DT UK No. 2, 2015

UK News / World News / Business / Trends & Applications: Cone Beam Computed Tomography / Perio Tribune United Kingdom Edition

Open PDF View E-paper Edit Epaper Edit Epaper ads save

Table of contents

Open Link

) [6] => Array ( [image_url] => Array ( [2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/2000/page-5.jpg [1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/1000/page-5.jpg [200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/200/page-5.jpg ) [key] => Array ( [2000] => 65656-c9939a3e/2000/page-5.jpg [1000] => 65656-c9939a3e/1000/page-5.jpg [200] => 65656-c9939a3e/200/page-5.jpg ) [ads] => Array ( [0] => Array ( [post_data] => WP_Post Object ( [ID] => 65659 [post_author] => 0 [post_date] => 2024-10-22 22:00:12 [post_date_gmt] => 2024-10-22 22:00:12 [post_content] => [post_title] => epaper-65656-page-6-ad-65659 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => epaper-65656-page-6-ad-65659 [to_ping] => [pinged] => [post_modified] => 2024-10-22 22:00:12 [post_modified_gmt] => 2024-10-22 22:00:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://e.dental-tribune.com/ad/epaper-65656-page-6-ad/ [menu_order] => 0 [post_type] => ad [post_mime_type] => [comment_count] => 0 [filter] => raw ) [id] => 65659 [id_hash] => 8bab3b3d3c71659351c069a61206322c30f0c2d4a34b72b667c07326346a46c8 [post_type] => ad [post_date] => 2024-10-22 22:00:12 [fields] => Array ( [url] => http://www.dental-tribune.com/companies/3873_croixture.html [link] => URL ) [permalink] => https://e.dental-tribune.com/ad/epaper-65656-page-6-ad-65659/ [post_title] => epaper-65656-page-6-ad-65659 [post_status] => publish [position] => 5.29,25.68,71.09,69.68 [belongs_to_epaper] => 65656 [page] => 6 [cached] => false ) ) [html_content] =>

Open Link

) [7] => Array ( [image_url] => Array ( [2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/2000/page-6.jpg [1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/1000/page-6.jpg [200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/200/page-6.jpg ) [key] => Array ( [2000] => 65656-c9939a3e/2000/page-6.jpg [1000] => 65656-c9939a3e/1000/page-6.jpg [200] => 65656-c9939a3e/200/page-6.jpg ) [ads] => Array ( [0] => Array ( [post_data] => WP_Post Object ( [ID] => 65660 [post_author] => 0 [post_date] => 2024-10-22 22:00:12 [post_date_gmt] => 2024-10-22 22:00:12 [post_content] => [post_title] => epaper-65656-page-7-ad-65660 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => epaper-65656-page-7-ad-65660 [to_ping] => [pinged] => [post_modified] => 2024-10-22 22:00:12 [post_modified_gmt] => 2024-10-22 22:00:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://e.dental-tribune.com/ad/epaper-65656-page-7-ad/ [menu_order] => 0 [post_type] => ad [post_mime_type] => [comment_count] => 0 [filter] => raw ) [id] => 65660 [id_hash] => 29e7de366737ec273011f22363450b32215f33b4f471733d5a694c252891b4c6 [post_type] => ad [post_date] => 2024-10-22 22:00:12 [fields] => Array ( [url] => http://www.dental-tribune.com/companies_3550_biolase_technology_inc.html [link] => URL ) [permalink] => https://e.dental-tribune.com/ad/epaper-65656-page-7-ad-65660/ [post_title] => epaper-65656-page-7-ad-65660 [post_status] => publish [position] => -0.53,0,100.27,99.45 [belongs_to_epaper] => 65656 [page] => 7 [cached] => false ) ) [html_content] =>

) [16] => Array ( [image_url] => Array ( [2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/2000/page-15.jpg [1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/1000/page-15.jpg [200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/200/page-15.jpg ) [key] => Array ( [2000] => 65656-c9939a3e/2000/page-15.jpg [1000] => 65656-c9939a3e/1000/page-15.jpg [200] => 65656-c9939a3e/200/page-15.jpg ) [ads] => Array ( [0] => Array ( [post_data] => WP_Post Object ( [ID] => 65664 [post_author] => 0 [post_date] => 2024-10-22 22:00:12 [post_date_gmt] => 2024-10-22 22:00:12 [post_content] => [post_title] => epaper-65656-page-16-ad-65664 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => epaper-65656-page-16-ad-65664 [to_ping] => [pinged] => [post_modified] => 2024-10-22 22:00:12 [post_modified_gmt] => 2024-10-22 22:00:12 [post_content_filtered] => [post_parent] => 0 [guid] => https://e.dental-tribune.com/ad/epaper-65656-page-16-ad/ [menu_order] => 0 [post_type] => ad [post_mime_type] => [comment_count] => 0 [filter] => raw ) [id] => 65664 [id_hash] => 9a6b6b7193e6cb34c5e7279dd1b1cc0b9d4e70da7782167d88eb86ead80e43aa [post_type] => ad [post_date] => 2024-10-22 22:00:12 [fields] => Array ( [url] => http://www.dtstudyclub.com/ [link] => URL ) [permalink] => https://e.dental-tribune.com/ad/epaper-65656-page-16-ad-65664/ [post_title] => epaper-65656-page-16-ad-65664 [post_status] => publish [position] => 5.29,43.44,52.34,53.01 [belongs_to_epaper] => 65656 [page] => 16 [cached] => false ) ) [html_content] =>

Open Link

Open Link

) ) [pdf_filetime] => 1729634412 [s3_key] => 65656-c9939a3e [pdf] => DTUK0215.pdf [pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/65656/DTUK0215.pdf [pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/65656/DTUK0215.pdf [should_regen_pages] => 1 [pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/65656-c9939a3e/epaper.pdf [pages_text] => Array ( [1] => Standard_300dpi

DTUK0215_01_Title 27.05.15 15:35 Seite 1

DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
www.dental-tribune.co.uk

Published in London

Vol. 9, No. 2

CONSEURO 2015

CONE BEAM CT

PERIO TRIBUNE

Dental Tribune sat down with
KCL professor Stephen Dunne in
London to discuss the event and
how technology is increasingly
shaping the field of dentistry.

In just over a decade, digital imaging technology has exploded
onto the dental landscape but is
dentistry ready for a new standard
of care?

Read the latest news and developments from the fields of periodontology and implant dentistry
in our specialty section included in
this issue.

” Page 4

” Page 12

” Page 17

IMPRINT
PUBLISHER:
Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT UK:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
CLINICAL EDITOR:
Magda WOJTKIEWICZ
ONLINE EDITOR:
Claudia DUSCHEK
ASSISTANT EDITORS:
Anne FAULMANN, Kristin HÜBNER
COPY EDITORS:
Sabrina RAAFF, Hans MOTSCHMANN
PRESIDENT/CEO:
Torsten OEMUS
CFO/COO:
Dan WUNDERLICH
MEDIA SALES MANAGERS:
Matthias DIESSNER
Peter WITTECZEK
Maria KAISER
Melissa BROWN
Weridiana MAGESWKI
Hélène CARPENTIER
MARKETING & SALES SERVICES:
Nicole ANDRAE
ACCOUNTING:
Karen HAMATSCHEK
BUSINESS DEVELOPMENT:
Claudia SALWICZEK
EXECUTIVE PRODUCER:
Gernot MEYER
AD PRODUCTION:
Marius MEZGER
DESIGNER:
Franziska DACHSEL

Published by
DENTAL TRIBUNE INTERNATIONAL
Baird House, 4th Floor, 15–17 St. Cross Street
London EC1N 8UW
Internet: www.dental-tribune.co.uk
E-mail: info@dental-tribune.com

Regional Offices
ASIA PACIFIC
DT Asia Pacific Ltd.
c/o Yonto Risio Communications Ltd,
20A, Harvard Commercial Building,
105–111 Thomson Road, Wanchai
Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199
THE AMERICAS
Dental Tribune America, LLC
116 West 23rd Street, Suite 500, New York,
NY 10001, USA
Tel.: +1 212 244 7181
Fax: +1 212 224 7185
© 2015, Dental Tribune International GmbH

All rights reserved. Dental Tribune makes every
effort to report clinical information and manufacturer’s product news accurately, but cannot assume
responsibility for the validity of product claims,
or for typographical errors. The publishers also do
not assume responsibility for product names or
claims, or statements made by advertisers. Opinions
expressed by authors are their
own and may not reflect those
of Dental Tribune International.
Scan this code to subscribe
our weekly Dental Tribune Uk
e-newsletter.

BDA calls on new government
to ﬁx dentistry system
By DTI
London: The British Dental Association (BDA) has said that it will work
with the new Conservative cabinet
and members of parliament towards a better contract for dentistry
in the UK. Remarking on last month’s
general election results, Chief Executive Peter Ward pledged his organisation will continue to fight for
better recognition of dentists and
distribution of funding for the profession under the new government.
“Healthcare was a central battleground between all of the parties in
this election and I am sure you will
all be interested what share of the
£8 billion, promised by the Conservatives to the NHS, will be spent on
provision of dentistry,” Ward said
during a special session at the
British Dental Conference and
Exhibition in Manchester.
Ward criticised that while all parties acknowledged the importance
of dental care for the overall health
system, little was actually mentioned in the party manifestos except for those of the Green Party
and Plaid Cymru.

PM David Cameron during a election debate. The Conservatives will have to stand up to their promises for a 'new dentistry
contract', the BDA said. © 1000Words/Shutterstock

“Doctors, nurses and midwives do
wonderful work, but so too do dentists across the UK. With a political
agenda that seeks to tackle the challenges of diet, alcohol, sugar and
tobacco, it is clear that dentists have
a role to play in a government strategy of prevention and integration
in healthcare,” he emphasised. Ward

said that the BDA will be reaching
out to the government’s new health
cabinet, as well as re-elected and new
MPs, as soon as possible to follow up
on critical issues, such as regulation.
“The small majority means that every
MP will have a stronger position to
influence Parliament, so engaging
with them will be all the more useful.”

The election saw the Conservative Party securing a small but
absolute parliamentary majority
owing to Labour losing most of its
seats north of the border to the
Scottish National Party. With over
65 per cent, the election produced
the highest participation of voters
since 1995.

Only one British institution
among top ten dental schools
By DTI
London: According to the QS World
University Rankings by Subject
2015, Swedish dental schools are
among the best in the world. With
the Karolinska Institutet leading the
list of top dental schools and the
University of Gothenburg following
closely in third place, the country
currently claims two of the world’s
best three dentistry faculties.
In second position, the University of Hong Kong is located in the

midst of the Swedish leaders. The
list of top ten dentistry schools
further includes the University of
Michigan in the US at number four,
KU Leuven in Belgium in fifth place
and the Tokyo Medical and Dental
University in Japan ranked sixth.
King's College London in the UK
at number seven is the only dental
school from Britain to have made
it in the top ten list this year.
The QS World University Rankings are published annually by

Quacquarelli Symonds (QS), a
British company specialised in
education and study abroad. Its
list comprises an overall university
ranking and a variety of subject
rankings. Dentistry is one of the
six new additions to the individual
subject rankings, bringing the total
number of academic disciplines
the report covers as of 2015 to 36.

ature database Scopus. For the QS
World University Rankings by Subject 2015, 85,062 academics and
41,910 graduate employers from
60 countries and 894 universities
were asked to list up to ten domestic
and 30 international institutions they
consider excellent in categories such
as academic reputation, citations per
faculty and employer reputation.

The rankings are based on major
global surveys of academics and
graduate employers, as well as research citations data from the liter-

The full QS World University
Rankings 2015, as well as the rankings by subject, can be accessed at
www.topuniversities.com.

[2] => Standard_300dpi

DTUK0215_02-03_News 27.05.15 15:35 Seite 1

UK News

Dental Tribune United Kingdom Edition | 2/2015

Military dentist follows
Cockcroft as Chief Dental Ofﬁcer
By DTI
LONDON: After two months of
searching, the National Health
Service (NHS) has recently appointed Sara Hurley from the
Royal Centre for Defence Medicine in Birmingham as new
Chief Dental Officer (CDO) for
England. She is the second woman to occupy the government advisory post after Dame
Margaret Seward became CDO in
2000.

Hurley follows Dr Barry Cockcroft, who retired in February after
holding the position for almost a
decade. She received her bachelor’s
degree from the University of Bristol, and holds an MSc in Dental Public Health from University College
London, as well as a King’s College
London MA in Defence Studies.
Appointed as a Queen’s Honorary
Dental Surgeon last year, she has also
served as Chief Dental Officer for the
Royal Army, among other posts.

In her recent position at Queen
Elizabeth Hospital Birmingham,
she has worked with the NHS to
assure access to and quality of
health care for injured military personnel. In her new role, Hurley will
work in partnership with other directorates, domain leads and other
clinical leaders in regional and local
area teams to improve outcomes
for patients, and champion the role
of dentists and dentistry within
the health system, the NHS said in
a note.

Hurley commented that as CDO
she will be working collaboratively
across the breadth of the dental
health care profession to develop
ideas that will contribute to achieving quality health outcomes and
better oral health for all.
Several dental associations in
the UK have responded positively
to the appointment. “This is the
time for new beginnings, fresh
eyes and renewed relationships,
and we intend to approach her

BDIA extends contracts with
London and Birmingham venues
By DTI
LONDON & BIRMINGHAM: The
British Dental Industry Association (BDIA) has announced that
it signed new contracts with
both the NEC in Birmingham and
the ExCeL London Exhibition
and Convention Centre in April
to hold its Dental Showcase for
another three years in each venue.
Alternating between the two cities,
the annual dental show attracts up
to 10,000 visitors every year.
According to the BDIA, the contracts secure its partnership with
ExCeL London for the upcoming
shows in 2016, 2018 and 2020.
The NEC, which will host this
year’s edition in autumn, has
agreed to host the event in 2017
and 2019.

New initiative aims to improve
oral health of care home residents
By DTI
LONDON: Several studies have
found that the oral health of care
home residents is often poor and
that in many cases carers have not
received specific training to help
residents with their daily oral
hygiene routine. This problem is
now being tackled in a new British
health initiative that was recently
launched by Health Education
Kent, Surrey and Sussex, supported by research from the University of Greenwich’s Centre for
Positive Ageing.
It is predicted that by 2020,
around 20 per cent of the UK population will be aged 65 years or

older. With increasing age, many
people have to face a deterioration in physical and cognitive
abilities and often need care.
The Improving Oral Health of
Older Persons Initiative aims to
improve oral health and quality
of life for older people living in
residential care homes in Kent,
Surrey and Sussex through education and training of care home
staff. “By helping to raise awareness of the importance of good
oral health, both for quality of
life and for general health, and by
introducing oral health training
for carers within this community,
we aim to establish a sustainable
quality standard for the oral

healthcare of older persons,” the
initiative stated.
In order to implement its
measures, the initiative builds on
research into the experiences of
older patients and their carers by
Dr Paul Newton, a research fellow
at the Centre for Positive Ageing.
Newton is an expert in patient
empowerment and the management of chronic conditions. His
work for the initiative has led to
new training methods and information for carers of people living
with dementia.
“Research about identifying
and managing dental pain and
oral health problems for people

appointment in that spirit,” Chair
of the British Dental Association’s
Principal Executive Committee
Mick Armstrong said. “Building
an effective working relationship
is in the best interests of both our
patients and our profession, and
genuine engagement will be reciprocated.”
“In a country where marked inequalities in children’s oral health
persist, we look forward to working
with her on the long overdue care
pathway for children’s dentistry.
Our commissioning group is ready
and waiting to progress this vital
piece of work,” British Society of
Paediatric Dentistry spokesperson
Claire Stevens commented. “We are
looking forward to a long and productive working relationship with
Sara.”

With an overall space of
186,000 m2, the NEC is Britain’s
largest exhibition centre. It also hosts
the Dentistry Show organised by
CloserStill Media in Coventry every
year in spring. The BDIA’s partnership with ExCeL London began in
2002. Last year’s show there saw
an overall attendance by 350 exhibitors and 9,500 professional visitors, according to the association.
“It is not easy to find suitable venues for a show of this size so securing contracts with both ExCeL and
the NEC that will give us stability
for the next six years is a significant
achievement for us,” Executive Director of the BDIA Tony Reed said.
An ExCeL London representative
commented that his company is
committed to helping the event
grow with further investment in
the venue’s infrastructure in the
year's to come.
The next edition of the Dental
Showcase is scheduled for 22–24
October at the NEC.

and the exacerbation of other
conditions, such as diabetes and
cardiovascular disease.

living with dementia was lacking—both in the literature and
in previous initiatives,” Newton
said. “We have worked closely
with the Older Person’s Initiative
to make sure the oral health needs
of this vulnerable group are addressed.”

Health Education Kent, Surrey
and Sussex is a local education
and training board, authorised as
a sub-committee of Health Education England. It was established
in April 2013, when it took on the
functions of the old Kent, Surrey
and Sussex Deanery, and aims to
ensure that health care providers
across the region have suitable
staff with the necessary skills.

Problems with teeth, gums and
dentures can significantly affect
the overall well-being of an older
person and his or her quality of
life. There is a range of oral health
challenges for elderly people,
including loosening teeth, dry
mouth and difficulty with eating
and using a toothbrush. These in
turn can lead to poor nutrition,
low self-esteem, social isolation

The Centre for Positive Ageing,
based in the university’s Faculty
of Education and Health, brings
together 12 research clusters from
across the university. It aims to
understand and develop solutions
to the problems facing individuals,
like chronic pain and dementia, as
well as those confronting society,
such as meeting the care needs of
a growing older population.

[3] => Standard_300dpi

DTUK0215_02-03_News 27.05.15 15:35 Seite 2

Dental Tribune United Kingdom Edition | 2/2015

UK News

Victorian baby teeth could help predict
future health of children today
By DTI
BRADFORD/DURHAM: A team of
researchers at the University of
Bradford and Durham University
has analysed the teeth of children
and adults from two nineteenthcentury cemeteries and found that
the biochemical composition of
teeth that were forming in the womb
and during a child’s early years provides insight into the health of the
baby’s mother and the future
health of the child. These findings
could help to develop a simple test
on baby teeth to predict potential
health problems in adulthood.
The analysed teeth came from a
cemetery at a workhouse in Ireland
where famine victims were buried
and from one in London that holds
the graves of some of those who
fled the famine. According to the
researchers, the biochemical composition of the examined teeth
not only provided insight into the
health of the baby’s mother, but
even showed major differences between those infants who died and
those who survived beyond early
childhood. Earlier work led by study authors Drs Janet Montgomery
and Mandy Jay from Durham’s
Department of Archaeology found
similar results in people living in
the Iron Age on the Isle of Skye and
in Neolithic Shetland.
Lead researcher Dr Julia Beaumont from Bradford’s School of
Archaeological Sciences explained:
“We know that stress and poor diet
in mothers, both during pregnancy
and after birth, can have an impact
on a child’s development. In the
past that could mean a child didn’t
survive; now it’s more likely to

mean a child has a greater risk of
health issues in later life. While
sometimes there are obvious signs
of maternal stress in the baby at
birth, such as a low birth weight,
that isn’t always the case. So a simple test on teeth that are naturally

four months’ growth, starting in the
womb, enabling it to be linked to a
specific period of a baby’s life.
These indicators have also been
thought to show when a baby has
been breastfed, which is seen as a

cemetery who lived during a period
of high rates of infant death. Beaumont believes that—far from being
an indicator of a good start in life—
the higher nitrogen isotope levels
showed that the mothers were malnourished and under stress.

by malnourished mothers do not
receive all the nutrients they need,
and this is possibly why these babies didn’t survive.”
Beaumont now hopes that the
insights gained from the historical
graves can be used to help children
in the future. If similar patterns can
be seen in current-day mothers and
children, she hopes this could lead
to a simple test on baby teeth to
predict potential health problems
in adulthood.
She is currently testing teeth
from children through the Born
in Bradford project, a long-term
study of a cohort of 13,500 children,
born between 2007 and 2010,
whose health is being tracked from
pregnancy through childhood and
into adult life.

Dr Julia Beaumont from the University of Bradford and her colleagues analysed teeth from two nineteenth-century cemeteries
to discover how baby teeth may help to predict a child’s future health. © University of Bradford

shed by children as they grow could
provide useful information about
future health risks.”
Levels of carbon and nitrogen
isotopes within bone and teeth, and
the relationship between the two,
change with different diets, so baby
teeth can reveal clues about the diet
of the mother during pregnancy
and the diet of the child immediately after birth. The first permanent molar also forms around birth
and is retained into adulthood. Each
layer of the tooth relates to around

healthy start in life. Nitrogen isotope levels are higher in people on
protein-rich diets and in breastfed
babies, and lower for vegetarian
diets. However, in the samples
taken from the famine cemetery,
the results were counter-intuitive.
The babies who showed higher
nitrogen isotope levels at birth
did not survive into adulthood.
Those who did survive had lower
and more stable nitrogen isotope
levels throughout early childhood.
Similar results were found among
Victorians buried in the London

“At the period we studied, it’s
likely that most babies were breastfed, but only some showed the
spike in nitrogen isotope levels normally associated with it,” she said.
“Where pregnant and breastfeeding mothers are malnourished
however, they can recycle their own
tissues in order for the baby to grow
and then to produce milk to feed
it. We believe this produces higher
nitrogen isotope levels and is what
we’re seeing in the samples from
the nineteenth-century cemeteries. Babies born to and breastfed

She hopes to be able to correlate
nitrogen and carbon isotope levels
to the medical history of the mother and the future health of the
children. “We currently cannot
analyse any other tissue in the
body where the stress we are under
before birth and during early childhood is recorded,” Beaumont stated.
“If we can show that baby teeth,
which are lost naturally, provide
markers for stress in the first
months of life, we could have an important indicator of future health
risks, such as diabetes and heart
disease.”
The study, titled “Infant mortality and isotopic complexity: New
approaches to stress, maternal
health, and weaning”, was published online in the American
Journal of Physical Anthropology
on 13 March ahead of print.

Periodontitis linked to heart attacks
in kidney disease patients
By DTI
BIRMINGHAM: Over 10 per cent of
the adult population suffers from
chronic kidney disease (CKD) and
those affected often have poor
health outcomes owing to an increased incidence of cardiovascular
disease compared with the general
population. A team of researchers
at Aston University recently found
that treating a common gingival
condition in CKD patients could
significantly reduce their risk of
potentially fatal heart disease.
CKD progressively worsens kidney function, raises blood pressure, and can cause progressive
vascular injury and heart disease.

The latest research at the university
suggests that increased mortality
in people with CKD may be linked
with chronic inflammatory conditions such as periodontitis, which
causes gingival inflammation, loss
of the bone that supports the teeth
and ultimately tooth loss.
Previous studies have found that
more than 85 per cent of people
with CKD have inflammatory gingival problems, caused by inadequate removal of dental plaque
from between the tooth and gingival margin and made worse by impaired immunity and wound healing. Experts have identified that
bacteria in the mouth can enter the
bloodstream through periodontal

conditions, causing blood cells to
malfunction and leading to clots
and narrowing of the arteries.
Dr Irundika Dias of Aston’s
School of Life and Health Sciences
is currently leading a study into
the underlying causes of increased
cardiovascular disease and outcomes of accelerated progression
observed in people with CKD and
periodontitis. She will observe how
successfully treating periodontitis
reduces oxidised lipids and inflammatory cell activity in people with
CKD, thereby lowering their risk of
life-threatening heart disease.
“This project has the potential to
make a real difference for people

with CKD. If we can prove managing
periodontitis reduces the threat
of cardiovascular disease then it
may well represent an efficient and
cost effective treatment for CKD,”
Dias stated. “In conjunction with
our study, I will be talking to dental schools about alternative ways
of helping periodontitis patients.
It is vitally important to keep your
gums healthy and have regular
dental check-ups to avoid the onset
of a disease that is very common,
poorly appreciated by the public
and causes tooth loss resulting in
reduced quality of life.”
The study will involve 80 people,
including healthy volunteers and
60 people with CKD, both with and

without periodontitis. Among these
will be a group of 20 people with CKD
and periodontitis who will be randomised to have the gingival condition
clinically treated over a 12-month
period. They will be reviewed at
three-monthly intervals to assess
markers of cardiovascular disease,
such as oxidative stress biomarkers
in the blood and arterial stiffness.
The project is part of a collaboration between Dias and Prof. Helen
Griffiths of Aston’s School of Life and
Health Sciences, Prof. Iain Chapple,
Head of Periodontology at the University of Birmingham, and Prof. Paul
Cockwell, consultant nephrologist
at University Hospitals Birmingham
NHS Foundation Trust.

[4] => Standard_300dpi

DTUK0215_04_Dunne 27.05.15 15:36 Seite 1

UK News

Dental Tribune United Kingdom Edition | 2/2015

“Holding ConsEuro in London
was a little bit of a risk”
An interview with Prof. Stephen Dunne, King’s College London Dental Institute
suitable for clinicians to provide
evidence-based knowledge for the
work that they do. Therefore, for
every session that we have this
year here at ConsEuro 2015, we have
an evidence-based start, followed
by clinical applications and handson sessions after lunch-time that
help practitioners get to grips with
equipment they heard about and
want to have a chance to play with.
That is very attractive to clinicians
and you can see a great deal of
interest there.

Prof. Stephen Dunne is also Professor and Chairman of the Department of Primary Dental Care at Kings College London—
Dental Institute.© Daniel Zimmermann/DTI

As one of many dental organisations
to do so, the European Federation of
Conservative Dentistry (EFCD) chose
to hold its international congress in
the UK this year. Dental Tribune UK
sat down with EFCD President and
King’s College London professor
Stephen Dunne in London to discuss
the event and how technology is
increasingly shaping the field of
dentistry.
Dental Tribune UK: Prof. Dunne,
the ConsEuro conference in London
seems to have been excellently organised. Would you say that the
event has met your expectations?
Prof. Stephen Dunne: To be honest, holding ConsEuro in London
was a little bit of a risk because
with all the other conferences to
be going on this year in the capital
and other parts of Britain there
could be an overload. We actually
spent months discussing a window
in which we would attract the
highest number of delegates. With
500 and growing so far, the congress has clearly exceeded our
expectations and, while previous
congresses in Italy or Turkey might
have had a bigger turnout, the conference here has attracted delegates from 29 countries, including
from Australia, the US and the
Middle East. It is probably one of
the most multinational conferences we have ever had.
You were originally planning for
350–450 participants. Can the outcome mainly be attributed to the
London factor?
While we chose one of the best
conference centres in the world
with the Queen Elizabeth II Centre
right in the heart of London, it is
fair to say that we also chose one

of the most expensive ones. This
made us very concerned when we
planning this three years ago because at that time we were in an economic downturn. Trying to request
sponsorship from companies was
difficult back then. They were all
downsizing and did not have any
money to spare for conferences.
Owing to the economic situation
gradually improving over time,
we exceeded our expectations with
regard to sponsorships. We actually
sold out the exhibition space several months ago. That has been very
successful and helped us to cover
the costs. We came above breakeven on the first day, so I am much
more relaxed today than I was
yesterday morning. And it looks as
though we might make a reasonable profit, which would then be
shared between the EFCD and
King’s College London.
King’s recently made it on to the list
of the top ten best dental schools
globally. How much do you think
the school’s reputation contributed
to the congress outcome?
There are a number of dental
schools surveys and rankings
worldwide. Despite different me-

thodologies and different variables, King’s usually comes out
very near the top, which I am very
pleased about. The school attracts
not only good teachers and researchers, but also equally good
clinicians from across the world.

The programme for ConsEuro 2015 is
very focused on technology issues.
Would you confirm this to be the
overall theme of this conference?
From the beginning, we planned
this to be a very high-tech conference. In society and certainly in
dentistry, medicine or surgery,
technology is becoming increasingly important. And while air turbines and scalpels are still staples of
the trade, there is a huge amount of
technological equipment coming
on to the market for operative work,
dental surgery, logistics and communication.
Our belief is that dentists need
to know about all of these things,
as well as to have an understanding

Technology has clearly expanded
the scope of this conference. Does
this also apply to clinical practice?
Almost every dental practice
across the world now employs
some form of technology, be it
electronic patient records, stocktaking or equipment, such as lasers,
CAD/CAM and digital imaging to
show patients areas of the tooth
they could not possibly see otherwise. Digital imaging and photography are also very important from
a medical and legal point of view, as
this area is increasingly becoming
a concern.
Where do you see the trends with
regard to dental materials?
The materials that we use now
were not available to me when
I was in training and in my early
practice and the stages or requirements for their use are infinitely
more sophisticated. Nowadays,
you might have ten stages to a
bonding procedure and every one
of those stages is critical. If you
fail in only one of them, your
restoration fails before it has even
started.
Historically, dentists have been
trained by representatives of the
companies who make the materi-

“From the beginning, we planned this
to be a very high-tech conference.”
When I first joined the EFCD
about ten years ago, there was very
much an effort to compete with the
International Association for Dental Research, so it was very focused
on academics and researchers from
the universities. My view is that
this was a mistake, as we really need
to provide a conference that has interest across the board, so it must
have academic content of excellence to attract researchers and
teachers, as well as clinical content

of the evidence base. Should they
be using these things and, if they
are using them, which particular
model? This was very much the rational when we were planning the
programme. We also ought to have
a paperless conference. Our website and app have been very effective and when I read statements
yesterday on our Twitter feed, participants commented that this was
the most technologically advanced
conference they have ever been too.

Almost every dental practice across
the world now employs some
form of technology...”

als and that means they may not
get the most honest or scientifically valid perspective. Although
we very much support manufacturers contributing to education
programmes, we certainly like clinicians and scientists to be involved in those to provide the
evidence base. This is exactly what
we are doing here now.
What other lessons will you take
home from the conference?
Our conference proves that
you can take a high-tech approach
and still hopefully be profitable
or at least break even. Technology
is definitely here to stay; we just
need to look at the evidence base.
We also need to have training in
the use of technology and need
to look at clinicians and scientists
to guide us in the selection of
the particular devices that we
should use.
Thank you very much for the interview.

[5] => Standard_300dpi

[6] => Standard_300dpi

DTUK0215_06_News 28.05.15 10:08 Seite 1

World News

Dental Tribune United Kingdom Edition | 2/2015

US to lower ﬂuoride in
drinking water after 50 years
By DTI
WASHINGTON, USA: US health
authorities have updated their
guidelines for fluoride in drinking

water and now recommend an
optimal fluoride concentration
of 0.7 mg/l. As Americans today
have greater access to fluoride
in the form of toothpaste and

mouthrinse and owing to the
increasing incidence of fluorosis
due to excess fluoride, the Department of Health and Human Services sought to replace its previous

recommendations that were issued in 1962.
Since the early 1960s, the practice of adding fluoride to public

drinking water systems has grown
steadily in the US. Nearly all water
fluoridation systems in the US have
used fluoride concentrations ranging from 0.8 to 1.2 mg/l. With the
recent update, however, this will
be reduced by 0.1–0.5 mg/l, and
fluoride intake from drinking water alone will decline by approximately 25 per cent. The total fluoride intake will be reduced by about
14 per cent.
According to the department’s
report issued on 27 April, the new
optimal concentration of 0.7 mg/l
was chosen to maintain caries prevention benefits, but reduce the
risk of dental fluorosis.
Although a number of studies
have found that community water
fluoridation has led to a significant
decline in the prevalence and
severity of tooth decay, data from
the 1999–2004 National Health
and Nutrition Examination Survey
and the 1986–1987 National Survey
of Oral Health in US School Children indicate that over 20 per cent
of people aged 6–49 have some
form of dental fluorosis.
Today, nearly 75 per cent of
Americans who are served by public water systems receive fluoridated water. In 2012, the Centers
for Disease Control and Prevention
estimated that approximately
200 million people in the US were
served by 12,341 community water
systems that added fluoride to water or purchased water with added
fluoride from other systems.
Artificial fluoridation of drinking water remains controversial
as a public health measure, as it
has been suggested that excess
fluoride may have adverse health
effects. For instance, it has been associated with neurodevelopmental
delays in children and with the development of attention deficit hyperactivity disorder only recently.
In contrast to fluoridation policy
in the US, many western European
countries, including Austria, Belgium,
Finland, Germany and Sweden, do
not fluoridate their water supply.
Other European countries, such as
Ireland and the UK, currently add
fluoride to drinking water at levels
ranging from 0.2 to 1.2 mg/l.

[7] => Standard_300dpi

W
NE

The Essential Addition
for Your Successful Practice

The WaterLase iPlus Version 2.0,
from the global leader in dental lasers, expands and enhances
the treatments you can offer your patients, reﬂecting the almost universal interest in practice growth.

Delight patients with gentle, minimally-invasive procedures

Expand your treatment offerings with REPaiRTM

Enable faster healing times and improved comfort*

All-new SureFire™ YSGG Delivery System, the new gold standard in all-tissue laser delivery systems
WaterLase is the all-tissue laser trusted by the most dentists worldwide, with over 27,300,000* patients treated. Its unrivaled clinical versatility
– with the ability to treat hard tissue, soft tissue and bone – gives you unmatched results in treatment outcomes and outstanding ROI...
making it the essential addition for your successful practice.

Regenerative Er,Cr:YSGG Periodontitis Regimen

Introducing
the New and Improved

BEFORE

20 MONTHS POST OP
Courtesy of Dr. Rana Al-Falaki

Version 2.0

“The WaterLase iPlus is an integral part
of every procedure I do. The results we
achieve are outstanding, with so much
less stress, so much more fun and
so much more comfort for patients.”
— Dr. Rana Al-Falaki, London, UK

Upgrade Available
for current WaterLase iPlus owners.

Grow your practice with WaterLase.
Contact your BIOLASE distributor today.

Practice Growth. Assured.
BIOLASE Europe GmbH Paintweg 10, 92685, Floss, Germany • +0049 9603 80802 • biolase.com
©2015 BIOLASE, Inc. All rights reserved. *Data on ﬁle.

DentalTribune-UK_2015May26.indd 1

5/26/2015 4:35:09 PM

[8] => Standard_300dpi

DTUK0215_08_Koirala 27.05.15 15:37 Seite 1

World News

Dental Tribune United Kingdom Edition | 2/2015

“We are still pretty much in shock”
An interview with Nepalese dentist Dr Sushil Koirala
villages, so the rehabilitation
phase for the earthquake victims
is going to be a great challenge
for our country. I personally feel
that in order to overcome this
difficult time our country needs
support from each individual
and professional in Nepal. We
have, therefore, started a humanitarian project, the Dental
Community for Humanity—
Nepal Earthquake Relief Project,
under the umbrella of the Punyaarjan Foundation, a charitable
and non-profit organisation
dedicated to supporting people
most in need. This project aims
to support poor children living
in these remote villages in particular. I humbly appeal to the
international dental community to support this cause.
Please, with your donations and
support, we can bring back the
smiles of our poor children.

In one of the worst earthquakes
in over 80 years, more than
10,000 people are believed to
have died in the Federal Democratic Republic of Nepal. Living
in and practising dentistry in the
capital of Kathmandu, dentist
Dr Sushil Koirala has been directly
affected by the disaster. Dental
Tribune had the opportunity to
talk to him briefly about the
situation in the country and how
the international community can
help it to overcome the humanitarian crisis.
Dental Tribune: The earthquake
on 25 April had a devastating effect on your country’s infrastructure and its people. What is the
situation currently in Kathmandu,
and how have you been affected
personally?
Dr Sushil Koirala: The situation in Kathmandu at present
remains very difficult owing to
the extensive damage to many
public buildings, government
offices and schools. Nearly
7,500 lives have been lost and
14,500 people have been injured.
Those who survived the earthquake are traumatised.
While physically my family
and I are fine, we are still pretty
much in shock. My children are
very distressed because they
were alone at home during the
first episode of the earthquake.
Some of my staff from the hospitals and clinics lost their houses

Thank you very much for taking
the time and all the best for the
future.

Monk looking at destruction caused by the 25 April earthquake in the Nepalese capital Kathmandu. Damages are estimated at
US$200 million. © Narendra Shrestha/EPA

and Sindhupalchowk districts
of Nepal’s Central Region, as well
as the Gorkha District of its
Western Region.
Have you received any correspondence from the dental community?

fore, is hampered and support
items cannot be delivered on
time. Many people in these small
villages are still waiting for basic
items, such as food and shelter.
Regardless of the efforts by the
Nepalese army, police and Red

“Daily life in Kathmandu is still very
stressful, as there are frequent
aftershocks and people are still terriﬁed.”
unfortunately and have to stay
with relatives for the moment.
Have you heard from colleagues
in other parts of the country, and if
so what is their situation?
Most of my dental colleagues
are unharmed, but many of
them are facing problems with
their damaged clinics. Most of
the dental hospitals in Kathmandu are still closed owing to
the damage and employees not
being able to work because they
are busy rebuilding their lives.
Various agencies have estimated
that more than eight million
people across 39 of the country’s
75 districts have been affected
by the earthquake. The most
severely affected areas include
the Bhaktapur, Dhading, Dolakha, Kathmandu, Kavre, Lalitpur,
Nuwakot, Ramechhap, Rasuwa,

I am glad to have received
many e-mails with best wishes
and prayers from our dental
friends around the world. It is so
gratifying to know that many of
them have pledged their support
of the earthquake victims of
Nepal. Some dental manufacturers have shown keen interest to
help us in the rehabilitation of
children who have been affected.
Despite an immediate response
from India and Western countries,
relief efforts seem to be insufficient, according to reports. What
is your impression?
International communities
have offered immediate support
and we really appreciate their
help. However, 39 of the most
affected villages are in remote
locations with mountainous
terrain. The relief work, there-

Cross Society, as well as national
and international organisations,
which are working 24/7, the manpower and supplies are still felt
to be inadequate.
In your opinion, how will this disaster affect the infrastructure of
your country in the long run?

Editorial note: Dental Tribune spoke
with Dr Koirala in early May. Since then
Nepal has experienced a number of aftershocks. He and his family are in safety.

Nepal’s development budget
depends mainly on foreign aid.
Rebuilding all the infrastructure
affected by the earthquake will
require an estimated US$200
billion. The government plans to
meet this mainly through foreign and international funding.
However, damaged infrastructure will definitely affect the
economic growth of Nepal negatively.
When I will be able to start
practising again depends on
when all my staff are mentally
ready for work. Daily life in Kathmandu is still very stressful, as
there are frequent aftershocks
and people are still terrified.
Under these conditions, I do not
expect people will come for general dental treatment, except in
the case of an emergency.
What do you consider the most
important to improve your situation, and how can the international dental community help?
More than 95 per cent of
houses and infrastructure have
been damaged in the affected

Dr Sushil Koirala

For more information on how to
support the Dental Community for
Humanity project, please contact
Dr Koirala at drsushilkoirala@gmail.com.

[9] => Standard_300dpi

DTUK0215_09_Business 27.05.15 15:38 Seite 1

Dental Tribune United Kingdom Edition | 2/2015

Business

MIS says it is all in the shape
Implant solutions provider launches new implant at special event in London
mote the initial scaffold-building
process for bone growth and allow
more space for blood pooling and
the establishment of a stable blood
clot. This way, V3 provides clinicians
with advantages from the start,
achieving a greater volume of bone
and soft tissue at the onset of implant placement.

Elad Ginat stated. He said that it will
be available to visitors to EuroPerio8
from Thursday and to clinicians
worldwide in the upcoming months.

MIS Product Manager Elad Ginat

MIS Implants Technologies launched
a new implant at a special event in
London that promises immediate
biological benefits for better treatment outcomes. The new V3 is a
multi-use implant suitable for a wide
range of surgical scenarios, according
to the implant solutions provider,
and is ideal in anterior regions, as well
as in regions where space and bone
may be limited and good aesthetic
outcomes are essential.
Designed in collaboration with
leading clinicians, including Prof.
Nitzan Bichacho and Dr Yuval
Jacoby, both from Israel, as well as
Dr Eric Van Dooren from Belgium,
the development of V3 took two years
to complete, MIS Product Manager

“MIS is immensely proud of our
innovative position in the global
implants industry, which has led to
the development of the unique V3
implant system. It’s a widely anticipated evolutionary next step in
dental implant performance, designed for the benefit of clinicians
and their patients all over the
world,” Ginat stated.
The design of V3 aims to provide
both specialists and general practitioners with optimum flexibility
in implant planning and placement
for a restorative-driven approach.
In particular, the triangular shape
of the coronal portion is intended to
encourage bone regeneration and
to gain greater volume of bone in
support of stable surrounding soft
tissue for restorations with improved aesthetics. According to Ginat,
the neck provides solid anchorage
at three points in the crestal zone
while forming three compressionfree gaps at the sides (between the
implant and the osteotomy), thus

A high-performance conical connection implant with platform
switching, V3 also features a variable
thread and self-tapping capability,
micro-rings, a concave inter-thread
for maximum bone-implant contact, as well as a flat apex supporting
immediate placement engagement. Ginat added that clinicians
can enjoy all of these design benefits
without having to learn new protocols. Furthermore, a dedicated
surgical kit makes procedures especially simple, safe and accurate,
resulting in ease of placement for
the dentist and shorter recovery
time for patients, he explained.

favouring conditions for better osseointegration, such as high primary
stability, reduced bone compression

and crestal bone resorption. The
gaps encourage blot clot formation
at the bone-implant interface to pro-

For more information and
photographs from the
launch event, please visit
www.dental-tribune.co.uk.

DENTSPLY introduces WaveOne GOLD
New single-ﬁle reciprocating technology to offer improved strength and ﬂexibility

Dr Julian Webber © Daniel Zimmermann/DTI

Dental consumables manufacturer
DENTSPLY has introduced its new
generation of single-file reciprocating technology for use in endodontics at the Dentistry Show. WaveOne
Gold features a number of improvements to its predecessor and is

available to dentists in the UK immediately, the company said. The
previous system will be discontinued
from October.
According to London endodontist
and WaveOne developer Dr Julian

Webber, the new system is aimed at existing WaveOne users, as
well as general practitioners who practise endodontics but
have limited time resources or are afraid
of file breakage related to the use of NiTi
files. WaveOne Gold,
which has been heattreated to offer improved strength and
flexibility, will allow
them to treat a greater
range of canal morphologies, he said.
Therefore, the system
features four files instead of three as previously.
“We believe that the enhancements we have made in WaveOne
GOLD will increase clinicians’ confidence, help take away the fear
factor and encourage them to take

on cases considered too difficult
in the past,” Webber commented.

DENTSPLY premiered the
WaveOne technology in 2011.
AD

[10] => Standard_300dpi

DTUK0215_10_Haque 27.05.15 15:39 Seite 1

Business

Dental Tribune United Kingdom Edition | 2/2015

Google Mobile Armageddon
and what it means

bar indicates the total sessions and
the orange bar segments the mobile
and tablet audience. In all traffic
sources, mobile has the lion’s share
of the market. In this project, we invested heavily in Google pay per click
and 95 per cent of conversions were
via mobile.

By Naz Haque, Dental Focus

To qualify this trend further, consider that desktop sales have started
to decline significantly since 2005.
After 2013, the growth in purchases of
mobile devices (mobiles, tablets and
phablets) has continued to outgrow
desktop sales. Google focuses on its
users and anyone who wants to have
a presence on Google is directed to
follow its guidelines to serve these
users. In this instance, such users
are dentists’existing and prospective
patients. Therefore, it is really important that your website deliver to their
online expectations or Google will
not present your website to them.

Google has just released an update
that will prioritise mobile-friendly
websites. It is indeed widely known
AD

that online audiences are moving to
smart phone and tablet computers.
At Dental Focus, we have seen massive
shifts in the online audience to the
point now where most clients see a

minimum of 55 per cent of their organic
audience visits from mobile devices.
Websites and marketing campaigns achieve higher conversions

when they are mobile optimised.
The diagram below shows a marketing campaign we are running at
the moment. In this, we achieved
10,835 sessions over 30 days. The blue

For your website to be mobile
friendly, there are specific factors
to which it must adhere. The website
must not make use of any mobileincompatible animations created
with software like Adobe Flash. This
appears as a black space in a mobile
screen and serves no purpose. The
text on your website should be readable on mobile devices without the
user needing to resize or zoom. Responsive websites will automatically
adjust to serve readability factors.
User experience has always been
a core area from Google’s perspective, and mobile-friendly websites
have links separated sufficiently to
allow a user to make a selection with
ease. Google provides a platform to
check whether websites are mobile
friendly. Just type in your website address at www.google.com/
webmasters/tools/mobile-friendly.
There is no reason to panic if your
website is not ready yet; however, expect to lose more customers to businesses with mobile-friendly websites,
as they will be favoured by Google.
The company has such a massive job
to do reading the entire Internet, it is
unlikely you will start suffering from
12.01 a.m., but you can expect to see
your rankings diminish over time,
especially on a mobile device search.
Your presence on Google is directly affected by your competition, so
if your practice is in the middle of
nowhere with limited competition
you will live another day, but surely
it is time that you start to think how
to best serve your audience before
it is too late.

Naz Haque, aka
the Scientist, is
Operations Manager at Dental
Focus. He has
a background in
mobile and network computing,
and has experience supporting
a wide range of blue-chip brands, from
Apple to Xerox. As an expert in search engine
optimisation, Naz is passionate about helping clients develop strategies to enhance their
brand and increase the return on investment
from their dental practice websites. He can
be contacted at naz@dentalfocus.com.

[11] => Standard_300dpi

1 Year Clinical Masters Program
TM

in Aesthetic and Restorative Dentistry
12 days of intensive live training with the Masters in Athens (GR) and Geneva (CH)

Three sessions with live patient treatment, hands-on practice, plus
online training under the Masters’ supervision.
Learn from the Masters of Aesthetic and Restorative Dentistry:

Registration information:
12 days of live training with the Masters
in Athens (GR), Geneva (CH) + self study

Details on www.TribuneCME.com
contact us at tel.: +49-341-484-74134
email: request@tribunecme.com

Curriculum fee: €9,900
(Based on your schedule, you can register for this program one session at a time.)

Collaborate
on your cases

University
of the Paciﬁc

and access hours of
premium video training
and live webinars

you will receive
a certiﬁcate from the
University of the Paciﬁc

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

100

C.E.

CREDITS

Tribune Group GmbH i is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
program provider are accepted by AGD for Fellowship, Mastership, and membership
maintenance credit. Approval does not imply acceptance by a state or provincial board of
dentistry or AGD endorsement.

[12] => Standard_300dpi

DTUK0215_12-16_Whitesides 27.05.15 15:40 Seite 1

Trends & Applications

Dental Tribune United Kingdom Edition | 2/2015

Cone Beam Computed Tomography
Is dentistry ready for a new standard of care?
By Dr Lee M. Whitesides, USA
No database exists to search verdicts in dental malpractice cases
in which CBCT has played an important or pivotal role. For a new
technology to become admissible
as a standard of care in court, it
must pass the Frey test. This standard comes from Frey v. United
States which is a 1923 in a case
discussing the admissibility of
a polygraph test as evidence. The
Frey standard maintains that scientific evidence presented to the
court must be interpreted by the
court as “generally accepted” and
expert testimony must be based
on scientific methods that are
sufficiently established and accepted.

Since its commercial introduction
into dentistry in 2001, cone beam
computed tomography (CBCT) has
been rapidly evolving into a new
standard of care in maxillofacial imaging. In just over a decade, CBCT has
exploded onto the dental landscape
and permitted dental professionals
a degree of three-dimensional (3-D)
anatomic truth in maxillofacial imaging previously unavailable and
unattainable.
Like many other new technologies, which have progressed from
the extraordinary to the ordinary
and thus gained acceptance by
professionals and patients, CBCT
has advanced from exceptional
use to almost commonplace use in
dentistry as cost decreases, access
to the technology increases, and
potential adverse patient interaction (i.e. radiation exposure) is
attenuated. Today, CBCT is seen by
many in dentistry as the standard
operating procedure for many
dental implant, orthognathic, orthodontic, or endodontic cases.
The advancement of CBCT in
dentistry has caught the attention
of manufacturers of radiological
equipment. In 2001, only one company sold a CBCT system. In 2014
there are at least 20 companies
selling CBCT machines and technology. Henry Schein, a leading
distributor of dental equipment
has seen CBCT sales expand from
5 per cent of their digital imaging
sales to almost 50 per cent of digital
imaging sales in the last five years.
CBCT has also been recognised
by general dentists and specialists
as a means by which they can separate, identify, and distinguish
their practices as being on the vanguard of technology in patient care.

Today’s patients expect their dentist and physicians to be contemporary with technology and services.
CBCT provides the doctor with
a technology, which not only has
significant advantages in treating
patients but also has a noteworthy
“wow” factor as the 3-D images are
seen on a large screen in “real time”
for the doctor and patient to view.
CBCT, like plain film radiographic studies, may be considered a revenue generator for a

Standard of
care inﬂuences
The influence of an emerging
technology, like CBCT, into a new
standard of care involves many
criteria. These criteria include but
are not limited to: court verdicts,
expert testimony, literature support, professional guidelines, cost
and availability of the technology,
reimbursement by third party
payers, and multi-specialty use and
recognition.

In Frey, the court opined: “Just
when a scientific principle or discovery crosses the line between the
experimental and demonstrable
stages is difficult to define. Somewhere in this twilight zone the evidential force of the principle must
be recognised, and while the courts
will go a long way in admitting
experimental testimony deduced
from a well-recognised scientific
principle or discovery, the thing
from which the deduction is made
must be sufficiently established
to have gained general acceptance
in the particular field in which it
belongs.”
In many jurisdictions and in
Federal court, the Frey standard
is superseded by the Daubet
standard. The Daubet standard
is used by a trial judge to make

“...a technology, which not only has
signiﬁcant advantages but also has
a noteworthy ‘wow’ factor.”
practice. The more a CBCT machine
is utilised, the more revenue it will
generate. Additionally, the owner
may allow others in the profession
to utilise the machine for a fee,
thereby reducing his overall cost
of operation.
Standard of care is a legal not a
medical or dental concept. Standards of care are constantly evolving as methods and techniques
in patient care improve. An appropriate definition for standard of
care may include such language as:
the dentist is under duty to use
that degree of skill and care which
is expected of a reasonably competent and prudent dentist under
the same or similar circumstances.
Standards of care may be local, regional or national.

Taken individually, these criteria
do not constitute a mandate for any
technology as a standard of care.
Nor are these the only criteria one
may use in determining standard
of care. Taken together, these criteria provide strong evidence that
CBCT technology has sufficiently
evolved to be considered the standard of care in maxillofacial imaging in selected cases to assist the
dentist in treatment for patients in
need of dental implants, orthognathic surgery, manipulation of
difficult impacted teeth, orthodontics, endodontics, and many other
facets of dentistry.

The legal perspective
The legal system in the United
States is complex and fragmented.

a preliminary assessment of
whether an expert’s scientific testimony is based on reasoning or
methodology that is scientifically
valid and can properly be applied
to the facts at issue. Under this
standard, the factors that may
be considered in determining
whether the methodology is valid
are:
• theory or technique in question
can be and has been tested,
• it has been subjected to peer
review and publication,
• there is a known or potential error
rate,
• the existence of maintenance
standards controlling its operation,
• widespread acceptance within a
relevant scientific community.

The theory or technique behind
medical grade computed tomography and CBCT has been tested
and proven sound over many years
of application in the medical and
dental arena. The Hounsfield unit
is the widely recognised standard
quantitative scale for describing radiodensity and provides doctors
with a known standard and error
rate in computed tomography.
The widespread acceptance of
CBCT by the medical and dental
community is demonstrated by
the ever increasing presence in
dental and medical practices of the
technology. Additionally, The Intersocietal Accreditation Commission, an accreditation organisation
for medical and dental imaging,
has developed guidelines and accreditation criteria for 3-D CBCT
imaging. Thus CBCT appears to
have satisfied both the Frey and
Daubet criteria for acceptance as a
standard of care technology.
Not to discount the value of CBCT
imaging or its ability to successfully satisfy the Frey or Daubet
criteria, the absence of CBCT is
not de facto evidence of lack of
a standard of care imaging. Many
patients present to their dentist
with uncomplicated cases where
traditional two-dimensional radiographic studies are appropriate
and provide the dentist with standard of care imaging of the patient.
For the more complicated cases,
3-D imaging may be employed to
provide the dentist with superior
anatomic evidence in treatment
planning and diagnosis. Threedimensional imaging with CBCT
can also be used in uncomplicated
cases, but it may not necessarily be
considered as the standard of care
for every case in 2014.

Expert Testimony
An expert is a person with sufficient minimal qualifications to
render an opinion on the subject at
hand. Not all experts are created
equal, and in fact in three states
(Iowa, South Dakota, and New
Hampshire) an expert need only
be qualified in a related field to
offer an opinion. Experts are used
by the courts to educate the judge
and jury as to what constitutes normal minimal acceptable care of a
patient in a given environment.
Expert testimony is by definition
the opinion of one practitioner. It is
an opinion based on fact, evidence,
experience, and knowledge which
the expert believes to be relevant,
valid, and upheld in the scientific
community.
When reviewing a case for suspected malpractice the expert examines many things, including,
but not limited to: chart notes, radiographic studies, depositions, and

[13] => Standard_300dpi

PRINT
L
A
T
I
G
DI
N
O
I
T
A
EDUC
S
T
N
E
V
E

T
A
S
U
VISIT

5
1
0
2
o
i
r
e
P
Euro
30e
BOOTH

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.

[14] => Standard_300dpi

DTUK0215_12-16_Whitesides 27.05.15 15:40 Seite 2

14
professional correspondences. In
the last five years, the author has
noticed a remarkable increase in
the number of cases in which plaintiffs and defence attorneys, as well
as experts, rely on pre and/or postprocedure CBCT imaging studies
to assist in proving malpractice
or defending good practice. Posttreatment radiographic imaging to
prove malpractice or support good
practice is not new to medicine.
In fact in the years preceding WWI,
some of the highest malpractice
claims were awarded in cases
where post-treatment radiographs
played a pivotal role.
Logic would dictate that if plaintiffs and defence counsels and experts are making CBCT part of their
strategy, then CBCT must be not

Key words in search

Trends & Applications

to addressing the use of CBCT in
treatment planning and diagnosis
of patients in dental implant therapy, oral and maxillofacial surgery,
orthodontics, and endodontics.
Articles on new applications of
CBCT technology to patient care
were also prevalent in the sample.
Some articles addressed the risk
and benefits of CBCT but none
denounced CBCT as harmful to
the patient or insignificant in treatment planning and diagnosis. Two
similar PubMed reviews of the literature on CBCT were performed by
authors Alamri et al (Applications
of CBCT in dental practice: A review
of the literature. Gen Dent 2012:
60(5):390–400) and De Vos et al
(Cone-beam computerized tomography (CBCT) imaging of the
oral and maxillofacial region:

representing approximately 95 per
cent of oral and maxillofacial surgeons practising in the US. Literature addressing the application of
CBCT in oral and maxillofacial surgery has been around since 2007.
The AAOMS has offered continuing
education in the use and application of CBCT for patient care as
far back as 2011.The AAOMS has
worked with the IAC to develop
guidelines and accreditation criteria for 3-D CBCT imaging. In a
recent survey of OMFS residency
programmes, 87 per cent of programme directors acknowledged
the use of CBCT in patient care by
their residents.
The American Association of
Endodontists (AAE) and the American Association of Oral and

Number of articles

Year article first appeared

CBCT

5,537

1988

CBCT + dental

1,951

1998

CBCT + dental implant

617

2002

CBCT + orthodontics

725

2003

CBCT + oral surgery

1,041

1998

CBCT + endodontics

313

2007

Table I

only prevalent and pertinent but of
significant value in the formation
of an opinion by an expert (and the
jury) when reviewing a case. CBCT
can be seen as an additional and
important piece of information to
help explain why the doctor did
what he did or why an unfortunate
outcome occurred. Additionally,
CBCT provides powerful and easily
understandable images for layperson jury.
Recognising the value that CBCT
adds to a case does not necessarily
indicate that CBCT is the standard
of care in each and every case. The
decision to obtain a CBCT study before the procedure is determined
by the dentist based on his experience and knowledge of the case.

Literature Support
For any technology to be considered as a standard of care, a
plethora of literature in support for
the technology should exist. The
literature must discuss the risk and
benefits of the technology, its application to patient care, and guidelines and protocols for acceptable
use.
To assess the influence of CBCT in
the dental literature, the author
performed a PubMed literature
search in October for the words
cone beam CT, cone beam CT + dental, cone beam CT + dental implants, cone beam CT + orthodontics, cone beam CT + oral surgery,
cone beam CT + endodontics in
the search line. The results are in
Table 1.
Evaluation of Table 1 data clearly
shows a significant presence in the
literature of articles pertaining to
the use of CBCT in the various disciplines in dentistry. The vast majority of literature discovered pertains

A systematic review of the literature. Int J Oral Maxillofax Surg
2009;38:609–625). Both of these
exhaustive articles demonstrate
the plethora of literature addressing CBCT and its application in the
many disciplines in dentistry.

Professional
Guidelines
For a technology such as CBCT
to become a standard of care in
dentistry, guidelines for its use and
application in patient care must be
established by the organisational
bodies of those disciplines in dentistry who employ the technology
to treat patients. In dentistry, the
dental practitioners most involved
in the use and application of CBCT
in patient care include general
dentists, oral and maxillofacial
surgeons, endodontists, oral and
maxillofacial radiologists, orthodontists, and periodontists.
The American Dental Association has over 180,000 licensed dentists representing approximately
75 per cent of dentists in the USA.
The American Dental Association
published an advisory statement
article in its principal journal,
The Journal of the American Dental
Association, in August 2012. The
article discusses the many positive
aspects of CBCT, but stops short of
calling CBCT a new standard of care.
Rather, the ADA encourages the
dentist to use CBCT “selectively, as
an adjunct to conventional radiography”. The ADA further recognises
the value and presence of CBCT by
including CBCT-related courses at
its annual meetings and continuing education courses during the
year.
The American Association of
Oral and Maxillofacial Surgery
(AAOMS) has over 9,000 members

Maxillofacial Radiologists (AAOMR)
have released a formal position
paper on CBCT. This paper makes
many important points, such as
limiting the field of vision to minimise radiation exposure and increase resolution, careful patient
selection in CBCT, and the responsibility of the clinician to interpret
the entire image. The position
paper goes on to declare “the use
of CBCT in endodontics should be
limited to the assessment and
treatment of complex conditions”.
The article then lists nine of these
“complex conditions”. In summation, the position paper recognises
the value of CBCT as an adjunct to
2-D images and “CBCT may provide
dose savings over multiple traditional images in complex cases”.
Literature pertaining to the
use of CBCT in endodontics first
appeared in the Journal of Endodontics in 2003. The American Association of Endodontists sponsor
continuing education in endodontic related CBCT on their website
and the organisation devotes valuable time at its annual meeting
to CBCT as it relates to modern
endodontics. Most residencies
(44 of 47) in endodontics provide
CBCT for patient care.
Literature pertaining to CBCT
in dentistry dates back to 1998.
The AAMOR devotes considerable
effort to continuing education relating to CBCT both on its website,
through CE events, and at its annual
meeting. All seven ADA approved
residencies in Radiology incorporate CBCT education and training
into the resident curriculum.
The tremendous value of anatomic truth in complex orthodontic cases involving patients with
cleft lip and palate, impacted teeth,
and maxillofacial deformities is

Dental Tribune United Kingdom Edition | 2/2015

widely recognised and discussed
in the literature. Review of the
AAO annual meeting lecture syllabus shows CBCT is a prominent
topic for today’s orthodontist. In
a recent article in the Journal of
Dental Education by Smith et al
use of CBCT in orthodontic programmes in the US and Canada was
evaluated. This article showed the
following:
• 83 per cent of orthodontic programmes have access to CBCT,
• 73 per cent of programmes report
“regular” use of CBCT in patient diagnosis,
• Areas of CBCT use focuses on
diagnosis and treatment planning for: impacted teeth, craniofacial anomalies, TAD placement,
TMJ assessment, upper airway
analysis, and maxillofacial development.
Literature discussing CBCT in
periodontics first appeared in the
AAP journal over a decade ago. The
American Association of Periodontist annual meeting agenda and the
Journal of Periodontology demonstrate a heavy influence of CBCT in
the field of periodontics. All 51 postdoctoral US periodontal programmes use CBCT in patient care.
The International Congress of
Oral Implantologists (ICOI), the
world’s largest dental implant organisation and provider of dental
implant continuing education
with an excess of 25,000 active
members, published a consensus
report on CBCT in its journal
Implant Dentistry in April of 2012.
In the article, authored by many
leaders in the dental implant field,
the ICOI states: “The literature supports the use of CBCT in dental implant treatment planning particularly in regards to linear measurements, 3-D evaluation of alveolar
ridge topography, proximity to
vital anatomic structures, and fabrication of surgical guides.” The
ICOI reminds the dentist that use
of CBCT must be justified in each
case and should be considered as
an imaging alternative where conventional radiographs may not
provide sufficient anatomic truth.
Literature discussing the application of CBCT in implant dentistry
is ubiquitous and comprises the
lion’s share of research in applying
CBCT technology to dentistry. The
vast majority of post-doctoral residencies involved in dental implant
patient care and all private dental
implant training courses in the US
incorporate CBCT in their dental
implant education curriculum.
Many professional organisations in dentistry for general dentists and specialists have weighed
in on CBCT by providing recommendations, guidelines, and a position paper. While these guidelines
are beneficial in establishing a
society or specialty’s position on
CBCT, they are not mandates. Recommendations, guidelines, CE programmes, and position papers are
used by professionals to influence
the practice of their discipline.
As the practice of the discipline
changes in response to many fac-

tors including, but not limited to
court verdicts, expert testimony,
literature support, professional
guidelines, cost of the technology,
and reimbursement by third party
payers; the recommendations,
guidelines, and position papers
may facilitate the evolution of
CBCT into a standard of care. Thus,
in 2014 the professional organisations that comprise dentistry may
not formally declare CBCT is the
standard of care for every patient,
but these organisations do recognise the influence CBCT is having
on the profession.

Educational
Institutional
Participation
For a technology to be considered a standard of care, those in
the profession must be educated
in its application in patient care.
In US, 56 of the 57 dental schools
(98 per cent) have CBCT available
for patient care for pre-doctoral
students. Forty-seven (84 per cent)
incorporate CBCT education in
their pre-doctoral curriculum. In
a survey performed by the author
and others 202 general practice
residency (GPR) and advanced education in general dentistry (AEGD)
programmes were surveyed regarding use of CBCT by their
residents. Eighty-two programme
directors responded to the survey.
Of the 82 respondents, 56 (68 per
cent) of program directors (PDs) responded affirmatively when asked
if CBCT was used in patient care
by their residents. The author also
surveyed 102 PDs in oral and
maxillofacial programs in the US.
Fifty-four PDs responded. Of the
54 PDs responding 47 (87 per cent)
affirmatively when asked if CBCT
is used in patient care by their
residents. In a phone survey of endodontic residencies, 44 of 47 PDs
indicated their residents use CBCT
in patient care. All seven ADAapproved oral and maxillofacial
radiology programmes use CBCT
in patient care. Additionally, all
51 periodontal residency PDs indicated that their residents employ
CBCT technology in patient care.
In orthodontics, 83 per cent of USbased orthodontic programmes
use CBCT in patient care.

Cost and Availability
The cost of CBCT machines
today range from US$150,000 to
US$250,000 with yearly maintenance fees in the US$8,000 to
US$20,000 range. As with any
emerging technology, advances
create a secondary market for
slightly used machines. Each new
step forward in technology renders
the CBCT machine of only a few
years ago slightly out-of-date, despite its obvious value and its superiority to two dimensional films.
As time progresses and advancement in the quality and capabilities
of the newest machines demonstrate themselves, the slightly noncontemporary machine will represent a significant advancement for
the dentist versus 2-D radiography,
while not burdening the dentist

[15] => Standard_300dpi

[16] => Standard_300dpi

DTUK0215_12-16_Whitesides 27.05.15 15:40 Seite 3

Trends & Applications

with significant cost. This will undoubtedly lead to an increase in the
number of dental professionals
utilising CBCT in their practices.
The bottom line for most practices
in regards to CBCT machines is: can
I afford this for my practice?
To determine affordability, the
price of the machine (purchase and
maintenance) must be considered
against potential revenue generated by the machine. Revenue can
be directly from patients, insurance
companies, or from other dentists
who utilise the CBCT machine.
A cost-effective alternative to owning and operating a CBCT device
can be the outsourcing of the study
to a third party (dentist or facility)
and insourcing the software necessary to employ the images in treatment planning and diagnosis.
CBCT machines are becoming
ubiquitous as more dentist purchase the machines and more third
party non-dentist owned imaging
centres enter the market. Since
more dentist and more patients are
becoming exposed to the technology, patient acceptance will

Dental Tribune United Kingdom Edition | 2/2015

“...incorporating the technology
into one’s practice may not be entirely
necessary but prudent.”
increase, facilitating the incorporation of CBCT into the mainstream
culture of dentistry. The increasing
omnipresence of CBCT technology
will not singularly make it standard
of care, but it will serve to increase
patient awareness of the technology, which in turn will influence
what the public perceives as a standard of care.

The insurance
industry
Reimbursement from major insurance companies and government-sponsored health care is
traditionally the last to embrace
(i.e. pay for) a new service such as
CBCT. Although codes for medical

CBCTs have been around for decades,
specific codes for in office CBCTs
began to materialise in 2009. Current reimbursement rates for in-office CBCTs average around US$300,
provided the study is covered.
By providing dentists with a CPT
code, the insurance industry has
validated the technology of CBCT
and thus acknowledged its value in
treatment planning and diagnosis.
As time progresses, insurance companies may, as they have in the past,
require CBCT owner/operators to
obtain a certification via the IAC
or some other regulating entity for
an owner/operator to qualify for
financial reimbursement from any
third party payer.

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

Two of the major malpractice
carriers of the insurance industry
(OMNSIC and MedPro) have influenced the evolution of CBCT as
a new standard of care by offering
coverage for CBCT owner/operators commensurate with the level
of risk to which the owner/operators are exposed. Were CBCT studies
believed to be of little value or
represent minimal risk these leaders in the dental malpractice industry would not offer such coverage.
Additionally OMNSIC requires the
owner/operator to have CBCT images interpreted by a dental or medical radiologist to minimise risk.

Multispecialty use
and recognition
Dentistry has nine recognised
specialties; four (oral and maxillofacial surgery, endodontics, oral
and maxillofacial radiology, and
orthodontics) and the American
Dental Association have produced
literature to address the impact of
CBCT on patient care. Of the remaining five specialties, periodontics and prosthodontics could logically be appropriate groups to
produce a position paper on CBCT
given their members participation
in dental implant treatment of
patients. Paediatric dentistry may
soon provide a position paper once
the long-term studies have been
done to assess the risk versus benefits analysis with respect to the total
overall radiation dose and its effect
on the paediatric population. The
specialty of dental public health is
unlikely to weigh on the matter.
The value CBCT has in diagnosis
and treatment of patients is widespread and recognised by medical
disciplines such as plastic and reconstructive surgery, ENT, Craniofacial/CLP surgeons, and OMFS
trauma surgeons. These medical disciplines recognise the high quality
three dimensional detail CBCT provides and assists doctors in the
treatment planning and diagnosis
of their patients. Such widespread
and multidisciplinary application of
CBCT imaging contributes to CBCT
is becoming a new standard of care.

CBCT in the
dental culture
Register for

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.

Many in the dental profession
acknowledge the benefit of 3-D imaging to patients and doctors.
There is little dispute that CBCT
provides superior representation
of the anatomy verses 2-D plain films.
Quality of product acknowledged,
at least four aspects of CBCT must
work their way through the dental culture before CBCT becomes
A standard of care: cost, availability,
legal, and patient expectations.

Two of these aspects (cost and availability) will more likely than not be
determined by the invisible hand
of the market as the Keynesians
laws of supply and demand move
the dental industry to provide the
best possible service at a price patients and insurance companies
are willing to pay. The third (legal)
will be slowly determined in the
court systems as attorneys and experts begin to rely more on CBCT in
support of their clients’ cases.
Patient expectations are difficult
to accurately ascertain. We know
patients expect our practices to be
contemporary. Buying the latest
and greatest machine for your practice may not be wise if cost exceeds
benefits both clinically and financially. As CBCT becomes widely
accepted and expected by our patients due to aggressive marketing
or clinical relevance, incorporating
the technology into one’s practice
may not be entirely necessary but
prudent as others in the profession
who possess the technology appear
to be more contemporary and advanced in their patient care.
There are many questions yet to
be answered definitively regarding
CBCT:
1. Who is responsible (and liable)
for interpreting the images?
2. Is an entire field of view interpretation necessary or simply
the pertinent structures?
3. Must all images be interpreted
by a board certified oral and
maxillofacial radiologist or can
the ordering doctor interpret
the images?
4. What level of training is sufficient to own and operate the
machine, as well as, and interpret
CBCT images?
5. What cases deserve a CBCT?
6. If the patient refuses a CBCT and
the dentist believes a CBCT is
necessary for successful case
completion, must the dentist
complete the case without the
CBCT study or can he refuse the
case without fear of legal repercussions?
Lastly, as mentioned earlier, standard of care is an evolving concept.
Darwin stated clearly any organism
(or concept in this case) which is
subject to the laws of evolution
must adapt in response to outside
forces in order to survive. The standard of care in dentistry is adapting
to CBCT as forces (legal, financial,
clinical, and consumer) act upon
the industry to account for the
powerful influence CBCT has on
treatment planning and diagnosis of
patients. While recognising that all
that glitters is not gold, CBCT may
soon represent a new gold standard
by which many cases will be judged.

The Dr Lee M.
Whitesides is an
o ra l s u rg e o n
from Dunwoody
near Atlanta in
the US. He can
be contacted
at Drmac5678@
gmail.com.

[17] => Standard_300dpi

DTUK0215_17_PTEuroperio 27.05.15 15:44 Seite 1

PERIO TRIBUNE

The World’s Periodontal Newspaper · United Kingdom Edition
www.dental-tribune.co.uk

Published in London

Vol. 9, No. 2

Landmark dental event opens
this month in London
Up to 10,000 dental professionals expected for EuroPerio8
By DTI
LONDON, UK: This month, London
will be welcoming experts in periodontology and dental implantology from Britain and the continent
to the next pan-European meeting
of the European Federation of Periodontology (EFP). With preparations finalised in May, dental professionals are invited to learn about
the latest trends and developments
in both fields, the organisation said.
Headed by King’s College London
Prof. Francis Hughes, EuroPerio8
is expected to bring together thousands members of the profession
at the ExCeL London Exhibition
and Convention Centre from 3 to
6 June. Hughes told Dental Tribune
Online earlier that participants can
look forward to one of the largest
and most successful congresses on
periodontology and implant dentistry ever held in Europe.

Over 100 distinguished international speakers have confirmed
their participation in the scientific
programme, which will be complemented by a number of sponsored
sessions and free oral sessions selected from submitted abstracts.
“There is lots for all the dental
team,” Hughes said. “We are particularly keen to attract many general dentists and hygienists. This is a
great opportunity for us to promote
the profile of periodontology within the profession and more widely in
the population both within the UK
and throughout Europe.”
According to a recent study conducted by Barts and The London

School of Medicine and Dentistry
in London, periodontitis, particularly in its severe form, remains
highly prevalent around the world,
with almost every tenth person
suffering from the condition. In
Britain, at least one in 15 adults
are currently affected by the most
severe form of periodontal disease,
according to National Health Service figures.
Experts will discuss these developments at EuroPerio8, as well as
other issues in the field. The event
will also be a showcase for the most
recent product innovations in oral
health, which will be presented by
up to 80 sponsors, including the
UK’s own Dentaid, as well as major

international dental consumables
companies Johnson & Johnson,
Oral-B and Sunstar.
Elected EFP President Prof. Phoebus Madianos from Greece stated,
“A major priority for EFP is the general recognition of periodontology
as a dental specialty in Europe.
Therefore, the organisation is working with all relevant parties to promote the rationale of periodontology being recognised among regulators, licensing bodies and policymakers across Europe. Closely
related to this goal of full recognition is the creation of a common
curriculum for postgraduate studies in periodontology, promoted by
the EFP according to standardised

criteria, a project aimed at enabling
free mobility of periodontal professionals and citizens across the
EU, the ultimate aim being to improve the quality of treatment and
people’s general health.”
Currently, the EFP represents
16,000 dental professionals, who
belong to its 29 member associations, including the British Society
of Periodontology located in Bubwith in Yorkshire. Its last congress
brought more than 7,000 visitors
to Vienna in Austria in 2012.

For more information, news and updates please visit the event website at
www.dental-tribune.co.uk.

DTI to publish ofﬁcial
congress newspaper of
Publisher signs long-term agreement with European Federation of Periodontology
By DTI

from EuroPerio8 before, during
and after the event, on its website,
www.dental-tribune.com. Daily online coverage, including interviews
with key opinion leaders and industry representatives, will be provided by an on-site editorial team.
Moreover, users of the DTI website
will have free access to a dedicated
EuroPerio8 topic page, on which all
important updates, photographs
and videos will be published.

LONDON, UK: Undoubtedly, the
EuroPerio Congress today is among
the leading conferences for periodontology and implant dentistry
worldwide. Dental Tribune International (DTI) has recently signed
an agreement with the event’s
organiser, the European Federation of Periodontology, one of the
largest dental associations in Europe, to establish DTI’s today show
daily newspaper as the official congress guide of EuroPerio8.

For more than a decade, DTI has
partnered with some of the world’s
largest exhibition and congress
organisers, publishing more than
65 editions of its today show daily
newspaper for major dental shows
and events annually.

As part of the agreement, DTI will
publish three daily issues of today
in English during the congress. The
newspapers will be distributed to
over 7,000 expected participants
free of charge at the main entrances
of the congress venue, the ExCeL
London Exhibition and Convention Centre.
In addition, the publisher will be
providing editorials and special
features, as well as the latest news

today distribution at the ExCeL London Exhibition and Convention Centre at the next EuroPerio congress. © Annemarie Fischer, Germany

The publication allows for better
planning and orientation, as well
as provision of general business
information for congress participants and exhibition visitors. It has
also established itself as a platform
for the dental industry for targeted
communication.

[18] => Standard_300dpi

DTUK0215_18_PTJepsen 27.05.15 15:42 Seite 1

Perio News

Dental Tribune United Kingdom Edition | 2/2015

“The high prevalence of
periodontal disease is alarming”
An interview with EFP President Prof. Søren Jepsen, Germany, about EuroPerio8 in London
There will be parallel sessions
with different themes and for different target groups, Master Clinician Forums aimed at surgical
experts, many sessions dealing
with all aspects of implant therapy,
sessions on realising modern periodontics in daily practice, as well
as a whole lecture series about the
current understanding of aetiopathogenesis of periodontitis. All
these are presented by the absolute
best in their respective fields.

Prof. Søren Jepsen

Dental Tribune UK: This month, the
EuroPerio conference will be held in
the UK for the first time. How was
collaborating with the British periodontal societies, and what is your
assessment of the preparations in
general?
Prof. Søren Jepsen: Collaborating
with EuroPerio Chairman Prof.
Francis Hughes, who lives and
works in London, was absolutely
fantastic. We all enjoyed his great
ideas, enthusiasm and humour.
The British Society of Periodontology with its president, Prof. Iain
Chapple, and chair of the EuroPerio
Ambassador Programme Prof.
Nikos Donos in particular, significantly contributed to the event.
Both the current and past presidents of the British Society of Dental
Hygiene and Therapy, Julie Rosse
and Michaela O’Neill, were also
highly involved in the local organising committee and thanks to
them we will see many dental hygienists coming to EuroPerio8.

The issue of peri-implantitis is more
relevant than ever with an increasing
number of implants being placed
worldwide. How is this important
area reflected in the programme?
Several main sessions are dedicated to this area and there will
be a number of internationally renowned experts, including EFP
General Secretary Prof. Stefan
Renvert and EFP-treasurer Jörg
Meyle, who will speak about this
issue. Moreover, some of the scientific short presentations will deal
with peri-implant disease.

EuroPerio8 will be officially opened
at the ExCeL London Exhibition and
Convention Centre in London in June.
Dental Tribune UK had the opportunity to speak with the President
of the European Federation of Periodontology (EFP), Prof. Søren Jepsen
from Germany, in advance about the
importance of the event and why he
recommends attending it.

Personally, I am looking forward
to the keynote lectures on Saturday, as well as the many short presentations given by our younger
generation, who have found an
appropriate place within the main
scientific programme. I also recommend that visitors not miss
our closing event on 6 June. While
I am not supposed to reveal more
information at this point, attendees
can be sure it will be a cracker!

from a patient’s perspective. This
will be followed by a podium discussion involving patients and
clinical experts.
Despite a high prevalence, periodontal disease still does not attract
the attention it deserves, even in
developed countries. Where do you
see the main obstacles and what can
be done to raise awareness among
professionals and the general public?

events like EuroPerio significantly
help to increase awareness of these
issues among dental professionals
and the general public. The congress has already received high interest from the profession and we
expect up to 10,000 visitors from
all over the globe. This demonstrates that EuroPerio8 has clearly
become the worldwide largest congress in the fields of periodontics
and implant dentistry.

“EuroPerio8 has clearly become the
worldwide largest congress in the ﬁelds
of periodontics and implant dentistry.”

I would also really like to thank
the many students from the various dental schools in London who
agreed to volunteer at the event.

The interaction between periodontal and general health will
also play a prominent role, starting
with a world première of a film on
Thursday morning.

With over 100 internationally prominent experts, EuroPerio8 will again
present an extensive and highly
diverse scientific programme. What
session can visitors particularly look
forward to and what are your personal highlights?
The scientific programme is really top notch and diverse. There is
something for everyone. Scientific
Chairman Prof. Mariano Sanz has
been very creative and has done
a really excellent job.

Will there be new offerings compared with the last congress in
Vienna?
For the first time, we will have
the Patient Engagement Session
on Wednesday afternoon. There,
Prof. Ian Needleman and his team
from London will present a film
titled The Sound of Periodontitis:
The Patient’s View of Gum Disease,
which seeks to show what it means
to suffer from periodontitis and to
have periodontal treatment done

Indeed, we know that more than
50 per cent of the adult population
have periodontal disease. Severe
periodontitis affects 11 per cent of
the population and is the sixth
most prevalent condition worldwide. Not many people actually
know this, as well as the fact that
non-treated periodontal disease
can have negative consequences
for one’s general health. The high
prevalence of periodontal disease
is alarming and demands significantly higher awareness and thorough prevention.
We intend to communicate these
messages at a large press event to
be held in London. Furthermore,

The afore-mentioned patient
symposium is going to strengthen
public awareness. Finally, we plan
to launch an information campaign for Europe that targets public
and health officials.
In addition to European Periodontal
Day, your organisation has recently
launched a manifesto with the title
Perio and General Health. What
do you seek to achieve with this
initiative?
The goal of European Periodontal
Day is to increase awareness of the
prevalence of periodontal disease
and its significance for general
health, especially among other medical professions and policymakers.

The same message is carried by the
manifesto and we invite everyone
to support this mission by signing
it at www.efp.org/efp-manifesto.
Next year, the EFP will be celebrating
its 25th anniversary. How do you see
the role of the organisation within
dentistry, and what goals are on the
agenda for the time being?
We will certainly celebrate this
anniversary properly at the general
assembly of all national member
societies of the EFP next year in
Berlin. However, the party starts
already here in London, where our
colleagues and friends from all
over the world are assembled.
At this point, the EFP is already one
of the worldwide driving forces in
the field of periodontics and implant
dentistry. Its influence on dentistry,
particularly through its annual
consensus conferences (European
workshops) and EuroPerio, should
not be underestimated. We also have
to to acknowledge the EFP’s Journal
of Clinical Periodontology with its
editor Prof. Maurizio Tonetti.
For the next three years, we are
planning to advance our vision of
“Periodontal health for a better
life”. For this, we will communicate
the most important findings from
our consensus conferences with
regard to the interrelationship
between oral and general health,
as well as the prevention of periodontal and peri-implant disease,
to the public. As mentioned, we are
currently in preparations to launch
a European-wide campaign.
Thank you very much for the interview.

[19] => Standard_300dpi

LONDON’S TOP 10
ATTRACTIONS

1. BRITISH
MUSEUM
The world-famous British
Museum exhibits the works
of man from prehistoric to
modern times, from around
the world. Highlights include
the Rosetta Stone, the
Parthenon sculptures and
the mummies in the Ancient
Egypt collection. Entry is
free but special exhibitions
require tickets.

6. SCIENCE
MUSEUM
From the future of space
travel to asking that difﬁcult
question: “who am I?”, the
Science Museum makes
your brain perform Olympicstandard mental gymnastics.
See, touch and experience
the major scientiﬁc advances
of the last 300 years; and
don’t forget the awesome
Imax cinema. Entry is free
but some exhibitions require
tickets.

2. NATIONAL 3. NATURAL
HISTORY
GALLERY
The crowning glory of
MUSEUM
Trafalgar Square, London’s

4.TATE
MODERN
Sitting grandly on the
banks of the Thames is Tate
Modern, Britain’s national
museum of modern and
contemporary art. Its unique
shape is due to it previously
being a power station. The
gallery’s restaurants offer
fabulous views across the
city. Entry is free but special
exhibitions require tickets.

5.THE
LONDON
EYE

National Gallery is a vast
space ﬁlled with Western
European paintings from the
13th to the 19th centuries.
In this iconic art gallery you
can ﬁnd works by masters
such as Van Gogh, da Vinci,
Botticelli, Constable, Renoir,
Titian and Stubbs. Entry is
free but special exhibitions
require tickets

As well as the permanent
(and permanently
fascinating!) dinosaur
exhibition, the Natural History
Museum boasts a collection
of the biggest, tallest and
rarest animals in the world.
See a life-sized blue whale,
a 40-million-year-old spider,
and the beautiful Central
Hall. Entry is free but special
exhibitions require tickets.

7. VICTORIA
& ALBERT
MUSEUM

8. TOWER OF 9. ROYAL
10. MADAME
LONDON
MUSEUMS
TUSSAUDS
Take a tour with one of the
At Madame Tussauds, you’ll
GREENWICH
Yeoman Warders around
come face-to-face with some

The V&A celebrates art and
design with 3,000 years’
worth of amazing artefacts
from around the world. A real
treasure trove of goodies,
you never know what you’ll
discover next: furniture,
paintings, sculpture, metal
work and textiles; the list
goes on and on… Entry is
free but special exhibitions
require you to purchase
tickets.

the Tower of London, one
of the world’s most famous
buildings. Discover its
900-year history as a royal
palace, prison and place
of execution, arsenal, jewel
house and zoo! Gaze up
at the White Tower, tiptoe
through a medieval king’s
bedchamber and marvel at
the Crown Jewels.

Visit the National Maritime
Museum - the world’s
largest maritime museum,
see the historic Queen’s
House, stand astride the
Prime Meridian at Royal
Observatory Greenwich
and explore the famous
Cutty Sark: all part of the
Royal Museums Greenwich.
Some are free to enter; some
charges apply.

The London Eye is a major
feature of London’s skyline.
It boasts some of London’s
best views from its 32
capsules, each weighing 10
tonnes and holding up to 25
people. Climb aboard for
a breathtaking experience,
with an unforgettable perspective of more than 55
of London’s most famous
landmarks – all in just 30
minutes!

of the world’s most famous
faces. From Shakespeare
to Lady Gaga you’ll meet
inﬂuential ﬁgures from
showbiz, sport, politics and
even royalty. Strike a pose
with Usain Bolt, get close to
One Direction or receive a
once-in-a-lifetime audience
with Her Majesty the Queen.

[20] => Standard_300dpi

DTUK0215_20_PTBartold 27.05.15 15:47 Seite 1

Trends & Applications

Perio Tribune United Kingdom Edition | 2/2015

Where periodontology has advanced
A critique of current trends in the ﬁeld
By Prof. Mark Bartold, Australia

Over the past 20 years there have
been some exceptional advances
made in periodontology. Many of
these have led to changes in our
thinking and our approach to periodontal therapy. In 1999, the American Academy of Periodontology
(AAP) devised a “new” classification
system for the periodontal diseases.
From this some 50 different types
of periodontal conditions were identified which were considered worthy
of individual classification. Clearly
this was an unwieldly system and in
reality it was distilled down to three
main types of plaque-associated periodontal diseases: gingivitis, chronic
periodontitis and aggressive periodontitis.
While the appropriateness of the
terms “chronic” and aggressive”
have been debated they have served
as a framework for both clinicians
and researchers to define specific
types of periodontitis with identifiable clinical parameters. It also provided a framework for understanding management protocols and
outcomes. Nonetheless, over time
it has become evident that such a
classification system (chronic and
aggressive) may be too simplistic
because of the heterogeneity of the
periodontal diseases. Therefore, it
may be timely to revisit such a classification system and determine
whether current understanding of
the epidemiology and pathology of
these diseases can be used to better
define them.
However, it is worth noting that
in the past 25 years there have been
at least 10 different classification
systems proposed, none of which
have been fully adopted. Clearly
there remain a number of important challenges in this field. Since
chronic and aggressive periodontitis are heterogeneous groups of
diseases, for example, there will
be unique subcategories based
on their multifactorial nature
basis of microbial, host response
and environmental components.
At present, apart from “plaqueassociated” designation, the current AAP classification is not based
on cause-related criteria.

Recognition that
bacteria are necessary
but not sufﬁcient
for periodontitis
to develop
During the 1990’s a very important conceptual advance occurred
in our understanding of dental
plaque and its interaction within
the subgingival environment.
The recognition that subgingival
plaque existed as a biofilm with
its own microregualtory and communicative properties changed our
thinking of how the subgingival

microbiota interacted not only
with itself but also the host. Notwithstanding this, research through
the 1990’s and 2000’s began to
question the role of the biofilm and
its component bacterial consortia
in the overall process of the development of periodontitis. While it
was very clear that periodontitis
cannot, and will not, develop in the
absence of bacteria, it was becom-

Development of the
sub discipline of
Periodontal Medicine
The term “Periodontal Medicine”
was first proposed by Offenbacher
in 1997 as “A broad term that defines a rapidly emerging branch of
periodontology focusing on new
data establishing a strong relation-

conditions for which there is good
evidence to support interrelationships with periodontitis include
cardiovascular disease, rheumatoid arthritis, obesity and renal
disease.
It remains to be established
whether treatment of periodontitis has any impact on systemic
conditions but there is emerging

ing increasingly obvious that clinically there were some patients
who, despite the presence of considerable plaque deposits, did not
develop periodontitis. On the converse it was also evident that there
were individuals who had very minor visible deposits of plaque yet
developed very advanced and destructive periodontitis.

ship between periodontal health
or disease and systemic health or
disease”. It arose with the emerging
evidence suggesting that a number
of systemic conditions and periodontal disease were inter-related.
By 2000 the evidence that oral
health and systemic health should
not be separated had become very
compelling. Indeed the relevance

evidence to indicate this may be
the case for diabetes, cardiovascular
disease and rheumatoid arthritis.
Unfortunately, this has become an
opportunistic field of research and
to date some 58 conditions have
been claimed to fall within the periodontal disease/systemic disease
axis, most of which have little or no
biological or clinical plausibility.

“It remains to be established whether
treatment of periodontitis has
any impact on systemic conditions...”
These observations led to a major
paradigm shift in periodontology
in which it was agreed that although
plaque was necessary for periodontitis to develop, it was not sufficient
for it to develop. Indeed it became
evident that in addition to dental
plaque, environmental and host
response factors were critical for
the clinical manifestation of periodontitis. With this came a new more
informed management process for
our patients which dictated that in
addition to management of oral hygiene patients must be assessed for
other factors which would lead to
the development of periodontitis
and these must be controlled in order for treatments to be successful.
Indeed, it is now recognised that
dental plaque (and its constitutive
elements) accounts for only 20 per
cent of the risk for developing
periodontitis and thus the other
80 per cent of modifying and predisposing factors must be taken
into account when diagnosis and
treating the periodontal diseases.

of oral health to overall health and
general well-being was recognised
by the US Surgeon General in a
landmark publication titled “Oral
Health in America”. This document
for the very first time articulated
the importance of oral health in an
holistic approach to medical care.
Despite the title, its content was
relevant to the whole global scene.
From this the concept of periodontal medicine gained further traction and its central hypothesis
stated that periodontal infection
and inflammation presents a significant chronic inflammatory
burden at the systemic level.
While there is considerable work
still to be done significant progress
has been achieved in the past
decade. Diabetes is now well recognised to be a significant risk factor
for development of periodontitis
and conversely periodontitis is
considered to be a significant
modifying or risk factor for glycaemic control in diabetics. Other

Understanding
that periodontal
regeneration is
biologically possible
Regeneration of damaged periodontal tissues as a result of
periodontitis has been considered
the ultimate goal of periodontal
treatment. Over the decades many
procedures have been advocated,
mostly associated with root surface conditioning and implantation of bone substitutes into periodontal defects as a means of obtaining periodontal regeneration.
Unfortunately, these early concepts were naïve owing to a poor
understanding of the requirements for periodontal regeneration, namely the encouragement
of new cementum, bone and periodontal ligament. Filling a periodontal defect with a substance
which had no relevance to the next

functional stage of reconstruction
is irrational. Nonetheless, as a profession, we had become obsessed
with filling holes in bone rather
than studying the natural healing
processes required to regenerate the
periodontal attachment apparatus. Ignorance of the contribution
of the various tissue components
in periodontal wound healing explained the widespread misuse of
bone transplantation in the treatment of intrabony pockets which
unfortunately still pervades some
areas of periodontology.
It is now recognised that regenerative treatment of periodontal
defects with an agent or procedure,
requires that each functional stage
of reconstruction be grounded in
a biologically directed process.
With such concepts in mind, the
seminal studies of Karring, Nyman
and coworkers from Gothenburg in
Sweden led to the development
of guided tissue regeneration (GTR)
as a treatment modality. While this
was a significant advance it became
evident that while periodontal regeneration was biologically possible, it was clinically very difficult
to achieve on a reliable basis owing
to a vast range of patient and operator variables.
More recently we have seen the
development of biological agents
and preparations which, when applied onto root surfaces, can result
in significant regeneration of damaged periodontal tissues. The use
of such agents offers a simpler approach to periodontal regeneration
with equivalent, and sometimes
superior, results compared to GTR
procedures. However, as has been
noted for GTR, the clinical outcomes
using biological agents can be variable and further work is needed to
improve their clinical utility. Moreover, the use of mesenchymal stem
cells and genetic modulation of periodontal cells have been explored
for the purposes of achieving periodontal regeneration. The future
looks promising but no doubt there
is a considerable amount of work
to be done before reliable and predictable periodontal regeneration
becomes a reality.
At EuroPerio8 in London, Prof. Barthold
will be presenting a paper on periodontal medicine as part of the scientific
programme in Capital Suite 2–4.

Mark Bartold is
currently Professor of Periodontics and Director
of the Colgate
Australian Clinical Dental Research Centre at
the University
of Adelaide in
Australia. He can be contacted at
mark.bartold@adelaide.edu.au.

[21] => Standard_300dpi

[22] => Standard_300dpi

DTUK0215_22-23_PTMaden 27.05.15 15:47 Seite 1

Trends & Applications

Perio Tribune United Kingdom Edition | 2/2015

The TwinLight® approach
to peri-implantitis
By Dr Ilay Maden & Dr Zafer Kazak, UK

Fig. 1: Removal of the soft-granulation tissue with Er:YAG in LP mode. – Fig. 2: Removal of the bacterial bioﬁlm on the implant surfaces with Er:YAG in MSP mode. – Fig. 3a: Ablation of the infected bone with Er:YAG
in QSP mode. – Fig. 3b: Bacterial reduction in the bone tissue with Nd:YAG in MSP mode. – Fig. 4: Biostimulation with Nd:YAG in VLP mode. – Fig. 5a: Pre-op X-ray. – Fig. 5b: Pre-op X-ray zoomed. – Fig. 5c: Pre-op clinical.

As the number of dental implants
being placed increases, reported
cases of peri-implantitis are becoming more frequent. The available data suggest that one in five
implant patients will develop periimplantitis, an irreversible inflammatory condition characterised
by bone loss around the site of
an implant, while four in five will
exhibit peri-implant mucositis, an
early stage of the disease in which
the inflammatory reaction is still
reversible.1
With peri-implant mucositis,
the inflammation is limited to the
peri-implant mucosa, while with
peri-implantitis the infection also
spreads to the peri-implant bone.
Both conditions include the presence of bacterial plaque and calculus, oedema and redness of
tissues, and involve bleeding on
probing. In the majority of cases,
classical treatment methods for
peri-implantitis are inadequate
due to a number of complicating
factors, including resistant bacterial strains, difficult debridement
procedures and the presence of
biofilm on the implant surface.2

The most prevalent reason for
the development of peri-implantitis appears to be poor occlusal
load distribution, with either
primary contacts or cantilever
bridges in implant-supported
prostheses. Good oral hygiene on
the patient’s part is mandatory,
however, the position and design
of prostheses that are difficult to
manage may limit the effectiveness of mechanical cleaning. Once
the underlying reason has been
determined and recurrence is prevented, laser therapy can help to
treat peri-implantitis.

The TwinLight®
peri-implantitis
treatment
A new laser treatment called
TwinLight® from Fotona is proving to be one of the most effective methods for fighting periimplantitis, successfully meeting the objectives of controlling
in fection by surface decontamination and halting the
disease’s progression. TwinLight®
is a minimally invasive tech-

nique combining dentistry’s two
gold-standard laser wavelengths
(Er:YAG and Nd:YAG) in a synergistic process designed to improve
peri-implantitis treatment success rates and shorten healing
time.
With TwinLight®, the Er:YAG
laser is used in a non-surgical
procedure to remove microbial
composition and in a surgical procedure to treat the damaged alveolar bone around the implant.
Using Er:YAG, it is possible to clean
the granulation tissues, both on
the bone and implant surfaces,
and thoroughly decontaminate
the site. Removal of granulation
tissue from the alveolar bone and
connective tissue with Er:YAG
laser is highly effective. The erbium laser targets the water content to remove the granulation
tissue selectively, due to its long
pulse duration and lower peak
power, while ablating the microorganisms on the surface of the
bone.
The bactericidal effect of Er:YAG
on the surgical site is effective

against lipopolysaccharides, and
the implant surface is completely
cleaned without chemicals. The
subsequent Nd:YAG treatment
step promotes faster healing by
bacterial reduction and biostimulation of the bone tissue. The same
principles apply also with more
severe treatments that require
surgical therapy.

The TwinLight®
procedure
The TwinLight® procedure is
performed according to the following five steps:
• Step 1: Removal of the softgranulation tissue with Er:YAG in
LP mode (Fig. 1).
• Step 2: Removal of the bacterial
biofilm on the implant surfaces
with Er:YAG in MSP mode (Fig. 2).
• Step 3: Ablation of the infected
bone with Er:YAG in QSP mode
(Fig. 3a).
• Step 4: Bacterial reduction of the
bone with Nd:YAG in MSP mode
(Fig. 3b).
• Step 5: Biostimulation with
Nd:YAG in VLP mode (Fig. 4).

For treatment of peri-implant
mucositis, only step 2 is performed.
Because the Er:YAG wavelength
is used with an optimal modality,
there is no danger of thermal
damage to the highly fragile surrounding bone and no significant
alterations of the implant surface,
as is frequently the case with other
lasers.3, 4 The effect of the laser
energy on the implant surface is
dependent on the amount of
energy density, power and pulse
duration. The parameters should
be chosen cautiously—lowering
the settings may make the procedure slower but safer for reosseointegration. Non-surgical use
of Er:YAG is also possible if the
problem is not extensive.

Clinical Case
In the accompanying clinical
case, a removable prosthetic
with two ball attachments was
planned. Due to the patient’s request, the implants were immediately loaded, which most probably is the reason for the resorption

Fig. 6a: De-granulation and disinfection of the implant surface with Er:YAG laser. – Fig. 6b: Bacterial reduction and biostimulation of the bone with Nd:YAG laser. – Fig. 7a: 3 years post-op X-ray. –
Fig. 7b: 3 years post-op X-ray zoomed.

[23] => Standard_300dpi

DTUK0215_22-23_PTMaden 27.05.15 15:47 Seite 2

23

Trends & Applications

Perio Tribune United Kingdom Edition | 2/2015

seen around the implant on the
right lower jaw (Fig. 5). The site
was directly accessed to clean
the granulation tissue and disinfect the implant surface with
Er:YAG laser, while bacterial reduction and biostimulation were
executed with Nd:YAG laser
(Fig. 6). The defect was augmented with synthetic bone substitute.
After three years of follow up
with very good healing (Fig. 7), the
patient demanded a fixed prosthetic, which was delivered with
an additional placement of implants in both jaws. X-rays taken
5 years after the peri-implantitis
treatment can be seen in Fig. 8.
Two more implants were placed
distally when the patient could
afford more treatments after one
year.
There are a number of advantages of using lasers in this type of
case. One of them is that there is no
mechanical, chemical or any other
means of trauma while removing
the granulation tissue around the
implant—neither to the implant
nor to the bone tissue. In addition
to being safe, both wavelengths
are known to promote healing by
bacterial reduction and biostimulation of the tissue. Shorter pulses
are used on the surface of the
implant to avoid thermal effects,
but with lower energies, so as to
not have a too high peak power
and thereby damage the surface.
With short pulses and higher peak
power (higher energy), we can
create bleeding spots on the bone
to improve healing of the augmentation material.
The penetration of Nd:YAG
through bone helps the achievement of bacterial reduction and
biostimulation. Care should be
taken to avoid contacting the
implant surface with Nd:YAG because the absorption in titanium
is high and could cause a rise in
temperature. It is also important
to use a fast, sweeping motion
with high suction to avoid heat
accumulation on one spot. Too
much bleeding would block the
penetration of the Nd:YAG laser.
Nd:YAG can also be used on the
incision line, vestibular, the oral
side of the surgical site and extraorally after suturing, and every
second day for faster and better healing, with less pain and
swelling.

8a

8b

Fig. 8a: 5 years post-op X-ray. – Fig. 8b: 5 years post-op clinical.
AD

The Dental Tribune International
C.E. Magazines
www.dental-tribune.com

I would like to subscribe to

CAD/CAM

implants

cone beam
cosmetic dentistry*
DT Study Club (France)***

laser
ortho
prevention*

gums*

roots

€ 44/magazine (4 issues/year;
incl. shipping and VAT for customers
in Germany) and € 46/magazine
(4 issues/year; incl. shipping for customers
outside Germany).** Your subscription will
be renewed automatically every year until
a written cancellation is sent to
Dental Tribune International GmbH,
Holbeinstr. 29, 04229 Leipzig, Germany,
six weeks prior to the renewal date.

4 issues per year | * 2 issues per year
*** €56/magazine (4 issues/year; incl. shipping and VAT)

** Prices for 2 issues/year are €22
and € 23 respectively per year.

Shipping address

Editorial note: A list of references is
available from the publisher.
This article was originally published in
laser 1/2015 (Oemus Media).

Dr Ilay Maden is
the co-director
of Seesaw Dental Education
Independent
D e nt a l L a s e r
Courses, a UKbased afﬁliate
of the Aachen
D e nt a l L a s e r
Center in Germany. He can be contacted
at ilaymaden@gmail.com.

City

Country

Phone

Fax

Signature

Date

PayPal | subscriptions@dental-tribune.com

Credit Card
Credit Card Number

\ SUBSCRIBE NOW!

Expiration Date

Security Code

fax: +49 341 48474 173 | e-mail: subscriptions@dental-tribune.com

[24] => Standard_300dpi

) [page_count] => 24 [pdf_ping_data] => Array ( [page_count] => 24 [format] => PDF [width] => 846 [height] => 1187 [colorspace] => COLORSPACE_UNDEFINED ) [linked_companies] => Array ( [ids] => Array ( ) ) [cover_url] => [cover_three] =>

[cover] => DT UK No. 2, 2015

[toc] => Array ( [0] => Array ( [title] => UK News [page] => 01 ) [1] => Array ( [title] => World News [page] => 06 ) [2] => Array ( [title] => Business [page] => 09 ) [3] => Array ( [title] => Trends & Applications: Cone Beam Computed Tomography [page] => 12 ) [4] => Array ( [title] => Perio Tribune United Kingdom Edition [page] => 17 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

UK News / World News / Business / Trends & Applications: Cone Beam Computed Tomography / Perio Tribune United Kingdom Edition

[cached] => true )