DT Middle East and Africa No. 4, 2019

"EMS office in Amman has equipped itself with top training centres accredited by SDA" / News / Industry / The mock-up: A clinician’s everyday tool for aesthetic dentistry / Reliable planning for an optimal workflow / Minimal invasiveness — maximal effectiveness / News / Biological Dentistry / Endo Tribune Middle East & Africa Edition / Lab Tribune Middle East & Africa Edition / Implant Tribune Middle East & Africa Edition / Ortho Tribune Middle East & Africa Edition / Hygiene Tribune Middle East & Africa Edition

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NL
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AL
DE

www.dental-tribune.me

Published in Dubai

July-August 2019 | No. 4, Vol. 9

ENDO TRIBUNE

LAB TRIBUNE

IMPLANT TRIBUNE

ORTHO TRIBUNE

HYGIENE TRIBUNE

Project for improved
root canal therapy launched

SS White introduces
Great White carbide lab burs

Study introduces new surgical
guide for placement of
zygomatic implants

Invisalign Q&A with Simon
Beard, Senior Vice President...

Reducing plastic footprint with
zero-waste toothpaste

ÿD1-4

ÿE1-4

ÿA1-4

ÿB1-4

ÿC1-4

"EMS office in Amman
has equipped itself with
ENTAL
RIBUNE
a top training
centre
The World’s Dental Newspaper Middle East & Africa Edition
accredited by SDA"

T

© EMS

D

By Kinga Mollov, DTMEA
Dental Tribune MEA recently interviewed Mr Ziad Al Asali, General
Manager for IMEA region in regards
to the opening of the new training
centre in Jordan.
Mr Ziad, could you please briefly
introduce yourself?
I completed my Master of Science
in Biomedical Engineering back in
1990 and since then worked with
several medical and dental companies in the MEA region. Last year I
had the pleasure to join EMS as the
General Manager for India, Middle
East and Africa (IMEA) region.
Please share with us your vision as
General Manager for IMEA of EMS.

What is your vision for the future
in the region?
IMEA region is a very rich region in
human resources with a very open
mentality to new technologies and
new clinical solutions, yet you can
find big differences in dental practices from one country to another.
Our mission here at EMS is simple,
we want to spread the GBT (Guided
Biofilm Therapy) culture in the area,
as it is one of the greatest inventions
in preventive dentistry.
Congratulations on having opened
the new EMS office in Jordan. What
was the thought process of chosing
Jordan as the main location?
Jordan has a unique position in the
area. It is located very close to Africa
with equal distance from other Mid-

dle Eastern countries, also not far
from India. At the same time Jordan
is rich with human resources from
neighbouring countries; additionally it has some additional beneficial
facilities for international regional
offices.
How will the dental professionals
benefit from the new office in Jordan?
The mission of the office is not only
to organise the relations with partners and end users but also to have a
regional aftersales department who
will take care of service issues in the
area from training, maintenance and
securing the right use of EMS equipment. We are proud to announce
that the EMS office in Amman is
equipped with one of the top train-

EMS team

ing facilities and according to Swiss
standards has been accredited by
Swiss Dental Academy (SDA).
Can we expect EMS to organise
more educational courses organised in the region?
Of course the presence of SDA training center in our Jordan office will
heavily contribute in organising GBT
courses on a weekly basis. We would
love to transfer the great experience of our local KOL's to the world
through the great presence of EMS
on the international tribune.
Can we expect EMS to open any
other offices in MEA in the near
future?

All options are open, however our
mission is to be less bureaucratic and
more practical with the customer.
EMS is ambitious to open training
centres’ for Swiss Dental Academy in
every country.

For more information contact:
E.M.S. Electro Medical Systems S.A.
Tel: +41 22 994 26 60
Mob: +41 79 569 12 14
Web: www.ems-company.com
Web: www.ems-dent.com

AD

Organiser

Partners

Call/WhatsApp: +971528423659 | www.cappmea.com/diplomas

[2] =>

NEWS

IMPRINT
PUBLISHER/
CHIEF EXECUTIVE OFFICER
Torsten R. OEMUS

The Dentsply Sirona
Global Clinical Case Contest 2018-2019
By Dentsply Sirona
Every year, dental undergraduate
and graduate students, with less
than 2 years of clinical practice, are
invited to participate by documenting a patient case with photographs
and text. Since its inception in 20042005, more than 3,900 dental students have participated, with the
2018-2019 competition drawing a
total of about 1,242 entries, from 134
universities.
This year the regional winner for
MENA was Rana Ali Al-Saadi from
Ibn Sina National College, Saudi Arabia. Check out her winning case!

DIRECTOR OF CONTENT
Claudia DUSCHEK
SENIOR EDITORS
Jeremy BOOTH
Michelle HODAS
CLINICAL EDITORS
Nathalie SCHÜLLER
Magda WOJTKIEWICZ
EDITORS
Franziska BEIER
Brendan DAY
Monique MEHLER
Kasper MUSSCHE

Introduction to the case

A 44 year-old male patient came to
the clinic to solve his aesthetic problem related to incisors, canines 13, 12,
11, 21, 22.

COPY EDITOR
Ann-Katrin PAULICK
Sabrina RAAFF
BUSINESS DEVELOPMENT & MARKETING
MANAGER
Alyson BUCHENAU

Treatment options

1: Crowns related to #11, 12, 21, Direct
veneer #22 and class V composite
restoration related to #13.
2: Build up related to #11, 12, 21, Direct
veneer #22 and class V composite
restoration related to #13.
Treatment options were discussed
with the patient and the patient
chose the second option.

CHIEF FINANCIAL OFFICER
Dan WUNDERLICH

DIGITAL PRODUCTION MANAGER
Tom CARVALHO
Andreas HORSKY
Hannes KUSCHICK
PROJECT MANAGER ONLINE
Chao TONG
WEBSITE DEVELOPMENT
Serban VERES

Student: Rana Ali AL-Saadi
Tutor: Dr. Gautam Singh
University: Ibn Sina National College
Country: Kingdom Of Saudi Arabia

E-LEARNING MANAGER
Lars HOFFMANN
SALES & PRODUCTION SUPPORT
Puja DAYA
Hajir SHUBBAR
Madleen ZOCH
EXECUTIVE ASSISTANT
Doreen HAFERKORN
ACCOUNTING
Karen HAMATSCHEK
Anita MAJTENYI
Manuela WACHTEL
EXECUTIVE PRODUCER
Gernot MEYER
ADVERTISING DISPOSITION
Marius MEZGER
DENTAL TRIBUNE INTERNATIONAL
Holbeinstr. 29, 04229 Leipzig, Germany
Tel.: +49 341 48 474 302
Fax: +49 341 48 474 173
www.dental-tribune.com
info@dental-tribune.com

Before

DENTAL TRIBUNE ASIA PACIFIC LTD.
Room A, 20/F
Harvard Commercial Building
105–111 Thomson Road, Wanchai, HK
Tel.: +852 3113 6177
Fax: +852 3113 6199

After

THE AMERICA, LLC
116 West 23rd Street, Ste. 500, New York
N.Y. 10011, USA
Tel.: +1 212 244 7181
Fax: +1 212 244 7185

Step 1 – Digital smile design
Digital smile designing done according
to golden proportions for a predictable
clinical outcome.

Step 5 – Bonding - palatal wall & build up
The Adhesive system was applied
(Prime& Bond univarsalTM) and lightcured. Build up of the palatal wall using the silicon key, the proximal wall
contours were created using sectional
matrix. Dentine shade (ceram.x® duo
D3) and enamel shade (ceram.x® duo
E2) were used.

Step 2 – Isolation
After shade selection (A3) the anterior
area was isolated with rubber dam and
stabilised with knot ligatures for preventing leakage and adequate retraction teﬂon tape used.

Step 6 – Contouring
Restorations were marked with graphite
to highlight transitional lines, mesial
- distal inclination and developmental
grooves. Gross three dimensional contouring was done using diamond burs.
Interdental ﬁnishing strips were used to
remove excess and shape emergence
proﬁle of the teeth.

Step 3 – Cavity preparation
Caries excavation and ﬁnal cavity preparation with bevel was prepared.

Step 7 – Finishing & Polishing
Finishing was completed using (Enhance® Finishing System) and then the
polishing procedure was completed using (Enhance® PoGo system and Prisma
Gloss® pastes).

Step 4 – Etching
The etching protocol was done using
DeTrey® Conditioner 36 for 15s then
rinsed with water spray.

Step 8 – Post operative view
Highly aesthetic outcome using
(ceram.x® duo).

DENTAL TRIBUNE MEA EDITION EDITORIAL
BOARD
Dr. Aisha SULTAN ALSUWAIDI, UAE
Prof. Paul TIPTON, UK
Prof. Khaled BALTO, KSA
Dr. Ninette BANDAY, UAE
Dr. Nabeel HUMOOD ALSABEEHA, UAE
Dr. Naif Almosa, KSA
Dr. Mohammad AL-OBAIDA, KSA
Dr. Meshari F. ALOTAIBI, KSA
Dr. Jasim M. AL-SAEEDI, Oman
Dr. Mohammed AL-DARWISH, Qatar
Dr. Dobrina MOLLOVA, UAE
Dr. Ahmed KAZI, UAE
Dr. Munir SILWADI, UAE
Dr. Khaled ABOUSEADA, KSA
Dr. Rabih ABI NADER, UAE
Dr. Ehab RASHED, UAE
Aiham FARRAH, CDT, UAE
Retty M. MATTHEW, UAE
PARTNERS
Saudi Dental Society
Saudi Ortho Society
Lebanese Dental Association
Lebanese Orthodontic Society
Qatar Dental Society
Oman Dental Society
Kuwait Dental Association
American Academy of Implant Dentistry
International Federation of Dental
Hygienist
British Academy of Restorative Dentistry
British Academy of Dental Implantology
AALZ - Aachen Dental Laser Center
Singapore Dental Association
DIRECTOR OF mCME
Dr. Dobrina MOLLOVA
mollova@dental-tribune.me
Tel.: +971 50 42 43072
DIRECTOR
Tzvetan DEYANOV
deyanov@dental-tribune.me
Tel.: +971 55 11 28 581
EDITING & DESIGN
Kinga MOLLOV
k.romik@dental-tribune.me
Tel.: +971 56 23 70 721

Material and Method

The digital smile design approach is
very beneficial in deciding the preferred ideal outcome. Interpretation
was onto the diagnostic wax up. After isolation with the rubber dam,
caries excavation and cavity preparation was performed. Teeth were

etched with DeTrey® Conditioner
36 rinsed and dried. Prime&Bond
universalTM was applied and lightcured. Reconstructions were made
with (ceram.x® duo) using a multilayering technique with dentin
shade (ceram.x® duo D3) and enamel
shade (ceram.x® duo E2). For finish-

ing & polishing firstly finished with
a diamond bur, then with Enhance®
Finishing System and Polishing with
Enhance® PoGo system and Prisma
Gloss® pastes.

Discussion and Conclusion

Re-creating an aesthetic smile was a

challenging task in the present case.
The final restoration satisfied the patient's expectations. Ceram.x® duo
showed a remarkable final natural
appearance in this case. Ceram.x®
duo has excellent handling, finishing, and polishing properties that resulted in a highly aesthetic outcome.

PRINTING HOUSE & DISTRIBUTION
Al Nisr Printing
P. O. Box 6519, Dubai, UAE
800 4585/04-4067170
©2018, Dental Tribune International GmbH.
All rights reserved. Dental Tribune International makes every effort to report clinical information and manufacturer’s product news
accurately, but cannot assume responsibility
for the validity of product claims, or for typographical errors. The publishers also do not
assume responsibility for product names or
claims, or statements made by advertisers.
Opinions expressed by authors are their own
and may not reflect those of Dental Tribune
International.

[3] =>

»Usability is my goal.
And Primescan is my answer.«
Florian Sobirey, UX-Designer

Primescan

E
 ngineered for superior performance.
Innovation requires commitment to ambition: Primescan sets new standards in dental technology,
making scanning more accurate, faster and easier than ever. It is engineered to enable all kind of
treatments, from single tooth to full arch. An increased field of view and the dynamic depth scanning
technology ensure a high data density right from the first scan. The excellent results are immediately
displayed on the wide format touchscreen of the new Acquisition Center. With Primescan, intraoral
scanning is as easy as never before.
Enjoy the scan.
Learn more at: dentsplysirona.com/primescan

[4] =>

Gunnar Reich, Germany

The next generation polyether:
Superfast. Super detailed.
Taking outstandingly precise impressions in an efficient procedure – this
is feasible for everyone using the new 3M™ Impregum™ Penta™ Super Quick
Polyether Impression Material launched by 3M in April 2018. The material
offers a working time of 45 seconds and an intraoral setting time of only
two minutes.
It is thus as fast as or even faster than many quick-setting VPS-based
impression materials and particularly suited for impression taking in the
context of producing single-unit restorations or small bridges. In addition to the
increased speed, it offers all proven polyether benefits that lead to a reliable
clinical performance and highly accurate results. These include a great flow
behavior and an intrinsic hydrophilicity, i.e. high affinity to water, which ensure
that the material flows deeply into the sulcus and captures every detail. In
addition, polyethers maintain their flowability consistently throughout the

Case 1

whole working time, meaning that a user does not need to be afraid of any
premature setting reaction that may have a negative effect on the quality of
the final impression.
The use of the new material developed for the monophase technique –
3M™ Impregum™ Penta™ Super Quick Medium Body Polyether Impression
Material – is demonstrated showing two different patient cases.
The first patient had a fractured composite restoration on her lower first molar
that needed to be replaced. The second patient had previously received an
implant in the region of the upper first premolar. After the healing phase,
the final prosthetic work needed to be produced and placed. A closed tray
impression technique was used in this case.

Case 2

Fig. 7: Initial situation of case 2: Implant with healing cap six months after
implant placement.
Fig. 8: Syringing of 3M™ Impregum™ Penta™ Super Quick Medium Body Polyether
Impression Material around the impression coping with the 3M™ Penta™
Elastomer Syringe.
5

Fig. 9: Impression coping securely fixed in the impression that was taken using
the monophase technique and a closed tray.

Fig. 1: Initial situation of case 1: Fractured old composite restoration on the
lower first molar.

Fig. 10: Final veneered all-ceramic crown cemented on an implant abutment.

Fig. 2: Deep distal preparation with bleeding from inflamed gingival tissue.
Fig. 3: Challenging moisture control and bleeding managed by using a soaked
retraction cord.
Fig. 4: Impression taken with the monophase technique. Syringing of 3M™
Impregum™ Penta™ Super Quick Polyether Impression Material (Medium Body)
around the preparation with the 3M™ Penta™ Elastomer Syringe.
Fig. 5: Final monophase precision impression made of 3M™ Impregum™ Penta™
Super Quick Polyether Impression Material (Medium Body).
Fig. 6: Final situation: 3M™ Lava™ Esthetic Fluorescent Full-Contour Zirconia
restoration cemented with 3M™ RelyX™ Unicem 2 Self-Adhesive Resin Cement.

Dr. med. dent. Gunnar Reich
gunnar.reich@web.de

Dr. Gunnar Reich attended the Universities of Munich and Berlin
and obtained his Dr. med. dent. (DDS) degree in 1986. Ever
since, he has been practicing dentistry in the South of Germany.
Today, he is the owner of a private practice in Munich.

3M™ Impregum™ Super Quick Polyether Impression Material

Be impressed.

[5] =>

3M™ Impregum™ Super Quick
Polyether Impression Material

Capture every
detail in 2 minutes?
Yes, it can.

Ideal for smaller cases with
superfast 2-minute setting.

A brand new chemistry unites
world-class polyether precision with
the speed of a VPS material.

A significantly improved taste
and less time in the mouth make
a better patient experience.
3M.com/Impregum
3M and Impregum are trademarks of 3M Company or 3M Deutschland GmbH. Used under license in Canada. © 3M 2019. All rights reserved.

[6] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 4/2019

Prosthodontist achieves same-day
dentures with NextDent 5100
Dr. Michael Scherer transforms patientexperience and expedites dental production
with the NextDent 5100 3D printer
By 3D Systems
Dr. Michael Scherer is a prosthodontist in Sonora, California, located ten miles from the heart
of the Stanislaus National Forest and 100 miles
southeast of Sacramento, the nearest city. A
long-time advocate of technologies that help
him enhance patient care, Dr. Scherer transitioned to intraoral 3D scanning several years
ago to spare his patients the uncomfortable
and messy experience of taking composite
impressions. Eager to extend the value of these
digital scans, he began experimenting with 3D
printing. He ordered two 3D Systems’ NextDent™ 5100 3D printers for his office shortly
after its launch and says they provide him with
an all-in-one solution for producing actual 3D
printed dental restorations at an efficient time
point.
Due to Dr. Scherer’s rural location, his patients
typically travel anywhere from 30 minutes to
several hours to get to his office. For dentures,
implants and bridgework, multiple visits are
common practice to address various stages of
traditional fitting and delivery. The need for
multiple appointments to achieve a conventional restoration can make seeking treatment
time consuming and challenging for the patient; a burden Dr. Scherer hoped to alleviate
through in-house 3D printing. Dr. Scherer reports that the addition of the NextDent 5100
printers to his office has accelerated his work-

Redeening
Digital Dentistry

that can be completed in the same day.
For elderly patients
who rely on others
for transportation to
and from appointments, Dr. Scherer
says this new capability makes treatment possible by
removing logistical
barriers: “The NextDent 5100 enables
me to do things in
my office – like expedited dentures – that
The speed of the NextDent 5100 enables same-day dentures to enhance patient I couldn’t do before,
and it’s having a
care.
real impact on my
patients’ lives.” 3D
flow and changed his patients’ experience, Systems’ NextDent materials are biocompatand says he can no longer imagine his practice ible and CE-certified, and are available in a wide
without them.
selection to answer a broad range of clinical
needs. This allows Dr. Scherer to use the NextFast print speeds enable same-day Dent 5100 not only for same-day, long-term
dentures, but for expedited implants, crowns,
dentures
bridges, bite guards and more. “Combining inThe new capabilities in dental care enabled by
traoral scanning technology with fast, accurate
the speed, accuracy and esthetics of the Nextand esthetic 3D printed teeth is the great, bringDent 5100 3D printer have helped Dr. Scherer
it-all-together moment we’ve been waiting for
deliver a superior patient experience. In parin dentistry for years,” Dr. Scherer says.
ticular, the ability to cut total denture delivery
time from five or six appointments to a process
To illustrate his case, Dr. Scherer cited an anonymous example of a patient who was moved
to tears after receiving their denture in a sameAD day appointment. “I got the NextDent 5100
printers for patients like that, who need an option for treatment that makes it feasible,” Dr.
Scherer says. Due to the loss of a loved one, the
patient told Dr. Scherer they could no longer
make multiple long drives for sequenced appointments. Understanding that, Dr. Scherer
assured them the denture could be done in a
single visit using innovative methods.

Award
Winning

High-speed dental 3D Printer revolutionizing dental applications with NextDent biocompatible materials

Eager for treatment, the patient made an
apointment and came in in the morning for an
intraoral scan. Dr. Scherer used the digital model to plan the denture, and his assistant ran the
3D printers, producing the denture teeth in
the first and the denture base in the second for
delivery by early afternoon of the same day.
When the new denture was delivered, the patient saw their new smile and started crying,
saying they never imagined how beautiful 3D
printed teeth could be. “With the two NextDent 5100 printers I can have the denture teeth
printing in one printer and the denture base
printing in another printer, and have a denture
ready in 20 minutes,” Dr. Scherer says.
The NextDent 5100 printers have reduced wait
times considerably for other restorations as
well. Depending on the model to be printed,
Dr. Scherer is experiencing print times of ten
to forty minutes with the NextDent 5100 compared to two- to four-hour print times for comparable models on other 3D printers he has
used. Dr. Scherer says this capability has led to
effective word-of-mouth marketing because
he is now able to accommodate patients with
service that exceeds expectations: “I frequently have patients who break teeth right before
a big trip or life event, and with 3D Systems’
NextDent printer I can now offer treatment
in the same afternoon versus the temporary
patches that are common practice using conventional techniques.”

Accurate & aesthetic 3D printed
outcomes minimize adjustments,
maximize doctor time

www.3d-me.com | +97144433938 | info@3d-me.com | Facebook.com/3dMiddleEast

According to Dr. Scherer, the accuracy of the 3D
printer contributes to shorter delivery times
and enhanced patient care as well. “The fact
that the NextDent 5100 can produce models
and dental prostheses in minutes instead of

CHALLENGE:
Increase eﬃciency of dental restoration production and delivery to ease logistical burden
of multiple appointments for patients
SOLUTION:
3D Systems’ NextDent™ 5100 dental 3D printers and NextDent materials for high accuracy,
high speed digital dentures and restorations
RESULTS:
– Reduced denture production and delivery
timelines from 5 or 6 visits to 1 or 2
– Enhanced patient experience through
expedited delivery of accurate, esthetic
restorations
– High accuracy dental models 3D printed in
20 to 40 minutes compared to 2 to 4 hours
on other tested systems
– Clinical time savings of 20% to 50%

By running two NextDent 5100 printers simultaneously, Dr. Scherer can have a denture ready in 20
minutes

hours and achieve accuracy under 100 microns
is a game changer for 3D printing in dentistry,”
Dr. Scherer says, explaining that accuracy helps
ensure he is delivering the highest quality care.
With traditional molds and poured stone models, Dr. Scherer says fitting crowns, implants or
bridges can take thirty minutes to an hour of
adjusting to achieve the right fit. With 3D printing, fitting the same type of restoration takes
significantly less time to adjust. “Doctor time
on the computer is money well spent, because
I find I am spending less time to fit prostheses
due to the accuracy of the prints. Being able to
shave off 20- to 50-percent of my clinical time
more than pays for itself,” Dr. Scherer says.
The NextDent 5100 is powered by 3D Systems’
Figure 4 technology and uses Digital Light
Printing (DLP) with a non-contact membrane
that delivers high quality, accurate outcomes
on delicate parts. 3D printed support structures
are also simple to add and fast to remove with
3D Sprint® software, reducing the post-processing time substantially and helping ensure
undamaged parts. According to Dr. Scherer:
“On another printer, just to remove the printing supports can take ten to fifteen minutes.
On the NextDent 5100 it takes maybe 30 to 60
seconds. And that includes polishing!”

Improving the dental profession
with digital dentures

In addition to his work at his practice, Dr. Scherer teaches courses on 3D printing and digital
dentures that are open to other dentists, clinicians and laboratories interested in expanding
their capabilities. He brings a patient from his
practice and provides a step-by-step demonstration of his digital denture workflow. He is
also active on social media with his group “Fast
Track Dental CE” (https://www. facebook.com/
fasttrackdentalce/), where he posts shareworthy experiences for discussion and learning.
“The opportunity to interact with clinicians all
over the world and share the vision of 3D printing in dentistry helps make the profession better and improve lives everywhere,” Dr. Scherer
says. “3D printing has become so important to
my clinical practice that I just can’t imagine going back.”
To learn more about the NextDent 5100 3D
printer, visit:
https://www.3d-me.com/nextdent-5100

[7] =>

ZirCAD MT Multi

The most esthetic high-strength,
1
multi-translucent zirconia
All ceramic,
all you need.

1

Composed of different material classes

www.ivoclarvivadent.com
Ivoclar Vivadent AG

Bendererstr. 2 | 9494 Schaan | Liechtenstein | Tel. +423 235 35 35 | Fax +423 235 33 60

[8] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 4/2019

mectron multipiezo – a benchmark
in the field of ultrasound scalers
By mectron s.p.a.

Being exceptionally user-friendly,
the multipiezo by mectron is not
only a flexible ultrasonic device for
dental prophylaxis interventions but the optimal assistant for every
dentist or dental hygienist. Besides
classical supragingival scaling it can
be used for subgingival debridement
as well as for implant cleaning.
Thanks to its innovative design and
its self-explaining ergonomics the
multipiezo sets new standards in
daily use management and hygiene.
Its ergonomic touch panel lets the
user control all functions fast and
intuitive - without having to study
the instruction manual at all. Due to
its smooth touch surface, it can be
cleaned and disinfected much easier
than other devices.
The intelligent mectron piezoelectric ultrasound technology makes

treatments even more comfortable
for the dentist as well as the patient:
during the therapy, it balances external factors, adjusts power level automatically and provides the special
soft mode. This innovative function
avoids excessive ultrasound oscillation, allowing a gentle and efficient
insert movement. Results: nearly
painless treatment for patients and
maximum comfort for clinicians.
While the pulse mode function allows the best performances in prosthetics and extractions. All these
make the mectron multipiezo an
innovative and unique combination
of intelligent technology and functional design.

the maximum flexibility in irrigation choice.

The integration of a 3600 adjustable LED handpiece makes working
with the multipiezo even easier: the
source of light can be directed right
to the spot of activity. The 500 ml
liquid holder is illuminated and can
get exchanged quickly and easily for

mectron S.P.A.
Via Loreto, 15/A
16042 Carasco (GE) – Italy
Tel: +39 0185 35361
Fax: +39 0185 351374
E-mail: mectron@mectron.com
Web: www.mectron.com
www.we-love-prophylaxis.com

With over 45 inserts available, mectron is offering one of the largest
ranges of ultrasound prophylaxis
tips in dentistry. The unique technology, the perfect ergonomics and the
maximum flexibility are the reasons
why mectron defines with the multipiezo the new benchmark for ultrasound prophylaxis units.

For more information contact:

Fill-Up! – The new dual-curing bulk composite
Worldwide, dental practitioners are
convinced of this innovative, efficient latest generation bulk composite. Overwhelming feedback since its
launch only few month ago shows
how great the demand has been for
a solution like Fill-Up! This is COLTENE's response to the disadvantages inherent to light-curing treatment
methods and has resurrected the
discussion on bulk filling materials.
Light-curing bulk filling materials are restricted to 4-5 mm curing
depth and often require a separate
composite covering layer. Studies
have shown that many dentists are
unsure whether conventional bulk

By Coltene

filling cures all the way to the base of
the cavity. Now a reliable solution is
available. The new dual-curing FillUp! bulk composite allows filling
quickly at any layer thickness and
without reservations.

Guaranteed and fast curing even with the deepest
cavities
No matter which filling depth is required, the light and chemical polymerisation properties of Fill-Up! reliably cure any filling size. In addition,
the shrinkage forces are considerably
less pronounced for chemical polymerisation, which supports the quality of marginal integrity.
Even the largest cavities can be filled
with the Fill-Up! single-layer technique quickly and easily, making it a
true bulk fill material. Following the
application of Fill-Up! completion of
the filling is possible immediately as

light-curing only requires 5 seconds.
The excellent mechanical properties
make a covering layer superfluous.
Due to the high self-blending of the
material, a single universal shade
(Vita A2-A3) is sufficient for the posterior region. Presentation in the
practical automix-syringe makes application easy and efficient.

Two, working
in perfect harmony

Fill-Up! and the multiple awardwinning ParaBond adhesive system
are matched perfectly. ParaBond accelerates polymerisation at the margins and thus improves the marginal
integrity of the filling. Study results

from the University Geneva confirm best marginal sealing values.
This helps to avoid secondary caries
and lays the foundation for a reliable
long-term restoration.
The universal composite Fill-Up! is
comes in the useful 4,5g automixsyringe. Due to the purpose-built
colour, between A2 and A3, there
is no need for complicated colourmanagement within the posterior
region.
For further information, please contact:
Coltène/Whaledent AG
Feldwiesenstrasse 20
9450 Altstätten SG | Switzerland

ONE COAT 7 UNIVERSAL
– All-purpose universal bond
State-of-the art, self-etching adhesive systems are easy to apply and
boost the success rate significantly,
especially within restorations in the
posterior area. Simultaneously they
stand for predictable results, independent of the applied basis or the
preferred application technique of
the dentist. Coming to reliability and
user-friendliness, research and development has now set new material
standards:

Reliably adhesive agent on
dentin and enamel
The new ONE COAT 7 UNIVERSAL
was developed on the basis of the
favoured ONE COAT 7.0, and is a re-

liable All-in-One Bond for every indication. Whether self etch, selective
enamel etch or total etch technique,
a single drop bonds light-curing filling materials easily, quickly and is
long-lasting. ONE COAT 7 UNIVERSAL is an excellent adhesion promoter on enamel and dentin, thus is a
guarantee for safe restorations even
in extraordinary cases. With only
a single bonding layer it provides
consistently high bonding strength,
excellent marginal sealing and excellent marginal integrity. These exceptional clinical values are convincing,
even when compared with conventional system adhesives.
In conjunction with ONE COAT ACTIVATOR it is optionally also possible

to use a chemically cured product.
You will always be making the right
choice with the light-curing singlecomponent adhesive One Coat 7
Universal!

ONE COAT 7 UNIVERSAL
One component light cured universal adhesive
 Self-Etch, Selective Etch and Total Etch,
one bond for all adhesive techniques
 With activator for chemical curing products
 Excellent shear bond strength to enamel and dentine

Ergonomic triangular
bottle and single dose
- Safe and easy

The universal bonding agent also
comes with a new presentation
form. The special triangular bottle,
with it`s excellent ergonomic handling, lies comfortably in the hand
and the precision dropper allows
precise and economical working.
ONE COAT 7 UNIVERSAL is available
as introductory kit with a 5ml bond
bottle including etch gel and acces-

oc7universal.coltene.com

By Coltene

sories. There are also practical single
dose units for one-off use. These are
also offered as refill packs in addition
to the 5ml bond bottle.

For further information, please contact:
Coltène/Whaledent AG
Feldwiesenstrasse 20
9450 Altstätten SG | Switzerland

Fill-Up!®
Filling in a single step – Hole in One
 Optimal depth polymerisation with minimal shrinkage due to

10
mm

5 sec.

[9] =>

ONE COAT 7 UNIVERSAL
One component light cured universal adhesive
 Self-Etch, Selective Etch and Total Etch,
one bond for all adhesive techniques
 With activator for chemical curing products
 Excellent shear bond strength to enamel and dentine
oc7universal.coltene.com

Fill-Up!®

10
mm

5 sec.

Filling in a single step – Hole in One
 Optimal depth polymerisation with minimal shrinkage due to
dual curing system restoration.
 Guaranteed single-layer technique – even in very deep cavities of 10 mm
 Optimised sealing of margins – reduced post-operative sensitivity
 Universal shade in a convenient Automix syringe for efficient placement

Deep. Fast. Perfect.

004602 03.19

dietmar.goldmann@coltene.com | P +41 71 757 54 40

[10] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 4/2019

The Red Dot Award Product Design
for Primescan
Digital impressions and outstanding design

Dentsply Sirona introduced Primescan in February – an innovation
in digital impressions. The new
intraoral scanner has now been
awarded the highly renowned Red
Dot Award Product Design 2019.
This award acknowledges Dentsply
Sirona's goal of developing attractive
and highly functional solutions for
its customers that provide valuable
results in everyday use.
Strong design and sustainable products – there were the emerging
trends at this year's Red Dot Awards
Product Design. Primescan, the new
intraoral scanner from Dentsply Sirona, was one of the award winners.
"We are very pleased to receive this
award, which we consider to be an
acknowledgement of our efforts to
provide our customers with prod-

ucts that are of high quality in all
respects," said Dr. Alexander Völcker,
Group Vice President CAD/CAM and
Orthodontics at Dentsply Sirona.
"Thanks to its design, Primescan is
easy to handle in the normal practice environment, it reliably delivers
clinically sound results, and it is just
fun to use."
Primescan features improved impressioning technology that scans
with an impressive level of accuracy.
This makes Primescan a remarkable
response to an important requirement in modern practices. After
scanning, the data from the digital
impressions are available for many
applications, both in restorative
dentistry and in implantology and
orthodontics.
The globally acknowledged Red Dot
Award has been awarded to out-

standing products, design concepts,
and communication designs for
more than 60 years. This year, the
39-member jury of independent designers, design professors, and journalists rated a total of 5,500 products
from 55 countries in 48 categories.
The most important criterion for
awarding the coveted prize is high
design quality.

For more information about the Dentsply
Sirona portfolio please contact your local
representative.
© Dentsply Sirona

By Dentsply Sirona

Dentsply Sirona
21st Floor, The Bay Gate Tower
Business Bay, Al Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0)4 523 0600
Web: www.dentsplysirona.com/MENA
E-mail: MEA-Marketing@dentsplysirona.com

The new Orthophos Society:
The perfect partner for your practice
By Dentsply Sirona

the automatic positioning of the patient and thus enables reproducible
and perfectly positioned panoramic
images. Depending on the clinical
problem, there are comprehensive
2D programs or a number of volume
sizes (Ø5cm x 5cm to Ø11cm x 10cm)
in high definition (HD), standard definition (SD) and low dose mode available to the user. MARS (Metal Artifact
Reduction Software) automatically
detects metals in every volume and
reduces the artifacts for the best possible image interpretation. Users can
select from 30 ambient light colors
that provide background illumination appropriate for their practice for
even more patient comfort. Its modern design was selected for the Red
Dot Design Award and the iF Design
Award.

Developing solutions for the individual needs of a dental practice - at
Dentsply Sirona, this also means providing both new users and specialists
with tailored services for X-ray units.
These ideas were very important for
the new Orthophos Society, which
provides solutions for different requirements with a clear functionality.

The three models in the Orthophos
series, Orthophos E, Orthophos S and
Orthophos SL each provide a different range of services that precisely
cover every desire for imaging systems that dental practices have specified. All models function using the
award-winning Sidexis 4 imaging
software. They provide an outstanding image quality with a low dose
and a high level of user comfort. Due
to this diversification, both entrylevel users and specialists will find
the right service package for them.

Orthophos E – for a simple
start to digital imaging

With Orthophos E, you can access the
world of digital extraoral imaging for
more efficiency in the daily practice
routine. Thanks to its optional cephalometric arm, Orthophos E is also
suitable for the orthodontic practice.
With its panoramic, pediatric panoramic, bitewing and other exposure
programs, it is equipped with all the
basic programs for the diagnosis process in 2D. Its MultiPad enables the
patient-friendly selection of the program. The motorised forehead and
temple support helps to stabilise the
patient. The integrated temple width
measurement also enables the appropriate orbital curve to be selected
automatically for results with outstanding image quality.

Orthophos S – the 2D/3D
all-rounder in the practice

Orthophos S can be used either as a
purely 2D device, or alternatively as
a combined 2D/3D device. It can also
be equipped with a cephalometric
arm. Orthophos S achieves its enhanced contrast in panoramic images using the auto-focus function.
In addition, the shape of the jaw arch
or the existence of tooth anomalies
no longer needs to be selected manually. This is also true when setting a

canine light localiser. The patented
occlusal bite block assists with the
automatic positioning of the patient.
Orthophos S can be upgraded by
adding the 3D option at a later date.
It provides suitable volumes and
modes for a large number of clinical problems, for example a focused
high-resolution volume, or a volume
that depicts three-dimensional information of the complete dentition
with the dosage range of a 2D image.

Orthophos SL
– the innovation leader

Orthophos SL is the innovation
leader and provides the "all-round
package" for digital imaging. The version with the most comprehensive
range of equipment with the Direct
Conversion Sensor (DCS) and Sharp
Layer (SL) technology caters to all users with the highest requirements
for panoramic and 3D imaging in
their daily practice routine. Its patented occlusal bite block assists with

"With the new Orthophos Society,
we are addressing the specialised
needs of our customers and have
developed an offer that simplifies
both entry into the world of digital
imaging and intensive use in specialized practices in several disciplines,"
said Jörg Haist, Vice President Global
Platform Management Equipment
& Instruments. "In this way, even
more dentists will receive access to
high-quality X-ray technology and
therefore to more reliable diagnoses
and treatments."

For more information about the Dentsply
Sirona portfolio please contact your local
representative.
Dentsply Sirona
21st Floor, The Bay Gate Tower
Business Bay, Al Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0)4 523 0600
Web: www.dentsplysirona.com/MENA
E-mail: MEA-Marketing@dentsplysirona.com

[11] =>

11
Dental
Facial
Cosmetic
Conference
Joint Meeting with
TH

Dental Hygienist Seminar
Hands-On Courses | Exhibition

Speakers Highlights

35

CME
available

Date: 08-09 November 2019
Venue: InterContinental Hotel, Dubai Festival City, Dubai, UAE

Lecture 1: How to Improve the Prosthetic Rehabilitation from
the Aesthetic and Tissue Health Point of View
Lecture 2: Sinus Lift from Crestal Approach

Innovative Periodontal Laser Treatment Concept with Additional Attention
to Gingival Recontouring and Depigmentation
Prof Dr med dent Norbert Gutknecht, Germany

Prof Domenico Bald, Italy

Non-invasive Teeth Discoloration Treatment.
Modern Aspects of Enamel Remineralising Therapy

Managing Aesthetics and Tooth Wear the MI Way
Prof Brian Millar, UK

Prof Andrey Akulovich, Russia

GBR and GTR. The Magic Bullets for Implant and Perio?

How to Achieve Long-term Aesthetic Success in Implant Rehabilitation

Asst Prof Attila Horvath, Hungary

Dr Maurizio Martini, Italy

True Bone Regeneration: What the Body Needs.
Translating Biology into Successful implant Dentistry.

Top Up Your Dental Plan with Facial Aesthetics

Prof Peter JM Fairbairn, South Africa

Dr Rami Haidar, UK

Oral Rehabilitation Inﬂuencing Smile Design and Facial Aesthetics

Digital Implant Workﬂows Maximising Clinical Outcomes

Prof Jean-Marie Megarbane, Lebanon

Dr Marcus Dagnelid, Sweden

Implant Site Optimisation Using Osseodensiﬁcation

Zygomatic Implant Solutions to Treat Sever Atrophy of the Maxillary

Dr Costa Nicolopoulos, Greece

Dr Nicolas Boutin & Dr Bernard Cannas, France

Interdisciplinary v/s Multidisciplinary Treatment of
Maxillofacial Trauma in the Aesthetic Zone

Full Ceramic Restoration: The Art Meet Layering Ceramic Restoration
Mike Prosperino, Italy

Dr Nadim Aboujaoude, Lebanon
What Should we Assess Before Approaching with any Device or
Debridement Instrument to Maintain our Restored and Healthy Patient?

Injection Moulding Technique: Easy
aesthetics, predictable outcome

Consolata Pejrone, Italy

Dr Simone Moretto, Brazil

Hands-On Courses

Date: 06-10 November 2019

07 November 2019 | InterContinental Hotel DFC | Dubai
Reconstruction of Large Ridge Defect by Particulated Grafts and
Membranes as a Prerequisite for Successful Implantation
Ass. Prof Attila Horvath, Hungar
07 November 2019 | CAPP Training Institute
Superior Outcome Using PIEZOSURGERY in Daily Practice
Prof Domenico Baldi, Italy
06-07 November 2019 | CAPP Training Institute
Minimal Invasive and Non Prep Veneers Smart Smile Design with Veneers

Coming Soon
Ihssan Hamadeh, Syria

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.

CAPP designates this activity for 35 CE Credits

10 November 2019 | CAPP Training Institute
Zygomatic Implant Solutions to Treat Sever Atrophy of the Maxillary
Dr Nicolas Boutin & Dr Bernard Cannas, France
09-10 November 2019 | CAPP Training Institute
Ceramic Veneers: From the Diagnosis and Preparation to
the Temporisation and Cementation
Dr Eduardo Mahn, Chile
09-10 November 2019 | CAPP Training Institute
Modern Dentistry without Erbium Laser Therapy is NOT Modern
Prof Dr med dent Norbert Gutknecht, Germany

Asst Prof Dr Cagdas Kislaoglu, Turkey
06-07 November 2019 | CAPP Training Institute
All What you Need to Know About Composites
Dr Eduardo Mahn, Chile
09 November 2019 | CAPP Training Institute
A Comprehensive Approach for the Dental and Periodontal Patient
Consolata Pejrone, Italy

Call/WhatsApp: +971502793711
Web: www.cappmea.com/aesthetic-dentistry

10 November 2019 | CAPP Training Institute
Tooth Wear Treatment:
Modern strategies to restore aesthetics and function
Prof Brian Millar, UK
07 November 2019 | CAPP Training Institute
Dental Technicians Supernatural –
“How do you Make in a Simple Step Supernatural Artiﬁcial Teeth”
Mike Prosperino, Italy
09 November 2019 | CAPP Training Institute
“Injection Moulding Technique”: Easy Aesthetics, Predictable Outcome
Dr Simone Moretto, Brazil

[12] =>

INDUSTRY
NEWS

Dental Tribune Middle East & Africa Edition | 4/2019

3ssential Kit By Werestore.It:
The easiest way for restoratives
By Hu-Friedy
In collaboration with WeRestore.it by
Drs. Gaetano Paolone and Salvatore
Scolavino, doctors with expertise
and the passion for restorative dentistry, Hu-Friedy announces the new
simplified basic kit for direct and indirect restorative procedures: 3SSENTIAL KIT.
POSTERIOR

Starting from the necessity of something essential and easy to use,
3SSENTIAL KIT is ideal for both clinicians and young students who want
to save precious time in their dental
office during restorative procedures
and are willing to achieve remarkable aesthetic and functional results.
“Until now the minimum number of
ANTERIOR

instruments for a restorative kit was
five”, says Dr. Paolone, co-founder
of WeRestore.it, “we wanted to create something even more compact,
essential and easy to use, and this is
why we chose three instruments instead of five”.
3SSENTIAL Kit is the most straightforward kit of restorative ever made,
with just three instruments at once:
Anterior, Posterior and Spatula with
three different colours (red, blue and
grey) to easily identify them while
operating. The choice of the instruments from the Hu-Friedy the Black
Line Collection lays in the useful conSPATULA

trast made between the instrument
itself and the tissue.

finding new ways to help clinicians
to perform at their best”.

“The concept behind the Posterior is
very simple: we wanted to go from
a Plug and Play to a Plug and Sculpt
method”, says Dr. Scolavino of WeRestore.it, “one tip is used to plug the
composite into the cavity and the
other one can sculpt and model
composite in additive and subtractive modelling techniques”.

For more information about 3SSENTIAL KIT and all the other Hu-Friedy
products, visit www.hu-friedy.eu.
and download the full catalogue at
catalog.hu-friedy.eu
Follow us on
@HuFriedyEU
@hu_friedy_europe

About the Anterior, the doctors call
it solid brush since it models and
spreads the composite very easily,
just like a brush.
“Hu-Friedy constantly works to further develop new partnership with
the very people involved in the industry”, says Giana Spasic, Manager
Key Opinion Leaders Strategy Europe at Hu-Friedy, “for example key
opinion leaders, specialists, private
practitioners, universities and educators, with the purpose of always

For more information contact:
Hu-Friedy Mfg. Co., LLC.
Kleines Öschle 8
D-78532 Tuttlingen
Free Phone 00800 48 37 43 39
Free Fax 00800 48 37 43 40
Email: info@hu-friedy.eu
Web: www.hu-friedy.eu

“The future of dentistry will be driven by data”
From digital dentistry
to data-driven dentistry

By Aleksandra Nyholm, Planmeca
HELSINKI, Finland: Digital dentistry
has been talked about as the future
of the industry for nearly two decades, but as digital dental technology gradually shifts from new to
normal in the dental clinic, where is
dentistry heading next? The answer
is likely to be found in one small
four-letter word: data.

Harnessing the Internet
of Things in dentistry

In the last few years, the Internet of
Things (IoT)—essentially, devices
exchanging data via a network—
has become something of a buzzword in dentistry as elsewhere. Behind the buzz lies a real industrial
shift towards ecosystems of network-based digital devices working
side by side, hand in hand—generating large amounts of data as they
go.
Solutions that depend on manual
data entry to collect information
on treatment content and the time
used have long existed in the dental industry. Until recent years, the
activities and operations during
treatment, such as chair times and
equipment use, have remained
largely unrecorded. In order to access and collect this data, it is im-

Digital dentistry has been the oftencited future of dentistry for well
over a decade—and with good reason. New digital technologies have
enabled same-day restorations of
patient smiles, simplified workflows and patient communication
and, indeed, transformed diagnostic and treatment practices in the
dental office. However, as digital
devices gradually become standard
in the dental clinic, where is the industry heading next? What is the
new future of dentistry?

There have been a number of innovations that have changed the
course of dentistry. One major
shift in the industry was the move
towards digital dental technology,
which led to the development of
such concepts as same-day restorations and the paperless dental
office. The emergence of analytics
solutions for dental clinics is a clear
sign that we are now in the middle
of another shift, towards an era of
data-driven dentistry.

Data software is the way of the future for maintaining an optimally running dental practice.

portant to choose technology that
is ready to go online.
Planmeca equipment has long been
designed with this in mind. Our
digital dental units, imaging devices and milling units have included
network connectivity for more
than a decade, relaying data seamlessly to our powerful Planmeca
Romexis software—all this well before IoT became a common talking
point in the tech industry.

Valuable insights
through data analytics

IoT-ready devices capable of producing and transmitting big data
provide visibility into the treatment session. This visibility is
essential to the evaluation of all

aspects of a clinic. The sooner the
right technology is brought into
the practice, the more readily available data will become. However, in
order to get the most out of this
enormous amount of data, it must
be collected into information in a
way that is intelligent, centralised
and automated.
The explosion of data in recent
years has already led to data analytics becoming commonplace in
fields such as marketing, modern
education and business intelligence. In medicine, for example,
operating room analytics enables
monitoring of case and procedure
volumes, operating room utilisation and scheduling efficiency.
Dentistry is now also following
suit. In 2017, Planmeca was the first

manufacturer of dental equipment
to launch a comprehensive IoT solution for dental clinics with Planmeca Romexis Insights.
Planmeca Romexis Insights is a
web-based analytics service which
combines data from Planmeca
dental units, imaging devices and
milling units to generate clear
visualisations of equipment usage,
device status and patient flows.
From smaller clinics to larger clinic
chains, the informative reports and
interactive views enable identification of trends, patterns and areas of
optimisation in order to maximise
clinic efficiency. As the name suggests, it’s about gaining insights
into how a dental practice is doing—anywhere, any time.

Today, analytics services such as
Planmeca Romexis Insights can
produce comprehensive and relevant information about patient
times, equipment usage and productivity, from the first appointment to the final check-up. Analytics helps make comparisons and
pinpoint best practices both over
time and across clinical procedures.
This, in turn, can guide the entire
dental team towards higher productivity, better outcomes and happier patients through continuous
learning and self-improvement.
Tomorrow, we may see data analytics taken even further, for example, through highly personalised
treatments informed by enormous
amounts of consolidated patient,
performance and quality assurance
data. Combining data with artificial
intelligence is likely to offer still
more possibilities for the future—
some of which are already being explored by the Planmeca R&D team.
What is the immediate future of
dentistry? In such an ever-moving
field, the possibilities are unlimited.
If there is one thing that does seem
clear, it is this: the future of dentistry will be driven by data.

[13] =>

THE COMPACT
MAKES
A BIG
CHANGE
To help any user of air driven handpieces
conver t to electric and enjoy the full
b e n e fi t s o f i t s h i g h f u n c t i o n a l i t y. A b i g
change in treatment environment is
brought with only a minor addition to the
current equipment in your off ice.

ELECTRIC MICROMOTOR UPGRADING SYSTEM
*NLZ E ：with Endo Function

[14] =>

INDUSTRY

Dental Tribune Middle East & Africa Edition | 4/2019

Continuous Perfection from
the Perfect White Range
By Beverly Hills Formula
Dental professionals across the Middle East will
have undoubtedly heard of Beverly Hills Formula, a brand that has successfully carved their
name as unrivalled experts in oral care and athome teeth whitening. The brand are the proud
creators of the Perfect White Range, which has
been making waves with both dental professionals and consumers since its launch in 2012.
Never before had the market seen such a range
– with bold daring colours with bold statements
to match.
Since the range hit the shelves, global sales have
been increasing rapidly - notably in the Middle
East where the brand has seen a huge demand
for the colourful range of whitening toothpastes and mouthwashes as well as the popular
whitening kit. Products in the range are nonabrasive, kind to enamel and remove up to 90%
of surface stains so it is not difficult to see why
the range has become a must have for consumers worldwide.
The range consists of Perfect White Black,
the brand’s hero product. The toothpaste is
scientifically formulated with Activated Charcoal – known for its love of tannins. The company were the first to bring such a formulation
to the market and although copycat products
have followed, they have never beaten Perfect
White Black when it comes to effectiveness and
popularity. The brand followed on from this,
adding Perfect White Black mouthwash to the
mix. The shake to activate’ formula helps eliminate the bacteria that cause bad breath and neutralises remaining odours for lasting freshness

Also, in the range is Perfect White Gold. Gold is
known for its anti-bacterial and anti-inflammatory properties. Combined with Beverly Hills
Formula’s non-abrasive stain removal power,
this has become another must for consumers.
The brand recently added to the range with
Perfect White Optic Blue, again with a first to
market formulation. The innovative Blue Filter Technology forms a special layer over teeth
during brushing to reflect the light, creating an
optical whitening effect providing immediate
results. Along with Optic Blue is the introduction of Perfect White Gold Mouthwash, a shake
to activate formula containing real gold particles. This luxurious mouthwash eliminates
bad breath and provides a long-lasting freshness whilst helping to remove surface and deep
stains. Plans are currently underway to add to
this increasingly popular range.
The brand has always been highly selective with
their advertising, having never felt the need to
heavily promote or push their products to consumers. Rather than expensive marketing campaigns, they have allowed the phenomenal success of the range speak for itself. However, this
year an opportunity presented itself that they
simply couldn’t pass by and threw the Perfect
White Black products onto the global stage.
In May this year, they announced their partnership with the iconic movie franchise Men
In BlackTM International , collaborating with
Sony Pictures for the much anticipated movie.
They had dipped their toes in movie partnerships before, teaming up with Paramount on
the recent Bay Watch movie. Having saw huge
success off the back of this campaign, they were

waiting for the right movie to come up again.
Men in Black saw an ideal opportunity for the
Perfect White Black products to take centre
stage.
The movie was released on June 14th and to
celebrate its release, the brand is offering consumers a once in a lifetime trip to London and
New York City to carry out their own Men in
Black mission. They have also launched three
limited edition packaged toothpastes and
one mouthwash which can be found in stores
across the UK and ROI.
It is the massive success of the Perfect White
Range that has allowed the brand to embark

on such exciting collaborations and they are
looking forward to further success in the second half of 2019.

Beverly Hills Formula
Unit P1/P2 North Ring Business Park
Swords Road, Dublin, 9, Ireland
Web: www.beverlyhillsformula.com
E-mail: info@beverlyhillsformula.com
Tel: + 353 1 842 6611
Fax: + 353 1 842 6647

Review shows distraction
techniques may
reduce dental anxiety

ultimate
reliability

By DTI
BELO HORIZONTE, Brazil: Dental anxiety is
globally regarded as a public health concern
owing to its effects on an individual’s oral
health and quality of life. The prevalence of
the condition in children ranges from 5%
to 61%. A recent systematic review assessed
whether distraction techniques reduce anxiety during dental treatments in children and
adolescents.

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190219_DTMEA_TornadoX_122x188_.indd 1

05.06.19 11:33

Twenty randomized controlled trials (RCTs) of
distraction techniques for the management
of dental anxiety and dental fear in children
and adolescents under the age of 18 were included. Among the distraction techniques
used were audio and audiovisual techniques,
instrument camouflage, biofeedback, a dental
operating microscope and toys. Dental treatments provided were dental examination,
oral prophylaxis, local anesthesia, dental restoration, endodontic treatment and extraction.
Qualitative analysis showed with very low certainty of evidence that distraction techniques
effectively reduced anxiety and fear depending on the distraction type, instrument used
to measure anxiety and fear, and procedure.

A recent study has investigated whether the use of distraction techniques has a positive influence on pediatric
dental treatments.

The authors thus concluded: “The heterogeneity of methodologies and findings in the
studies, however, suggests more robust, and
well–executed RCTs are needed.”
The study, titled “Use of distraction techniques for the management of anxiety and
fear in paediatric dental practice: A systematic
review of randomized controlled trials,” was
published online in the International Journal
of Paediatric Dentistry on March 25, 2019,
ahead of inclusion in an issue.

[15] =>

[16] =>

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 4/2019

The mock-up: A clinician’s everyday tool
for aesthetic dentistry

Fig. 1: Cartridge with self-curing composite (Structur 3)

By Dr Yassine Harichane, France
For a wax-up, also known as a diagnostic wax model, laboratory wax is
used to create an aesthetic concept
model based on the patient’s plaster
model. However, its aesthetic and
functional use is limited. From an
aesthetic perspective, even though
the wax does not reproduce the
tooth shade perfectly, it facilitates
visualisation of the shape and position of the teeth in the concept model. As far as function is concerned,
even when a high-performance articulator is used, it is still difficult to
replicate the full range of masticatory movements.
The mock-up, essentially a preview
produced from composite, is a technique all too rarely employed by
dentists, but that proves exceptionally practical in a wide variety of situations in routine clinical practice. It
offers a preview of the intended aesthetic result and as such plays a decisive role in treatment planning.1–3
The mock-up phase follows validation of the wax-up. In this phase, the
concept model is adapted directly in
the mouth after validation on the
plaster model.4,5 This facilitates transfer of the wax-up data from the patient model directly to the mouth.6,7
The trial fitting in the mouth offers
the opportunity to verify the concept model from an aesthetic, func-

Fig. 2: Pre-op situation, portrait

tional and psychological perspective.
This last aspect is of particular significance, considering that it imparts an
important principle of patient acceptance, namely being able to first
try out a solution and then make an
educated final decision. In this way,
the patient plays an active role in
the decision-making process, which
considerably improves communication.8
It is important to note that communication with the dental technician
too is optimised in the any corrections, a duplicate of the mock-up is
sent to the laboratory. The dental
technician now has at his or her disposal additional information, with
which he or she can achieve a predictable aesthetic result.

Treatment plan

Mock-ups are suitable for treatment in the anterior region requiring corrections to the shape of teeth
through the addition of material
and, to a lesser extent, adaptation of
the position of the teeth. The main
indications are thus loss of substance
on vital teeth, missing individual
teeth, diastema or other congenital
aesthetic defects that permit a bioaesthetic approach.10
Once a diagnosis has been established and the type of treatment selected, the dentist orders a wax-up

based on the patient’s tooth model.
Of course, he or she needs to inform
the dental technician in the laboratory of what he or she expects in terms
of shape and position, but not yet the
shade. The first step is for the dentist
to validate the wax-up on the model;
this allows him or her to make any
necessary corrections directly in
the practice using suitable materials. In such cases, it is always worth
asking the dental technician to send
additional wax with which any corrections requiring addition of material can be performed. The wax-up
is then shown to the briefed patient
(it is a 3-D simulation of the concept
design)—and the limitations (the
tooth shade cannot be replicated in a
wax-up) mentioned—and it is compared with the plaster model without wax-up in order to demonstrate
the improvements objectively. Once
the patient has accepted the wax-up
and any necessary corrections have
been made, the wax model is transferred from the plaster model to the
patient’s mouth in order to simulate the treatment intraorally. These
steps are described in the “Step by
step” section.
The mock-up is shown to the patient
in order to determine the optimal
tooth length and the general proportions of the new smile. It is still possible to make corrections at this stage.
After any corrections, the dentist

Fig. 3: Pre-op situation, smile

and patient approve the mock-up
and an impression is taken, which is
then sent to the laboratory, where it
serves as a reference for the final production of the concept model.

Materials

Mock-ups are easy to produce in routine clinical practice as long as there
is sufficient material available and
the user masters the necessary skills
in advance. In this article, I describe
a technique in which a self-curing
composite (Structur 3, VOCO; Fig.
1), which is usually employed in the
production of temporary crowns,
bridges, inlays and onlays, is deployed in the scope of an off-label
use. In contrast to laboratory wax,
which is used for wax-ups, the visual properties of this material allow
reproduction of the natural tooth
shade (within a sufficiently large
range of A1 to A3.5, including the
Shades B, C and Bleach Light). The
mechanical resistance of the material makes it possible to simulate
the occlusion of the mock-up in the
mouth. Self-curing composites are
similar to conventional light-curing
composites. As a result, the composite can be adhered to the mock-up
in order to compensate for defects
or change the shape (tooth elongation, curvature of vestibular tooth
surface, incisal cut-back, etc.). The retention occurs mechanically, that is
no cement is required. In contrast to

“The mock-up, essentially a preview
produced from composite, is a technique all
too rarely employed by dentists”

Fig. 4: Pre-op situation, intra-oral in occlusion

Fig. 5: Pre-op situation, intra-oral in non-occlusion

a temporary crown, the mock-up is
ultimately destroyed upon removal.

Step by step

The clinical case presented here
to illustrate the workflow was a
consultation for aesthetic reasons.
The patient wanted to improve his
smile considerably without resorting to invasive techniques (I restrict
myself here to the implementation
of a mock-up in the maxilla). The
first step involves taking a number
of photographs in order to analyse
the initial clinical situation with the
patient (Figs. 2–5).11 A plaster model
serves as the basis for production
of the wax-up (Fig. 6). An impression is taken of the wax-up (Figs. 7 &
8), which is used in the mouth as a
guide for the implementation of the
mock-up.
The guide is tried in the mouth and
any necessary corrections made with
a scalpel. The shade of the self-curing
composite (in this case, Shade A1) is
now selected in accordance with the
patient’s expectations and the tooth
shade of the natural teeth.
The impression is filled with the
composite (Fig. 9) and inserted into
the mouth (Fig. 10). The impression
is removed, at the earliest, 1.5 minutes after mixing (Fig. 11). However,
final processing can only be performed after 4 minutes. The shape is
adjusted either by means of contouring in conjunction with water cooling, as in the case of conventional
composites, or by filling defects with
a flowable composite (Grandio Flow,
VOCO; Figs. 12–14). Finally, the structure and dynamics of the occlusion
are verified.
Once all adaptations have been completed, the mock-up is presented to

Fig. 6: Wax-up without preparation of the teeth

ÿPage 18

[17] =>

From British Academy of Restorative Dentistry

DUBAI

2019-2021

Prof. Paul Tipton,UK
Specialist in Prosthodontics
President, British Academy
of Restorative Dentistry

Prof. Edward Lynch, UK
The University of Warick, Coventry
PhD, Lond, MA, BDentSc, TCD, FDSRCSEd,
FIADFE, FDSRCSLond, FASDA, FACD

Prof. Göran Urde, Sweden
Director Futurum Clinic
Program Director P.G Education
Dept. of Materials Sci. & Tech.

Prof. James Prichard, UK
BDS (ULond), MSc(ULond),
LDSRCS (Eng), MFGDP (UK)
FIADFE (USA)

Dr. Malcolm Riley, UK
BDS (Lon), LDS RCS(Lon),
FDS RCS(Lon), MRD(Ed),
FDS RCS(Ed)

Dr. Matthew Holyoak, UK,
BDS, Dip Rest Dent
(RCS Eng), MSc (Rest Dent)

Dr. Timothy Eldridge, UK
BDS Birm
Clinical Director myFACE

Dr. Adam Toft, UK
BSc (Hons), BDS (Hons), MFGDP (UK),
MMedSci (Rest Dent), Dip Aesth (BARD)
FBARD PGCertEd (Sheffield)

Dr. Ash Rayeral, UK
BDS MFGDP(UK) MSc
(Aesthetic and Restorative
Dentistry)

Dr. Adam Nulty, UK
BChD MJDF RCS Eng
PGCert MSc (Dist.)
MAcadMEd

Group 5
Registration Open

Pathway to UK
Masters

210 CME & Daily
Hands-on

Certificate | 4 Modules | 15 Days

Module 1 | 19-21 September 2019 | Prof. Paul Tipton & Dr. Adam Toft & Dr. Ashish Rayarel

Treatment Planning in Advanced Restorative Dentistry | The Principles of Occlusion in Advanced Restorative Dentistry | Tooth
Preparation in Advanced Restorative Dentistry
Module 2 | 20-23 November 2019 | Prof. Paul Tipton & Dr. Matthew Holyoak & Dr. Adam Toft & Dr. Ashish Rayarel

Minimally Invasive Veneer Preparations | Master the Art of Composites Part 1 - Adhesion Composites & Anterior Composite
Restorations | Master the Art of Composites Part 2 - Composite Veneers | Master the Art Composites Part 3 - Posterior Composites
Module 3 | 19-22 February 2020 | Prof. Paul Tipton & Prof. James Prichard & Dr. Adam Toft & Dr. Ashish Rayarel

Enhance Your Expertise in Endo Part 1 | Enhance Your Expertise in Endo Part 2 | Occlusal Examination | Emax & Zirconia Anterior
& Posterior Restorations
Module 4 | 08-11 April 2020 | Prof. Paul Tipton & Dr. Malcolm Riley & Dr. Adam Toft & Dr. Ashish Rayarel

Bridge Design | Aesthetic Perio Connective Tissue Grafting | Aesthetic Perio Crown Lengthening | Modern Post and
Core Techniques

Diploma | 4 Modules | 15 Days

Module 5 | September 2020 | Prof. Paul Tipton & Dr. Adam Toft & Dr. Ashish Rayeral

Bridge Preparation Techniques | Articulator selection in Restorative Dentistry | Porcelain Inlays & Onlays | Veneer Cementation
Techniques Practical
Module 6 | November 2020 | Prof. Paul Tipton & Mr. Gary Jenkinson & Dr. Adam Toft

The Art & Science of Aesthetic Dentistry Part 1 & Anterior Diagnostic Waxing | The Art & Science of Aesthetic Dentistry Part 2
& Posterior Diagnostic Waxing | TMD, It's Diagnosis and Treatment | Adhesive Bridge Preparation Techniques
Module 7 | February 2021 | Prof. Paul Tipton & Prof. Edward Lynch & Dr. Adam Nulty & Dr. Adam Toft & Dr. Ashish Rayeral

Minimally Invasive Dentistry | Digital Dentistry Workflow & Photography Principles, Hardware and Storage Part 1 & 2
Module 8 | May 2021 | Prof. Göran Urde & Dr. Timothy Eldridge & Dr. Adam Toft & Dr. Ashish Rayeral

Implant Prosthodontics Part 1 & 2 | Botox & Dermal Fillers – A Dental Facial Aesthetics Part 1 & 2

[18] =>

RESTORATIVE
NEWS

Dental Tribune Middle East & Africa Edition | 4/2019

◊Page 16

Fig. 7: Silicone wax-up impression

Fig. 8: Verification of the accuracy of the wax-up impression

Fig. 10: Insertion of the impression with self-curing
composite

Fig. 11: Occlusal view of the mock-up after removal
of the impression and all excess material

Fig. 14: Surface of the mock-up at tooth #21 after filling of the defect

Fig. 9: Filling of the impression with self-curing composite (Structur 3)

Fig. 12: Filling of a bubble in the mock-up with flowable composite (Grandio Flow)

Fig. 15: Post-op situation, portrait

Fig. 13: Curing of the flowable composite

Fig. 16: Post-op situation, occlusion check

“Patient compliance increases,
as he or she can follow the treatment plan
more calmly and is better informed.”
the patient for his or her aesthetic
approval regarding shape, position
and tooth shade. If necessary, further adaptations can be effected in
the same way, that is via contouring
or filling with composite. The data
is sent to the laboratory as photographs (portrait, smile and intra-oral;
Figs. 15 & 16), along with an impression of the mock-up and the analysis
of the smile. The dental technician
in the laboratory then has the necessary and sufficient information at
his or her disposal to produce the actual prosthetic restoration in accordance with the patient’s and dentist’s
wishes.12
At the end of the treatment session,
the question remains as to what to
do with the mock-up. The dentist
has the choice of two possibilities.
One option involves removing the
mock-up and permitting the patient to leave the practice with the
restored initial clinical situation. No
invasive or irreversible interventions have been performed and the
patient is happy to have tried out his
or her future smile without having
to sacrifice any tissue or be anaesthetised. The other option is to allow the
patient to leave with the mock-up
still inserted. This allows him or her
to show off his or her new smile to
his or her nearest and dearest and to

verify its acceptance in social situations. Furthermore, this enables the
patient to test the articulation and
masticatory loads in daily life. At this
point, it must be reiterated that the
material is suitable for situations of
this type, as it was developed for the
production of temporary crowns.4
It is up to the dentist to decide how
long the mock-up can remain in the
patient’s mouth, and it goes without
saying that special attention must
be paid to exceptional oral hygiene.
From the perspective of the psychological period for visual acclimatisation and functional aspects,
one week appears to be a practical
period.4, 5

Discussion

The mock-up technique offers a
whole range of advantages. The
quick, cost-effective method allows
the patient to assess the desired result in his or her mouth.13 Until now,
patients went along with dentists’
decisions without being actively involved in the treatment plan, and
this occasionally resulted in unexpected outcomes and possible conflicts. A waiting period with temporary restorations makes it possible to
assess the required result, but is not
indicated in clinical cases with conservative or non-invasive approaches. In future, the patient will be able

to try out his or her new smile in order to become used to it quickly and
even go home wearing it to test it
extensively from an aesthetic, functional and psychological perspective.
Patient compliance increases, as he
or she can follow the treatment plan
more calmly and is better informed.
In addition to improved patient
communication, communication
with the dental technician is facilitated. Owing to the impression and
photographs of the mock-up in the
mouth, the dental laboratory has at
its disposal a wealth of invaluable
information, which was not systemically provided in the past.12 The dental technician is then able to test the
wax-up not only from a functional
perspective (structural and dynamic
occlusion, position of the free margin for articulation, lip support, etc.),
but also from an aesthetic perspective (tooth shade, shape and volume
of the teeth, smile symmetry, smile
alignment with regard to facial aesthetics, etc.). The user friendliness of
the material means this technique
is suitable for use in routine clinical
practice.
For the dentist, this technique is just
as easy to perform as the production
of temporary crowns. There is no
need for a rubber dam, as the mockup is produced under the same con-

ditions as for a temporary crown.
In addition, this non-invasive technique does not require preparation,
retention, bonding or anaesthesia.
The patient will certainly appreciate
this tissue-preserving approach. As
such, the patient will perceive the
treatment as more of an adventure.6
Of course, however, mock-ups are
not without their restrictions. Their
indication is restricted to prosthetic
restorations in the anterior region,
with severe malformations representing a contraindication, as the
teeth may be positioned outside of
the shape of the wax-up. The technique is also not indicated in cases
in which enameloplasty is required
(too long or too severely curved
tooth).
As production of a mock-up requires a certain degree of dexterity, it should be initially practised
on a plaster model before work is
performed directly in the patient’s
mouth. The therapeutic treatment
of a patient may require a longer
period; even though the mock-up
phase can be very informative and
useful for patient communication,
it remains an additional, facultative
phase. Furthermore, dentists who do
not use self-curing composites for
temporary restorations could view

procurement of these materials as
an additional cost factor. However,
it is worth weighing up the fact that
the mock-up could considerably
improve patient acceptance in an
extensive treatment and thus the
investment could indeed be worth
it. Nothing is more frustrating for a
dentist than investing time and effort in the development of a long,
complex treatment plan only for it
to be rejected by the patient because
it fails to meet his or her expectations.
From the dental laboratory’s perspective, this method provides the
dental technician with additional information, which allows him or her
to tailor his or her work precisely to
the patient’s and dentist’s expectations. The improved communication reinforces the cooperation between the dentist, patient and dental
technician.
Note: This article was originally published in the Dental Tribune Study
Club France magazine, 03/2015. It is
published here with the kind permission of the author and OEMUS MEDIA. A list of references is availa- ble
from the publisher.

About the Author
Dr Yassine Harichane
graduated from the Faculty of Odontology at Paris Descartes University and now
works in research. He is a member of the
Cosmetic Dentistry Study Group and can
be contacted at:
yassine.harichane@ gmail.com.

[19] =>

[20] =>

CAD/CAM

Dental Tribune Middle East & Africa Edition | 4/2019

Reliable planning for an optimal workflow
User case abstract
An additional DVT image was made
in the Orthophos SL’s Low Dose
Mode as a check post-implantation.
We chose hybrid abutments on tibase for the final restoration.

Summary

Matching of Orthophos SL 3D data with the prosthetic proposal in Galileos Implant.

Prosthetic alignment of the implant in planning.

in need of a restoration shows the
advantages of utilizing 3D imaging
and an integrated digital workflow.

Methods

In this case, an Orthophos SL 3D
from Dentsply Sirona was used for
both panoramic and DVT scans.
Digital impressions of the patient
were taken with a CEREC camera
and implant planning took place
within the Galileos Implant software. For guided surgery, the team
used CEREC Guide 2 milled in-house
at their dental laboratory on an inLab MC X5 milling machine.

By means of a low-dose recording, the implant was checked three-dimensionally.

By Dentsply Sirona
Part of creating an optimal workflow involves the ability to reliably
plan for variables that differ with

each patient. 3D imaging gives the
clinician the ability to view anatomical structures not seen in twodimensional images. The following
case study involving a male patient

Case Study

A 52-year-old male patient presented to our practice with gap in
the area of teeth 45-47. He wanted
this area restored. We used the Or-

thophos SL 3D to take a panoramic
scan for planning purposes.

Reliable planning makes for an efficient treatment while helping to
minimize risk. 3D imaging is an important part of creating a solid plan
and the integrated digital workflow
offered by using the Orthophos SL
along with relevant planning software saves time for the practitioner
and is also efficient for the patient
by reducing the number of times
he/she has to come to the practice.

The patient opted for a treatment
plan involving the insertion of two
implants and then an implantsupported bridge. Digital imaging,
combining DVT with CEREC optical
impressions were used to plan the
implant surgery in Galileos Implant
software.
The software creates an implant
proposal as well as enables planning
of the alignment of the prosthetic.
The ability to plan and perform
virtual surgery allowed the team to
maximize safety and minimize risk.
CEREC Guide 2 was chosen in the
treatment plan and then milled in
our practice to use during surgery.

MisterE

Time for introductions.
Meet the New Orthophos Society. Here each
one is a master of their class – and always
your best choice for extraoral imaging. No
matter if you’re a digital beginner or already
an expert, you’re sure to pick your favorite
and join the NOS.
dentsplysirona.com/NOS

LadyS

SL
Sir SL

[21] =>

[22] =>

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 4/2019

Minimal invasiveness
— maximal effectiveness
The paradigm of the present decade in restorative dentistry
By Dr Maciej Żarow, Poland

Introduction

This article describes a case in which severe tooth damage was
presented and complex oral rehabilitation was planned. Part
of the rehabilitation had been completed more than a decade
before, and the rest only recently. Although there was only ten
years between these two treatments (upper arch in 2005 and
lower arch in 2015), a significant paradigm shift was evident concerning the treatment planning and with respect to the amount
of tooth reduction.

Case report

A 25-year-old female patient reported to the dental of- fice 12
years ago in order to improve her smile (Figs. 1–3). Her anterior
maxillary and mandibular teeth were severely damaged owing
to a past chronic eating disorder. In 2005, complex oral rehabilitation was planned for the patient, starting from the upper
arch. For the maxillary posterior teeth, full-ceramic onlays were
planned and placed, while for the maxillary anterior teeth, fullceramic crowns were fabricated (Figs. 4–6). A decade ago, this
was the standard procedure in such a case of structural damage.

wax-up of the lower arch was obtained,
and the vertical dimension of occlusion
(VDO) was slightly increased, based on
aesthetic analysis. The obvious benefit
of the VDO increase was also the fact that
there would then be enough space for the
restorative material without additional
tooth reduction. The appropriate mockup procedure and phonetic analysis were
performed to confirm this. In the posterior area, lithium disilicate onlays were
used, while direct composite resins were
planned for the anterior teeth.
Restorative phase: Posterior teeth
For the mandibular posterior teeth, minimally invasive preparation took place,
generally only in order to produce sharp,
visible borders for the laboratory preparation procedures. The entire preparation

surface was meticulously polished, with
the exception of the borders, to remain
sharp and evident for the dental technician. In order to ensure sufficient occlusal
volume for the restorative space, a pattern resin jig was fabricated on the articulated study models with increased VDO
and transferred to the mouth for control
(Fig. 10). Impressions were taken, and the
lithium disilicate (IPS e.max, Ivoclar Vivadent) onlays were fabricated in the laboratory (Fig. 11). At the next appointment,
the onlays were tried in for correct marginal adaptation and adhesively luted
under rubber dam isolation (Figs. 12–20).
Restorative phase: Anterior teeth
The teeth were cleaned with pumice,
and the incisal parts were abraded with
50 µ aluminium oxide particles. On the

The patient, happy with the appearance of the maxillary teeth
when smiling, did not present for the completion of the complex rehabilitation until 2015. During the past ten years, some
of the full-porcelain crowns had sustained minor chipping (Figs.
7–9), which was a result of the unfinished rehabilitation. After
a decade of advances in dental technology and treatment planning, we could propose to the patient a new option, one that was
minimally invasive and without the extent of tooth reduction
associated with the work carried out ten years earlier.

Treatment planning

The Kois deprogrammer was employed in order to register the
centric relation and articulate the models in this position. A

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

incisal vestibular edge, a 1 mm chamfer
was obtained using a diamond ball tip
(001-006-2, Olident), and the lower part
of the chamfer was delicately elongated
using an 80° bevel (around 0.5 mm; Figs.
21 & 22). The mandibular anterior teeth
were found to be tight and crowded; consequently, the operator found it easier
to restore the teeth without rubber dam
isolation.
The enamel and dentine were etched
with 38% phosphoric acid for 20 seconds,
then OliBOND adhesive (a fifth-generation prime and bond adhesive, Olident)
was meticulously applied to the dentine
and enamel, rinsed with water, air-dried
and light-cured for 20 seconds.

ÿPage 24

[23] =>

RESTORATIVE

HU-FRIEDY 3SSENTIAL KIT
*
BY WERESTORE.IT

THE ESSENTIAL RESTORATIVE KIT
INCLUDING “PLUG&SCULPT” INSTRUMENT
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restorative ever made, with just 3 essential instruments at once: Anterior, Posterior
and Spatula, from the Hu-Friedy Black Line Collection. The three instruments are synergic
and interchangeable and the word “Essential” refers to the easiness of all restorative
procedures focused on the essential steps to create high aesthetic composite restorations
while using this kit. The revolutionary concept of “Plug&Sculpt” of the Posterior is very
simple: one tip is used to plug the composite into the cavity and the other one can sculpt
composite in additive and subtractive modelling techniques. The Anterior, instead, is
called by the doctors “solid brush” since it models and spreads the composite very easily,
just like a brush.

FEATURES AND BENEFITS

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• Essential method: having only three instruments makes restorative procedures
straightforward
• Plug&Sculpt concept: The Posterior can plug and sculpt the composite by using its
two different tips
• Solid brush: The Anterior models and spreads the composite easily, just like a brush
• Different colours: each colour helps to easily identify the instrument:
RED for Anterior, BLUE for Posterior and GREY for Spatula
• Black Line Collection instruments: smooth surface reduces stickiness to
composite material and the black colour has more contrast to the dental hard and
soft tissues.
• Ergonomics and visibility improved: allow dental clinicians to perform at their best

[24] =>

RESTORATIVE

Dental Tribune Middle East & Africa Edition | 4/2019

◊Page 22

Fig. 12

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

Fig. 21

Fig. 22

Fig. 23

Fig. 24

Fig. 25a

Fig. 25b

Fig. 25c

Fig. 26

Fig. 27

Fig. 28

Fig. 29

Fig. 30

Fig. 31

Fig. 32

Fig. 33

Fig. 34

The restorative phase of the anterior teeth consisted of creating an
external box, placing inside a layer
of inner composite followed by a
final outer composite layer. The procedure does not have to be too complex to achieve a predictable result;
one can obtain correct layering with
only two syringes of composite resin
(Fig. 23).
Based on the wax-up (Fig. 24), a silicone index was made and cut in the
frontal plane. With the lingual part
of the index, the back shell of the
reconstruction was created using a
thin layer of nano-filler composite
(OliREVO, Shade A3, Olident). In the
next stage, the approximal surfaces
were built up with the same com-

posite material, and by means of
the BlueView VariStrip (Garrison),
which provides an anatomical shape
mesially and distally (Figs. 25a & 26).
When all of the boxes had been prepared, the inner, more opaque layer
(OliREVO, Shade OA2) was applied,
and the mamelons were shaped before polymerisation in order to create natural internal characterisation
(Figs. 25b, 27 & 28). The inner layer
was polymerised, and finally the
outer layer of composite (OliREVO,
Shade OA2) was applied in a thickness of more or less 0.5 mm (Figs. 25c
& 29). This layer was meticu- lously
brushed with the modelling brush
and finally polymerised with slight
time extension (40 seconds for each
of the surfaces). After minor bite cor-

rections, the final characterisation
was done. First, the primary anatomy was achieved by contouring the
transition angles and incisal edge.
The next step was to start reproducing the secondary anatomy: the division of the lobes. These were drawn
in pencil (Fig. 30) and formed with
a diamond bur (831-204-012, Komet
Dental/ Brasseler; Fig. 23). Next, a
rubber point was used to smooth
the rough surface left by the bur. The
rubber point was also used to give an
initial gloss to the restoration. The
restoration was polished with 1 µm
diamond paste applied with a natural goat hair brush used at 1,000 to
10,000 rpm.
The satisfactory clinical result of the

lower arch restorative rehabilitation
can be seen in Figures 31 to 33. The
24-month clinical control showed
excellent clinical behaviour with respect to the lithium disilicate onlays
and anterior composite resin restorations (Fig. 34).

Editorial note:
This article was originally published in
cosmetic dentistry magazine beauty
& science, Issue 1/2018.

Conclusion

By increasing the VDO, it is possible
to achieve additional space for the
restoration, and in this way to minimise the tooth reduction and maximise the adhesion owing to residual
enamel. Correct treatment planning
and utilisation of a wax-up and silicone index allow predictable results
for the final shape and shade of the
composite restoration.

About the Author
Dr Maciej Żarow (DDS, PHD)
is in private practiceand runs a dental education centre in Cracow in Poland (www.
kursydentist.pl). He can be contacted a:
t maciej.zarow@dentist.com.pl or
facebook: Maciej Zarow.

[25] =>

[26] =>

NEWS

Dental Tribune Middle East & Africa Edition | 4/2019

Interview:
“Mouth cancer is a growing problem”
With oral cancer rates continuing to
increase worldwide, it has become
clear that more needs to be done to
raise awareness and combat this issue. Dental Tribune International
spoke with Dr Niall McGoldrick,
Specialty Registrar in Dental Public
Health with NHS Fife and the convenor of the charity Let’s Talk About
Mouth Cancer, about the charity’s
origins, its mission and much more.
Dr McGoldrick, how did Let’s Talk
About Mouth Cancer get started,
and was there anything in particular that led to its creation?
It all started in 2013, soon after my
colleague Dr Orna Ni Choileain and
I graduated from dental school. We
were both working as dental foundation trainees at the Edinburgh Dental Institute and had a shared drive to
raise awareness of oral cancer among
the public. We had an initial idea and
we were introduced to three other
colleagues, Dr Ewan MacKessackLeitch, Dr Stephanie Sammut and
Prof. Victor Lopes, and from there

the idea began to grow. We all could
see first-hand the impact the disease
had on people’s lives and on the people around them and wanted to do
something active, different and visible to bring change at all levels.
In the early days, we thrived on putting together public campaigns with
few resources and little funding. We
had to think outside the box and
be thrifty to get our campaign off
the ground. We used lunchtimes,
evenings and weekends to design
leaflets, paint backdrops and peruse
items in charity shops to find the
things we needed. It was really fun,
and we quickly began to get support
from other dentists and dental care
professionals as word spread about
our work. All five of us went forward
to found the charity in 2014 and we
have grown year-on-year. We now
provide training for undergraduates
and continuing professional development for postgraduates, and run
regular public campaigns throughout Scotland. We have partnered
with national and territorial health
boards across Scotland to spread our

message about oral self-examinations to help promote early detection.
Today, Let’s Talk About Mouth Cancer is a multi-award-winning charity
still driven by the same five volunteers, who are now close friends. We
are still true to our humble beginnings, have kept our running costs
low and continue to be extremely
grateful to patients, colleagues, relatives, students and everyone who
has donated or raised funds in any
way to help us continue with our
work.
What is Let’s Talk About Mouth
Cancer’s mission? How do you
hope to achieve this?
Our mission is to improve the prognosis of patients with oral cancer
through early detection and diagnosis. We are trying to tackle this in
a number of ways. Our public campaign is focused on empowering
people with the skills and knowledge
needed to carry out oral self-examination to identify this disease themselves and present early. We also

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From left to right: Let's Talk About Mouth Cancer's Prof. Victor Lopes; Dr Orna Ni Choileain; Dr Niall McGoldrick; Dr Stephanie Sammut; and Dr Ewan MacKessack-Leitch.

counsel the public on reducing risk
from well-known risk factors such
as tobacco and alcohol. Secondly,
we provide training for healthcare
professionals at undergraduate and
postgraduate level. This work is focused on improving the confidence
of healthcare professionals when
dealing with a suspicious lesion in
primary care and ensuring they are
up to date with signs, symptoms and
urgent referral pathways.
Our third approach is through advocacy. We have lobbied the Scottish
Parliament on issues related to human papillomavirus gender-neutral
vaccination and our general work
has been supported by a Scottish
parliamentary motion.
How big of a problem is oral cancer
in the UK and, more specifically, in
Scotland?
Oral cancer is a growing problem in
the UK, but especially in Scotland.
Scotland has more cases of this disease per head of population than
any of the other UK nations. Prognosis for patients remains poor, with
50 per cent of those diagnosed losing
their lives within five years. Further
to this, the inequalities that exist
among those who develop the disease and those who do not are stark;
the vast majority of people developing oral cancer come from our more
deprived communities.
There are issues of social justice that
need to be addressed. Improving
the environment that people live in,
making access to services simpler,
making the healthy choice the easy
choice and empowering people to
care for themselves are just some of
the areas that need to be addressed
in order to prevent a further rise in
the cases of oral cancer. Society’s
current approach of mitigating the
circumstances when it is too late will
not solve the wider issues.
What steps can individuals take to
combat oral cancer?
On an individual personal level, we
should all be aware of what is going
on in our mouths. Being familiar
with what is normal in your own
mouth is important, so that if there
is a change you can pick up on it
early. We want everyone to be carrying out oral self-examination to
help identify what could be the early
signs and symptoms of oral cancer.
Our website has details on how to
carry out a simple five-point check in

less than a minute. In terms of reducing risk in the first instance: if you
smoke, stop; if you drink alcohol, do
so in moderation; do not use chewing tobacco and avoid betel quid and
areca nut. It goes without saying that
leading a healthy lifestyle and having a balanced diet will do wonders
for your general health, but it will
also reduce the risk of developing
oral cancer. The last thing, of course,
is to see your dentist as often as recommended.
At the health professional level, we
need to be up to date, vigilant and
competent in dealing with suspicious lesions. Being familiar with
signs and symptoms of oral cancer
is important, as is listening to the
patient’s concerns and taking him or
her seriously, understanding the urgent referral pathway in the area in
which we work and being competent
in referring appropriately. Healthcare professionals also have a role in
educating patients about reducing
risk and teaching them how to carry
out oral self-examinations.
Let’s Talk About Mouth Cancer will
be hosting the Global Oral Cancer
Forum 2020 (GOCF’20) in Edinburgh in March next year. What
can dentists and other health professionals look forward to at this
event?
GOCF’20 takes place over two
days—6 and 7 March 2020—and the
theme is “Reducing risk; prevention,
early diagnosis and innovative treatments”. We have lined up a selection
of high-calibre international speakers and expert panellists to inform
the conversation with attendees
from around the world. Our aim is
to develop actionable outputs in the
global battle against oral cancer.
Unlike other international events,
GOCF’20 invites attendees from all
backgrounds: dentists, doctors, surgeons, public health practitioners,
NGOs, charities, data scientists, survivors and patients to join the conversations and establish new thinking in the challenge oral cancer poses
globally. Registrations for the conference will go live soon and all the info
is available on the event’s website.
We want as wide and varied an audience as possible to join the conversation as we develop these ideas. Come
along and be part of the action!

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GENERAL DENTISTRY

Dental Tribune Middle East & Africa Edition | 4/2019

Biological Dentistry
By Dr. Carla Schweer, France
Biological dentistry is a more biocompatible approach to oral health
and offers alternative therapy to
conventional dentistry. It regards the
patient as a whole and does not treat
the mouth in isolation. What happens to the teeth and gingivae has
an impact on the rest of the body,
and conversely, a systemic condition can affect oral health. Teeth are
often a reflection of a general state
of health. It involves a more organic
approach to care, with less-invasive
protocols and materials. Biological
dentists always seek the safest, least
toxic way to accomplish the mission
of therapy and all the goals of modern dentistry. Biological dentistry
describes a philosophy that can apply to all facets of dental practice and
healthcare in general.

Oral ecology

The human mouth contains around
500–1,000 different types of bacteria with various functions as part
of the human flora and oral microbiology. Individuals who practise
oral hygiene have 1,000 to 100,000
bacteria living on each tooth surface,
while less clean mouths can have
between 100 million and one billion
bacteria on each tooth.1 Some of the
bacteria in our mouths are harmful
and can cause serious illness, while
others are beneficial and prevent disease. Periodontal treatment is an essential aspect of biological dentistry
to prevent diseases such as diabetes,
cardiovascular disease, rheumatoid
arthritis, metabolic syndrome and
Alzheimer’s disease.2–4

Immune system

The biological dentist will give the
patient nutritional advice and prescribe vitamins and food supplements to enhance the immune system for a better outcome of therapy.
For example, in biological dentistry,
it is commonly known that a high
vitamin D level and low LDL cholesterol are key factors for a better outcome for bone surgery and implant
osseointegration.5

Dental mercury

An amalgam restoration is of great
concern to biological dentists. This
is because 50% of it consists of mercury, which is one of the most toxic
non-radioactive elements on the
planet. Therefore, biological dentists feel that it has no place in the
human mouth. Scientific evidence
has established beyond any doubt
that amalgam continuously releases
mercury in small amounts and creates measurable exposure in people
with amalgam restorations.6 Chronic
exposure to mercury could be detrimental to their health. Mercury
is stored within the brain and other
parts of the central nervous system,
as well as in the liver, kidneys, large
intestine, fat tissue and thyroid
gland.7, 8
Biological dentists follow sciencebased procedures to minimise mercury exposure during amalgam
removal9 and use special containers
and collectors to avoid pollution of
the environment. At Dr Roze & Associates, we use the Safe Mercury
Amalgam Removal Technique, a protocol designed by the International
Academy of Oral Medicine and Toxicology (https://thesmartchoice.com;
Fig. 1)

Metals and oral galvanism

Biological dentists believe that placing
metal and other foreign materials in
the teeth and gingivae may have unintended consequences. That is why
biological dentists only offer metalfree alternatives such as ceramics
or composites. Composites are also
chosen with care, as they should be
methacrylate-free and non-allergenic.
Consequently, they are free of HEMA,
bis-GMA and TEGDMA.
A bridge framework and titanium
implants are replaced by a zirconia
alternative, which has better biostability and great osseointegration and
is non-corrosive, non-conductive,
hypo-allergenic and more aesthetic.
These implants contain zirconia, a
biocompatible ceramic material free
of metal. These types of implants
promote complete assimilation into
the jawbone and the surrounding
gingivae.10, 11
Aside from their ability to provoke
immune reactivity, metals are electrically active. Oral galvanism has
been discussed for well over 100
years, but dentists have tended to ignore it and its implications.12 Biological macromolecules can influence
the rate of corrosion by interfering
in different ways with anodic or cathodic reactions. When combined
with mechanics (such as static loading, dynamic loading or wear) and inflammation, corrosion is intensified.
The corrosion behaviour of a metal
in non-physiological in vitro studies
versus physiological in vitro studies
and versus in vivo studies may vary
dramatically. The corrosion control
in vivo is currently limited to careful design, proper material selection,
and surface modification. The effectiveness of coatings may be limited
in vivo due to wear (Fig. 3).13

Endodontic treatment

Endodontically treated teeth are
dead tissue left in the body. This type
of procedure is not found in any
other medical discipline. Inflammation is common at the root apex, as
it is almost impossible to clean thoroughly in this area. Even the best endodontic specialist can never achieve
a complete cleansing free of bacteria.
Accessory lateral channels and the
endodontic-periodontal connection
via the dentinal tubules remain unsealed.14 Thus, bacteria harboured in
root canal areas such as isthmuses,
dentinal tubules and ramifications
may evade disinfectants.15 These
pathogenic bacteria produce toxic
and potentially carcinogenic hydrogen sulphide compounds (thioether
and mercaptans) from the amino
acids cysteine and methionine as byproducts of anaerobic metabolism.
Studies have reported several different strains of bacteria found in endodontically treated teeth with periapical periodontitis.16 Enterococcus
faecalis and yeast, mainly Candida
albicans, are very resistant and have
been repeatedly identified as the species most commonly recovered from
root canals undergoing retreatment,
in cases of failed endodontic therapy
and canals with persistent infections.17 The predominance of Gramnegative anaerobes associated with
endodontic infections and evidence
of cytokine production in inflamed
pulp and periapical granulomatous
tissue has shown an elevation of
systemic levels of inflammatory mediators in endodontic patients which
could have an impact on distant organs.18

Fig: 1

Fig: 3

References

Fig: 2

Since the human body and its robust
immune system can compensate
relatively well, and conventional
medicine does not consider the
body to be an integrative system
and focuses much more on its parts,
the link between the oral cavity and
symptoms elsewhere in the body
has not been well established.
The biological dentist takes this relation very seriously and watches
endodontically teeth closely. The
best way to diagnose inflammation
of the root apex is to rely on 3-D radiographic imaging (CBCT). It has
been shown that in many cases it can
detect periapical periodontitis where
2-D radiograph shows a sound picture (Fig. 4).

Cavitation or jawbone
osteonecrosis

Cavitation or ischaemic osteonecrosis describes a disease process in
which the lack of blood supply (ischaemia) to an area of bone results
in a dead portion of the jawbone. It
can also occur in other bones of the
body. Neuralgia-inducing cavitational osteonecrosis (NICO) is similar, but
produces neuralgic facial pain.
In the simplest terms, cavitation
is a hole in the jawbone, occurring
mainly after a tooth extraction that
has not healed correctly. Dr Greene
Vardiman Black, one of the founders of modern dentistry, described
this process as early as 1915.19 Pathogens, a biofilm form of bacteria, are
also present in this dead tissue and
release highly toxic waste products
that can pass into the bloodstream
and have detrimental effects on the
heart, kidney and joints, as well as
the immune, nervous and endocrine
systems.
Recent work in the field of facial pain
syndromes and NICO has led to the
realisation that the jawbones are a
frequent site of ischaemic osteonecrosis. This can be called aseptic necrosis and also affects the femoral
head. As a result, many extraction
sites that appear to have healed have

actually not healed completely. It
can trigger pain in other parts of the
face and head, and in distant parts of
the body. Even though most of these
sites present with no symptoms at
all, pathological examination reveals
a combination of dead bone and
slowly growing anaerobic pathogens
in a mixture of highly toxic waste
products where there otherwise appears to be proper healing.
Blame for these infections has been
placed on the periodontal ligament
left behind after extraction. However, it is most likely that cavitation
occurs as a result of a combination
of initiating events, predisposing risk
factors and environmental factors.
Notably, if patients have infections
after their extractions or experience
traumatic events such as dry sockets,
there is a higher likelihood of cavitation development. Usually in these
cases, the wound has not been thoroughly cleaned and sterilised. An effective way to sterilise the extraction
socket is by using laser and ozone.

Biological dentistry today

Dentistry is a rapidly evolving field.
Especially, biological dentistry is always seeking the latest research for
a better and safer approach. In the
past, it was revolutionary to be able
to restore a tooth instead of just pulling it out; amalgam, gold and denture teeth were, at the time, innovative materials and a better option
than extraction. But today, we can do
better dentistry in a less toxic, more
individualised, more integrated and
more environmentally friendly way
than ever. Biological dentistry is a
mindset more than a specialty. It
could also be called advisory dentistry or common sense dentistry. When
dentists choose to put biocompatibility first, they can look forward to
practising effective dentistry while
knowing that patients are provided
with the safest experience for their
overall health.

1. Stevens JE. Oral ecology. MITS Technol Rev. 1997 Jan 1;100:48–55.
2. Preshaw PM, Alba AL, Herrera D,
Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012 Jan;55(1):21–31.
3. Dhadse, P, Gattani, D, Mishra R. The
link between periodontal disease
and cardiovascular disease: How
far we have come in last two decades? J Indian Soc Periodontol. 2010
Jul;14(3):148–54.
4. Dominy SS, Lynch C, Ermini F,
Benedyk M, Marczyk A, Konradi A,
Nguyen M, Haditsch U, Raha D, Griffin C, Holsinger LJ, Arastu-Kapur S,
Kaba S, Lee A, Ryder MI, Potempa
B, Mydel P, Hellvard A, Adamowicz
K, Hasturk H, Walker GD, Reynolds
EC, Faull RL, Curtis MA, Dragunow
M, Potempa J. Porphyromonas
gingivalis in Alzheimer’s disease
brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019 Jan
23;5(1):eaau3333. doi: 10.1126/sciadv.
aau3333.
5. Choukroun J, Khoury G, Khoury
F, Russe P, Testori T, Komiyama Y,
Sammartino G, Palacci P, Tunali M,
Choukroun E. Two neglected biologic
risk factors in bone grafting and implantology: high low-density lipoprotein cholesterol and low serum
vitamin D. J Oral Implantol. 2014
Feb;40(1):110–4.
6. Krausß P, Deyhle M, Maier KH,
Roller E, Weiß HD, Cledon P. Field
study on the mercury content of
saliva. Toxicol Environ Chem. 1997
Sep;63(1–4):29–46.
7. Eggleston DW, Nylander M. Correlation of dental amalgam with mercury in brain tissue. J Prosthet Dent.
1987 Dec;58(6):704–7.
8. Danscher G, Hørsted-Bindslev
P, Rungby J. Traces of mercury in
organs from primates with amalgam fillings. Exp Mol Pathol. 1990
Jun;52(3):291–9.
Editorial note:
A list of references can be obtained
from the publisher.

About the Author
Dr Carla Schweer
IAOMT biological dentist and CAD/CAM
specialist

[29] =>

CR POSITION
Emilio Carlos Zanatta
DDS, MSc, PhD. Brazil
ezanatta@uol.com.br

HOW TO LOCATE, REGISTER, AND TRANSFER TO THE ARTICULATOR.

Stable temporomandibular joint (TMJ) allows stable occlusion. Thus, after the (TMJ) examination, the static and dynamic occlusion should be transferred
and analyzed with cast models in the semi-adjustable articulator.
Occlusal adjustment by addition, decrease, orthodontic treatment and/or orthognathic surgery should be based, such as cast models xed in the semiadjustable articulator in the Centric Relation position. The use of the anterior deprogrammer device, AFR-MiniReg (dentrade.com), relined with Polyvinyl
siloxane - PVS or stick compound is efcient and reproducible for this purpose.

The AFR - MiniReg technique, combines the deprogrammer device with the Gothic Arch. The lines inscribed in the graph represent the mandibular
movements in the horizontal plane and the vertex represents the mandible centered in relation to the maxilla. Thus, the position of the Centric Relation is
located.

This graphic recorded with the AFR - MiniReg
allows the dentist to capture the mandibular
position of centric and eccentric.
The wax of quality, shape and thickness can be
used with the MiniReg.
This is the Interocclusal record to x the lower cast
model in the Centric Relation position.
The AFR - MiniReg is not transferred to the cast
models.

The semi-adjustable articulator and the Interoclusal Record with the AFR
MiniReg offers:
1 Consistent data results for the complete use of the semi-adjustable
__.articulator.
2 Safety for the Dentist and the Dental Technician when carrying out the
__planning of each particular case.
3 The patient treated in this way will benet with well-being and comfort.

[30] =>

NEWS

Dental Tribune Middle East & Africa Edition | 4/2019

FEFU scientists may have found way
to grow new teeth for patients
By DTI
VLADIVOSTOK, Russia: A group of
histologists and dentists from the
Far Eastern Federal University (FEFU)
have collaborated with Russian and
Japanese colleagues and discovered
cells that may be responsible for the
formation of human dental tissue.
The findings could provide a basis
for the development of bioengineering techniques in dentistry aimed at
growing new dental tissue.
The scientists used human prenatal tissue to study the early stage of
development of the embryonic oral
cavity during the fifth and the sixth
week of tooth formation. They rec-

ognised several types of cells that
are involved in the formation of one
of the tooth rudiments, namely the
enamel organ. Additionally, they
identified the chromophobe cells
responsible for the development of
human teeth in the first weeks of
embryo growth.
“Numerous attempts to grow teeth
from only the stem cells involved
in the development of enamel, dentin and pulp, i.e. ameloblasts and
odontoblasts, were not successful:
there was no enamel on the samples,
teeth were covered only by defective
dentin. The absence of an easily accessible source of cells for growing
dental tissue seriously restricts the

development of a bioengineering
approach to dental treatment. To
develop technologies of tissue engineering and regenerative medicine,
promising methods of treatment in
dentistry, the cells identified by us
may become the clue to the new level of quality dental treatment,” said
Dr Ivan Reva, senior researcher in the
Laboratory for Cell and Molecular
Neurobiology at the FEFU’s School of
Biomedicine.
“Natural implants that are completely identical to human teeth will no
doubt be better than titanium ones,
and their lifespan can be longer than
that of artificial ones, which are guaranteed for 10–15 years. Although for a

successful experiment, we still have
a lack of knowledge about intercellular signalling interactions during the
teeth development,” he added.
The scientist noted that large chromophobe cells do not reside only
where the teeth of the embryo
form. They also exist at the border
where the multilayered squamous
epithelium of the oral cavity passes
into the cylindrical epithelium of
the developing digestive tube. This
means that the new bioengineering
approach is relevant not only for
growing new dental tissue but also
for growing organs for subsequent
transplantation and will probably be
applied in gastroenterology.

The scientists have yet to understand
how, in the earliest stages of human
embryo development, different
types and forms of teeth develop
from the seemingly homogeneous
and multilayered ectoderm which
is located in the forming oral cavity.
However, it is already clear that more
kinds of cells are engaged in the earliest stages of human tooth formation
than were previously supposed.
The study, titled “Embryonic development of human teeth”, was published in the March 2019 issue of the
International Journal of Applied and
Fundamental Research and is only
available in Russian.

Oral Health Foundation launches new
guidelines for denture adhesives
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By DTI
RUGBY, UK/VANCOUVER, Canada: The
Oral Health Foundation (OHF) has recently
published a new set of global science-based
guidelines for denture adhesives. The new
recommendations will combat the current
lack of guidance for complete denture wearers regarding the correct use of denture adhesives.
According to data from World Population
Prospects: The 2017 Revision, there are expected to be 2.1 billion people aged 60 years
or older in the world by 2050. This number
represents 16% of the expected population
and is triple the figure for this age group in
2010. Consequently, there will be a growing
need for denture adhesives, as older adults
are more likely to experience tooth loss. Denture adhesives or fixatives offer better retention and stability of dentures, improved
confidence and comfort, and reduction or
elimination of food debris beneath dentures.

“The current lack of guidance on the use of
denture adhesives may mean that denture
wearers are left confused,” said Dr Nigel Carter, OBE, Chief Executive of the OHF. “The evidence is clear; using an adhesive can provide
benefits for patients with best-fitting dentures both in terms of function, confidence
and comfort. These new guidelines will give
dental professionals the confidence to know
how and when to recommend denture adhesives for maximum patient benefit,” he
continued.
The new denture adhesive guidelines follow
on from previous advice on how to clean
dentures published by the OHF in August
2018. Together, they form a comprehensive
resource on complete dentures for dental
professionals, carers and denture wearers.
The guidelines were announced at the 2019
International Association for Dental Research General Session and Exhibition in
Vancouver in Canada.

A task force, which included experts from
the OHF, King’s College London and representatives from the US, Greece, Japan and
Switzerland, undertook a comprehensive
review of existing guidance for the best use

of denture adhesives. The panel found only
limited recommendations and guidance
available.

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Bearing in mind the ageing population around the world, experts from the Oral Health Foundation and
King’s College London, together with representatives from the US, Greece, Japan and Switzerland, have
recently reflected on the global need for advice for denture wearers.

[31] =>

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Basic practice management.
Module 3 | July 2020 (4 days) | Restorative Aspects of Implantology

Programme outline: restorative techniques, prosthetic hands-on training, patient treatment, follow-up and
oral hygiene, complications to avoid and treat. In depth practice management.

Diploma | 3 Modules | 12 Days

Module 4 | October 2020 (4 days) | Immediate and Early Loading Concepts and Treatment of the Resorbed Jaw

Programme outline: tooth now concept, immediate and early loading concepts from single tooth to fully
edentulous patients, severely resorbed jaws, sinus lift and ridge splitting techniques, hands-on training and
live patient surgical treatment.
Module 5 | January 2021 (4 days) | Medical Compromised Patient and Soft and Hard Tissue Management |
Aesthetic and Restorative Challenging Patient

Programme outline: medications related osteonecrosis, GBR techniques, soft tissue management, implant
aesthetics, ceramics and implants.
Module 6 | April 2021 (4 days) | Rare Complications and Techniques

Programme outline: rare complications, combination implants and teeth, live patient treatment, written and oral
examination and case presentations.

+971 528423659 | p.mollov@cappmea.com

www.cappmea.com/implant

[32] =>

NEWS

Dental Tribune Middle East & Africa Edition | 4/2019

Dr. Hassan Jassar (seated) tests out the new technology that helps a clinician better understand a patient’s pain.

By DTI
ANN ARBOR, U.S.: Management of
a patient’s pain during even the simplest of procedures can be difficult.
In a development that may one day
simplify the task, a team of scientists
from the University of Michigan
(UM) have created a technology to
help clinicians “see” and map patient
pain in real time, through special

augmented reality glasses. Although
it is still some years away from being
integrated into dental offices, the researchers believe the technology is a
good first step in the advancement
of pain management technology.
“It’s very hard for us to measure and
express our pain, including its expectation and associated anxiety,”

said Dr. Alex DaSilva, associate professor at the UM School of Dentistry
and Director of the Headache and
Orofacial Pain Effort Laboratory.
A portable clinical augmented reality and artificial intelligence (CLARAi)
platform combines visualization
with brain data using neuroimaging
to navigate through a patient’s brain

Technology may
help clinicians
“see” a patient’s
real-time pain
while in the chair. The technology
was tested on 21 volunteer dental
patients, and the researchers hope to
include other types of pain and different conditions in the future.

pain data to develop algorithms that,
when coupled with new software
and neuroimaging hardware, predicted pain or the absence of it about
70% of the time.

Patients wore caps fitted with sensors to detect changes to blood flow
and oxygenation. Their reaction
to cold when applied to their teeth
was then measured. While seated in
the dental chair, patients wore augmented reality glasses that allowed
the researchers to view the subject’s
brain activity in real time on a reconstructed brain template. According
to the researchers, they used brain

With CLARAi, practitioners could
begin to understand a patient’s pain
better while still remaining focused
on the procedure at hand. “Right
now, we have a one to ten rating system, but that’s far from a reliable and
objective pain measurement,” noted
DaSilva.

Children with autism often overlooked
for dental care
AD
By DTI
CHARLESTON, S.C., U.S.: Autism affects
a child’s social skills. Even simple tasks,
such as scheduling an appointment at a
dentist’s office, may often be a challenge
for children with autism spectrum disorder (ASD) and their parents. As a result,
by delaying or missing early dental appointments, children with ASD develop
an increased risk of dental caries and oral
infections that could impact their entire
body. They also miss out on the opportunity to develop a comfortable routine with
a dentist.
Dentably magazine recently ranked
South Carolina as one of the top states
where children with ASD have a high risk
of oral health problems. The ranking was
based on data obtained from the National
Survey of Children’s Health. The survey
reported that more than 90 percent of
children in South Carolina with behavioral and developmental disorders are not
receiving services like behavioral, occupational and speech therapy. Autism Speaks,
an advocacy organisation, lists behavior as
one of the most crucial things parents of
autistic children consider when thinking
about receiving dental care.
“Everybody deserves a dental home,” said
Dr. Cynthia L. Hipp, associate professor at
the Medical University of South Carolina
(MUSC). Hipp also works in MUSC’s Pamela Kaminsky Clinic for Adolescents and
Adults with Special Health Care Needs and
recalls going to great lengths to help patients feel more comfortable during their
visit, even doing dental examinations on
the floor or in cars. “You have to think outside of the box,” she said, while noting that
it may often require great patience to ease
a child’s fear of the dentist.
To facilitate the process, Hipp advises parents to contact a dentist before scheduling an appointment and to communicate

what makes their children feel comfortable. It may also help to familiarize children with the office prior to the dental
appointment, since it is important for
them to establish routines. Finally, there
are children’s books available for parents
to help them educate their children about
the visit.
Resistant or combative patients may require a higher level of emergency care.
Some dentists who are not familiar with
patients with autism may refuse to treat
them, Hipp explained. The Centers for Disease Control and Prevention has reported
that each year an increasing number of
children have been diagnosed with autism. “As our population is growing ... we
really have to train our future dentists,”
said Dr. Michelle Ziegler, Programme Director of Advanced Education in General
Dentistry and Division Director for Special
Care Dentistry at MUSC.
In a 2005 study of over 200 randomly selected dentists in Michigan, more than 60
percent agreed that dental school did not
prepare them for working with patients
with special needs. “I think it’s certainly
not been a priority for dental schools to
teach this,” Ziegler commented. Another
web-based survey published in 2010
found that the 22 U.S. and Canadian dental schools chosen for the study used a
vast number of approaches to educating
predoctoral students about the issue, but
reported curriculum overload as the main
challenge for implementing changes in
curriculum.

[33] =>

Mastership Programme
Lasers in Dentistry

Certiﬁcation Course

From Aachen Dental Laser Center &
RWTH International Academy - RWTH Aachen University & CAPP

DUBAI
AACHEN

Group 7
Registration Open

Prof. Dr. med. dent.
Norbert Gutknecht
DDS, MS, PhD
Germany

Dr. Dimitris Strakas
DDS, MSc, PhD
Greece

Dr. Miguel Rodrigues Martins
DDS, MSc, PhD
Portugal

Priv.-Doz. Dr. rer. medic.
Rene Franzen
Germany

Pathway to
German Masters
84 CME
& Daily Hands-on

One-year clinical specialisation course for selected wavelengths
Module 1 | 23-26 October 2019 (4 days) | Laser Safety, Laser Devices and Diode Lasers

Laser Safety Officer course | e-learning | Laser technique (Diode lasers) | High power Diode lasers (clinics) |
Scientific background and clinical indications | Skill training every day of every clinical indication | Patient treatments
(demonstrations)
Hands on: Pigmentation on soft tissue, gingivectomy and gingivoplasty, frenectomy, fibroma removal, crown
lengthening, depigmentation, endodontic procedure- canal irradiation performed on sheep heads | Patient treatments (demonstrations)

Module 2 | 11-14 March 2020 (4 days) | Module Erbium Lasers

Laser Safety Officer course | e-learning | Laser technique (Diode lasers) | High power Diode lasers (clinics) |
Erbium Lasers (clinics) | Laser technique (Erbium lasers) | Er:YAG and Er,Cr:YSGG | Scientific background and clinical
indications | Skill training every day of every clinical indication | Patient treatments (demonstrations)
Hands on: Preparation in enamel and dentine, generation of a retentive surface, canal decontamination, apicectomy,
soft-tissue cut with short pulses, soft-tissue cut with long pulses, open curettage, crown lengthening and bone
preparation performed on sheep heads. | Patient treatments (demonstrations)
Module 3 | 13-16 December 2020 (4 days) | Combined Wavelengths Therapy Concepts & Mastership Exams

Laser therapy concepts with the use of 2 different wavelengths | Written multiple-choice exam |
Oral Exam (presentation of 5 patient treatments cases with diode or Erbium lasers) |
Graduation Ceremony, after successful completion of an examination at RWTH Aachen University |
600 hours total workload | Over the complete course duration: case documentation & discussions
The programme targets dentists who would like to specialise in certain wavelengths. Over the course of one year, participants are taught fundamental physical
and technical knowledge, and how to recognise primary, secondary, and tertiary indications on 12 attendance days split into 3 modules held over 3 educational
blocks. This programme concludes with an official certificate of RWTH Aachen University, and is offered in collaboration with the RWTH Aachen International
Academy, the post graduate education wing of the University..

+971 528423659 | p.mollov@cappmea.com

www.cappmea.com/laser

[34] =>

NEWS

Dental Tribune Middle East & Africa Edition | 4/2019

Otago University opts for Dentsply Sirona
Over 210 Sinius treatment centers are ready for training
By Dentsply Sirona

Supporting workflow-oriented dental training

Professor Alison Rich, Dean of the
Faculty of Dentistry at Otago University, adds: “The fact that the Sinius
treatment centers are installed and
operational is an exciting milestone
because it demonstrates clearly that
we will be in our new facility soon.
We designed the clinics with a dedicated focus on people – patients,
students and staff – and thus chose
Dentsply Sirona’s Sinius treatment
centers.” The new building’s design is
tailored to modern dental processes

and workflows. Each bay offers adequate space for students, supervisors and patients. Every treatment
center is equipped with a host of services – including power, data, water,
drainage, compressed air, dental suction and a central dosing system that
cleans internal pipework.

Over 210 Sinius treatment
centers – completely digitised

Otago University opted for Dentsply
Sirona’s Sinius treatment centers
and additional equipment in the
context of an international call for
tenders in 2018. “Our offer met the
Faculty of Dentistry’s needs and enables all the services to be connected
to New Zealand standards” explains
Peter Rössling, Director Sales International Special Clinic Solutions at
Dentsply Sirona.
Each of the 211 Sinius treatment
center integrates various functions,
for example:
• The patient’s records as well as
digital x-rays and scans is displayed
chair-side at a screen.
• Digital impression systems – Dentsply Sirona’s CEREC Omnicam –take
dental images that are also accessible
via the chair-side screen.

• A digital self-cleaning system ensures stringent infection control
standards.
Dentsply Sirona’s VIONEX software
solution connects all Sinius treatment center. So, their functioning
can be monitored centrally via the
Internet to immediately identify and
address maintenance needs.
“The Sinius treatment centers are
designed specifically for the Otago
University’s requirements to fit perfectly to several areas of applications
– for example in terms of general
dental care as well as orthodontics,
special care and pediatrics”, summarizes Joerg Vogel, Vice President Sales
International Special Clinic Solultions at Dentsply Sirona. Prior to the
installation of all Sinius treatment
centers, the Faculty of Dentistry performed rigorous tests with a sample
unit in the mock-up of a typical clinic
treatment bay to ensure that the
real-life set-up would work for staff
and students.

installed the Sinius treatment centers on behalf of Otago University.
The project team comprised internationally trained technicians from
Germany and experts from a local
medical engineering company who
went through an intensive training
at Dentsply Sirona’s production site
in Bensheim, Germany, earlier.
They installed the entire dental
equipment including:

New Zealand’s dental students and
patients are about to benefit from
an entirely new-built dental teaching
facility at Otago University (Dunedin
campus). As one of the last steps of
this demanding construction project, Dentsply Sirona provided experienced trainers from Germany and
Australia to teach the so-called super-users how to work with the new
Sinius treatment centers. Mid-March
2019, they learned to use the full capability of the state-of-the-art treatment centers and their associated
equipment. Henceforth, the qualified super-users will run on-going
training sessions with small groups
of the dental faculty’s staff and students to prepare them for putting
the building into full operation in
April/May 2019. The completion of
the new training facility is the first
part of a two-phase building project
with a total volume of 130 million
New Zealand dollars.

Building up a dental training facility from the scratch – this ambitious
project is nearing completion at Otago University’s Faculty of Dentistry
in New Zealand. Mid-March, 2019,
so-called super-users have started
their training with the over 210
Sinius treatment centers that Dentsply Sirona installed on the University’s Dunedin campus by the end of
2018. Dentsply Sirona accompanied
through the final steps by providing
high-quality trainers from Germany
and Australia.

• 211 Sinius treatment centers in
eight different configurations,
• 33 intra oral imaging systems (Heliodent Plus) as well as Orthophos 2D
and 3D extra oral imaging systems
and
• 2,000 instruments.
Besides the specialty and teaching
clinics, the new building will house
the Otago University’s Primary
Care Unit, radiography and surgical
suites. It belongs to a two-part building complex that includes the Walsh
Building which has been used hitherto for the new training facility’s
purposes. Following its refurbishment, the Walsh Building will serve
for research laboratories, academic
offices, student support, and teaching laboratories.

Successful conclusion of an
ambitious installation project
By the end of 2018, Dentsply Sirona

Tipton Training awarded Royal College of
Surgeons of England accreditation
By Tipton Training
The Royal College of Surgeons of
England have awarded Centre Accreditation to Tipton Training for its
Courses in UK and Ireland. With this
Tipton Training becomes the first
private post graduate dental education provider in UK to have an RCS
England accredited center. The provisional accreditation conferred on
Tipton Training in December 2018
and was ratified by the RCS Council
on the 13th of June 2019.
This means that, in addition to the
valuable skills a Tipton Training

course delivers, delegates can be rest
assured of the quality of education
and methods of training has been
reviewed by the best in the industry.
The entire Level 7 Course portfolio
successfully meets the criteria and
standards for accreditation.
To achieve accredited status, Tipton
Training underwent a comprehensive review from RCS senior figures,
including Professor Michael Escudier (Dean of the Faculty of Dental Surgery), Vanita Brookes (Board
Member), Dr Selina Master (Board
Member), along with Salim Nazir
(Head of Quality Assurance and Ac-

creditation). Specifically, areas such
as Facilities, Resources and faculty,
Education portfolio and Infrastructure and quality management processes were assessed.

hours delivered by Tipton Training
will be RCS England Accredited
2. Course completion certificates and
Enhanced CPD certificates will carry
the RCS England Logo

Senior management from Tipton
Training – including Professor Paul
Tipton (Clinical Director), Vivek
Gupta (CEO) and Les Pringle (Head of
Course Operations) – also discussed
course development and delivery,
decision-making processes and general management.

“With this RCS accreditation, our delegates can rest assured that Tipton
Training courses are of the very highest standards. Becoming the first RCS
England accredited private dental
education center in UK, is exciting
but also reinforces our commitment
to quality dental education that adds
real clinical skills.” explains Vivek
Gupta, CEO of Tipton Training.

As a result of this accreditation:
1. Going forward, the Enhanced CPD

“Our Postgraduate Certificate and
Diploma courses also have Level 7
(Masters Level) status. This means
that Tipton Training alumni possess
a real advantage when applying for
competitive positions, or when looking to expand the range of treatment
options for their practice patients.”

[35] =>

GUIDED BIOFILM
THERAPY
R

MAKE ME SMILE.

[36] =>

www.celtra-dentsplysirona.com

CEREC® CAD/CAM Solutions

Designed to simply work better together
Celtra® Duo (ZLS) blocks, Prime&Bond universal™ Adhesive, and Calibra® Ceram Cement
were designed to enhance and strengthen the individual benefits each of them
provides, resulting in an easy-to-use system that streamlines the restoration process.
Celtra Duo (ZLS) blocks
• Restoration longevity of Celtra Duo (ZLS) is ensured when used with
Prime&Bond universal Adhesive and Calibra Ceram Cement
• Firing is optional: choose either fire and seat or polish and seat
Prime&Bond universal Adhesive
• No need to use a self cure activator when used with Calibra Ceram Cement
• Low film thickness to allow passive seating of the crown
Calibra Ceram Cement
• One-step curing when used with Prime&Bond universal Adhesive
• 10-second tack cure window and 45-second gel phase ensures an easy, no-stress cleanup

[37] =>

NL
Y
O
LS
NA
IO
SS
FE
O
PR
NT
AL
DE

www.dental-tribune.me

Published in Dubai

July-August 2019 | No. 4, Vol. 9

Project for improved
root canal therapy launched
By DTI

this IPUCLEAN joint research project
is the development of a piezoelectric
ultrasonic cleaning system to support root canal therapy with rotating super-elastic files made of shape
memory alloys.

ROSTOCK, Germany: In Germany,

Research teams from Rostock, Dresden, Leipzig and Lemgo in Germany
have begun a new project aimed at
improving root canal therapy. Sponsored by the German Federal Ministry of Education and Research’s
(BMBF’s)
funding
programme
Twenty20—Partnership for Innovation, and the smart3 consortium,
members of the medical faculty at
the University of Rostock and the
Fraunhofer Institute for Ceramic

about 7.5 million root canal therapies
are carried out annually. With the
help of an innovative system, it may
soon be possible to carry out ultrasonic preparation of the root canal
and to monitor the condition of the
file during treatment. In addition,
protection against thermomechanical overloading will prevent the instrument from breaking.

In Germany, about 7.5 million root canal therapies are carried out annually

Technologies and Systems are working together on the project.
“We are pleased to have strong part-

ners at our side in this project and
are working very closely and in an
interdisciplinary way with them.
We are counting on great benefits

for our patients,” emphasised Prof.
Emil Reisinger, dean and scientific
director of the medical faculty at the
University of Rostock. The aim of

“The joint project is intended to improve the treatment process and
patient safety during root canal
therapy in the medium term—at the
same time ensuring and increasing
the quality of the treatment results
achieved,” said Prof. Rainer Bader,
head of the FORBIOMIT research
laboratory for biomechanics and implant technology at Rostock University Medical Center.
The project is being funded by a
BMBF grant of more than €1 million.
The research is being supported by
Komet Dental, Werner Industrielle
Elektronik and Zahntechnik Leipzig.

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.

[38] =>

ENDO TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

Strategies for the treatment of extremely
curved root canals
By Dr Bernard Bengs, Germany
One of the major challenges in endodontics is the enormous complexity
of root canals. Among other things,
a large number of difficulties must
be overcome in terms of the number, position, possible branches and
curvatures of the canals. Case studies are used to demonstrate how
predictable treatment results can be
achieved in adverse anatomies too.
The aim of root canal preparation
is the complete removal of all vital
and necrotic tissue, infected canal
wall dentine, foreign matter and root
filling material. Adequate chemical
disinfection should be made possible and shaping should allow wall-towall obturation of the canal system.
As early as 1974, Herbert Schilder
published guidelines on this topic,
which have virtually remained unchanged, including the creation of
a continuously conical canal shape
from the access cavity to the apex,
respecting the course of the root canal and maintaining the position of
the apical foramen at a size as small
as practicable.1

Fig. 1: Pre-op radiograph of tooth #25

In the presence of very pronounced
curvatures, espeially abrupt or even
S-shaped (i.e. double) curvatures, it
can prove extremely difficult to implement these guidelines. The angle
of curvature is not the only factor
here; the length of the distance after the curvature is also decisive for
the demands on the instruments. As
the degree of difficulty increases, the
risk of step formation, splinting and
instrument fracture quite naturally
increases.

In vital cases, the size of the preparation may be more moderate than in
cases of pulp necroses or revisions,
as less removal of dentine will be
required here. Ultimately, of course,
the treatment size should be determined by apical gauging (apical
measurement). As this is only practicable to a limited extent in the case
of very extreme, even opposing
curvatures, even more attention
should be paid to tactile feedback
during instrumental canal preparation. Sufficient preparation is always
required for root canal irrigation
and subsequent obturation so that a
shape of at least size 30.04, or better
of size 30.06 or 35.06 (rarely larger in
the case of strong curvatures), which
is usually required in extreme cases,
must be prepared manually using
the step-back technique. Otherwise,
it will not be possible to achieve sufficient disinfection and filling of the
root canal.

Treatment planning

Notes on preparation

Initial information is provided by the
preoperative radiographic image. In
complex anatomies, such as those
that often occur in the posterior region, a CBCT scan provides valuable
information on 3-D curvatures and
the confluence of canals.2 This information is extremely important for
treatment planning, as it allows the
clinician to determine a strategy regarding the instruments to be used
and canal preparation in advance.
For example, very narrow, strongly
curved roots should, if applicable, be
prepared with a smaller ISO size or a
slimmer taper, since even very flexible nickel-titanium (NiTi) file systems
become significantly stiffer with increasing dimensions, which entails
unwanted transportation or even
strip perforations as risks. Each case
should be considered individually to
allow sufficient removal of infected
tissue without risking unwanted excessive removal of dentine.

Fig. 6: The master point image

The preparation of an optimal primary and secondary access cavity is
extremely important, particularly in
the case of strong curvatures. Therefore, a most straightline access to the
canal system is very important, as
otherwise steps or blockages are created right at the beginning of treatment that can only be corrected with
great difficulty.
First, the course of the canal should
be probed with an ISO size 6, 8 or 10
scouting file, if necessary, after coronal pre-flaring with an orifice shaper
or Gates–Glidden drill. Irrespective
of the file system used, the preparation of a glide path is essential for
safe canal preparation. Particularly
in the case of strongly curved, narrow canals, the use of rotary NiTi
glide path files is not only less prone
to complications than with manual
instruments, but also more comfortable. The gliding space created allows

Fig. 2: Trepanation

Fig. 3: The untwisted PathFile after use in the canal.

Fig. 4: Radiographic measurement

Fig. 5: The HyFlex CM file sequence

a significantly lower-risk use of the
following rotary NiTi files for canal
preparation.3
The point of confluence of canals
represents a special case of curvature, as this often occurs particularly
abruptly. It, therefore, makes sense,
for example in the case of two canals
in the mesial root of a mandibular
first molar, to initially prepare only
one canal fully to its working length.
This will often be the mesiolingual
canal. To determine the confluence,
a gutta-percha point is then positioned in the prepared canal and a
Kerr file is inserted into the other
canal. The marking of the instrument tip in the gutta-percha point
determines the length up to which
the second canal must now be prepared. This avoids risky stressing of
the instruments, as well as the unnecessary removal of dentine. Furthermore, the chemical preparation
of the canal system is an indispensable part of the preparation, since
only part of the canal wall surface is
addressed during mechanical preparation.

Figs. 7 & 8: Root canal filling and check of tooth #25

Case 1: Pulp necrosis in an S-shaped
canal
In November 2013, a 46-year-old
emergency patient with acute symptoms of tooth #25 presented. The
tooth had been restored with a ceramic inlay, the sensitivity test for
cold was negative, and the tooth was
sensitive to percussion and pressure.
The preoperative radiograph revealed periapical periodontitis (Fig.
1). The diagnosis was pulp necrosis
after a previous preparation close to
the pulp. The inlay was removed and
an adhesive pre-endodontic buildup was fabricated from composite.
During trepanation, pus drained
from the canal entrances. Working
length was then determined, followed by initial preparation with
Kerr files up to only ISO size 8, for
time reasons, together with intermittent irrigation with heated 6%
sodium hypochlorite (NaOCl). Subsequently, a drug deposit was inserted by rotating in Ledermix. Owing to
the small preparation size, the use of
calcium hydroxide would only have
been possible to a limited extent.
Root canal therapy was continued
approximately six weeks later: after
anaesthesia and placement of a rub-

ber dam, tooth #25 was trepanned
under the microscope (Fig. 2). The
glide path was first prepared manually with C+ Files of ISO sizes 6 and 8
(Dentsply Maillefer), then mechanically with PathFiles of size 13, 16 and
19 (Dentsply Maillefer). The more
flexible HyFlex Glidepath files (COLTENE) were not yet available at the
time of treatment. A detailed image
of the brand-new PathFile illustrated
how extremely the S-shaped canal
configuration had stressed the rotary NiTi instruments after a single use
(Fig. 3). It depicted the plastic deformation of the instrument, a clear indication that this instrument could
only withstand the requirements
with good fortune. A fractured instrument would certainly have been
within the realms of possibility.
After radiographic confirmation of
the working length, the canals were
prepared with the HyFlex CM (controlled memory) NiTi files (COLTENE;
Figs. 4 & 5). The following sequence
was used: 15.04, 20.04, 20.06, 25.04,
25.06, 30.04 and 30.06. Intermittent irrigation was again per- formed
with heated 6% NaOCl.

ÿPage A3

[39] =>

ENDO TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

◊Page A2
Taper hand files S1 and S2 (Dentsply Maillefer),
which were prebent with the Endo-Bender
(Kerr). Rotary preparation was performed with
the HyFlex CM.
In this case, the following sequence was used
with ascending sizes and tapers: 15.04, 20.04,
20.06, 25.06, 30.04, 30.06 and 35.06. The path
of the canal was manually expanded intermittently with prebent ProTaper hand instruments F1 to F3 and then perfectly shaped with
the corresponding rotary HyFlex files, as the
instruments were stopped in the mesial root
by the speed limiter of the endodontic motor
owing to the extreme curvature. The entire
preparation was performed under intensive
irrigation with heated 6% NaOCl. In addition,
an ultrasound-activated final irrigation with
17% EDTA and NaOCl was performed three
times for 20 seconds. After the master point
try-in, the root canal was obturated vertically
with warm gutta-percha using the modified
Schilder technique (Figs. 16–18). Tooth #37 was
sealed adhesively with a glass-fibre pin and
composite (Fig. 19). Postoperative radiographic
con- trol after one year and approximately 4.5
years showed continued uneventful apical
conditions (Figs. 20 & 21).

Figs. 9–11: Pin check and post-op check after one year and 4.5 years, respectively

Discussion

These cases demonstrate that the safe preparation of even extreme curvatures is predictable
Fig. 12: Preoperative radiograph of tooth #37

Fig. 13: The opened pulp

Figs. 15 & 16: Radiographic measurement and master point image

Fig. 14: Removal of the coronal pulp

Figs. 17 & 18: Root canal filling and check of tooth #37

owing to the use of highly flexible instruments
such as the HyFlex CM.4

Figs. 19–21: Pin check and post-op check after one year and 4.5 years, respectively

After apical gauging, the final
preparation was performed in
steps of 0.5 mm from ISO size 35 to
ISO size 60 using manual NiTi Kerr
files in the step-back technique for
safety rea- sons. Thus, a cone of ten
was created in the apical region.
Although possible in principle, the
use of a 35.06 HyFlex CM was deliberately abstained from, as while
these instruments offer high
flexibility in general, the stiffness
might still have been too great for
the S-shaped course of the canals.
Finally, irrigation was performed
with a 17% EDTA solution and 6
% NaOCl, activating the irrigation
liquids by ultrasound.
After the master point try-in with
configured gutta-percha points,
warm vertical root canal filling
was performed using the modified Schilder technique (Figs. 6–8).
The tooth was sealed adhesively
with composite and a glass- fibre pin (Fig. 9). Postoperative radiographs after one year and 4.5
years, respectively, showed the
complete healing of the extensive
osteolysis (Figs. 10 & 11).

Figs. 22 & 23: HyFlex Glidepath files and HyFlex EDM 10.05 Glidepath file.

Case 2: Pulpitis aperta of tooth #37
A 46-year-old patient presented
with pulpitis complaints regard-

ing tooth #37 in October 2013. The
tooth had been restored with a
partial gold crown, and the marginal seal was incomplete (Fig. 12).
After local anaesthesia, the restoration and the cement build-up
were removed. Underneath was
the opening of the pulp chamber
(Fig. 13). The diagnosis was pulpitis aperta. First, an adhesive, preendodontic composite abutment
was created under rubber dam
isolation. At the same time, the
coronal pulp was removed during
trepanation of the pulp chamber
(Fig. 14). As pain treatment, Ledermix was applied as a drug owing
to the time limitation, and the
tooth was closed adhesively with
composite.
Further treatment was performed
in one visit in December 2013. After local anaesthesia, the drug was
removed and the course of the canal was probed with C+ Files of ISO
sizes 6, 8 and 10 under control of
an endodon- tic motor. The radiographic confirmation of the working length showed a pronounced,
abrupt curvature of the canals in
the apical third of the mesial root
(Fig. 15). The glide path was prepared with PathFiles of sizes 13, 16
and 19, then expanded with Pro-

Meanwhile, additional instruments have become available in sizes 15.01, 15.02 and 20.02, as
has HyFlex EDM size 10.05, which are superior
to the files used at the time in terms of material properties and thus offer greater safety in
difficult cases (Figs. 22 & 23).5 Furthermore, it
can be seen that hybridisation with manual
instruments can be helpful or even necessary
to minimise the risk of fracture and to control
abrupt curvatures. The file sequences used are
of course material-intensive, especially since
the files were discarded after use in each patient case. This procedure is costly, but offers
the best possible safety to avoid cross-contamination and instrument fracture.

Conclusion

The postoperative radiographic checks after
several years proved that even very complex
anatomies can nowadays be treated safely, predictably and sustainably with suitable instruments. For the patient, this implies the longterm preservation of the natural dentition,
even in challenging cases.
Editorial note: A full list of references is available
from the author.
This article was originally published in rootsinternational magazine of endodontics, Issue
4/2018.

About the Author
Dr Bernard Bengs
is a specialist in endodontics certified by the German
Society of Endodontology and Traumatology.
Voxstraße 1, 10785 Berlin, Germany
He can be contacted on dr.bengs@gmx.de

[40] =>

WaveOne® Gold

Now with WaveOne® Gold Glider

Surf the canal
with confidence
WaveOne® Gold offers you the simplicity of a one-file
shaping system combined with higher flexibility* to respect
the canal anatomy. Now available with a corresponding glide
path file to optimize your shaping preparation. Experience
the feeling of confidence throughout your treatment.

*compared to WaveOne
© 2018 Dentsply Sirona, Inc.

Rx Only

ST8/ B EN W1G0 ADV 000 / 03/2017 – updated 04/2018

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www.dental-tribune.me

July-August | No. 4, Vol. 9

SS White introduces
Great White carbide lab burs
By SS White

and lower instrument cost. With optimal material reduction, the laboratory cutters produce a high-quality
surface ﬁnish, which helps reduce
remakes,” reported Miles.

COLOGNE, Germany: When choos-

For increased performance and durability in laboratories, SS White recently introduced its Great White Lab
Series Carbide Burs, with a patented
proprietary zirconium nitride coating to increase the surface hardness
of the bur and create an extremely
efﬁcient cutting instrument. According to Brant Miles, Director of Business Development at SS White, the
Great White laboratory burs offer up
to ten times increased durability and
longevity compared with products
not coated with zirconium nitride.
With a tungsten carbide head, the
burs cut a multitude of different
dental substrates, and a stainless-

ing a dental bur, the options seem
endless, even for specialty burs like
those designed for laboratory applications. The needs and requirements
of dental laboratories have changed
signiﬁcantly over the past ten years,
and today’s laboratories cut everything from plaster to titanium and
require a product that offers great
efﬁciency.

For increased performance and durability in laboratories, SS White recently introduced its Great White Lab Series Carbide Burs with a
patented proprietary zirconium nitride coating

steel shank reduces unnecessary
wear to the handpiece. The burs are
abrasion-resistant, reducing surface
heat and vibration for a cooler and
more consistent surface ﬁnish.
With the versatility to cut all types of
materials, the Great White laborato-

ry burs are available in cross-cut and
spiral-ﬂuted blade conﬁgurations in
a variety of shapes, sizes and grits.
Dental professionals can choose the
correct instrument for all applications, whether for bulk reduction,
adjusting or ﬁne ﬁnishing on all dental materials, including stone, acrylic,

SS White invites anyone interested
in adding Great White carbide laboratory burs to their SS White product line or becoming an SS White
dealer to contact International Director of Sales Michael Schwartz at
mschwartz@sswhitedental.com. By
partnering with SS White and representing the 175-year-old brand, dealers will benefit from:
•
a differentiated restorative and
endodontic full product line
•
world-class quality
(ISO 13485:2003)
•
preferred pricing commitment
•
industry leading delivery times
•
full sales and marketing support.

precious and non-precious metal, or
any other material used in the dental
laboratory.
“The Great White Lab Series burs offer excellent value owing to their
industry-leading cutting efﬁciency,
which leads to increased service life

For more information can be found at
www.sswhitedental.com

New 3Shape Dental System 2019
software now available
COPENHAGEN, Denmark: 3Shape
has announced the release of the
2019 version of its industry-leading
design software for laboratories. The
new and improved 3Shape Dental
System 2019 includes significantly
enhanced solutions for designing
and producing dentures, splints and
clear aligners, as well as improvements to core workflows.
“3Shape Dental System 2019 enables
labs to do what they love, creating
great aesthetic and functional dental art,” said 3Shape Vice President
for Product Strategy Rune Fisker. He
added, “With every new 3Shape Dental System software release and as a
part of our 3Shape LabCare promise,
we develop stronger software with
increased productivity and new opportunities for labs to expand their
business and unleash their potential.”
Powerful advancements to 3Shape’s
denture design software and new developments in materials and manufacturing allow for higher profit margins for laboratories when producing

dentures digitally. The new features
of teeth-in-blocks, optimised try-in
denture workflow, and improved
TRIOS integration and alignment
reduce labour time, production costs
and improve efficiency.
Clear Aligner Studio enables laboratories to expand their offerings
with clear aligners. The new version
of Clear Aligner Studio brings 20–40
per cent efficiency gains to the setup and staging of clear aligners and
includes new automated features,
such as ID tagging, attachment sizing
and placement.
3Shape Splint Studio enables laboratories to easily produce splints, night
guards, protectors and similar dental
appliances with just a few clicks. It is
important to note that 3Shape Splint
Studio has not yet been approved by
the Food and Drug Administration
in the US.
Globally renowned certified dental
technicians Przemek Seweryniak
and Kate Brantvik have created a
complete set of new smile libraries for 3Shape Dental System and
3Shape Smile Design. The smile li-

braries are based on real people’s
smiles and are included in a corresponding coffee table book meant
for patients and dental practices. Patients can leaf through the book and
choose a desired smile. Laboratories
can then create the restoration chosen from the book using the matching library in 3Shape Dental System.
Additionally, 3Shape Dental System
2019 is now up to ten times faster in
starting new cases, re-opening previously designed cases, and importing
and exporting material settings. The
system now offers design proposals
with just one click—for example,
for beautiful gingivae for implant
bridges. There is also a new advanced
function using the patient’s real jaw
motion.
Speaking about the new Dental System software, 3Shape co-founder
Tais Clausen remarked, “Dental System 2019 is for labs of all sizes that
want to stay ahead in a changing
industry. And dentistry is indeed
changing. More and more dentists
want to enjoy the efficiency and
improved patient experience enabled by intraoral scanners and 3D

By DTI

3Shape Dental System 2019 adds more features to software for laboratories.

software for diagnostics and treatment. Labs can play a key role in this
change because the digital dentist
needs a strong digital partner—a lab
they can work with to realize the full
potential of today’s technologies.
“Labs are also seeking partners. Many
labs work closely with expert design
services, milling centers and 3D print

providers to ensure that they can fulfill their customers varied demands.
The open system philosophy behind
Dental System will enable you to
work directly and seamlessly with
the industry’s strongest providers.”

[42] =>

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

inLab software update 19.0: organise and
link digital processes efﬁciently
New Connect Case Center Inbox for all dental lab oratories

By Dentsply Sirona
The broad range of indications and
the easy to use software interface
make Dentsply Sirona’s inLab CAD/
CAM software a central component
of the digital workﬂow in many laboratories. The brand new inLab software 19.0 update offers more design
options, better efﬁcient organization
of production and enhanced networking with the dental practice.

inLab users still beneﬁt from the
ability to receive digital impressions
and order data transmitted through
Connect Case Center, formerly Sirona Connect, directly within the
inLab software. The Connect Case
Center Inbox is a new feature. This
standalone application gives labs
that also, or only, work with other
CAD/CAM software ﬂexible access
to digital impression data that has
been generated from a CEREC digital
impression unit, such as Primescan
or Omnicam. For further processing
in the preferred laboratory software,
the Inbox not only generates the
inLab format, but for the ﬁrst time,
also the dental project format validated for exocad®, providing model
and case data, color information and
preparation margins. Other common open data formats, such as STL
and OBJ, are also available. Further
functions can also be used, such as
multiple downloading for the storage of cases in predeﬁned work folders and linking to laboratory management software.

The continuous development and
optimization of the inLab software
strengthens professional application
opportunities for more productivity in the laboratory. The inLab CAD
SW 19.0 Model App now allows laboratories to use both nt-trading and
ELOS Medtech model analogs when
designing implant prosthetic cases.
Furthermore, Atlantis® Core Files
that are received can now be made
into a model, under consideration
of the appropriate abutment geometry, so that an analog model is not
required for such cases.
The cooperation between Dentsply
Sirona and exocad®, which was announced earlier this year, represents
a synergistic partnership that beneﬁts the dental laboratory. exocad®
users can now take advantage of
a validated workﬂow that utilizes
Dentsply Sirona’s high-precision
extraoral scanner, the inEos X5. This
workﬂow enables a case to be created
in exocad®, then scanned with inEos
X5 from inLab software version 19.0
or higher, and designed with the exocad® software* in a fully integrated
workﬂow.

The Connect Case Center Inbox is
subject to license, but customers
who upgrade to inLab software 19.0
will receive it for free with the current update. The application can be
used on a separate Windows PC, independently of an inLab PC. For the
ﬁrst time, the inLab software 19.0 is
also available for download (search
‘inLab software 19.0’ online). As usual, the inLab software update 19.0 license (CAD and CAM) can be ordered
from specialist retailers.

inLab CAM software with
new process options

inLab CAM software 19.0 provides
even more efﬁcient production processes, particularly when used with
the 5-axis inLab MC X5 grinding and
milling unit. For the ﬁrst time, inLab
CAM 19.0 contains an analysis tool
that ensures a high-level of reliability by providing a production simulation that previews the ﬁnal production, on the basis of positioning,
sprueing and tool conﬁguration. The
thickness of the walls of the object
can also be tested before processing.
For the manufacturing of Dentsply
Sirona Digital Dentures, the software
update offers freespace milling of
the Lucitone 199 Denture Base disk

the provides easier access for the lab
technician when bonding Portrait
IPN Denture Teeth in place. Furthermore, 35mm disks in height (of all
material classes) can now be processed in the inLab MC X5, including
Lucitone 199.
In the case of restoration data from
other CAD software, tool-compatible
machining of the ﬁtting surfaces is
also possible with the inLab production machines. The inLab MC X5 can
now also be used to produce crowns
with screw access channels from

grinding materials using the wet
grinding process, e.g., Celtra Duo, for
the manufacture of implant-based
restorations.
Be it seamless inLab system integration with automatic data transfer or
the import of open data: regardless
of which CAD data basis is used, the
inLab CAM software has an intelligent query system, and guides the
user safely through the manufacturing process depending on the type
of restoration. In addition, the extended validated construction info

interface with exocad® enables restoration data to be conveniently imported into the inLab CAM software
for the ﬁrst time in a compatible format, where it can be processed with
inLab MC X5 or inLab MC XL.*
The new Cercon® xt ML disk from
Dentsply Sirona – the extra translucent zirconia with a natural color
gradient for high-quality esthetic
results – has also been validated for
production with inLab MC X5. It can
be selected directly in the inLab CAM
19 software or higher going forward.

*Available from exocad® 2.3 Matera.
Availability may differ between exocad® sales partners – please direct your
inquiries to the respective sales partner.
You will find a list of the authorized exocad® sales partners at exocad.com/ourpartners/reseller

11th Dental Facial Cosmetic Conference
HANDS-ON COURSE
LECTURE

with Mike Prosperino, Italy

Dental Technicians
Supernatural
CAPP Training Institute
Dubai | UAE

07 November 2019
Friday-Saturday

Mike Prosperino
Italy

Full Ceramic Restoration:
The Art Meet Layering
Ceramic Restoration
InterContinental Hotel | DFC
Dubai | UAE

08-09 November 2019
Friday-Saturday

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Published in Dubai

July-August | No. 4, Vol. 9

www.dental-tribune.me

Study introduces new surgical guide for
placement of zygomatic implants

of zygomatic implants requires surgical experience owing to the close
proximity of vital anatomical structures. It used methods of superimposition that illustrated satisfactory
correspondence between inserted
implants and the virtual plan. No
adjacent vital anatomical structures
were damaged. The novel surgical
guide design afforded the surgeon
visual control of the drilling protocol.
Positioning the guide in close proximity to the entry point of the zygomatic body aided control of the drills
up to the vicinity of the exit point,
significantly limiting problems associated with angular deviation.
The researchers concluded, “Reducing errors and complications is essential for zygomatic implants to remain a viable treatment alternative,
and further research on a guided approach to their placement is encouraged.”

For more than 20 years, the use of zygomatic implants has been demonstrated to be a predictable and safe alternative treatment modality for complex dental restoration in the
maxilla and has exhibited a high rate of success.

By DTI
BOLOGNA, Italy/FORT LEE, N.J., US:
Dental patients who show a deficiency of bone volume cannot be treated
with root-form dental implants.
Thus, new treatment modalities
were sought for these patients. One
of the therapies considered was the
placement of zygomatic implants,
which were introduced to the market over 20 years ago. A recent study

has investigated a novel protocol
for the placement of zygomatic implants using a specific surgical guide.
The protocol relied on large field of
view CT/CBCT scan for an accurate
assessment of the maxillary arch to
plan zygomatic implant receptor
sites. A CT/CBCT-derived surgical
guide of a novel design and an exact
replica of the entire maxilla and zygomatic bone were fabricated using

3-D printing technology. Four patients with completely edentulous
maxillary arches received a total of
ten zygomatic implants.
To evaluate whether the actual surgical placement of the zygomatic
implants matched the computerised
planning and simulation, the preoperative positions were compared
with the postoperative positions
by merging the pre- and postopera-

tive scan data sets. The degree of accuracy of the superimposition was
measured utilising sophisticated
software. Apical, coronal and angular deviations were determined for
each implant. Deviations from the
computerised project to the actual
implant positions ranged from 2
mm to 3 mm, and angular deviations
ranged between 1.88° and 4.55°.
The study found that the placement

The study, titled “Computer-guided
approach for placement of zygomatic implants: Novel protocol and surgical guide”, was published in the June
2019 issue of Compendium.

Implantology Master Study Club Session:
“Advanced Treatment of the Severely Resorbed Jaw Lecture &
Your Own Implantology Cases Discussion and Guidance.”
Aimed at clinicians who are experienced of placement of implants and who wish to expand
their expertise and discuss cases
Prof Göran Urde
Sweden

Prof Jonas Peter Becktor
Sweden

CAPP Training Institute
Dubai | UAE

05 September 2019
Thursday
18:00-20:30

www.cappmea.com/implantologymaster-study-club-session

[44] =>

IMPLANT TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

Straumann BLX implant
First human case study yields positive results for molar replacement
By Straumann
BASEL, Switzerland: Straumann is
pleased to report the very positive
results of the first human case study
to track the condition and progress
of a patient treated for a missing
molar with the new Straumann BLX
implant. Straumann BLX is a nextgeneration implant system that
combines an innovative design for
optimised stability with the company’s high-performance Roxolid metal alloy and SLActive surface and that
offers new levels of confidence—for
immediacy and beyond. Additionally, the improved usability in immediate protocols and simplified
surgical and prosthetic workflows
translate into higher treatment efficiency and shorter chair time for the
patient.
Dr Eirik Aasland Salvesen, a periodontist at Oris Dental in Stavanger
in Norway and executive director of
the Oris Dental Academy, was the
treating surgeon. One year ago, he

placed a Straumann BLX implant
into a healed mandibular first molar site and restored the implant
prosthetically through an analogue
workflow in the temporary phase
and digital workflow for the final restoration.

crown (Figs. 9 & 10). A stone master
cast was made in the laboratory, and
a temporary screw-retained PMMA
crown was manufactured over a
Straumann wide base temporary
abutment for the crown (Fig. 11) and
placed on to the implant (Figs. 12–14).

The patient, a 67-year-old non-smoking man without any relevant medical history, was referred to the office
with a missing tooth (#36) due to
persistent apical periodontitis. The
tooth had been extracted more than
one year prior to the procedure and
the molar site was well maintained
and fully healed (Fig. 1). A CBCT scan
showed that the patient had favourable bone availability (Fig. 2), on
which basis a one-stage placement
of a 5.5 × 10.0 mm Straumann BLX
implant was planned. After surgically installing the implant (Figs. 3–7),
Salvesen allowed the surrounding
soft tissue to mature and heal for six
weeks (Fig. 8). He then removed the
healing abutment to begin the prosthetic procedures for a temporary

After 12 weeks, Salvesen removed the
temporary crown, revealing that the
soft tissue had healed very well (Fig.
15). He then began the digital workflow. For the final crown, a digital impression was taken with a 3Shape intra-oral scanner, using a Straumann
CARES scan body. A monolithic
zirconia crown was then seated passively on to the implant in a healed
and preconditioned soft-tissue environment (Figs. 16–19).

Fig. 1: Panoramic radiograph confirming the well-maintained anatomical conditions one year after tooth extraction

One year after the treatment, the
patient reports complete satisfaction with both his chewing function
and the overall aesthetics (Figs. 20
& 21). Radiographs confirm that the
molar site is stable and healthy (Fig.
22). In this first human case, use of

Fig. 2: CBCT scan measurements
demonstrate availability of bone
of adequate height and width

Fig. 5: Surgical torque control instrument showing
theimplant in the final position and a torque value
of 35 N cm

Fig. 6: Radiograph confirming the seating of a healing
abutment of 6.5 mm in diameter and 1.5 mm in
gingival height

Fig. 10: Impression tray with impression post
retained

Fig. 11: Temporary PMMA
crown ona wide base temporary titanum abutment

Fig. 15: Extraordinary keratinisation pattern
visible when the temporary crown was
removed

Fig. 16: Monolithic zirconia crown on
wide base Variobase abutment ready
for placement

the Straumann BLX wide base implant delivered efficient and reliable
performance, even in soft bone with
early loading conditions.

The risks of previous
routine treatments

For many years, conventional fixed
bridges were considered routine
treatment for replacing a missing
single tooth, according to periodontist and oral surgeon Dr Christian
Rado Jarry of Straumann’s Global
Medical Affairs Department in Basel.
“However,” Jarry noted, “this treatment increased the risk of iatrogenic
endodontic damage during the
invasive preparation of otherwise
healthy, undisturbed teeth, which
decreased the survival of these teeth
over time.”
The use and success of dental implants for rehabilitating the partially
edentulous posterior jaw is well established. In addition to its high success rate, it leaves the adjacent teeth
undisturbed. That said, Jarry added,

Fig. 3: Implant being removed from the vial cap for
insertion into the osteotomy

Fig. 7: Healing abutment
in position, occlusal view

Fig. 12: Radiograph confirming the correct seating of the temporary crown – no gap visible

Fig. 17: Final crown in position, occlucal view

Fig. 8: Favourable softtissue healing after six
weeks

successful use of dental implants depends on optimal conditions of the
peri-implant tissue. To determine
implant dimensions, one must first
do a 3-D evaluation of the patient’s
bone condition and availability, a
key step for the long-term stability of
hard and soft tissue.

About single
molar restorations

The success of single molar restorations is influenced by factors such
as the clinician’s skills, arch morphology, proximity of adjacent
teeth, vertical access, anatomy and
patient-related limitations. Salvesen
noted that the use of wide implants
has been proposed as a successful
option, with survival rates similar
to those of standard-diameter implants.
While osseointegration remains the
basis for success, patients’ increasing

Fig. 4: Implant insertion with the handpiece at 15rpm

Fig. 9: Impression post engaged on to the implant correctly – no gap visible

Fig. 13: Temporary crownin position with the screw
access channel closed , occlusal view

Fig. 18: Final crown in position, lateral view

ÿPage C3

Fig. 14: Temporary crown
in a position with the screw
access channel closed, lateral view

Fig. 19: Radiograph confirming the correct seating of the final crown – no gap visible

[45] =>

IMPLANT TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

◊Page C2
An enthusiastic
response from clinicians

In total, more than 100 clinicians
have been working with BLX and
have documented their results. A
non-interventional
multicentre
clinical study, currently running,
specifically details the new implant’s
performance in the everyday practice setting.
Fig. 20: One-year follow-up
occlusal view

Fig. 21: One-year follow-up lateral view

expectations add new requirements
to the definition of success and failure. From a patient’s perspective,
success may be defined by not only
how functional and natural the outcome is, but also if the treatment re-

Fig. 22: One-year follow-up radiograph

quired fewer visits to the clinic.
“Clinicians increasingly are using
CAD/CAM materials and chairside
systems, as well as digital workflows,
especially for single-unit restora-

tions. This has been shown to allow
for cost-effective and efficient treatment protocols that improve patient
satisfaction,” added Jarry.

“The related feedback is extremely
positive,” said Dr George Raeber,
Head of Global Product Management for the Straumann Dental
Implant System. “An impressive
amount of clinical data is already
available as we begin to commercialise Straumann’s BLX. We sometimes
prefer to go to market a little bit later,
but with a rock-solid proposal.”

“When I work with immediacy,”
said Salvesen, “I want products that
provide me with peace of mind
in demanding clinical situations.
Straumann BLX implants with Roxolid and SLActive give me that confidence. BLX is exciting because it extends the treatment options we can
offer with Straumann products. It’s a
new era of implant treatment.”

Editorial note: The case study, titled
“Pristine function and aesthetics: Oneyear follow-up of molar replacement
with a new fully tapered implant system”, was published in Issue 1/19 of
EDI Journal.

Dental implants are medically advisable
for patients with Sjögren’s syndrome
By DTI
MALMÖ/GOTHENBURG, Sweden:
Up until now it was not known
whether dental implants were
successful in patients affected by
Sjögren’s syndrome. In fact, many
professionals advise against them,
as they believe these patients have a
higher risk of implant failure. However, researchers at the universities
of Malmö and Gothenburg in Sweden have found that dental implants
are a viable option for people with
Sjögren’s syndrome, even though
these patients may experience a
higher marginal bone loss around
their implants than others.
Sjögren’s syndrome is a systemic
disease characterised by the progressive destruction of some glands,
particularly those around the eyes

and mouth. “It is known to reduce
the saliva flow, resulting in a dry and
very sensitive oral mucosa. Patients
may more rapidly lose their teeth
caused by caries and periodontitis
compared with patients who are not
affected by this disease,” co-author
Dr Ann Wennerberg from the Department of Prosthodontics at Sahlgrenska Academy at the University of
Gothenburg told DTI.
“The very small amount of saliva
results in a lack of necessary lubrication,” continued Wennerberg. She
explained that this would cause
the patient soreness and pain. “For
patients with Sjögren’s syndrome
removable dentures may be impossible to wear,” she added. As a result,
many affected patients turn to dental implants.

The researchers conducted the study
in two parts. First, they reviewed a
clinical series of 19 Sjögren’s patients
who, together, had received 107 dental implants. Second, they conducted
a review of published literature and
assessed the cases of 186 patients
who had received a total of 712 implants, of which 705 were followed
up.
Through the clinical series, the researchers found that, out of 19 patients, two patients lost three implants, together, which led to a failure
rate of 2.8 per cent. All failed implants
were caused by a lack of osseointegration. The implants were followed for
a mean period of ten years. At the last
follow-up, the mean marginal bone
loss for patients was -2.19 mm. The research team estimated the marginal
bone loss after 30 years at 4.39 mm.

From the literature review, the researchers found that, out of the 705
implants—which were followed up
for approximately six years—29
failed, resulting in a failure rate of 4.1
per cent. After conducting statistical
analysis, researchers found that the
probability of failure was 2.8 per cent.

the results also demonstrate the
marginal bone resorption to be
higher than for patients without the
syndrome. This is indicative for the
need for regular control visits to the
dentist and short intervals between
appointments to a dental hygienist,”
concluded Wennerberg.

When stratifying patients based on
primary or secondary Sjögren’s syndrome, the researchers found that
those with primary disease had a
lower failure rate of implants of 2.5
per cent compared with patients
with secondary Sjögren’s syndrome.
These patients showed a failure rate
of 6.5 per cent.

The study, “Dental implants in patients with Sjögren’s syndrome: A
case series and a systematic review”,
was published online on 1 March
2019 in the International Journal
of Oral and Maxillofacial Surgery,
ahead of inclusion in an issue.

“The results show that a treatment
with dental implants can be done
with a good prognosis, in contrast
to what has been feared. However,

Long-term study investigates risk factors
for short dental implants
ANKARA, Turkey: The use of standard dental implants has become a
widely accepted treatment modality for the rehabilitation of complete
and partial edentulism. However, in
severe alveolar resorption, standardlength implant placement is not possible without additional surgical intervention. For such cases, the use of
short implants is considered a major
contribution to the field of implant
dentistry. Now, a recent study has
determined the risk factors for short
dental implant survival.
The study, conducted by the Ankara Yildirim Beyazit University in
Ankara, the Cumhuriyet University in Sivas in Turkey and a private
dental practice in Ankara, aimed to
identify the different implant- and
patient-related risk factors for longterm short dental implant success.
Through a retrospective chart review
of three centres, patient information
regarding demographic variables,
smoking habits, history of periodontitis and systemic diseases, and med-

ications was collected. In addition,
information was gathered relating
to the parameters for short implant
placement, including implant manufacturer, design, anatomical location, diameter and length, and type
of placement.

success at the implant and patient
levels.
These results support the use of
short implants as a predictable longterm treatment option; however,
smoking and a history of periodonti-

tis are suggested to be the potential
risk factors for short implant success.
According to the researchers, these
outcomes are consistent with the
findings of other long-term studies.

ated with short dental implant success: A long-term retrospective evaluation of patients followed up for up
to 9 years”, was published online in
Brazilian Oral Research on 11 April
2019, ahead of inclusion in an issue.

The study, titled “Risk factors associ-

For the statistical analysis, univariate regression models were used at
implant and patient levels. A total of
460 short implants—ranging from 4
to 9 mm in length—placed in 199 patients and followed up for up to nine
years were reviewed. Survival rates
of the short implants were 95.86 per
cent and 92.96 per cent and success
rates were 90.00 per cent and 83.41
per cent for implant- and patientbased analysis, respectively.
Peri-implantitis was reported as the
cause of short dental implant failure
in 73.91 per cent of the cases. Univariate regression models revealed that
the female sex was strongly related
to short implant success. In addition,
smoking and a history of periodontitis were found to have a significant
negative influence on short implant

By DTI

In a long-term study, researchers have reported high survival rates for short dental implants.

[46] =>

[47] =>

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Published in Dubai

www.dental-tribune.me

July-August | No. 4, Vol. 9

Invisalign Q&A with Simon Beard,
Senior Vice President and Managing Director,
Align Technology EMEA
Almost 6 million people have successfully straightened their teeth using Invisalign®
clear aligners, treated by Invisalign trained doctors.

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By Align Technology
Almost 6 million people have successfully straightened their teeth
using Invisalign® clear aligners,
treated by Invisalign trained doctors. Tell us more about this market
for straighter teeth. Can you give
us a breakdown on demographics?
The Invisalign clear aligners are an
alternative to traditional brackets
and wires, and Align Technology
has been driving the transformation in digital dentistry for 21 years
now, offering a modern end-to-end
approach to straightening teeth. Increasingly, more and more people
see the many benefits of clear aligner
therapy that can deliver aesthetic
and orthodontic solutions without
the need for using traditional, fixed
braces.
One of the benefits of the Invisalign
solution is that it can be used by
both younger people, ever conscious
of their looks, as well as adults, who
may otherwise have refused conventional orthodontic treatment. As
a result, we see strong interest from
both groups also here in the UAE and
Middle East. The interest is reflected
in the overall market dynamics – it
is estimated that the dental devices market will grow 6.58 per cent
through 2021.
We can observe it in the Middle East
as well as in other markets: there has
never been more demand for a beautiful smile than these days. Thanks to
the Millenial or “selfie” generation,
we can clearly see more and more
consumers proactively looking for
a treatment option that will allow
them to straighten their teeth and
get that camera-ready smile they always wanted. The Invisalign system
offers this opportunity.
This new trend presents a great opportunity for the doctors to leverage
growing demand from consumers
and embrace digital technology,
such as clear aligner therapy or intraoral patient scan. A more digital
practice will allow them to see and
treat more prospective patients visiting their clinic and asking for a treatment of their choice, but also to mirror more closely consumer buying
behaviour and capture new patient
interest and untapped segments.

Innovation in dental technology has
prompted
major
growth in the dental
health industry lately. Could you tell us
more about how you
use 3D technology to
make the aligners?
As a pioneer in the industry of clear aligner
orthodontics
and
digital dentistry, we
were one of the earliest adopters of 3D
printing. We are the
largest 3D print manufacturer worldwide,
and our priority is to
ensure the highest
Simon Beard, Senior Vice President and Managing
quality of our manuDirector, Align Technology EMEA
facturing
process.
Currently, as many as
359.000 aligners are manufactured ly in EMEA by 36,2% compared to the
every single day, using stereolithog- corresponding quarter last year. That
raphy (SLA) to 3D print the molds. said, there is definitely a growing apThat means each patient receives petite for the clear aligner treatment.
their own, unique set of clear alignThe potential to grow the market for
ers to wear.
teeth straightening is enormous - acIt`s worth pointing out how Invis- cording to our estimates, as many as
align clear aligners differ from the 100 million patients in EMEA region
other market offering. The Invisalign could benefit from some type of
system is a unique combination of teeth straightening. We would like to
patented SmartTrack material that tap into this opportunity and make
applies constant force and improves clear aligner therapy accessible to as
control of tooth movements, Smart- many patients as possible, helping
Force attachments engineered to doctors create new, beautiful smiles.
make complex tooth movements To make this happen, we are working
possible without braces and wires, closely with a growing network of
as well as SmartStage technology, Invisalign trained doctors - general
which optimizes tooth movements dentists and orthodontists alike – to
and aligner activation for greater pre- make clear aligner therapy widely
dictability, while utilizing data from available to patients in the region.
almost 6 million cases. Currently,
we offer custom-made solutions for What are your plans for growth in
younger patients with early mixed the region? Who do you compete
dentition, teenagers and adults alike, with in our region?
and the Invisalign system can be ap- As a pioneer in the field of digital
plied to treat approximately 80% or- dentistry, our focus is very much
on expanding our presence in the
thodontic case starts.
region– which is still a relatively new
Tell us about the orthodontics mar- market for our technology. We will
ket globally and how is it different continue drive innovation in the
dental industry – as we have done
to the region in terms or growth.
The global orthodontic supplies for the past 21 years - by offering
market is expected to reach USD 6.63 doctors and patients cutting-edge
billion by 2023 from USD 4.32 billion solutions to respond to their everin 2018, growing at a CAGR of 8.9%, changing needs. Our technology as
well as commercial setup we have
according to a recent report.
built in EMEA to support the InvisThese market trends correspond to align trained doctors gives us great,
our business growth. In Q3 2018, we competitive advantage over other
saw an increase in the number of In- orthodontic solutions, available on
visalign cases shipped international- the market.
© Align Technology

[48] =>

ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

In-office welding by Nd:YAG laser
By Prof. Carlo Fornaini & Prof.
Caroline Bertrand, France

Introduction

Just after the introduction of the
first laser by Maiman in 1960,1 there
was a very fast evolution of this new
technology, characterised by constant progression in techniques and
applications, increasing the possibility to have smaller and cheaper
devices and introducing ever-new
wavelengths. Laser welding was first
introduced in the jewellery industry
during the 1970s and soon after successfully used by dental technicians
as well.2 The first lasers used were the
carbon dioxide and Nd:YAG lasers,
but the market was rapidly conquered by the second, owing to the
results that could be obtained with
it.3, 4
Laser welding offers a great number of advantages compared with
traditional welding. Firstly, the laser
device saves time in the commercial laboratory because all welding
is done directly on the master cast.
Inaccuracies in assembly caused by
transfers from the master cast along
with investment are reduced.5 The
heat source is a concentrated light
beam of high power, which can minimise distortion problems in metals.6 By using laser technology, it is
possible to weld very close to acrylic
resin or ceramic parts with no physi-

cal (cracking) or colour damage.7 This
means it is possible to save time and
money during the restoration of broken prostheses or orthodontic appliances, because it is not necessary to
remake the non-metallic parts. This
welding technique may be used on
every kind of metal, but its property of being very active on titanium
makes it particularly advisable for
prostheses supported by endosseous implants.8
Many laboratory tests have demonstrated that laserwelded points have
a high reproducible strength for all
metals, consistent with that of the
substrate alloy.9 All these advantages
led to this method being extensively
used in dental technicians’ laboratories and stimulated companies
to put on the market increasingly
upgraded appliances. Some aspects,
such as large dimensions, high costs
and delivery systems, today still
characterise those machines that use
fixed lenses, strictly limiting their
use to dental technicians’ laboratories.
The aim of this study is to show,
through the description of a series of
clinical cases, the utilisation of a laser
device normally used for surgery in
the dental office to weld orthodontic
appliances and to demonstrate the
advantages of this technique. The
appliance used, the Fidelis Plus III
(Fotona), is a combination of two dif-

ferent laser wavelengths, the Er:YAG
(λ = 2,940 nm) and Nd:YAG (λ = 1,064
nm). The first allows the dentist to
treat hard tissue (enamel, dentine
and bone) with a mechanism that,
utilising the affinity of this laser for
water and hydroxyapatite, induces
the explosion of intracellular water
molecules and so causes the ablation of the tissue.10 Its utilisation
may be extended also to dermatology, where it can be employed in the
treatment of keloid scars and wrinkles with resurfacing, in addition to
the elimination, by vaporisation, of
lesions such as condyloma, naevi,
warts and mollusca contagiosa.11 The
Nd:YAG laser allows the dentist to
perform surgery with complete haemostasis, utilising the affinity of this
wavelength for haemoglobin and
thus avoiding the use of sutures.12
The delivery system for this laser is
provided by optic fibres of different
sizes, chosen according to the kind
of application needed, ranging from
200 μm (endodontics) to 900 μm
(whitening).
In addition to a pulse duration of microseconds, which is necessary during dental interventions, the peculiarity of the Fidelis Plus III appliance is
the possibility of pulse durations of
milliseconds (15 or 25), which can be
utilised in phlebology, in the treatment of lesions of vascular origin,
owing to the affinity of this wavelength for haemoglobin.13

In our previous work,14 we demonstrated, by in vitro tests on different
metal samples, the good quality and
high resistance of a joint welded by
this device, while in this paper we
demonstrate the clinical application
of this technique.

Material and methods

The laser device used was, as already
stated, the Fidelis Plus III, with a 900
μm fibre and a 2 mm spot handpiece
(R32, Fotona), normally utilised in
dermatology, or in some cases a prototype provided by Fotona itself. The
parameters that we normally use for
welding are:
– Wavelength:
1,064 nm
– Energy:
9.9 J
– Frequency:
1 Hz
– Spot diameter:
1 mm
– Pulse duration: 15 m/s
– Fluence:
1,260 J/cm2
– Working distance: 8 mm

Clinical cases

Case 1
A 9-year-old female patient in orthodontic treatment in our office came
in urgently owing to damage to the
rapid palatal expander applied to her
maxillary molars. The clinical examination revealed that the brace had
been damaged close to the connection with the arm (Fig. 1). The patient
had just finished one stage of the expansion, and since it was very risky
to leave her without an appliance, we

decided to weld it directly in the office with the Fidelis laser.
The expander was prepared with the
conventional procedure required before laser welding (sandblasted with
alumina powders of 50 μm in diameter using the Miniblaster, Deldent;
cleaned with acetone and both parts
dried). The appliance was directly
welded in the office using CoCr-Schweißdraht welding wire (DENTAURUM). After a few minutes only, the
appliance was ready to be recemented into the patient’s mouth (Fig. 2).
Case 2
An 8-year-old male patient in treatment in our office with a Schwartz
removable orthodontic appliance
came to us for periodic checking of
the appliance, and we saw that one of
the Adam’s hooks had broken (Fig. 3).
We welded it without filler metal (Fig.
4), and the plastic shield, although
very close to the welding zone, was
not damaged or modified (Fig. 5). We
were able to reseat the repaired appliance in the patient’s mouth after
only some minutes (Fig. 6).
Case 3
An 8-year-old male patient in treatment in our office with a Frankel
removable orthodontic appliance
came to us for periodic checking of
the appliance, and we saw that one
of the wires had broken (Fig. 7). We
welded it without metal filler (Fig. 8),

Fig. 1: The damaged appliance removed from the mouth.

Fig. 2: The repaired appliance.

Fig. 3: The Schwartz appliance with a broken Adam’s hook.

Fig. 4: Laser welding process without filler metal.

Fig. 5: The hook repaired without damaging the nearby acrylic part.

Fig. 6: The appliance replaced into the mouth.

and the plastic shield, although very
close to the welding zone, was not
damaged or modified. We were able
to reseat the repaired appliance in
the patient’s mouth after only some
minutes.
Case 4
A 14-year-old male patient came to
our office with the lingual wire of his
appliance broken. The appliance was
an orthodontic appliance called Delaire consisting of two wires, one ves-

Fig. 7: The Frankel orthodontic appliance with a fractured wire.

Fig. 8: The orthodontic appliance repaired.

ÿPage D3

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ORTHO TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

◊Page D2

Fig. 9: The Delaire appliance with a broken wire arm.

Fig. 10: Laser welding of the appliance.

Fig. 11: The appliance repaired.

Fig. 12: The Veltri appliance with a broken arm.

Fig. 13: Intra-oral laser welding.

Fig. 14: The wire of the appliance repaired.

tibular and one lingual, connected to
two braces on first maxillary molars
(Fig. 9). Owing to the presence of a
sizable restoration on the first maxillary right molar, we decided not to
remove the appliance and to perform an intra-oral laser welding. A
previously made screen in silicone
was used to protect the soft tissue,
and the appliance was welded without filler metal; the entire operation lasted 4 minutes; the welding
was done in 75 s (Fig. 10). After a few
minutes, without having to send it
to the dental laboratory and with no
discomfort to the patient, the appliance could be repaired (Fig. 11). The
follow-up was done monthly for six
months and showed that the appliance was active and strength-proof.
Case 5
A 14-year-old female patient, in orthodontic treatment with a Veltri
fixed appliance to open the space
in the upper arch in order to insert
the second premolar, came to us
for a normal check of the appliance,

and it was observed that an arm had
broken near the brace of the first
premolar (Fig. 12). The removal of the
appliance in order to send it to the
laboratory was deemed as having
too many risks, since the treatment
was still in the activation phase.
Therefore, it was decided to perform
an intra-oral laser welding. In order
to protect the soft tissue, a silicone
film was employed (Fig. 13). The procedure was performed without filler
metal and took 2 minutes, and the irradiation time was 20 s (Fig. 14). After
the reparation, the therapy was continued, turning the screw until the
required space was achieved (Fig. 15).

Conclusion

The ability to weld broken orthodontic appliances directly in the office represents for the dentist a new
prospect, allowing the restoration of
appliances extremely quickly without additional costs (the welding appliance is the same used for dental
therapies).

Being able to maintain the integrity
of plastic, acrylic and ceramic parts
close to the welding zone and the
ability to make the reparation while
the patient is sitting in the chair and
in one visit only are, in our opinion,
the great advantages in terms of
costs, marketing, patient satisfaction
and efficiency of the office. Moreover, as shown in the clinical cases presented, the welding process may also
be performed intra-orally without
risks and discomfort to the patient.
The period of learning for dentists is
very short, owing to the simple and
fast procedure, because the parameters are standard and it is not necessary to change or adapt them to
different clinical situations. We think
that this technique represents a valid
aid in our daily practice and, simultaneously, opens a new chapter in laser
dentistry, bringing new possibilities
we intend to analyse and test in further research.

Fig. 15: The appliance reactivated after welding of the wire.

Prof. Carlo Fornaini
is researcher in the MICORALIS Laboratory
at the University of Nice and teacher of
the Diplome InterUniversitaire (DIU) in
“Oral Laser Applications” of the Universities of Nice and Bordeaux.
He can be contacted at:
carlo@fornainident.it.

Prof. Caroline Bertrand
is the Dean of the Faculty of Dentistry of
the University of Bordeaux and Director
of the Diplome InterUniversitaire (DIU) in
“Oral Laser Applications” of the Universities of Nice and Bordeaux.
She can be contacted at carolin:
bertrand@u-bordeaux.fr.

Orthodontic treatment not associated with
overall happiness, study finds
By DTI

The study, the first of its type in Australia and the second in the world,
investigated whether having undergone treatment with fixed orthodontic appliances led to a greater
level of happiness or psychosocial
outcomes later in life. The longitudinal study followed 448 13-year-olds
from Adelaide who had previously
participated in an oral epidemiology
study between 1988 and 1989. By the
time the participants turned 30 in
2005 and 2006, more than a third

ADELAIDE, Australia: Research undertaken at the University of Adelaide has examined whether an
orthodontic treatment has an impact on psychosocial outcomes. The
study concluded that, contrary to
popular belief, such therapy does not
result in better psychosocial functioning later in life.

A recent study has reported that, regardless of the initial malocclusion severity, previous
orthodontic treatments do not automatically boost the patient’s self-confidence or
guarantee happiness later in life.

had received an orthodontic treatment.
“There was a pattern of higher psy-

chosocial scores in people who did
not have orthodontic treatment,
meaning people who hadn’t had
braces fitted were significantly more

optimistic than the ones that did
have braces,” said study co-author
Dr Esma Doğramaci, lecturer in orthodontics at the university’s School
of Dentistry. “Those who didn’t have
braces had varying levels of crooked
teeth, just like those who had braces treatment, ranging from mild
through to very severe.”
The study looked at four psychosocial aspects. First, it examined how
well the participants felt they coped
with new or difficult situations and
associated setbacks. Then, the researchers checked how confident
they felt in taking care of their own
health. The researchers also assessed
the support the participants believed they received from their personal network and, finally, their level
of optimism.
“These indicators were chosen because they are important for psycho-

social functioning and are relevant
to health behaviours and health
outcomes, since the core research
question was the impact of braces
treatment on patients’ self-confidence and happiness in later life,”
Doğramaci noted. “A lot of people are
convinced that if they have braces,
they will feel more positive about
themselves and do well, psychosocially, in later life. This study confirmed that other factors play a role
in predicting psychosocial functioning as adults—braces as a youngster
was not one of them.”
The study, titled “The long-term influence of orthodontic treatment on
adults’ psychosocial outcomes: An Australian cohort study”, was published
online on 27 May 2019 in Orthodontics and Craniofacial Research, ahead
of inclusion in an issue.

[50] =>

Creating the ideal smile
in the best possible way
For better, safer, faster orthodontic care.
When it comes to orthodontics, each patient is a unique case. Creating
their ideal smile means balancing many variables, including treatment
eff ectiveness, visibility, and time. Our range of innovative solutions,
spanning from traditional to low visibility braces, provides the options dental
professionals need.
For more information, please contact your Dentsply Sirona representative,
or visit dentsplysirona.com/Orthodontics

[51] =>

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www.dental-tribune.me

Published in Dubai

July-August | No. 4, Vol. 9

Reducing plastic footprint with
zero-waste toothpaste
– Denttabs (paper laminated foil
made from corn starch, Germany)
– Davids (metal tube, US)
– Lamanuza (cardboard box, France)
– Zero Waste Beauty (glass jar, Australia).

By Monique Mehler, DTI
LEIPZIG, Germany: The climate
change caused by human influences—such as littering and overconsumption of non-biodegradable
waste products—is a reality that
concerns all of us. This is why dental care should not be exempt from
environmental awareness. Bamboo
toothbrushes, for example, have
moved into many bathrooms in the
last couple of years, since they are
now more easily obtainable in most
chain pharmacies. But what about
sustainable toothpaste?
© LuminoOne/Shutterstock

But what about shipping all
that glass?

Sustainability in demand

The new generation is constantly
on the lookout for environmentally
friendly alternatives, ideally without,
or with more sustainable packaging.
That means thoughtfully designed
packaging which is compostable or
reusable.
Home-made toothpaste probably
constitutes the easiest way to achieve
a zero-waste oral healthcare routine.
For this purpose, the Internet offers
various recipes. Understandably, not
everyone has the time or energy to
experiment with ingredients, consistencies and flavours. This does not
mean, though, that convenience and
sustainability have to be mutually
exclusive.

The environmental impact
of disposable plastic
In general, plastic toothpaste tubes
contribute to a throwaway society.
It is estimated that about one billion
toothpaste tubes are sent to landfill sites every year and it can take
hundreds of years before they even

Glass, metal, paper, corn starch—the dental industry is slowly but surely adopting more sustainable toothpaste packaging alternatives.

start to break down. On top of that,
the tubes that end up there are filled
with ingredients like sodium lauryl
sulphate, triclosan, artificial dyes and
preservatives that can be harmful to
our health and our earth.
According to an article by Ian Johnston, environment correspondent
of The Independent, “79 per cent of
the plastic produced over the last 70
years has been thrown away, either
into landfill sites or into the general
environment. Just 9 per cent is recycled with the rest incinerated.” He
continued: “With more than 8 mil-

lion tonnes going into the oceans
every year, it is estimated there will
be more plastic than fish by 2050
and 99 per cent of all the seabirds
on the planet will have consumed
some. It is thought the sea now contains some 51 trillion microplastic
particles—500 times more than
stars in our galaxy.”

from around the world have recognised that plastic packaging is not
the way forward and offer more
sustainable alternatives. Toothpaste
now comes in the form of powder or
tablets, for example, without chemical additives and in glass jars with
metal lids which are reusable and
recyclable.

What are the alternatives?

The list below includes a small range
of companies and information on
how their products are packaged:

Thinking about the unimaginable
amount of waste that is being produced by such a standard routine
as toothbrushing alone can be quite
daunting. Luckily, many brands

– Georganics (glass jar, UK)
– Bite (glass jar, US)

The plastic industry uses the argument that shipping glass is more
expensive than shipping plastic to
sell itself as eco-friendly. Some companies, like Bite from the US, have
thought of a way to provide their
customers with a sustainable subscription model. For Bite, this means
that the first order will include the
product in its original packaging,
a glass jar with a metal lid. Then all
refill orders are sent in compostable
and marine-degradable biomaterials. Orders are sent via already existing mail routes. This may take a little
more time but reduces the company’s carbon footprint, which is the
ultimate goal of all sustainable oral
healthcare companies.

And of course, there is always the
possibility of buying toothpaste
without packaging in bulk and zerowaste stores. The independent think
tank and open knowledge platform
Bepakt has created an online index
which provides a list of packagingfree grocery stores and supermarkets around the world.

The verdict

Plastic production, consumption
and disposal contribute to the earth’s
pollution as The Independent article
explained. With so many options on
the market today, there is really no
excuse not to make one or two small
but impactful changes.

Vital tooth bleaching has adverse effects
on oral health, study concludes
By DTI
DUNEDIN, New Zealand: A newly
published systemic review has revealed that, while tooth bleaching
treatment yields positive changes
for young participants in aestheticrelated areas, such as smiling, laughing and showing teeth without
embarrassment, it causes tooth sensitivity and can affect quality of life
and thus oral health.
Tooth discoloration is common

these days and has resulted in the
widespread popularity of tooth
bleaching treatment. Hydrogen
peroxide and carbamide peroxide
are the bleaching agents most often
used in the whitening processes.
Despite the benefits of tooth bleaching, its side effects are of concern
to dentists and patients. Therefore,
scientists carried out a systematic
review and meta-analysis of studies
that had previously investigated the
changes in perceived quality of life
after vital tooth bleaching.

In total, 313 studies were identified,
but only four met the inclusion criteria. Two of them showed a statistically significant improvement, one
showed worsening and the last one
was inconclusive. Within the studies,
there was a pattern of improvement
in aesthetic-related domains, such as
smiling and psychological discomfort, and deterioration in functionrelated domains, such as hygiene
and pain.
The authors concluded that tooth

bleaching was not associated
with improvements in the overall
oral health-related quality of life
(OHRQOL) in these heterogeneous
populations. The dental procedure
appeared to impact some domains
of OHRQOL positively and some
negatively, indicating the need for
clinicians to treat patients receiving
whitening treatment with the utmost care in order to obtain the best
results in aesthetics with minimal
side effects. The researchers also noted that clinicians should be aware of

the potential impact caused by tooth
sensitivity and either offer instruction to prevent it or recommend the
right treatment to reduce its impact.
The study, titled “Vital bleaching
and oral-health-related quality of
life in adults: A systematic review
and meta-analysis”, was published in
the May 2019 issue of the Journal of
Dentistry.

[52] =>

HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | 4/2019

Interview: “For most people,
toothbrushing is an unconscious action.
iTOP changes this.”
By Kasper Mussche, DTI

language, network, learn all about
prevention and, of course, have fun.
It’s a unique opportunity for students and ideal as an addition to the
Erasmus projects organised by universities.

Dr Angelini, what is iTOP and what
does individually trained oral
prophylaxis mean?
In the iTOP programme, dental professionals become a personal coach
to their patients, guiding them and
teaching them how to keep their
gingivae and teeth clean and perfectly healthy using the correct tools
and the correct techniques on their
own and with conscious thought. I
say “conscious” because, for most
people, toothbrushing is a purely
unconscious action. iTOP changes
this. The word “individually” is very
important to iTOP, as dental professionals and, later, their patients are
literally taken by the hand and individually instructed on how to brush
their teeth perfectly.
iTOP is also based on the scientific
statement that a clean tooth cannot
become diseased, or at least that the
risk of periodontal disease, caries or
tooth loss is significantly reduced
by mechanical prevention. iTOP has
become a philosophy over the years,
thanks to the hard work of all the
people who believe in it and teach it.

Although toothbrushing is the most
decisive factor in preventing oral disease, only a few patients and dental
professionals know how to brush
perfectly. After earlier working as a
dental technician and also as a dancer, Dr Fabio Angelini qualified as a
dental hygienist and is now teaching internationally as an instructor
in CURADEN’s iTOP programme. Individually trained oral prophylaxis
(iTOP) is an interactive programme
that teaches dental students and
professionals perfect oral hygiene
habits, so that they, in turn, can train
their patients to achieve oral health
that will last a lifetime.

Dental hygienist Dr Fabio Angelini teaches dental professionals and dental students perfect brushing habits at an iTOP seminar in
Prague

Is correct brushing a skill that is often overlooked?
When clinicians start their careers,
they already have many years of
studying behind them and have
been taught the best flap techniques,
how to place an implant the best
way and so on. However, what they
have never been taught is how to
brush correctly, although it is the
most fundamental skill of all to prevent oral disease. More often than
not, we have been doing it the same
way since we were just old enough to
hold a toothbrush. It is often just an
automatic movement and we have
never learnt exactly how to brush.
In reality, however, brushing teeth is
an art; it’s a science. Brushing teeth
properly, efficiently and atraumatically is not easy, nor is it something
you should do without thinking.

How can iTOP help patients and
dental professionals?
iTOP helps patients because dental
professionals can offer them the
knowledge which they themselves
have gained at a seminar. They can
teach patients to control biofilm formation on their teeth and gingivae
and how to do this in the most effective and atraumatic way. Patients
who incorporate the techniques
taught at an iTOP seminar into their
daily brushing routine can expect
to achieve optimal oral health. The
tools and techniques used at an iTOP
seminar are really a gateway to lifelong oral health, which in turn offers
benefits to the whole body.
For dental professionals, the acquired iTOP skills can play a key role
in their daily practice, for instance, as
an essential part of therapy after oral
surgery or periodontal treatment.
iTOP gives professionals the skills to

work to the best of their ability, and
it is really personal teaching which
allows clinicians to ally with their
patients in order to obtain and maintain good oral health.
How strong is iTOP currently in
Italy?
In Italy, the interest of dental professionals in iTOP is growing day by day.
There are some professionals who
have attended a seminar in the past
but many are new to the concept and
have only just heard about it. Moreover, iTOP is gaining importance at
universities too, as there are more
and more students participating in
the seminars or student camps that
take place all around Europe and
South America. For dental students
these camps are a really good way
to get in touch with their peers from
other countries, exchange experiences, get to know a new culture or

What is touch to teach?
Touch to teach is the most important
aspect of iTOP. It means that, as an instructor, you take participants by the
hand and let them feel or discover a
specific movement or sensation. As
Dr Jiri Sedelmayer, the dentist who
invented the iTOP programme, once
said: “It is impossible to understand
how to brush your teeth from reading a book”. What this means is that
theory is not enough to develop the
best skills. You have to do it yourself,
practise, have an instructor correct
you and try again. Because of touch
to teach, participants have the opportunity to truly understand and
experience the sensation of having the thousands of bristles of a CS
5460 working together in the sulcus.
For the professionals we teach, it is
an exciting tactile experience and
they can teach their patients in turn.
If no one shows them how it is really
done, then how can they achieve the
best oral hygiene?
What is the main lesson participants take home from an iTOP
seminar?
The greatest lesson clinicians take
home is the knowledge of how significant the impact of instruction
is on their patients’ long-term oral
health and how the iTOP skills can be
used right away. From the very next
day, patients can put prevention
into practice and see how a change in
their oral hygiene habits will help to
improve their oral health.
For more info on an iTOP seminar
near you, visit:
www.itop-dental.com/en/seminars.

New evidence confirms long-term benefits
of electric toothbrush use
By Oral-B

shown that the long-term use of an
electric toothbrush slows progression of periodontal disease and helps
to prevent tooth loss. As indicated
by an 11-year observational study,
electric toothbrush users demonstrate 20 per cent less tooth loss than
manual toothbrush users do. For
one market leader in electric toothbrushes worldwide, Oral-B, the results confirm the company’s efforts
to improve periodontal health by
plaque removal.

the Study of Health in Pomerania
and the type of toothbrush as exposure variable, periodontal status,
caries and tooth loss were analysed
by researchers from the University
of Greifswald in Germany. Overall, the study found that the use of
power toothbrushes improves periodontal health by plaque removal,
resulting in reduced pocket depth
and clinical attachment loss. Subsequently, those users were found
to have 20 per cent more teeth present than manual toothbrush users.
Thus, the researchers concluded that
widespread usage of powered toothbrushes can be recommended.

Using data on 2,819 subjects from

Besides the oral health benefits of

SCHWALBACH, Germany/GREIFSWALD, Germany: A new study has

power toothbrushes, their rising
popularity is also indicated by the
findings. At the start of the 11-year
study, 18 per cent of the participants
used an electric toothbrush. Towards
the end, the figure had risen to 37 per
cent. This trend is supported by the
fact that the power brush market
grew by 6 per cent from 2012 to 2016.
Dr Anja Carina Borer, Head of Professional and Scientific Relations for
Europe, the Middle East and Africa
at Oral-B, said in a statement: “We
are very happy that our efforts to
promote electric toothbrushing as a
way to improve oral and especially
gum health are now also scientifically supported in the long term. It

proves what over 150 clinical studies
have already indicated and will further drive the trend among patients
to choose superior electric toothbrushes with oscillating-rotating
technology.”
As the market leader in this segment,
Oral-B links the positive results to
its proven oscillating-rotating technology. Its effectiveness stems from
movements in 3-D and a small,
round brush head. This makes it possible to remove up to 100 per cent
more plaque in even hard-to-reach
areas. For the third time, its superiority over manual toothbrushes
was confirmed by the renowned
Cochrane organisation—an inter-

national, independent institute
which reviewed 51 clinical studies
with 4,624 participants. The results
confirmed that oscillating-rotating
electric toothbrushes reduce plaque
more effectively, improving oral and
especially gingival health demonstrably, both in the short and in the
long term, compared with manual
toothbrushes.
The study, titled “Long-term impact of powered toothbrush on oral
health: 11-year cohort study”, was
published online on 22 May 2019 in
the Journal of Clinical Periodontology, ahead of inclusion in an issue.

[53] =>

HELP PATIENTS
STOP THE CLOCK ON
GINGIVITIS NOW
GINGIVITIS

TOOTH
LOSS

HALITOSIS

GINGIVAL
RECESSION

Parodontax helps stop the clock on gingivitis
and gets your patients back to healthy gums.

CHSAU/CHPDX/0001/19 - Production Date: January 2019
With twice daily brushing
Please read the label before use
We Value your Feedback
+973 16500404 - Gulf & Near East countries
contactus-me@gsk.com
www.gsk.com

[54] =>

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[cover] => DT Middle East and Africa No. 4, 2019

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Table of contents

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