DT Middle East and Africa No. 2, 2016

Dentsply Sirona: Merger Creates the Dental Solutions Company™ / News / Checklists not just for pilots anymore / Long-term clinical success in the management of compromised intertooth spaces utilizing small-diameter implants / Oral Health / Restorative / Aesthetics / General Dentistry / Ortho Tribune / Interview: “It is important for us to adapt our global projects to the culture in the Middle East” / Interview: "Keep your natural smile on because you are beautiful" / Assessing your practice success / Hygiene Tribune Middle East & Africa Edition / Endo Tribune Middle East & Africa Edition / Lab Tribune Middle East & Africa Edition / Implant Tribune Middle East & Africa Edition / 11th CAD/CAM & Digital Dentistry International Conference Dubai - May - 2016

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of e
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www.dental-tribune.me

PRINTED in dubai

March-April 2016 | No. 2, Vol. 6

HYGIENE TRIBUNE

ENDO TRIBUNE

LAB TRIBUNE

IMPLANT TRIBUNE

CAPP will host a gathering for dental hygienists
in November in Dubai

Endodontic imaging
mode available from
Planmeca

IPS Style: more beautiful,
easier and more
comfortable

AAID MaxiCourses

ÿInsertion

ÿInsertion

Dentsply Sirona: Merger
Creates the Dental
Solutions Company™
By Dentsply Sirona
YORK, PA USA/AUSTRIA: Dentsply
Sirona Inc. (NASDAQ: XRAY) today
announced that it has successfully
completed the merger of equals
between DENTSPLY International
Inc. (“Dentsply”) and Sirona Dental
Systems, Inc. (“Sirona”). The merger
of DENTSPLY, the market leader in
dental consumables and Sirona, the
market leader in dental technology
and equipment, creates the world’s

largest and most diversified manufacturer of professional dental products and technologies. Dentsply Sirona will have leading positions and
some of the most well-established
brands across consumables, equipment, technology, and specialty
products to address the needs of
dental professionals, specialists and
dental labs. Each day, approximately
600,000 dental professionals will

ÿPage 2

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news

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 1
use a Dentsply Sirona product.(1)
With the largest R&D platform in the
industry, Dentsply Sirona will develop and support innovative end-toend clinical solutions that advance
patient care.

Total Solution Provider
By combining DENTSPLY’s consumables platform with Sirona’s
technology and equipment, the new
company offers more products and
integrated solutions than any other
dental organization. Dentsply Sirona’s wide array of products for dental professionals and labs enable the
treatment of general and specialty
procedures including implantology,
endodontics, and orthodontics. With
the broadest clinical education platform in the industry, the company
is driving the adoption of new and
approved technology and integrated
solutions for more efficient workflows. Customer service and satisfaction will remain a key value to the
new company and will be supported
by the industry largest sales and
service infrastructure comprised of
direct sales and leading distributors.

Two Innovation Drivers coming together
The merger unites the two leading
innovators in dental, each with over
100 years of experience. Combined,
Dentsply Sirona will have largest and
strongest R&D platform with over
600 experienced scientists and engineers to foster the development
of better, safer and faster dental care.
With its enhanced commitment
to innovation, the company will
advance patient care, improve the
patient experience and reduce chair
time for procedures.
Jeffrey T. Slovin, Chief Executive Officer of Dentsply Sirona comments:
“With our merger complete, Dentsply Sirona can now focus its efforts
on empowering dental professionals to provide better, safer and faster
dental care. As The Dental Solutions
CompanyTM, we will drive longterm growth by being uniquely
positioned to deliver innovative solutions and support our customers
with the broadest product portfolio
and the largest sales and service infrastructure in the industry. Dent-

sply Sirona will continue to be at
the forefront of the digitization of
dentistry, single visit dentistry and
improving clinical outcomes for patients around the world.”
Great results are a combination of
the right tools and the right skills.
Dentsply Sirona offers the largest
clinical education platform in the
industry – the goal is to equip dental
professionals with everything they
need: from the best available products to expert-led clinical education
to support the use of these products
and services to improve patient care
and treatment outcomes. Bret W.
Wise, Executive Chairman of Dentsply Sirona, adds: “This is a transformational day for Dentsply Sirona
and the entire dental market. Our
unparalleled offering of some of the
most trusted brands in consumables, equipment and technology
makes Dentsply Sirona the partner
of choice to dental professionals and
labs today. With an unmatched commitment to investing in research,
product development and clinical
education, Dentsply Sirona will ad-

vance patient care and improve oral
health on a global scale for years to
come.”

IMPRINT

Merger Close

Tel.: +44 161 223 1830

DENTSPLY and Sirona completed
their merger on February 29, 2016.
Shares of Sirona will be halted from
trading prior to the open of the NASDAQ stock market and will cease
trading effective at the close of business today. Under the terms of the
merger agreement, Sirona shareholders are entitled to receive 1.8142
shares of Dentsply Sirona for each
existing Sirona share.

Group Editor

Daniel Zimmermann
newsroom@dental-tribune.com

Clinical Editor
Magda Wojtkiewicz

Online Editor
social media manager
Claudia Duschek

editorial assistants
Anne Faulmann
Kristin Hübner

Copy Editors

Sabrina Raaff
Hans Motschmann

Publisher/President/CEO
Torsten Oemus

Chief Financial Officer
Dan Wunderlich

Chief technology Officer
Serban Veres

Business Development Manager
Claudia Salwiczek-Majonek
Dentsply Sirona
Sirona Straße 1
5071 Wals bei Salzburg, Austria
T +43 (0) 662 2450-588
F +43 (0) 662 2450-540
www.dentsplysirona.com

The Intelligent Solution
Exceptional performance, at an everyday price

Junior Manager Business
Development
Sarah Schubert

project manager online
Tom Carvalho

Event Manager
Lars Hoffmann
EDUCATION Manager
Christiane Ferret
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Manager
Marc Chalupsky
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Executive Producer
Gernot Meyer
advertising disposition
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Dental Tribune International

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Dental Tribune mEA Edition
Editorial Board

Dr. Aisha Sultan Alsuwaidi, UAE
Dr. Ninette Banday, UAE
Dr. Nabeel Humood Alsabeeha, UAE
Dr. Mohammad Al-Obaida, KSA
Dr. Meshari F. Alotaibi, KSA
Dr. Jasim M. Al-Saeedi, Oman
Dr. Mohammed Al-DarwisH, Qatar
Prof. Khaled Balto, KSA
Dr. Dobrina Mollova, UAE
Dr. Munir Silwadi, UAE
Dr. Khaled Abouseada, KSA
Dr. Rabih Abi Nader, UAE
Dr. George Sanoop, UAE
Dr. Olivier Carcuac, UAE
Dr. Ehab Heikal, Egypt
Aiham Farrah, CDT, UAE
Retty M. Matthew, UAE

Partners

Emirates Dental Society
Saudi Dental Society
Lebanese Dental Association
Qatar Dental Society
Oman Dental Society

Adapts to every patient – just like you!
A cost-efficient and easy-to-use system made to adapt
to your requirements. High image quality in 2D and 3D,
with 4 FOV and 4 individual resolution options, including
Dose Reduction Technology.
It‘s the Gendex way of doing things!

Find your solution, visit:
www.kavo.com/gxdp-800

• Cone Beam 3D Imaging Systems
• Panoramic X-ray Systems

Director of mCME
Dr. Dobrina Mollova
mollova@dental-tribune.me
Tel.: +971 50 42 43072
DIRECTOR
Tzvetan Deyanov
deyanov@dental-tribune.me
Tel.: +971 55 11 28 581
Designer
Kinga Romik
k.romik@dental-tribune.me
PRINTING HOUSE
Al Nisr Printing
P. O. Box 6519, Dubai, UAE

[3] =>

SMALL CHANGE.
BIG DIFFERENCE.

The new imaging plate scanner XIOS
Scan completes the intraoral
family from Sirona. Whether you‘re
taking the first steps into the digital
world or establishing or updating a
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XIOS XG Sensors offer perfectly
synchronized solutions for everyworkf low. Enjoy every day.
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[4] =>

news

Dental Tribune Middle East & Africa Edition | 2/2016

Efficient & Easy Dentistry
3M Saudi Arabia Roadshow, January, 22-26 2016

By 3M
3M has always been and remains
a company which is staying at the
forefront of customer education.
On January, 22-26 3M Oral Care Solutions Division in Saudi Arabia held
a 4-day 3M Health Care Academy
Roadshow covering 4 major cities in
the country with participation of 2
leading speakers in esthetic dentistry Dr. Carlos Sabrosa (Brazil) and Dr.
Paul Nahas (Lebanon).
The Roadshow started in Jeddah
and then continued in Taief, Riyad
and Al Khobar. During these 4 days
over 850 dentists from both private
and governmental clinics of Saudi
Arabia attended the event. 3M Company also had an honor to host Dr.
Mohammed Al Rafee, General Director of Dentistry of the Ministry of
Health of Saudi Arabia.

The event was designed around
Efficient and Easy Dentistry, exposing dentists to the different procedure solutions from 3M which will
make dentistry really efficient and
easy for them. The program covered
posterior restorative procedure solutions, especially focusing on the
newly launched Filtek™ Bulk Fill
Posterior Restorative material. It
also covered different techniques of
posterior indirect restorations right
from the core buildup, retraction,
automix impressions, temporization and final placement of the restorations with various cements, shedding light on the different solutions
that 3M has to offer in this area.
The program consisted of the
combination of lectures and handson workshops. Dr. Carlos Sabrosa
covered Indirect Procedure topic and

Dr. Paul Nahas focused on Posterior
Restorative Procedure.
There is a large variety of steps
to be followed to achieve success.
Understanding the concept makes
it easy to apply the use of modern
materials. The lecture of Dr. Sabrosa
was providing the evidence-based
requirements that should be followed such as tooth preparation
design and tooth surface topography, core build-ups, provisional restorations, impression materials and
techniques, cements and adhesive
cementation.
Knowing that dentists always
seek for better materials with easier
manipulation, faster hardening, low
shrinkage or low stress, combined
with an excellent esthetic outcome,
Dr. Nahas shared his experience on

Fig. 1. Indirect Procedure hands-on workshop. Dr. Sabrosa and Dr. Mohammed
Al Rafee, General Director of Dentistry of Ministry of Health.
techniques related to bulk fill composite restorations using either open
or close sandwich technique. He also
talked about the properties of the
materials used, the advantages, indications and the difficulties that dentists may face during the posterior
restoration creation.
The Roadshow was highly appreciated by the attendees who told that
both lectures and workshops from
both speakers were relevant to their
daily practice and offered easy and
effective techniques using innovative 3M products to solve challenges
they face.

About the lecturers

Fig. 2. Dr. Sabrosa with the Roadshow participants

Fig. 3. Dr. Carlos Sabrosa and Dr. Paul Nahas at the opening of the Roadshow

Dr. Carlos Sabrosa is an Associate
Professor of the Department of Restorative Dentistry at the University
of the State of Rio de Janeiro Dental
School, Brazil. He received his DDS

from the University of the State of
Rio de Janeiro Dental School and the
Clinical Advanced Graduate Studies (CAGS) Degree in Prosthodontics
from Boston University Goldman
School of Dental Medicine, USA. Dr.
Sabrosa also received his Master of
Science and Doctor of Science Degrees in Prosthodontics/Biomaterials from Boston University Goldman
School of Dental Medicine, USA. He
has a private practice, focused in Oral
Rehabilitation and Implantology, in
Lebon, Rio de Janeiro, Brazil.
Dr. Paul Nahas graduated from
the Lebanese University, Beirut. He
received his post-graduate degree
in fixed and partial removable prosthodontics in France at the University of Claude Bernard, Lyon. He is
the chairperson of the Esthetic and
Restorative Dentistry department at
the Lebanese University.

New 3M Oral Care Products
and Solutions at AEEDC 2016

Fig.1. Demo-session on impression materials with Dr. Rasha Ahmed
By 3M
On 2-4th of February 3M Company
took part in AEEDC 2016, one of the
leading dental exhibitions in the
Middle East and Africa. The newest
products and technologies for dental
and orthodontic professionals were
presented at 3M booth, which became
the area of active customer interaction and engagement during all three
days of the exhibition.
3M Oral Care booth was designed to provide the most comprehensive information about the newest 3M products and technologies to
the dentists and orthodontists which
came from various parts of Middle East and Africa Region. Exciting
customer journey included testimo-

nial, educational and entertainment
areas filled with various interactive
activities.
At the product testimonial areas experienced 3M specialists were
sharing information about the new
and existing products for the Direct
and Indirect dental procedures, solutions for Preventive and Pediatric
treatment, innovative technologies
for Orthodontic practice. Doctors
could perform a test-drive of a new
Elipar™ DeepCure S curing light
and assess quality of cure of the
most modern Filtek™ composites
for anterior and posterior restorations, get precise impressions or
carry out hydrophilicity test with
Impregum™Penta™ polyether and
Express™ A-silicone automix impression materials.

At the educational area of the
booth doctors could attend rich
scientific program consisting of lectures and demo-sessions on the new
dental and orthodontic products
held by 3M Oral Care Scientific Affairs and Education experts. Dental
professionals had opportunity to
learn more about fast and efficient
posterior restorations with Filtek™
Bulk Fill Posterior Restorative, stressbearing class I and II restorations
with new Ketac™ Universal Glass
Ionomer material, discover how to
create highly esthetic restorations
with Style Italiano technique using
Filtek™ Z350XT nano-composite
restorative material, or discuss reliable cementation techniques using
variety of RelyX™ cements with Dr.
Rasha Ahmed, Scientific Affairs and
Education Expert from 3M Gulf.
High interest of the doctors was also
attracted by the discussion about direct and indirect procedure efficien-

Fig.2. 3M Oral Care Team at AEEDC

cy using signature 3M restorative
and prosthodontic products.
And during orthodontic sessions
Dr. Ahmed Basyoni, MEA Scientific Affairs and Education Manager,
shared peculiarities of work with
Clarity™ Advanced Ceramic Brackets, new Victory™ Series Superior
Buccal Tubes and APC™ Flash-Free
Adhesive Coated Appliance System.
After the educational activities
guests could rest in the comfortable lounge area or take photos with
their colleagues next to the ‘Wall of
Fame’. And at the area for customer feedback visitors were willingly
sharing their experience of working with 3M dental and orthodontic
products, providing new ideas how
to strengthen customer interaction
and were simply expressing their
positive emotions writing their
wishes and words of appreciation!

During the three exhibition days
more than 4,000 customers visited
3M Oral Care booth. Among them
over 250 doctors took part in 20 presentations and live demonstrations.
And those doctors who couldn’t
attend the event could afterwards
watch an interview about 3M educational activities which Dubai TV took
with Dr. Rasha Ahmed.
In addition to the exhibition part
traditionally 3M held pre- and postconference workshops for the dentists coming from various countries
of Gulf Region. On the February, 1 Dr.
Nabil Outaik (Canada) carried out lecture and workshop for Pediatric dentists and on the February, 5 Dr. Ajay
Juneja (UAE) held lecture and workshop on Indirect Aesthetic Veneers.
3M Science. Applied to Life.
For more information please visit
www.3MGulf.com/espe

Fig.3. Dr. Angelo Putignano with the 3M Team

[5] =>

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[6] =>

news

Dental Tribune Middle East & Africa Edition | 2/2016

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• Low polymerisation shrinkage
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• Comfortable handling, easy modellation
• Also available as a flowable version

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Tel.
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Internet www.promedica.de

Innovation award for Monobond Etch & Prime
Self-etching glass-ceramic primer impresses thousands of users
By Ivoclar Vivadent
SCHAAN, LIECHTENSTEIN: Monobond Etch & Prime is the first selfetching glass-ceramic primer in the
world. First presented at IDS 2015 in

Cologne, it has since won over many
users. Now it has received an innovation award.
Ivoclar Vivadent is the first dental
manufacturer to develop a material

that successfully etches and silanates
glass-ceramic surfaces in one single
step. It is for this reason that Monobond Etch & Prime is considered an
innovation. The primer has enjoyed
great popularity on the market since

Presentation of the Innovation Award for Monobond Etch & Prime. From left to right:
Uwe Jerathe, Pluradent AG, Norbert Wild, Ivoclar Vivadent Germany, and Dr Marion Marschall, DZW.

it was introduced because it eliminates the need for etching contact
surfaces with unpopular hydrofluoric acid.

Chosen by the dentists' vote
Several thousand dentists took part
in a poll to vote on the most innovative products of the year to be awarded an innovation award launched by
a German dental dealer and a dental
newspaper. By a wide margin, the
participants selected Monobond
Etch & Prime for first place in the
"Materials and Instruments" category. Just over 20 per cent of the votes
cast in this category were given to
the Ivoclar Vivadent product. In total, twenty products that were first
presented at IDS 2015 were put forward for selection in the different
categories.

Meeting customer needs
"We are delighted and proud to see
that Monobond Etch & Prime has
received several innovation awards
so soon after having been launched,"
says Armin Ospelt, Head of Global
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(Liechtenstein). "The awards show

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us that we meet the requirements of
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www.ivoclarvivadent.com

[7] =>

Dental Tribune Middle East & Africa Edition | 2/2016

news

E.M.S. Dental presents
Researchers find
GUIDED BIOFILM THERAPY varying patterns for
during AEEDC in Dubai
sealant treatment
recommendation
Hans Obermeier, Area Sales Manager
of E.M.S. in the Middle East, was very
satisfied with the results of AEEDC.
“Our booth was much better frequented than last year. This clearly
shows that the understanding for
the importance of professional and
regular tooth cleaning is growing in
the Gulf and Middle-East countries
and that the clinicians are looking for
support in education, technologies
and protocols to improve their service for the patients.”
Hans Obermeier underlines as
well the interest amongst the practitioners of the live-demonstrations of
the different E.M.S. products realized
by the clinical expert Dr. Neha Dixit
which attracted a large audience.

EMS booth team

By E.M.S.
The Swiss company E.M.S. Electro
Medical Systems who is the innovator of Piezon® and AIR-FLOW®
technologies and a global leader in
dental prophylaxis as well as Guided
Biofilm Therapy participated at the
20th edition of AEEDC from 2nd to
4th of February 2016. AEEDC takes
place annually in the International
Convention and Exhibition Center in
Dubai and represents a very impor-

Since September 2015, the company Al Hayat is the exclusive agent
of E.M.S. in UAE.
tant platform within the Gulf and
Middle-East countries for E.M.S.
The main focus of E.M.S. during
AEEDC was to promote the importance of Biofilm Management with
the message BYE BYE BIOFILM and
its newest product, the AIR-FLOW®
powder PLUS, an advanced powder
based on erythritol and a very fine
particle size of 14 microns which allows treatments both above and below the gingival margin.
After three exhibition days,

Contact Information
Al-Hayat Pharmaceuticals U.A.E.
312 Al Wahda Street, Office no. 101
4483 Sharjah, UAE
Mobile: +971 50 6352496
Telephone: +971 6 559 2481
Fax: +971 6 559 3573
Email: alhayat@eim.ae
Web: www.alhayatuae.com

By DTI
KITAKYUSHU, Japan: Japanese researchers have examined dentist
practice patterns regarding the recommendation of dental sealants
for treatment and identified characteristics associated with this recommendation. They found that these
patterns vary widely. According to
the researchers, recommending a
sealant was significantly related to
the dentist having a greater belief in
the effectiveness of caries risk assessment.
In the study, the researchers surveyed 189 dentists recruited from
the Japanese Dental Practice-Based
Research Network regarding the
treatment decision in the case of a
12-year-old patient with a high caries
risk via a cross-sectional questionnaire. The participants were presented with a series of clinical photographs of the occlusal surface of a
mandibular first molar portraying
increasing depths of cavitation.

ants varied from 16 to 26 per cent.
Nineteen per cent of the dentists recommended sealants in the absence
of dark brown pigmentation. Fortyeight per cent of the dentists recommended sealants to more than 25
per cent of patients aged 6–18. An
analysis of the responses suggested
that the dentist’s belief in the effectiveness of caries risk assessment
was significantly associated with the
percentage of patients who would receive sealants.
Dr Naoki Kakudate from Kyushu
Dental University first presented the
study, titled “Evidence-practice gap
for sealant application: Results from
a Dental PBRN”, at the 45th Annual
Meeting and Exhibition of the American Association for Dental Research,
which was held from 16 to 19 March
in Los Angeles in the US.

For the hypothetical scenarios, the
dentists’ recommendations of seal-

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[8] =>

mCME

Checklists not just for
pilots anymore

Dental Tribune Middle East & Africa Edition | 2/2016

CAPP designates this activity for 2 CE Credits.

mCME articles in Dental Tribune have been approved by:
HAAD as having educational content for 2 CME Credit Hours
DHA awarded this program for 2 CPD Credit Points

By Patti DiGangi, RDH, BS, Judy Bendit, RDH, BS
With popularity of the television
show “Mad Men,” 1960's themes
such as war, racism and sexism are
memorialized, as are once-common
habits such as smoking. Women
were marketed in the 1960s with
their own cigarette brand that had
the catch phrase, “You’ve come a
long way, baby.” Following release
of Smoking and Health: Report of
the Advisory Committee to the Surgeon General of the United States,1
all smoking-related advertising was
banned from TV in 1970.2
Sit-down dentistry also evolved in
the 1960's. “You’ve come a long way,
baby” is gone from advertising, but
it remains an accurate slogan when
it comes to ergonomics in dentistry.
We have come a long way, but for
many dental professionals, that’s
still not far enough.
In 1937, pilots developed the concept
of the checklist after planes began
crashing. Dental professionals may
not be crashing in the literal sense,
but many clinicians have been
forced into early retirement because
of musculoskeletal disorders (MSD)
or they continue to try to work
through them. By incorporating a
checklist concept similar to that used
by pilots, dental professionals can be
more successful, productive — and
able to practice without pain.

Pain in dentistry
Pain of dentistry is a common fear
that keeps patients away from the
dental office. Pain in dentistry is
common, but has nothing to do with
the patient. The individuals having
pain in dentistry are the practitioners. It is estimated that more than
half of practitioners have some kind
of painful musculoskeletal disorder
that is work related.3
In 2007, the Center for Health
Workforce, funded by the American Dental Hygienists’ Association
(ADHA), conducted a sample survey
of licensed dental hygienists about a

Fig. 2. Steve Knight at LeMans. Today, as a business turnaround specialist, Knight brings lessons
from racing to dentistry. His goal is to turn around the world of seating for dental hygienists
and all dental professionals. (Race photos/Provided by Steve Knight)

wide variety of issues, including occupational injury or illness related to
their work. It was reported that just
more than one-third (33.8 percent)
indicated had experienced an occupational injury or illness. Figure 1
shows the types and percentages of
occupational injury or illness experienced. More than half (53 percent)
used medication to control the discomfort and nearly half (49.5 percent) indicated they had shortened
their work hours as a result of their
injury or illness.4
Ergonomics evolved as a recognized
field during World War II. It is the
science of adjusting the work environment to the worker.5 The Occupational Safety and Health Administration (OSHA) has links to ergonomic
information.6 The American Dental
Association (ADA) published Introduction to Ergonomics7 with suggested interventions and in 2011
published Ergonomics for Dental
Students.8 The ADA website has an
ergonomics section with links to fliers about specific problems.9 Even
with numerous articles and C.E.
courses (both in person and online)
on ergonomics in the five years since
the ADHA survey, MSDs continue to
escalate. Much of this is because of a

Fig. 1. Type of occupational injury or illness experienced by dental hygienists with employment-related injury or illness, 2007.3 (Chart/ Provided by the Center for Health Workforce and
American Dental Hygienists’ Association)

hand-me-down mentality in many
dental offices.
For the safest flight, pilots use many
checklists. In dentistry, a one-sizefits-all checklist is not enough to
evaluate how we do things because
of the wide variety of body types,
shapes and preferred work styles.
This article will develop checklists
for dental-operator seating, just one
of the many parts creating a healthy
ergonomic environment.

Checklists help find the way
In the days of early aviation, pilots
were crashing because they could
not reach the controls. Investigators
found it was pilot error as the cause.
Pilot error doesn’t necessarily mean
the pilot did something wrong; it can
mean the pilot wasn’t familiar with
the equipment or the equipment
didn’t match the pilot. For those who
work in a temporary dental situation
at multiple offices, ergonomic challenges are huge. When such practitioners walk into a new office, trying
to match their individual needs to
the available equipment is nearly
impossible.
Pilot checklists were developed to
match the steps needed for the job,
making sure that everything is done
and nothing is overlooked. Checklists have become fundamental to
the aviation industry.10 In a similar
way, checklists should become fundamental to the dental industry.
Two books, “The Checklist Manifesto: How to Get Things Right”11 by Dr.
Atul Gawande, a surgeon, and “Safe
Patients, Smart Hospitals”12 by Dr.
Peter Pronovost, discuss checklists
as an effective way to reduce medical errors. These books are not just
about the checklists, they are about
the culture of medicine and how the
checklist can foster better teamwork.
Checklists are starting to become
common in some hospital settings,
but not nearly common enough. It
takes a change of culture to adopt
something that on the surface can
seem so simple — as a core strategy
for enhancing care.
A recent success story illustrates the
difference checklists can make in
medicine. The intensive care unit
(ICU) at a hospital is a crucial part of
health care delivery and one of the

Fig. 3. Steve Knight at Laguna. In racing, perfect driver ergonomics is critical. Knight’s Goldilocks theory applies to a dental practice using existing seating simply because it was already
there: Sometimes it’s too tall or too short, and no matter how much it is adjusted, it is still not
just right.

most complex and expensive. The
Centers for Disease Control (CDC)
reported that nearly every patient
admitted to an ICU experiences
some type of complication during
his or her stay.13 Checklists were used
in the Michigan Keystone Project to
make patient care safer in more than
100 ICUs in Michigan. The project
targeted the expensive and potentially lethal catheter-related bloodstream infections that cost $18,000
when a patient contracts one and
causes 24,000 deaths per year. The
Keystone team made a checklist,
measured infection rates — and
changed hospital culture. There was
a 66 percent reduction in this type
of infection statewide, saving more
than 1,500 lives and $200 million in
the first 18 months of the program.14
It was the combination of checklists
and the culture of teamwork that
made the difference.
Race car drivers and race cars take
quite a beating during a race, both
physically and mechanically. Like pilots, race car drivers and their teams
use checklists. The teamwork of a pit
crew during a race is artistry to watch
that is fostered by checklists. Steve
Knight, once a professional Le Mans
race car driver (Figs. 2 and 3) and business turnaround specialist, has taken
lessons from racing and brought
them to dentistry. His goal is to turn
around the world of seating for dental hygienists and all dental professionals.

Seating risk factor checklist
Before Knight got into a Le Mans car
there were many considerations to
be addressed. An impression of the
driver’s body is taken to ensure a
perfect fit into the seat of the car for
optimal performance. This molding
created: proper leg-stretch to reach
the clutch, accelerator and brake;
comfort in reaching and holding the
steering wheel; and most important,
the ability to sit comfortably for
long periods of time while driving
around the race course. Success for a
top-level race car driver is driven by
a strict regimen for eating, exercise
and nearly all activities of daily life so
they can be in top shape physically.
It is the total package, including the
racing team and pit crew all using

checklists, that creates this success.
The idea of a form-fitting chair for
dental practitioners might not be
practical, yet think of the possibilities. Those same ideas can be brought
into the treatment rooms with the
“Seating Risk Assessment Checklist”
shown in Table 1. This checklist helps
to evaluate overall balance. Many
professionals have damaged themselves by repeatedly sitting, leaning,
stretching and twisting for so many
years. As Cindy Purdy, RDH, BS, consulting with Crown Seating recently
said to an online group, “Changing
stools alone will not treat medical
issues, but it can certainly offer benefits for the future.”15

Recline/incline seating
Passengers are required to sit upright
at take-off and landing on any plane
(Fig. 4). Most passengers can’t wait
to hear the announcement that the
cruising altitude has been reached
so the seats can be leaned back for
more comfort. Unfortunately, dental
professionals tend to sit in this upright position all day. When seated
in this position for long periods of
time, practitioners both elongate
and shorten different muscle groups
in the legs. Humans are not meant to
sit completely upright and especially
not for a long day in the office. 16
A more comfortable sitting position
for most is in a reclined position (Fig.
5). Think of your comfortable recliner in front of the television after
a long day of work or the experience
sitting in a first-class seat on a plane.
Reclining is so very comfortable. This
is the way race car drivers sit; but it’s
not very practical for treating dental
patients.
Now take that reclined position and
rotate the torso on its axis to create
the inverse position, called an inclined position17 (Fig 6). Incline is the
automatic position created when
sitting on a horse or a saddle stool.
It is a more balanced position. This
balance helps preserve the hips and
spine in the proper position. It is defined as an open body position that
is more comfortable, less harmful
and allows for proper lumbar cur-

ÿPage 9

[9] =>

mCME

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 8
vature. The pelvis rotates downward
and forward, enabling the knees to
stay below hip level. This creates less
stress and strain on the back, neck
and shoulder muscles. A slight incline of the seat (5-15 percent) is ideal.
If you adjust more than 20 percent
out of a neutral position for an extended period of time, muscle imbalances are created, which means the
muscles are adaptively shortening
on one side and elongating on the
other. This results in misalignment
of the spine and joints, and in this
case, the hip joint. When a person sits
properly on a saddle seat, the pelvis
is properly positioned and stabilized,
so the body naturally and automatically assumes the least-stressful position.

Static vs. dynamic seating
For sitting positions, there are two
more checklist considerations. In traditional chairs, the practitioner sits
in a static position that does not provide much movement or stimulation of the muscles. A new term has
been given to some of the advanceddesign chairs: dynamic seating. The
dynamic chair offers the option of
movement, allowing the muscles to
both contract and relax while one
remains seated. Prolonged muscle contraction results in increased
pressure of the blood vessels in the
muscle, creating a decreased blood
flow through the muscle. Blood flow
assists in the repair and health of the
muscles by delivering oxygen to the
muscle and removing waste products in the muscle that might otherwise cause localized, intense pain
(ischemia). A dynamic chair allows a
period of rest and rebuilding for the
muscles needed for healthy seating.
In some dynamic stools the seat pan
moves; with others it’s the seatback
that moves forward and backward as
you move; and, with some, all parts
of the chair move. In any case, these
chairs help strengthen the body’s
core.

Seating materials
A chair can be made of rubber,
plastic, leather, mesh or other manmade materials that may or may not
breathe. These materials can make
a difference in comfort depending
on where you live. In the South, or
if there is high humidly in the office, a practitioner might complain
about the material of the seat. If
there is sweating while sitting, the
seat may not allow the legs and back
to breathe. This can be uncomfortable and/or embarrassing. Asking
the manufacturer about options for
breathability is the best choice. There
are new fabrics that control odor and
stain-causing bacteria.

With or without arms
Many practitioners wonder if they
should or shouldn’t have arms on
their chairs. The answer depends on
how that individual works. If the person’s arms are always flapping in the
breeze because the patient isn’t seated back properly, then arms on the
chair will not help. It is imperative
for the patient to either lay back in

the appropriate position, or the practitioner must stand. One suggestion
is instead of saying “Ok, let’s put the
chair back and get started,” the practitioner says, “Let’s put the chair back
and get both of us comfortable.”
They are very similar phrases with
very different meaning. Patients are
not the only ones who need to be
comfortable; the best work can happen when everyone is comfortable.
How many times during the day
do practitioners stop to get comfortable? Usually none. Health care
providers often worry more about
patient comfort and end up compromising themselves all day long, leading to pain and injury.

Goldilocks theory of seating
Chairs are often inherited from
someone else when first employed
in a different practice. Steve Knight’s
Goldilocks™ theory is like the old
story, sometimes it’s too tall or too
short and no matter how much it is
adjusted, it is still not just right. Not
getting that just-right position will
lead to pain and other issues. Many
companies can exchange the cylinder in a stool, for different heights
to make it just right. Checking with
the supplier or the manufacturer of
the stool is the best way to find out if
the cylinder can be changed to create
a better fit. The important lesson is:
Don’t just try to live with it; it hurts
the practitioner, the patients, and
eventually, the practice’s bottom
line.
Considering alternative seating
may be the best choice. Creating a
checklist for buying a new chair (Table 2) can help you find the best one
for your needs. A new chair may be
needed because some chairs can’t
be jerry-rigged enough to fit. Other
issues also play a part. Some patient
chairs are extremely wide, or our
patients can be very broad. This can
make it impossible to work close
enough when seated in a traditional
stool. The saddle stool allows much
closer access to the patient, so tasks
can be accomplished with less stress.
The professional should not have
to reach more than 15 inches. The
light, instruments on the bracket
tray, the handpieces, the computer
or anything needed for patient care
should be within arms-reach. Straining for items stresses the muscles in
the neck and shoulder. The biggest
culprit is the overhead light. A headlight attached to loupes is no longer
a choice; it is a necessary part of a
healthy ergonomic armentarium.

Checklists and the culture of
teamwork
Hospital checklists are saving lives
and money. Pilots use several different checklists for every flight
to prevent pilot error and crashes.
Winning race car teams and race car
drivers use checklists for every race.
Dentistry can use checklists to great
benefit as well. We’ve come a long
way, yet dentistry still has a way to
go. It won’t happen without a change
of culture. First, the problem must be
recognized, hopefully before there is

Fig. 4. Traditional upright seating: Notice how
this causes a stretching in the thigh muscles.
(Drawings/Provided by Crown Seating)

serious damage.
Dental professionals know that before there is a cavity, before there
is periodontitis, before there is oral
cancer; there is a risk for a cavity,
periodontal disease and oral cancer.
Preventive care and early detection
is the purpose of routine hygiene
care. Half or more of those reading
this article already have MSDs; the
other half are probably accumulating damage but haven’t reached critical mass to experience symptoms.
Dental professionals are caring individuals who don’t have to hurt themselves to help others. Ultimately not
sitting comfortably hurts the practitioners, the patients and the practice
bottom line. With simple ergonomic
seating checklists professionals can
be more successful at practicing in a
pain-free environment.

References
1. The 1964 Report on Smoking and
Health. National Library of Medicine.
1964. Available at: www.profiles.
nlm.nih.gov/ps/retrieve/Narrative/
NN/p-nid/60.
2. Nixon signs legislation banning
cigarette ads on TV and radio. Time
Magazine. April 1 1970. Available at:
www.history.com/this-day-in-history/nixon-signs-legislation-banningcigarette-ads-on-tv-and-radio.
3. Nonfatal Occupational Injuries
and Illnesses Requiring Days Away
From Work, 2010. U.S. Department
of Labor, Bureau of Labor Statistics.
Available at: www.bls.gov/news.release/osh2.nr0.htm.
4. Survey of Dental Hygienists in the
United States Executive Summary.
American Dental Hygienists Association. 2007. Available at: www.adha.
org/downloads/DH_pratitioner_
Survey_Exec_Summary.pdf.
5. Weerdmeester, B. Ergonomics for
Beginners: A quick reference guide.
2008. CRC Taylor & Francis.
6. Hazard Recognition, Control and
Prevention. Occupational Safety &
Health Administration. Available at:
www.osha.gov/SLTC/dentistry/recognition.html.
7. An Introduction to Ergonomics:
Risk Factors, MSDs, Approaches and
Interventions. A Report of the Ergonomics and Disability Support
Advisory Committee to Council on
Dental Practice American Dental

Fig. 5. Reclined seating

Association. 2004. www.rgpdental.
com/pdfs/topics_ergonomics_paper(2).pdf.
8. Ergonomics for Dental Students.
American Dental Association. 2011.
Available at: www.ada.org/sections/
educationAndCareers/pdfs/ergonomics.pdf.
9. Ergonomics. American Dental Association Alliance. Available at: www.
ada.org/4500.aspx.
10. Schamel, J. How the Pilot’s Checklist Came About. January 1, 2011.
Flight Field Service History. Available at: www.atchistory.org/History/
checklst.htm.
11. Gawande, A. The Checklist Manifesto: How to Get Things Right. New
York: Metropolitan Books, 2010.
12. Pronovost, P., Vohr, E. Safe Patients, Smart Hospitals: How One
Doctor’s Checklist Can Help Us
Change Health Care from the Inside
Out. Penguin Group, 2011.
13. Checklist for Ergonomic Risk Factors. PMA.org. Available at:
www.pma.org/osha/docs/wscchecklist.pdf.
14. Scott II, R. The Direct Medical
Costs of Healthcare-Associated Infections in U.S. Hospitals and the
Benefits of Prevention. March 2009.
Centers for Disease Control and Prevention. Available at: www.cdc.gov/
HAI/pdfs/hai/Scott_CostPaper.pdf.
15. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cos-

Fig. 6. Inclined seating

grove S, Sexton B, Hyzy R, Welsh
R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease
catheter-related bloodstream infections in the ICU. N Engl J Med. 2007
Jun 21;356(25):2660. Available at:
www.nejm.org/doi/full/10.1056/
nejmoa061115#t=articleTop.
16. Purdy, Cindy. “Ergonomics” email. E-mail to AmyRDH group. August 14, 2012.
17. Gilkey, D. Occupational Ergonomics Certificate. 2012. Available at:
www.ramct.colostate.edu/webct.

Judy Bendit, RDH,
BS, Patti DiGangi,
RDH, BS. They are
national speakers
who created and
present Creating
a Flight Plan Beyond the Routine.
The one-of-a-kind
program includes
topics such as electronic health records, risk assessment, instrumentation and ergonomics to name
a few. They are presenting “Flight Plan:
Checklists” in its new format during the
Yankee Dental Congress, www.yankeedental.com, in January. Contact DiGangi
at pdigangi@comcast.net or Bendit at
JZBeducate@aol.com.

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Table 1. Seating Risk Assessment Checklist (Table adapted from the
Occupational Safety and Health Administration’s ‘Checklist for Ergonomic Risk Factors’)

Table 2. Checklist for buying a new chair

FOR INTERACTION WITH THE AUTHORS FIND THE CONTACT DETAILS AT
THE END OF EACH ARTICLE.

[10] =>

mCME

Dental Tribune Middle East & Africa Edition | 2/2016

Long-term clinical success in the
management of compromised intertooth
spaces utilizing small-diameter implants
mCME articles in Dental Tribune have been approved by:
HAAD as having educational content for 2 CME Credit Hours
DHA awarded this program for 2 CPD Credit Points
By Paul S. Petrungaro, DDS, MS
Management of edentulous sites in
the oral cavity with dental implants
has been well documented in dental literature during the past 25-plus
years.1-3 Patients seeking tooth replacement for partial or totally edentulous situations have been able to
enjoy natural appearing and functioning prostheses that are fixed, stable and, in some cases, so natural it’s
difficult to ascertain a dental implant
restoration from a tooth restoration.
Using dental implants to replace
the natural tooth system in the esthetic zone has also seen an increase
in restorative treatment plans and,
with the advent and perfection of
immediate restoration protocols
initially reported in the literature,4-7
achieving natural soft-tissue esthetics around dental implants can be
predictable and successful. However, certain clinical situations can
complicate or negate the procedure
altogether.
One of these complications is insufficient intertooth spacing between
natural teeth and, most commonly,
with congenitally missing lateral
incisors following orthodontic treatment.8 Often as a solution to this, the
dentist chooses a removable partial
denture or some type of resin-bonded bridge, both of which may not be
appealing to younger individuals. In

extreme cases, the dentist may elect
to proceed with a fixed bridge, which
would cause excessive destruction
to the natural teeth serving as abutments and, for a young individual,
this could be devastating to these
teeth during a 40-50 year period, if
not sooner.8
To properly form an ovate pontic
type emergence profile in the soft
tissue, which is required for a fixed
bridge to have a natural clinical appearance, consideration must be
given to the intertooth edentulous
space.9-12 This is also very important
when choosing dental implants for
natural tooth replacement. Wallace,
Misch and Salama, et al,9-11 stated that
for a normal two-piece implant, the
implant should be placed at least 1.5
mm from the adjacent teeth.
As a result, using a 3.5 mm diameter
implant, the minimum inter-tooth
space to support interproximal bone
and natural soft-tissue papillary contours should be 6.5 mm, and with a
3.0 mm diameter implant, 6.0 mm
for the edentulous space. Often, the
intertooth space in these types of
cases is smaller than 6.0 mm.
Taking these parameters into account, small-diameter implants (3.0
mm is the smallest from most dental
implant manufacturers) should not
be used in cases with less than 6.0
mm of inter-tooth space, to prevent

potential tooth root damage, crestal
bone loss and unnatural-appearing
gingival tissues and papillae.
Small-diameter, or mini, implants
were developed more than 20 years
ago and, initially, the recommended
use was to support temporary removable prostheses during the healing phase for advanced bone-grafting procedures and/or conventional
implant placement.12-13
Their use was later expanded into
immediate conversion of full dentures into implant-supported dentures, support for partially edentulous cases and for anchorage of
single tooth implant restorations in
compromised intertooth spaces.14-15
Implants are available from 1.8 mm
diameter to 2.8 mm diameter and
offer a fixed permanent tooth replacement option for patients who
otherwise would not be able to have
implants placed and restored. Their
ease of use and atraumatic placement utilizing a flapless approach,
with only one coring procedure, as
well as simplistic abutment transfer
and provisional construction make
the use of these implants in the
aforementioned sites a must for the
dental implant practice.
The following case report will demonstrate the use of the Dentatus
ANEW (Dentatus USA, Ltd, New York,

CAPP designates this activity for 2 CE Credits.

N.Y.) implant for the management
of the compromised, congenitally
missing lateral space in a 17-year-old
young woman with a 10-year clinical
follow up.

Case report
A 17-year-old, non-smoking female
presented for tooth replacement in
the congenitally missing maxillary
left lateral incisor site (Fig. 1). The patient had recently completed orthodontic therapy, and the orthodontist
and general practitioner had agreed
this was the final obtainable result in
regard to the remaining intertooth
space between the maxillary left central incisor and maxillary left canine
(Fig. 2).
The resultant intertooth space was
less than 5.0 mm, and conventional
two-stage implants with abutment
options were ruled out. The patient
and her parents ruled out conventional tooth-replacement options
and chose the minimally invasive
procedure: a small-diameter implant, 1.8 mm in diameter, which
would allow for natural papillary
contours to be developed.
After administration of an appropriate local anesthetic, an ovate
pontic contour was created utilizing a football-shaped diamond in
the attached, keratinized tissue of
the edentulous site (Fig. 3). This scalloped-type tissue contour helps in
the creation of the natural-appearing
papillary contours.
The small-diameter implant chosen,
a 1.8 mm x 14 mm Dentatus ANEW
Implant was then placed after a
single coring of the site with a 1.4
mm needlepoint CePo to full depth,
within the sculpted tissue emergence profile previously created (Fig.
4). Conversion to an esthetic provisional restoration was completed
by placing an abutment coping with
a delrin retention screw (Dentatus
USA, New York, N.Y.).
An ion shell provisional crown was
then hollowed out and retrofitted
to the abutment coping with flow-

Fig. 1. Pretreatment clinical view. (Photos/Provided by Dr. Paul S. Petrungaro)

Fig. 2. Preoperative periapical radiograph.

able composite. The margins of the
provisional were corrected and provisional contoured out of the mouth.
The restoration was polished and
seated with the set screw from the
palatal. The immediate postoperative clinical view is seen in Fig. 5. The
immediate postoperative periapical
view is seen in Fig. 6.
The patient then went through the
three-month healing and observation phase prior to construction of
a lab-processed provisional restoration (Fig. 7). One year later, the patient underwent final restoration
fabrication at the left lateral incisor
site. A 10-year postoperative clinical image can be seen in Fig. 8 and a
10-year postoperative CT scan of the
implant in Fig. 9.
Please note the beautiful soft-tissue
esthetic result obtained and excellent maintenance of the crestal and
lateral contours.

Conclusion
The management of compromised
intertooth spaces presents a challenge for the contemporary dental
implant team. These spaces have
limits on how they are handled and
require implants 3.0 mm wide or
less, as was demonstrated in the text
of this article. Availability of smallerdiameter implants allows patients
who normally would have to proceed with a fixed bridge, or resinbonded bridge, the luxury of dental
implants with no preparation and/
or reduction to the adjacent natural
dentition.
Proper placement procedures and
restorative techniques can lead to
very esthetic results, allowing for
natural tissue contours and emergence profile formation, reminiscent
of the natural tooth.

Acknowledgement
Originally published in Inside Dentistry. © 2014 to AEGIS Publications,
LLC. All rights reserved.
Reprinted with permission from the
publishers.

References
1) Branemark P-I, Zarb GA, Albrektson
T, eds. Tissue-Integrated Prosthesis:
Osseointegration in Clinical Dentistry. Carol Stream, IL: Quintessence
Publishing: 1985:11-81
2) Adell R, Lekholm U, Rockler B, et al.
A 15-year study of osseointegrated
implants in the treatment of the
edentulous jaw. Int J Oral Surg. 1981;
10(6):387-416.
3) Babbush CA. Dental Implants: The
Art and Science. Philadelphia, PA: WB
Saunders Co. 2001:201-216.
4) Kan JY, Rungcharassaeng K. Immediate placement and provisionalization of maxillary anterior single
implants: A surgical and prosthetic
rationale. Pract Periodontics Aesthet

Fig. 3. Ovate pontic type defect created

Fig. 4. Dentatus ANEW implant seated minimally invasive protocol

ÿPage 11

[11] =>

Dental Tribune Middle East & Africa Edition | 2/2016

mCME

Dent. 2000; 12:817-824.
5) Saadoun AP. Immediate implant
placement and temporization in extraction and healing sites. Compend
Contin Educ Dent. 2002; 23:309-323.
6) Petrungaro PS. Immediate implant placement and provisionalization in edentulous, extraction and
sinus grafted sites. Compend Contin
Educ Dent. 2003; 24:95-113.
7) Petrungaro PS. Immediate restoration of implants utilizing a flapless
approach to preserve interdental
contours. Pract Proced Aeshtet Dent.
2005; 17:151-158.
8) Misch CE. Treatment options for a
congenitally missing lateral incisor.
A case report. Dentistry Today. 2004;
Fig. 5. Immediate postoperative clinical view

Fig. 6. Immediate postoperative radiograph

Fig. 7. Lab-processed, long-term provisional restoration

Fig. 8. 10-year postoperative clinical view

Pract Periodontics Aesthet Dent.
1997;9(9):1071-1078
13) Froum S, Emtiaz S, Bloom MJ, et
al. The use of transitional implant
for immediate fixed temporary
prosthesis in cases of implant restorations. Pract Periodontics Aesthet
Dent. 1998; 10(6):737-746.
14) Petrungaro PS. Management of
the Compromised Implant Site with
Small-Diameter Implants. Inside
Dent. March 2006, 78-80.
15) Petrungaro PS. Management of
the Compromised Intertooth Space
with Small-Diameter One-Piece Implants in the Esthetic Zone. Funct Esthet & Rest Dent; 1 (2):70-75.

Fig. 9. 10-year postoperative CT serial view

Vol 23, No.8 pp 92-95.
9) Wallace SS. Significance of the
“biologic width” with respect to root
form implants. Dent Implantol Update. 1994;5:25-29.
10) Misch CE. Early bone loss etiology
and its effect on treatment planning.
Dent Today. Jun 1996; 15:44-51.
11) Salama H, Salama M, Garber D, et
al. Developing optimal peri-implant
papillae within the esthetic zone:
guided soft-tissue augmentation. J
Esthet Dent. 1996; 8: 12-19.
12) Petrungaro PS. Fixed temporization and bone-augmented ridge stabilization with transitional implants.

Paul S. Petrungaro, DDS, MS, FICD, FACD,
DICOI. He is internationally recognized for
his educational and clinical contributions
to modern dentistry. He graduated from
Loyola University Dental School in 1986,
where he completed an independent study
of periodontics at the Welsh National Dental School in Wales, U.K. He completed his
residency in periodontics and has a specialty certificate in addition to a master’s of
science degree in periodontics from Northwestern University Dental School. He is
the former coordinator of implantology,
Graduate Department of Periodontics,
Northwestern University Dental School.
Petrungaro has been in the private practice of periodontics and implantalogy since
1988 and holds a license in both Illinois and
Minnesota.

[12] =>

oral health

Dental Tribune Middle East & Africa Edition | 2/2016

“It all starts here. Healthy
Mouth. Healthy Body”.
World Oral Health Day 2016
celebrated across Dubai, UAE
An interview with Dr. Aisha Sultan - President
Emirates Dental Society
Demonstrations during WOHD 2016 in Dubai

By Dental Tribune MEA/CAPPmea
DUBAI,UAE: On 20th of March, the
world celebrated World Oral Health
Day across the globe with an aim to
put the global spotlight on the importance of maintaining good oral
health. The awareness campaign is
an initiative of the FDI World Dental
Federation.
Dubai joined the celebrations spearheaded by the Emirates Dental Society, Emirates Medical Association in
cooperation with Philips Sonicare,
Baraha Hospital, Department of
Tourism and Commerce Marketing
and the Ministry of Health.
The organizing partners celebrated
the World Oral Health Day (WOHD)
at various locations in Dubai, UAE.
The event took place during the
course of an entire week between 2024th of March 2016. The awareness
was based on the initiative of the

FDI World Oral Health Day: 20th of
March 2016. Dental Tribune International is the official Media partner of
the WOHD and was present in Dubai
to cover the activation event.
Dental Tribune MEA/CAPPmea: Dr. Aisha Sultan, what is the theme of the
World Oral Health Day (WOHD) 2016
in Dubai?
Dr. Aisha Sultan: The theme of this
year’s WOHD 2016 is “It all starts
here. Healthy mouth. Healthy body”
which is based on the concept of the
World Dental Federation, FDI celebrated across the world on 20th of
March 2016.
What is the main focus for Dubai during this special week?
Dubai is focusing on an overall
healthy society. We are proud of our
government for officially announcing 20th of March as ‘The Happiest
Day’ in the United Arab Emirates
every year which coincides with the

FDI’s World Oral Health Day. Furthermore, His Highness Sheikh Mohammed Bin Rashid Al Maktoum,
created a so called Ministry of State
for Happiness, a first of its kind in
the region and one of the few in the
world which will have the responsibility to make the citizens of the UAE
happy. The Minister of State for Happiness has set goals on how to implement happiness in peoples’ lives in
the country, for both local and nonlocal citizens. There are certain criteria consisting of 13 tasks that should
be implemented to make everyone
happy. During this week we are also
pleased that the dentists will share
this day together with World Oral
Health Day.
One of the locations of the celebrations is the Department of Tourism
and Commerce Marketing in Dubai.
What exactly will happen there?
The concept of the celebrations is
divided amongst the theme of the
activation. The activities lined up for
“Healthy mouth” are related to oral
health awareness, education and
motivation for every person that

joins us here today. After the educational part, the visitors will move
on to the next station which is the
practical part, in order to implement
the oral hygiene. We will be explaining how to use the mouth wash and
electronical brushes, the visitors
will further have the opportunity to
practice new brushing techniques
explained by professional staff from
Philip Sonicare who were also present. For the “Healthy body” part,
there is a physical section where
the physiotherapist specialists will
educate visitors on a proper, healthy
body position. Next, there is a clinical examination, just outside of the
building in our mobile dental clinic
where each visitor is examined and
will receive a form with the recommendations on the follow up treatment (cleaning, filling, etc.)
Another location of the activation will
at the famous Jumeirah Kite Beach on
Thursday 24th of March. What will exactly happen there?
On Thursday we will relocate to celebrate the World Oral Health Day
at Jumeirah Kite Beach. We expect

to have a large audience, especially
families with children. The children
will have the same type of examination and education as the previous location. In addition, free dental
screenings, checkups, brushing stations, giveaways and professional
consultations on visitor’s teeth will
be performed in order to strengthen
the importance of Oral Health.
Thank you Dr. Aisha, we wish you
and team good luck in the awareness
campaign.

As the official media partner of
WOHD 2016, Dental Tribune International provided comprehensive coverage of the FDI’s message. Among
other activities, the publisher helped
promote WOHD 2016 through news
articles, banners and advertisements
in its various international print publications and on its website, www.
dental-tribune.com, including a topic
page solely dedicated to WOHD 2016.

Build healthy habits for life with Philips
this World Oral Health Day
“It all starts here.
Healthy mouth.
Healthy body”

By Philips
DUBAI, UAE: Royal Philips has united with FDI World Dental Federation
to celebrate World Oral Health Day
(WOHD), March 20th, 2016 and raise
awareness of the importance of good
oral health and its impact on overall
health and wellbeing. Together we
will support the 2016 campaign ‘It all
starts here. Healthy mouth. Healthy
body’.
In a world where 90% of the population will suffer from a condition
in the mouth, teeth or gums during
their lifetime , WOHD is an opportunity to remind and engage with patients that good oral health is at the
heart of overall well-being.
Philips understands the importance
of instilling good oral hygiene routines from an early age that continue through life to help prevent
long-term health issues. We know
that good oral health goes beyond a
healthy smile and has wider implications for overall health. Our ambition is to help patients improve their
oral healthcare and WOHD is a great
platform to communicate this.
“World Oral Health Day allows us

Mobile Clinic in Dubai

to engage and encourage people to
think about their oral health and
understand the positive impact it
has on their overall health and wellbeing,” said Egbert van Acht, CEO,
Philips Health & Wellness. “Increasing education around the importance of looking after oral health
is one of our key goals and we are
committed to bringing meaningful
innovation to address global societal needs. At Philips, we are actively
promoting the link between oral and
overall health to help improve people’s lives.”

Through meaningful innovation,
Philips launched a connected children’s toothbrush and app, designed
to reinforce and help build healthy
oral hygiene habits from the outset.
With a comprehensive range of oral
healthcare solutions, Philips continues to support patients’ oral care
needs throughout their lifetime to
encourage good oral hygiene routines to help prevent long term
health issues.
An example of a Local WOHD activation Philips Sonicare, in collaboration with the Emirates Dental As-

sociation, is implementing include
free dental screenings and checkups
on Kite Beach on March 24. Brushing
Stations, prize give aways and professional consultation on consumer’s teeth will help strengthen the
importance of Oral Health. They’ll
also be school visits in Jordan and an
engaging exhibition booths in major
malls in Lebanon. Social activations
can be found on the Philips Oral
Health Care Facebook page, including ‘making the pledge’ to better oral
health care for a change to win Sonicare prizes.
Our efforts don’t stop there and this
WOHD we’re making sure people of
all ages are motivated to take care
of their teeth and mouths. Providing top tips and guidance on how to
improve their daily regime, Philips

wants patients to make simple
changes that lead to broader health
benefits that go beyond a healthy
smile.
For more information about the
Philips Oral Healthcare and World
Oral Health Day please visit philips.
com/wohd or become a fan on
Philips Oral Healthcare Middle East
Additional information about FDI
and World Oral Health Day can be
found here: http://www.worldoralhealthday.org/

[13] =>

Ultimate clean.
Superior results.
*

Philips Sonicare DiamondClean removes 7x more
plaque than a manual brush1 and eliminates surface
stains to whiten smiles in just one week.2 And with
accessories like an innovative glass charger for home
use and a portable charging case, it’s the jewel of our
collection for good reason.

For enquires contact
Castle General Trading
Tel: 0097143328795
or email: cgtdub@emirates.net.ae

[14] =>

oral health

Dental Tribune Middle East & Africa Edition | 2/2016

Mirror mirror on the wall who has the
whitest teeth of all…
our enamel by brushing with a soft
toothbrush, not brushing too hard,
and using a toothpaste that is also
gentle and kind to our enamel.
Consumers are increasingly
aware of stains that build up on
their teeth by their diet. How much
diet influences teeth stains, differs
from market to market, but there is
a general awareness around some of
the main products that contribute to
daily stain build-up.

Photo: Pixabay/PublicDOmainPictures

By Jordan
The American Dental Association
asked consumers what would they
most like to improve about their
smile, and the reply was whiter teeth.
This is in line with the research we
have conducted, that shows a clear
trend that more consumers are concerned with their teeth’s appearance.
The basic need for clean teeth
has evolved into clean and white

teeth. Supporting the macro health
and beauty trends, consumers want
to live better lives that also last longer. Yellow teeth are associated with
poor personal hygiene and are also
considered a sign of aging.
As we age our teeth naturally
become yellower. The outer layer of
our enamel gradually breaks down,
exposing the under-layer, called
dentin, which is naturally yellower
than enamel. We can take care of

The trend in Norway is that more
and more patients are asking their
dentists for help when it comes to
whitening. Whitening treatments at
the dentist are by far the best choice.
Not only are they safer, they are also
tailor-made to the patient’s mouth.
Prior to treatment, a check-up will
ensure there are no undetected cavities. If there are, these should be filled,
prior to whitening applications. The
treatments are, as a rule, more effective and quicker. It is important that
the patients are informed that these
will not work on crowns, fillings, caps
or veneers. To ensure a good and lasting result it is also important to help
them find the most effective routine
for maintaining their new white(r)
smile. Help your patients keep daily
surface stains, sometimes referred to
as extrinsic stains, in check.

Gentle Stain removal

WHIT
E

Deeper stains, or intrinsic stains,
are more difficult to remove. These
can be caused by a past injury, use
of certain medications and antibiotics and grey or dull teeth can also be
hereditary. Teeth bleaching, using ei-

CH™ BR
I
TE

POLISHING
PAD

By DTI

After use testing:
Target White scores
hight on BOTH
Softness &
Effectiveness 1

For more information
www.jordan.no
jordndub@emirates.net.ae
+971 4 8871050

References
1. www. ADA.org
2. Needscope, Norway and Sweden
2014
3. Mintel rapport, 2014
4. Nordental dentists & Hygienists
survey, 2014

World Oral
Health Day 2016:
Healthy Mouth.
Healthy Body.
GENEVA, Switzerland: Every World

¹ Technical tests performed by Pedex, Germany.
² Intertek, UK, 2010: tested against Colgate Max White & Pepsodent white system.
3
Stain stock mixture (ground instant coffee (Nescafé), instant tea (PG Tips) and
Mucin type from porcine stomach.

Consumers try whitening products because they want white(r)
teeth². Many consumers are skeptical to the working power of whitening products. However, they buy
them anyway as they feel they have
nothing to lose². A whitening toothpaste gives them all the other benefits they need, for example, cavity
protection and fresh breath, and on
top of that they also get any whitening advantages that they might have
missed out on if they choose a product without whitening claims. 27% of
all toothpastes launched globally are
whitening toothpastes. In comparison only 10% of toothbrush launches
are³. These numbers are expected to
keep growing, in line with an escalating trend of consumers wanting nice
looking white teeth.

LES
ST

WHITE TECH™
BRISTLES

The number one recommendation from dentists is to encourage
their patients to floss once a day.
Flossing before brushing will remove food particles and plaque between the teeth (where 30% of cavities start) and leave this space clean
and receptive to fluoride treatment
from the toothpaste. Using a straw
could also be recommended if the
patient has a high intake of caffeinated drinks like coffee, tea, juices or
carbonated drinks. Tobacco intake is
also one of the worst offenders when
it comes to staining teeth. Patients
might experience some sensitivity
post treatment, so it is also important to advise them on what to do
should this happen to them.

ther a hydrogen or carbonite peroxide will help break up these deeper
stains into smaller, less colored pieces that will make the teeth appear
brighter and whiter.

Most dentists already recom-

Brush away daily stains
and keep teeth naturally white
Effective stain removal

mend a soft toothbrush and are positive to gentler formulated whitening toothpastes (most commercial
whitening toothpastes contain some
level of silica to lift plaque and tartar during daily brushing sessions).
There are also several toothbrushes
that have specialized bristles that effectively lift stains.

¹ Source: Perceptor in-use test: 74 consumers, Finland, 2014

Oral Health Day (WOHD), which is
celebrated annually on 20 March
around the world, is held under a
new and specific theme. This year’s
WOHD will focus on raising awareness of the link between good oral
health and overall well-being, with
the slogan “It all starts here. Healthy
mouth. Healthy body.”
Oral disease affects 3.9 billion people
worldwide, with between 60 per cent
and 90 per cent of children globally
suffering from tooth decay. Yet, poor
oral health goes far beyond the initial
implications of dental disease and
tooth decay; it has been associated
with a number of health conditions,
such as heart disease, pancreatic cancer, pneumonia and lung disease. In
a recent study, 40 per cent of people
with serious periodontal disease also
reported suffering from an additional chronic condition.
Despite these links, people are unaware of the long-lasting and wideranging effects of poor oral health.
Therefore, WOHD 2016 will shed
light on the importance of good oral

health in a simple and engaging way,
encouraging understanding that
good oral health is fundamentally
intertwined with overall well-being.
The WOHD 2016 website, www.worldoralhealthday.org, focuses on communicating that prevention, early
detection and treatment are key to
ensuring the best outcomes and reducing oral disease and associated
health complications.
A series of dynamic and engaging
material, including a global video,
new smartphone game, media strategy and social media content have
been designed to inspire people
across the world to participate in the
WOHD campaign and improve their
oral health regime.
Dental professionals, companies and
institutions that would like to be involved in this year’s WOHD activities are invited to e-mail WOHD@
fdiworldental.org for a full campaign
guide, which is available in English,
French and Spanish and includes
materials for download, such as
poster visuals, social meme designs
and information on the WOHD video and smartphone game.

[15] =>

oral health

Dental Tribune Middle East & Africa Edition | 2/2016

Success with Air-Polishing
Christina Chatfield explains how she has embraced air-polishing for both stain
and biofilm removal
By Christina Chatfield, UK
When I opened Dental Health Spa in
2007, I wanted to market something
different to the Brighton consumer
that other dental practices were not
offering to their hygiene patients, so
I invested in two air-polishing units.
Was it new? No, it had been around
for 30 years, so just about my entire
clinical life. In fact, way back in 1999,
I had one in my practice, where I had
a nurse all the time, but I knew nothing about it other than it tasted foul,
was messy and a nightmare to maintain (or so I had heard). No one had
shown me how to use it, I had never
been taught anything about it during my training at dental school – my
boss did not tell me, or indicate to me
why I had one. Yet air-polishing is the
very thing that I have used to build
my practice over the last seven years.
All technology evolves, from twin
tubs to automatic washing machines, manual toothbrushes to the
all singing oscillating, pulsating and
sonic technology we have today.
Things improve because research
shows us what we want or need
more. It’s about comfort, aesthetics,
health and feeling good.
Move forward 30 years with EMS
and we can see how the powders
have evolved, enhancing comfort, efficacy, ease of use and, more importantly, removal of biofilm.
Some of my patients say their
teeth are sensitive. The sensitivity
they commonly refer to is from ultrasonic treatment. I am not talking
about the patient who needs nonsurgical root surface debridement, I
am referring to our recall and maintenance patients or people with lots
of stain. So, initially we thought of
air-polishers just for stain removal.
With the latest family of powders,
the move away from the larger grain
size of classic sodium bicarbonate
(at 65 microns) to smaller particle
erythritol, (at 14 microns) means that
patient comfort, taste and efficacy
are instantly improved. This can be
used on both stain and biofilm above

Figure 3: Using the AIR-FLOW

Figure 1: Before using AIR-FLOW

and below the gum margin for our
routine maintenance patients, with
pockets less than 4mm or in the
Perio-Flow hand piece for deeper
biofilm disruption/removal. We can
reduce the bacterial load at every appointment, sub- and supra-gingival,
as well as remove stain from the
hard to reach places and from dentine, quickly and effectively. No salty
taste, no mess – what’s there not to
like!
For me, it’s down to two powders: firstly, Comfort, the new supragingival sodium bicarbonate powder
from EMS. It has the same efficiency
as the previous Classic powder, but
more comfortable on the soft tissues with a smaller grain size (40
microns) for the removal of supragingival plaque and heavy extrinsic
staining with a fresh lemon taste.
And for the whole mouth, the
Plus powder, with erythritol, is great
both sub- and supra- gingivally. This
extra fine particle size of only 14 microns, makes it great to use on all the
soft tissues, including the tongue
and in pockets, disrupting and killing biofilm and removing stain. This
can be used on both dentine and
composites too. So, one powder that
does everything and no changing of
powder!

Case studies - The proof is in
the pudding
1. Hamish (Figures 1-5): worn lower

anteriors, dentine exposed, heavily
restored and crowned posterior upper and lower dentition, perio good,
no calculus, lots of stain.
How would you normally treat
him? Prior to Air-Flow Powder Plus,
lots of scraping and abrasive polishing paste. A nightmare to treat and
how long would it take?
This took 20 minutes, a much
more pleasant experience for both
Hamish and myself. It is easy to use
and the softer powder meant that it
was not traumatic to any of the soft
tissues both supra- and sub-gingivally. A great all round mouth detox,
tongue clean and stain removal. First
thing I say to my clients as I sit them
up before they even look is: ‘How
does it feel?’ That feeling of clean,
sells the Air-Flow before they have
even seen the results, and then it’s
the wow factor!
2. Ben (Figures 6+7): he continued
to lose attachment and mobility
despite ongoing periodontal treatment. He is an unresponsive, chronic, generalised, severe periodontitis
case. He has previously seen a periodontist, had been treated non-surgically, but was reluctant to have any
teeth taken out. Ben’s contributing
factors are his stress levels, his bruxism, oral hygiene due to poor access
and his tolerance to maintenance
therapy. He is an ex-smoker, having stopped six years ago. I took Ben
to King’s as part of my diploma in

Figure 2: After using AIR-FLOW

periodontology. He had five molar
extractions and a further course on
non-surgical intervention more than
24 hours under local anesthetic (LA)
and combined antibiotic therapy. I
treated Ben in practice with PerioFlow/Air-Flow, purely for biofilm
management. He was assessed at
eight weeks and surgical intervention was decided for the upper left
quadrant and a Michigan splint to
replace his existing soft splint.
At nine months post-treatment,
Ben’s tolerance would still be an issue. He is now treated with Air-Flow
sub- and supra- gingival and his
pockets remain below 4mm. My
anxiety levels used to rise when
treating Ben (as did his). He is now
on a three monthly maintenance
programme, and Air-Flow is our
treatment of choice. It is quick, 100%
effective and comfortable.

Market your product
Once you have a great product, you
need to keep up-to-date and, like
anything else, you need to market it.
I use radio advertising to market
air-polishing and flyers, which I am
about to update and introduce AirFlow as our premium service. We are
launching a Spa Plan for both our
dental and our hygiene only clients
and will be offering this premium
service to our Spa Plan members. I
bought the Air-Flow Master Piezon,
having listened to the lectures at
Europerio 7, mainly for my perio
and implant patients. I now have
two additional hygienists working
alongside me. We have the Air-Flow
Master Piezon in one of the surgeries, which means I now need another
because we all see the benefits and it
is key for developing my Spa Plan client database. I have additional marketing support from Dental Beauty
TV that means my website is being
updated with fantastic video clips,

Figure 5

Figure 4

which in turn improves the Google
search engine, and these can also be
sent out as a download in newsletters.
Hands-on courses are essential
to understand how in practical terms
to both use and maintain Air-Flow
and Perio-Flow. Sharing experiences
with other colleagues will help you
develop skills and ideas as to how to
market them and up sell to your existing clients.

Figure 6

Figure 7

Christina Chatfield
Christina is a clinical director and hygienist at Dental Health Spa in Brighton.
She qualified as a hygienist in Dundee in
1982.

[16] =>

oral health

Dental Tribune Middle East & Africa Edition | 2/2016

Providing thorough oral hygiene
instructions in a clinical setting
By Theodora Little, UK
“iTop” stands for “individually
trained oral prophylaxis”. You may
argue that hygienists deliver this
to their patients all the time, right?
Unfortunately, with the time constraints placed upon hygienists in
the UK, with 30- or 20-minute appointments and many without a
nurse, the burning question is, how
we are supposed to give patients the
essential care, as well as effectively
provide thorough oral hygiene instructions?

We mention time and time again
that we strive for prevention and
that this is key, but unfortunately
all there is time for is a scale and polish with a little oral hygiene instruction. We are thus placed in a vicious
cycle of patients returning for each
appointment with the same oral
hygiene as before. Habits remain
unchanged. At Curaden Dental
Clinic, my hygiene appointments
last a minimum of 1 hour. Curaden
is a Swiss company, so this is something of the norm for it. The company takes great pride in offering

high-quality products and services
to patients, which is also why we
recommend CURAPROX products.
It is not just about their vibrant colours, which initially attract attention,
naturally; there is more to the products than meets the eye. CURAPROX
uses CUREN filaments instead of
nylon, and their manual toothbrush
contains 5,460 filaments—approximately 4,500 more than the average
manual toothbrush. All of this is included in iTOP, since they only use
the best in their training for dental
professionals.

I suppose many will say I am lucky to
be able to offer hour appointments,
but as a practice we want the best
for our patients. Our practice focus
is prevention, and it is necessary to
give time to our patients to achieve
this. On occasion, the whole hour
is used for iTOP training only, with
my main emphasis on educating
the patient, starting with the basics.
I will discuss products in depth with
the patient, giving him or her the full
knowledge to understand the benefits of these. I will also brush for the
patient, not just a few teeth but all

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four quadrants, so he or she can feel
exactly how it is supposed to feel in
each area. I will of course then ask the
patient to demonstrate toothbrushing to me afterwards. Usually, I will
brush my teeth at the same time,
as we can also learn from watching
others carrying out the same task
(and the patient will feel less selfconscious). With floss and interdental brushes, I do the same and will fill
out the full-mouth chart for the patient to take home if more than one
size interdental brush is required.
Moreover, I will discuss toothpastes
and mouthwashes, explaining the
advantages and disadvantages, and
how to gain the most benefit from
them.
You may question why you need
iTOP training, since surely you learnt
all of these skills at university? You
would think that in training to be a
hygienist and therapist, the most basic training given would include correct and efficient brushing of teeth. I
am somewhat ashamed to say that
not once during my time at university did we have intra-oral demonstrations with a manual, electric, sonic or
any other toothbrush. Certainly, we
had a lecture on the different types
of toothbrushing techniques used
in the past and the techniques we
should use now, and were then told
verbally how to use these techniques.
We also received slide show lectures
from company representatives who
left us some samples, but did anyone
actually teach me how to brush effectively? How do you really know
until you feel? You’re just supposed
to know, right? Who taught me? My
parents? And who taught them? Is it
just expected that we should know
this basic oral hygiene care? Is it just
common knowledge? I think not,
as I treat many patients young and
old and they still do not know how
to brush correctly. I was trained as a
hygienist and therapist and I did not
know, nor was I shown at university,
until I completed iTOP courses.
I have now completed my iTOP beginner and advanced courses and will
hopefully attend the teachers’ seminar later this year. Going through
this programme, I started to realise
that correct, effective and thorough
toothbrushing is somewhat of an
art, and it should not be dismissed
so easily. It is also something that
should not be rushed; great care and
time do need to be taken to change
a patient’s habits. Of course, many
may argue that patients will not
want to spend x amount to receive
oral hygiene instructions and that
one cannot teach an old dog new
tricks. I agree to an extent; however,
once one has gained a patient’s trust
and he or she understands the value
of this service, the patient will be
more than happy to accept. We all
understand how important it is to
communicate well with our patients,
and this combined with sufficient
working time, allowing for iTOP, is
one of the greatest factors. Not only
are my patients satisfied, happy and
grateful, they are also shocked that
they have never had training on how
to brush properly. As a hygienist and
therapist, I too gain enormous job
satisfaction and can honestly say I
love what I do.
I would encourage my fellow dental colleagues not to disregard the
importance of being taught how to
brush correctly until you have had
iTOP training. It opened my eyes
and made me feel the difference,
and now I can pass my oral hygiene
knowledge on to my patients, because I believe my service should include more than just cleaning their
teeth for them.

[17] =>

Dental Tribune Middle East & Africa Edition | 2/2016

restorative

Cleanic: Clinical use of
a recognised prophy paste
with Perlite

Procedure

By Dr. Fabio Cosimi D.D.S., Dr. Susanna Giovannini D.I., I-Ostia Lido,
Rome
Cleanic® prophy paste by Kerr has a
creamy and smooth consistency. It
also has a pleasant fresh taste that is
not too strong and is well accepted
by the patient.
This creaminess and the clever
use of binding agents have made the
paste easy to use. Available in a tube,
used with both cups and brushes,
the paste stays more compact on
the tooth surface, thereby avoiding
the unpleasant sensation caused by
coarse particles left in the patient’s

Before
mouth. Within a few seconds after
application (during the cleaning cycle), Cleanic® paste removes extrinsic
dischromia caused by chlorexidine
or stains caused by cigarette smoke.
(If either of these are present in
a patient at a recall of 6 months, the
application should be repeated).

After
About 8 seconds after application, the paste automatically starts
its polishing action thanks to Perlite
technology making the tooth appear
smooth and shiny.
After our usual professional oral
hygiene procedures (debridement,
scaling and root-planing), Cleanic®
paste, compared with others on the

An ideal combination for
optimized esthetic success

market, seems to be less apparent in
the gingival sulcus.

helps to prevent damage to adjacent
teeth.

Pro-BrushTM new generation
brushes are very suitable for patients
with dental overcrowding or malpositioned teeth. Plastic replaces the
traditional metal part and allows the
brush to rotate more efficiently. This

Pro-Cup® cups have been designed and developed to avoid
pastes being splattered as with traditional cups.

Michele Temperani, CDT, Italy
is a speaker at
Dental Technician Int'l Meeting!

06-07 May 2016 | Jumeirah Beach Hotel, Dubai, UAE

CAD/CAM technology provides an efficient and reliable method to create full-contour restorations from high-quality zirconia for complex restorative needs in the posterior region.
By Marko Jakovac, DMD, MSc, PhD,
Croatia, and Michele Temperani,
CDT, Italy
Modern dentistry is not only concerned with oral hygiene or caries
prevalence – wear from attrition,
abrasion or erosion is increasingly
becoming a subject of concern.
These destructive oral processes
are in large measure attributable to
stress. Stress can trigger parafunctional habits and lead to gastric reflux and low pH values in saliva.
Additional factors such as bulimia and excessive consumption of soft
drinks also come into play.

Fig. 2: On examination, a substantial loss of tooth structure in the cervical and palatal region was observed.

Fig. 3: Mock-up and temporaries were created using a
silicone matrix of the wax-up.

Fig. 4: Mock-up placed in the patient’s mouth

Fig. 5: Situation after surgical crown lengthening

Fig. 1: Patient before the treatment:
She wanted her esthetic appearance
to be improved.

Case presentation
A 30-year-old female patient presented at our practice with pain in
the posterior region. She was also
dissatisfied with the esthetic appearance of her anterior teeth (Fig.
1). Considerable erosive loss of tooth
structure on the palatal and cervical
surfaces was observed at the preliminary examination (Fig. 2). An initial
interview revealed that the patient
consumed large quantities of soft
drinks. On the basis of the clinical findings, we concluded that the
woman was suffering from stomach
problems with suspected bulimia.

Treatment planning
After careful history taking and a
thorough assessment including a
radiographic evaluation, we began
to develop a treatment plan. The
plan was to rehabilitate the entire
oral cavity, to restore all teeth that
had been damaged by erosion or
tooth decay and to protect the existing dentition from further damage.
We aimed at restoring the shape
and function of the teeth by raising
the vertical dimension of occlusion.
Interventions involving such a high
level of complexity require both a

comprehensive plan outlining in detail every part of the treatment and
close collaboration between dentist
and dental technician. Following
initial examination, an impression
and bite record were taken. Portray
imagery and DSD technology (Digital Smile Design) have proven to be
highly useful in situations where
the dental technician cannot gain an
impression of the patient’s oral situation in person.

Mock-up and initial
temporaries
As provided for in the treatment
plan, the dental technician fabricated a diagnostic wax-up to visualize the ideal oral situation. Wax-ups
are convenient to assess the feasibility of such complex prosthetic treatments. Duplicate casts were made
from the contoured wax-up and silicone matrices were created (Fig. 3). In
the first step, the matrices assisted
in the construction of the mock-up
and, further on, in the fabrication
of the baseline temporaries in the
patient’s oral cavity. The mock-up
was completed on the basis of the
wax-up. It was then used to simu-

late the final outcome on the patient
and visualize the inclination of the
occlusal plane (Fig. 4). The patient
agreed to the treatment plan and we
proceeded to implement the necessary surgical measures – i.e. tooth
extraction and crown lengthening.
It is important to consider the form
identified in the wax-up when performing surgical crown lengthening
(Fig. 5). Subsequently, the patient underwent periodontal treatment and
root canal therapy. Additionally, all
existing restorations were replaced.

Preparation and temporization
The teeth were prepared in two sessions. At the first session, we prepared the teeth along the gingival
margin. Impressions were taken and
temporaries fabricated. Generally,
temporization is essential to achieve
an optimum healing result after surgical crown lengthening and tooth
extraction. Since the temporaries

should follow the parameters established in the wax-up, we decided to
employ CAD/CAM technology for
this step.
The wax-up and master models
were digitized using a lab scanner
(Wieland Dental) and the resulting
data sets superimposed using dental
design software (3Shape). This method allowed us to transfer the shape
of the wax-up to the model that
contained the tooth preparations.
The virtual project is automatically
converted into a STL data format
and sent electronically to the program responsible for the CAM process. In this case, the STL data were
imported into the milling program
of a Zenotec® mini CAD/CAM unit
(Wieland Dental) to manufacture
temporaries from Telio® CAD PMMA
material (Fig. 6). Occlusal and functional adjustments were repeatedly
performed over the three-month
healing period (Fig. 7). After success-

ful healing, the second stage of the
preparation process was implemented. When carrying out this step, visual aids (loupes, dental microscope)
are recommended to achieve accurate results. After completion of the
preparation procedure, an impression of the oral situation was taken
(Fig. 8).
Jaw relations were established
with the help of a bite record.
The jaw position was “test driven” during the healing phase when
the patient was wearing the temporaries. A special procedure (crossmounting method) enables the
clinician to communicate the jaw
relations to the technician without
loss of information.

ÿPage 18

[18] =>

restorative

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 17

Fig. 6: Long-term temporaries were instrumental in stabilizing the vertical dimension of occlusion.

Fig. 8: Anterior teeth prepared for the final restoration

Fig. 7: After long-term temporization: a bite record was taken to document the
occlusal position created in the course of long-term temporization.

Fig. 9: The master models were digitized to create the final restorations.

Fig. 10: Virtual construction based
on the situation created by the
long-term temporaries

composite Variolink Esthetic DC. In
the mandible, the veneers were luted
using the light-curing variant of the
same luting composite (Variolink
Esthetic LC) in a neutral colour. This
luting composite is easy to apply and
excess material can be effortlessly
removed during the cementation
process.
Two weeks after the restorations
had been placed, the patient came
for another visit to our practice. Pink
and white esthetics was harmoniously balanced (Figs 14 to 17). This

Fig. 11: Restorations after having been milled from preshaded Zenostar T1 zirconia material (Wieland Dental)
outcome was possible due to the
careful adaptation of the treatment
to the needs of the patient and the
smooth communication between
practice and lab.

Conclusion

Fig. 12: Molars were created in full contour and the vestibular aspects of the
premolars were layered over.

Fig. 14: Two weeks after the restorations had been seated: optimal situation
with successful pink and white esthetics

Creating the final restorations
We used the Zenotec CAD/CAM
system and Zenostar® zirconia materials (Wieland Dental) to fabricate
full-contour crowns and bridges for
the premolar and molar region. The
plan was to customize the premolar
restorations with IPS e.max® Ceram
veneering ceramic using the layering technique. The anterior restorations were manufactured using the
press technique with IPS e.max Press
lithium disilicate glass-ceramics.
These restorations were also customized using IPS e.max Ceram. On the
one hand, the final restorations had
to be manufactured in such a way
that they were faithful to the param-

eters established in the simulation
models. On the other hand, the final
restorations should reproduce the
shape and occlusal dimension of the
temporaries, which had been consistently optimized during the longterm temporization stage. To achieve
an ideal outcome, the laboratory was
provided with a range of useful data
to allow the technician to mount the
models on the articulator and to interchange them with one another:
- Impressions for master models
- Impressions of the temporaries
after functional and occlusal adjustments
- Occlusal record
- Facebow

Fig. 13: Frontal view of the completed restorations on the model
The master models and the
models of the most recently modified temporaries were scanned and
uploaded to the 3Shape software
program using the “cross-mounting” method (Figs 9 and 10). Given
the level of complexity involved
in this case, we preferred to mill
the components first from wax to
be able to assess the quality of the
virtual construction in a conventional fashion. With this inexpensive
method, we were able to assess the
shape and function of the structures
in “real life”.
In the present case, we noticed
that a few areas had not been properly contoured in the wax. These areas were corrected accordingly.
The corrected STL data were processed in the CAM module and the
data required for the milling process imported into the program of
the Zenotec mini milling unit. The
restoration was then milled from a
pre-shaded Zenostar zirconia disc
(shade T1) (Fig. 11). It is an advantage
of this material that it is supplied
in discs that are pre-shaded. Normally, framework shading requires
a separate working step to apply
metal-oxide based colouring liquids
either by an immersion or brush-on
technique prior to sintering. In preshaded discs, the shades are added
to the zirconia powder and homogenised during the industrial production process. The result is a material
that demonstrates a highly homoge-

neous shade. As the need for manual
shading is eliminated, time savings
can be gained in the fabrication of
restorations, providing an additional
advantage. Colour consistency is another advantage that should not be
underestimated. A consistent colour
is achieved, irrespective of the skills
and experience of the technician.
To ensure an optimum integration of the posterior restorations
made of zirconia and the anterior
restorations made of lithium disilicate, the vestibular areas of the
premolars were layered over with a
veneering ceramic (IPS e.max Ceram) (Fig. 12). We used a conventional
press technique in conjunction with
IPS e.max Press ingots (shade LT A1)
to fabricate the anterior lithium disilicate restorations and then completed the pressed crowns individually
using the cut-back technique (Fig. 13).

Seating the restorations
CAD/CAM technology was used to
fabricate the posterior crowns and
bridges from monolithic zirconia.
The occlusal conditions established
in the long-term temporaries were
accurately taken into account. Prior
to seating the final restorations,
we checked their accuracy of fit
and shade match intraorally using
glycerine-based try-in pastes (Variolink® Esthetic Try-In). The crowns
and bridges were permanently cemented using the dual-curing luting

Figs 15 to 17: All-ceramic restorations: integrated harmoniously and unobtrusively into the dentition and facial appearance of the patient

Successful treatment of young patients with complex treatment needs
requires a high degree of accuracy
and minimally invasive preparation methods. Full-contour zirconia
restorations milled using CAD/CAM
strategies provide a straightforward
method to achieve accurate restorations, particularly for the posterior
region. The success of anterior restorations continues to depend largely
on the skills of the technician and on
the use of materials with optimum
properties, such as the IPS e.max
lithium disilicate glass-ceramics.

Marko Jakovac, DMD, MSc, PhD
Assistant Professor
Department of Fixed Prosthodontics
School of Dental Medicine
University of Zagreb
Gunduliceva 5
1000 Zagreb, Croatia
jakovac@sfzg.hr
Michele Temperani, CDT
Laboratorio Odontotecnica Temperani
Via Livorno 54\2
50142 Florence, Italy

[19] =>

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[20] =>

restorative

Dental Tribune Middle East & Africa Edition | 2/2016

Advanced Restorative Techniques
and the Full / Partial Mouth Reconstruction
- Part 2 Occlusal Concepts
In the second part of the series on advanced restorative techniques,
Prof. Paul Tipton focuses on occlusal concepts
By Prof. Paul Tipton, UK
Most advanced restorative dentistry
techniques have changed little over
the last 20-30 years, including that
of the full mouth reconstruction.
However, the impact of new dental materials, such as titanium and
zirconia, has had a major influence
on aesthetic dentistry and implantology during this time period. As a
result, the profession may have an
over-reliance on new materials rather than tried and tested techniques.
Some fundamental techniques are
just as relevant today as they were
when I started my Master’s degree
in conservative dentistry at the Eastman Dental Hospital in 1987.
During the course of this series
of articles on advanced restorative
techniques, some old techniques
will be revisited in light of today’s
aesthetic and restorative requirements and some newer concepts will
be discussed in greater detail whilst
dealing with the overall topic of full
mouth reconstruction. This article
discusses the topic of occlusion and
occlusal concepts.

Gnathology
Stallard first coined the term gnathology in 1924, defining it as the science that relates to the anatomy, histology, physiology and pathology of
the masticatory system. McCollum
formed the Gnathological Society in
1926 and is credited with the discovery of the first positive method of locating the transverse horizontal axis
and transferring the recording to an
articulator using a facebow.
Stuart became associated with
the Gnathological Society early and
published the classic ‘Research Report’ with McCollum in 1955. Their
observations led to the development
of the principles of mandibular
movements, transverse horizontal
axis, maxillomandibular relationships, and an arcon-style articulator that was designed to accept the
transfer of these occlusal records.
The goal was to truly capture max-

illomandibular relationships that
accurately reproduced border jaw
movements and which would then
allow the technician to produce the
most stable, functional and aesthetic occlusal form for indirect cast
restorations. The registration of the
horizontal and sagittal movements
of patients was believed to allow the
maximum cusp height-fossae depth
with proper placement of ridges and
grooves to enhance stability, function and aesthetics.

Fundamentals of gnathology
The fundamentals of gnathology include the concepts of retruded axis
position (centric relation), anterior
guidance, occlusal vertical dimension, the intercuspal design, and the
relationship of the determinants of
mandibular movements recorded
using complex instrumentation to
the occlusion in fixed prosthodontics. This has evolved into the five
principles of occlusion I embrace
today:
1. RCP = ICP around RAP
2. Mutually protected occlusion
3. Anterior guidance
4. No non-working side interferences
5. Posterior stability.
The early gnathologists studied
the recorded tracings made during mandibular movements. When
the mandible travels forward along
the sagittal plane it is considered a
protrusive excursion or protrusion.
Therefore, retrusion is the movement toward the posterior; and it is
the most retruded physiologic relation of the mandible to the maxilla
to and from which the individual can
make lateral movements that initially defined retruded axis position
(RAP) or centric relation (CR) to the
gnathologist. Further investigations
led the gnathologists to believe that
mandibular (condylar) movements
are governed by the three axes of
rotation.
The concept of retruded axis
position evolved into a three-dimensional position, resulting in its
description as the rearmost, upper-

most, and midmost
(RUM)
position of the
condyles in the
glenoid
fossa.
More
recently,
with the input of
anatomists and
physiologists, the
concept has also
included a bone
braced position
slightly anterior
to the RUM posi- Figure 1: Full face pre-op view
Figure 2: ICP
tion. Whilst there
can be discussions
between groups
as to the exact definition of RAP, it is
generally accepted as a muscular
relaxed, reproducible and braced
position that is
an area not a pinpoint and can
only be achieved
with relaxed musculature.
Figure 3: Upper arch pre-op
Figure 4: Facebow recording
Placing the
condyles with the
correct position and having immedi- (RAP); centre related occlusion (CRO) in’ the posterior occlusion (long cenate disclusion (canine guidance and instead of retruded contact position tric).
The incisal guidance, along with
incisor guidance) upon movement (RCP) and centric occlusion (CO) inaway from that position, with no ver- stead of inter-cuspal position (ICP). ‘long centric’, is determined by the
tical or horizontal deflective contacts Beyron, following his observations distance from transverse horizontal
is fundamental to gnathology. Tooth on Australian Aborgines, suggested axis-centric relation and the norwear is considered pathological in that uniform tooth contact and mal freedom of movement in the
gnathology and one of its funda- resultant wear on several teeth in envelope of function. This method
mental concepts is trying to advance lateral occlusion was a positive and requires that the incisal guidance
inevitable outcome. As a modifica- be established and the mandibular
a dentition with minimal wear.
tion of canine guidance, the Pankey posterior buccal cusps be placed
Alternative occlusal concepts: Mann Schuyler philosophy in com- to a height measured along the ocplete full mouth reconstruction was clusal plane as dictated by the curve
Pankey Mann Schuyler
to have simultaneous contacts of of Monson. The maxillary posteAs gnathology was evolving, several the canine and posterior teeth in the rior teeth are developed after the
competing occlusal concepts and laterotrusive (working) excursion, completion of the mandibular respermutations were theorised, such known as group function, and only torations as dictated by a wax funcas the Pankey Mann Schuyler (PMS) anterior teeth contact in the protru- tionally generated path record. The
theory of occlusion. The Pankey sive excursive movement.
definitive restorations are equilibratMann Schuyler concepts evolved
Schuyler further suggested that ed into a centric relation position
out of an initial study group headed incisal guidance without freedom with mandibular buccal cusps onto
by LD Pankey on the east coast of of movement from a centric related
America. Nomenclature was differ- occlusion (CRO) to a more anterior
ÿPage 24
ent and included centre relation (CR) tooth intercuspation (CO) will ‘lockinstead of retruded axis position

Figure 5: Upper cast front view

Figure 6: Upper cast right-hand view

Figure 7: Upper cast left-hand view

Figure 8: Lower study cast

Figure 9: Diagnostic waxing front view

Figure 10: Diagnostic waxing right-hand view

Figure 11: Diagnostic waxing left-hand view

Figure 12: Lower wax-up

[21] =>

[22] =>

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[23] =>

[24] =>

24

restorative

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 20

Figure 13: Prototypes types upper arch

Figure 14: Prototypes lower arch

Figure 15: Upper prep guide

Figure 16: Lower prep guide

Figure 17: Upper right restoration on fully adjustable articulator

Figure 18: Upper left restoration on fully adjustable articulator

Figure 19: Anterior crowns front view

Figure 20: Anterior crowns right hand view

Figure 21: Anterior crowns left hand view

Figure 22: Upper arch occlusal view

Figure 23: Upper right quadrant with palatal
ramps

Figure 24: Upper left quadrant with palatal
ramps

Figure 25: Intercuspal position with no anterior
contacts

Figure 26: Upper anteriors

Figure 27: Upper anteriors final view

Figure 28: Lower anteriors final view

commodated changes in head position and postural closure (Mohl position).

Gnathology versus PMS

Figure 29: Full face final view

a flattened fossae-marginal ridge
contact with ‘freedom in centric’ anterior guidance and group function
in laterotrusive (working) excursion.

Deflective contacts
Though 90% of natural dentitions
have a deflective occlusal contact or
an occlusal ‘prematurity’ between
centric related occlusion (CRO) and
centric occlusion (CO), it is usually
in the form of a slide that has both a
vertical and horizontal component
occurring in all three planes. According to Ash and Ramfjord, the horizontal ‘long centric’, from centric related occlusion to centric occlusion,
should be incorporated into a restoration by means of a post restorative
occlusal adjustment.
Dawson illustrates the ‘freedom
in centric’ concept within the lingual
concavity of the maxillary anterior
teeth. He redefines long centric as
‘freedom to close the mandible either into centric relation or slightly
anterior to it without varying the
vertical dimension at the anterior
teeth’. Additionally, long centric ac-

Gnathologists believe that once the
condyles are positioned in retruded
axis position (centric relation), any
movement out of this position
should disocclude the posterior segment, thus nullifying any horizontal
cusp-fossae area contact.
This belief, combined with the
immediate anterior disocclusion,
forms the basis of a mutually protected occlusion and limits tooth
wear. The PMS occlusal scheme, however, encourages multiple occlusal
contacts during lateral movements
(group function or wide centre) and
during protrusive movements (long
centric). This may have the effect of
increasing tooth wear. It is, therefore,
logical that the PMS occlusal scheme
recommends that occlusal wear is
physiological, not pathological as
suggested by gnathologists. The task
of adjusting maximum intercuspation contacts in two different positions on an articulator may result in
a lack of precision in both positions.
However, the masticatory system
has the ability to adapt to various influences and though, in the author’s
opinion, the concept of gnathology will produce stable long-term
results, some patients may require
more freedom in their occlusion
and the PMS concepts are not to be
dismissed in these patients. Indeed,
some PMS concepts such as waxingup the curve of Spee and Monson
prior to occlusal rehabilitation are
incorporated into every day occlusal
practice.

Case study
Patient A was referred to me for a full
mouth reconstruction and aesthetic
improvements to her smile (Figures
1-3). Initial impressions, facebow
and jaw registration were taken for
mounted study models (Figure 4).
The study models showed the degree of over-eruption of her anterior
segments and disturbances to the occlusal plane (Figures 5-8).
Initial diagnostic waxing (Figures 9-12), prototypes (Figures 13 and
14) and prep guides (Figures 15 and
16) were completed using a lower
curve of Spee of a 4” radius (anatomical average as recommended by the
PMS techniques).
Initial prototypes were placed
with large palatal ramps on the upper anterior teeth to allow anterior
tooth contacts and thus an immediate disclusion style of occlusal
scheme as recommended in the gnathological approach.
During the course of the initial
preparation and prototypes and
after a period of stabilisation, the
patient was struggling to come to
terms with the palatal ramps from
a speech and comfort point of view.
The decision was made to
change the occlusal scheme to a PMS
‘freedom in centric’ style approach
where initial guidance in both left
and right lateral excursions came
from posterior teeth until such time
as the canines contacted and then
took over as canine guidance. In protrusion, a similar long centric was established on posterior teeth so that
in protrusive movements the initial
guidance was from the posterior
teeth until such time as the incisors
touched and then took over the further smooth protrusive movements.

This was achieved by using a fully adjustable articulator to complete the
restorations (Figures 17 and 18).

Conclusions
The definitive anterior crowns were
made of Procera all ceramic (Nobel
Biocare) (Figures 19-21). The posteriors were constructed of traditional
porcelain fused to metal with large
flat areas on the palatal cusps for the
establishment of both ‘long and wide
centric’ (Figures 22-24) as in the new
intercuspal position there were no
anterior contacts (Figure 25) due to
loss of the palatal ramps. The final
aesthetic result can be seen in Figures 26 to 29.
Occlusion and the various occlusal concepts have caused – and
continue to cause – debate. Whilst
the author has been trained throughout his career in the concepts of gnathology, there is the recognition that
other occlusal concepts, such as PMS
and bilateral balance, may have a
part to play in treatment of some
patients.
During the rest of this series, the
principles of gnathology will be used
in the treatment of the partial or full
mouth reconstruction.

Acknowledgements
For the writing of this article on advanced restorative techniques, the
author would like to thank the following people for their help:
Dr Ibrahim Hussain, BDS, M.Med.Sci.
Implantology – implant surgeon
Dr Andrew Watson, BDS, MSc, specialist in endodontics
Mr Bradley Moore – dental technician,
ADS Laboratory, Harrogate.

Professor Paul
Tipton BDS, MSc,
DGDP RCS (UK)
DENTAL SURGEON
Visiting Professor
of Restorative
and Cosmetic
Dentistry, City of
London Dental
School
www.colds.co.uk
SPECIALIST IN PROSTHODONTICS
www.drpaultipton.co.uk
T Clinic @ Manchester , London
www.tclinic.co.uk
TIPTON TRAINING Ltd
www.tiptontraining.co.uk
President of the British Academy of
Restorative Dentistry (BARD)
www.bard.uk.com

[25] =>

Dental Tribune Middle East & Africa Edition | 2/2016

aesthetics
Dr. Eduardo Mahn, Chile
is a speaker at
11th CAD/CAM & Digital Dentistry Int'l Conference!

Two approaches
and one goal

06-07 May 2016 | Jumeirah Beach Hotel, Dubai, UAE

State-of-the-art CAD/CAM materials are offering clinicians the possibility of producing certain
types of restorations in the dental practice using a semi-direct technique. Ceramic veneers, for
example, are easy to fabricate in-office with IPS CAD Multi, without the need for glazing.
By Dr. Eduardo Mahn, Chile
Recently developed restorative materials have opened up a myriad
of exciting possibilities for dental
practitioners. In the restoration of
anterior teeth, clinicians have to select the most appropriate material
for the case at hand on the basis of
specific criteria. In situations where
teeth show signs of erosion, abrasion, abfraction or a combination
of these phenomena, practitioners
will tend towards using ceramics or
composite resins, depending on how
much intact tooth structure remains
available. Traditionally, composites
are used for Class III, IV and V defects.
However, ceramic veneers are preferred in cases where a large amount
of tooth structure is missing or a
major change is planned (e.g. smile
makeover).

The challenge
When two central incisors need esthetic enhancement, the choice of
approach is not so clear. Irrespective
of the material used a minimally
invasive route involving very little
preparation of the tooth structure
can be taken nowadays due to the
high strength of modern materials
(e.g. lithium disilicate glass-ceramic).
Nevertheless, it is important to remember that minimal preparation
is an option, only if the teeth are
properly aligned. As long as the desired changes of the tooth shape and
shade are small, preparation can be
limited to the enamel.
In many cases, however, orthodontic treatment is needed before
the tooth position and/or shape can
be optimized by means of restorative procedures. This minimally invasive approach requires the dental
practitioner to convince the patient
of the necessity of undergoing preliminary orthodontic treatment.

The solution
It is our aim to remove as little of the
tooth structure as possible in every
case that we treat. With modern materials such as lithium disilicate or
leucite-reinforced ceramics, we can
confidently press or mill veneers
that are as thin as 0.5 mm and even
0.3 mm. One of the main advantages
offered by this type of ceramic is its
wide range of applications. Until a
few years ago, the treatment with indirect restorations required at least
two appointments.
Ceramic materials such as IPS Empress® CAD allow dental practition-

ers to produce polychromatic monolithic
veneers and crowns in
less than one hour,
without having to
glaze them. Nonetheless, many dentists
still believe that dental
technicians with their
well-honed manual
skills produce better
esthetic results than Fig. 1: Initial situation: The patient was referred to an or- Fig. 2: One year later when the patient returned to the practice, the teeth
showed unsatisfactory composite veneers.
a machine, and they thodontist.
do not see the need
to embrace digital technology. As a
result of this point of view and the
high acquisition costs of the milling
machines some clinicians are reluctant to invest in this technology. On
the basis of the present clinical case
study we would like to highlight the
following aspects: the importance of
having the right treatment plan, the
possibilities currently available for
the fabrication of veneers, the potential of the press and CAD/CAM tech- Fig. 3: The veneers were removed and the teeth were tran- Fig. 4: The two-cord technique was used for the impression.
The retraction cords remained in the sulcus.
niques and the latest improvements silluminated to identify any composite residue.
made in the field of cementation.

Clinical case
Patient history
A thirty-one-year-old female patient
came to our office because she was
dissatisfied with her anterior teeth.
She complained about the misalignment of the upper and lower
central incisors (Fig. 1). A detailed
clinical examination revealed that
the composite restorations in these
teeth were defective. As a result of
erosion, a considerable amount of
tooth structure had been lost. In addition, the misalignment of tooth 21
and 41 in particular was quite obvious. The treatment plan presented
to the patient included initial orthodontic treatment followed by minimal preparation of the two central
incisors for two ceramic veneers. The
patient was subsequently referred to
an orthodontist for treatment. Unfortunately, it took more than a year
before she presented to the practice
again. At this consultation, we were
quite surprised to find that the two
central incisors had been restored
with poorly finished direct composite veneers (Fig. 2). Many clinicians
simply underestimate the challenging nature of this type of restoration,
and this was a case in point. In addition to preventing any contamination of the working field, the clinician
must also accomplish the arduous
task of creating an appropriate emergence profile, proper contours and
contact areas and producing a suitable micro and macro-texture, and

Fig. 5: Temporary restoration

Fig. 6: Try-in of the IPS
e.max Press HT A1 veneers
(fabricated in the laboratory)

Fig. 7: Try-in of the polished
IPS e.max CAD A1 veneers
(fabricated in the dental
office)

Figs 8a and b: Try-in of the veneers with a light try-in paste (Light+)

Figs 9a and b: Try-in of the veneers with a dark try-in paste (Warm+)

“With the advent of
CAD/CAM technology, The treatment
clinicians now have
the possibility of
making semi-direct
restorations.”

all this within a single appointment.

The composite veneers had to be removed and replaced with new ones.
In this particular case, the advantages of using the indirect technique
were obvious. The patient agreed to
have two ceramic veneers made for
her. For this purpose impressions
were taken and a master cast was
produced. This working model pro-

vides the dental technician with the
opportunity to evaluate the situation in detail. He or she has the time
to think about possible ways of correcting the misalignment.
Dentists do not have this “luxury” of time when they are treating a
patient in the dental chair. They have
to finish the restorations as quickly
as possible in order to prevent contamination of the treatment field
and keep chair time to a minimum

for the comfort of the patient. In
the present case, an additional hurdle had to be overcome: Any composite material that might have remained on the tooth structure had
to be clearly identified and carefully
removed without damaging the
healthy tooth structure. Transillumination with white LED light came in

ÿPage 26

[26] =>

aesthetics

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 25
ple, however, highly esthetic results
can be achieved with both approaches if the appropriate treatment protocol is followed.
The article was republished with permission of Reflect Magazine.

Fig. 10: Enamel etching with phosphoric acid

Fig. 11: Application of a single-component adhesive (Adhese Universal)

Fig. 12: Removal of excess composite
cement

Fig. 13: Light-curing with Bluephase
Style polymerization lights with water cooling

composite (Telio CS Link)
(Fig. 5).

(IPS e.max Press) with the consent
of the patient, since we were able to
achieve a slightly better match to the
neighbouring teeth by staining the
restorations.

10 and 11). Then the excess luting
composite was carefully removed
and a glycerine gel (Liquid Strip) was
applied (Fig. 12). This gel prevents
the formation of an oxygen inhibition layer at the margins. The luting
composite was cured with two curing lights (Bluephase® Style) simultaneously and cooled with plenty of
water (Fig. 13). Figure 14 shows the
harmonious result produced by the
lithium disilicate veneers.

Fabrication of the
restorations
Two different routes were
pursued in the fabrication of the veneers. We
instructed our lab technician to make two ceramic veneers using the
press technique with IPS
e.max® Press (shade HT
A1, stained). At the same
time, we milled two ceramic veneers with our
in-office CAD/CAM machine using an IPS Empress CAD Multi block
(shade A1). The veneers
made in the dental office were not glazed, just
polished. Figures 6 and
7 allow the results to be
Fig. 14: The result: The patient with the ceramic compared from a facial
veneers in place
perspective. This experiment illustrates the esuseful for this purpose (Fig. 3). Next, thetic potential of modern ceramics.
the teeth were prepared, retraction Both types of restorations blend in
cords were placed and an impression beautifully with their surroundings.
The appearance of the veneers
(Virtual®) was taken (Fig. 4). The patient was provided with a temporary produced with the help of CAD/
restoration, which was made with a CAM technology came very close to
temporary crown and bridge mate- that of the manually manufactured
rial (Telio® CS C&B, shade A1) and version. Nevertheless, in the end we
cemented with a dual-curing luting opted for the lab-fabricated veneers

Placement
Figures 8 and 9 show the try-in
pastes (Variolink Esthetic LC) on the
prepared teeth. The most suitable
composite cement was determined
on the basis of two differently coloured pastes. Two extreme options
were compared: Light+ and Warm+.
The difference was clearly visible
when the pastes were applied. Even
though the darker shade (Warm+)
was very close to that of the natural tooth structure and would have
worked well with the veneers, we
ended up choosing the lighter shade.
This was a typical decision. In most
cases, we tend to prefer the lighter
version, since it provides a better
contrast to the tooth structure and
therefore renders the removal of excess cement easier and faster. Before
the veneers were seated, retraction
cords were placed and the enamel
was etched; the dentin remained unetched. Adhese®
Universal
was
used as the bonding agent to place
the veneers (Figs

Conclusion
State-of-the-art restorative materials
have immense potential. Depending
on the particular requirements of
the patient and the indication, they
allow a suitable treatment option to
be found quickly and easily. The case
presented here shows that highly
esthetic ceramic veneers can be fabricated with minimal effort using
in-office equipment (IPS Empress
CAD). Nevertheless, pressed ceramic
veneers were chosen for this patient,
since they offered the possibility of
applying stains, through which a
very close match to the neighbouring teeth could be attained. In princi-

Contact details
Dr. Eduardo Mahn
Director of Clinical Research and
the Esthetic Dentistry Program
Universidad de los Andes
Monseñor Álvaro del Portillo 12455
Santiago, Chile
emahn@miuandes.cl

[27] =>

[28] =>

research

Dental Tribune Middle East & Africa Edition | 2/2016

Intraoral Device for the treatment of Sleep Apnea
By Dr. Luis Gavin, Spain
Bad sleep is the new boogeyman,
threatening the overstimulated,
overworked masses with disease
and even an early death. Numerous
scientific studies from researchers around the world have demonstrated the harmful effects of
sleep deprivation on human health.
When stress levels go up, people gain
weight and forget things. Without
shut-eye, the body doesn't have a
chance to produce enough growth
hormones to build itself back up.
Sleep Apnea (SA) is a disorder
that causes pauses in breathing during sleep that expose the heart to
oxygen deprivation. It is common
in patients with heart failure (HF)
where it is associated with increased
risk of hospitalizations and death.
In the treatment of snoring and
sleep-disordered breathing the mandibular repositioning devices are an
increasingly important instrument.
Its mechanism is based on the
advancement of the mandible,
which increases the dimensions of
the upper airways and the air flow
during sleep. Aim of this study was
the investigation of the efficiency
and tolerability of two types of adjustable devices: one with screw jaw
lateral excursion, opening and jaw
protusion, and TAP, custom made
appliances placed in 34 patients (24
men and 10women), mean age 47
years old, undergoing an ambulatory, uncontrolled sleep screening
before and after using the appliance

Intraoral device

during one month (placed onto the
teeth during sleep).

Key Words
OSAS, sleep apnea, snoring, protusion

Introduction
The OSA Syndrome (obstructive
sleep apnea syndrome) is one of
the clinical pictures that play an important role in the chronic diseases.
It has been demonstrated that a
timely diagnosis and an adequate
treatment can decrease neurological
consequences and have a favorable
effect on the cardiovascular health
status of affected patients. Clinically
it consists in the obstruction of the
air flow during sleep that is caused by
a partial or total collapse of the upper
airway structures. These respiratory
obstructions are accompanied by

“snoring” and frequent arousals.
Patient have a number of symptoms: daytime sleepiness and fatigue, due to a restless sleep; morning
headache, loss of intellectual capacities and nighttime micturition. Sleep
apnea affects approximately 7% of
the adult population, but the problem may be underestimated, due
to the growing global prevalence of
obesity. For decades the continuous positive airway pressure (CPAP)
mask has been the treatment option of choice, but its’ disadvantages,
rejection and intolerance on part
of the patients complicate the optimum compliance of the therapy and
it has lost its therapeutic hegemony
compared to other available alternatives. This resulted in the necessity of
working on other solutions that are
equally effective but more tolerable.
New option of this new therapeutic line is based on the increas-

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ing interest in the application of oral
appliances, especially of mandibular
advancement devices. The use of
these devices is a simple, noninvasive and completely reversible treatment option that achieves many
advantages in comparison to other
treatment solutions by an easy and
immediate therapeutic way. These
systems underwent technological
developments in the last years the
treatments of choice for patients
who suffer from with snoring and
mild or moderate sleep apnea.
Why is important the treatment
of snoring and sleep apnea? Importance is based on the following reasons:
1. High prevalence in today’s society, as various studies have demonstrated in the last years. There exists
an incidence of 28% for snoring, approximately 49% of adults snore

frequently and 35% habitually. The
prevalence of OSA ranges from 6-8%
in males and 4-6% in women among
the general adult, middle aged population and this numbers increase
markedly with age.
2. It represents a problem in two aspects, the social that converts these
patients in intolerable bed partners
and the more serious clinical impact
of significant morbidity. These impacts can reach a noise level of about
78-88dB (equal to the noise of a truck
at high speed on a highway). The limit for hearing damages is estimated
at an intensity of 75 dB. Snoring disturbs social and family relationships
of patients. Its psychological pressure influences both lives, the daily
routine of people who snore, as well
as the every day life of people, who

ÿPage 29

[29] =>

research

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 28

Lateral view vertical dimension opening

Lateral view relevant jaw advancement with competent,
comfortable lips seal

DAM 1
AGE Median
(Standar Deviation)
SATISFACTION Median
(Standar Deviation)
SEX (% women)

DAM 2

Before
Before DAM
DAM 2
2

Table 2

IAM
IAM
IR
IR
IDO
IDO
EPW
EPW

7.7
7.7
9.17
9.17
3.93
3.93
8.6
8.6

49.1 (10.5)

48.2 (9.2)

0.644

4.5 (0.7)

4.6 (0.6)

0.983

Before
Before DAM
DAM 2
2

12.3
12.3
14.23
14.23
6.43
6.43
11.63
11.63

After
After DAM
DAM 2
2

5.17
5.17
8.23
8.23
2.93
2.93
6.07
6.07

7.12
7.12
10.67
10.67
4.47
4.47
6.73
6.73

P
P (Wilcoxom)
(Wilcoxom)

0.002
0.002
0.001
0.001
0.01
0.01
0.006
0.006

0.001
0.001
0.001
0.001
0.003
0.003
0.001
0.001

Table 3

Difference IAH
Difference IR

DAM 1
-3.43
-4.23

DAM 2
-4.17
-4.57

P
-0.333
-0.783

Table 4

suffer from the noisy consequences
causing problems in the partnerships.
3. Disordered breathing by sleep is
very habitual and, therefore, a constant source of problems regarding
health and economic impacts. Poor
sleep habits aggravate the impairments of health and quality of life
causing countless traffic accidents,
labor accidents and accidental home
injuries. The majority of these disorders lead to drowsiness in its clinical description, disabling affected
patients to drive. In all countries the
number of fatal accidents increases
constantly.
It s the first cause in men aged between 16 and 25.
4. The access to diagnosis possibilities is the major problem facing the
specialists, as only about 6 to 9% of
the population with relevant OSA
is diagnosed. Clinical researchers
seek for diagnostic alternatives to
the costly polysomnography that
is currently the first diagnosis commendation (6). The OSAS is rarely
known to the public. The lack of diagnosis is the main medical problem
to solve. Recent studies show that in
only 7% of medical examinations of
primary care, explicit references regarding possible sleep disorders are
included. This incorrect diagnosis
involves fatal consequences because
the pathology is ignored by patients
that, without being diagnosed, do
not know how to justify and cope
with the symptoms that they face
day by day.
To conclude, school and work absence and the reduced capacity at
work also cause economic damages.

Objectives and hypotheses
Hypothesis
Mandibular advancement devices
(MAD) are efficient for the treatment
of snoring and mild to moderate
sleep apnea.

Frontal view initial opening , visible screw

Exclusion Criteria

Table 1

IAM
IAM
IR
IR
IDO
IDO
EPW
EPW

Frontal view with lateral excursion for patient comfort

Objectives
1. Applying a nocturnal cardio-respiratory and pulse oximetry monitoring (“ApneaLink”) in a qualified
“snorer” population evaluating the
OSA grade (mild/moderate) and if
the patient is a candidate for MAD
treatment.
2. Describe the clinical findings of
the situation before and after treatment with two types of mandibular
advancement devices in a series of
adult patients.
3. Comparative analysis of the effectiveness of mandibular advancement devices by means of objective
and subjective criteria.
4. Evaluating the possibility of implementing this system as an efficient method for the treatment of
mild or moderate OSA and cases that
do not tolerate CPAP.

Methodology
Description and subject group
selection
The study group consists of 30 snoring adults, with mild/moderate
sleep apnea, aged between 36 and
68 years, 8 women and 22 men, who
were treated with a mandibular advancement device (MAD).
A complete dental examination
was performed to get more detailed
information about TMJ and dental
and bone structure. It included: periodontal and dental examination,
panoramic radiography and lateral
cephalometry, evaluation of the
tongue and soft tissues and, finally,
possible occlusion defects.

Inclusion Criteria
- Snorers
- The patient should have the ability to advance the mandible forward
and open it without significant limitations.

- Patients with severe OSAS
- Patients with rhino-pharyngeal pathology
- Inappropriately dentition, periodontal diseases without treatment
- Serious problems in the temporomandibular joint (TMJ)
- Insufficient protrusion capacity

Methods
1. Cardio-respiratory polygraphy
2. Epworth test
3. Dental impressions
4. Appointment for adaptation and
user instructions

Used devices
Although there exist over three
hundred systems of mandibular advancement devices, we have tested
two devices that have, in our opinion, a greater international presence
placing them randomly among our
study group. The used devices were
intraoral with lateral excursion,
opening and protusion appliance
and the TAP appliance (Figs. 1 and 2).

Procedures
The study and evaluation were performed by the same professional
with over 20 years of experience in
the treatment of mandibular advancement devices. Objective and
subjective assessments were performed prior to placement and after
one month of treatment.
The study subjects had to fill in the
Epworth test and undergo the ApneaLink after one month of treatment; they underwent also a questionnaire of satisfaction that the
subjects answered in collaboration
with their partners. This test evaluates the satisfaction of both regarding a better quality of life and noise.
The analyzed variables were: age, sex,
MAD type, AHI before and after the
MAD therapy, risk index before and
after MAD therapy, Epworth index
before and after MAD therapy and
the level of satisfaction of the patient
and his partner after MAD therapy.

Analytic study
In table 2 the mean values of the received indices before and after using
MAD1 during one month are compared.
The comparison of the parameters was taken by the Wilcoxon test,
as it is about paired and small quantity data. In table 3 the same analysis
for MAD 2 is repeated.
As reported in table 2, MAD1 has
decreased the mean value of all indices, this diminution is statistically
significant (p<0.005) in all indices.
Also in the use of MAD2 appeared a statistically significant
(p<0.005) diminution of all indices.
To compare both MADs we calculated the mean values of the differences between the indices before
and after using each MAD. In table
4 the mean values of the differences
(index after MAD – index before
MAD) for each type of MAD and its
comparison through the test of the
U of Mann-Whitney is reported, as it
is about two different sample groups
and the group size is relatively small.
It can be evaluated that MAD2

“Bad sleep is threatening the overstimulated,
overworked masses
with disease and even
an early death”
achieves a greater reduction of all indices than MAD1, although the only
statistically significant parameter
(p<0.005) is the EPW.

Conclusions
1) With regards to the medical complications of snoring and OSA and
the social restrictions and the negative effects on the quality of life
the physician should identify the
patients that need support. It is a
public health problem that can be
easy diagnosed and treated. Recent
studies even demonstrated that the
consumption of public resources is
2-3 times higher in patients with non
treated snoring and OSA than in the
population without OSA.
2) Totally advisable for all patients
to obtain an objective valuation of
the multidisciplinary diagnosis results. The specialist should perform
a clinical diagnosis, a prior nocturnal
monitoring and, after a period of
adaptation, a new clinical valuation
and objective and subjective examinations. The experienced specialist
dentist in the treatment of sleep
apnoea with MADs should select
adequate cases, perform design and
adaption of the devices and control
possible side effects through a regular follow up.
3) We prove the efficiency of the
mandibular advancement devices
was proven. In both cases the mean
values of all indices decreased and
this diminution is statistically significant (p< 0.05) in all indices.
4) Analysis of the efficiency between
both types of MADs shows that the
screw Lateral excursion, opening
and protusion appliance achieves
a greater reduction of all indices,
although the only statistically significant index was the Epworth test
result (p<0.05).
5) Our medical trial should be performed through a cost and efficiency
analysis, as the basic advantages of
the treatment, like the decrease of
the morbidity rate in the long and
short term, are very evident.
6) This study support the use of
cardio respiratory polygraph monitoring for the evaluation of sleep
apnea detection in subjects of high
probability of disease suspicion and
a high prevalence or in populations
of high prevalence of sleep breathing
disorders. Although the controlled
PSG is the standard diagnosis tool for
sleep apnea, not all patients have access to such a study in the sleep unit.
The sleep unit installations could
differ from the patients sleeps standards, there exist long waiting lists in
the neumology services, the sleep
study is connected with high costs

and the patient’s willingness to sleep
one night in a sleep unit undergoing
a nocturnal PSG without confirmed
OSAS could be very low. This results
show that the cardio respiratory polygraphy is a useful complementary
technology for the diagnosis of sleep
apnea, due to the sensibility, specificity, and simple use of the device and
the resulting low costs of the sleep
study. The cardio respiratory polygraphy can be useful in situations
where the PSG is a practical principle
or in populations with high prevalence of sleep apnea supporting the
options of diagnosis and treatment.
This could lead to a timely evaluation of sleep apnea and a better attention to the patient causing a better health status and life style.
7) Can be conclude that the adjustable mandibular repositioning device
is an efficient treatment alternative
for patients with snoring and sleep
apnea. The severity of the OSAS motivates the specialist to get a better
knowledge about it and makes him
aware of the importance of its multidisciplinary character. Including
the participation of a dentist that is
well experienced in the treatment
of OSAS patients through the use of
MAD, a treatment alternative with a
high patients’ acceptance, because of
its low treatment costs and high efficiency being an individualised treatment option or in combination with
other treatments.
8) It s a good recommendation that
the public health authorities formulate a valid preventive dentistry plan,
as it was demonstrated that the sleep
apnea problem is a sanitary priority
of high relevance because the efficiency of mandibular advancement
devices for the treatment of snoring
and mild and moderate sleep apneahypoapnea.

Dr Luis Gavin.
Stomatologist,
Oral & Maxillo Facial Surgeon; Med.
Consultant (Spanish & UAE Board).
Areas of Expertise: Oral & Facial
Surgery; Top Dentistry;
TMJoint;
Sleep Medicine;
Med Wellness and
Special Medical Needs. Contact: info@
drluisgavin.com; www.drluisgavin.com;
facebook.com/drluisgavin
Facilities: Abu Dhabi; Dubai; Marbella

[30] =>

general dentistry

The New Frontier of
Interceptive Aesthetic
Orthodontics

Dental Tribune Middle East & Africa Edition | 2/2016

Dr. Tif Qureshi is a speaker at
11th CAD/CAM & Digital Dentistry Int'l Conference!

06-07 May 2016 | Jumeirah Beach Hotel, Dubai, UAE

How the simple “3 –Step Smile” can offer far more than you might realize. Dr. Tif Qureshi,
discusses how the treatment of mild and moderate crowding has far more than just cosmetic
orthodontic objectives.

By Dr. Tif Qureshi, UK
Currently in the market of dentistry
it seems as if they are 1000 shortterm orthodontic systems out there.
The term “cosmetic orthodontics”
has been around for a little while but
in this article we are going to take
an alternative view of what we can
achieve. The problem with the term
“cosmetic” is that it often suggests
things are being done just for visual
reasons. This article will argue that in
treating mild and moderate crowding cases we are potentially carrying
out an interceptive functional treatment.
There have been criticisms from
people suggesting that the cosmetic
orthodontics and short term orthodontics causes anterior flaring and
loss of control of the anterior occlusion. This may be true if there has
been no arch evaluation/ planning
or space creation strategy. If these
things have been carried out then
actually the opposite is true, and
arguably every better control of the
anterior occlusion than in any other
form of orthodontics.
This article will also look how simple
three-step approach can massively
improve the patient’s appearance,
their function and intercept the
continual crowding life causes more
problems without the need to pick
up a drill or damage any teeth.
This three-step approach we call the
‘three step smile’ through alignment
bleaching and bonding. With the
right components carried out at the
right time it is possible to make the
patient’s own teeth look more beautiful without the need for porcelain
veneers or other irreversible procedures.
The most important article in dentistry that the profession seems to
miss! Br J Orthod. 1990 Aug; 17(3):23541. Stability and relapse of dental arch
alignment.

Little RM
1. Arch length reduces following orthodontic treatment, but also does
so in untreated normal occlusions.
2. Arch width measured across the
mandibular canine teeth typically
reduces post-treatment whether
the case was expanded during treatment or not. 3. Mandibular anterior
crowding during the post-treatment
phase is a continuing phenomenon
well into the 20-40 age bracket and
likely beyond. 4. Third molar absence
or presence, impacted or fully erupted, seems to have little effect on the
occurrence or degree of relapse. 5.
The degree of post-retention anterior
crowding is both unpredictable and
variable and no pretreatment variables either from clinical findings,
casts, or cephalometric radiographs
before or after treatment seem to be
useful predictors.
This 40 year study is so important

ÿPage 32

Fig 1. Uppers treated lowers left 30 years on

Fig 2. Uppers treated lowers left 25 years on

Fig 3. Relapsed comprehensive treatment

Fig 4. relapsed comprehensive treatment

Fig 5. Before treatment 2004

Fig 6. After treatment weeks later 2004

[31] =>

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the simulated patient, on-screen visual tracking of
the procedure s/he is performing, real-time digital
feedback and evaluation of procedures performed.

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[32] =>

general dentistry

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 30
for two main reasons. The first highlights the point now widely accepted
that retention after orthodontics is
for life.
The second point is even more important- that in adults with mild or
moderate crowding, the arch length
will reduce regardless of whether the
patient had orthodontics or not.
This is a critical point for all dentists
to understand especially anyone
carrying out restorative treatment.
That is the teeth you have restored,
that you may expect to remain same
position through life will keep moving and the functional contacts will
change. It is one typical reason why
composite fillings classically chip on
the front teeth. Basically if you have
crowded it will get worse and arch
width will collapse which may have
an effect on the patient’s guidance.
It also means that lower incisors,
which have wear facets due to crowding caused by irregular dynamic contacts, will get worse and wear faster
causing more dentine exposure and
darkening from the soaking of stain.
These two patients were told 25-30
years ago that the upper teeth needed treatment but the lowers were
not crowded enough to treat. At the
time they were not that crowded, but
over time as per the findings of Little’s study the teeth have continued
to crowd causing the evident result.
(Fig. 1,2)
These two patients both had comprehensive orthodontics but no
fixed retainers were used and no
long-term follow-up was carried out
by their orthodontist -as a result the
patient teeth relapsed almost to the
original position. (Fig 3,4)
This patient was treated 10 years ago
for mild crowding having relapsed
3 years after comprehensive treatment. There was differential tooth
wear already visible and at the 10

““Three step smile” alignment
bleaching and bonding, with far
less risk, better consenting
and arguably a far more
natural outcome than traditional
veneer preparations.”
years follow up there’s been no irregular wear because the teeth have
been held in the correct position.
Her teeth were aligned with an Inman Aligner in 4 weeks and fixed
retained. The original retainer has
remained in place for 10 years. Being
a regular patient, in GDP practice, the
retainer can be reviewed at correct
intervals. (Fig-5-7- Lucy)
This patient was only 21 and her
crowding was getting worse, as was
the differential tooth-wear on her
lower teeth. Her canine guidance was
collapsing and she was slowly moving into group function. Her lower
incisors were starting the wear differentially. After aligning her teeth in
9 weeks and fix- retaining, her canine
width was increased and held, function returned and 7 years later there
has been barely any increase in wear
in the lower edges Fig. 8 Cara.

Detailed case
This case example will go through
the steps needed for the three-step
smile, and outlined planning and
consenting processes involved.
This patient presented originally
wanting porcelain veneers. However
he was aware of the high costs and
that it would involve heavy preparation on his teeth so he decided to
consider aligning his teeth. When he
was shown the results possible with
combined bleaching and bonding
the patient decided against veneers
altogether.
After a full examination and orthodontic assessment, our first step was
to decide on a landmark reference
tooth. This is a tooth, which is considered aesthetic by the patient and
aesthetic and functional to the clinician.

An Arch evaluation and an occlusal
trace is carried out with this reference point in mind using Spacewize
software, so that the 3-D setup created by the technician following the
exact prescription of the dentist. In
this case it was decided that the canines were in an ideal position so
we certainly should not be flared on
the set up. The curve strictly dictated
the position to be achieved (Fig SW
trace).

Simultaneous bleaching

It was discovered when considering
the landmark point in looking at
a chin up view, that to achieve the
ideal upper position, a lower tooth
was in the way and would need treatment. (Fig)

At two weeks notice a significant improvement in the tooth colour.
A mockup outline was carried out
using flowable composite- and the
patient was happy with the proposed build-ups, which involved 4
teeth.

A full 3D digital setup was produced
by the laboratory based on this curve
- this was checked by the dentist before going ahead. A 3-D model was
then produced the before and after
positions. The patient has shown the
print before any aligners were built.
This ensured he was fully consented
that he understood the potential
compromises of only treating the
anterior teeth. The patient reviewed
the models in his hand and was happy with what was proposed. The 3-D
models were returned to the lab and
an upper Inman aligner and lower
Clear Smile aligners were built on
the setups.
A full Inman Aligner space creation
guide with provided that outlined
not only IPR but also PPR (predictive
proximal reduction) -understanding
this makes the difference between
average aesthetic and superb aesthetic results.

Towards the last part of treatment
bleaching trays were made the patient started bleaches teeth simultaneously. Impressions were taken
and super sealed trays were made
on the nearly aligned teeth - 6% Day
white whitening from Philips was
given to the patient with full instructions. He carried out whitening once
to twice a day for 35 minutes at a
time.

Edge Bonding

step smile” alignment bleaching
and bonding, with far less risk, better
consenting and arguably a far more
natural outcome than traditional
veneer preparations. With upper
and lower fixed retainers in position
canine widths and guidance can also
be maintained meaning reduced
chance of composite fracture better
long-term function and better longterm aesthetics. The 2 year follow up
showed no changes in occlusal contacts or shifts in guidance.

2 weeks later the edges were permanently built using Venus Diamond
and a very simple 2-layer reverse triangle technique. No preparation was
required.
The retainer was fitted on the same
day using a jig made on an impression post alignment. This was bonded using Venus Flow.

Conclusion
One can see the natural- looking end
result of this patient. He was thrilled
with the fact that the treatment simply made his own teeth look as good
as they possibly could, rather than
totally changing his appearance and
feeling as if someone else’s teeth
were in his mouth. More significant
is the fact that this could be done by
any dentist with the simple “Three

Dr. Tif Qureshi, UK.
He is a Director of
Intelligent Alignment Systems.
You can learn
about the Unique
mentored Pathway of Learning
from IAS starting
with Inman Aligners and Clear Smile
Aligners, then Clear Smile Braces right
up to Clear Smile Advanced taught by
Professor Ross Hobson by visiting www.
Iasortho.com
Dr. Tif Qureshi will give two hands-on
courses at 11th CAD/CAM & Digital Dentistry Int'l Conference in Dubai.

Progressive space creation was carried out over a period of 12 weeks.
The patient’s teeth started to align.

Fig. 7. 10 years after IA treatment 2015

Fig. 8. Before treatment 2007

Fig. 9. 9 weeks later 2007

Fig. 10. 7 years later

Fig. 11. Before treatment

Fig. 12. 9 weeks later

Fig. 16. Chin up view before

Fig. 17. Printed model set to spacewize

Fig. 21. Before treatment

Fig. 22. 2 year review

Fig. 14. Occlusal view
Fig. 13. 7 years later 2014

Fig. 15. Spacewize through landmark points

Fig. 18. Before treatment

Fig. 19. After 3 step smile

Fig. 20. Occlusal after treatment with retainer

[33] =>

Dental Tribune Middle East & Africa Edition | 2/2016

general dentistry

“Never stop being curious and
open for new things”
An interview with Dr. Gun Norell
By Dental Tribune MEA/CAPPmea
Dental Tribune MEA & CAPPmea
spoke with Dr. Gun Norell about Inman Aligner Academy.
Dental Tribune MEA/CAPPmea: A true
pleasure having the opportunity to interview Dr. Gun Norell. You have been
quite active in the Middle East since
2007 now. Could you elaborate on
your experience in the region and the
experience behind working in Dubai
as a dentist?
Dr. Gun Norell: To work as a Dentist in this region has been a wonderful experience but also a great challenge since we have a multicultural
population. Everyday I meet patients
with different needs and complaints.
Some of them need comprehensive
multidisciplinary treatments while
other patients only need small cosmetic treatments. It is very important to listen carefully and respect
every individual patient. This means
I continuously have to develop my
skills.
You have famously become an advocate for minimal invasive dentistry
and the Inman Aligner Academy, how
were you first exposed to the possibilities behind the Alignment, Bleaching
and Bonding concept/treatment and
why did you start?
First time I heard about Inman
Aligner was in the US when I attended a meeting AACD (American
Academy for Cosmetic Dentistry)
and talked to a Swedish colleague.
She told me about the Inman Aligner
and the concept with bleaching and
bonding. This immediately caught
my interest so I signed up for next
Certification course in London 20011.
After the course I couldn’t wait to get
back to Dubai and start treating my
patients this way. Finally I had the
knowledge and the treatment to give
my patients a great smile in a fast,
safe and predicable way that fits the

often misaligned and discolored. If
you cut these teeth and fit them with
veneers you put them into a great
risk for further treatments later on.
The gum line recede by the time and
veneers usually has to be replaced after 10-15 years.Each time you replace
the veneers you remove more tooth
substance. Therefore veneers should
be the last resort.
To align the teeth the minimal
invasive way with the Inman Aligner
before bleaching and bonding with
composite gives you a natural beautiful smile with white and straight
teeth for life.
How do you best describe the Inman
Aligner as a concept and its integration into the Alignment, Bonding and
Bleaching package?
What has been revolutionary
with Inman Aligner is to show how
you can combine different kind of
treatments in a way that has not
been described before and since the
GP can do all treatment it is available
for all patients.
When should dentists use the concept
of the Academy and how long can
each treatment last before the patient
is happy with the results?
IAS training doesn’t stop there,
however, a learning continuum
has been developed that encourages clinicians to carry on refining
their practical skills and experience
through a range of additional courses, study clubs, workshops and online resources. Full case mentoring is
also provided and new users can submit their first completed cases for review and evaluation the online support to achieve full accreditation.”
If dentists in the MEA region would
like to use The New Concept of ABB,
they should first attend the certification course of the Inman Aligner Academy. What exactly happens during

“The Inman Aligner
treatment has been a
great success from
the very beginning and
the treatment usually
only takes 6-16 week”
lifestyle of most people in UAE. As
predicted, the Inman Aligner treatment has been a great success from
the very beginning and the treatment usually only takes 6-16 week.
With the experience you have in the
region, why is minimal invasive dentistry so important for the patients as
opposed to invasive dentistry?
Most people want white, straight
teeth and a beautiful smile but they
do not understand the full procedure for different treatments. My
patients in this region are young
and that means most of them they
have healthy front teeth but they are

the hands-on course and how does
this guarantee certification?
The hands on course is structured in these different parts. Introduction, philosophy and terminology, applications and movement
summary, case diagnosis and selection process, occlusion and arch
planning, treatment execution IPR/
Anchors, finishing and retention,
case discussion and troubleshooting,
case submission process, support,
marketing and implementation. To
guarantee certification we recommend to submit the two first cases
on the Inman Aligner forum online
so you can be guided to execute

Dr. Gun Norell, Sweden
the treatment.
Would you like to share anything additional with our readers?
Never stop being curious and
open for new things - even if you

are not convinced from beginning.
It is never too late to learn new techniques. Always listen to and be honest with your patient - that will make
you trust you and feel confident with
you. For me Inman Aligner truly

change my way of thinking of Dentistry. After 30 years in the business
I’m still excited every morning going
to work to see what each new day has
to bring.

[34] =>

ortho tribune

4D Orthodontics
From Morphologic Diagnosis to Time Factor
By Dr. Matteo Beretta, Italy and Dr.
Nunzio Cirulli, Italy

Where do we stand now in
modern orthodontics?
New methods of orthodontics
take great advantage of digital technologies. They do this by preparing
an individual treatment plan for
the patient, which addresses his/
her complex needs. Such a plan factors matters of biocompatibility and
sustainability, which might not be
exclusively related to his/her orthodontic problems.
Our research in this area has recently been exploring new scientific
grounds that focus on the question
of how new technologies could effectively change the way we diagnose
health problems and plan the corresponding treatment.
A new player is emerging in the tridimensional era, the 4D technology!

What does it mean? Can we
talk of a new revolution in applied science?
In 2007, Tiziano Baccetti and
Lorenzo Franchi, in their systematic
review, entitled “Efficacia e timing
della terapia della malocclusione di
II Classe con apparecchi ortopedicofunzionali”, concluded that the inclusion of the pubertal growth spurt
in the determination of the treatment timing could be considered a
key factor in reaching maximal efficiency of the functional therapy of
the mandibular growth (Ref.: Ortognatodonzia Italiana vol. 14, 1-2007:1320).
This means that the correct timing of the treatment could be a major
prerequisite to accomplish its main
objectives. The “timing requirement” is by far a very clear concept
but it can be further enhanced by
adding an extra degree of dynamicity. Let’s see how!
To do this we have to go back in
time …. looking for studies on the
same subject matter.
In 1956, Harold D. Kesling, in an
article published in the American
Journal of Orthodontics, entitled
“The Diagnostic Setup with Consideration of the Third Dimension”,
said:
Good orthodontic casts not only
provide exact duplicates of every
tooth in the mouth, but they also
give a fairly accurate pattern of the
apical base. Since neither the apical
base nor the tooth size can be altered
materially, some intelligent rearrangements of the plaster teeth, as
it appears on the model, can remove
confusion arising from pure speculation by replacing it with concrete
objective manipulation.
In short, he have just invented
the morphologic diagnosis and the
diagnostic set up.
Harold D. Kesling further noticed: Without dissecting the teeth
from the orthodontic models and
rearranging them in the most desirable positions on the available apical bases, the orthodontist can only
speculate on available options and
limitations of the treatment. (Ref.:
Am. J. Orthodontics, October 1956,
vol.42 N°10, pages 740-748)
Dynamics is the branch of mechanics interested in studying bodies’ motion and its causes or, more
clearly, the circumstances that determine or modify it.

Orthodontics is gradually evolving towards a more dynamic concept
of occlusion, of functional harmony
and biologic/mechanic interconnection.
Luckily, the progress from the
old “static concept” of Class I occlusion to the present concept of functionally supported occlusions is not
completely new to the orthodontists.
This is what W.J. Thompson
wrote in 1979 in his article in Angle Orthodontist entitled “Occlusal
Plane and Overbite”. (Ref.: Angle Orthodontist, 1979 January 49(1):47-55.).
Hence, we are not talking of a
new concept!
What can these two studies offer
to orthodontists?
Form and Function, this is what
our teachers have taught us to make
a correct diagnosis, to set a proper
plan of health care and to define the
objectives of stability and, above all,
the maintainability of the results of
our orthodontic treatments
Let’s see a clinical example of
how form and function determine
diagnosis and prognosis!
A patient aged 25 was orthodontically treated in the past with fixed

Fig. 1. Frontal view

Dental Tribune Middle East & Africa Edition | 2/2016

Dr. Matteo Beretta & Dr. Nunzio Circulli, Italy
are speakers at
11th CAD/CAM & Digital Dentistry Int'l Conference!

06-07 May 2016 | Jumeirah Beach Hotel, Dubai, UAE

orthodontic appliances. He came to
our attention due to progressive recession of 4.1, increase in sensitivity,
and difficulty to maintain proper
oral hygiene. The patient has unnecessarily been brought to us for periodontal surgery. Upon examination,
we discovered severe gingival recession of 4.1 associated with buccal root
inclination and traumatic contact
with the antagonist for extrusion. It
also featured a fixed lower retainer,
from 3.2 to 4.2, repeatedly repaired.
(Figures 1-3)
The old fixed retention previously managed incorrectly has become
an active retainer on 4.1 with buccal
root torque unchecked. A proper
morphologic diagnosis must consider the three-dimensional position of
the root in the alveolar bone and not
just detect the buccal gingival recession, whose single consideration has
already led to a treatment failure.
The treatment plan involved: (a)
removing the old retainer and fixing
a lingual appliance by self-ligating
brackets i- TTЯ from 3.4 to 4.4 with
the purpose of aligning the lower
frontal teeth; (b) correcting the root
torque of 4.1; and (c) eliminating the
occlusal trauma to allow recovery

of an adequate periodontal health
conditions and secure maintainability. The required correction has
been completed in 8 weeks from
the removal of the old retainer and
the simultaneous bonding of the
lingual orthodontic appliance. The
buccal gingival recession of 4.1 has
improved significantly, only thanks
to its repositioning in an appropriate periodontal environment, which
has also improved the conditions
for maintainability. The lingual appliance, very well tolerated by the
patient, is maintained as a fixed retainer. (Figures 4-8 )
In this case, an orthopantomography had been done before the
treatment, which made no apperent
morphological contribution to the
clinical diagnosis.
Should a tele-radiography have
be useful in this case?
Obviously not! How could we
then make any use of tele-radiography?
In an editorial in the American
Journal of Orthodontics of 2008, David L Turpin says:
If the intraoral palpation of maxillary canines in an 8 year-old child
is difficult and there is a reasonable
suspicion for a complicated eruption, you should consider doing a
tele-radiography!
In the same editorial, we found
the following recommendations by
the British Orthodontics Society:
- a radiography should be done
only after an accurate clinical examination and when it offers an effective
diagnostic advantage for the patient;
- generally, the advantages of a
radiographic survey exceed the risks;

when the patient has a health advantage with the ALARA dose (ALARA: as
low as reasonably achievable) (Ref.:
Am. J. Orthodontist Dentofacial Orthop. 2008;134:597-8)
A review of relevant literature in
the University of Oporto, Portugal,
published in Progress in Orthodontics in 2013, entitled “Validity of 2Dlateral Cephalometry in Orthodontics: a Systematic Review, reveals:
The literature suggests that the
lateral cephalometry has been applied without adequate scientific
evidence, irrespective of whether it
is mandatory for the diagnosis and
without regard to its therapeutic efficacy. (Ref.: Ana R Durão1, Pisha Pittayapat, Maria Ivete B Rockenbach,
Raphael Olszewski, Suk Ng, Afonso
P Ferreira and Reinhilde Jacobs. Progress in Orthodontics 2013 14:31; 3-11)
This article, as many other publications, recommend that additional
research is required on a larger number of patients to clarify better the
matter. The message is pretty clear.
The cephalometry has been used
in orthodontics for long time for diagnostic purposes and for training of
generations of orthodontists, which
helps them understand better the
significance of angles and planes.
It does nothing more than express
numerically what patients’ maxillary and cranial bones morphology
provides.
Of course, with study and experience as fundamental preconditions,
wise orthodontists would likely not
need those numbers at all.
Moreover, could we do the cephalometry without radiation for a pa-

- the risk level is justified only

ÿPage 35

Fig. 4. Lingual appliance

Fig. 2. Detail of 4.1

Fig. 5. Frontal view at the end of treatment

Fig. 3. Occlusal view

Fig. 6. Occlusal view at the and of treatment

[35] =>

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†
Defined as non-antibacterial fluoride toothpaste.
References: 1. Fine DH, Sreenivasan PK, McKiernan M, et al. J Clin Periodontol. 2012;39:1056-1064. 2. Collins LMC, Dawes C.
J Dent Res. 1987;66:1300-1302.

[36] =>

Dental Tribune Middle East & Africa Edition | 2/2016

ortho tribune

◊Page 34
tient?
In his Master’s Thesis in Orthodontics at the University of Insubria,
which is expected to be published in
some time, Dr. Piero Antonio Zecca,
demonstrates the superimpossibility of data obtained from a traditional cephalometry and a cutaneous
cephalometry from a 3D scanning
of the patient’s face, without any further radiation.

What does it mean?
The Digital Disruption is deeply
changing our way to work as orthodontists. It is the moment when
new technologies generate a major
change in an established activity and
totally modify the previous model.
Professor Clayton Christensen at
Harvard University, who has invented the Digital Disruption tool, has
demonstrated how such a change
took place many times in the past
but, while once it was a high cost
deal with a very long period of implementation, today - with digital
technologies coming into play - the
process has stepped up considerably.
Disruption and innovation are interrelated! Is disruption the only way
to innovate? According to Professor
Christensen, it is the best way to do
so because when digital instruments
do the innovation, the result is much
better.

From 3D to 4D
Starting by the intraoral digital
scanning of the dental arches, we can
obtain virtual models and the occlusal details of a patient can be analysed and measured, without resorting to stone models. This technology
was not conceivable at all some years
ago.
A digital set up of orthodontic
movements can be performed on
such virtual models to simulate and
define treatment objectives, to project appliances and to develop skills
how to apply it.

Fig. 7. Follow up after two years

Fig. 8. Follow up after two years: note the presece of healty gingiva

Fig. 9. In red the ideal set up of 3.3 without considering the real anatomical
limits: the root is outside the bone

Fig. 10. In blu the lower arch set up considering the bone limits of the patient

During the treatment, new virtual models can be obtained by further
digital scans of the dental arches,
which may be superimposed on the
initial ones, if desirable. In this way,
it is possible also to monitor the progression of the therapy.
In more complex cases requiring morphologic diagnosis, it is
possible to superimpose the digital
models and the 3D reconstruction
of the maxillary bones and the roots
obtained from the CBCT. By specific
software, one can do a set up that
considers the real anatomical limits
of the radicular movement, which is

systematically the match to the set
up and, if necessary, restructuring it.
The follow up to our cases is
not any longer confined to controls
administered after the treatment. It
becomes a dynamic concept, where
time does not tell us what we have
to do with the orthodontic therapy,
if we identify the right moment of
treatment.
The virtual follow up tells us
what is happening today, now, beyond what our eyes see and with
maximum care for the patient.
4D Orthodontics introduces a
diagnostic fourth dimension, which

named “set up bone safe”. (Figures
9-10).
In this case, the virtual tooth of
the patient is obtained by mixing
the crown derivated from the intraoral scan and the root from the CBCT.
In this way, the radicular position in
the maxillary bones could also be
defined during and at the end of the
treatment by repeating the intraoral
scan, without further exposure to Xrays.
It is thus possible to monitor the
real progression of the orthodontic
treatment, respecting the anatomical limits of the patient, evaluating

relates to the time that flows and
communicates with us.

References
1. Ortognatodonzia Italiana vol. 14,
1-2007:13-20
2. Am. J. Orthodontics October 1956,
vol.42 N°10; Pag 740-748
3. Angle Orthod 1979 Jan;49(1):47-55.
4. Am J Orthod Dentofacial Orthop
2008;134:597-8
5. Ana R Durão1, Pisha Pittayapat,
Maria Ivete B Rockenbach, Raphael
Olszewski, Suk Ng, Afonso P Ferreira
and Reinhilde Jacobs. Progress in Orthodontics 2013 14:31; 3-11

CEREC Zirconia: Valued material
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Full contour zirconia has become a
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CEREC now provides a completely new process to dental practices: by
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Fig. 1: CEREC Zirconia can be dry milled with the CEREC milling and grinding unit.

Fig. 2: The new sintering furnace CEREC SpeedFire needs
10-15 minutes for crowns

Fig. 3: The product family for the chairside production of
CEREC Zirconia inthe practice (from right): CEREC AC with
Omnicam, the new CEREC SpeedFire sintering furnace as well
as the CEREC milling and grinding unit

furnace and CEREC Zirconia material,
dentists can now deliver full contour
crowns and small bridges made of
the full-strength high-quality zirconium oxide in their own practice
while the patient waits.

High strength, short manufacturing process
Fig. 4: Crown made from CEREC Zirconia after sintering.

Fig. 5: The CEREC SpeedFire sintering furnace is the smallest of its kind on the market and really saves time with a
sintering process that takes 10-15 minutes for each crown.

The greatest benefit of CEREC Zirconia is the high flexural strength of
the material.1 It is suitable for individual crowns as well as small bridges and can be processed in thin wall
thicknesses. Since these restorations

are manufactured in monolithic
form, there is no risk of chipping.
Another benefit for dentists is that
zirconium oxide can be cemented
conventionally.
CEREC Zirconia is a pre-shaded
translucent zirconium oxide available in 10 shades on the basis of the
VITA Classic Shade Guide®.
The material is milled in an enlarged form and then densely sintered to its final size in the new sinter-

ÿPage 38

[37] =>

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[38] =>

cadcam

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 36
ing furnace CEREC
SpeedFire.
The
over-sized milling
facilitates a new
level of milling accuracy leading to
superb, precisely
fitting
restorations. The sintering process takes
just 10-15 minutes
for crowns and
25 minutes for
bridges. The subsequent glaze firing gives the restoration a high gloss
finish.

Fig. 6: Experts on a small
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are small supports on which
crowns and bridges can be
securely fixed, allowing for
all-round glazing.

The short process to produce
CEREC
Zirconia
restorations
is
both convenient
and economical.
With this market launch, all CEREC
milling/grinding units now provide
wet and dry milling. Dry milling reduces the overall processing time
for zirconia and, combined with the
world’s fastest sintering cycles, enables the chairside procedure.

Fig. 7: The CEREC SpeedGlaze spray quickly gives the restoration its high
gloss. Spray on, fire for about 10-15 minutes and it’s ready.

It is obvious that advanced technologies in automobiles, computers
and smartphones make our daily

The workflow is easy to learn
since the CEREC Software 4.4.1 guides
the dentist through the entire process, and even sends the sintering
and glazing information to the furnace. No programming of the furnace is required – it is all handled
automatically by the software. A
high-performance material and a
specially tailored workflow ensure
a simple process and high-quality
treatment. CEREC meets patients’
needs Eighty three percent of patients in a recent survey said they
prefer single visit dentistry to traditional treatment. The majority said
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Patients avoid impression material,
receive fewer anesthetics and don’t
need a temporary.

lives easier. CEREC is also a technology that further develops a dental
practice and can make it well positioned for the future. Especially now,

Fig. 8: The CEREC SW 4.4.1 turns fabricating a restoration into a simple
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as the system is highly flexible, it
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[39] =>

interview

Dental Tribune Middle East & Africa Edition | 2/2016

“It is important for us to adapt our global
projects to the culture in the Middle East”
Interview with Dr. Patrick Hescot, former President of the FDI European
Regional Organization
By Dental Tribune MEA/CAPPmea
Dental Tribune MEA had the pleasure to interview Dr. Patrick Hescot,
President of the FDI World Dental
Federation who was present in Dubai
last February in order to promote
World Oral Health Day and celebrate
FDI global partnership with Philips
and to promote FDI 2016 in Poznán,
Poland later this year (7-10 September). During the exclusive interview,
Dr. Hescot shared his passion for
prevention including the transfer of
expertise to the regional dental societies around the Middle East region.
Dental Tribune MEA/CAPPmea: Dr
Patrick Hescot our pleasure to welcome you to the Philips booth at the
AEEDC meeting here in Dubai where
you are present to promote World
Oral Health Day and FDI Annual World
Dental Congress, amongst other
things. Can you share a little bit about
yourself?
Dr. Patrick Hescot: It is my pleasure

portance of oral health. Please share
your views on the overall partnership
and how you plan to transfer this to
the Middle East region?
It is a pleasure to work with Philips
whom I very much admire. We
have welcomed them happily to
our group of sponsors and supporters and once again congratulate
them for demonstrating their commitment to the cause of global oral
health awareness. The upcoming
World Oral Health Day is a perfect
example of the opportunity to position oral health where it belongs
and to demonstrate the importance
of prevention. Philips has a great
product and I recommend their electric toothbrush as an essential part
of maintaining a good oral health
standard.
As an advocate of prevention, what is
important for good oral health?
The main principle of the FDI has
always been to promote oral health.
It is important to prevent and main-

From Right to Left: Dr. Mounzer Srour - Sr. Business Dev. Manager Philips, Dr. Patrick Hescot - President FDI,
Ms. May Buhaisi & Mr. Chris Watts - Marketing Team Philips, Mrs. Henny Arstal - General Manager Castle
Trading (UAE Distributor Philips) and Mr. Tzvetan Deyanov - Dental Tribune MEA.

“It is important to prevent and
maintain good oral health
standards and this is what our
programs are all about.”
to be here. First of all, we are here to
stress the very importance of the
teamwork surrounding the World
Oral Health Day and how we can
transfer our experience to the regional dental associations and societies. As you may know, before
becoming the president of the FDI, I
have been involved in the FDI work
for over 20 years. I was the former
President of the FDI European Regional Organization, served on the
FDI council since 2007 and was designated President-Elect in 2013. Prevention has been a lifelong hobby of
mine and I have had the pleasure to
head the prevention campaigns for
the French Dental Association in the
last 20 years whilst further serving as
an advisor to the French Ministry of
Health.
FDI and Royal Philips recently signed a
global agreement to promote the im-

tain good oral health standards and
this is what our programs are all
about. The treatment stage is already too late, a good oral health lifestyle starts with our children in the
schools, the parents, the families, and
these are the people we need to educate on proper prevention. We have
to create a new process of oral health
and this process is about therapeutic
education, maintenance and again
prevention. We will be presenting
this extensively at the upcoming FDI
in Poznán where we aim to showcase
the new definition of oral health. We
welcome all dental professionals to
attend the FDI Annual World Dental
Congress between 07-10 September
2016 in Poland. The most important
for each person is their own self esteem which is greatly affected by
their oral health. It is impossible to
speak or live a good social life without good oral health.

What are the oral health challenges
you come across most in dentistry today?
One of the most important problems is Peri Implantis, one of the
long term risks associated with dental implants which is the infectious
disease causing inflammation of the
surrounding gum and bone of an
already integrated dental implant
which leads to the loss of supporting bone. FDI has a big focus on this
problem as there are many patients
nowadays with placed implants. The
problem is caused not only by bad
implants but also by improper dentistry and this is a condition which is
becoming very dangerous and FDI
has a focus to tackle this issue.
Working with Philips is very important because they must understand
electric toothbrush is good, dentsits
must receive explanation why it is
good. Manual vs electri.

Dr. Patrick Hescot, former President of the FDI European Regional Organization
being interviewed by Dental Tribune MEA.

Philips Sonicare booth in Dubai, UAE
How is the FDI transferring the knowledge to dentistry in the Middle East?
It is important for us to adapt our
global projects to the culture in the
Middle East which differs from Europe. Through our trip here in Dubai,
we have been able to meet and discuss with various dental societies
and associations such as the Qatari,
Omani and Saudi Dental Societies
the very importance of our programs and how they themselves can
carry these out in their own countries. Through the expertise and toolkits the regional dental societies can
educate their populations in their
respective countries. This is what the
World Oral Health Day is all about.
It is our duty to provide dentistry in

the region with the right tools to get
the messages across through promotion with an end goal to improve the
oral health of the children and the
families.
What are some of the examples of the
toolkits for WOHD?
There are various opportunities, in
Europe we work a lot at the schools,
it is very important to educate children at a young age who will communicate with the parents and the
families. Through activations at the
schools, events on the streets and
within the dental practices there
are numerous possibilities for the
regional dental associations to cam-

paign for a healthier smile, a healthier life. We have shared our papers,
posters, documents and toolkits
which are used globally during this
global World Oral Health Day. It is a
pleasure to see that several countries
have gone beyond and organized entire dental weeks in their respective
countries. The WOHD benefits all
and it is important that all have one
day one way, this is the FDI WOHD.
Thank you Dr. Patrick Hescot for your
informative feedback. We wish you
lots of success at the upcoming congress in Poznán, Poland between 0710 September 2016.

[40] =>

interview

Dental Tribune Middle East & Africa Edition | 2/2016

"Keep your natural smile on because
you are beautiful"
An interview with Dr. Rim Bogari
owner of Dr. Rim Bogari Dental
Center in Bahrain

By Dental Tribune MEA/CAPPmea
Dental Tribune MEA & CAPPmea
spoke with Dr. Rim Bogari.
Dental Tribune MEA/CAPPmea: Dr.
Rim can you tell us about yourself and
your work experience in Bahrain and
your Dr. Rim Bogari Dental Center?
Dr. Rim Bogari: My Name is Dr. Rim
Bogari, I am from Saudi Arabia living & working in Bahrain. I learned
the German language and concluded my doctorate degree from the
prestigious university of Berlin in
Germany. There has always been an
artistic side of me including drawing
and handcraft, my artistic side was
a major factor in choosing Cosmetic
Dentistry, the ability for me to realize the fusion between art and dentistry giving me the uniqueness to
my career and future ambitions. Dr.
Rim Bogari Dental Centre is just the
start of my dreams, it expresses my
passion and art fusion in Dentistry, I
wanted to create a new level in dentistry, creating my own signature of
outstanding quality & service.
What is the look and atmosphere of
your clinic? A typical dental Clinic?
Why do patients feel special with you?
Dr. Rim Bogari Center is a boutique
style Dental Centre with a Parisian
flare. It is a place that is so far from
your usual dental atmosphere, starting from the entrance where the patient would be exclusively welcomed
to a front desk and have their information filled in digitally. Our waiting area is a place where the patient
can relax before going into the treatment room, while having a great
view staring in the heart of the city
centre with relaxing music playing
in the background. Our patients will
always be offered to drink refreshments before their treatment. Our
treatment rooms have a panoramic
view overlooking the main road in
the heart of Bahrain. Our Dental Centre is happy to be the first to clinic
to have the Porsche Design Dental
Chair exclusively in our region. Our
patients feel different when treated
at our Centre and we provide them
with all the time needed to listen
and understand their needs carefully
before we try our best to reach what
both parties consider as the best
treatment plan. We have built extremely trustful relationships with
our patients which are important to

us not only during the treatment but
also after. Our clients are our guests.
You are the Country Chairperson in
the Gulf Region for the European Society of Cosmetic Dentistry (ESCD), how
have you taken on this responsibility
and what does it involve?
It is with pride and honour to be
the Gulf Chairperson of the ESCD,
it is a great Society that offers a lot
of updated knowledge in the cosmetic field. We meet in different
countries and offer lectures to our
members that would add to their
practice rich information through
known speakers from all over the
world. It is a great responsibility &
pleasure to have been delegated the
chairpersonship for the Gulf region
representing mutual values and best
practices amongst being part and
member of this prestigious society.
How do you see Cosmetic and Aesthetic Dentistry evolving into the future?
Cosmetic Dentistry is becoming the
main concentration in Dentistry especially in the last few years through
all dental fields with an aim to have
a beautiful smile as a final stage in
the treatment plan. Cosmetic Dentistry has developed a lot and we see
it becoming as minimal invasive or
non-invasive as possible, whereas in
the past dentists used to practice cosmetic dentistry with a lot of damage
to natural teeth. I really like the current and future direction of cosmetic
dentistry as it is completely trying to
stay as natural as possible and this
in my opinion is the hardest part,
where we try to keep the personality and the character of the patient
whilst enhancing the appearance of
the teeth in a very natural and much
less invasive way. It is a challenge for
us dentists and only a few can master
this.
We know you are very active in updating your dental education continuously, what motivates you to constantly
stay on the edge of updates, and how
do you make time ?
I always like to deliver to my patients the best and most advanced
treatments available. As dentistry
changes from year to year, if we
weren't up to date than i think we are
disappointing our patients who have
their trust and belief in us. Especially
if we are talking about cosmetic or

The waiting room - a boutique style Dental Centre with a Parisian flare.

Dr. Rim Bogari, Bahrain

“Cosmetic Dentistry is a Dental
Art Fusion between your natural
teeth, our art and passion, latest
technology and science.”
aesthetic dentistry, which is now the
talk of the town and has changed a
lot especially the last couple of years
due to all the advancements in Digital Dentistry. I think we can easily
describe it as the era of modern Dentistry. I am a mother with a kid and
it is so hard to balance between my
work and family life. I will not deny
that there are days where I cannot
see my child especially when I am
out of town visiting some courses
or conferences, but we all know that
building a career is not an easy path.
Will you be attending the upcoming
11th CAD/CAM & Digital Dentistry or
8th Dental Facial Cosmetic Int'l Conference by CAPPmea in Dubai this year?
Yes I will and I am waiting for that,
especially the Dental Facial Cosmetic Conference which has amazing
workshops and hands-on courses
every year. I think it is one of the best
conferences done in Dubai, if not the
best.

With such a busy schedule, how do
you combine personal life with your
work?
It is very hard to balance between
both especially for a person like me
who just established a Dental Centre
and is aiming for much more to grow
in the Gulf Region. I could say I think
less of myself as a woman and I am
fully concentrating on my work and
how to succeed. The most important
thing is to stay healthy and fit, sports
and having my own time sometimes
is a need. I could say that my family might miss me, but I know in the
near future I will be available much
more.
Do you read, follow Dental Tribune
MEA in the Region?
Of course I do as it is the largest Dental Newspaper in the world containing the latest up to date information
for us Dentists. Especially for dentists
who are interested in further education and in being always on the edge

The Dr. Rim Bogari Dental Center operating room

of Dentistry. I enjoy reading the articles, I have personally added much
value to my personal knowledge
from the dental tribune, thank you
for such a great newspaper.
Would you like to share anything else
with the readers?
I would like to thank you so much for
having me on board, I would like to
mention one important note to our
readers, nothing competes to the
natural beauty of yourself. Even in
Cosmetic Dentistry nothing would
come close to the beauty of a natural
tooth. Dentists should always concentrate on preserving the natural
teeth, we have to try and spread this
message out and change the concept of what real beauty is like. Being
natural is being yourself, even if we
are talking about having white teeth,
this could also be done in a very
natural way, Cosmetic Dentistry is
a Dental Art Fusion between your
natural teeth, our art and passion,
latest technology and science. So
keep your natural smile on because
you are beautiful!

Contact Information
Dr. Rim Bogari
Cosmetic Dentist
Gulf Chairperson ESCD
Dr. Rim Bogari Dental Center
+97333009008
+97317300114

[41] =>

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DIODE LASER COURSE (6 CPD/CME) - Lecture & Live Demo

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EXPECTED DHA ACCREDITATION:
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LASER IN PERIODONTICS - Lecture & Live Demo

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MODERN ENDODONTICS - Lecture & Hands-On

Prof. Philippe Sleiman, D.D.S., MSc, PhD

ULTRASONIC IN ENDODONTICS FROM ACCESS CAVITY TO REMOVAL OF SEPARATED FILES Lecture & Hands-On

Prof. Philippe Sleiman, D.D.S., MSc, PhD

MICROSURGICAL APPROACH FOR ROOT CANAL - Lecture & Hands-On

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FULL ARCH IMPLANT REHABILITATION UTILIZING THE ALL IN ONE ARCH TREATMENT CONCEPT
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THE AESTHETIC AND FUNCTIONAL REHABILITATON:
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Dr. Mauro Fradeani, D.D.S., MSc

THE TREATMENT PLANNING FOR SUCCESSFUL FULL REHABILITATION A COMPREHENSIVE PROSTHETIC APPROACH - Lecture & Hands-On

Dr. Dario Adolfi, D.D.S., C.D.T.

PREDICTABLE IMPLANT PROSTHETICS - An Intensive Lecture & Hands-On

Prof. Stewart Harding, D.D.S., MSc

“HEY, IT WASN’T THAT BAD” KNOW YOUR ANATOMY, IMPROVE YOUR ANESTHESIA - Lecture

Prof. Salam Hani, D.D.S., MSc

“THE ABC OF MANAGING MEDICALLY COMPROMISED PATIENT - Lecture

Prof. Salam Hani, D.D.S., MSc

“FROM ADVIL TO ZITROMAX, A DENTAL JOURNEY” - Lecture

Prof. Salam Hani, D.D.S., MSc

COMPOSITE ARTISTRY - CREATING ANTERIOR MASTERPIECES - Lecture

Dr. Newton Fahl, D.D.S.

MASTERING ANTERIOR AND POSTERIOR COMPOSITE RESTORATIONS A DIRECT & INDIRECT APPROACH TO DENTAL ARTISTRY - Lecture

Dr. Newton Fahl, D.D.S.

THE POLYCHROMATIC LAYERING APPROACH FOR CREATING ANTERIOR MASTERPIECES
WITH COMPOSITE RESINS - Lecture & Hands-On

Dr. Newton Fahl, D.D.S.

ACHIEVING EXCELLENCE WITH ANTERIOR COMPOSITES from “WHY” to “HOW TO” - Lecture

Dr. Newton Fahl, D.D.S.

MASTERING CLINICAL PHOTOGRAPHY - Lecture & Hands-On

Paul Macleod

MANAGEMENT OF GINGIVAL CERAMICS:
CREATING A BALANCE BETWEEN IMPLANT RESTORATION AND NATURE - Lecture & Hands-On

Jungo Endo R.D.T.

HOW TO ACHIEVE HIGHLY AESTHETIC ANTERIOR RESTORATION WITH TRANSLUCENT
MULTI COLOUR LAYERED ZIRCONIA - Lecture & Hands-On

Aki Yoshida R.D.T.

ATROPHIC MAXILLA - GUMS - Lecture

August Bruguera R.D.T.

CERAMIC CROWNS ZIRCONIUM OR DISLICATE?... STANDARD COLOUR OR PATIENT? - Lecture

August Bruguera R.D.T.

COURSE TOPICS TO BE ANNOUNCED SHORTLY - Lecture

Dr. John Kois D.M.D., M.S.D.

For Inquiries, please contact us at Vilafortuny Training Centre,
Al Wasl Road, Villa 728B, Jumeira 3, Dubai, UAE
email: cristina.cimpoi@vftdubai.com | Tel: +971(0)502416405
www.vilafortuny.com

[42] =>

practice management

Dental Tribune Middle East & Africa Edition | 2/2016

Assessing your practice success
By Dr. Ehab Heikal, Egypt
How is practice success determined?
This is not an easily answered question. It is virtually impossible to
point to one positive practice statistic. Yet in today’s fast-paced world,
everyone wants a quick fix. We are
programmed to want cut-and-dried
solutions and easy answers for everything. Unfortunately, there is no
simple equation to measure practice
success.
Sometimes it is tempting to
view overhead as the barometer of
practice success. The overhead is the
amount spent to generate a specific
sales amount (Fixed costs). It varies
from industry to industry, and since
reliable data is very rare in our, area;
thus I will use the example of the
average overhead rate in the west.
So for example, 40 percent generally is regarded as an ideal overhead
percentage for a general practice (It
could reach 60% as an ideal in USA).
In our area, it could be far lower, it
reaches 15% in some cases, yet I will
stick to the high measure international measure just for the sake of
the example.
So does attaining the ideal overhead ensure success? To answer this
question, lets consider and compare
three clinic or dental centers’ situations.
Dental Center A: has an annual production of $250,000 and overhead
of 40 percent. If having the ideal
overhead is all that matters, this
practice is successful. However, at
$250,000, production can be considered decidedly below average.

Determining success (Photo: Pixabay/geralt)

The center’s ability to invest in staff,
technology or continuing education
also is limited. By all definitions, this
center is unsuccessful even though
the overhead percentage may be on
target.
Clearly, overhead is not the true
indicator of success, yet magic numbers also are sought elsewhere. Many
view production as the only figure
that truly matters. High production
means a great deal of revenue is
coming into the practice; surely, that
is a good indicator of success.
Dental Center B: To address that issue, let us examine dental center B,
which has an annual production of
$1.1 million and an overhead of 85
percent. Although the production
of this center is extremely high, the

overhead is equally high. Should this
center be defined as successful? $1.1
million sounds wonderful. However,
appearances can be deceiving. Although the gross revenue measurement may be impressive, the reality
of everyday profit creates the same
scenario for this dentist as it does
for the one in center A. With both
having an approximate net profit
of $150,000 - $165,000, there is little
difference between centers A and B
at the end of the day.
Dental Center C: Now consider C, with
an annual production of $800,000
and a 50 percent overhead. Although
this center has an overhead slightly
higher than recommended, the
overall picture is much better than
that for either A or B. It is a good bet

that the dentist in C is substantially
better off. If center C is managed and
operated properly, the dentist will
have a fairly low-stress environment
with substantially higher profit.
The moral of the story: When
comparing these three centers,
keep in mind that the percentage
of overhead is not the only factor to
consider. It is only a ratio and always
needs to be viewed in context. Despite the excellent overhead of 40
percent, center A with $250,000 in
production cannot be deemed as financially successful as center C with
$800,000 in production and a 50
percent overhead. The same philosophy must be applied when assessing
all areas of the dental center to evaluate opportunities for improvement.

– Average production per new patient.
Only through consistent tracking of
critical KPI’s can the clinic truly determine its situation.
No single number or statistic
determines clinic success. A clinic
that relies on one statistic to determine the state of the clinic will not
achieve an accurate assessment. In
today’s increasingly competitive
field of dentistry, dentists must consistently analyze and monitor clinic
KPIs. Dentists who are keenly aware
of clinic performance are able to effectively adjust strategies to meet
the demands of our ever-changing
economic and technological realities
and achieve both professional and
personal success.

Key Performance Indicators (KPI’s)
We often tend to look at only one
aspect of the clinic’s performance indicators. Dentists need the total picture to determine the success of their
clinics and plan for the future effectively. It is unwise to rely on a single
number or statistic. For this reason,
you can use key performance indicators (KPIs) to determine the health of
your dental office.
The following KPIs are among the
most crucial for dental practices:
– Production (Total income)
– Profit
– Collections
– Production/collections ratio
– Number of new patients
– Number of referrals
– Total of accounts receivable (Uncollected payments from patients)
– Average production per patient

Dr. Ehab Heikal
BDS, FICD, MBA, DBA.
Practice Management
consultant. He can be
contacted at:
eheikal@gmail.com

[43] =>

*with twice daily brushing

Going beyond pain relief

[44] =>

[45] =>

www.dental-tribune.me

PRINTed in dubai

March-April 2016 | No. 2, Vol. 6

Dental Hygienist Seminar to take place
for fourth consecutive year organized
by CAPP in Dubai
The event will include eduaction through engagement and exhibition

By Dental Tribune MEA/CAPPmea
DUBAI, UAE: Centre for Advanced
Professional Practices (CAPP) will
be hosting the 4th Dental Hygienist (DHS) Seminar attracting the regions dental hygienists to Jumeirah
Beach Hotel on 05 November 2016.
Attendees will have the opportunity
to attend various accredited lectures
and hands-on courses throughout
the week of the 8th Dental Facial Cosmetic International Conference on
04-05 November 2016 in Dubai.

With an increased focus on the Dental Hygienist profession, clinics in
the Middle East are becoming progressively aware of the importance
of having a complete dental team
which includes the dental hygienist
professional role. A career as a dental
hygienist offers a wide range of challenges and continuous education on
the latest techniques and methods is
a must. In the dental office, the dentist and the dental hygienist work together to meet the oral health needs
of patients.

Beautiful view at Burj Al Arab. (Photograph: Pixabay/Unsplash)

Centre for Advanced Professional
Practices (CAPP) works very hard in
helping dental hygienists make a difference in their communities, and

How effective is
toothbrushing?
By ADAA
In Western society, toothbrushing
was introduced as an oral care habit
in the 18th century, and plastic toothbrushes with nylon bristles have
been used since the middle of the
last century. However, while there
are numerous versions of manual
toothbrushes on the market, there
has been no clear evidence that any
specific design is superior to another.
Therefore, the choice of toothbrush
is mainly a matter of individual preference. Despite daily use, in practice
the efficacy of manual brushing is
such that it does not appear to result
in optimal oral hygiene.
A systematic review was conducted to determine the average
amount of plaque removed during

manual brushing. The citation for
the review is: Slot DE, Wiggelinkhuizen L, Rosema NAM, Van der Weijden
GA. The efficacy of manual toothbrushes following a brushing exercise: a systematic review. Int J Dent
Hygiene (2012) 10:187–197.
The two best-known databases, Pubmed and Cochrane, were
searched for articles that addressed
the efficacy of a manual toothbrush
following a single brushing exercise.
In order for an article to be included
in the review, subjects in the study
had to be healthy adults who were
not wearing an orthodontic appliance or a removable prosthesis, and
who had brushed without using ad-

ÿPage 2

offers continuous resources to help
raise awareness and share information.

Following the previous three successful editions, 4th DHS will include

ÿPage 6

[46] =>

hygiene tribune

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 1
ditional oral hygiene products. Furthermore, full mouth plaque scores
had to be measured using the most
frequently used indices (Silness &
Loe, Quigley & Hein, and Navy).
After screening 2,119 articles,
120 were reviewed. Of these, 59 articles involving 212 separate brushing experiments ultimately met the
inclusion criteria. No studies were
detected which evaluated the efficacy with the use of the Silness &
Loe plaque index. The plaque score
reduction was 30% if measured using the Quigley & Hein index and if
the NAVY-index had been used, the
plaque score reduction was 53%.

“...reduction of 61%,
the most effective
toothbrush was one
with angled bristles...”
In summary, the overall weighted mean plaque score reduction
after a single manual brushing exercise was 42%. A sub-analysis of the
various bristle designs revealed that
the most frequently recommended

manual toothbrush – one with a ‘flattrim’ bristle design – numerically removed less plaque than a toothbrush
with multi-level bristles. Based on
an estimated weighted mean Navy
Index plaque score reduction of 61%,

the most effective toothbrush was
one with angled bristles.
In conclusion, the mean plaque
score reduction efficacy following a
single brushing exercise being 42%
is influenced by the duration of
brushing and bristle design. From
a practical perspective, if only approximately 40% of the plaque score
is reduced this means that there is
room for improvement. This could
be partly achieved by increasing the
awareness of brushers with individually tailored instructions, for example, through their use of disclosing agents and a mirror. Motivating
brushers to improve their brushing
technique and to brush for a suf-

ficient length of time is also important. In studies where it was possible,
an analysis of the influence of brushing duration on brushing efficacy revealed the plaque score was reduced
by 27% after one minute of brushing.
With two minutes of brushing, the
reduction almost doubled to 41%.
Article published in RDH, Feb
2013; adapted from article in Nederlandse Vereniging voor Parodontologie newsletter, 2012.

Coronary heart disease patients with no
teeth have nearly double risk of death
Researchers connect levels of tooth loss (due primarily to poor dental hygiene that leads
to periodontal disease) with increasing rates of death and stroke

By Dental Tribune U.S.
Coronary heart disease patients with
no teeth have nearly double the risk
of death as those with all of their
teeth, according to research recently
published in the European Journal
of Preventive Cardiology.1 The study
with more than 15,000 patients
from 39 countries found that levels
of tooth loss were linearly associated
with increasing death rates.
“The relationship between dental
health, particularly periodontal disease, and cardiovascular disease has
received increasing attention over
the past 20 years,” said lead author
Dr. Ola Vedin, cardiologist at Uppsala University Hospital and Uppsala
Clinical Research Center in Uppsala,
Sweden. “However it has been insufficiently investigated among
patients with established coronary
heart disease who are at especially
high risk of adverse events and death
and in need of intensive prevention
measures.”

Analysis included 15,456 patients from 39 countries on
five continents
This was the first study to prospectively assess the relationship between tooth loss and outcomes in
patients with coronary heart disease
(CHD). The results are from a substudy of the STABILITY trial2, which
evaluated the effects of the Lp-PLA2
inhibitor darapladib versus placebo
in patients with CHD.
The analysis included 15,456 patients
from 39 countries on five continents from the STABILITY trial.2 At
the beginning of the study, patients
completed a questionnaire about

higher risk who need more intense
prevention efforts. While we can’t
yet advise patients to look after their
teeth to lower their cardiovascular
risk, the positive effects of brushing
and flossing are well established. The
potential for additional positive effects on cardiovascular health would
be a bonus.”

lifestyle factors (smoking, physical
activity, etc), psychosocial factors
and number of teeth in five categories (26-32 [considered all teeth remaining], 20-25, 15-19, 1-14 and none).
Patients were followed for an average of 3.7 years. Associations between
tooth loss and outcomes were calculated after adjusting for cardiovascular risk factors and socioeconomic
status. The primary outcome was
major cardiovascular events (a composite of cardiovascular death, myocardial infarction and stroke).
Patients with a high level of tooth
loss were older, smokers, female, less
active and more likely to have diabetes, higher blood pressure, higher
body mass index and lower education.
During follow up there were 1,543
major cardiovascular events, 705
cardiovascular deaths, 1,120 deaths
from any cause and 301 strokes.
After adjusting for cardiovascular risk factors and socioeconomic
status, every increase in category
of tooth loss was associated with a
6 percent increased risk of major
cardiovascular events, 17 percent increased risk of cardiovascular death,
16 percent increased risk of all-cause
death and 14 percent increased risk
of stroke.

746 patients had a myocardial infarction during the study
Compared with those with all of their
teeth, after adjusting for risk factors
and socioeconomic status, the group
with no teeth had a 27 percent increased risk of major cardiovascular
events, 85 percent increased risk of
cardiovascular death, 81 percent increased risk of all-cause death and 67
percent increased risk of stroke.

“746 patients had a
myocardial infarction
during the study”

About the European Journal
of Preventive Cardiology
The European Journal of Preventive
Cardiology describes itself as being
the world’s leading preventive cardiology journal, playing a pivotal role
in reducing the global burden of cardiovascular disease.

About the European Society
of Cardiology

Cumulative incidence rates by tooth loss level: (a) Major adverse cardiovascular events (MACEs) (cardiovascular death (CV dth), myocardial infarction (MI),
or stroke); (b) cardiovascular death; (c) stroke; and (d) all-cause death from 0 to
1,400 days from randomization, stratified by tooth loss level (26–32, 20–25,
15–19, <15, or no teeth). Chart/Provided by European Journal of Preventive
Cardiology
“The risk increase was linear, with the
highest risk in those with no remaining teeth,” said Vedin. “For example,
the risks of cardiovascular death and
all-cause death were almost double
to those with all teeth remaining.
Heart disease and gum disease share
many risk factors such as smoking
and diabetes, but we adjusted for
these in our analysis and found a
seemingly independent relationship
between the two conditions.
“Many patients in the study had lost
teeth so we are not talking about a
few individuals here,” continued Vedin. “Around 16 percent of patients
had no teeth and roughly 40 percent
were missing half of their teeth.”
During the study period, 746 patients
had a myocardial infarction. There
was a numerically increased risk of
myocardial infarction for every increase in tooth loss, but this was not

significant after adjustment for risk
factors and socioeconomic status.
Vedin said, “We found no association
between number of teeth and risk
of myocardial infarction. This was
puzzling (because) we had robust associations with other cardiovascular
outcomes, including stroke.”
Tooth loss could identify patients
who need more prevention efforts
Gum disease is one of the most common causes of tooth loss. The inflammation from gum disease is thought
to trigger the atherosclerotic process
and may explain the associations
observed in the study. Poor dental
hygiene is one of the strongest risk
factors for gum disease.
“This was an observational study so
we cannot conclude that gum disease directly causes adverse events
in heart patients,” Vedin said. “But
tooth loss could be an easy and inexpensive way to identify patients at

The European Society of Cardiology
represents more than 90,000 cardiology professionals across Europe
and worldwide. Its mission is to reduce the burden of cardiovascular
disease in Europe.

References
1. Vedin O, Hagström E, Budaj A,
Denchev S, Harrington RA, Koenig W,
Soffer J, Sritara P, Stebbins A, Stewart
RHA, Swart HP, Viigimaa M, Vinereanu D, Wallentin L, White HD, Held C
on behalf of the STABILITY Investigators. Tooth loss is independently associated with poor outcomes in stable coronary heart disease. European
Journal of Preventive Cardiology.
2015;OI:0.1177/2047487315621978
2. The Stabilization of Atherosclerotic
Plaque by Initiation of Darapladib
Therapy (STABILITY) study evaluated the efficacy of darapladib, an oral
inhibitor of lipoprotein-associated
phospholipase A2, compared to placebo. Patients were eligible to participate if they had coronary heart
disease, defined as prior myocardial
infarction, prior coronary revascularisation, or multivessel coronary
heart disease without revascularisation.
(Sources: European Society of Cardiology and European Journal
of Preventive Cardiology)

[47] =>

PATIENT SENSITIVITY

CAN BE GONE
IN SECONDS.

BEFORE

Open tubules

AFTER

Closed tubules in

60 SECONDS

with Colgate®
Sensitive Pro-Relief™
Toothpaste*

COLGATE® SENSITIVE PRO-RELIEF™ WITH PRO-ARGIN™ TECHNOLOGY
PROVIDES INSTANT AND LONG-LASTING RELIEF.
Extensive scientific research has shown that Colgate® Sensitive Pro-Relief™ protects against the triggers
and causes of sensitivity, and is proven to occlude dentin tubules in 60 seconds.*
Finally, a way to quickly improve your patients’ satisfaction and comfort.

YOUR PARTNER IN ORAL HEALTH
www.colgateprofessional.com

*When toothpaste is directly applied to each sensitive tooth for 60 seconds.
Ayad F, Ayad N, Delgado
et al. J Clin
Dent. 2009;20(4):115-122.
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[48] =>

hygiene tribune

Dental Tribune Middle East & Africa Edition | 2/2016

New toothpaste removes four times more
plaque than other toothpastes
By DTI
CHICAGO, USA: Microbial biofilms,
or dental plaque, on teeth significantly contribute to the development of dental caries, gingivitis and
periodontitis, and should therefore
be managed through daily brushing
and flossing. A recently published
study has now shown that a new
toothpaste, which contains teal dis-

closing agents to color and identify
plaque build-up on teeth, helps users remove up to four times more
plaque than a standard toothpaste
does.
In the study, 35 healthy patients
aged 18–64 who had all 12 anterior
teeth were divided into two groups.
At two visits to the University of
Illinois at Chicago College of Dentistry over the course of seven to ten

days, participants in the first group
brushed their teeth with a control
toothpaste only. Participants in the
experimental group used the control toothpaste at one visit and the
Plaque HD toothpaste, which contains an FDA-registered annatto seed
extract dye, as well as FD&C Blue No.
1, giving the toothpaste a green color
that adheres to intra-oral plaque, at
the second visit.

After brushing, participants
rinsed with fluorescein solution. The
presence of plaque on tooth surfaces
was visualized by plaque-bound
fluorescein, photographed and digitally quantified to calculate the percentage of remaining plaque. The
data analysis showed a statistically
significant mean plaque reduction
between the initial baseline appointment and the second appointment
for the experimental group. While
participants in the control group
were only able to eliminate about 8
percent more plaque, participants
in the experimental group removed
over 50 percent more dental plaque
compared with the first visit.
“This study demonstrates that
brushing with a toothpaste with
plaque-indicating dye, combined

with proper use instructions, significantly increases plaque removal
efficacy,” the researchers concluded.
According to the manufacturer
of Plaque HD, the toothpaste incorporates Targetol Technology, which
contains all-natural, plant-based
disclosing agents, and colors any
plaque. Currently Plaque HD is sold
through dental and orthodontic offices across the U.S. and on Amazon.
It is available in a professional version for $21.00 and a retail version
for $14.95.
The study, titled “Evaluation of
plaque removal efficacy of a novel
dye-containing toothpaste: A clinical
trial,” was published on Jan. 13 in the
International Journal of Dentistry
and Oral Science.

Study finds high
urinary mercury
levels in children
with amalgam
fillings

The use and toxic risk of dental amalgam fillings in children is a controversial
ssue among health care experts. (Photograph: Pixabay/jarmoluk)
By DTI
DAEGU, South Korea: Although
equivalent alternatives have become available over the past decade,
dental amalgam remains in use as a
restorative material for dental caries
in children in many countries. The
safety of dental amalgam, however,
is still a controversial issue among
experts, as it has been associated
with developmental disorders and
systemic conditions. A Korean study
has recently provided evidence that
dental amalgam exposure can affect
systemic mercury concentration in
children.
In order to assess chronic exposure to elemental mercury, researchers at Kyungpook National
University in South Korea evaluated
mercury concentrations in urine
samples from more than 1,000 children aged 8–11, who also underwent
oral examination.
They found that children with
more than one amalgam-filled tooth
surface exhibited significantly higher urinary mercury concentrations

than those with none. The researchers thus concluded that dental amalgam exposure could affect systemic
mercury concentration in children.
A number of studies have indicated that mercury exposure could
be involved in problems in early
brain development. Mercury has
also been associated with adverse
health effects relating to the digestive and immune systems, as well
as the lungs, kidneys, skin and eyes.
Awareness and recognition of these
health and environmental implications have led to a ban on the use
of dental amalgam in some highincome countries. However, dental
amalgam restorations are still taught
in the dental curriculum in SouthEast Asia. In Myanmar, for example,
about 50 per cent of fillings placed
are of amalgam.
The study, titled “Dental amalgam
exposure can elevate urinary mercury concentrations in children”, was
published online on 1 February in the
International Dental Journal.

[49] =>

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[50] =>

[51] =>

[52] =>

[53] =>

www.dental-tribune.me

Published in Dubai

March-April 2016 | No. 2, Vol. 6

ENDO TRIBUNE

Endodontic imaging mode
available from Planmeca

The World’s Endodontic Newspaper Middle East & Africa Edition

By DTI
Planmeca has introduced a new imaging mode that was developed especially for use in endodontics and
in cases dealing with small anatomical details, such as imaging of the ear.
The new mode, which produces extremely high-resolution images with
a very small voxel size of only 75 μm,
is available for all Planmeca ProMax
3D imaging units.

According to Planmeca, the new
mode provides clinicians with perfect visualisation of even the smallest anatomical details. Owing to new
intelligent noise and artefact removal algorithms, noise-free and crystalclear images can be produced, the
Finnish dental equipment manufacturer said. With Planmeca ARA, for
example, artefacts resulting from
metal restorations and root fillings
in the patient’s mouth that cause

“... produces extremely
high-resolution images
with a very small voxel
size of only 75 μm...”

shadows and streaks in CBCT images can be removed effectively. In
addition, the new Planmeca AINO
Adaptive Image Noise Optimiser is
intended to reduce noise in CBCT
images resulting from a particularly
low radiation dose or small voxel
size without losing valuable details.
The company said that the filter particularly improves image quality in
the endodontic mode, where noise is
inherent due to the extremely small
voxel size. It has also proven useful
when used in accordance with the
Planmeca Ultra Low Dose protocol,
where noise is induced by the particularly low dose.
Planmeca AINO also allows the reduction of exposure values and consequently the radiation dose in all
other imaging modes, according to
Planmeca.

3D efficiency_
optimal cleaning while preserving dentine

Now available in 21 mm & 25 mm

FKG Dentaire SA
www.fkg.ch

[54] =>

endo tribune

Dental Tribune Middle East & Africa Edition | 2/2016

Anatomical pin: A clinical case report
By Profs. Frederico dos Reis Goyatá
& Orlando Izolani Neto, Brazil
Endodontic treatment of teeth with
significant coronal destruction is
a very common clinical procedure
in the restorative clinical practice.
When we are faced with this clinical
situation, there will be an eminent
need for the use of intra-radicular
retainers to obtain greater stability
and retention of the restoration to
the remaining teeth. [1,2]
The use of an anatomical pin is
proposed for the rehabilitation of
anterior teeth with extensively compromised root canals and with significant loss of dentine tissue. [3] In this
restorative method, in addition to
the fibreglass pin, a compound resin
is used to model the radicular con-

Fig. 1

duit with the objective of reducing
the space that would be filled by the
resin cement. In this way, the combination of two restorative materials
(pin and compound resin) will serve
and behave biomechanically as a replacement of the dentine structure
lost. [4]
Anatomical pins have an extremely
favourable prognosis in cases of
fragile roots due to loss of dentine
structure and they contribute significantly to the rehabilitation of the
tooth in terms of both masticatory
function and aesthetics. [5] In addition, the fibreglass pins have a more
uniform distribution of tension in
the occlusal and radicular regions
compared with metal pins. [6] Etching and silanisation of the pins are of
the utmost importance for pro mot-

ing interfacial adherence, especially
in the region prepared for the core.
[7,8]
This study reports on a clinical case
that demonstrates the preparation
technique for the anatomical pin,
using fibreglass pins and compound
resin, in a maxillary central incisor
with weakened roots, with the objective of re-establishing the coronal
portion of the tooth.

Case report
A young male patient came into the
integrated dentistry clinic at Universidade Severino Sombra needing
restorative treatment of tooth #21. In
the clinical and radiographic examination, significant coronal destruction and satisfactory endodontic
treatment were noted (Figs. 1–3).

Restoration with an anatomical pin
was proposed to the patient, in order
to recover the function and aesthetics of the tooth and provide for future rehabilitation of the tooth with
a full ceramic crown.
First, the decayed tissue was removed from the remaining tooth
structure and the fibreglass pin was
selected (Exacto # 3, Angelus), as well
as the accessory pins (Reforpin, Angelus; Fig. 4). The radicular conduit
was isolated with mineral oil and
the compound resin was applied
(Fill Magic NT Premium, Vigodent/
COLTENE) over the remaining tooth
(Figs. 5 & 6) with the aid of a #1/2 Suprafill spatula (SS White). After filling
of the conduit with resin, the Exacto
pin and the pre-silanised accessory
pins (Silano, Angelus) were inserted
with the application of an adhesive

Fig. 2

Fig. 3

Fig. 4

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Fig. 5

(Fusion-Duralink, Angelus; Figs. 7–9).
Next, the initial photoactivation was
conducted on the pin and resin for
20 seconds.
Finally, the coronal reconstruction
was performed with the previously
used compound resin in incremental portions and photoactivation was
conducted (Figs. 10 & 11). A marking
was made on the most incisal portion of the pins to guide the subsequent cropping of the pins (Fig. 12).
The anatomical pin was then removed and the final photoactivation
was performed for 40 seconds (Fig.
13). Soon after, the pin was adapted
to the remaining coronal structure
(Fig. 14).

ÿPage 3

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◊Page 2

Fig. 22

Fig. 23

Fig. 24

Fig. 25

Prof. Frederico dos Reis Goyatá
He is a Level I adjunct professor and co-ordinator of the dentistry programme at Universidade Severino Sombra in Vassouras in Brazil. He is also co-ordinator of the
graduate programmes (improvement and specialisation in prosthetic dentistry) at the Escola de Aperfeiçoamento Profissional (professional development school) of
the Associação Brasileira de Odontologia (Brazilian dental association) in Barra Mansa in Brazil.
Prof. Orlando Izolani Neto
He is a professor in the integrated clinic of the dentistry programme at Universidade Severino Sombra.

Fig. 26
After the preparation phase of the
anatomical pin and coronal portion
of the core with compound resin,
preparation for adhesive cementation to the remaining tooth began
(Fig. 15). Acid etching of the pin was
performed for 30 seconds, and then
it was washed and dried. The silane
was then applied (Silano) for 20 seconds, as well as the adhesive (FusionDuralink) with subsequent photoactivation for 20 seconds (Figs. 16–18).
After the anatomical pin had been
prepared, acid etching was performed on the remaining tooth for
20 seconds, followed by washing and
drying it lightly to leave the dentine
moist (Fig. 19). The dentine primer
and the adhesive (Fusion-Duralink
system) were applied and then photoactivated for 20 seconds (Fig. 20).
The cementation was done with
auto-polymerisable resin cement,
waiting a period of five minutes for
the cement to chemically set (Figs.
21 & 22). Once the cementation of
the anatomical pin was finished, the
adhesive was applied to the coronal
portion and photoactivated for 20
seconds, and the compound resin
was applied in incremental portions
for creation of the core (Figs. 23 & 24).

PRINT
L
DIGITA N
TIO
A
C
U
D
E
EVENTS

In order to complete the restorative
process, the prosthetic preparation
of the core was performed for future
seating of a full ceramic crown (Fig.
25).

Conclusion
The anatomical pin constituted a
clinical alternative for coronal and
radicular reconstruction of endodontically treated teeth with significant destruction of dentine. In addition to rehabilitating the tooth, this
clinical approach promotes a more
balanced distribution of masticatory forces without com - promising the remaining tooth structure,
minimizing the risk of radicular
fracture. Moreover, this restorative
alternative provides the possibility
of an aesthetic result with the use of
a metal-free full crown.
Editorial note: A complete list of
references is available from the publisher. This article was published in
roots – international magazine of endodontology No. 01/2015.

The DTI publishing group is composed of the world’s leading
dental trade publishers that reach more than 650,000 dentists
in more than 90 countries.

[56] =>

[57] =>

www.dental-tribune.me

PRINTed in dubai

March-April 2016 | No. 2, Vol. 6

IPS Style: more beautiful, easier and more
comfortable
Ivoclar Vivadent launches a new metal-ceramic system Interview with Martin Frontull
and Domenika Diesing, both product managers at Ivoclar Vivadent.

By Ivoclar Vivadent AG
Ivoclar Vivadent is a pioneer in dental ceramics and a global market
leader in several product areas. The
company has revolutionized the
ceramic market over the past decades and created a comprehensive
product portfolio. Ivoclar Vivadent
has also gained a strong foothold in
the field of metal-ceramic materials,
which have been used as a standard product in dental labs for many
years. Although metal-free ceram-

of restorations are made of metalceramics. Overall, the market figures
show a stable global trend for this
business segment. All this indicates
that metal-ceramics continues to
play a relevant role. And will go on to
do so in the foreseeable future.
In spite of this, metal-ceramics has
seen very little development over
the past years. Digital framework
manufacturing is increasingly becoming a standard in laboratory
procedures, yet the manufacturers
of existing metal-ceramic systems

In spite of the new combination of crystals, the application and processing
procedure of IPS Style has remained unchanged. The ceramic materials are
handled as before and they are easy to shape. They offer considerable stability,
which is an advantage when applying them.
ics and digitally processed materials
have recently been at the focus of
public attention, Ivoclar Vivadent is
currently introducing a new metalceramic: IPS Style. Editor-in-Chief
Dan Krammer wanted to find out
more about this material. He invited
product managers Martin Frontull
and Domenika Diesing to a talk with
him.
Dental Tribune MEA/CAPPmea:Metalceramic materials have been around
for more than 40 years. Digital processing and CAD/CAM are gaining
momentum all over the world. Why
do you launch another metal-ceramic
now?
Domenika Diesing: Although the
media and communication are
dominated by the topic of CAD/CAM
technologies, metal-ceramic restorations - and therefore the conventional working method - are still part
of the day-to-day work in the dental
lab. Metal-ceramics still account for
the lion’s share of fixed prosthetics. Worldwide, still more than 60%

are hardly addressing this situation. New approaches reflecting this
development are nowhere to be
found. With regard to the economic
efficiency of processing procedures,
metal-ceramics still offer a great deal
of potential. If users are asked directly, it becomes once again evident
that they have unmet needs. With
increasing economic pressure, the
workflow has to be more efficient.
Customers want products that are
easy to use yet offer maximum esthetics. Transitions from analogue
to digital procedures should be
smooth. In a nutshell: even if metalceramics have been on the market
for a long time, there is still a lot of
potential for improvement.
Dental Tribune MEA/CAPPmea: In
other words, does IPS Style offer anything truly new or is it just “old wine in
new bottles”?
Martin Frontull: No, not at all! The
new metal-ceramic system offers
important innovations. It provides
a solution for many limitations

that existing systems have never
addressed in spite of having been
around for 40 years. Examples in
this respect are shrinkage and a handling procedure that often is less
than straightforward. Another example is esthetics - the number one
visible sales argument for any dental
lab work. IPS Style offers improvements in all these aspects.
The basic idea behind IPS Style is to
offer users as much freedom as possible in their work - and in their selection of framework materials.
Dental Tribune MEA/CAPPmea: What
exactly do you mean by this?
Martin Frontull: IPS Style is compatible with all customary alloys in the
indicated CTE range. It is even possible to apply IPS Style without bonding material if a base metal alloy is
used. This is an essential feature with
regard to compatibility with frameworks that are manufactured using
an analog or digital method. It goes
without saying that we have also assessed the compatibility of IPS Style
with our own alloys. The results have
been positive.
Dental Tribune MEA/CAPPmea: What
exactly is new or different about IPS
Style? What is special about it?
Martin Frontull: IPS Style is the first
metal-ceramic material to use patented oxyapatite. Oxyapatite crystals have never been used in a dental
ceramic before. This is a world first.
Leucite and fluorapatite crystals
have largely become established
as integral constituents of metalceramics. IPS Style complements
the known crystals with oxyapatite
to create a new crystal architecture.
This imparts the ceramic with tailormade properties. Leucite controls
the expansion and stability of the
ceramic. Fluorapatite provides a
natural inherent brightness, vitality
and expression. Oxyapatite crystals
fulfil a special function: They have a
high capacity for reflecting incident
light. This means that they reflect
a high amount of light or, the other
way round, they do not absorb light.
This significantly contributes to the
natural optical properties of the restoration and creates a depth effect.
Oxyapatite crystals are contained
in all shaded components of the
IPS Style range. Their content varies from opaquer to incisal materials. The translucency or opacity of
the material can be controlled by
varying the content of oxyapatite
crystals. The material’s excellent
inherent brightness leads to results
that look very natural in their oral

settings. They maintain their shade
regardless of how many times they
are fired.
Optimized shrinkage behaviour and
minimized rounding at the edges
during firing are further essential
aspects that give IPS Style its special edge. Users arrive at the desired
result in a short time. The final contours can already be established during the layering procedure before
the first firing process. The number

of firings is reduced as the need for
time-consuming layering procedures, required for corrective firings,
is eliminated. The time that the user
requires to complete the restoration
is reduced accordingly.
Domenika Diesing: In spite of the
new combination of crystals, the

ÿPage 2

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IPS e.max PRESS MULTI
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THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT

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• Monolithic LS2 restorations showing a lifelike shade progression
• Exceptional combination of strength, esthetics and efficiency
• For crowns, veneers and hybrid abutment crowns
• Coordinated with high-precision Programat press furnaces
• Maximum cost effectiveness in the press technique

www.ivoclarvivadent.com
Ivoclar Vivadent AG
Bendererstrasse 2 | 9494 Schaan | Liechtenstein
Tel.: +423 235 35 35 | Fax: +423 235 33 60

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◊Page 1

Patented oxyapatite is the distinguishing feature of the new IPS Style metal-ceramic. This means that IPS Style combines the known leucite and fluorapatite crystals with oxyapatite to form an innovative crystal structure. Oxyapatite crystals have a high capacity for reflecting incident light. A large amount of light is reflected…

application technique has generally
remained the same. The ceramic is
used as usual. The materials are easy
to contour and offer excellent stability during application. The combination of oxyapatite and fluorapatite
crystals, described by my colleague

above, imparts the material with its
unique optical characteristics.
In addition, the system has been designed to offer a large degree of flexibility: It includes components for
classic multi-layer techniques and
for single-layer techniques. Given

the comprehensive selection of
materials, IPS Style is a ceramic that
offers virtually limitless colour combinations.
Dental Tribune MEA/CAPPmea: Mr
Frontull, you said above that IPS Style

has been designed with the aim to afford users as much freedom as possible in their work. What do you mean
by this?
Martin Frontull: IPS Style does not impose restrictions on users in terms of
their preferred working style - all

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in keeping with our motto “Make it
your Style!”. As mentioned above,
the system comprises not only a
multitude of materials but also
specially designed components for
single-layer and multiple-layer techniques. This allows users to select
those materials from the IPS Style
range that match their personal
preferences and the given indication. Everything is possible - from
fast one-layer applications to highly
esthetic layering methods.
Dental Tribune MEA/CAPPmea: What
were the special challenges in the development of the new ceramic?
Martin Frontull: The market generally
expects to be supplied with innovations, but not in metal-ceramics. We
therefore had to develop a new product that was so well designed that it
would convince users of its benefits
straight away when they first see it.
Achieving this objective was a challenge. Another task was related to
materials science: The effects of the
individual constituents of a material
cannot always be reliably predicted
from the beginning. We had to solve
this aspect by carefully approaching
an optimum balance. We also had to
take into account that the targeted
improvement of one property may
result in the deterioration of another.
Our goal was to take advantage of the
benefits of oxyapatite without sacrificing the proven properties of leucite and fluorapatite. In addition, the
new metal ceramic should allow low
fusing temperatures while exhibiting the top-of-the-range properties
of high sintered ceramics. And one
more thing: The ceramic had to fit
into our existing ceramic concept. In
sum, we faced quite a few challenges.
Dental Tribune MEA/CAPPmea: For
what is IPS Style particularly suitable?
Martin Frontull: IPS Style is suitable
for any metal-ceramic restoration,
ranging from single crowns to multiple-unit bridges, veneers and restorations involving gingival parts. The
system encompasses both IPS Style
Ceram for the conventional multilayer technique and IPS Style Ceram
One for the one-layer technique. IPS
Style Ceram is particularly suitable
for areas where esthetics plays an
especially significant role such as in
the anterior region. In the posterior
region, IPS Style Ceram One is ideally used. IPS Style can be perfectly
matched with restorations made
of IPS e.max because the ceramic
blends with the overall oral surroundings functionally and esthetically without any difficulty. As a consequence, complex clinical cases can
be solved to the complete satisfaction of both the operator and patient.
Dental Tribune MEA/CAPPmea: What
do technicians need to know before
they use IPS Style for the first time?
Martin Frontull: IPS Style is an entirely new material and cannot be compared with existing products. However, the application procedure is the

ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

ÿPage 3

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lab tribune

◊Page 2

In spite of the fact that metal-ceramics are well known and long established
in the market, they still offer ample scope for optimization. The objective of
Ivoclar Vivadent has been to realize these optimizations and they have been
incorporated into the new IPS Style.
same as before. IPS Style can be processed in the customary procedure.
The matching powder opaquer, IPS
Style Ceram Powder Opaquer, is easy
to apply and reliably masks alloy
frameworks in a single thin coating.
The risk for errors is therefore minimized and special training is not required. The product is easy to handle
- and this is true for both the layering
materials and opaquer. IPS Style can
be described best in the following
words: more beautiful, easier and
more comfortable.
Dental Tribune MEA/CAPPmea: Who
is the new metal-ceramic designed
for?
Domenika Diesing: For everybody,
from beginner to experienced user.
It is equally suitable for those who

use an elaborate conventional layering technique and for those who
prefer a straightforward streamlined
method to fabricate restorations.
Because of these criteria, IPS Style is
suited for all laboratories, small or
large. It does not matter whether a
laboratory predominantly manufactures metal- or all-ceramic restorations, IPS Style meets the needs of
both types of labs. Being compatible
with the IPS Style range, IPS Ivocolor,
the new stains and glaze assortment
from Ivoclar Vivadent, bridges the
gap between these ceramics.
Dental Tribune MEA/CAPPmea: What
do you mean by this? Can you give us
more information about IPS Ivocolor?
Martin Frontull: IPS Ivocolor is a
universal assortment of glazes and

Fact box Make it your Style!
About IPS Style:
- First metal-ceramic with patented oxyapatite
- For maximum efficiency, easy handling and natural esthetics
in the dental lab
- Low-fusing ceramic in the classic CTE range
- Components for single and multiple layer techniques
- IPS Ivocolor is part of the IPS Style range and is suitable for
individualized staining and characterizations of restorations.
Indications:
- Single or multiple unit bridges
- Partial or fully contoured single crowns
- Veneers
- Restorations with gingival parts
- Ceramic shoulder contouring
IPS Style Powder Opaquer:
- Reliable masking effect even if applied in a thin coating
- Conventional brush application or spray-on technique

...and hardly any light is absorbed. This property contributes significantly to the depth effect of restorations veneered with IPS Style, similar to the depth effect of natural
teeth.

The IPS Style system includes not only a wide gamut of
materials but also special components for single- and
multiple-layer techniques. Users can select those materials that are best suited to their personal preferences and
the indication at hand.

The IPS Style system has been designed with flexibility
in mind. It comprises components for both conventional
multiple layer techniques and single-layer techniques. The
comprehensive offering of materials enables virtually limitless colour combinations.

stains that comprises an innovative
portfolio of shades.
What is special about Ivocolor is the
fact that it can be used in conjunction with all fired IPS ceramics from
Ivoclar Vivadent and with the zirconium oxide materials from Wieland
Dental, e.g. Zenostar. This means that
IPS Ivocolor also provides a fabulous
option for all-ceramic restorations,
e.g. IPS e.max.
In the lab, IPS Ivocolor can be used as
an overarching link between metaland all-ceramic restorations. This not
only reduces the number of shades
that need to be kept in stock but also
considerably streamlines the fabrication of complex restorations.
Domenika Diesing: The advantage is
that now a single system can be used
for the entire gamut of ceramic materials. The aim of providing a range

that is manageable and economical
has been greatly achieved with this
system. It offers users a great deal of
flexibility: from staining and glazing
to mixing with ceramic materials.
Dental Tribune MEA/CAPPmea: What
initial feedback have you received
from the market? What conclusions
do you draw from this feedback?
Martin Frontull: We have received
very positive feedback from our
user tests so far. The initial feedback
described exactly those points that
mattered most to us. It confirmed
that IPS Style is easy to use, shows
low shrinkage and is stable when
layered. The esthetic properties have
been described as outstanding. There
is a great interest in this material.
Dental Tribune MEA/CAPPmea: Please
describe once again briefly the fea-

tures that make IPS Style so special.
Domenika Diesing: IPS Style combines productivity, product performance and esthetics in a single product. Fast, easy and faithful to nature.
Users can fabricate the restorations
using the method that suits them
best in line with the given clincial
situation without having to make
compromises. IPS Style has been
desigend to liberate dental technicians from annoying restrictions in keeping with the product motto:
“Make it your Style!”
Mr Frontull and Ms Diesing, thank you
for this interview.

Successful Launch of the Dentsply Sirona
CAD/CAM Disc Line
By Dentsply Sirona
Intelligent CAD/CAM solutions
from a single source – Dentsply
Sirona CAD/CAM now offers not
only the hardware and software for
single-source restorations, but the
materials as well. The most recent
confirmation of this comes from the
successful launch of the disc line for
the 5-axis inLab MC X5 production

Fig. 1: The disc line from Dentsply Sirona CAD/
CAM includes a conventional and a pre-shaded
translucent zirconium oxide sintered ceramic.

unit. From conventional-sintered zirconium oxide to pre-shaded translucent zirconium oxide to transparent
PMMA plastic for surgical guides, the
range of materials ensures high quality and safety for dental labs.
Bensheim/Salzburg, March 24th ,
2016. Dental technicians and inLab
MC X5 users all over the world can
now use various discs in the stand-

ard format (Ø 98.5 mm) from Dentsply Sirona CAD/CAM. The disc line
includes the inCoris ZI disc, a conventional zirconium oxide sintered
ceramic for producing frameworks
or more complex jobs, such as attachments and connecting bars. The
inCoris TZI C disc is just right for
those who want pre-shaded, translucent zirconium oxide. The inCoris
PMMA guide gives labs a transparent
plastic disc for
fast and cost effective in-house
production of
surgical guides.
Thus, integrated
implant
planning with inLab
software SW 15
requires neither
a model nor a
radiographic
template to produce guides. The

Fig. 2: Thanks to the standard format (Ø 98.5 mm), the
Dentsply Sirona CAD/CAM discs, such as the inCoris PMMA
guide disc pictured here, are optimally compatible with inLab MC X5 and with other production units as well.

color coding for material classes on
the Dentsply Sirona CAD/CAM discs,
which is applied consistently to
tools, tool magazine and in the inLab
CAM software, ensures convenient,
safe processing of discs with the inLab MC X5 laboratory unit.
With the standard format (Ø 98.5
mm), Dentsply Sirona CAD/CAM
discs can be used not only with the
inLab MC X5 production unit, but
with many other production units
that are open and suitable for the
disc format as well.
The inCoris PMMA guide, the inCoris
ZI and inCoris TZI C disc- the latter
two in various heights and colorsare available from specialized dealers. Furthermore, additional discs are
being developed, such as the cobaltchrome sintered metal inCoris CCB.
Visit www.dentsplysirona.com for
more information about Dentsply
Sirona and its products.

Fig. 3: The intelligent inLab MC X5 color
class concept is also used for Dentsply Sirona CAD/CAM discs, tools, tool magazine,
and in the inLab CAM software.
Dentsply Sirona
Sirona Straße 1
5071 Wals bei Salzburg, Austria
T +43 (0) 662 2450-588
F +43 (0) 662 2450-540
www.dentsplysirona.com

[60] =>

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Dental Tribune Middle East & Africa Edition | 2/2016

Mesa Dental Alloys: More than 40 Years’
Experience Directly at your Premeses
The Italian dental alloys manufacturer is increasing its efforts for its longstanding commitment

By MESA
With over 40 years’ experience and
located in Northern Italy, MESA
manufactures more than 50 types
of CoCr and NiCr based alloys (for
PFM, partials/prostheses, crowns &
bridges, soldering) and CoCr based
discs and bars for CAD/CAM milling.
All products have undergone
severe medical tests, comply with
ISO standards (ISO 9001: 2008;
ISO 13485:2012), are CE-marked and
FDA-certified (Operator Number:
10044677).
MESA products are successfully
used and distributed throughout
the world in comply with the local
necessary certifications and authorisations.
Now MESA is committed to work
personally with its international
partners and is organizing technical
trainings on-site. Hold by the Senior
Dental Technician Daniele Beccalossi with the assistance of dedicated MESA Sales Area Managers, the
courses focus on all the main steps
to properly use casting alloys in order to obtain the best Porcelain Fuse
to Metal results.
Starting from different plas-

Training Course Cambodia
ter and resin work solutions for
the model preparation, covering
all main steps of waxing build-up
and pinning, comparing the most
used casting methods, explaining
the best metal finishing techniques
and showing concretely how to proceed with the single steps of porcelain stratification (opaque, dentine,
enamel, translucent and stains layers, glazing and finishing), the cours-

es have been met with much success
in China, Pakistan, India, Sri Lanka
and Cambodia.
In particular the last training
held in the Faculty of Dentistry at the
International University of Phnom
Penh in February 2016 gathered
more than 30 participants from 15
different local laboratories.
Daniele Beccalossi praises a longstanding experience as Senior Dental

Dental Alloys
Via dell’Artigianato 35/37/39
25039 Travagliato (BS) Italy
T. +39 030 6863251
F. +39 030 6863252
info@mesaitalia.it - sales@mesaitalia.it

www.mesaitalia.it

Technician, trainer and demonstrator, having opened his own activity
already in 1990 and cooperating as
official lecturer for MATCHMAKER
CERAMIC by SCHOTTLANDER (UK),
GC DENTAL and NORITAKE porcelain (Japan). He has been working
with MESA since 2013.
MESA training are not only focused on traditional PFM procedure:
during the upcoming 11th edition of

DTIM (DENTAL TECHNICIAN INTERNATIONAL MEETING), which will be
held in Dubai next May, MESA staff
will introduce its CAD CAM material,
CoCr discs and bars.
Mesa has been producing
Chrome Cobalt discs for CAD/CAM
milling systems for over 10 years.
During this period of time, CAD/
CAM discs have been supplied in
many different materials and shapes,
meeting up the continuous changes
of the market requirements. At
present Mesa’s CAD/CAM discs are
provided from 6mm up to 30mm
height, with 95mm und 98,5mm diameter. Mesa also produces discs on
customers’ specifications.
MESA Cobalt Chrome Bars for
CAD/CAM processing instead have
been specifically designed to the
manufacturing of implant abutments. They are available in different
Co-Cr based materials, sizes, diameters and lengths. Their specifically
designed shape is intended to reduce
the milling costs and material scraps
typical of discs.

ÿPage 5

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Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 4

Bars for CAD/CAM processing

The main messages MESA wishes to communicate through these
efforts is its longstanding commitment: the health of the dental technician and the patient.
MESA selects only the best available raw material on the market, car-

Dental Alloys for casting

ries out severe medical tests
(bio-compatibility and corrosion
resistance) and guarantees the total
absence of any carcinogenic or toxic
element in all of its products, in particular the absence of beryllium.
In fact, exposure to beryllium

vapor or particles is associated with
a number of diseases from contact
dermatitis to chronic granulomatous lung disease, this last known as
Chronic Beryllium Disease (CBD).
Beryllium and some beryllium
compounds in vapor and particulate

Discs for CAD/CAM processing

form have been shown to be human
carcinogens based on sufficient evidence of carcinogenicity from studies in humans.
Risks from exposure to beryllium result from casting, grinding,
polishing and finishing procedures:
dental laboratory technicians has to
be alert.
Reports of toxicity to Be-containing alloys for dentist or patients
are limited to a few cases of transient contact dermatitis, but in cases
where Be-containing dental prostheses are ground or polished in the
dental office, we incur the same risk.
For over 40 years MESA has been
working with passion and commitment, confident of the quality and
reliability of its materials: the company is going to keep on following
this path supporting its partners and
customers in the years to come.

References
1. American Dental Association
(ADA); ADA Positions Policies and
Statements: Proper Use of Beryllium
Containing-Alloys
2. Occupational Safety & Health Administration (OSHA); Beryllium and
Chronic Beryllium Disease

MESA DENTAL ALLOYS
Via dell’Artigianato 35, 37, 39
25039 Travagliato (Brescia), Italy
CONTACTS:
T. +39 030 6863251
F. +39 030 6863252
info@mesaitalia.it
sales@mesaitalia.it
www.mesaitalia.it

Company

A sneak peek into one of the largest shops
for dental laboratories
By Marc Chalupsky, DTI
DT&SHOP, one of the world’s main
dental laboratory suppliers, is participating at IDEM Singapore 2016
with a 50 m² booth. Among the
many highlights, the company demonstrates its CAD/CAM units and
presents the new FINOCAM A5 milling machine for the first time. Dental Tribune Asia Pacific spoke with
Eva Maria Roer, CEO of DT&SHOP.
The successful female entrepreneur
studied economics in Germany and
Canada and is recipient of the Order of Merit of the Federal Republic
of Germany, among the country’s
highest recognitions.
Dental Tribune: Ms Roer, you have had
a long and successful career in dental
technology. Why did you decide to
work in this segment?
Eva Maria Roer: At first, I just wanted
to enter a niche segment. Back in
the 1970s, dental technology was

The modern DT&SHOP headquarters

not nearly as developed and a relatively small industry. There were
no CAD/CAM systems, of course.
Today, dental technology is one of
the most important and innovative
areas within dentistry. The segment
has embraced digitisation and used
it for the benefit of the patient. The
range of crowns, bridges, and partial
and complete dentures available is
enormous and diverse, as is evident
in our shop’s portfolio. In 2003, we
had 30,000 products and there are
nearly 50,000 items today. The assortment is constantly changing,
which means that customer service
too has increased throughout the
years. At the same time, cheap providers began competing with quality
shops like DT&SHOP. However, we
responded with courage, determination, perseverance, joy and creativity
to achieve our current market position, of which I am most proud.
DT&SHOP is now among the world’s

Eva Maria Roer, CEO of DT&SHOP
largest service providers and distributors of dental technology. What have
been the most important interna-

The modern DT&SHOP headquarters
tional milestones since the company’s
establishment in 1978?
In 1978, we established DT&SHOP
with less than US$5,000. We introduced catalogues, then a revolutionary step in the distribution of dental
technology. We also attached great
importance to equality between
women and men and to a high level
of customer advisory services. We
always intended to develop into a
major shop and have pursued this
plan without deviation. Internationally, the German-speaking region
was initially important for us. In
1991, we introduced the shop in Switzerland and Austria. With the Maas-

tricht Treaty and the founding of the
European Union in 1993, we added
France, the Netherlands, the UK and
Denmark. Today, we export to about
100 countries, have our own subsidiaries and associates in 15 countries,
and communicate in many languages. Our customer service is mainly
provided from Germany.
In Asia, there are already quite a
number of dealers in dental laboratory products. What distinguishes
DT&SHOP from these companies?

ÿPage 6

[62] =>

6

lab tribune

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 5

The milling centre

What services and products can you
offer for this region?
Both nationally and internationally,
we are a very proficient partner in
dental technology. Dental laboratories need distributors that can offer
the complete range of dental technology. This is difficult for smaller
traders. We can support laboratories
with our expertise and sales network. Our service is fast, our range
attractively priced and our team consistently competent – with regard to
our full assortment including our
own brand FINO.
Our head office is in Germany, from
where we run our global operations.
Every one of our customers, no matter where in the world, experiences
our commitment every day. Our
employees are specialists and always
advise on the latest CAD/CAM technologies and systems. With FINO
Digital, we offer comprehensive
CAD/CAM systems for laboratories.

The milling centre

inLab MC X5:
DENTAL LAB
FREEDOM OF CHOICE.

Our logistics and shipping centre
stands out too owing to its many
advantages. All orders are processed
promptly owing to an innovative enterprise resource planning system.
We have the most comprehensive
product range in the segment and
offer a stock availability of over 95
per cent. Most orders are dispatched
the same day and quickly reach our
customers in Asia. Also, orders are
packaged safely using environmentally friendly materials.
Moreover, I am proud of our customer service. Our employees are very
competent and speak more than ten
languages. We place significant importance on providing expert advice
to our clients. Our customers in Asia
Pacific value this service very much.
In which countries of the Asian region
do you see particular growth potential
for your products and services?
I first travelled to Asia in 1992 and
have made several trips back to the
continent since 1994. In China, there
are import barriers, but the market
is huge and remains very appealing. In alphabetical order, I consider
Indonesia, Malaysia, Myanmar, the
Philippines, Thailand and Vietnam
to hold good business opportunities.
Thank you very much for the interview.

The customer service and sales department

Experience new freedom in your lab processes breaking the chains of
former dependencies with inLab and the new 5 axis milling and grinding
unit inLab MC X5. Open for all restoration data, combining the largest
material range and the possibility to machine both wet and dry disks
and blocks – for no limitations to your production. Enjoy every day.
With Sirona.

INLABMCX5.COM

[63] =>

[64] =>

Joint meeting with

11 CAD/CAM & Digital Dentistry Int’l Conference
th

h
T

A
e

Contact Us
Mobile: +971 50 2793711
Telephone: +971 4 3616174
FAX: +971 4 3686883
E-mail: events@cappmea.com
www.cappmea.com/dtim

f
o
rt

a
n
s
m
h
s
t
i
p
f
a
r
C

CAPP designates this activity for 14CE Credits

Jumeirah Beach Hotel, Dubai, UAE

[65] =>

www.dental-tribune.me

PRINTed in dubai

AAID MaxiCourses
By AAID
The American Academy of Implant
Dentistry founded in 1951 is the first
professional organization in the
world dedicated to Implant Dentistry. Its members include general
dentists, Oral and Maxillofacial Surgeons, Periodontists, Prosthodontists, and others interested in the
field of Implant Dentistry. The Academy continues to expand the opportunities for dentists to obtain comprehensive, non-biased curriculum
of quality education to prepare them
for including implantology in their
scope of practice. The recent launching of the MaxiCourse Japan after
approval brings to 11 the number
of MaxiCourses offered around the
world. The First Annual AAID MaxiCourse in UAE was offered in 2009
in Abu Dhabi and to date 196 doctors
–Consultants, Specialists and general
dental practitioners have graduated
from the Program. Currently the
UAE Program is in its Eighth Year.
The Program consists of 5 modules
and each Module is of 6 days with
a didactic and Clinical Component
with in depth review of surgical and
prosthetic protocols based on scientific and evidence based practice. It
is a non commercial, non sponsored
course covering a wide spectrum
of implant types and system. The
Eighth Annual Program was accredited by the Health Authority of Abu
Dhabi for 269.25 CME hours.
MaxiCourses are the preferred
means for a doctor to obtain comprehensive foundation in Implant
Dentistry says Dr. Rod Stewart, Chair
of AAID’s MaxiCourse subcommittee of the Academy’s Education
Oversight Committee during his
recent visit to the UAE as one of the
speakers of Module 5 of the MaxiCourse in Abu Dhabi. The Faculty
of the Program, all credentialed by
the American Board include Drs.
Shankar Iyer(Course Director) , Jaime
Lozada, Robert Miller, Alfred Duke
Heller, Hilt Tatum, William Locante,
Natalie Wong, Stuart Otten Jones,
Irfan Kanchwala, Mathew Kattadiyil, Frank LaMar, Robert Schroering,
Amit Vohra, said Dr.Ninette Banday

who is the co-Director of the Program
in the UAE and also an instructor in
the Program. These Top Speakers
discuss a broad range of interesting
topics that all experience levels can
benefit with scientific support. The
Program moves from the basics to
the advanced level and so in Module
1 all participants review the Anatomy, basic suturing skills, flap designs
along with placing implants on artificial jaws. This prepares them for
and sets the basis for the subsequent
clinical sessions where the participants work under direct supervision
of the instructors on patients. The
Ninth batch scheduled to start from
August 30th 2016 will allow the participants to place 10 implants as part
of the Program. The participants
therefore get an opportunity for
discussion of actual problems and
to find solutions which they can apply in their clinical practices. Adding
the supervised Clinical sessions both
surgical and restorative has further
elevated the level of the Program. All
the expertise developed in turn benefits’ the patients the dentists serves.
The Program fullfills the educational requirements for the Examination for Associate Fellow Membership Examination for the American
Academy of Implant Dentistry. In
several parts of the world the Associate Fellowship or Fellowship of the
AAID is an acknowledged credential
that represents quality training in
Implantology and skills in the Art
and Science of Implant Dentistry.
To obtain these credentials our participants have to take the AAID examinations which involves a written
Examination – the Part 1 and an Oral/
Case Examination which is clinically
oriented, the Part 2. The Part 1 the
written part can be taken at several
Prometric Centers in Abu Dhabi and
Al Ain and also in other centers in the
Middle East Region. For the Part 2,
previously participants had to travel
to Chicago, but now since last two
years they can take it in Dubai and
the next Part 2 Examination is scheduled in May 2016. The Faculty are
now working to start an advanced
Bone grafting and a Soft tissue Management Course that is scheduled

March-April 2016 | No. 2, Vol. 6

AAID is attending
11th CAD/CAM & Digital Int’l Conference and
8th Dental Facial Cosmetic Int’l Conference

to start from August 2016 to further
the clinical skills of the MaxiCourse
Alumni.
The AAID Foundation also
awards Research Grants to help
members continue dental implant
specific research work. Recently
$60,000.00 was awarded to three

researchers that brings the amount
awarded by the Foundation to over
$700,000.00 over the past few years
since the inception of the Endowment Fund.
The AAID is making every effort
to make implant education more
accessible and beneficial to the par-

Participants are required to do rigorous hands on session
on models, typodonts and lamb jaws in Module 1 before
the clinical sessions in Modules 2, 3, 4 & 5

ticipants ensuring comprehensive
training Programs in Implant Dentistry. For the MaxiCourse Asia additional information can be obtained
online at www.maxicourseasia.com
or by emailing Dr. Ninette Banday at
drnbanday@yahoo.com

Dr. Shankar in an interactive clinical session

THE NINTH ANNUAL AMERICAN ACADEMY OF IMPLANT DENTISTRY
MaxiCourse®- UAE 2016 – 2017 Starts August 30

A UNIQUE OPPORTUNITY
DENTAL IMPLANTOLOGY

In Fulfillment of the Educational Requirement for the Examination
for Associate Fellow Membership for the American Academy
The Faculty are as follows:
Dr. Shankar Iyer, USA

Director, AAID Maxi Course®UAE
Diplomate AAID
Clinical Assistant Professor,Rutgers School
of Dental Medicine.

Dr. Ninette Banday, UAE

Co-Director AAID Maxicourse- Abu Dhabi, UAE
Academic Associate Fellow AAID

Dr. Amit Vora, USA

Diplomate of the American Board of
Periodontology
Professor (partime) ,JFK Hospital and the Veteran
Affairs (V.A.) Hospital

Dr. Jaime Lozada, USA

Director of the Graduate Program in Implant
Dentistry
Fellow, American Academy of Implant Dentistry

Dr. William Locante, USA

Diplomate of ABOI
Fellow of American Academy of Implant Dentistry

Dr. Robert Horowitz, USA

Dr. Stuart Orton-Jones, UK

Dr. Frank LaMar, USA

Fellow, American Academy of Implant Dentistry
Diplomate, American Board of Oral Implantology

Founder Member, The Pankey Association
Member, Alabama Implant Study Group
Director, The Stuart Orton-Jones Institute

Dr. John Minichetti, USA

Dr. Robert Miller, USA

Diplomat, American Board of Oral Implantology
Honored Fellow, American Academy of Implant
Dentistry

Dr. Robert Schroering, USA

Board Certified by the American Board of Oral
Implantology/Implant Dentistry
Honored Fellow American Academy of Implant
Dentistry

Board Certified by the American Board of Oral
Implantology
Fellow, American Academy of Implant Dentistry

Dr. Philip Tardeu, France

Dr. Kim Gowey, USA

Dr. Natalie Wong, Canada

Past President – AAID
Diplomate ABOI

Founder and Author, Computer Guided
Implantology and the Safe System.

Diplomate, American Board of Oral Implantology
Fellow, American Academy of Implant Dentistry

Dr.Burnee Dunson, USA

Fellow, American Academy of Implant Dentistry
Diplomate ABOI

Dr. Ahmed Ibrahim Osman UAE

Director of Implant Center, University of Sharjah.
Assistant Director of University Dental Hospital.

Dr. Irfan Kanchwala, India

Implant Fellowship ( UMDNJ, USA)
Diplomate , American Board of Prosthodontics

Dr. Jason Kim, USA
Diplomate of ABOI

Diplomate American Board of Periodontology
Clinical Assistant Professor New York University

Eighth Annual Program Accredition by Health Authority Abu Dhabi for 252.75 CME Hours.
Accredition for the Ninth Annual Program under process both with DHA & HAAD.

Program Includes placement of 10 Implants with all surgical and
prosthetic components, all materials for hands – on workshop and
lecture handouts plus one complete surgical instrument Kit.









MaxiCourse ® Advantage:

300 hours of comprehensive lectures, live surgeries,
demonstration and hands-on sessions.
In depth review of surgical and prosthetic protocols.
Sessions stretch across 10 months in 5 modules of 6 days.
Each session is always inclusive of a weekend.
Over 15 speakers from the International Community who are
amongst the most distinguished names in implantology will
teach the curriculum.
Certificate of completion awarded by the American Academy
of Implant Dentistry.
Non commercial, non sponsored course covering a wide
spectrum of implant types and system.
Hands-on patient treatment under direct AAID faculty
supervision.
Membership for AAID awarded for 2016 – 2017

Dates:
Module 1
Module 2
Module 3
Module 4
Module 5

August 30th – September 4th 2016
November 3rd – 8th 2016
February 2nd – 7th 2017
April 26th – May 1st 2017

Dates to be announced

Registration :
Pre-Registration is Mandatory as it is a limited Participation Program.
For further information and registration details visit website: www.maxicourseasia.com or e-mail
Dr. Ninette Banday, Coordinator AAID-MaxiCourse UAE at drnbanday@yahoo.com

Dr. Ninette supervising a surgical case

[66] =>

implant tribune

Dental Tribune Middle East & Africa Edition | 2/2016

Treatment of Peri-Implantitis with
the Picasso Diode Laser
A long-term follow-up after debridement and grafting

By Gregori M. Kurtzman, DDS,
MAGD, Markus Weitz, DDS, Ron
Kaminer, DDS, Daniel D. Gober, DDS
The prevalence of peri-implant
complications is rising significantly
as implant treatment increases.
Periodontal disease associated with
implants can range from gingival
inflammation in the absence of bone
loss to significant bone loss and mobility of the fixture. The latter can
occur when the disease process is
not identified early in the process or

Figure 1. Fistula present at the distal of the maxillary right canine in close proximity to the gingival
margin.

a “watch and wait” attitude is taken.
Treatment has traditionally involved flap elevation and mechanical debridement with surgical hand
instruments to remove any granulation tissue present on the implant
threads. As a result of the limitations
of surgical tools, removal of additional bone might be required to
reach areas that are not visible.
Success diminishes as more surface area is left untreated.
Diode lasers have several benefits related to peri-implantitis treatment. The small diameter of the
flexible glass fiber allows easier and
more complete access without the
need to remove as much bone as
when only surgical instruments are
utilized. Additionally, the diode has
the ability to sterilize the implant’s
contaminated surface, eliminating
any existing bacteria and keeping
them from preventing healing after
treatment.1 The added benefit of using a diode in these procedures is
biostimulation of the mesenchymal
stem cells in the surrounding bone
and soft tissue, an important tool
for regenerative therapy and tissue
engineering to provide better healing.2,3 Thus, the diode laser is a good

adjunct in the treatment of peri-implantitis, improving the clinical results observed with more traditional
methods.4

Case Presentation
A 64-year-old male patient presented in June 2010 with a fistula
draining on the buccal of the upper
right canine. The fistula was located
distal to the canine midline in close
proximity to the gingival margin
(Figure 1). A guttapercha cone was
inserted into the fistula totrace the
origination point of the draining infection and a radiograph was taken.
It was determined that the fistula
traced to the apical of the implant
situated at site No. 6. Implants had
been placed and restored for teeth
Nos. 3 through 7 several years previously. The implant was identified as
a Brånemark Mark III RP (Nobel Biocare, www.nobelbiocare.com) at site
Nos. 4 through 6, and a NobelReplace
(Nobel Biocare) at site No. 7. A radiograph was taken to evaluate the underlying osseous structure around
the implant, which demonstrated radiolucency associated with the apical
of implant No. 6 and crestal bone loss
with thread exposure under the soft

Figure 2: Initial radiographic presentation demonstrating a large radiolucency around the apical half of the implant at site No. 6.
Figure 3: Following a full-thickness flap and removal of the granulation tissue with the Picasso diode laser, a lack of buccal bone is
noted down the entire length to the apical. Figure 4: Osseous graft material was placed into the defect that had been cleaned with
the Picasso diode laser and built out to the proper contour for the buccal plate

Figure 5: Periapical radiograph taken
post-surgically demonstrating defect
filled with the osseous graft material.

Figure 6 & 7: CBCT of a cross section (6.)
and coronal slice (7.) of site No. 6 taken
5 years after peri-implantitis treatment
demonstrating maintenance of the buccal
plate and no return of the initial periodontal problem.

Figure 8: Periapical radiograph at 5-year
follow-up.

tissue on implant No. 7. Clinically, no
recession was noted and no implant
mobility was detected.
The patient was informed of
the clinical issues and the available
options, including removal of the
ailing implant, grafting the site, and
placing and restoring a new implant
after an appropriate healing period.
The other option would be elevating
a flap, cleaning out any granulation
tissue, and treating the site with a
diode laser and graft to replace any
lost bone.
He was also informed that the
latter option meant that the site
would need to be evaluated once
entered and there was a possibility
that the implant would need to be
explanted should it exhibit mobility
following debridement. The patient
chose peri-implantitis repair.
Preoperative antibiotics (2.0
g amoxicillin) were given orally 1
hour prior to the initiation of treatment. A local anesthetic (Septocaine® 1:100,000 with epinephrine,
Septodont, www. septodont.com)
was administered for local infiltration on the buccal and palatal of the
treatment area. A horizontal incision
was made from the distal of the first
premolar to the mesial of the lateral
incisor several millimeters apical to
the gingival margin to limit posttreatment recession potential. A
vertical releasing incision was made
at the mesial and distal extent of the
horizontal incision and a full-thickness flap was elevated.
Upon flap reflection, it was noted that a large dehiscence was present on tooth No. 6 from the crest
to several millimeters beyond the
apical of this implant. Additionally,
some dehiscence was noted on the
buccal of implant No. 5 with threads
minimally covered with bone over
the apical half of the implant.
Site No. 7 presented with 30% to
50% of the threads circumferentially
denuded of bone with complete soft
tissue coverage.
A hand instrument was utilized
to remove any gross granulation
tissue adherent to the bone and exposed implant threads (Figure 3).
An activated 300-μm diode tip
on the Picasso laser (AMD Lasers,
www.amdlasers.com) set at 1.5 W in
continuous mode was used to remove any residual granulation tissue on the exposed threads at the
defect and sterilize the defect area.5,6
The diode’s fiber tip was placed into
physical contact with the implant
surface to remove any residual
granulation tissue and sterilize the
area of any bacteria that contributed
to the peri-implantitis, leaving clean
threads.
Following debridement and sterilization, bleeding points in the osseous walls were created.
Geistlich Bio-Oss® (Geistlich
Pharma North America Inc., www.
geistlich-na.com), a bovine biocompatible porous bone mineral substitute, was packed into the defect
around the implant and allowed to
absorb blood from the surrounding

tissue to form a coagulated mass.
The bone graft was built out buccally to create a new buccal plate
covering the entire implant below
the crestal level (Figure 4). A piece of
resorbable membrane (Ossix® Plus,
OraPharma, Inc, www.orapharma.
com) was trimmed to overlay the osseous graft and end on native bone
and was placed over the graft under
the flap. The flap was repositioned
and secured with nine interrupted
sutures using 5-0 silk to achieve
primary closure. A radiograph was
taken to document the bone fill of
the osseous graft (Figure 5). Hemostasis was confirmed and the patient
dismissed. A prescription for a Z-Pak
(Zithromax®, Pfizer, www.pfizer.
com) was given with the instructions
to use as directed until finished. Additionally, a prescription was given
for Dolobid® (Merck & Co., Inc., www.
merck.com) 500 mg for pain to be
taken twice daily for the initial 3 days
post-surgically. The patient returned
after 1 week for suture removal and
indicated no significant postoperative discomfort. The site appeared to
be healing normally and he was appointed for a follow-up to check healing. At the next postoperative visit,
the site appeared healed with a lack
of inflammation and the patient was
placed on periodontal recall alternative with his general dentist office.
At 5 years post peri-implantitis
treatment, cone-beam computed
tomography (CBCT) was used to
evaluate the long-term status of the
repaired area. The cross section slice
at the right maxillary canine demonstrated that the grafted buccal plate
remained at the position completely
covering the implant with no sign
of further infection noted (Figures 6
and 7). A periapical radiograph confirmed osseointegration (Figure 8).

Discussion
Managing peri-implantitis can
be a challenge. As this case illustrates,
bone loss may be progressing for an
extended period of time before the
clinician becomes aware of it. Treatment requires a surgical approach to
remove any granulation tissue that
has replaced bone overlaying the implant to achieve any success.
The benefit of the Picasso diode
laser is the fiber can be extended into
hard-to-reach areas around the implant to achieve better sterilization
and debridement without the need
to remove additional bone for access,
which would be necessary if only debridement with surgical hand instruments was utilized.
Traditional methods have reported mixed results in removing
all of the granulation tissue from the
exposed implant threads without
altering or gouging the implant’s
surface or coating. A pulsed Er:YAG
laser has also been reported to cause
implant surface alterations.7,8
Scanning electron microscope
analysis has demonstrated no dam-

ÿPage 3

[67] =>

implant tribune

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 2
age or alteration of titanium surfaces
from a diode laser, regardless of the
power setting.8 No visible difference
between lased and non-lased titanium surfaces after irradiation has
been reported, ensuring that the
result yields the best surface guided
tissue regeneration compared to either mechanical debridement or a
Er:YAG laser.
Success in peri-implantitis treatment is strongly linked to the ability
to eliminate the bacteria in the site
that could hamper regeneration.
This becomes more critical with
implants that have been surface
treated. Treated implant surfaces
exhibit micro roughness that are

ing better access to eliminate more
granulation tissue than when only
mechanical means are utilized. This
case demonstrates that the protocol
can provide long-term predictable
results showing 5-year maintenance
of the grafted area and an absence of
inflammation over that time.

advantageous for initial integration,
but also will harbor bacteria when
peri-implantitis has occurred. Removal of bacteria in these micro irregularities is difficult by mechanical
means.
The diode laser has the ability to
decontaminate the exposed surface
and threads without any negative
effects.9

Acknowledgement

Conclusion

Treatment for the case presented performed by Dr. Markus Weitz.

The key to successful peri-implantitis treatment is early identification to limit bone loss from
inflammation and infection. The
diode laser is a powerful adjunct
to treating periimplantitis, allow-

2 . Barboza CA, Ginani F, Soares DM,
et al. Low-level laser irradiation induces in vitro proliferation of mesenchymal stem cells. Einstein (Sao
Paulo). 2014; 12(1):75-81.
3. Authors, the reviewer requested
an additional reference for this statement. Can you please provide one?
Perhaps Dörtbudak O?
The full list of references is available
from the publisher.

References

Gregori M. Kurtzman, DDS, MAGD
Private Practice
Silver Spring, Maryland
Markus L. Weitz, DDS
Private Practice
Cedarhurst, New York
Ron Kaminer, DDS
Private Practice
Hewlett and Oceanside, New York
Daniel D. Gober, DDS
Private Practice
Cedarhurst, New York

1. Authors, the reviewer requested
an additional reference for this statement. Can you please provide one?

Multidisciplinary approach

Figure 1. Pre-op

Figure 2. Pre-op occlusion

Figure 3. Pre-op full upper dental arch with miss- Figure 4. Pre-op x-ray showing
ing teeth and bone defect
short bone height

Figure 9. Hydrolic sinus lift using normal saline
through the osteotomy

Figure 6. Buccal view during orthodontic treatment
Figure 5. occlusal view showing buccal defect

Figure 7. Full thickness flap elevation, and thin ridge

Figure 8. Complete exposure of
the site after vertical releasing
incision

Figure 14. Implant Placement
and the narrow ridge

Figure 10. Bone harvesting from the external Figure 11. Blood extraction for PRF membrane Figure 12. PRF membrane
oblique ridge
preparation
Figure 13. Sinus floor elevation
using PRF

Figure 15. Buccal view of the
implant site showing bone dehiscence

Figure 16. Augmenting the site

Figure 17. Fully augmented site

Figure 18. Correction of the buccal defect

Figure 21. Buccal view of Ti mesh

Figure 22. Ti mesh covered by PRF
membrane

Figure 23. Tension free closure
and PTFE suture

Figure 19. Ti mesh use
to protect the bone
the augmented site

Figure 20. Ti mesh
stabilize by cover flat
screw

ÿPage 4
Figure 24. Healed site

[68] =>

4

implant tribune

Dental Tribune Middle East & Africa Edition | 2/2016

◊Page 3

Figure 28. Gingival healing around the
temp. crown after adjustment of the mesio-distal dimension
Figure 24. Surgical dissection and
Ti mesh removal

Figure 25. Customize screw retained temp. crown

Figure 26. Temp. crown placed and 2 stabilization
sutures

Figure 27. Adjustment the contact of the temp. crown and orthodonticly reducing the mesiodistal dimension

Figure 31. Buccal view of the healed site after soft tissue conditioning

Figure 29. Temp. crown occlusal
view of the healed site

Figure 30. Implant site after soft
tissue conditioning

Figure 32. Duplicating the gingival tissue site

Figure 33. Gingival sulcus duplicated

Figure 38. Pre-op full arch view
Figure 40. Buccal view with the
final screw retain crown

Figure 35. Impression post

Figure 41. Occlusial view of screw
final crown

Figure 36. Impression post
with sulcus shape

Figure 39. Post-op full arch view

Figure 42. Final frontal view after orthodontic and restorative
correction

Figure 45. Frontal pre-op photo

Dr. Ehab Rashed
BSc, BDS, MSc.
Dipl. ICOI, Dipl.DGOI
DentalXP expert

Figure 43. Final occlusial view post-op

Figure 44. Final occlusial view post-op before insertion of the
final crown showing correction of the buccal defect

Figure 46. Frontal post-op photo

Figure 47. Final view with the smile line after cementation of
4 units veneers

[69] =>

11 CAD/CAM & Digital Dentistry
International Conference
th

06-07 May 2016

Jumeirah Beach Hotel, Dubai, UAE
www.dental-tribune.me

Printed in Dubai

Show Edition

Six days of
lectures and
continuing
education in
dentistry
By Dental Tribune MEA/CAPPmea
DUBAI, UAE: From 4 to 9 May 2016,
the Centre for Advanced Professional Practices (CAPP) will be hosting 15
hands-on dental education courses
supplementary to the 11th edition
of its annual CAD/CAM and Digital
Dentistry International Conference,
which will be held on 6 and 7 May
at the symbolic Jumeirah Beach Hotel in Dubai. In addition, the Dental
Technician International Meeting
will take place parallel to the conference.

About the conference
The 11th CAD/CAM and Digital Dentistry International Conference is a
two-day event targeted at addressing
the business and educational needs
of independent dental professionals. Prior to and after the conference,
hands-on courses on various multidisciplinary topics will be held.
Participants will have the opportunity to meet other dental professionals
from all over the world during educational sessions led by industry experts and earn continuing education
credits. Furthermore, attendees will
have face-to-face business opportunities with representatives of leading
dental manufacturers at the dental
exhibition at Jumeirah Beach Hotel.

Delegates during the Scientific Programme

The conference features
- Accredited scientific dental education sessions focused on digital and
esthetic dentistry
- Accredited scientific dental technology education sessions for dental
technicians
- Pre- and post-conference hands-on
courses by industry experts on multidisciplinary topics
- Poster presentations
- Extensive exhibition focused on
the latest digital and esthetic dentistry technologies
- Educational sessions with industry
experts
- Face-to-face appointments with
suppliers of your choice
- Networking opportunities with
industry peers and supplier representatives
- Unparalleled social programme.

Scientific programme
presenters
This year’s scientific programme
once again features prominent international speakers, including:
Prof. Jan-Frederik Guth, Germany
Dr. Michael Dieter, Switzerland
Dr. Çağdaş Kışlaoğlu, Turkey
Prof. Jihad Abdallah, Lebanon
Dr. Mario J. Besek, Switzerland
Mr. Vanik Kaufmann-Jinoian,
CDT, Switzerland
Michele Temperani, CDT, Italy
Dr. Matteo Beretta, Italy

Dr. Nunzio Cirulli, Italy
Dr. Guillaume Jouanny, France
Dr. Jan Paulics, Denmark
Dr. Tif Qureshi, UK
Prof. Paul Tipton, UK
Dr. Kiril Dinov, Bulgaria
Dr. Eduardo Mahn, Chile
Assoc. Prof. Joseph Sabbagh,
Lebanon
Dr. Munir Silwadi, UAE
Aiham Farah, CDT, Syria
John Philipp, Canada
Yamen Chaban, TSS, CDT, Germany
Maffei Simone, Italy
Christopher Adamus, Denmark
Clemens Schwerin, MDT Germany.

Dental Technician
International Meeting
The Dental Technician International
Meeting has arisen from CAPP’s
Dental Technician Sessions over the
last eight years. These were targeted
not only at dental laboratory owners
and dental technicians, but also at
the entire dental technology profession. The Dental Technician International Meeting will cover the latest
groundbreaking hot topics focused
on the needs of the dental technology profession. The meeting will be
held on 6 and 7 May at the Meyana
Auditorium in the Jumeirah Beach
Hotel conference centre. Over 200
dental technicians, clinical dental

Round Table Training

technicians, laboratory owners and
other visitors are expected to attend.
The DTIM will combine invigorating
sessions with cases, debates, discussions and various hands-on opportunities. The two day scientific programme includes world renowned
dental technician speakers such as
Michele Temperani, CDT (Italy), Vanik Kaufmann-Jinoian, CDT (Switzerland), Yamen Chaban, TSS, CDT (Germany), John Philipp (Canada), Maffei
Simone (Italy) and Aiham Farah, CDT
(Syria). Participants will become reenergised by new knowledge and
insight that will have an immediate
impact on their work in the lab. The
meeting will further serve as a networking bridge between dental technicians, dentists and dental industry
creating interesting debates on clinical cases and the pros and cons of the
latest dental technologies available.
Round Table Clinic Trainingswill be
hosted by the sponsors and the industry’s most respected speakers. Regardless of specialisation, the participants will enjoy and learn during the
trainings. They will have a chance to
attend numerous presentations split
in smaller groups, having a chance
to ask questions immediately and
receive personal treatment from the
presenters.

Exhibition

Who should attend?
Over 2,000 international participants interested in the fields of digital dental technologies are expected
to attend the CAD/CAM and Digital
Dentistry Conference in order to
learn more about digital dentistry,
minimally invasive treatments, digital esthetic approaches, digital smile
design and clinical experience. Interaction with industry partners will be
one of the greatest benefits of the
Dubai conference. The substantial
opportunities for networking are
aimed at bridging the gap between
clinical knowledge and technical
industry experience in the field of
dentistry.
Participants can already take advantage of the early bird registration
and special room rates at the exclusive Jumeirah Beach Hotel. Further
information is available at www.
cappmea.com/cadcam11 and www.
cappmea.com/dtim.

CAPPmea
Mobile: +971 50 2793711
Telephone: +971 4 3616174
FAX: +971 4 3686883
E-mail: events@cappmea.com
Web: www.cappmea.com

[70] =>

PROGRAMME

11th CAD/CAM & Digital Dentistry International Conference
06-07 MAY 2016 · Jumeirah Beach Hotel, Dubai, UAE

11th CAD/CAM & Digital Dentistry Int’l Conference
FRIDAY 06 MAY 2016 | GROUND FLOOR - MAIN CONFERENCE ROOM
08:00 - 09:00

BREAKFAST WITH THE SPONSORS | REGISTRATION

09:00 - 09:45

Prof. Jan-Frederik Güth, Germany

Digital Biomimetics – Concepts for Predictive Treatments

09:45 - 10:30

Asst. Prof. Dr. Cagdas Kislaoglu, Turkey

Introduction to Digital Dentistry and Smile Design

10:30 - 10:45

MEET THE SPONSORS | COFFEE BREAK

10:45 - 11:30

Dr. Michael Dieter, Switzerland

Bond it or Lose it – How to Fix Prosthetic Restorations in Daily Practice

11:30 - 12:15

Dr. Tif Qureshi, IAA, UK

ABB- from the Simple to the Interceptive Restorative

12:15 - 14:00

LUNCH | PRAYER TIME | MEET THE SPONSORS

14:00 - 14:45

Dr. Jan Paulics, Denmark

New Opportunities for your Dental Practice with Intraoral Scanning, Digital Implant Planning and Surgical guides

14:45 - 15:30

Dr. Mario J. Besek, Switzerland

Composite in CAD CAM Technology - a new Challenge

15:30 - 16:15

Vanik Kaufmann-Jinoian, CDT, Switzerland

Digital Solutions for Today and Tomorrow & Understanding Materials Optimized for Digital Dental Applications

16:15 - 17:00

Dr. Kiril Dinov, Bulgaria

How Digital a Smile can be? SKYN concept

17:00 - 17:45

Dr. Eduardo Mahn,Chile

CAD/CAM Technology, Easier, Faster and Better than Ever

17:45 - 18:00

DISCUSSIONS WITH THE SPEAKERS

SATURDAY 07 MAY 2016 | GROUND FLOOR - MAIN CONFERENCE ROOM
08:00 - 09:00

BREAKFAST WITH THE SPONSORS | REGISTRATION

09:00 - 09:45

Vanik Kaufmann-Jinoian, CDT, Switzerland

Trouble Shoot Problems in Digital World

09:45 - 10:30

Dr. Guillaume Jouanny, France

Challenges in Modern Endodontic Instrumentation

10:30 - 11:15

Dr. Michael Dieter, Switzerland

How to Treat CAD/CAM Restorations Surface

11:15 - 11:30

MEET THE SPONSORS | COFFEE BREAK

11:30 - 12:15

Asst. Prof. Dr. Cagdas Kislaoglu, Turkey

Managing Esthetic Challenges in Smile Design using CAD/CAM and the one day Smile Makeover

12:15 - 13:00

Prof. Jihad Abdallah, Lebanon

Assessment of Marginal Bone Stability around Dental Implants using Digital Radiography (CBCT)

13:00 - 14:15

LUNCH | PRAYER TIME | MEET THE SPONSORS

14:15 - 15:00

Dr. Nunzio Cirulli & Dr. Matteo Beretta, Italy

Complete 3D Virtual Planning of Orthodontic Treatment Using CT Cone Beam and Intraoral Scanner

15:00 - 15:45

Dr. Jan Paulics, Denmark

Advanced features of the Intra-oral Scanner Allowing the Dentist to Excel in Accuracy and Aesthetics

15:45 - 16:30

Assoc. Prof. Joseph Sabbagh, Lebanon

Golden Rules for Successful Digital Restorative Dentistry

16:30 - 17:15

DISCUSSIONS WITH THE SPEAKERS

Dental Technician Int’l Meeting
FRIDAY 06 MAY 2016 | FIRST FLOOR - MEYANA AUDITORIUM
08:00 - 09:00

BREAKFAST WITH THE SPONSORS | REGISTRATION

09:00 - 09:40

Yamen Chaban, TSS, CDT, Germany

The new DNA in glass ceramics

09:40 - 10:20

Christopher Adamus, Denmark

Design possibilities of customized abutments when made using dental CAD system

10:20 - 10:40

MEET THE SPONSORS | COFFEE BREAK

10:40 - 11:20

Michele Temperani, CDT, Italy

All Ceramics and CAD/CAM Technology: An Ideal Combination for Greater Esthetic Success

11:20 - 12:00

Aiham Farah, CDT, Syria

Esthetic Dentistry between Machines and Human hands - Shape & Shade Control

12:00 - 12:15

DISCUSSIONS WITH THE SPEAKERS

12:15 - 14:00

LUNCH | PRAYER TIME | MEET THE SPONSORS

14:00 - 14:40

John Philipp, Canada

Freedom of Choice for the Dental Technician

14:40 - 15:20

Aiham Farah, CDT, Syria

How white a bleach Veneer can be? Reality and possibility

15:20 - 16:00

Michele Temperani, CDT, Italy

Lithium Disilicate Glass Ceramics: Selecting the right Ingots for Ideal Integrations and Maximum Esthetic Results

16:00 - 16:45

PANNEL DISCUSSIONS WITH ALL THE SPEAKERS ON STAGE

16:45 - 18:00

FREE ACCSES TO THE MAIN EXHIBITION (GROUND FLOOR)

SATURDAY 07 MAY 2016 | FIRST FLOOR - MEYANA AUDITORIUM
08:00 - 09:00

BREAKFAST WITH THE SPONSORS | REGISTRATION

09:00 - 09:40

Clemens Schwerin, MDT, Germany

The digital workflow

09:40 - 10:20

Maffei Simone, Italy

New aspect in all ceramic crowns

10:20 - 11:00

Vanik Kaufmann-Jinoian, CDT, Switzerland

Digital Solutions for Today and Tomorrow & Understanding Materials Optimized for Digital Dental Applications

11:00 - 11:30

PANNEL DISCUSSIONS WITH ALL THE SPEAKERS ON STAGEDISCUSSIONS

11:30 - 12:00

FREE ACCSESS TO THE MAIN EXHIBITION

12:00 - 13:30

LIGHT LUNCH | PRAYER TIME

ROUND TABLE CLINIC TRAININGS (Company Demonstration)
TABLE 1 DEGUDENT

TABLE 2 MESA ITALIA

TABLE 3 ZIRKONZAHN

TABLE 4 3SHAPE

TABLE 5 GC

SESSION A 13:30 - 14:45

SESSION B 15:00 - 16:15

SESSION C 16:30 - 17:45

ROUND TABLE CLINIC TRAININGS – 5 table clinics will operate simultaneously on 07 May from 13:30 - 18:00 with a rotation of three groups for each table. The trainings will be held in small groups
(10 seats available per session) in order to have the highest impact. Outstanding Dental Technicians will present various topics of great interest to the dental technicians. Participants will have the opportunity to interact immediately and ask their personal questions of interest. The practical demonstrations will, at the same time, provide inspiration and offer means of trouble shooting.

[71] =>

11th CAD/CAM & Digital Dentistry International Conference
06-07 MAY 2016 · Jumeirah Beach Hotel, Dubai, UAE

PROGRAMME

HANDS-ON COURSES
Wednesday / 04 May 2016
09:00 - 18:00

Dr. Eduardo Mahn, Chile

Veneers Vs Crowns: the Challenge in Smile Design
Thursday / 05 May 2016

09:00 - 18:00

Dr. Munir Silwadi, UAE

Indirect Veneers

09:00 - 18:00

Dr. Eduardo Mahn, Chile

Direct Veneers: the Shades Dilemma

09:00 - 18:00

Prof. Paul Tipton, UK

Veneers, Bonded Crowns and Bridge Design

09:00 - 18:00

Yamen Chaban, TSS, CDT Germany

Cercon TCT (True Color Technology) – Individual and Standard Approach to Fast and Esthetic Zirconium Restorations

Dr. Eduardo Mahn, Chile

Friday / 06 May 2016
Non-Prep-Veneers and Modified Non-Prep-Veneers

09:00 - 18:00

Saturday / 07 May 2016
09:00 - 18:00

Prof. Paul Tipton, UK

Veneers, Bonded Crowns and Bridge Design

09:00 - 18:00

Dr. Eduardo Mahn, Chile

Modern Preparation and Cementation for Inlays, Onlays and Occlusal Veneers

11:30 - 18:30

Dr. Guillaume Jouanny, France

Bioceramic Materials in Endodontics

09:00 - 18:00

John Philipp, Canada

Design needs good software
Sunday / 08 May 2016

09:00 - 18:00

Dr. Tif Qureshi, IA, UK

The New Concept of Alignment, Bleaching and Bonding (Inman Aligner) - CERTIFICATION

09:00 - 18:00

Dr. Munir Silwadi, UAE

Indirect Inlays, Onlays & Partial Crowns

09:00 - 18:00

Dr. Eduardo Mahn, Chile

Advanced Anterior Composite (Direct Veneer and Diastema Closure)

09:00 - 18:00

Michele Temperani, CDT, Italy

Master in metal-free IPS e.max® lithium disilicate
Monday / 09 May 2016

09:00 - 18:00

Dr. Eduardo Mahn, Chile

Non-Prep-Veneers and Modified Non-Prep-Veneers

09:00 - 18:00

Michele Temperani, CDT, Italy

Master in metal-free IPS e.max® lithium disilicate

PLATINUM SPONSOR

GOLD SPONSORS

OFFCIAL SPONSORS

EXHIBITORS

CRYSTAL SPONSOR

SILVER SPONSOR

3

[72] =>

The winning combination

CAD/CAM and 3D in one software
Planmeca Romexis is the only dental software platform
®

in the world to combine CAD/CAM work and all imaging data.
Take advantage the software’s advanced specialist tools
and create a new standard of care for patients.

software

Find more info and your local dealer
www.planmeca.com

Planmeca Oy Asentajankatu 6, 00880 Helsinki, Finland. Tel. +358 20 7795 500, fax +358 20 7795 555, sales@planmeca.com

) [page_count] => 72 [pdf_ping_data] => Array ( [page_count] => 72 [format] => PDF [width] => 808 [height] => 1191 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT Middle East and Africa No. 2, 2016

[toc] => Array ( [0] => Array ( [title] => Dentsply Sirona: Merger Creates the Dental Solutions Company™ [page] => 01 ) [1] => Array ( [title] => News [page] => 04 ) [2] => Array ( [title] => Checklists not just for pilots anymore [page] => 08 ) [3] => Array ( [title] => Long-term clinical success in the management of compromised intertooth spaces utilizing small-diameter implants [page] => 10 ) [4] => Array ( [title] => Oral Health [page] => 12 ) [5] => Array ( [title] => Restorative [page] => 17 ) [6] => Array ( [title] => Aesthetics [page] => 25 ) [7] => Array ( [title] => General Dentistry [page] => 30 ) [8] => Array ( [title] => Ortho Tribune [page] => 34 ) [9] => Array ( [title] => Interview: “It is important for us to adapt our global projects to the culture in the Middle East” [page] => 39 ) [10] => Array ( [title] => Interview: "Keep your natural smile on because you are beautiful" [page] => 40 ) [11] => Array ( [title] => Assessing your practice success [page] => 42 ) [12] => Array ( [title] => Hygiene Tribune Middle East & Africa Edition [page] => 45 ) [13] => Array ( [title] => Endo Tribune Middle East & Africa Edition [page] => 53 ) [14] => Array ( [title] => Lab Tribune Middle East & Africa Edition [page] => 57 ) [15] => Array ( [title] => Implant Tribune Middle East & Africa Edition [page] => 65 ) [16] => Array ( [title] => 11th CAD/CAM & Digital Dentistry International Conference Dubai - May - 2016 [page] => 69 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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