DT Middle East & Africa Edition No. 4, 2023
News
/ Industry
/ Artificial intelligence in dentistry
/ Industry
/ A new endo-resto approach in digital dentistry
/ Researchers publish guide to support dentists in treating patients with epilepsy
/ Jeddah, Riyadh, and Dubai hosted over 750 delegates at the "Success Simplified Roadshow" with Dr. Carlos Sabrosa, supported by 3M
/ Background music found to enhance dental students’ clinical competence
/ 3D-printed mouth guard helps remove dental plaque in older and disabled patients
/ News
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[1] =>
DTMEA_No.4. Vol.13_DT.indd
LY
N
O
S
AL
N
IO
SS
FE
O
PR
TA
L
EN
D
PUBLISHED IN DUBAI
ENDO TRIBUNE
www.dental-tribune.me
LAB TRIBUNE
Vital pulp therapy—
the clinical perspective
Researchers use generative
artificial intelligence to design...
Insertion A
Insertion B
IMPLANT TRIBUNE
Neodent- Zi Ceramic Implant System in aesthetics region...
Insertion C
Vol. 13, No. 4
ORTHO TRIBUNE
HYGIENE TRIBUNE
Digital Orthodontics Symposium An exciting programme ahead!
This novel mouthwash protects
your patients in three ways
Insertion D
Insertion E
Study identifies new bacterial species
involved in dental caries formation
By Iveta Ramonaite, Dental
Tribune International
PHILADELPHIA, US: It was previously believed that Streptococcus
mutans was the main microorganism responsible for dental caries.
However, in a recent study, researchers have discovered that another bacterial species, Selenomonas sputigena, plays a major role in
dental caries development. The
unique insights gained in the study
could help in the development of
new strategies for caries prevention.
In the study, the researchers
analysed samples of plaque from
the teeth of 300 children aged 3 to
5 years, half of whom had caries.
They then validated their findings
on a further set of 116 plaque sam-
▶ Page 02
A large study in children has demonstrated a highly complex microbial interaction in dental plaque.
(Image: Yulia YasPe/Shutterstock)
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14.09.2021 12:17:41
[2] =>
DTMEA_No.4. Vol.13_DT.indd
NEWS
02
Dental Tribune Middle East & Africa Edition | 04/2023
◀ Page 01
ples from 3- to 5-year-olds. They
found that, although S. sputigena
does not cause caries on its own,
S. sputigena interacts with S. mutans in a manner that enhances its
cariogenic power.
“This was an unexpected finding that gives us new insights into
the development of caries, highlights potential future targets for
cavity prevention, and reveals
novel mechanisms of bacterial biofilm formation that may be relevant
in other clinical contexts,” said senior author Prof. Hyun Michel Koo,
a founding director of the Center
for Innovation and Precision Dentistry at the University of Pennsylvania School of Dental Medicine.
The researchers explained that
S. mutans metabolises sugars to
produce glucans to protect the
biofilm bacteria and that S. sputigena can become trapped in the
glucans. Once this occurs, S. sputigena grows rapidly, forming honeycomb-shaped superstructures
that further encapsulate and protect S. mutans, thus increasing acid
production within the plaque.
The study was a collaboration
between the University of Pennsylvania School of Dental Medicine
and the University of North Carolina at Chapel Hill Adams School of
Research has discovered that Selenomonas sputigena interacts with Streptococcus mutans in caries formation. (Image: © 2023 Cho et al., licensed under CC BY 4.0)
Dentistry and Gillings School of
Global Public Health. “This was a
perfect example of collaborative
science that couldn’t have been
done without the complementary
expertise of many groups and individual investigators and trainees,”
said co-author Prof. Kimon Divaris
from the University of North Carolina at Chapel Hill.
The researchers are now planning to further investigate how
S. sputigena ends up in the aerobic
environment of the tooth surface.
“This phenomenon in which a bacterium from one type of environ-
ment moves into a new environment and interacts with the bacteria living there, building these remarkable superstructures, should
be of broad interest to microbiologists,” Prof. Koo concluded.
The study, titled “Selenomonas
sputigena acts as a pathobiont me-
diating spatial structure and biofilm virulence in early childhood
caries”, was published online on 22
May 2023 in Nature Communications.
Nanorobots quickly and effectively target
fungal infections in the oral cavity
By Franziska Beier, Dental
Tribune International
PHILADELPHIA, US: Because of
the threat to global health, the
World Health Organization has initiated efforts to strengthen the
global response to fungal infections and antifungal resistance. It
is important to improve anti-fungal efficacy at the site of infection.
Current
nanomaterials
have
demonstrated potential as anti-fungal agents, but lack the necessary efficacy and specificity,
leading to longer treatment times,
potential unexpected effects and
drug resistance. Researchers from
the University of Pennsylvania
have now developed a new way to
eradicate oral fungal infections
rapidly and precisely using magnetically controlled nanorobots.
IMPRINT
INTERNATIONAL
HEADQUARTERS
PUBLISHER AND CHIEF EXECUTIVE OFFICER:
Torsten OEMUS
CHIEF CONTENT OFFICER:
Claudia Duschek
The microrobotic system they
used is the result of an ongoing
collaboration between the university’s dental school and School of
Engineering and Applied Science.
The system consists of nanoparticles that can brush, floss and rinse
teeth in a single step, helping to
effectively eliminate biofilm from
teeth. The researchers previously
tested the system for endodontic
applications, and the robots were
able to access difficult-to-reach
root canal surfaces, disrupt biofilm, retrieve samples for diagnosis
and even deliver drugs.
In a university press release on
the most recent application of
these microrobots, co-researcher
Prof. Hyun Michel Koo of the university’s Department of Orthodontics explained the rationale for
the study: “Candida forms tena-
cious biofilm infections that are
particularly hard to treat. Current
anti-fungal therapies lack the potency and specificity required to
quickly and effectively eliminate
these pathogens.”
“The methods we use to control the nanoparticles in this study
are magnetic, which allows us to
direct them to the exact infection
location. We use iron oxide
nanoparticles, which have another
important property, namely that
they’re catalytic,” explained co-researcher Dr Edward Steager, a research investigator at the School
of Engineering and Applied Science.
In the presence of hydrogen
peroxide, these catalytic nanoparticles, known as nanozymes, generate large amounts of various oxygen-containing molecules, exert-
ing an antimicrobial effect. The researchers discovered that the
nanozymes bind strongly to fungal cells, allowing targeted elimination of the fungi. Exploiting
these properties, the researchers
were able to precisely eradicate
fungi within 10 minutes by directing the nanozymes to the infection
site.
“Our nanozyme assemblies
show an incredible attraction to
fungal cells, particularly when
compared to human cells. This
specific binding interaction paves
the way for a potent and concentrated anti-fungal effect without
affecting other uninfected areas,”
said Dr Steager.
The research team believes
that their nanozyme-based robots
hold great potential for the future.
Prof. Koo commented: “We’ve un-
covered a powerful tool in the
fight against pathogenic fungal infections. What we have achieved
here is a significant leap forward,
but it’s also just the first step. The
magnetic and catalytic properties
combined with unexpected binding specificity to fungi open exciting opportunities for an automated ‘target-bind-and-kill’ anti-fungal mechanism. We are eager
to delve deeper and unlock its full
potential.”
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sibility for the validity of product claims or for typographical errors. The publisher also does not assume
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made by advertisers. Opinions expressed by authors
are their own and may not reflect those of Dental Tribune International GmbH
MEA PUBLISHER:
Dr. Dobrina MOLLOVA
Material from Dental Tribune International GmbH that
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issue is copyrighted by Dental Tribune International
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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
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Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’
product news accurately but cannot assume respon-
The study, titled “Nanozyme-based robotics approach for
targeting fungal infection”, was
published on 4 May 2023 in
Advanced Materials, ahead of inclusion in an issue.
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dtmea@dental-tribune.me
[3] =>
DTMEA_No.4. Vol.13_DT.indd
Transforming smiles with
a revolution in digital dentistry
LET’S STAY CONNECTED:
VISIT OUR
WEBSITE:
[4] =>
DTMEA_No.4. Vol.13_DT.indd
INDUSTRY
04
Dental Tribune Middle East & Africa Edition | 04/2023
Success CD
By Promedica
The material for perfect temporary crowns and bridges
Success CD is PROMEDICA’s
composite-based, self-curing pastepaste system for quick and easy
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High-quality temporary restorations within 5 minutes
After a retention time of 30 to
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material takes on an elastic consistency, which facilitates removal
without risking deformation. The
material cures completely within a
further 3 minutes and can then be
polished. This procedure is timesaving and thus highly economical.
Excellent physical properties
and great aesthetic results
As far as the material’s physical
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CD convinces with its excellent flexural and overall strength as well as
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The product’s minimal polymerisation shrinkage results in
precisely fitting temporary restorations. Success CD’s high colour
stability and brilliant, enamel-like
gloss ensure long-term aesthetic
results. Moreover, its natural fluorescence and the choice of available shades promote perfect aesthetic results.
For more information contact
Promedica Dental Material GmbH
Domagkstrasse 31
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Tel: +49 43 21/5 41 73
E-mail: info@promedica.de
W&H – uncompromising hygiene
and safety
By W&H
Clean and clear – this slogan
from medical technology company
W&H aims to highlight the synergies between its transmission instruments and processing devices.
W&H turbine handpieces and
straight and contra-angle handpieces boast a range of features
that make them extra robust and
hygienic. The accompanying processing and sterilization devices
also ensure that the handpieces are
reliable and hygienic for both patients and practice staff to use.
Elegant design, advanced technology, and reliable performance:
W&H's turbine and straight and
contra-angle handpieces from the
Synea and Alegra brands are synonymous with top quality, and ensure optimal treatment conditions
thanks to their technical and functional characteristics.
“The innovative features of
W&H’s transmission instruments
mean that dentists can focus fully
on treating the patient“, says Patrick Lang, Product Manager at
W&H.
Innovative technology for
safe treatment
The company’s transmission instruments meet the most demanding requirements and enable safe
and gentle treatment thanks to
their high-end technology. Along
with the W&H HeatBlocker, which
prevents the push-button from
overheating, the spray ensures uniform cooling and optimal cleaning
of the treatment site. Furthermore,
the patented hygienic head system
vastly reduces the number of aerosol particles sucked in when the
rotor is running down. Ceramic ball
bearings ensure excellent preparation results and ultra-quiet operation.
W&H transmission instruments enable safe and gentle treatments thanks to their
high-end technology.
Clean and clear – this slogan from medical technology company W&H aims to highlight the synergies between its transmission instruments and processing devices.
Perfectly prepared and maintained
It is essential that transmission
instruments are properly maintained in order to keep their value
and ensure a long service life.
W&H's Assistina processing devices are the ideal solution to ensure that transmission instruments
continue to work flawlessly. For example, they ensure ultra-quiet operation and minimise the likelihood
of malfunction due to premature
wear. “Regular processing of the
turbine and straight and contra-angle handpieces ensures that their
service life is extended. This provides clear economic benefits for
dentists”, explains Patrick Lang. All
of this means that W&H’s durable,
high-quality products save valuable resources and therefore also
help the company achieve its aim of
developing sustainable product
solutions without exception.
Hygiene management par
excellence
The well-being of patients and
the treatment team is always top
priority. The sterilizers and thermal
washer disinfectors from W&H are
therefore essential for proper hygiene management and provide
the best possible support for protecting against infection in dental
practices. W&H turbine and
straight and contra-angle handpieces have an array of features
that make them especially easy to
maintain. The ScratchBlocker coating protects against scratches and
combined with the elegant Monobloc design, ensures the highest
hygiene standards are maintained.
The extensive W&H product portfolio is therefore a complete solution which supports a professional
reprocessing workflow. The medical technology company's products complement each other and
are specially designed to be used
together – hygienically, safely and
without compromise.
[5] =>
DTMEA_No.4. Vol.13_DT.indd
CAD/CAM Digital
Oral Facial Aesthetics
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[6] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
06
Dental Tribune Middle East & Africa Edition | 04/2023
Artificial intelligence in dentistry
By Dr Miguel Stanley, Portugal
For those who have been paying attention to the latest news in
the technology space, you will
most certainly have noticed that
OpenAI recently launched ChatGPT,
a new artificial intelligence (AI)
chatbot. It is amazing to see how
this technology works and how
quickly it can do incredibly complex tasks and have virtually all the
information that is online at your
disposal in a matter of seconds. I
had to test it multiple times and try
to force it to make a mistake on the
information that I wanted, but this
machine learning technology is really powerful.
For example, I asked it to write
me a song around a specific theme
and asked for the chords I liked
best, and in less than 10 seconds, I
had a song that I could easily play
on the guitar. I even asked it to
write this article quoting articles
and giving examples of application
of AI in medicine, and the result was
quite complete, but naturally as the
applications of AI in dentistry are
still few and of little relevance, naturally there was little information it
could combine and use in an intelligent way. As such, the result was
somewhat interesting, but not
what I was looking for. That is not
to say that in a year or two when the
bot can obtain more information
online, and there are more cases
and documentation, the technology will not be able to be even better.
If ChatGPT is asked things for
which a great deal of information is
already available, the responses are
simply amazing, and the scary
thing is that the bot is still learning.
It learns with every question and
with every answer. It is going to
revolutionise the way we search for
information and the way we learn,
and certainly many jobs are at risk
with this technology. As a rule, I am
not a person who is afraid of technologies, but if we look at the automobile industry, which used to rely
almost entirely on people, all tasks
are now mainly done using robots.
The work of cashiers at the supermarket can also already be 100%
automated. There are already platforms for lawyers and legal articles
written by AI programs and translated almost instantly. It is all quite
impressive.
Our dental business has three
main components:
•
diagnosis and treatment plan;
•
execution of treatment; and
•
daily management of the
clinic.
Of course, I am simplifying
here. We all know that it is far more
detailed and that there are many
more factors at play than these, but
I think that these are the main areas
in the day-to-day running of a
modern dental practice. Where
might AI have an immediate impact
on these specific areas?
(Alexandra_Koch/Pixabay)
Diagnosis and treatment plan
There are already several online
platforms available to help in diagnosis. Of course, they are not perfect, but they are already able to
very quickly through a panoramic
radiograph or CBCT scan segment
all the teeth and identify problems
such as caries, endodontics and
missing teeth. Some of these platforms also assist the dentist incredibly quickly in preparing a treatment plan beyond diagnosis. We
are still in the early days of this
technology, but I believe that within
a very short time the application of
AI in the diagnosis and treatment
planning of our patients will be the
norm, and for those who work for
insurance or large dental groups, it
will almost be a requirement.
The advantages implicit in this
technology are that we can often
miss small details because we
might be looking at more complex
problems in our patients’ mouths
and for example miss a small cavity
between two teeth or because we
do not have the requisite amount
of time in our initial appointment to
look at everything or are focused
on the primary reason the patient
came to us and might overlook
broader aspects. This technology
will help mitigate error incredibly in
this very important process when
we are diagnosing a patient for the
first time or re-evaluating our case
after a few years. We all know that
our eyes can sometimes deceive us.
Here this technology will play an incredibly powerful role in helping to
analyse CBCT scans and radio-
graphs, and I believe that intra-oral
scanners and laboratory scanners
will also be a part of this process, as
well as the various software programs available for the dental laboratory.
AI will also play a predominant
role in the preparation of a treatment plan, as well as in the sequence of treatments to be performed, making sure that the right
methods are in place. Depending
on the technology used, the software will serve the clinic or the patient. Different groups may create
AI programs according to their various goals, such the promotion of
biomimetics or all-on-four or aesthetic treatment. This means that
programs are going to be trained
to prompt a specific outcome by
whoever programmed them. AI
software does only what it is programmed to do, so whoever creates these AI programs can set
whatever parameters they want.
Imagine an AI program available to the patient through which
the patient could influence the
dentist’s treatment plan and the
materials used. The second the
dentist presents the treatment plan
based on his or her diagnosis, the
patient would be able to ask for
that report and enter it into the
program on his or her smartphone
and instantly critically analyse
whether the dentist’s goal is financial only rather than the pursuit of
optimal treatment. This program
might enable instant recommendations from nearby clinics that can
perform the same type of treat-
ment at a lower cost and with
greater proficiency because they
have better means and materials to
do so. It appears that soon all this
information will be available to everyone, not just dentists.
That is why I have been warning
for some time in my lectures and at
international conferences that this
is a very good time to start investing in quality and to be as ethical as
possible in our professional conduct, because sooner or later there
will be technological entities controlling the way we work. It is going
to be very difficult to deceive your
patients, and we all know that there
are many today who practise dentistry that is not congruent with
current science and clinical evidence in order to save time or
money. It will certainly be very interesting to see the evolution of all
these technologies in our industry.
Personally, I think that this is
great! Since the beginning of my
career, I have been putting myself
on the side of the patient and not
on the side of the industry. I practise empathy every day when I have
a patient in front of me. I am sure
that every patient in the world
wants the same thing: good treatment performed with the best materials, painlessly and with care and
that lasts a lifetime with high aesthetics. Of course, this magic formula does not exist, but surely the
incredible tension that exists between patients and the industry
will dissipate if we have a technological referee in our midst.
We all know that there are patients with unrealistic expectations
who have a very complicated phenotype and want complex mouth
treatments that are unachievable.
An AI program will be able to immediately mediate in the conversation by introducing an objective examination so that the dentist can
have more tools to demonstrate
the facts of the case based on science and to support a challenging
explanation to the patient and, by
the same token, so that the patient
will have extra support to ensure
that he or she is not being misled
and that the dentist is not trying to
sell something outside of the necessary scope, in defence of the patient’s oral health and wallet. I think
that it will be an incredible help to
many.
Of course, clinics that practise
dentistry without regard to quality
and ethics should be very concerned about these new technologies. I think that this mediation is
something that is missing in our industry. I have already been working
with companies and been helping
some of them, learning from them
and trying to ensure that decision-making and implementation
are based only on ethics, science
and clinical evidence.
To summarise, I think that AI
will provide an incredible means to
improve the effectiveness of diagnoses and treatment plans, making
the process much safer for everyone involved, and to ensure that no
step is forgotten in developing a
treatment plan and that the sequencing of treatment steps is
done according to the principles of
biology and mechanics, based on a
deep understanding of what is possible and tangible, in order to
achieve longevity and success for
the dentist and of course the patient.
Just like we have been doing
with clear aligner treatment for
over 18 years, this whole process
has to be validated by a human, the
dentist—who of course is sovereign at the end of the day! If he or
she changes the treatment plan,
however, the AI program will inform the patient of this change immediately, giving the patient the
opportunity to ask why. If things go
wrong in the future,
AI programs will certainly give
patients the means to engage with
their dentists. This will have legal
implications, and I believe will make
life more difficult for some but easier for others.
Execution of treatment
I believe that this will be an area
explored more by robotics than by
AI. There are already robots that
can place dental implants remotely
with incredible precision, and naturally they will be controlled by AI in
the future. For now, we can be assured that, at least for the next few
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[7] =>
DTMEA_No.4. Vol.13_DT.indd
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DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
08
Dental Tribune Middle East & Africa Edition | 04/2023
◀ Page 06
years, the art of taking care of our
patients’ mouths will still be very
manual, and here dentists play a
leading role. I believe that, if we are
smart and use the time saved in
creating the treatment plans and
diagnoses by AI, we can use that
time to invest more time in our patients. Certainly, there will be clinics
that will quickly ll those hours with
more patients, but as you know I
am a strong advocate of Slow Dentistry (slowdentistry.com), and I believe this is how we will secure our
future. The human touch is going
to be the major differentiator. I believe that we have to focus on the
human side of our art because in
the future the dentists who create
the best relationships with their patients will be more successful. Patients will surely want to be sure
that their dentist is doing things
right, and we all know that working
in a hurry is very difficult. There are
more and more young dentists in
the business. Experience takes
years to acquire, and it is imperative to give young people adequate
time to be able to do their jobs well.
I even believe that there will be an
AI program that will be able to
measure what the optimal time is
for performing each task with quality and that will inform the patient
that the average optimal time for a
Class I restoration on a molar is 35
minutes, for example, and that fitting a dental dam for treatment is
essential.
Regarding the execution of
treatment, I think that AI will play a
very relevant role in the selection of
materials and technologies to use.
Here it is easy to understand how.
When the AI program compiles the
treatment plan, it will be able to
analyse all materials available
quickly and determine the best material for each step in the treatment
to be executed, helping the dentist
to select the materials more carefully for his or her treatment. This
will also help laboratories avoid
materials not congruent with the
long-term success of the treatment
being performed. Each time, the
dentist or dental technician does
not accept the recommendation
provided the AI, the patient will be
warned.
Consider blockchain technology, a digital ledger in which transactions made in a cryptocurrency
are recorded chronologically and
publicly. This data is distributed
across a network of computers and
cannot be changed without verification and approval via timestamp. This means that the security
of these assets does not rely on a
third party, heralding a significant
decentralisation of power over information.
All the information that we acquire from our patients, for example via radiographs, intra-oral
scans, CBCT scans and photographs, belongs to the patient. I
believe that every time that information is shared with entities outside the clinic, the patient will be
notified via an AI program. Imagine, for the groups that send crowns
to be manufactured in China or
India or anywhere for that matter,
the patient will be notified that his
or her file has been sent abroad. Of
course, this is no problem at all if
the dentist has informed his or her
patient that he or she will be doing
this to lower costs, but it will be difficult to explain this to the patient if
he or she has been given a guarantee that the crown will be manufactured in Portugal, for example. This
demonstrates that ethical care will
be facilitated by default in the dental industry and in the health business in general in the future, thanks
to AI and the associated technologies.
Daily management of the
clinic
We all know the difficulties we
have managing in complex schedules. I believe that AI will play a
major role in supporting the dayto-day management of our clinics.
The following are some areas
where I believe that AI will very
quickly be of great use to us:
•
stock management;
•
calculation of dental professionals’ commissions;
•
invoicing;
•
legal documentation for patients;
•
patient conflict management;
and
•
improving communication between departments.
Nowadays, all these tasks require endless hours of human resources day in and day out throughout the year, at great cost to clinic
owners. Yet it is difficult to include
redundancies in these tasks, and
there are many possibilities for
error. All these errors come at a
great cost as well. Surely, it will be
incredibly welcome for practice
owners, insurers and all those involved in managing practices to
have support that can enable them
to reduce error and increase efficiency.
Let us consider an example.
Imagine a healthcare group that
has one dentist. This dentist works
in three different clinics and, at the
end of the month, is remunerated
based on a calculation of the treatment activities performed. It is necessary for an accountant or an account manager to confirm all the
facts described and entered into
the system by the dentist. Now, the
healthcare group must confirm
that the dentist has indeed performed these tasks, but how can it
know whether he or she has done
them well? How can it be sure that
he or she has not made a mistake?
An AI program used by the clinic
management could very quickly go
through the radiographs, the photographs, the clinic’s and dentist’s
e-mails, all communication between the parties involved, the
stock record for the materials removed from the stock for the treatment, the chair time allocated for
the treatment and the laboratory
workflow around the treatment
and calculate immediately whether
in fact what the dentist claims to
have done was in fact done and
done well. Naturally, the dentist will
feel more secure because his or her
entire effort will be validated and
confirmed by management, and his
or her payment will be effected
without problems.
The problem arises if the dentist has not been correct in his or
her conduct, because the AI program will quickly warn both parties
of an error and help correct it to the
benefit of both parties. Surely no
dentist will want to be paid for work
he or she did not do, and no organisation will want to pay for work not
done. Certainly in the future there
will be a discussion about whether
organisations should pay for poorly
performed work, but that is another discussion for another time.
I think that AI may make things
more difficult for some but also
much easier for others. We are still
a long way from seeing all this happening, so do not become worried
just yet. It is important, however, to
keep an eye on how things are developing because it is not a matter
of whether it will happen but when.
Editorial Note: This article was published
in digital international magazine of
digital dentistry vol. 4, issue 2/2023.
Dr Miguel
Stanley
Dr Miguel Stanley is the clinical director of White Clinic, based in Lisbon,
Portugal, and founded 20 years ago.
He is a passionate advocate for
high-quality dental care, and his
career has consequently been focused
on restoring smiles with his interdisciplinary team, using state-of-the-art
technology, software and materials,
according to a strong sense of ethics
and in pursuit of minimal invasiveness
to better protect his patients. This is
the reason that he created the No Half
Smiles treatment philosophy and Slow
Dentistry, both aimed at improving the
patient experience and the overall
quality of care. Based on his training in
implant dentistry, cosmetic dentistry
and functional occlusion, Dr Stanley
has developed an advanced biological
cosmetic dentistry approach to his
work that incorporates the full scope
of action of modern dentistry. He
spends most of his time managing his
longtime team and learning about
new technologies in dentistry.
Dr Stanley has given over 200 keynote
lectures in more than 50 countries,
and his lectures are critically acclaimed
by dentists of all ages and specialties
for the open dialogue and simple and
beautiful manner in which complex
cases are presented. He is the vice president of the Digital Dentistry Society
and a member of many implant and
cosmetic dentistry societies around
the world. He is an ambassador for the
CleanImplant Foundation and has
been an expert for the online education platform DentalXP since 2009. Last
year, Dr Stanley hosted a documentary
on the new boundaries of dentistry for
National Geographic, and he has even
given a TED Talk on the future of the
dental profession. He was nominated
one of the top 100 dentists in the
world by his peers in 2020.
Rua Dr. António Loureiro Borges 5
1º Andar Arquiparque
Miraores
1495-131 Algés
Portugal
info@whiteclinic.pt
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[9] =>
DTMEA_No.4. Vol.13_DT.indd
[10] =>
DTMEA_No.4. Vol.13_DT.indd
INDUSTRY
10
Dental Tribune Middle East & Africa Edition | 04/2023
Can teeth whitening be harmful?
By Ultradent Products
They’re all too common questions: Can whitening harm teeth? If
so, what’s the least harmful teeth
whitening? Can too much whitening damage the teeth? Are there
safe teeth whitening products that
don’t harm teeth at all?
Teeth, and more specifically,
smiles, are one of the most unique,
inimitable things we possess, and
they deserve protection.
That said, so many yearn for
more confidence in showing their
smile to the world. Teeth whitening
helps—especially when years of
food, wine, coffee, and/or tobacco
stains have taken their toll.
Stubborn yellow or brown
staining can prove difficult to simply “brush away.” Yes, the right
whitening toothpaste with a gentle
amount of grit can buff away surface discoloration, but often, the
problem lies deeper within the
enamel. Factors like aging and genetics contribute to tooth shade
too.
Thing you should know
When it comes to teeth whitening, it’s important to take several
factors into consideration. After all,
you want to choose a whitening
product that’s both safe and effective. In fact, many potential consumers shy away from teeth whitening out of the fear of decalcifica-
AD
tion or tooth enamel damage,
which is entirely preventable.
Choosing a safe whitening
product
Dr. Dan Fischer, founder of Ultradent Products, Inc., as well as
Opalescence Whitening products
(the #1 professional teeth whitening brand in the world), has always
adhered to the following science:
“It all comes down to the pH of the
whitening product, because the reality is that tooth decalcification is
caused by exposure to acidity—or
a low pH in the mouth.”
Dr. Fischer adds, “For this reason, all Opalescence teeth whitening products feature a nearly neutral pH that closely matches the pH
of the patient’s mouth.”
This prevents harm and decalcification of tooth enamel, allowing
patients to whiten their teeth and
maintain a healthy smile. Furthermore, while an excess of anything
isn’t always the best option, if patients choose a safe, studied, and
effective teeth whitening product
like Opalescence whitening (under
the supervision of their dentist),
they can rest assured the product
won’t damage their teeth. In fact,
most esthetic dentists recommend
whitening until the patient’s
enamel shade matches the color of
the whites of their eyes, then stopping until further whitening is
needed.
(Image: Ultradent Products)
What about DIY teeth whitening?
Are the active ingredients in
teeth whitening (e.g., hydrogen
peroxide or carbamide peroxide)
dangerous, and is one ingredient
preferable to the other? What
about “natural” ingredients like
charcoal or baking soda for teeth
whitening?
While trendy, whitening teeth
with ingredients found at home or
over the counter like charcoal, baking soda may remove surface staining, but can’t lighten the shade of
teeth. Additionally, patients using
such ingredients run the risk of
abrading their tooth enamel, causing long-term damage and discoloration.
Studied, proven, safe teeth
whitening
The only substance proven to
whiten tooth enamel color is peroxide—whether it be carbamide
peroxide or hydrogen peroxide,
with both yielding high quality results.1 Both amounts of hydrogen
peroxide and carbamide peroxide,
depending on the product, are in
are commonly found in and processed by the body, and are considered safe and non-toxic to use on
the teeth. 2
Dentists can help determine
the right whitening product for
their patient’s unique case, as Ultradent’s Opalescence teeth whitening systems offer solutions fea-
turing both carbamide peroxide
and hydrogen peroxide.
There are also methods and kits
to accommodate every lifestyle.
These include Opalescence Go prefilled disposable whitening trays,
Opalescence PF custom teeth whitening, and the Opalescence Boost
in-office whitening system.
References
1. Mokhlis GR, Matis BA, Cochran
MA, and Eckert GJ. A clinical evaluation
of carbamide peroxide and hydrogen p
eroxide whitening agents during daytime use. 2000;131(9):1269-1277. www.
jada.info/cgi/content/full/131/9/1269
2. Data on File
[11] =>
DTMEA_No.4. Vol.13_DT.indd
STUDIED, TESTED AND INNOVATED
OVER ANY PROFESSIONAL
TEETH WHITENER
800.552 .55 1 2 | U LTR A DEN T.COM
[12] =>
DTMEA_No.4. Vol.13_DT.indd
INDUSTRY
12
Dental Tribune Middle East & Africa Edition | 04/2023
Inside the world of the Monofilament
Surgical Sutures
By HuFriedyGroup
PTFE
Are you looking for the best in
practice suture and provide the
best dental services to your patients? HFG PTFE is the answer.
PTFE surgical sutures in dental
are the gold standard today and
leading suture material for different surgical procedures like ridge
augmentation, periodontal surgeries, tissue regeneration, tissue
grafting, implant surgeries and
bone grafting procedures. HFG
PTFE is a monofilament, synthetic,
non-absorbable material manufactured from 100% high-density
polytetrafluorethylene. The suture
is undyed and contains no additives.
Some of the main features of
the HFG PTFE are:
•
Monofilament but handles
smoothly like a multifilament
•
Little to no package memory
•
Has excellent soft tissue response because the material
itself is soft and smooth, minimizing tissue reaction
•
Biologically inert – not subject
to weakening by tissue enzymes
•
Promotes wound healing because it does not absorb
blood, saliva, bacteria, or food
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•
White in color, so nice if used
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•
And the most important very
comfortable for the patient
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All company and product names are
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@HuFriedyGroupEurope
@HuFriedyGroup Europe
Charalampos Amanatidis
Senior Product Manager Sutures
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Hu-Friedy Mfg. Co., LLC.
European Headquarters
Astropark - Lyoner Str. 9
60528 Frankfurt am Main, Germany
Tel.: +49 (0)69 24753640
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[13] =>
DTMEA_No.4. Vol.13_DT.indd
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All company and product names are trademarks of Hu-Friedy Mfg. Co. LLC, its affiliates or related companies, unless otherwise noted.
©2022 Hu-Friedy Mfg. Co., LLC All rights reserved. HFL-771/1222
For more information on HuFriedyGroup products
call at 00800 48 37 43 39 or visit HuFriedyGroup.eu
[14] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
14
Dental Tribune Middle East & Africa Edition | 04/2023
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 (BRILLIANT Crios, Coltene),
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.
[15] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
15
Dental Tribune Middle East & Africa Edition | 04/2023
◀ 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.
[16] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
16
Dental Tribune Middle East & Africa Edition | 04/2023
◀ 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
[17] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
17
Dental Tribune Middle East & Africa Edition | 04/2023
◀ 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.
[18] =>
DTMEA_No.4. Vol.13_DT.indd
NEW
your vision
powerfully, s eamlessly, immediately
with the iTero Element Plus Series
intraoral scanners
[19] =>
DTMEA_No.4. Vol.13_DT.indd
20+ years of expertise
to amplify your experience and capabilities.
A powerhouse of capabilities:*
State-of-the-art experience:
• Integrated 3D intraoral1 camera—
get more out of one scan
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• 20+ years of engineering expertise poured
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See the iTero Element Plus Series
scanners in action.
Request a demo at iTero.com
*Unless otherwise specified, all comparisons are relative to previous generation iTero Element scanners
1
Available on iTero Element 5D Plus and Lite software configuration
2
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.
3
This product will not be available for sale until March 2021.
scanning. Based on the results of 10 peer-reviewed papers 2018-2020. Data on file at Align Technology, as of April 6, 2020
Invisalign, iTero, iTero Element, the iTero logo, among others, are trademarks and/or service marks of Align Technology, Inc. or one of its
MKT-0005633 Rev A
[20] =>
DTMEA_No.4. Vol.13_DT.indd
Bleeding
gums Gingivitis
Your
professional
advice
Healthy
gums
Help keep your patients on a
journey to healthy gums
AT LEAST
5 %
Gingivitis is often ignored by patients in
the early stages, so maintaining optimal
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
gingivitis can have a negative impact on
daily life causing anxiety, embarrassment
and affecting social life, especially when
symptoms become noticeable to others.3
INTENSIVE TREATMENT
Parodontax Extra Mouthwash
TREAT & MAINTAIN
Parodontax Complete Protection toothpaste
Short-term intensive treatment
for patients with gingivitis.6,7
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
Twice-daily specialist
gum health toothpaste
for patients with, or
susceptible to gingivitis.4,5
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
[21] =>
DTMEA_No.4. Vol.13_DT.indd
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
†vs. brushing alone.
‡GI: Gingival index measuring bleeding and inflammation
Forms a protective antibacterial layer to help gum healing11
67% sodium bicarbonate plus fluoride formulation, which enhances
the physical removal of plaque achieved by brushing9
Week 4
in GI ‡ at
4 weeks **
68%
reduction
Prevents plaque build up through 12-hour substantivity11
Parodontax Extra Mouthwash
Baseline
in GI ‡ at
2 weeks
57%
reduction
4x more effective at removing plaque*8
Control toothpaste
(with 0% sodium bicarbonate)
p=0.001
0
0.5
1
1.5
2
Clinically proven to reduce the symptoms of gingivitis10
parodontax® toothpaste
(with 67% sodium bicarbonate)
Mean change from baseline in plaque removal
great er plaque
removal*8
4x
2.5
3
Clinically proven to reduce plaque, bleeding gums and inflammation8
0
2
4
6
8
12
14
16
18
20
Clinically proven to improve patients’ periodontal health†10
Significantly greater plaque removal after 6 months*8
to help patients maintain their optimal
To
gum health between dental visits
Parodontax Extra Mouthwash
Reduction in plaque
from baseline levels (%)
parodontax ® toothpaste
Recommend parodontax® toothpaste
and Parodontax Extra Mouthwash
Mean Gingival Index
[22] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
22
Dental Tribune Middle East & Africa Edition | 04/2023
Researchers publish guide to support
dentists in treating patients with epilepsy
Patient communication
Collaborating with the patient with epilepsy to
establish a long-term dental care plan is a valuable
way of making dental care easier and ensuring that
the patient is less hesitant to receive dental treatment regardless of epilepsy status. Planning adjustments to standard dental treatments in light of the
patient’s condition and explaining the rationale to
the patient are also critical. For example, the researchers recommend fixed prostheses over removable ones for safety in the event of a seizure, as they
are not as likely to fracture or potentially obstruct an
airway.
The use of a mouth prop during treatment ensures that any instruments used will be clear of the
oral cavity should a seizure begin during treatment.
Explaining specific treatment decisions makes dental
care collaborative and further increases the likelihood of treatment compliance, such as providing patients with a mouth guard that they can use prior to
a seizure to help prevent bruxism and tooth attrition.
Proper anaesthetic protocol and management of dental anxiety
Regarding the clinical application of anaesthetic
drugs, the researchers note that clinicians should be
aware of the difference between seizures due to lidocaine overdose and those due to epilepsy and that
traditional lidocaine with adrenaline is generally safe
for most patients. However, when utilising medications to ease dental anxiety, such as methods for
conscious sedation, the clinician should consult with
the patient’s neurologist to avoid inadvertently reversing the anti-seizure effect of the patient’s medication when reversing sedation. Overdose is a real
possibility in epileptic patients being treated with
benzodiazepines, as they have a far higher tolerance
for sedatives used in dentistry, such as midazolam,
supporting the establishing of a care plan prior to
treatment. Non-pharmacological techniques for
dental anxiety are recommended in some cases, and
the use of the modified dental anxiety scale can be
useful for clinicians in assessing anxiety and creating
an anxiety management plan.
Although patients with epilepsy may require alternative treatment options, a newly published guide makes providing a custom dental treatment plan
easier regardless of the severity of the patient’s epilepsy. (Image: Sketchepedia/Freepik)
By Anisha Hall Hope, Dental
Tribune International
MECCA, Saudi Arabia: Affecting
over 70 million people globally, epilepsy is a disorder that may give
dental professionals pause, as the
treatment of patients with epilepsy
can be complex and many clinicians
may not feel qualified to provide
sufficient care. Researchers at Umm
Al-Qura University in Saudi Arabia
have developed a practical reference guide for dentists who seek to
be more confident in providing
care to patients with epilepsy of
varying severity.
Taking a multidisciplinary
approach
In addition to providing suggestions for consulting with the patient’s neurologist, the guide outlines the importance of dental professionals being able to identify
risk and trigger factors for their epileptic patients. In patients with
poorly controlled epilepsy, trigger
factors are valuable in determining
what could potentially cause a seizure during dental treatment. Understanding basic epileptic treatments and being able to differentiate between different types of seizures are useful for dental
treatment, particularly when attempting to estimate length of an
episode that occurs during dental
care and whether or not the patient
requires further medical intervention.
The guide provides a handy reference for essential evaluation of
the seizure type, typical symptoms
reported prior to onset and descriptions of bodily events during
an episode. For patients well versed
in their condition, they may be able
to indicate to their treatment provider that they are experiencing
symptoms signalling the onset of
an epileptic attack, allowing clinicians to prepare. Practitioners can
also verify with patients with diagnosed epilepsy whether they have
been consistently taking their medications, have been experiencing
more seizures lately, need special
care to prevent triggers and are eating regularly—blood
glucose level being a key component in preventing seizures for some patients.
Medication awareness
Being educated in epileptic care is also critical to differentiating between seizures and other potential medical issues, such as migraines or strokes. The guide provides an overview of essential antiepileptic medications
which are key for being able to treat a patient who may
suffer from side effects or require medication for dental
treatment that could conflict with their antiepileptic
medication regimen.
Some antiepileptic medications specifically affect the
oral cavity, such as gingival enlargement, ulceration, xerostomia, glossitis and stomatitis. Establishing a point of
communication with the patient’s neurologist can therefore help the dental clinician feel more comfortable with
carrying out treatment and planning for dental procedures.
Citing the common antiepileptic drug sodium valproate as an example, the researchers note in the guide
that it is vital to assess whether a patient is taking it, as it
increases bleeding risk. They also advise consulting the
patient’s neurologist when planning prescriptions for
treatment of oral conditions, as some non-steroidal anti-inflammatory drugs, antibiotics, anti-fungal agents
and other drugs common in dental practice can interfere
with some antiepileptic medications.
Management of seizures and seeking assistance
The guide also includes useful tables detailing
care management in the event of a seizure, such as
how to clear the dental treatment area of trays or machines, recording details of the seizure, assessing
vital signs and knowing when further medical treatment may be necessary. Being able to evaluate the
severity of a seizure is key in knowing when a patient
just needs to recover in the clinical room before
being escorted home or whether an emergency care
team should be summoned. The guide provides
points of caution in care, detailed procedures and
emergency medication administration.
Creating a plan for and with each patient will go
a long way to helping both the clinician and the patient feel more confident with treatment. An individual care plan, which may involve pursuing useful alternatives to traditional treatment protocols, increases the likelihood of improved long-term oral
health, which the majority of epileptic patients struggle to maintain.
The guide, titled, “Special care dentistry and epilepsy”, was published online on 10 June 2023 in King
Khalid University Journal of Health Sciences.
[23] =>
DTMEA_No.4. Vol.13_DT.indd
[24] =>
DTMEA_No.4. Vol.13_DT.indd
GENERAL DENTISTRY
24
Dental Tribune Middle East & Africa Edition | 04/2023
Jeddah, Riyadh, and Dubai hosted
over 750 delegates at the "Success
Simplified Roadshow" with Dr. Carlos
Sabrosa, supported by 3M
(Photos: CAPP Events & Training)
By CAPP Events & Training
The Success Simplified Roadshow with Dr. Carlos Sabrosa, an
event organized by CAPP and GNP
Academy and supported by 3M,
took place across three different
cities in United Arab Emirates and
the Kingdom of Saudi Arabia, attracting the participation of over
750 dentists eager to enhance their
knowledge and skills.
The roadshow kicked off on
June 15 at the Dubai Grand Plaza
Movenpick Media City, where dental professionals from the region
gathered to benefit from Dr. Carlos
Sabrosa's insightful lecture. Dr. Sabrosa, a distinguished expert in the
field of dentistry, captivated the
audience with his topic, "When
Clinical and Scientific Facts Meet
Simplicity, Precision, and Efficiency." His lecture focused on optimizing and streamlining modern
restorative practices, with a special
emphasis on impression and cementation procedures. Attendees
were able to gain evidence-based
insights and conceptual frameworks to overcome challenges and
achieve exceptional results. Dr.
Rasha Ahmed also gave a lecture
on "Easy Steps for Success in Direct
Restoration."
The second leg of the roadshow took place on June 16 at Le
Meridien Hotel in Jeddah, where
dental professionals from the city
and surrounding areas eagerly engaged in discussions and networking opportunities.
The final stop of the Success
Simplified Roadshow was held on
June 17 at the prestigious Radisson
Blu Hotel in Riyadh. Dental professionals from Riyadh and neighboring cities attended the event to
learn from Dr. Carlos Sabrosa and
discover innovative approaches to
restorative dentistry. The lecture
shed light on evidence-based requirements, enabling attendees to
enhance their clinical practices and
achieve exceptional results.
The collaboration between 3M,
CAPP and GNP Academy proved
instrumental in making the events
a resounding success. By offering
this event as a complimentary experience, the organizers demonstrated their commitment to advancing dental education and supporting the professional growth of
dental practitioners.
[25] =>
DTMEA_No.4. Vol.13_DT.indd
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
Apple
Google
Podcast
Podcast
Scan QR code to
listen to the podcast
[26] =>
DTMEA_No.4. Vol.13_DT.indd
26
INTERVIEW
Dental Tribune Middle East & Africa Edition | 04/2023
Background music found to enhance
dental students’ clinical competence
By Iveta Ramonaite, Dental
Tribune International
KUOPIO, Finland: In a recent
study carried out at the University
of Eastern Finland, researchers
have investigated the effect of slow
background music on dental students’ preclinical manual skills
training. They found that background music can effectively reduce dental students’ stress and
improve their motivation and performance during preclinical tooth
preparation exercises.
Dental students often experience great stress during their studies, which may have serious repercussions on their mental health.
AD
A recent study has investigated whether slow background music has an impact on
dental students’ anxiety, satisfaction and performance during preclinical exercises.
(Image: Vladimir Sukhachev/Shutterstock)
Advantages
of Laminators
in your clinic
Laminator is a practical and versatile equipment that
allows the manufacturing of trays from various
materials for different specialties, such as:
Orthodontics, Prosthodontics, Aesthetics Dentistry,
Sports Dentistry, Sleep Dentistry, Bruxism/Teeth
Grinding, among others.
Having a laminator in the clinic is time-saving, as in
certain cases it is possible to deliver the tray to the
patient in the same session. It is also money-saving as
less is spent on outsourcing.
Easy to use equipment, boosting your resulting
when manufacturing:
• Trays for at-home teeth whitening;
• Orthodontic aligners;
• Retainer (retention);
• Bite plate and/or bruxism;
• Mouthguard;
• Matrix for composite resin
• Matrix for Mockup;
• Temporary bridge;
• Bracket bonding;
• Tray for fluoridation
• Surgical Guide
• Base plate;
• Individual impression trays;
• Copings;
• Study models packaging (file).
Typically, you find 2 laminator models on the market:
positive pressure and vacuum. What determines
your choice is your work flow and application.
Do your research and invest in that equipment
that will change your clinic!
Various studies have previously reported that music can have a positive impact on emotions and
well-being. It has also been shown
that background music can promote education and learning and
can increase student satisfaction
and productivity.
Adding to the existing literature, researchers from Finland examined whether background music
can influence preclinical dental students’ anxiety levels or performance during preclinical practice.
The study included 36 third-year
dental students who filled in a
questionnaire that measured their
subjective evaluation of the effects
of slow background music on the
stress or anxiety levels experienced
during a preclinical cariology
course.
The data suggested that more
than 50% of the dental undergraduates felt that slow background
music helped to relieve stress while
preparing the teeth, and 68% of the
students thought it helped with
stress reduction while doing cavity
restorations. Students reported
enhanced relaxation and reduced
feelings of stress during complex
procedures and higher levels of
positive feelings when practising
while listening to slow background
music.
Additionally, 24 out of the
36 students participated in a crossover study on the impact of slow
background music on the quality of
cavity preparation and on the time
taken for this procedure. These students were split into two groups.
The first group listened to background music such as classical, jazz
or slow pop music while working,
whereas the second group worked
in the normal ambient noise of the
simulation laboratory.
Using music for cavity preparation
For the purpose of the study,
the researchers used a virtual reality haptic dental trainer and monitored the students’ basic manual
skills. Using ImageJ software and
macrophotographs of the prepared teeth, they also examined
how slow background music can
improve students’ cavity preparation performance during their preclinical simulation training.
The researchers found that the
majority of the students were satisfied with listening to background
music during practice. Music was
found to reduce stress while increasing the motivation to learn
and practise. According to the students, background music did not
disrupt communication in the
classroom. Additionally, it was
found that background music enhanced the students’ use of time
during cavity preparation and improved the quality of the procedure.
In line with the findings, the researchers believe that dental educators should be aware of students’
learning obstacles and take steps
to improve their emotional well-being. To that end, the study has
shown that playing soothing background music during preclinical
training sessions might benefit students’ education. Finally, the researchers believe that music intervention could also be an effective
tool to reduce stress in other dental
education environments.
The study, titled “Influence of
background music on stress reduction and impact on performances
during students’ simulation exercises”, was published online on
9 May 2023 in the Journal of Dental
Education, ahead of inclusion in an
issue.
[27] =>
DTMEA_No.4. Vol.13_DT.indd
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[28] =>
DTMEA_No.4. Vol.13_DT.indd
INTERVIEW
28
Dental Tribune Middle East & Africa Edition | 04/2023
A new device developed by researchers in Hong Kong channels air and water in a novel way to remove dental plaque. (Image: H_Ko/Shutterstock)
3D-printed mouth guard helps
remove dental plaque in older and
disabled patients
By Anisha Hall Hoppe, Dental
Tribune International
HONG KONG: Researchers
from the University of Hong Kong
AD
have developed a personalised
3D-printed mouth guard that they
say has plaque removal results between those of a manual toothbrush and a mouthrinse. They
cited Hong Kong’s rapidly ageing
population as a catalyst for the
search for ways to improve oral
health for elderly and disabled
people and said that the newly de-
signed mouth guard could prove a
valuable tool in preserving oral
health in these groups.
Older adults and disabled persons may lack the required arm
and wrist dexterity to use toothbrushes, oral irrigators and dental
floss. By next year, Hong Kong will
have more than 21% of people
over the age of 65, according to
the researchers, compounding the
need for improved oral health
solutions when resources for oral
healthcare may be more difficult
to come by. Recent analysis of information from the World Health
Organization
indicates
older
adults are at the highest risk of
periodontitis. A number of other
dental conditions also increase in
incidence with age and comorbid
conditions, leaving those individuals with additional health impairments more vulnerable to dental
disease. Creating an easier way to
clean teeth for these populations
is vital to oral health.
Building on prior research
using micro-mist technology as an
effective method of cleaning
teeth, the researchers developed a
brand-new mouth guard device
easy for older adults and disabled
individuals to handle safely on
their own. The custom mouth
guard has specifically designed
outlets for micro-mist targeted at
the gingival margins of each tooth.
The micro-mist is generated at the
outlets by mixing the air and water
routed through two individual
channels from a machine that
pumps both into the mouth guard.
To test plaque removal effectiveness, the researchers tested
the mouth guard in 55 patients 60
years of age or older. For each patient, a digital impression was
taken with a standard intra-oral
scanner, and the shape and outlet
locations of the mouth guard design were customised in CAD software. It was then printed using stereolithography and elastomeric
resin.
The overall findings indicated
that the micro-mist technique was
able to remove plaque while also
mitigating risks of pain, injury,
dental hyperaesthesia, gingival recession and tooth wear that can
arise through toothbrushing. The
mouth guard system was shown to
have an efficacy between that of
mouthrinses and manual toothbrushing. The researchers also
found no association between
tooth number and plaque removal
effectiveness, and they suggested
that this could be related to the
even distribution of the water and
air outlets, enabling thorough
cleaning. Because it does not require much manual dexterity, the
system could be suitable for both
elderly and disabled people unable to brush their teeth.
The study, titled “A personalised 3D-printed dental plaque
removal mouthguard for older
adults”, was published online on
16 May 2023 in the International
Dental Journal, ahead of inclusion
in an issue.
[29] =>
DTMEA_No.4. Vol.13_DT.indd
[30] =>
DTMEA_No.4. Vol.13_DT.indd
NEWS
30
Dental Tribune Middle East & Africa Edition | 04/2023
Osstem Implant to develop
synthetic bone by 2026
By Osstem Implant
SEOUL, South Korea: Specialists
at the Osstem’s Bone Science Research Institute devote themselves
to developing ways to regenerate
bone and soft tissue by applying a
state-of-the-art molecular and cell
biology technique to tissue response and taking a physicochemical approach to implant and
bio-implant materials.
Development of an industry
first: Bioabsorbable apatite surface technology
In 2013, Osstem’s Bone Science
Research Institute developed the
first bioabsorbable apatite surface
technology that enables the rapid
formation of bone by maintaining
excellent blood wettability without
having to keep the implants in solution. The technology combines the
strengths of sandblasting with alumina, of acid etching and of apatite
surface processing. The researchers
coated the sandblasted and acidetched surface with a layer of apatite
of 20 nm in thickness. The apatite is
resorbable and has an inorganic
constituent with a degree of crystallinity that is identical to that of
human bone. Thus, it has been
found to improve osseointegration
by over 30% compared with the
sandblasted and acid-etched surface and solves the issue of peeling
of the coating, which is an occasional problem of a hydroxyapatite
coating. The outcome was reported
in a study published in 2020 in the
Journal of the American Dental
Association.
Through continued research on
the mechanism of tissue regeneration in accordance with the properties of the implant’s surface, the
Bone Science Research Institute will
further enhance the global competitiveness and product value of implants with a bioabsorbable
hydroxyapatite-coated surface by
developing and adopting unrivalled
technologies. The products are
available in global markets, including the US and Europe, and are sold
under the brand name ET NH implant system (Hiossen Implant).
Plans to unveil bone grafting
material based on osteoinductive composite material
The A-Oss bone grafting material was launched in 2013 and obtained the European CE mark for
Class III medical devices in 2020.
Currently, A-Oss is available from
25 overseas subsidiaries of Osstem
in Canada, Germany and Japan, as
well as from its headquarters in
South Korea. It is also available in
some other countries, including the
US, under the brand name A-Graft
(Hiossen Implant). The 3D connected microporous structure of
A-Oss facilitates the inflow of bodily
Ha Kyung-Won (middle), director of Osstem Implant’s Bone Science Research Institute, and fellow senior researchers holding up diverse bone grafting materials.
(Image: Osstem Implant)
fluids and the ingrowth of blood
vessels and attachment of osteoblasts and fibrin network and maintains its volume while bone is regenerated.
“Based on proprietary organic
substance removal technology of
Osstem, we remove immunogens
and possible sources of infection.
A-Oss is a safe and pure inorganic
bone grafting material,” said Ha
Kyung-Won, director of Osstem’s
Bone Science Research Institute.
“A-Oss delivers excellent new bone
formation by providing an environment favourable to interaction, proliferation and differentiation of bone
cells owing to its optimised surface,
porous structure and granule
shape,” he explained.
Osstem’s Bone Science Research
Institute aims to position A-Oss as
the top heterogenous bone grafting
material in the global market this
year. In the first half of 2022, the institute introduced an upgraded
A-Oss in South Korea that has a 36%
higher ability to form bone compared with previous products, and
this improvement was achieved by
controlling calcium ionic behaviour.
The institute has diversified its
product line by launching products
such as A-Oss Collagen and Q-Oss+
Collagen and by adding collagen to
existing products, such as A-Oss
and Q-Oss. It is now concentrating
its efforts on developing new synthetic materials, such as LCA-R and
LCA-N, and an osteoinductive composite material that is hoped to shift
the paradigm of bone grafting materials.
LCA-R is scheduled for launch in
2023. According to Ha, it is being
developed using new synthetic ma-
Ha Kyung-Won (right) at the research centre conducting tests on A-Oss with fellow senior researchers.
(Image: Osstem Implant)
terial and has delivered an ossification performance identical to that of
allogeneic bone. He believes that
LCA-R will become the nextgeneration bone grafting material,
having outstanding bone formation
and volume maintenance ability, all
thanks to its synthetic bone (tentatively called LCA-A), which has physical, chemical and biological properties identical to that of autogenous
bone, exceeding the level of allogeneic bone. As the originator,
Osstem’s Bone Science Research
Institute aims to pioneer a new bone
grafting material market by 2026.
A-Oss bone grafting material. (Image: Osstem Implant)
[31] =>
DTMEA_No.4. Vol.13_DT.indd
[32] =>
DTMEA_No.4. Vol.13_DT.indd
#whdentalwerk
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