DT Middle East and Africa No. 4, 2014

News / CEREC Desert Fest 12-13 September - 2014 DUBAI - UAE / Over 1 - 580 dental professionals attended the 9th CAD/CAM & Digital Dentistry Int’l Conference / Dental Photography Part II: Protocol for shade taking and communication with the lab / The diode laser as an electrosurgery replacement / Weightlifter grits his teeth – a case for VITA ENAMIC / Cleanic: Clinical use of a recognised prophy paste with Perlite / Pulp protection in today clinical practice: what about the role of materials? / Hygiene Tribune / KaVo CAD/CAM workflow with the new products ARCTICA AutoScan - KaVo multiCAD Virtual Articulator and VITA ENAMIC / Now is the time to consider investing in your own CBCT System / Simple - planned aesthetic orthodontics for the General Practitioner / Management Of Ectopically Erupted First Permanent Molars

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www.dental-tribune.me

Printed in Dubai

news

mcme

EVENT

R 14-15, 2014
BEACH HOTEL
DUBAI, UAE

July-August 2014 | No. 4, Vol. 3

“New treatment center
from Sirona: Quality
“made in Germany”...”

6th Dental Facial Cosmetic “Dental Photography
Part II: Protocol for shade
Int’l Conference
taking and...”
14-15 November 2014

cappmea.com

>Jumeirah Beach Hotel Dubai

>Page 4

>Page 6

CEREC
Desert Fest
12-13 September, 2014
DUBAI, UAE

The Palace Hotel Downtown Dubai, UAE

Part of Continuing Dental Education CAPP Series Dubai Dental Meetings
By Centre For Advanced
Professional Practies (CAPP)

D

UBAI, UAE: CAPP has
the pleasure to welcome
you to a Dubai dental
meeting from the upper echelon
in Dental Medicine at the spectacular The Palace Hotel Downtown Dubai. The full solution for

clinical and Lab restorations, designed for beginners, advanced
and future CEREC users will get
together the ‘creme de la crème’
in Prosthodontics, Implantology,
Aesthetics and digital dentistry.
An event, first of its kind taking
place in the heart of Dubai featuring exceptional panelists and
trainers, rounding up with an

unforgettable social program.
The event featuring Dentists and
Dental Technicians – beginners,
advanced and future CEREC users who are just considering this
revolutionary system or for the
professionals who would like
to keep up with latest trends in
high tech dentistry. The two days

will cover a Panel Show on 12th
of September and Table Clinic
Presentations on 11, 12 and 13th
September 2014.
The panel show on 12th September, known as CEREC Desert
Fest will look at the networks,
which exist within the digital
dental world. The five panelists

with their vast knowledge will
show how fast the digital technology and science joined up
unexpectedly in dentistry, faster
than we ever imagined. All panelists will have debates after
each presentation amongst each

> Page 4

Dr. Aisha Sultan Al Suwaidi Over 1,580 dental professionals
officially elected to lead the attended the 9th CAD/CAM &
APDF for 2014-2015
By Emirates Dental Society

D

Dr. Aisha Sultan Al Suwaidi,
President Emirates Dental
Society

UBAI, UAE: In the presence of His Excellency,
the Minister of Health,
Dr. Abdulrahman Al Oweiss, Dr.
Aisha Sultan Al Suwaidi, Head
of Dental Services in Ministry
of Health and Head of Dental
Chapter of Emirates Medical
Association, has been officially
elected to lead the Asian Pacific
Dental Federation for the year
2014-2015.
Representatives of 32 countries attended the ceremony. Accordingly, the United Arab Emirates has hosted the Asian Pacific
Dental Congress from 17-19th
June 2014, with pre-congress
workshop and a very rich scientific program.

Digital Dentistry Int’l Conference
By Dental Tribune MEA

D

UBAI, UAE: The 9th edition of the CAD/CAM
& Digital Dentistry International Conference gathered 1,580 dental professionals,
leading industrial players and
visitors from 37 countries at the
Jumeirah Beach Hotel on 09-10
May 2014 for the biggest Digital
Dentistry Show.
Participants Feedback
We received great feedback
from participants attending the
conference, which can all be
summarized into a message

Social gathering at 9th CAD/CAM & Digital Dentistry Int’l
Conference on 09-10 May 2014

> Page 34

NEWS

ACADEMIA TRIBUNE HYGIENE TRIBUNE CAD/CAM TRIBUNE ORTHO TRIBUNE

Page 4

Page 13

“New treatment center from
Sirona: Quality “made in
Germany” at an attractive
price”

Pulp protection in today
clinical practice: what about
the role of materials?

Page 17

“Philips introduces its best
brush yet, Sonicare DiamondClean...”
“How much do you care for
your hands?”

Page 22

Page 33

Page 25

“Management Of Ectopically
Erupted First Permanent
Molars”

“KaVo CAD/CAM workflow
with the new products...”

“Simple, planned aesthetic
orthodontics for...”

[2] =>

2 news

Dental Tribune Middle East & Africa Edition | July- August 2014

Dental Wings integrates Neodent implants
into guided surgery software
By Dental Tribune International

URITIBA, Brazil/ MONTREAL, Canada: Dental
Wings, international provider of CAD/CAM and guided
surgery solutions for dental
laboratories and clinics, has announced that it has integrated
products from Brazilian implant
manufacturer Neodent into its
coDiagnostiX software. Through
the collaboration, users of the
guided surgery software will
gain access to Neodent’s implant
and sleeve system, consisting of
two implant series, three sleeves
and one fixation pin.

Neodent is one of the leading
dental implant companies in
Latin America and targets the
nonpremium segment in the
implant market, thus making its
products accessible to a broader
population. According to Matthias Schupp, Neodent’s executive vice president of sales and
marketing, the company has
sold over 5 million implants to
about 30,000 clinicians worldwide already.
Frank Stockmann, vice president of guided surgery at Dental
Wings, said that his company is
pleased to be able to give its cus-

tomers access to products from
one of the most rapidly expanding implant companies in the
world through its coDiagnostiX
software. “We are confident that
Neodent customers will enjoy
the benefits of a sophisticated
and user-friendly guided surgery solution,” he added.
Neodent was founded in 1993
and was the first Brazilian company in the implant segment to
receive certification from the
Brazilian ministry of health.
Headquartered in Curitiba in
Brazil, the company runs subsidiaries in the U.S., Mexico,

Portugal and Spain. Today, Neodent employs more than 900
people, operates more than ten
branches in Brazil and works
with a wide network of distributors.
In addition to coDiagnostiX,
which was acquired from Straumann in 2013, Dental Wings offers an open CAD/CAM platform
called DWOS, both of which are
aimed at improving the quality of restorations and dental
treatment, and increasing the
productivity of laboratories and
clinicians. The company announced that coDiagostiX will
be fully integrated with the
DWOS platform by fall 2014.

Group Editor

Daniel Zimmermann
newsroom@dental-tribune.com
+49 341 48 474 107
Clinical Editor

Magda Wojtkiewicz
Online Editors

Yvonne Bachmann
Claudia Duschek
Copy Editors

Sabrina Raaff
Hans Motschmann
Publisher/President/CEO

Torsten Oemus
Director of Finance &
Controlling

Dan Wunderlich

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[3] =>

[4] =>

4 news

Dental Tribune Middle East & Africa Edition | July- August 2014

New treatment center from Sirona:
Quality “made in Germany” at an attractive price
By Sirona

ENSHEIM, Germany:
On May 12, Sirona,
global market and
technology leader in
the dental industry, has introduced a new treatment center:
INTEGO offers top quality and
flexible configuration options
at an attractive price.
All dentists around the world
share a common wish: To provide their patients with the best
possible treatment. That’s why
they ideally want to work with
high-quality devices and systems which offer optimum support for their day-to-day work.
The treatment center plays a
key role here; after all, this is
where they spend a large part
of their working day. As the
global innovation and technology leader in the dental industry, Sirona has developed a
new product generation for the
treatment center division. This
new product line can be very
flexibly configured to suit the
needs of various practitioners
– introducing INTEGO! “Dentists should not have to forego
outstanding quality, innovative
features and modern design
depending on how much they
can afford to invest in a new
center”, explained Michael
Geil, Vice President Treatment
Centers at Sirona and Managing Director of the Bensheim

Sirona CEO Jeffrey T. Slovin explaining the new INTEGO. The
treatment unit was developed over a period of four years. (Photo:
Daniel Zimmermann, DTI)

Dental Tribune MEA was invited to the official Sirona presentation of
INTEGO and Sirona Factory visit Bensheim.

site in Germany. “INTEGO is a
future-proof, high-quality German product which satisfies
these demands.”

between C8+ and SINIUS. With
INTEGO TS and CS versions,
the dentist element can be positioned above the patient. In
contrast, TENEO and SINIUS
feature a sliding track which
positions the dentist element
either automatically or manually. As high-end products,
SINIUS and TENEO also offer
motorized functions, for example an adjustable headrest,
a massage function to ensure
patient comfort as well as the
option of hand-free operation of
the center. As such, Sirona satisfies a wide range of the most
diverse requirements made by
dentists and patients alike. The
treatment centers represent
high-quality and proven solutions at an attractive price. As
with all other Sirona centers,

Top quality and flexible configuration options
The new treatment center
comes in two versions: INTEGO
and INTEGO pro with extended
functionality. Each model can
be supplied as a hanging hoses
model (TS) or with whip arms
(CS) in a wide range of shades.
Both versions are based on a
chair concept which takes the
four dimensions of ergonomics
into account – intuitive sitting,
comfortable positioning, optimum visibility and integrated
workflows – and thus ensures
that practitioners achieve ideal

results. The individual functions, the instruments and
all the settings can be simply
selected and controlled via
an intuitive user interface. In
comparison, INTEGO pro offers enhanced functionality.
Some features, e.g., the 4-way
foot switch and the automatic
disinfection device, are even
included in the basic INTEGO
pro model. Furthermore, INTEGO pro offers more optional
functions: For example, the
customer can choose features
such as the ApexLocator.
INTEGO is the perfect complement to the product family
INTEGO is an ideal addition
to Sirona’s treatment center
product family and fills the gap

the INTEGO is also produced
in Bensheim, Germany, where
it is put through its paces. The
long-lasting design, use of
high-quality, robust materials, product quality “made in
Germany” and a focus on ergonomic operating procedures
and patient comfort make this
a treatment center which is not
only future-proof, but also facilitates the everyday working
lives of dentists and assistants.
INTEGO is available now from
dental dealers. More detailed
information on the functions
and specifications of this treatment center can be found at the
official Sirona company website. The price of the INTEGO
will vary between 15.000 and
25.000 Euro, depending on individual configuration.

< Page 1
other on stage. Open discussions
with CEREC followers from the
public will be made available
through live-stream feed and
the audience onsite in Dubai.
Let’s look into what are our
panelists are preparing for the
delegates. Dr. Todd Ehrlich,
who is using CEREC for a long
time, said: “It is truly powerful
this idea of a one visit dentistry
– it’s awesome! The Omnicam
from Sirona is by far the greatest invention in dentistry today. I
love using this thing every single
day.” And his suggestion: “Make
sure you get a good demo of it

use of technology with CEREC
Omnicam, the digital imprisoning has recreated dentistry to
become simple, accurate, and
cost effective. Who would have
ever imagined that throughout the years dental techniques
would become extremely high
tech and evolve from the simple onlay restoration to now the
most sophisticated implant restorations being created!

“The Omnicam Rocks!”
– Dr. Tod Ehrlich
Arabian Flavored Aspirations For Digital Dentistry.

“I am honored to be a part of such a fine group of
clinicians! This looks like a fabulous event!”
- Dr. Todd Ehrlich, USA
– you are going to be fascinated
how easy this camera really
works. You can see his whole
practical presentation about
what the Omnicam can do on
www.cerecfest.cappmea.com.
Dr. Bernd Reiss, teacher at the
German Institute for Advanced
Dental Studies since 1999 is a
President of the Association for
Ceramics in Dentistry and Executive Director ISCD. Since 1987
he lectured at more than 400
seminars, congresses and workshops in more than 40 different

countries worldwide. At CEREC
Desert Fest he will bring a new
Dimension into CAD CAM Dentistry with CEREC 2014. Clinical
possibilities in the Dental practice, integration of different digital systems and integration of
time in different ways will bring
you to the question: What can
we expect?
“It’s incredible how easy and
fast new users learn to operate
the new Camera CEREC Omnicam. Come learn and engage
in this one day lecture/hands-

on and discover in how you can
integrate CEREC Omnicam to
your practice.” - Dr Vasquez. Dr.
Vasquez develops his passion for
CAD-CAM dentistry leading him
to be trainer for Patterson Dental
and Sirona Dental Latin-American. He has lectured nationally and internationally for Sirona Dental Systems on CEREC

En Español, Speaker/ trainer for
CEREC On Demand and Trainer of Trainers for CEREC Latin
America. “The Evolution of Simplicity with CEREC AC, New Possibilities No Alternative” - The
only limitation you have today
with the CEREC systems is your
own imagination… The evolution of CEREC technology has

“Digital advancements in dentistry are growing at
a break-neck speed” - Todd Ehrlich, DDS
BlueCam and Omnicam in restorative process, integration of
CEREC / Galileos and “Speaking the same language with Sirona Connect”. Dr. Vasquez is an
Apollo DI beta tester for Sirona
Dental, Co-founder of CEREC®

been progressing and forever
changing the lives of people. 29
years ago when CEREC was first
introduced into the dental society it was only to carve the basic inlay and onlay restorations.
Today with the combinational

Prof. Att, the President of the
Prosthodontics Group of the
International Association for
Dental Research (IADR) and
the President of the Arabian
Academy of Esthetic Dentistry
(ARAED). Will talk about the
Current aspect in contemporary
implant dentistry. He has many
publications focusing on implant therapy and basic science
in the most respected journals in
these ﬁelds. His research work
about the discovery of biological aging and rejuvenation of
implant surfaces was honored
by listing under “Images of the
Year” by Biomaterials journal.
CEREC meets SMILE DESIGN

> Page 31

[5] =>

[6] =>

6 mcme

Dental Tribune Middle East & Africa Edition | July- August 2014

Dental Photography Part II: Protocol for
shade taking and communication with the lab
mCME articles in Dental Tribune have been approved by:
HAAD as having educational content for 2 CME
DHA awarded this program for 2 CPD Credit Points
CAPP designates this activity for 2 CE credits.
By Dr. Eduardo Mahn, DDS,
DMD, PhD
Universidad de los Andes
Clinica CIPO Santiago-Chile

art I of this article discussed the basic equipment that is necessary for
dental photography. In addition, a few examples of pictures
taken that were better than
others for the same situation
were also shown. In part II, a
protocol of taking digital photographs will be presented which
has been of great help to the author, specifically in achieving
the right shade and value. It is
based on standardized pictures
that should be taken in order to
show certain individual characteristics of the patient to be
treated and standardized comparisons of the shade tabs and
the natural tooth structures
in order to give the technician
more information than the usual A2 or A1 written on a piece of
paper.
Introduction - Shade taking
The evolution in digital photography and the possibility of

taking pictures and evaluating
them immediately as well as
almost instantaneous access
of the information by someone
located off-site in the same city
or even another country, we
have a great resource available that can help us achieve
the right shade of our indirect
restorations. Standardized high
quality photographs are also an
advantage when the shade is
taken for a direct restoration for example a direct veneer or
a class IV.
In this case a picture can really help the clinician identify
the opalescent areas and the
halo effect of the adjacent tooth,
before re-doing the restoration
(Figure 1).
Dental shade taking at the
dental lab or in the dental practice can be frustrating as most
dentists do not really know how
to use the shade guide when
they finish their undergraduate
studies. In particular, if work
has to be redone, because the
clinician does not know what
was done incorrectly wrong or
how to obtain the right shade.
Dental shade guides are used

Figure 1: This picture will help the clinician
to understand the challenge of reproducing
the opalescent areas and the halo effect at the
incisal third.

by dentists, dental assistants
and dental laboratory technicians to communicate proper
tooth color, translucency, and
brightness.
However, many variables
come into play no matter what
system you decide to use. Before
even starting to think about
shade taking; you need to answer an extremely simple and
obvious question: are you using
exactly the same shade system
as the lab? There are many
shade taking systems available,
with variations in the shades
between different manufacturers, even though the concept
may be the same. They are also
manufactured from different
materials with different optical properties. For example,
some labs are familiar with the
Chromascope system, most of
the dentists with the A-D shade
guide, while the younger generation of dentists learned with
the 3D master shade guide.
(Figure 2)
The role of a shade guide is
to help standardize the perception and so facilitate the communication in order to match

Figure 2: Example of different shade guides
showing the same shade.
The differences are obvious.

Figures 3 - 5: Different appearance of the shade tabs under different light conditions.

Figure 6: The technician
should always check the
final appearance of the
restorations with the use
of the natural die material
shade guide in order to come
to the optimum result.

Figures 7 and 8: Mayor differences in the appearance of the
same veneers teeth 11 and 21, due to the use or lack of lipstick.
(Thanks for the pictures to CDT Juergen Seger, Liechtenstein)

Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals
in identifying quality providers of 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.

EXCLUSIVE WITH CAPP:
Dr. Eduardo Mahn Hands-On Courses
6th DFCIC 12 – 15 Nov 2014
Jumeirah Beach Hotel DUBAI
Veneers vs Crowns: 12 Nov. 2014
Direct Veneers: 13 Nov. 2014
Face And Smile Analysis: 15 Nov. 2014

info@cappmea.com
the shade of the natural teeth
with the required restoration.
Shade guides are not a perfect representation of what
is actually seen but are close
enough to identify a range of
tooth colors. Eyes are still the
best tool for identifying and
communicating the correct
dental shade. Tooth color can
be referred to as being an A1
or A2, or between a B2 and B3
when describing the respective tooth closest to the one being restored. It is always best to
get the patient to the dental lab
and have a custom shade taken,
if possible, particularly for the
more difficult cases. However,
in most of the cases this is not
possible, due to unwillingness
of the patient to spend time going to the lab, or the location of
the lab not being in close proximity.
The use of shade guides
should be used in conjunction
with digital photography. If no
direct light is projected to the
mouth and the shade tabs, the
main light source will be the
flash of the camera, which has
always the same temperature
(between 5500° and 6000° K)
and can be used by the dentist
in the clinic and the technician
in the lab. When pictures are
taken under different light conditions, the variations between
the same shades can be considerable.
(Figures 3 - 5) A good photo
for both the dentist and the lab
technician can be emailed so
that they are both looking at the
tooth color under the same conditions. When the technician
compares the color of the restoration with the shade guide,
he can take a picture that will
create an image to be used as
a comparison under the same
light conditions as the natural
teeth in the image sent by the
clinician. (Figure 6)
Due to the flash of the camera, the technician can then
whether the restorations look
similar to the original shade tab
sent by the clinician. (Figure 6,
Veneers by CDT Juergen Seger,
Liechtenstein)
Tooth Color Basics
Color has two basic characteristics: Hue and Chroma. Natural
tooth color also displays these

same characteristics. Hue can
be defined as the actual color
such, as yellow or gray. Chroma
is the intensity of that color and
is sometimes called saturation.
Hue and Chroma are typically
represented by a shade guide
in terms of which color comes
closest to the actual tooth being
measured. For example, shade
guides will have a range of A1
to A4 or B1 to B4, plus C and
D shades. (Figure 17c) Value
is the brightness of a tooth. It
is therefore given a separate
classification than color when
communicating shade. Teeth
also exhibit translucency and
can be measured by how much
light can pass through different sections of a tooth. Shade
taking problems arise because
most natural teeth are not an
exact match to a shade guide,
nor do shade guides adequately
express tooth translucency and
value. In many cases, when
it is decided that a tooth has a
certain shade, the Hue and the
Chroma are communicated
to the lab, but never the value
and this is where the problems
arise. Very few crowns are accepted if the value is incorrect,
while moderate inaccuracies in
chroma and hue may go unnoticed. For this reason the shade
taking protocol needs to be
based on this information being communicated to the lab in
the most accurate way possible.
Before the shade is taken
conventionally or a picture is
taken for the same purpose,
several factors need to be controlled:
1. If patient is wearing bright
colored clothing, drape him
or her with a neutral colored
cover.
2. Have patient remove lipstick
and other make-up, as well as
eyewear .
3. Teeth must have been
cleaned.
4. The shade taking should be
done at the beginning of the
appointment, so that teeth are
moist (the patient must lick
their teeth constantly to keep
them moist) and your eyes
fresh.
5. The operatory light should be
turned off or pointed in another
direction. It must not focus on
the patient.

Figures 9 and 10: Overview pictures with different shade tabs.
Figures 11 and 12: Close-up pictures with different shade tabs.

> Page 7

[7] =>

mcme

Dental Tribune Middle East & Africa Edition | July - August 2014

< Page 6
6. The room light conditions
should have a temperature of
5500-6500° K. (when pictures
are taken, these parameters are
no longer relevant, because the
light of the flash will prevail).
7. Obtain value levels by squinting.
8. Women are far less likely to
be color blind than men, so it
is a good idea to have your as-

sistant assist in shade taking
decisions (assuming that the
assistant is a woman and not
color blind)
In Part 1 of this article, the
necessary equipment and accessories for adequate intraoral
pictures was discussed. Please
refer to it for the necessary information if you are planning to
purchase adequate equipment.

Figures 13 and 14: Colored and black and white picture.

Figure 15: Unhappy patient with
unsatisfactory crowns.

Figure 16: The smile is high,
situation that makes the metal
margin of the PFM crown obvious.

Once the patient is ready, place
the shade tabs in front of the
anterior teeth, before starting
the treatment itself. The same
applies for pictures with lips. It
is important to repeat the same
protocol intraorally, as well
as extraorally, because of the
large influence of the reds in
shade taking. (Figures 7-8) In
addition to the points presented
before, the following should be
considered initially when photographs are taken: (Figures 9
- 13)
1. Avoid the large reflection
areas of the metal parts of the
shade guide as they reduce the
detail of the pictures
2. Take pictures using two different shade tabs
3. The surface of the shade tab
must be at exactly the same level of the buccal surface of the
teeth, as even minor discrepancies can make a tooth look
darker or brighter due to the
power of the flash)
4. The incisal edge of the tabs
should be at roughly 1mm dis-

Figures 17a-17d: The stump shade is shown compared with a shade tab. Ideally the natural die material
shade guide should be used. As an example A2 looks similar to ND2.

Figure 18: Discolored stump.

Figure 19: Situation after internal
bleaching and composite build up.
Figure 20: IPS e.max CAD crowns
after milling with the MC XL
(Sirona) unit. The copings need to
be crystalized in order to get the
final shade.

Figure 21: Layering steps.
The shade is compared with the
natural die material stumps.

Figure 22: Final appearance of
the crowns placed on top of the
natural die material stumps,
which has the same shade than
the dentin-composite stumps in
the patient´s mouth.

Figure 23: Proximal contact and
integration control in the model.

Figure 24: A retraction cord was
placed prior etching.
Figure 25: Etching with hosphoric
acid.

Figure 26: Bonding with Excite
DSC.

Figure 29: Final result after 2 weeks.

tance from the natural teeth,
or as close as possible, without
touching each other.
5. Take pictures with and without contrasters. This is especially relevant in young teeth
with opalescent areas and clear
halo effects.
6. In cases where an all-ceramic restoration is planned,
the shade of the stump should
also be given to the lab, using
a special shade guide, such as
the natural die material shade
guide of the IPS e.max system
(Ivoclar Vivadent, Liechtenstein).
7. Consider taking some pictures in black and white. A
black and white photograph
will help show the value of the
shade tab in relation to the patient’s tooth. (Figure 14)
Clinical case
A 27-year-old female patient
came to our office unsatisfied
with the appearance of her 2
anterior pfm crowns (Figure
15). The value of both crowns
clearly did not match the other
teeth and her smile line unfortunately also showed the discolored cervical part of tooth 11
(Figure 16).
An overview picture of the
stump shade was taken with
a reference (Figure 17a). This
reference should ideally be the
natural die material A - D shade
guide (Figure 17d). Both shade
guides, the natural die material guide and the A-D shade
guide have some similarities,
for example, as a rule of thumb
an ND2 looks quite similar to
an A2 (Figure 17b). Obviously,
the natural die material shade
guide has shades that are dark,
since its purpose is to correlate
to artificially discolored stumps
and not to recreate natural
shades as the A-D shade guide
(Figures 17c and 17d). Internal

bleaching of the stump was
then performed with 35% hydrogen peroxide (Figure 18) in
2 sessions of 20 minutes each.
Figure 19 shows the final result
after the composite build-up
with Excite DSC and Multicore
flow (Ivoclar Vivadent, Liechtenstein). An impression was
taken and sent to the lab. The
cast was scanned and an IPS
e.max Cad LT block was milled
(Figure 20). The appearance of
the crowns is always checked
with the natural die material
stumps in order to get the correct value and chroma (Figures
21 and 22). Finally, contacts
and final integration of the
crowns were checked in the
solid cast (Figure 23, laboratory work done by CDT Volker
Brosch, Germany). A retraction
cord was placed prior to bonding the crowns (Figure 24).
The stumps are etched with
phosphoric acid (Figure 25)
and Excite DSC was applied
(Figure 26). Variolink N (base
and catalyst, translucent shade)
were mixed and applied to the
crowns (Figure 27 and 28).
After 4 weeks a natural integration of the crowns with the
right hue, value, chroma and
effects can be seen in Figure
29.
Acknowledgements
The author would like to thank
CDT Juergen Seger and Volker
Brosch for their valuable technical work presented in this
article.
Editorial note:
References are available from
the author.

Contact Information
Contact Publisher for author’s
information if needed.

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its mCME- Self Instruction Program a quick and simple way to meet
your continuing education needs. mCME offers you the flexibility to
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time. The content is international, drawn from the upper echelon
of dental medicine, but also presents a regional outlook in terms of
perspective and subject matter.
Membership:
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After the payment, you will receive your membership number and
Allowing you to start the program.
Completion of mCME
•
CME participants are required to read the continuing
m
medical education (CME) articles published in each issue.
•
Each article offers 2 CME Credit and are followed by a quiz
Questionnaire online, which is available on http://w w w.
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•
Each quiz has to be returned to events@cappmea.com or faxed
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For more information please contact events@cappmea.com or
+971 4 3616174

Figures 27 and 28: Mixing
and application of Variolink N
(Ivoclar Vivadent).

Figure 30: The value of the
restorations match the one from
the natural teeth.

Figure 31: Natural integrated
crowns.

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

[8] =>

8 mCME

Dental Tribune Middle East & Africa Edition | July- August 2014

The diode laser as an electrosurgery replacement
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 Glenn A. van As, BSc, DMD

n 2008, Dr. Gordon Christensen wrote an article in
JADA comparing the soft tissue cutting abilities of diode lasers to those of electrosurgery
(radiosurgery) units.1 In comparing these two technologies
against each other, he found that
both dental lasers and the less
expensive electrosurgery units
have advantages and disadvantages, and he summarized with
several key points:
1. Although there was considerable overlap in their uses and
both technologies were effective,
Christensen found that diode lasers were able to be used around
metal (amalgam and gold) as well
as with dental implants.
2. He stated that lasers did not
harm dental hard tissues (bone)
or soft tissues (pulp), and that
the clinician could use the laser
with less anesthetic, and finally
he mentioned that lasers were
antimicrobial (antibacterial).
3. The acceptance and use of
lasers, especially the diode laser, was increasing in dentistry,
and that lasers attract patients
because of their recognized and
accepted role within the field of
medicine (LASIK eye surgery).
4. Electrosurgery units were
“far less expensive than the least
expensive diode lasers” and he
questioned whether “the advantages of the diode laser were significant enough to compensate
for the additional cost.”
There are two basic types of
electrosurgical units that can be
purchased in dentistry:
• Monopolar, in which a single
electrode exists and the current
travels from the unit down a single wire to the surgical site. The
patient must be grounded with a
pad placed behind the patient’s

back (a part of the procedure
that many patients may question).
Heat is produced when the electrode contacts the tissue, and due
to pain that is produced, anesthetic must be used.
• Bipolar, in which two electrodes are placed in very close
proximity to each other. Bipolar
units are more expensive than
diode lasers and the electrical
current flows from one electrode
to the other, thus eliminating the
need for a grounding pad. Bipolar
units, because of the two wires,
create less of a precise cut than the
monopolar or diode laser.
Although electrosurgical units
are inexpensive, require no safety
glasses and can remove large
amounts of tissue quickly, diode
lasers have become much more
common in dental operatories in
the four years since Christensen’s
article was published. The primary reasons for their increased
popularity are that diode lasers
have a small footprint, are reliable and durable lasers, and are
portable. Where a few short years
ago, diode lasers could cost in the
range of $10,000 to $15,000, they
are now cost effective and can be
purchased for less than $2,500.

in hemoglobin, melanin (pigment) and to some degree water
(Fig. 1). These mid infrared dental wavelengths in the absorption
spectrum offer the dental clinician the ability to ablate soft tissues precisely while controlling
hemostasis, providing the clinician with an excellent view of
the surgical site with a reduced
reliance on sutures. Diode lasers
have features that make them attractive as mentioned earlier, but
they also have several advantages
in function over electrosurgical
units2 (Table 1).
Perhaps the greatest benefit of these lasers is that they
allow the clinician to work safely
around metals. The literature
has shown that monopolar electrosurge units can accidentally

Advantagesofthediodelaserover
electrosurgery
Ability to work around metals
intraorally
Diode lasers in the range of
810–1,064 nm are well absorbed

Figure 1: Absorption curve of various tissue components shows diode lasers to be well absorbed in
melanin (pigment), hemoglobin and to some degree water. (Images/Provided by Glenn A. van As,
BSc, DMD)

Table 1: Comparison of diode laser versus monopolar electrosurgery units.

Figure 6: Four healing cuffs
in place in maxilla immediately after uncovery with the
diode laser.

Figure 7: Replace select implant fixtures for upper right
premolars.

Figure 2: Gingival hyperplaFigure 8: Abutments in place
sia around orthodontic apfor both teeth.
pliances.

Figure 3: Immediate post-op
after diode laser gingivectomy completed.

Figure 9: Soft tissue on margins preventing full seating
of crowns.

Figure 4: Eight-day healing
of soft tissue around brackets.

Figure 10: Picasso Lite diode laser removing tissue on
abutment margins.

Figure 5: Diode laser for second-stage implant uncovery
in edentulous maxilla.

Figure 11: Note tissue off the
margins of abutments after
diode use.

CAPP designates this activity
for 2 CE credits.
create catastrophic results when
touching metal intraorally. Published reports have shown that
contact for very short periods of
time with the electrode of a monopolar electrosurgical unit can
cause both pulpal and periodontal problems,3 bone loss,4 severe
intraoral burns,5 arcing, and that
within three seconds of exposure
to a dental implant electrosurgical units can cause failure of
osseointegration and loss of an
implant.6,7
In clinical practice, with today’s emphasis on the more esthetically pleasing composite resins and newer porcelains, there
are still many metallic materials
used intraorally, including cast
partial denture frameworks, gold,
amalgam, orthodontic brackets
and semi-precious alloys.
Diode lasers, unlike their electrosurgical counterparts, show
little interaction with metallic
objects used intraorally. It is important to remember that due
to the laser’s ability to reflect off
mirrored surfaces and potentially
cause eye damage, that all members of the dental team as well as
the patient must wear laser safety
glasses for eye protection if they
are within the nominal ocular
hazard zone (NOHZ) during laser
operation. This zone is most often
between 3 and 7 feet, but some
diodes can have extended NOHZ
ranges of 40 feet.
Orthodontic patients will often exhibit gingival hyperplasia
when in brackets that can make
it difficult to work on them. This
overgrowth of tissue can be due to
poor oral hygiene, space-closing
mechanics, excess cement or a
combination of factors. The diode
laser can be used for gingivectomies to safely remove and recontour the excess tissue and healing
can be remarkable in a very short
period of time (Figs. 2–4).
Ability to work around dental
implants safely
Various laser wavelengths that
are available today can offer the
clinician who needs to expose
an implant during second stage
surgery an alternative to traditional methodologies. The ability
of the diode laser to ablate tissue,
at times without the need for local
anesthetic, while controlling hemostasis, provides the clinician a
great view of the surgical site.
In addition, the diode wavelength, like all laser wavelengths,
provides for decontamination of
the implant site through its antibacterial actions. Bacterial reduction with the diode laser can lead
to an almost sterile operative field
(98 percent reduction of pathogenic bacteria). Finally, there is

a growing body of evidence that
suggests that lasers used at lower
energy settings can have a biostimulatory effect on tissue, which
in turn can reduce postoperative
discomfort, improve healing and
shorten healing times while even
improving early osseointegration.8–12
As an aside, there have been
clinicians who routinely use monopolar electrosurgery units to
expose implants. It is imperative
to realize that although more expensive bipolar (two electrodes)
electrosurgery units can be used
safely around implants, that the
more commonly purchased single electrode (monopolar) units
may damage the implant surface
and can cause complete loss of osseointegration with resulting implant failure with contact times as
short as three seconds.13,14 Lasers,
in contrast, can be used safely with
tremendous coagulation and a reduction in pain postoperatively
for the patient15 (Figs. 5,6)
Diode lasers are also useful
when it comes time to seat the
final abutment and restoration.
Tissue management around dental implant restorations can be
difficult, be it for the initial cementation or, even worse, if an
implant-restored crown comes
loose. Tissue quickly slumps onto
the abutment, and subgingival
margins can be almost impossible to retrieve with traditional
methodologies. The laser can
truly be a “life-saver” for these
situations where soft tissue must
be safely and quickly removed to
allow for ideal cementation of the
implant retained crowns onto the
abutments (Figs. 7–12).
Reduced need for anesthetic
Monopolar
electrosurgery
units do not have the ability to
be used routinely without local
anesthetic. In contrast, diode lasers can often be used either with
low wattages or in pulsed modes
to remove minor to moderate
amounts of soft tissue with only
topical anesthetics. Although at
times this may not seem significant to the clinician, there are
many instances where soft tissue acts as a barrier to ideal restorative treatment, and if local
anesthetic can be eliminated it
becomes a big selling point to
patients.
Many patients are looking for
alternatives to local anesthetic,
and when the occasion allows for
the procedure to be completed
without the patient being numb,
the overwhelming majority
of patients are grateful for this.
Situations such as laser gingival

> Page 9

[9] =>

mCME

Dental Tribune Middle East & Africa Edition | July - August 2014

< Page 8
crown troughing for tissue management around endodontically
treated teeth, exposure of partially erupted canines for orthodontic brackets and gingivectomies around moderately sized
Class V lesions in geriatric patients are all situations where the
author has been able to routinely
and consistently complete soft tissue ablation with only a stronger
topical anesthetic. In fact, the literature has shown that a variety
of soft-tissue procedures (even
frenectomies) can be completed
with only topical anesthetic16–18
(Figs. 13–16).
Ability to do gingivectomies
and crown troughing with less
recession
White et al. have mentioned
that laser gingivectomies are the
most common soft-tissue procedure done with diode lasers,19
and when combined with esthetic
porcelain restorations, the simple
recontouring of tissue can take a
good case and make it great.20–24
A key difference from electrosurgery ablation of soft tissue is
that alterations to the symmetry
of the soft-tissue contours in the
maxillary anterior teeth can be
safely and precisely completed on
the same day as the preparation
and impressions of these teeth.
The risk of recession and expo-

sure of margins can be far less
with a diode laser than with other
techniques, particularly when adequate magnification (e.g., 4.0X
loupes) and cautious settings
(0.6–0.9 w continuous wave) are
used for the recontouring.
When biologic width is respected, and adequate attached
and keratinized tissue exists, then
judicious recontouring of the gingiva on the same day as the preparations can yield stunning results
(Figs. 17–19).
The diode laser has become a
popular technology as an alternative for tissue management compared to the traditional methodology of placing a single or double
retraction cord in the sulcus. The
diode laser can be used in almost
all instances to produce gingival retraction as an alternative to
cord with excellent results both
in terms of gingival retraction and
margin delineation for the laboratory.
Unlike electrosurgical units
where recession can be an issue,
as can postoperative pain, diode
lasers offer the clinician the ability
to precisely remove overhanging,
inflamed tissue while creating a
gingival trough that is not likely
to cause damage to bone, cementum or pulp tissue like electrosurgical units can. In addition, there
is research that suggests that the
lateral thermal damage done with
lasers is significantly lower than
that with electrosurgery.25

Figure 12: Final crowns
cemented onto abutments
without soft-tissue impingement.

Ability to photocoagulate vascular lesions and treat oral lesions
One of the advantages of a diode laser is the ability to treat oral
lesions, including: recurrent aphthous ulcers (RAU), venous lake
lesions of the lips and herpetic
lesions. Research has shown that
lasers can be safely used to treat
these lesions,26–28 and in addition
it is possible that if caught early
during the prodromal stage that
herpetic lesions can be aborted
or significantly reduced in terms
of length of time they are present.29 In addition, it has been the
author’s experience that, once
treated with the laser, the lesions
are often less likely to reappear
in the same area. In fact some
evidence suggests that herpetic
lesions treated in the early stages
with the diode laser can cut the
healing time in half and create a
remission period that is twice as
long before it reoccurs.30,31
Vascular lesions called venous
lakes or hemangiomas can occur
on soft tissue-areas including the
upper and lower lips, buccal mucosa and palate. These lesions can
be difficult to treat with traditional
methods where significant bleeding may occur. The diode wavelengths are rapidly absorbed by
hemoglobin and therefore can be
used to coagulate and eradicate
these esthetically undesirable
purplish lesions often with only
topical anesthetic. Literature has
shown that the diode can be used
in almost 100 percent of cases to
eliminate these lesions, most often in only a single session lasting
only a couple of minutes32–35 (Figs.
20–22).

Anti-bacterial capabilities of
lasers
Many articles in the literature
have demonstrated the tremendous ability of all lasers with respect to the reduction of bacterial
and even fungal infections.36–43
The excellent antibacterial capabilities make lasers effective and
desirable in many areas in the oral
cavity where the risk of postoperative infection may be reduced.
Electrosurgical units do not typically possess the same ability to
provide bacterial reduction as lasers do. Particular interest is now
occurring with the role of lasers in
endodontic, periodontic and periimplantitis cases where there is
need to reduce bacterial loads
without such a great reliance on
antibiotics.
Although more research is
needed on how the bactericidal
capabilities of the diode laser
might be beneficial in these areas, there is no debating that all
lasers can help healing through
decreasing the risk of infection
through laser light alone (Figs.
23–25). In addition, growing research has demonstrated that the
risk of high bacterial loads in periodontal pockets and in particular
in endodontic situations may be
reduced by lasers.
This latest research has implications for improving traditional
methodologies locally where
used, and in helping to reduce the
potential greater systemic health
risks generally. The role of lasers
continues to be researched today,
but present research has shown
that diode lasers can be used
safely within root canals with
minimal fear of developing iatrogenic complications when conservative settings are used.44–48

Conclusion
The diode laser has become
the “soft-tissue handpiece” in
many dental offices. The advantages of being able to work around
metals including dental implants,
a reduced need for anesthetic, a
reduced risk of recession postoperatively, the ability to reduce
bacteria, and to use the diode to
photocoagulate vascular lesions
have all provided dentists with
a new alternative for soft-tissue
surgery.
Lasers have two added benefits in that they do not require a
pad to be placed under the patient
for grounding, and they can be
used safely with pacemakers. Diode lasers have found their place
in dentistry. Once considered an
application looking for a purpose,
these small, cost-effective and reliable lasers have discovered their
niche as the new go to solution for
many soft tissue problems in our
daily dental practices.
References
1. Christensen GJ. Soft-tissue
cutting with laser versus
electrosurgery. J Am Dent
Assoc. 2008 Jul;139(7);981–
984.
2. van As G, The Diode Laser
as
an
Electrosurgery
Replacement. Dentaltown.
June 2010. pgs. 56–64.
Full list of references is available
from the publisher.

Contact Information
For more information you can
contact Dr. Glenn A. van As on:
glennvanas@me.com.

Figure 17: Pre-op prior to
maxillary incisor veneers.

Figure 22: Two-week healing
of lesion on lip is complete.
Figure 13: Partially exposed canine requires orthodontic bracket.

Figure 14: Topical gel
placed on soft tissue prior
to gingivectomy to uncover
soft tissue.

Figure 15: Pulsed mode at
1.4 w shows removal of attached tissue to expose canine.

Figure 16: Brackets in place
on both canines — immediate post-op view.

Figure 18: After recontouring of lateral incisors and
laser crown troughing for
tissue management prior to
Figure 23: Diode direct pulp
impressions.
cap to lower bacteria count
on MO cavity preparation.

Figure 19: Immediate postoperative result for four
Figure 24: Diode laser in
Emax veneers.
gingival sulcus lowering
bacteria count (image of
diode pulse captured with
video camera on operating
microscope — typically the
image is not visible to the human eye).
Figure 20: Pre-op view of venous lake on lower lip.

Figure 25: Diode laser used
to reduce bacterial counts
inside a DB canal of upper
right second molar after
completion of instrumentaFigure 21: Immediate post- tion and prior to obturation
of the canals.
op appearance.

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[10] =>

10 news

Dental Tribune Middle East & Africa Edition | July- August 2014

Weightlifter grits his teeth – a case for VITA ENAMIC
By Hermann Loos

tress and high demands
literally make us grit our
teeth. On a colleague’s
homepage it says on the subject
of teeth grinding and bruxism:
“We can develop a weightlifter’s
strength just by using our teeth”.
The masticatory organ is exposed to forces of up to 800 newtons during teeth clenching. The
normal pressure of mastication
is generally around 20 - 30 newtons. Those affected are often
people in certain professions,
for example, those who work for
long periods of time on the computer, as well as those whose
work involves intensive physical
exertion, like runners, cyclists,

bodybuilders and, as previously
mentioned, weightlifters.
During subconscious clenching
of the upper and lower teeth, the
limit of physiological function is
far exceeded. Not only natural
tooth substance, however, but
also restorative materials reach
their limit during mechanical
overload. In the clinical case example described here, this led to
the fracture of an old all-ceramic
crown restoration.
Patient case
The patient was a weightlifter by
profession. He sought treatment
for a fracture on the vestibular
wall of his all-ceramic crown
on tooth 25 (Fig. 1). He wanted

a new, metal-free restoration.
For the sake of time efficiency,
treatment was planned with the
CEREC chairside system.
The material of choice
A suitable material in this case
was the new VITA ENAMIC,
whose material composition
and mechanical and physical
properties offer a combination
of ceramic and composite. The
hybrid ceramic is a completely
new generation of ceramic
materials. The unique, dual
network structure consists of a
dominant ceramic network reinforced by a polymer network.
This follows the principle of
compound materials, i.e. both
networks penetrate each other

Fig. 1: Initial situation - f racture of the all-ceramic crown
on tooth 25.

Fig. 3: The digital model.

Fig. 2: Preparation.
Fig. 4: Design.

VITA ENAMIC ® redefines load capacity.*
The first hybrid ceramic with dual network structure for unsurpassed absorption
of masticatory forces

Fig. 5 a: Dif ferent views of the
crown af ter completion of the
design ...

Fig. 5 b: ...in the milling preview.

3411 E

mutually. Thus immense stability as well as extraordinary elasticity are guaranteed for the first
time. In addition to classic, single tooth restorations (inlays, onlays, veneers and crowns), VITA
ENAMIC’s range of indications
includes minimally invasive
restorations and restorations exposed to high masticatory forces.
VITA ENAMIC is available in the
geometry (size) EM-14 (12 x 14
x 18 mm) and in the translucency levels HT (High Translucent) and T (Translucent) and in
five VITA SYSTEM 3D-MASTER
shades 0M1, 1M1, 1M2, 2M2 and
3M2. VITA ENAMIC can be processed with Sirona’s CEREC or
inLab MC XL systems, software
version 4.0 or higher.

VITA ENAMIC sets new standards for resistance by

that VITA ENAMIC restorations are identical to natural

combining strength and elasticity and providing unsur-

teeth. VITA ENAMIC is particularly suited for crown resto-

passed absorption of masticatory forces. VITA ENAMIC

rations in the posterior area and minimally invasive restora-

ensures utmost dependability and efficient processing

tions. More information at www.vita-enamic.com

for dental practices and laboratories. And patients feel

The treatment procedure
After removing the fractured
crown, further preparation suitable for ceramic was carried out
on tooth 25 (Fig. 2). The digital
impression (Fig. 3) was performed using the CEREC AC
acquisition unit and the Bluecam. The CEREC 3D-software’s
automatic biogeneric tooth
modelling function was used for
designing the crown restoration
(Fig. 4). Occlusion registration
was performed. The opposing jaw was not scanned. The
biogeneric reconstruction of the
occlusal surfaces is based on a
mathematical procedure that allows the automatic reconstruction of the patient’s individual
tooth morphology based on the
morphology of the patient’s re-

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The En formula for success: strength + elasticity = reliability²
*) In addition to a high degree of elasticity, this innovative hybrid ceramic guarantees particularly high strength after adhesive bonding.

> Page 12
3411E_210x297 V13 neu.indd 1

06.06.13 11:01

[11] =>

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[12] =>

12 industry

Dental Tribune Middle East & Africa Edition | July- August 2014

Cleanic:
Clinical use of a recognised
prophy paste with Perlite

Cleanic

Before

A universal prophy paste with Perlite technology
Procedure

Af ter

By Dr. Fabio Cosimi D.D.S.
Dr. Susanna Giovannini D.I.
I-Ostia Lido, Rome

leanic® 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 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).
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 rootplaning),
Cleanic®
paste,
compared with others on the
market, seems to be less apparent in the gingival sulcus.
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 helps to prevent damage to
adjacent teeth.
Pro-Cup® cups have been designed and developed to avoid
pastes being splattered as with
traditional cups.

< Page 10
maining natural dentition. We
obtained very good results using
the 3D-software to adjust the occlusion of posterior crowns with
the aid of the centric bite registration function and the automatic adaptation of the crowns’
occlusion with the antagonists.
When required, manual corrections can, be made by the user
at any time. Figures 5 a and 5b
show the crown in the milling
preview after completion of the
design. According to the results
obtained in situ (shade of prepared tooth 4L2,5 / tooth shade
3M2), a block in the shade 3M2
was chosen for the manufacture
of the crown.
The VITA ENAMIC Polishing Set
clinical and the VITA ENAMIC
STAINS KIT are available for
reworking chairside manufactured VITA ENAMIC restorations. The polishing set includes

a total of eight polishers for the
handpiece, four for prepolishing
and four for high-glaze polishing. A staining set is also available. Beside six stains, this also includes VITA ENAMIC Glaze for
sealing the surface. The stains
and the glaze are light-curing
and very easy to process. The definitive intraoral cementation of
the marginally accurate crown
(Figs. 6 and 7)was performed
with Multilink Automix (Ivoclar
Vivadent), since VITA ENAMIC
has a high loading capacity after
adhesive bonding with the residual natural dentition.
Material benefits
Experience shows that the new
VITA ENAMIC blocks can be
milled very quickly from the digital design. This ensures milling
results with high precision, edge

> Page 29

[13] =>

Dental Tribune Middle East & Africa Edition | July - August 2014

academia tribune 13

Pulp protection in today clinical practice:
what about the role of materials?
By Dimitrios Tziafas, DDS, PhD

ital Pulp Protection and
Therapy (VPPT) is the
treatment that maintains
pulp tissue in a healthy and
functional state, whenever the
dentin-pulp complex has been
compromised by caries, trauma
or restorative procedures. Pulp
vitality and function is not essential for mature tooth survival.
Mature permanent teeth without a vital pulp can survive for
a long time after a successful
endodontic treatment. However,
the maintenance of pulp vitality in both mature and developing teeth provides benefits. Ιn
immature permanent teeth the
vital pulp plays a central role
for continuation of root development and strengthening of the
root canal walls. Furthermore,
with living pulp the capacity of
the dentin-pulp complex of mature permanent teeth to repair
dentin defects and to retain the
damaged complex as a functional unit, is maintained (Bergenholtz 2005). The objective
of VPPT is to minimize reversible inflammatory reactions, to
allow pulp tissue healing and to
protect it from exogenous stimuli. It is well recognized that the
damaged dentin-pulp complex
requires protection from thermal conduction, chemical injury
from the overlying restorative
materials and further bacterial
invasion from dentinal caries
or oral bacteria leakage. It must
be clarified here that protection
from thermal conduction depends mainly on the conductivity of the main restoration and
is beyond the aim of the present
article. In order to assess the
therapeutic validity of the currently used techniques and materials in vital pulp protection,
the biology of dentin-pulp complex is briefly reviewed.
Biology of dentin-pulp complex
The pulp and the dentin have
been widely considered as
a complex, on the basis that
they form an embryological
and functional entity. The dental pulp is a connective tissue
entirely enclosed by dentin in
the pulp chamber of the tooth.
Dentin is a collagenous mineralized tissue characterized by
the presence of parallel dentinal
tubules, forming a semipermeable substrate which is regulated by the defensive function
of the pulp and is effective in
protecting the pulp from leaking
bacterial threats and chemical
irritants. Pulp structure is not
uniform, consisting of the pulp
periphery and the pulp proper.
The peripheral pulp region has
two interconnecting structures:
the odontoblast layer, which is
a layer of highly differentiated
cells (odontoblasts) and a zone
of biosynthetic product of odontoblasts (predentin). Odontoblasts are responsible for formation of predentin, which further
form the mineralized structure
of dentin. Odontoblasts form primary dentin during tooth devel-

opment, secondary dentin during the whole life of pulp tissue,
and tertiary reactionary dentin
during the pulp-dentin complex repair. Since odontoblasts
are post-mitotic cells, they are
not able to proliferate. In case
of severe iatrogenic, or physical trauma, odontoblasts can be
replaced by newly differentiated
odontoblast-like cells, which can
repair minor defects of the dentin-pulp complex by producing
tertiary reparative dentin. The
predentin reflects the activity of
odontoblast layer and its role is
crucial in maintaining the homeostasis in the pulp environment. The existence of intact
pulp periphery seems to be the
most important requirement for
the long-term survival of dental
pulp tissue.
A network of inflammatory
reactions of pulpal cells, microcirculation and nerves, directly
affect the outcome of the fundamental defensive mechanisms
in the dental pulp. Whenever
the basic structure of pulp periphery is affected due to exogenous stimuli, regardless of the
existence of pulpal exposure, a
typical wound healing process
of the pulp tissue takes place.
Complete reconstitution of the
pulp peripheral region, by repairing the biosynthetic activity
of survived odontoblasts and/
or replacement of lost odontoblast with odontoblast-like cells
might be considered as the optimal end result of the healing
process in the dentin-pulp complex. Under pathological conditions in the pulp-dentin complex
a wide spectrum of atypic forms
of matrices could be formed at
the pulp periphery. These atypic
matrices are characterized from
porosity due to their osteotypic
appearance and they are not
effective in protecting the pulp
from leaking bacterial threats
and non-destructive external irritants. Clinical and experimental data clearly show that the
presence and quality of the tissue reconstituting pulp periphery in the damaged dentin-pulp
complex is important prognostic
factor for the long-term successful outcome of VPPT. The
clinical exploitation of dentinogenic potential of pulp tissue to
reconstitute the structural and
functional specificity of pulp periphery represents the basis of
modern VPPT (Tziafas 2010).
Clinical variables in VPPT
Numerous experimental and
clinical studies carried out
over than 6 last decades clearly
showed that the successful outcome for vital pulp therapy is
primarily depended on the type
of injury, while other variables
related to the status of the dentinpulp complex and the treatment
modality have also been investigated. In general and beyond
the role of treatment modality
(techniques and materials), as
the most important mechanism
in effective long-term protection
of the damaged pulp which will
be analysed below, other critical
factors have attracted attention.

The reader of the present article
is encourage to study a number
of excellent papers reviewing
experimental and clinical observations as well as the level
of evidence in relative clinical
research, which have been presented in the symposium held
on 2007 in Chicago, Illinois, on
“Emerging science in pulp therapy: new insights into dilemmas
and controversies” jointly sponsored by American Association
of Endodontists and American
Academy of Pediatric Dentistry
(see Pulp Symposium, Journal of
Endodontics, July 2008, Volume
34, Number 7S). It has been well
recognized that the following
critical factors are playing a role:
a.Treatment indications
As has been well demonstrated
the VPPT is indicated for teeth
with healthy pulp or reversible
pulpitis. More particularly:
Pulp protection, where a
material is placed on the pulpal surface of a dentinal cavity
to act as a barrier between the
permanent restoration and the
sound dentinal base of the cavity, is indicated for a. Carious or
non-carious tooth cavities with

remaining dentin thickness less
than 1 mm, no history of lingering or spontaneous pain, negative percussion and palpation
tests and positive pulp vitality
test, and ii. Young permanent
teeth after luxation trauma and
crown fracture exposing the inner third of the dentin, regardless of the presence of clinical
symptoms.
Indirect pulp capping is a
technique in symptom-free
teeth with deep carious lesion
where a thin zone of carious
dentin is remained to avoid pulp
exposure. The ultimate goal of
this technique is to complete
caries removal just before the
pulp exposure, where the potential of pulp healing can effectively protect the pulp and stimulate
tertiary dentin formation. Presence of symptoms of irreversible
pulpitis, positive percussion and
palpation tests, or radiographic
appearance of apical lesion consist absolute contra-indications
for indirect pulp capping.
b.Control of infection
It is well-known that the pulpal
wound healing depends largely
on the extent to which infection

can be avoided (Bergenholtz
2005). Thus, control of pre-operative and post-operative infection, is a critical clinical concern
with various VPTT techniques.
a. Pathology of dentin-pulp
complex. Among various clinical variables that have been accounted as factors playing a role
in the outcome of the VPT, most
important are issues related to
different patho-physiology and
healing potential of the dentinpulp complex, as in primary, immature and mature permanent
teeth :
• Dental treatment of primary
teeth must satisfy different goals
than treatment for mature permanent teeth, due to the limited
life span of primary teeth and
their possible relationship to the
permanent tooth successor. The
anatomical structure, pathophysiology, and diagnosis of endodontic diseases are different
between primary and permanent teeth. However, recent advances in primary tooth biology
demonstrated that primary teeth
have also a potential for wound
healing and tertiary dentin formation. In light of these observations VPPT in primary dentition
has been already re-evaluated
and similar techniques as in permanent teeth are widely used
(American Academy of Pediatric
Dentistry, 2006).
• Similarly, dental treatment

> Page 14

[14] =>

14 academia tribune

Dental Tribune Middle East & Africa Edition | July- August 2014
c. Remaining dentin
Effective protection from the
chemical and bacterial irritants
depends on the following two
parameters (Smith 2002):
i. The remaining dentin thickness has been widely recognized
as the main factor which determines the long-term success of
the treatment, in absence of bacteria. In general remaining dentin thickness more than 1 mm is
considering to be a safe limit for
adequate pulp protection.
ii. Situation and dimensions of
the exposed dentinal surface
in the cavity seem to influence
the overall dentin permeability
through the number of exposed
and open dentinal tubules.
d. Operative trauma
The operative trauma has been
also implicated with pulpal injury and subsequent pulp healing.
Frictional heat due to uncontrolled mechanical cavity preparation, over-drying of the exposed dentin, direct damage to
odontoblastic processes in deep
cavities, and the chemical treatment of the dentinal surface due
to acid-etching, may be associated with transient pulp damage and/or increased dentinal
sensitivity, which can delay pulp
healing, while also development
irreversible pulpitis cannot be
excluded.

< Page 13
of immature permanent teeth
must satisfy different goals than
treatment for mature permanent teeth, due to the central
role of the pulp in the physiological continuation of root development and in further deposition of

primary dentin which strengthen the root dentinal walls. Thus,
preservation of pulp vitality is
particularly important in the immature permanent teeth, even
with very different treatment indications.

The role of materials - In general similar materials are widely
used in today clinical practice
for both sites, pulp protection
in deep sound dentinal cavities,
and in active carious dentinal lesions, despite the facts that the
objectives of the two techniques
are clearly different. For many
years the hard setting zinc oxide eugenol cements have been
used under amalgam restorations, and the calcium hydroxide-containing cements have
been considered as materials
of choice for pulp protection in
deep dentinal cavities, especially in cases of indirect pulp treatment. Conventional glass ionomers, as well as resin-modified
glass ionomers have been evaluated during the last two decades,
while direct application of adhesive materials in the base of the
cavity has also been proposed.
Recently calcium silicate-based

materials, acting as dentin replacement materials, are under
preclinical and clinical evaluation.
Four criteria seem to be concerned to the characterization of
an effective pulp protective material (see table):
Physical properties
Adherence to dentin, resistance
to dissolution, setting time, flow,
and dimensional stability represent the most important physical properties of an ideal pulp
protective material. The physical limitations of Ca(OH)2–based
materials, such as the non-adherence to dentin, dissolution
in tissue fluids and degradation
upon tooth flexure ranked them
in the last position of the materials for using in pulp protection.
Lack of any adherence to dentin
has also been found for the zinc
oxide-eugenol based materials.
On the opposite excellent physical and mechanical properties
have been reported for the resinous materials. The glass ionomers present several important
properties, such as an elasticity
similar to dentin, and bonding
to dentin and enamel. However
glass ionomers are not resistant
to water and have a slow setting
rate. Improved physical properties have been obtained with the
resin modified glass ionomers.
Newly released calcium silicatebased dentin substitutes have
also showed interesting physicochemical properties.
Antibacterial activity
It is widely accepted that the
ability of the pulp protective material to reduce bacterial leakage
and to prevent post-operative
growth of leaking bacteria and
their invasion into dentinal tubules is the most critical requirement to avoid deleterious pulp
inflammation and necrosis (Bergenholtz 2005, Smith, 2002, Tziafas 2010). Furthermore several
micro-organisms could be isolated from deep carious lesions
and hence, the use of a material
with antimicrobial activity underneath restorations has been
highly recommended. Since
bacteria can differentially affect
the ability of odontoblasts to repair the dentine barrier function,

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• treatment of hypersensitive dentine
• fast desensitisation
• fluoride release
• easy and fast application

the role of capping material in
reduction of bacterial growth is
important. Histological investigations have demonstrated
prevention for bacterial growth
in almost 100% of the restorations with glass ionomer-based
materials, in caries free teeth of
young adults for post-operative
period up to one year. In a few
recent studies the MTA and
hydroxyapatite-based materials
showed significantly better antibacterial activity than Ca(OH)2.
Biocompatibility
Absence of cytotoxic effects and
biocompatibility of the restorative materials are reasonably
of critical importance to reduce
the possibility of pulp tissue irritation or degeneration. Various
cell culture systems, implantation testing models in animals
or usage tests in animal or human teeth have been repeatedly
evaluated the biocompatibility
of materials used as pulp protective bases. Calcium hydroxide-based materials have been
much studied and represent the
gold standard in the research of
dental material biocompatibility.
Conventional glass ionomers are
highly biocompatible materials,
while the resin modified glass
ionomers, the resin composites
and the adhesive systems have
been shown to be considerably
more cytotoxic, due to the release of non-polymerized monomers (BISGMA, UDMA, TEGDMA, HEMA). These monomers
can cause directly pulp inflammation in toxic concentrations,
or dramatic reduction of the defensive ability of the pulp in subtoxic concentrations. However
histological studies in deep cavities of human teeth are expected
to confirm these issues.
Biospecificity
It is associated with the capability of material to stimulate reduction of dentin permeability
(barrier function). Systematic investigations on the ability of the
use pulp protective materials, including the gold standard group
of calcium hydroxide-based materials, to mediate inflammation
in the underlying pulp and to

> Page 29

[15] =>

Dental Tribune Middle East & Africa Edition | July - August 2014

hygiene tribune 15

Editorial report on the Dental Hygiene Day
at the 9th CAD/CAM & Digital Dentistry
International Conference
09-10 May 2014 Dubai
By Victoria Wilson,
Dental Hygiene Therapist, UK

UBAI, UAE: A truly remarkable day for Hygienists in the MENA,
over 100 Hygiene delegates
attended the first Dental Hygiene Day on Saturday May
10th, 2014 which was a continuation of the 9th CAD/
CAM & Digital Dentistry Int’l
Conference, May 09-10, 2014
at the Jumeirah Beach Hotel,
Dubai, UAE. Hygienists practicing in the UAE and from
other countries in the MENA
attended the first of it’s kind in
the Middle East.
The timetable included a variety of relevant topics tailored
specifically to the Hygiene
profession.
The exceptional speakers
made it worthwhile for any
hygienist to attend.
Prof. Crawford Bain delivered
an interesting informative lecture on the maintenance of
the dental implant patients,
an extremely relevant topic
for all Hygienist in light of the
growing number of implants
being placed and the crucial
role of the Hygienist in the
necessary maintenance.
Dr. Matthieu Gabriele gave a
lecture on Oral Hygiene protocols and complications with
various fields of dental treatment, a must know-how for
every Hygienist.
Dr. Rasha Ahmed presented
the important topic on dentine
hypersensitivity management.
Hygienists face patients common complaints of hypersensitivity on a daily basis, and
the well presented topic by Dr.
Rasha was much appreciated
by the audience.
Victoria Wilson’s Lecture, the
Editor of Hygiene Tribune,
focused on communication
within Dentistry, a topic essential for the delivery of oral
health education and achieving long term compliance and
maintenance of oral health.
The afternoon consisted of a
hands on course on periodontal instrumentation, with the
renowned Prof. Mary Rose
Pincelli Boglione from Italy
and the International Federation of Dental Hygienists
IFDH. Due to the popularity
and demand the course was

extended to 2 days. We were
honored to have such an expert in the profession join us
on a revision of the essential
skills of scaling and instrumentation. Hygienists are
trained extensively on scaling
and instrumentation in their
education, however it is easy
to fall into bad habits. This
was an invaluable refresher
course for Hygienists and we
hope that Mary will join us in
the future for more courses.
Dr. Rasha Ahmed also delivered a very informative hands
on continuing course in the
afternoon on the practical application of the management
of dentine hypersensitivity.
In the 7 years I have been living and working in the UAE I
have never known for there to
be such an extensive program
for the profession on one day
and for so many Hygienists to
be in one room at one time.
The year 2014 is an exceptionally exciting time for the
profession of Dental Hygiene
in the MENA. Four months
ago the Dental Tribune Middle East opened the Dental
Hygiene Tribune section dedicated entirely to the Dental
Hygiene profession. More
and more dental and medical
professionals are requesting
to have a Hygienist on board.
Following on from the Dental
Hygiene Day we look forward
to more Hygienists days by
CAD/CAM with more hands
on courses, and lectures tailored to the needs of hygienists professionals
What we all have to keep in
our mind is that a healthy periodontium is the backbone to
all good restorative dentistry
and medical treatment – not
in the whole process an essential part in over all health
and wellbeing.

Contact Information
Ms. Victoria Wilson, Dental
Hygiene Therapist, UK
Dr Roze & Associates Dental
Clinic
wilson@dental-tribune.me
www.dental-tribune.me

Dental Hygiene Day
15 November 2014
Jumeirah Beach Hotel Dubai
www.cappmea.com/aesthetic2014

PARTNER

Dental Hygiene Day, supplement to the 9th CAD/CAM & Digital Dentistry Int’l Conference on
09-10 May 2014

[16] =>

New Philips Zoom WhiteSpeed
Light-Activated Whitening System.
A better experience for your patients and
your practice.
Philips Zoom In-Ofﬁce Whitening kit makes treatments easier
Packed in procedural order, you get everything you need for each treatment, including
Philips Zoom at-home whitening gel for follow up and maintenance complete in a single
package. The Philips Zoom Kit also includes simpliﬁed visual instructions.

Unique products for your sensitive patients
Each treatment comes with a Patient Post Care and Maintenance kit that includes the
Relief ACP Oral Care Gel. This unique formula combines
potassium nitrate for sensitivity relief along with Amorphous Calcium Phosphate (ACP)
that helps create healthier smiles through advanced
enamel protection. To ensure a more comfortable experience all around, instruct
patients to use it for 10-30 minutes after treatment.

New Philips Zoom WhiteSpeed Whitening LED Accelerator
The advanced Philips blue LED technology provides approximately 50,000 hours of
use—reducing operating costs, downtime and is 40% more
energy efﬁcient. The light also emits 100% greater light intensity* with no compromise
to safety. Redesigned to be easier to position and more
ergonomic, your patients and your treatment will be better than ever.

New support for your practice
Philips Zoom is funding a worldwide public relations campaign to drive patients to
dental professionals, and new programs to help you quickly
and easily integrate Zoom into your practice.

“With this new light the patient’s sensitivity is minimal,
making the procedure much more pleasurable.”
– Juban Dental Care - Baton Rouge, LA

Reveal your patients’
most healthy, radiant
smile with Philips Zoom
WhiteSpeed
Give your patients the immediate white smile they want and the
healthy white teeth they need, with the new Philips Zoom
WhiteSpeed. The number one patient-requested professional
teeth whitening brand* is clinically proven to deliver superior
whitening results in just one ofﬁce visit. WhiteSpeed is shown to
whiten teeth up to 8 shades in 45 minutes; that’s 40% better than
a comparable non-light activated system.†
The new Whitening LED Accelerator’s variable intensity settings
allow you to customize the output to ensure each patient
receives a more comfortable treatment. 91% of patients
experienced little to no sensitivity with Zoom WhiteSpeed.‡
Now better than ever — Philips Zoom WhiteSpeed.
* In the U.S.
† Compared to Philips Dash
‡ Results based on 500-person study. Data on ﬁle.

[17] =>

hygiene tribune 17

Dental Tribune Middle East & Africa Edition | July - August 2014

Philips introduces its best brush yet, Sonicare
DiamondClean, helping users achieve brushing
brilliance every time
By Philips
ubai, U.A.E - Philips is proud to present the new Sonicare DiamondClean – a brush
that takes sonic tooth brushing
to its most sophisticated level
and which delivers Sonicare’s
best clean yet removing up to
100% more plaque in hard to
reach places than a manual
toothbrush.

to 100% of plaque from hard
to reach places and to improve
gum health in just 2 weeks. It is
also clinically proven to whiten
teeth in 1 week ; and its gentle
technology actually helps protect against gum irritation and
recession to help reduce sensitivity. Now is the perfect time
to give your teeth the celebrity
treatment and switch to Sonicare to really experience the
difference.

Sonicare
DiamondClean
harnesses Philips Sonicare’s
patented sonic technology to
produce a powerful dynamic
cleaning action for a difference
users can see and feel. It is gentler on teeth and gums than a
manual toothbrush, helping to
keep teeth stronger and healthier for longer. Philips Sonicare
gently whips toothpaste into an
oxygen-rich foamy liquid and
directs it between and behind
teeth and along the gumlinewhere plaque bacteria flourish.
Sonicare DiamondClean is
clinically proven to remove up

The brush is able to deliver
a unique whole mouth clean
feeling thanks to its five brush
modes that allow you to tailor
your brushing according to
your needs as well as your dental professional’s advice. The
brush modes range from:
• Clean – the standard mode
for a whole mouth clean
• White – removes surface
stains to whiten teeth
• Polish – brightens and polishes teeth to bring out their
natural brilliance
• Gum Care – gently stimulates and massages gums

D

• Sensitive – an extra-gentle
mode for sensitive teeth
Highly charged
DiamondClean’s chrome base
also features a unique charging glass that can be used for
mouth rinsing, but also incorporates the latest in inductive
charging technology to charge
the toothbrush as it rests in the
glass – making it stylish enough
to display in the most fashionforward bathroom.
Not only is Sonicare DiamondClean Philips’ most advanced
brush yet, it’s also our most
easy to use and stylish. DiamondClean’s power handle has
a ceramic finish and a chrome
accent ring highlights the elegant neck of the brush. The
technology in the handle is
hidden so that the sleek matte
white finish of the brush is uncluttered by electronic visual
displays. Only when the on button is pressed are the brushing
modes illuminated to reveal
the array of options. These are

then simply selected by scrolling
down using a one
button action.
When travelling or on the go,
Sonicare
DiamondClean is designed for convenience with users
being able to keep their brush
fully charged using a revolutionary USB travel case that
can be plugged into almost any
lap top computer and saves the
hassle of having to pack plugs
and adaptors. But only the most
intrepid travellers need worry
about this advanced feature as
Sonicare DiamondClean holds
an impressive three weeks
charge.
Brilliant cut
Sonicare
DiamondClean
brush heads also sport a new
diamond-cut tuft formation
to provide you with an even
more efficient brushing experience. The uniquely designed

diamond bristle heads have
44% more bristles than Philips
Sonicare’s standard sized ProResults brush heads, providing
you with both superior plaque
removal and whiter teeth. The
heads come in two sizes – Standard and Compact – for focused
cleaning in areas of special
need, for orthodontic patients
and those with smaller mouths.

Contact Information
For more information about
Philips Sonicare DiamondClean
or the Philips Sonicare range,
including copies of clinical studies, visit www.mea.philips.com/e/
oralhealthcare/ar

How much do you care for your hands?
By Beverley Watson RDH,
Kings College, London

XP Technology American DuraGradeMax LM steel
Eagle
²Specially filtered titanium Hardened steel alloy by
nitride/stainless steel alloy thermo-mechanical heat
not a coating but infused. treatment, controlled gas
atmosphere and cryogenic
³Rockwell hardness test
processing.
most steel instruments 5860, XP 89, Diamond 100
Figure 7 shows its
durability out lasts any
Strokes 1500 XP – 1,500
other instrument including
other
XP Technology.

L

ONDON, UK: It is
understood that out
of many professions
Dental Hygienists are
in the high risk category of suffering from Repetitive Strain
Injury RSI or Carpal Tunnel
Syndrome CTS. This article
aims to evaluate ways to reduce this strain by using the
Ultra Sonic Scaler USS as much
as possible and by choosing the
most beneficial hand instrument on the market today to
reduce this risk.
Two widely used brands
of Hand instruments are to be
evaluated as a comparison, LM
DuraGradeMax and American
Eagle XP Technology.

Figure 1. The repeated activity
can compress the median Ner ve
travelling through the Carpal
Tunnel.

Figure 5

Figure 3. Examples of treatment options for RSI or CTS
when the strain has become
chronic, and simple exercises
are inef f icient.

Method: Online research publications.
Conclusion: After reviewing
the information from both LM
and American Eagle instruments, It was found that some
parts of the LM information
in Figure 3 was not able to
clearly state what it was trying
to prove. Yet with electron microscope photographs and the
Rockwell hardness test proves
the hardness of the cutting
edge of American Eagle instruments.
Objectives: To determine the
best ways a Dental Hygienist
can avoid RSI or CTS throughout their career. This will include exercises’ and what to

FROM THIS

Figure 7

Figure 6

Figure 2. Examples of stretching exercises to perform between patients.

be aware of when choosing
ergonomic hand instruments
for hand scaling, such as the
comparisions LM DuraGradeMax and American Eagle XP
Technology. The criteria will
be judged on the handles lightweight quality, the best grip
and the need for sharpening.

TO THIS

Figure 4

Introduction: RSI Repetitive
Strain Injury or CTS Carpal
Tunnel Syndrome“Repetitive
strain injury (RSI) is a general
term used to describe the pain
felt in muscles, nerves and
tendons caused by repetitive

movement and overuse”
This clearly describes a
Dental Hygienists average
working day, the repetition of
the same movements. RSI can
affect different parts of the
body the neck, shoulder, elbow,
wrists and hands. For the purpose of this article the focus
will be on the wrist and hands.
Four common causes of RSI:
1. Repetitive activities
2. Doing a high-intensity activity for a long time without rest

3. Poor posture or activities
that require work in an awkward position
4. Holding the instrument USS
or hand scalers with the wrist
is bent. It is best to keep the
wrist in line with the arm not
at an angle compressing the
meridian nerve (Figure 1).
Signs and symptoms can vary
but the most common are: pain,
aching or tenderness, stiffness,
throbbing, tingling or numbness, weakness and cramp.

> Page 20

[18] =>

Dentures contain surface pores in
which microorganisms can colonise.1
Corega® cleanser is proven to penetrate the biofilm*
and kill microorganisms within hard-to-reach surface pores.2

Help your patients eat, speak and smile
with confidence with the Corega® denture
care regime.
SEM images of denture surface.
*In vitro single species biofilm after 5 minutes soak
References: 1. Glass RT et al. J Prosthet Dent. 2010; 103(6): 384-389.
2. GSK Data on File, Lux R. 2012.
Date of preparation: June 2014.
Ref: CHSAU/CHPLD/0008/14c

Arenco Tower, Media City, Dubai, U.A.E.
Tel: +971 4 3769555, Fax: +971 3928549 P.O.Box 23816.
For full information about the product, please refer to the product pack.
For reporting any Adverse Event/Side Effect related to GSK product
please contact us on contactus-me@gsk.com.

[19] =>

Helps stop bleeding gums

In ‘bleeding on probing’ trials over 4 weeks, parodontax®
demonstrated significant effects in reducing bleeding
gums by 22% (p<0.01)
Bleeding on probing increased after 4 weeks of brushing
with the fluoride control toothpaste

Reduced bleeding on probing index after 4 weeks with parodontax®9*

Change vs baseline in bleeding
on probing index after 4 weeks

30.00

22%

reduction in
bleeding

25.00

(p<0.01 vs. baseline)

20.00
15.00
10.00
5.00
0.00
4 weeks

Fluoride-containing
control toothpaste

Baseline

4 weeks

parodontax®

Helps stop bleeding gums
Adapted from Saxer et al 1994. All interdental spaces from 6+ to +6 were tested at baseline and 4 weeks for bleeding on probing on the
right side (buccal) and left side (lingual). Findings were recorded as 0=no bleeding; 1=slight/isolated bleeding; 2=marked bleeding. Mean
scores were determined. N=22.
Baseline values [Mean SD]: Control (fluoride-containing toothpaste) group 24.75 (6.34); parodontax® group 25.40 (6.80). After 4 weeks:
Control (fluoride-containing toothpaste) group 26.00 (9.14); parodontax® group 19.80 (7.38). *parodontax® vs control p<0.05.

OH/CA/00/13/003

Baseline

[20] =>

20 hygiene tribune

Dental Tribune Middle East & Africa Edition | July- August 2014

< Page 17
Prevention: Take regular hand
breaks to stretch and exercises
the muscles, tendons and ligaments. See Figure 2 for some
possible exercises.
Breaks don’t only include
time away from scaling, but also
time away from the computer
and writing notes. Typing can
also compress the nerves in the
Carpal Tunnel.
Treatment: If it is not possible
to take long term time out from
the activity causing the repetitive strain on the small muscle
groups, then it is necessary to
take regular short breaks and
stretch (Figure 2, 3).
A hand splint, the hand is held in
a relaxed position to take pressure of the Median nerve running through the Carpal Tunnel
and as a final resort surgery.
A brief history of Hygiene
The earliest recorded text asso-

“...Ultra Sonic Scaler should be used as much as
possible to avoid excessive strain on the transverse
carpal ligament and median nerve.”
ciated with teeth cleaning dated
3000 BCE where tooth picks
were used in Mesopotamia (early Iraq) according to the M dentistry Time line of Dental Hygiene, but it was not until 1915
in USA, Conneticut that Alfred
C. Fones trained 97 Dental Hygienists and the Dental Act set
regulations stating their duties.
Then in UK 1943 saw the 1st
Dental Hygienists trained in the
Women’s Auxiliary Army WAAF.
Instruments: The 1st Dental
hand instruments were very
thin and heavy with smooth
metal handles requiring a very
tight grip. Later a cross hatch
was scored into the metal handles for easier grip but were still
very thin, wider lighter steel
gripped handles were introduced and in the last 10 years
a wider ergonomic soft silicone

was used around a metal inner
part then came into production,
a very light completely resin
handle with a grip for less wear
on the muscles and tendons.
Ultra Sonic Scalers have dramatically improved the Dental
Hygienists ability to remove
hard deposits from the tooth
surface by either working in
a Magnitoconstictive or Piezo
electric capacity. This reduces
the need for excessive forces
applied by the hand over an extended period of time increasing
the risk of strain and inflammation of the wrist muscles and
tendons resulting in RSI or CTS
(Figure 4).
Sharpening: Numerous articles
state the different methods of
sharpening instruments:
Arkenstone different shapes
round, flat, long, short. Differ-

FOR:
• PFM
• ZIRCONIA
• LITHIUM DISILICATE

ent sizes, angles, grades course,
medium, fine
Machines: The Hu-Freidy instrument sharpener, the LM
Rondo- plus electrical disc
sharpener
The Neivert Whittler to name a
few.
The consistency of the precision of angulation is unpredictable and operator error possible.
It is possible to affect the cutting
edge, causing more strain on
the fingers hand and wrist. It is
human nature to not sharpen
immediately when required.
Figure 5 shows the different
types of next generation hardened steel.
Results: LM handles present to
be ergonomically superior with
a wider silicone grip to help keep
the Carpal Tunnel open, however they do still contain an inner
part of steel. This runs the entire
length of the handle increasing
the overall weight compared to
the completely resin handle of

the American Eagle.
The XP Technology instruments requires no sharpening
at all, and will allow more repetitive strokes with minimal pressure on the tendons and wrist.
The LM DuraGradeMax states a
hardened steel alloy more durable than the XP Technology. It is
advised to send the instruments
back to the LM company for factory sharpening, requiring double the amount of instruments in
order to continue a full working
schedule, resulting in LM being
less cost effective . Once the XP
technology tips becomes dulled
it is feasible to use their Quick
tip® to replace the tip at less cost
than the full instrument.
The statistics in Figure 7 do
not clearly state how the results
were determined for LM instruments, it is not clear what
numbers 9, 7, 5 and 3 represent,
minutes, hours, Days, Strokes?
It is possible however to see in
photographic evidence 15000
strokes to 1,500 from American
Eagle instruments.
Regarding the hardness of
the Steel alloy of the LM instruments there is no evidence to
support this but the American
Eagle XP instruments have the
Rockwell hardness test to prove
their claim.
Conclusion: In conclusion the
Ultra Sonic Scaler should be
used as much as possible to
avoid excessive strain on the
transverse carpal ligament and
median nerve. It is clear that
some calculus deposits remain
interdentally after Ultra Sonic
Scaling alone. Ultra Sonic Scaling alone is not sufficient and
hand instrumentation is necessary in conjunction with Ultra
Sonic Scaling.
The correct choice of hand instrument is essential for a Dental hygienists to help avoid RSI.
It seems the American Eagle
lightweight resin handle with
the XP Technology blade will be
of most benefit long term. Due
to its superior stokes carried out
15000 to 1,500 before starting to
dull.
For this reason it seems the
American Eagle XP technology would be in the instrument
of choice compared to the LM
DuraGradeMax. The American
Eagle XP will ensure less pressure is exerted on the median
nerve, the transverse ligaments
and the carpal tendons reducing
the risk of RSI or CTS.
References:
1. NHS UK choices website May
2014
2. May 2012, RDH Feature, No
more dull instruments, Dianne
Glasscoe Watterman RDH, BS,
MBA
3. http://school/sindecuse-museum/timeline-dental-hygiene
Figure 1: http://en.wikipedia.
org/wiki/File:Carpal_Tunnel_
Syndrome.png
Figure 2/3/4: Google images
Figure 5: DG Double Graceys
XP technology next generation/
http://www.lm-dental.com/
sites/lminstruments.com/files/
materials/duragrademax_en_
flat.pdf
Figure 6: DG Double Graceys
XP technology next generation.
Figure 7: http://www.lm-dental.
com/sites/lminstruments.com/
files/materials/duragrademax_
en_flat.pdf

[21] =>

[22] =>

22 cad/cam | digital tribune

Dental Tribune Middle East & Africa Edition | July- August 2014

KaVo CAD/CAM workflow with the new products
ARCTICA AutoScan, KaVo multiCAD Virtual
Articulator and VITA ENAMIC
By KaVo

ith the production of
two monolithic posterior crowns, the KaVo
CAD/CAM application technology demonstrates a practical
case in which the new CAD/
CAM products ARCTICA AutoScan, KaVo multiCAD Virtual
Articulator and VITA ENAMIC
for KaVo ARCTICA play a major
role.
Described below are the following individual steps, which
consist of:
1. Order preparation
2. Scanning
3. CAD construction
4. Preparation for manufacture
5. Manufacturing
6. Completion
Order preparation: 30 seconds
First, the practitioner, the patient and the respective technician are defined in the order

entry form. The second step
consists of the definition of the
indication including all parameters. In the present case, this
concerns the creation of two
full crowns to be made of Vita
ENAMIC Regio 46 and 47. The
parameters for the respective
practitioner can be referenced
in the KaVo multiCAD software. This function guarantees
consistent quality regardless of
the originator of the order (Figure 1, 2).

followed by a vestibular scan
allowing the correct positioning of the jaws by the software
Figure 3.
The next step consists of
matching the individual jaw
scans and the vestibular scan
by marking three identical
points on the respective jaw
and vestibular scan. Afterwards, the software calculates
the exact position of the upper
and lower jaw scans(Figure 4,
5, 6).

Scanning: 180 seconds

Construction of the restoration in the KaVo multiCAD
software: 180 seconds

This case is scanned with the
new fully-automatic ARCTICA
AutoScan. The scan process
is very simple as the software
guides the user step by step
through the scan process. The
individual scans are performed
completely automatically. First,
the upper jaw is scanned, followed by the lower jaw. If necessary, single stumps may then
be scanned separately. This is

In the KaVo multiCAD software, the contact relief of the
corresponding jaw is displayed
in the scan software.
For analytical purposes, it may
be displayed in color. The respective color and intensity
indicate the distance to the antagonist.

Figure 1

Figure 4

Figure 5

Figure 2

KaVo ARCTICA® CAD/CAM system

Expect more of your
CAD/CAM solution.
KaVo ARCTICA® CAD/CAM-system –
NEW one
system, many advantages.
The KaVo ARCTICA CAD/CAM system, meets all the technical and
economic requirements for modern dental solutions, that are
presumed in everyday practice and laboratory life.
• Maximum investment protection and future security, due
to wide range of applications and extensive material options.
• Outstanding flexibility
with maximum integration options.
• Maximum precision for all results,
combined with easy handling.
www.kavo.com/arctica

Figure 6

Figure 3

Afterwards, the articulator
KaVo PROTAR evo 5B is started
in the KaVo multiCAD software.
The respective patient-specific
settings of the physical PROTAR articulator such as, for example, the condyle track inclination and the Bennett angle,
are entered into an entry mask.
The correct positioning of the
models in the virtual articulator (KaVo PROTAR 5B) is done
automatically. Based on the
scan of the articulated models
in the ARCTICA AutoScan and
the positioning of the models
by the KaVo Splitcast system,
the correct positioning is automatically transferred to the
CAD software. This positioning
also applies to models that were
inserted into the articulator by
means of a facebow.
After the adjustment of the patient-specific parameters, the
motion tracks are simulated
and any interferences are corrected by the software (Figure
7, 8, 9).
The illustration shows a laterotrusion to the left (Figure
10).
In the subsequent construction
process, the movements of the
jaws may be visualized at any
time (Figure 11).

KaVo Dental GmbH · Arjaan Tower 9th Floor · Dubai Media City, UAE · PO Box 71569 · Phone +971 4 433 21 86 · Fax +971 4 457 93 73 · Email: info.mea@kavo.com · www.kavo.com/mea

The manufacture of the two
VITA ENAMIC crowns on 46
and 47 is performed quickly
and easily by means of library

Figure 7

Figure 8

Figure 9

teeth that are automatically positioned onto the preparations
and may be loaded into the situation via a simple mouse click.
Furthermore, the library teeth
may subsequently be matched
to the individual occlusal relief
of the chewing surface. The
user is able to adjust the suggestions of the software via a
wizard (step-by-step assistant)
at any time during the construction process. Various tools

> Page 27

[23] =>

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class of

restoratives

Giomers are a remarkable class of bioesthetic
restorative materials that exhibit the aesthetics,
strength and durability of nano-hybrid resin
composites, further enhanced with the benefit of
fluoride and anti-plaque effect pertaining to S-PRG
fillers.
These unique fillers are manufactured through
Shofu’s patented PRG filler technology that imparts
Beautifil II
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Flow, Beautifil Injectable
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Tel: 65-6377 2722 Fax: 65-6377 1121 eMail: mailbx@shofu.com.sg www.shofu.com.sg

[24] =>

Dental Tribune Middle East & Africa Edition | July - August 2014

cad/cam | digital tribune 24

Now is the time to consider investing
in your own CBCT System
By Ernesto Jaconelli

his Century has seen the
introduction of 3D imaging as a readily available
dental diagnostic tool. This
trend has been inspired by
the development of both Cone
Beam Computed Technology
(CBCT) and PC storage capability making 3D imaging more
convenient, easier to use, and
affordable.
To be able to view the area
of interest in all three dimensions significantly improves

the accuracy of diagnosis and
this in turn makes for faster
better patient treatment. Each
year new systems are becoming available such as the new
CS 8100 3D System form Carestream Dental. These new
systems are now significantly
smaller, more versatile and
user friendly than their predecessors. The CS 8100 3D has a
“resting” width of 33cm (110cm
when in use) and weighs only
92Kgm so will fit easily into
most compact dental clinics.
A very important feature of

all modern CBCT systems is that
they provide the Dentist with a
choice of volumes that will be
right for the area of interest.
These volumes are known as
the Field of View (FOV). The
CS 8100 3D for example gives
choices from taking a 2D Panoramic to capturing a selection
of 3D FOVs of 4 x 4 / 5 x 5 / 8 x 5
/ 8 x 8 and 8 x 9 mm. As with
all x-rays it is essential to minimise the dose to the patient
- the larger the FOV the more
dose to the patient. Each area
of dental surgery will require a

Having the choice of either a 2D panoramic or a
range of 3D FOV’s is ideal

different FOV depending on the
treatment being considered so
it is essential to have a choice of
FOVs to select from.
For a single implant a FOV
of 5 x 5 mm will be sufficient
and the dose to the patient in
this case will be similar to that
from a 2D panoramic scan.
However for the preparation of
multiple implants or surgical
guides then a single arch FOV
of 8 x 8 / 8 x 9mm FOV would

The CS 8100 compact size will fit
into most Dental Clinics

Visit us at

6th Dental Facial
Cosmetic Int’l
Conference
Jumeirah Beach Hotel Dubai
14-15 November 2014

be selected. Dentist who specialising in Implants were the
first to fully appreciate the benefits of 3D imaging such that it
is now unusual to find one who
does a not have their own CBCT
system.
For Endodontists, the key
diagnostic tool is always their
surgical loupes. But they are
also adopting 3D image to reveal more clearly any additional
canals that are present and possibly missed from a 2D image as
well as their exact position and
apical areas. A sectorial FOV
of 5 x5 mm will provide a very
high definition image for an
Endodontist to be able to examine the area in precise detail.
Until now Orthodontists have
mainly been satisfied with a
2 D panoramic view. However having a CBCT system
that switches easily from a 2D
panoramic to 3D image allows
the Orthodontist to select a 3D
view when required. Retention
and angulation for example are
more precisely diagnosed from
an 8 x 5 / 8 x 9 mm FOV.
3D imaging will soon be the
norm for dental diagnostics requiring all dentists to be familiar with the technology and capable of analysing 3D images.
There has never been a more
appropriate time to consider
having your own CBCT System.
Manufactures are supplying
more in depth training such
as at the Carestream Dental
Training Centre at Ajman University of Science and Technology, and now that CBCT
systems are available from
40,000€, a return on the investment can be achieved within
two years.

Contact Information
For more information on either
CBCT technology, the new CS
8100 3D or courses at Ajman
University please contact:
montassar.bentili@carestream.
com
or visit www.carestreamdental.
com

[25] =>

25 cad/cam | digital tribune

Dental Tribune Middle East & Africa Edition | July- August 2014

Simple, planned aesthetic orthodontics for
the General Practitioner
By Dr. Tif Qureshi
Dr. Tif Qureshi shows how
digital technology has moved
progressive smile design on and
the enormous benefits this will
have on planning and consent.
Digital Smile Design is making a come back in a very smart
and intelligent form through the
use of live video, cameras, and
keynote presentations.
I commend the users of this
technique as it is clearly a far
better form of smile design planning than just using plain static
before and after pictures with
someone else’s smile stitched
into place.
However in cases where
there are alignment issues, I
would still argue that any patient who does not at least go
down the pathway of alignment
and bleaching, cannot really see
their teeth change in a dynamic
way.
I have found that patient’s
feelings about their smiles
change, you may think they
want one thing but after they see
their smile change a little they
start to appreciate it in a different way. How can someone really be consented unless they are
given the opportunity to bleach
their teeth, perhaps with slight
alignment and bonding.
This case is the perfect example and will show how progressive smile design also using
digital technology can produce
beautiful predictable results that
often require far less invasive
treatment.
We use digital technology
in a different way of course and
this is all to do with planning and
consent. Previously with Inman
Aligners, we had to use Kesling
models. These are effectively
fairly crude stone models which
take a cut and once repositioned
in wax the aligner is then built
on that model. As soon as the
aligner is fitted into an uncorrected mouth the forces are
there to push the teeth to the
final position. The real downside of it at the wax creates quite
large inaccuracies. Also it is very
difficult to see how much adjustments have been made to the
teeth to get them to fit within the
curve. This is even more so of a
problem for flared teeth which
have been out of the arch for
many more years. These teeth
tend to be highly triangular and
often need more targeted adjustment to get them to fit within the
arch form. You can visualize the
wits of these teeth, it is almost
impossible to accurately know
how much production is required to each.
Of course with digital 3-D
printing this has all changed.
The difference if you like is night
and day. We can also use printed models to show the patients
the proposed outcome. This
is excellent for the consenting
process. Untreated patients will
now see any compromises areas
and the final outcome. If they

are not happy they could reject
the treatment before it starts.
A case
A 22 year old gentleman did not
like the appearance of his teeth
especially because the two centrals was so prominent. He had
considered having porcelain veneers done just to improve his
smile in one treatment. He did
not like the appearance of his
enamel and also the discrepancy
in the shape of his front teeth. We
showed him the occlusal view of
his teeth and he could see that
the upper anterior is one mildly
misaligned. Indirect veneers
would have been fairly aggressive towards the preparation of
the upper central incisors. By
showing examples of other cases where simple alignment had
dramatically improved the aesthetic value the patient agreed to
try to align his teeth first before
having veneers done.
Consent part one
A full orthodontic examination
was carried out. All orthodontic
options were discussed and the
patient understood the benefits
of fully comprehensive orthodontics, and was also given a
range of short-term techniques
that he could have chosen. He
declined comprehensive orthodontics on the basis that he only
wanted to deal with his anterior
teeth.
He chose to have an Inman
Aligner because of the shorter
wear time and the minimal
cost impact on his overall treatment desires. Our first goal was
to evaluate the aesthetics and
function to decide on landmark
or reference teeth. As part of the
digital planning process- these
teeth are not moved and ensure
the setup accommodates these
teeth to ensure the proposed
curve is not flared out or over
constricted.
In this case the patient also
had a retained upper left deciduous tooth (no canine had
developed).
Fortunately this
tooth was in the right position
so it became the reference tooth
and hence no orthodontic force
would need to be applied to it.
Both upper centrals needed to
be retracted and both laterals
slightly advanced. It was important to visualize a chin up view
to ensure this is viable for the
patient from an occlusal and
guidance point of view. All the
movements were possible.
(Figure 1) Occlusal showing
landmark and desired movements.
(Figure 2) Showing Spacewize
trace
In the chair the occlusal photo
is taken and uploaded into the
spacewize digital calculator.
The curve is set according to the
landmark teeth and required
movements. This showed a
crowding result of 3mm which
was within the easy limits for Inman treatment.
Impressions were taken and
were sent to the lab with the
spacewize trace

Figure 1

the laterals advanced by about
1.75mm exactly.
These setups can be viewed as
digital files in 3D if needed beforehand by the dentist and adjustments can be made if needed. Once we are happy, the 3D
model was printed.
Consent part two
The 3D model was returned and
we could view the proposed setup made according to the spacewize instructions
Figure 3: Overjet before
Figure 4: Overjet reduced and
proposed on 3D print
Figure 5: 3D Print Occlusal

Figure 2

Setup
Using a calibrated Ortho analyzer software, the teeth are then
moved according to the spacewize trace- meaning the deciduous tooth and other canine were
not moved at all. Centrals were
retracted by about 3mm and

An appointment was made
with the patient to sit down and
examine the models. At this
point the patient clearly sees
any compromises in the posterior region of his mouth. These
were again highlighted but the
patient insisted he did not want
these treated. The over jet was
also discussed with the patient
he could see a reduction but not
complete closure, he was happy
with this.
You can see the width differences in the anterior teeth that
would require adjustment and

Figure 3

Figure 4

Figure 5

> Page 26

[26] =>

Dental Tribune Middle East & Africa Edition | July - August 2014

cad/cam | digital tribune 26

< Page 25
tooth shaping with PPR (predictive proximal reduction). This
made it far easier for him to understand the processes required
to create the space. Finally he
could also see the differential
wear in his tooth outline that
would be evident after alignment. He clearly understood
that edge bonding and tooth
contouring might be required
after alignment and bleaching
were complete. That is assuming he did not want to continue
with porcelain veneers.
It was noted that the patient had
reviewed and understood the
3-D model and what it was proposing. The Inman Aligner was
then built and fitted.
Treatment
Inter-proximal and Predictive
proximal reduction were carried out in a progressive and
measured manner over 3 visits.
This was done to ensure good
anatomy and to reduce the
risk of gouging, over stripping
and poor contacts. With Inman
Aligner treatment stripping is
never carried out in one go.
Composite anchors were also
placed in a timed and sequenced
manner to ensure the forces
could be directed at the right
time. This allows for rapidly increased treatment times.
After only nine weeks the patient’s anterior teeth had nearly
aligned. Bleaching trays impressions were taken at this stage.
Super sealed trains are used
with 6% day white from Phillips.
The patient bleaches 35 to 45
minutes a day while the aligner

is out of the mouth.
After a week the patient returned his teeth had improved in
alignment already but with the
improvement in color as well
made him view his teeth in a different way.
At this point he decided not
to have porcelain veneers and
instead to ask for composite
bonding and buildups. He had
seen examples of this already.
We used some mockup flammable material to show the patient
what was possible and he was
thrilled with the results. So an
appointment was booked for 2
weeks to have this done.
Figure 6: Before Close front view
Figure 7: After alignment and
bleaching at 10 weeks
Figure 8: Immediately after
bonding

Figure 6

Figure 7

Figure 8

Composite bonding was carried
out on the 7,9 and 10. A composite veneer was placed on the
11. All these were carried out
with only roughening and no
prep or bevel. Venus Diamond
composite from Heraeus Kulzer
was used. I find that the Opaque
shades allow superb blocking
out of light meaning that if layered as dentine, it means a long
bevel is not required to block out
the join. Enamel shade can then
be placed thicker towards the incisal edge.
A wire retainer was fitted and
the guidance adjusted to ensure
there were still balanced excursive contacts on the left side so
the load was not focused on the
deciduous tooth.
Roughening, total etch Optibond solo and Venus flow were
used to bond the wire in place.
A clear essix retainer was also
given to the patient to wear at
night initially then to use occasionally and to have as a back up
if the wire de-bonded.
Discussion
Figure 9: Before front smile view
Figure 10: After Alignment and
bleaching at 10 weeks
Figure 11: After Edge bonding
and retainer
Figure 12: Side profile before
Figure 13: Side Profile after
Figure 14: Side Smile before
Figure 15: Side Smile After alignment and bleaching
Figure 16: Side Smile at 6 months
Figure 17: Before occlusal
Figure 18: After occlusal at 10
weeks
Figure 19: After 6 months with
retainer

Figure 19
Figure 9

Figure 10
Figure 20

Figure 11

Figure 21
Figure 12

Figure 13

Figure 14

Figure 15

Figure 16

Figure 17

Figure 20: Before Full face
Figure 21: After full face (at 6
month review)
On viewing the sequenced shots
it is clear to see the changes.
The patient was delighted
that he had emerged from the
treatment with his own teeth
looking more attractive rather
than having ceramic porcelain
veneers. As good as ceramic
restorations are, they will always require further treatment/
maintenance and replacement.
On a 22 year old if alignment,
bleaching and bonding can satisfy the patient that it has to be
better than placing ceramic veneers. The problem with digital
smile design is that the patient is
not really given the opportunity
to see the teeth change slowly
and in situ.
It is fine if whitening, bonding and alignment are part of
those protocols but arguably
patients should not be shown
images of multiple veneers until they can visualize their own
teeth looking better.
You can see how very subtle changes can dramatically
improve the appearance. Even
though the colour is not truly
homogenous and the teeth have
a mottled appearance the most
important thing here is that the
patient was completely delighted with the treatment.
Ultimately a patient being
happy with their own smile has
to far outweigh the parameters
that are set up traditional smile
design.
Final images at the 6 month review are also shown.

Contact Information
Figure 18

Dr Tif Qureshi teaches Inman
Aligner Training
For course info visit:
www.inmanalignertraining.com
or email: inman@mdentlab.com

[27] =>

NEWS 27

Dental Tribune Middle East & Africa Edition | July - August 2014
< Page 22

Figure 12

Figure 10

Figure 16
Figure 13

Figure 17

crowns may be displayed in the
KaVo multiCAD module TruSmile in a photo-realistic manner (Figure 16, 17).
Figure 14
Figure 11

may be used for this purpose,
for example free forming, virtual wax knife, scaling, turning
and shifting of teeth.
Interferences
remaining
after the construction will be
displayed by the software and
automatically removed in consideration of both static as well
as dynamic factors (by means
of the virtual KaVo PROTAR Evo

5B) including the previously
identified motion tracks. This
allows for a drastic reduction or
even the complete omission of
subsequent follow-up work in
the mouth of the patient for the
practitioner. Not only does this
facilitate time and cost savings,
the danger of chipping may be
reduced as well (Figure 12, 13).
The following colour illus-

Figure 15

tration shows the occlusal pattern after dynamic adjustment
(Figure 14).
In the image, one can clearly

recognize the deviations (color
markings) between the static
and dynamic structure and the
adjustment of interferences in
the chewing relief.
The dynamic adjustment
may be displayed over the static
one as wire netting. Any interferences to be expected are
clearly recognizable (Figure
15).
After the dynamic adjustment,
the finalized VITA ENAMIC

Preparation for manufacture
in the KaVo CSS: 60 seconds
The next steps for the completion of the dentures are performed in the KaVo CSS software, which is a job, material,
tool and machinery management software by KaVo.
First, the manufacturing
method is defined. This means
that the user has the opportunity to send the produced,

> Page 28

[28] =>

28 NEWS

Dental Tribune Middle East & Africa Edition | July- August 2014

< Page 27

Figure 18

Figure 21
Figure 24

Figure 19

Figure 22

Figure 25

Figure 23
Figure
20
DTI_Mediamix2014_A3_NEU_Layout
1 22.01.14 10:19 Seite 1

Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry
www.dental-tribune.com

open STL data of the restoration to his ARCTICA engine, his
Everest engine or to other KaVo
milling partners via the free
KaVo Everest portal. The work
to be manufactured and the
predefined material to be used
may be reviewed in a 3D view.
If necessary, additional modifications such as, for example, a
change of the material may be
made.
After the selection of the KaVo
ARCTICA engine as the production machine and a VITA ENAMIC for KaVo ARCTICA block,
which was previously booked
into the KaVo CSS via RFID
technology, the nesting, i.e. the
positioning of the restoration in
the virtual material block, may
be performed (Figure 18).

Production on the KaVo ARCTICA engine: 25 minutes per
crown
Now, the blanks are inserted in
the block bracket of the ARCTICA engine and affixed with
a torque wrench with a defined
tightening torque (Figure 19,
20, 21).
Afterwards, the tool stack
with the tools required for the
Vita ENAMIC - in this case, 4
different grinding tools with diameters between 0.6 – 3.6 mm
- is inserted.
These tools were also previously booked in the KaVo CSS
software via RFID chip and
assigned to the glass ceramic
tool stack. The advantage is
that the tool service times are
precisely logged and that the
ARCTICA engine uses a traffic light pattern (green, yellow,
red) to show the user when a
tool should be exchanged. This
also helps to minimize application errors.
In case of an automatic
tool change in the KaVo ARCTICA engine, the tools are once
again inspected with a laser for
breakage or faulty positioning
once they have been removed
from the stack.
The processing is started
at the touch of a button on the
touch-screen of the ARCTICA
engine or, alternatively, directly at the PC (Figure 22).
Completion of the VITA ENAMIC crowns: 180 seconds
each
After the succesful production of the two restorations on
the KaVo ARCTICA engine, the
VITA ENAMIC crowns may be
separated from the material
block. The ARCTICA engine
may be connected to a KaVo
lab handpiece (ERGOgrip and
POWERgrip) and used to further process the works. Prior to
the start of the grinding procedure, there is also an opportunity to reduce the diameter of
the connectors to a minimum
at the end of the production
process, so that the time expended for the separation of the
restoration becomes negligible.
After the grinding procedure, the VITA ENAMIC
crowns are polished in a timesaving manner with the tools
from the VITA ENAMIC polishing set. An additional subsequent individualization of
the work is possible with the
colours of the VITA ENAMIC
stains kits. In this case, an additional individualization was
omitted upon the request of the
patient (Figure 23, 24, 25).
Thanks to the use of the virtual articulator during the construction in the KaVo multiCAD
software and the precise 5-axle
technology of the ARCTICA engine, the work could be inserted directly into the mouth of the
patient and corrections of the
occlusal relief could be waived.
As can be seen, precisely integrated process chains pay off.

Contact Information
For more information, visit:
www.kavo.com/MEA
Or email us: info.mea@kavo.com

[29] =>

ortho tribune 29

Dental Tribune Middle East & Africa Edition | July - August 2014
< Page 14
stimulate directly tertiary dentin
formation and intratubular mineralization, are entirely lacking
from the literature. A few recent
investigations at the preclinical
level have shown that application of newly commercialized
calcium-silicate based materials in deep dentinal cavities resulted in rapid stimulation of the
biosynthetic activity of odontoblasts and dramatic reduction of
dentin permeability. Again, all
these data have to be confirmed
clinically.
In conclusion, despite the
fact that numerous scientific
articles studied experimentally
or clinically the pulp protective
materials in experimental or
clinical investigations (Bjorndall

et al. 2010) and a number of critical and systematic reviews discussed their results, it must be
emphasized that they have not
been evaluated for the complete
range of their effect. Given that
application of a calcium hydroxide -based material in combination with a glass ionomer, seem
to be the best choice according
to the guidelines of American
Academy of Pediatric Dentistry
and the position statements delivered by the American Association of Endodontists, further
randomized
multi-centered
controlled clinical research
is needed to assess firstly the
overall role of capping material
in the VPPT, and then the ability of today used and/or newly

developed materials to provide
long-term pulp protection.
References
1. American Academy of Pediatric Dentistry. Clinical guidelines
on pulp therapy for primary and
young permanent teeth: reference manual 2006-07. Pediatr
Dent 2006;28:144-8.
2. Bergenholtz G. Advances
since the paper by Zander and
Glass (1949) on the pursuit of
healing methods for pulpal exposures: historical perspectives.
Oral Surg Oral Med Oral Pathol
Oral Radiol Endod. 2005;100
(Suppl 2): 102-108.
3. Bjørndal L, Reit C, Bruun G,
Markvart M, Kjaeldgaard M,
Näsman P, Thordrup M, Dige I,

Table: A schematic overview of the pulp protective materials’
performancein clinical and experimental investigations.

Nyvad B, Fransson H, Lager A,
Ericson D, Petersson K, Olsson
J, Santimano EM, Wennström
A, Winkel P, Gluud C. Treatment of deep caries lesions in
adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and
direct pulp capping vs. partial

pulpotomy. Eur J Oral Sci. 2010
Jun;118(3):290-7.
4. Smith AJ. Pulpal responses to
caries and dental repair. Caries
Res 2002;36:223-32.
5. Tziafas D. Dentinogenic potential of the dental pulp: facts
and hypotheses. Endodontic
Topics, 2010;17:42-64.

< Page 12

SEVEN

Fig. 6: The marginally accurate crown af ter etching with
hydrof luoric acid gel...

FEWER

OFFICE VISITS

PER CASE

Fig. 7: ... was adhesively cemented and seated.

stability and accurate reproduction of details. The material
already exhibits a surprisingly
good surface quality after milling; this simplifies the further
manual processing as well as
saving time. Polishing, staining and glazing are particularly
quick and simple with the corresponding polishing sets. No firing cycles, e.g. a glazing firing,
are required. We’ve received
only positive feedback from the
patients; this case is no exception. Along with natural esthetics, the surface of the restorative material feels smooth to the
tongue, which contributes to a
high degree of wearing comfort.
On account of the special material concept and its resulting physical properties, such
as an elasticity modulus of 30
GPa and a Weibull modulus of
20, etc., VITA ENAMIC is much
less vulnerable to the shear and
compressive forces acting on
the stomatognathic system than
many traditional CAD/CAM ceramics. As a result, it offers a
particular potential for certain
risk groups, such as patients
with parafunctions (teeth grinding and clenching), regardless
of the manufacturer’s official
recommendation for use only in
the case of patients with normal
occlusion.
Last published in: DENTAL
MAGAZIN 02/2013, Deutscher
Ärzte-Verlag GmbH, Germany

YOU KNOW WHAT THAT MEANS

The personalization offered by Ormco Custom can reduce treatment time on average by
37% with 7 fewer office visits per case.* With the unrivaled efficiency that Ormco Custom
provides, you’ll have a little more of that priceless “you time” to hit the back nine. It’s your
world – Ormco Custom is just here to help you maximize it.
To learn more about how our portfolio of products can
improve your practice visit: OrmcoCustom.com

Contact Information
For more information, please
contact: chef@zahnarzt-loos.de

*Weber DJ 2nd, Koroluk LD, Phillips C, et al. Clinical effectiveness and efficiency of
customized vs. conventional preadjusted bracket systems. J Clin Orthod. 2013

[30] =>

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WWW.CROIXTURE.COM

[31] =>

NEWS 31

Dental Tribune Middle East & Africa Edition | July - August 2014
< Page 4
describes using of Smile Design
inside CEREC software and software DSD Connect by Dr. Josef Kunkela. Dr. Kunkela is an
innovative Czech dentist with

kela will focus on detailed workflow in his table clinic presentation on 12 September “CEREC
Guide work flow & CEREC
Abutments; Smile Design work

“It’s fun to be part of such an amazing team of
speakers”
- Dr. Daniel Vasquez, USA
extensive experience in prosthodontics, restorative dentistry,
preventative care and dental
marketing. He currently presents his research in Czech Republic, USA, Germany, France,
Ireland, Malta, Poland, Hungary
and Slovakia. He also organizes
practical courses in prosthodontics and CAD/CAM dentistry in
the Czech Republic. His studies
are published in the dentistry
journals Quintessence, International CAD/CAM Magazíne,
Dental Tribune and DentalCare
Magazine.
Five table clinics will operate
from 11th to 13th September
in groups. Outstanding CEREC
trainers will run a premiere extensive training for future and
advanced CEREC users. 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 other
means of trouble shooting.

flow, Digital Face Bow and Virtual Articulator”
Almost 30 years ago, the first
Chairside Indirect Ceramic
Restorations were introduced; a
posterior tooth Bonded Ceramic
Inlay was digitally imaged, designed, and manufactured us-

ing CEREC Chairside CAD/
CAM equipment. Nowadays,
the system is capable to digitally
produce almost every type of
single tooth restorations as well
as bridges both on natural teeth
and implants.
Dr Munir Silwadi with his table
clinic presentation “Chairside
Indirect Veneers, Inlays, and Onlays: A - Z” will make a demonstration on models created out of
actual cases. Participants will be
able to use the full capabilities of
the system to practice all steps
required to produce and bond
Veneers and Partial Crowns,
especially to restore Endodontically treated teeth.

Social Program
Work hard, play hard is the
motto of the CEREC Desert Fest.
With a content rich Scientific
Program it is only fair to have a
suitable social program. On the
first day there will be an opportunity for a sponsored DESERT
SAFARI for the interested – a
must for everyone who is visiting
UAE. A memory to share with
your family and friends back
home. Be sure to bring a camera
when going to a desert safari in
Dubai as the views are breathtaking. There will be plenty of
opportunities for socializing
with your colleagues at our special Social Program. On the second day there will be a special

encore finish with CEREC Night
– a special event overlooking the
Majestic Dubai Fountains which
are dancing to the sound of the
angelic voices of Andrea Bocelli
and Sarah Brightman. We look
forward to spend a wonderful
two days with you at the dynamic Emirate of Dubai in UAE.

Contact Information
CAPP
events@cappmea.com
Tel: +971 4 3616174
Mob: +971 50 2793711
www.cerecfest.cappmea.com
www.facebook.com/cerecfest

Science in Every Smile

IT IS TIME TO SEE THE

FUTURE NOW!

Dr. Todd Ehrlich, USA - Summer of CEREC
“If you are a current CEREC
user wanting to hone your skills,
or someone curious about the
technology, this narrative instruction will guide you for the
best outcome.”
Dr. Daniel Vasquez, USA - Explore CEREC Omnicam
“It’s incredible how easy and fast
new user learn to operate the
new Camera CEREC Omnicam.
Come learn and engage in this
One day lecture/hands-on and
discover in how you can integrate CEREC Omnicam to your
practice.”
CEREC inLab Basic & Advanced
Training is featuring Dental
Technicians. Mr. M. Al-Zu’bi,
Canada Mohammad Al-Zu’biRDT, owner of Optimus Dental Lab Inc. a Crown & Bridge
lab which focuses on Digital
Dentistry and CAD/CAM Technology. How the inLab system
works for non users. Digital
work flown in Dental Laboratories. Material used with the system. Utilizing the system to the
fullest potentials! Mohammad
is a Sirona Beta Tester, Sirona
international speaker/trainer,
CEREC & inLab basic/advanced
Trainer, Founder of the inLab
Study Group. He has been a dental technician for 18 years working in most lab departments.
CEREC onlay is one of the most
common indications for patient
restoration – be it on a vital or
root-canal treated teeth. The
sheer quantity and frequency of
these procedures may result in
a large number of errors unless
one is intimately familiar with
all the strengths and weaknesses of the used work-protocol and
applied materials. Dr Josef Kun-

Invisalign uses 3D CAD/CAM
technology to visualize the
treatment and a step-by-step
simulated results.

INVISALIGN® CERTIFICATION

• Apply the most healthy orthodontic treatment
• Expand your adult patient practice
• Enhance your competitive edge
• Elevate the patient experience
• Your patients will love it
Dubai Office: +971 4 385 1663
Riyadh Office: +966 56 114 2557
info@invisaligngcc.com

SEPT 24 DUBAI : GP
SEPT 25 DUBAI : ORTHO
NOV 6 KUWAIT CITY : ORTHO
DEC 13 JEDDAH : ORTHO

Learn about our next course at:
re g i s t e r. i n v i s a l i g n g c c . c o m

[32] =>

[33] =>

ortho tribune 33

Dental Tribune Middle East & Africa Edition | July - August 2014

Management Of Ectopically Erupted First
Permanent Molars
By Dr Manal Al Halabi, BDS MS;
Postgraduate Pediatric Program
Director at Dubai College of
Dental Medicine

ctopic eruption of the first
permanent molar occurs
due to the abnormal mesioangular eruption path of the
molar resulting in an impaction
at the distal prominence of the
primary second molar’s crown.
It can be suspected if asymmetric eruption is observed or if the
mesial marginal ridge is noted
to be under the distal prominence of the second primary
molar. Ectopic eruption can be
diagnosed from bitewings or
panoramic radiographs, Fig 1, 2.
The prevalence of this condition
is reported to be up to 0.75%1.
The ectopic eruption is more
common in cleft lip and palate
patients1.

Ectopic eruption of permanent
molars is classified into two
types. There are those that selfcorrect or “jump” and others that
remain impacted. In 66 percent
of the cases, the molar jumps2.
In most of these self-corrected
cases, the condition goes unnoticed and is discovered later
by evidence of resorption of the
distal root of the second primary
molar in routine radiographs. A
permanent molar that presents
with part of its occlusal surface
clinically visible and part under
the distal of the primary second
molar normally does not jump
and is the impacted type3. Nontreatment can result in early
loss of the primary second molar and space loss, molar impaction, undetected caries and abscess formation1.
Aetiology
The aetiology of this condition
is multifactorial, some of these
factors might be:
- Alteration in the chronology of
bone growth at the tuberosity
region
- Small or posteriorly positioned
maxilla.
- Larger second primary molars
and first permanent molars.
- Unfavorable second primary
molar crown morphology

Figure 1: A panoramic radiograph showing ectopically
erupted upper right and lower
right f irst permanent molars.

Figure 2: A periapical radiograph showing ectopically
erupted upper right f irst permanent molar.

- Abnormal eruption angle “mesial” of the first permanent molar
- Heredity
- Cleft lip and Palate
Treatment considerations
Treatment depends on how severe the impaction appears clinically and radiographically. For
mildly impacted first permanent
molars, where little of the tooth
is impacted under the primary
second molar, elastic or metal
orthodontic separators can be
placed to wedge the permanent
first molar distally4, Figure 3.
For more severe impactions,
distal tipping of the permanent
molar is required. Tipping action can be accomplished with
brass wires, removable appliances using springs, fixed appliances such as sectional wires
with open coil springs, Figure 4,
sling shot-type appliance3, Figure 5, a Halterman appliance5,
Figure 6, or surgical uprighting6.
After the distal tipping of the
permanent molar, attention
should be given to the condition
of the second primary molar.
Distal root resorption might lead
to early loss of the tooth. Close
monitoring of the situation is
necessary and the provision for
space maintenance by means of
an upper bilateral Nance appliance should be considered if the
second primary molar is lost.
In instances where the distal
tipping of the first permanent
molar is not possible due to
lack of patient’s cooperation
or other limitations, the distal
prominence of the second primary molar can be reduced to
alleviate the problem. Some
loss of space will occur in this
situation. Full coverage by a
stainless steel crown might be
needed if the primary second
molar is compromised.
References
1. Chintakanon K, Boonpinon P.
Ectopic eruption of the first permanent molars: Prevalence and
etiology factors. Angle Orthod
1998;68(2):153-60.
2. Young DH. Ectopic eruption
of the first permanent molar.
ASDC J Dent Child 1957;24:15362.
3. Gehm S, Crespi PV. Management of ectopic eruption ofpermanent molars. Compend Cont
Educ Dent 1997;18(6):561-9.
4. Warren JJ, Bishara SE, Steinbock KL, Yonezu T, Nowak AJ.
Effects of oral habits’ duration
on dental characteris-tics in the
primary dentition. J Am Dent
Assoc 2001;132(12):1685-93.
5. Halterman CW. A simple
technique for the treatment of
ectopically erupting first permanent molars. J Am Dent Assoc
1982;105(6):1031-3.
6.Terry BC, Hegtvedt AK. Selfstabilizing approach to surgical
uplifting of the mandibular second molar. Oral Surg Oral Med
Oral Pathol 1993;75(6):674-6.

Figure 3: A plastic orthodontic
separator is placed to attempt
to correct a mild ectopic eruption in the upper right f irst
permanent molar.

Figure 5: Bilateral ectopic
eruption of the upper f irst permanent molars treated by a
sling shot type appliance.

Figure 6a

Figure 4: An ectopically erupted f irst primar y molar corrected by an open coil spring f ixed
orthodontic appliance.

Figure 6b

Figure 6c
Figure 6: a) showing a Halterman appliance in place b)
showing the tooth movement
af ter one month of treatment
and c) showing the up righting
of the molar af ter 2 months of
treatment.

Contact Information
Manal Al Halabi, BDS MS
Diplomate, American Board of
Pediatric Dentistry
Postgraduate Pediatric Program
Director
Direct +971 4 424 8602
Dubai College of Dental Medicine
Dubai Healthcare City - Bldg 34
Dubai, UAE
www.dcdm.ac.ae

[34] =>

34 NEWS

Dental Tribune Middle East & Africa Edition | July- August 2014

< Page 1
that the event was like all other
editions of CAD/CAM & Digital
Dentistry Int’l Conference before, a great success, well organized, with a lot of benefits for all
dental professionals - amazing,
grand and successful conference. We received many thanks
from the participants. We wish
to take this opportunity to thank
all the participants for so many
extraordinary feedbacks and
thank you notes. Thank you and
see you soon on 14-15 November 2014 at the Jumeirah Beach
Hotel for the 6th Dental Facial
Cosmetic Int’l Conference!
Scientific Session
The conference was organized
by Emirates Dental Society and
Center For Advanced Professional Practices (CAPP) with co-

organizers Saudi Dental Society
and Lebanese Dental Association. Supported by 12 sponsors
(Sirona, Ivoclar Vivadent, Planmeca, KaVo, 3M ESPE, VITA,
GSK, Amann Girrbach, Carestream, Dentegris, Wrigley and
MPC) and 23 other industrial

The Scientific Program included
28 international Key Opinion
Leaders from Germany, France,
UAE, USA, UK, Italy, Greece and
Lebanon all presenting the latest hot topics in the dental field.
The conference also saw the
introduction of a new parallel

“2015 to mark 10th Anniversary of CAD/CAM &
Digital Dentistry Int’l Conferences.”
players who showcased the latest in digital dentistry – CAD/
CAM system, scanners, 3D
printing, digital imaging, digital
orthodontics and all related materials from milling to bonding.
We would like to thank again to
all who supported our efforts to
create this amazing conference.

session, the Dental Hygiene Day
which gathered over 120 dental hygienists from the region.
Delegates enjoyed in total eight
hands on courses throughout
the two day event.

Presentation Highlights
“ Is CAD/CAM the Future due to
Biological Risks of Direct Filling
Materials?”
Prof. Dr. Dr. h.c. Georg Meyer,
Germany
“ Craniomandibular Function
and Dysfunction Related to Other Medical Discipline - Consequences for Dental Diagnostics
and Occlusal Therapy.”
Prof. Dr. Dr. h.c. Georg Meyer,
Germany
“Connecting the Digital Dots.”
Dr. Lida Swann and Lee Culp,
CDT
“The Management of Missing
Teeth (Part 1) - Fixed Partial
Dentures.”
Dr. Andreas Kurbat, Germany
“The Management of Missing
Teeth (Part 2) - Implant Supported Restorations.”
Dr. Andreas Kurbat, Germany
The Digital Diary - “A Day in the
Life of The Digital Team.”
Lee Culp, CDT, USA
“Digital Intra Oral Scanner and
Direct CAD/CAM Solutions in
the Fully Digital Workflow.”
Dr. Andrea Mastrorosa Agnini,
Italy & Dr. Alessandro Agnini,
Italy
“Management and Clinical
Workflow in Complex Cases in
Light of the new Technologies.”
Dr. Andrea Mastrorosa Agnini,
Italy & Dr. Alessandro Agnini,
Italy
“Do You Have All the Pieces of
the Puzzle?”
Dr. Maria Hardman, UK
“Digital Work Flow and 3D
Printing Applied to Implant
Treatment. The new 3D Vision.”
Dr. Nicolas Boutin, France and
Dr. Bernard Cannas, France
“High Performance CBCT and
Intraoralscanners In Modern
Implantology - A State of The Art
Review.”
Dr. Kurt Dawirs, DMD, DD, Germany
“Creative Esthetic Solutions In
Veneers, Crowns & Bridges.”
Aiham Farah, CDT, Syria
“CAD/CAM Screw Retained Implant Prostheses.”
Dr. Petros Yuvanoglu, Greece
“3D Bone Defect Treatment in

the Esthetic Zone.”
Dr. Ehab Rashed, UAE
“Advanced Innovations In Dentine Hypersensitivity Management How To Treat The Beast?”
Dr. Rasha Ahmed, UAE
“Oral Hygiene Protocols and
Complications Within Various
Fields of Dental Treatments.”
Dr. Matthieu Gabriele, France
‘Lost in Translation’ Enhanced
Effective Communication in
Dentistry.
Victoria Wilson, UK
“Computer Assisted Periodontal
Probing and Diagnosis.”
Ron D. Joos, USA
“Accurate digital impression of
multiple implants.”
Mr. Adrian Hernandez Gutierrez,
Spain
Keeping up with the fast moving technology
Though the dental CAD/CAM industry has reached quite a very
high level of development and
became a major trusted player
in Dentistry, it continues to improve on a fast pace. Statistics
tell us that by the year of 2050,
more that 50% of dental services
will be done through CAD/CAM
technology. This serves only
to highlight the importance in
keeping up with this fast moving
technology through such highly
specialized conferences.
10th Anniversary
In May 2015 CAPP will celebrate
the 10th Anniversary of the
CAD/CAM & Digital Dentistry
International Conference. We
will continue to bring to our audience the most recent updates
of technology in the CAD/CAM
field with few “surprises” as
well.
Make sure you subscribe to the
CAPP / Dental Tribune newsletter in order to get all the updates
on the coming conference and
regional news as soon as the first
information will be released.

Contact Information
More Information & Contact
CAPP
events@cappmea.com
Tel: +971 4 3616174
Mob: +971 50 2793711
www.cerecfest.cappmea.com
www.facebook.com/cerecfest

[35] =>

Modern life can be

challenging
Modern, healthy lifestyles and dietary habits often mean an increase in the
consumption of acid-rich foods and drinks. However, experts believe that as few
as 4 acidic challenges a day can put patients at risk of Acid Wear.1-3 In addition to
giving behavioural advice (e.g. diet and brushing), your patients may also benefit
from a daily toothpaste that can protect enamel from these multiple acid challenges.
Pronamel is proven to reharden acid-softened enamel and provide ongoing
protection from the effects of Acid Wear.4-6

Daily protection from the effects of Acid Wear

References: 1. Murakami C et al. Caries Res 2011; 45:121-129. 2. Lussi A, et al. Caries Res 2004; 38(suppl 1): 34-44. 3. Dugmore CR,
et al. Br Dent J 2004; 196(5): 283-286. 4. Hara AT et al. Caries Res 2009; 43: 57-63. 5. Fowler C et al. J Clin Dent 2006; 17: 100-105.
6. Fowler C et al. J Clin Dent 2009; 20(Spec Iss): 186-191.

Date of Preparation: June 2014

Arenco Tower, Media City, Dubai, U.A.E.
Tel: +971 4 3769555, Fax: +971 3928549 P.O.Box 23816.
For full information about the product, please refer to the product pack.
For further information please contact your doctor/healthcare professional.
For reporting any Adverse Event/Side Effect related to GSK product
please contact us on contactus-me@gsk.com.

CHSAU/CHSENO/0011/14a

[36] =>

1SeNSItIVItY
Complete
tootHpASte
Sensodyne® understands that dentine
hypersensitivity patients have differing needs

Sensodyne® Complete Protection helps
maintain good gingival health4-6

Sensodyne® Complete Protection, powered by NovaMin®,
offers all-round care with specially designed benefits to meet
your patients’ different needs and preferences. With twice-daily
brushing, Sensodyne Complete Protection:

Good brushing technnique can be enhanced with the use of a
specially designed dentifrice to help maintain good gingival health.18,19

Clinically proven to provide dentine hypersensitivity relief1-3

In clinical studies, NovaMin® containing dentifrices have shown up
to 16.4% improvement in plaque control as well as significant reduction
in gingival bleeding index, compared to control toothpastes.4-6

Contains fluoride to strengthen enamel
Significant reduction in gingival bleeding index (GBI)
over 6 weeks with a NovaMin® containing dentifrice4

Helps to maintain good gingival health4-6

Sensodyne® Complete Protection, powered
by NovaMin® – an advanced approach to
dentine hypersensitivity relief

In vitro studies have shown that the hydroxyapatite-like layer starts
building from the first use7-9* and is up to 50% harder than dentine.9,14
The hydroxyapatite-like layer binds firmly to collagen within
exposed dentine10,15 and has shown in in vitro studies to be
resistant to daily physical and chemical oral challenges,9,14-17
such as toothbrush abrasion16 and acidic food and drink.14-17

with a NovaMin® containing dentrifrice4

1.4
1.2
Mean GBI*

NovaMin®, a calcium and phosphate delivery technology,
initiates a cascade of events on contact with saliva7-12 which
leads to formation of a hydroxyapatite-like restorative layer
over exposed dentine and within dentine tubules.7, 9-13

58.8% reduction from baseline in 6 weeks
p<0.001

p=ns

Baseline
6 weeks
NovaMin® containing
dentifrice

Baseline
6 weeks
Placebo control

1.0
0.8
0.6
0.4
0.2
0

Adapted from Tai et al, 2006.4 Randomised, double-blind, controlled clinical study of 95
volunteers given NovaMin® containing dentifrice or placebo control (non-aqueous dentifrice
containing no NovaMin®) for 6 weeks. All subjects received supragingival prophylaxis
and polishing and were instructed in brushing technique.4 *GBI scale ranges from 0–3.

In vitro studies show that a hydroxyapatite-like layer forms
over exposed dentine and within the dentine tubules:7,9,10,12,13
Hydroxyapatite-like
layer over exposed
dentine

Hydroxyapatite-like
layer within the
tubules at the surface

5 µm

Adapted from Earl et al, 2011 (A).13 In vitro cross-section SEM image of hydroxyapatite-like layer
formed by supersaturated NovaMin® solution in artificial saliva after 5 days (no brushing)13

All-round care for dentine hypersensitivity patients1-6

References:
1. Du MQ et al. Am J Dent 2008; 21(4): 210−214. 2. Pradeep AR et al. J Periodontol 2010; 81(8): 1167−1113. 3. Salian S et al. J Clin Dent 2010; 21(3): 82-87. Prepared November 2011, Z-11-496. 4. Tai BJ
et al. J Clin Periodontol 2006; 33: 86-91. 5. Devi MA et al. Int J Clin Dent Sci 2011; 2: 46-49. 6. GSK data on file (study 23690684) 7. LaTorre G, Greenspan DC. J Clin Dent 2010; 21(3): 72-76. 8. Edgar WM.
Br Dent J 1992; 172(8): 305-312. 9. Burwell A et al. J Clin Dent 2010; 21(Spec Iss): 66–71. 10. Efflandt SE et al. J Mater Sci Mater Med 2002; 26(6): 557-565. 11. de Aza DN et al. J Mat Sci: Mat in Med 1996;
399–402. 12. Arcos D et al. A J Biomed Mater Res 2003; 65: 344–351. 13. Earl J et al. J Clin Dent 2011; 22[Spec Iss]: 62-67. (A) 14. Parkinson C et al. J Clin Dent 2011; 22(Spec Issue): 74-81. 15. West
NX et al. J Clin Dent 2011; 22(Spec Iss): 82-89. 16. Earl J et al. J Clin Dent 2011; 22(Spec Iss): 68-73. (B) 17. Wang Z et al. J Dent 2010; 38: 400−410. 18. “Dentifrices” Encyclopedia of Chemical Technology
4th ed. vol 7, pp. 1023-1030, by Morton Poder Consumer Products Development Resources Inc. 19. van der Weijen GA and Hioe KPK. J Ciul Periodontal 2005; 32 (Supp 1.6): 214-228. Date of Preparation:
July 2013, Code: CHSAU/CHSENO/0008/13

Arenco Tower, Media City, Dubai, U.A.E.
Tel: +971 4 3769555, Fax: +971 3928549 P.O.Box 23816.
For full information about the product, please refer to the product pack.
For reporting any Adverse Event/Side Effect related to GSK product please contact us on contactus-me@gsk.com.
Code: CHSAU/CHSENO/0008/13

®

) [page_count] => 36 [pdf_ping_data] => Array ( [page_count] => 36 [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. 4, 2014

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => CEREC Desert Fest 12-13 September - 2014 DUBAI - UAE [page] => 01 ) [2] => Array ( [title] => Over 1 - 580 dental professionals attended the 9th CAD/CAM & Digital Dentistry Int’l Conference [page] => 01 ) [3] => Array ( [title] => Dental Photography Part II: Protocol for shade taking and communication with the lab [page] => 06 ) [4] => Array ( [title] => The diode laser as an electrosurgery replacement [page] => 08 ) [5] => Array ( [title] => Weightlifter grits his teeth – a case for VITA ENAMIC [page] => 10 ) [6] => Array ( [title] => Cleanic: Clinical use of a recognised prophy paste with Perlite [page] => 12 ) [7] => Array ( [title] => Pulp protection in today clinical practice: what about the role of materials? [page] => 13 ) [8] => Array ( [title] => Hygiene Tribune [page] => 15 ) [9] => Array ( [title] => KaVo CAD/CAM workflow with the new products ARCTICA AutoScan - KaVo multiCAD Virtual Articulator and VITA ENAMIC [page] => 22 ) [10] => Array ( [title] => Now is the time to consider investing in your own CBCT System [page] => 24 ) [11] => Array ( [title] => Simple - planned aesthetic orthodontics for the General Practitioner [page] => 25 ) [12] => Array ( [title] => Management Of Ectopically Erupted First Permanent Molars [page] => 33 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )