DT UK No. 5, 2015

UK News / Short-term gains…long-term problems? / World News / Show Tribune BDIA Dental Showcase 2015 / Data security: How not to become the next Ashley Madison / Avoiding common problems in tooth extractions / Mandibular body reconstruction with a 3-D printed implant / formnext powered by tct is rising high

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DTUK0515_01_Title 15.10.15 12:51 Seite 1

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

Published in London

Vol. 9, No. 5

ORTHODONTICS

DATA SECURITY

AVOIDING PROBLEMS

DT contributor Aws Alani, London,
discusses the emergence and
future implications of short-term
orthodontics in general practice.

The principles of moving and
protecting one’s data and what
dentists should consider to not
become the next Ashley Madison.

Some tips not usually included in
traditional textbooks or lecture
notes to help general practitioners
to perform safer extractions.

” Page 4

” Page 17

” Page 18

World largest
More UK dentists see no future dental
for their profession
companies
merge

By DTI
BIRMINGHAM, UK: Recent changes
to the dental care system seem to
have taken their toll on dentists’ expectations for the future of their
profession. According to a recent
poll conducted by Birmingham financial service provider Wesleyan,
half of the dentists surveyed stated
that they would advise against
entering the field when asked
whether they would recommend
dentistry as a career to friends or
family members.
Most of those surveyed named
increasing costs, including those
for education and training, along
with changes to pay and working
conditions, as the main reasons
for the grim future of the field.
The overall majority admitted that
pressure on the profession owing
to these changes has increased.
Other issues, such as the introduction of the new NHS dental contract and the changes to the NHS
Pension Scheme, were also identified as having an impact on the
field in the years to come.
“There are huge stresses in the
dental profession and great un-

DENTSPLY International and
Sirona Dental Systems have entered
into a definitive merger agreement
and will operate under the name of
DENTSPLY SIRONA in the future. Both
companies will retain their respective
headquarters. The current DENTSPLY
head office in York will serve as the
new company’s global headquarters,
while the international headquarters
will be located in Salzburg.

One in two dentist would not recommend dentistry as a career.

happiness, even fear, regarding our
regulator, not to mention an uncertain NHS future,” Judith Husband,
a dentist and member of the Wesleyan Members Advisory Board,
said. “More than half of dentists in
England and Wales are associates
and, because of the massive rise in
the value of practices, it is becoming increasingly difficult for those

with an ambition to own their own
practice to actually achieve this.”
In an earlier Wesleyan poll conducted among dentists last year,
only every third dentist said that he
or she would recommend the profession to others. In sharp contrast,
more dentists then ever would
choose to enter the profession again

if given the opportunity to start
over. According to the latest poll,
almost two-thirds of dentists would
choose the same career path again,
compared with 60 per cent in 2014.
“Practising dentistry and looking
after patients remains a rewarding career with lots of varied opportunities,”
remarked Husband on the results.

Upon close of the transaction,
Jeffrey T. Slovin, current president
and CEO of Sirona, will serve as CEO
of DENTSPLY SIRONA and will be a
member of the board of directors.
Bret W. Wise, current chairman and
CEO of DENTSPLY, will assume the
position of executive chairman of
the newly founded company. In their
respective positions, they will collaborate in executing the corporate
strategy and in integrating the companies and their respective corporate
cultures.
Together, the companies expect
to generate a net revenue of about
US$3.8 billion (€3.4 billion) and adjusted EBITDA of more than US$900
million (€796 million), excluding the
incremental benefit of synergies.
AD

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DTUK0515_02_News 23.03.16 17:38 Seite 1

UK NEWS

Dental Tribune United Kingdom Edition | 5/2015

First Brit to assume presidency
of world’s largest ortho body

IMPRINT

By DTI

ONLINE EDITOR:
Claudia DUSCHEK

“There must be strong support
for our present fellows and elected
representatives in these countries
who are trying to maintain both
a service and high standards for
patients under challenging conditions,” he said.

LONDON, UK: Former President of
the British Orthodontic Society
Dr Allan R. Thom is the new President of the World Federation of
Orthodontists (WFO), the organisation announced on the last
day of its 2015 international congress in London. He is the first
orthodontist from the UK to assume the presidency of the specialist body, which represents
110 orthodontic societies around
the globe.
Thom is taking over the role from
Dr Roberto Justus from Mexico,
who has headed the WFO for the
last five years. In his first speech,
he said that under his presidency

Thom (right) with his predecessor Dr Roberto Justus.

the WFO will help young dentists
and those living in areas of civil

unrest to play a more active role
in the organisation.

Thom’s term as president will
end in 2020. An expert witness
from Tunbridge Wells in Kent,
Thom has been a consultant orthodontist and author of clinical books
for over 30 years. Among other
things, he helped to establish an
orthodontic service in Malta when
working as a consultant adviser to
the country’s health department.
He has also served on the WFO’s
Executive Committee for over a
decade.

PUBLISHER:
Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT AP & UK:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
CLINICAL EDITOR:
Magda WOJTKIEWICZ

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
Antje KAHNT
MARKETING & SALES SERVICES:
Nicole ANDRAE
ACCOUNTING:
Karen HAMATSCHEK
BUSINESS DEVELOPMENT:
Claudia SALWICZEK

Maternal stress linked to higher
caries prevalence in children

EXECUTIVE PRODUCER:
Gernot MEYER
AD PRODUCTION:
Marius MEZGER
DESIGNER:
Franziska DACHSEL
INTERNATIONAL EDITORIAL BOARD:
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany

By DTI
SEATTLE, USA/LONDON, UK: New
research has related chronic maternal stress to a higher prevalence
of cavities among children. The
study, which was conducted by researchers at King's College London
and the University of Washington,
further showed that chronic stress
levels also influenced mothers’
care-taking behaviors, such as
breast-feeding, dental visits, and
giving breakfast daily.

measure the impact of maternal
stress on children's oral health, the
researchers analysed data from
716 US mothers of children aged
two to six. Data was taken from the
1988–1994 National Health and
Nutrition Examination Survey.
The investigators noted that even
though the data used was relatively old, the public availability
of the file allowed for a unique
opportunity to analyze mother–
child pairs from a large US study
sample.

associated with socio-economic
status, affecting care-taking behaviors, such as breast-feeding, dental
visits, and giving breakfast daily.
“Mothers with lower income were
significantly less likely to breastfeed
or to have taken their child to the
dentist in the prior year. They were
also less likely to feed their child
breakfast than higher income counterparts. It is important to better
understand the dynamics of these
links, so that we might develop

nificantly less likely to breast-feed
than those with a normal AL level.
This behavior was found to affect
caries prevalence in children, as
dental cavities were almost twice as
common among children whose
mothers did not breast-feed than
those whose mothers did—62.9 per
cent vs. 37.1 per cent.
“This study uniquely highlights
the importance of considering the
influence of socioeconomic status
and maternal stress on children’s
oral health through mothers’
struggles to adopt healthy patterns that are major predictors of
dental cavities, such as brushing
her children's teeth regularly, maintaining healthy dietary habits and
taking regular visits to the dentist for preventive care,” Erin E.
Masterson, a PhD student from
the schools of Public Health and
Dentistry at the University of
Washington, said.
“Policy that aims to improve dental health, particularly the prevalence of cavities among children,
should include interventions to
improve the quality of life of mothers. Chronic maternal stress as a
potential risk factor is something
we need to consider, in addition to
the wider implications of maternal
wellbeing, social, and psychological environment on dental health,”
Sabbah concluded.

While this is not the first study
to associate maternal exposure to
stress with childhood cavities, it is
the first to examine the relationship using biological markers of
chronic stress, an incident known
as allostatic load (AL). In order to

The findings showed that caries
was more common among children
whose mothers had two or more
biological markers of AL compared
with no such markers—44.2 per
cent vs. 27.9 per cent. They further
identified that maternal AL was

effective public health programs
and interventions,” Dr. Wael Sabbah,
a senior lecturer at the Dental Institute at King’s College, remarked.
In the study, mothers who had
one or more markers of AL were sig-

The study, titled “Maternal Allostatic Load, Caretaking Behaviors,
and Child Dental Caries Experience”, was published online ahead
of print on Sept. 17 in the American
Journal of Public Health.

Dr George Freedman, Esthetics, Canada
Dr Howard Glazer, Cariology, USA
Prof. Dr I. Krejci, Conservative Dentistry, Switzerland
Dr Edward Lynch, Restorative, Ireland
Dr Ziv Mazor, Implantology, Israel
Prof. Dr Georg Meyer, Restorative, Germany
Prof. Dr Rudolph Slavicek, Function, Austria
Dr Marius Steigmann, Implantology, Germany

Published by DTI.
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DTUK0515_04-05_Alani 15.10.15 12:02 Seite 1

OPINION

Dental Tribune United Kingdom Edition | 5/2015

Short-term gains…long-term problems?
The emergence of STO and its future implications in general practice
By Aws Alani, UK
The provision of orthodontics can be
a life-changing experience for young
patients whose “crooked” teeth can
affect their confidence and self-esteem. Indeed, where mature patients

present with a history of malalignment, equally beneficial and fulfilling
results can be achieved. In government-funded systems, patients with
congenital abnormalities receive
treatment that is essential to their
ongoing oral health. Restorative den-

tists work closely with orthodontists,
who can appreciate how small details
can aid in achieving positive restorative outcomes.
As a young dentist, I corrected
a tooth in crossbite with a simple

T-spring appliance. It was enjoyable
and brought a different type of delayed gradual satisfaction to the more
cerebral but tenuous molar endodontics or the more artistic and instant
composite build-up. I was not a specialist, but I managed to do some or-

The Dental Tribune International
C.E. Magazines

The specialist training pathway for
orthodontics involves a competitiveentry three-year full-time course
linked with the achievement of a master’s level qualification that many may
feel daunted by. Indeed, navigating
the pathway from start to finish can be
difficult academically and financially
when factoring in fees and loss of earnings during training. Once qualified,
the majority of these specialists reside, like the majority of all specialists,
in the south-east of England. With
this skewed distribution of specialists
and assumed need for access, it might
seem prudent for general dental practitioners to contribute to meeting the
need for orthodontics.

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thodontics. In contrast to my experience, general dental practitioners are
now more routinely providing tooth
movement with the emergence of
short-term orthodontics (STO). This
has resulted in some conjecture as to
the methods of achieving “straighter”
teeth. Indeed, some may consider
STO as an emerging entity competing with specialist orthodontics, but
should it be?

Security Code

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

Indeed, the long-cited managed
clinical networks have yet to be fully
realised, although all planning and
documentation related to managed
clinical networks identify general
dental practitioners as integral to the
function of the network. The number
of orthodontic therapists has gradually increased over the last ten years
or so since inception of the first
courses in Wales and Leeds. Therapists are allegedly more cost-effective to train and employ in a large
orthodontic practice; however, unlike their hygiene or therapy colleagues, they cannot practise without a specialist’s treatment plan and
supervision.
Patients who qualify for orthodontic treatment under the UK government-funded system need to be assessed according to the index of orthodontic treatment need. There will
be an obvious shortfall of adults or
adolescent patients with minor malocclusions who do not meet the criteria who would like their teeth
straightened. This cohort may have to
seek treatment privately from orthodontic specialists or general dental
practitioners. As such, these minor or
straightforward cases may be managed in a number of different settings
utilising various techniques with the
advent of STO. This may have resulted
in some territorial paranoia between
the two camps of traditional orthodontics versus STO systems. Conversely, it may be that differing scientific, technical and ethical ethos on
managing the same problem is the
source of the debate.

Quick and easy?
Commercialisation has modified
the provision of orthodontics in the
UK. Indeed, there are now orthodontic
brands with courses attached and a

[5] =>

DTUK0515_04-05_Alani 15.10.15 12:02 Seite 2

Dental Tribune United Kingdom Edition | 5/2015

OPINION

faculty of individuals who promote
their particular product. Companies
tend to boast that their product is the
best with limited complications and
treatment being low risk, predictable
and easy. Somewhat surprisingly,
courses are being run on how to convert patients into orthodontic clients.
There are books describing strategies
on promoting and increasing revenue. They outline detailed strategies
on attracting more patients than
one’s local competitor—or is that colleague? Sounds more like capitalism
than commercialism to many interested observers.
The rapid development of STO has
not escaped the venture (or some
may say vulture) capitalists. In the
same vein as DIY whitening and sports
guards, one can now have one’s teeth
straightened via online companies
using products delivered by Her
Majesty’s Royal Mail and so cut out
the middleman (i.e. the dentist). To
my knowledge, STO has yet to make
it on to the price list of Samantha’s,
a beauty salon in Peckham.
What may cause fear and worry is
that the provision of tooth movement
set against a backdrop of a focus on
increasing revenue and patient conversion may detract from the real reasons we are providing the treatment.
The risk and benefit of treatment
must remain balanced or be rebalanced in favour of the patient.
The best things in life are rarely
quick, easy and without reflection.
While learning or training, one gains
stature from one’s mistakes and
learns by way of osmosis from those
of individuals one hopes to emulate.
Becoming an expert in many a field
requires time, effort and experience.
Orthodontics is a complicated discipline that is difficult to deliver optimally and efficiently. Treatment planning should be performed in person
not only to appreciate the challenges
the patient presents with but also to
develop a lasting patient rapport.
Equally important, patients need to be
diligent during treatment and forever
more for purposes of retention. Is it
possible that a one- or two-day course
with a treatment plan lasting half
a year or less can provide equally optimal results to a specialist orthodontist utilising traditional means?
In any case, placing a time limit on
any treatment could be considered
contentious. Patients ask me all the
time‘How long is this treatment going
to take Doc?’ I always reply ‘Ill tell you
when its finished’. As such I am rarely
wrong.

Advertising cosmetic
treatments the fair
dinkum way
The Australian health ministry
recently examined the provision of
cosmetic procedures and in particular the modes of promoting the treatments. The working group found
that advertising and promotion
more often than not focused on the
benefits to the consumer, downplaying or not always mentioning risks.
The group went on to identify advertising practices that were not driven
by medical need and where there was

significant opportunity for financial
gain by those promoting these. They
identified the need to regulate promotion and advertising ethically
with factual, easily understood information from a source that is
independent of practitioners and
promoters. This is unfortunately not
always readily available. In some
Australian jurisdictions, there are
specific guidelines that need to be adhered to for promotion of cosmetic
treatments and they specifically
cover before and after treatment adverts, which we know in the UK is a
popular practice among the cosmetically driven. This is commonly one
ideal, perfect case showcased on the
front end of the practice website with
no mention of any problems, either
acute or chronic. Another aspect of
the report detailed prohibition of
time-limited offers or inducing potential customers through free consultations for the purposes of treatment uptake. The latter is something
that has seen STO promoted by way
of voucher deals on the Internet or
via smartphone applications. Others
may consider such a practice as loss
leading; one could ask who is losing
and who is gaining and at what price?
One important aspect of the report
identified the wider social impact of
cosmetic procedures in that people
may become increasingly dissatisfied
with themselves and their appearance, culminating in deeper concerns
for the person and reducing scope for
individuality. Many dentists throughout the country may have a slipped
contact here, a rotation there or a
space distal to a canine who are unlikely to be waiting in earnest for the
next voucher deal alert on their
iPhones. Inducing misgivings or raising concerns about the patient’s tooth
position where the teeth are otherwise healthy and the patient presents
with no concerns could be considered
unethical and worryingly dishonourable.

Relapse of conﬁdence
In a recent publication from an indemnity provider, orthodontics was
identified as an emerging area for
claims against their clients. This is
likely to be the tip of the iceberg, whose
size will probably continually grow as
more and more orthodontics is provided and the repercussions of which
may only become apparent gradually
in the future.

In the now highly litigious arena of
UK dentistry, the failure of orthodontic treatment against the backdrop
of Montgomery v. Lanarkshire Health
Boardis likely to result in increased litigation. The movement of teeth into

05
what the patient and the dentist feel is
the correct position may be possible
in the short term, but in the long term
complications may arise owing to a
variety of soft- and hard-tissue factors
that cannot accommodate this new
and supposedly “right” position. Indeed, orthodontics requires the appreciation of detail where symmetry
and alignment are “king”, but longterm stability is the likely “empress”.
Relapse of position is a common complaint and where patients have paid
handsomely for a result they may
have been happy with at the time of
the cheque clearing, over time tiny
tooth shuffles can result in disproportionate and vehement dissatisfaction.
Where teeth are moved indiscriminately, recession in the labial segment
is a complication difficult to explain
and remedy in the high lip line of
a conscientious and ambitious corporate female patient. Indeed, more
haste, less speed may result in a case
being etched longer in the memory
of the patient and the clinician for
the wrong reasons.

Clear steps to
business building
A cornerstone of a successful business is the repeat customer who values the dentist and his or her service
and returns with no qualms or misgivings about what the dentist feels
should be provided. A successful business relies on patients returning in
the long term owing to their positive
experiences. Focusing on short-term
gains without due consideration of
quality or reliability of the treatment
provided has potential repercussions
for patients, the business of dentistry
and perception of the profession.

Aws Alani is a
Consultant in Restorative Dentistry at Kings College Hospital in
London, UK, and
a lead clinician for
the management
of congenital abnormalities. He
can be contacted at awsalani@hotmail.com.
AD

www.DTStudyClub.com

Y education everywhere
and anytime
Y live and interactive webinars
Y more than 500 archived courses
Y a focused discussion forum
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scientific articles and case reports
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credit administration

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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.

[6] =>

DTUK0515_06_Branemark 15.10.15 12:03 Seite 1

WORLD NEWS

Dental Tribune United Kingdom Edition | 5/2015

“We need to stay open-minded
to new crazy ideas”
An interview with Dr Rickard Brånemark, Sweden
The concept of osseointegration has
been applied to dental implants for
several decades. As an orthopaedic
surgeon and engineer, Dr Rickard
Brånemark has continued the work
of his famous father by adapting
the concept to the treatment of amputees. In an recent interview with
Dental Tribune at the EAO congress
in Sweden, Brånemark explained
the benefits and future possibilities of osseointegrated amputation
prostheses.
Dental Tribune: Dr Brånemark, could
you please give an outline of the
development of osseointegrated
prostheses?
Dr Rickard Brånemark: The work
started by my father was the foundation of what we do in ortho-

paedics today. Using his concept,
I developed new treatments for
amputees based on osseointegrated
implants, which I have been performing for about 25–30 years now.
Since 1998, I have mostly worked
with my own companies, namely
Brånemark Integration, the dental
company I started with my father,
and Integrum, which does all the
development for orthopaedic osseointegration. However, we now also
have multinational collaborations
with universities in Gothenburg,
Vienna, San Francisco and Chicago,
and hopefully also Göttingen in the
near future. As the Swedish implant
system has recently been approved
by the US Food and Drug Administration (FDA) for the treatment of

PRINT
L
DIGITA N
TIO
EDUCA
EVENTS

Dr Rickard Brånemark

What do you consider the main
challenges of this treatment?
Anchoring something to the
bone is the core of osseointegration
technology and that is a fairly robust
technology we have proven in millions of dental implants. However,
in orthopaedics, we face additional
challenges. There are, for example,
no materials available today that
are strong enough to withstand
20–50 years of high physical activity.
Therefore, we have developed and
continue to develop new materials
and surfaces that better withstand
the higher loads.
Another important concern is the
mucosal area and skin penetration,
which is maybe even more challenging. We are working with a concept
very similar to the old Brånemark
protocol and the bone-anchored
hearing aid in that we have a smooth
surface that is not an attachment.
There are many groups working
with attachments and, as far as
I know, all have failed, especially in
the orthopaedic field.
However, just like with every
surgical procedure, the outcome
largely depends on the skills of the
surgeon too.

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.

The main advantage of our
approach compared with our competitors is that they have to use
wireless technology because they
do not have the means to bring
wires out of the body owing to the
risk of infection. However, we have
this fantastic osseointegrated implant to use as a conduit so that
the wires can pass through the
implant system. Similar to a fibreoptic Internet connection, the wired
connection in a robotic arm is much
better, stable and robust.
We have already successfully
treated one patient. However, our
research is still in the early phase,
but I think we could do amazing
things in the future.

amputees, I am currently establishing an orthopaedic osseointegration centre in San Francisco and am
working closely with the US Department of Defense, which has many
soldiers with amputations and is
thus very interested in supporting
our work.

prosthesis, which helps us to direct
the prosthetic device in a much
better way and provides feedback.
This is extremely important for
truly restoring function.

For the last six years, you have also
been using osseointegration in conjunction with implanted electrodes.
Could you tell us more about this
programme?
Yes, we are also developing the
next generation of amputation
prostheses. In addition to the osseointegrated implant, we are able
to attach electrodes to muscles and
nerves to have a brain-controlled

Do you think that osseointegrated
prostheses could potentially replace
traditional prostheses in the future?
This treatment would not apply
to amputations of the lower leg as
a result of poor circulation caused
by diabetes or vascular diseases
related to smoking. Such patients
constitute about 90 per cent of the
amputee population. However, the
younger population who have been
in road or war accidents or who have
musculoskeletal tumours, which
are more likely to occur in younger
patients, will be candidates for this
treatment.
If the technology continues to be
as promising as it appears now, the
majority of patients will opt for it—
just like they now have the choice
between dentures or fixed dental
implants, which are much better
for the patient. There will be a shift,
but this will take some time. The
introduction of dental implants
took about 17 years; similarly, this
shift could take another ten to
20 years. However, receiving FDA
approval and having the system in
use by the military could definitely
speed up the establishment.
Overall, this treatment offers
many alternatives to conventional
treatments. However, there is often
too much conservatism in the dental and medical fields when it comes
to innovations, but I think we need
to stay open-minded to new crazy
ideas. This research shows what
might be possible in the future.
We might be able to restore sensory
function of a non-existing limb,
creating good artificial sensation.
It also shows that the dental and
the medical professions should
work more closely together. As one
can see, there are many synergies
that could be drawn from the fields
of dental and orthopaedic research
in our case. The idea of translation
of knowledge was also the original
idea of the EAO, which has now
become a purely dental meeting.
This is a pity because we have to collaborate more, but maybe there will
be more cross-disciplinary presentations and meetings in the future.
Thank you very much for the interview.

[7] =>

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
Madame Tussauds, you’ll
GREENWICH Atcome
Yeoman Warders around
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.

[8] =>

DTUK0515_08_WorldNews 15.10.15 12:03 Seite 1

WORLD NEWS

Dental Tribune United Kingdom Edition | 5/2015

FDI releases second edition
of Oral Health Atlas
By DTI
BANGKOK, Thailand: The FDI World
Dental Federation has released the
second edition of its Oral Health
Atlas at the Annual World Dental
Congress (AWDC) in Bangkok in
Thailand. Titled The Challenge of
Oral Disease—A Call for Global
Action, it aims to serve as an advocacy resource for all oral health care
professionals and recommends
strategies to address the global
challenge of oral disease.
At the launch event held at the
Bangkok International Trade and
Exhibition Centre, Dr Habib Benzian and Prof. David Williams, the
publication’s editors-in-chief, presented the new edition of the atlas
and spoke with DTI group editor
Daniel Zimmermann about the
contents of the book and the global
challenge of preventing oral disease and implementing adequate
oral health care worldwide.
The first edition of the Oral
Health Atlas, titled Mapping a
Neglected Global Health Issue, was
released at the FDI 2009 AWDC in
Singapore and highlighted the extent of the problem of oral disease
worldwide. The second edition of
the atlas provides an update of the
global health challenge and reflects
on policies and strategies that address the burden of oral disease,
such as tooth decay, periodontal
disease and oral cancer, Benzian
pointed out.
The book summarises the key
oral health issues based on the

latest available information from
various international sources,
Benzian and Williams explained,
including the impact of oral disease, major risk factors and inequalities in oral health, as well as
oral disease prevention and management. Moreover, it aims to ensure that oral health is granted
higher priority on the global health
and development agendas. Written for national dental associations, health organisations, industry professionals and the general
public, the atlas provides them
with the means to address policy-

Dr Habib Benzian (left) and Prof. David
Williams, editors-in-chief of the second
edition of the Oral Health Atlas.

of all serve as an advocacy tool
for institutions, policymakers and
dental associations in their effort
to improve access to oral health
care worldwide.

Benzian and Williams discussing the new publication with WDD Editor Daniel Zimmermann, DTI, during the launch event.

makers, governments and local
authorities based on sound facts
so that they can better advocate for
change in oral health-related policies, Williams said.
According to the atlas, only about
two-thirds of the world’s population have access to adequate oral
health care, even though oral dis-

ease, particularly tooth decay, is
among the most common human
diseases. “Untreated tooth decay is
the most common health condition of children across all countries,
recently confirmed by the Global
Burden of Disease Study looking at
the burden of 281 diseases and conditions,” said Benzian. “Children
with severe untreated tooth decay

Clear aligners more
beneﬁcial than braces
By DTI
MAINZ, Germany: In recent years,
clear aligners have become a
favourable treatment alternative
in orthodontics to fixed orthodontic appliances (FOA). However,
there are few studies about the effects of aligner treatment on oral
hygiene and gingival condition.
A team of German researchers has
now compared the oral health status, oral hygiene and treatment
satisfaction of patients treated
with FOA and the Invisalign
aligner system. They found that
Invisalign patients have better
periodontal health and greater
satisfaction during orthodontic
treatment.

To date, the majority of patients,
particularly during childhood and
adolescence, are treated with FOA.
However, these appliances tend
to complicate oral hygiene and
thus interfere with patients’ periodontal health. Moreover, treatment with FOA is not very popular
in adult orthodontics for aesthetic
reasons. Therefore, other orthodontic techniques have been developed to improve aesthetics and
simplify oral hygiene procedures.
An alternative to FOA is clear aligners, which are discreet and have
the advantage of being removable
during oral hygiene and eating or
drinking. The use of clear aligners
has increased greatly in the last
decade, one prominent example

being Invisalign, produced by
Align Technology since 1999.
However, only a limited number of
studies have compared the effects
of Invisalign and FOA on oral hygiene, the researchers from the
Johannes Gutenberg University of
Mainz pointed out.
Their study included 100 patients who underwent orthodontic
treatment, divided equally between
FOA and Invisalign, for more than
six months. The researchers performed clinical examinations
before and after treatment to
evaluate the patients’ periodontal condition and any changes.
Furthermore, a detailed ques tionnaire assessed the patients’

are impacted in their growth, have
frequent episodes of pain, miss
days in school and have a generally
lower quality of life,” he continued.
They also usually have the lowest
access to oral health care and preventive services, added Williams.
Therefore, the two editors-in-chief
hope that the second edition of
the Oral Health Atlas will most

personal oral hygiene and dietary
habits, as well as satisfaction with
the treatment. All of the patients
received the same oral hygiene
instructions before and during
orthodontic treatment. This included the use of toothbrush, dental floss and interdental brushes
three times daily.
The data analysis showed no differences between the two groups
regarding periodontal health and
oral hygiene prior to the orthodontic treatment. However, the
researchers observed notable
changes in periodontal condition
in both groups during orthodontic
treatment. They found that gingival health was significantly
better in patients treated with
Invisalign, and the amount of
dental plaque was also less but not
significantly different compared
with FOA patients.
The questionnaire results
showed greater satisfaction in
patients treated with Invisalign.

The compilation of the new
edition of the Oral Health Atlas
was supported by the Hong Kong
Dental Association and the FDI’s
Vision 2020 oral health initiative.
The book content includes chapters and data from 30 contributors,
and was reviewed and edited by the
two editors-in-chief.
The atlas can be downloaded free
of charge from the FDI website and
will be translated into the FDI’s official languages of French and Spanish. These versions will be available
electronically in early 2016.

Only 6 per cent of the Invisalign
patients reported impairment of
their general well-being during
orthodontic treatment, compared
with 36 per cent of the FOA patients.
Other negative effects that
also were significantly higher
in FOA patients included gingival irritation (FOA: 56 per cent;
Invisalign: 14 per cent), being kept
from laughing for aesthetic reasons (FOA: 26 per cent; Invisalign:
6 per cent), having to change
eating habits during orthodontic
treatment (FOA: 70 per cent;
Invisalign: 50 per cent), and having to brush one’s teeth for longer
and more often (FOA: 84 per cent;
Invisalign: 52 per cent).
The researchers concluded
that orthodontic treatment with
Invisalign has significantly lower
negative impacts on a patient’s
condition than treatment with
FOA, both with regard to gingival
health and overall well-being.

[9] =>

DTUK0515_09-10_STBdia 15.10.15 12:04 Seite 1

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

Published in London

Vol. 9, No. 5

NEC welcomes dental professionals
to BDIA Dental Showcase 2015
By DTI

and government policy. In fact, all
the things needed to keep your
practice one step ahead,” said BDIA
president Mike Cann.

In October, the National Exhibition
in Birmingham becomes the epicentre of all things dentistry in the
UK again. This year’s show, which
follows a highly successful edition
in London, promises to set another
milestone with hundreds of dental
companies, dealers and service
providers showcasing their portfolio of innovative products and
solutions for dental practices and
laboratories. Some of them will be
available to dental professionals in
the UK for the first time, such as the
TS1 Tongue Sanitizer, a revolutionary
device that simply fits onto the
saliva ejector and effectively removes bacterial tongue coatings in
just one minute.
On display will also be new and
updated equipment such as handpieces, dental units, practice management systems or whitening
solutions. Overall, up to 350 dental
companies have registered for this

Along with the industry showcase, over 100 mini-lectures will be
held over all three days, including
product presentations and papers
on clinical issues discussed by nationally distinguished experts. By
attending these lectures, visitors
are entitled to continuing professional development certification.
Instructions on how to obtain the
certificates are provided on the
show’s website.

year’s exhibition, which will run
from 22–24 October at Britain’s
largest convention and exhibition
centre.

“There is no better way to see,
touch and use all manner of dental
equipment. With over 300 exhibitors Showcase is a great oppor-

tunity for the whole team to keep
up to date with a vast range of products, from instruments and devices
to technology, software, regulation

Visitors who have not registered
for the show in advance can still gain
admission onsite. Daily news and updates from the show will be available
at the DT UK website and through the
daily Dental Tribune UK
newsletter. To access
the news stream, please
scan this QR code with
your mobile device.

“Any non-compliant or counterfeit
medical device is a risk to public safety”
An interview with MHRA investigator and BDIA Dental Showcase presenter Maxine Marshall, London
In response to an increase in
counterfeit and unapproved
dental products seized in
the UK, the Medicines and
Healthcare products Regulatory Agency (MHRA) launched
an initiative in partnership
with the British Dental Industry Association (BDIA) last
year to make dental professionals aware of the dangers
these products can pose to
their own and their patient’s
safety. Dental Tribune had the
opportunity to speak with investigator Maxine Marshall, Maxine Marshall
who will discuss the dangers
of buying dental products online
Maxine Marshall: Most of them
were. In the years 2013 and 2014,
during her mini-lecture programme
we seized about 12,000 indiin Birmingham, about the outvidual pieces of dental equipcome and what needs to be done
ment, with the majority being
to ensure the removal of these
curing lights, dental handpieces,
products from the market.
files, pliers and other equipment that dentists use. That
Dental Tribune: Last year saw a
was quite a large seizure for that
worrying number of counterfeit
year.
or unapproved dental goods being seized in the UK. Were the majority of these products purWhat is the estimated number of
chased online?
unknown cases?

Unfortunately, we do not
know and this is one of reasons
that we are continuing our
work with the BDIA. This year,
our main focus is to communicate to health professionals
that they need to report to us.
If there is an incident with
the equipment purchased or if
they think it is not what they
had bought, instead of disposing of it, they should submit
a report. Any non-compliant or
counterfeit medical device is a
risk to public safety or patient
safety. Our main objective is to
try to stop such products coming into the UK at the port of entry,
but we can only do that if we can
trace the product back to the source
from which it was purchased.
Purchases of critical devices can
be made through various channels nowadays. What are the ones
to be the most cautious of and
what product categories are the
most sought after?
Online purchases are made
mainly through eBay or Google.

There, one can simply search for
handpieces or curing lights, for
example, and from there be taken
to the respective websites. The majority of the devices that we seize
in the UK come from China via the
ports and quite often through fulfilment houses. Of most concern
are dental handpieces, especially
those that run at very high speeds.
If something happens in the patient’s mouth when using such a
device, it can be quite nasty.
Together with the BDIA, you
launched the Counterfeit and substandard Instruments and Devices
Initiative last year to heighten
awareness of these products among
dental professionals. Have these
efforts paid off in your opinion?
From 2014 to 2015, we have actually seen a reduction in the
number of investigations we conducted. Our latest figures are from
four weeks ago. We hope that much
of it has to do with the work that
we are doing with the BDIA. On top
of that, the MHRA, General Dental
Council and NHS England have

formed a working group over the
last 12 months and they regularly
discuss the issue of dental equipment. All these organisations have
also sent out messages to all health
professionals through publications and general lines of communication to raise dentists’ awareness of the importance of buying
from reputable sources.
Would you say that awareness
among dental professionals has
generally improved?
We hope it has, considering the
amount of work we have put into
this. This matter is something we
want to focus on at the BDIA Dental Showcase. One of the things we
need to do is to talk to dentists at
our stand and ask them if they
have seen anything we put out on
this issue. Hopefully from that,
we will receive positive feedback.
I do believe the message is getting
out there, if not initially to everyone, but we are getting there.
Thank you very much for the interview.

[10] =>

DTUK0515_09-10_STBdia 15.10.15 12:04 Seite 2

SHOW NEWS

Show Tribune United Kingdom Edition | 5/2015

BDIA extends Showcase contracts
The British Dental Industry Association (BDIA) has 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.
AD

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, has agreed to host the event in
2017 and 2019.
With an overall space of 186,000
square metres, 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.

committed to helping the event
grow with further investment in
the venue’s infrastructure in the
year's to come.

An ExCel London representative
commented that his company is

Wanted

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procedures and products. The
company is looking to identify
five individuals, one in each of
the following countries: Germany,
Spain, France, United Kingdom
and Poland.

Responsibilities will include:
• Manage and promptly respond
to all incoming inquiries (emails)
through the eCommerce site.
• Store, process, and ship customer
orders received through the
eCommerce site
If you are a motivated dental professional, bilingual including English with an entrepreneurial spirit
then this opportunity is for you!
Attractive equity position in
Euro Dental Depot will be awarded
to approved candidates.
Applications may be submitted
via email at info@eurodental
depot.eu or scan this QR code.
You can also reach us
at +1 262 833 4067.
Please attach your
curriculum vitae and
supporting documents.

[11] =>

[12] =>

DTUK0515_12_Programme 15.10.15 12:04 Seite 1

SHOW SCHEDULE

12

Mini Lecture Programme
BDIA Dental Showcase
Thursday, 22 October
12:00–12:20
Exploring New Horizons
with mydentist (Theatre 1)
Speaker: Steve McCarron
An Introduction to IAS Academy:
The Inman Aligner and ClearSmile
Aligner (Theatre 2)
Speaker: Dr James Russell BDS
Attracting New Patients from
Google and Websites (Theatre 3)
Speaker: Krishan Joshi

12:40–13:00
Exciting, Innovations that
will change the way you practice
your dentistry (Theatre 1)
Speaker: Dr Janise van Rensburg
Completing and Maintaining
the Surface Finish on Anterior
Restorations (Theatre 3)
Speaker: Thomas O'Connor
Learn how to stay on top of your
compliance needs and meet the
new CQC Fundamental Standards
(Theatre 3)
Speaker: Paul Mendlesohn,
Alex O’Neill

13:20 – 13:40
Attract More Private Patients &
Increase Profits. How to market
your practice and guarantee results
(Theatre 1)
Speaker: Malcolm Counihan
A new way of treating temporomandibular joint disorders(Theatre 2)
Speaker: Dr Daniel Saund
Tax Update for Dentists (Theatre 3)
Speaker: Ian Simpson, Karen Wicks

14:00–14:00
Understanding On-line Patient
Journeys (Theatre 1)
Speaker: Nazrul Haque
Experience the Leading Ortho
System for GDPs (Theatre 2)
Speaker: Dr. Daz Singh
The Golden Rules of Clear Aligner
Therapy (Theatre 3)
Speaker: Gary Dorman

14:40–15:00
What’s so special about
this seminar? (Theatre 1)
Speaker: Heidi Marshall ACA
Better understanding of how
banks assess lending propositions
(Theatre 2)
Speaker: Ian Crompton
Tax Update for Dentists (Theatre 3)
Speaker: Ian Simpson, Karen Wicks

15:20–15:40
Attracting New Patients from
Google and Websites (Theatre 1)
Speaker: Krishan Joshi

Experience the Leading
Ortho System for GDPs (Theatre 2)
Speaker: Dr. Daz Singh

What’s so special about
this seminar? (Theatre 1)
Speaker: Heidi Marshall ACA

Xero Online Accounting
for Dentists (Theatre 3)
Speaker: Phil Beavan

A new way of treating temporomandibular joint disorders(Theatre 2)
Speaker: Dr Daniel Saund

16:00–16:20

13:00–13:20

Quick Straight Smiles From
Cfast and SmileTRU—Multiple
Appliances’, One Great System from
The World's Premier Cosmetic
Orthodontic Provider (Theatre 1)
Speaker: Dr David Bloom

Exploring New Horizons with
mydentist (Theatre 1)
Speaker: Steve McCarron

Understanding On-line Patient
Journeys (Theatre 3)
Speaker: Nazrul Haque

Completing and Maintaining
the Surface Finish on Anterior Restorations (Theatre 2)
Speaker: Thomas O'Connor

Dangers of buying on-line (Theatre 2)
Speaker: Maxine Marshall
Attracting New Patients from
Google and Websites (Theatre 3)
Speaker: Krishan Joshi

17:20–17:40
Dental Marketing & Growth
Strategies (Theatre 1)
Speaker: John Christensen
Guiding you through six key success
factors that will help you boost
practice profitability (Theatre 3)
Speaker: Bill Starkie

11:00–11:20
Understanding On-line Patient
Journeys (Theatre 1)
Speaker: Nazrul Haque
TScan: The predictable and reliable
way to diagnose, treatment plan and
review restorative cases (Theatre 2)
Speaker: Thomas O'Connor
When self-employed is really
employed (Theatre 3)
Speaker: Sarah Buxton

11:40–12:00
Attract More Private Patients & Increase
Profits. How to market your practice
and guarantee results (Theatre 1)
Speaker: Malcolm Counihan

16:20–16:40

Completing and Maintaining
the Surface Finish on
Anterior Restorations (Theatre 2)
Speaker: Thomas O'Connor

Buying or Selling a practice—top tips
from NASDAL accountants (Theatre 1)
Speaker: Alan Suggett
Dental Marketing & Growth
Strategies (Theatre 2)
Speaker: John Christensen
Learn how to stay on top of your
compliance needs and meet the
new CQC Fundamental Standards
(Theatre 3)
Speaker: Paul Mendlesohn,
Karen Wicks

Dangers of buying on-line (Theatre 2)
Speaker: Maxine Marshall
Facial Aesthetics—Why every dentist
should be involved (Theatre 3)
Speaker: Dr Bob Khanna

Saturday, 24 October

Exciting, Innovations that
will change the way you practice
your dentistry (Theatre 1)
Speaker: Dr Janise van Rensburg

Understanding On-line Patient
Journeys (Theatre 1)
Speaker: Nazrul Haque

An Introduction to IAS Academy
and ClearSmile Braces (Theatre 2)
Speaker: Dr Anoop Maini BDS

TScan: The predictable and reliable
way to diagnose, treatment plan
and review restorative cases
(Theatre 2)
Speaker: Thomas O'Connor

14:20–14:40
Quick Straight Smiles From
Cfast and SmileTRU—Multiple
Appliances’, One Great System from
The World's Premier Cosmetic
Orthodontic Provider (Theatre 1)
Speaker: Dr David Bloom
Ergonomic sitting in
dental practice (Theatre 2)
Speaker: Sari Hintikka-Varis
Guiding you through six key success
factors that will help you boost
practice profitability (Theatre 3)
Speaker: Bill Starkie

Attracting New Patients from
Google and Websites (Theatre 1)
Speaker: Krishan Joshi
What is my practice worth?(Theatre 2)
Speaker: Martyn Bradshaw
Predictable alternatives to
amalgam: resin composites, glass
ionomers and giomers (Theatre 3)
Speaker: Professor
Christopher Lynch

Bracket Digital Indirect Bonding
(Theatre 3)
Speaker: Hugo Patrao

11:20–11:40
What’s so special about
this seminar? (Theatre 1)
Speaker: Heidi Marshall ACA
Ergonomic sitting in
dental practice (Theatre 2)
Speaker: Sari Hintikka-Varis
Predictable alternatives to
amalgam: resin composites, glass
ionomers and giomers (Theatre 3)
Speaker: Professor
Christopher Lynch

12:00–12:20
Attract More Private Patients &
Increase Profits. How to market
your practice and guarantee
results (Theatre 1)
Speaker: Malcolm Counihan
An Introduction to the IAS
Academy: Inman Aligner case
planning and execution (Theatre 2)
Speaker: Dr Tif Qureshi

15:40–16:00
TScan: The predictable and reliable
way to diagnose, treatment plan and
review restorative cases (Theatre 1)
Speaker: Thomas O'Connor
Better understanding of how banks
assess lending propositions(Theatre 2)
Speaker: Ian Crompton

Predictable alternatives to
amalgam: resin composites, glass
ionomers and giomers (Theatre 3)
Speaker: Professor
Christopher Lynch

13:20–13:40
Associate dentists—accountancy
mistakes to avoid (Theatre 1)
Speaker: Jeff Williamson,
Hayley Hudson

17:00–17:20

10:40–11:00

15:00–15:20

Friday, 23 October

The World's Premier Cosmetic
Orthodontic Provider (Theatre 1)
Speaker: Dr David Bloom

13:40–14:00

16:40–17:00
Preparing to sell your practice(Theatre 1)
Speaker: Alison Oliver

The Golden Rules of
Clear Aligner Therapy (Theatre 3)
Speaker: Gary Dorman

12:20–12:40

Ergonomic sitting in
dental practice (Theatre 2)
Speaker: Sari Hintikka-Varis

NHS Pension and the Lifetime
Allowance (Theatre 2)
Speaker: Jon Drysdale

Show Tribune United Kingdom Edition | 5/2015

Better understanding of how
banks assess lending propositions
(Theatre 2)
Speaker: Ian Crompton
Bracket Digital Indirect Bonding
(Theatre 3)
Speaker: Hugo Patrao

14:00–14:20
Attracting New Patients from
Google and Websites (Theatre 1)
Speaker: Krishan Joshi
Experience the Leading
Ortho System for GDPs (Theatre 2)
Speaker: Dr. Daz Singh
Learn how to stay on top of your
compliance needs and meet the
new CQC Fundamental Standards
(Theatre 3)
Speaker: Paul Mendlesohn,
Alex O’Neill
A new way of treating
temporomandibular joint
disorders (Theatre 2)
Speaker: Dr Daniel Saund
The Golden Rules of Clear Aligner
Therapy (Theatre 3)
Speaker: Gary Dorman

14:40–15:00
Exciting, Innovations that
will change the way you practice
your dentistry (Theatre 1)
Speaker: Dr Janise van Rensburg

15:20–15:40
Exploring New Horizons
with mydentist (Theatre 1)
Speaker: Steve McCarron
Dental Marketing & Growth
Strategies (Theatre 2)
Speaker: John Christensen
Facial Aesthetics—Why every
dentist should be involved(Theatre 3)
Speaker: Dr Bob Khanna

16:00–16:20
Facial Aesthetics—Why every
dentist should be involved(Theatre 3)
Speaker: Dr Bob Khanna

12:40–13:00
Quick Straight Smiles From
Cfast and SmileTRU—Multiple
Appliances’, One Great System from

Tax Update for Dentists (Theatre 1)
Speaker: Ian Simpson
Dangers of buying on-line(Theatre 2)
Speaker: Maxine Marshall
Tax Update for Dentists (Theatre 3)
Speaker: Ian Simpson, Karen Wicks

[13] =>

6 Months Clinical Masters Program
TM

in Aesthetic and Restorative Dentistry
8 days of intensive live training with the Masters in Dubai (UAE)

2 sessions, hands-on in each session, plus online learning and mentoring.
Learn from the Masters of Aesthetic and Restorative Dentistry:

Registration information:
8 days of live training with the Masters
in Dubai (UAE) + self study

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

Curriculum fee: €6,900
(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.

[14] =>

DTUK0515_14_News 15.10.15 12:05 Seite 1

SHOW NEWS

Show Tribune United Kingdom Edition | 5/2015

Less complexity and more
creativity with Essentia
As a family-owned Japanese company continuously improving its
core competences and technologies,
GC (Stand J15) strives to develop
smart solutions for dentists’ daily
challenges. This sometimes implies
going against traditional concepts.
In this respect, the company has
announced to reveal a daring new
approach to aesthetic dental restorations with Essentia at this year’s
BDIA Dental Showcase in Birmingham, which was developed together
with a group of experts in aesthetics.
Once more, GC conquers new
frontiers and is offering an innovative solution for daily challenges,
which perfectly blends versatility,
simplicity and aesthetics in a smart
solution—enabling dentists to
just follow their intuition. Essentia
does no longer rely on the tradi-

tional Vita colours but on a very
simple assortment of seven shades,
created to mimic natural teeth at
any patient’s age and offering dentists the maximum of creative freedom. GC pursued a long development process creating a very lean
and simple colour scheme, including only seven different shades.
According to the company, this
material is more than a real alternative to conventional shade systems, as it marks a paradigm shift
in restorative dentistry. Shades are
no longer named after the traditional “hue” (A, B, C, D) of commonly
used systems, but instead following the chroma (intensity) and
value (lightness) of teeth, in order
to copy best the natural enamel and
dentin build-ups. Therefore, the
two enamels and three dentins

could be characterised as being
light, medium or dark.
By combining enamel and dentins, four main combinations following the patient’s age (Young,
Junior, Adult & Senior) will make
the shade selection become easier
and will be sufficient to form the
basis of any restoration, at any age.
Thus, four different compositions
were used to give specific properties to each shade, each of it
best suited to their respective use:
while enamels will present a high
polishability and gloss retention,
dentins display an amazing shade
adaptation to the cavity and can
be easily modelled. The Universal
shade will provide the best
chameleon effect for mono-shade
posterior restorations, and the
Masking Liner with high opacity

www.idem-singapore.com

will offer an
easy placement
thanks to its
injectable consistency. This
makes Essentia
a simple and reliable solution
for all aesthetic restorations,
and the perfect
partner for dentists who are looking for a simplified, yet highly aesthetic system.
Certainly, this straightforward
approach goes along with many
advantages. Practitioners will primarily benefit from a simplified
build-up process, allowing highly
aesthetic restorations to be created
in significantly less time, while
patients will profit from a longlasting gloss as well as a reduced
risk of plaque accumulation and
staining, thanks to the optimised
composition of the enamel shades.

In addition, even dentists willing
to give more detailed characterisation to their restorations are
gaining from Essentia. The four dedicated modifiers have been developed to satisfy various demands,
such as the desire for an opalescent
halo on the incisal border, fissure
staining or mimicking white spots.
By boldly reducing the complexity of conventional shade systems,
Essentia brings restorative dentistry to its essence and opens up the
way to maximal creativity.

STRIVING FOR CLINICAL EXCELLENCE

Online Registration Now Open!

APRIL 8 - 10, 2016

Glass Carbomers
on display
in Birmingham

Suntec Singapore Convention & Exhibition Centre

Featured Speakers
IDEM Singapore 2016’s conference theme is built upon the common goal of all dentists – both general and specialist:
Striving for Clinical Excellence. Look forward to world-class clinicians, researchers and educators discussing
contemporary issues in the field of dentistry.
Robert Edwab, USA
Treating Medical
Emergencies in the
Dental Office

Elif Keser, Turkey
PiezocisionTM for Rapid
Orthodontic Therapy:
A Multi-disciplinary Team
Approach

Walter Dias, Germany
Clinical Excellence in Aesthetic
Restorations - Hybrid and Indirect
Techniques Using Smart Composites

Ian Meyers, Australia
Full Day Symposium:
Towards the PostAmalgam Era

Hien Ngo, Kuwait
Chairperson of the Full
Day Symposium: Towards
the Post-Amalgam Era

Shinya Murakami, Japan
Cell to Cell Communcation:
Oral Health and General Health
– A Video Premiere
Periodontal Regeneration:
Present Status and Future Outlook

Meet over 550 Exhibitors!
Join the IDEM Singapore Trade Fair to meet over 550 internationally recognized manufacturers, distributors and
traders. With exhibitors showcasing their latest products and services on levels 4 and 6, your visit will be packed with
opportunities to strike new deals and re-enforce existing partnerships. Register online for your FREE exhibition entry.

Endorsed By

Supported By

Held In

In Co-operation With

Co-organizer

Singapore Dental Association

Ms. Cindy Tantarica
Tel: +65 6500 6721
Fax: +65 6294 8403
idem-reg@koelnmesse.com.sg

Glass Carbomer technology is the
result of over a decade of scientific
and clinical research from teams at
Amsterdam University and Queen
Mary College, London. In Birmingham, the products will be on display
for visitors to see and discover at
Stand B145.
According to GCP, Glass Carbomer
represents a new generation restorative material developed from
glass ionomer cements augmented
with nano fluor/hydroxyapatite
and silicon oil. This development
provides enhanced remineralisation, hardness, flexural strength,
reduced solubility properties coupled with excellent biocompatibility. GCP utilises biomimetic
natural re-mineralising processes
to help rebuild the tooth to resemble its original structure. These are
developed through mineral release
from nano-sized particle fluoridealuminium-silicate glass supported
by liquid silica to provide greater
stability and resistance to solubility.
Additionally the materials contain fluor/ hydroxyapatite crystals
as seeds upon which calcium and
phosphate ions can concentrate

and reinforce the restoration over
time.
GCP bonds directly to tooth
structure, providing excellent
marginal adaption, and is not sensitive to moisture. Its strength is
optimised using light generated
thermocure to accelerate the crosslinking of the polymer chains.
The use of GCP Gloss (liquid silica)
prevents desiccation during curing
and also to prevent adhesion to
instruments, matrices and gloved
fingers.
Glass Carbomers come in predosed capsules and are available
in a number of formulations and
shades for different restorative
applications including GCP Glass
Fill for permanent restoration of
molar teeth and core build-up,
GCP Glass Seal for effective fissure
sealing, GCP Glass Crown Cement
for direct fusion to both prep and
crown, as well as GCP Glass Bridge
Cement similar to Crown Cement
but with extended working time.
GCP products are available from
all major UK dental distributors.
Further information are available
online at www.gcp-dental.com.

[15] =>

DTUK0515_15_List 15.10.15 12:05 Seite 1

SERVICE

Show Tribune United Kingdom Edition | 5/2015

15

Exhibitors list BDIA Dental Showcase 2015
COMPANY

BOOTH

3DISC Imaging
M185
3M Oral Care
J45
A-Dec Dental UK Ltd
M65
Acteon UK
J135
Acumag Ltd
A35
ADAM
D145b
Alexandra
F125
Alkapharm UK Limited
F60
Alpha Dent Implants Ltd
D5
AMS Accountants Medical
M215
Anglian Dental
L65
Anyone 4 Tea Ltd
H165
Appointmentor Online Booking
(Welltime)
H5
Ascend Contract
Management Ltd
I65
Association of
Dental Implantology (ADI)
N215
Astek Innovations Ltd
K165
AWB Textiles
C190
BA International Ltd
K150
Back Quality Ergonomics G165/L95
Bambi Air Compressors Ltd
C30
BDIA (British Dental
Industry Association)
D145L
BDSI Ltd
D20
Beauty Gate
D190
Belmont
J115
Beverly Hills Formula
O20
Bien-Air UK Ltd
E25
Biodent Europa GmbH
B165
Blossom /
Mexpo International, Inc.
M10
Blueprint Dental
F140
Bradgate Dental
I120, M47
Braemar Finance
H75
Bridge2Aid
M65b
British Association
of Dental Nurses
D145c
British Association
of Dental Therapists
D145j
British Dental Association
G55
British Dental
Health Foundation
G180
British Dental Journal
G50
British Orthodontic Society D145k
British Society
of Periodontology
D145m
Brosch Direct
C85
BSDHT
D145d
BugBrush Ltd
C55
Burtons
Medical Equipment Ltd
N155
C & D Microservices Ltd
I195
Carestream Dental Ltd
G15
Cattani Esam UK Ltd
L25
Cavex
F165
Centrix
C180
Ceramic Systems Ltd
E95
Cerezen
K5
Charles Russell Speechlys LLP F110
Chrisad
F135
Christie & Co
H130
Clark Dental
G195
Cleancert
O65
CODE iComply
H150
Colgate
G65, G95
COLTENE
G45
Confident Clinical UK Ltd
D135
Core3dcentres
E205
CTS Dental Supplies
N10, N15
Curaprox UK
I70
Custom Dental and
Medical Furniture Limited
N70
Danville
L95
DB Dental
F185
DBG
A10
DecaDent
I120, M47
Denmat UK Ltd
L175
Denplan
M25
Dentaid
C135

COMPANY

BOOTH

Dental Design Products Ltd
Dental Directory
Dental Dynamix Imaging
Dental Elite
Dental Focus
Dental Fusion Organisation
Dental IT Ltd
Dental Nursing
Dental Practice /
Dental Technician
Dental Sky
Dental Supplies Magazine
Dental Update / The Dentist
dentaldiamonds.co.uk
Dentally
Dentalstyle
Dentists’ Provident

M50
A10
D250
I135
M210
D145a
C185
I180

COMPANY

BOOTH

COMPANY

BOOTH

M255
H15
J235
J25
D185
O160
N115
L10

Hager & Werken
O140
Hague Dental
N70
Happythreads
Dental Uniforms
K215
Healthcare Learning
J5
Heart Your Smile
A50
Heka Dental
G175
Henry Schein Dental
E50, F45
Heraeus Kulzer
H120
HORICO
A75
Humphrey & Co
Chartered Accountants
I165
IAS Academy
N205
Implant Direct Europe AG
C90
In-Line Orthodontic UK Ltd
B45
Infodent Srl
N195
ISFY Limited
M220

NASDAL
I175
National Examining Board
for Dental Nurses
D145g
Nichrominox
F155
NimroDental
N105
North Loupes Lights
Camera Corp
A45
NSK
K50, L45
Nuview
K90
Oasis Dental Care
O55
On Hold Communications
J215
Optident Ltd
H50
Optiloupe
M175
Orabloc
E132
Oral-B
J65, J95
Orascoptic
D7
Ormco
B85

DENTSPLY
G125
Deppeler SA
F70
Design Medica Sp. z o.o.
B185
design4dentists
D200
Digital Dental
O185
Digital Dental Solutions Ltd
J230
Directa AB
J205
DLT Magazines
M190
DMG UK
F210
Dodd & Co Specialist
Dental Accountants
E120
DP Medical Systems Ltd
I55
DPAS Dental Plans
J30
DTA
D145e
DTEC
K170
Dürr Dental
K195
Dux Dental
M5
e-cloth
L95
Edenta
H200
Elexxion
F165
Enlighten Smiles
C125
Eschmann Equipment
K65
ESM Digital Solutions
C140
Eurodontic Ltd
A55
Euronda SpA
L75
Euroteknika UK
E215
Evident
L95
ExamVision
L95
F.E. Cardozo Ltd
H125
FDI World Dental Federation
C60
FGDP (UK)
C100
Filhol Dental
K80
Fimet
D20
FMC
B65, B75, C65, C75
FooCo Video Marketing
M180
Frank Taylor Associates Ltd
I95
FT&A Finance
I95
G9 Medical
C165
GC UK Ltd
J15
General Dental Council
H170
General Medical
H215
Grundon Waste Management O95

iSmile
H10
Ison Harrison Solicitors
M195
J&S Davis Ltd
F165
KaVo Dental
E45
Kemdent
E220
Kent Express
Dental Supplies Ltd
K75
Kerr
D45
Komet-West One Dental
F130
Kuraray Dental
F165
LCF Law
N190
Lease UK
O35
Lemonchase
H175
Lilyhead Practice Sales Ltd
N25
Lloyds Bank
D100
LM-Instruments
F165
MacPractice
I200
MAKE A DENT
C225
Maruchi
A70
Marz Dental Equipment Ltd
J200
McKillop Dental
I120, M47
MDDUS
N185
MDS Medical Limited
F195
MediCruit Ltd
K45
Medident Italia
O100
MediEstates
K45
Medifinance
G195
MediFinancial
K45
MEDiVision
E15
Meisinger
F165
Mercia Dental Equipment Ltd J240
MHRA
N160
Micro-Mega
F165
Microbrush International
O10
Microminder
F80
Midmark EMEA Ltd
L135
Milkshake Dental Marketing
B215
Modwood Ltd
D15
Morris & Co
C95
Mouth Cancer Action Month G180
Munroe Sutton
M205
mydentist
M95

Orthodontic National Group D145n
Orthodontic Technicians
Association (UK)
D145h
Panadent Ltd
N145
Paradigm Design
Solutions Ltd
F230
Park Cameras/Canon UK
B170
Pars Dental
F115
PatientComms
K185
Perfection Plus Ltd
H35
Performance Finance Ltd
K95
Periochip
D115
Personalized Oral Care/
Optimal Solution 4 You
A60
PFM Dental—
Practice Sales & Valuations
D125
Philips Oral Healthcare
K115
Pierson Surgical Ltd/
Keeler Ltd
J195
Planmeca UK Ltd
E10, O205
Playbrush
J185
Practice Plan Ltd
E165
Precision Dental
C105
Premier Dental Products
C45
Premium Plus UK
E195
Pro Surgical Ltd
A40
Profi
L215
PSUK
D95
Public Health England
L180
Purple Media Solutions Ltd
H145
Q-Optics UK
H105a
Quality Endodontic
Distributors Ltd (Q.E.D Ltd)
I205
Qudent
K170
Quicklase Quickwhite
H40
Quicksmile
B95
Quintess Denta
O70
Quintessence
Publishing Co Ltd
A30
R A Medical Services Ltd
E135
R&D Surgical Ltd
E125
RA Accountants
I115

COMPANY

BOOTH

RBS
F225
Renfert GmbH
J225
Renishaw
I45
Robinson Healthcare Ltd
C205
RPA Dental Equipment
B115
Rups
E200
Rxaligners
I125
S4S & Smilelign
B205
Saber Tooth White
B135
Salli Systems
J220
Santander Corporate
& Commercial
H180
Schottlander
I15
Score, Seats to Suit
A80
SDI Dental Ltd
C15
Sendoline UK
G120
Septodont
K15
Serve I.C.E. Ltd
B145
Shire Dental Systems
J210
SHOFU UK
D35
Sident Ltd
E95
Sirona Dental Systems Ltd
F15
Six Month Smiles
A90
Smiletru/Cfast
O75
Snowbird Finance Ltd
N95
Software of Excellence
E80, F75
Solo
F165
Source1uk—Dental
Marketing + Recruitment
H210
SPS Dental Sales Ltd
I120, M47
Status Point Ltd
L195
Stoddard Manufacturing
Company Limited
B90
Sunlike Industries
M225
Support Design
K170
Surgery Express
M170
Surgisol Ltd
B175
Survival-32
N100
Swallow Dental Supplies
H105b
Systems for Dentists
J175
Tandex
M200
TePe Oral Hygiene
Products Ltd
N55
The Bambach Saddle Seat
(Europe) Ltd
J10
The British Endodontic
Society
D145i
The Cocoon
M165
The Dairy Council
D225
The Dr Bob Khanna
Training Institute
G195
Titan Care Ltd
K175
Tri Hawk S.A.
M230
Trolldental UK Ltd
I75
Trycare
E115
TS Pro GmbH
B180
Turn Key Dental Supplies Ltd
N65
UCL Eastman
Dental Institute
E210
Velopex
B105
VITA Zahnfabrik
C5
VOCO GmbH
M135
VSDent
E230
VSM Healthcare
F200
W&H
G115
Walsall College
O15
Waterpik
N45
We Make Any App
E225
Wesleyan
E185
Wired Orthodontics
A65
Wisdom Toothbrushes Ltd
G17
Wrights, The Dental
Supply Company
M120, M145
WYSdom Dental Technologies H115
Xero
I165
Zhermack
E75
Zimmer Biomet
N200
Zirkonzahn
I5
Information are subject to change.
Last update was 14 October, 2015.

[16] =>

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[17] =>

DTUK0515_17_Haque 15.10.15 12:05 Seite 1

Dental Tribune United Kingdom Edition | 5/2015

TRENDS & APPLICATIONS

Data security: How not to become the
next Ashley Madison
By Naz Haque, UK
guidance on keeping up to date and
resolving these issues. Make sure
your data is secured and protected
before it is too late.

At the heart of the relationship
between a dentist and a patient lies
trust and respect. Unless you have
been hiding under a rock, I am sure
you have heard of the Data Protection Act (DPA) 1998 and patient
confidentiality, both of which exist
to support these relationships.
Recent events, such as the Sony or,
more currently, the Ashley Madison
breach, have brought to public
awareness the importance of securing one’s data.
Data security and governance is a
very tricky area. I must make it clear
I am not a lawyer, and practices
should make their own decisions
about specific aspects of Care Quality Commission (CQC) compliance.
I am a highly experienced information technology professional with
a good understanding of data protection and other relevant legislation. All interpretations provided
here are my own.
Even if a dental practice has not
embraced the digital age and all
records and correspondence are
ink and paper based, the practice
still has a number of responsibilities regarding data security. As dental practices collect patient details,
they must register with the Information Commissioner’s Office
(ICO). Dental records must be
stored safely and securely for
a number of years (up to six years
for the National Health Service;
NHS) and kept for a maximum of
30 years (Department of Health).
Aside from the General Dental
Council, NHS and CQC governing
bodies in the UK, there are a number of legislative acts, the DPA being
the most well known, that require
dental record storage, such as the
Consumer Protection Act 1987, under which an action could arise for
a defective product (such as implants), the Medical Devices Directive (Council Directive 93/42/EEC),
which relates to custom-made devices (such as retainers or aligners),
as well as the Medicines Act 1968 and
the Misuse of Drugs Regulations 2001.
Records must also be disposed of in
a policed manner to avoid fines.
What about dental practices who
have embraced digital? Data is
accessed in two situations, storage
and movement, the same as physical records are. This also means
that there are the two situations in
which data can be compromised in
the digital world. Dental practices
have an obligation to ensure patient data is backed up, recoverable
(in case of disasters), secure and
protected. This applies during both
storage and movement. If you are
using one of the popular industry
patient management systems,
such as EXACT (Software of Excel-

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.

lence), it should have features to
support this in place; liaise with
your account manager to verify
this.
The next area of concern then is
movement of data. This can be via
e-mail, online referral tools or portals,
feedback platforms or devices, and
your website. E-mail is not a secure
medium, and communication with
patients about their medical history
or medical circumstances using this
platform raises potential issues. The
service provider you use for your
e-mail could also be inadvertently
making you breach data security
rules. For example, if you are using
one of the popular US-based organisations for e-mail, such as AOL,
Hotmail and Gmail, and liaise with
your patients via this e-mail platform, you have to consider where
the e-mails are being stored; most
likely on servers outside the UK.
The DPA states that “personal
data shall not be transferred to a
country or territory outside the
EEA [European Economic Area]
unless that country or territory
ensures an adequate level of protection for the rights and freedoms
of data subjects in relation to the
processing of personal data”. As a
dental practice, you should reconsider if you are using a commercial
e-mail provider to liaise with your
patients, and determine whether
your website communication tools
and feedback portals are compliant
and if not ensure your designated
data policy controller addresses
this as a priority.
The ICO can issue monetary
penalty notices, requiring organisations to pay up to £500,000 for
serious breaches of the DPA occurring on or after 6 April 2010. If you
have reservations, there are a number of solutions to protect practices
from these risks. Clients at Dental
Focus expect us to take care of
online compliance and provide

Poznan, Poland
7-10 September 2016

Annual
World
Dental
Congress

Face the world with a smile!

[18] =>

DTUK0515_18-19_Gaballah 15.10.15 12:06 Seite 1

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 5/2015

Avoiding common problems
in tooth extractions
By Dr Kamis Gaballah, UAE
dental nerve (IDN) is a well-known
complication of surgical extraction of deeply impacted LM3. It
should be acknowledged that this is
not simply a loss of sensation; the
damaged nerve can be responsible
for a number of abnormal sensations, including sharp pain and
abnormal response to stimuli, such
as the perception of a light touch
as a sharp stab. This can have a significant impact on quality of life
for many patients.
Injury to the IDN may occur from
compression of the nerve, either
indirectly by forces transmitted
by the root and surrounding bone
during elevation or directly by surgical instruments, such as elevators. The nerve may also become
transected by rotary instruments
or during extraction of a tooth
whose roots are notched or perforated by the IDN. The risk factors
for IDN injury during extraction
of LM3 are shown in Table I.

The last two decades have seen
significant advances in restorative
techniques and materials for dentistry. The latter, along with community-based preventive measures
that aim to reduce the incidence of
caries, have resulted in many patients living with functional teeth
for a longer period. Yet, extraction of
teeth forms the considerable bulk
of the workload in oral surgeries
owing to several factors, including
the late presentation of patients
with advanced dental disease, the
presence of symptomatic impacted
teeth, such as third molars, and the
need to extract teeth for orthodontic or orthognathic treatment.
The extraction of teeth varies
greatly based on the type of patient
who is undergoing the procedure.
For example, elderly patients with
significant co-morbidities and on
a complex combination of medications as compared with young
healthy individuals render the procedure complicated and require
much more preparation with modifications during and after patient
management. Additionally, extractions can range from a single, fully
erupted tooth with favourable morphology to multiple misaligned,
impacted teeth or teeth with challenging morphology. Local anatomy, such as tooth proximity to
the nerve, maxillary sinus and tuberosity, also plays a significant role.
These variations usually dictate
who is to perform the extraction, as
many general practitioners deal
with less complicated cases of dental extraction in individuals regarded as healthy patients and may
not feel comfortable operating on
medically complex patients.

Complex extraction cases have
been linked to a higher rate of postoperative complications; therefore, a cautious and systematic
approach should be adopted that
includes a detailed preoperative
assessment to predict the potential
difficulties that might arise during
extraction. The documentation of
all complicating risk factors along
with their potential postoperative
morbidities is crucial and should
be included in the informed consent. In the following article, other
useful tips will be provided that are
not usually included in traditional
textbooks or lecture notes to help
general practitioners to perform
safer extractions.

The resistance of hard tissue
should be expected, particularly if
maxillary second and third molars
are being extracted, as the potential for fracture of both the buccal
plate and the tuberosity is relatively common when excessive
force is applied with dental forceps.
Fracture of the tuberosity may produce irregular sharp bony boundaries, significant soft-tissue laceration and potentially an oroantral
fistula. If such risk factors are iden-

During clinical examination, it
has been proven useful to observe
the patient’s build. Tall and muscular individuals tend to have a long
ramus with a higher mandibular
foramen, and this increases the
possibility of failure of the inferior
dental nerve block procedure if the
former is not taken into account
when determining the height of
the injection site. This can be aided
by tracing the inferior dental canal
(IDC) to the mandibular foramen
in the preoperative panoramic
radiograph. The teeth of such individuals may also have longer and
more curved roots and be embedded in highly dense, compact alveolar bone, and thus sectioning of
the teeth may be required to ease
the resistance. Racial differences
should also be taken into account,
as extractions of teeth from individuals of Afro-Caribbean descent
tend to be more challenging owing
to the hardness of their bone and
divergence of roots in their molars.

Preoperative radiographic investigations may include intraoral images, such as occlusal radiographs; panoramic views of the
jaws; and conventional CT or CBCT
scans. It should be noted that riskpredicting signs in radiographs
only indicate that there is an increased risk of nerve damage associated with the extraction of the
corresponding third molar. However, they cannot actually prevent
the nerve injury if the tooth is to be
extracted. The effective strategies
that may avoid or minimise the

dental and the lingual nerve owing
to the nerve block procedure.
This injury may be related to the
pharmacological properties of the
agent itself or the injection technique. Studies have shown that the
lingual nerve is affected approximately twice as often as the IDN,
and one reason for this may be the
fascicular pattern in the region
where the injection is given. It also
appears that about half of patients
feel an electric shock sensation
during injection.
There is a higher incidence of reports of nerve injury after the use of
articaine and prilocaine. Although
the reason for this remains unknown, it has been suggested that
this may be because they are 4 %
solutions, whereas the other commonly used local anaesthetics have
lower concentrations. Others associate the damage with the neurotoxicity potential of 4 % articaine
and 3–4 % prilocaine. Hence, it is
recommended that the use of such
anaesthetics be limited to local infiltration. It has been claimed that
needle contact with a nerve felt by
the patient as an electric shock is
related to injection injury. An obvious explanation is that the possibility of mechanical injury to the
nerve is more likely in the case of
multiple repeated attempts at the
inferior dental nerve block procedure. Therefore, it is crucial that
the operator achieve optimal pain
control with minimal episodes of
injection with minimal doses of
anaesthetic agent.
The surgery should be planned
according to the information obtained from the preoperative assessment process. The procedure
itself should aim to minimise the
manipulation around the IDC.
Both should include the carefully
planned access, tooth sectioning
and elevation techniques. In many
scenarios, the extraction of the

Overall risk factors for IDN injury

Radiographic signs of increased risk of IDN injury

Full bony impactions

Apices of the LM3 located inferior to the lower border of the IDC

Horizontal impactions

Darkening of the root

Use of burs for extraction

Abrupt narrowing of the root

Radiographic risk markers

Interruption and loss of the white line representing the IDC

Clinical observation of the bundle during surgery

Displacement of the IDC by the roots

Excessive bleeding into the socket during surgery

Abrupt narrowing of one or both of the white lines

Patient’s age

representing the IDC most of dentists and surgeons

Table I: Risk factors for IDN injury during LM3 extraction.

tified, tooth sectioning should be
followed by elevation of roots with
dental luxatomes instead of traditional elevators or forceps, which
are known to deliver much higher
force to the alveolar bone.
The indications for the extraction of impacted lower third molars (LM3) have been the subject
of long-standing debate. Surgical
procedures for the extraction of
unerupted LM3 are associated
with significant morbidity. This
includes pain, swelling and the possibility of temporary or permanent
nerve damage, resulting in altered
sensation of the lip, chin, gingiva
or tongue. Damage to the inferior

risk of injury to the IDN can be collectively categorised into two main
sets. The first is the preoperative
workup, which should include
critical assessment of the need to
extract the third molar, clinical
examination and radiographic investigation, and the second is intraoperative measures, including proper
selection of local anaesthetic agent,
the injection technique, modification of the surgical procedure and
measures to reduce the degree of
potential injury to the nerve.
Most literature published in the
last decade has given us sufficient
evidence to suggest a significant
risk of damage to both the inferior

whole tooth may carry an unavoidable risk of injury to the nerve,
therefore intentional retention of
parts of the tooth was proposed via
a planned procedure introduced
around 20 years ago called coronectomy. This is the removal of the
crown of a tooth, leaving the root
in situ. It is merely adopted to avoid
or minimise damage to the IDN.
The rate of complications after
coronectomy is comparable to that
observed after surgical extraction,
except with a significantly low incidence of injury to the IDN.
It should be noted that both sectioning and coronectomy can be
performed with a shorter incision,

[19] =>

DTUK0515_18-19_Gaballah 15.10.15 12:06 Seite 2

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 5/2015

as the amount of bone removal required is minimal, thus minimising the postoperative morbidity.
However, it cannot be performed
in all cases in which the LM3 is close
to the IDC and is certainly contraindicated when the LM3 is decayed
or its roots are associated with
a pathology and should be considered with caution in severely
inclined mesio-angular and horizontal impaction cases. The author
does not recommend distal bone
removal or retraction of the lingual
flap with the intention of protecting the lingual nerve, as these may
increase the risk of damaging the
lingual nerve. It should be emphasised that incision may not extend
beyond the distobuccal aspect of
the tooth.
The other important aspect of
the dental extraction procedure is
the future replacement of the
tooth to be extracted. The current
trend of tooth replacement for
both functional and aesthetic reasons is the placement of dental
implants. The success of this treatment largely depends on the availability of healthy bone in sufficient
volume. Therefore, it is crucial for
the dental practitioner not to compromise the alveolar bone during
extraction of the teeth. Changes
in the alveolar bone ridge after an
extraction are inevitable. After all
dental extractions, bone height
and width always undergo dimensional changes. Bone does not
regenerate above the level of the
alveolar crest, that is, its height
will not increase during healing.
The buccal plate tends to shrink,
shifting the crest of the alveolar
ridge lingually, and often forms
a concavity. Such changes are proportional to the amount of trauma
to the soft and hard tissue during
the extraction.
An additional unfavourable
change that may take place is the
slow remodelling of the bone
formed to fill up the extraction
socket owing to lack of functional
stimulation. The presence of poorly
remodelled alveolar bone may
compromise the stability and
function of the future implant.
Furthermore, studies show that
the stripping and elevation of
mucoperiosteal tissue produce a
higher number of osteoclasts within the alveolar ridge and hence
greater resorption and shrinkage
are seen after the classical surgical
or the traumatic extraction of teeth.
The preservation of alveolar
bone for future implant placement
may be achieved by avoiding
unnecessary bone removal and
stripping of the periosteum during
surgery, as well as performing
a surgical alveolar bone preservation procedure. Bone removal can
be largely avoided or minimised
through modification of the traditional extraction technique.
The first such modification is
the use of dental periotomes and
luxatomes to gently strip the periodontal ligament fibres and widen
the socket without causing cracks
or fracture of the cortical plates,
as commonly encountered when

using dental forceps or the bulky
elevators. The use of such gentle
instruments also eliminates the
need for elevation of mucoperiosteal tissue. However, it should be
noted that the safe use of these instruments requires adequate training and should be encouraged during
undergraduate clinics. Clot stabilisation through light packing of the
socket with collagen sponges may
help to minimise clot dislodgment,
as well as accelerate the healing
process and bone regeneration.

The second strategy is the alveolar bone preservation procedure.
This includes packing the extraction socket with different fillers,
such as osteoinductive or osteoconductive materials, like autogenous, natural or synthetic bone
grafting materials that support
the alveolar socket walls, thus preventing their collapse and shrinkage. It should be noted that this
intervention can only slow down
the post-extraction changes to
improve the success of the dental

19
implant, but cannot stop them
altogether.
Finally, post-extraction care
should include an explanation
of the healing process and potential symptoms encountered
after such procedures. The prescription of medications should
be limited to non-steroidal antiinflammatory drugs in most cases
and imprudent use of antibiotics
or socket dressing should be
avoided.

Educated in the
UK and Ireland,
Dr Kamis Gaballah is currently
a n a s s o c i at e
professor and
senior specialist
in oral and maxillofacial surgery
at the Ajman
University of Science and Technology in
the United Arab Emirates. He can be
contacted at kamisomfs@yahoo.co.uk.

Call for Abstracts - Now Open!
Abstracts may be submitted via internet using
online submission module – www.wioc2015.com
Abstracts should be prepared in English.
Maximum 2 oral presentations and max. 2 poster
presentations by the same presenting author will
be accepted for presentation at the Conference
Accepted abstracts will be published on the
conference website
For all enquiries regarding abstracts:
please contact wioc2015@mci-group.com

Important Dates www.wioc2015.com
Conference Dates: 10 - 13 November 2015
Abstract Submission Deadline: 1 September 2015
30 September 2015
Organized by:

Official Designation Partner

Conference Secretariat: MCI Middle East Tel: +971 4 311 6300, Fax: +971 4 311 6301, Email: wioc2015@mci-group.com

[20] =>

DTUK0515_20-21_Kazemi 15.10.15 12:06 Seite 1

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 5/2015

Mandibular body reconstruction
with a 3-D printed implant
By Dr Saeid Kazemi, Reza Kazemi, Sita Rami Reddy Jonnala & Dr Ramin S. Khanjani, Sweden
topography of the surrounding
structures. Thanks to the available
technology and material, now it is
possible to 3-D print such intricate
designs with above-standard accuracy and minimum technical
glitch. The result is the highest fit
of precision always craved for by
maxillofacial surgeons to complement their skilful incisions.

Case presentation

Fig. 1: One-of-a-kind mandibular implant as reconstruction for the missing mandible body.—Fig. 2: Replica of the patient’s
skeleton. Missing mandible body replaced with a ﬁbula graft.

Nowadays, no aspect of human life
seems to have been left untouched
by the ever-expanding digital technology. Particularly in scientific
fields, digitalisation has working
wonders during the past few years,
to the degree that it is even difficult
to imagine going back to the ordeal
of analogue methods and putting
up with their vagaries. A remarkable blessing of digital technology,
among others, is the exceptional
precision and high control over the
measurements, never possible to
obtain through any of the preceding
methods. There is no surprise then
that it has the strongest appeal to
the fields of knowledge and practice
wherein precision is amongst the
most critical element of success.

Hot spot for digital
technology
With a lot of technical sensitivity
at its heart, the dentistry can easily

be viewed as a hot spot for implementing digital technology to
achieve the most-wished precision. Indeed, the digital technology has already gained a stable
foothold in dentistry and there is
an ongoing shift towards embracing digital systems into the dental
practice. Predictably, the majority
of the advertised technologies and
services are geared towards routine
dental procedures. On the other
hand, the most significant advancements have been witnessed
in an area which falls only within
the experience of specialists; it is
the domain of maxillofacial surgery where tailoring the treatment
plan to the unique conditions of
the patient is the key to success.
Here the state-of-the-art digital technology comes in handy to fully customise the treatment by taking the
slightest details into consideration
and reflecting that into the surgical
and restorative solutions.

Though the successful reconstruction of any human structure is
justifiably a challenge, the stakes
are even higher when the oral and
maxillofacial area is affected. In this
latter case, care must be taken to retrieve function in conjunction with
restoring aesthetics. Oftentimes,
even the second objective might
take precedence. As such, the significance of precision and adaptability
to the existing structures for the
maxillofacial implants cannot be
overemphasised. Fortunately, with
the advent of 3-D digital designing
and additive manufacturing a fully
satisfactory treatment is no more
a remote possibility.
The virtual environment of 3-D
software accommodates full inspection of the surgical area from
multiple angles. It also facilitates
designing and adjustment of the
form of the future implant with
much ease and with respect to

Since its inception, DRSK Company has been committed to explore potentials for incorporation
of the digital and computer science
into the dental field by devising
innovative solutions. With 3-D services being a major activity of DRSK,
the company has been approached
for 3-D designing the maxillofacial
implants of different kinds and
successfully accomplished them.
All these 3-D designed implants are
highly customised and feature great
accuracy and therefore satisfy both
surgical and mechanical standards.
Patient case
One such recently carried out project that merits further elaboration
is the design and manufacture of
one-of-a-kind mandibular implant
(Fig. 1) for reconstructing the missing
mandible body (Fig. 2). The patient,
a young man, had lost the entire
mandible except for the rami after
being severely injured in a blast. Over
the years, the patient had undergone
several surgeries with little improvements achieved. In point of fact, one

consequence
of those surgeries was the
formation of fibrous scar tissues
which, as will be explained in the
following, exacerbated the situation
and restricted the chance for an
effective treatment.
At the time the surgical team
contacted DRSK, the patient had
already received a graft taken from
his fibula. Owing to the extent of
structure loss, the graft alone failed
to yield the anticipated results.
Needless to say, the ultimate goal
of the treatment was to improve the
aesthetics and retrieve the function
of the reconstructed jaw by a prosthetic treatment and giving the
patient a chance to experience an
almost normal mastication once
more. However, the form and size of
the grafted bone could not provide
the required support for prosthetic
structures such as dental fixtures.
Eventually, the surgical team decided to seek assistance from DRSK
and use its 3-D services expertise
to design and manufacture an ad
hoc mandibular implant that fully
complies with the patient’s unfavourable conditions and enables
the complementary prosthodontics

Fig. 3: Left and right segments of the implant were designed to be placed and screwed over the corresponding ramus.—Fig. 4: At the front, left and right segments of the implant met and dovetailed into each other.—
Fig. 5: A temporary or surgical middle piece was designed to be placed over the left and right sections at the surgical session.—Fig. 6: The middle piece should hold two pieces in place at the front.—Fig. 7: The prosthetic,
permanent middle section.—Fig. 8: After the healing period: Insertion of the prosthetic component with unscrewing und removing of the surgical middle part.—Fig. 9: Insertion of the prosthetic middle section,
carrying the teeth.—Fig. 10: Fixation of the prosthetic middle section.

[21] =>

DTUK0515_20-21_Kazemi 15.10.15 12:06 Seite 2

Dental Tribune United Kingdom Edition | 5/2015

TRENDS & APPLICATIONS

3-D printing
As the designing procedure finished, the designed implant had
to be manufactured and delivered
to the surgical team. All three pieces
were 3-D printed in Titanium Grade 5
using EBM technology. Also before
installing the implant, patient’s
facial skeleton needed to be reproduced in a plastic material. It was 3-D
printed by means of SLS technology.
This replica was produced in order
to give the surgeon a better idea of
the surgical site and therefore facilitate the surgical process.

treatment. The overall shape of the
implant and its relation with other
anatomic structures, including the
grafted bone and the soft tissue were
all fleshed out and requested by
the surgical team. One stipulation
of the surgical team was to keep
the previously grafted fibula. They
considered it as a safety measure in
event of implant’s failure.
The design solution
One big challenge to carry out
this particular project was to design the implant in such a way that
it can be easily seated in the correct
position. There were two major impediments to a one-piece implant
solution. First of all, the implant
was intended to be mounted over
the remaining parts of the patient’s
jaw, i.e. his two rami. To achieve the
maximum anchorage from the
rami, those parts of the implant
connecting them were supposed to
adapt to their external anatomy.
Since the rami converge to the
front, the same was expected from
the corresponding implant design.
However, such designing choice
would have made the matters complicated for surgical placement
of the implant. What’s more, the
fibrous tissues resulting from the
previous surgeries have dramatically reduced the patient’s ability
to open his mouth. Therefore,
DRSK 3-D design team had to cross
out the one-piece implant solution.
Eventually by taking different limitations into account and after
consulting with the surgical team
and receiving their endorsement, it
was decided to make the prosthesis
in three pieces.
Each of the two larger left and
right segments of the implant was
designed to be placed and screwed
individually over the corresponding ramus (Fig. 3), while at the front
they met and dovetailed into each
other (Fig. 4). A third part then had
to be placed over the two pieces
at their interface, embrace both
and hold them together securely
(Figs. 5 & 6). This way the whole
thing turned into a unified structure.
Excellent fit with 3-D designing
The success of the proposed design was to a large extent reliant on
obtaining an excellent fit for each
piece. This is the reason why the
role of 3-D design and manufacture
was so essential in this procedure.
The parts of the right and left sections that meet the rami had to
be exactly adapted to the form
of their corresponding anatomic
structures. Each of them had to be
formed in such a way that can fold
over the edges of the ramus and
embrace it enough for a proper
support. Using 3-D design as well
guaranteed the perfect contacts
between three pieces which otherwise might have been an area of
concern for a design of this nature.
Given the necessity for including
a prosthetic solution and considering the patient’s limited mouth
opening, the most feasible solution
was to incorporate the artificial
teeth into the structure of the

Fig. 11: Final prosthesis shown over the patient’s model.

mandibular implant. As described
above, during the surgical procedure and after screwing left and
right pieces over the rami, the two
overlapping front ends of left and
right parts were fully fixed in place
by adding the middle segment.
The idea for the final design was
to include the artificial teeth as part
of this middle section.
However to eliminate the risk of
any force or pressure that would
have compromised the success of
the surgery, a temporary or surgical middle piece was designed to be
placed over the left and right section at the surgical session (Fig. 5).
The function of this piece was simply to hold two pieces in place at the
front (Fig. 6) before being replaced
with the prosthetic, permanent
middle sections (Fig. 7).
The prosthodontic component
On the surgical team’s recommendation, the mandibular dentition included in the design of the
middle section only comprised ten
teeth including incisors, canines
and premolars on both sides (Fig. 7).
Due to the size of third surgical
piece and its function of uniting
the other two sections, only incisors and canines are in contact
with the interconnecting surface
of the middle part. So when the
middle prosthetic piece is seen independently, the premolars look
unsupported in the manner of a
cantilever bridge.
However, after insertion of this
enfolding middle part over the
overlapped arms of left and right
pieces, the premolars become
tightly in contact with left and right
sections; this prevents any destructive lever function from taking
place. Again such close contact has
only been enabled by the accuracy
of 3-D designing and the following
3-D print procedure.
The particular design of arms
of left and right pieces, which collectively form the body of the
mandible, is also worthy of note.
These arms feature a 90 degree
twist in the approximate area of
molars. In this way they can adopt
to both the thinner posterior part
which is anchored over the ramus
and the frontal part that required

a broader width for carrying the
teeth. Such twist also offered a solution for the relative lack of space
in the posterior part of the mouth.
This curve can as well bolster the
physical resistance of the mandibular implant to the mechanical
pressures.

After the healing period, the
time comes for insertion of the
prosthetic component. At this
stage the surgical middle part will
be unscrewed and removed (Fig. 8)
and the prosthetic middle section,
carrying the teeth, will be inserted
(Fig. 9) and fixed in place (Figs. 10
& 11). After checking the occlusion
the patient’s bite is to be registered.
The sizes of the teeth have to be
adjusted accordingly. As the next
step, a layer of porcelain should
be added to the teeth to finalise
the prosthetic phase and thereby
the treatment process.

Summary
In brief, the 3-D design has paved
the way for devising unorthodox,
novel surgical and prosthodontics
solutions, as exemplified by the
case presented in this article. Such
alternative solutions could not be
achieved through traditional technology with the same level of accuracy, which is essential for achieving
the desired outcome. The 3-D designing and 3-D printing therefore have
infinitely widened the scope of
maxillofacial surgeries by expanding and improving the potentials
for customisation. Hence, it is now of
utmost importance for maxillofacial
surgeons to get further familiar with
areas of application of these empowering tools and learn about opportunities for enlisting its assistance.

Dr Saeid Kazemi
is the CEO of
DRSK, a Swedish
company specialised in implantology and
3-D services.
He can be contacted at drsk@
drsk.com.
AD

[22] =>

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Tribune Group GmbH i is designated as an Approved PACE Program Provider by the
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[23] =>

DTUK0515_23_formnext 15.10.15 12:07 Seite 1

Dental Tribune United Kingdom Edition | 5/2015

formnext
powered by tct
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Internationally renowned companies in the 3-D printing sector have
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In addition, renowned and innovative companies and organizations from the fields of research,
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“formnext already has a very
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According to Thoma, this very
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“We are receiving great support
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The descision to establish in Frankfurt a new
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formnext will use the
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Where ideas take shape.

“The additive procedures enable
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Vice President at Mesago and responsible for the formnext.“This is
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On November 18 and 19, 2015,
formnext will also hold an international conference in which the
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The hall layout plan and the
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Get your free ticket here:
formnext.com/tickets

Information:
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formnext@mesago.com

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[cover] => DT UK No. 5, 2015

[toc] => Array ( [0] => Array ( [title] => UK News [page] => 01 ) [1] => Array ( [title] => Short-term gains…long-term problems? [page] => 04 ) [2] => Array ( [title] => World News [page] => 06 ) [3] => Array ( [title] => Show Tribune BDIA Dental Showcase 2015 [page] => 09 ) [4] => Array ( [title] => Data security: How not to become the next Ashley Madison [page] => 17 ) [5] => Array ( [title] => Avoiding common problems in tooth extractions [page] => 18 ) [6] => Array ( [title] => Mandibular body reconstruction with a 3-D printed implant [page] => 20 ) [7] => Array ( [title] => formnext powered by tct is rising high [page] => 23 ) ) [toc_html] =>

Table of contents

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