involve making patients
aware of the practice’s services and
the value of the ongoing care that
the team provides. This includes
the amazing advancements in dental materials and digital technologies and the treatment options
available. It is important to emphasize the improved patient experience and faster results that can be
achieved with these tools.
In summary, an efficient, structured case presentation policy ensures that patients say yes to our
treatment plans. It also addresses
one of the core values of dentistry,
which is a commitment to oral
health as a component of the general health of our patients. When
we gain and retain patients who
value our practice, we will have the
opportunity to practice with less
stress and more joy in our clinics.
Editorial Note: A list of references is
available from the publisher.
This article was published in
CAD/CAM international magazine of
dental laboratories vol. 13, issue 2/2022.
Dr Kübel Özkut graduated
in dentistry
from Istanbul
University in Turkey in 1996 and
received her MBA with a focus on
healthcare management from Yeditepe University in Turkey in 2003 and
her master’s degree in prosthodontics, aesthetics and digital dentistry
from the University of Siena in Italy
in 2020. She is an adjunct professor
of business and administration at
the dental school of the University
of Siena, teaching in its residency
master’s programme in prosthodontic sciences, and is a visiting lecturer
at Acıbadem University in Istanbul.
Since 2009, she has been the clinic
director of the dental department
of Acıbadem Health Group’s Maslak
Hospital in Istanbul. Her special
interests are aesthetics, advanced
restorative and digital dentistry. She
also gives consultations and lectures
on the management of healthcare organisations. Dr Özkut is the
president of the Turkish Academy
of Esthetic Dentistry and a scientific
committee member of the European Academy of Digital Dentistry,
European Association for Osseointegration and European Society of
Cosmetic Dentistry.
[21] =>
[22] =>
GENERAL DENTISTRY
22
Dental Tribune Middle East & Africa Edition | 03/2023
Why is Slow Dentistry calling
for a system reform of the hiring process in dental practices?
(Image: styles66/Pixabay)
By Dr Huthaifa AbdulQader,
Switzerland
The dental industry is doing its
best to forestall the increasing
rates of employee turnover and attrition amidst inflation in a
post-pandemic world. Clinic owners are facing a bewildering conundrum of applicant shortages and
misfits, staffing needs beyond the
norm and patients’ continued demand for excellence. To stem the
flow, it is important for clinic owners and practitioners to equip
themselves with the tools to identify employee burn-out and to cultivate strategies to shape culture.
A major cause of turnover in the
dental profession is “quiet quitting”, a global phenomenon that
has become widely popularised. It
is thought to be largely linked to
the pan- demic and its aftermath.
However, the Slow Dentistry Global
Network (SDGN), a Swiss nonprofit organisation, is proposing a
deductive argument and an approach that addresses the root
cause of this phenomenon.
Slow Dentistry—a modern-day
work philosophy—places an emphasis on seeing an appropriate
number of patients per day. Our research indicates that many clinics
around the world utilise a business
model that relies on seeing an excessive number of patients per day,
leading to a multitude of problems.
The movement advocates for a
stress-free operatory environment that is crucial for the well-being of the patient, practitioner and
practice as a whole. It is based on
four cornerstones:
1. room disinfection;
2. informed consent;
3. proper anaesthesia; and
4. the use of dental dams.
These cornerstones revolve
around an all-encompassing hallmark: personal congruence. From
dental practitioners’ perspective,
congruence refers to living in such
a way that their blueprint of how
they should be practising and their
reality of how they practise is completely harmonious. SDGN asserts
the premise that the more congruence is cultivated within a person,
the more self-awareness and
self-confidence develop.
The ultimate ramification of not
following this growth mind-set is a
cycle of desperation hiring. The
“Great Resignation” predicted by
Anthony Klotz is slowly becoming a
reality. Experiences connected to
the COVID-19 pandemic have
opened the eyes of many to the
value of family time, pursuing passion projects and, most importantly,
consciously
detecting
chronic stress and early stages of
burn-out.
Lockdown-induced
solitude
juxtaposed the old-fashioned
rushed style of dental care. This
created a situation where younger
practitioners had the opportunity
to enjoy their work in a way that
was previously prevented by the
nature of profit-driven dental practice. In addition to many fresh graduates who are very scared and anxious to enter the workforce, the upand-comers have needs that are
not satisfied by the doctrine embraced by their employers, thus
leading to a toxic workplace culture—the main cause of quiet quitting.
The aforementioned four cornerstones of Slow Dentistry correspond to four pillars of personal
congruence:
1. emotional intelligence;
2. conscious communication;
3. healthy responsibility; and
4. impeccable agreement.
Our philosophy matches each
pillar of personal congruence to
the corresponding value of each
cornerstone. The complexity of this
suggested coalescence is far beyond a straightforward elucidation.
The aim of this article is to outline
these factors and show how aligning and engaging the skill set, efficiency, talent and attitude of team
members can result in a positive
workplace culture.
Commercialised volume-based
dentistry has led to an increased
exposure to low-grade stress,
which negatively affects the employee even prior to arriving at the
clinic. Many dental employees who
previously struggled quietly with
stress have provided testimonials
for SDGN. They reported that they
felt stuck in their workplace and
were afraid that their opinions
would be dismissed or met with retaliation. The attraction–selection–
attrition model proposed by Benjamin Schneider explains this situation with a psychological theory
which suggests that employees
base their person–organisation fit
perception on the values portrayed
in the workplace.
SDGN is establishing training
programmes and advocacy campaigns to effect change. These programmes target both the younger
generation who are transitioning
from university to the workforce
and the older generation who are
agonised by chronic exhaustion
and burn-out. These programmes
will nurture a universal contemporary approach towards shaping culture to eventually forge real relationships and co-create alignment
within the workplace.
The Slow Dentistry Experience
(SDE) is a tutorship programme
aimed at providing pre-employment training and development
opportunities for young dentists at
top Slow Dentistry-certified clinics
around the world. Exclusive externships, internships and mentorships will be offered that fully explore Slow Dentistry’s ethos and
that build a unified, stress-free relationship between the employer
and the employee, which ultimately
promotes a healthy work–life bal-
ance. The Slow Dentistry Experience is for those who seek inspiration and empowerment in their
work and deeply believe in their
ability to radically change dental
care worldwide. This programme is
planned to facilitate and optimise
the employment process in dentistry. It is the first stage of system
reform.
The Slow Dentistry Job Board is
a complementary stage to the Slow
Dentistry Experience. Both stages
will formulate a hiring strategy
where both parties follow the same
guide-book. There is a current lack
of a unified system of linking applicants to job providers in dentistry,
and SDGN aims to gather likeminded dentists who share the advocated ethos on the same platform. This will drastically diminish
turnover rates, resulting in fewer
costs, higher productivity and
greater knowledge preservation
for dental practices. Desperation
hiring fills a position with the wrong
person, which means a host of
problems later. Safeguarding turnover is a process not a policy and is
an investment not a quick fix.
A community platform with a
networking hub will be launched
where dental professionals at all
points of their careers can communicate with each other in one place.
Nurturing the next generation in
the nuances of Slow Dentistry is expected to generate a resilient
workforce with a high degree of
self-awareness. The first element of
success in dealing and communicating with the dental team and patients is self-confidence, which develops from heightened self-awareness.
Slow Dentistry places more
value on the concept of seek- ing
instead of chasing. It promotes the
journey over the destination by advocating for No Half Smiles—a philosophy proposed by Dr Miguel
Stanley, a major proponent of ethically based treatment planning
rather than financial. The more we
learn how to reject quick fixes demanded by patients and enact
sound, comprehensive treatment
plans, the sooner practitioners will
start to put themselves first, creating internal harmony. This harmony
cannot be attained without having
already developed self-confidence.
The emotional and financial aspects of workplace manage- ment
are the least taught subjects in
dental schools, if taught at all,
meaning that many young professionals graduate with low self-esteem. SDGN will create a coaching
programme to introduce interested dentists to the Slow Dentistry
values. The programme will educate young den- tists entering the
workforce on the principles of innovative leadership by co-creating
a customised management style
with the operating team, one that
aligns with the needs, values and
culture of the workplace and attracts patients seeking complete
healthy smiles.
Slow Dentistry’s financial model
is the ultimate hedge against indebtedness. Its management style
characterises a steadier pace towards financial growth. It garners
target patients over a longer period, which ultimately balances out
the financial gap that was created
by seeing an appropriate number
of patients per day. This approach
will save the new generation of
dentists from falling into possible
failure patterns and guide them to
foster a well-thought-out mind-set
for a successful future that satisfies
their aspirations. It will not only
sustain the careers of those who
prefer to keep working as practitioners, but also expedite the transition from practitioner to clinic director for those who possess leadership personality traits.
Battling quiet quitting and attrition can only be avoided by embracing Slow Dentistry’s philosophy and eliminating a toxic culture,
burn-out, misfits and favouritism in
the workplace. The more congruent we are, the higher our
self-awareness will be and ultimately the more self- confident we
will become to preserve our mental
health. A sustainable dental practice is a Slow Dentistry-certified
practice.
Editorial Note: This article was published
in digital international magazine of
digital dentistry vol. 4, issue 1/2023.
Dr Huthaifa
AbdulQader
General secretary of the Slow Dentistry Global Network
www.slowdentistryglobalnetwork.org
[23] =>
Season 1
Building the Aspirational Practice
‘The Practice’ is a podcast by Align Technology that seeks out the
stories of prominent orthodontists from across the Middle East.
Join host Chris Barrow as he goes behind the scenes to understand
the mindsets and motivations that have driven their careers and
shaped their practices and lives beyond orthodontics.
Episode 1 | Dr Reem Alansari
“A holistic practice is key to work-life balance”
Date: 03.04.2023
Episode 2 | Dr Suliman Shahin
“Patient perception matters”
Date: 23.04.2023
Episode 3 | Dr Mubarak Alsaeed
“Almost half of my patients are remote”
Date: 09.05.2023
Episode 4 | Dr Nasser Alqahtani
“How do we nurture a code of self-awareness”
Date: 09.06.2023
Episode 5 | Dr Akshay Bantwal
“From a chisel and a mallet to an iTero™ intraoral scanner”
Date: 09.07.2023
LISTEN NOW:
Spotify
Anchor
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Google
Podcast
Podcast
Scan QR code to
listen to the podcast
[24] =>
GENERAL DENTISTRY
24
Dental Tribune Middle East & Africa Edition | 03/2023
Six-month evaluation of a sodium
bicarbonate-containing toothpaste for the
reduction of established gingivitis:
A randomised USA-based clinical trial
By Anto Jose, Jonathan
Pratten, Mary-Lynn Bosma,
Kimberley Milleman, Jefferey
Milleman, Nan Wang
Aim
A single-blind, examiner-side
controlled trial was conducted to
evaluate and compare the effects
of Parodontax toothpaste and regular toothpaste on plaque control,
bleeding index, and gingivitis. The
study assessed the participants
after 6, 12, and 24 weeks of twicedaily use of the respective toothpastes. The trial aimed to determine the efficacy of Parodontax
toothpaste compared to regular
toothpaste in improving these oral
health parameters over the specified time intervals.
Study products
The study compared the effects
(Image: AZFAR ARTS/Shutterstock)
of two toothpaste formulations:
Parodontax toothpaste and regular
toothpaste.
Parodontax toothpaste conAt baseline, participants had
twice daily at home for 24 weeks,
tains 67% sodium bicarbonate and
moderate gingivitis, a positive refollowing a dental prophylaxis.
is formulated with 1150 ppm fluosponse to bleeding after brushing,
Subjects were re-assessed for
ride (as NaF). The sodium bicarbonand more than 20 bleeding sites
overnight plaque at weeks 6, 12,
Results
ate content provides its unique
(derived from the modified bleedand 24.
209
subjects completed the study
composition.
ing index).
Both toothpastes
were well tolerated
adversesoft
eventstissue evaluation,
Regular toothpaste,
on with
theno seriousOral
Results
Gingival
bleeding,
gingivitis
and
plaque
indices
were
significantly
improved
over
time
after
twice-daily
other hand, does not contain somodified gingival index (MGI),
A total of 209 subjects combrushing
with parodontax
in participants
dium bicarbonate
and(67%
has sodium
a fluo-bicarbonate-containing)
bleeding indextoothpaste
(BI), and
dental with
pleted the study, and both toothmoderate gingivitis
ride concentration of 1100ppm (as
plaque assessment using the modpastes were well tolerated with no
At
24
weeks,
there
was
a
19%
difference
in
reduction
of
overall
plaque
scores
versus
baseline
NaF). It serves as the control toothified Turesky index were conducted
serious adverse events reported.
for parodontax compared with the 4.3% reduction vs baseline for regular toothpaste
paste
in
the
study.
as
baseline
assessments
for
all
subParticipants with moderate gingivi(0% sodium bicarbonate)
jects.
tis showed significant improveThe interproximal plaque score vs baseline at 24 weeks showed a 16% difference in reduction
Subjects
ed based
ments in gingival bleeding, gingiviMethodscompared to a 3.2% reduction in build
for parodontax
up for awere
regularstratifi
toothpaste
on
the
number
of
baseline
bleedtis, and plaque indices over time
Entry
criteria:
The
presence
of
46-48% reduction of BI and bleeding
ing sites and smoking status.
after twice-daily brushing with
blood within the sink following
A total of 246 subjects were
Parodontax toothpaste, which con1 minute of brushing at screening
randomly assigned to either the
tains 67% sodium bicarbonate.
with a regular toothpaste and
Parodontax or control group. They
At 24 weeks, there was a 19%
toothbrush was used as an entry
usedwith
theirmean
assigned
toothpaste
difference in reduction of overall
criterion.
Mean whole mouth plaque scores,
change
vs baseline
plaque scores compared to baseline for Parodontax toothpaste,
whereas the reduction for the regular toothpaste without sodium bicarbonate was 4.3% compared to
baseline. The interproximal plaque
score at 24 weeks showed a 16%
difference in reduction for Parodontax toothpaste compared to a
3.2% reduction for the regular
toothpaste. Additionally, there was
a significant reduction of 46-48% in
bleeding index and bleeding for
participants using Parodontax
toothpaste.
Summary of the study conclusion
twice-daily brushing, Parodontax
toothpaste significantly reduced
the bleeding index, gingival inflammation, and plaque at 6, 12, and 24
weeks (p < 0.0001). In comparison
to regular toothpaste, Parodontax
toothpaste removed over four
times more plaque buildup, which
is the primary cause of bleeding
gums, over the course of 6 months.
These results demonstrate the
long-term clinical significance of
using a toothpaste containing 67%
sodium bicarbonate in preventing
plaque buildup and maintaining
gingival health following professional cleaning.
The study findings indicate that
with professional cleaning and
Mean interproximal plaque scores with mean change vs baseline
3.5
3.05
n=117
Mean TPI score
2.5
3.01
n=117
2.90
n=115
2.92
n=113
4.3%
reduction
n=118
2.56
n=118
2.0
3.0
19%
reduction
3.05
2.54
n=111
2.47
n=109
1.5
1.0
3.21
n=117
3.10
n=117
2.5
Mean TPI score
3.0
3.5
3.01
n=115
3.11
n=113
3.2%
reduction
16.1%
reduction
3.23
n=118
2.76
n=118
2.63
W6
W12
n=111
2.71
n=109
2.0
1.5
1.0
0.5
0.5
0.0
BL
W6
W12
W24
BL
Regular Paste
W6
W12
parodontax
W24
0.0
BL
W6
W12
W24
BL
Regular Paste
W24
parodontax
All patients received a professional clean at baseline and followed a twice daily brushing regime for 6 months
All patients received a professional clean at baseline and followed a twice daily brushing regime for 6 months
Mean overall TPI score ± standard error*, ITT population. Adapted from Jose et al. 2018
Mean interproximal TPI score ± standard error*, ITT population. Adapted from Jose et al. 2018
*Raw mean at baseline; adjusted mean at Weeks 6, 12, and 24. TPI was scored on a scale from 0 to 5.
*Raw mean at baseline; adjusted mean at Weeks 6, 12, and 24. TPI was scored on a scale from 0 to 5.
Mean whole mouth plaque scores, with mean change vs baseline.
Mean interproximal plaque scores with mean change vs baseline.
Summary of study conclusions
With professional cleaning and twice daily brushing, parodontax significantly reduced the bleeding
index, gingival inflammation and plaque at 6, 12 and 24 weeks (p<0.0001)
[25] =>
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[26] =>
INTERVIEW
26
Dental Tribune Middle East & Africa Edition | 03/2023
“Roxolid is one of the most significant
advances in the last 20 years”
An interview with Paul Fugazzotto
By Straumann
Team for Implantology) is so valuable to us as clinicians. The ITI carries out unbiased basic science and
clinical research. Results built upon
this research by clinicians throughout the world further support the
use of innovative implants and surface technologies.
In this interview, Dr. Paul Fugazzotto from Milton, Massachusetts
talks about Straumann’s material
and surface technologies, Roxolid
and SLActive and their impact on
the evolution of implant dentistry:
an increased acceptance of implant
therapy by clinicians and patients –
and why he thinks that all of his patients deserve to be treated with
advanced technologies.
Dr. Fugazzotto, innovative
implant materials and surfaces
have a significant influence on
dental implantology. Where do
you see the benefits?
The impact on clinical practice
is indeed on a number of levels, including the expansion of therapeutic possibilities, the patient experience and practice management
ramifications. The utilization of
shorter implants affords the opportunity to employ implant therapy in previously untenable situations. In addition, the course of
therapy is influenced both with regard to complexity of care and
overall time of treatment. For the
patient, the therapy becomes simpler, less invasive1, less costly, and
less traumatic. The net result is a
better patient experience. The
same is valid for the practice man-
What are your experiences
with Straumann’s hydrophilic
surface SLActive?
I have utilized exclusively SLActive implants since they became
available for clinical practice. Why?
Because an implant surface which
has demonstrated faster osseointegration and a superior osseointegrative bond is the first choice
for me. Which patients deserve to
be treated differently, when such
an advanced surface technology
like SLActive is readily available?
agement ramifications: patient acceptance of therapy increases as
treatment becomes simpler and
less expensive. Such increased acceptance impacts the surgical specialist, the restorative dentist, and
the “all-in-one” practitioner. The
surgical specialists are further im-
pacted as their referring partners
become more likely to refer a given
patient for implant therapy, due to
the simplification of care through
the use of innovative implant materials and surfaces.
up the course of therapy. The superior osseointegrative bond offers
significant clinical advantages
when dealing with poorer-quality
bone.
What kind of data do you
need to have confidence in using
“A number of ‘postulates’ have also been disproven
throughout the years in numerous finite element
anilities and independent clinical field research.“
(Images: Straumann)
How is your implant selection
influenced by material and surface properties?
Implant materials influence
much more than merely implant
selection. Treatment planning is altered, new treatment end points
are defined and execution of therapy is simplified. Naturally, the utilization of the Straumann Roxolid
material, with its superior strength,
allows the clinicians to confidently
place narrower implants, to treat
given situations with fewer implants, and to place implants with
more confidence in more challenging scenarios, such as in patients
demonstrating significant para-functional habits. Innovative implant surfaces do more than speed
a new implant or surface technology?
I have a simple criterion when
deciding whether or not to employ
a new implant or surface technology. Would I place said implant in
my mouth? If the answer is no there
is no reason to discuss the implant
any longer. For the answer to be
yes, I require specific types of data.
This data must be the result of independent unbiased research, carried out by reputable people and or
organizations. In addition to basic
science and histology, I expect to
see clinical data with well-defined
treatment end points, in sufficient
numbers to underscore the efficacy
of utilization. This is one of the
many reasons the ITI (International
Can you tell us something
about the Straumann Roxolid
Ø3.3 mm implants which you
have been using regularly?
My experiences with the
Roxolid Ø 3.3 mm implants are the
same as my experiences with other
Straumann implants. I have encountered no implant fracture, and
am positive that these implants,
with the SLActive surface, utilized
in appropriately treatment-planned
and -executed situations, will
demonstrate a success rate of up to
99 % over time. I specifically use the
term “success” rather than “survival,” as I assess implants both radiographically and through bone
sounding to determine their long
term stability. Roxolid implants
allow clinicians to place implants
without fear of fracture, due to
their superior strength2. So, I am
confident that, utilized appropriately, Roxolid implants offer at least
as high an implant success rate as
Straumann implants with SLActive
surface in general.
Do you see benefits of Straumann Roxolid implants over
comparative diameter-reduced
competitor implants?
The superior strength properties of Roxolid afford a greater
“safety margin” with regard to implant deformation and or fracture,
which is a clear advantage over
other reduced-diameter implants.
Simply put, Roxolid in combination
with SLActive offers advantages to
clinicians, and more importantly to
the patients they serve. Do you see
a potential for Roxolid to further
transform dental implantology if it
were available on more implant diameters and lengths? In my opinion, the development of the
▶ Page 28
[27] =>
[28] =>
INTERVIEW
28
Dental Tribune Middle East & Africa Edition | 03/2023
◀ Page 26
Roxolid material is one of the most
significant advances in implant
therapy in the last 20 years. Companies and clinicians constantly
tout new implant morphologies,
various restorative connections,
and surface technologies. While
these are important, the Roxolid
material represents a more basic
evolutionary phase in implantology. The material the implant is
composed of offers superior
strength over titanium, regardless
of the implant morphology, restorative connection or surface technology. How can such a material
not transform dental implantology
as it becomes available in more implant diameters and lengths?
Most implantologists follow
the principle of choosing the
largest and longest implant possible. If scientifically proven,
well-established materials would
allow you to use smaller diameters or shorter implants, how
would this influence your daily
work?
I do not accept the premise of
this question. The more progressive, experienced clinicians and
teachers I interface with, the majority of whom are ITI fellows or members, no longer follow the dogma
of choosing the largest and longest
implant possible in a given situation. The introduction of wider implants in the 1990s, and their utili-
zation in a variety of situations led
to disastrous results with regard to
buccal bone resorption and other
post-operative sequellae, giving
clinicians reason to pause. We have
learned from this debacle, and understand that adequate bone must
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be present around an implant to
withstand functional forces over
time, and thus help ensure longterm implant success. A number of
“postulates” have also been disproven throughout the years in numerous finite element anilities and
independent clinical field research.
These so-called postulates include
the utilization of longer implants
for greater stability; employing
longer implants when a narrow implant is placed to “make up” for lost
surface area; and the need to exceed a 1:1 implant-crown ratio.
None of these teachings have held
up well under scrutiny. Forces
placed upon implants are transmitted primarily to the peri-implant crestal bone. Such transmission has
nothing to do with implant length
and everything to do with implant
diameter. Crown-to-implant ratio
has been shown not to be a significant factor in implant failure, when
implants are placed in adequate
bone, where an appropriate occlusion has been established and
parafunctional habits managed.
“Shorter” implants (the precise
length dependent upon the individual clinician’s definition) demonstrate long-term cumulative success rates equal to their longer
counterparts. In my practice, when
an implant is not placed in an extraction socket where greater implant length is required to attain
primary stability, the average implant length I employ is 8mm. I am
very comfortable with an 8 mm
long Straumann Tissue Level implant with a Wide Neck platform to
replace a missing molar. Simply
put, the SLActive surface technology gives me the confidence to
place such implants. The introduction of Roxolid material allows me
to utilize innovative implant designs with narrower bodies and appropriate platforms in a variety of
situations.
Where is the paradigm of
using the largest and longest implant still valid and where do you
consider this differently in your
daily practice?
In my opinion, the paradigm of
using the largest and longest implant in a given situation is an outmoded way of thinking. I am more
concerned with having an adequate diameter for establishment
of a sufficient osseointegrated
bond between the implant and the
peri-implant crestal bone, which is
housed in adequate bone to withstand functional forces over time
(at least 2 mm of supporting bone
at the line angles of the buccal and
lingual/alveolar crests) and avoidance of trauma and maceration of
thin buccal extraction socket walls
at the time of implant placement. I
see no advantage to the utilization
of the largest and longest implant
possible in any situation.
In a formerly published article you talked about reducing
the implant diameter or using
short implants. Which benefits
do you see behind these considerations?
The advantage of shorter or
narrower implants include fewer invasive procedures, avoidance of
vital structures, a lessening of the
need for regenerative therapy, and
a simplification of regenerative
therapy when required. While I do
not advocate you stepping down
more than one level in implant diameter to utilize narrower implants,
I do believe that narrower implants
will become an ever increasing part
of any progressive clinicians’ practice. For example, in an area where
I would usually place a wide diameter Wide Neck Straumann Tissue
Level implant, I would not substitute a narrow diameter implant.
However, I would be comfortable
stepping down from a Ø 4.8 mm to
a Ø 4.1 mm or from a Ø 4.1 mm to a
Ø 3.3 mm Roxolid implant.
In 2013, Straumann launched
the Roxolid material on all their
implant lines and diameters and
will introduce a 4 mm short Roxolid implant line. How could the
expanded portfolio change your
treatment options and patient
selection?
This means therapy will be
more accessible to patients illsuited to extensive regenerative
therapies, to patients with greater
financial limitations, and to patients with significant resorption
which places vital structures at risk
should implants be inserted. These
are just a few of the examples of
how an extended portfolio will in
turn increase the possibilities for
implant placement in the patient
population I treat. When would you
use a Ø 3.3 mm Roxolid implant instead of a Ø 4.1 mm implant and a
Ø 4.1 mm Roxolid implant instead
of a Ø 4.8 mm implant, respectively? Assuming the appropriate
implant configurations and restorative options are available, I will utilize a Ø 3.3 mm Roxolid implant instead of a Ø 4.1 mm implant in situations where such application ensures adequate bone on buccal and
lingual aspects of the implant,
without subjecting the patient to
extensive augmentation therapy.
The same is true of utilizing a
Ø 4.1 mm Roxolid implant in place
of a Ø 4.8 mm implant. However, it
is important to realize that such utilization requires the availability of
these implants in the desired configurations.
Which additional treatment
options does a 4 mm short Roxolid implant offer you?
As already mentioned, the impact of Roxolid and SLActive technologies on the evolution of implantology includes greater penetration of implant therapy into both
clinical practices and the patient
population in a given clinical practice, greater implant penetration
into the vast ocean of untreated
patients who are missing teeth, and
increased acceptance of implant
therapy by clinicians who currently
see implant treatment as a ‘last resort.’
Editorial note: This interview was
first published in STARGET 3/13.
1. The term “less invasive treatment”
in this interview is to be understood as
avoidance of GBR.
2. Compared to titanium.
[29] =>
[30] =>
NEWS
30
Dental Tribune Middle East & Africa Edition | 03/2023
Osstem Implant’s Biotechnology R&D
Center leads development of implant
surface technology and dental biomaterials
By Osstem Implant
SEOUL, South Korea: The
Osstem Biotechnology R & D Center
was announced as an organisation
affiliated to the recently established
Tissue Regeneration Institute. In response, Osstem is further accelerating efforts for the development of
next-generation implant surface
technology and dental biomaterials.
Birth of novel SOI surface
material, securing stability after
a nine-year verification process
Osstem Implant concentrated its
corporate-wide R & D capabilities
on developing an implant surface
material that prevents implant ageing. Osstem Implant obtained a patent right of source technology for
the SOI surface technology, and a
paper on SOI surface effect was
published in Coatings, a Science
Citation Index (SCI) journal.
Having developed SOI technology in 2013, Osstem Implant repeated verification tests over a period of nine years. During this time,
by protecting the surface through
the K-material of SOI, the company
was able to increase the attraction
speed of osteocytes in the early
stages of generating bone after
placing an implant. The force of
binding with gingival bone in the
final stage was improved by 50%
compared with SA surface products
now in use. Consequently, it shortened the implant treatment period
from a maximum of six months to
between one and two months.
Il-Seok Jang, senior researcher
at Osstem Implant’s Biotechnology
R & D Center, explained: “When
placing an implant, the primary stability between bone and implant declines as a certain period of time
elapses. The SOI surface technology
minimises stability dip and enhances
clinical predictability by maximally
moving up the secondary stability
time that biochemically combines
new bone and the surface of the implant.” Osstem Implant obtained approval for SOI technology products,
including the TSIII SOI line-up, in 13
countries, including Germany, New
Zealand, India and Chile, and will
seek approval next year in the US,
Japan and Brazil.
Ju-Dong Song, director of the Biotechnology R & D Center (front centre), and researchers at Osstem Implant.
(All images: Osstem Implant)
less in a real sense as they can be
applied to a variety of medical technology areas, including technology
for the surface treatment and development of materials for plastic surgery prostheses, in addition to dental fields.”
For more information of readers
in Middle East and Africa, please contact to Osstem Middle East.
Ju-Dong Song, director of the Biotechnology R & D Center, and Min-Gyeong Kim,
senior researcher, test the performance of TissueMax.
A researcher at the Biotechnology R & D Center conducts a test using human oral
bacteria.
Outstanding women scientists at Osstem Implant’s Biotechnology R & D Center
are striving to develop next-generation biomaterials used for dentistry and plastic surgery. Front left: Jeong-Ju Kim, senior researcher on the breast implant development team at Osstem Implant’s Biotechnology R & D Center, and front right:
Min-Jeong Kim, senior researcher on the biomaterials development team.
TissueMax, a self-inflating
dental tissue expander, leads
guided tissue regeneration procedures
The development of TissueMax,
which is expected to be launched in
South Korea in the first half of 2023,
was inspired by technology being
used in plastic surgery, and it raises
the success rate of the bone grafting
that is necessary for placing an implant. Tube-shaped TissueMax enhances the success rate of surgery as
its insertion in the gingiva expands
space and it discourages gingivitis
by inserting bone graft materials
into the newly created space. A clinical study using TissueMax was published in Clinical Oral Implants Research, one of the most prestigious
journals on dental implants in the
world.
Min-Gyeong Kim, senior researcher, said “TissueMax is the
starting point of Osstem Implant’s
next-generation GTR (guided tissue
regeneration) product line-up.” The
R & D Center plans to complete development of an absorptive GTR
product by the end of 2023, and by
2026, it intends to develop a drug
release microneedle patch which will
have an antibacterial effect and accelerate the growth of cells when
the patch is attached to soft tissue.
Technologies developed at
the Biotechnology R & D Center
expand the business possibilities
of Osstem Implant
“The technological capabilities
of the Biotechnology R & D Center
are built on knowledge of biochemistry and biomaterials and can be
expanded to the development of
new materials needed for orthodontia beyond implants, such as
transparent retainers,” explained JuDong Song, director of the Biotechnology R & D Center. He added:
“Moreover, research areas are limit-
Images from a clinical case using TissueMax published in 2020 in Clinical Oral Implants Research, one of the world’s most
authoritative journals on dental implants.
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News
1 - 2
view
-
Industry
4 - 4
view
-
Artificial intelligence: A gift to dentists
6 - 6
view
-
Industry
8 - 10
view
-
A new endo-resto approach in digital dentistry
12 - 16
view
-
Help your patients say yes!
20 - 20
view
-
Why is Slow Dentistry calling
22 - 22
view
-
Six-month evaluation of a sodium bicarbonate-containing toothpaste for the reduction of established gingivitis: A randomised USA-based clinical trial
24 - 24
view
-
“Roxolid is one of the most significant advances in the last 20 years”
26 - 28
view
-
News
30 - 30
view
[toc_titles] => News
/ Industry
/ Artificial intelligence: A gift to dentists
/ Industry
/ A new endo-resto approach in digital dentistry
/ Help your patients say yes!
/ Why is Slow Dentistry calling
/ Six-month evaluation of a sodium bicarbonate-containing toothpaste for the reduction of established gingivitis: A randomised USA-based clinical trial
/ “Roxolid is one of the most significant advances in the last 20 years”
/ News
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