DT Middle East and Africa No. 6 (November), 2015

DT Middle East and Africa No. 6 (November), 2015

DENTSPLY –Sirona merger to create world’s largest dental manufacturer / Industry / How to avoid extractions when treating malocclusions using MRC’s Bent Wire System and Trainer System for arch development / Identification and management of passive eruption / Oral health / Lifelike esthetics achieved with minimally invasive methods / The “All Hall” case: A case report of maximum capacity use of the Hall technique in a single child patient / Bluephase: Two new products for a precise and economic use / CAD/CAM / Ortho Tribune Middle East & Africa Edition / Implant Tribune Middle East & Africa Edition / News / Practice Management / Endo Tribune Middle East & Africa Edition / Lab Tribune Middle East & Africa Edition / Hygiene Tribune Middle East & Africa Edition / 7th Dental-Facial Cosmetic Int’l Conference – part of Dubai Dental Week / Emirates Dental Society to hold its dental board election at 7th DFCIC

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Printed in Dubai

www.dental-tribune.me

November-December 2015 | No. 6, Vol. 5

Lab Tribune

Hygiene Tribune

Endo Tribune
Supernumerary teeth:
Diagnosis and treatment

IPS e.max Smile
Award 2016: In search
of the world’s most
esthetic dental cases

New Philips Sonicare
AirFloss Ultra improves
periodontal health in
just four weeks

>Insertion

>Insertion

>Insertion

DENTSPLY–Sirona merger to create
world’s largest dental manufacturer
By Dental Tribune International

S

ALZBURG, Austria/YORK, Penn.,
USA: DENTSPLY International and
Sirona Dental Systems announced
that the companies have entered into a
definitive merger agreement. It is expected that the new company will be the
world’s leading manufacturer of professional dental products and technologies,
having the largest sales and service in-

frastructure in the global dental industry
with about 15,000 employees across the
world.
The newly founded company will operate under the name of DENTSPLY SIRONA. Both companies will retain their
respective headquarters. The current

> Page 2

DENTSPLY-Sirona merger

The 25th BIDM 2015
Another success for
Lebanese Dental Association
By Dental Tribune MEA/CAPPmea

B

EIRUT, Lebanon: In his welcoming speech, President Elie Maalouf
opened with “Our Target is to have
a BIDM that attracts the major dental
business in the area”. Several new projects were also launched in order to im-

industry

4-7

media mcme

8-14

oral health

16-18

aesthetics

19

paediatric tribune 20-24
cad/cam

25-30

ortho TRIBUNE	

31-33

implant tribune

35-39

news

40-46

practice mng

48-50

prove dentistry in Lebanon by the LDA
during the BIDM meeting.
The conference proved to be a vital platform for the participants to share their
ideas, explore potential new advances
in technology and foster closer ties. “The
theme of ‘Redefining the standards of
Care’ is more relevant than ever as we
face conflicting ideas in our daily practice and there is a real urge to be able
to respond to this with evidence-based
knowledge” said Dr. Nabih Nader, LDA
President of the Scientific Committee.
Despite the difficult situation in the
region, the event attracted over 2,072
Lebanese and International registered
dentists, 38 highly esteemed guest
speakers from 18 countries around the
world (Brazil, USA, France, Germany,

> Page 44

Careers
Career Opportunities
Job oppenings
Dental Categories
www.dental-tribune.com/careers

[2] =>

2 news

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 1: “DENTSPLY–Sirona merger to create world’s largest dental manufacturer”
Group Editor

DENTSPLY head office in York
will serve as the new company’s
global headquarters, while the
international headquarters will
be located in Salzburg.
Upon close of the transaction,
Jeffrey T. Slovin, current president and CEO of Sirona, will
serve as CEO of DENTSPLY
SIRONA and will be a member
of the board of directors. Bret
W. Wise, current chairman and

CEO of DENTSPLY, will assume the position of executive
chairman of the newly founded
company. In their respective
positions, they will collaborate in executing the corporate
strategy and in integrating the
companies and their respective
corporate cultures.

and adjusted EBITDA of more
than $900 million (€796 million), excluding the incremental
benefit of synergies.

In addition to thousands of employees in more than 120 countries, DENTSPLY SIRONA will
have over 600 scientists, and
research and development staff
Together, the companies ex- working to accelerate the develpect to generate a net revenue of opment of new dental technoloabout $3.8 billion (€3.4 billion) gies, especially in the rapidly

growing areas of digital dentistry and integrated solutions.

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

The merger is expected to be
completed in the first quarter
of 2016. However, the transaction is still subject to the receipt
of certain regulatory approvals
and other customary closing
conditions and approvals.

Magda Wojtkiewicz

Online Editor
social media manager

Claudia Duschek

editorial assistants

Anne Faulmann
Kristin Hübner

Copy Editors

Sabrina Raaff
Hans Motschmann

Publisher/President/CEO

Torsten Oemus

Chief Financial Officer

Dan Wunderlich

Chief technology Officer

Serban Veres

The Intelligent Solution
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Business Development Manager

Claudia Salwiczek

Junior Manager Business
Development

Sarah Schubert

project manager online

Tom Carvalho

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Dr. Dobrina Mollova
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[3] =>

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4 industry

Dental Tribune Middle East & Africa Edition | November-December 2015

Ketac™ Universal Glass Ionomer Restorative
Clinical Case
By Dr. Gunnar Reich , Germany

Fig. 1: Initial situation: upper first premolar
with insufficient disto-occlusal restoration

Fig. 2: Cavity preparation after removal of the
defective restoration

Fig. 3: Placement of sectional matrix system

Fig. 4: Bulk placement of Ketac™ Universal
Glass Inonomer Restorative into cavity

About the Author
Dr. Gunnar Reich, Munich, Germany
Owner of Dr. Gunnar Reich Private Dental Practice specialized in the following focus areas: aesthetic restoration and reconstruction with plastic, filling material in
anterior and posterior regions, complex dental prostheses and implantology.
Author of several publications in Germany and abroad.
Fig. 5: Shaping of occlusal surface with the instrument

Fig. 6: Final Ketac™ Universal restoration after polishing with Sof-Lex ™ Spiral Polishing
Wheels

Ketac™ Universal Restorative. Dentist satisfaction ratings
By 3M

etac Universal restorative
is designed to save steps
and time… therefore the
handling must also support a

fast, easy procedure. In an application test 3,510 fillings were
placed using Ketac™ Universal
Glass Ionomer restorative. Den-

tists were pleased with overall
handling, ease of placement and
cavity adaptation1.

References
1. Please refer to the Technical
Data Sheet.

3M Announces New 3M Oral Care Organization
By 3M

onsistent with 3M’s strategy to increase customer
relevance, the company
has announced the formation
of 3M Oral Care, combining the
former 3M ESPE Dental and 3M
Unitek Orthodontics into a single
new division, led by Vice President & General Manager James
D. Ingebrand.
“Building on our strong brands
and technologies, 3M Oral Care
will leverage our fundamental
strengths in science and innovation to deliver a complete suite of
solutions across the continuum

of oral care for dentists and orthodontists, to improve patient
outcomes,” said Joaquin Delgado, Executive Vice President, 3M
Health Care Business Group.
“We are committed to further
building on our more than half a
century of innovation in the oral
health industry,” Ingebrand said.
“This will accelerate our momentum as we continue to deliver quality innovative solutions
for doctors and their patients.”
3M was recognized recently
as the “Most Innovative Dental
Company” for the 10th consecutive year, by The Anaheim Group

(publisher of Dental Fax Weekly), for continuing to bring exciting new ideas to dentistry. 3M’s
wide range of dental products
and supplies includes restorative,
crown and bridge, mini-dental
implants, preventive, infection
control and others. In addition,
3M helps integrate advanced
digital technology and materials
science through CAD/CAM dentistry and digital impressions. 3M
has brought a number of amazing firsts to the dental industry,
including the first-ever toothcolored restorative material, the
first self-adhesive universal resin
cement, the first nano ionomer,
the first malleable, preformed

temporary crown and the first
automated mixing of impression
materials.
3M also is known as a leader in
orthodontic solutions. Recent innovations include: Clarity™ Advanced Ceramic Brackets which
combine brilliant aesthetics with
consistent strength and small
bracket design for enhanced patient comfort; APC™ Flash-Free
Adhesive which allow doctors
to move directly from bracket
placement to bracket cure without removing adhesive flash – no
clean up; and Victory Series™
Superior Fit Buccal Tubes to hold
arch wires to molars, designed

with a large compound contour
base for superior fit, exclusive
“contoured funnel” for easy wire
insertion and low profile and
flush-mount hook for patient
comfort; and “invisible” 3M™ Incognito™ hidden braces, which
are placed on the lingual side
of the teeth for highly aesthetic
treatment.

Contact Information
For more information please
visit www.3MGulf.com/espe

[5] =>

Finish
faster.
Finish strong.
3M, ESPE and Ketac are trademarks of 3M or 3M Deutschland GmbH.
© 3M 2015. All rights reserved.

Now, get them out of the chair faster!
Pediatric. Geriatric. And busy teens in between. Treating patients who
can’t sit still long feels like a race against the clock—and every second
counts. That’s why 3M ESPE Dental developed Ketac™ Universal Aplicap™
Glass Ionomer Restorative.
• One-step placement—no conditioning, coating or light-curing steps
to slow the procedure down
• Stress-bearing properties enable extended indications
• Continous fluoride release over 12 months

Ketac

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Universal
Aplicap
™

Ketac Universal restorative … because the most caries-prone
patients are also the most restless.
For more information please visit:

www.3MGulf.com/espe

Glass Ionomer Restorative

[6] =>

6 industry

Dental Tribune Middle East & Africa Edition | November-December 2015

AEEDC 2016
German Pavillion

Glass Ionomer Filling Cement
Self-curing Calcium Hydroxide Paste

• Excellent biocompatibility due to low acidity
• High compressive strength
• Stable and abrasion resistant
• Tooth-like thermal expansion
• No temperature rise during setting
• Enamel-like translucency and excellent radiopacity

• For indirect pulp capping and linings under dental filling materials
• Sufficient working time in combination with a short setting time in the mouth
• Bacteriostatic
• Antimicrobic effect due to a high pH-value
• Contains 26% calcium hydroxide
• Preservation of vitality due to pulp recovering

Dental Material GmbH

Visit www.promedica.de to learn more about all our products!

24537 Neumünster / Germany
Tel.
+49 43 21 / 5 41 73
Fax
+49 43 21 / 5 19 08
eMail
info@promedica.de
Internet www.promedica.de

Individual design for your treatment unit
and your furniture
aesthetics and individuality. It
improves the productivity in the
he glass elements of the dental office with simple and
treatment unit ARIA SR practical solutions. The careful
quality maand the furniture line selection of high-
Cameo can be designed accord- terials, a very attractive design
ing to your personal preference. and outstanding functionality
Perfectly harmonized, the two guarantee fantastic results. The
elements fit perfectly in your surface parts of the ARIA-SR are
made of pure metal and polyesclinic branding.
Choose your own motives, per- ter with high-quality gel coating.
sonal images or your practice No usual plastic parts are used.
logo in order to create an amaz- This guarantees an extraordinary stability and the long-term
ing brand recognition!
consistent appearance, free
The new treatment unit ARIA SR from yellowing. For the purpose
combines efficiency and user- of preventive care treatment
friendly handling with pure and prophylaxis, the operating

components, best materials
and an outstanding design this
young furniture line meets all
expectations in terms of hygiene, reliability, comfort and
aesthetics. The matching wall
cupboards for disposable materials complete the furniture line
optional.

By Ritter

Contact Information
ARIA SR is perfectly complemented by modern furniture line Cameo

lamp of ARIA SR can be particularly equipped with a bleaching
adapter and a cosmetic mirror.

ARIA SR is perfectly complemented by modern furniture
line Cameo. With its modular

RitterConcept GmbH
Bahnhofstraße 65,
08297 Zwoenitz
Tel. 0049 (0) 37754/13-314
info@ritterconcept.com
www.ritterconcept.com

Design prize ju
SIDEXIS 4 as “
By Dental Tribune International
ADVANCED
PRESS TM

ADVANCED PRESS
Process

The patented ADVANCED PRESS process ensures a uniform temperature distribution from the temperature sensor of the press furnace to the inside of the
press ring.
Pressing always takes place within the ideal temperature range for pressing lithium disilicate. Thus hardly any reaction layer is created on the surface. This is
enhanced by an extermely short press time.
The result is a smooth surface and an enormous time savings!
TM

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P.O.Box: 24476, Sharjah - United Arab Emirates, Tel. : +9716 5308055, Fax : +971 6 5308077
E-mail : dt_uae@eim.ae, www.dme-medical.com

ENSHEIM,
Germany/
SALZBURG,
Austria:
Dental manufacturer Sirona has recently been awarded
the Red Dot Award in Communication Design as “Best of
the Best” for its new SIDEXIS
4 imaging software. Each year,
the international design award
gives recognition to products of
the highest level of design quality. Overall, almost 7,500 projects
from 53 countries were submitted. The award will be presented
at the Red Dot Gala in Berlin on 6
November 2015 in the presence
of approximately 1,000 guests.
Together with software specialist Heinrich & Reuter Solutions,
Sirona has been recognised for
its extensive efforts in designing
the intuitive, user-friendly interface of SIDEXIS 4. Dentists can
use the software to access all per-

[7] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

industry

7

Qualident Dental Laboratory Introduces JUVORA
– The Next Generation Dental Material
By Qualident

J

UVORA™, the first approved
high performance polymer
material that allows the
CAD/CAM fabrication of a removable denture framework
from a non-metal material – provides a more efficient process
for dental professionals and an
improved patient experience.
Intended for use in telescope
attachments, precision attachments and implant supported
superstructures, the JUVORA™
Dental Material uses only the
purest biomaterial sourced from
the market leading provider of
PEEK-OPTIMA
biomaterials,
Invibio® Biomaterial Solutions
(that has more than a decade of
experience and proven success
in over 4 million implanted devices globally.)

Patient benefits
Prosthetic frameworks made
from JUVORA™ provide patients with premium solutions:
• Strong and lightweight to improve patient comfort
• Digitally designed to match patient’s anatomy
• Elastic modulus similar to
bone – allowing for increased
flexibility in both denture design
and patient use.
• Shock absorbent during chewing
• High strength to weight ratio
• Resistance to wear, abrasion
and corrosion – less damage to
adjacent natural teeth
• Metal-free denture framework
• Taste-neutral (no metal taste)
• Reduced thermal or electrical
conductivity when compared to
metal

JUVORA™ material offers significant benefits
for patients as both the design
and material properties, enabling
the manufacture of precise, lightweight and
comfortable non-metal removable dentures

ury recognises
“Best of the Best”
tinent patient image data. The
software can handle all common
image formats and types, including digital SLR, intra-oral, panoramic and 3-D images. Thus,
data from previous and current
imaging technologies can be accessed and easily displayed and
managed. SIDEXIS 4 acts as a
central hub for the integration
of diagnostic image data of any
kind that the practice team has
not only prepared during the
course of the treatment, but also
received from other dentists for
long-term patients. The dentist
can display a full overview of
the patient’s treatment history in
a timeline. Using a digital lightbox, the dentist can easily make
cross-comparisons between the
image data and recognise subtle
changes in the course of treatment.
The numerous interfaces make
it possible to connect to all digi-

tal systems in the dental practice. The imaging software can
also be extended with plug-ins
and applications to enable perfect coordination with integrated digital processes for simultaneous surgical and prosthetic
planning of implants, and for orthodontic applications.
According to Sirona, SIDEXIS 4
has also been well received by
the expert community. “We have
received feedback from many
users that the entire workflow in
the practice has improved with
the software upgrade and that
diagnosis, planning and treatment are simpler, faster and safer,” remarked Dr Nadia Amor,
Senior Product Manager of Imaging Software at Sirona.
Sirona has already won two Red
Dot Awards this year for its innovative ORTHOPHOS SL radiographic solution and inLab MC
X5 dental device.

• X-ray and scanner friendly (Xray Transparent)
Indications
1) Implant-supported superstructures
Our high-performance, biocompatible JUVORA allows a strong,
yet lightweight, framework for
cantilever designs (e.g. all-infour) and is clinically proven for
implant applications.

connectors. The CAD/CAM digital design process results in a
precise denture framework that
is more comfortable and better
fitting than alternative materials.
At Qualident Dental Laboratory,
we are vigilant about ensuring
the quality of our product.

Contact Information

2) Telescope attachments:
Telescope attachments manufactured from a JUVORA™ provide improved friction, accuracy
and better retention of zirconia
primary crowns and offer less
intrusive telescope transversal

3) Precision attachments
Denture attachments made
from a JUVORA™ are more
comfortable and better fitting
than those made from other materials. The JUVORA™ is made
from a revolutionary PEEKOPTIMA® denture base material that is clinically proven for
implant applications and noted
to improve the retention of the
dental structure.

Dr. Noor Al-Aswad
Mob: 056 7945588
Dubai, U.A.E,
Century Plaza 101,
Jumeirah 1 Beach Road.
Tel: +971 4 3427576
Sharjah, U.A.E,
Al Ettihad Road
Opposite Safeer Mall,
Wasl Bldg, 101,
Tel: 06-5255199
www.qualident-online.com

[8] =>

8 mCME

Dental Tribune Middle East & Africa Edition | November-December 2015

How to avoid extractions when treating malocclusions
using MRC’s Bent Wire System and Trainer System
for arch development
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 German O. Ramirez-Yañez,
DDS, PhD, and Chris Farrell,
BDS

bstract
Maxillary and mandibular expansion has been
proposed to increase the arch
perimeter and to avoid extractions during orthodontic treatment. Although controversy has
persisted over the stability of expansion techniques, there is an
increasing trend toward “nonextraction.”
This paper describes a novel
method to produce expansion
of the dental arches, and at the
same time, to treat muscular
dysfunctions that may be the
etiological factor of the maloc-

Fig. 1: Photos/Provided by Drs. German O. Ramirez-Yañez and Chris
Farrell.

clusion. The system has been
developed by Myofunctional Research Co. (MRC), Queensland,
Australia, as a simpler method
of phase one expansion, which
may produce improved stability
because of simultaneous habit
correction in selected cases. Two
cases treated with the Farrell
Bent Wire System™ (BWS™)
are described and the advantage
of this method of treatment is
discussed.
Introduction
Expansion of the jaws has been
increasingly performed in orthodontics to achieve better occlusal and maxillary relationship and, in doing so, improving
oral functions. Maxillary and

Fig. 2

Fig.3

Fig. 4a

Fig.5

Fig. 4b

mandibular expansion has been
proposed since Edward Angle to
avoid extractions (Dewel, 1964).
This paper presents a novel
method to produce dental arch
development in the maxilla and
the mandible, while at the same
time correcting or maintaining
the inter-maxillary relationship
either if a sagittal and/or vertical problem exists or a Class I
malocclusion with normal overjet and overbite is present at the
beginning of treatment.
There is a controversy regarding
the ideal time for performing the
expansion. Sari and co-workers
reported that rapid maxillary
expansion by means of a fixed
screw (eg. Hyrax) produces better results when it is performed
in the early permanent dentition
(Sari, 2003). Although this statement appears to be supported by
other studies (Chung; Housley,
2003; Spillane, 1995), maxillary
expansion may also be successfully done in older adolescents
and adults (Stuart, 2003; Iseri,
2004; Lima, 2000). In the maxilla, rapid and semi-rapid expansion produce an increase of the
lower nasal and maxillary base
widths, with the maxilla moving
forward and downward (Chung,
2004; Sari, 2003; Iseri, 2004).
These changes in the maxilla
produced by the expansion are
accompanied by a spontaneous
mandibular response, which
increases the dental arch perimeter (Lima, 2004; McNamara,
2003) and rotates the mandible
posteriorly (Sari, 2003; Chung,
2004). Mandibular displacement
is associated with an increase in
facial height (Sari, 2003, Chung,
2004).
Net gain in the arch perimeter
may be calculated accordingly
with the expansion performed.
Motoyoshi and co-workers reported that 1 mm increase in
arch width results in an increase
in arch perimeter of 0.37 mm
(Motoyoshi, 2002). Akkaya and
collaborators determined that
arch perimeter gain through
expansion could be predicted
as 0.65 times the amount of the
posterior expansion when treatment is performed with rapid
maxillary expansion, and 0.60
times the amount of posterior
expansion when treatment is
performed with semi-rapid
maxillary expansion (Akkaya,
1998). This is also supported by
Adkins and co-workers, who
determined that arch perimeter
may increase 0.7 times the expansion produced at the premolars.
An expected relapse in the
amount of expansion has been
reported by some authors
(Hime, 1990; Housley, 2003),
which appears to be the result
of that pressure delivered by the
cheeks on the maxillary arch

CAPPmea designates this activity
for 2 continuing education credits.

and the resistance to deformation of maxillary sutures and
surrounding tissues to maxillary
expansion.
Nevertheless, maxillary and
mandibular expansion rises up
as one of the important phases
of orthodontic treatment, producing arch perimeter increase,
and thus, avoiding extraction
of teeth. Increasing numbers of
multi-banded techniques using
passive self-ligating brackets
have become popular, but few
address the challenges of adapting the soft tissues to this new
dental position. Long-term retention is the recommended solution to stability. Thus, the aim
of the current paper is to present
a new method to produce maxillary and mandibular expansion
and, at the same time, to treat the
soft-tissue dysfunction that may
be responsible for treatment
relapse (Ramirez-Yañez, 2005).
Two example cases treated with
the BWS Orthodontic System
developed by Myofunctional
Research Co (MRC) in Australia
are presented to explain the proposed treatment.
The BWS Orthodontic System
The BWS Orthodontic System
discussed in this article is composed of two different appliances: the Trainer™ and the
BWS. These two appliances
combined may simultaneously
produce arch development and
treat poor myofunctional habits.
The Trainer, a pre-fabricated
functional appliance, has amply
demonstrated an ability to relocate the mandible (Usumez,
2004) to correct improper forces produced by the muscles of
the cheek and lips (Quatrelli,
Ramirez-Yañez, 2005a) and to
change the dimensions of the
dental arches (Ramirez-Yañez,
2005b). Further research (Yagci
2011) showed that treatment using the Trainer produced a positive influence on the masticatory
and peri-oral musculature.
However, in those cases where
more maxillary and mandibular
expansion is required to avoid
teeth extractions, the Trainer
combined with the BWS produces higher amounts of expansion and, therefore, a higher
increase in arch perimeter. It is
also proposed that by utilizing
the Trainer in conjunction with
the arch expansion, the force of
the tongue activates further alveolar changes that other techniques may not achieve because
of the bulk of the appliance being located in the palate where
the tongue should naturally position.
The BWS is typically composed
of a lingual arch, which follows
the lingual surfaces of the teeth
crowns at the gingival third and
ends in a loop at the inter-

proximal space between the
second premolar and the first
molar at both sides. The distal
end engages a tube (0.7 Farrell
tube by MRC) welded to a cemented band on the first molars
(Fig. 1). Additionally, the BWS is
maintained in place, facing the
gingival third of teeth’s crown,
by two begg premolar brackets
cemented on the first premolars
with the slot directed toward
gingival or alternately composite stops bonded to the premolar or anterior dentition (Fig. 2).
The wire component is 0.7 mm
spring wire and is fabricated
to the arch form of the starting
models either by the laboratory
or the orthodontist. The simple nature of the BWS makes it
possible to assemble in-house,
avoiding the fees that accompany laboratory-constructed appliances.
An advantage of this system is
that it does not involve using
acrylic in the palatal vault. A
functional appliance designed
with acrylic on the palate and
that is not properly built may
lower the tongue, encouraging tongue thrusting, and, thus,
either worsening the malocclusion or producing a relapse
(Fig. 3). The Trainer is a prefabricated functional appliance,
which means no laboratory involvement, and the BWS can be
entirely constructed “in office.”
The BWS is not made of acrylic,
nor does it occupy the palate.
It allows the tongue to position correctly and the patient to
speak normally.
The BWS is also suitable for
use in the lower arch. Typical
treatment tends to use only upper expansion for three to four
months, after which time the
wire component of the BWS is
removed (the bands are kept
for later use of the BWS). The
i-2 Trainer (with the inner-cage
that produces arch expansion)
is then used to maintain the initial arch expansion gained using
the BWS. Lower alignment is reevaluated throughout this stage
of i-2 Trainer use. Often, as can
be demonstrated in the cases
selected, lower alignment and
arch form improves because
of the maxillary expansion and
peri-oral musculature functional improvement (Fig. 4).
The BWS is held in place using standard ligatures placed
around the BWS tube as pictured (Fig. 5).
The following two cases show
the effect of the BWS Orthodontic System on arch development.
Case No. 1
This 10-year-old female patient

> Page 9

[9] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

mCME

< Page 8

Fig. 6a

Fig. 6b

Fig. 6c

Fig. 6d

Fig. 7a

Fig. 7b

Fig. 7c

Fig. 7d

consulted because of a crowded
dentition involving unusually
misaligned upper central incisors with a midline shift of 10
mm and with lost “c” space on
the lower left side. The parents
requested that the treatment be
non-extraction, although they
had previously been advised
that future orthodontic treatment might require this option
(Fig. 6).
The occlusion was classified as
Class I with normal slight overjet and with normal overbite. No
skeletal alteration was found on
cephalometric measurements
and analysis of cast models reported a lack of arch development. This case was diagnosed
as a Class I malocclusion with
underdevelopment of both dental arches. Midline shift was
primarily as a result of the lost
lower “c” space. Soft-tissue analysis showed a mouth-open posture and hyperactive peri-oral
musculature. It was considered
the myofunctional habits were a
contributing factor to the malocclusion and, thus, a suitable case
for the BWS and Trainer combination prior to fixed appliances
once the permanent dentition
was fully erupted.
The plan of treatment involved
a first phase with a BWS for the
upper arch combined with an
I-2n Trainer — “n” for no core
or cage for increased flexibility
and use with the BWS. The i-2n
Trainer was used one hour daily
plus overnight while sleeping.
Monthly adjustment to the activating loops of the BWS were
made in increments of 1-2 mm
per month.
This treatment was continued
for four months, after which
time the upper BWS was removed and i-2 Trainer was
used to maintain the expansion
achieved by the BWS. The i-2
Trainer also encouraged the
tongue to assist in maintaining
the maxillary expansion without
retainers. At this stage, the lower
arch form and dental alignment
was assessed and showed considerable improvement. It was
noted the space for the lower
left permanent canine had increased — an effect thought to
be produced by the combination of maxillary arch expansion
and correction of myofunctional
habits. The midlines were also
self-correcting.
Space for the lower canines was
ultimately achieved without a
lower BWS.
The case is further improved by
continued use of the i-2 Trainer

and the Myobrace Regular™ to
exploit the eruption stage prior
to treatment finalization with
fixed appliances as required.
The observation of the effects
and benefits of the BWS Orthodontic System are evident from
this case, and the concepts are
not new to orthodontics. Maxillary expansion tends to also
improve the lower arch length
and assists the orthodontist in
achieving non-extraction outcomes with more stable results
because of simultaneous correction of tongue position and
retraining of the peri-oral musculature. The second phase of
treatment did not require the
BWS on the lower arch as arch
development during the treatment period sufficiently opened
the space for the lower permanent canine. The lower anterior dentition did not require the
use of fixed appliances (Fig. 7).
Thus, this case was treated in a
2-year period, required minimal
chair side time and a difficult extraction case was converted to a
simple, non-extraction case.
Case No. 2
This 12-year-old female patient
consulted because of very underdeveloped maxillary arch
form and ectopic erupting canines (Fig. 8). This is far from
an ideal stage to be considering non-extraction treatment;
however, the parent insisted
that the case was attempted
non-extraction. The lower anterior teeth were also considerably
crowded, and it would regularly
be justified in extracting the first
four premolar teeth and going
into upper and lower straight
wire fixed appliances.
It could be argued that treating
non-extraction will prolong the
treatment and certainly incur
greater expense on the parent.
However, there is a growing demand from parents who have
had extraction orthodontics in
the past to avoid this approach
for their children. Therefore, the
BWS Orthodontic System can be
a beneficial technique that the
orthodontist can use in these exceptional cases.
Treatment was similar to case
1. An upper BWS was fitted and
combined with the use of the
i-2n Trainer initially for four
months, after which time the
BWS wire was removed, leaving
the molar bands in place. The i-2
Trainer was introduced at this
stage for a further three months
to maintain the expansion prior
to a second phase of treatment

using the BWS and i2n Trainer
for three months (as mentioned
earlier in this article).
This allows the dentition to
“catch up” and prevents excessive tooth mobility. It is thought
that much of the expansion
achieved by this system is dentoalveolar rather than sutural, as
with a rapid maxillary expander
and other acrylic expanders.
Also, there is more development
in the anterior arch form, which
is an effect previously found
in the research on the Trainer
(Ramirez-Yañez, 2005b).
The difficulty in cases like this,
requiring large amounts of expansion to achieve a non-extraction result, is a tendency to
create an open bite. Although
this occurs to some extent, the
BWS Orthodontic System does
not open the bite as much as
more conventional techniques
because the tongue position is
favorably altered by use of the
Trainer. This conjecture may
require further investigation to
ratify.
Once again, spontaneous alignment of the lower anterior dentition has occurred without the
requirement for an additional
BWS for the lower arch. This effect is not just restricted to these
two cases but is a routine observation of the BWS Orthodontic
System. This case also illustrates
the stability achieved in the lower dentition as no retainers were
used apart from night use of the
Trainer.
Although this patient is not at the
ideal age, the pictures show that
it was possible to obtain space
for all permanent canines, without extractions and with good
stability.
The bite opening is minimal and
tends to decrease with further
dental development. Although
this case was finalized with the
Myobrace Regular™ from MRC,
fixed appliances on the upper
arch would possibly have delivered quicker results following
the BWS Orthodontic System.
The assistance of correcting the
forces delivered by the muscles
of the cheek (buccinator) and
lips (orbicularis oris) at swallowing cannot be ignored and is
a key part of the modus operandi
of this expansion system.
After two years of treatment
and observation, along with
night-time retention using the
i-2 Trainer for 12 months after
treatment, the BWS produced
enough upper arch development to not only accommodate
the erupting canines, but also

achieve lower anterior alignment with minimal intervention
and minimal retention (Fig. 9).
This case was a more extreme
example that orthodontists will
face in the future as more parents demand the non-extraction
option with minimal use of multi-bracket systems.
Conclusions
Maxillary and mandibular expansion has been shown to be an
excellent alternative to increase
the arch perimeter and, thus, to
avoid the need for extractions to
properly align teeth. This paper
has presented two cases treated
using the BWS Orthodontic System, which involves the combination of two appliance systems:
the Trainer, a pre-fabricated
functional appliance, and the
BWS.
Both appliances, Trainer and

BWS, have to be used in order
to get the results reported in
this paper. The BWS Orthodontic System showed in these two
cases and in many cases treated
by the authors is an excellent
means to produce arch development in both upper and lower
dental arches in a short time.
The effect of the BWS Orthodontic System on arch development
does not change the inter-maxillary relationship when a Class I
occlusion exists at the beginning
of treatment.
However, when a Class II malocclusion associated to a crowded
dentition is present the BWS Orthodontic System produces arch
development and, at the same
time, the mandibular relocation

> Page 10

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[10] =>

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Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 9

Fig. 8a

Fig. 8b

Fig. 8c

Fig. 8d

Fig. 9a

Fig. 9b

Fig. 9c

Fig. 9d

effect is produced by the Trainer
(Usumez, 2004; Ramirez-Yañez,
2005a; Quadrelli, 2002), which
treats the distal position of the
mandible.
Additionally, the BWS Orthodontic System has shown to improve
the overjet and overbite but to
maintain them when they are
correct at the beginning of treatment. This system treats muscular dysfunctions that may be the
cause of crowding and malocclusion and may cause relapse
after treatment is finished.
Thus, the BWS Orthodontic Sys-

tem may be proposed as an excellent alternative form of treatment in those cases where arch
development is required to align
teeth, patients want to minimize
or even avoid brackets and extractions, the mandible needs to
be relocated, soft tissue dysfunction is present and treatment
needs to be performed in a reasonable period of time.
References
1. Adkins MD, Nanda RS, Currier
GF. Arch Perimeter changes on
rapid palatal expansion. Am J

Orthod Dentofacial Orthop 1990;
97:194–199.
2. Akkaya S, Lorenzon S, Ucem
TT. Comparison of dental arch
perimeter changes between
bonded rapid and slow maxillary expansion procedures. Eur
J Orthod 1998; 20:255–261.
3. Chung CH, Font B. Skeletal
and dental changes in the sagittal, vertical and transverse
dimensions after rapid palatal
expansion. Am J Orthod Dentofacial Orthop 2004; 126:569–575.
4. Dewel BF. Serial extraction:
its limitations and contraindica-

tions in orthodontic treatment.
Am J Orthod 1967; 53:904–921.
5. Hime DL, Owen AH 3rd. The
stability of the arch expansion
effects on Frankel appliance
therapy. Am J Orthod Dentofacial Orthop 1990; 98:437–445.
6. Housley JA, Nanda RS, Curier GF, McCune DE. Stability
of transverse expansion in the
mandibular arch. Am J Orthod Dentofacial Orthop 2003;
124:288–293.
7. Iseri H, Ozzoy S. Semirapid
maxillary expansion – a study
of long term transverse effects
in older adolescents and adults.
Angle Orthod 2004; 74:71–8.
8. Lima RM, Lima AL. Case report: Long-term outcome of
Class II, division 1 malocclusion
treated with rapid palatal expansion and cervical traction. Angle
Orthod 2000; 70:89–94.
9. Lima AC, Lima AL, Filho RM,
Oyen OJ. Spontaneous mandibular arch response after rapad
palatal expansion: a long term
study on Class I malocclusión.
Am J Orthod Dentofacial Orthop
2004; 126:576–582.
10. McNamara JA Jr, Baccetti T,
Franchi L, Herberger TA. Rapid
maxillary expansion followed
by fixed appliances: a long-term
evaluation of changes in arch
dimensions. Angle Orthod 2003;
73:344–353.
11. Motoyoshi M, Hirabayashi
M, Shimazaki T, Nawra S. An experimental study on mandibular
expansion: increases in arch
width and perimeter. Eur J Orthod 2002; 24:125–130.
12. Quadrelli C, Gheorgiu M,
Marcheti C, Ghiglione V. Early
Myofunctional approach to
skeletal Class II. Mondo Orthod
2002; 2:109–122.
13. Ramírez-Yáñez GO, Farrell C. Soft tissue dysfunction:
A missing clue when treating
malocclusions. Int J Jaw Func
Orthop 2005; 5.
14. Ramírez-Yáñez GO, Junior
E, Sidlauskas A, Flutter J, Farrell
C. The effect of a pre-fabricated
functional appliance on arch
development. 2005 (in preparation).
15. Sari Z, Uysal T, Usumez S,
Basciftci FA. Rapid maxillary expansion. Is it better in the mixed
or in the permanent dentition?
Angle Orthod 2003; 73:654–661.
16. Spillane LM, McNamara JA
Jr. Maxillary adaptation to expansion in the mixed dentition.
Semin Orthod 1995; 1:176–187.
17. Stuart DA, Wilkshire WA.
Rapid palatal expansion in the
young adult: Time for a paradigm shift? J Can Dent Assoc

2003; 69:374–377.
18. Usumez S, Uysal T, Sari Z,
Basciftci FA, Karaman AI, Guray
E. The effects of early preorthodontic Trainer treatment on
Class II, division 1 patients. Angle Orthod 2004; 74:605–609.

About the Authors

Chris Farrell, BDS, graduated
from Sydney University in 1971
with a comprehensive knowledge of traditional orthodontics using the BEGG technique.
Through clinical experience,
he took an interest in TMJ/TMD
disorder and, after further research, Farrell discovered that
the etiology of malocclusion
and TMJ disorder was myofunctional, contradicting the
current views of his profession.
Farrell founded Myofunctional
Research Co. (MRC) in 1989
and has become the leading designer of intra-oral appliances
for orthodontics, TMJ and sports
mouthguards.

German O. Ramirez-Yañez,
DDS, PhD, is a dentist from Colombia (South America) with
more than 20 years of experience in guiding craniofacial
growth and development. He is
a specialist in pediatric dentistry
(Mexico) and functional maxillofacial orthopedics (Mexico and
Brazil), and is trained in orthodontics (Mexico). Ramirez has
a master’s in oral biology and a
PhD in dental sciences (Australia). He has published more than
20 articles about early orthodontic treatment and about craniofacial biology in peer- reviewed
international journals.

[11] =>

mcme 11

Dental Tribune Middle East & Africa Edition | November-December 2015

Identification and management of passive eruption
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 Gregori M. Kurtzman, USA

xcessive gingival display
can affect the total esthetics of a smile, becoming
the focus instead of the frame of
the smile. This can be the result
of passive eruption of the gingival complex as the teeth erupt.1,2
The condition of delayed or altered passive eruption exists
when the gingival complex remains positioned coronal to the
cementoenamel junction with
the attachment on the enamel
instead of the cementum of the
root, giving the appearance of
short clinical crowns.3
Crown lengthening4 is critical to
the success of creating a smile
that is harmoniously balanced
with its surrounding facial features.5
Patients who clinically display
too much gingival tissue and
short teeth require a thorough
diagnosis and treatment plan to
provide a predictable esthetic
outcome.6
If a patient has altered passive
eruption (APE) of the maxillary
anterior teeth either secondary to orthodontic treatment
or without orthodontic treatment, but the patient has completed facial growth,7 then the
practitioner must first correct
the gingival levels with either a
gingivectomy or esthetic crown
lengthening procedure before
the placement of veneers or
crowns. Thus ensuring that the
eventual gingival margins of the
maxillary anterior teeth will be
at their correct level relative to
the adjacent anterior teeth.8
Understanding altered passive
eruption
In a human mouth absent of
periodontal disease, the osseous structure roughly follows
the scalloped parabolic contour
of the cementoenamel junction
(CEJ), from facial to interproximal at an average distance of 2
to 3 mm.9
In addition, the average interproximal bone height is 3 mm
coronal to the facial crest of
bone.10 Because the soft-tissue
topography is usually determined by the underlying hard
tissue, this osseous “scallop”
usually results in a gingival scallop of 3 mm.11
Examination of the peri-apical
radiographs or periodontal vertical bite-wings will allow the
clinician to ascertain the position of the alveolar bone relative to the CEJ of the teeth to
determine whether the crest of
bone (COB) is 2 to 3 mm apical
to the CEJ, allowing for biologic
width.12
However, where the COB is coronal to the CEJ, a condition results that is referred to as APE.13
In this situation, the gingival
margin will usually be located,

on average, 3 mm coronal to the
level of the crest of bone, being
more coronal on the body of the
tooth and creating the appearance of a short, clinical crown.14
These visual findings are coupled with the clinical information obtained by “bone sounding.”
Bone sounding involves using a
periodontal probe to locate the
CEJ and determine whether it
can be felt within the gingival
sulcus or only when the probe
penetrates through the base of
the sulcus.15
Additionally, the periodontal
probe is also used to feel for the
COB. This value is expressed
as a numerical distance in millimeters, revealing the distance
between the COB and CEJ to
ascertain whether there is sufficient biologic width.16 In a normal, non-diseased human periodontium, the COB is 2 to 3 mm
apical to the CEJ.17
In addition to the gingival margin on the facial aspect of the
teeth, in non-diseased dentition, the interproximal papilla
between teeth with no bone loss
due to periodontal disease is approximately 4.5 mm coronal to
the interproximal crest of bone.
The mid direct facial is about 1.5
mm more coronal to the COB.
This additional 1.5 mm, with the
3 mm average osseous scallop
from the CEJ, results in the tip of
the papilla being an average of
4.5 mm coronal to the facial free
gingival margin, where there is
a “normal” periodontium, with
no loss of bone or periodontal
attachment due to periodontal
disease.18
Anatomic considerations act as
parameters when practitioners
perform esthetic gingival recontouring. A useful guide can
be fabricated by modifying the
mounted diagnostic casts so that
the waxed modification reflects
the ideal tooth proportions desired in the final result, based on
the guidelines previously published by Chiche and Pinault.19
These guidelines suggest that
the average length for esthetically pleasing maxillary central
incisors is 10–12 mm.20 These
guidelines for the length of the
central incisors, along with the
recommended width-to-length
ratio of 75 to 80 percent,21 should
be kept in mind when recontouring the gingival tissues so as
not to leave the teeth too long or
too short.22
After proportions are achieved
on the central incisor proportions, practitioners should focus
on the height of contour of the
gingival margin on the centrals
(zenith).23
The proper placement of the
gingival zenith should be at the

CAPPmea designates this activity
for 2 continuing education credits.

Fig. 1: Excessive gingival display with pigmented gingiva.

Fig. 2: Wide band of heavily pigmented attached gingiva
with passive eruption of the anterior teeth.

Fig. 3: Vacuform stent that has been scalloped at the desired gingival height to act as a surgical template.

Fig. 4: Incision made at the desired gingival height to
provide proper length-to-width ratios of the anterior teeth
being treated. Note width of attached gingiva that will remain.

Fig. 5: The right half of the anterior has been treated with
a gingivectomy to service as a comparison of the length-towidth ratios that were present before and after treatment.

Fig. 6: Immediately following gingivectomy of the anterior
maxillary teeth to correct the passive eruption and provide
better length-to-width ratios.

Fig. 7: Patient smiling immediately following gingivectomy showing less gingival display and better lengt- towidth ratios.

Fig. 8: The patient two weeks post treatment showing better esthetics with less gingival display and a reduction in
the gingival pigmentation.

Fig. 9: The patient four weeks post treatment showing a
more natural esthetic smile.

Fig. 10: Patient presenting with old composite on the anterior teeth to mask discoloration, spacing issues and excessive gingival display.

Fig. 12: Models as the patient presents (left) compared with
the wax-up (right) from an occlusal view.

> Page 12
Fig. 11: Thickness of old composite placed in an attempt to
mask the underlying discolored tooth structure. Note the
banded discoloration of the lower anterior teeth.

[12] =>

12 mcme

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 11

Fig. 13: Models as the patient presents (left) compared
with the wax-up (right) from a facial view showing the
better length-to-width ratios that are planned.
Fig. 14: Patient following removal of the old composite revealing dark tetracycline banded teeth below.

Fig. 15: Vacuform surgical stent based on the wax-up to
be used as a surgical guide when performing the gingivectomy. Note the edges of the stent are colored black to
improve visibility intraorally.

Fig. 17: Immediate composite mock-up placed improving
the final esthetics.

Fig. 16: Patient following Gingivectomy to improve the
length to width ratios.

Fig. 18: Patient one week post treatment showing an improved smile with less gingival display and better length
to width ratios.

Fig. 19a, b: Comparison of before and after gingivectomy an placement of functional mockup.

peak of the parabolic curvature
of the gingival margin, which for
the central incisors, cuspids and
bicuspids, should specifically
be located slightly distal to the
middle of the long axis on these
teeth.
This gives the centrals, cuspids
and bicuspids the subtle distal
root inclination, which is paramount for the scaffold of a beautiful smile.
The zenith for the lateral incisors is located at the midline of
the long axis of the tooth. Furthermore, the height of the gingival crest for the lateral incisors
should be 1 mm shorter than the
gingival margins of the adjacent
teeth (centrals and cuspids).
Finally, the gingival tissues
should be manipulated to have
a resulting “knife-edge” gingival
margin.24 When the presence
of short clinical crowns and crestal bone levels approximating
the CEJ has been determined,
a diagnosis of APE can be made
through the maxillary arch.
The practitioner can then fabricate an esthetic guide that can
be placed over the patient’s existing teeth to enable both the
practitioner and patient to visualize what the smile would look
like with the gingiva in a modified, more esthetic position.25
The central incisors should
demonstrate midline symmetry,
as well as the correct 75 to 80
percent width-to-length ratio.
In addition, the incisal smile

line follows the curvature of the
lower lip.26
The newly established periodontal smile line should show
a reduction of the gummy smile
and make the smile more esthetically appealing and harmonious with surrounding facial
features.27
Gingival levels should be assessed relative to the projected
incisal edge position. A predictable method of determining the
proper gingival positions is to
determine the desired tooth size
relative to the projected incisal
edge position. The practitioner
should remember that the incisal edge should not be positioned using the relative position
of the gingival margin to create
the proper tooth size. This is because the gingival margin can
move with eruption or recession.28
It is also paramount when establishing the proper position of the
maxillary anterior teeth for an
optimal cosmetic outcome to assess the levels of the interdental
papillary tissues and their position relative to the crown length
of the maxillary incisors.
Gingivectomy and gingivoplasty for esthetic soft-tissue
correction
Traditionally, scalpels and periodontal knives (Orban and Kirkland) were utilized to sculpt soft
tissue when gingivectomy was
the treatment being used to

improve esthetics.29 These provided precise incisions, but the
resulting raw, bleeding surfaces
complicated postoperative healing. Monopolar electrosurgery,
another option, requires a dry
field during treatment and this
may increase tissue inflammation during the initial healing
period and subsequent tissue
shrinkage.
“Charring” of the tissue margins
at surgery has also been reported with monopolar electrosurgery and may be a result of the
need for operating in a dry field
and the high wattage needed to
overcome resistance between
the cutting tip located intraorally
and the grounding plate located
a distance away on the body.30,31
Bipolar electrosurgery was developed to overcome the obstacles associated with monopolar
electrosurgery.
True bipolar electrosurgery as
used today in dentistry is a cross
over from neurosurgery, which
requires delicate incisions in
wet fields with no lateral heat
generation. The Bident Bipolar
surgical unit (Synergetics, King
of Prussia, Pa.) transfers those
neurosurgical requirements to
the dental environment, allowing intraoral soft-tissue surgery
in wet fields with char-free, nonbleeding incision margins.32 This
eliminates marginal shrinkage
related to tissue inflammation
and provides a more comfortable postoperative period for the
patient.
When using the bipolar surgical unit, because the tips have
two electrodes that are either
straight wires or loops, one must
remember that the first electrode to touch the tissue acts as
the return and the second electrode does the cutting or coagulating, depending on which foot
pedal is depressed. Because the
bipolar surgical unit is fully isolated from ground, unlike mo-

nopolar electrosurgical units,
a ground is not required. Additionally, as no grounding plate is
required and resistance through
the body is not an obstacle to be
overcome, wattage is one-quarter of that used with monopolar
electrosurgery.
It is also advised by the author
that when you are cutting tissue, your assistant is constantly
spraying water from the air/water syringe to keep the field wet
while using the high-volume
evacuation. This improves efficiency with the handpiece and
prevents charring.
Another benefit of the bipolar
surgical unit is that even during
cutting there is some coagulation that occurs, so the wound
edges that result do not ooze and
interfere with any restorative
procedures being performed
during the same appointment.33
Case No. 1: Passive eruption
A 32-year-old female patient
presented for treatment of excessive gingival display in the
anterior region and requested
a restorative option that would
provide improved esthetics (Fig.
1). Initial clinical examination
revealed a wide band of attached gingiva in the maxillary
and mandibular anterior with
associated passive eruption (Fig.
2).
Periodontal probing indicated
that the depth of the sulcus on
the facial of the maxillary anterior teeth was coronal to the
CEJ, supporting the presence of
passive eruption.
Also noted was the presence of
peg-shaped laterals bilaterally,
which were tipped both mesially
as well as palatally.
A gingivoplasty was scheduled
to move the gingival margin to
be equal or apical to the CEJ,
and perform restorative correction of the lateral incisors.
To aid in the treatment planning, the preoperative smile image was modified using Adobe
Photoshop (Adobe, San Jose,
Calif.) to indicate the proposed
location of the modified gingival
margin. This was performed to
determine if sufficient attached
gingiva would remain following
gingivoplasty.
Next, the cervical area of each
of the teeth to be treated in the
maxillary anterior was altered
on the photograph to simulate
the cosmetic change in a photographic mock-up.
The patient indicated that the
suggested correction of the excessive gingival display would
meet her esthetic concerns and
she would consider placement
of porcelain veneers on the
maxillary lateral incisors in the
future.
As the mandibular passive eruption of gingiva was not apparent
when smiling, the patient declined treatment of that gingival
tissue.
Surgical procedures
A line was drawn on the maxillary master model indicating the
intended position of the gingival margin based on width-tolength criteria.
A sheet of 0.30-inch vacuform
material (Raintree Essix, Metairie, La.) was thermoformed
over the cast using a Drufomat
pressure former (Raintree Essix,
Metairie, La.).
After cooling, the thermoformed

material was trimmed, scalloping the facial margin to follow
the line that had been placed on
the master model. The edge was
then colored with a black sharpie marker to make it more visible intraorally during surgery
(Fig. 3).
Following administration of a
local anesthetic, 4 percent Septocaine with 1:100,000 epinephrine (Septodont, New Castle,
Del.), a periodontal probe was
used to feel the CEJ at the mesial, distal and mid-facial aspect
of each of the anterior teeth and
the premolars. The vacuform
surgical template was inserted
and the edge of the tray on the
facial was visualized in relation
to the mucogingival line.
A 3301 gingivectomy pen was
used with a bipolar surgical unit
to follow the facial edge of the
surgical stent from teeth #4 to
#8 (Fig. 4). While the clinician
applied the bipolar pen, the assistant sprayed a continuous
stream of water over the field,
followed by high-volume evacuation to keep the tissue hydrated
during the procedure.
The surgical template was removed and the outline of the
proposed gingival margin was
evaluated. The gingivectomy
pen (Bident, Synergistics USA,
King of Prussia, Pa.) was used to
complete the contouring gingival cut using a semi-lunar shape,
sparing the papilla. To avoid a
resultant “black triangle,” the
papilla was not included in the
gingivoplasty cut. A periodontal
scaler was used to detach the
gingival tissue from the tooth
surface and remove any tissue
tags remaining on each site.
A 3302 Gingivoplasty pen (Synergistics USA, King of Prussia,
Pa.) was used to plane back the
thick tissue at the facial aspect
of the papilla to achieve normal
contours and taper in the tissue.
Again, water spray was used to
maintain tissue hydration and
improve postoperative healing.
Finally, a 3102 coagulation ball
pen (Synergistics USA, King of
Prussia, Pa.) was used in the bipolar unit on coagulation mode
to seal any bleeding over the
gingivoplasty surface. The right
quadrant was compared to the
left to ensure proper reduction
and the process was repeated on
teeth #9 through #13 (Figs. 5–7).
Postoperative instructions
The patient was dismissed and
instructed to avoid spicy foods
and to use warm salt water rinses three to four times daily until
she presented for the follow-up
appointment two weeks later. At
the follow-up appointment, the
patient indicated that postoperative sensitivity and gingival
irritation were not experienced,
and the patient was satisfied
with the improved smile (Fig. 8).
Clinical examination noted a
lack of gingival inflammation
except for a small spot on the
papilla between the right lateral
incisor and central incisor. All
areas except this spot were covered with keratinized gingiva
that was less pigmented than
what was initially present.
At four weeks post surgery, the
patient returned and healing
was noted as complete (Fig. 9).
The patient indicated that she

> Page 13

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Dental Tribune Middle East & Africa Edition | November-December 2015
< Page 12
had received comments from
friends and family that she appeared to be smiling more. Additionally, she commented that
she was no longer self conscious
about her smile and was indeed
smiling more and would, when
finances allowed, proceed with
the recommended veneers on
the maxillary lateral incisors.
Case No. 2: Passive eruption
with spacing issues
The patient, a 40-year-old
woman, presented with a history of previous direct bonding
to correct moderate tetracycline
discoloration of the teeth and
generalized diastemas. Examination revealed an excess display of gingiva when the patient
smiled, as well as bulky, chipped
and discolored direct-resin restorations on the maxillary anterior teeth (Figs. 10, 11). The
patient expressed a desire for a
less gummy smile and an overall
improvement in the esthetics.
A full series of radiographs was
taken and a periodontal examination was performed. It was
noted that a wide band of attached gingiva was present. Examination of the radiographs,
coordinated with intraoral probing, determined that removal of
2 mm to 3 mm of gingival tissue
would not encroach on the crestal margin of bone and an osseous component to the gingival
surgery would not be needed.
After a consultation with the patient and a discussion using the
modified photograph, treatment
progressed to a wax-up phase
on the casts. A duplicate cast of
the maxillary arch was altered to
give the teeth normal thickness
and eliminate the bulky composite that was present.
This was followed by application
of a dentin adhesive (Bond 1,
Pentron Clinical Technologies,
Wallingford, Conn.) to the cast to
aid in retention of the wax-up to
the cast. Next, composite (Simile®, Pentron Clinical Technologies) was applied to the cast and
shaped with composite instruments so that contour and tooth
proportions developed.
Material was placed over the
gingival aspect of the cast to
position the tooth’s cervical line
where it would be positioned
clinically using the modified
photograph as a guide. When
the contour and position of the
composite were finalized, the
casts were cured with a handheld curing light (Figs. 12, 13).
The modified maxillary model
was then placed into Futura
floor wax and allowed to soak
for five minutes, followed by
bench drying for 30 minutes to
seal the cast.
Kromopan alginate (Kromopan,
Des Plaines, Ill.) was mixed to
a runny consistency with more
water then normally used and
placed into a rubber base-former. The modified cast was
inserted tooth side down into
the material and allowed to set.
Upon setting, the model was
separated from the alginate and
a stone cast was poured.
After the stone cast had completely set, it was removed
from the alginate and trimmed
to eliminate the palatal area of
the cast. This was performed to
permit better adaptation of the
vacuform material to fabricate
stents.
Using a Druformat™ pressure-

Fig. 20: Patient presents with passive eruption,
wear of the incisal edges and length equaling width
with a wide band of attached gingiva.

forming machine (DENTSPLY
Raintree Essix, Metairie, La.),
two separate stents were fabricated using Tray-Rite sheet
material (DENSTPLY Raintree
Essix).
The first stent was trimmed to
follow the gingival margins on
the cast and would act as a guide
during gingival surgery. To aid
in visualization during surgery, a
black sharpie marker was used
to color the scalloped gingival
margin of the surgical stent. The
second stent was trimmed to be
used as an intraoral form to fabricate the functional mock-up.
After application of local anesthetic, the first step at the clinical
appointment was to strip the old
composite using a diamond bur
in a high-speed handpiece with
water. Care was taken to avoid
removal of any enamel at this
time. Upon removal of the old
composite, it was noted that the
teeth had moderate tetracycline
staining with a banded appearance.
The maxillary lateral incisors
were also noted to be in slight
crossbite orientation (Fig. 14).
The crossbite situation was mild
with no negative overbite, presenting with no contact between
tooth #7 and the lower teeth
when the teeth were moved into
lateral excursions.
The mock-up would be able
to determine if during normal
function, the resin at the incisal
of tooth #7 would chip, which
would then require consideration of a full-coverage restoration vs. a labial veneer. When
the maxillary tooth is “locked”
behind the mandibular tooth,
the crossbite would not allow a
more normal positioning of the
maxillary tooth without drastic
preparation of the tooth in crossbite and would require orthodontic intervention to correct.
The surgical stent was inserted
and assessment of the new gingival margins was made following the black edge of the surgical stent to ensure that adequate
attached gingiva would remain
after gingival recontouring (Fig.
15).
Using the bipolar surgical unit,
a 3304 gingivectomy pen (Synergetics) was used to follow the
edge of the surgical stent while
the assistant sprayed a constant
stream of water spray with one
hand and used the high-volume
evacuation device with her other hand. This allowed the tissue
to remain hydrated and eliminated any tissue charring during the procedure. This permits
improved healing with the lack
of inflammatory response often
seen with monopolar soft tissue
surgery.
Healing time for a gingivectomy
is approximately three weeks
before the tissue is in a stable
position and all associated inflammation is concluded. The
Bident Bipolar unit would per-

Fig. 21: Chu proportion instrument used to match
length to the width and achieve better proportions;
also shown is the instrument used to mark the new
zenith.

Fig. 22: Patient following gingivectomy to eliminate
passive eruption and achieve better length-to-width
ratios.

Fig. 23: Patient following gingivectomy and placement of immediate direct resins to length of the
anterior maxillary teeth and position the incisal
edge where it would be had the incisal wear not
occurred.

Fig. 24: Patient one week following gingivectomy
and placement of immediate direct resin veneers
showing a more esthetic smile with better length-towidth ratios.

mit progress to impressions or
final restorations immediately,
with no healing change in the
position of the new margin position because of the lack of heat
at the cut margin and lack of inflammatory response.
Osseous surgery requires longer
periods of healing because of
the manipulation of the osseous crestal position and greater
amounts of soft-tissue manipulation before a stable position
is achieved. An additional benefit of the Bident Bipolar unit is
a lack of tissue bleeding after

treatment that could discolor the
composite that is being placed.
The stent was removed and gingival margins were further refined with the gingivectomy pen.
Tissue was then planed back to
develop good papilla contours
using a 3302 gingivoplasty pen
(Synergetics). Completion of the
gingival recontouring did not
result in exposure of the crestal
bone and non-bleeding gingival
margins were noted (Fig. 16).
The position of the crestal bone
was determined through sulcular sounding with a periodontal

probe.
The information gathered indicated that some passive eruption
issues were present and with the
wide band of attached gingiva
present would allow removal of
3 mm of gingival tissue and still
provide a normal sulcular depth
after healing. The restoration
margins were placed at the new
gingival margin position.
The functional mock-up stent
was tried in, and the gingival po-

> Page 14

[14] =>

14 mCME

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 13
sition was assessed. Teeth were
isolated with cotton rolls and the
facial and interproximal of teeth
#5—#12 were etched with a 37
pecent phosphoric acid-etchant
gel for 30 seconds then rinsed
and dried. Bond-1 dentin adhesive was applied to all surfaces
and light cured for 20 seconds
per tooth.
The patient requested a very
white bleaching shade and Artiste® nano composite (Pentron
Clinical Technologies) Super
Bleach dentin shade and Bleach
enamel were selected for the
functional mock-up. A thin
layer of Bleach enamel shade
was placed into the stent in the
area of the incisal edge and incisal half of the coronal of teeth
#4—#13.
Next, the Super Bleach dentin
shade was placed into the stent
and the facial aspect of each
tooth was filled with material.
The stent was then carried intraorally, seated and adapted to
the teeth with finger pressure.
Each tooth was then light cured
for 30 seconds on the cervical
followed by 30 seconds on the
incisal.
The stent was removed, leaving
the bonded functional mockup on the teeth, and additional
light curing was performed. A
needle finishing diamond (Brasseler, Savannah, Ga.) was used
in a high-speed handpiece with
water to remove the cervical
flask and provide contours without any overhanging margins.
Cervical embrasures were also
opened, and definition given to
the interproximal line angles.
Occlusion was checked in centric occlusion and lateral excursions and adjusted for proper
anterior guidance. Polishing
was accomplished using Fini™
polishing paste and a cloth buffer tip (Pentron Clinical Technologies) (Fig. 17).
The patient was recalled 24
hours later to check soft-tissue
healing and assess the occlusion.
At this time, minor refinement of
the esthetics was accomplished
and the patient indicated no irritation gingivally where tissue
had been treated with the bipolar surgical unit. Slight sloughing of the keratinized layers of
the tissue was observed, but a
lack of inflammation was noted
(Fig. 18).
The patient was next seen at two
weeks post-treatment. At this
visit, it was noted that the soft tissue had a normal appearance in
color and tone and no inflammation was observed. Further refinements in the esthetics were
made in the functional mock-up,
opening the incisal and gingival
embrasures, shortening the incisal edges of the lateral incisors
and working with the patient to
achieve her view of ideal esthetics that would serve as a blueprint for the final restorations.
Figures 19a and 19b depict the
patient before and after correction of the gummy smile and
placement of the functional
mock-up. After a period of use
of the functional mock-up to
verify that the anterior guidance
was not causing any chipping or
damage to the functional mockup, final restorations would be
planned and a determination
between ceramic veneers and
full-coverage restorations would
be made. The teeth would be

prepared, stripping off all of the
functional mock-up, and the
stent used to fabricate the functional mock-up would then be
used to make a temporary prosthesis while the laboratory was
fabricating the final restorations.
Case No. 3: Passive eruption
with incisal wear
A female patient presented with
the complaint that her teeth appeared short and her smile was
gummy. Diagnosis determined
that the patient had good periodontal health, with no gingival
inflammation nor bleeding and
a wide band of attached gingiva
(Fig. 20).
Probing depth in the maxillary
anterior was within normal
limits at depths of 1–2 mm. The
gingival margin was positioned,
in general, 2 mm coronal to the
CEJ. Radiographically, the osseous crest was positioned apical
to the CEJ and no bone loss was
evident.
Local anesthetic was infiltrated
into the buccal vestibule from
the second premolar to second
premolar. A perio probe was introduced into the facial sulcus to
sound the osseous crest in relation to the CEJ and no bone was
noted coronal to the CEJ on the
teeth. The Chu instrument for
determining
width-to-length
proportions (Hu-Friedy, Ill.) was
used to determine where the
gingival margin needed to be
placed to have ideal length (Fig.
21).
The Bident Bipolar 3303 gingivectomy handpiece (Synergistics, King of Prussia, Pa.) was
used to mark the zenith of each
tooth to be altered. Using the
gingivectomy handpiece, the
gingival margin was sculpted
to ideal contours (Fig. 22). The
papilla is spared to avoid the potential of creating black triangles

interproximally.
The resulting tissue margin
after use of the gingivectomy
handpiece results in a soft-tissue
ledge that needs to be tapered
onto the tooth. A Bident Bipolar
3302 gingivoplasty handpiece
(Synergistics, King of Prussia,
Pa.), also referred to as a “fishhook,” is used to plasty (taper)
the gingival margin to create a
natural knife edge. As the papilla following a gingivectomy is
often bulky facially, the facial aspect of the papilla is planed back
to debulk the papilla with the
fishhook. Although the altered
margins appeared red, due to
the coagulation abilities of the
Bident Bipolar unit, no active
bleeding was noted.
The author recommends the
use of constant irrigation during use of the Bident Bipolar
surgical unit to maintain tissue
hydration and eliminate tissue
charring during treatment and
post operative inflammation. As
the practitioner uses the bipolar
handpiece, the assistant sprays
water from the air/water syringe
while suctioning with the highvolume evacuation.
The teeth were then isolated
and acid etched with a 37 percent phosphoric acid gel for 30
seconds then rinse and dried.
Bond-1 adhesive was applied to
the etched tooth surface then
light-cured. Using a stent previously fabricated to the desired
incisal length, Artiste nano composite (Pentron Clinical, Orange,
Calif.), the length was built using an enamel shade of resin
and light cured. The stent was
removed and each tooth was
then built to full contour of the
new length created by lengthening both gingivally and incisally
with dentin and enamel shades
of Artiste nano composite. Following finishing and polishing

of the direct resin restorations,
occlusion was checked and adjusted to maintain the anterior
guidance that was present before treatment (Fig. 23).
The patient was dismissed and
instructed to avoid any alcohol or
peroxide containing mouthrinses for the first week and to rinse
with warm salt water three to
four times daily for the first
three days. Additionally, the patient was instructed to continue
oral hygiene including brushing
the area with a toothbrush and
her regular toothpaste. At 24
hours, the patient was called to
check on her comfort level, and
she indicated no postoperative
discomfort nor irritation during
normal daily activities.
At one-week post surgery the
patient returned for a postoperative examination where a lack
of inflammation was noted (Fig.
24). A four-week postoperative
examination demonstrated a
more esthetic smile with better width-to-length proportions
with elimination of excess gingival display.
Conclusions
Practitioners frequently tend to
ignore the gingival tissues’ position relative to the tooth’s incisal
edge, and also in relation to the
adjacent teeth, when evaluating
the cosmetic aspects of patients.

Passive eruption appears to be
infrequently recognized and can
affect the final cosmetic result
when not addressed as part of
the overall treatment.
Editorial note:
The full list of references is available from the publisher.

About the Author

Gregori M. Kurtzman DDS,
MAGD, FACD, FADI, FPFA, DICOI, DADIA, is in private practice in Silver Spring, Md., and is
an assistant clinical professor
at the University of Maryland
School of Dentistry, Department of Restorative Dentistry.
He has lectured both nationally and internationally on the
topics of restorative dentistry,
endodontics and dental implant
surgery and prosthetics. You
may contact him via e-mail at
dr_kurtzman@maryland-implants.com.

Dental Humor

[15] =>

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Winner in the Oral Care Category

‫ ﻣﺴﺘﻬﻠﻚ ﻓﻲ دول اﻟﺨﻠﻴﺞ‬3600 ‫ﻋﻴﻨﺔ‬
ّ ‫ ﻋﻠﻰ‬TNS ‫دراﺳﺔ اﺳﺘﻘﺼﺎﺋﻴﺔ ﻣﺴﺘﻘ ّﻠﺔ ُأﺟﺮﻳﺖ ﻣﻦ ﻗﺒﻞ ﺷﺮﻛﺔ‬
A representative independent survey conducted by TNS on a sample of 3,600 consumers in the GCC

[16] =>

16 oral health

Dental Tribune Middle East & Africa Edition | November-December 2015

Abrasion Levels – How Low Can You Go?
By Beverly Hills Formula

he variety of toothpastes
available means that
many patients choose a
brand based on how effective it
is at targeting some of the most
common dental problems;
staining, bad breath, sensitivity
and gum disease. They probably do not even give a second
thought to the ingredients and
the effect they may be having
on their teeth and overall oral
health.
However, results from Missouri Analytical Laboratories
confirm that dental professionals and patients should be
concerned with the ingredients
in toothpaste and their level of
abrasiveness, and how by using
a lower abrasion toothpaste, serious oral health issues can be
avoided.
As a dental professional your
advice and professional recommendation carries considerable weight and it’s important
that your patients understand
what’s inside their toothpaste
before committing to a particular brand.

High vs. Low
All toothpastes contain abrasives; they provide the cleaning power needed to keep teeth
clean and help prevent gum
disease by removing plaque,
stains and debris. However, in
the search for the right toothpaste, it’s important to find one
that does “all of the above” but
is not so harsh that the abrasives attack the enamel.
The development of toothpaste
and its abrasive qualities date
back as far as the Egyptians
in 4th Century AD and the Romans, when the most effective
recipes included crushed flowers, bones and oyster shells.
Today, abrasive ingredients
include particles of aluminum
hydroxide (Al(OH)3), calcium
carbonate (CaCO3), various
calcium hydrogen phosphates,
silicas and zeolites, and hydroxyapatite (Ca5(PO4)3OH),
and can account for up to 60 %
of some brands of toothpaste.

Abrasivity
Beverly Hills Formula whitening toothpastes are
low in abrasion, safe for everyday use!

Patients should steer clear of
highly abrasive toothpastes as
they can damage the teeth and
gums. As tooth enamel is worn
away, the dentin beneath is
more visible and teeth become

more yellow in appearance.
They can also remove the luster and polish of porcelain
veneers and crowns, dulling
an otherwise beautiful smile.
Abrasive toothpastes can also
cause teeth to be become sensitive and in the most severe
of cases can result in infection
and even tooth loss.
Abrasion Testing
The abrasiveness of toothpaste
is measured according to the
RDA (relative dentin abrasivity)
value, and any value over 100
is considered to be “abrasive”.
Unfortunately the RDA Value is
often not included in the marketing or promotional information supplied with toothpaste
products, masking what is a
common problem.
In a study recently performed
by Missouri Analytical Laboratories (July 2011), a range
of whitening toothpastes were
tested to compare and evaluate their levels of abrasion. The
results confirmed that Beverly
Hills Formula toothpaste is
proven to be less abrasive than
some other leading brands of
both whitening and regular
toothpastes. In fact, Beverly
Hills Formula Total Protection
Whitening toothpaste scores
as low as 93 on the RDA table
whilst some leading competi-

tors have levels as high as 147.
To support this, in a study conducted at Bristol University
Dental School, Beverly Hills
Formula whitening toothpaste
was also found to remove stains
in just 1 minute, with over 90%
of stains removed over a 5 minute period. For extra stain removal, patients can be advised
to leave the toothpaste on their
teeth for up to 1 minute before
brushing.
These results signal a breakthrough in oral care and
aesthetics. Removing stains
caused by tea, coffee, red wine
or tobacco no longer requires
harsh abrasives or bleach, as
this new generation of whitening toothpaste offers a more
tooth-friendly solution, helping
patients to restore their teeth to
a natural white colour, quickly,
safely and effectively.
Beverly Hills Formula’s Perfect
White Range has been proven
as a safe and effective at-home
whitening method, which can
be carried out daily. Studies
have shown that Beverly Hills
Formula’s toothpastes and
mouthwashes provide powerful stain removal, a high performance whitening boost and
also care for teeth and gums.
With so many teeth whitening

products available on the market that have high abrasivity,
it is important that you inform
your patients the safest and
most effective form of teeth
whitening.
Complete tooth protection
Choosing a lower-abrasion
toothpaste is important in the
fight to ensure a healthy mouth
and using the wrong type of
toothpaste can lead to serious
oral health issues. For peace
of mind, the Beverly Hills Formula lower abrasion whitening
range also contains fluoride to
offer fast-acting, long-lasting
protection against acid attack,
whilst helping to strengthen,
re-mineralise and harden tooth
enamel for complete tooth protection.

Contact Information
For more information on Beverly Hills Formula products
please call +353 1842 6611,
email info@beverlyhillsformula.com or visit www.beverlyhillsformula.com.

About the Author
Eric Peterson is founder of the
whitening toothpaste Beverly
Hills Formula.

[17] =>

ORAL hEALTH 17

Dental Tribune Middle East & Africa Edition | November-December 2015

Size matters when recommending
daily cleaning with an interdental brush

By Jordan

n a recent survey1 we asked
dentists and hygienists what
the most important criteria
was when recommending an
interdental brush to their patients. The right size, a good grip
and effective bristles that do not
break topped the list.

So why should you or your patients start using them? Studies2 tell us that most of us (up to
90%) will experience some form
of mild gum disease (gingivitis).
Early symptoms of gum disease
(gingivitis) can be detected by
inflamed gum tissue. This is
caused by the bacteria in dental plaque. If the bacteria is not
brushed away, it may form tartar
and can eventually result in a
cavity. As many as 30% of cavities are between our teeth3.
The good news is that gingivitis
is reversible and preventable
with daily brushing and cleaning between your teeth. A tooth
has five surfaces that you need
to clean thoroughly in order to
get the best cleaning results.

An international study4 showed
that brushing with an interdental brush removes more plaque
than brushing with a toothbrush
alone. The study showed a positive significant difference using an interdental brush with
respect to plaque scores, bleeding scores and probing pocket
depth. The majority of the studies also showed a positive significant difference in the plaque
index scores when using an interdental brush compared to using dental floss.
Size is important when using an
interdental brush5. Interdental
brushes are a good alternative
for many of your patients. Statistics show that the population
is aging and growing, and many
of these people are also keeping their own teeth. This is also
a contributing factor to the increase in bridges, crowns and
implants. Interdental brushes
are easier to use than many
other products, including traditional floss. Our advice is to look
for an interdental brush that has
a sturdy but compact handle so
that the users get a good and

comfortable grip. Shorter handles give the user more control
as the position of thumb/finger
grip is closer to the point of contact.
A non-slip grip also helps controlled movement. It is important that the user is able to
navigate easily in the mouth,
reaching the back molars.
The highest usage of interdental brushes was found among
consumers between the ages of
40-496. 6 out of 10 of these use
the interdental brushes on average 3-7 times a week. But not all
your recommendations should
be to older patients. As many as
1/3 of children in Norway have
orthodontic treatment³. Among
these, there are a number that
do not necessarily need it, but
for cosmetic and confidence
reasons choose to have corrective treatment. The most common age to start using braces is

between 12-14 years but we are
also seeing a trend in an increasing number of older consumers
wearing braces, says Renate Deraas, dental Hygienist, Norway.
Two of the most common diseases within the U.S., diabetes
and cardiovascular disease,
have growing evidence of a relationship with plaque within
the mouth7. To keep your teeth
free of plaque you need to do
more than just brush your teeth
twice a day. Help your patients
keep their teeth healthy by recommending the best option for
them to clean properly between
their teeth as well as motivate

T
ming.

he case refers to a young
patient who suffered a
fracture while swim-

The fracture, as we can observe
in the initial shots, concerns the
entire incisal edge even with a
cervical flute-beak fracture
(Fig.1).
After physical and electrical
vitality tests were performed
(pulp tester), two impressions
were taken for diagnostic waxup’s to reconstruct the patient’s
teeth, both functionally and
aesthetically. (Fig.2, 3 and 4).
We examined the patient two
days later, checked pulp vitality
and used fluoride free Cleanic® prophy paste on the surface
of the preparations, together

References
1. Questback Nordental , Norwegian dental fair, 2013
2. www.ada.org
3. Statistics, Norway 2011
4. www.ada.org
5. Questback Nordental , Norwegian dental fair, 2013
6. Perceptor Quantitative survey,
Sweden, 2014
7. Chronic Diseases and Health
Promotion. Centers for Disease
Control and Prevention. 13 Aug.
2012. Web. 15 Sept. 2013.

NEW Interdental brushes with WaveCut™
bristle technology for better cleaning

Clinical Case:
Restoration of
Anterior Sectors
By Prof. Angelo Putignano,
Italy

them to use daily.

Soft tip makes it easy
to insert between teeth.
Shorter bristles are
perfect for effective
cleaning between teeth.
Bristles bounce back
effectively cleaning around
front and back sides of teeth.

with water spray to avoid dehydration that would interfere
with shade selection. We then
conducted a morphological and
colorimetric study of the dentition requiring reconstruction.
On completion of the study, the
case did not appear too difficult, except for a hint of orange
in the central area, and several
white spots on the incisal edge.
We selected Herculite® XRV
UltraTM A2 Enamel, A2 and A3
Dentin & Universal Incisal, and
Ochre and White Kolor + Plus®
to be applied in a pictorial technique.
The Palatal wall is constructed with A2 Enamel, followed
by the application of a small
amount of A3 Dentin on the
most coronal part of the preparation. A layer of A2 Dentine

> Page 18

Jordan scores significantly higher than leading competitor
brush¹ for control during brushing and overall quality²
+13%

Jordan

Find your size

+8%

TePe

Quality product

Jordan

TePe

Control during use

¹ Tested against TePe , Market leader in Sweden
²Perceptor, Sweden, 2014, tested on 104 consumers, Age 40+

For more information
www.jordan.no
enquiry@jordan-co.no

[18] =>

18 AESTHETICS

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 19

Fig.1

Fig.2

Fig.3

Fig.4

Fig.5

Fig.6

Fig.7

Fig.8

Fig.9

Fig.10

was then applied to cover the
previous layer and then the
mamelons were sculpted.(3)
(Fig.5-9)
Fig.11

Fig.13

Fig.12

Fig.14

The most coronal aspect is
slightly pigmented with Ochre,
while whitish areas are replicated with White Kolor + Plus®.
(Fig.11)

Cleanic

®

At this point we coated it all
with a very fine layer of A2
Enamel, also considering the
enamel mass’ limited translucency. (Fig.12)

The one step Prophy Paste

PATENTED PERLITE
TECHNOLOGY
Featuring integrated
abrasion variability

ALL IN ONE

TIME SAVING

Universal prophy paste
guarantees outstanding
results

From cleaning
to polishing
in one step

The incisal composite is placed,
both around and between the
mamelons, to create a translucent effect, and to highlight the
dentine anatomy. (Fig.10)

A 40 micron diamond was used
to finish the anatomy, while the
initial polishing was achieved
using silicon polishers with
decreasing abrasive grades.
(Fig.13)

SCIENTIFICALLY
PROVEN
Maximum cleaning
& polishing with
low abrasion of
enamel and dentine

Berry Burst with fluoride
A NEW tantalizing taste for an outstanding prophy result

After checking the occlusion,
the patient’s treatment was
completed; the final polishing
and shade confirmation was
postponed for 10 days. At the
next appointment the structure
surface was replicated and the
restoration was polished using
Occlubrush® which is impregnated with Silicon carbide and
aluminium oxide paste applied
with felt pads. (Fig.14)
The patient was pleased with
the final result, but we reminded him that, considering the
extent of the injury, he should
attend periodic pulp vitality
checks, and that the need for
endodontic treatment should
not be ruled out.
Herculite® XRV UltraTM performed a significant mimetic
feature and, with the addition
of Kerr Kolor + Plus® for the incisal characterizations, a highly
aesthetic value end result.

About the Author

prevention.KerrDental.eu

Prof. Angelo Putignano
MD, DDS
Polytechnic University
of Marche, Ancona, Italy

[19] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

aesthetics 19

Lifelike esthetics achieved with minimally
invasive methods

Direct anterior restoration placed with IPS Empress Direct
By Dr. Ali H. Özoglu, Turkey

ooth-conserving
treatment is a major priority in
modern dentistry. This includes minimally invasive strategies for repairing lesions and/
or concealing discoloured tooth
structure in the anterior dentition.
The possibilities of restoring
teeth have grown immensely
over the past few decades due
to the development of innovative
dental composites. In the past,
indirect veneers were needed
to produce highly esthetic results; today, advanced dental
composites are available which
offer a suitable alternative in
many cases. Composite resins
have undergone considerable
changes in recent times. The
dental research community and
the dental industry have reacted
to the emerging demand among
practitioners and patients for
these materials, and as a result
composite resins are now at a
level where they are regarded
as state-of-the-art. With modern
materials such as IPS Empress®
Direct, anterior restorations can
be efficiently layered to produce
highly esthetic results which are
virtually indiscernible from the
natural tooth structure. Consequently, dental practitioners
can benefit from the convenient
handling properties of composites, without having to make any
compromises in terms of esthetics.

Physical properties
In our opinion IPS Empress Direct is the best material available
of its kind for satisfying exceptionally high esthetic requirements. Due to the material’s
lifelike opacity, fluorescence and
opalescence, true-to-nature restorations can be fabricated using
a very efficient method. Generally, the filler composition used
in composites plays a more significant role in anterior than in
universal materials. A composite
resin has to meet special physical property requirements with
regard to volume shrinkage, surface hardness, flexural strength,
polishability and wear resistance.
Furthermore, the optical characteristics have to be carefully balanced. IPS Empress Direct from
Ivoclar Vivadent fulfils all these
major requirements. The monomers contained in the composite
determine its reactivity, strength,
shrinkage and handling. The
monomer matrix incorporates
fillers which determine the wear
resistance, strength, polishability, surface gloss, radiopacity
and translucency of the material. A coarse barium glass filler
imparts the Dentin shades with
high strength, while the finer
barium glass filler contained in
the Enamel shades ensures excellent polishability, high gloss
and low susceptibility to wear.
Optical properties
The composite system com-

prises 32 shades and five translucency levels. The properties
of fluorescence, translucency
and opalescence are decisive for
the esthetic appearance of the
restoration. IPS Empress Direct
obtains its lifelike fluorescence
from special pigments. The material owes its exceptional optical characteristics to its composition. The Dentin shades of the
IPS Empress Direct assortment
exhibit a higher opacity and colour saturation than the Enamel
materials. Therefore, the esthetic effect is enhanced from within
the restoration. The translucency of the Enamel shades allows
the Dentin materials to scatter
light like natural tooth structure.
Furthermore, the Trans Opal
shade gives the restoration a
true-to-nature opalescence: In
reflected light, it looks bluish
and in transmitted light reddishorange, which corresponds to
the appearance of natural tooth
structure.
Nevertheless, ideal physical and
optical properties alone are not
enough to ensure an esthetic
result. Skill and expertise are
required on the part of the dental practitioner who has to impeccably layer and shape the
restoration as well as faithfully
reproduce the shade and optical
characteristics of the tooth. For
this purpose, a composite should
be convenient to handle. IPS Empress Direct is applied according
to an intuitive method.
Case study
A 28-year-old patient was referred to our practice. He was
dissatisfied with the colour and
position of the left lateral incisor (Fig. 1). The examination
showed that tooth 22 had been
endodontically treated, which
explained its substantial discolouration. The shade of the
existing composite restoration
considerably deviated from that
of the natural tooth structure.
In addition, the position of tooth
22 contributed to the suboptimal
overall appearance of the dentition. It was inclined towards
the palatal aspect and therefore
looked very small compared
with the adjacent teeth. The patient desired an esthetic result,
which could be achieved in one
appointment. This was the ideal
indication for IPS Empress Direct.
Layering
We suggested that the patient
considered having the tooth restored with a direct composite.
This type of restoration would involve minimally invasive preparation and could be placed in one
appointment. The patient accepted this proposal and we proceeded to prepare tooth 22 for a
modified veneer and to remove
any discoloured dental tissue.
In the process, as little as possible of the healthy tooth structure
was ground. Since minimally
invasive criteria were being followed, the existing composite
restoration was not completely

Fig. 1: Initial situation: Tooth 22 is discoloured as a result of endodontic treatment.

Fig. 2: Minimally invasive preparation of tooth 22 for the placement of a
composite restoration

Fig. 3: The prepared tooth surface
is covered with IPS Empress Direct
Color white.

Fig. 4: The tooth is completely coated
with a layer of IPS Empress Direct A2
Dentin.

Fig. 5: Internal play of colours: IPS
Empress Direct Color blue in the incisal area and a yellowish IPS Empress Direct Color honey yellow in the
cervical area to match the neighbouring teeth

Fig. 6: Contouring of the composite with an OptraSculpt Pad instrument

Fig. 7: After final shaping of the restoration and polymerization

Fig. 8: Finished and polished restoration on tooth 22

Fig. 9: Two months after the treatment: The result is stable.

layers and imitated the enamel
areas of the adjacent teeth. The
natural incisors exhibited several dark incisal areas as a result of
their relatively high translucency.
These areas were imitated with
IPS Empress Direct Color blue.
Due to the thin enamel layer,
the cervical areas of the natural
teeth had a yellowish tinge. This
feature was recreated in tooth 22
using IPS Empress Direct Color
honey yellow (Fig. 5). The enamel layer was completed with IPS
Empress Direct A2 Enamel. This
layer was shaped with the help of
an ingenious contouring instrument called OptraSculpt® Pad
(Figs 6 and 7). This instrument
is used to form the final contours
of the restoration. The foam pad
attachments allow composites
to be shaped quickly and without sticking. This instrument
has become an indispensible
tool in our day-to-day work. Finally, a thin layer of IPS Empress
Direct Trans Opal was applied
and the restoration was shaped
again with OptraSculpt Pad. The
Trans Opal material allowed us
to successfully imitate the natural optical properties of the tooth
surface. Subsequently, the restoration was polymerized according to the recommendations of
the manufacturer.
Finishing
The excess material was removed with finishers and finegrit diamond burs. The occlusion
and function of the restoration
were checked. Then the restoration was polished to a highgloss
finish with silicone polishers
and polishing discs in a few easy
steps. The patient was thrilled
with the new appearance of his
anterior teeth (Fig. 8). The shape
and shade of tooth 22 blended in
smoothly with the existing teeth.
The optical characteristics of the
restoration were comparable to
those of the natural dentition.
Two months after the treatment,
the patient returned to the practice for a recall appointment. On
this occasion, the restoration
showed excellent integration. Its
shape and shade completely fulfilled our expectations
(Figs 9 and 10).
Conclusion
IPS Empress Direct is a nanohybrid composite for direct restorative procedures. It features
lifelike opacity, fluorescence and
opalescence. Esthetic anterior
restorations can be skillfully created with the material in a very
short time. Given the appropriate conditions, this material can
be used to offer patients an adequate alternative to lab-fabricated ceramic veneers.

Fig. 10: Examination of the functional situation two months after the treatment

removed (Fig. 2).
The tooth was conditioned and a
bonding agent was applied. Next,
the discoloured dentin tissue
was concealed with IPS Empress
Direct Color white. The material
was applied on the tooth surface
in such a way that the restoration

would not appear completely
opaque (Fig. 3). Then the tooth
surface was entirely covered
with IPS Empress Direct A2 Dentin (Fig. 4). In order to impart a
lifelike appearance to the incisal
part of the tooth, we applied IPS
Empress Direct A2 Enamel in

Contact Information
Dr. Ali H. Özoglu
ART Dental Clinic
Gokce Residance D:1
Atatürk C. No:50 Seyhan
Adana, Turkey
aliozoglu@yahoo.com

[20] =>

20 paediatric tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

The “All Hall” case: A case report of maximum capacity
use of the Hall technique in a single child patient

Fig.1a

Fig.1b

Fig.1c

Fig.1d

Fig.1e

Figures 1 (a, b, c, d & e) are showing typical dental caries in a 3 year old. He
had no symptoms whatsoever. In Figures 1 b & d an orthodontic separator can
be seen fitted distally to 64.

By Dr. Batool Ghaith, Dubai
& Dr. Iyad Hussein, Dubai

bstract
Managing the carious primary molar in children
using the “Hall Technique” is
a controversial but acceptable
novel method. Restoring all
eight carious primary molars in
a single child by using this technique, however, has not been
reported by those who advocate its use. We report a case in
which the Hall technique was
employed to maximum capacity, out with normal practice, to
restore all Es and Ds in a three
year old child (hence the name

All Hall). Follow up showed no
clinical or radiographic complications. This negated the need
for unnecessary invasive treatment under local anaesthesia
or general anaesthesia. In this
article the concept of “All Hall”
is introduced as a convenient
and cost effective tool in the
management of all carious primary molars in a single child.
It is relevant to GDPs, working
in busy practice environments,
keen to avoid child LA treatment or GA referrals. The reader should understand that it is
possible to restore eight carious
primary molars in one child using the HT.

Introduction
The carious primary molar is
a clinical problem reported,
in the paediatric dental literature1, to have several solutions.
These management options
range, historically starting from
conventional surgical treatment involving the excision of
caries (under local anaesthesia) and restoring the tooth and
ending simply by managing the
plaque’s biological environment employing minimal interventional techniques2.
One example of the latter is
the “Hall Technique or HT”3,4
which entails entombing the

Fig.2a

Fig.2b

Figures 2 (a & b): Bitewing radiographs showing caries on all Ds and Es. There
were clear bands of dentine between the carious lesions and the pulp. There
were no radiographic signs of interradicular pathology. Although the furcation
areas of upper Es were not visible, no further xrays were justified as the upper
Es had shallow radiographic lesions.

carious lesion by sealing it from
the oral environment using a
preformed metal crown (the
stainless steel crown or SSC).
The HT is usually prescribed to
manage carious primary molars according to clear selection
criteria and was developed in
the UK as a child friendly treatment modality5.
Although conventional restoration of all primary molars using SSCs has been the norm for
many years, this had not been
the same when using the HT.
The operating manual of the
HT stated that “Hall crowns are
not a universal answer to managing all carious primary molars and the Hall Technique does
not suit every carious primary
molar in that child”3. Therefore it became current acceptable clinical practice, by those
who advocate the use of the HT,
not to restore all the primary
molars in one child using this
technique. In other words, restoring all carious Ds and Es in
one single child, using the HT
was inadvisable. The reasoning
behind this had not been clarified, but it may possibly be due
to perceived concerns about

Table 1. Treatment plan

the occlusion. The effect of the
HT on the occlusion had been
previously studied6,7. The occlusion tended to suffer opening of the bite by 1.5mm on
average, which later resolved
due to possible dento-alveolar
compensation6 or intrusion7 of
the crowned tooth. The effect
was studied when one or two
crowns were placed, however
no study had shown the effect
of restoring all Es and Ds in one
child, on the occlusion.
We report a case whereas the
HT was deployed to maximum
capacity, contrary to the usual
clinical doctrine, to restore all
eight primary molars in one
child. There were no known
complications and the occlusion was deemed satisfactory.
This case had been labeled the
“All Hall” case.
Case report
A fit and healthy three year old
boy (MF) attended with his father to the Department of Paediatric Dentistry at Hamdan Bin
Mohammed College of Dental
Medicine (HBMCDM) in Dubai
Healthcare City, Dubai (UAE).
The father was concerned

> Page 22

[21] =>

[22] =>

22 paediatric tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 20

Fig.3a
Fig.3b
Fig.3c
Fig.3d
Fig.3e
Figures 3 (a, b, c, d & e): Immediate post- treatment completion images. All Es and Ds were restored using the HT. Notice the good gingival status. Using the primary canines as a guide, opening of the
bite is noted in Figures 3 (d & e). 51 became discoloured with no sinus present. No known trauma. We opted to manage 51 conservatively as x-ray showed no pathology. The patient by this time had no
experience of LA, avoided GA and was gradually becoming cooperative.

Fig.4a

Fig.4b

Fig.4c

Fig.4d

Fig.4e

Figures 4 (a, b, c, d & e): 9 months post- treatment. The patient had no complaints. The occlusion had equilibrated (note primary canines in Figures 4 b & c and compare to Figure 3 a, d & e). All Es and Ds
remained asymptomatic. Good gingival health and oral hygiene were noted. As his cooperation improved plans are in place to monitor 51 with a view to carry out pulp therapy in addition to restoring
upper anteriors with composite strip crowns.

about ‘holes in his son’s teeth’.
The father reported that MF
suffered no pain whatsoever.
After clinical and radiographic
examination, MF was found to
have multiple asymptomatic
carious primary molar and incisor teeth fitting with the diagnosis of Severe Early Childhood
Caries (S-ECC). Interestingly,
MF’s eight carious primary molars (55, 54, 64, 65, 75, 74, 84 &
85) were free from symptoms
of pain, and clinical and radiographic signs of pulpal patho-

sis. See Figures 1 (a, b, c, d &
e) for clinical features, and Figures 2 (a & b) for radiographic
findings.
He also had initial caries on
53, 52, 51, 61, 62 & 63. There
was no known trauma history.
His initial cooperation was categorized as “pre-cooperative”.
MF’s behavioural scale was assessed to be negative initially
but improved dramatically to
positive behavior as treatment
progressed. Treatment options

for the carious primary molars
that were discussed and explored with MF’s father were;
prevention only, conventional
restorative treatment using local anaesthesia (LA), the “Hall
Technique” with no LA (and
restorations of the upper primary incisors) or full mouth
rehabilitation under general
anaesthesia (GA). MF’s father
was keen for his son to receive
dental treatment in the dental
chair rather than under GA due
to many reasons including fi-

Table 2. Sequence of appointments

nancial constraints (children’s
dental GA is not routinely provided by a free public service
-available to everyone- in the
UAE as it is in the UK for example). After sufficient consideration, the father consented for
the HT as the child’s cooperation for LA was not forthcoming and he was adamant about
avoiding GA.
Treatment
A treatment plan was arranged
on our postgraduate clinic (See
Table 1). An extensive preventive programme was instigated
to improve MF’s very poor oral
hygiene in addition to diet assessment, analysis and advice.
Over a period of two months
and following the HT protocol3,
the child had all his eight primary molars fitted with SSCs
and cemented with GIC. No LA
was used. The molars were fitted with elasticated orthodontic
separators in order to create
space to prepare the teeth to
receive the SSC a week later.
Two molars were treated per
appointment (see Table 2).
As per the standard Hall manual3, the following principles
were adhered to during treatment:
1) Compliance with the indications and contra indications
and selection criteria for the

HT5. Assurance of the absence
of any symptoms or signs of
pulpal pathosis or sepsis (clinical or radiographic assessments).
2) Blue elasticated orthodontic
separators were used and left
in situ for one week (see Figure
1b & d) to create interdental
spaces where required.
3) Two SSCs placed in a single
appointment were never:
a. In the same arch adjacent
to each other (i.e. never in the
same quadrant)
b. On the same side in opposing
arches
4) When two crowns were
placed in a single appointment
they were diagonally in opposing arches (for example 64 and
84).
5) Appointments were at least
one to two weeks apart to allow the occlusion to settle. The
appointments were short; no
longer than 15-20 minutes.
The SSCs crowns were placed
as per the schedule in Table
2. The patient also had simple
restorations placed (with no
LA) on his upper anterior primary incisors and canines, using simple excavation and GIC
with a view to eventually receiving composite strip crowns.

> Page 24

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24 paediatric tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 22
remain under observation in
the long term. Plans are in
place to manage his upper anterior teeth as outlined above.

Fig.5a

Fig.5b
Fig.5c
Figures 5 (a, b & c). 5a & b show Bitewing radiographs taken 6 months post
treatment completion (9 months from the first assessment) show fully seated
crowns with no secondary caries and no pathology noted although could not
assess furcation areas of 65 and 84 but no clinical features warranted repeating the radiographic exposures. Figure 5 c showed 51 and 61 no visible periapical pathology despite discoloured 51. As 51 asymptomatic decided to leave
under observation with a view to carry out pulp therapy.

“Hall crowns are not a universal answer to
managing all carious primary molars and the
Hall Technique does not suit every carious
primary molar in that child”3

Figures 3 (a, b, c, d & e) show
the mouth immediately after
completion of treatment. The
bite appeared open and was initially raised by approximately
1-1.5 mm.
The patient was followed up
three, six and ninth months later. He, nor his parents, had any
complaints whatsoever. There
were no issues with the occlusion, symptoms or signs of pulpal pathosis or sepsis affecting
the molars. The bite had completely recovered. See Figures
4 (a, b, c, d & e). The parents’
satisfaction in reaching a positive outcome, without resorting
to the use of GA, was very high.
Post op radiographs (Figures
5 a & b) showed satisfactory
clown placement and no recurrent caries.
Long term treatment plan:
1. Continue follow up at 3
months intervals of all Es and
Ds clinically.
2. Close monitoring of tooth
51 for any sign of infection.
Pulpectomy or extract if symptoms.
3. Bitewing radiographs every
6 months to monitor all Es and
Ds. Interval to increase if caries
risk status changed.
4. Restore remaining upper
anterior teeth with composite
strip crowns once cooperation
allows.
5. Reinforce preventive measures (oral hygiene, diet), professional topical fluoride varnish application 4 times/year.
Discussion
In 2007 a new technique took
the paediatric dentistry world
by suprise4. It recommended a
simple way in managing early
enamel and dentinal decay
in the primary molar using
a SSC; it was named the Hall
technique (HT) after UK based
Scottish dentist Dr. Norna Hall
started using this method5. The
HT involved no local anaesthesia, no rubber dam, no drilling
and took place in a child friendly play manner. No dental caries removal took place at all.
The HT relied on sealing caries in situ cutting off its supply
of sugary substrate, therefore

changing the lesion’s bacterial
plaque and resulting in the arresting of the caries process in
the tooth1. The HT was confirmed as a mainstream modality in treating carious primary
molars1,2 after a prospective
split mouth randomized control
study was conducted showing
very high success rates of the
HT after two4 and five years8.
There were mixed international reactions to the development
to the HT in paediatric dentistry
circles with many advocating
such a treatment method9,10,11
while others opposed it completely12,13,14. At the time of writing this article, this healthy debate was still in progress15. It is
important to note that there is
no disagreement about the fact
that SSCs are the restorative
materials of choice in multisurface caries affecting primary molars16. The disagreement
lies in the method used to apply
them.
This report showcased treatment that may be of interest
to general dental practitioners
(GDPs) and specialists in paediatric dentistry alike. It highlighted simple non- invasive
treatment that eliminated the
need for treatment under LA
and avoided a dental GA in a
very young child. A situation
many face in practice on a daily
basis.
This case had been a great
challenge due to important factors which were; the patient’s
young age, anxiety, the number
of molars involved, pre-cooperation, the limited financial
capacity of the parents to afford general anaesthesia and
the scepticism that other dentists15 had of the HT. However,
the parent’s dedication to attend to multiple appointments,
motivation and great support
to their child made it successful. Modelling techniques had
worked successfully to reduce
MF’s dental anxiety, where he
observed and learned appropriate behaviour from his parents
and sister. Separation anxiety
is very common at this age and
having the parent or his sister
around was helpful. MF had a

high risk dental caries status,
so his primary molars were
treated using SSCs, although
other options such as complete
caries removal and composite
restorations, partial caries removal or even non restorative
caries treatment (NRCT)1 were
possible.
MF was a good candidate for
the HT, as his moars were
carious, asymptomatic, had no
signs of irreversible pulpitis
or sepsis, no clinical or radiographic signs of pulpal involvement or inter-radicular pathology and had a good amount
of tooth structure for crown
retention. In other words, the
molar lesions were “captured”
before they became pulpally
involved. The HT was effective
as it sealed the caries under the
crown without local anaesthesia, tooth preparation or caries
removal. Priority was given to
tooth 84 as it had the deepest
lesion compared to the rest.
MF accepted the minute occlusal changes after cementation of
each HT crown. The occlusion
clinically appeared to have reestablished itself in a very short
time (see Figures 3 and 4 using
the primary canines as indices)
and this was always checked
before proceeding with the
next phase.
Managing the upper anterior
cavities with permanent restorations would have been
impossible in this case due to
the child’s lack of cooperation.
Therefore, temporization of
open cavities with GIC was a
straightforward way to introduce the child to dental procedures. It was also advantageous
in terms of preventing the progression of caries, reducing the
chance of sepsis and pain, reducing the oral load of plaque
and a good source for fluoride.
Composite strip crowns will be
considered as an alternative if
cooperation allowed. Coincidently the patient’s 51 became
discoloured, albeit asymptomatic. Although no history
of trauma was elicited in this
case, it was assumed to be the
case. Persistent dark discolouration in the patient’s 51 may be
associated with pulp necrosis.
Since the tooth is asymptomatic
clinically and in the absence of
radiographic pathological signs
(Figure 5 c), it was decided to
keep under close review. Parents were aware that this tooth
may require future treatment; a
pulpectomy or extraction.
As for the Es and Ds, the patient was followed up for ninth
months after treatment was
completed. He remained clinically free of symptoms and
became a patient who enjoyed
attending our clinic. They will

Conclusion
This case is an “All Hall” case
where maximum capacity of
the HT was used in one single
child. The HT is one tool in the
toolkit available to dentists in
the fight against dental caries11.
Although well designed trials
are in place to support the HT,
this case highlights that restoring eight carious primary molars in one child, with no short
to medium term complications,
is achievable using the HT. The
lesions need to be “caught” prior to any pulpal involvement.
It may be of interest to GDPs
and primary care dentists,
rather than specialists in paediatric dentistry, who deal with
the majority of child dental
patients. The HT is a suitable
modality for the GDP environment, hence this case report.
References
1) Kidd, E. Should deciduous
teeth be restored? Reflections
of a cariologist. Dent Update
2012; 39: 159–166.
2) Scottish Dental Clinical Effectivness Programme. Prevention and Management of Dental
Caries in Children Dental Clinical Guidance. SDCEP Manual.
http://www.sdcep.org.uk/wpcontent/uploads/2013/03/SDCEP_PM_Dental_Caries_Full_
Guidance1.pdf
3) Evans, D & Innes N. The Hall
Technique. A Minimum intervention, child centred approach
in managing the carious primary molar. A user manual. Free
downloadable online manual.
http://dentistry.dundee.ac.uk/
sites/dentistry.dundee.ac.uk/
files/3M_93C%20HallTechGuide2191110.pdf
4) Innes NP, Evans DJP and Stirrups DR. The Hall Technique; a
randomized controlled clinical
trial of a novel method of managing carious primary molars in
general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral
Health 2007, 7:18. Available online at http://www.biomedcentral.com/1472-6831/7/18
5) Innes NP, Evans DJP, Hall N.
The Hall Technique for Managing Carious Primary Molars.
Dent Update 2009; 36: 472–478.
6) van der Zee V, van Amerongen WE. Influence of preformed metal crowns (Hall
Technique) on the occlusal vertical dimension in the primary
dentition. Eur Arch Paediatr
Dent 2010; 11: 225–227.
7) So D, Evans, D, Borrie F,
Roughley M, Lamont T, Keightley A, Gardner A, Hussein I,
De Souza N, Blain K, Innes NP.
Measurement of occlusal equilibration following Hall crown
placement; pilot study. Presentation to the International Association of Dental Research
(IADR), Boston, USA, March
2015 (Abstract). J Dent Res,
2015; 94: A.
8) Innes NP, Evans DJP and
Stirrups DR. Sealing caries in
primary molars: randomized
control trial, 5-year results. J
Dent Res 2011; 90:1405-1410.
9) Santamaria R, Innes N,

Machiulskiene V, Evans D,
Alkilzy M, Splieth C. Acceptability of different caries management methods for primary molars in a RCT. Int J Paed Dent
2015; 25:9-17
10) Ludwig KH, Fontana M,
Vinson LA, Platt JP, Dean JD.
The success of stainless steel
crowns placed with the Hall
technique: A retrospective
study. JADA 2014; 145:12481253.
11) Hussein, I. The Hall technique: The novel method in
restoring the carious primary
molar that is challenging old
concepts. A new tool in the general dentist’s toolbox? Dental
Tribune 2015; 4: 18-20.
12) Hashim Nainar SM. Success
of Hall crown questioned. Pediatr Dent 2012; 34:103
13) Yalgnkaya Erdemci Z, Burgak Cehreli S, and Ebru Tirali R.
Hall versus conventional stainless steel crown techniques: in
vitro investigation of marginal
fit and microleakage using
three different luting agents.
Pediatr Dent 2014; 36: 286-90
14) Seale, NS & Randall, R. The
use of stainless steel crowns:
A systematic literature review.
Pediatr Dent, 2015; 37: 147-162
15) Croll TP, Killian CM, Simonsen RJ. The Hall technique: serious questions remain. Inside
Dentistry 2015; 6: 30-32.
16) Kindelan SA, Day P, Nichol,
R, Willmott, N & Fayle SA. UK
national clinical guidelines in
paediatric dentistry: stainless
steel preformed crowns for primary molars. Int J Paed Dent
2008; 18(Suppl. 1): 20–28.

About the Authors

Dr. Batool Ghaith, UAE
BDS (Dublin), BA (Dublin), MFDSRCI
Postgraduate Resident in Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine (HBMCDM)
Mohamed Bin Rashid University
of Medical and Healthcare Sciences. Dubai, United Arab Emirates (UAE)
E: batool.ghaith@hbmcdm.ac.ae

Dr. Iyad Hussein, UAE
DDS (Dam), MDentSci (Leeds),
GDC Stat. Exam (London), MFDSRCPS (Glasg)
Asst. Clinical Professor in Paediatric Dentistry & UK Specialist in
Paediatric Dentistry
Hamdan Bin Mohammed College
of Dental Medicine
Mohammed Bin Rashid University of Medical and Health Sciences
E: iyad.hussein@hbmcdm.ac.ae

[25] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

cad/CAM 25

Bluephase: Two new
products for a precise
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For the polymerization of some
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430 and 490 nm, a polymerization device of the second LED
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sphere, the deviation in measurement is only + 10 per cent.

Bluephase® is a registered
trademark ot the Ivoclar Vivadent AG.

CS 8100 3D
3D imaging is now
available for everyone
Many have waited for a redefined 2D/3D multifunctional 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 μm resolution

Contact Information
Ivoclar Vivadent AG
Bendererstrasse 2
9494 Schaan/Liechtenstein
Tel.: +423 235 35 35
Fax: +423 235 33 60
E: info@ivoclarvivadent.com
W: www.ivoclarvivadent.com

• 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

Fig. 2: Bluephase Style M8: The LED for economical use

[26] =>

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.

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.
Date of preparation: June 2014, CHSAU/CHPLD/0008/14c
We value your feedback
Saudi Arabia: 8008447012
All Gulf and Near East countries: +973 16500404

[27] =>

Maintain your patients’ confidence and
satisfaction with their dentures by helping
them overcome daily social, emotional and
physical challenges.
Help your patients eat, speak and smile
with confidence with the Corega® denture
care regime.
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.
Date of preparation: June 2014, CHSAU/CHPLD/0008/14b
We value your feedback
Saudi Arabia: 8008447012
All Gulf and Near East countries: +973 16500404

[28] =>

28 cad/cam

Dental Tribune Middle East & Africa Edition | November-December 2015

30 years of CEREC: Innovation brings
more flexibility and efficiency
By Sirona

EREC means much more
than restorations in a single patient visit. The latest available innovations make
the system even more flexible
in dental practices and open up
new practice efficiencies in the
areas of implantology and orthodontics.
With CEREC, Sirona is celebrating the anniversary of a technology that has significantly
changed the dental practice and
the patient experience. Sirona
is still setting trends and new
standards with CEREC in its 30th
year:
CEREC offers remarkable flexibility in the areas of hardware
and software, unlocking new
clinical possibilities and efficient
workflows for the practice.
In addition to the proven CEREC
AC cart version, two new acquisition versions are available: the
CEREC AF flexible tabletop ver-

Fig. 1: CEREC AI integrates the
CEREC Omnicam directly into the
TENEO treatment center – saves
space and is suitable for the usual
workflow.

sion and the CEREC AI which
is integrated into the treatment
center. Both new models use the
market-leading CEREC Omnicam powder-free color camera
with its very small camera tip allowing for easy scanning even in
the distal area.
CEREC Omnicam for efficient
workflows
The CEREC AF model consists of
the CEREC Omnicam with camera cradle and a PC with a 24” or
19” monitor. The camera can be
easily removed from the cradle
and be taken from one treatment room to another. Scanning and design processes can
be performed in different rooms.
If desired, the patient can even
follow the design process on the
included tablet. CEREC AF is
also interesting for practices that
already have one CEREC system
and want to add more flexibility.
Dentists can equip their practice
with the AF components (cam-

Fig. 2: CEREC AF ensures maximum
flexibility when using the CEREC
Omnicam as it can be taken from
room to room. The design process is
independent of scanning.

era, cradle, PC, and monitor) and
use the already available CEREC
Omnicam from their CEREC AC.
CEREC AI allows dental practitioners to use the CEREC Omnicam directly on the chair: The
system consists of a CEREC Omnicam that is integrated into the
TENEO treatment center by a
separate support arm. This ensures that the CEREC Omnicam
is easily accessible even in the 12
o’clock position.
CEREC integrated implantology
With CEREC SW 4.4, Sirona
is bringing a new simple and
userfriendly software update to
the market. The software also
includes several new functions
that further improve the workflow. As one of the new applications, the CEREC Guide 2 is the
first surgical guide that can be
produced chairside and costeffectively right in the practice.

Fig. 3: The guided scanning process
allows dental practitioners to take
precise images of the entire jaw for
orthodontic applications.

The guide is designed based
upon the ideal prosthetic and
surgical positioning made possible by the patented combination of CEREC intra-oral digital
impressions and Sirona’s 3D
X-ray volume data. After the
simple design, the guide is then
milled from PMMA on one of the
CEREC MC X or CEREC MC XL
Premium Package milling units.
The guide can be manufactured
in less than one hour and requires no models or radiographic guides with reference bodies.
Further optimizations in CEREC
SW 4.4 ensure even more accurate results throughout the
design process. The new Biojaw algorithm uses the entire
scanned area as a reference for
the restoration to be created,
and generates outstanding initial
restoration proposals. Editing
by the user is hardly necessary,
which means significant time
savings. The latest software uses

Fig. 4: The highlight of the CEREC
SW 4.4 is the unique biojaw technique. The customized initial restoration proposal for each individual
patient is so good that in most cases
the restoration can be made straightaway.

improved algorithms that allow
for even smoother surfaces and
deeper fissures when grinding
feldspathic, glass and silicate
ceramics. With the new extrafine grinding tools of the 4-motor CEREC MC XL Premium
Package in particular, designs
are milled with more detail and
greater precision than ever before.
CEREC enters the field of Orthodontics
CEREC can now also be used
for digital impressions for orthodontic indications, e.g., for treatment with transparent aligners.
Thanks to the highly innovative
guided scanning procedure introduced by the new software,
precise full-arch digital impressions can be carried out reproducibly, quickly and easily and
can therefore be delegated to
staff. Following a reliable guided
scan using the CEREC Omnicam, the CEREC Ortho software
creates a digital model of the
entire arch. The data obtained
can then be sent for planning
the orthodontic treatment and
manufacturing the required appliances. As a result, it is no longer necessary to create and send a
physical model.
A cooperation agreement with
Align Technology allows dentists to also use digital impressions for aligner therapy with
Invisalign. The CEREC Ortho
software provides a direct connection to the Align Doctor’s Site.
The scan data can be stored in
the existing customer portal. For
patients and doctors this means
treatment begins sooner.

CopraSintec K

perfection in Argon-Sintering-Alloys

* marked terms are registered brand names and trademarks

[29] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

cad/cam 29

Planmeca Romexis®
– CAD/CAM work and CBCT data in one software
By Planmeca

he field of digital dentistry is rapidly evolving, with new dental
technologies emerging as part
of a more efficient and comprehensive workflow. Pairing
Planmeca CAD/CAM solutions
with X-ray units in the Planmeca ProMax® 3D family allows
dental professionals to bring together a wide range of detailed
information for treatment planning and diagnostic purposes.
This seamless combination of
CAD/CAM and CBCT technology presents new possibilities
for an improved standard of
care for patients – offering several high-quality specialist features, all available through one
software interface.

flow and enhance the level of
care offered.
Seeing more than ever before
Bringing together CBCT data
and CAD/CAM work provides a
comprehensive level of clarity.
Planmeca ProMax® 3D imaging units reveal intricate information on soft and hard tissue
structures, including the mandibular nerve canal, while the
Planmeca PlanScan® intraoral
scanner captures precise data
above the gum line. This combination of these data ensures a
complete understanding of any
case and makes 3D prosthetic
designing quick, accurate and
easy.
Clinics are able to operate
more flexibly, as restorations
can either be milled at a clinic
with the Planmeca PlanMill®
40 milling unit, or easily sent
to a dental lab in an open STL
data format.

Planmeca Romexis® is the only
dental software platform in the
world to combine all imaging
and the complete CAD/CAM
workflow. This powerful solution is at the heart of the Planmeca ecosystem, as it provides
dental professionals with the The rise of same-day denability to acquire more detailed tistry
data sets than ever before. A more active role in the manuPlanmeca Romexis includes facturing of restorations opens
advanced tools for all speciali- up avenues for dental clinics
ties, such as implant planning to significantly increase their
and other restorative treat- patient volume and grow their
ments. The software presents business. A streamlined digital
dental clinics with a superior workflow ensures the full utili14ER3194 Dental Tribune_A4_Layout 1 12/2/14 4:15 PM Page 1
way to improve their patient sation of resources, leading to

a more efficient treatment environment. Same-day dentistry
is as beneficial for patients as
it is for clinics; instead of two
visits, patients can be treated in
one hour – with no temporary
crowns or physical dental models required.

force behind many of the latest
developments in digital dentistry, as it guarantees the interoperability of images and dental
data across different hardware
platforms – reducing costs, increasing predictability and enhancing patient safety.

Open architecture for maximised efficiency
Standardised data is the driving

Bringing Planmeca’s CBCT and
CAD/CAM systems together
through the Planmeca Romexis

software platform makes effective chairside dentistry a reality and presents dentists with a
streamlined opportunity to substantially grow their practice.

BRAND PR MISE
QUALITYSELECTIONPERFORMANCE

Henry Schein is a name you can trust.
Our products offer you maximum value without compromising on
quality. We offer over 8,000 products you can trust to fulfill your
needs—each bearing the Henry Schein Seal of Excellence—
your guarantee of satisfaction.
• Growing selection of value-priced products
• All essential categories including diagnostics
and infection control
• High standards of quality and effectiveness

Our Brand Promise
We provide the broadest selection of relevant products in
the industry at the best possible value, to help you run
your business more profitably. We stand behind all of our
with dentistry
a 100% guarantee of satisfaction.
The fieldproducts
of digital

is rapidly evolving, with new
dental technologies emerging
as part of a more efficient and
comprehensive workflow.

Rely On Us for Quality, Selection and Performance.

Contact: Antonio Plata
Phone: 631-843-5325

email: antonio.plata@henryschein.com

[30] =>

30 cad/cam

Dental Tribune Middle East & Africa Edition | November-December 2015

CEREC: Generating interest even in the waiting room
By Sirona

T

his fall Sirona’s CEREC
system will be celebrating its 30th anniversary.
Even so, there are still patients
who have not yet heard about
this advanced technology and
the numerous advantages of
its fully digitalized workflow.
This is why Sirona is now offering CEREC dentists a complete package of informative
and marketing material which
highlights the advantages of the
CEREC system.

The attractively designed mateFig. 2: In addition to printed materials, Sirona additionally gives CEREC dentists films, presentarial which is tailored to patient
tions and other content for use in the waiting room or on their own websites.
questions focuses on the advantages offered by CEREC: Rapid
tooth restoration in one sitting
“,Rapid tooth restoration in one sitting without a
without a temporary prosthesis,
no annoying follow-up appointtemporary prosthesis, no annoying follow-up apments and without the need to
pointments and without the need to undergo the
undergo the unpleasant proceunpleasant procedure of creating an impression
Fig. 1: The consultation process begins in the waiting
dure of creating an impression
room – Sirona now provides dentists with a complete
using impression material.”
using impression material. The
package of informative material.
package includes posters, flyers and appointment cards. A
special marketing highlight: on a screen in the waiting room. Moreover, the decision for ex- material on CEREC from Si- ers. The digital data can also be
The option of integrating a
ample in favor of an inlay is rona is a great help in terms downloaded from http://www.
personalized microsite dedi- The initial reactions to this pa- then reached more quickly”, of providing initial information cerec.com.
cated to CEREC. Furthermore, tient information have been explains Wolfgang Lüder, a and also for acquiring new paSirona provides materials for very positive. “If the patient dentist in Rosenheim, Germany. tients.”
A personalized microsite can be
dental practice websites (e.g., already knows about CEREC “Lots of my patients refer to inregistered at http://www.onlyobanners) as well as videos and then I am able to answer his formation that they got prior to Dentists who are interested nevisit.com/signup/.
presentations. This content can questions more rapidly and in treatment, for example from In- in this package can order the
be integrated into practice web- greater detail.
ternet research, which brought informative material for their
sites
or
alternatively
displayed
my site to their attention. The practice from specialist dealIDEM16 297x210mm Dental Tribune Middle East.ai
1
23/2/15
11:30 pm

www.idem-singapore.com

THE BUSINESS OF DENTISTRY
INTERNATIONAL DENTAL
EXHIBITION AND MEETING

APRIL 8 - 10, 2016
Suntec Singapore Convention & Exhibition Centre

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Endorsed By
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Supported By

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Singapore Dental Association

[31] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

ortho Tribune 31

Tapping into a Promising Market:
Targeting the Adult Whitespace
By Debby Hartman, USA

T

wo years ago, the American Association of Orthodontists (AAO) kicked
off its first-ever national advertising campaign targeting
adults. Why? According to Dr.
Michael B. Rogers, president of
AAO, there are many adults on
the fence when it comes to re-

ceiving orthodontic treatment,
making it increasingly important for the AAO to educate the
adult audience on the benefits
of braces.
Recent AAO statistics reported
by The New York Times show
that from 1994 to 2010, the
number of Americans 18 years
and older getting braces—or
some type of teeth-straightening treatment—from an
orthodontist has jumped
58 percent, from 680,000
annually to 1.1 million.
Furthermore,
those
same statistics show
that adults undergoing treatment
account for 22
percent of all
orthodontic cases—that’s more
than one in every five patients.
Another study
commissioned
by the AAO reports that onethird of American adults are
unhappy with
their smile. Out
of those adults,
36 percent believe they would

have a better social life if they
had better teeth.
This sentiment is especially
true among young adults, as 48
percent of Americans ages 1824 have untagged a picture on
Facebook because they didn’t
like their smile.
With such vast potential to treat
the adult whitespace, orthodontists can increase their practice
revenue by better understanding this untapped market and
effectively promoting the latest treatment methods proven
to deliver exceptional patient
results. To help, I invite you to
explore the following tips that
offer insight into the growing
audience of adult orthodontic
candidates.

P IC
E
ARE R
STATS
IN US ED
D

Start with Mom
Most doctors know the importance of targeting mothers—
typically the key household
decision maker. It is widely
reported that women make or
influence the majority of all
purchasing decisions.

states that 64 percent of moms
ask other moms for advice before purchasing a new product.
Therefore, doctors who market adult treatment options to
moms will have the best chance
to treat parents and their children. Education is the best way
to kick off your targeted adult
marketing efforts.

But did you know that according to consultancy firm Girl
Power Marketing an astounding 80 percent of healthcare
decisions are made by women?
Furthermore, thenextweb.com

Educate Adults
While many parents seek orthodontic treatment for their
children, the majority of them
may not realize the benefits of
straight teeth for themselves.

In fact, there are approximately
23 million U.S. adults who are
interested in improving their
smiles, but don’t seek treatment due to lack of education,
according to a study from the
Millennium Research Group.
The same study indicates that
adults are more likely to seek
treatment after reviewing educational materials that showcase the benefits of orthodontic
treatment, as well as advancements in the treatment experience itself.

> Page 32

ARIA SR & Cameo:
Aesthetics and individuality for the individual style of your clinic

Ritter
made in germany

The treatment unit ARIA SR and the furniture line Cameo combine
efficiency and user- friendly handling with pure aesthetics and
individuality and improve the productivity in the dental
office with simple and practical solutions.
The careful selection of high-quality materials, a very attractive design
and outstanding functionality guarantee fantastic results. In terms of
design the products amaze with elegant glass elements in fresh colours
that can be customized according to the all preferences, with personal
images, motifs or clinic logos.
Create your distinctive brand recognition!

Individual design of
glass surfaces:
Choose your preferred
colours, patterns or
photos!

*** Exclusively distributed by Henry Schein Middle East ***

Henry Schein Dental, Dr. Ghassan Nasser Hussein,
Sales and Marketing Director (Henry Schein)
Middle East and North Africa, Mobile: +971 50 4813292,
Tel: +971 6 5252842, Fax: +971 6 5531291
E-mail: ghassan.nasser@henryschein.com
Ritter Concept GmbH, Germany, Christian Findeisen
Sales and Key Account Manager , Middle East/ Africa
Ritter Concept GmbH, Mobile: +971 56 9578689
E-mail: christian.findeisen@ritterconcept.com
www.ritterconcept.com

[32] =>

32 ortho tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 31
webpage assets and more for
doctors offering the Damon™
System, Insignia™ and Inspire
ICE™.
In addition to implementing
marketing materials that target adults throughout your office and practice website, it’s
important to provide potential
adult patients with information
on treatment that addresses
their key concerns. This includes advanced solutions that
are aesthetically pleasing, comfortable and fast.

To learn about the benefits of Insignia from a patients’ perspective, visit www.
insigniasmile.com – Ormco’s consumer education website with an Insignia
Doctor Locator.

Showcase Advanced Technology
Many adults are open to advanced treatment solutions
that will create the best possible smile, despite marginal
price increases. In fact, an
Ormco study conducted by
Boston Consulting Group indicates that patients would pay a
premium for treatment that is
faster, more aesthetic and more
comfortable.
Another Ormco study conducted by the Millennium Research
Group found that potential
adult patients are only moderately price sensitive in selecting
a treatment option, citing very
little difference in preference
for a treatment priced at $250
versus $300 per month.

Patient education brochures
and consultation aids featuring
adult patients are also effective
and available via Ormco’s online practice marketing library.
Doctors may contact their
Ormco sales representative to
access this online resource library of patient imagery, conCouv 16P Ormco with QR 2015_Mise
en page
1 videos,
01/06/15 10:42 Page1
sultation tools,
practice

With this in mind, it’s important
to ensure that your practice
website, lobby and consultation
rooms resonate with the adult
audience by featuring photographs of adults in treatment
and adult patient before-andafter photographs.

Your Practice. Our Priority.

To learn about the benefits of Damon Clear from a patients’ perspective, visit
www.damonbraces.com – Ormco’s consumer education website with a Damon Doctor Locator.

The bottom line? Adult patients
are willing to evaluate treatment options based primarily
on outcome and total treatment
time—leading them to consider
advanced treatment options
even despite marginal increases in price.
Ormco’s Insignia™ Advanced
Smile Design™ is an all-inclusive digital solution that can
also help to differentiate your
practice. Insignia combines
3D smile design software with
customized appliances to help
orthodontists deliver efficient,
precise outcomes—often in less
time and with fewer office visits. This is a huge advantage not
only for busy moms-on-the-go,
but also imageconscious adults
who love customization—from
beauty products and makeup to
tailored clothing.
When speaking with prospective patients, be sure to communicate how Insignia allows
you to add a level of precise
detail and customization that
provides the best long-term occlusion and smile in less time.
Insignia also serves as a powerful consultation tool, allowing
doctors to present prospective
patients with a 3D video morph
of their final smile before starting treatment.
Now patients can be confident
they’re making the right decision to undergo treatment before bonding day.

www.ormcoeurope.com
www.ormco.com

2ND MENA SYMPOSIUM
DUBAI - DECEMBER 3rd to 5th - 2015

Aesthetics Matter
Patient demand for aesthetic
treatment continues to grow. If
you haven’t considered expanding service offerings to include
virtually invisible bracket solutions, now is the time. For imageconscious adults, Damon™
Clear™ provides a discrete
treatment experience with results that go beyond straight
teeth — providing wider smiles
with smoother cheek contours,
better facial symmetry and improved profiles. When guiding
adult prospects through Damon Clear features, doctors
and treatment coordinators
should stress how the brackets
resist staining, are easy to keep
clean and offer exceptional
comfort without tightening.
What’s more, Damon Clear is a
treatment option with Insignia,
providing patients with a customized, efficient and discrete
treatment experience.
For patients who require minor

anterior tooth movements, consider showcasing the benefits
of Insignia™ Clearguide™ Express virtually invisible aligners that won’t discolor over the
wear period.
Clearguide Express combines
Ormco’s Insignia Advanced
Smile Design™ software with
AOA Lab’s custom aligner expertise. This aligner is an affordable option for patients of
all ages—especially adults—
who are looking for an alternative to braces to quickly transform their smiles and boost
confidence.
What’s the best way to showcase aesthetic options to
adults? In addition to including adult patient photographs
on your practice website, office
walls and education materials,
your patients in treatment are
even more convincing. Consider treating your office staff
members and referring dental
hygienists with your clear braces and/or aligners to proudly
showoff their discrete treatment to visiting parents in your
office.
The saying goes, “A picture is
worth a thousand words.” That
may be true, but a happy, smiling patient and corresponding
referral is worth at least $5,000
in practice revenue.
Use the Power of Social Media
Now that we’ve addressed the
importance of showcasing
leading orthodontic technology to potential adult patients,
let’s talk marketing. Relying
solely on a practice website
may no longer be enough to
ensure a steady flow of new patients. With 62 percent of adults
worldwide using social media,
according to thesocialskinny.
com, one of the best ways to
reach and educate them is
through channels such as Facebook, Twitter, YouTube and
Yelp. Facebook has more than
901 million users, and is an especially effective way to reach
adult consumers. In fact, one
in three consumers say they’re
likely to purchase from a company they follow on Facebook,
according to eMarketer.com.
The benefits of social media
are twofold for doctors. First,
actively monitoring practice reviews and tracking social media conversations about ortho-

> Page 33

[33] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

ortho tribune 33

< Page 32
dontics provides doctors with a
better understanding of patient
concerns and preferences. Second, engaging with current
and prospective patients online
helps to strengthen relationships, build trust and achieve
thought leadership positioning.
Make it easy for prospects to
find you. To increase search
hits, always include your practice’s name on your social
media platforms. Once social
profiles are created, consider

including URLs to those profiles in all of your marketing
collateral, such as business and
appointment reminder cards,
posters, t-shirts and mailers.
When you’re ready to post content via your social media profiles, make sure it’s interesting
and relevant to the adult audience, and engage with patients
by encouraging them to comment, retweet or “Like” your
posts. It’s also important to remember that social media isn’t
just about pushing information
out to potential patients, but
fostering two-way engagement
that will build trust, educate
and ultimately drive patients
through your door.
Discuss Third-Party Financing
A recent research study
conducted by the Millennium Research Group
found that the cost of
treatment is the No. 1
barrier holding adults
back from seeking
orthodontic care. If
parents are already
investing in their
child’s braces, they
often wonder how
they can afford it
for themselves.
Offering flexible
financing options
is a good way to
ease
financial
concerns. Orthodontists
should
investigate available third-party
financing plans
that enable them

to offer patients more affordable monthly payments over
longer periods of time. This is
especially helpful as treatment
costs increase and treatment
times decrease as a result of
technologies such as self-ligation and digital solutions. Offering financing options helps
increase case acceptance and
cash flow, while decreasing accounts receivables.
Remember the “Why”
A common question doctors often hear from adults exploring
orthodontic treatment is, “Why
should I invest time and money
in obtaining a better smile? I’m
too old.” But the fact is orthodontics has come a long way
from when adults were kids,
thanks to decades of research
and development. A good way
to mitigate these questions is to
stress the positive long-term effects orthodontic treatment can
have on their lives. Nearly onethird of Americans say the first
aspect of someone’s face they
typically notice is his or her
teeth. Underscoring the point,
a recent perception study from
market research consultancy,
Kelton, found that when looking at images of other people,
American adults perceive those
with straight teeth to be 45
percent more likely than those
with crooked teeth to get a job
when competing against someone with similar skill sets and
experience. Furthermore, the
same study found people with
straight teeth were 58 percent
more likely to be successful,
and wealthy.

Most doctors know the importance of detailing the oral
health and self-confidence benefits of a better smile, but it’s
equally as important to stress
how an improved smile can
help potential patients increase
their chances to excel in the
workplace and live more fruitful lifestyles.

About the Author

Remember, it’s never too late
for your adult prospects to look
their best.
Ormco, AAO and You
The eligible adult treatment
population represents a lucrative and largely untapped
opportunity.
Doctors
who
are motivated to understand
what appeals to this particular market segment will see
more patients in their chairs
and increase profitability. The
emerging trend of adults seeking orthodontic treatment is
not slowing down, and orthodontists have more support and
resources to treat this patient
population than ever before.
By leveraging marketing assets and advanced treatment
solutions from Ormco, as well
as materials from the AAO’s
recent campaigns targeting the
adult market, you will have a
significant opportunity to demonstrate your dedication to improving the smiles of adults and
make your practice even more
successful.

Debby Hartman
Director of Marketing Ormco
Corporation Debby Hartman
brings more than 20 years of
marketing experience to her position as director of marketing at
Ormco.
Over the past eleven years, Debby has overseen Ormco’s global
brand development, Damon™
System marketing for doctors
and patients, the Ormco graphic
design department and practice
marketing support programs.
Prior to joining Ormco, she
served as tooth whitening marketing manager for Discus Dental, senior marketing manager at
Lippincott Williams & Wilkins,
and held marketing positions
at TBC advertising agency and
Legg Mason investment firm.
She earned a bachelor’s degree
in business administration from
the University of Delaware.

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Dental Tribune Middle East & Africa Edition | November-December 2015 implant tribune 35

Role of the Tissue-Engineered Structure’s Proteome
at Compensation of Bone Defects by Synthetic
Osteoplastic Materials
By Desjatnichenko K.S., Russia, Kichenko S., Russia, Kurdjumov S.G., Russia

A

bstract
The authors furnish
proofs of active participation of osteoplastic materials
implanted in the bone defect
in initiation of bone tissue regeneration and support – neoosteogenesis processing. The
material placed in the bone defect, provided that it is affine to
non-collagen proteins of blood
and tissue fluid, sorbs the latter ones forming a functional
complex – tissue-engineered
structure’s proteome, which
launches the cascade: attraction of pluripotential stromal
cells, their retention, proliferation, osteogenic differentiation,
expression of bone tissue-specific proteins, the extracellular
matrix capable of mineralization. It can be modified already
at the stage of production of
the osteoplastic material by its
introduction in the NBP composition, which increases its
osteoinductive properties and
creates prospects for favorable
outcomes of osteoplasty in patients with a reduced regenerative potential.
The technologies of implantation of osteoplastic materials
representing derivatives of the
allo and xeno bone have been
more and more widely used in
traumatology and orthopaedy
for compensation of bone defects. There is also a tendency
of an increase in the share of
synthetic
tissue-engineered
structures (STES) at such interventions. There is a widespread
opinion that the role of the material implanted in the bone defect is reduced to formation of
an inert matrix, a frame, “building timbers” for osteogenic
cells and/or their progenitors.
The purpose of this study is to
prove active participation of
osteoplastic materials in initiation of bone tissue regeneration
and support – neo-osteogenesis
processing.
Based on the references and
our own data we have offered
[1] a concept shown in the diagram (Fig.1). The material

placed in the bone defect, provided that it is affine to non-collagen proteins of blood and tissue fluid, sorbs the latter ones
forming a functional complex
– tissue-engineered structure’s
proteome, which launches the
cascade: attraction of pluripotential stromal cells, their
retention, proliferation, osteogenic differentiation, expression of bone tissue-specific proteins, the extracellular matrix
capable of mineralization. This
concept is confirmed by some
of our observations.
Besides, studying non-collagen
bone tissue proteins (NBP) –
minor fraction of the extracellular bone matrix, has helped
us to determine that about 20 of
them have a biological effect of
local growth factors (LGF).
They dose-dependently impact
proliferative activity of progenitors of osteogenic, blood-forming and immunocompetent
cells, their differentiation and
expression by differentiated
cells of tissue-specific proteins
[2, 3]. Induction of a composition of several NBP with LGF
properties has a more energetic influence on reparative
osteogenesis due to cooperativity of their effect. We have also
registered different affinity of
NBP with a different physiological effect to three basic bone
tissue ingredients: hydroxuapatite, β-tricalcium phosphate
and collagen of type I, which
contributes to deposition of
proteins with a regulatory function. A composition with physical, chemical and biological
properties identical to NBP was
obtained from the blood serum
at application of the same sequence of the preparative protein chemistry techniques.

tivity: at low concentrations it
stimulates proliferation (DNA
synthesis, increase of the number of viable cells), at high
concentrations it stimulates osteodifferentiation and expression of differentiated cells (NBP
synthesis, alkaline phosphatase
activity, formation of calcific
nodules) – Fig.2-3.
In this case, bone NBP ensuing chemotaxis and adhesion
of osteogenesis progenitor
cells, supporting skeletal homeostasis and taking part in
mineralization, can be detected
in circulating blood. At compensation of bone defects at
medium and acute periodontitis with application of the osteoplastic material* presence
of osteopontin (OPN) – bone
phosphosialoproteid exercising connection between the
mineral bone tissue phase and
its collagen matrix, as well as
adhesion of osteogenic cells on
it, and cytokines of the tumor
necrosis factor family – osteo-

Pic.2. Cytotoxicity test (MTT-test)
Recovery of yellow methyltetrazoliumtetrabromide (MTT) to purple
formazan by dehydrogenases of live
cells - metabolically active cells

INDOST-plates (RF patent # 2317088),
2 days, DMEM medium, 10% ETS

Fig.4. Impact of NBP (0,1 mkg/ml) on osteodifferentiation of fibroblasts of human embryos in vitro (INDOST series)
A – calcific nodules colored alizarin red;
B – registration of the alkaline phosphatase activity in cells of a calcific nodule

Then, the composition of noncollagen bone tissue proteins
consisting of 10-12 fractions
with a molecular weight within
the range of the isoelectric point
from 3 to 9, migrating under the
impact of electrophoresis in the
area of α1- and α2-globulins,
in the culture of embryotic fibroblasts
dose-dependently
impacts their physiological ac-

Fig. 1. Neo-osteogenesis processing at implantation of the osteoplastic material
in the bone defect

Fig.3. Spreading and adhesion of
fibroblasts of mouse embryos on the
material containing NBP

Moscow, 105094
Semenovskaya Naberezhnaya, 2/1, p. 1, of. 215
+7 (499) 922-35-36
e-mail office@polystom.ru

> Page 36

[36] =>

36 implant tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 35

Fig.5. Dynamics of the content of bone remodeling markers in crevicular fluids
at compensation of the bone defect by Stimulus-Oss osteoplastic material
(Belkozin, Russia).

progeterin (ORG) and its soluble ligand (sRANKL) responsible for the dynamic balance
in the resorption-osteogenesis
system (skeletal homeostasis),
were detected in crevicular fluids – tissue fluid homolog – be
means of the enzyme multi-

plied immunoassay (example
in Pic. 5), which confirms the
referential data [5, 6].
The morphological dynamics
of bone formation in the place
of STES implantation for compensation of the bone defect

in the experiment is one more
proof in favor of the above concept (pic. 6): – on the third day
after implantation we registered formation of an inflammatory cell shaft around the
implant with an approximately
equal share of inflammatory
cells (degrading and native
lymphocytes), monocytes-macrophages (source of cytokines
coming into the tissue fluid)
and fibroblast-like cells (undifferentiated progenitors of osteogenic cells). On the border
of the implant and bone tissue
of the recipient bed there appear osteoclasts, which by the
7th day (b) contributes to STES
resorption (defragmentation),
between the units of which
there appears granulated tissue. The granulations contain

A
C

D
B
Fig.6. Dynamics of compensation of the shin bone hole defect by implantation
of INDOST sponge osteoplastic material (POLYSTOM, Russia)
Time after the operation: A – 3 days (ob.10×oc.5), B – 7 days (ob.20×oc.5), C – 14
days (ob.20×oc.5), D – 75 days (ob.10×oc.5). Eosine and haematoxylin

osteoblasts, which ensure appearance of the first bone rods
– provisional bone tissue by the
14th day (c). Vascularisation of
the newly formed tissue, metabolic processes and biomechanics of the regenerate set
conditions for its tissue-specific
remodeling with formation of
mature spongeous bone by the
75th day (d).

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Thus, for implementation of
the above neo-osteogenesis
scheme in the place of osteoplastic material implantation
there exist all the necessary
and sufficient conditions. Osteoinduction of the material, as
well as chemotaxis, adhesion
and proliferation of osteogenic
progenitor cells are enabled
by the complex of non-collagen proteins affine to mineral
and organic ingredients of the
implant. This complex – the
tissue-engineered structure’s
proteome – is formed by means
of diffusion in the implanted
material from the circulatory
bed, post-surgery hematoma,
produced by the cells of the inflammatory shaft surrounding
the implant and released from
the resorbed bone tissue of the
recipient bed. This complex
consists of NBP with the following functions: 1) attractants of
PPSC, 2) affine to integrins of
these cells, 3) signaling molecules modeling their physiological activity – depending on
the dosage stimulating proliferation or differentiation of these
cells. The cooperative effect of
the components of this complex
initiates a pleiotropic cascade
of cell processes, which results
in formation of a newly formed
bone tissue. The speed of the
STES proteome formation depends on the composition and
properties of the implanted
material. It is evident that the
composition of hetero-phase
calcium orthophosphates and
collagen of type I is optimal.
To the best of our knowledge,
silicates and sulfates used at
production of osteoplastic materials are not tested for affinity
to NBP. On the contrary, fibrillous heteropolysaccharides –
hyalurates, alginates, chitosan,
etc. - due to their physical and
chemical properties can have
properties of a biochromatographic system forming the

> Page 37

[37] =>

Dental Tribune Middle East & Africa Edition | November-December 2015 implant tribune 37
< Page 36
STES proteome.
The latter can be modified already at the stage of production
of the osteoplastic material by
its introduction in the NBP composition, which increases its
osteoinductive properties and
creates prospects for favorable
outcomes of osteoplasty in patients with a reduced regenerative potential, in the so-called
risk groups, without application of externally prepared cell
grafts. We have translated this
possibility into action at creation of INDOST materials produced by POLYSTOM Scientific
production Association since
2006 [1].
The authors thank Professor
N.A. Slesarenko (Moscow State
Academy of Veterinary Medi-

cine and Biotechnology named
after K.I. Skriabin), Professor
A.B. Shekhter (Moscow State
Academy named after M.I.
Sechenov) and Candidate of
Physical and Mathematical Sciences I.I. Slesarenko (Institute
of Theoretical and Experimental Biophysics at the Russian
Academy of Sciences) for help
in morphological and cytological studies.
References
1. Desjatnichenko K.S., Kurdjumov S.G. Tendencies in construction of tissue-engineered
systems for osteoplasty // Cell
Transplantation and Tissue
Engineering. – 2008. - # 2. – P.
62-69.
2. Shevcov V.I., Desjatnichenko

K.S. Development and experimental evaluation of pharmpreparations from mature bone
tissue // Skeletal Reconstruction and Bioimplatation (ed.
T.S. Lindholm). Ostin (Texas,
USA). – Landes Biosciens. 1997. – 78-81.
3. Desjatnichenko K.S. Distraction osteogenesis in terms of
biochemistry and pathologic
physiology // Genii ortopedii. –
1998. - #4. – P.120-126.
4. Shevcov V.I., Desjatnichenko K.S., Berezovskaya О.P.,
Kuznetsova L.S. Biochemical
aspects of distraction osteogenesis regulation // Bulletin of the
Russian Academy of Medical
Sciences. – 2000. - #1. – P. 30-34.
5. McCormick R. Osteoporosis:
Integrating biomarkers and

other diagnostic correlates into
the management of bone flagilit // Alternative Medicine Review. – 2007. – Vol. 12, № 2. – pp.
113 – 145.
6. Sikora V.Z., Pogorelova М.V.,
Tkach G.F., Bumeister V.I. Non-

collagen bone tissue proteins
as bone remodeling markers//
Ukrainian Morphology Almanac. – 2011. – V.9. – #3 (appendix). – P. 28-35.

About the Author
Desjatnichenko Konstantin Stepanovich
Doctor of Medical Science, Professor, head of the department of
POLYSTOM Scientific Production Association CJSC
Kichenko Sergey Mikhailovich
Doctor of Medical Science, Professor, lead researcher of the
Central Research Institute of Dental and Maxillofacial Surgery
named after academician A.I. Rybakov
Kurdjumov Sergey Georgievich
Ph.D. in Engineering Science, Laureate of the state prize for science and technology, Director General of POLYSTOM Scientific
Production Association CJSC

Evaluation of dental implant therapy – implant loss
By Olivier Carcuac, UAE

he concept of osseointegration was first introduced by P.I. Brånemark and his co-workers in
Sweden (1969; 1977). On a
global perspective, acceptance
of the clinical application followed the Toronto conference
held in 1982. Implant-retained
prostheses have since become
a popular treatment modality,
aiming to fulfil functional and
aesthetic needs. Today, the use
of dental implants in the rehabilitation of fully and partially

edentulous patients is a safe,
well-documented and commonly applied method (e.g.
Jung et al., 2012; Pjetursson et
al., 2012).
About 15 million dental implants are installed annually
worldwide and it is estimated
that about 4-5 million patients
receive dental implants every
year. Clinical research evaluating dental implant therapy
has mostly been limited to descriptive observational studies.
Evaluations were performed
following different time inter-

vals and focused on implant
survival rate, marginal bone
loss, and included, to a lesser
extent, biological and technical complications. Outcomes
were mostly presented on the
implant rather than the patient
level. Furthermore, study samples were usually small and
consisted of selected patient
groups, treated by trained specialists. Thus, existing clinical
documentation represents, for
the most part, evaluation of efficacy, (i.e. the probability of an
intervention being beneficial
to patients under ideal condi-

tions), while evaluations of effectiveness (the care provided
to the general population under
conditions found in practice)
are essentially lacking.
Due to traditional attitudes
within the field, approaches to
research, including study design, have changed little over
time. Although a small number
of controlled studies have been
performed, critical issues were
rarely considered. In addition,
study populations were usually too small to analyse possible differences between patient

groups, categories of clinicians
or dental implant systems. In
addition, clinical prospective
studies should be registered
at designated websites prior to
recruitment in order to guarantee validity and quality of the
research. Today, only few dental journals require such documentation.
Long-term success of dental
implant therapy depends on
the initial and long-term in-

> Page 38

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[38] =>

38 implant tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 37
tegration of the implant with
hard and soft tissues. In line
with this prerequisite for success, the second field of interest for implant research is the
occurrence of biological complications (Tonetti and Palmer,
2012). By definition, such complications include issues related to the soft and hard tissues
surrounding the implant.
Implant loss
The most dramatic biological
complication, which occurs
when both soft and hard tissue integration has failed, is the
complete loss of the implant.
From a research point of view,
implant loss is an easy outcome
to study and is rarely disputed.
Thus, no specific case definition is required. In fact, loss

of dental implants is the most
commonly reported outcome
in the literature (Needleman
et al., 2012). As mentioned earlier, implant loss has usually
been presented as a percentage of implants installed. This
in itself is not incorrect but
somewhat misleading. Thus,
it was argued that, in addition
to implant-related figures, the
proportion of affected patients
should be presented (Berglundh et al., 2002; Berglundh and
Giannobile, 2013).
Early implant loss
Traditionally adopted treatment
strategies include a healing period of 3 to 6 months following
implant installation (Brånemark et al., 1977). During this
time, osseointegration should

occur, and, thereafter, prosthetic devices replacing the missing
tooth/teeth may be connected.
Implant loss occurring prior to
loading is considered as early
implant loss. In other words,
such implants have failed to
achieve osseointegration during the healing phase and need
to be removed. In this context
it should be realized that some
authors considered implants
lost during the first 6 (Vervaeke
et al., 2015) or 12 months (Jemt
et al., 2014; Friberg and Jemt,
2015) of function as early lost
implants.
Evidence in regard to early implant loss originates from studies describing efficacy rather
than effectiveness of treatment.
In selected patient groups treat-

ed at specialist clinics, the rate
of early implant loss is generally low. Figures of about 1%
of implants being lost prior to
prosthetic loading have been
described (Roccuzzo et al.,
2010; Friberg and Jemt, 2015).
In contrast, findings from studies including larger patient cohorts described higher proportions (about 3%) (Cecchinato
et al, 2004). The proportion of
affected patients was usually
higher than the proportion of
implants lost. Alsaadi et al.
(2007) reported early implant
loss for 3.6% of all implants,
while 8.9% of all patients were
affected. Similarly, Vervaeke et
al. (2015) reported on an early
implant loss of 0.8% affecting
2.9% of all patients.

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Late implant loss
Implant loss occurring after
loading has been defined as
late implant loss. Similar to
what has been reported for
early implant loss, the rate of
late implant loss is described
as low, particularly in studies originating from well-controlled clinical settings. Friberg
& Jemt (2015) observed a loss
of 0.7% of implants following the first year in function.
Larger patient cohorts have
been described to present with
rates of late implant loss of
around 2% or above (Alsaadi
et al., 2008; Jemt et al., 2014).
Proportions of affected patients
were not always reported but
were higher when compared
to implant-related data. Figures
ranging from 2.1% (Vervaeke
et al., 2015) to 16.0% (Alsaadi
et al., 2008) were observed. In
a recently study, Derks et al.
(2015) evaluated effectiveness
of dental implant therapy including the occurrence of implant loss. In this nation wide
project, patient records and radiographs from 2,765 patients
were obtained from about 800
clinicians. Information on patients, treatment procedures,
and outcomes related to the
implant-supported restorative
therapy was extracted from the
files. 596 of the 2,765 subjects
attended a clinical examination 9 years after therapy. Early
implant loss was assessed in
patient files, while late implant
loss was recorded at the clinical
examination. While total implant loss (early and late) was
noted for 3.0% of all installed
implants, the proportion of affected patients was higher. In
total, 7.6% of all individuals, i.e.
1 out of 13, lost one or more im-

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The apparent variation in terms
of proportion of early implant
loss is intriguing and may be
explained by factors related to
patient selection and to experience of the clinician. A systematic review on implant complications observed that the extent
of the restorative therapy was
of significance (Berglundh et
al., 2002). While less than 1%
of implants failed to integrate
in situations of single-tooth replacement, the rate of early implant loss in overdenture (full
jaw) cases was almost three
times as high. Patient- and
clinician-related factors associated with early implant loss
were studied by Alsaadi et al.
(2007). The authors reported
that osteoporosis, Crohn’s disease, smoking habits, implant
length, implant diameter and
implant location were all significantly associated with early
implant loss. Implant installation in fresh extraction sockets (immediate installation)
has also been shown to lead
to an increased rate of early
implant loss. Analyses on the
consequences of early implant
loss are however lacking. Ultimately, it is the consequence
of a complication that is of the
highest interest to the patient.
Early implant loss might entail
additional surgical interventions or alterations of the treatment strategy.

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[39] =>

Dental Tribune Middle East & Africa Edition | November-December 2015 implant tribune 39
< Page 38
plants over the 9-year period.
As late implant loss presents
with different features when
compared to early implant loss,
associated risk indicators/factors may also differ. Few studies have evaluated risk indicators of late implant loss. History
of periodontitis (Roccuzzo et
al., 2010) and radiotherapy (Alsaadi et al., 2008) have been
identified as patient-related
risk indicators. Implants installed in the posterior region of
the mandible were also shown
to be at higher risk for late loss
(Alsaadi et al., 2008).
Factors associated with implant loss
In the nation-wide project conducted by Derks et al (2015),
results of different regression
analyses revealed that several
of the patient-, and implantrelated factors were associated with implant loss. It was
demonstrated that implants installed in patients with a history
of periodontitis, as reported in
patient records, showed significantly higher odds ratio (3.3)
for early implant loss when
compared to implants placed
in subjects without a history
of periodontitis. Smoking was
associated with a higher risk
for early implant loss, demonstrated by an odds ratio of 2.3
for implants placed in smokers. Implant-related factors
were also identified, as short
implants (<10 mm) were more
likely to be lost prior to prosthesis connection (odds ratio
3.8) when compared to longer

implants. In addition, certain
implant brands were associated with a higher risk for implant loss: Straumann implants
show the lowest rates of early
implant loss when compared to
Nobel Biocare, Astra Tech and
the other implants represented
in this observational study (including Biomet 3i, CrescoTi,
Xive, Frialit, Lifecore, Implamed and API).
References
1. Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma
DS (2012). Systematic review
of the survival rate and the incidence of biological, technical,
and aesthetic complications
of single crowns on implants
reported in longitudinal studies with a mean follow-up of
5 years. Clin Oral Impl Res 23
Suppl 6:2–21.
2. Pjetursson BE, Thoma DS,
Jung RE, Zwahlen M, Zembic
A (2012). A systematic review
of the survival and complication rates of implant-supported
fixed dental prostheses (FDPs)
after a mean observation period of at least 5 years. Clin Oral
Impl Res 23 Suppl 6:22–38.
3. Brånemark P-I, Adell R,
Breine U, Hansson BO, Lindström J, Ohlsson A (1969). Intraosseous anchorage of dental prostheses. I. Experimental
studies. Scand J Plast Reconstr
Surg 3:81–100.
4. Brånemark P-I, Hansson BO,
Adell R, Breine U, Lindström
J, Hallén O, et al. (1977). Osseointegrated implants in the
treatment of the edentulous

jaw. Experience from a 10-year
period. Scand J Plast Reconstr
Surg Suppl 16:1–132.
5. Tonetti M, Palmer R (2012).
Clinical research in implant
dentistry: study design, reporting and outcome measurements: consensus report of
Working Group 2 of the VIII
European Workshop on Periodontology. J Clin Periodontol
39 Suppl 12:73–80.
6. Needleman I, Chin S, O’Brien
T, Petrie A, Donos N (2012).
Systematic review of outcome
measurements and reference
group(s) to evaluate and compare implant success and failure. J Clin Periodontol 39 Suppl 12:122–132.

ICOI 2015:
World of oral
implantology comes
to Berlin

Editorial note:
The full list of references is available from the publisher

About the Author
Olivier Carcuac
(1)DDS, Specialist in Periodontics
My Dental Clinic
Al Thanya Road, Villa 61A,
Umm Suqeim 2, Dubai, UAE
(2)Odont. Dr. (PhD)
Department of Periodontology,
Institute of Odontology,
Sahlgrenska Academy, University
of Gothenburg, Sweden
Specialist in Periodontics at
My Dental Clinic
P: + 971 43388939
E: olivier@mydentalclinic.ae

The Berlin Wall is a historical landmark. (Photograph: Peter Dargatz/Pixabay)

By Dental Tribune International

he International Congress of Implantologists (ICOI) is not only
the world’s largest dental implant organisation, but also
the world’s largest provider
of continuing dental implant
education. For more than three
decades, the ICOI has drawn
dental professionals to various
places around the globe each
year. In 2015, the congress is
taking place in Berlin from 15
to 17 October and will address
contemporary concepts and
philosophies in implantology.
On 15 October, scientific presentations as part of the Young
Implantologists
programme
and several free sponsored
pre-congress workshops will
be held, followed by the welcome reception. On 16 and 17
October, 16 international main
podium speakers will offer clinicians an understanding of
current implant treatments and
their applications. Topics include treatment planning and
the use of 3-D imaging, implant
site development, hard- and
soft-tissue regeneration, simple
to complex surgical and prosthetic procedures, and management of complications. The
gala dinner will be held on the
evening of 16 October.
More than 1,000 dental professionals, including general
dentists, specialists, laboratory
technicians, students and industry representatives, from all
over the world are expected to
attend.
For the meeting in Berlin, the
ICOI joined forces with two
German partner societies for
the first time, namely the German Association of Dental Im-

plantology and the European
Association of Dental Implantologists.
Berlin is a unique city with
many historical sites and creative hot spots. It is the largest
city in Germany and the country’s capital. Since the fall of
the Berlin Wall in 1989, Berlin
has become one of the world’s
most popular cities, a metropolis where culture, the economy,
science, and politics meet. With
around 3.4 million residents
from about 180 nations, it is
also one of the largest cultural
melting pots in Europe.
The congress venue is the Maritim Hotel, situated in the city’s
embassy district in the picturesque Tiergarten close to the
Brandenburg Gate, the historic
symbol of Berlin’s reunification.
The ICOI, which was founded
in 1972, is an association of various dental professions, including general dentists, oral and
maxillofacial surgeons, periodontists, prosthodontists, endodontists, orthodontists, and
laboratory technicians. The
organisation currently has over
13,000 members.

Contact Information
More information about the congress and registration can be
found at www.icoiberlin2015.
org.

[40] =>

40 news

Dental Tribune Middle East & Africa Edition | November-December 2015

Dental composite curing system apparatus and method
By Dr. Mohammad Al-Rifai, UAE

his invention will be a
revolution in the field of
dental composite restorations, as it will change the prevailed principles and the current rules within the procedure
of composite application significantly. With the techniques
used in this research, any composite material that has inferior
properties concerning stress
or shrinkage will behave as
an ideal composite restorative
material. I was able to achieve
this outcome by decreasing the
shrinkage and stress to a value
of approximately up to 70% for
the same materials currently
used by dentists using the current techniques. This motivated me to publish my invitation.
Basically, the idea deals with
the issue of reducing the side
effects of shrinkage and stress

of a composite.
Research and development
departments in manufactories
and universities tried to develop the best possible outcome
concerning composites’ minimal side effects of the throughout many ways, such as:
1. As resin is the main reason
for undesired side effects in
composites, companies tried
to create a material (a composite) by improving the quality of
resin and trying to reduce it in
within the composite mix.
2. Working on developing
the curing light devise (light
source) by increasing the light
wave’s power to reach 1,600
mw/cm2, increase the range of
the light wave length to 300-500
nm, using a soft start technique
and change the light beams
coming from the tube light
source from a straight to an angle beam (conic shape).

3. In addition to above, other
techniques were used but with
a minimal impact in reducing the undesired side effects
of the composite; e.g. using a
perforated plate with different shapes. Unfortunately this
technique was not successful
and was left aside and not commercially produced.
Considering all of these above,

I will explain the difference between my invention and others.
I would like to clarify a few simple things to be able to reach
solid results:
1. The light beams in all light
cure devices has a conic form
2. During the composites polymerization,
unfavorable
shrinkage and stress appears
3. Stress is the power produced
from the shrinkage of a resto-

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ration connected to the edges
of a tooth’s walls. The restoration cannot depart from the
walls because the power of the
adhesive is greater than the
shrinkage power (undesired
side effect). The stress power is
concentrated inside the corners
like a tri-angle and rectangle
unlike the circle shape.
4. Using the perforated plate, it
will divide the curing process
within the restoration to cured
and uncured areas. The uncured areas will slightly expand
and compensate the shrinkage
generated by the cured area.
We benefit from this division
that the stress and shrinkage
allocated to many areas in the
restoration and is not concentrated in the edges of the restoration, because when the restoration gets cured without a
perforated plate, shrinkage and
stress will pull the restoration
to the center and the tooth’s
walls will prevent this action
(vide figure 1.1 -1.2)
In the beginning of my researches, using a perforated
plate was also not effective and
I tried to find the reason what
could be changed in order to
succeed. The main problem using the perforated plate is that
a large part of the restoration
or the whole restoration is being cured (keeping in mind that
the transformation from plastic
-soft- form to a solid state takes
3 to 5 seconds). I made the following reasons responsible for
this effect:
There seemed to be not enough
space between the holes to
prevent the light beam from
reaching the restoration. Thus,
there will not be enough uncured areas between the cured
areas. Since the light beams
spread in an angle shape from
the source, this the cured area
will be increased as well and
might cure the entire restoration (vide Figure 2).
To solve this issue I came up
with the idea of leaving 1 mm
space between the holes. The
diameter of the holes is 1 mm.
In the following, I would like
to point out the reason why I
decided to use a diameter of
exactly 1 mm and not measurements of more or less:
The main concept is trying to

1-800-496-9500
www.zahndental.com

> Page 41

[41] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

news 41

< Page 40

find the best combination that
allows the highest number of
possible perforations and that
achieves the highest number of
both cured and non-cured areas in the composite restoration
(the smallest size of perforations and the smallest distance
separating the perforations).

I studied several combinations
of both perforation size and
separating distance, and examined the following:
I. Perforations of 0.5 mm did
not allow a sufficient amount of
curing light to pass through the
perforated plate and thus was
not able to cause the desired
curing effect within the composite.
II. Perforations of 1 mm, allowed a sufficient amount of
curing light to pass through
the perforated plate (I recorded
400 mw/cm2 out of a source of
1100 mw/cm2) and was able to
cause the desired curing process in the composite.
III. Perforations of more than 1
mm were not desirable, mainly
for two reasons:
1. It will reduce the number
of perforations possible which
contradicts with the general
concept.
2. In dental practice there are

restorations of 1.5-2 mm in size.
Which means that a perforation
of 1.5 mm or 2 mm in diameter
has the potential of covering
the whole surface of the restoration and that may cause the
curing of the entire restoration,
which is what we are essentially trying to avoid.
IV. Perforations of 1 mm diameter and 0.5 mm separating
distance: I found that the light
beams passing through the perforated plate (the plate must not
exceed 0.5 mm in thickness to
reduce the diminishing of curing light power) have almost
reunited on the restoration
surface after passing through
the plate (due to the conic pattern of the light beams passing
through the plate) and caused
the curing effect on almost the
whole restoration’s surface.
V. Perforations of 1 mm and 1
mm separating distance: This
combination allowed enough
light power to pass through

suitable
separations,
and
achieved the desired result of
both cured and non-cured areas of the composite’s restoration.
VI. Perforations of 1 mm and
1.5 - 2 mm separating distance
were not suitable for reasons
very similar to the reasons that
lead to the rejection of 1.5-2
mm perforations above.
VII. In conclusion I found out
that a plate of 1 mm perforations and 1 mm separating distance are the best combination
that allows enough curing light
power to pass through the perforated plate and achieve the
desired focal curing process.
My suggested shape of circular
holes of 1 millimeter in diameter and separated from each
other by a distance of 1 millimeter is unique and completely
different from the shapes suggested in the existent proposals.

Why using circles as a perforation shape?
My experiments indicate that
this formation will result in
minimal shrinkage effects in
comparison to other suggested
formations. Furthermore, my
suggested formation does not
contain any angles (in contrast
to the other suggested shapes
of parallel lines or grid). It is
well known that stress points
are usually formed in the tips
of angles and thus will result
in minimal stress points in the
restoration after polymerization.
Based on the researches above
and after my experiments, I
considered that the shapes of
the cured areas have a cylinder
or conic shape, when using a
perforated plate with holes in
circle shape. Instead, I ended
up a different result:
When I investigated the cured
areas within the restoration,
I found out that the areas are
bigger than the hole-diameter
from the perforated plate and
that its shape is random (not
conic or cylinder shaped). Furthermore, these cured areas
are fused with the cured areas
next to it. It seems as if there
are no effects or benefits from
using the perforated plate. The
reason why we received cured
areas of a random shape and

> Page 42

[42] =>

42 news

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 41
dimensions. This makes the
ring suitable to a large number
of devices as shown in the in
figure 4.2 above.
The ring allows moving the
plate and the holder in different
directions around the axis of
the curing device’s tube, where
the special part of the holder
(5) can apply on different walls
of the tooth (lingual, buccal).
surfaces that were bigger than
expected (when using a holediameter of 1 mm), is the vibration of the doctor’s hand during
the curing process. Due to this
vibration a change of the light
beam is caused and more areas
are cured than we would like to
cure. (Please vide Figure 5.1)
To solve the issue of the light
beam not being stable and to
mitigate the vibration of the
doctor’s hand, I figured out that
the light source, the perforated
plate and the tooth should be
connected with each other in
a single handle. Such a single
handle has many advantages
(please vide figure 4.1 and figure 4.2. below).
Above you see a simple illustration of the proposed handle.
1. Flexible metal ring
2. Fiberglass tube (end of the
light cure device)
3. Metal holder (connecting the
ring with the plate)
4. Perforated plate
5. Special part of the holder de-

signed to stand on side of the
tooth
6. Light beam passing the plate
In this new design, the plate
was carried independently.
Thus, it can be fixed on the
tooth, while the light source is
placed above it.
In this pattern, the plate can be
fixed on the light cure device
directly through the flexible
metal ring (1), then the device
and the plate can be connected
to the tooth. This will simplify
the treatment with the plate;
result in good stability of all
components. Therefore, the
light beam does not suffer from
hesitation/shaking of the doctor’s hand during the curing.
The plate and the fiberglass
tube are connected with each
other through the handle. A
flexible ring within the handle
allows the head of the fiberglass tube an accurate incorporation (1). The ring has an open
spot for the fiberglass. It allows
a simple expansion within the

While using the special handle with the perforated plate, I
received favorable results: the
dimensions and the shapes of
the cured restorations are close
to the diameter of the circles
within the perforated plate
(around 1 mm) and the shape
is close to the conic shape. Furthermore, the cured areas did
not fuse with the cured areas
next to them. Consequently, it
can be examined that the special created handle has a significant impact and improves
the results.
I also want to add some more
things to the main idea. Details
about the suggested design that
have not been covered by others yet, such as:
1. The thickness of the perforated plate: According to my researches 0.5 mm is the plate’s
best thickness, since a thickness of more than 1 mm will
reduce the light beams passing
through the circle holes (keeping in mind that the diameter
of the hole is 1 mm) and this
will reduce the cured areas sig-

nificantly. If the thickness of the
plate is less than 0.25 mm, more
light beams will pass through
the hole and this consequently
will increase the cured areas
significantly.
2. The design of the handle allows the plate to move within
a range of 360 degrees around
the light cure device’s tube,
which will give the doctor the
ability to use the plate for any
tooth’s surface - wherever located in the mouth (upper, lower, right or left).
3. The design is created to allow
a minimal distance between
the light source, the plate and
the tooth’s surface, which will
keep the light beam straight to
the chosen spot on the certain
restoration.
4. It is easy to develop the proposed design commercially
with low costs and with the
ability to be sterilized easily
(since it is supposed to be made
of stainless steel)
5. The shape of the handle’s
part is made to allow a loose
fixation on the tooth surface,
since it has a curved shape –
thus, a high stability on the
tooth’s surface is granted.

ness
2. The handle that connects the
light source, plate and tooth’s
surface within one object
3. The ability to produce a practical design which guarantees
the ability to be used on any
tooth’s surface, being easy to
sterilize and being developed
with low costs.

All others ideas presented before focused on preventing a
part of the light beam to reach
the restoration by using a perforated plate. This perforated
plate was never presented in a
practical way, and did not mention any of following:
1. The shape and diameter of
the holes and the plate’s thick-

Dr. Mohammad Abdulkarim Al
Rifai
Business Address:
Unique Smile Clinic LLC
Office: + 971 4 2502471
Mobile: +971 52 8695212
Al Serkal Bulding, office 902
Port Saeed, Al Maktoum Road
D73
P. O. Box 91190
Dubai, United Arab Emirates

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[43] =>

news 43

Dental Tribune Middle East & Africa Edition | November-December 2015

New agent of E.M.S. Dental in U.A.E.
leading medical companies in
the U.A.E., and has an emphatic
across the U.A.E. & Middle East.
Furthermore to deliver continuous education to dentists and
dental hygienists the company
will offer the Swiss Dental Academy courses starting from the
beginning of 2016.

By EMS

YON, Switzerland E.M.S. Electro Medical
Systems who is the innovator of Piezon and AIR-FLOW
technologies and the leader in
Prophylaxis and GUIDED BIOFILM THERAPY announces
that it signed a contract with the
company Al-Hayat Pharmaceuticals based in Sharjah as the
exclusive agent for all E.M.S.
dental products in U.A.E.
Since its foundation in 1981,
the Swiss company E.M.S. with
its headquarters in Nyon has
evolved into one of the most successful dental companies worldwide. Due to the concentrated
power of the medium-sized
company, consisting of innovative technology, perfection, precision and Swiss quality the den-

tal prophylaxis has achieved an
entirely new and virtually painfree standard.
The new cooperation with AlHayat will strengthen the presence of E.M.S. additionally and
will point the high quality of
E.M.S. devices and products.
“We are very glad about the new
collaboration with Al-Hayat.
The visions and strengths of this
company reflect the mission of
E.M.S. This ensures the highest customer service level for
all clients in U.A.E. and provides
the best quality to the patients”,
says Hans Obermeier, Area Sales
Manager of E.M.S. in Middle
East.
Al-Hayat currently operates 3 offices in U.A.E. with a sales team
of highly educated people. Established in 1982, it is one of the

New world record:
Third molar erupts in
92-year-old

(Photo credit: Coombesy/Pixabay)

By Dental Tribune International

AARBURG,
Germany:
Usually third molars erupt
during early adulthood,
typically between the ages of
17 and 25. In very rare instances, these teeth erupt at a later
point in life. At the beginning
of the year, a woman already
in her 90s set a new record for
an erupting wisdom tooth at an
advanced age.

The incidence was confirmed
on 23 February in Saarburg. Ingeborg Wolf-Wimmer, who was
born in 1922, was 92 years and
258 days old when she was entered into the Guinness World
Records.

As reported online by the Luxemburger Wort newspaper,
Wolf-Wimmer, who is originally from Austria and now lives
in a nursing home in Luxembourg, complained about her
denture and her dentist identified an erupting third molar as
the cause of the problem.
Wolf-Wimmer is now officially
the oldest person in whom a
wisdom tooth has erupted. The
previous record was held by an
80-year-old person in South Africa.
According to the Luxemburger
Wort, radiographs showed that
Wolf-Wimmer has three more
unerupted third molars in the
palate.

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

[44] =>

44 news

Dental Tribune Middle East & Africa Edition | November-December 2015

Splyce ID: Designing Bespoke
Modern Wonder Clinics - Part II
By Nijas Salim, UAE

“

Design is not just about aesthetics” says Ranjit Prasad,
the Creative Director of Splyce, who is in full flow, about
the one subject that has become
his passion in life.
“Function is as important as
form if not more important. If
form does not follow function,
you end up creating cognitive
dissonance among users that is
experiencing the space. Sometimes you can’t even put it in
words but people certainly feel
it when something is wrong. So
when you are in the design process there are different roles the
users of a space are engaged in
and you have to ensure that the
design is consistent with expectations.”

I remember taking a walk
through the Apa Aesthetic Dental & Cosmetic Centre, and looking at a few features that struck
out. The button that opened the
sliding door to the sterile room

was placed at the optimum
height and was big to facilitate
gloved doctors using their elbow
to open the doors. The design
of the conference room and the
computing power in the server
room was to ensure that discussions and meetings with Dr.
Apa on the days he was seated
11,000 kms away felt like he was
next to you. The need to drown
out the sound of the powerful
motor connected to all the dental chairs was crucial because
otherwise the little alcove with
the fountain would not serve its
purpose. We wanted the space to
be lit up by natural light. But this
natural light would hinder the
personnel manning the reception desk. The height of the desk
became important to the design,
and tracking the suns path with
respect to the space became cru-

pre-conference workshops, organized by Professor Carina
Mehanna, LDA Director of Continuing Education Programs
and included over 113 sessions,
9 workshops, poster presentations and a newly introduced
panel discussion together with a
series of 8 pre-congress courses
which gathered 262 participants

at the Beirut Arab University
Campus. The event combined
excellence and expertise in all
fields of dentistry and served as
a forum to explore new technologies, innovations and new materials helping the participants
to take smart decisions on why,
when and how to use them.
The event received sponsorship

“We were designing a training
room for a medical company
and the client were going to
use a manikin to provide classroom instructions and training.
The client wanted to ensure
that all participants would have
an unobstructed clear view of
the manikin wanted while also
utilizing most of the space for
participants. We had the manikin drop from the ceiling at the
press of a button. It certainly has
a futuristic “Wow” effect to it.
But that is just secondary to the
experience of the users and its
main purpose.”

“Design is not just about aesthetics”

cial. This was what good design
was all about. Leaving no stone
unturned.
Splyce Interior Designs is a boutique agency driven to meet
satisfactions of a clientele that

know the value of good design
and incorporated that into their
own philosophy. Splyce believes
its reason d’être is creating stunning designs that exceeded client expectations.

< Page 1
United Kingdom, Italy, Belgium,
France, South Korea, Canada,
Lithuania, and from the Arab
countries Kuwait, Sultanate of
Oman, Egypt, Yemen, Bahrain,
Sudan) in addition to an interesting panel of Lebanese talented lecturers.
The four day event began with

Dental Tribune MEA

from over 97 major international industry players and regional
dealers taking part under the
impressive 6000 square meter
as flat space especially designed
to hold the event.
BIDM 2015 further enjoyed a
high standard supported and
documented with high tech au-

dio visual equipment during the
4 days.
Dental Tribune Middle East &
Africa / CAPPmea was proud to
be the official media partner at
the event.

Opening Ceremony at Pavillon Royale-Biel

Presidents of Dental Association from Tunis, Turkey, KSA, Italy, Maroco, Qatar, Kuweit,
Oman, in addition to FDI president

LDA Board Members welcoming the guest during gala dinner on
Friday

Crest & Oral-B booth

GSK booth

Colgate booth

Droguerie Tamer

Dr. Nabi Nader (Chairperson of BIDM 2015)

From the left Ms. Nadine Abdallah, President Abdulwahab Alawady
“President of Kuweit Dental Sociaty”, Pres Ibrahim Tarawneh, “President of Jordanian Dental Association”, Dr. Ahmed Hamdan “JDO
Board Member)

[45] =>

news 45

Dental Tribune Middle East & Africa Edition | November-December 2015

Showcase of Eye Special C-II @ FDI 2015
A Smart Digital Dental Camera for the entire dental team
By SHOFU

ince its global launch a
year ago, Shofu’s EyeSpecial C-II has been hailed
as a game changer for every
day dental photography. FDI
2015 in Bangkok, Thailand provided the platform for Dr. Przemyslaw Grodecki to share his
perspectives on the EyeSpecial
C-II dental camera at the DTI
Media lounge.
A successful practitioner from
Poland with a stellar academic
career, Dr. Grodecki is no amateur when it comes to dental
photography and has worked
with various DSLR cameras in
his dental clinic.
An advocate of minimally invasive and holistic dentistry,
Dr. Grodecki discussed how
EyeSpecial C-II designed exclusively for dentistry, offers a
whole new approach to dental
photography. He added, “considered essentially as macrophotography in low light conditions, capturing the full dental
arches or a single tooth is now
much easier than ever before
with the EyeSpecial C-II dental
camera” EyeSpecial C-II outperforms commercial cameras
of similar size to effortlessly
fulfill everyday dental photography needs.
Compact and ultralight, Shofu
EyeSpecial C-II is easy to use,

straight out of the box, eliminating the need for complex
settings, expensive training or
a dedicated camera specialist,
thus enabling him to seamlessly integrate dental photography in his routine treatment
protocol.
This one of a kind dental camera comes with 8 automated
pre-set dental shooting modes,
a large, intuitive LCD touchscreen with onscreen guides
and in-built distance finder to
simplify usage and eliminate
the need for extensive training
on dental photography. Proprietary Flashmatic system in
EyeSpecial C-II optimizes flash
intensity, shutter speed, f-stop
with built in auto-focus and auto-zoom features with remarkable anti-shake capabilities to

Tooth enamel first
evolved in the skin
By Dental Tribune International

PPSALA, Sweden: Tooth
enamel is the hardest
substance produced by
the human body. Since enamel
is one of the four major tissues
that make up the teeth and gives
them their distinctive shiny
white appearance, it comes as a
surprise that a study has found
that enamel most likely originated from an entirely different
part of the body: the skin.

Unlike humans, who only have
teeth in the mouth, certain fish
species have little tooth-like
scales on the outer surface of
the body. In the study, researchers from Uppsala University
in Sweden and the Institute of
Vertebrate Paleontology and
Paleoanthropology in Beijing
in China analysed Lepisosteus,
an ancient gar fish from North
America whose scales are covered with an enamel-like tissue
called ganoine.
They found genes for two of the
three unique matrix proteins of
enamel expressed in the genes
of Lepisosteus’s skin, and this
strongly suggests that ganoine is
a form of enamel. In order to determine where the enamel first

capture
accurate
intra-oral shades
and textures while
neutralizing the influence
of ambient light and capturing the desired depth of field.
Images can also be directly
viewed on the computer, tablet or smart phone with a Class
10 Wi-fi SD card and easily archived with the freely downloadable Surefile image management software, without the
fear of patient images being
misplaced. Moreover, a chemi-

informed consent, lab communication, training, legal /
malpractice defence to practice marketing, the EyeSpecial
C-II in short enables the dental
team to easily capture precise
dental images every time.
cal and water resistant camera
body complies with the infection control protocol in the dental operatory.
Designed to meet a range of
critical applications ranging
from routine intraoral photography for treatment planning, orthodontic evaluation,

Contact Information
SHOFU Dental Asia-Pacific
PTE. LTD.
T: (65)-6377 2722
F: (65)-6377 1121
E: mailbx@shofu.com.sg
W: www.shofu.com.sg

Science in Every Smile

WHEN THE MOST TECHNOLOGICALLY
ADVANCED ORTHODONTIC SYSTEM IS ALSO
A MOST ATTRACTIVE NEW REVENUE GENERATOR,
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originated—the mouth or the
skin—the researchers then investigated the dermal denticles
on two fossil fishes: Psarolepis
from China and Andreolepis
from Sweden. In Psarolepis, the
scales and the denticles of the
face are covered with enamel,
but there is no enamel on the
teeth; in Andreolepis, only the
scales bear enamel.
Their findings suggest that
enamel in fact first evolved in
the skin. Dr Per Ahlberg, Professor of Evolutionary Organismal
Biology at Uppsala University,
explained: “Psarolepis and Andreolepis are among the earliest bony fishes, so we believe
that their lack of tooth enamel
is primitive and not a specialisation. It seems that enamel originated in the skin, where we call
it ganoine, and only colonised
the teeth at a later point.”
The study is the first to combine novel palaeontological and
genomic data in a single analysis
to explore tissue evolution. The
results have been published online on 23 September in the Nature journal in an article titled
“New genomic and fossil data
illuminate the origin of enamel”.

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[46] =>

46 news

Dental Tribune Middle East & Africa Edition | November-December 2015

TRIOS shade measurement tool more reliable
than the human eye
®

By Dental Tribune International

he University of Copenhagen and University of Cyril and Methodius conducted a joint study comparing the
reliability of three teeth shade
color assessment methods used
in dentistry. The study evaluated
TRIOS® shade measurement
tool versus the MHT SpectroShade™
spectrophotometric
computer-based system and the
human eye.
The university study found
that the two objective methods,
TRIOS® digital impression solution’s shade measurement tool
and the MHT SpectroShade™
spectrophotometric computerbased system, to be more reliable than the conventional visual
system – the human eye. This is
in accordance with a number of
other studies cited by the study’s
authors. [7-9, 15, 16]
Published in the International
Journal of Oral and Dental
Health, the 2015 in vivo study
compared the three teeth shade
color assessment methods. Concluding that “The reliability of

the objective, computer-based
systems was higher compared
with the subjective, visual method for color determination.”*
Shade matching in the restorative workflow
The study noted that patients
consider shade match to be the
most important factor when
judging the quality of a restoration, especially in the anterior
region.**
However, reliable visual shade
selection by the human eye and
in nature can be inconsistent
due to the complexity of tooth
color and outside factors like
room lighting, patient clothing
and even makeup.
To compensate for these variables, the study performed the
color determination in natural
daylight, but away of all windows with no direct light. Patients were sat in the same unitchair and with the dental lamp
turned off. The angle of the view
for MHT Spectroshade, 3Shape
TRIOS® Color and subjective
VITA 3D-master Vitapan was the
same. Lipstick or other effects
that may affect color assessment

TRIOS® shade measurement screen shot

Study Fact: “The TRIOS® intraoral scanner was easy to handle and more convenient to the patient than the colorimetric
camera system used.”*

were removed and patients with
strong colored clothing were
covered with a white-grayish
cloth.
The study found TRIOS® shade
measurement to be more reliable than the human eye. An
important result because few
practices have the time or resources to meet the ideal con-

ditions used in the study for
evaluating patient’ teeth shades.
When you factor in possible doctor or assistant eye fatigue as
well, then the proven reliability
of TRIOS® shade measurement
becomes even more significant.
To be able to rely confidently on
TRIOS® to identify teeth shades
saves a tremendous amount of
time and steps in the workflow
and adds consistency and accuracy to the procedure.
TRIOS® is the only intraoral
scanner on the market with an
automatic shade measurement
tool included. The digital impression solution embeds the
teeth shade information into
the intraoral scan which is then
used to design the restoration.
This makes communication of
the unique teeth shades much
simpler and eliminates several
steps in the workflow for both
the lab and dentist.
The teeth shades are embedded
in the scan. And in TRIOS® case,
the digitally-shared scan can be
augmented with HD intraoral
images and video – as TRIOS®
also includes an intraoral camera featuring high speed video
and image capture integrated
within the IO scanner.
Study methodology
The study pitted the three shade
measurement methods against
each other: the subjective
(visual) method and the objective TRIOS® and MHT SpectroShade™. Eighty-seven teeth
from twenty-nine patients were
used in the testing.
Visual pairwise comparison was
used in the study for benchmarking because the human
eye and perception is believed to
be the most important factor in
color evaluation.
The study concluded by supporting the use of scanning and color
measuring computer-based systems for dentistry.
Saying, “the TRIOS® Color
Shade system as well as the
MHT SpectroShade™ colorimetric system were able to measure

Same tooth - MHT Spectroshade™
device for colorimetry

all the various shades appearing
all over the tooth surface, thus
give a very detailed shade determination at the tested tooth.”
The study also determined that
“the further development of
such systems for clinical use
would be warranted and could
serve as a valuable tool for material selection and restoration design, particularly in the area of
aesthetic, restorative dentistry.”
References
*Effectiveness of Shade Measurements Using a Scanning and
Computer Software System: a
Pilot Study
**Schropp L (2009) Shade
matching assisted by digital
photography and computer software. J Prosthodont 18: 235-241.
7. Bahannan SA (2014) Shade
matching quality among dental
students using visual and instrumental methods. J Dent 42:
48-52.
8. Judeh A, Al-Wahadni A (2009)
A comparison between conventional visual and spectrophotometric methods for shade selection. Quintessence Int 40: 69-79.
9. Gehrke P, Riekeberg U, Fackler O, Dhom G (2009) Comparison of in vivo visual, spectrophotometric and colorimetric shade
determination of teeth and
implant-supported crowns. Int J
Comput Dent 12: 247-263.
15. Derdilopoulou FV, Zantner
C, Neumann K, Kielbassa AM
(2007) Evaluation of visual and
spectrophotometric shade analyses: a clinical comparison of
3758 teeth. Int J Prosthodont 20:
414-416.
Study Highlights
• TRIOS® shade measurement
is more reliable than the human
eye
• TRIOS® shade measurement
is as accurate as the human eye
• TRIOS® intraoral scanner was
easy to handle and more convenient to the patient than the
colorimetric camera system
• Further development of such
systems for clinical use is warranted and could serve as a valuable tool for material selection
and restoration design in aesthetic and restorative dentistry
• TRIOS® is the only intraoral
scanner on the market with
shade measurement

[47] =>

[48] =>

48 practice management

Dental Tribune Middle East & Africa Edition | November-December 2015

Handling Dissatisfied Customers
By Dr. Ehab Heikal, Egypt

n my earlier book, I have
written how to handle negahollic patients; I am adding
here some extra tips.
There is a difference between
dissatisfied or disappointed
customers and complainers.
The former often only have to
answer to themselves; the latter
most likely will have to answer
to others about the results of
their experience.
Everyone has dissatisfied or
disappointed and complaining

customers and clients. Businesses have them, organizations have them, government
certainly has them, and, unfortunately both employees and
employers have them.
Anyone offering ideas, information, skills, services or
products has obligations:
1. The first obligation is to what
is being offered – to make sure
that what is being offered is
presented in the best possible
manner, given the limitations
of time, space, effort, and/
or money. These limitations

should not be used as excuses
for a poor presentation.
2. The second obligation is to
give customers enough choices
(more than one of two or yes or
no but not so many as to confuse customers) so they believe
that in making their decision
to buy or not they have made
the best decision. If customers
sense they are not being given
enough options, they will delay
their decision until they find
the right options to satisfy their
needs.
This is called giving custom-

ers a “marketplace,” a place
where they see what their options are.
3. The third obligation is to
make sure one’s customers
are never embarrassed for accepting or, even, contemplating accepting what is offered.
If a customer thinks they will
be embarrassed for buying a
service or even contemplating
buying or accepting what is offered that they will not bring
the subject before their family,
friends, associates, acquaintances, customers/clients. Often
this is because you did not give

the customer the information
necessary to use in their presentation when relating their
experience. The result may
be that the customer will badmouth the clinic, the clinic’s
presentation and the services
much to the detriment of the
clinic and the clinic’s services. For example, a customer
came for an implant and you
found that -for clinical reasons like bad oral hygiene or
diabetes- the customer should
have a partial denture (just a
mere example), then your customer needs to know precisely
why you cannot perform the
required service and explain
clearly your strong reasons.
Or if you find that the financial
status of the customer cannot
afford the quality implant service that you provide, and still
prefer to treat the customer using other options. You need to
explain clearly to the customer
why are you more expensive
than other competitors and
that you are selecting for him
the second best alternative you
can perform for him.
Conversely, customers have
three obligations:
o To pay for what was received
as agreed.
o To expect, and possibly demand, that everything be presented in its best possible manner.

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o To complain if they don’t like
the way they were treated or
the way something was presented.
When a Customer comes in to
complain, they are exercising
their obligation to whomever
is offering the idea, information, skill, service or product.
When an employee receives a
complaint from their supervisor, the supervisor is exercising their obligation to the employee. When management
receives a complaint from
their employee, the employee
is exercising their obligation to
their management.
No one likes complaints. If a
clinic doesn’t have complaints,
it’s not doing anything... and
that will bring on the complaint
from someone that the clinic
isn’t doing anything.
An adage is, every business deserves the customers they have.
By this, it is meant that when
one has a demanding customer
one has to understand why that
person is so demanding. There
could be many reasons:

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o The customer does not believe they are getting “addedvalue” -- they want to get more
than they are paying for or, as
with a complainer, they want to
pay less, i.e., complaining with
the idea that they will get their
money back.

> Page 50

[49] =>

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[50] =>

50 practice management

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 48
because they see you do it, and
that you want them to repeat
the complaint several times so
you know you have it right.
If a customer keeps calling
about trivial things it may be
due to any of the above or it
may be that doing so makes
them feel that, by doing so, they
are letting you know that they
have confidence that you will
not steer them wrong.
It may be that calling you
makes them feel that they are
an important customer even if
you don’t think so.

o They have a problem, they
are being challenged by someone else and in order to come
up with an answer to alleviate
the problem they will be take
that problem back to the seller.
This is known as the-squeakywheel-that-gets-the-grease
syndrome.
o They have been sent on a
mission to come back with the
“right” (in someone else’ mind)
and they believe something or
someone is getting in the way.
Hence, they will be “punished”
i.e. embarrassed for not having
the information wanted.
o It could be that they had “buyer’s remorse” (buyers regret)
in that they could not justify

their purchase without getting
something additional from the
dentist that would give them
the “power” to justify the purchase.
When people find that their or
others’ complaints are not met,
they will get even in any way
they can. This could be to come
in and yell where others can
hear them, delay paying or not
paying, telling others their side
but not the dentist’s side, of the
problem, story, etc.
There are many ways to handle
complaints. The first thing is
to let them know that not only
are you listening to them, you
are writing down what they
are saying as they are saying it

While disgruntled customers
may not fit this term, certainly
complainers are often called
“customers from hell.” Customers from hell are those that
do not come in but tell hundreds of others that you are a
vendor from hell. When that
happens you may both meet in
the same place.
Handling complaints can be
outline in four steps:
1. Make sure the complainer
is sitting down. If left standing
when the recipient of the complaint in interrupted or goes
to look up some records the
complainer will become impatient or just leave the situation.
Sitting in a chair can be tantamount to having the Customer
glued to the chair.
2. If possible, do not put a table, counter, or desk between
the complainer and the person
receiving the complaint. Doing
so makes it adversarial. Sell-

ing is a partnership – and the
listener before, during and after the hearing the problem is
the complainer’s liaison to the
organization or business. Of
the customer senses that their
time, effort, space or effort is
being wasted, it can acerbate
the problem. When one’s Customer/partner has a problem,
guess who has the problem?
3. Get out a pad and pencil,
ask the complainer to state the
problem. Write down what they
are saying as they are saying it.
This has two different effects
on the situation. First, the Customer’s complaint is intangible
until it is put down in tangible
form. By writing down all the
particulars of the complaint it
becomes tangible. Secondly,
since the listener cannot write
as fast as the complainer talks,
the complainer while waiting
for the writer to catch up will
be slowing down their presentation, hence causing a calming
effect.

swers to questions they needed
to answer the questions before
the question(s) were asked.
4. Process the complaint as
soon as possible. Let the customer know when they will be
getting a reply... and get back
to them before that time. If the
service or Products is defective,
do not argue! Make it right,
right away. Do not hesitate to
replace it, do it over, or give a
refund.
If the reply is negative to what
the complainer wants, the
negative reply has to be sold
to whomever the dissatisfied
or disgruntled or complaining
customer will be talking to.
Lastly, it is everyone’s obligation within their working or familiar environment where the
problem arose to discuss the
problem, the situation and the
solution. This information will
help others handle the problems later.

Get the Customer to repeat the
story as many times as possible
and note each change in the
story. Each time, more pertinent information will come out.
Very often, the complainer has
been told what to say by someone else. It is their sales presentation. The person receiving
the complaint is the buyer and
will not buy the validity of the
complaint unless they can sell
the validity to someone else.
Many complaints stem from the
fact that the customer was not
given, in tangible form, the an-

Contact Information
Dr. Ehab Heikal
BDS.FICD.MBA.DBA
(Practice Management
consultant)
eheikal@gmail.com

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[51] =>

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a robust hydroxyapatite-like layer over exposed dentine and within dentine tubules.1–5
With Sensodyne Repair & Protect, you can do more than treat the pain of dentine
hypersensitivity – you can repair and protect your patients’ exposed dentine.

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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
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References: 1. Burwell A et al. J Clin Dent 2010; 21(Spec Iss): 66–71. 2. LaTorre G, Greenspan DC. J Clin Dent 2010; 21(3): 72-76. 3. West NX et al. J Clin Dent 2011; 22(Spec Iss):
82-89. 4. Earl J et al. J Clin Dent 2011; 22(Spec Iss): 62-67. 5. Efflandt SE et al. J Mater Sci Mater Med 2002; 26(6): 557-565. Prepared December 2011, Z-11-516.

[52] =>

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References.. 1. Jeandot J et al. Clinc (French) 2007; 28: 379–384. 2. Nagata T et al. J Clin Periodontol 1994; 21(3): 217–221. 3. GSK data on
file. DOF Z2860473. 4. Leight RS et al. J Clin Dent 2008 19(4) 147-153. 5. Schemehorn BR et al. J Clin Dent 2011 22(1) 11-18. 6. Shellis RP
et al. J Dent 2005 33(4) 313-324. 7. GSK data on file. DOF Z2860415. 8. GSK data on file. DOF Z2860435.
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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
Prepared: July 2014, Item Code: CHSAU/CHSENO/0034/14
We value your feedback
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[53] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

ENDO tribune 1B

Supernumerary teeth: Diagnosis and treatment

ENDO TRIBUNE

By Drs Javier Martínez Osorio & Sebastiana Arroyo Boté,
Spain

bstract
We report the case of
a 17-year-old patient
who came into the clinic because she had noticed a colour
change to the maxillary left
central incisor (tooth #21) of
48-hour duration. During clinical examination, tooth #21 appeared darker than the rest of
the teeth.
After performing a complete
exploration and obtaining no
response to vitality tests, a pulp
necrosis of tooth #21 was diagnosed. Differential diagnosis
began with the completion of
the medical record. The patient
had received orthodontic treatment and a supernumerary
tooth in the anterior region of
the maxilla had been extracted.
The patient did not recall hav-

ing suffered injuries or trauma
in the incisal region. A dental panoramic tomogram was
obtained, and a high-density
area was observed at the apical
level in the area of tooth #21.
A 3-D computed tomography
(CT) scan was then obtained,
and it showed the presence of
a supernumerary tooth in the
periapical region of tooth #21,
palatally located and oriented
upwards.

Case report
A 17-year-old patient who had
undergone orthodontic treatment four years before came
into the clinic because she had
noticed a colour change to her
maxillary left central incisor
lasting for 48 hours. The patient presented with a tooth discoloration (Fig. 1) with slight
pain that ceased with a nonsteroidal
antiinflammatory
drug. During the initial visit
to her general dentist, vitality tests were performed and a
slight response to the tests was
detected. After that, the patient
was referred to a specialist.
When she presented to the endodontist, the tooth had darkened to a grey-brown colour.
In addition to that, the tooth no
longer responded to pulp vitality tests. During the visit, the endodontist performed periapical
radiographs of the area (Fig. 2),
and based on this the existence
of a supernumerary tooth at the

apical level of the incisor growing towards the floor of the nasal cavity was confirmed.
The endodontist requested a
CT scan to study the position
and assess the possibility of
surgical extraction. The CT
scan showed the position of
the supernumerary tooth relative to the roots of the adjacent
teeth, confirming growth towards the periapical region of
tooth #21, that is, a 180-degree
deviation from the correct orientation for eruption in the
dental arch. Reconstruction in
3-D showed this phenomenon
clearly (Figs. 3–6).

The World’s Endodontic Newspaper Middle East & Africa Edition

Necrosis by compression of
the neurovascular pedicle of
tooth #21 due to the expansion
of the erupting follicle of the
supernumerary tooth was diagnosed. Pulpectomy and surgical removal of the supernumerary tooth were performed.
During surgical removal of the
supernumerary tooth, the neurovascular pedicle appeared
oedematous and congested and
was the cause of the tooth pulp
necrosis.

Endodontic treatment of tooth
#21 was performed, during
which the congested pulp was
removed and some bleeding
was observed. The length of
the guttapercha obturation
was deliberately longer than
required in order to facilitate
surgery (Figs. 7–9).

Surgical treatment was planned
and consisted of raising a semilunar flap on the periapical region of tooth #21 and performing a minimum root resection
of 2 mm approximately without
a bevel, using a size 0.23 round
bur with a straight handpiece,
to expose the supernumerary
tooth’s crown. The crown was
sectioned at the coronal middle
third and the incisal portion
was removed (Fig. 11). A hole
was made in what would be
the middle and cervical thirds
of the supernumerary tooth to
force it up (Fig. 12) and make
the extraction through the
osteotomy created for apicectomy, thereby achieving a complete extraction (Fig. 13) with
minimal trauma to bone and
the roots of the incisors.
The oedematous pedicle that

> Page 2B

Pre-Op

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Tooth 38
Dx : Acute pulpitis
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[54] =>

endo tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 1B

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Fig. 9

Fig. 10

Fig. 11

Fig. 12

Fig. 13

Fig. 14

Fig. 15

Fig. 16

Fig. 17

Fig. 18

Fig. 19

Fig. 20

was compressed by the erupting follicle of the supernumerary tooth and caused a lack of
blood supply to the pulp of the
left central incisor can be observed in the image, held by a
haemostat (Fig. 14).
Afterwards, preparation for
retrograde root filling was
performed using a Satelec ultrasonic system and the appropriate handpiece for this
surgery. Retrograde root filling
was performed with SuperEBA
(Bosworth), thereby achieving
sealing of the canal at apical
level (Figs. 15 &16). The flap
was closed with three silk sutures (Fig. 17), which were removed after seven days.
Supernumerary tooth after extraction can be observed in the
picture (Fig. 18).
Two months after the intervention, internal whitening
was performed to improve the
colour of the incisor. The last
two images show the clinical
appearance (Fig. 19) and a radiograph (Fig. 20) three years
posttreatment.
Discussion
CT scans, which have been
widely used in endodontic diagnostics for fractures and

fissures, for example, and in
implantology, are not yet commonly used in surgical planning to obtain diagnostic and
anatomical data. The relevant
and detailed information that
this imaging technique provides, especially regarding
the position of supernumerary
teeth, is proof that it should
form part of the protocol during
surgical planning.
The second point of discussion
is the pathway used to approach
the supernumerary tooth. We
could have used a palatal pathway, but the CT scan revealed
that the vestibular pathway was
less risky, provided greater visibility and better respected the
important anatomical structures, such as the adjacent
teeth, without injuring them by
accident and risking an iatrogenic injury.
Another important point to be
observed is the pathophysiological mechanism that resulted
in pulp necrosis. We suspected
an apical or periapical resorption of tooth #21 because of the
expansion of the erupting follicle and secondary osteolysis,
which cannot be excluded. In
order to eliminate the greatest
number of cells involved in the
resorptive-destructive process,
an apicectomy was performed.

Nevertheless, pulp congestion
suggested that the most probable pathophysiological mechanism involved was venous stasis of the vascular plexus that
enters the incisor, just before
apex.
The last point of discussion is
when these supernumerary
teeth should be removed. If possible, the best time for removal
is before any pathology signs
appear. This requires consideration of the individual case
of each patient, and performing clinical and radiographic
follow-up of the case in order to
determine the right time.
Conclusion
The presence of supernumerary teeth in the permanent
dentition has a frequency of
between 0.1% and 3.8%. Necrosis of the adjacent teeth is one
of the possible complications
of this phenomenon; therefore,
clinicians must consider the
possibility of a supernumerary
tooth during diagnosis, especially in patients with pulp necrosis without previous traumatic dental pathology.
Editorialnote: This article was
published in cone Beam - international magazine of cone
beam dentistry No. 01/2015

About the Author

Dr. Sebastiana Arroyo Boté
Graduated in medicine in 1983
from the University of Barcelona. She specialized in dentistry
in 1985. She has been Associate
Professor of Conservative Dentistry and Endodontics at the
University of Barcelona since
1992. She maintains a specialist private practice for conservative dentistry and endodontic
treatment in Barcelona.

Dr Javier Martínez Osorio
Graduated in medicine in 1981
from the University of Barcelona in Spain. He specialized in
dentistry in 1983 and in plastic
surgery in 1987. He has been Associate Professor of Conservative Dentistry and Endodontics
at the Faculty of Dentistry at the
University of Barcelona since
1996. He maintains a specialist
private practice for implant and
endodontic treatment in Barcelona. He is the author of numerous publications, and lectures
around the world on current issues in endo dontics and implantology. He is a member of the Sociedad Española de Implantes,
Asociación Española de Endodoncia, Sociedad Española de
Odontología Conservadora and
Sociedad Española de Cirugía
Oral y Maxilofacial (Spanish
associations for oral implantology, endodontics, conservative
dentistry, and maxillofacial surgery).He is also president of the
Societat Catalana d’Odontologia
i Estomatologia (Catalonia society of dentistry). He can be contacted at 16486jmo@comb.cat.

She has authored a number of
publications, and lectures on
current topics in endodontics
and conservative aesthetic dentistry. She is a member of the
Asociación Española de Endodoncia and Sociedad Española
de Odontología Conservadora
(Spanish societies for endodontics and conservative dentistry). She can be contacted at
20506sab@comb.cat.

[55] =>

Dental Tribune Middle East & Africa Edition | November-December 2015

ENDO tribune

EndoSequence® BC Sealer™ and Root Repair
Material (RRM™)
By BUSA

ndoSequence BC Sealer
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have been in search of the ideal
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material. Unlike other facets
of dentistry, endodontic seal-

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needs and so much more!
EndoSequence® BC Sealer™
EndoSequence BC Sealer is a
revolutionary premixed root

canal sealer which utilizes new
bioceramic
nanotechnology.
Unlike conventional base/catalyst sealers, BC Sealer utilizes
the moisture naturally present
in the dentinal tubules to initiate its setting reaction. The
canal should be dried just like
you normally would but unlike
other sealers the set will not
be inhibited by moisture. This
highly radiopaque and hydrophilic sealer forms hydroxyap-

EndoSequence® BC Sealer™

atite upon setting and chemically bonds to both dentin and
to our bioceramic points (EndoSequence BC Points™). BC
Sealer is anti-bacterial during
setting due to its highly alkaline pH (+12) and unlike traditional sealers; BC Sealer exhibits absolutely zero shrinkage
and is extremely biocompatible! BC Sealer can either be syringed directly into the coronal
3rd of the canal or delivered via

a hand file or point. BC Sealer
can be used with cold or heated
methods. However, many specialists have come to the conclusion that heat is not necessary with BC Sealer because
of its slight expansion (.03%)
and its ability to bond to dentin. This truly revolutionary
sealer has remarkable healing
properties and is designed specifically to be non-resorbable.
In the event of a slight overfill
(puff) an anti-inflammatory
reaction will not occur because
the sealer is essentially a root
repair material with a flowable
viscosity.
EndoSequence® Root Repair
Material (RRM™)
EndoSequence® Root Repair
Material (RRM™) is available
in two specifically formulated
consistencies (syringable paste
or condensable putty) and contains many of the same characteristics as BC Sealer. Like BC
Sealer the setting reaction of
RRM is driven by the moisture
naturally present within the
dentinal tubules so there is no
mixing required. The favorable
handling properties, increased
strength and shortened set
time (~1.5-2 hours) make RRM
highly resistant to washout and
ideal for all root repair and pulp
capping procedures. The putty
consistency is ideal for retrofills, one step apexifications
(apical barrier technique), external resorptions and pulp
capping. The syringable version is recommended for retrofills, perfs, internal resorptions
and pulp capping. Many specialists employ a retrofill technique which involves syringing
some of the flowable RRM into
the prep and following it up
with pre-formed cones of the
RRM Putty. The consistency
of RRM Putty is similar to that
of Cavit™ and it is extremely
resistant to washout making
it ideal in difficult fields. The
unique properties of RRM Putty
allow the practitioner to adjust
the consistency to their liking.
The more you manipulate the
material (via kneading it with
a sterile instrument within the
jar provided) the more flowable
it will become. RRM is antibacterial (12+ pH) and is extremely
biocompatible and osteogenic.
Join the thousands of specialist that have set their spatulas
aside and joined the RRM revolution!

Contact Information
For more information or to order contact Brasseler USA: 800841-4522 or visit www.brasselerusa.com
For more information call BrasselerUSA at 800-841-4522 or
visit www.BrasselerUSA.com

[56] =>

4D

[57] =>

lab tribune 1C

Dental Tribune Middle East & Africa Edition | November-December 2015

IPS e.max Smile Award 2016:
In search of the world’s most esthetic
dental cases

Ivoclar Vivadent is launching an international contest

By Ivoclar Vivadent AG

PS e.max is the most popular all-ceramic system in
the world.* It has proven
itself a million times over. A
decade of clinical studies and
more than 100 million restorations confirm the success and
reliability of this system. Its
manufacturer, Ivoclar Vivadent, is now launching a worldwide contest to find the most
esthetic dental cases solved
with the IPS e.max system.
Users from all over the world
are called upon to hand in
their most impressive dental
work.

evaluate the projects presented with regard to esthetics,
complexity and harmony and
select the winners. The top
submissions will receive international recognition. The
awards for the best entries will
be presented on 10 June 2016,
on the eve of Ivoclar Vivadent’s
International Expert Symposium in Madrid, Spain.
Teamwork is a must
This is how it works: Participation is restricted to dentist/
dental technician teams only.
After signing in at www.ipsemax.com/smileaward, the

A panel of noted experts will

> Page 3C

Ivoclar Vivadent launches the IPS e.max Smile Award 2016

LIFELIKE ESTHETICS –
EFFICIENTLY PRESSED

20 years of digital panoramic
imaging: Seeing better with
modern technology
By Sirona

he first digital panoramic X-ray machine that
Sirona put on the market
20 years ago made perceptible
changes in radiological imaging in dentistry – away from
films that had to be developed
with chemicals and then physically stored to a fast, more precise method with easy storage
function.

IPS e.max PRESS MULTI
®

Digital X-rays, first patented
in 1988, became a marketable
commodity in 1995. Sirona
presented the first panoramic
X-ray machine with a digital
sensor, the ORTHOPHOS Plus
DS, 20 years ago. The ultimate
goal: top image quality for an
even more reliable diagnosis
with lower radiation exposure
for patients. The workflow
within the practice was simultaneously improved. It was no
longer necessary to develop
films with chemicals.
Since then, digital imaging has

THE WORLD’S FIRST POLYCHROMATIC PRESS INGOT

20 years later: ORTHOPHOS SL (here: 2D) provides top image quality
thanks to the innovative Direct Conversion Sensor technology.

become a fixed component of a
dental practice and has many
advantages over conventional
imaging with X-ray films: time
is saved because the images
are available immediately, the
images can be processed on a
computer and the image quality is higher with reduced ra-

diation exposure. Today, sensor
or scanner systems are usually
used for intraoral images instead of conventional films.
Three-dimensional imaging
has become standard, especially for implantology.

> Page 2C

amic
all cer need
u
all yo

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

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

[58] =>

2C lab tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

Ceramill Dicom Viewer - Ceramill Mind upgrade
module for the visualisation of Dicom data
By Amann Girrbach AG

he Ceramill Mind upgrade module “Ceramill
Dicom Viewer” is a visualisation and communication
software. It allows data from
CT or CBCT machines (Dicom format) to be imported,
displayed and merged with stl
data to make underlying or superficial anatomical structures
of the patient visible. Different
visualisation
options
enable
DTSC_A4_EN_Layout
1 04.02.14
14:23 Seite 1

easier, more precise and
therefore more reliable
quality of communication between the dentist
and laboratory.
Three-dimensional radiographic images imported into the Ceramill
Dicom Viewer thus provide
information about the paths
of the jaw and facial nerves,
bite relationship of the teeth
to one another or the bone

quality. The sections and anatomical planes to be displayed
can be regulated via recognition of the tissue thickness,
which achieves more precise
pre-planning of the restoration.
Once stored as an stl data record, the patient data can be accessed in the Ceramill Mind for
checking or information, e.g.
when designing abutments.

Contact Information
Amann Girrbach AG
Herrschaftswiesen 1
6842 Koblach/Austria
Tel. +43 5523 623 33-0
austria@amanngirrbach.com

< Page 1C

The beginning of digital panoramic images: ORTHOPHOS Plus DS
was launched in 1995 and set new
standards for whole-jaw scans.

www.DTStudyClub.com

Y education everywhere
and anytime
Y live and interactive webinars
Y more than 500 archived courses
Y a focused discussion forum
Y free membership
Y no travel costs
Y no time away from the practice
Y interaction with colleagues and
experts across the globe
Y a growing database of
scientific articles and case reports
Y ADA CERP-recognized
credit administration

FREE!

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

Digital imaging constantly
improving
The latest innovations by Sirona in imaging techniques have
taken digital imaging to a whole
new level. The Direct Conversion Sensor (DCS) is new and
absolutely unique in this form.
It generates electrical signals
directly from X-rays without
the previously required intermediate stage of first converting them to light. The image
data this yields is significantly
better in relation to the exposure to radiation. The Direct
Conversion Sensor generates
extremely sharp X-ray images
very efficiently.
For one panoramic image the
Sharp Layer technology, which
is also new, uses several thousand individual projections
that are taken very rapidly from
several angles in one rotation
and reproduce the individual
morphological situation very
precisely.
The advantages are excellent
panoramic images and the possibility of compensating for positioning errors retroactively.
The future means integration
With respect to the many possibilities for digital imaging diagnostics, there is a clear trend:
More and more processes in
dental practices are digital.
The next step here is integration. “Our products can be easily integrated with one another,”
says Jörg Haist, Head of Product
Management Imaging Systems
at Sirona.
“Our SIDEXIS 4 imaging software ensures that panoramic
and other X-ray data can not
only be processed, but also accessed in the treatment center,
documented in the practice
administration, and used with
CEREC.” Thanks to interfaces
that have been implemented,
Sirona products will remain
open for integration of different
imaging systems in the future.

[59] =>

lab tribune 3C

Dental Tribune Middle East & Africa Edition | November-December 2015

Ceramill Argotherm 2

Shielding gas sintering furnace for Ceramill Sintron enters the next generation

By Amann Girrbach

wo years after the market
launch and more than
one million Ceramill
Sintron restorations placed
clinically, Amann Girrbach
now supplies a new, improved
generation of the Ceramill Argotherm shielding gas sintering furnace – elegant and in the
already familiar design of Ceramill equipment. The enlarged
furnace chamber enables easier and more reliable han-dling

of the removable Ceramill Argovent sinter chamber, while
an integrated compressed air
and shielding gas monitor ensures even higher process reliability during the sintering proce-dure. Equipped with touch
screen and a clear conceptualised display for optical control
of the sintering process the
successor model also provides
increased comfort in terms of
operability and handling.

were specially developed for
sintering the dry millable CrCo
sinter metal Ceramill Sintron
and guarantee distortion-free,
predictable and cavity-free final sintering of restorations at
the press of a button. The compact furnace with minimum
space requirement is used as a
bench model and actively cools
after sintering.

Contact Information
Amann Girrbach AG
Herrschaftswiesen 1
6842 Koblach/Austria
Tel. +43 5523 623 33-0
austria@amanngirrbach.com

Ceramill Argotherm furnaces

Ceramill Argotherm 2

< Page 1C
participants will receive the
login credentials for their individual account. They are asked
to submit their best project,
which should include at least
six units. The case should be
documented in detail using
pictures and videos. Entries
will be accepted until 28 February 2016.
International recognition
As esthetic perception varies
from continent to continent
and region to region, there will
be several winners. The best
three teams of the four regions
Europe/Middle
East/Africa,
North America/Oceania, Latin
America and Asia will win the
“IPS e.max Smile Award 2016”.
They will receive worldwide
attention: their works will be
presented to a broad public
through social media, at trade
shows and other events and in
professional journals.
IPS e.max® is a registered
trademark of Ivoclar Vivadent
AG.

The STRONG alternative to lithium disilicate.

*based on sales quantities

Contact Information
Ivoclar Vivadent AG
Bendererstrasse 2
9494 Schaan/Liechtenstein
Tel.: +423 235 35 35
Fax: +423 235 33 60
E: info@ivoclarvivadent.com
W: www.ivoclarvivadent.com

Highly aesthetic and reliably stable –
Ceramill Zolid FX anterior restorations with precise staining
concept according to the VITA classical shade guide.
Beirut | Lebanon I Fon +961 3133911
mea@amanngirrbach.com
www.amanngirrbach.com

Dental Tribune_ET1507_Ceramill Zolid FX_A4_4c_AG4990_EN_v01.indd 1

20.07.15 14:27

[60] =>

4C lab tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

The esthetics of slowness
By Sirona

T
Fig. 1: A new look at CEREC – super slow: A high speed camera shows the
fascinating precision of the Sirona CEREC MC XL Premium Package milling
machine.

he tempo of our times is
fast. Many things today
happen at such a breathtaking speed that the details of
movement can hardly be perceived. But behind the speed
lies utmost precision – for example when milling a crown with
CEREC.
Thanks to technical advances,

highly precise production is possible at a breathtaking speed.
Ultra-modern technology also
allows us to record these movements in super slow motion so
we can make things that happen too fast to be detected by
the human eye become visible.
Sirona used this technology to
record the production process
of a CEREC crown in the Sirona
CEREC MC XL Premium Package milling machine using a

inLab MC X5:
DENTAL LAB
FREEDOM OF CHOICE.

Fig. 2: Visitors to Facebook were enthusiastic about this new way of experiencing the precision of CEREC.

high-performance camera at a
speed of 2,000 images per second. The result is a fascinating,
choreographed ballet of technology. Milling tools, ceramic,
and water jets act in a very small
space, recorded using a special
lens and with a soundtrack of
appropriate classical music.
“No one has ever seen CEREC
like this in 30 years,” even Aaron Dayringer, CEREC Product
Manager at Sirona, was impressed.
The video, which was posted on
various social media sites, creates an emotional feeling about
this fascinating technology,
as numerous comments have
shown. “The number and kind
of reactions are overwhelming;
we certainly did not expect that,”
says Andreas Blauig, Corporate
Social Media Manager at Sirona.
The video has now been viewed
on Facebook more than 70,000
times, more than 800 viewers
have shared the clip, many times
the average for the industry.

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

INLABMCX5.COM

But at the same time, the video
is more than merely image advertising. “The appeal of CEREC
restorations stems from their
high level of precision. Only if
they fit precisely can restorations be completed in one sitting without any problem,” says
CEREC specialist Dayringer.
“The sophisticated milling processes ensure that dentists no
longer have to do any regrinding by hand. The striking video
shows how precisely the CEREC
MC XL Premium Package milling machine works at high
speeds.”
The video can be viewed at this
link https://youtu.be/lGbllSvLluA and may be reused.

[61] =>

hygiene tribune 1D

Dental Tribune Middle East & Africa Edition | November-December 2015

New Philips Sonicare AirFloss Ultra
improves periodontal health in just four weeks
By Philips

OLOGNE,
Germany: Dutch healthcare
manufacturer
Philips
presented its latest innovations in oral healthcare at the
Philips media breakfast on
10 March at the International
Dental Show (IDS) in Cologne.
One of the main innovations is
the new interdental cleaning
device, Philips Sonicare AirFloss Ultra. Study results show
this device is able to improve
periodontal health in just four
weeks. The product is now
available in the UAE
Among other products, Philips presents the next generation Philips Sonicare FlexCare Platinum with a new
AdaptiveClean brush head and the new Air Floss Ultra. (Photograph: Claudia Duschek, DTI)

Oral Probiotics - it is Time to add
Friendly Bacteria to the Mix
By Dr. Jaco Smith, UK

rush more, floss more,
use automated toothbrushes, a water pik,
or place sulcular antibiotics?
What regimens are you currently recommending in your
office for your patients’ oral
hygiene maintenance and prevention? What if I told you that
mechanical removal of bad
bacteria might not be enough
to ensure optimal oral health in
all of your patients? After all, if
simple removal of bacteria was
beneficial then mouth washes
would rein supreme chemical adjunct to mechanical removal. The problem is that this
chemical warfare kills all types
of oral bacteria, including the
good!
The potential issue is that problems can become worse because good bacteria are targeted and reduced and numbers
can decline to levels that allow
bad bacteria to take over. What
if the war on bad bacteria could
be won with target warfare by
out numbering them! It is time
to consider adding friendly bacteria to the mix.
There is an entire category of
products that is underutilized
in the dental profession — oral
probiotics. In fact, they are a
category unto themselves.
Oral probiotics have the potential to make a significant impact on the oral health of our
patients, and systemic health

by extension. While not yet a
therapeutic modality that we
could include in a periodontal
patient’s active phase of treatment, oral probiotics are among
the best options we can use for
patients in differing states of
disease or health.

various pathogenic bacteria for
binding sites. The sites on the
teeth and gums occupied by the
probiotic bacteria reduce the
surface area available for disease-causing bacterial colonization. Furthermore, they also
compete for nutrients.

According to the current adopted definition by the World
Health Organization, probiotics are: “Live microorganisms
which when administered
in adequate amounts confer
a health benefit on the host.”
Lactic acid bacteria (lactobacillus), Streptococcus and Bifidobacteria are the most common
types of microbes used as probiotics and have been widely
accepted in the medical profession. Some benefits of probiotics are decreased hypertension,
managing lactose intolerance,
lowering cholesterol, overall GI
health and soon to be added is
improved oral health and caries prevention.

Use of oral probiotics
Caries As dentists we advise
patients to avoid sugar to prevent caries. Have you ever wondered why some patients’ diets
are loaded with sugar, and yet
they are relatively caries free,
while others partake in a diet
only light with sugar (substrate) and they are highly caries active? How do you respond
to this patient amongst team
members? “They are drinking
more soda then they are telling
us” or “eating more sugar-filled
snacks then they let on.” Here is
the truth when it comes to caries: It isn’t the sugar that causes
cavities but how streptococcus
bacteria use sugar and produce
lactic acid that causes decay.
The ecological plaque hypothesis states that caries and periodontitis, the 2 most common
biofilm- associated diseases
in the world, originate from a
disturbance in the balance and
diversity in the biofilm. Contributing causes may be inadequate oral hygiene, incorrect
diet, stress and/or other factors
which determine the microecology. Caries is caused by the
presence of acidogenic and aci-

The beauty of oral probiotics
are the simple, commonsense
manner in which it works.
All oral probiotics are naturally occurring live bacteria,
freeze-dried and delivered to
the mouth in different ways,
i.e. mouthwash and lozenges.
These products contain different species of oral probiotics,
which are natural colonizers
of a healthy mouth, rather than
genetically engineered. The
patient dissolves one mint in
the mouth per day. The bacteria
are released and compete with

> Page 4D

Sinead Kwant, Category Leader for Philips Oral Healthcare,
said: “We’re very excited to
present the latest solutions
from the Philips Oral Healthcare range at IDS, particularly
as we’re seeing consumers
show an increasing interest in
the role that oral health care
has on people’s overall health
and wellness.”
Philips introduced a wide
range of innovative products
and solutions at this year’s IDS,
such as new electric tooth-

> Page 2D

[62] =>

2D hygiene tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 1D: “New Philips Sonicare AirFloss Ultra improves periodontal health in just four weeks”
Ultra, an innovative product
designed to provide an easy
and effective way to clean inbetween teeth and achieve
healthy gingiva. The device
features Philips Sonicare’s
proprietary technology, which
has been combined with a new
Triple Burst function that delivers three powerful blasts of
liquid (mouthwash or water)
and air to remove plaque and
unwanted bacteria more effectively and efficiently than previous models.
Vistors could test the new Air Floss on site

brushes, interdental cleaning
devices, apps which monitor
and encourage superior oral
hygiene routines, as well as innovative professional whitening products. The company’s
focus is on solutions that encourage holistic health improvements.
A lot of novel products come

from Philips’ Sonicare product line, for example, the new
Sonicare for Kids Connected, a
Bluetooth electric toothbrush
that works together with an
app specifically designed to
encourage children to develop
healthy oral-care habits.
The centre of attention was
the Philips Sonicare AirFloss

“Based on feedback from dental practitioners, we focused on
upgrading the existing model
with new specifications designed to improve interproximal plaque removal and make
interdental cleaning even easier,” Kwant said. “In laboratory
studies, our improved proprietary ‘Microburst’ technology
removed up to 99.9 per cent of
plaque from treated areas, although results will vary from

Bernd Laudahn, head of the Consumer Lifestyle section at Philips DACH,
opened the event

patient to patient.”
A recent clinical study of the
Philips Sonicare AirFloss Ultra
reported up to 97 per cent of
users had improved periodontal health in just four weeks.
While the Philips Sonicare
AirFloss Ultra has not been designed to replace dental floss
for those people who already

floss consistently, it is clinically proven to be as effective as
string floss for improved periodontal health — when used in
conjunction with an anti-microbial rinse in patients with
mild to moderate gingivitis.

“Magical Minutes” Gained with
Air Polishing – What’s the Return
on Investment?

Fig.1: EMS Air-Flow spray

By Karen Davis, Texas

ental Hygienist around
the world share a common habit… monitoring
the clock. How can we increase
efficiency without sacrificing
clinical effectiveness? Biofilm
management with air polishing devices and low-abrasive
powder has been shown to be
significantly more efficient and
more comfortable than biofilm
removal with hand and ultrasonic instruments. Let’s take a
closer look at the benefits.
Biofilm covers the surfaces of the
teeth and all of the tight, narrow
periodontal pockets. It is sticky
and adherent and requires mechanical disruption to remove it.
While power ultrasonic tips and
site-specific hand instruments
are ideal to remove calcified deposits, removal of sticky biofilm
requires numerous overlapping
and repetitive strokes. But by
using air polishing devices that
combine the synergy of air, water, and fine powder, biofilm can
be lifted off with just 5 seconds
of exposure. It is kind to the tissue, enamel and root surfaces,

porcelain and composite restorations, and even implants and
implant abutments.
Multiple studies have found that
while hand instrumentation of
subgingival biofilm removal in
deep pockets can take between
30-64 seconds, air polishing
with glycine powder has repeatedly been found to take only 5
seconds1,2. Comparable clinical
results were achieved in these
studies, but patients consistently favored air polishing from
a comfort standpoint. And, seriously… biofilm removal in 5
seconds per pocket! This is exactly what I have experienced
clinically since shifting to this
technology.
Since not all air polishing devices on the market are suited
for low-abrasive powders, clinicians desiring to efficiently manage biofilm with subgingival
air polishing would likely find
themselves investing in devices
that give clinicians freedom
to use low-abrasive powders
such as the E.M.S. AIR-FLOW®
handy or the AIR-FLOW Master
Piezon® (Fig. 1).

While it would be compelling
to reference a double-blind,
placebo-controlled study confirming a specific dollar amount
as a return-on-investment that
study does not exist. So instead,
I will share real-world experiences. First, let’s appreciate
that biofilm management with
low-abrasive powder requires
a different approach. Since lowabrasive powders and air polishing devices are so efficient
in biofilm removal, clinicians
can begin with use of that technology, finishing up with use of
power and hand instruments to
remove calcified deposits and
remaining stains. Rubber cup
polishing is not required. This
simple transition of going after
the biofilm first with the most
efficient technology saves about
10 minutes of instrumentation
time per patient.
The most obvious use of those
magical minutes could easily be
to couple them together to see
one more patient per day, per
dental hygienist, but I have experienced and observed a very
different return-on-investment.
Within the allotted time per patient on the schedule, having an
extra 8 to 12 minutes due to efficient biofilm management with
air polishing gives the clinician
freedom to be more comprehensive in his or her services.
For example, how many dental
hygienists have intra-oral technology that goes unused due
to time constraints? When is
the last time you sat the patient
upright and performed a shade
guide analysis to discuss the options of veneers versus whitening or Invisalign? What percent-

age of your adult patients today
have comprehensive periodontal charts that have been updated within the past 12 months including recession, bleeding and
furcation involvements? What if
you had time to walk a patient
with pending treatment through
the benefits of not waiting until
symptoms manifest? What if you
had time to take impressions for
whitening, or collect comprehensive periodontal data leading to early diagnosis and treatment of periodontal disease, or
play an educational video explaining the benefits of implants
for missing teeth, or provide
varnish, sealants and desensitizers to better manage caries risk?
These and many other comprehensive and billable services
can be provided, per patient,
without running behind when
you start your appointment by
managing biofilm first with air
polishing devices. What is this
real return-on-investment?
• Happy patients because the
process is more comfortable
and more efficient.
• Happy clinicians because they
finally have more T-I-M-E per
visit to perform services that
have been elusive
• Increased profitability as a result of increased services and
treatment enrollment by the
dental hygienist
Sounds too good to be true?
Try it yourself, and experience
the return-on-investment possibilities with your own magical
minutes.
References
1. Wenstrom JL, Dahlen G, Ramberg P. Subgingival debridement
of periodontal pockets by air
polishing in comparison with ul-

trasonic instrumentation during
maintenance therapy. Journal
of Clinical Periodontology 2011;
38:820-827.
2. Moene R, Decaillet F, Andersen E, Mombelli A. Subgingival
plaque removal using a new air
polishing device. Journal of Periodontology 2010; 81:79-88.

About the Author

Karen Davis is a practicing
dental hygienist in Dallas,
Texas and is owner of Cutting
Edge Concepts, a continuing
education company. She is an
accomplished speaker on topics related to practicing comprehensively. Throughout her
career as a dental hygienist and
consultant she has served on
numerous advisory boards and
councils. Many corporations
within the industry consider
Karen a Key Opinion Leader,
and Dentistry Today has recognized her as a “Top Clinician in
Continuing Education”.

Contact Information
For any questions, please contact: karen@karendavis.net

[63] =>

[64] =>

4D hygiene tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 1D
duric bacteria (mainly mutans
streptococci) metabolizing dietary sugars to create a low local pH environment which can
de-mineralize enamel. Thus
patients whose bacteria war
is being won by the bad bacteria will have more decay than
those where the bad bacteria
is kept at lower levels. How can
we help?
Oral probiotics are able to naturally alter the oral ph levels and
because they are early biofilm
colonizers and non-aciduric,
they build a much smaller biofilm.
Streptococcus rattus JH145 is
a unique strain of streptococcus that does not produce lactic acid, and has been shown

to successfully compete for
nutrients and space on tooth
surfaces with the native strain
of streptococcus that produces
lactic acid. The result is a reduction in decay despite the potential presence of sugar (substrate) in the oral environment.

ets, the future oral health of the
patient is determined by the
type of bacteria that colonizes
first in the base of that clean
pocket. If the harmful bacteria
are first to colonize, the disease
condition will quickly return. If
the beneficial bacteria are first,
then good oral health will be
established and the dental office procedure will have been
successful (Socransky and
Hafajee, 1992, J. Perio, p. 322).
Pathogenic biofilm has a couple
of requisites, and one is a low
pH. So a biofilm with early colonizers that doesn’t make acid
has a harder time harboring
the bacteria that we associate
with dental disease. Harnessing this pH characteristic of
biofilm goes right up into the
face of traditional methods -

Gum and Tooth Health
What do you make of patients
who brush and floss, their
plaque indices are down, and
yet their periodontal health
continues to slump? Can the
same be true of these patients?
Despite their commitment to
mechanically remove bacteria, chemically the bad is still
winning the war.Research has
revealed that even after the aggressive process of scaling to
clean out the periodontal pock-

PRINT
L
DIGITA N
TIO
EDUCA
EVENTS

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

brush ‘n’ floss. Adjusting the pH
allows your patients a way to
manage their biofilm without
having the dexterity and laserfocused education of a dental
hygienist.
When giving brush ‘n’ floss
directions, we end up focusing only on the teeth, and we
miss the elephant in the room
- the tongue. Tongue coating
is not innocuous, nor is it only
a cosmetic concern. Biofilm
on the tongue releases planktonic bacteria in what’s called
a planktonic storm. A coated
tongue sends new biofilm to the
rest of the mouth.
So it’s time for the tongue to be
included in discussions about
biofilm management and prophylaxis and it is here that pro-

biotics plays a very important
role due to their activity in all
oral biofilm.
Probiotic bacteria like Streptococcus oralis KJ3, and Streptococcus uberis KJ2 colonise supra- and sub gingival sites and
produce hydrogen peroxide,
which aids in inhibition of periodontal pathogens. The ability
to reduce these types of harmful bacteria in return results in
a reduction of pathogenic biofilm on the teeth because they
can only cause disease when
they are in direct contact with
the gingival epithelium. If they
are in contact with the tooth
or surfaces other than the gingival epithelium, or if they are
freely floating in the mouth,
they cannot cause periodontal
disease.The patients who suffer from refractory periodontal
disease, or who have poor results from traditional periodontal treatment now have a new
conservative approach which
might provide them results
they were previously unable
to achieve with contemporary
treatments alone. The story of
oral probiotics gets better! This
way of biofilm management is
not the wave of the future any
longer. Recommending oral
probiotics with natural strains
from healthy mouths may be
the ticket for patients who cannot or will not remove their
own biofilm to dental hygienist
standards.
Antimicrobial agents — including therapeutic doses of
systemic and locally applied
antibiotics, mouthwashes, subgingival irrigants, etc. — will
kill probiotic bacteria. This is
why they are not used during
active periodontal therapy. One
of the ideal situations in which
oral probiotics are used is immediately following successful
periodontal treatment. Reducing the repopulation of cariescausing and periodontal bacteria gives the patient a fighting
chance to remain healthy. Probiotics are also ideally used in
periodontally healthy patients,
especially those with a family
history of periodontal disease.
The optimal time to take the
probiotic mint is in the evening,
following the use of all biofilmcontrol devices.
Fresher Breath
In general, amino acids are the
main substrate for the production of oral malodorous compounds. As freshly secreted human saliva contains low levels
of free amino acids, halitosis
occurs as a result of bacterial
putrefaction by several anaerobic species found in the oral
cavity. The most widely used
strategies in the treatment of
halitosis are comprehensive
oral hygiene, including tongue
scraping and brushing, as well
as the use of mouth rinses containing antibacterial agents.
Antibacterial
mouthwashes
and breath fresheners promote
killing up to 99.9% of bacteria
and germs in the mouth. These
products indiscriminately wipe
out both the essential, good

> Page 6D

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6D hygiene tribune

Dental Tribune Middle East & Africa Edition | November-December 2015

< Page 4D

bacteria along with the harmful bacteria. Within several
hours after using an antibacterial mouthwash or breath
freshener, the surviving .1% of
the bacteria remaining in the
mouth will repopulate the full
level of harmful bacteria that
was present in the mouth before the product was used. This
indiscriminate destruction of
bacteria creates ongoing imbalances in the microflora that
naturally inhabit the oral cavity. Antibacterial mouthwashes
and breath fresheners simply
mask the malodor and can never effectively address the issue
on the causal level. Oral probiotics are natural antagonists to
the malodor-creating bacteria,
quickly colonizing to create a
healthy balance of micro flora
and resulting in longer lasting,
truly fresher breath .
The use of benign, commensal

probiotics could therefore offer a complementary and more
long-term treatment strategy to
combat bad breath.
Whiter Teeth
A natural by-product of oral
probiotics is a low-dose of hydrogen peroxide. As this good
bacteria is replenished daily, it
creates a gradual teeth whitening effect with the full benefits
of long contact times, delivering
24 hour per day coverage of balancing and brightening. Yellowing, surface discoloration
or staining are all results of
lifestyle choices: tobacco use,
coffee, tea, beets, etc. Anything
that stains will affect the color
of the teeth. Tooth enamel is
porous, filled with microscopic
cracks and pores that hold onto
staining products. Commercial tooth whiteners employ
extremely high levels of harsh,

chemical hydrogen peroxide
which can actually damage the
tooth and create a roughness
on the tooth’s surface. This increases the film that builds up
on the tooth surfaces and in the
micro cracks and is available
to hold on to stains much better. Streptococcus oralis KJ3
binds to the surface of the teeth,
crowding out harmful bacteria by competing for the same
nutrients and surface spaces.
In laboratory studies, the lowdose hydrogen peroxide produced by the Streptococcus
oralis KJ3 created a continuous
whitening benefit that did not
plateau over the duration of the
study. With daily use, the colonization of Streptococcus oralis
KJ3 provides a constant and
expanding population for gradual and continual whitening
effects. The hydrogen peroxide metabolites of Streptococcus oralis KJ3 also contribute to
the breath-freshening features
of oral probiotics by inhibiting
the growth of harmful bacteria.
The decrease in these harmful
bacteria results in a substantial
reduction in the volatile sulfur
compounds associated with
bad breath. Unlike other whitening products, oral probiotics
are completely safe for veneers,
caps and dentures.
Systemic link
The patient’s health and family
history are sources of considerable impactful information. A
patient with a strong family history of diseases and conditions
such as cardiovascular disease,
diabetes, periodontal disease,

high blood pressure, and rheumatoid arthritis, among many
others, has a potentially heightened risk for these diseases as
well. A large body of research
has demonstrated several different mechanisms of oral-systemic associations. One is the
effect of the chronic inflammatory properties of periodontal disease on various diseases
and conditions. Another is the
effect of the periodontal pathogens on cardiovascular diseases and events, independent
of periodontal disease. There
is also the increase in insulin
resistance from the inflammatory and infectious components
of periodontal disease. Insulin
resistance is the biggest root
cause of atherosclerosis, which
is the initiating event for heart
attacks and strokes. Reducing
the number of pathogenic bacteria, along with the oral contribution to the total inflammatory burden in the body,
by consistently and effectively
controlling periodontal disease
can only result in better patient
health.
As clinicians, it is important to
take these risk elements into
account when evaluating a
patient and developing a treatment plan for periodontal disease. The maintenance phase
of periodontal therapy, along
with the effectiveness of the patient’s home care, determines
how long a perio patient will remain healed. Using all the tools
at our disposal, including oral
probiotics, will help to optimize

our patients’ oral and general
health.
Patients who have been susceptible to health breakdown
due to age related or medically
induced changes can now have
conservative treatment to help
reverse these issues. Patients
who undergo extensive dental
treatment such as implants,
veneers, full mouth rehabilitations, or even are currently undergoing orthodontic therapy
now have a simple treatment
to aid in the protection of their
dental investment. The science and research on probiotic
therapy for overall health and
wellbeing is constantly advancing in new areas and uncovering new benefits. The probiotic
benefits for oral health are an
exciting and newly expanding area of this type of therapy.
The obvious patient demand
for fresher breath is apparent.
How about introducing them to
a mint that not only tastes good
and freshens breath, but allows
for reduction in caries and periodontal disease?
References
• Dr J. J. Smith, (B.CH.D ) Dental Expert and founder of Cleanition Oral Care
• John Nosti, DMD, FAGD,
FACE: Cosmetic case protection
and oral health - Dental Town
Dec 2010
• Shirley Gutkowski, RDH,
BSDH, FACE: An in-depth view
of oral probiotics- Dentistry IQ
• Am. J. Clin. Nut.r 2000:71

Seeing teeth everywhere (while trying not to)
By Patricia Walsh, USA

can always tell when I’m in
great need of a vacation: I
start to dream about teeth.
There are more subtle signs
that often escape me. The first
of which is the emergence of
the robotic hygienist. She lurks
inside of me and, fortunately
for all those involved, doesn’t
rear her ugly head too often.
The other is the OCD hygienist.
The one who doesn’t enjoy the
human variety of her coworkers and sees them only through
OSHA-colored glasses.
To survive the reality of a dental office for decades, one has
to care for both the body and
the mind. They say, “Dentistry
maims its survivors.” This can
be true of both mental and
physical well being if we don’t
take an adequate amount of
time off.
I’ve been labeled a C.E. junkie
in the past. But this vacation
week, I wanted nothing to
do with teeth. Big teeth, little
teeth, interestingly odd teeth or
perfect teeth: They were not on
the vacation agenda.
But I was wrong.
I took a cab from my hotel in the
French Quarter of New Orleans
to the cruise ship terminal. My
taxi driver, Dimitri, told me

he was from Croatia. “That’s
different,” I thought. Not that
I expected him to look like
Satchmo, but I was unaware
of NOLO being the melting pot
that it is. It reminded me of the
time I was on the banks of the
Thames in London. It was the
day of the Lord Mayor’s parade.
A beautiful majestic spectacle
full of all the pomp the Brits do
so well. What surprised me was
the music. It was one Dixieland
jazz band after another. Who
knew the English were so fond
of traditional American music?
And this was long before London had a mayor born on U.S.
soil.
While my cab was at a stoplight
on Bourbon Street, a young
man crossed the road in front of
us. The only thing odd I noticed
about him was his plaid undergarments hiked up to his waist.
His jeans seemed to sit, precariously balanced, farther south.
I thought that style had come
and gone. “Look at him,” Dimitri said with his heavy Eastern
European accent. Dimitri held
his hand up and dramatically
waved it around a bit. “Just look
at him. All his tattoos, probably cost $400 a piece, and yet
he is missing a front tooth.
Just stupid. He cannot fix his
front tooth?” I wanted to say,
“You’re preaching to the choir.”
But instead I uttered my newly
learned Southern expression,

“Um- Hmm,” with a big emphasis on the “Hmm.”
A few days on the cruise ship
and I was starting to feel like
my old self again. I eagerly
awaited climbing Mayan pyramids in Belize with my newfound zest for life. Halfway up
a hill to the Xunantunich ruins,
my guide stopped to pull a leaf
off a tree and asked, “Anybody
know what this is? Here, taste
and see if you can tell me.” It
was allspice, but nobody in
the group had guessed it. The
Mayans used this leaf to cure
toothaches. They tucked it between the gum and the tooth
to relieve pain. Hmmm. While
I wasn’t so sure about the pain
part, it certainly may have had
some antiseptic qualities to it.
On we went to the pyramids.
During the excavation, remains
had been found entombed midway up, in the front of the structure. What the archeologists
were surprised to discover was
that the deceased were Guatemalan. According to my guide,
this was established by analyzing the teeth. Dead slaves or
prisoners perhaps? The Guatemalans had a diet that consisted of different grains than
those commonly used in Belize. The guide speculated that
it was the wear and tear on the
teeth that distinguished them
as Guatemalan. Hmmm again.
I had a vague recollection of ar-

cheologists doing an analysis of
a sacrifice victim’s calculus at
a Mayan site. It enabled them
to determine the origin of the
remains based on diet. Part of
me wanted to raise my hand
and say, “’Scuse me, ’scuse me,”
like that annoying apple polisher we all once sat next to in
grammar school. But I was on
vacation. And I wondered, “Was
there no escape from teeth for
me this week?”
When I returned home, I decided to write about my exciting
trip and all of its dental anecdotes. Just as I started, I noticed
a ladybug land on my keyboard.
I remembered my grandmother telling me it was good luck to
have a ladybug land on you (in
spite of the fact that the bug’s
house was on fire and her children all gone). I looked up the
origin of the children’s rhyme.
I found out more than I wanted to know. And what I found
made me wince and smile at
the same time. Ground up ladybugs were once used to cure
toothaches. They were placed
inside the cavity. Seems I don’t
know everything there is to
know about teeth after all. And
there is no escaping the wonderful joy of our odd little niche
of knowledge.

Ready for a recharge by escaping all things
dental, Hygiene Tribune Editor in Chief Patricia Walsh, RDH, keeps encountering teeth
throughout her vacation, even while exploring Mayan ruins in Belize. Photo/Patricia
Walsh

About the Author
Patricia Walsh, RDH, BS, has
been a clinical dental hygienist for more than 20 years.
She is a graduate of the Fones
School of Dental Hygiene,
University of Bridgeport in
Connecticut. She has an extensive history in international volunteer work in oral
health, including being instrumental in the creation of
The Thailand Dental Project,
a volunteer program focused
on providing educational,
preventive and restorative
dental care to children in a
tsunami-affected region of
Thailand. Contact her at pwalshrdh@uberhygienist.com.

[67] =>

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Recommend Sensodyne – specialist expertise
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*With twice-daily brushing
References.. 1. Jeandot J et al. Clinc (French) 2007; 28: 379–384. 2. Nagata T et al. J Clin Periodontol 1994; 21(3): 217–221. 3. GSK data on
file. DOF Z2860473. 4. Leight RS et al. J Clin Dent 2008 19(4) 147-153. 5. Schemehorn BR et al. J Clin Dent 2011 22(1) 11-18. 6. Shellis RP
et al. J Dent 2005 33(4) 313-324. 7. GSK data on file. DOF Z2860415. 8. GSK data on file. DOF Z2860435.
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[68] =>

[69] =>

Dubai, UAE			

www.cappmea.com/aesthetics2015

Show Edition

7th Dental-Facial Cosmetic Int’l Conference
– part of Dubai Dental Week
By Dental Tribune MEA | CAPPmea

W

ith the 21st Century being a time
where science and trade go
hand in hand, it is of utmost important to stay updated in our profession-

al lives. With the internet opening doors
to information to everyone, the dental
patient has unrestricted access to global
standards of dental care. The thought of
success in Dentistry today is underlined
by innovation and cutting edge technol-

ogy as well as evidence based scientific
improvements. It is a fact that the dental
industry has seen a shift from being trade
to being evolved as a scientific trade. With
this being said, 7th Dental-Facial Cosmetic International Conference in Dubai has

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become the regions trendsetter when it
comes to showcasing the latest evidence
based scientific cases through Centre for
Advanced Professional Practices’ (CAPPmea) accredited Continuing Dental Education programs alongside modern day
innovations and cutting edge technologies shown by the dental manufacturers.
In the 10th year Anniversary of CAPPmea,
7th DFCIC is proud to offer an expanded
partnership with eminent strategic partners such Emirates Dental Society, Saudi
Dental Society, Lebanon Dental Association as well as American Academy of Implant Dentistry, Inman Aligner Academy
and the International College of Dentists
who all hold their annual events as part of
the Dubai Dental Week.
The organizers have once again planned
an unparalleled Continuing Dental Education program for November 2015. Featuring some of the most prolific educators in the field of Dentistry, delegates
will have a choice of a full-day Seminar
on Alignment, Bonding, Bleaching and
more (Inman Aligner Symposium - 12th
November), two day Scientific Conference on the latest in Dental Facial Aesthetics (7th DFCIC joint event with AAID
13-14 November), half-day seminar (ICD

> Page 2E

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Emirates
Dental Society
to hold its
dental board
election at 7th
DFCIC
By EDS

D

UBAI, UAE: The Dental Society of
the Emirates Medical Association
is going to hold its dental board
election to elect a new board on November 13, 2015 as part of the 7th Dental Facial Cosmetic International Conference
(13-14 November). These events will be
part of the Dubai Dental Week (11-15
November 2015) which has become the
largest international dental event for the

> Page 3E

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[70] =>

7th Dental-FACIAL COSMETIC International Conference
11-15 november 2015 . Jumeirah beach hotel, dubai, uae

2E
< Page 1E
– 14 November), Dental Hygienist Day on prevention and oralhealth (14 November) and 19
hands-on workshops covering
a large number of current concepts in Aesthetic Dentistry (1115 November).
All delegates are not only welcome to participate in the many
education programs offered by
CAPPmea, but to also visit the
state-of-the-art trade exhibition featuring the leading dental
manufacturers in the industry
(13-14 November) including the
likes of; Sirona - Platinum Sponsor, Ivoclar Vivadent -Crystal
Sponsor, 3M ESPE, KaVo, OralB, Heraeus Kulzer, KERR - Gold
Sponsors, GSK - Silver Sponsor
and Philips Sonicare, Dentegris,
Invisalign, Henry Schein, Shofu,
Coswell, Southern Implants,
VITA and Carestream - Official
Sponsors. The exhibition is an
important part of the 7th DFCIC
experience as delegates will
have the chance to interact with
over 45 dental manufacturers to
provide your valuable feedback
in order to advance the science
of dentistry forward.
Highlights of 7th DFCIC include
Dr. Shankar Iyer’s (Vice-Presi-

Jumeirah Beach Hotel, Dubai, UAE

dent AAID, USA) modern kickstart of Day 1 with ‘Facetime
– Make The Perfect Dental Connection’ followed by a full mouth
reconstruction case using CAD/
CAM and Minimal Invasive
Dentistry by Dr. Julian Gutierrez
from Costa Rica. Delegates are
advised to further look out for
Prof. Dr. Markus Balkenhol, Germany lecturing on Laser Milling
– Entering a New Dimension of
Aesthetic Dentistry, Dr. Gaetano
Paolone, Italy (Direct Restoration Workflow in Anteriors and
Posteriors) and Dr. Mario Besek

Participants focused on the presenters

of Switzerland who will demonstrate Componeer® The Next
Generation of a Direct Veneering System. Day 2 highlights
include Prof. Paul Tipton known
for the famous Tipton Training
courses for dental professionals in the UK who will speak
on The Role of Vertical Dimension of Facial Aesthetics. AAID
speakers Dr. James Lozada,
USA, Dr. Cheryl Pearson, USA,
Dr. Stuart-Orton Jones, UK and
Dr. Roderick Stewart, Canada
will cover topics such as CEREC
and Implants, Evidence Based

Implant Dentistry, Full Arch
Implant Supported Strategy and
Treatment of Inadequate Ridge
Height using Tatum Ridge Repositioning.
CAPPmea is an ADA C.E.R.P.
Recognized Provider of Continuing Education and the Dubai
Dental week has additional accreditations from Health Authority Abu Dhabi and Dubai
Health Authority. The main scientific conference includes 19
international speakers from 12
countries presenting their latest

clinical cases in the field of Dental Facial and Aesthetic Dentistry on topics such as Minimal
Invasive Dentistry, Chairside
CAD/CAM, Restorative Dentistry, Implantology, Laser, Prevention, Veneers, Crowns, Bridges,
Impression,
Cementation,
Prophylaxis, Alignment, Bonding, Bleaching and many more.

Inman Aligner Academy proudly holds its Annual
Symposium with 7th Dental Facial Cosmetic
Int’l Conference
By Dr. James Russell, UK

nman Aligner and Intelligent Alignment Systems are
pleased to announce our Annual Symposium on 12 November 2015. Following a superb
2014 meeting in Copenhagen
our 2015 venue is DUBAI! We
are also pleased to share the
venue in a joint meeting with
the 7th Dental - Facial Cosmetic
International Conference (DFCIC) organized by CAPPmea so
those wanting to combine some
winter sun with even more superb CPD can combine both

meetings.
We have a world renowned lineup of speakers including Dr.
Tif Qureshi, UK (Past President
British Academy Cosmetic Dentistry) who will start the event on
the Current Trends in Anterior
Aesthetic Orthodontics! Inceptive Occlusal Dentistry – The
new path for dentistry.
Further presentations will cover
GDP Orthodontic pre-alignment
prior to composite bonding and
veneers - a technique case study
by Dr. James Russell, UK and
Emulating natures morphology
with direct composite by Dr. Ja-

son Smithson, UK. The morning
session will conclude with Dr.
Jens Nolte, Germany and Dr.
Andy Wallace, UK speaking on
Creating the Dream Aesthetic
Practices and Why every dentists should offer simple orthodontics.

The IAA Symposium will additionally cover Dental Photography (Dr. Richard Field, UK), 50
Years of Odontology (Dr. Erik
Svendsrud, Norway), Alignment,
Bonding and Bleaching (Dr.
Charlotte Nyby, Denmark). Prof.
Ross Hobson, UK will conclude
the promising and highly anticipated IAA 2015 Symposium with
Avoiding orthodontic pitfalls as a
GDP.

With an expanded program,
two dedicated hands-on courses
and an update course will keep
delegates busy throughout the
Dubai Dental Week scheduled
between 11-15 November 2015.
The Inman Aligner Certification
Course designed to teach attendees how to use the Inman Aligner in order to be a certified user
will take place on 15 November
2015. All aspects of the treatment will be covered from case
evaluation to fitting and then retention, so that attendees will be
able to handle simple to moderate cases immediately. The Advanced Course also scheduled
for 15 November will be run by
Dr. Tif Qureshi, and is designed

to allow experienced Inman
Aligner users to treat more complex cases with confidence. We
recommend that dentists have
completed at least 10 cases to
make sure they benefit from
this training. Update course on
13th November is the 2015 instalment of the highly rated update course. A day packed with
the latest tips and techniques to
boost your Inman Aligner treatments.
We look forward to welcoming
all delegates to our Annual Symposium.

AAID - 4th Global Conferece meets 7th Dental Facial
By Dr. Shankar Iyer, USA

he first Global conference
of the AAID was held in
New Delhi in 2010 along
with the World Congress of Oral
Implantology. Four years later
the AAID will hold its 4th Global
Conference with the 7th Dental
Facial Cosmetic International
Conference at Jumeirah Beach
Hotel Dubai on 13-14 November 2015. World Class Faculty
and experts will present the
new concepts to explore the
controversies surrounding dental implant therapy. Which is
the best method to grow bone
vertically? Evidence Based Implant Dentistry, The Full arch
Implant Supported Strategy,
Cerec & Dental Implants - 21st

Century Dentistry and several
other issues will be presented at
this conference. I am delighted
to work with Dr. Ninette Banday who is the Secretary for the
Congress and has made some
significant strides in educating
AAID MaxiCourse participants
in the UAE over the last decade.
The AAID will be bringing renowed International speakers:
Dr. Jaime Lozada, Dr. Cheryl
Pearson, Dr. Roderick Steward,
Dr. Stuart Orton Jones to name
a few. In addition to the main
congress there will be numerous hands-on courses and the
dental industry will proudly be
displaying their latest technologies as well. A hall mark of this
congress will be the pre-confer-

ence hands-on Advanced bone
grafting Workshop – Implants in
the Atrophic Maxilla including
Sinus Grafting and Sinus Floor
Elevation.
I am pleased to invite you to this
conference to make the Perfect
Dental Connection and be immersed with the fusion of Aesthetics and implant dentistry.
I am sure you will bring back
some valuable tips and information that will enhance your
existing implant and aesthetic
practice. If you are a novice, you
will get excited to incorporate
implant dentistry to expand the
scope of your practice. Founded in 1951, the AAID is the first
professional organization in the
world dedicated to implant den-

tistry. Its membership includes
general dentists, oral and maxillofacial surgeons, periodontists,
prosthodontists, Endodontists,
Restorative Dentists and others
interested in the field of implant
dentistry.
The American Academy of Implant Dentistry (AAID) stands for
excellence in education, scientific development and patient care.
Members who demonstrate the
highest standards in implantology find the AAID to be the organization which supports their
clinical and research interests,
as well as recognition for their
achievements. The Academy’s
mission is simple: to advance the
science and practice of implant
dentistry through education, re-

search support and to serve as
the credentialing standard for
implant dentistry for the benefit of mankind. The Academy
provides bona fide credentialing in implant dentistry through
the Associate Fellow and Fellow
membership examinations. The
Associate Fellow and Fellow
credentials are recognized by
numerous state boards.
I hope to personally greet you
at the conference and welcome
you to be part of our International Community. You will find
an atmosphere of camaraderie,
warmth and friendliness that
will entice you to be there.

[71] =>

7th Dental-FACIAL COSMETIC International Conference
11-15 november 2015 . Jumeirah beach hotel, dubai, uae

< Page 2E
Middle East region providing a
total of 35 CME credit points to
international delegates throughout a series of scientific sessions.
The election will take place concurrently with the 7th Dental
Facial Cosmetic International
Conference to be held at the

Jumeirah Beach Hotel, Dubai,
UAE. The Emirates Dental Society and CAPPmea have enjoyed
a strong collaborative relationship over the past 10 years and
holding the Dental Society General Election in conjunction with
CAPP is an example of the strong
relationship between the two in-

stitutions. All members of EDS
are invited to attend this important election scheduled on 13th
of November at 18:00 in order to
support the EDS for the better of
dentistry of the UAE.
Throughout the period of Dr.
Aisha Sultan as the President of

the EDS, one of the most memorable achievements was her
election as the President of the
Asia Pacific Dental Federation
for the period 2014-2015 and to
successfully host the Asia Pacific
Dental Conference in Dubai for
the first time outside of Asia and

in the Middle East. It is important to continue the strong progress and evolution of the dental
profession in the United Arab
Emirates.

A day out for the Dental Hygienist – 14 November 2015
By Dental Tribune MEA/CAPPmea

disease, diabetes, magnification and ergonomics as well as
probiotics from an oral and dental perspective. 9 International
Speakers will give their best interpretations of what is best for
the Dental Hygienist profession.
The pre-Dental Hygienist Day
hands-on course (13 November) will focus on Individually
Trained Oral Prophylaxis – iTop,
where delegates will learn about
Biofilm characteristics, failures
in existing oral prophylaxis,
technique and tools selection
and much more. The full day
hands-on course will be given
by Dr. Franka Baranovic-Huber

ith an increase focus
on the Dental Hygienist profession, clinics
in the Middle East are becoming more and more aware of
the importance of a complete
dental team including the Dental Hygienist role. Following the
previous two successful editions, 3rd Dental Hygienist Day
will include hot topic presentations on oral care, prevention,
evidence-based dentistry, oral
prophylaxis, early childhood
caries prevention, how diets
effect oral health, periodontal

Practice during the hands-on course

from Switzerland. A further Periodontal Instrumentation handson course (14 November) will be
provided by Mary Rose Pincelli
Boglione, Italy on miniaturized
instruments in non-surgical
periodontal therapy and further
how polishing will brighten the
smile.
The 3rd Dental Hygienist Day
will further host a dedicated exhibition featuring sponsors EMS
– Electro Medical Systems, OralB, Philips Sonicare, Coswell, HuFriedy, Curaden and KERR.

25th Annual
Meeting of Advance your Experience with
The Int’l
19 Hands-On Courses
College of
11-15 November 2015
Dentists
By Dental Tribune MEA/CAPPmea

he International College
of Dentists (ICD) is the
oldest and largest international honor society for dentists in the world. Established
in 1928, the College has over
12,000 members in 122 countries, who have been awarded
the prestigious title of Fellow in
the ICD. The Middle-East section received its charter as autonomous section in 1967 and
is divided in 2 districts that governs 11 countries in the Middle
East. The event will take place
on 14 November at Jumeirah
Beach Hotel and will be sponsored by Sirona and hosted by
CAPPmea. This will mark the
25th milestone Annual Meeting
of the ICD with its topic focusing on “Achieving Optimum
Esthetics”. The event will feature speakers Prof. Richard
Simonsen, USA, Dr. Munir Silwadi, UAE, Dr. Ali Al-Ehaideb,
Dr. Ninette Banday, Dr. Nadim
Aboujaoude, Dr. Naser Al Hamlan, Dr Georges Tawil and Dr.
Khalid Said.
ICD ME Officers include: President: Dr. Ali Al-Ehaideb; President Elect Dr. Georges Tawil;
Vice President Dr. Aisha Sultan;
Past President Dr. Riad Bacho;
Registrar Dr. Nadim Aboujaoude; Treasurer Dr. Ibrahim
Nasseh; Councilor Dr. Cedric
Haddad; Deputy Treasurer Dr.
Zuhair Salamoun; Regent D1
Dr. Andre Sacy and Regent D2
Dr. Emtiyaz Turkistani.

Over 19 Hands-On Courses are scheduled to take place between
11-15 November 2015 organized by CAPPmea.
With a constant increase in demand for a hands-on approach, CAPPmea
partners with several internationally key opinion leaders and industry partners
to host numerous hot topics in dentistry including:
Essential Esthetics – from Design to Creation | Prof. Brian Millar, UK
Veneers Vs Crowns: the Challenge in Smile Design | Dr. Eduardo Mahn, Chile
Indirect Veneers | Dr. Munir Silwadi, UAE
Direct Veneers: the Shades Dilemma | Dr. Eduardo Mahn, Chile
Esthetic Direct Restorations - Predictable Procedures | Dr. Gaetano Paolone, Italy
Implants in the Atrophic Maxilla including Sinus Grafting and Sinus Floor Elevation | Dr. Stuart Orton-Jones, UK
Individually Trained Oral Prophylaxis – iTOP | Dr. Franka Baranovic-Huber, Switzerland
Non-Prep-Veneers and Modiﬁed Non-Prep-Veneers | Dr. Eduardo Mahn, Chile
Veneers, Bonded Crowns and Bridge Design (Specialist Prosthodontic Techniques in Aesthetic...) | Prof. Paul Tipton, UK
Modern Preparation and cementation for Inlays, Onlays and Occlusal Veneers | Dr. Eduardo Mahn, Chile
Use of the Miniaturized Instruments in Non-Surgical Periodontal Therapy and... |Mary Rose Pincelli Boglione, Italy
Angled & Wide Implants | Dr. Costa & Team, Greece
Advanced Anterior Composite (Direct Veneer and Diastema Closure) | Dr. Eduardo Mahn, Chile
Indirect Inlays, Onlays & Partial Crowns | Dr. Munir Silwadi, UAE
The New Concept of Alignment, Bleaching and Bonding (IA) Basic & Advance | Dr. James Russell and Dr. Tif Quereshi, UK
Next Generation Direct Composite Veneering for Anterior Teeth with Componeers | Dr. Mario Besek, Switzerland
Organized by:

Supported by:

[72] =>

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[cover] => DT Middle East and Africa No. 6 (November), 2015

[toc] => Array ( [0] => Array ( [title] => DENTSPLY –Sirona merger to create world’s largest dental manufacturer [page] => 01 ) [1] => Array ( [title] => Industry [page] => 04 ) [2] => Array ( [title] => How to avoid extractions when treating malocclusions using MRC’s Bent Wire System and Trainer System for arch development [page] => 08 ) [3] => Array ( [title] => Identification and management of passive eruption [page] => 11 ) [4] => Array ( [title] => Oral health [page] => 16 ) [5] => Array ( [title] => Lifelike esthetics achieved with minimally invasive methods [page] => 19 ) [6] => Array ( [title] => The “All Hall” case: A case report of maximum capacity use of the Hall technique in a single child patient [page] => 20 ) [7] => Array ( [title] => Bluephase: Two new products for a precise and economic use [page] => 25 ) [8] => Array ( [title] => CAD/CAM [page] => 28 ) [9] => Array ( [title] => Ortho Tribune Middle East & Africa Edition [page] => 31 ) [10] => Array ( [title] => Implant Tribune Middle East & Africa Edition [page] => 35 ) [11] => Array ( [title] => News [page] => 40 ) [12] => Array ( [title] => Practice Management [page] => 48 ) [13] => Array ( [title] => Endo Tribune Middle East & Africa Edition [page] => 53 ) [14] => Array ( [title] => Lab Tribune Middle East & Africa Edition [page] => 57 ) [15] => Array ( [title] => Hygiene Tribune Middle East & Africa Edition [page] => 61 ) [16] => Array ( [title] => 7th Dental-Facial Cosmetic Int’l Conference – part of Dubai Dental Week [page] => 69 ) [17] => Array ( [title] => Emirates Dental Society to hold its dental board election at 7th DFCIC [page] => 69 ) ) [toc_html] =>

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