DT Middle East and Africa

Heartburn drugs Prilosec - Nexium block benefits of blood thinner Plavix warns FDA / Winners for Aesthetic Dentistry MENA Awards 2009 Announced! / Does your patient suffer from dry mouth? / Dubai International Implantology Summit concludes with overwhelming Success / It is with great pleasure that Medicals International W.L.L. introduces to you our new Astra Tech Dental Implants. / Media CME: Smile Design Wheel™: A practical approach to smile design / GlaxoSmithKline to re-launch the leading dry mouth brand - Biotene - in the Middles East. / AAE: Issue in implant debate comes down to saving teeth / Testing the bluephase 20i / Interview with Dr. Fredrick Bergstrand: D.D.S (Ortho) Global Professional Services Manager 3M Unitek / Aesthetic Dentistry MENA Awards 2009 / Dental Cafe / Are children receiving prompt cleft lip/palate treatment?

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Table of contents

DTME1109_ME 11/30/2009 4:53 PM Page 1

DENTAL TRIBUNE
The World’s Dental Newspaper · Middle East & Africa Edition
PUBLISHED IN DUBAI

NOVEMBER 2009

News
Aesthetic Dentistry
MENA Awards 2009.

NO. 6 VOL. 7

Media CME
Smile Design Wheel™

Trends & Applications
Testing the
bluephase 20i

Hours

4Page

Heartburn drugs Prilosec, Nexium block benefits Medical
tourism
of blood thinner Plavix warns FDA
slows down,
USA —A popular variety of
heartburn medications can interfere with the blood thinner
Plavix, a drug taken by millions
of Americans to reduce risks of
heart attack and stroke, Federal health officials said
The Food and Drug Administration said the stomach-soothing drugs Prilosec and Nexium
cut in half the blood-thinning effect of Plavix, known generically
as clopidogrel.
Regulators said the key ingredient in the heartburn medications blocks an enzyme the body
needs to break down Plavix, muting the drug's full effect. Procter
& Gamble's Prilosec OTC is available over-the-counter, while AstraZeneca's Nexium is only
available with a prescription.
"Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will
not get the full effect of this medicine," the agency said in a statement.
Plavix is marketed by SanofiAventis
and
Bristol-Myers
Squibb. With global sales of $8.6

billion last year, it's the world's
second-best selling drug behind
Pfizer's cholesterol drug Lipitor.
Because Plavix can upset the
stomach, it is often prescribed
with stomach acid-blocking
drugs.
The FDA says patients who
need to reduce their acid should
take drugs from the H-2 blocker
family, which includes Johnson
& Johnson's Mylanta and
Boehringer Ingelheim's Zantac.
FDA scientists say there is no evidence those drugs interfere with
Plavix's anti-blood clotting action.
Nexium and Prilosec are part
of a class of drugs known as proton pump inhibitors, but FDA
regulators said they don't have
enough information to say
whether other drugs in that class
shouldn't be used with Plavix.
The FDA said the warnings on
Plavix have been strengthened
based on a 150-patient study submitted by Sanofi over the summer.
But some consumer advocates said the agency's action fell
short, arguing that regulators
should have placed the informa-

but could
recover

tion in a "black box" warning label, the most serious available.

a heart attack, stroke or chest
pain.

While the economic recession has eroded the growth rate
for medical and dental tourism
by approximately 13.6 per cent
from 2007 to 2009, the economic
recovery may help spur a sustainable 35 per cent annual
growth rate for the medical
tourism industry by 2010, according to a new report released
by the Deloitte Center for Health
Solutions in the US.

"This information still has not
risen to as prominent a level of
warning as it should have," said
Dr. Sidney Wolfe, director of
health research at the consumer
advocacy group Public Citizen.
Information about the drug
interaction between Plavix and
other medications is not new. Researchers at pharmacy benefit
manager Medco Health Solutions reported last year that taking Plavix with Nexium significantly
increased
patients'
chances of being hospitalized for

WBB Securities analyst
Steven Brozak said the news
would put pressure on Parisbased Sanofi and New Yorkbased Bristol-Myers to provide
more safety data on their bestselling product.
"This is going to create a
chain reaction as patients start
calling their physicians, and they
are forced to make a spot decision on limited information,"
said Brozak. "That's not gonna
help either company's bottom
line." DT

Medical tourism has experienced a significant slow down
driven by consumers putting off
elective medical procedures over
the past two years. However, a
better economy and health care
reform in the US will likely propel
growth in the elective outpatient
market, particularly if elective
cosmetic and dental procedures
are not considered basic benefits,
the report states. In 2009, a projected number of 648,000 Americans will travel abroad for outbound medical and dental care. DT
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[2] => ME

DTME1109_ME 11/30/2009 4:53 PM Page 2

DENTAL TRIBUNE Middle East & Africa Edition

News

Winners for Aesthetic Dentistry
MENA Awards 2009 Announced!
The judging and evaluation
process of the first edition of the
awards was completed and the
much anticipated results were
announced on November 05th,
at the prestigious Jumeirah
Beach Hotel, where winners,
nominees and judges from
Middle East were gather with
the elite of the aesthetic dentistry to pay tribute to the most
outstanding achievements in
dental treatment.
Members of the jury panel
faced a tough evaluation process
due to the large number of quality cases submitted but finally
came to a conclusion. The event
showcased 29 short listed dental

istry of Health and CAPP – Centre
for Advanced Professional Practices.
The winners were awarded
with special selection of professional equipment with the generosity of Sirona, Nikon, Al
Mazroui, Nobel Medical, Al
Hayat, Glaxo Smith Kline,
Dentoflex and Canon. We would
like to thank all participants who
entered the awards for their hard
work and dedication to the Dental Industry.
MENA "Aesthetic Dentistry"
Awards 2009 is the biggest, one of
the most remarkable dental assembly in the region which

MENA Awards 2010. Presented
by CAPP Centre of Advanced Professional Practiced and EMA
Dental Society. DT

Editorial Board
Dr. Talal Al-Harbi, Orthodontist, Qatar
Dr. Mohammed H. Al Jishi, Bahrain
Dr. Lara Bakaeen, Prosthodontist , Jordan
Dr. Aisha Sultan, Periodontist, UAE
Dr. Kamal Balaghi Mobin Aesthetics, Iran

Prof. Abdullah Al-Shammary, Restorative Dentistry, KSA
Prof. Hussain F. Al Huwaizi, Endodontics, Iraq
Prof. Samar Burgan, Oral Medicine, Jordan
Dr. Abdel Salam Al Askary, Implantology, Egypt

DENTAL TRIBUNE
The World’s Dental Newspaper · Middle East & Africa Edition

President/CEO

Yasir Allawi
y.allawi@dental-tribune.ae

Director mCME:

Dr. D. Mollova
info@cappmea.com

Marketing manager

Sawsan Alhalwachi
info@dental-tribune.ae

Production manager

Hussain Alvi
dentalme@dental-tribune.ae

Published by Education Zone
in licence of Dental Tribune International GmbH
© 2009, Dental Tribune International GmbH. All rights reserved.
Dental Tribune makes every effort to report clinical information and manufacturer’s product news accurately, but cannot assume responsibility for the
validity of product claims, or for typographical errors. The publishers also do
not assume responsibility for product names or claims, or statements made
by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune International.

PO Box 214592, Dubai, UAE, Tel + 971 4 391 0257
Fax + 971 4 366 4512 www.dental-tribune.com

The new era in Aesthetic Dentistry

4th CAD/CAM &
marks the dental calendars and
puts the regional dental achievements on the World Dental Professional map.

13-14 May 2010, Dubai
The Address Dubai Marina Hotel

We would like to invite all dental
professionals to join the 2nd Edition of the Aesthetic Dentistry

Conservative Best Case
1st Place Lamberto Villani, Oral Design Laboratory, Dubai
2nd Place Dr. Michael Ziegler, American Dental Clinic Dubai
3rd Place Dr. Michael Ziegler, American Dental Clinic Dubai
Orthodontic Best Case
1st Place Dr. Edgard Irany, Al Zahra Private Hospital, Sharjah
2nd Place Dr. Mazen Hamadi, Ghoudousi Medical Centre, Dubai
3rd Place Dr. Vishwanath Kedilaya, NMC Specialty Hospital, Dubai
Prosthodontic Best Case
1st Place Dr. Ajay Juneja The Dental Studio, Dubai
2nd Place Prof. Jean-Marie Megarbane, Lebanon
3rd Place Dan Stenkilsson, Middle East Dental Laboratory
Charity Best Case
1st Place Dr. Dushan Motwani Al Musalla Medical Centre
2nd Place Dr. Muhammad Zaman Sherani, Munir Shaheed Dental Clinic
3rd Place Winner Dr. Sanaz Soheilifar, Hamdan, Iran
Implantology & Red Aesthetic Best Case

www.cappmea.com/cadcam4

professionals from 88 entries,
from 14 countries across the
MENA Region. All winning Doctors attended the Gala Dinner
Ceremony at Jumeirah Beach
Hotel. The trophies were presented by Emirates Medical Association – Dental Society, Min-

Computerized Dentistry
International Conference

* CAD/CAM in Aesthetic and Prosthetic Dentistry
* CAD/CAM Dental Laboratories
* CAD/CAM Materials
* Computerized Scanning and Imaging
* Implantation Navigation Systems
* Computerized Orthodontic Planning and Design
* Computerized Management and Planning

1st Place Dr. Angela Husung, German Dental Clinic Dubai

* Computerized Informational and Educational Software

2nd Place Dr. David Rose, Drs. Nicholas & Asp, Dubai
3rd Place Prof. Jean-Marie Megarbane, Lebanon
Facial Reconstruction Best Case
1st Place Dr. Ali Jamil, Iraqi Dental Association
2nd Place Dr. Joseph Kamal Muhammad, Rabha Hospital
3rd Place Dr. Vishalakshmi Sunethra, Rashidiya Private Polyclinic

Organized by:

Estimated 14 CME Hours
CAPP Tel: +971 4 3616174 | Fax: +971 4 3686883 | Mob: +971 50 2793711
info@cappmea.com

Gold Sponsor

Official Sponsors

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DTME1109_ME 11/30/2009 4:53 PM Page 3

DENTAL TRIBUNE Middle East & Africa Edition

News

Does your patient suffer from dry mouth?
What is dry mouth?
We can all suffer from dry mouth
at some point, for example, if we are
nervous or stressed. So most of us
are familiar with the feeling of not
having enough saliva in our mouth
to keep it moist and lubricated.
For some people, however, dry
mouth can be a regular problem. As
we get older we are more likely to
experience dry mouth, but it’s also a
problem that can affect people from
their 30s onwards.
What causes dry mouth?
Dry mouth occurs when the
salivary glands stop working effectively. Medicines are known to
cause over 60% of dry mouth cases,
with more than 400 different medications linked to dry mouth. The
number of medicines a patient
takes is also directly related to the
likelihood of experiencing dry
mouth. Health conditions are also
linked to dry mouth, such as diabetes or Sjögren’s syndrome. People who smoke, who are pregnant,
stressed, anxious or dehydrated are
also more likely to have dry mouth.
What are the symptoms?
The symptoms of dry mouth can
include:
• difficulty in eating, especially with
dry foods,
such as cereals or crackers
• difficulty in swallowing and
speaking
• a burning sensation in the mouth
• taste disturbances
• painful tongue
• dry, cracked, painful lips
• bad breath
• persistent difficulty in wearing
dentures
• feeling thirsty, especially at night
• dry, rough tongue.
Sometimes the amount of saliva
a person produces may be reduced
by up to 50% before these symptoms
are noticed. These symptoms can
sometimes have a profound effect
on self confidence. Does dry mouth
cause other problems? Saliva plays
a very important protective role in
the body. It not only keeps our
mouth moist, it also helps to protect
our teeth from decay, helps to prevent infections and helps to heal
sores in the mouth.
Are your patients dry mouth sufferers?
• Do they have difficulty swallowing
certain foods?
• Does their mouth feel dry when
eating a meal?
• Do they need to sip liquids to help
you swallow dry foods?
• Are they taking multiple medicines?
If a patient answered yes to any
of these, he/she may have dry Products to ease dry mouth
The Biotène system is specifically designed to treat dry mouth.
The different products in the
Biotène system allow you to choose
the ones that best meet your lifestyle
and dry mouth needs:
1 product specifically designed to
help relieve your dry mouth: the
gel provides long lasting relief
2 products to help maintain healthy
teeth and prevent tooth decay in
people with dry mouth: a toothpaste, with fluoride, and mouthwash which can be used twice a

day in place of the usual products.
These are designed to be gentle
on your mouth as they are alcohol-free and don’t contain harsh
detergents. Biotène supplements
the make-up of normal saliva to
replenish dry mouths. It has a
patented enzyme formulation
that:
• helps supplement saliva’s natural
defences

• helps maintain the oral environment to provide protection
against dry mouth
• helps supplement saliva’s natural
antibacterial system - weakened
in a dry mouth. Biotène’s gentle
formulation is also free from alcohol and harsh detergents.
What else can a patient do to manage dry mouth?
• Sip water or sugar-free drinks often

• Avoid drinks which dry out the
mouth, such as caffeine-containing drinks (coffee, tea, some fizzy
drinks) and alcohol
• Chew sugar-free gums or sweets
to stimulate saliva flow
• Avoid tobacco as this has a drying
effect
• Use a humidifier at night to keep
the air full of moisture.
To help keep healthy teeth and
avoid tooth decay:

• Brush teeth with a soft toothbrush
after meals and at bedtime
• Floss teeth gently every day. If
there is bleeding from gums
when flossing, this could be a sign
of gum disease.
• Use an SLS-free, fluoride toothpaste, like Biotène, with its gentle
formulation
• Avoid alcohol-containing mouthwashes as these can dry out the
mouth
• Avoid sweet, sugary foods
• Visit the dentist at least twice a year
for a check-up. DT
AD

[4] => ME

DTME1109_ME 11/30/2009 4:53 PM Page 4

DENTAL TRIBUNE Middle East & Africa Edition

News

Dubai International
Implantology Summit concludes
with overwhelming Success
Dubai, United Arab Emirates,
Dubai International Implant
Summit has successfully concluded last Thursday. High end
profile attendees, specialized

in Implantology have strongly
praised the high level of the
first DIIS edition in terms of
participation and organization.

“We are proud to achieve this
success during the first edition of
Dubai International Implant
Summit, we are very pleased
with the highly positive response
AD

“Industry Specialists
Praise High Participation and Organization Levels”
from all attendees to the high
level sessions in terms of attracting an elite of the most prominent
experts in implantology in addition to presenting the latest techniques and treatments and the
opportunity of exchanging
knowledge and experiences related to this field. This achievement encourages us to continue
putting all the efforts to develop
the medical sector in UAE and
the region” said Anas Al Madani,
Vice President, Index Holding.
Latest international advanced technologies related to
implantology have been presented and discussed at Dubai International Implant Summit.
Sessions continued for three days
highlighted the current major issues related to and implantology
and ways of development. .
“The summit sessions are of a
very high level in terms of participation as well as organization.
And we had highly benefited
from the opportunity of exchanging knowledge and experiences
in major implantology issues
from different countries around
the world” said Dr. Khaled Sadek,
who was among the summit attendees. DT

Alkalines
can damage
teeth too
A new study from the
Sahlgrenska Academy in Sweden has revealed that substances with high pH values
damage enamel, a condition
usually associated with acid
erosion. The researchers exposed extracted teeth to a number of alkaline substances such
as household degreasers and
found that organic material on
the surface of the tooth dissolves rapidly indicating that
the organic components of
the enamel are also affected,
as the enamel becomes more
porous.
Alkaline degreasers are
mainly used in the food industry, among other things to clean
professional kitchens, but are
also common in the automobile
care industry and to remove
paint from walls and other
surfaces. DT

[5] => ME

DTME1109_ME 11/30/2009 4:53 PM Page 5

DENTAL TRIBUNE Middle East & Africa Edition

Practice Matters

It is with great pleasure that Medicals International W.L.L.
introduces to you our new Astra Tech Dental Implants.
The launching of Astra Tech
Implants in UAE comes as a
second step to the Pre-Launching seminar that was held at the
Crowne Plaza Hotel, Sheikh
Zayed Road, Dubai, on 13th and
14th of June 2009. During those
2 days, 4 well renowned speakers presented their latest clinical and experimental researches (Prof. Stig Hansson
(one of the engineers of the Astra Tech of implant system), Dr.
John Sorensen from USA, Dr.
Tarek Bourzek and Dr. Hadi AL
Saffar from Kuwait). Around 25
dentists from all over UAE had
the opportunity to participate
in this major event.
The theme tackled the issue
of "Immediate Concept" in implantology in a demanding and
fast moving environment. The
seminar focused on developing
implant esthetics utilizing Immediate Concepts, Minimal Invasive Protocols, Tissue Management, Restorative Techniques, Design and Material Selection.
Medicals International who
hosted the event with the collaboration of Astra Tech Dental, is a
regional organization servicing
12 countries in the Middle East,
Arabian Gulf and North Africa. It
was established in 1994 in
Lebanon, and it supplies now 4
different businesses in the medical industry (Contact Lenses,
Optical, Ophthalmology and
Dental).
We have been in the United
Arab Emirates market for over 10
years now. We have a very successful and well-experienced
team bringing us to the top as
Market Leaders in different segments and fields. We are situated
in 48 Al Diyafa Street, in Dubai.
Our phone numbers are 04
3460998 while the fax number is
04 3460986.

Patients in danger
of zinc overdose
The US Consumer Healthcare Products Association has
recently issued a national alert
against the use of denture
creams containing zinc. According to the organisation, exposure
to excess zinc through those
creams can lead to unexplained
weakness, loss of sensation or
other nerve symptoms. DT

China rivals US
in research race
A new report by Thomson
Reuters has found that Chinese
researchers have more than
doubled their output of scientific
papers in recent years and now
rank second after the United
States in terms of volume. In
2008, China published 112,000
papers compared to 340,000 in
the US. DT

Our transparent “Business
with Ethics” style of work helps
us establishing greater visibility
between final user and supplier
through our entity thus ensuring
smoother communication and

on all levels, product, clinical
support and service.
Our Mission Statement “We
Think of the Patient First”, describes exactly what Medicals International is all about. We be-

lieve that a better clinical outcome is the end result of a true
team work effort combining
good understanding of the product in question along with proper
training for the professional who
will end up prescribing or using

this important tool. From this angle, we work hard and around the
clock in search for better alternatives, get trained on how to present and service them better to ensure that the final outcome is optimized. DT
AD

[6] => ME

DTME1109_ME 11/30/2009 4:54 PM Page 6

Media CME
2
Hours

DENTAL TRIBUNE Middle East & Africa Edition

Smile Design Wheel™:
A practical approach to smile design

The article has been accredited by Health Authority - Abu Dhabi as having educational content and is acceptable for up to 2
(Category 1) credit hours. Credit may be claimed for one year from the date of subscription.

Dr Sushil Koirala
Nepal

Modern trends in cosmetic
dentistry and media coverage
of smile makeovers have increased public awareness of
dental aesthetics. People now
know that smile aesthetics
plays a key role in their sense of
well-being, social acceptance,
success at work and in relationships, and self-confidence. The
aesthetic expectations and
demands of dental patients have increased
substantially. Now, a
glowing, healthy
and vibrant smile
is no longer
available only
to millionaires
and
movie
stars. Therefore,
many
dentists are
incorporating
various smile
design protocols in their
daily practices to
meet the increasing aesthetic demands of their patients.

Smile aesthetics
A smile is a facial expression that is closely related to
the emotions and psychological state of a person. A smile is
exhibited when a person expresses happiness, pleasure or
amusement.1 It is the most important of facial expressions
and is essential in expressing
friendliness, agreement and
appreciation.2 A smile requires the coordination of facial, gingival and dental
components that are stimulated voluntarily or involuntarily by various
emotions. It is evident
that each smile is different and particular
to each individual.3
An impaired smile
on
the
other
hand, has been
associated
with higher
incidences of
depression.4
Aesthetics Fig. 2
deals with objective and subjective beauty.5
Objective beauty is based on
the appreciable properties
possessed by the object itself.
However, subjective beauty is
relative to the perception and
emotion of the observing person. Perception, however, in
smile aesthetics is based on
personal beliefs, cultural influences, aesthetic trends and
fashion, and input from the

media. Hence, smile aesthetics
is a multifactorial issue, which
needs to be adequately addressed for any aesthetic treatment. The objective beauty of a
smile can be established with
the application of various principles of smile design, and the
creation of subjective beauty
may
enhance
cosmetic
value.5,6

ical aspects—perception, personality, desire—the state of
health, the mathematical ratio
of the facial, dento-facial and
dento-gingival components.
The psychological aspects are
highly subjective and fluctuate
constantly because of identity,
peer and media pressure.
Hence, the only objective
method of aesthetic analysis is
mathematical.
Indeed, mathematics has
been considered the only
frame of reference for comprehending nature.8 Therefore,
the cosmetic dentist needs
to be familiar with various
mathematical and geometric concepts for
achieving smile aesthetics and their clinical protocols.

Fig. 1

Smile design
Smile design has been defined in various ways in the literature; I would like to summarise it as follows: “Smile design is a systematic process
governed by the psychology,
health, function and rules of
natural aesthetics to bring
about some changes in softand hard-oral tissue within
anatomical, physiological
and psychological limitations, thereby creating a
positive influence on
the overall aesthetics of a person’s
face and personality as a
whole”.7
W e
all appreciate a
beautiful
smile when we see it,
but it is difficult to explain
exactly what makes a smile
beautiful. It is evident that a
pleasing smile depends on the
following features: the quality
of the dental and gingival components, their conformity to
the rules of structural beauty,
the relationship between teeth
and lips, and their harmonious
integration with the facial
components.8 Overall facial
beauty and smile aesthetics are
normally judged by psycholog-

The Smile Design
Wheel
For any smile design procedure, the clinician needs to consider
the elements of the smile
design pyramids—psychology, health, function
and aesthetics (PHFA),
listed here according to order of importance.7 It is
necessary to determine
the patient’s psychological status, establish a
healthy oral environment, restore function and then give
attention to enhancing the aesthetic aspect. All
four pyramids
should be accorded equal
importance
Fig. 3
to achieve a
desirable
clinical result.
By integrating these PHFA
pyramids, I developed the
Smile Design Wheel (Fig. 1), in
which each pyramid is subdivided into three related zones.
The Smile Design Wheel was
devised as a simple guide to the
most important components of
smile design, their clinical significance and sequence to be
maintained during the smile
design procedure. I believe
that the Smile Design Wheel
will help clinicians to easily
comprehend the ‘complex’
smile design procedures of
aesthetic dentistry. In the next
section, I briefly explain the
Smile Design Wheel protocols
with PHFH pyramids assessment and their basic objectives.
Step I: Understand—
The pyramid of psychology
According to Prof. Robert A.
Baron, psychology is best de-

fined as the science of behaviour and cognitive processes.
Behaviour deals with any action or reaction of a living organism that can be observed or
measured.
Cognitive
processes deal with every
aspect of our mental life:
our thoughts, memories,
mental images, reasoning, decision-making,
and so on, in short,
with all aspects of
the human mind.
In smile design, we normally try to
understand
the second
part of psychology, i.e. Fig. 4
the human
mind or rather the minds of
our patients. There are three
fundamental zones we consider in detail for the psychological pyramid assessment:
perception, personality and
desire.
Perception
Perception is the process
through which a person can select, organise and interpret
input from their sensory
receptors. A person cannot imagine beauty
and aesthetics without some input in
advance.
The
media is the
most comm
o
n
source
of information
at present regarding beauty and
aesthetics. A patient usually
conceives his or her own perception of smile aesthetics
based on his or her own personal beliefs, cultural influences, aesthetic trends within
society and information from
the media.
Dentists need to communicate with their patients to determine such information during the initial consultation,
which helps in understanding
the patient’s perception of the
treatment result. The use of
questionnaires, visual aids,
such as previous clinical cases
or smiles of various celebrities,
can aid immensely in this
process.
Personality
According to the human
psychology, personality is an
individual’s unique and relatively stable pattern of behaviour, thoughts and emotions. It
is to be noted that each patient’s problem or concern

should be comprehensively
evaluated with respect to his or
her personality type. According to Roger P. Levin,9 there are
four personality types:
Driven: This type of person
focuses on results, makes decisions quickly and dislikes
small talk. They are highly
organised, like details in
condensed form, are
businesslike and assertive.
Expressive:
This type of
person wants
to
feel
good, is
highly
emotional,
makes
decisions
quickly, dislikes details or
paperwork, and likes to have a
good time.
Amiable: People with this
personality type are attracted by people with similar interests, fear consequences, are slow in decision-making, react poorly
to pressure, are emotional
and slow to change.
Analytical: This type of person requires endless details and information, has
an inquiring mind, is highly
exacting and emotional.
This type is the most difficult to convince and takes
the longest to reach a decision.
Desire
Desire is a subjective component. Increased public
awareness of smile aesthetics
through the media has lead to a
rapid increase in patients’ desires and levels of expectation.
Patients are now willing to pay
for the enhancement of their
smile aesthetics. Therefore,
the ethical responsibilities of
cosmetic dentists in identifying the need- or want-based
desires of patients have also increased. The desires and levels
of expectation in many patients
are higher than what is clinically achievable, and it is the
clinician’s duty to explain and
guide patients towards a realistic aesthetic goal.
The psychological assessment of any person is very subjective; however, aspects like
perception, personality, expectation or desire are important for the smile design procedure. Patient satisfaction is
closely related to these aspects.
Hence, understanding the
pyramid of psychology is an integral aspect in smile design.
Step II: Establish—
The pyramid of health

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DTME1109_ME 11/30/2009 4:54 PM Page 7

DENTAL TRIBUNE Middle East & Africa Edition
The pyramid of health is divided into three zones: general
health, specific health and
dento-gingival health. The
health pyramid assessment
and its management play a vital role in most cases, as patients may have certain limitations owing to their health, like
uncontrolled diabetes, soft-tissue pathology, poor bone structure, poor oral hygiene, tooth
decay, periodontal disease etc.,
which should be addressed
prior to functional and aesthetic treatment.
The health pyramid assessment process includes patient
history (medical, dental, nutritional), examinations (extraoral, intra-oral) and investigations
(radiographs, pulp vitality
test, study models
analysis). Various
types of questionnaires and clinical examination
and investigation protocols
can be used
to obtain the
necessary
information relating to the Fig. 5
patient’s
health.
The clinician can use this information to prepare a personalised treatment protocol. All
three components of the pyramid of health should be established within normal limits before starting any aesthetic
restorative procedure on a patient.
Step III: Restore—
The pyramid of function
Function is related to force
and movement. Hence, for the
pyramid of function assessment, the existing occlusion,
comfort and phonetics are
properly examined with the
evaluation of para-functional
habits, level of comfort during
chewing and deglutition, and
temporomandibular
joint
movement. The clarity of normal speech and pronunciation
are also examined. The occlusion, comfort and phonetics
components of the functional
pyramid should be restored
and maintained at an acceptable level before starting the
treatment of any aesthetic
component.
Step IV: Enhance—
The pyramid of aesthetics
The pyramid of aesthetics is
the last but most sensitive
pyramid of the Smile Design
Wheel, as aesthetics has both
subjective and objective aspects. The assessment of the
subjective aspects—perception, personality, desire—is
carried out during the pyramid
of psychology assessment. It is
to be noted that the assessment
of the objective aspects depends on the distance (focal
length) used to visualise the
aesthetic component. Hence,
the aesthetics pyramid can
broadly be divided into three
major zones: macro, mini and
micro.

Macro-aesthetics
Macro-aesthetics
deals
with the overall structure of the
face and its relation to the
smile (Fig. 6). To appreciate
the macro-aesthetic components of any smile, the visual
macro-aesthetics
distance
should be more than 5 feet.
However, in clinical practice
the assessment of the macroaesthetic components is done
using various facial photographs with geometric and
mathematical appraisals, using reference points and their
interrelation. Various facial
reference points and guidelines are used for aesthetic assessment for orthognathic and
facial cosmetic surgery; however, in smile design the following
macro-aesthetic
guidelines are considered
fundamental:
• facial midline;
•
facial thirds;
•
interpupillary
line;
•naso-labial
angle; and
•
Rickett’s
Eplane.
Mini-aesthetics
Mini-aesthetics deals
with the aesthetic correlation
of the lips, teeth and gums at
rest and in smile position (Fig.
7). The aesthetic correlation
can be appreciated properly
when viewed at a closer distance than the visual macroaesthetics distance.
The visual mini-aesthetics
distance is similar to the
across-the-table
distance,
which is normally within 2 to 5
feet. There are various guidelines in aesthetics based on the
relationship and ratio between
lips, teeth and gingival tissue.
These can be analysed during
mini-aesthetic assessment using frontal, vertical and transverse characteristics of the
smile. Clinical photographs
are the basic tools for mini-aesthetic analysis. The smile can
be analysed at rest (M-position) or smile (E-position).
In the M-position, the following references are measured and analysed:
• commissure height;
• philtrum height; and
• visibility of the maxillary incisors.
In E-position the following
references should be analysed:
• smile arc (line);
• dental midline;
• smile symmetry;
• buccal corridor;
• display zone and teeth visibility;
• smile index; and
• lip line.
Micro-aesthetics
Micro-aesthetics deals with
the fine structure of dental and
gingival aesthetics (Fig. 8).
Mini-aesthetics can be appreciated at a visual micro-aesthetic distance of less than 2
feet or within normal make-up
distance. For the clinical assessment of micro-aesthetic
components of the teeth and
gingival tissue, appropriate il-

Fig. 6

Media CME

Fig. 7

Fig. 8

lumination and magnification
tools are required for intraoral examination. Necessary
clinical intra-oral photographs
should be taken for documentation and future reference.
For micro-aesthetics, the
detail of the individual tooth
structure and its relation to the
surrounding gingiva and the
adjacent teeth should be
analysed. The following are
the major points to be considered:
• upper centrals (tooth size
ratio);
• principle of golden ratio;
• axial inclination;
• incisal embrasures;
• contact point progression;
• connector progression;
• shade progression; and
• surface micro-texture.
In smile design, the aesthetic conditions related to gingival health and appearance
are an essential component.
The gingival shape, position,
embrasure, and contour in relation to the teeth are interdependent. The following are
major aspects that should be
addressed during smile design
to achieve gingival or pink aesthetics:
• gingival shape;
• gingival contour;
• gingival embrasure;
• gingival zenith; and
• gingival height (position or
level).
To achieve higher patient
satisfaction and long-lasting
treatment results, the following should be the sequence in
any smile design procedure:
proper comprehension of psychological aspects, the establishment of health and the
restoration of function within
its normal limit, and the subse-

quent enhancement of aesthetic components.
Conclusion
Today, various protocols of
smile design are available in
cosmetic dentistry. However,
most clinicians wish to use the
simplest protocol with the most
predictable results. It is to be
noted that smile design should
always be a multifactorial decision-making process that allows the clinician to treat patients with an individualised
and interdisciplinary approach.

The Smile Design Wheel
presented in this article clearly
indicates the most important
components (PHFA pyramids)
of smile design, their clinical
significance and sequence to
be maintained during the
smile design procedure. I believe that the Smile Design
Wheel is a simple and practical
protocol in smile design that
can help the clinician to easily
comprehend the ‘complex’
smile design procedures of
aesthetic dentistry. DT

MEDIA CME
Self-Instruction Program
Dental Tribune Middle East &
Africa in collaboration with CAPP
introduce to the market the new
project mCME - Self Instruction
Program.
mCME gives you the opportunity to have a quick and easy way
to meet your continuing education needs.
mCME offers you the flexibility to work at your own pace
through the material from any location at any time. The content is
international, drawn from the
upper echelon of dental medicine, but also presents a regional
outlook in terms of perspective
and subject matter.
How can professionals enroll? They can either sign up for a
one-year (10 exercises) by subscription for the magazine for
one year ($65) or pay ($20) per ar-

ticle. After the payment, participants will receive their membership number and will be able to
attend to the program.
How to earn CME credits?
Once the reader attends the distance-learning program, he/she
can earn credits in three easy
steps:
1.
Read the articles.
2.
Take the exercises
3.
Fill in the Questionnaire and Submit the answers by
Fax (+971 4 36868883) or
Email :info@cappmea.com
After submission of the answers, (name and membership
number must be included for
processing) they will receive the
Certificate with unique ID Number within 48 to 72hours.
Articles and Questionnaires
will be available in the website
after the publication.
www.cappmea.com

[8] => ME

DTME1109_ME 11/30/2009 4:54 PM Page 8

DENTAL TRIBUNE Middle East & Africa Edition

Business

GlaxoSmithKline to re-launch the leading dry
mouth brand, Biotene, in the Middles East.
Dry Mouth brand Biotene®
end 2008.

GlaxoSmithKline Consumer
Healthcare is planning to relaunch the Biotene® Oral Care
products in the Middle-East
early next year. The company
finalized the agreement with
Laclede, a privately held company, to purchase the leading

“The re-launch of Biotene
extends our portfolio in therapeutic oral healthcare to include
a proven treatment for Dry
Mouth in the Middle East,” said
Mazen Zaytoun, Biotene Brand

Manager , GSK Consumer
Healthcare. “This opportunity
leverages our established capability with dental and medical
professionals in the region and
is a further step towards our mission of improving the quality of
life of our Middle-East consumers.”

Biotene
is
the
world’s number one
dentist and hygienistrecommended
Dry
Mouth product for the
growing population
that suffers from this
condition. Biotene is a

leaders in dry mouth treatment
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www.cappmea.com

Biotene was occasionally
available in some Middle-East
markets but on a very small
scale. GlaxoSmithKline Consumer Healthcare plans to grow
the brand behind an awaress
campaign on the growing problem of Dry mouth.

Dental Academy

4th CAD/CAM & Computerized Dentistry
International Conference
13-14 May 2010
The Address Dubai Marina Hotel

Estimated
CME 14 Hours

The new era in Aesthetic Dentistry
Hands on course in Aesthetic Dentistry - Module 1, 2, 3
2010 Dubai / Abu Dhabi
Tutors: Prof. Philippe Tardieu and Dr. Ninette Banday

Clinical Photography in Dentistry
2010 Dubai / Abu Dhabi
Tutor: Prof. Philippe Tardieu
CPD 5 Hours

2nd Dental - Facial Cosmetic
International Conference

Aesthetic Dentistry
MENA Awards 2010

05 - 06 November 2010
Dubai, UAE

Entry Submission Opens
December 01, 2009
Dubai, UAE

mCME with
Dental Tribune
International

Endodontics Training Module
from University of North Carolina
Chapel-Hill - Hands On
2010 Dubai / Abu Dhabi
Tutor: Prof. Philippe Sleiman

Accredited by UNC
(PACE & ADA CERP) CME 14 hours

Denture Academy
Organized by CAPP & Vertex Dental Academy for Dentists and Dental Technicians
Six Master Classes
2010 Dubai / Abu Dhabi
Tutor: Onno J.R. Blok

Hotline: +971 50 2793711

+971 4 3616174 | Fax: +971 4 3686883

www.cappmea.com

brand in strong growth, with
global sales in 2007 of around
$50 million up 17%. Approximately 65% of the brand’s current sales are in the United
States.

info@cappmea.com

Dry Mouth, a condition
known as Xerostomia, is a significant health issue associated
with chronic medical conditions
that include diabetes, rheumatoid arthritis, Sjogren’s syndrome and Parkinson’s disease.
Additionally,
cancer
chemotherapy or radiation
treatment, as well as any of more
than 400 medications that, as a
side-effect, can cause Dry
Mouth. Globally, Dry Mouth is as
prevalent as dental sensitivity,
affecting around one-in-five
adults.
Biotene joins a world-class
portfolio of Oral Healthcare
Brands, including:
 Sensodyne®, the leading
toothpaste to treat dental
hyper-sensitivity
 Aquafresh®, a leading range
of toothpastes, toothbrushes,
mouthwashes
and
whitening
products
 Corsodyl®, Chlorhexamed®
gingivitis treatment
 Parodontax, a toothpaste for
healthy gums
 Corega®, a range of denture
adhesives & cleansers
How Biotene works
Biotene is a proprietary system founded on three enzymes:
glucose oxidase, lactoperoxidase and lysozme, each found in
healthy saliva. The augmentation of these enzymes through
the introduction of Biotene into
an oral healthcare regimen aids
the symptomatic relief of Dry
Mouth. The Biotene range includes mouthwash, toothpaste,
gel, spray and gum formulations
for convenient, effective relief.
New innovation in 2008 added
additional enzymes that attack
and breakdown plaque biofilm.
GlaxoSmithKline – one of the
world’s leading research-based
pharmaceutical and healthcare
companies – is committed to improving the quality of human life
by enabling people to do more,
feel better and live longer. For
further information please visit
www.gsk.com DT

[9] => ME

DTME1109_ME 11/30/2009 4:54 PM Page 9

DENTAL TRIBUNE Middle East & Africa Edition

Business

AAE: Issue in implant debate
comes down to saving teeth
Sierra Rendon
DT America

CHICAGO, IL, USA: The
American Association of Endodontists (AAE) has expressed serious concerns over
recent assertions by the American Academy of Implant Dentistry (AAID). According to the
endodontist group, the implantologist group’s position reinforces outdated myths about
root canal treatment.
A press release distributed
by the AAID on 21 September
positioned implants as a better
option than root canal treatment for a variety of reasons,
including higher success rates
and lower financial burdens
—claims that root canal specialists say are inaccurate and
misleading to potential patients.
“Not only has it been proven
that both treatments have
the same success rates,” said
Dr Gerald N. Glickman, president of the AAE, “but several
studies show that root-canal
treated teeth are retained at
about 95 to 97 per cent after
eight years, versus implant
retention of 85 to 90 per cent
during a similar time period.
The AAID chose to ignore the
scientific literature in its news
release.”
Dr Glickman also noted the
inference that diseased teeth
are not worth saving, which he
said does a disservice to both
patients and the dental profession as a whole.
“Do patients with a broken
arm expect their doctor to give
them a prosthetic arm?” he
asked. “Why would the same
patients believe they need to
get a prosthetic tooth screwed
into their jaw if the real tooth
could be healed?”
Saving teeth is not so much
a matter of ‘dental heroics’ as
it is serving the best interests
of the patient, and root canal
specialists proudly do so in a
manner that is consistent with
the American Dental Association’s Principles of Ethics and
Code of Professional Conduct.
“And arguments that root
canal treatment is more costly
are fatuous,” Dr Glickman
added. “Recent research has
proven that saving the natural
tooth with a root canal rarely
requires follow-up treatment
and generally lasts a lifetime;
implants, on the other hand,
have more post-operative
complications, and therefore
would probably present the
more significant financial
burden.”
Dr Glickman recognises
that there are cases when
a tooth cannot be saved, for

which implants would be a realistic option. He pointed out
that root canal specialists are
ideally qualified to make such
a determination with a patient’s general dentist, and that
all dental professionals are
ethically obligated to inform

patients of all available treatment options. “This whole paradigm is ultimately not about
which treatment modality is
better, but what is best for each
patient. And that is the pre servation of the natural dentition,” he said. DT

AEE President Gerald N. Glickman. (DTI/Photo Daniel Zimmermann)
AD

[10] => ME

DTME1109_ME 11/30/2009 4:54 PM Page 10

DENTAL TRIBUNE Middle East & Africa Edition

10 Trends & Applications

Testing the bluephase 20i
A user report on the new bluephase 20i LED light
Dr Niklas Bartling
Switzerland

We have been using a firstgeneration bluephase LED
light for more than two years
in our dental practice. This
curing light offers a light intensity of 1.200 mW/cm2 and
achieves a wavelength range
similar to the spectrum of
halogen lights, owing to its
poly-wave LED technology.
There was therefore no need
to purchase a new light unit.
Nonetheless, I let myself be
persuaded into testing the
bluephase 20i for three weeks
in my practice, focusing on
assessing the light’s per formance in the Turbo programme when used at a
maximum light intensity of
2.000 mW/cm2.
In the past, several suppliers offered curing lights that
were claimed to provide high
light intensities and short
polymerisation times. Unfortunately, most of these lights
failed to live up to these claims
when they were evaluated in
field tests. Against such a background, the employees in my
practice were less than enthusiastic about conducting the
trial. To overcome their resistance, they were first shown
how to operate the four programmes of the bluephase 20i
light. In addition, we drew up
a table of all the materials that
would be used in the trial and
their respective curing times in
conjunction with the Turbo
programme (Fig. 1). Normally,
we select the curing programme individually at each
step in the treatment together
with the dental assistant. It
transpired that the well-known
bluephase programmes—High,
Low and Soft modes—were
used whilst the Turbo programme of the bluephase 20i
was studiously avoided.

Reclaiming trust
The objective of our field
test was to identify the limitations of the new LED light.
Given the reservations of the
team members, we decided to
establish first the depth of cure
achieved using the Turbo programme of the bluephase 20i.
It was hoped that this would
dispel the objections of the
team members. The Heliotest
kit, which used to be available for the fabricating of
custom-made shade samples,
is no longer manufactured. We
therefore created our own test
samples by cutting an approximately 1 cm-long piece from a
straw. Next, we pressed a small
amount of low-viscosity silicone into one side of this piece
of straw and allowed the ma terial to set. Then, we inserted
the piece of straw into an empty
composite syringe and filled
the syringe with composite.

Material

Curing time in conjunction
with the Turbo program
Tetric EvoCeram /
5s

Tetric EvoFlow /
IPS Empress Direct
Compoglass F /

2x5s

Compoglass Flow
Variolink II *,
Variolink Veneer *

5 s per mm ceramic
and per segment

Multilink Automix **
Heliosit Orthodontic

5 s per segment
2x5s

* applies to base paste only; ** applies to dual-curing

Fig. 1: Curing times in conjunction with the Turbo programme of the bluephase 20i
for the materials used in the trial.

Fig. 2: A typical case treated during the trial phase: replacement of defective
fillings on teeth 11 and 12.

If a light probe is placed on the
composite and the material is
polymerised, the depth of cure
can be established as an alternative test method.
As it is not always possible
to place the light probe directly
onto the tooth in dental applications, I increased the distance to the material with a matrix in the course of conducting
my tests. The results were unambiguous: the bluephase 20i
successfully passed all test series conducted with the Turbo
programme in conjunction
with the composites used in
our practice.
I repeated the tests in front
of the practice team with good
effect and all reservations regarding the Turbo programme
and its short curing time of five
seconds suddenly vanished.
From then onwards, nothing
hindered the Turbo programme being used routinely.
On the contrary, this programme became very popular
amongst the team members
and they used it frequently. The
usual waiting times associated
with the layering technique
decreased drastically and swift
working during light-curing
was soon established. All team
members repeatedly commented on the substantial
amount of time that can be
saved by reducing the polymerisation time from twenty to
five seconds.

Fig. 3: The defective restorations were removed…

Fig. 4: …the cavities were filled with Tetric EvoCeram…

Fig. 5: …and the composite was polymerised with the Turbo programme of the bluephase 20i light. A common situation:
the light probe cannot always be placed in an optimal position. With the Turbo light probe (10 > 8 mm), the curing time only
has to be doubled if the distance to the material is 8 mm or more.—Fig. 6: Completed Tetric EvoCeram composite restoration.

Field test in the
dental practice
Several patient cases treated during the trial phase of
bluephase 20i are described
below to provide examples of
how the new light unit may
work.

Fig. 7: Another test case: a gap between two anterior teeth had to be closed. Veneers made of IPS Empress Esthetic were
selected for this purpose.—Fig. 8: When ceramic veneers and Variolink II are polymerised using the Turbo programme
(five seconds per mm of ceramic), it is advisable to protect the margins with Liquid Strip.

In the first case, two defective restorations had to be replaced, one on the distal side of
tooth 11 and the other on the
mesial side of tooth 12 (Fig. 2).
The defective fillings were removed and the cavities filled
with EvoCeram (Figs. 3 & 4).
Next, the restorative material
was polymerised using the
Turbo programme of the bluephase 20i (Figs. 5 & 6). As can
be seen on the pictures, the
Fig. 9: The time-saving was clearly noticeable when the six veneers were placed.—Fig. 10: The result: six IPS Empress
Esthetic veneers placed on teeth 13 to 23 and bleaching of the mandibular teeth.

[11] => ME

DTME1109_ME 11/30/2009 4:55 PM Page 11

DENTAL TRIBUNE Middle East & Africa Edition
light probe cannot always be
positioned directly onto the
tooth. It is therefore essential
to use a high-performance
polymerisation light to ensure
a complete depth of cure in
every situation. The polymerisation time only has to be doubled if the distance between
the composite and the light
emission window is larger
than 8 mm if a Turbo light
probe (10 > 8 mm) is used.
Furthermore, the bluephase 20i provides a clear
advantage when treating children. In such cases, swift working is of paramount importance to prevent the treatment
from turning into a struggle.
Reducing the polymerisation
time to twice five seconds in
conjunction with Compoglass
F is very helpful in these circumstances.

Light-curing through ceramic
Ceramic restorations are
usually more opaque than
composite ones. If a luting composite is light-cured through
an all-ceramic restoration, the
polymerisation time has to be
increased to ensure complete
polymerisation. In this case,
we had to close a gap between
two anterior teeth, as the
patient was unhappy with the
appearance of his teeth (Fig. 7).
The patient did not desire
orthodontic treatment. As an
alternative, we decided to insert IPS Empress Esthetic veneers. If the Turbo programme
of the bluephase 20i light is
used, a polymerisation time of
five seconds for each millimetre of ceramic and for each
segment is required (Fig. 8).
The built-in fan presents a
real advantage in these situations. Curing lights without integrated cooling tend to overheat after a short time when
used in continuous operation
and, as a result, have to be
switched off repeatedly to allow them to cool down for a few
minutes. This situation can be
avoided with the bluephase 20i
light. The restorations can be
placed swiftly. In this case, six
veneers had to be placed in the
upper jaw and the gain in time
was clearly noticeable (Fig. 9).
The time-saving is particularly
substantial when placing extensive multiple restorations
(Fig. 10).

Given the high power of this
curing light, a few glimpses of
doubt emerged at times. In particular, concerns around heat
development during polymerisation were voiced. We asked
ourselves if the gingival tissues
might suffer thermal damage
during polymerisation. To
clarify this issue, I tested the
curing light on myself by having various sites on my tooth
necks irradiated with the light
strength of the Turbo programme for five seconds. I then
took the light probe and placed

Trends & Applications 11

“None of the patients complained about pain
when cervical restorations
were cured with the bluephase 20i”
it directly onto my gingiva
without help. During all these
cycles of irradiation I did not
feel the slightest heat-induced
pain. Similarly, none of the patients complained about pain
when cervical restorations
were cured with the bluephase

20i, even when the restorations
were inserted without anaesthetic.

Conclusion
Although I had a few reservations at the beginning of the
trial, I was satisfied with the

bluephase 20i in every aspect.
All composites can be reliably
cured, as this curing light emits
light in a similar spectrum as
halogen lights. In addition,
the Turbo programme offers
substantial time-saving when
treating patients. DT
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[12] => ME

DTME1109_ME 11/30/2009 4:55 PM Page 12

12 Meeting & More

DENTAL TRIBUNE Middle East & Africa Edition

Interview with Dr. Fredrick Bergstrand
D.D.S (Ortho) Global Professional Services Manager 3M Unitek
How many orthodontists are
taking part in these workshops
and where do they come from?
There are 55 orthodontists in
attendance today; all of them
come from across the Middle
East region.
What will you be your topic of
discussion in today’s program?

I will be discussing self ligation and how to utilize modern
wire materials in orthodontics. I
will look at the developments
made in the technology and the
benefits of using these new self
ligation methods. I will also look
at the differences these new
treatments provide compared to

older mechanisms. In addition, I
will demonstrate the benefits of
3M Unitek’s SmartClip™ SL3
Self-Ligating Appliance System.
What benefits does using
Smart Clip™ have compared to
other braces?
We are now working with the
3rd generation of the Smart

Clip™ which has been developed
to offer better control and increased versatility.
The Smart Clip™ bracket system increase efficiency through
their versatility and the reduction of target time. Self ligation
technology offers reduced friction leading to more efficiency in
AD

For Registration & More Info:
Contact Person in Athens:
Lito Christophilopoulou
¨HO +30 210 213 2084, +30 210 222 2637
E-mail: mp-mediterranean@gidedental.com
Nena Puga
Tel.: +1 310 696 9025
E-mail: nena@gidedental.com
website: www.gidedental.com

the treatment using lighter
forces and reduced chair time.
The increased efficiency in treatment time is due to the ‘click in,
click out’ action of the wire into
the SmartClip™
Where can patients receive this
treatment?
This treatment is available at
most orthodontist surgeries
across the region.
What is your role within 3M
Unitek?
I work as the Professional
Services Manager for 3M Unitek
and head up a team which runs
product development, education
and professional services for orthodontics. Working for 3M is not
just about the products on offer.
Education and development are
also crucial, and with my background as an orthodontist, I use
my knowledge and experience of
the field to show how 3M’s products can be used efficiently in
practice.
A little bit about your background?
I am from Stockholm, Sweden
and I have over 25 years of experience in clinical work in Pedodontics (denistry for children)
and Orthodontics. I got my Dental License in Sweden in 1975. In
1983 I joined the board of Pedodontics, Sweden and in 1986 I
specialized in orthodontics and
joined the Swedish board of Orthodontics.
Since 2001, I have been a visiting Professor at USC in L.A.. I
am additionally a member of the
Swedish Dental Association,
Swedish Dental Society, Swedish
Orthodontic Society, British Orthodontic Society, European Orthodontic Society, IADR, World
Federation of Orthodontists
(WFO) and the American Orthodontic Society.
I also run a private practice in
Stockholm.
3M Unitek’s plans for the future?
We have three Incognito
workshops planned for 2010 and
our next Unitek Symposium
planned for 2011. These are all
important, because as we are
continually developing our products, we need to share the
changes with the orthodontists
that will later use them. These
workshops, like the one here in
Dubai, are very hands on – and
the orthodontists present will be
able to test out what 3M Unitek
has to offer.
I personally think the future
of orthodontics is digital. Digital
technologies are still in their development and evolutionary
stages and we are working on a
way for these digital technologies to be more cost. DT

[13] => ME

DTME1109_ME 11/30/2009 4:55 PM Page 13

DENTAL TRIBUNE Middle East & Africa Edition

Meeting & More 13

Aesthetic Dentistry MENA Awards 2009

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r© Gentle MIMI implantation with more than 20.000 successful immediately loaded
implants since 1994
r© Best primary stability through crestal micro thread –> safe immediate loading
r© Zirconium-blasted, etched Ti-IV surface
r© „Intelligent“ dental neck area for each mucosa thickness
r© Zirconium ‚Prep Caps‘ (for optional cementing) for compensating divergences &
aesthetics & immediate loading for dentist chamfer preparation (GOZ 221 / 501)
r© Excellent German Milling and Laboratory Center, including the Master Dental
Technician, for biocompatible, ﬁrst-class & perfectly priced tooth replacement
(One zirconium framework: 94 €
One ceramic laminate: 94 €)
(Phone: +49 (0) 6734 - 961592
Fax: +49 (0) 6734 - 960844)
r© Planning, diagnosis and therapy assistance free of
charge and patient marketing service
r© No initial investment for the ﬁrst delivery on commission

Exciting advanced training workshops for:
dentists with certificates & beginners & ‚Only-Women-Power‘ &
Updater Champions-MotivaCtion courses
Incl. many live implantations & safe
prosthetic concept (15 or 30 education points)
Courses taught by Dr. Armin Nedjat (Flonheim/Mainz),
specialized in Implantology, Diplomate ICOI, developer
and consultant of Champions

For more information, course dates, orders:
0HONEª ª ªª ªªªsªª&AXª ª ªª ª
Info & online shop: www.champions-implants.com

[14] => ME

DTME1109_ME 11/30/2009 4:55 PM Page 14

DENTAL TRIBUNE Middle East & Africa Edition

14 Dental Cafe

Only in Canada ! No Picking (your nose) Law !
For those of you not following
the news over in the Great
White North I will fill you in a
little bit. Last month the ‘distracted driving’ law came into
effect, where-as you will not be
able to chat away on a cell
phone while driving without
risk of incurring a fine of up to
$500. It seems one Canadian

politician wants to take it one
step further!
Jim Bradlley (Ontario’s transportation minister) made this
statement Thursday after telling
reporters he was proud of the
new legislation he helped draft
and as they walked away he mentioned his plans to make this law

much more encompassing in the
near future.
He was quoted as saying;
“Sure talking on a cell phone
while driving is dangerous but
there are many other activities
occuring during driving that are
just as dangerous if not more-so.”
“For example the other day I was
almost side-swiped by a man that
was completely distracted while

picking his nose, and I don’t
mean just a nose scratch - he was
in up to his knuckle”.
There has been testing done
that has shown that picking your
nose while driving is even more
dangerous than using a cell
phone because of the high occurrences of physical injury while
conducting this type of behavior.
AD

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I would like to see all types of distractions lead to a hefty fine, my
advice for this particular offense
would be an $850 fine.
Experts have questioned the
effectiveness of distracted driving laws. In other jurisdictions
they have not always changed
drivers’ habits. After an initial reduction in New York, for example, cellphone use was reportedly back to pre-ban rates within
one year.
The insurance industry says
the new law is a good first step in
making distracted driving socially unacceptable. In fact Bill
Crespen of Walden’s Insurance
says, “personally we would like
to see all distractions result in
large fines, whether it is picking
your nose, applying make-up or
talking on a cell phone - they can
all potentially kill you”. DT

Mum fined
for feeding
ducks

A Birmingham mother has
been fined £75 for feeding the
ducks at her local park - but her
toddler son was allowed to
carry on as he's too young to
prosecute.
Vanessa Kelly, 26, was accosted by a council warden as she
and 17-month-old Harry threw
the birds scraps of bread in
Smethwick, reports the Daily
Telegraph.
She said: "The warden
walked towards me and asked
me to stop feeding the ducks because of complaints about children slipping over on their way to
school on duck mess.
"I said fair enough, but then
she started doing a fine. I asked
'what for?' and she said 'littering'.
"Harry was still throwing the
bread though and the warden
told me he could carry on as he
was too young to prosecute. I
couldn't believe it.
"I was horrified. It is ridiculous. I take my son to feed to the
ducks every week. He loves it. It
is for his entertainment and to
keep him happy."
Miss Kelly said there are no
signs warning people they could
be fined for feeding the ducks
and vowed: "I do not intend to pay
the fine. I am going to fight this to
the end." DT

[15] => ME

DTME1109_ME 11/30/2009 4:55 PM Page 15

Time to talk about dry mouth?
Dry mouth is an increasingly common condition, primarily
related to disease and medication use.
In fact more than 400 medicines can cause dry mouth1 and
the prevalence is directly related to the total number of
drugs taken.2

Ask your patient
Some patients develop advanced coping strategies for dealing with
dry mouth, unaware that there are products available that can help
to alleviate the symptoms, like the biotène system.
Diagnosis may also be complicated by the fact physical symptoms
of dry mouth may not occur until salivary flow has been reduced by
50%.3

Diagnosing dry mouth
Four key questions have been validated to help determine the
subjective evaluation of a patient’s dry mouth:4
1
2
3
4

Do you have any difficulty swallowing?
Does your mouth feel dry when eating a meal?
Do you sip liquids to aid in swallowing dry food?
Does the amount of saliva in your mouth seem to be too little, too
much or you do not notice?

Clinical evaluations can also help to pick up on the condition, in
particular:
s USE OF THE MIRROR @STICK TEST PLACE THE MIRROR AGAINST THE BUCCAL
mucosa and tongue. If it adheres to the tissues, then salivary
secretion may be reduced
s CHECKING FOR SALIVA POOLING IS THERE SALIVA POOLING IN THE FLOOR OF
the mouth? If no, salivary rates may be abnormal
s DETERMINING CHANGES IN CARIES RATES AND PRESENTATION LOOKING FOR
unusual sites, e.g. incisal, cuspal and cervical caries.

Consequences of unmanaged dry mouth include caries,
halitosis and oral infections.

Saliva’s natural defences
Saliva’s natural defences contain a mixture of proteins and enzymes,
each of which plays a specific role:5

Protein:
s LACTOFERRIN n CHELATES IRON $EPRIVES BACTERIA OF IRON WHICH IS
essential for bacterial growth.

Enzymes:
s LYSOZYME n DISRUPTS CELL WALLS OF BACTERIA RESULTING IN CELL DEATH
s LACTOPEROXIDASE n SYNTHESIS OF HYPOTHIOCYANITE A POTENT
antimicrobial agent.

The biotène patented salivary LP3 enzyme
system
The biotène formulation supplements natural saliva, providing
some of the missing salivary enzymes and proteins in patients
with xerostomia and hyposalivation to replenish dry mouths.
The biotène system allows patients to choose the right product
to fit in with their lifestyles:
s RELIEF PRODUCTS /RAL "ALANCE GEL
s HYGIENE PRODUCTS TOOTHPASTE AND MOUTHWASH
The range is specifically formulated for the sensitive mucosa of
the dry mouth patient:
s ALCOHOL FREE

s 3,3 FREE

s MILD FLAVOUR

The biotène formulation:
s HELPS MAINTAIN THE ORAL ENVIRONMENT AND PROVIDE PROTECTION
against dry mouth
s HELPS SUPPLEMENT SALIVAS NATURAL DEFENCES
s HELPS SUPPLEMENT SALIVAS NATURAL ANTIBACTERIAL SYSTEM
weakened in a dry mouth.

GSK welcomes
biotène to its oral
care family

leaders in dry mouth treatment
1. %VESON *7 @8EROSTOMIA 0ERIODONTOLOGY 2. 3REEBNY ,- 3CHWARTZ 33 @! REFERENCE GUIDE TO DRUGS AND DRY MOUTH n ND EDITION 'ERODONTOLOGY 3. $AWES # @(OW MUCH
3ALIVA )S %NOUGH FOR !VOIDANCE OF 8EROSTOMIA #ARIES 2ES 4. &OX 0# "USCH +! "AUM "* @3UBJECTIVE REPORTS OF XEROSTOMIA AND OBJECTIVE MEASURES OF SALIVARY GLAND PERFORMANCE *!$!
5. 4ENUVUO * @#LINICAL APPLICATIONS OF ANTIMICROBIAL HOST PROTEINS LACTOPEROXIDASE LYSOZYME AND LACTOFERRIN IN XEROSTOMIA EFFICACY AND SAFETY /RAL $ISEASE

[16] => ME

DTME1109_ME 11/30/2009 4:55 PM Page 16

DENTAL TRIBUNE Middle East & Africa Edition

16 News & Opinions

Imagine all the high-tech wizardry of advanced digital SLR picture taking in an easy-to-use camera. Now
imagine the D3000, a camera that combines Nikon technology with simplicity never before found in a
camera so advanced. The D3000 features a new Guide mode, intuitive in-camera assistance that allows
even first-time users to transform everyday moments into stunning pictures.

ABU DHABI: Abu Dhabi Mall - Tel: 02 6451115, Khalidiya - Tel: 02 6312100, Marina Mall - Tel: 02 6817817, AL AIN: Al Ain Mall - Tel: 03 7515551
DUBAI: Bur Juman Centre - Digital - Tel: 04 3523641, Deira City Centre - Digital - Tel: 04 2943070, Dubai Festival City - Digital - Tel: 04 2329391, Dubai Mall - Digital 1 Tel: 04 3398915, Dubai Mall - Digital 2 - Tel: 04 3398614, Dubai Marina Mall - Digital - Tel: 04 4342540, Ibn Battuta Mall - Tel: 04 3685353, Maktoum Street Tel: 04 2213700, Mall of the Emirates - Digital - Tel: 04 3414555, Image Arts - Garhoud - Tel: 04 2868010 SHARJAH: Mega Mall - Digital - Tel: 06 5746341
Email: photography@grandstores.ae

www.grandstoresuae.com

Are children
receiving
prompt cleft
lip/palate
treatment?

The timely repair of orofacial
cleft (OFC) can greatly improve a child’s medical and psychosocial well-being.
The
American
Cleft
Palate–Craniofacial Association
(ACPA) has set forth guidelines
for the optimal time by which primary repair surgery should be
received, broken down by type of
OFC.
A retrospective study, published recently in The Cleft
Palate–Craniofacial
Journal
(Vol. 46, Issue 6, Nov. 2009) was
conducted to determine whether
children with OFC receive primary repair surgery within the
time recommended by these
guidelines.
The study, conducted in
North Carolina, found that most
children in that state are undergoing primary repair surgery by
the recommended age.
The study involved vital statistics, birth defects registries
and Medicaid files for resident
children with OFC born between
1995 and 2002.
The many variables analyzed
fell into five broad categories:
maternal, child and system characteristics, perinatal care region
and place of residence.
The findings suggest that
most 78.1 % percent) North Carolina children with OFC received
primary repair surgery by the
time recommended by the APCA
guidelines.
Percentages varied among
cleft lip (about 90 percent), cleft
palate (58 percent) and cleft lip
and palate (89.6 percent).
According to the authors of
the study, “Children whose
mothers received maternity care
coordination, received prenatal
care at a local health department,
or lived in the southeastern or
northeastern region of the state
were more likely to receive
timely cleft surgery.”
The populations least likely to
receive the surgery in a timely
manner were African-American/non-Hispanic and those in
the southwestern region of the
state.
This is most likely due to the
distance to the craniofacial center and the services provided by
the different centers.
To read the entire article,
“Timeliness of Primary Cleft
Lip/Palate
Surgery,”
visit
w w w. p i n n a c l e . a l l e n p r e s s .
com/doi/abs/10.1597/08154.1?j
ournalCode=cpcj DT

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[cover] => DT Middle East and Africa

[toc] => Array ( [0] => Array ( [title] => Heartburn drugs Prilosec - Nexium block benefits of blood thinner Plavix warns FDA [page] => 01 ) [1] => Array ( [title] => Winners for Aesthetic Dentistry MENA Awards 2009 Announced! [page] => 02 ) [2] => Array ( [title] => Does your patient suffer from dry mouth? [page] => 03 ) [3] => Array ( [title] => Dubai International Implantology Summit concludes with overwhelming Success [page] => 04 ) [4] => Array ( [title] => It is with great pleasure that Medicals International W.L.L. introduces to you our new Astra Tech Dental Implants. [page] => 05 ) [5] => Array ( [title] => Media CME: Smile Design Wheel™: A practical approach to smile design [page] => 06 ) [6] => Array ( [title] => GlaxoSmithKline to re-launch the leading dry mouth brand - Biotene - in the Middles East. [page] => 08 ) [7] => Array ( [title] => AAE: Issue in implant debate comes down to saving teeth [page] => 09 ) [8] => Array ( [title] => Testing the bluephase 20i [page] => 10 ) [9] => Array ( [title] => Interview with Dr. Fredrick Bergstrand: D.D.S (Ortho) Global Professional Services Manager 3M Unitek [page] => 12 ) [10] => Array ( [title] => Aesthetic Dentistry MENA Awards 2009 [page] => 13 ) [11] => Array ( [title] => Dental Cafe [page] => 14 ) [12] => Array ( [title] => Are children receiving prompt cleft lip/palate treatment? [page] => 16 ) ) [toc_html] =>

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