DT Middle East and Africa No. 5, 2014

News / Bleach Cases From dead white to natural bright / Esthetic rehabilitation of posterior teeth using Bulk-Fill Composite / CAD CAM Technology: a Review / Meeting esthetic challenges with Herculite XRV Ultra / Dr. Ahmed Zuhaili performs yet another groundbreaking surgery / BIDM 2014 / Empirical comparative study confirms thixotropic wound dressing for haemostasis / Pre-Align then design / Ormco Custom: It’s all about profitability / Analyze adult snoring carefully / Management of Intracanal Separated Instruments / Crown for the queen of the jungle / Industy / Meet Carestream’s CS 3500 Intraoral Scanner. A game changing paradigm Shift / Ivoclar Vivadent discusses monolithic restorations in London / VITA ENAMIC: a greater similarity to natural dentition and more cost-effective than previous CAD/CAM ceramics? / Lab Tribune Middle East & Africa Edition / Hygiene Tribune Middle East & Africa Edition

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www.dental-tribune.me

Printed in Dubai

LAB
TRIBUNE
9th CAD/CAM
& Digital DentistrymCME
International Conference

“Dental Technicians are
“Bleach Cases From Dead
BOOK YOUR CALENDAR
more than just trained hands”
white to Natural brights“
09-10 MAY 2014
ORGANIZED BY

15% discount for
DTMEA club members

>Page
1B
E: events@cappmea.com

DENTAL FACIAL
NOVEMBER
14-15, 2014
6th Dental Facial
Cosmetic
JUMEIRAH BEACH HOTEL
DUBAI, UAE
Int’l Conference
14-15 November 2014

Joint Meeting with

ORGANIZED BY

JUMEIRAH BEACH HOTEL, DUBAI
CO-ORGANIZERS

M: +971502793711

>Page 6

E: events@cappmea.com

M: +971502793711

www.cappmea.com

Jumeirah Beach Hotel, Dubai

www.cappmea.com/cadcam9

DTI
publishers
meet for tenth
anniversary
in Italy
By Dental Tribune International

T

URIN, Italy: Over the last
three days, Dental Tribune
International (DTI) has
held its tenth annual publishers’
meeting. This year, the meeting
drew over 50 licence partners
from the US, Latin America,
the Middle East and many other countries from all over the

Turin with Mole Antonelliana and the Alps in the background.

world. Meeting attendees learnt
about a number of new projects
for the upcoming year and discussed strategic approaches for
future development.
At the meeting, DTI CEO Torsten
Oemus reviewed the impact of
DTI’s various print, online and

> Page 4

Sirona presents “CEREC Desert Fest 2014”
By Sirona

T

he latest findings in digital dentistry, live demonstrations, and an exciting
social program: Sirona and the
Centre For Advanced Professional Practices (CAPP) invite
you to the “CEREC Desert Fest”
conference. The event held in
Dubai from September 12–13
is aimed at potential CAD/CAM
users and experienced CEREC
users.

event features a number of
expert presentations followed
by panel discussions as well as
live demonstrations of CEREC
in various areas. Dr. Joachim
Pfeiffer, Vice President CAD/
CAM Systems and Chief Technology Officer at Sirona, says
“this first-class event combines
specialist knowledge with user
experiences. We expect this interesting conference to contribute greatly to the further development of CEREC.”

In front of breathtaking scenery
at the Palace Downtown Dubai,
Sirona presents the “CEREC
Desert Fest” for the very first
time. On September 12 and
13, dentists and dental technicians can share their experience with the most used CAD/
CAM system with colleagues
from all over the world. The

The panel show focuses on
presentations by experts on the
use of CEREC. Dr. Todd Ehrlich, a master CEREC trainer
who has been teaching dental
CAD/CAM technology for a
number of years, provides an

NEWS

ENDO TRIBUNE

ORTHO TRIBUNE

LAB TRIBUNE

HYGIENE TRIBUNE

Page 2

Page 18

Page 20

Page 1B

Page 1C

“The Ebola virus epidemic:
A concern for dentistry?”

Page 26

“Crown for the queen of the
jungle”

Fig. 1: Dubai’s skyline and the spectacular Dubai Fountain – highlights of the visit to the largest city
in the United Arab Emirates.

> Page 4

“Empirical
comparative
study confirms thixotropic
wound dressing for haemostasis”

“Pre-Align then Design”

Page 22

“Ormco Custom:
It’s all about profitability”

“Dental Technicians are
more than just trained
hands”

Page 2B

“Milling and grinding in high
definition (HD)”

“A Date for your - Diary Hygiene Day announcement “

Page 2C

“Developing Oral Care
Products Imaging and Innovation”

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2 news

Dental Tribune Middle East & Africa Edition | September-October 2014
Group Editor

The Ebola virus epidemic:
A concern for dentistry?
By Prof. L. Samaranayake

wenty-two years ago, a
seminal report from the
Institute
of
Medicine
(IOM) in the US, titled “Emerging Infections: Microbial Threats
to Health in the United States”,
warned of the dangers of socalled newly emerging and reemerging diseases. The concept
of “emerging infectious diseases”, introduced then by the IOM
is now well entrenched, and to
our chagrin we have witnessed
many such diseases over the last
two decades. These include variant Creutzfeldt–Jakob disease/
bovine spongiform encepha-

Roman and Persian writers documented the emergence of many
new epidemics. In more recent
times, the scientist Robert Boyle
presciently observed in 1865 that
“there are ever new forms of
epidemic diseases appearing […]
among [them] the emergent variety of exotick and hurtful […]”.
Arguably though, the most noteworthy relatively new emerging
infectious disease with the greatest impact on the dental profession has been the human immunodeficiency virus and Aids.
And now we have a severe epidemic of Ebola virus infection.
It is back with a vengeance, this
time in West Africa, with over

behaviour, including injectable
drug abuse and sexual promiscuity. Societal occurrences, such
as economic impoverishment,
war and civil conflict, too are
critical according to the IOM.
The current outbreak of Ebola
virus infection is a perfect storm
created by a lethal combination
of these factors, including rampant deforestation, poverty and
the war-stricken situation in
many African countries.
So how does Ebola spread? According to World Health Organization reports, Ebola virus
disease (EVD) is introduced into
the human population through

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

Magda Wojtkiewicz

through saliva contamination.
Infection in health care settings
has been due to health care
workers treating patients with
suspected or confirmed EVD,
especially when infection control precautions were not strictly
practised. Reports indicate that
those who recovered from the
disease could transmit the virus
through their semen for up to
two months after recovery.
EVD is a severe acute illness
characterised by the sudden onset of fever, intense weakness,
muscle pain, headache and sore
throat. This is followed by vomiting, diarrhoea, rash, impaired
kidney and liver function, and
both internal and external bleeding in some cases. Oral manifestations, such as acute gingival
bleeding, have been reported.
The mortality rate of EVD is very
high and 50–90% of patients die
owing to the profound systemic
haemorrhage or its complications. The incubation period of
EVD is 2 to 21 days.
Up to now, there have been no
reported cases of transmission of
EVD in any dental settings. However, the fact that it is transmitted through human secretions,
which includes saliva, and that
the incubation period could last
up to 21 days implies that dental care workers in the endemic
areas of the virus, such as West
Africa and sub-Saharan Africa,
may run the risk of acquiring
the disease if strict standard infection control measures are not
routinely followed.

A laboratory worker in the Democratic Republic of Congo does a test using a micropipette. Quick onsite laboratory diagnosis enable the World Health Organization response team to precisely diagnose
new suspected Ebola patients within two to six hours. (Photograph courtesy of WHO/Christopher
Black)

lopathy, severe acute respiratory
syndrome, and Middle East respiratory syndrome, and above
all the pandemic of acquired
immune deficiency syndrome
(Aids), which has claimed millions of lives the world over. The
re-emerging infectious diseases
we have seen include diseases
caused by meticillin-resistant
Staphylococcus aureus, and multidrug-resistant and extensively
Interestingly, the concept of
“emerging infectious diseases”
is not new. Indeed ancient Greek,

380 cases and a 69% case fatality
ratio at the time of writing. The
culprit is the Zaire ebolavirus
species, the most lethal Ebola
virus known, with case fatality
ratios up to 90%.
According to the IOM report,
there are many reasons that
new diseases emerge and reemerge. These include health
care advances with the attendant
problems (e.g. transplantation,
immunosuppression, antibiotic
abuse, and contaminated blood
and blood products) and human

close contact with the blood, secretions, organs or other bodily
fluids of infected animals. Human-to-human transmission is
through direct contact (through
broken skin or mucous membranes) with the blood, secretions, organs or other bodily
fluids, such as saliva, of infected
people, and indirect contact with
environments
contaminated
with such fluids. Transmission
through the air has not been
documented in the natural environment, nor have there been
any case reports of transmission

In dentistry, we are constantly
exposed to these emerging and
re-emerging infectious threats
and we cannot afford to let our
guard down. Vigilance, awareness and good clinical practice
with standard infection control
at all times are fundamental to
prevention, as yet-unimagined
new diseases surely lie in wait.
Although we have made spectacular technical and scientific
advances since the release of the
original IOM report some two
decades ago, it appears that humans are still defenceless in the
face of the relentless march of
our microbe foes. drug-resistant
tuberculosis.

Malaysia provides dental
records for MH17
investigation
By DT Asia Pacific

UTRAJAYA, Malaysia: The
Health Minister of Malaysia
has confirmed that the dental records of all of the Malaysian victims of Malaysia Airlines
Flight 17 have been collected and
sent to the Netherlands for forensic identification. According
to Datuk Seri Dr Subramaniam
s/o K.V. Sathasivam his ministry
has also provided DNA samples
and fingerprints of the deceased
passengers of the flight, which
was bound for Kuala Lumpur on
17 July, to an Interpol disaster response team.

Forty-three Malaysian passengers, including 15 crew members, were on board the Boeing,
which is believed to have been
shot down by pro-Russian rebels
over Donetsk in Ukraine three
weeks ago. Since access to the
crash site remains difficult owing to ongoing conflict in the region, only 70 coffins containing
the remains of the victims have
been collected and sent to the
Netherlands so far, according to
Subramaniam. He told the New
Strait Times newspaper in Kuala Lumpur that the first results
from the identification process,

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Hans Motschmann
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Torsten Oemus
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event Manager

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Accounting
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Executive Producer

Gernot Meyer
Dental Tribune International

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Dental Tribune
Middle East & Africa
Edition Editorial Board

Dr. Aisha Sultan Alsuwaidi, UAE
Dr. Ninette Banday, UAE
Dr. Nabeel Humood Alsabeeha, UAE
Dr. Mohammad Al-Obaida, KSA
Dr. Meshari F. Alotaibi, KSA
Dr. Jasim M. Al-Saeedi, Oman
Dr.Mohammed Sultan Al-Darwish
Prof. Khaled Balto, KSA
Dr. Dobrina Mollova, UAE
Dr. Munir Silwadi, UAE
Dr. Khaled Abouseada, KSA
Aiham Farah, CDT
Dr. Rabih Abi Nader, UAE
Dr. George Sanoop, UAE
Retty M. Mathew, UAE
Rodny Abdallah, Lebanon
Victoria Wilson, UK
Partners

Emirates Dental Society
Saudi Dental Society
Lebanese Dental Society
Qatar Dental Society
Oman Dental Society
Director of mCME

International investigators survey the MH17 crash site, 5 August
2014. (Photograph courtesy of OSCE/Evgeniy Maloletka)

which is currently underway at a
military facility in Heelsum near
Amsterdam, are expected to be
available within the next two
weeks.
A total of 298 passengers, most

Dr. Dobrina Mollova
mollova@dental-tribune.me
+971 50 42 43072

of whom were of Dutch descent,
were killed in the incident, which Business Partner | BDM
is still under investigation by in- Tzvetan Deyanov
deyanov@dental-tribune.me
ternational organisations, such +971 55 11 28 581
as the Organization for Security
and Co-operation in Europe.
designer
Kinga Romik
k.romik@dental-tribune.me

[3] =>

[4] =>

Dental Tribune Middle East & Africa Edition | September-October 2014

< Page 1

DTI held its tenth publishers’ meeting in Turin. (Photograph: Daniel
Zimmermann, DTI)

educational portfolio over the
past decade. He pointed out that
the company’s educational offerings in particular have become
an essential part of DTI’s product portfolio. Besides its flagship

e-learning platform, the Dental
Tribune Study Club, and customised campuses for important
dental companies, such as Colgate, DTI provides continuing
medical education through its

Tribune CME Clinical Masters
programmes, which offer comprehensive training in aesthetic
dentistry, orthodontics and implantology, among other fields
of dentistry. To date, about 200
dental professionals have graduated from the programmes.
Oemus also informed the attendees of a new partnership
with the Brazilian Dental Association, the largest dental association in the world. Through
this collaboration, DTI will provide dental education to a vast
number of dental professionals
in Brazil through a special DT
Study Club from September this
year.

Implant Real-time Imaging System
(IRIS-100)
By EPED

I
Implant Imaging System
(IRIS-100)

mplant Real-time Imaging
System (IRIS-100) features
the utilization of optical tracking systems to visualize instantly
the implant handpiece and drill
with a CBCT image. With the
aid of this intra-bone GPS function, users can see the position
of the drill and data such as

OLOGNE,
Germany:
Digital dental procedures
are increasingly becoming
an essential part of the daily routine in the modern dental practice. They render patient management and treatment planning
processes more economical and
increase time efficiency. At the
upcoming International Dental
Show (IDS), digital technologies
will thus form a core subject,
with many exhibitors presenting
their latest product solutions in
the field.
At IDS 2015, the digital technology offerings available for dental
practices will form a focal point
for all visitors in the fields of dentistry and dental technology. The
product ranges to be exhibited
contribute to simplifying work-

flows and, as a result, to reducing treatment times. They create
synergies with the digital range
for dental laboratories, yielding
positive implications for practice
management and therapeutic
procedures. That is why the state
of the art in digital technology for

digital imaging devices, including CBCT and CT, which have
been used alongside conventional radiographic techniques in recent years.

Products presented will include
software for efficient patient
management and integrated
treatment planning, as well as

Many manufacturers will be exhibiting their latest innovations
in digital dental technology at IDS 2015. (Photograph courtesy of
Koelnmesse)

HAHRAN, Saudi Arabia:
Surgeons in Saudi Arabia have found a white
bony mass inside the nose of a
22-year-old. They said that the
mass was an extra tooth growing in the young man’s left nasal
cavity. The patient had suffered
from nosebleeds once or twice a
month for the past three years,
the doctors reported.

tion is poorly understood. “One
theory is that there is a defect
in the migration of neural crest
derivatives destined to reach the
jawbones. A more plausible explanation is multistep epithelial
and mesenchymal interaction,”
the surgeons stated.
While supernumerary teeth are
usually asymptomatic, patients
may present with a variety of
symptoms, including nasal obstruction, headache, nosebleed

Anterior rhinoscopy (upper left) and endoscopic view of the
supernumerary tooth in the patient’s nasal cavity. (Photograph: Al
Dhafeeri et al., American Journal of Case Reports, 2014)

The patient was admitted to King
Fahd Military Medical Complex
in Dhahran owing to recurrent
nosebleeds and tonsillitis. Close
examination of the man’s nasal
cavity found a 1 cm-long white
cylindrical bony mass arising
from the floor of the nose, according to the case report.
A consultant dentist made the
diagnosis of intranasal eruption
of a supernumerary tooth. The
prevalence of such teeth is not
known, as they usually remain
asymptomatic in many patients
and the mechanism of erup-

and external nasal deformities.
They may be associated with conditions such as cleft palate. The
surgeons further said that such
teeth can be easily detected using nasal endoscopy, panoramic
radiographs, and CT scans.
In the present case, the patient
underwent endoscopic extraction of the supernumerary tooth
with its surrounding granulation
tissue under general anaesthesia. After three months, the area
was completely healed and the
patient did not experience further nosebleed.

IDS 2015 will also give special attention to digital scanners, which

“1,400 exhibitors from 46
countries have already confirmed
their participation.”
dental practices will be a major
topic at IDS 2015, said Dr Martin
Rickert, Chairman of the Association of German Dental Manufacturers.

By Dental Tribune International

bone quality, nerve, sinus location and more. This critical
data can assist the implantologists to navigate and give real
time guidance during implant
surgery. Similar to a car navigation system, the system is set up
to visualize the destination and
helps to guide the preplanned
placement of implants, avoiding
dangerous areas, reducing risk
and increasing the likelihood of
successful implant surgery.

IDS 2015:
Digital technology
determines daily routine
in modern dental practice
By Dental Tribune International

Supernumerary
Tooth Grows in
Man’s Nose

offer a wide range of advantages
for patient-specific restorations
and implant planning. In particular, intra-oral scanners will be
in the spotlight, as they have contributed significantly to making
prosthetic treatment workflows
simplifier and more precise.
Overall, both patients and dentists benefit from the use of digital technologies. They help shorten treatment time and reduce
the number of work stages, and
enable the dentist to immediately
examine and explain preparations on screen. Furthermore,
the data gained through digital
procedures can be quickly processed in the dental practice and
sent to dental laboratories .
The 36th IDS will take place
from 10 to 14 March 2015 in Cologne. According to the latest figures provided by IDS organiser
Koelnmesse, 1,400 exhibitors
from 46 countries have already
confirmed their participation.

< Page 1
overview of the use of CEREC
for anterior teeth restorations.
Dr. Bernd Reiss, President of
the Association for Ceramics in
Dentistry and President of the
German Association for Computer-Aided Dentistry (DGCZ),
traces the development of dental CAD/CAM technology over
the past few decades and offers an outlook for the coming
years. Dr. Josef Kunkela, an
expert in prosthodontics and
restorative dentistry, highlights
some new approaches for anterior teeth restoration, which include Smile Design in the current CEREC software and the
CEREC Connect software. His
colleague Dr. Daniel Vasquez,
who instructs CEREC trainers
in South America among other
things, explains the possibilities
of the CEREC Omnicam in restorations. Finally, Professor Dr.
Wael Att, President of the Prosthodontics Group of the International Association for Dental
Research (IADR) and President
of the Arabian Academy of Esthetic Dentistry (ARAED), ex-

plains what to consider for the
rehabilitation of implants.
Additionally five table clinics will
operate from 11 to 13 September
in groups. Outstanding CEREC
trainers will run a premiere extensive training for future and
advanced CEREC users. Participants will have the opportunity to interact immediately and
ask their personal questions of
interest. The practical demonstrations will, at the same time,
provide inspiration and other
means of trouble shooting. The
aforementioned doctors Todd
Ehrlich, Daniel Vasquez and
Josef Kunkela will be joined by
certified inLab trainer Mohammad Al-Zu’bi from Canada and
Dr. Munir Silwadi from the UAE.

Contact Information
Visit for more information:
http://cerecfest.cappmea.com.

[5] =>

SIRONA.COM
CEREC Omnicam

POWDER-FREE
AND IN NATURAL
COLOR.
Scanning with the new CEREC Omnicam combines powder-free ease of handling with natural color reproduction to
provide an inspiring treatment experience for the patient. Discover the new simplicity of digital dentistry. Enjoy every
day. with Sirona.

Dubai Contact: Sirona Dental Sytsems Ltd, Dr Amro Adel, Building 49, Suite 304
Dubai Healthcare City, Telephone: +971 4 375 2355, E-Mail: amro.adel@sirona.com
Kuwait Contact: Sirona Dental systems GmbH, Dr. Mostafa Al. Khouly
Office: +965 2 224 6063, Mobile: +965 9 800 2225

[6] =>

6 mcme

Dental Tribune Middle East & Africa Edition | September-October 2014

Bleach Cases
From dead white to natural bright
mCME articles in Dental Tribune have been approved by:
HAAD as having educational content for 2 CME Credit Hours
DHA awarded this program for 2 CPD Credit Points
By Aiham Farah, Syria

ubstituting
the
white
opaque dentin ceramic material with a high brightness
transparent effect is the secret
of manipulating the 4 bleach
shades (BL4, BL3, BL2, BL1),
and the key factor to make them
close to the natural-looking
shades in our (A-D) shade guide.
(Fig 1)
• The visual perception in which
Opal Effect ceramic material appears to be radiating or reflecting light is called luminancity,
and luminance is the intensity
of light that generates what we
see in dental ceramic as natural
white. Why natural? Because it
simulates the optical properties
of the natural enamel of healthy
tooth.
Our following case is a very good
example of producing attractive
natural-looking bleach shade.
Case Presentation
A 45-year-old female presented
to the clinic with an esthetic
request, she desires a smile
change. Apparently she was
seeking a new look on multiple cosmetic aspects, and she
chooses to start at the dental
studio.
The dentist interviewed her and
found out what category she is
seeking (esthetic), and what was
her major complain. He reported
the followings; Major complain
was a non-vital appearance of
the current old restorations besides discoloration, which drew
a pale smile on her face, and an
inflammatory appearance of the
surrounding gingiva. (Fig 2, Fig
3)
The patient was examined intraorally, and her dental history
was recorded. The radiographic
exam of the upper incisors revealed a good endodontic situation. Preliminary impressions
were also taken to produce a
study model. The dental lab
technician presented to the
clinic to evaluate the old veneers
condition, and grasp the patient’s needs and discus her expectations from the whole treatment. Complete photos protocol
was taken to the teeth, lips and
face, those photos were crucial
during the lab working steps.
Treatment plan
The treatment plan included the
following measurements;
Removing the old veneers, reprepping the incisors and the
4 upper premolars according
to the general principles of allceramic veneers preparation,
0,6mm chamfer was created

equigingivally and a 0.9mm buccle reduction was necessary to
allow the veneers to mask from
one hand and give the desired
color from the other hand, final
impression of the maxillary arch
was made using addition silicon
Virtual (IvoclarVivadent).
Dental Laboratory procedure
The failure
According to the patient’s desire of having bleach veneers,
the brightest color of IPS e.max
press ingot suitable for veneers
fabrication (Low Translucency,
LT BL1) is used, followed by
delicate cut back and layering
Transpa-Incisal powders from
IPS e.max Ceram.
On the day of the try- in, patient
showed up to the clinic, she was
excited to see the new smile.
When she looked at the mirror
she felt the change. (Fig 5) All
the measurements of esthetic
smile, from teeth arrangement
to lips dynamic appeared perfect
on her face. The dental team
members had different point

Fig 1. Bleach shade guide, (Ivoclarvivadent A-D shade guide)

of view on the shade after taking few minutes to absorb the
tried-in set. They all agreed that
something still missing for the
case to be esthetically pleasing,
as if all the light rays coming
from inside the veneers faded
down after being placed on the
prepped teeth (dentist stated in
privacy). Soon we realized that
the discoloration of the prepped
dentin continued on darkening during the 10 days lab work
process. So at the day of the try-

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 2 CE credits.

set with the bleach shade guide
held into position were important to be reviewed to find out
what to do and what to avoid
in the new veneer set. (Fig 6) A
black and white photo was important to define the matching
level of brightness, and what
bleach shade we reached. (Fig
7)
Ingot selection judgment
The Success
Priority number one was mask-

Fig 5. The patient checking her smile with the first set
of veneers

and incisal material and characterize with variety of brighter
impulse colors from IPS e.max
Ceram powders. Texturized Fig
9, glazed, then the final outcome
shin was balanced by further
manual polishing.
A comparison with the failed
previous set; in order to make
sure that I succeeded boosting
the luminosity level was important after transferring the dentin
background of the natural prep
from the patient mouth to my

Fig 6. The non-vital appearance of the first set of veneers
centrals on the day of Try-in

Fig 7. The low value of the first set of veneers compared to the bleach shade guide in a B&W photo

Fig 8a, 8b. Masking test of the MO0 ingot shells

Fig 2. The pre-operative situation

Fig 3. The pre-op situation reflecting
the non-vital appearance of the
old veneers and the surrounding
gingiva

Fig 4. The degree of discoloration of
the prepped dentin according to the
ND shade guide

Fig 9. The texturized veneers on the control (non- Fig 10. A comparison between the LT BL1 veneer and
the MO0 veneer
segmented) model

in, it was ND4, noting that the
one reported in the beginning
was ND2. (Fig 4) It seems that
those veneers lost luminosity after placing them on the
prepped teeth, what indicated a
bad influence on the final color.
Nothing can be done at this moment to get those veneers back
to life. A decision to repeat the
case was simply taken, with no
hesitation, photos of the tried-in

ing the discoloration and then;
increasing
the
luminosity,
though we choose the opacity
ingot (Medium Opacity) MO0,
to be pressed on a thickness
of 0.5 mm, and before we proceed I had to double check the
masking capability, so I drew
two marks on the stone (redblue) and check if they are visible through the MO0 shells (Fig
8a, 8b) then layered with dentin

bench through the IPS Natural
die material ND4. (Fig 10)
Cementation
Veneers were finally cemented
with Bleach XL (only Base)
Variolink-II resin cement (from
Ivoclarvivadent), After they have
been tried-in and all seating and

> Page 7

[7] =>

mcme

Dental Tribune Middle East & Africa Edition | September-October 2014

< Page 6
esthetic parameters of fit have
also been checked carefully,
fine-grit diamond burs, finishing and polishing rubber heads
(OptraFine Assortment, IvoclarVivadent) were used to remove
excess residual cement and to
eliminate all occlusal interferences and to give natural glamor
of ceramic surface shin. (Fig 11)
During the follow up appointment, a final checkup and modifications were made to eliminate
all occlusal interference.
Relative translucency level
The level of translucency was
kept minimal relatively to the
patient age and shade whiteness chosen by her, as our priority was to mask and boost the
brightness, and brightness and
translucency contradict to a certain extent, though translucency

kept relatively minimal. (Fig 12)
Color restriction
What makes bleach cases more
complicated is color restriction,
as in our present patient case,
she wants to keep the old lower
veneers that she had before, and
replace just the uppers with a
brighter and more vital set of
bleach veneers, so we are obligated here to keep a chromatic
shade matching especially on
the cervical part of the upper
veneers with the lowers, and
increase the level of brightness
in the mid-third of the upper
veneers than that of the lowers.
(Fig 13)
Personality change
What we simply did was changing not just the patient smile
literally, but changing the smile
on her face emotionally, the feel-

Fig 11a.11b. The glamor smile right after cementing the second set of veneers, and using the polishing rubber heads
(OptraFine, Ivoclarvivadent)

Fig 12. One month recall, Close-up front picture, showing the improvement
in the interdental papilla and the relative translucency level with the lower
set

Fig 13. One month recall, Profile
picture, showing the cervical
chromatic color restriction

Fig 14. The change on our patient face from the time she showed up to the clinic, till one year recall visit

Fig 15. Bright mamlons strips overlapping with
translucent opal strips, all framed with halo effect

Fig 16. One of the artistic photos taken by Mr.Florin
Stoboran, Romania, big thank to him

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ing that she can look younger
pushed her to continue working
on herself, and that appeared
clearly on each follow up visit to
the clinic she was making, one
time skin was taken care off, the
next time hair and make-up,
then back again to the smile to
contour it with a better frame of
lips by using fillings. (Fig 14) So
what we did is that we put her
on the beginning of the cosmetic
track, (A year after the dental
treatment she looked one year
younger) what dentist stated. So
we contributed to change her
life.
Dental Photo shooting
Our patient has a photogenic
face and she didn’t mind to be
our model for a few photo shooting sessions, which encouraged
us to take all possible poses that
showed clearly the strength areas and talent in fabricating such
cases, some snakes with different color contrast were used to
show the optical properties of
the translucent opal and bright
Mamlone material used. Thanks
to the expert Mr. Florin Stoboran
from Romania who helped in
the final photoshoot. (Fig 15, Fig
16, Fig 17)
Conclusion
A decision to repeat the veneers
with a new brighter set of veneers was faithfully taken (after
recognizing that a flawless set
can be achieved if all obstacles

Fig 17. The front set of veneers with a black background contrastor

can be taken into considerations). The honest and ethical
opinion of the dental teamwork
(what we did was okay, but we
can do better), even if the patient
okayed the present outcome.
This is what really takes the
level of esthetic dentistry to the
next level.

I would like to thank Dr. Duval
Aloush for his faithful opinion
and esthetic vision that played
a big role in the successful outcome of this case.

About the Author

Aiham Farah, Syria
Certified Dental Technician by
the National Board for Certification in USA (Dental Laboratory
Technology) with a specialty of
Dental Ceramic. And a member
of the National Association of
Dental Laboratory in USA, currently he is a material consultant and opinion leader for Ivoclarvivadent dental company for
the Near East & Orient region
since 2009, and MDT (Master
Dental Technician) certified by
the ICDE Ivoclarvivadent, Switzerland. He was a Teacher Lecturer at Alkalmoon University,

in Dental Technology division
for graduate students in AllCeramic Subject in Syria (2010,
2011). He had his private dental-lab practice “one-man-show
cosmetic laboratory” in Syria
(2003-2006/2009-2012)
specialized in selective cosmetic
cases, currently he is a lecturer
in dental international conferences, speaks in esthetic dentistry about topics like (Ceramic
material, Esthetic solutions in
CAD/CAM, Dental teamwork,
Psycho-morphology, Advanced
cosmetic characterization etc),
and a demonstrator in courses
and workshops for dentists and
dental technicians. He writes
and publishes articles in local
and international dental magazines like (Reflect, Dental Labor middle east, Dental News,
Dental Tribune etc), in different
teaching topics based on both
theoretical researches and own
practical experience, also he
reviews and edits all the (Arabic language translations) of
the IvoclarVivadent communication tools publications.

[8] =>

8 clinical

Dental Tribune Middle East & Africa Edition | September-October 2014

Esthetic rehabilitation of posterior teeth
using Bulk-Fill Composite

Figs 1 and 2. SEM of the filler composition and surface structure of Tetric N-Ceram Bulk Fill (magnification: 200x)

By Prof. Dr Masahi Miyazaki

n modern restorative dentistry, a strong emphasis is
placed on preserving healthy
tooth structure and achieving
esthetic results. The use of direct
composite restoratives can assist
in meeting these demands.
Composite resins have become
widely accepted in dentistry as
direct placement restorative
materials for posterior teeth.
The advances made in adhesive technology as well as the
improvement of the mechanical properties of composite resins (e.g. wear resistance) have
contributed to this development.
Nevertheless, the polymerization shrinkage and limited curing depth of composite resins
continue to be a concern to
the clinician. Polymerization
shrinkage of composite restoratives has been associated with
micro-leakage, de-bonding of
the restoration as well as increased risk of secondary caries
or postoperative sensitivity. To
reduce the rate of polymerization shrinkage, incremental filling techniques have been recommended for many years. The
reduced shrinkage per composite layer is believed to minimize
the total volumetric shrinkage
[1].

Even though incremental layering may be necessary to ensure
adequate polymerization of the
composite resin, there are also
some disadvantages to this technique. For example, air entrapment between the different layers may occur.
Moreover, the fact that incremental placement requires considerable time may render the
restorative procedure excessively long. The controversy among
researchers and practitioners
with regard to the appropriate
placement technique, namely,
incremental layering versus
bulk placement, continues to
persist.
In recent years, dental manufacturers have gone to considerable
lengths to develop bulk-fill composites that demonstrate lower
shrinkage stress during polymerization and offer much greater
depth of cure. The goal behind
these efforts has been to shorten
the duration of the restorative
procedure [2]. In the meantime,
several posterior composites of
this type have been launched on
the market. What dentists need
now is some sort of guideline
for their application in concrete
clinical situations.

Advantages and limitations of
direct composite resin restorations
A major advantage of adhesive
composite restorations in posterior teeth is the possibility of
preserving healthy tooth structure. Unlike indirect procedures,
the direct restorative technique
with composite requires only
minimal removal of sound tooth
structure. Preparation to gain
access to the lesion is normally
limited to the affected area. Nevertheless, the shape of the cavity
should be adjusted to match the
restorative material. Elimination
of slightly undermined enamel
is not always necessary because
adhesive composite resin restorations may contribute to the
stabilization of the remaining
tooth structure.
As a result of the shrinkage
stress that occurs during the
light-curing of composite resin,
there are restrictions with regard to the placement technique
employed. Studies have shown
that the magnitude of the stress
generated is dependent on a
combination of the material
properties and characteristics of
the prepared cavity. Contributing factors include the confinement conditions imposed on the
composite, the volume of the
restoration, the restorative tech-

niques used and the suitability of
the bonding substrate.
When restoring cavities with
a high C factor, the resultant
stress puts the resin-tooth interface under increased tension
because there is less free, nonbonded surface. An increase in
the C factor is associated with
potentially deleterious effects on
the marginal integrity and the
formation of gaps [3]. Alternatively, high bond strength may
cause cusp deflection and cracking of the enamel.
Methods of lowering the
shrinkage stress
Polymerizing low-volume increments may minimize the
resulting shrinkage stress and
maximize double bond conversion of the monomers to a polymer. Compared with bulk-filling
techniques, incremental filling
produces lower shrinkage stress
(up to a certain threshold thickness of the composite layer).
Incremental placement techniques have the advantage of
maximizing the polymerization

Apart from low residual stress
and good adaptation, thorough
polymerization of the composite
resin is an important factor for
restorative success. The main
concern about the bulk-filling
technique is whether the composite cures sufficiently in the
deeper portions, as this is a prerequisite for any filling with acceptable physical and biological
properties.
Recently, several so-called lowshrinkage stress materials have
been launched on the market.
The majority of them are more
translucent than conventional
composites. They feature a
modified initiator system which
allows them to be placed in increments of up to 4 mm thickness (bulk-filling technique),
but still ensures a reliable cure
with short irradiation times.
Bulk-fill materials have been
reported to demonstrate significantly less shrinkage stress than
conventional posterior composite resins [6].

Composite restoratives suitable for
the bulk-filling technique need to fulfil
certain requirements. Among other
things, they should demonstrate low
polymerization shrinkage and ensure
a high depth of cure.
of each increment because of
the reduced attenuation of light
through the smaller increments
of material and better adaptation of the composite to the cavity walls [4]. Nevertheless, the
value of incremental placement
in reducing shrinkage stress has
been repeatedly questioned [5].
The contradictory conclusions
at which studies have arrived
might be due to differing testing
methods.

Trouble-free restoration
In the restoration of teeth with
composite resin, incremental
layering is generally preferred
because it reduces gap formation at the adhesive interface
and the postoperative sensitivities associated with it. However,
multiple layers of highviscosity composite may be difficult to
place. Recent studies have suggested that fewer increments
and even bulk filling can be
equally successful. However, the
unavailability of suitable bulkfill materials has discouraged
clinicians from employing such
techniques [7]. Today, various
dental manufacturers have expanded their offering to include
lowershrinkage composites, allowing clinicians to achieve reliable and predictable results with
the bulk-filling technique.
Bulk-fill composites should offer high depth of cure. This is

Fig. 3. Preoperative situation: The restoration
of the upper posterior tooth shows a marginal
fracture.

Fig. 4. After the rubber dam has been placed, the
restoration as well as carious tissue are removed.

Fig. 5. Prior to the application of the adhesive,
the cavity is etched with phosphoric acid.

Figs 6 to 9. The anatomical features of the cusps are successively rebuilt until an ideal occlusal anatomy is achieved.

> Page 9

[9] =>

clinical

Dental Tribune Middle East & Africa Edition | September-October 2014

< Page 8

Fig. 10. Carbide burs are recommended for
the removal of marginal overhangs.

achieved by means of the photoinitiator Ivocerin® for example, which is employed by Ivoclar Vivadent. Good mechanical
properties such as high flexural
strength and wear resistance are
also important in order to make
a composite resin suitable for
use in occlusion bearing areas
[8].
Tetric® N-Ceram Bulk Fill from
Ivoclar Vivadent combines all of
these qualities. This light-curing
posterior composite has been
specifically developed for the
bulk-filling technique.
Increments of up to 4 mm thickness can be cured in only 10
seconds at a light intensity of >
1,000mW/cm2.
Tetric N-Ceram Bulk Fill contains four different types of fillers: a barium aluminium silicate filler, ytterbium trifluoride
and mixed oxide. Additionally,
a prepolymer filler (a shrinkage
stress reliever) has been incorporated which keeps polymerization shrinkage and shrinkage
stress to a minimum (Figs 1 and
2). It acts like a spring, dampening the forces generated during
polymerization. As a result, gap
formation and marginal leakage
are minimized, thereby helping
to eliminate the risk of secondary caries and postoperative
sensitivity.
The photoinitiator system in Tetric N-Ceram Bulk Fill includes
conventional initiators as well
as the polymerization booster
Ivocerin. This polymerization

Fig. 11. Final polishing is performed with
Astrobrush.

booster ensures a reliable depth
of cure in the deeper portions of
the cavity after a relatively short
irradiation time. A special light
sensitivity inhibitor has also been
incorporated which makes the
composite resin less sensitive to
ambient light and thus gives the
clinician more time to apply and
contour the restoration. Another
useful quality of this material
is its good polishability, which
supports the achievement of a
glossy surface, excellent resistance to wear in the contact areas and a high flexural strength
of 120 MPa. Moreover, Tetric NCeram Bulk Fill is highly radiopaque; therefore, the restorative
result is easy to examine on dental radiographs.
A clinical case
The shade of the composite to be
used should always be selected
at the start of the appointment,
i.e. before the rubber dam is
placed. This prevents incorrect
colour matching due to dehydration. After the carious tissue
has been removed (Figs 3 and 4)
and the adhesive has been applied (Fig. 5), the entire restorative procedure can be performed
with Tetric N-Ceram Bulk Fill.
As a consequence, a uniform
restoration featuring homogeneous strength is achieved.
Because of the material’s natural-looking translucency, the
shade of the restored site will
blend in with the remaining
tooth structure. If stained substrate is visible within the cavity,

Figs 12 and 13. The result is an esthetic posterior restoration without postoperative sensitivity.

the clinician may opt to place a
layer of Tetric® N-Flow Dentin
first. This material has a higher
opacity and is thus capable of
masking the darker colour of the
underlying dentin.
Although the incremental technique has been advocated for the
reduction of shrinkage stress,
the composite resin described
above is an ideal option for the
restoration of deeper cavities using the bulk-filling technique.
The successive build-up technique makes it possible to ensure correct occlusal morphology through the incremental
placement of composite. Thinbladed placement instruments
and special brushes are used to
sculpt and contour the restored
site.
The composite is applied in bulk
increments to rebuild each anatomic entity of the affected area.
Each cuspal portion is reconstructed with one increment of
composite resin, imparting to
each of the cusps its adequate
anatomical form.
The size and location of the cavity determines the number of
increments needed. Relatively
small Class I cavities can be
filled with a single bulk increment. Medium-sized and large
cavities are restored with several
increments. Each cusp is rebuilt
with an increment of maximum
4 mm thickness.
Anatomical features of the occlusal surface should be taken

into consideration during the application of the composite resin
to mimic the natural tooth structure. Insensitivity to light is a
considerable advantage of Tetric
N-Ceram Bulk Fill, as it ensures
that sufficient time is available
to shape and contour the restoration (Figs 6 to 9).
If the composite resin is carefully placed using suitable instruments, only little time is required
for the contouring and finishing
of the restoration. Hand instruments such as LM Arte-Eccessa
(LM Dental) are recommended
for the removal of composite excess. Marginal overhangs can be
removed with carbide burs (Fig.
10). Composite finishers are
then used to refine the anatomical features. Polishing can be accomplished with ease and in one
step using Astrobrush® (Fig. 11).
The result is an esthetic posterior restoration without postoperative sensitivity (Figs 12 and 13).
Conclusion
Direct composite resin restorations can be performed in a
predictable and efficient way if
an appropriate technique and
advanced materials are used. As
the understanding of the characteristics of new filling materials
improves among clinicians, the
quality of the direct restorations
they fabricate will also increase.
Tetric N-Ceram Bulk Fill with
its many innovative features
enables clinicians to restore
posterior teeth in a much more

efficient way. Proper attention
to technological advances in
the field of restorative therapy
allows esthetic treatment to be
provided that will satisfy not only
the patient but also the dentist
performing the restorative procedure.
Full list of references is available from the publisher.

Contact Information

Prof. Dr Masashi Miyazaki
Nihon University School of
Dentistry
Department of Operative
Dentistry
1-8-13, Kanda-Surugadai,
Chiyoda-ku
Tokyo 101-8310
Japan
miyazaki-m@dent.nihon-u.ac-jp

CAD CAM Technology: a Review
Dr. Kassis Cynthia., DDS, MSc
Dr. Khoury Pierre., DDS, DESS
Dr Tatiana Zogheib, DDS
Dr. Hardan Louis., DDS CES
PhD head of Esthetic and Restorative Dentistry department ,USJ
Prof. Mehanna Carina. , DDS
CES PhD FICD Director of Esthetic and Restorative Dentistry Postgraduate Program USJ,
President of the continuimg
Education committee, Lebanese Dental Association

AD/CAM technology and
materials are currently
used in a number of clinical applications, including the
fabrication of indirect restorations. CAD-CAM gives both the
dentist and the laboratory an
opportunity to automate fixed
restoration fabrication. Both
chairside and chairside – laboratory integrated procedures
are available. The properties
of these restorative materi¬als
and their indications and appropriate use must be understood in order to enable the

achievement of predictable and
esthetic results for patients.
KEYWORDS:
CAD-CAM systems
Intraoral scanner
Digital impression
Introduction
In the past decade, the demand
for all ceramic restorations has
increased in both anterior and
posterior teethand the search
for materials with improved
properties has expanded.1 The
need for a uniform material
quality, reduction in production cost, and standardization
of manufacturing process has
encouraged researches to seek
to automate the manual process via the use of CAD- CAM
technology since 1980.2
Computer-aided design (CAD)
and computer-aided manufacturing (CAM) technology systems use computers to collect
information and design, and to
manufacture a wide range of
products.3 The introduction of

the first digital intraoral scanner for restorative dentistry
was in the 1980s by a Swiss
dentist, Dr. Werner Mörmann,
and an Italian electrical engineer, Marco Brandestini, that
developed the concept for what
was to be introduced in 1987
as CEREC® by Sirona Dental
Systems LLC (Charlotte, NC),
the first commercially CAD/
CAM system for dental restorations.4,5 Ever since research
and development sectors at a lot
of companies have improved
the technologies and created
in-office intraoral scanners.
All the existing intraoral scanners try to face with problems
and disadvantages of traditional impression fabrication process and are driven by several
non-contact optical technologies and principles.
The purpose of this present
publication is to provide an
extensive review on the CADCAM technology and to emphasise on the application of

this technology in restorative
dentistry.
CAD –CAM techniques
The major goals of the impression – taking process in restorative dentistry are obtaining a
copy of one or several prepared
teeth, healthy adjacent and antagonist teeth, establishing a
proper interocclusal relationship and then converting this
information into accurate replicas of the dentition on which
indirect restorations can be
performed.6
Traditional restorative techniques for fixed restorations
require the use of impression
materials to record the contours and dimensions of the
preparation. This is followed
by the pouring of stone models
and dies prior to laboratory fabrication of the definitive fixed
restoration. Taking an accurate
impression is one of the most
difficult procedures in dentistry, requiring careful retraction
or removal of soft tissue around

preparation margins, hemostasis, and selection of an appropriate impression material and
tray for the technique used.
By using a CAD/CAM restorative technique, a number of
steps can be simplified or eliminated.7
Digital systems now offer the
opportunity to avoid traditional, analog impressions, including the usual impression
materials, time, and handling
limitations associated with
them. Intraoral scanners have
the potential to offer excellent
accuracy with a more comfortable experience for the patient
and more efficient workflow
for the office. But care must be
taken to ensure that the whole
preparation is scanned, to avoid
introducing errors.
Two techniques can be used
for CAD/CAM restorations: The
chairside technique or the integrated chairside-laboratory
procedure.

> Page 10

[10] =>

10 clinical

Dental Tribune Middle East & Africa Edition | September-October 2014

< Page 9
1 - Chairside technique:
The development of Computer
Aided Design-Computer Aided
Machining (CAD-CAM) technologies for dental applications has enabled clinicians to
prepare and indirectly restore
tooth tissue with an esthetic
all-ceramic restoration, manufactured at the chairside in a
single patient visit.
Chairside CAD-CAM techniques offer advantages to the
patient including eliminating
the laboratory procedure and
the requirement for intra-visit
temporization of the prepared
tooth structure:8
It eliminates several cumbersome dental office tasks, such
as selecting trays, preparing
and using materials, disinfecting and sending impressions to
the laboratory. It also removes
a source of discomfort and
gagging. Moreover, it enables
the clinician to take a digital
impression as well as design
and mill the restoration in-office, and to fabricate cosmetic
crowns, onlays and veneers,
With full management over
contours and tooth shade and
finally it enhances the accuracy of adaptation of the restoration to the preparation.9
In summary, with these systems, final restorations are produced in models created from
digitally scanned data instead
of plaster models made from
physical impressions.
There are three main sequences to this workflow. The first sequence is to capture or record
the intra-oral condition to the
computer. This involves the use
of a scanner or intra-oral camera.
During scanning , the clinician
must ensure that all margins
of the cavity are captured by
the scan and visualized. The
accuracy of CAD/CAM restorations depends on the scanner’s
ability to visualize the margin.
A true laser scanner/digitizer
takes precise digital images
of the preparation, including
the margin, the undercuts, the
contours, the adjacent dentition, and the gingiva. It captures hundreds of thousands of
points of reference with each
image, and then utilizes a million data points to create an exact replica of the prepared tooth
and neighboring dentition.
Depending on the system, a
light and rapid dusting of an
opacifier may be required prior
to capturing the digital scans of
the preparation arch, opposing
arch, and buccal bite registration. Once the data has been
recorded to the computer, a
software program is used to
complete the custom design of
the restoration, the preparation
is shown on the monitor and
can be viewed from every angle
to focus or magnify areas of the
preparation. Inadequate images are automatically detected.
The “die” is virtually cut on the
virtual model, and the finish
line is delineated by the dentist
directly on the image of the die
on the monitor screen. Then, a
CAD system, called “biogeneric”, provides a proposal of an
idealized restoration and the

The earlier versions of CEREC®
employed an acquisition camera with an infrared laser
light source. The latest version
employs blue light-emitting
diodes (LEDs); the shorterwavelength intense blue light
projected by the blue LEDs allows for greater precision of the
output virtual model.
The E4D Dentist system was
introduced in early 2008. It
consists of a cart containing
the design center (computer
and monitor) and laser scanner
head , and a separate milling
unit. The IntraOral Digitizer is
a single image camera with red
laser light. It also works by recording reflected data from the
hard and soft tissues.10

LTD, IL came into the market
in early 2007. iTero system employs a parallel confocal white
and red laser light camera to
record series of single images
to create 3D model. The scanner emits a beam of light that
is reflected off the tooth surface. Only data reflected back
through the filtering device at
the correct focal distance is recorded.11
Using this technique iTero captures all structures and materials found in the mouth without
the need to apply any reflective
coating to the patient’s teeth.
2 - Integrated chairside-laboratory procedure
An integrated chairside—laboratory technique requires two
visits.
The clinician either can scan
the preparation directly and
then send the scan to the laboratory, or can take a traditional
impression, after which a stone
model is poured and the laboratory scans the stone model.
The digitalization of the dies
was performed by a laser scanner (Cercon eye, DeguDent®,
Hanau, Germany) and the
substructures were designed
on the CAD program of the
system. Digital impression systems are designed to electronically transmit the recorded
data file to the dental laboratory for restoration fabrication.
Efficient chairside assistants
will increase the overall production of dental practices by
aiding dentists in completing
their procedures more quickly
and more effectively.
Other systems are also used by
laboratories to create copings,
substructures, and abutments
by CAM, after which hand fabrication of any required ceramics and finishing is conducted
either by the same laboratory or
by the laboratory that scanned
and referred the case for milling of the substructure. Ceramic blocks for laboratory-milled
restorations are available as
zirconia (zirconium oxide) and
lithium disilicate glass blocks.
Zirconium oxide can be used to
create accurate and strong copings and bridge substructures.
After milling, the unit can be
adjusted using an external liner (Zirliner, Ivoclar Vivadent)
that enables characterization
before the outer ceramic suprastructure is created. The
external ceramic layer can be
created either using press ceramics (in the same manner
as for a traditional bridge) or
layering ceramic material onto
the substructure using a fine
brush and powder/liquid.
Advantages of a laboratory
CAD/CAM milled restoration
include reduced chairside time
and increased accuracy. Since
a stone model is not used, stone
pouring errors are eliminated
as well as errors associated
with abrasion of the adjacent
and opposing teeth due to manipulation of the models during
fabrication that could result in
over-contouring, tight contacts,
and excessive occlusal height.
In addition, reduced time is
required for fabrication of the
substructure.

The Cadent iTero digital impression system by Cadent

Materials
CAD/CAM restorative mate-

dentist can make adjustments
to the proposed design using a
number of simple and intuitive
on-screen tools.
The software identifies matching morphological characteristics (fissures, cusps, marginal
ridges, gliding contact angle)
and then inserts corresponding
cusps, fossae, fissures, contacts
surface into the virtual model
of the restoration. On the basis
of the contact point distribution, the cusp apexes and the
proximal contacts, the software is capable of creating a
well-matched tooth and detecting possible collisions with the
bite registration.
This biogeneric modelling process creates natural, individual
and functional occlusal surfaces.
A pre-manufactured block is
inserted into the machine and
is milled using diamonds.
The final sequence requires a
milling device to fabricate the
actual restoration from the design data in the CAD program.
Digital systems
The Cerec Bluecam, E4D intraoral digitizer, and i Tero
scanner are considered singleimage cameras. They capture a
series of individual digital images that overlap one another.
The overlapping images are
“stitched” together by the computer software program to process a single 3-D virtual model.
CEREC AC ® system powered
by BlueCam: A LED camera
projects a changing pattern of
blue light onto the object using projection grids that have
a transmittance random distribution and which are formed by
sub regions containing transparent and opaque structures.
Thus, the intensity of light detected by each sensor element
is a direct measure of the distance between the scan head
and a corresponding point on
the target object. As a disadvantage of the system, the triangulation technique requires a uniform reflective surface since
different materials (as dentin,
amalgam, resins, gums) reflect
light differently. It means that
it is necessary to coat the teeth
with opportune powders before
the scanning stage to provide
uniformity in the reflectivity of
the surfaces to be modeled.

rials are currently available
in number of sizes in many
shades and translucencies, including multiple shades within
one dense gradated restorative
block. The material used depends on functional and esthetic demands and on whether
a chairside or laboratory CAD/
CAM restoration is fabricated.13
A range of dental ceramic substrates have been developed for
chairside machining and are
represented as prefabricated
blocks, manufactured using
processing routes identified to
reproducibly control the resultant ceramic composition and
microstructure.15,15,16
For chairside CAD/CAM restorations, an esthetic, strong
material requiring minimal
post-milling esthetic adjustment to minimize chairside
time is needed.17,18,19 Leucitereinforced glass ceramics (IPS
Empress CAD, Ivoclar Vivadent; Paradigm C, 3M ESPE)
and lithium disilicate glass
ceramics (IPS e.max, Ivoclar
Vivadent) can be used for chairside and laboratory CAD/CAM
single restorations. Leucite-reinforced material is designed to
match the dentition for strength
and surface smoothness and to
offer esthetic results by scattering light in a manner similar to
enamel.20
A study has been done to evaluate and compare the marginal
gap, internal fit, and fracture
load of resin-bonded, leucitereinforced
glass
ceramic
mesio-occlusal-distal (MOD)
inlays fabricated by computeraided design/manufacturing
(CAD/CAM) or hot pressing:
as a result, they provided clinically acceptable marginal and
internal fit with comparable
fracture loads after luting.21
Ceramic blocks for laboratorymilled restorations are available as zirconia (zirconium oxide) and lithium disilicate glass
blocks. Zirconium oxide (IPS
e.max ZirCAD, Ivoclar Vivadent; Cercon, Dentsply Ceramco) can be used to create accurate and strong copings and
bridge substructures. Zirconia
offers some significant physical properties that are advantageous for dental restorations
besides its high strength. It has
a similar color to natural teeth,
which reduces the need to
opaque it or mask it as would be
done for a metal substructure.
Zirconia also has good opacity. This may be an advantage
when trying to block out underlying discolored teeth or restorative materials. It may also be
a disadvantage when trying to
develop a more translucent appearance to the crown. Some
manufacturers can color the
zirconia substructure to simulate dentin shades to improve
the desired esthetic result.22
After milling, the unit can be
adjusted using an external liner (Zirliner, Ivoclar Vivadent)
that enables characterization
before the outer ceramic suprastructure is created. The
external ceramic layer can be
created either using press ceramics (in the same manner
as for a traditional bridge) or

layering ceramic material onto
the substructure using a fine
brush and powder/liquid.
Composite resin blocks are also
available for CAD/ CAM restorations.23 Another option is the
use of a new resin nano-ceramic block that consists of ceramic
clusters within a highly crosslinked resin matrix. The resulting block is homogenous, and
the restoration can be CAD/
CAM-milled chairside or in the
laboratory.
Discussion
Marginal adaptation is an important factor affecting the longevity of all-ceramic restorations.24 Considerable research
has been invested in the margin
fit and internal adaptation of
CAD-CAM restorations.25,26,27,28
Software limitations as well
as accuracy of milling devices may affect the fit of CAD/
CAM restorations. Most clinicians agreed that marginal gap
should not be greater than 100
μm. It has been reported in the
literature that restorations produced by CAD/CAM systems
can have marginal gaps of 1050 μm which is considered to be
within the acceptable range.29
Giannetopoulos S and Al investigated and compared the
marginal integrity of ceramic
copings constructed with the
CEREC3 and the EVEREST
system employing three different margin angle designs.
They explored to what extent
these CAD/CAM machines can
produce acute marginal angles
creating restorations with acceptable margins. They found

Fig 1. Scnannig the preparation

Fig 2. Drawing the limit line

Fig 3. Designed molar restorations using
dental designer software. Lingual view

Fig 4. Designed molar restorations using
dental designer software. Occlusal view

> Page 12

[11] =>

Tetric N-Ceram Bulk Fill
®

The nano-optimized 4-mm composite

Discover the new
time-saving

composite
4 mm

4 mm to success
• Bulk filling is possible due to Ivocerin®, the patented light initiator
• Special filler technology ensures low shrinkage stress
• Esthetic results are achieved quickly and efficiently in the posterior region

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[12] =>

12 clinical

Dental Tribune Middle East & Africa Edition | September-October 2014

< Page 10

Fig 5. CAD-CAM milling machine

Fig 6. Milling machine

that the average Chipping
Factor (CF) of the CEREC copings was: 2.8% for the 0° bevel
angle, 3.5% for the 30° bevel
angle and 10% for the 60° bevel
angle. For the EVEREST copings the average CF was: 0.6%
for the 0° bevel angle, 3.2% for
the 30° bevel angle and 2.0%
for the 60° bevel angle. Univariate Analysis of Variance and
multiple comparisons showed
that there was a statistically
significant difference in the
quality of margins between the
two systems for the 0° and 60°
bevel finishing line.30
Mjör and Al have evaluated
CAD/CAM restorations and
found that they have a marginal fit as good as or superior to
that of traditional impressions.

A further benefit found with
CAD/CAM restorations has
been the reduced incidence of
secondary caries (the leading
cause of direct restoration failure with both amalgam and
composite materials), attributed to the high accuracy of the
approximal fit and the ability to
ascertain that this is accurate
prior to completion of the restoration and cementation.31
Another study evaluated the accuracy of marginal and internal fit between the all-ceramic
crowns manufactured by a conventional double-layer computer-aided design/computer-aided manufacturing (CAD/CAM)
system and a single-layer system. Ten standardized crowns

were fabricated from each of
these two systems: conventional double-layer CAD/CAM system (Procera) and a single-layer system (Cerec 3D). Marginal
discrepancies of Procera copings were significantly smaller
than those of Procera crowns
and Cerec 3D crowns (p 0.05).
On internal gaps, Cerec 3D
crowns showed significantly
larger internal gaps than Procera copings and crowns (p <
0.05). Within the limitations of
this study, the single-layer system demonstrated acceptable
marginal and internal fit.32
On the other hand, depending
on the preparation design, either an adhesive or a non-adhesive luting cement can be used

Herculite XRV Ultra
®

™

with these materials.
CAD/CAM restorative materials can be cemented with either traditional luting cements
such as zinc phosphate, polycarboxylate cement, glass ionomers, or resin-modified glass
ionomers. Materials that can be
sealed with these include zirconia, lithium disilicate, alumina, and resin nano-ceramics
.33,34
Concerning the resin adhesive
cements, they offer superior esthetics and low viscosity.
They chemically bond to the
restoration surface and the
tooth surface, either providing
all of the retention or, for retentive preparations, improved retentive strength. They also have
greater compressive strength.35
Meanwhile zirconia fixed partial dentures showed good to
sufficient marginal integrity
in combination with Panavia/
ED, Compolute/EBS and RelyX
Unicem.36
When evaluating the initial and
the artificially aged push-out
bond strength (PBS) between
ceramic and dentin produced
by one of five resin cements,
there was a significant effect
of resin cement (p<0.0001):
RelyX Unicem showed significantly higher PBS than the
other cements. Syntac/Variolink II showed significantly
higher PBS than SmartCEM2
(p<0.001). No significant differences were found between
SpeedCEM, SmartCem2, and
iCEM. The predominant failure mode was adhesive failure
of cements at the dentin interface except for RelyX Unicem
which in most cases showed
cohesive failure in ceramic.37
Conclusion
Digital impressions tend to reduce repeat visits and retreatment while increasing treatment effectiveness. Patients
will benefit from more comfort
and a much more pleasant experience in the dentist’s chair.38
The quality of adaptation of
CAD/CAM-generated restorations is an area of current interest. Studies demonstrate the
clinically acceptable durability of CAD/CAM restorations
for color matching, interfacial
staining, secondary caries,
anatomic contour, marginal
adaptation, surface texture,
and postoperative sensitivity.39,40,41,42,43

Kerr, making history
again

Adhesive cementation seems
to be the key for the long-term
clinical success of CAD/CAM
inlays and onlays.44
References
1. WittnebenJG, Weber HP:A
Systematic review of the clinical performance of CAD/CAM
single-tooth restorations.Int J
Prosthodontics 2009; vol 22,5:
466-471
Full list of references is available from the publisher.

Your practice is our inspiration.™

Contact Information
Contact mail:
cynthiakassis@yahoo.com

[13] =>

clinical 13

Dental Tribune Middle East & Africa Edition | September-October 2014

Meeting esthetic challenges
with Herculite XRV Ultra
About the Author
Dr. Abdi Sameni is a Clinical Associate Professor of Dentistry and a 1991 graduate of Herman
Ostrow School of Dentistry at USC. He has been
a member of the USC clinical faculty since 1998.

Before

He is a former faculty for the “esthetic selective”
which emphasizes a “biomimetic approach” to
restorative and esthetic care. He was the original director of the USC Advanced Esthetic Dentistry Continuum for the portion relating to indirect porcelain veneers.

After
Preparation

By Dr. Abdi Sameni

He is the chairman and developer of the “USC International Restorative
Dentistry Symposium” for the Ostrow School of Dentistry at USC.

Herculite® XRV Ultra offers the
best of both worlds: strength
and esthetics, to give you longlasting, beautiful restorations.

Dr. Sameni lectures nationally and internationally on topics related to
interdisciplinary dentistry, digital photography and its applications for
dentistry, and various aspects of biomimetic and esthetic dentistry.

Ortho was performed to create
space for ideal width.
Mock Up

A silicone matrix is made from a
wax-up (not pictured) and then
verified for adaptation.

Dr. Sameni is Past-President of the USC Dental Alumni Association,
past-president of the USC Century Club, Board of Directors of the Pan
pacific Center for Continuing Oral Health Professional Education and
a member of the Board of Counselors for the USC School of Dentistry.
Dr. Sameni serves on the Board of Governors for the USC Alumni Association and he is currently the co-chair of the Ostrow School of Dentistry at USC Scholarship Selection Committee. Dr. Sameni is a member
of numerous professional organizations and societies, which include
OKU and the Pierre Fauchard Academy.
He maintains a private practice in West Los Angeles, where he emphasizes comprehensive restorative dentistry, including implant reconstruction and esthetic dentistry. Dr. Sameni received an honoraria from
Kerr Corporation for this case.

The lingual shell is made with
Herculite Ultra Light Incisal.

Dentin XL1 and B1 Enamel are
applied and covered with Light
Incisal.

Shade mock up is removed.

Bonding

Herculite Ultra Light Incisal is
adapted to matrix.

Dentin XL1 and B1 Enamel are
applied and covered with Light
Incisal.

Dentin shade XL1 and enamel shade
A1 are layered and cured. Finishing
and polishing steps completed with
Axis instruments.

Process repeated for tooth #9.

Ordering

35485 Herculite XRV Ultra Aesthetic Kit Unidose
35486 Herculite XRV Ultra Aesthetic Kit Syringe
35370 Herculite XRV Ultra Incisal Refill Packs
35371 Herculite XRV Ultra Incisal Refill Packs
33856 Herculite XRV Ultra Standard Kit Syringe
33857 Herculite XRV Ultra Standard Kit Unidose
33858 Herculite XRV Ultra Intro Kit Syringe
33859 Herculite XRV Ultra Intro Kit Unidose
33860 Herculite XRV Ultra Mini Kit Syringe with OptiBond Solo Plus
34071 Herculite XRV Ultra Mini Kit Unidose with OptiBond Solo Plus
34956 Herculite XRV Ultra Mini Kit Syringe with OptiBond All-In-One
34957 Herculite XRV Ultra Mini Kit Unidose with OptiBond All-In-One

www.kerrdental.ae
To place your order, please contact your local dealer

images requested by
Tzvetan,
awaiting

[14] =>

14 clinical

Dental Tribune Middle East & Africa Edition | September-October 2014

Dr. Ahmed Zuhaili performs yet another
groundbreaking surgery
By Dr. Izdihar Alchab

e are proud to announce
that our surgeons at the
French Dental Clinic
Dubai, have recently performed
a new surgery of its kind for a 21
year patient with Papillon Lefe-

Fig 3.

Fig 2.

Fig 1.

ver syndrome. Papillon Lefever
syndrome is characterized by
periodontitis and palmoplantar
keratoderma. The severe destruction of periodontium results
in loss of most primary teeth by
the age of 4 and most permanent
teeth by age 14. An alternative
to conventional management
of this disease which is dentures, Dr Ahmad Alzahaili and
Dr Jean Francois Tulasne who
is an inventor and developer of
the partial bone graft technique

performed a groundbreaking
surgery by extracting bone from
the cortical extern of the parietal
bone and replacing it in the patient’s mouth. Basically giving
the patient a chance at leading a
normal life since he had lost all
his teeth and the bone along at
the tender age of 13. The patient
was referred to us by implantologist colleagues from Boston University who had previously attended a conference done by our
surgeon Dr. Ahmed Zuhaili and
his teacher Dr. Jean Francois
Tulasne who is inventor and developer of the partial bone graft
technique.

When the patient initially came
to us we made sure that the patient was fit for surgery under
general anesthesia. We determined the same by doing CT
Scans and X-rays of his upper
and lower jaw as well as skull to
check the bone skull density of
the cortical external and internal
regions.
The surgery was performed under general anesthesia, in which
we prepared and made ready the
upper and lower jaw to receive
the parietal bone grafts. We then
collected the bone from the cortical extern of the parietal bone

Fig 6.
Fig 4.

Fig 7.

Fig 5.

Fig 8.

Fig 9.

of the skull and replaced it in the
upper and lower jaw with surgical screws and finally sutures.
We had to wait for 3 months after
the surgery to check if the graft
had been successful and properly
integrated in the jaw. We were
extremely pleased with the results, which were perfect.
Our colleagues from Boston University, Dr. Kinaya then placed 9
impants in the upper jaw and 6
implants in the lower jaw.
After another 3 months our patient was overjoyed to receive his
upper and lower teeth done by Dr
Soukaria again from Boston university.
Even though the whole process
took around 6 months, it was
completely worth it for the patient and for us. The patient has
been given a new life and with

his own teeth without having to
compromise and go through life
with dentures at such a young
age.

Contact Information

Dr. Izdihar Alchab
2026, Block C, Al Razi Building,
Health Care City, Dubai
French Dental Clinic
For more information, please
visit our website:
www.frenchdentalclinic.com

[15] =>

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[16] =>

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

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

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

[17] =>

43rd Conference of the Arab Dental Federation
24th BIDM . Beirut Lebanon . 10-13 September 2014

BIDM 2014
show edition

Professor Elie Maalouf, President of
the Lebanese Dental Association

Dear Colleagues,

t is with great pleasure that I
welcome you on behalf of the
Lebanese Dental Association
to the 24th Beirut International
Dental Meeting, which will take
place from 11-13 September 2014
at Biel.
We encourage you all to attend
the meeting under the theme of
“Planning for the Future” in order
to better prepare your practices
with cutting-edge techniques and
equipment for a more prosperous future. The organizers of this
meeting have prepared a three-

Dr. Nabih Nader Chairperson,
Scientific Committee BIDM 2014

Dear Friends and Colleagues,

n behalf of the Scientific
Committee, It gives me
great pleasure to welcome
you to the “Beirut International
Dental Meeting” (BIDM 2014),
Lebanese Dental Association An-

www.bidm-lda.com

day program that will feature leading experts and world-renowned
speakers who will share the most
up-to date developments in dentistry and related disciplines. Participants will enjoy the learning
opportunities in various plenary,
symposia, panel discussion sessions that will be put in place. This
year you will be able to attend
lectures and then have the opportunity to participate in workshops
to implement the knowledge you
gained from the lecture. There
will be interesting workshops
throughout the 3 days of the conference for a limited number of
attendees at very enticing fees.
The workshops will emphasize on
esthetics and cosmetic dentistry,
but there will be a range including
surgery, implants, prosthodontics
and endodontics. You will all have
a chance to attend an innovative workshop, which will bridge
the gap between us dentists, and
our Lab technicians. Through
this workshop you will be taken
through the steps after your impression has been taken at the
clinic and you will be able to see
live demos and hands on to help
you digitalize your practice, taking it to the future with CAD-CAM
technology.

I would also like to extend a warm
welcome to all the Presidents of
Arab Dental Associations who will
be present at this event and encourage all Arab& foreigner dentists to participate in BIDM 2014
that is held in collaboration with
Saudi Dental Association.

nual Congress held in Biel, from
11-13 September, 2014.

A variety of session types, including Plenary Lectures, Symposia,
Young Podium session, Interactive
session, Poster Session, Panel Discussion as well as a Pre-congress
will be held on September 10, 2014
at St. Joseph University.

The Scientific Committee has
been working hard to put on a
high quality meeting which will
provide the expected blend of education and exchange of knowledge
that has been consistently enjoyed
by many of you at the BIDM over
the years.
Under the theme of “Planning
for the Future”, this congress will
offer a platform to learn and exchange ideas with a host of key
opinion leaders from around the
world, as well as many locally
renowned experts. This will be a
great opportunity to be exposed to
the latest views and techniques in
our constant effort to improve the
lives of our patients.

Dental Meeting with the collaboration of the Saudi Society that will
be held on September 11-13, 2014
at Biel Beirut, Lebanon.

Dr. Mohammad I. Al-Obaida
President, the Saudi Dental Society

Dear Colleagues,
It is my pleasure to welcome you
to the 24th Beirut International

With the theme of the Meeting
“Planning for the Future”, we
encourage all our colleagues to
participate and be a part of this
prestigious event to enhance our
knowledge and be updated with
the new trends in th efield of dentristy and plan for the future with
the use of highly innovative dental
technologies.
This meeting will be an educational and professionally rewarding experience with the participation of internationally renowned
experts present their latest find-

Lebanon is a great cultural and
touristic country; there will be
several social programs that have
been designed for participants
who would love to discover Lebanon.
I also strongly encourage you to
take advantage of the presence of
over 90 exhibiting companies to
keep you updated with evolving
technologies of equipment and the
latest dental materials.

Show Edition | BIDM 2014
WELCOMING MESSAGES
Prof. Elie Azar Maalouf
Dr. Nabih Nader Chairperson
Dr. Mohammad I. Al-Obaida
> Page 1

SCIENTIFIC PROGRAM
Scientific Program
Report Saint Joseph University - Faculty of Dentistry
> Page 2-3

PLANMECA
Chairside CAD/CAM™ Integrated workflow
> Page 4

I am confident that you will find
this meeting beneficial to your career, having the advantage of the
innumerable learning and networking opportunities.
I’m looking forward to meeting
you all.
Sincerely,
Prof. Elie Azar Maalouf
President, LDA / BIDM 2014

Ribbon Cutting during JO14

BIDM2014 will be covering all
dental disciplines, meeting the
needs of all participants, from
trainees to the most esteemed professors.
We offer you our warmest welcome and hope to make BIDM
2014 Convention a memorable experience for you!
Sincerely,
Dr. Nabih Nader Chairperson,
Scientific Committee BIDM 2014

ings and are ready to share their
experiences with dentists from
around the globe. The conference
provides a top forum for a passionate discourse and a fruitful interchange of views.
I wish you informative days and
discussions that are mutually enriching as well as inspiring for the
future.
Once again, on behalf of the Saudi
Dental Society, I would like to extend best wishes for a successful
conference.

Dr. Mohammad I. Al-Obaida
President, the Saudi Dental Society

Openning Ceremony 11th JO2014 AT USJ-fmd

VISIT OUR
BOOTH:

F18

[18] =>

43rd Conference of the Arab Dental Federation
24th BIDM . Beirut Lebanon . 10-13 September 2014

2 Scientific program

SCIENTIFIC PROGRAM
BDIM 2014 - PRE-CONGRESS PROGRAM - PRODENT SAL
Victoria Tower Victoria Tower | Corniche El Naher 7th floor | Beirut, Lebanon
Time

MON. 8 th of SEPTEMBER 2014

TUES. 9 th of SEPTEMBER 2014

Philosophy of 20minute Smile Design
(Part I)

Nasser Shademan

Nasser Shademan

Nasser Shademan

09:30-09:40

Philosophy of 20minute Smile Design
(Part II)

Nasser Shademan

Nasser Shademan

Nasser Shademan

Designing Maxillary Anterior Aesthetic
with Wax "Hands On"

Fabricating High Aesthetic Provisionals for
Six Maxillary Anteriors

20minute Smile Design Live Patient
"Hands On"

10:30-10:40

Nasser Shademan

Nasser Shademan

Nasser Shademan

10:50-11:00

Luch Break

10:00-10:10

Angelo Putignano

10:10-10:20

ProTaper Next &
Swaggering File Designs ( Part I )

Break & Exhibition Visit

Nasser Shademan

Nasser Shademan

11:30-11:40

Q&A

The “Style Italiano Philosophy”:
Feasible Teachable Repeatable ( Part II )
Angelo Putignano

11:40-11:50

ProTaper Next &
Swaggering File Designs ( Part II )
Michael Scianamblo

11:50-12:00

Periodontal Approaches in Growing
Orthodontic Patients
Turi Bassarelli

ORTHODONTICS

Nasser Shademan

11:20-11:30

ENDODONTICS

11:10-11:20

ESTHETICS

20minute Smile Design Live Patient
"Hands On"

Break & Exhibition Visit

Break & Exhibition Visit

11:00-11:10

Fabricating High Aesthetic Provisionals for
Six Maxillary Anteriors "Hands On"

Rachid Mally

Joseph Bou Serhal

Michael Scianamblo

10:40-10:50

Designing Maxillary Anterior Aesthetic
with Wax "Hands On"

17:30- 18:00

The “Style Italiano Philosophy”:
Feasible Teachable Repeatable ( Part I )

10:20-10:30

Coffee Break

15:30-16:00
16:00-17:30

09:50-10:00

Fabricating High Aesthetic Provisionals for
Six Maxillary Anteriors "Hands On"

Orthodontic Treatment
in Mouth Breathing

Adult Orthodontics:
What Makes the Difference?

Break & Exhibition Visit

ENDODONTICS

14:00-15:30

09:40-09:50

Designing Maxillary Anterior Aesthetic
with Wax "Hands On"

12:30-14:00

Roger Rebeiz

09:20-09:30

ESTHETICS

Coffee Break

Recent Advances in Endodontic Concepts,
Tools for Shaping, Cleaning Fine & Curved

Exhibition Visit

HALL KAVO
ORTHODONTICS

Fabricating High Aesthetic Provisionals for
Six Maxillary Anteriors

HALL PRODENT
ENDO

Aesthetically Driven Tooth Anatomy in
Anterior Zone

09:10-09:20

DAY 1 - THURSDAY 11th of SEPTEMBER 2014

HALL CREST ORAL-B

Time
09:00-09:10

10:00-11:00
11:00-12:30

WED. 10 th of SEPTEMBER 2014

Registration

08:30-09:00
09:00-10:30

BDIM 2014 - SCIENTIFIC PROGRAM

12:00-12:10

BDIM 2014 - PRE-CONGRESS PROGRAM - USJ
PERIO

PROSTHO

Perio Pre-Congress
Course

11:00-11:30

One – Day Advanced
Pre-Congress Course
on Everything you
wanted to know
about Implant
Overdentures
and Implant Fixed
Complete Dentures

11:30-12:00

Lunch Break

Time

WEDNESDAY 10 of SEPTEMBER 2014
th

ENDO

09:00-10:00

10:30-11:00

12:00-12:30
12:30-13:00
13:00-13:30

LASER

Pedo Pre-Congress
Course

Laser Pre-Congress
Course on
Basic Laser
Certificate Course
by WFLD

SURGERY

Registration

08:30-09:00

10:00-10:30

PEDO

Surgery Mucograft

Endo Pre-Congress
Course

Lunch Break
Lunch Break

"Hands On"

Lunch Break

Brunch

13:30-14:00
20 Heads of Sheep

14:30-15:00

"Hands On"

16:00-16:30

"Hands On"

"Hands On"

17:00-17:30

"Hands On"

17:30-18:00

BDIM 2014 - SCIENTIFIC PROGRAM

External Sinus Lift
on Model Using
Ultra-Sonic Surgery
"Hands On"

DAY 1 - THURSDAY 11th of SEPTEMBER 2014

HALL CREST ORAL-B

Time

HALL PRODENT

13:40-13:50

Lunch & Exhibition Visit

Lunch & Exhibition Visit

13:50-14:00

Lunch & Exhibition Visit

14:00-14:10
14:10-14:20
14:20-14:30
14:30-14:40

Is Teeth Whitening a Safe Procedure?

Root Canal Preparation
Current Concepts, Challenges & Solutions

Carina Mehanna Zogheib

Prosanna Neelakantan

14:40-14:50
14:50-15:00
15:10-15:20
15:20-15:30
15:30-15:40

Management of
Severely Damaged Teeth ( Part I )

15:40-15:50

Miguel Roig

15:50-16:00
16:00-16:10

Break & Exhibition Visit
Management of
Severely Damaged Teeth ( Part II )

16:50-17:00

Miguel Roig

17:00-17:10

Difficult or Severe Cases
in Orthodontics

Hani Ounsi

Turi Bassarelli

Use of Laser in Dental Prosthetic Surgery
Samir Nammour
Immediate Implant Placement in
Extraction Sockets in the Esthetic Zone
Pascal Valentini

BDIM 2014 - SCIENTIFIC PROGRAM

Break & Exhibition Visit

17:50-18:00

18:20-18:30
18:30-18:40

Minimally Invasive &
Non Invasive Solutions for Challenging
Aesthetic Dentistry
Nasser Shademan

18:40-19:50
18:50-19:00

Single Tooth Replacement in the
Esthetic Zone: Surgical Aspects
Pascal Valentini

BDIM 2014 - WORKSHOP PROGRAM

Opening Ceremony

HALL LISTERINE
Innovative Methods in Implantology and
Bone Regeneration. Why, How and What?
Soheil Bechara

Digitalize Your Dental Practice
Amann Girrbach Workshop

LAB

“Keys to Success” is the theme
of this year; our profession
is changing very fast and re-

Exhibition Visit

IMPL

Prof Nada Naaman (Dean of
faculty of dentistry) declared:

You will also have the opportunity to visit a large exhibition that will help keeping
you informed of all the new
materials in our profession.
The successful experience of
the seminar in 2012 offered
to dental assistants will be repeated and your clinical aid
may well enjoy a half-day focus on hygiene and asepsis.

Break & Exhibition Visit

12:30-13:30

Exhibition Visit

13:30-15:00
15:00-18:00

Rami Chayah

ENDO

The campus of Medical Sciences, Faculty of Dentistry
has organized the 11th Dental
meeting from 28th till 31th of
May 2014.

How to Attach a 2-Implant Mandibular
Complete Denture with Locator Attachments
Tony Daher

12:00-12:30

The “Style Italiano Philosophy”
Angelo Putignano

15:00-15:10

We hope to see you on the
campus and we look forward
to discuss and share our ideas,
knowledge and experience.
The event received sponsorships by major dental market
players in Lebanon; over 50
exhibitors were present which
gave attendees the opportunity to get hands-on with the
latest products and treatment
solutions in the field.
Faculty of Medicine has been

ESTH

B

EIRUT, Lebanon: Saint
Joseph University plays
an important role in the
Lebanese dental community,
All through the academic year;
it offers numerous activities of
interest to society as a whole.

quires us to be continuously
informed on new technologies. Local and international
speakers will provide brilliantly rich discussions, animate roundtables and live
clinical interventions on patients. The pre-congress day
will cover current topics and
hands-on seminars.

Maxillary Sinus Grafting: State of the Art
Pascal Valentini

Imman Aligner and the New Philosophy
in Approaching Cosmetic

PROS

By Rodny Abdallah, DT MEA

09:00-12:00

HALL TAMER
IMPL

During the laser workshop

Optimized Strategies in Complex
Interdisciplinary Cases

DAY 1 - THURSDAY 11th of SEPTEMBER 2014

HALL 3M

Time

Proposition d’une "Nouvelle" Définition
et Classification - Kamal Philippe Harb

Patrick Anhoury

IMPLANTOLOGY

18:10-18:20

Pascal Valentini
Break & Exhibition Visit

LAB TECHNICIANS

18:00-18:10

Immediate Implant Placement in
Extraction Sockets in the Esthetic Zone
"continued"

ORTHODONTICS

Miguel Roig

17:40-17:50

Kamal Philippe Harb

HALL KAVO
IMPLANT

17:30-17:40

Management of
Severely Damaged Teeth ( Part II )
"continued"

HALL PRODENT
ESTHETICS

17:20-17:30

Break & Exhibition Visit

DAY 1 - THURSDAY 11th of SEPTEMBER 2014

HALL CREST ORAL-B

Time
17:10-17:20

Roy Sabri

Non Surgical Management
of Endodontic Lesions

IMPL

16:40-16:50

Philippe Sleiman

LASER

16:20-16:30
16:30-16:40

Modern Endodontics

Multidisciplinary Management for
Old & Recent 1st Permanent

Break & Exhibition Visit

16:10-16:20

ESTHETICS

Report Saint Joseph
University Faculty of Dentistry

HALL KAVO

13:30-13:40

15:00-15:10

Presentation of
different Laser
System

16:30-17:00

Opening Ceremony

12:30-13:30

ORTHODONTICS

15:30-16:00

20 Heads of Sheep

One – Day
Advanced PreCongress Course on
External Sinus Lift
& Intra-Oral Bone
Grafting using
Ultra-Sonic Surgery

Break & Exhibition Visit

12:20-12:30

ESTHETICS

15:00-15:30

VDW Reciproque /
Dentsply Protaper Next

Lunch Break

Break & Exhibition Visit

ENDODONTICS

14:00-14:30

One – Day Advanced
Pre-Congress Course
on Everything you
wanted to know
about Implant
Overdentures
and Implant Fixed
Complete Dentures

Laser Pre-Congress
Course on
Basic Laser
Certificate Course
by WFLD

One – Day
Advanced PreCongress Course on
External Sinus Lift
& Intra-Oral Bone
Grafting using
Ultra-Sonic Surgery

Break & Exhibition Visit

12:10-12:20

Root Canal or
Root Canal System Treatment
Philippe Sleiman
Exhibition Visit

organizing dental meetings
every two years; its latest
event was attended by over
1100 dental professionals from
several countries according to
its figures.
Additionally, a number of participation workshops on topic
ranging from implant dentistry, aesthetic dentistry, and
orthodontics and laser symposium .it were remarkable
this year a joint laser full day
symposium organised in col-

laboration with the University
of Genoa in Italy.
At the symposium, Prof. Stefano Benedicenti, Dean of the
Center for Laser Surgery and
Laser Therapy at the University of Genoa in Italy, educated
attendees on the applications
of dental lasers.
The Dental Tribune supported
the event through its edition.

[19] =>

43rd Conference of the Arab Dental Federation
24th BIDM . Beirut Lebanon . 10-13 September 2014

Scientific program

3

SCIENTIFIC PROGRAM
BDIM 2014 - SCIENTIFIC PROGRAM

DAY 2 - FRIDAY 12th of SEPTEMBER 2014

HALL CREST ORAL-B

Time

HALL PRODENT

HALL KAVO

12:00-12:10
12:10-12:20

Management of Vertical Defects in the
Posterior Mandible.
Evidence-Based Proposals?
Georges Tawil

12:20-12:30

BDIM 2014 - SCIENTIFIC PROGRAM
12:30-12:40

Break & Exhibition Visit

HALL PRODENT

Dimitar Filtchev

14:50-15:00

How to Improve Quality and Productivity”
for Dentists
Sami Bahri

Soheil Bechara

16:00-16:10

BDIM 2014 - SCIENTIFIC PROGRAM
HALL PRODENT

A Confident Approach to Immediate
Implant Placement - "continued"
Break & Exhibition Visit

Jin Kim

17:40-17:50
Break & Exhibition Visit

17:50-18:00

Break & Exhibition Visit

Joe Massad

18:40-19:50

Lateral and Internal Sinus (LISA)
Technique: A New Approach to the
Maxillary Sinus
Jin Kim

18:50-19:00

BDIM 2014 - WORKSHOP PROGRAM
Time
9:10-9:20
9:20-9:30

11:10-11:20
11:20-11:30
11:30-11:40
11:40-11:50
11:50-12:00

Traitement Non Invasif des
Hémangiomes par Laser - Nicole El-Hajj
Dental Erosion, Attrition, Abrasion and
Abfraction. Their Share in Tooth Wear
Gabriel El-Hajj

HALL LISTERINE

11:00 - 13:10

• Relationship of Apices of the Third Mandibular Molar and the Inferior Aalveolar Canal in Conventional
Radiography v/s CBCT - Sara Abbass, Kassem Moussa
• Effect of Immersion Cleansers on the Fracture Resistance, Surface Hardness and Weight of
Heat-Polymerized Aacrylic Resin - Ben Afia Imene, Ramy Walha, Bouali Radhia, Trabelsi Mounir
• Les Préparations Préprothétiques en Rapport avec l'Appui Dentaire en Prothèse Partielle Amovible
Ramy Oualha
• Increased Beta 2 Defense in Recurrent Aphthous Ulcer - Ahmed Al-Samadi
• Effect of Orthodontic Treatment on Head and Neck Posture: Preliminary Report of a Pilot Study
Terry Wak, Elie Amm, Joseph Ghoubril
• Occlusal Finishing in a Therapeutic Class III: A Case Report - Carine Abi Dergham, Elie Khoury, Joseph Ghoubril
• Facial Profile Preferences by Groups of Lebanese Subjects: a Cross-Sectional Survey
Marwan Helou, Adib Kassis, Joseph Ghoubril
• Evaluation of Skeletal Age: Hand-Wrist vs CVM - Shana Harb, Roula Akl, Joseph Ghoubril
• Assessment of Dental Decays and Oral Hygiene Among Adolescent School Children in Greater Beirut:
A Comparison Between Public and Private schools - Katy Bitar, Monique Chaaya, Miran Salame Jaffa,
Mayada Kanj, Joseph G. Ghafari
• Malocclusion, Orthodontic Treatment Need, and Oral Health-Related Quality of Life in Adolescents:
A Comparison Between Public and Private Schools in Beirut - Suzanna Al-Ma??ali, Monique Chaaya,
Miran Salame Jaffa, Mayada Kanj, Joseph G. Ghafari
• Complications of Orthognathic Surgeries - Liliane Bachir, Samar Bou Assi
• Prophylactic Extraction of Lower Third Molars: How Can Radiology Aid In Decision-Taking?
Mohammad Hussein

Aris Tripodakis

BIDM 2014 Board
Prof. Elie Azar Maalouf 		
Dr. Mohamad Kataya 		
Dr. Walid Khattar 		
Prof. Nouhad Rizk 		
Dr. Fadi Abillamaa
Dr. Hasan Alloul
Dr. Abdel Kader Bsat
Dr. Nizar el Kadi
Dr. Daniel Kahale
Dr. Fadl Khaled
Dr. Atef Nohra
Prof. Georges Tehini

Scientific Committee
Dr. Nabih Nader 		
Prof. Roula Abiad 		
Dr. Fadl Khaled 			
Dr. Rima Abdallah
Dr. Cynthia Chemaly Abillama
Dr. Tony Dib
Dr. Nicole Geha
Prof. Fadi El Hajj
Dr. Wasfi Kanj
Dr. Elie Khoury
Dr. Ahmad Mekkawi
Prof. Sami Mouwakdie
Dr. Dona Raad Zakhia
Dr. Maria Saadeh

Concomitant Reconstruction of
Temporomandibular Joint with Total Joint
Prostheses and Orthognathic Surgery - A
Case Report - Mohammad Naji Bou Wadi
Face off: A Dream Comes True
Mohammad Ahmad Al Shokeimy
Indications for Removal of Impacted
Mandibular Third Molars : A Single
Institutional Experience in Libya
Hamed Orafi
Closing Ceremony

President
Vice president
General Secretary
Treasurer

Chairperson
Executive Coordinator
LDA Representative

Dr. Walid Khattar 		
Dr. Mohamad Eid El Khalil
Dr. Tony Fawaz
Dr. Maria Khoury
Dr. Josette Richa Maalouf

Chairperson

Continuing Education Committee
Prof. Carina Mehanna Zogheib
Dr. Samer Rifaii 			
Prof. Paul Boulos
Dr. Abir El Kaissi
Dr. Nicolas Naffah
Dr. Hitaf Nasrallah Nasseh

Chairperson
Executive Coordinator

Official Media Partner
Digitalize Your Dental Practice
Amann Girrbach Workshop

PROS

Rolando Nunez

ESTH

Smile Design Protocol

Are the Ceramic Abutments the Sole Way
to Trans-Mucosal Implant Esthetics?

Dental Tribune Middle East

Maya Rassy
Break & Exhibition Visit
Nour Bou Saleh

Break & Exhibition Visit

Organizing Committee

Exhibition Visit

12:00-15:00
15:00-18:00

La Photodestruction par Laser Diode en
Pathologie Orale - Dolly Roukoz

PROSTHETICS

11:00-11:10

Joseph Sabbagh

Digitalize Your Dental Practice

10:50-11:00

Recent Concepts for Bulk Filling of
Posterior Cavities

Amann Girrbach Workshop

10:40-10:50

PROSTHETICS

10:30-10:40

Implant Provisional Crowns: Clinical Tips

10:20-10:30

Tony Daher

10:10-10:20

Haitham Elbishari

POSTER SESSIONS - 10 minutes each

9:30-9:40
9:50-10:00

Wear & Tear in Implant Supported
Restorations - “Prevention & Management"

HALL TAMER
TIME:

10:00-10:10

Botulinum Toxin Type-A (Botox) as
a Symptomatic Treatment of TMD
Disorders - Ahmed Abdelhamid

DAY 2 - FRIDAY 12th of SEPTEMBER 2014

HALL 3M

9:00-9:10

9:40-9:50

Break & Exhibition Visit

PATHOLOGY

18:30-18:40

What's New in Removable
Prosthodontics in this Digital World
( Part II )

PROSTHETICS

18:20-18:30

Le " Thermosens " pour la Fabrication des
Bases des Prothèses Amovibles , pourrait -il
un Jour Remplacer la "Résine "?
Najib Abou Hamra

Break & Exhibition Visit

PERIODONTOLOGY

18:00-18:10
18:10-18:20

Treatment Options for the Edentulous
Maxilla - Nazem Assaad

ESTH

Joe Massad

17:30-17:40

13:50-14:00

14:30-15:00

PROS

17:20-17:30

What's New in Removable
Prosthodontics in this Digital World
( Part I )

PROSTHETICS

17:10-17:20

Designing, Creating and Maintaining
Pristine Implant-Bone-Soft Tissue
Interface: Key Factors that Determine
Long-Term Success

PERIODONTOLOGY

16:50-17:00

13:40-13:50

14:20-14:30

TMD

Break & Exhibition Visit

16:40-16:50

Break & Exhibition Visit

13:30-13:40

14:10-14:20

HALL KAVO
IMPL

PROS

How to Avoid .....for your Daily Practice
"continued"

16:30-16:40

Atraumatic Extractions Using the
Piezoelectric Technology: Advantages
and Limitations - Claude Chaanine

DAY 2 - FRIDAY 12th of SEPTEMBER 2014

HALL CREST ORAL-B

Time

13:20-13:30

Dentists in Business: Let's Face It- We
Are Not Only Dentists, We're Also
Running a Business!
Anna Maria Yiannikos

HALL KAVO

Maryline Eddo
Nour Abou Zahr

What Should Primary Healthcare
Providers Know about Current &
Future Concepts in TMJ Management
Mohammed A Al-Muharraqi

13:10-13:20

14:00-14:10

Endo-Crowns: The Recent History and
the Upcoming Future
Ahmad Khaled Aboelfadel

IMPL

A Confident Approach to Immediate
Implant Placement

15:50-16:00

17:00-17:10

13:00-13:10

PROSTHETICS

Tony Daher
Vahik Meserkhani

15:40-15:50

16:20-16:30

12:50-13:00

Implant Placement with Similtaneous
Lifting in Very Reduced Bone Height - 3
Year Study - Amine Choueiry

Aris Tripodakis

Roula Tarabay
Maryam Abboud
Eliane Ziade

HALL PRODENT
Quantitée Importée et Consommée des
Dentifrices et Brosses à Dents au Liban
Depuis 2000 jusqu'en 2014
Fida Al Sayyah

12:10-12:20

12:40-12:50

Break & Exhibition Visit

DAY 3 - SATURDAY 13th of SEPTEMBER 2014

Break & Exhibition Visit

MANAGEMENT

PROSTHETICS

How to Avoid and How to Manage
Complications in Implant Dentistry:
Practical Prosthodontic Pearls for your
Daily Practice

Break & Exhibition Visit

HALL CREST ORAL-B

Dento-Facial Architecture
& Fixed Prosthodontics

Sandra Andari

Mohannad Khandakji

IMPLANTOLOGY

14:40-14:50

PROS

Digital Solutions to Achieve Perfect
Results with Implant Treatment

14:30-14:40

15:30-15:40

Time

Hasna Ghaleb

Marc BAKALIAN

Break & Exhibition Visit

ESTHETICS

14:20-14:30

16:10-16:20

Lunch & Exhibition Visit

Reconstruction of the Anterior Maxilla:
The Advanced Surgical Therapy
Peter Tawil

14:10-14:20

Redefining Pediatric Dentistry
Dina Dbaibo

12:20-12:30

SURGERY

Lunch & Exhibition Visit

14:00-14:10

12:00-12:10

Break & Exhibition Visit

Lama Matar

BDIM 2014 - SCIENTIFIC PROGRAM

Theraputic Alternatives in Implant
Treatment in the Posterior Maxilla
Joseph Saade

Lunch & Exhibition Visit

13:50-14:00

15:20-15:30

Evaluation of the Diagnosis, Treatment
Planning & Long-Term Follow-up of
Cystic Lesions with CBCT - Saydé Sokhn

11:50-12:00

Maryline Bitar

Break & Exhibition Visit

YOUNG

SURGERY

13:40-13:50

15:10-15:20

The Use of CBCT in the Extraction of
Lower Third Impacted Teeth
Elie Abdo

Sinus Floor Elevation with Simultaneous
Implant Insertion using the Layered Graft
Technique - Charles Khoury

13:30-13:40

Luca Dalloca

Break & Exhibition Visit

11:40-11:50

HALL KAVO

Atrophic Manidble Panel
"continued"

ESTHETICS

Antonio Cerruti

13:20-13:30

15:00-15:10

11:30-11:40

Break & Exhibition Visit

12:30-12:40

12:50-13:00
13:10-13:20

11:20-11:30

DAY 2 - FRIDAY 12th of SEPTEMBER 2014

12:40-12:50
13:00-13:10

11:10-11:20

Mohamad Al Bazzal

OTHER

HALL CREST ORAL-B

CBCT in the Daily Dental Practice

ESTHETICS

Time

11:00-11:10

Latest Use of Fluoride Varnishes
in Dentistry - Guitta Abi Nasr
Fundamental of Team Approach in
Aesthetic with Non and Minimal
Invasive Dentistry to Achieve Natural
Smiles that Blends Harmoniously into
our Patients Faces' ( Part II )

Break & Exhibition Visit

PODIUM

Antonio Cerruti

10:50-11:00

INTERACTIVE SESSION

RADIOLOGY

11:50-12:00

ESTHETICS

11:40-11:50

10:30-10:40
10:40-10:50

Marcel Noujeim - Ibrahim Nasseh

Notre Profession Devient-Elle
Plus Féminine? - Rola Al Karnib

Break & Exhibition Visit

Ahmad Tarabaih

Hani Arakji
Break & Exhibition Visit

10:10-10:20
10:20-10:30

Dina Dbaibo

Monaf Abdulrahim Shalha

YOUNG

11:30-11:40

Long Term Evaluation of Immediately
Loaded Implants in the Atrophic Jaw
Jihad Abdallah

Luca Dalloca

How Can We Improve Children's Smiles?

PEDIATRIC

11:20-11:30

Radiographic Follow-up and
Re-evaluation Using CBCT Studies

10:00-10:10

Fundamental of Team Approach in
Aesthetic with Non and Minimal
Invasive Dentistry to Achieve Natural
Smiles that Blends Harmoniously into
our Patients' Faces ( Part I )

PEDIATRIC

Break & Exhibition Visit

09:50-10:00

Marcel Noujeim

HALL KAVO
Hussein Samih Basma

ESTHETICS

11:10-11:20

Atrophic Manidble Panel
Surgical & Prosthetic Treatment Options
of the Edentulous Mandible
Nadim Abou Jaoude
Nabil Barakat

11:00-11:10

09:40-09:50

Marcel Noujeim

SURGERY PANEL DISCUSSION

Michel Jabbour

Evidence-Based Dentistry: Is it For Me?
Asim Al-Ansary

C.D.

10:50-11:00

10:30-10:40

SURGERY

10:40-10:50

Les Augmentations Osseuses Maxillaires
et Mandibulaires: Quelles Techniques
Chirurgicales Utiliser et Quels Matériaux
( Part II )

10:20-10:30

09:30-09:40

Recommendations for Use of CBCT in
Orthodontics

RADIOLOGY

CAD/CAM History & Beyond
Nawaf Al-Dousari

10:10-10:20

PROS

Break & Exhibition Visit

10:00-10:10

09:20-09:30

09:10-09:20

HALL PRODENT

PODIUM

09:50-10:00

Alexandre Khairallah

HALL CREST ORAL-B

PEDIATRIC

Rolando Nunez

09:00-09:10

ESTHETICS

Michel Jabbour

Update in
Universal Adhesive Technology

ESTHETICS

09:40-09:50

09:20-09:30

SURGERY

09:30-09:40

Les Augmentations Osseuses Maxillaires
et Mandibulaires: Quelles Techniques
Chirurgicales Utiliser et Quels Matériaux
( Part I )

09:10-09:20

Time

Cone Beam CT:
Endodontic Applications

DAY 3 - SATURDAY 13th of SEPTEMBER 2014
YOUNG

09:00-09:10

BDIM 2014 - SCIENTIFIC PROGRAM

[20] =>

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[21] =>

Helps stop bleeding gums

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

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

Change vs baseline in bleeding
on probing index after 4 weeks

30.00

22%

reduction in
bleeding

25.00

(p<0.01 vs. baseline)

20.00
15.00
10.00
5.00
0.00
4 weeks

Fluoride-containing
control toothpaste

Baseline

4 weeks

parodontax®

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

OH/CA/00/13/003

Baseline

[22] =>

18 endo tribune

Dental Tribune Middle East & Africa Edition | September-October 2014

Empirical comparative study confirms
thixotropic wound dressing for haemostasis

Application of HEMOSTASYL after bleeding following dental caries treatment. (Photograph courtesy of ACTEON)

By Dr. Sven Schomaker

aemostasis is fundamental to the prevention of excessive blood
loss and for wound healing
after injury, or wound setting.
It is a basic prerequisite for
flawless work in restorative
dentistry. There are numerous
tissue management systems
available on the dental market
for haemostasis and retraction
today. Both purely mechanical
techniques and locally acting
chemical agents in the form of
solutions, gels and pastes are
available, which can be applied
alone or in combination with
retraction sutures.

In a German survey, 510
dental professionals tested
the practicality of various
haemostatic
agents
and compared them. The
thixotropic HEMOSTASYL
(Pierre Rolland, Acteon
Group) achieved the best results. The gel received a rating of very good, primarily
for its astringent and haemostatic effects, as well as
for its handling properties.
The best means of avoiding possible bleeding complications is a conservative
procedure that causes little
trauma to the tissues and
vessels. In many cases, a

sufficient local therapy can
also help prevent bleeding
complications during and
after surgical procedures or
reconstruction.

company introduced a new
type of gel in Germany in
October 2007, which adopts
a different approach to the
problem of haemostasis.

In addition to the body’s
own haemostatic mechanisms, there are a number of measures and substances in dentistry that
support the achievement of
haemostasis. They can be
of a mechanical, chemical,
thermal or surgical nature,
as well as a combination of
these. The products or techniques selected depends on
the clinical situation (localisation, and the extent or
risk of bleeding), as well as
on the practitioner’s preferences.

HEMOSTASYL is a thixotropic product for light to
moderately heavy bleeding,
and contains aluminium
chloride. Its angled syringe
applicator facilitates direct,
precise application. Indications for the haemostatic
wound dressing include
composite fillings, tooth
preparation,
impression
taking, temporary crowns
and bridges, root tip resections and cementation.

Rapid haemostasis with
aluminium chloride and
kaolin
Since the products available on the dental market at
the time did not adequately
meet the requirements for
a local haemostatic agent
(risk free for patients; quick,
effective and reliable bleeding control; easy handling;
and fast), the Pierre Rolland

The haemostatic effect of
HEMOSTASYL is brought
about through the combination of aluminium chloride and kaolin, and is mechanically augmented by
the thixotropic properties
of the material. Haemostasis should begin to take effect in less than 2 minutes,
after which the treated location should be free from
(seepage) bleeding. The gel
is applied with the application cannula, with no pressure exerted on the gingiva.

After haemostasis has been
achieved, the turquoiseblue substance is removed
with a light air and water
spray and simultaneous
suction (Figs. 1– 4).
Methods
In order to determine
whether this medical product offers advantages over
other products used for haemostasis, some 1,000 sample packs were distributed
to dentists, orthodontists
and oral surgeons throughout Germany, along with
instructions for use and a
questionnaire. Of these, 510
respondents agreed to test a
sample pack and return the
completed
questionnaire
within a period of three
months of receipt.
Questionnaire
The questionnaire was developed in collaboration
with the Institute for Medical Biometrics and Epidemiology at the University
Medical Center Hamburg-

> Page 19

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[23] =>

endo tribune 19

Dental Tribune Middle East & Africa Edition | September-October 2014
< Page 18
respondents (386) reported
that haemostasis using the
gel required little time.
Only 34.7% of the respondents (177) rated the other
products just as highly.

Fig. 1: Bleeding following dental
caries treatment.

Graphic 1: Assessment of heamostasis

Fig. 2: Application of HEMOSTASYL

Discussion

Fig. 3: Haemostasis achieved in less
than 2 minutes.
Graphic 2: Assessment of handling

Fig. 4: After removal of HEMOSTASYL using a gentle water spray, the
site is free of any bleeding or oozing.

Eppendorf. It was divided
into two sections. The first
dealt with general information on other products used
for haemostasis and their
indications. In the second
part, the study respondents
were asked to evaluate HEMOSTASYL and compare it
with other products with respect to haemostatic properties, handling and application time.
Results
Comparator products and
indications
HEMOSTASYL was tested
2,542 times, having been
applied four to ten times by
the majority (69.4%) of the
study respondents. During the study, its properties
were compared with those of
more than 13 other haemostatic products. The three
most frequently mentioned
comparator products (ViscoStat, Ultradent; Astringedent, Ultradent; and Racestyptine, Septodont) made
up more than half (56%).
On the question regarding
primary indication, just under half of the respondents
cited impression taking.
The second leading indication was composite fillings,
at just under 40%. This was
followed, by a wide margin,
by tooth preparation, which
was listed as an indication
by 10% of the testers. Relatively rarely cited indications included cementation,
temporary crowns, bracket
bonding, retainer bonding,
and amalgam and CEREC
restorations.
Haemostatic properties
(Graphic 1)
Using the Mann–Whitney
test, it was determined that

Direct comparison
(Graphic 4)
As to the question regarding
overall impression (haemostasis, handling/application
properties and time to haemostasis),
HEMOSTASYL
was rated better overall by
305 of the respondents (approximately 60%) than the
comparator products.

the respondents rated haemostasis with HEMOSTASYL statistically significantly better than with one
of the other products for the
listed indications. Haemostasis with the thixotropic
gel was rated 1 or 2 by 86.9%
of the respondents (443).
Only 69.4% of the respondents (354) gave this very
good grade to their comparator product.
A result of no bleeding after application of HEMOSTASYL was recorded by
32.2% of the respondents
(164), while only 20.2% of
the respondents (103) found
the same effect for one of
the comparator products.
Moderate bleeding with
HEMOSTASYL was reported
by only 10.4% (53) of the
respondents. By contrast,
moderate bleeding after
application of one of the
comparator products was,
notably, relatively frequent
at 26.3% (reported by 134 of
the respondents).
Handling/application
(Graphic 2)
HEMOSTASYL also achieved
a statistically significantly
better result in the evaluation of its handling: 91.4%
of the respondents (480) rated its handling as very good
(301) or good (179), while
this rating was given to the
other haemostatic products
in only 54.5% (278) of cases.
The comparator products
received a score of 1 from
only 13.9% (71) and a score
of 2 from 40.6% (207) of the
respondents.
Time to haemostasis
(Graphic 3)
Using the chi-squared test,
it was determined that the
rating for HEMOSTASYL regarding time to haemostasis
was also statistically significantly better than for the
comparator products. More
than three-quarters of the

With regard to haemostasis, HEMOSTASYL received
a score of 1 or 2 more often
than the other products.
The aluminium chloride
contained in the gel for its
astringent effect thus appears to offer additional
enhancement of the haemostasis. Because the gel
can be applied directly and
precisely in the mouth with
the angled syringe applicator, it also fared better with
the testers with regard to
its handling and application properties. Other advantages are that it can be

removed easily with an air
and water spray, and is easy
to detect because of the contrasting turquoise colour.
HEMOSTASYL was also rated better by most of the users with respect to the time
factor. Treatment (such as
taking an impression or
bonding inlays) can be continued immediately after
haemostasis with the haemostatic wound dressing
under optimal conditions.

Conclusion
The results of this study
make it evident that HEMOSTASYL is indicated for efficient haemostasis in cases
of light to moderate bleeding. With clear indications
for use and easy application
without risk to the patient,
it offers quality assurance
to the dental practice.

Further advantages reported by the testers included
painless treatment, particularly when the wound dressing is applied to a healthy
periodontium, and good tolerability without undesirable systemic side-effects,
such as can be the case with
haemostatic agents containing epinephrine.
Overall HEMOSTASYL distinguishes itself with its
thixotropic properties and
consequent ease of application and very good adhesion
to the tissue without exerting pressure, as well as the
associated mechanical effect.

About the Author
Dr. Sven Schomaker
• Born 1975 in Hamburg
• Promotion 09.09.2011 Berlin
Charite
• Settled since 01.01.2008 in the
practice of Dr. Engeln and Dr.
Schomaker in Hamburg
•Training assistant 01.01.200631.12.2007 of Dr. Matthias Engeln
in Hamburg
• Training assistant 01.01.200431.12.2005 of Dr. Wulf Elstermann in Hoisdorf
• Approval 09.12.2003 in Hamburg
• Degree in Dentistry 1997-2003
University Hospital Hamburg
Eppendorf
Internet:
www.zahnarzt-hamburg.biz

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[24] =>

20 ortho tribune

Dental Tribune Middle East & Africa Edition | September-October 2014

Pre-Align then design
By Dr. Tif Qureshi

minimal enamel loss. However
for patients with moderate to severe misalignment deep preparation into dentine and possible
devitalisation may be the result
of trying to align by tooth preparation alone.

if Qureshi, Past President
of the BACD shows how
the combination of prealignment with simple orthodontic techniques and ceramic technology have created a paradigm
shift in the way cosmetic dentistry can be carried out.

Figure 1. Lateral view

If the nineties were the decade of
the Ultra White Hollywood Smile
the noughties seem to have ushered in an era of more refined
tastes in smile design. While
there is still demand for whiter
teeth many patients are now asking for a more natural look rather
than the over-bright identikit
smile designs of the last decade.
In keeping with this more conservative mood patients are
also becoming more aware of
the good sense of preserving as
much of their own tooth structure as possible and are questioning how their restorations will affect the health of their teeth. Can
combination therapy with orthodontics and minimal thickness
veneers satisfy patients demands
for minimum intervention, natural aesthetics and a rapid result?
Smile makeovers with ceramic

Figure 2. Spacewize capture
showing 3.3mm crowding
veneers can certainly achieve
patients desire for an instant
cosmetic result, for patients with
mild misalignment good aesthetic outcomes can be achieved with

Frequently adult misaligned patients have explored and rejected
orthodontic options as too slow a
route to their aesthetic goal and
are willing to risk their pulp to
have the perfect smile for their
wedding, holiday or new partner. Many of these patients can
now be offered a safer way to
the ideal smile. The risk of restoring these patients has been
reduced by two recent developments, rapid adult orthodontics
and emax high strength pressed
ceramics. Appliances such as the
Inman Aligner have speeded up
the alignment process to as little
as four weeks for moderate misalignment to 8 weeks for severely
misaligned cases. While emax
has enabled thinner, stronger veneers to produced with a natural
appearance.

Misaligned anterior teeth often
show irregular incisal edge wear
which after aligning becomes
more apparent due to the differing lengths of the teeth. While
the arch alignment may have
been perfected the crooked incisal line now becomes more apparent. Starkly outlined against
the darkness of the oral cavity the differing incisal outlines
of the incisors require further
treatment before the ideal smile
can be achieved.
Lengthening the incisal edges
with composite tips may provide a medium term solution
particularly on the lower anteriors where the occlusal forces
are mostly compressive and less

Figure 3. Occlusal pre op

For older patients misalignment
is often associated with occlusal
abnormalities and enamel wear
which paradoxically may become more visible after aligning.

likely to debond the composite
from the tooth. In the upper arch
however incisal tips are subject
to more shear stress during function and guidance and in this
situation composite tips are more
likely to chip or debond than a
well-designed incisal wrap ceramic veneer.
The Inman Aligner
This patient presented complaining that he hated his smile.
He felt they were dark, short and
crooked.
On examination several key
problems existed. Firstly his
anterior teeth were badly misaligned. They were also dark
having had years of staining and
this had been compounded by occlusal trauma that had worn the
edges of his teeth badly allowing
of absorption of stain through the
tips. The misalignment and occlusal wear also meant that his
teeth were actually quite different lengths.
He wanted a great smile and he
wanted it quickly.
Several options were available
and outlined:

Figure 4. Pre op smile view

Figure 5. Inman with expander

1) Fixed orthodontics - the patient did not want fixed brackets
placed in his mouth even with
short term ortho being presented
as a compromised alternative to
a referral for ideal specialist orthodontics.
2) Invisible clear aligner braces
- the patient refused this because
of the time quoted for treatment,
but was keen on the removability.
The cost was also an issue because the patient would still need
further
aesthetic/restorative
treatment afterwards.
3) Veneers placed instantly were
requested by the patient, but
due to the massively destructive
preparations, were discouraged
immediately. An occlusal view
showing the amount of tooth destruction needed was enough to
convince the patient that it was a
poor choice.

Figure 6. 12 weeks of aligning
whitening

Figure 7. Final Alignment

Figure 8. Occlusal after with
fixed retainer

4) Inman Aligner - the patient
accepted this because of the
short-expected treatment time
and because he wanted removability.
Our plan was then to perform
anterior alignment of the teeth
with simultaneous whitening
and then to re-assess the smile
design and occlusal function afterwards to realign, then design.
Treatment
A full examination with x-rays
and occlusal analysis was carried out. Full BACD style photos
were taken. Analysis of the occlusal photo showed that there was
3.3mm crowding. We chose to
use an Inman Aligner with combined expander.
The Aligner was used over 12
weeks by the patient and only
worn 16-18 hours a day.
The patient turned the midline
expander once a week and some

Figure 9. IPS Emax veneers

> Page 21

[25] =>

Dental Tribune Middle East & Africa Edition | September-October 2014

ortho tribune 21

< Page 20
progressive, anatomically respectful IPR was carried out.
At week 9 of alignment, bleaching trays were constructed and
short acting Day - white whitening gel was used to whiten over
the same period. Because the
Inman Aligner can be removed
and because it only needs to be
worn a maximum of 20 hours a
day, it is very easy for the patient
to whiten at the same time. This
is excellent for motivation.
By week 12 the patient’s teeth
were whiter and straighter. The
patient was then held in retention
on a temporary essix retainer.
However at this point we needed
to reassess including the patient’s
perception of the aesthetics.
The patient’s posterior occlusion
was balanced but he had no anterior or canine guidance.
After alignment we offered the
patient the option to simply use
edge bonding on the upper teeth
as we commonly do but he expressed a wish to still have veneers to give a fuller look. Upper
edge bonding was simulated by
adding composite in a mock up
fashion. He viewed the result but
still felt his teeth looked flat and
wanted them to appear fuller.
So at this point a purely additive
wax-up was made and a direct
preview was placed in the mouth
from a silicone stent taken from
the wax up.
The patient was happy with the
new tooth length and dimensions.
At the next appointment, Edge
bonding was placed from lower
premolar to premolar to open
the bite and enhance guidance.
The Dahl principle was used and
no more than 2mm of composite
was added anteriorly with most
loading on the canines and a long
centric on the incisors. (-Within
2 months the posteriors were in
full contact again)
One week later the upper teeth
were prepared. Minimal preparations could be used because
the teeth were in the right position so the preparations could be
truly in enamel.
Temporaries were placed immediately based on the silicone stent
of the wax up.
At this point no retainer was
needed because the temporaries were locked together except
of course at the gingival embrasures where small interdental
brushes could be used to ensure
adequate hygiene.
Aesthetics, function and phonetics were checked, rechecked and
modified over a 4 week period.
Guidance corrections were made
in situ on the temporaries and the
lower composite edge bondings.
Once the patient was happy and
fully comfortable, an accurate
silicone rubber impression was
given to the technician and he
then had an exact copy to follow
for the final veneers.
The patient visited the lab for a
shade match and discussion on
tooth characterization. His input
and requirements were noted by
the technician.
In the lab once the veneers were
made, an impression was taken
of the veneers on a solid model
and this was used to produce an

immediate temporary retainer.
Of course once the temps are
removed the teeth will still need
retaining so this could be used
before a fixed retainer was fitted
later. On the fitting appointment,
the temporary veneers were removed and the finals tried in.
The patient was happy and the
veneers were then bonded.
A new impression was taken
to make a wire retainer. In the
meantime the patient wore the
temporary essix made on the veneer cast.

to achieve the texture and feel of
teeth polished for years by the
tongue, cheeks and lips. The difference in feel and appearance of
hand polished ceramic to glazed
ceramic is noticeable and patients often comment on the natural feel of the restorations. The
high strength and polish-ability
of the Lithium Disilicate Emax
ceramic allows hand finishing
with a low risk of fracture during
the process.
For the patient with more com-

One week later a wire retainer

Figure 10. Close view before

Figure 13. Fine anatomy carved
with fine FG diamonds

plex aesthetic or functional / occlusal issues or high aesthetic demands a combination therapy of
realignment and minimally invasive ceramic restorations can
be the solution that satisfies both
the patients desire for great aesthetics and the clinicians desire
to conserve enamel. An added
advantage of this approach is that
the pre-alignment of the teeth
ensure much less dentine exposure during prep and a greater
area for the stronger enamel
bonding.

The smile design is performed
progressively not instantaneously. It allows the patient to see the
improvements in their alignment
and whitening before a final decision on ceramics is made. This
is fundamentally different approach to what has gone before
and thanks to the new techniques
available such as simpler anterior
orthodontics and Emax technology it is now making advanced
cosmetic dentistry far simpler
and safer for all.

Conclusion
This multidisciplinary case
shows what is possible when orthodontics, whitening, and advanced ceramic techniques are
combined and sequenced.

Contact Information

Everything is done to simplify
the treatment and lower risk to
make the results more predictable and importantly to involve
the patient along the way with
decision-making.

Figure 11. Close view after alignment
Figure 14. Enhancing colour
with surface shades

Figure 12. Close view after veneers
made by the orthodontic lab was
bonded to the back of the upper
6 front teeth. Because the preps
were minimal the veneers were
only on the facial surface so
bonding to the back of the teeth
was easy.
The patient was thrilled with
his result not only because he
achieved a natural more attractive smile, but also he did it with
the minimal amount of invasion
needed.
Emax veneers
Due to it high strength of 400500mpa (compared to feldspatic
ceramic 100mpa) emax ceramic
veneers may be fabricated as thin
as 0.2mm. The high strength
and resistance to chipping when
polishing fine edges make Emax
veneers ideally suited to minimal prep techniques. With such a
thin veneer the skilled ceramist
has little space to create his magic with internal layering techniques. In order to create the illusion of depth in the ceramic very
subtle washes of almost invisible
colour must be applied layer on
layer and fired after each colour
to build up an almost three dimensional effect.
The other challenge technician
with ultrathin veneers is to create a natural surface texture on
such a fine sliver of ceramic. In
order to create the micro fine
surface texture in such a delicate
structure standard dental laboratory burs are often too course
and bulky. Fine dental surgery
burs in a low speed electronic
contra-angle motor are ideal to
reproduce the subtle surface detail of the natural tooth.
Glazing locks in the colour washes and protects the effect. The
glaze is then hand polished using silicon rubbers, fine pumice
and diamond polish. This is done

Figure 15. Natural surface morphology and subtle colouring before glazing and polishing

Figure 16. Final IPS Emax veneers

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

[26] =>

22 ortho tribune

Dental Tribune Middle East & Africa Edition | September-October 2014

Ormco Custom: It’s all about profitability
By Ormco

ou might have seen
the Ormco Custom debates at the AAO Annual Session. Profitability
vs. personalization: That’s
the debate. When looking
at the Ormco Custom suite
of digital products —Insignia Advanced Smile Design,
Lythos Digital Impression
System, and AOA Labs — the
core drivers behind the innovative 3-D diagnostics,
treatment planning and
customized appliances are
practice profitability and
treatment personalization.

You may ask, why profitability? Governor Cash would
respond, “Why not?!” However, in all seriousness, the
business trend toward digital technology is one made
to enhance efficiencies and
reduce costs.
In fact, according to Harvard Business Journal, 87
percent of companies surveyed plan to increase their
investments in research
and development — with a
significant portion of this
investment devoted to digital technologies.
Furthermore, 68 percent

said their investments in
digital technologies are primarily focused on process
efficiencies and cost reduction. This same concept is
infiltrating the orthodontic
practice environment, and
increased efficiency leads
to profitability.
As you weigh the benefits
of both profitability and
personalization, the below
takes a look at profitability
features of today’s leading
digital solutions.
Insignia Advanced Smile
Design

Insignia’s
software
and
application
system
that
combines 3-D diagnostic
technology and interactive
treatment planning is the
result of three decades of
intensive research and development.
After years of exploration,
the Insignia Advanced Smile
Design platform is proven to
reduce treatment time by 37
percent with seven fewer
patient visits.[1] Through
advanced technology, Insignia allows clinicians to deliver a completely customized treatment experience

Can You See

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(Your patients can’t see them either)

from initial smile design to
fabrication of patient-specific aligners, brackets and
wires.
With the treatment designed specifically for each
patient — and exactly to
doctors’ preferences — Insignia creates a more predictable treatment path,
providing
fewer
adjustments and less time in the
chair. Additionally, Insignia
offered software enhancements this year to make the
platform more intuitive and
integrate added support elements for ease of use. The
new interface, Insignia Ai,
is now available for download.
Lythos Digital Impression
System
Specifically engineered to
integrate easily into any
practice, Lythos allows users to own, store and send
treatment scans to anyone
who accepts .stl files — at
no cost. In terms of profitability, professional teams
are able to quickly transition to digital impressions
while keeping chair time to
a minimum.
Even more appealing for
the bottom line, Lythos is
backed by Ormco’s unique
open platform format and
rebate program. Lythos’
open system allows data to
be easily integrated with
orthodontic labs and manufacturers to produce a variety of custom appliances
and/or study models. In addition, the rebate-per-click
program, where customers
are credited for every Insignia and/or Insignia Clearguide Express case submitted with a Lythos digital
impression, reduces overhead and creates more opportunity for revenue generation.
AOA Labs
With Ormco Custom comes
integration of a full-service,
digital orthodontic laboratory serving dental professionals worldwide, AOA Lab.
The laboratory fabricates
customized appliances, including Class II correctors,
aligners, splints, retainers
and more.

Damon patients treated by Dr. Stuart Frost.

NEW!

To help streamline the practice workf low, AOA Lab accepts .stl digital impression
files, including scans from
Lythos. The connectivity —
and end-to-end structure —
of Ormco Custom allows for
streamlined operations.

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Contact Information

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e-mail:
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[27] =>

American Dental Association Education Day
Dubai Healthcare City in collaboration with American Dental Association • 7-8 November 2014
Date

7-8 November 2014
(Friday and Saturday)

Time

7 November 2014
(0800 - 1700 Hrs)
8 November 2014
(0800 - 1200 Hrs)

Venue

Mohammed Bin Rashid
Academic Medical Center
Dubai Healthcare City,
Dubai UAE

CPD

Up to 11 CME credits available

Target General Dentists
Audience

@AmerDentalAssn
@HealthcareCity
Facebook “f ” Logo

CMYK / .eps

Facebook “f ” Logo

A comprehensive lecture and hands-on workshop presented
by ADA Past-President, Dr. Robert Faiella and ADA Senior Vice
President of Science/Professional Affairs, Dr. Daniel Meyer.
Learn about America’s leading efforts in periodontology as well
as the importance of Evidence-Based Dentistry in practice.
Presenters
Robert A. Faiella, D.M.D., M.M.Sc.
Dr. Faiella is the Immediate Past-President of the American Dental
Association. He received his pre-doctoral education from Villanova
University, earning two Bachelor of Science degrees, and his D.M.D.
degree from Fairleigh Dickinson University School of Dental Medicine.
He received his graduate training in Periodontology as an NIH PostDoctoral Fellow at Harvard School of Dental Medicine, as well as a
Masters of Medical Science degree from Harvard Medical School.
He is a Diplomate of the American Board of Periodontology, and a
Fellow of the American College of Dentists, the International College
of Dentists, the Pierre Fauchard Academy, the American Academy of
Dental Dental Science, and the International Team for Implantology.
Daniel M. Meyer, D.D.S.
Dr. Meyer is an Endodontist and is the senior vice president for
the American Dental Association Division of Science/Professional
Affairs, which includes the Council on Scientific Affairs, Research
and Laboratories, Professional Product Review and the ADA Center
for Evidence-Based Dentistry™.

CMYK / .eps

American Dental Association
Dubai Healthcare City
American Dental Association
Dubai Healthcare City
dubaihealthcarecity
AmericanDentalAssoc
DHCC2011
www.dhcc.ae
ADA.org/international

Register now at http://events.dhcc.ae
For inquiry, please contact Ms. Rose Clemente
Email: CPDevents@dhcc.ae
Office No. +971 4 3622861

The American Dental Association 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. The American
Dental Association designates these activities for up to 14 continuing education credits. Concerns or complaints about a CE provider may
be directed to the provider or to ADA CERP at ADA.org/cerp.

[28] =>

24 ortho tribune

Dental Tribune Middle East & Africa Edition | September-October 2014

Analyze adult snoring carefully
By Earl O. Bergersen, USA

noring in an adult is considered to be a most important symptom that is
strongly associated with daytime sleepiness, inattention,
restlessness while sleeping,
high blood pressure, stroke,
atrial fibrillation, heart attacks
and even diabetes. It is considered a frequent cause of auto
accidents because of daytime
sleepiness and lack of attention.
What should a doctor be asking
to gain important diagnostic

hints as to potential problems
strongly related to snoring?
Helpful questions can be summarized as follows:
1. Do you snore?
2. How often? Two to four
nights a week — this is considered moderate snoring. If it is
five to seven nights per week, or
almost always when sleeping, it
is considered habitual.
3. Is the snoring interrupted by
a cessation in breathing? When
the breathing resumes, the pa-

tient usually shifts the head to
one side but may or may not
wake up.
4. Count the number of seconds
the breathing has stopped. If it
is 10 seconds or more, and if
these cessations occur at least
10 times per hour, this is considered a serious problem, usually involving sleep apnea.
5. Does the patient seem to
have difficulty breathing while
sleeping? This is a sign of hypopnea, another serious form
of sleep disturbance that is

An adult Snore-Cure appliance. (Photos: Ortho-Tain)

very similar to apnea (the complete cessation of breathing).
6. Does the patient often fall
asleep watching television or
while reading a book?
7. Most often (but not exclusive-

ly), it is a middle-aged male who
is overweight and has a large
neck size (usually 17 inches
or more). There are, however,
those who have serious sleepdisordered breathing problems
who are not overweight and
are not a typical candidate.
How should the doctor deal
with a snoring patient? To simply issue an anti-snoring device
will solve the irritating snoring
problem but may ignore much
more life-threatening symptoms as mentioned above.
The simplest way is to use a
home-night study, which consists of a device (such as supplied by Res-Med) that can
monitor not only the severity
of snoring (intensity of sound,
frequency and when it occurs),
but the type and frequency of
apnea, blood oxygen and number of breaths, etc. If there is no
evidence of apnea (a complete
cessation of breathing) or hypopnea (labored breathing),
then a snoring device could be
prescribed.
A simple device is called a
Snore-Cure, which is preformed and advances the
mandible and tongue at different amounts (4 mm and 7 mm
from an end-to-end incisal
position). The 4-mm advancement (Snore-Cure) appliance
is used for those individuals
with an overjet (horizontal
jaw discrepancy — posteriorly
positioned mandible or anteriorly positioned maxilla or protrusive incisors) that exceeds 4
mm. The 7-mm advancement
appliance is for those with a
fairly normal overjet (less than
4 mm) and those with severe
snoring problems.
The posterior section of the
mandibular half of the appliance can be lined with a specifically formulated self-cure
acrylic to maintain the appliance in the mouth while
asleep. This is not necessary
in most cases because the appliance rarely ever falls out of
the mouth. If the patient’s teeth
are crooked, it is advisable to
trim the inside of the appliance
so that minimal pressure is
placed on these teeth.
The two adult Snore-Cure appliances are available in an
open and a closed version: (a)
the 4 mm mandibular advancing appliance for overjets of
4 mm or more and (b) the 7
mm advanced style for normal
overjets and severe snorers.
These adult appliance are not
to be used in patients younger
than 20 years of age.

[29] =>

Dental Tribune Middle East & Africa Edition | September-October 2014

Management of Intracanal Separated Instruments
By Dr Ala Al-Dameh

ccasionally during nonsurgical root canal therapy, an instrument will
separate in a canal system, hindering cleaning and shaping
procedures and blocking access to the canal terminus. Any
instrument may break-steel,
nickel-titanium (NiTi), hand,
or rotary. Separation rates of
stainless steel (SS) instruments
have been reported to range between 0.25% and 6.0%1, while
separation rates of NiTi rotary
instruments have been reported to range between 1.3% and
10.0%2. Even with experienced
clinicians this problem can
occur and is a source of disappointment for both clinicians
and patients.
There are many factors that
contribute to instrument separation. The most common
causes are improper use, limitations in physical properties,
inadequate access, root canal
anatomy and possibly manufacturing defects3. The purpose
of this article is to summarize
current understanding of the
impact of separated instruments on prognosis, treatment
options, and to make recommendations for their management.
Prognosis
The prognostic impact of a retained separated instrument on
endodontic treatment and retreatment has been investigated in only a few studies, most of
which are based on small numbers of cases. Recent clinical
studies document that prognosis is not significantly affected
by the separated instrument
itself. Prognosis depends on
how much undebrided and unobturated canal apical to and
including the instrument remains. The outcome is better if
the canal was instrumented to
the later stages of preparation
when the separation occurs4.
If vital and uninfected pulp
tissue was present, and there
was no apical periodontitis, the
presence of the separated instrument should not affect the
prognosis5. If the instrument
can be removed without causing iatrogenic complications
such as perforations, ledging, extrusion of the fragment
through the apex, or excessive
weakening of tooth structure
(Figure 1), the prognosis will
not be affected. However, if the
instrument cannot be removed
or bypassed in a tooth with a
necrotic infected pulp and apical periodontitis, the prognosis
will be uncertain. These cases
should be followed closely and
if symptoms persist, apical surgery or extraction should be
considered4.
Treatment Options
A clinician could either (1) attempt to remove the separated
instrument, (2) bypass it, (3)
prepare and obturate to the
segment. Before a clinician
makes the decision to remove
a separated instrument, he/she
should ensure the availability
of and successful handling of

the required armamentarium.
The surgical operating microscope is an invaluable tool in
helping to remove separated
instruments. It increases visibility by the use of magnification and light and increases the
efficiency and safety of almost
all techniques used.
Various methods have been
proposed for removing separated instruments. Chemical
solvents have historically been
used to achieve intentional
corrosion of metal objects6. If
the separated instrument is
clinically visible in the coronal
access and there is sufficient
space for a hemostat or Stieglitz
Pliers (Henry Schein, Melville,
NY) (Figure 2), these should be
used to remove the fragment
through the access cavity preparation. In more recent times,
specialized devices and techniques have been introduced.
Masserann instruments, wire
loop techniques, hypodermic
surgical needles, extractors,
the Post Removal System (SybronEndo), the EndoPlus System
(EndoTechnic, San Diego, CA)
and the Instrument Removal
System (DENTSPLY Tulsa
Dental, Tulsa, OK) have all
shown limitations7.
Ultrasonic instruments have
been shown to be very effective
for the removal of separated instruments8. Nevertheless, successful removal relies on factors such as the position of the
instrument in relation to the
canal curvature, depth within
the canal, and the type of the
separated instrument7. To remove the instrument predictably, the clinician must create
straight-line coronal radicular
access. Ultrasonics tips can
then be used to create a staging
platform to trephine dentine
around the fragment (Figure
3). With this trephining action
and the vibration being transmitted to the fragment, the
latter often begins to loosen
and occasionally it will appear to jump out of the canal3.
Care must be taken, however,
to avoid complications such as
ultrasonic separation or root
perforation.
Clinical Recommendations
and Conclusions
Removing a separated instrument requires skilled use of
the operating microscope and
is generally considered within
the remit of the endodontic specialist.
Attempts at removing a separated instrument can be established as a first management
option if the instrumented separated at an early stage of root
canal cleaning and shaping,
and the fragment is accessible.
If the fragment is at or beyond
the canal curve, retrieval is
much less predictable. As removal is associated with considerable risk, by passing the
instrument should be considered. If retrieval attempts prove
unsuccessful without further compromising the tooth,
and the tooth continues to be
symptomatic or fails to show

any signs of healing at recall
reviews, alternative treatment
options such as apical surgery,
intentional replantation or extraction can always be considered. In all situations, management options should always be
thoroughly discussed with the
patient and the definite treatment plan should take into
consideration factors that will
affect prognosis (especially the
presence of periapical pathology) and should be towards the
patient’s best interest.
References

1. Spili P, Parashos P, Messer HH.
The impact of instrument fracture on outcome of endodontic
treatment. J Endod 2005; 31: 84550
2. Madarati A, Hunter M, Dummer P. Management of intracanal
separated instruments. J Endod
2013; 39: 569-581
3. Bachall JK, Carp S, Miner M,
Skidmore L. The causes, prevention, and clinical management of
broken endodontic rotary files.
Dent Today 2005; 24. 74, 76, 7880.
4. Torabinejad M, Walton RE,
editors: Priniciples and practice
of endodontics, ed 4, St. Louis,
2009, Saunders.
5. Crump MC, Nakatin E: Re-

Figure 2. Steiglitz forceps for removal
of accessible fragments.

Figure 1. Separation of a second
instrument while attempting
to remove the first separated
instrument is not uncommon.

lationship of broken root canal
instruments to endodontic case
prognosis: a clinical investigation. J Am Dent Assoc 1970; 80:
1341-7
6. Hulsmann M. Methods for removing metal obstructions from
the root canal. Endod Dent Traumatol 1993; 9: 223-37
7. Parashos P, Messer HH. Rotary
NiTi instrument fracture and its
consequences. J Endod 2006; 32:
1031-43
8. Ruddle CJ. Nonsurgical retreatment. J Endod 2004; 30: 82745

Figure 3. A selection of ultrasonic
tips with contra-angled designs &
different lengths to enable removal of
dentine from the root canal system and
facilitate instrument removal .

About The Author
Dr Ala Al-Dameh is Assistant
Professor of Endodontics at
Dubai College of Dental Medicine.

[30] =>

26 news

Dental Tribune Middle East & Africa Edition | September-October 2014

Crown for the queen of the jungle
By Sirona

ensheim,
Germany:
Spectacular dental procedure on a big cat in Denmark: The CEREC CAD/CAM
technology was actually developed for humans but was successfully used for the first time
on a lioness in a Danish zoo.
After Danish zoos received negative headlines in the press over
the past few months, one Danish zoo is now attracting positive
attention – with a spectacular

Fig. 1: Vet Jens Ruhnau while treating Naomi. Copyright Niels Dencker
and Jannich Hegelund.

Fig. 2: The simulation of the lion crown in the CEREC software. Copyright
Niels Dencker and Jannich Hegelund.

dental procedure. The damaged
carnassial tooth of a lioness in
Ree Park Safari in Ebeltoft (near
Aarhus) was restored using the
CAD/CAM system CEREC. The
Danish zoo wanted to use the
benefits of the chairside system,
which allows treatment in just
one session, for its animal patient.
No second anesthesia required
The veterinary team was faced
with a few challenges when operating on the 12-year-old African lioness Naomi. Adult lions
cannot be anesthetized for more
than two to three hours, meaning that the entire procedure
needed to be completed in that
period of time. Since extracting
such a large tooth is difficult and
lions need the carnassial tooth to
be able to bite, a root canal treatment was carried out and the tip
of the carnassial tooth was fitted
with a crown. The CEREC method allowed the entire treatment
to be successfully completed in
just a single procedure. “Anesthesia is very stressful for wild
animals. This was unavoidable
for the root canal treatment but
we did not want to put Naomi
through it a second time to fit the
crown,” says vet Jens Ruhnau,
who led the operation. Naomi
recovered from the operation
quickly without any complications and is now back to her old
self.
State-of-the-art technology for
wild animals
Treating such a big cat shows
the universality of CEREC. “The
clear advantage of using CEREC
since it requires only one procedure to take a digital impression of the tooth and carry out
the restoration is beneficial not
only for humans,” says Birgit
Möller, Head of Product Management CEREC at Sirona. After
treatment was successfully completed, all those involved were
clearly relieved. “It was a fascinating procedure and I am sure
that it will not be the last time
we use state-of-the-art technology like CEREC to improve the
lives of our animals,” said Jesper
Stagegaard, the director of Ree
Park.

Contact Information
Dr. Amro Adel
Area Manager GCC & Pakistan
Country Manager Saudi Arabia
Sirona Dental GmbH
amro.adel@sirona.com

[31] =>

industry 27

Dental Tribune Middle East & Africa Edition | September-October 2014
Visit us at
www.promedica.de

high quality glass ionomer cements
first class composites

Glass ionomer luting cement
• highly biocompatible, low acidity
• micro-fine film thickness
• excellent adhesion
• no temperature rise during setting

innovative compomers
modern bonding systems
materials for long-term prophylaxis

Light-curing nano-ceram composite
• highly esthetic and biocompatible
• universal for all cavity classes
• comfortable handling, easy modellation
• also available as flowable version

temporary solutions
bleaching products …
All our products convince by
excellent physical properties

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

perfect aesthetical results

PROMEDICA Dental Material GmbH

phone: +49 43 21/5 41 73 · fax +49 43 21/5 19 08 · Internet: www.promedica.de · eMail: info@promedica.de

Interview: “KaVo is the Rolls Royce in the dental world”
By Dental Tribune MEA

UBAI, UAE: Dental Tribune MEA had the opportunity to catch up
with Alexia Valera, Marketing &
Communications Manager for

KaVo Dental, located in Dubai,
UAE. For the past 15 years, KaVo
has been operating in the Middle
East and North Africa.
Alexia Valera joined the KaVo
team a year and a half ago. Since,

KaVo has participated in key
events in the region such as the
CAD/CAM & Digital Dentistry
International Conference and
AEEDC giving them an even
higher exposure in the Middle
East market. In addition, KaVo

KaVo ARCTICA® CAD/CAM system

Expect more of your
CAD/CAM solution.
NEW

KaVo ARCTICA® CAD/CAM-system –
one system, many advantages.

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

KaVo MEA Team

will be present as a Gold Sponsor
at the upcoming Dental Facial
International Conference taking place on 14-15 November in
Dubai, UAE.
Dental Tribune MEA: Regarding
the KaVo product range, what are
the key solutions you offer dentists
and dental technicians alike?
Alexia Valera: Our core business
is focused in the fields of Dental
Instruments, Dental Equipment,
High-Tech and Imaging. We offer
treatment units with outstanding
ergonomics and quality, three
ranges of dental instruments
for every dentist, diode laser,
diagnostics tools such as the DIAGNOcam, as well as Imaging
systems. For dental laboratories
of any size as well as for laboratories in dental practices, KaVo offers a very economical, digitally
integrated and flexible range of
dental CAD/CAM systems. All
made in Germany.
How do you experience the Middle East market and where does
KaVo fit in?
Due to the political and economic issues that we are currently
facing in some countries in the
Middle East, I would say that it
is definitely very challenging.
Nevertheless, KaVo is a brand
that is over 100 years old. That
being said, we have an outstanding reputation because we provide High-End quality products.
A few days ago, a customer told
me “KaVo is the Rolls Royce in the
dental world”.

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

Are there any upcoming surprises
you have planned for us? What
activities will KaVo be carrying

out in the coming months?
We just launched our “Show us
your LoVe for KaVo” campaign on
our Facebook page. We are very
excited because it will give us a
great chance to engage with our
customers and have a direct interaction. You can find more information on our website www.
kavo.com/MEA or on our official
Facebook page www.facebook.
com/KaVoGlobal.
What are your expectations for
the upcoming Dental Facial International Conference on 14-15 November 2014 at Jumeirah Beach
Hotel in Dubai, UAE?
We are really looking forward to
this event. Nowadays dental education is very important and we
are proud to take part in this conference and bring our knowledge
and experience. It will be an opportunity for us to meet with the
dental community up close. In
addition, we will be exhibiting
our range of X-Rays from Gendex
and showcase our Dental Microscope from Leica Microsystems.
Thank you very much Alexia Valera, we wish you and the KaVo
team great success in the coming
years in Middle East and worldwide.

Contact Information
KaVo Dental GmbH
Alexia Valera
9th Floor Rotana Arjaan Tower
Dubai Media City, UAE
Tel. +971 4 4332186
Mob. +971 56 1757141
E-Mail alexia.valera@kavo.com
www.kavo.com/MEA

[32] =>

28 cad/cam

Dental Tribune Middle East & Africa Edition | September-October 2014

Meet Carestream’s CS 3500 Intraoral Scanner.
A game changing paradigm Shift
By Ernesto Jaconelli

The USA web site publication,
PCL-USANEWS
(Precision
Ceramics Dental Laboratory)
recently reviewed the CS 3500.
This is what they had to :
Our newsletter style guide abhors superlatives such as ‘game
changer’ and ‘paradigm shift,’
when reporting on dental products.

A

CareStream launched the CS
3500 Intraoral Scanner at the
2013 American Dental Association Annual Meeting in
New Orleans as an integral
part of their CAD/CAM portfolio, which includes their CS
Restore design software, and
CS 3000 Milling Machine.The
CS 3500 is an open-format intraoral scanner that captures

CS 3500

major part of the Carestream Dental CS Solutions CAD CAM restorative Dentistry system is the CS
3500 Intraoral Scanner.Fully
portable, powder free and capturing true colour the CS 3500
takes dental digital scanning
to a higher level.And because
Carestream Dental’s CS Solu- However, when it came time to
tions is an open system where write about the CareStream CS
any one of the parts can be 3500 Intraoral Scanner, we had
taken separately many Dentists to break the rules.
have
chosen
to take 1their
first 10:49 Page 1
CS3500
A4 advert:Layout
06/08/2014
steps into digital restoration by This small, easy to use, no
powder, no fee-per-use scaninvesting in the CS 3500.

ner crashes the cost of entry.
The CS 3500 scanner represents a paradigm shift in much
the same manner as PC’s did to
mainframe computers four decades ago.

NO
impression material

high-resolution images with
30-micron accuracy using
True Color technology, and
provides exceptional practitioner flexibility.Doctors can send
restoration cases directly to a
lab, such as Precision Ceramics
or another third party, or to the
system’s chair-side mill.
PCDL News had the opportunity to review this scanner in
the field with dentists and work
with files in the Precision Ceramics lab design center. Our
team came away impressed
and learned why Keith Nelson,
Western Regional Sales Spe-

NO
focusing on the screen
NO
limitations

Since the unit is an open architecture program, one can connect it to any laptop or desktop
via a USB 2.0 or USB 3.0 connection. Nelson pointed out that
CareStream believed it was important to provide doctors with
system flexibility, which is why
they did not use proprietary
acquisition hardware.“Being
able to move the scanner from
operatory to operatory without
carrying a laptop or pushing a
trolley makes the system easier
to use and allows it to integrate
directly into an office’s existing
network.”

NO
powder

Visit us at:

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

In the new reality, the CS 3500 intraoral scanner creates highly accurate, true color
2D images and 3D models of teeth without conventional impressions.

Carestream Dental will once
again be attending the 6th
Dental Facial Cosmetic International Conference held in
Dubai on 14-15 November at
Jumeirah Beach Hotel.

• Truly handheld, portable with no trolley and plug and play
• Powder-free with slim scanner head for comfortable, custom-fit restorations
• Unique light guidance system for more patient-focused scanning
• Part of a flexible and open system, allowing you to choose between in-house
or lab milling

© Carestream Health, Inc. 2013.

In summary, the CareStream
CS 3500 provides easy to learn,
easy to use, highly accurate,
open architecture system, with
a low cost port of entry. Add
up all of these pluses and you
have a scanner that is a ‘game
changer’, and the way forward
for intraoral scanning technology.
Read the whole review on:
http://w w w.pcd l-usa news.
com /2014/06/03/meet-carestreams-cs-3500-intraoralscanner/

WELCOME TO THE NEW REALITY

Enter the new reality at carestreamdental.com/cs3500

cialist for CareStream Dental
uses the acronym “WIN” when
describing the system. “It is a
simple, easy way to explain the
CS 3500,” he says. “Workflow,
Integration, and No Fees,” and
this is where the paradigm
shift begins.
System integration with the
CS 3500 is unique to scanning
technology and mirrors other
open architecture computer
platforms. There is no need for
a trolley and the scanner integrates directly with the imaging platform, which in turn
integrates with most practice
management systems.Consequently, the practice does not
need a second database for intraoral scans, as the data stores
automatically within the patient’s record in the same manner that other types of images
are stored. Single source integration reduces admin time
and simplifies practice record
keeping.

NO
trolley

ALL YOU NEED FOR THE
PERFECT RESTORATION,
AND NOTHING YOU DON’T

The CS 3500 is easy to use because
there is no need to carry a laptop or
push a trolley

Contact Information
SCAN

DESIGN

MILL

Ernesto Jaconelli
Trade Marketing Manager
Carestream Dental
Ernesto.jaconelli@carestream.com
Visit www.carestreamdental.com

[33] =>

cad/cam 29

Dental Tribune Middle East & Africa Edition | September-October 2014

Ivoclar Vivadent discusses monolithic
restorations in London
By Daniel Zimmermann, DTI

ONDON, UK: For over
150 years, the Westminster Hospital in London
took care of the sick and disabled until making way for the
Queen Elizabeth II Convention
Centre in 1994. One of the most
high-profile convention venues in the British capital today,
this modern flat-roofed building opposite Westminster Abbey now stages over 350 events
each year. Recently, dental
manufacturer Ivoclar Vivadent
from Liechtenstein hosted hundreds of professionals from all
over the globe at the prestigious
venue to discuss the latest in
monolithic restorations.
Following the principle that
dental restorations should always mimic the natural dentition, prominent clinicians
from Europe and the Americas
presented a number of clinical
cases that demonstrated what
can be achieved with dental ceramics. Impressive restorative
work was shown by German
dental technician Oliver Brix
and the UK’s own Dr James
Russell, among others, who
discussed clinical cases treated
using Ivoclar Vivadent’s IPS emax. While it is still not able
to reproduce nature entirely,
the restorative system, along
with other modern dental materials, has not only changed
how cosmetic dentistry is performed, but also allowed it to be
increasingly less invasive, Russell said.

Officer at Ivoclar Vivadent Josef
Richter said.

among other features, to make
restorations easier and faster.
In response to increasing demand, Wieland Dental, part
of Ivoclar Vivadent since 2012,
will be launching a new version of its compact CNC milling
system Zenotec that will allow
wet pressing. The company’s
offering of Zenostar zirconia,
as well as abutment solutions,
will also be extended.

Delegates can look forward to
a number of new products to
be launched by Ivoclar Vivadent during the year, including the much-anticipated IPS
e.max Press multi, which will
allow horizontal pressing for
long-lasting clinical success.
Also announced were new furnaces in Ivoclar Vivadent’s Programat line with a new design
that
will offer
guided
pressing,
CS81003D
A4:Layout
1 06/08/2014
10:32 Page 1

US dentist Dr George Eliades (second from right) discussing aspects
of monolithic restorations with other experts onstage. (Photo Daniel
Zimmermann, DTI)

THE WAIT
IS OVER
Visit us at:

6th Dental Facial
Cosmetic Int’l
Conference
Jumeirah Beach Hotel Dubai

The use of CAD/CAM technology, was further shown
by Italian technician Michele
Temperani to achieve higher
aesthetic outcomes when combined with all-ceramic materials. Issues in the field were also
addressed, including the correct bonding technique, which,
according to Belgian presenter
Bart van Meerbeek, depends on
functional monomers. While
research has shown that selfetching is often the most effective approach, the etch and
rinse technique is still required
in many cases, he explained.
During a round-table discussion held on the first day, all
experts agreed that a thorough
diagnosis and a good working
relationship between the clinician and dental technician are
still among the most important
criteria for achieving the best
results.
Overall, Ivoclar’s latest expert
event drew over 750 delegates
to London. Organised in collaboration with King’s College
London Dental Institute, one of
the most prestigious dental institutions in the UK, it was the
second edition of a series that
started in Berlin in Germany
two years ago. A follow-up
event has already been scheduled for 2016 and will be held
in Madrid in Spain, Chief Sales

14-15 November 2014

CS 8100 3D

3D imaging is now available for everyone
Many have waited for a redefined 2D/3D multi-functional system that was more relevant to their everyday work, that was
plug-and-play and that was a strong yet affordable investment for their practice. With the CS 8100 3D, that wait is over.
• Versatile programs and views (from 8 cm x 9 cm to 4 cm x 4 cm)
• New 4T CMOS sensor for detailed images with up to 75 m resolution
• Intuitive patient placement, fast acquisition and low dose
• The new standard of care, now even more affordable
LET’S REDEFINE EXPERTISE
The CS 8100 3D is just one way we redefine imaging.
Discover more at carestreamdental.com
© Carestream Health, Inc. 2014.

[34] =>

30 industry

Dental Tribune Middle East & Africa Edition | September-October 2014

VITA ENAMIC: a greater similarity to natural
dentition and more cost-effective than previous
CAD/CAM ceramics?
By Dr. Otmar Rauscher

he hybrid ceramic VITA
ENAMIC is an innovative CAD/CAM material. Using a clinical case as an
example, this report explains
how VITA ENAMIC offers commercial benefits in comparison
with similar materials. The
time required to complete processing and the service life of
milling tools are criteria that
are worth looking at from an
economic perspective.
New structure, new possibilities
The innovative hybrid ceramic, which is comprised of
a structure-sintered ceramic
matrix, together with an integrated polymer network, offers
abrasion behavior similar to
enamel as well as a modulus
of elasticity of 30 GPa, which
is similar to that of dentin. The
hybrid ceramic demonstrates
unusual properties thanks to a
combination of flexibility and
load capacity. For example,
the static fracture load is approx. 2890 newtons while the
Weibull modulus, an indication
of material reliability, is 20. As
a result, VITA ENAMIC is recommended as a CAD/CAM material particularly in the case
of minimally-invasive restorations and in areas subject to
high occlusal load. Even inlays
with a wall thickness of just 0.2
mm can be reliably implemented. During processing, the hybrid ceramic also demonstrates
high edge stability in the case
of restorations with thin margins. This stability combined
with integrated cracking prevention allows milling to be
performed in fast milling mode
even if walls are thin. Thanks
to the short milling time and
long service life in the case of
milling tools, VITA ENAMIC is
an interesting option from an
economic standpoint. No firing
is required either.
Case study
In a 30-year-old patient, tooth
45 had been fitted with an inadequate acrylic restoration and
also showed secondary caries
(Fig. 1). The goal of treatment
was to provide a new minimally-invasive restoration using an
inlay. VITA ENAMIC was selected as the material, promising rapid chairside fabrication
in combination with CEREC
MC XL (Sirona). Shade 2M2
was the outcome following determination of the correct tooth
shade using VITA Easyshade
(Fig. 2). A HT (high translucency) VITA ENAMIC block was
used.
The acrylic filling and caries
(Fig. 3) were removed first,
and preparation performed in
accordance with all-ceramic
guidelines. CEREC Optispray

powder was then applied, followed by scanning of the prepared tooth and the antagonists. Digital processing of the
model was carried out using
CEREC SW 4.03. Once a new
case had been created (Fig. 4),
VITA ENAMIC was selected
in the program as the material (Fig. 5). Using the digital
impression data of the preparation, antagonists and maximum intercuspation, digital
models were created (Fig. 6 to
8). The software also generated
buccal bite registration (Fig.
9 and 10). Figure 11 shows the
occlusal contacts. In the next
step, concrete planning of the
new inlay began with the definition of the preparation margin (Fig. 12). When determining the modeling parameters,
using the “Minimal Thickness
(Radial)” setting (Fig. 13) allowed margins to be delicately
milled so that one of the special
properties of VITA ENAMIC
could be used to full effect.
A software-generated model
was then suggested for the inlay (Fig. 14). Following slight
adjustment of the design, the
block was selected (Fig. 15)
and the milling preview displayed (Fig. 16). Fabrication
was performed using CEREC
MC XL. The processing time
for an inlay using normal milling mode is just under eight
minutes; in fast milling mode,
approximately four-and-a-half
minutes. Tests conducted by
the manufacturer show that
a longer service life can be
achieved: using one set of milling tools, it was possible to fabricate 148 posterior crowns in
normal milling mode and 132
posterior crowns in fast milling
mode. Initial practice experience confirms this trend.
The fact that no firing is required at all also saves time.
The VITA ENAMIC STAINS
KIT (six stains including accessories) can be used for shade
characterization. The stains
are bonded to the restoration
as part of a polymerization process and surface sealing can be
performed using the chemical
glaze material VITA ENAMIC
GLAZE.
Try-in was carried out for the
inlay followed by adhesive
bonding using VITA Duo Cement. Final polishing was performed for one minute in each
case using the VITA ENAMIC
Polishing Set clinical and silicon carbide polishing instruments, and was followed by
high-gloss polishing using gray
diamond burrs. The final results blend in perfectly with the
remaining natural dentition
(Fig. 17).
Summary
VITA ENAMIC is a material that
is convincing, not only because

Fig. 1: Tooth 45 (initial situation):
inadequate acrylic filling.

Fig. 2: VITA Easyshade Advance 4.0
for precise shade determination.

Fig. 9: Bite registration of the upper
and lower jaw separately…

Fig. 13: Selection of the model parameters.

Fig. 10: … and in occlusion.
Fig. 14: Virtual design suggested for
the inlay.

Fig. 3: Following preparation.

Fig. 11: View of the occlusal contacts.

Fig.15: The material block is selected …

Fig. 4: Inlay modeling using in
CEREC SW 4.03.

Fig. 12: Definition of the preparation
margin.
Fig. 16: … and the milling preview
shown.

Fig. 5: Material selection.

Fig. 6: Generated based on the scan
data, a view of the prepared tooth...

Fig. 7: … and of the antagonists.

Fig. 8: Buccal bite registration.

Fig.17: Final result: the inlay blends in perfectly.

of its properties similar to those
of natural dentition, but also
because of its outstanding efficiency thanks to ideal processing characteristics, which has
been proven in practice. The
hybrid ceramic helps save you
both time and money in a range
of steps. The patient also benefits from shorter treatment
times – as well as from superior
quality results that offer properties similar to natural dentition in terms of look, feel and
functionality.

About The Author
Dr. Otmar Rauscher
1991: Doctorate degree awarded
by the University of Munich,
Germany
Since 1992: Own dental practice
in Munich, Germany
Since 1995: CEREC user
Since 2001: Lecturer for CEREC
training courses nationally and
internationally
Since
2006:
ISCD-certified
CEREC trainer
Consultant in the further development of CEREC and inLab
software
2010: Establishment of a special commercial laboratory for
CEREC Connect and CEREC
inLab
Contact:
praxis@dr-otmar-rauscher.de

[35] =>

1 Text

Dental Tribune Middle East & Africa Edition | September-October 2014

[36] =>

[37] =>

Dental Tribune Middle East & Africa Edition | September-October 2014

lab tribune 1B

Dental Technicians
are more than just trained hands
increase. And when 59% of the
patients approaching the dental
clinics are concerned about esthetics in the first place, do you
believe that the skilled ceramist
who can provide the finishing
artistic and esthetic touches required for esthetic zone can be
skipped?

By Aiham Farah, Syria

n a time when material and
machining capabilities are
improving drastically, and
the cost of the technology itself
continues to decrease while its
ease of use and predictability

The answer is NO. Because quality of the final esthetics from machining alone is still marginal.
Function, biology, phonetic, or
treatment plan based on a teamwork approach can’t be managed
by machines alone. Besides computerized machines generate a
big failure if not driven by human
brain.
Brain is behind those trained
hands of a skilled dental technician. That brings creative solutions, and creative solutions for
critical clinical cases need reli-

able material. Dental manufacturers recognized this from the
beginning. And for that reason
directed a big share of information flow and communication
supportive tools toward the dental laboratory.
Teamwork approach, material
science, and artistic touches, are
all behind those trained hands,
and most important of all is the
knowledge coming from various
sources, books, articles, study
clubs, lectures, conferences..
Etc. That will not only improve
our daily performance, but it will
train our eyes to see esthetic better, and will give us the motivation and peer pressure needed to
never stop pursuing flawless esthetic results.
Dentistry is in transition period,
especially in our Middle East
region. We need to thank those

Attention Dental Technicians!
Esthetic In One Layer Metal Ceramic & composite gingiva

IPS Inline ONE & SR Nexo
15 - 16 November 2014, Jumeirah Beach Hotel, Dubai
as part of

6th Dental Facial Cosmetic
International Conference Dubai
A working model will be handed over to the participants with metal
framework, we will do the steps of building up the ceramic, then will contour, and all esthetic touches required for esthetic zone will follow, then
will apply the pink composite on the gingival part, you will walk away with
a nice model of your work on it, and IvoclarVivadent course certificate.
Objectives:
Simple Dentcisal layering.
Morphology of anterior teeth.
Texture and micro texture.
External staining & shade matching.
Glaze and controlling the gloss.
Pink (light cure) composite application.
Manual Polishing.
REGISTER NOW

http://www.cappmea.com/
aesthetic2014/workshops.html

who recognized this fact and reacted to it, the people behind the
non-stop education, around-theyear scientific conferences and
seminars, behind the on-site international expertise, behind all
the courses and classes, and to
the constant support and investment from the international dental manufactures, believing that
training requires acquisition of
knowledge and skills.
In our (Lab Tribune) corner, we
will always continue, to bring the
level of dental technology to the
next level. In every issue, we will
discuss a certain topic, and dif-

ferent experience, we’ll solve a
problem or troubleshoot it; we’ll
bring up a failed case and highlight how we can turn it into successful case. We will make this
corner a real tribune to show
the world our dental technology
level and our passion and vision
to make the difference.

Contact Information
Aiham Farah. CDT
Technical Training Consultant
Near East & Orient
IvoclarVivadent
Email:aiham.farah@ivoclarvivadent.com

[38] =>

2B lab tribune

Dental Tribune Middle East & Africa Edition | September-October 2014

Milling and grinding in high definition (HD)
By Amann Girrbach

U

nbelievable details produced by a combination
of ultra-fine instruments
and meticulously developed
milling strategies for Ceramill
Motion 2 – in-house without preparatory work or reworking.

Milling in HD quality - Amann
Girrbach enables the processing of CAD/CAM materials with
absolutely unique precision using a new cutter and diamond
trimmer for all Ceramill Motion
generations and a special milling and grinding strategy, which
was specially developed for these

Figure 1. Ceramill Zolid Preshade milled/Ceramill HD

Figure 2. Ceramill Zolid Preshade sintered/Ceramill HD

Figure 3. VITA SUPRINITY grinded/Ceramill HD

Figure 4. VITA SUPRINITY sintered/Ceramill HD

instruments. Due to the fineness
of the cutters of 0.3 mm and 0.4
mm for the diamond trimmer,
customised details such as occlusal surfaces and fissures can be
milled or ground to a fine contour
previously only attainable with
porcelain veneering or a natural
tooth. Perfect coordination of material and CAM strategy avoids
overloading and consequently

fracture of the instrument. The
perfect interplay of hardware
and software allows all Ceramill
CAD/CAM materials to be processed to a degree of precision,
which sets new standards.

Contact Information
Abdo Salem
Area Manager Middle East &
Africa
Amann Girrbach AG
Herrschaftswiesen 1
6842 Koblach | Austria
abdo.salem@amanngirrbach.com

[39] =>

lab tribune 3B

Dental Tribune Middle East & Africa Edition | September-October 2014

inEos X5 Extraoral Scanner storms
dental laboratories
By Sirona

he innovative inEos X5
lab scanner was well received in the market: Just
one year after its launch, Sirona
has delivered the 1,200th scanner. Outstanding precision, a
broad spectrum of applications,
and easy handling make it a flexible CAD/CAM partner in dental
laboratories.
Bensheim/Salzburg, June 30,
2014. The inEos X5 extraoral
scanner from Sirona is a versatile
and reliable aid for all digitaliza-

Figure 1. The inEos X5 works both
manually
and automatically, is
DTI_Mediamix2014_A3_NEU_Layout 1 22.01.14 10:19 Seite 1
quick and extremely precise.

tion tasks in dental laboratories.
Its success speaks for itself: One
year after the market launch,
1,200 scanners have already
been sold, and for good reason.
It is the only five-axis scanner
with a robot arm that has an impressively large, high precision
scanning range with innovative
model positioning and both automatic and manual imaging techniques. It offers users fast scanning, versatile options for use,
and full process control. inEos
X5 can also be integrated with
other CAD/CAM systems.
Manual and fully automatic
scanning
As the successor to the inEos

Figure 2. Quick access to the
model and allows all standard
articulators to be easily positioned:
the working area of inEos X5.

Blue, the inEos X5 laboratory
scanner by Sirona has been available from specialist dealers since
May 2013. The new development
from Sirona scans partial and
whole jaw models and impressions – either automatically or
manually – depending on the
user’s needs. The scanner features innovative five-axis technology and uses a rotation arm
to optimally position and align
the objects to be scanned. While
the manual scanning mode saves
time for simpler operations, the
fully automatic scanning mode
has its benefits, especially with
regard to extensive operations
such as shortening the work time
and reducing the steps required
by the user. In addition, the
data volume is optimized which
speeds up the subsequent calculation of the model.
A versatile tool for the laboratory
The features and handling make
inEos X5 a favorite with new users as well as experienced dental
technicians. The large working
area is accessible for all conventional articulators. Due to the
universal model and impression tray holder, all conventional
model support and split cast systems, as well as impression trays
in all sizes, can be used. The

Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry

multi-die scanning (multiple
rotation imaging) of up to four
stumps offers optimal support
where the proximal contacts are
difficult to see and in the fabrication of frameworks and copings
for single restorations. The already integrated STL interface
allows flexible linking with other
CAD/CAM systems.
“inEos X5 is very precise and,
due to its large pivot range, it can
cover any situation optimally.
This gives us very good model
reproduction for further processing with CAD/CAM. I rarely need
to make additional, individual,

manual images. The scanner offers fast, precise imaging technology and a good operating concept for various model systems.
The switch is very fast, smooth,
and poses no problems. The STL
files allow all downstream CAD/
CAM units in our laboratory to be
used easily,” says Ingo Raschert,
master dental technician and
managing director of Teuber
Dental Laboratory in Darmstadt.
With its outstanding precision,
speed, and user-friendly functions, inEos X5 has become an
innovative, versatile tool for every laboratory.

Going all-digital:
Customized implant
restorations, for
CEREC and inLab

Figure 1. New: Telio CAD A16 for temporary restaurations

www.dental-tribune.com

Figure 2. Telio CAD A16: Especially for CEREC and inLab users

By Ivoclar Vivadent

elio CAD A16 ensures
more flexibility and esthetics in the fabrication of
implant-supported restorations
even at the temporization stage.
The trend towards a fully digital
workflow has become ubiquitous. The last gap in the treatment of teeth with implant restorations is now closed. The new,
highly cross-linked polymer
block Telio CAD A16 completes
the digital workflow to include
temporary restorations in implant dentistry.
For the first time, a block with a
pre-fabricated interface is available, which allows the direct
fabrication of hybrid implant
restorations for single-tooth temporization. Moreover, the block
enables CEREC and inLab users to create customized monolithic hybrid abutment crowns.
The pre-fabricated interfaces in
sizes S and L are tailored to the
requirements of titanium bases
from Sirona. The completed restorations can be directly cemented on the Ti base.
As a result of the industrial production process, temporary hybrid abutment crowns made of

Telio CAD A16 fit extremely accurately. Therefore, the treatment
time for both users and patients
is reduced. The hybrid abutment
crown is easy to adjust and provides a clear idea of what the permanent restoration will look like.
In addition, a proper emergence
profile can be ideally developed
and shaped. The restoration can
be incorporated immediately after the implantation procedure
or after the healing phase.
Telio CAD A16 forms an ideal
basis for long-term, implantsupported restorations fabricated
with IPS e.max CAD Abutment
Solutions. The self-curing luting composite Multilink Hybrid
Abutment ensures an excellent
bond of the restoration to the titanium base. The PMMA block
is offered in size A16 and in 6
shades (BL3, A1, A2, A3, A3.5, B1).
Restorations made of this block
are indicated for a wear period of
up to 12 month.
About Ivoclar Vivadent Abutment
Solutions
Under the heading “Abutment
Solutions”, the company has been
supporting the trend towards automated, digital procedures for
CAD/CAM-fabricated, implantsupported restorative solutions
for several years.

[40] =>

[41] =>

hygiene tribune 1C

Dental Tribune Middle East & Africa Edition | September-October 2014

My journey as a
dental hygienist
By Kareen Wilson, USA

W
1st Hygienist Day, 10th May 2014, CAD/CAM & Digital Dentistry International Conference 9th Edition.
Photo Robin Lane

A date for your diary Hygiene Day
announcement
th
15 November 2014
By Victoria Wilson

s Editor of Hygiene Tribune MENA I am extremely pleased to be
announcing the forthcoming
Hygiene Day on Saturday 15th
November organized by CAPP.
This will be the second Hygiene Day with CAPP following on from an unprecedented
turnout at the launch of the first
Hygiene Day earlier this year
in May 2014.
In the previous issue of Hygiene
Tribune MENA I reviewed the
1st Hygiene Day, sharing the excellent feedback on the speakers and the day. We anticipate a
similar turn out as last time, if
not more!
This Novembers Hygiene Day
will be held at the 6th Dental Facial Cosmetic International
Conference at the fabulous Jumeirah Beach Hotel.

It is a very exciting time for
Hygienists in the MENA, as
we are gradually getting more
recognition for our valuable
contribution and commitment
to Oral Health, with more and
more dentists viewing the Hygienist as a key member of the
Dental team.
A career in Dental Hygiene
certainly offers a wide range of
challenges, and it can be quite a
solitary career at times, for this
reason days that we can come
together to deepen our skills
set, exchange knowledge and
information about our profession is invaluable to us. Thanks
to CAPP a Hygiene Day now
exists for us to continue with a
high standard of CPD.

years of experience, knowledge and skill set first hand.
Mary will be talking on ‘The
Management of Orthodontic
Patients’. As well as delivering
a hands on course that should
not be missed.

I will take this opportunity to
welcome Professor Mary Rose
Pincelli Boglinon, from Italy
this November. It is such an
honour to have Mary lecturing
to us and share her extensive

Contact Information

We do have 3 more speakers
organized, these will be announced shortly.
The Hygiene Day stands yet to
help solidify the recognition of
the profession in the MENA.
Please arrange with your colleagues tickets and transport
to the day, it is guaranteed to be
excellent!

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

All about Loupes
By Optometrist Rune Oerts
OD, MSc

hat are Loupes?
• A loupe is a simple,
small magnification
device used to see small details
more closely. Unlike a magnifying glass, often set in a frame, its
lenses are contained in a cylinder holder, or into an enclosing
housing that protects the lenses.
What is the History of the
Loupes?

• The 25th Sept. 1608, a Dutch
lens manufacture, Hans Lipperhey born in Wessel, noticed that
when you hold two lenses up
to a certain distance from each
other, an object seems closer. He
then applied a patent on an apparatus with the ability to make
“all things observed at a greater
distance seemingly closer”.
• The father of microscopy, Anton Van Leeuwenhoek of Holland (1632-1723), started as an
apprentice in a dry goods store
where magnifying glasses were

used to count the threads in
cloth. Anton van Leeuwenhoek
was inspired by the glasses used
by drapers to inspect the quality
of cloth. He taught himself new
methods for grinding and polishing tiny lenses of great curvature which gave magnifications
up to 270x diameters, the finest
known at that time.
• These lenses led to the build-

> Page 4C

e all live to be an inspiration to others. At
my alma mater, Loma
Linda University, there is a statue in front of the dental school
that carries the inscription, “To
make man whole.” That statue
and inscription was there to
remind us that it is our duty to
inspire and make our patients
whole. It can be your children,
spouse, loved one or people
around you that you want to
influence and change their life
for the better. As a hygienist, I
know that I inspire my patients
to live healthy and happy lives.

ride to patients in this desperate
country is indescribable. The
patients in Haiti are so grateful
for the dental care. When our
nonprofit organization, Bethesda Medical Mission, visits Haiti,
we also bring dental supplies
like toothbrushes and toothpaste to be distributed to all the
patients who visit the clinic. We
bring books, toys and games for
the children to enjoy. I also believe that I am an inspiration to
the children in Haiti by giving
them hope for a better life.

Through classroom education
I am able to instruct students
on nutrition, oral and overall health. I have
been using the Es“We all live to be an inspiration
ther Wilkins children
education
to others”
program to go to
Through clinical education, preschools and grade schools to
I make sure that my patients educate the children on dental
have all the knowledge to cre- health. You would be surprised
ate their happiness through a to know what children think
beautiful and healthy smile. I and know about dental health!
also strive to use my physical The program is presented in
skills to bring joy and relief a fun and exciting way, so the
from discomfort by improving children are excited about taktheir oral health. The hygien- ing care of their oral health.
ist is usually the social life line
of a dental practice, and we The profession of dental hytend to bridge the gap between gienist has progressed over the
dentist and patient. It is great years. There are so many hyto be able to interact and build gienists who are doing amazmeaningful relationships with ing things in the workforce,
my patients. My experience as including philanthropy, educaa hygienist for the past 17 years tion and making a difference
has been wonderful. I have with each and every patient.
seen children grow and lose Through the Pros in the Proprimary teeth, go through orth- fession Award program, Crest

“In the country of Haiti, there is one dentist
for every 90,000 residents”
odontic treatment, and then go
off to college. I have helped
patients lose weight through
sharing and giving health tips.
Many of my patients have come
from a mouth full of decay and
periodontal disease to healthy,
beautiful smiles. But most of
all, our patients actually like
coming to see us at our office
because they know they will be
accepted and appreciated.
Through mission work in Haiti,
I am able to touch the lives of
many people who would never
have access to dental care. In
the country of Haiti, there is
one dentist for every 90,000
residents. There are very few
if any dental hygienists in the
whole country, and 95 percent
of all dental professionals in the
country practice in the capitol
of Port-au- Prince. The joy of
providing treatment and fluo-

Oral-B continues to recognize
hygienists who go above and
beyond the call of duty.
I was so blessed to have been
chosen as a Pros in the Profession Award Recipient in 2011.
It allowed me to be confident
in my career. This award also
opened doors to using my expertise in education and advocacy. I have been asked to sit on
the board of the Connecticut
Oral Health Initiative, which is
a nonprofit advocacy organization in the state of Connecticut
that is dedicated to promoting
oral health. I have been asked
to join the Connecticut Dental
Hygiene Association board to
help strengthen hygiene membership to the association. I
have been able to meet some

> Page 6C

[42] =>

2C HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | September-October 2014

Developing oral care products imaging
and innovation
By Paul Sagel

PD hears from research
fellow in oral care at
Procter & Gamble Paul
Sagel, as he explains how advances in digital imaging are
being used to improve oral
health.
The development of innovative
oral care products requires the
willingness to think outside the
box and exercise diligence. The
ultimate goals are to produce
products that meet a need, succeed in the marketplace and
help make a difference in patients’ lives - such as the confidence that a whiter smile gives
someone, or the patient who reverses gingivitis with the help
of anti-bacterial dentifrices and
superior toothbrushes. Digital
imaging is a prime example of
such thinking and has become
an integral part of product development at Procter & Gamble.
Space Age Technology
Digital imaging in oral care
began with efforts focused on
quantifying dental plaque and
later on tooth colour measurement and eventually on to gingival health assessments. As
with many instrumental techniques used today in dentistry,
the fundamental technology is
usually developed outside the
world of oral care. For example,
accurate and precise colour
measurement and the governing mathematics were developed for colour matching in the
paint industry. Thinking innovatively, it was clear that there
was great potential in the oral
care research field if this could
be adapted. We were looking for
technologies that would give us
rapid and objective results to
improve product development
and the time it took to bring
new products to dental professionals and the general public.
The internal research at Procter & Gamble on digital imaging was originally conceived
as a method to assess the antiplaque activity of dentifrices
and was then later also used as
a method to assess tooth whitening. Typically, testing for
anti-bacterial activity has involved clinical studies and the
use of standard plaque and
gingivitis indices such as the
Turesky index or Löe and Silness Index. These are subjective assessments that involve
clinical measurements and
judgement, and that often require large sample sizes to assess the potential efficacy of
prototype technologies and
product designs. Digital imaging is reliable, fast and objective; it allows the research team
to efficiently and objectively
screen potential products in
vivo. Digital imaging also produces a source image which

can be analysed in a variety
of ways after the study is complete.
Digital Plaque Imaging
The assessment of anti-plaque
activity using digital imaging
involves automated measurement of the area of plaque on
the facial aspects of the anterior
teeth. After disclosing the teeth
with fluorescein, the dentition
is digitally imaged in the presence of standardised long wave
UV lighting. Using a computer
algorithm, the pixels are then
individually assigned to plaque,
teeth, gingivae or background
based on colour. The areas
of coloured pixels associated
with the disclosed plaque are
then summed up to determine
the amount of plaque present.
Similarly, the area of pixels for
the teeth and plaque combined
is summed up, and then a calculation is made to determine
the plaque coverage as a percentage of the total area. In this
manner, it is possible to make a
precise and objective determination of the significant reductions in plaque obtained with
the stabilised stannous fluoride
contained in Oral-B Pro-Expert.
One study using digital plaque
imaging, conducted in 2009,
gives an example of its use to
determine the effectiveness of
anti-plaque agents. Using this
technology, it was possible to
objectively measure statistically significant overnight and
daytime plaque reductions
with use of stabilised stannous
fluoride/sodium
hexametaphosphate dentifrice relative
to a marketed control. Other
research using digital plaque
imaging showed a 24.4% reduction in overnight plaque
growth using stannous fluoride dentifrice. Digital plaque
imaging is an ideal method to
assess plaque reductions - it’s a
real step forward to objectively
prove the efficacy of products,
more quickly optimise them
and then introduce them to improve the lives of consumers.
Regimens have also been tested using digital plaque imaging. As an example, one study
assessed overnight plaque
coverage and plaque coverage
following brushing with a standard fluoride dentifrice. We
then compared the esults with
overnight plaque coverage and
post-brushing plaque coverage
following two weeks of use of a
regimen which included twicedaily brushing with stannous
fluoride dentifrice and twicedaily rinsing with cetylpyridinium chloride (CPC) mouthrinse. As shown in Figure 2,
the differences were dramatic
- they were measured using
digital plaque imaging which
provided objective evidence for

the efficacy of the regimen.
Digital Whitening Imaging
Digital imaging at Procter &
Gamble was next used to determine the effectiveness of
tooth whitening formulations
and products. As with digital
plaque imaging, this enabled

Figure 1. Digital Plaque Imaging

Picture i: Pre-treatment - pre-brush
plaque area: 24%

Picture ii: Pre-treatment - postbrush plaque area: 13%

Picture iii: Post treatment - prebrush plaque area: 4%

Picture iv: Post treatment - postbrush plaque area: 3%

digital plaque imaging

1. Disclose the teeth with fluorescein
2. Take digital images of the facial surfaces
with standardised UV lighting
3. Automated (computerised) assignment of
pixels (to plaque/tooth/ gingivae/ background)
4. Summation of the area of pixels associated
with plaque
5. Summation of the area of pixels associated
with teeth and plaque combined
6. Calculation of the percentage of the
summed total area of pixels associated with
plaque

the research team to rapidly
and objectively assess the actual benefits of products. It first
provided proof of concept and
later clinical proof for the effectiveness of hydrogen peroxide formulations contained in a
novel and disruptive whitening
product that delivered the
whitening agent on a thin plastic strip which was applied
directly to the teeth (Crest
Whitestrips). Imaging also
provided the objective comparative whitening results that
were needed to prove that this
product worked better than
many tray-based whitening
products. The digital imaging
provided a robust method for
the evaluation of whitening efficacy, with research showing
that the clinical measurement
of tooth colour via digital imaging is accurate, precise and
reliable.
Fast Forward to The Present
The research and development
team at Procter & Gamble now
has extensive experience using
digital imaging to assess antibacterial activity and whitening efficacy. This technology is
currently used to develop just
about every oral care product
at Procter & Gamble. It is excellent for research and also
makes a great demonstration
tool to visually show the efficacy of our products. Procter
& Gamble has also used digital imaging at conventions
and been able to show dentists
and dental hygienists images
of their own dentition. Even a
very small amount of plaque
is so easily visible using this
technology that you can really see the difference. Digital
imaging technology is credentialed by ASTM International
(previously the American Society for Testing and Materials
(ASTM)).
Rather than just visual dra-

matisations, seen in some
advertising, by using this credentialed, objective imaging
technology it is possible to show
actual plaque reductions and/
or colour improvement. It also
allows rapid assessment of
competitive products for results
that make strong, truthful performance claims possible.
In the early 1990s, Procter &
Gamble spent countless hours
developing this technology and
realised that it is prudent for
the entire industry to have access to the technology so that
all products and technologies
can be objectively evaluated.
The company invites everyone
to evaluate their products with
this objective imaging system
and often places imaging systems at other companies and
universities so that they can
use the technology as well. The
plaque imaging system was
also on display at the American
Dental Association a few years
back.
The Future
With respect to the future of
digital imaging, the difference
between conventional imaging
and microscopy is closing due
to the advent of highresolution
cameras. From the early beginnings using digital imaging,
the research team at Procter
& Gamble has continued to develop and explore other uses for
it. We currently use imaging to
measure plaque, gingivitis and
colour.
Looking further into the future,
it is possible to foresee digital
imaging being used to measure
biochemical markers associated with oral disease.
For a list of references or to ask
a question/comment on this article, email PPD@fmc.co.uk

[43] =>

[44] =>

4C HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | September-October 2014

Philips introduces its best brush yet,
Sonicare DiamondClean, helping users
achieve brushing brilliance every time
By Philips

UBAI, UAE - Philips
is proud to present the
new Sonicare DiamondClean – a brush that takes
sonic tooth brushing to its most
sophisticated level and which
delivers Sonicare’s best clean
yet removing up to 100% more
plaque in hard to reach places
than a manual toothbrush.
Sonicare DiamondClean harnesses Philips Sonicare’s patented sonic technology to
produce a powerful dynamic
cleaning action for a difference
users can see and feel. It is gentler on teeth and gums than a

manual toothbrush, helping to
keep teeth stronger and healthier for longer. Philips Sonicare
gently whips toothpaste into an
oxygen-rich foamy liquid and
directs it between and behind
teeth and along the gumlinewhere plaque bacteria flourish.
Sonicare DiamondClean is
clinically proven to remove up
to 100% of plaque from hard
to reach places and to improve
gum health in just 2 weeks. It is
also clinically proven to whiten
teeth in 1 week; and its gentle
technology actually helps protect against gum irritation and
recession to help reduce sensitivity. Now is the perfect time

< Page 1C
ing of Anton Van Leeuwenhoek’s
microscopes considered the first
practical microscopes, and the
biological discoveries for which
he is famous. Anton Van Leeuwenhoek was the first to see and
describe bacteria (1674), yeast
plants, the teeming life in a drop
of water, and the circulation of
blood corpuscles in capillaries.
During a long life he used his
lenses to make pioneer studies on an extraordinary variety
of things, both living and nonliving, and reported his findings
in over a hundred letters to the
Royal Society of England and the
French Academy.
What are the different types of
Loupes the dental profession
can buy?
• Hygienist and Dentists use both
of their hands while performing
dental procedures, dental loupes
are binocular and usually take
on the form of a pair of glasses.
Some dental loupes are flip-up
types, which can easily be removed from your eyesight by
flipping them up the two small
cylinders, in front of each lens of
the glasses. Other types are inset within the lens of the glasses
called TTL systems. (Though
The Lens) In that way you will
get closer to the eye!
• A typical magnification for use
in dentistry is from 2.0 x till 2.5
x, but dental loupes can be anywhere in the range from 2.0 x to
8.0 x.
• The most common types of
lens system inside the loupes are
the Galilean or Kepler (Prism)
system.
What happens long term if you
don’t wear Loupes?
• Nothing, you cannot alternate
with your eyes whether you use
loupes or not. The only thing
could be that you will miss out
on improved treatment quality
and ideal treatment ergonomics
enhancing motor skills to improve the ability of maintaining
the right posture. Performing
minimally invasive dental procedures with ease and precision
are possible today with the use of
magnification in dental practice.

What are the benefits of wearing Loupes?
• Many Hygienist and Dentists
use loupes to better scrutinize
things in their patients’ mouths
in order to make a better diagnosis. Loupes are also used in
order to perform a more precise
level of treatment; while drill or
cleaning teeth on a millimeter
scale, magnification can enlarge the view of the teeth, perhaps making it easier to inspect
teeth for decay or see things that
ordinarily would not be seen
without magnification.
• There are three principal reasons for adopting magnifying
loupes for dentistry: to enhance
visualization of fine detail, to
compensate for the loss of near
vision (presbyopia over 40ys)
and to ensure maintenance of
correct posture.
Can there be any side effects to
wearing Loupes?
• Use of magnification devices
(or any optically ground lens will
not adversely affect vision in the
short or long term. Some people
will initially experience some
post-use blurring, eyestrain, or
headache, but this should only
occur in the beginning after
initial use and not persist for
more than a few days. Your visual perception will adapt to the
magnification change. If long
term problems persist, return
to your prescribing doctor for
a checkup. Surgical telescopes
have been used for the last 30
years by dentists, ophthalmologist, neuro-surgeons, plastic
and vascular surgeons! To date,
there are no known adverse effects from any form of surgical
magnification
• The only “side effect” could be
that by using high quality loupes
they are addictive and you very
quickly get used to see thing
much better and there no turning back!

Contact Information
Optometrist Rune Oerts
OD, MSc
Ph. +45 21 24 97 98
info@exam-vision.ae

to give your teeth the celebrity
treatment and switch to Sonicare to really experience the
difference.
The brush is able to deliver
a unique whole mouth clean
feeling thanks to its five brush
modes that allow you to tailor
your brushing according to
your needs as well as your dental professional’s advice. The
brush modes range from:
• Clean – the standard mode
for a whole mouth clean
• White – removes surface
stains to whiten teeth
• Polish – brightens and polishes teeth to bring out their
natural brilliance
• Gum Care – gently stimulates and massages gums
• Sensitive – an extra-gentle
mode for sensitive teeth
Highly charged
DiamondClean’s chrome base
also features a unique charging glass that can be used for
mouth rinsing, but also incorporates the latest in inductive
charging technology to charge
the toothbrush as it rests in the
glass – making it stylish enough

to display in the most fashionforward bathroom.
Not only is Sonicare DiamondClean Philips’ most advanced
brush yet, it’s also our most
easy to use and stylish. DiamondClean’s power handle has
a ceramic finish and a chrome
accent ring highlights the elegant neck of the brush. The
technology in the handle is
hidden so that the sleek matte
white finish of the brush is uncluttered by electronic visual
displays. Only when the on button is pressed are the brushing
modes illuminated to reveal
the array of options. These are
then simply selected by scrolling down using a one button
action.
When travelling or on the go,
Sonicare DiamondClean is designed for convenience with
users being able to keep their
brush fully charged using a revolutionary USB travel case that
can be plugged into almost any
lap top computer and saves the
hassle of having to pack plugs
and adaptors. But only the most
intrepid travellers need worry

about this advanced feature as
Sonicare DiamondClean holds
an impressive three weeks
charge.
Brilliant cut
Sonicare
DiamondClean
brush heads also sport a new
diamond-cut tuft formation
to provide you with an even
more efficient brushing experience. The uniquely designed
diamond bristle heads have
44% more bristles than Philips
Sonicare’s standard sized ProResults brush heads, providing
you with both superior plaque
removal and whiter teeth. The
heads come in two sizes – Standard and Compact – for focused
cleaning in areas of special
need, for orthodontic patients
and those with smaller mouths.

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

[45] =>

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

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

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

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

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

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

[46] =>

6C HYGIENE TRIBUNE

Dental Tribune Middle East & Africa Edition | September-October 2014

Diet advice from a Nutritionist
– extending beyond the dental chair
mendations if they come from
a trusted practitioner. So your
relationship with your patient is
the perfect opportunity to create
a positive influence that extends
far beyond the dental chair.

By Robin Treasure

ygienists and dentists are
well aware of the impact
that diet has on a patient’s
oral health and overall wellbeing, and patients will be more
likely to follow dietary recom-

While you may already encourage a “healthy diet”, there
is much confusion over what
“healthy”
actually
means.
Snacking can be especially challenging, so in this article I’d like
to offer a number of suggestions
you can give your patients especially in light of individual nutritional requirements:
• Low energy: fatigue is a chief
complaint among many people
today, which sets off a vicious cycle of consuming sugar to obtain

brief bursts in energy. Telling
people to “just avoid sugar” will
be ineffective if they’re struggling with fatigue. Instead, such
patients should be encouraged
to consume protein with a bit of
healthy fat. Both the protein and
the healthy fats provide a steady
source of energy that burns efficiently without peaks and
troughs, and without encouraging weight gain (as opposed to
sugar). Here are some examples
of protein and health fat:
- Chicken breast and avocado
slices wrapped in a leaf of Romaine lettuce
- Almond butter on celery sticks
or carrot sticks
- Hardboiled egg with sea salt

low energy (above), as well as
dehydration, the patient should
address the underlying energy
issues and drink adequate water. Yet to satisfy the immediate
craving, suggest one of the following snacks:
- Crunchy, sweet apple or ripe
banana (fruit should always be
ripe and in season, otherwise it
won’t taste good!)
- Fresh berries on whole, plain
yogurt
- Herbal tea or green tea sweetened with stevia (the extract
of a sweet herb that is entirely
natural and does not affect blood
sugar)
- Glass of water with fresh
squeezed lemon juice and stevia

• Craving sweets: often linked to

• Dental decay: in addition to

avoiding processed sugar as
much as possible, dental decay
must also be addressed by ensuring the patient is consuming
enough of the fat-soluble vitamins (A, D, K and E). These vitamins work synergistically with
the minerals in our body to ensure the strength of our teeth.
Examples of good sources of fatsoluble vitamins are:
- Butter from grass-fed cows
(such as “Kerrygold” brand)
spread on a rice cracker
- Smoked salmon and cucumber
slices rolled up in nori seaweed
Ideally, your patients’ main
meals should be nutritious and
satisfying enough that they
won’t actually need snacks in
between. But if they’re experiencing the issues cited above,
these snacks will be satisfying
and are packed with nutritional
value.
Robin Treasure is a wellness
coach who hails from the United
States and received her professional training from the Institute
for Integrative Nutrition. She
works with clients experiencing stress and burnout by helping them make key changes in
their diet, lifestyle and mindset.
Moreover, she designs strategies
to help her clients thrive while
meeting the demands of their
daily lives.

Contact Information
For further information,
please visit:
www.robintreasure.com

< Page 1C

extraordinary people and have
had the opportunity to be a
dental professional spokesperson on a popular day-time television show.
Most importantly, this award
has reinforced in my heart and
soul why I wanted to become
a registered dental hygienist. I

“The goal of the Pros
in the Profession award
is to honor those who
inspire us.”
wanted to touch people’s lives. I
wanted to motivate and inspire
people. That is what the Pros in
the Profession is all about! The
goal of the Pros in the Profession award is to honor those
who inspire us. I do hope that I
have inspired others to be awesome at whatever they strive to
make their life mission, and I
thank Crest Oral-B for the opportunity to represent their
idea of an outstanding hygienist.

[47] =>

G Text

Dental Tribune Middle East & Africa Edition | September-October 2014

P R O F E S S I O N A L

M E D I C A L

C O U T U R E

EXPERIENCE OUR ENTIRE COLLECTION ONLINE
WWW.CROIXTURE.COM

[48] =>

[49] =>

Modern life can be

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

Daily protection from the effects of Acid Wear

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

Date of Preparation: June 2014

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

CHSAU/CHSENO/0011/14a

[50] =>

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

Sensodyne® Complete Protection helps
maintain good gingival health4-6

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

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

Clinically proven to provide dentine hypersensitivity relief1-3

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

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

Helps to maintain good gingival health4-6

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

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

with a NovaMin® containing dentrifrice4

1.4
1.2
Mean GBI*

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

58.8% reduction from baseline in 6 weeks
p<0.001

p=ns

Baseline
6 weeks
NovaMin® containing
dentifrice

Baseline
6 weeks
Placebo control

1.0
0.8
0.6
0.4
0.2
0

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

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

Hydroxyapatite-like
layer within the
tubules at the surface

5 µm

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

All-round care for dentine hypersensitivity patients1-6

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

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

®

) [page_count] => 50 [pdf_ping_data] => Array ( [page_count] => 50 [format] => PDF [width] => 808 [height] => 1191 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT Middle East and Africa No. 5, 2014

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => Bleach Cases From dead white to natural bright [page] => 06 ) [2] => Array ( [title] => Esthetic rehabilitation of posterior teeth using Bulk-Fill Composite [page] => 08 ) [3] => Array ( [title] => CAD CAM Technology: a Review [page] => 09 ) [4] => Array ( [title] => Meeting esthetic challenges with Herculite XRV Ultra [page] => 13 ) [5] => Array ( [title] => Dr. Ahmed Zuhaili performs yet another groundbreaking surgery [page] => 14 ) [6] => Array ( [title] => BIDM 2014 [page] => 17 ) [7] => Array ( [title] => Empirical comparative study confirms thixotropic wound dressing for haemostasis [page] => 22 ) [8] => Array ( [title] => Pre-Align then design [page] => 24 ) [9] => Array ( [title] => Ormco Custom: It’s all about profitability [page] => 26 ) [10] => Array ( [title] => Analyze adult snoring carefully [page] => 28 ) [11] => Array ( [title] => Management of Intracanal Separated Instruments [page] => 29 ) [12] => Array ( [title] => Crown for the queen of the jungle [page] => 30 ) [13] => Array ( [title] => Industy [page] => 31 ) [14] => Array ( [title] => Meet Carestream’s CS 3500 Intraoral Scanner. A game changing paradigm Shift [page] => 32 ) [15] => Array ( [title] => Ivoclar Vivadent discusses monolithic restorations in London [page] => 33 ) [16] => Array ( [title] => VITA ENAMIC: a greater similarity to natural dentition and more cost-effective than previous CAD/CAM ceramics? [page] => 34 ) [17] => Array ( [title] => Lab Tribune Middle East & Africa Edition [page] => 37 ) [18] => Array ( [title] => Hygiene Tribune Middle East & Africa Edition [page] => 41 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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