DT Asia Pacific No. 1+2, 2017

Asia-Pacific News / Interview with Prof. Debbie Guatelli-Steinberg - US: “Essentially - we are not adapted to the diets we eat today” / Business / Interview with Dr Kashif Hafeez - UK: “We need to establish patient-centred care in all practices” / Hybrid ceramics in practice / Aesthetics and function / Ortho Tribune Asia Pacific Edition No. 1+2 - 2017

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

Table of contents

Open Link

Open Link

) [11] => Array ( [image_url] => Array ( [2000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/70749-24bfbc7e/2000/page-10.jpg [1000] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/70749-24bfbc7e/1000/page-10.jpg [200] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/70749-24bfbc7e/200/page-10.jpg ) [key] => Array ( [2000] => 70749-24bfbc7e/2000/page-10.jpg [1000] => 70749-24bfbc7e/1000/page-10.jpg [200] => 70749-24bfbc7e/200/page-10.jpg ) [ads] => Array ( [0] => Array ( [post_data] => WP_Post Object ( [ID] => 70753 [post_author] => 0 [post_date] => 2024-10-23 06:53:06 [post_date_gmt] => 2024-10-23 06:53:06 [post_content] => [post_title] => epaper-70749-page-11-ad-70753 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => epaper-70749-page-11-ad-70753 [to_ping] => [pinged] => [post_modified] => 2024-10-23 06:53:06 [post_modified_gmt] => 2024-10-23 06:53:06 [post_content_filtered] => [post_parent] => 0 [guid] => https://e.dental-tribune.com/ad/epaper-70749-page-11-ad/ [menu_order] => 0 [post_type] => ad [post_mime_type] => [comment_count] => 0 [filter] => raw ) [id] => 70753 [id_hash] => 28e535db4fd00e1793f7019a30b5fe83851de7b9f6b648bd5f29b13e6d94a16d [post_type] => ad [post_date] => 2024-10-23 06:53:06 [fields] => Array ( [url] => http://www.dental-tribune.com/companies/content/id/25/code/wh_dentalwerk_buermoos_gmbh_austria [link] => URL ) [permalink] => https://e.dental-tribune.com/ad/epaper-70749-page-11-ad-70753/ [post_title] => epaper-70749-page-11-ad-70753 [post_status] => publish [position] => 23.61,25.68,76.97,74.63 [belongs_to_epaper] => 70749 [page] => 11 [cached] => false ) ) [html_content] =>

) ) [pdf_filetime] => 1729666386 [s3_key] => 70749-24bfbc7e [pdf] => DTAP01+0217.pdf [pdf_location_url] => https://e.dental-tribune.com/tmp/dental-tribune-com/70749/DTAP01+0217.pdf [pdf_location_local] => /var/www/vhosts/e.dental-tribune.com/httpdocs/tmp/dental-tribune-com/70749/DTAP01+0217.pdf [should_regen_pages] => 1 [pdf_url] => https://epaper-dental-tribune.s3.eu-central-1.amazonaws.com/70749-24bfbc7e/epaper.pdf [pages_text] => Array ( [1] =>

DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

INTERVIEW

Vol. 15, No. 1+2

HYBRID CERAMICS

Book author and anthropologist
Prof. Debbie Guatelli-Steinberg
about the link between human
living conditions and tooth and
jaw development.

This case describes the noninvasive use of a CAD/CAM material for treating a patient with
severe temporomandibular joint
dysfunction.

” Page 4

” Page 12

By DTI
XI’AN, China: A Chinese study
comparing implant stability and
peri-implant tissue response in
heavy smokers and non-smokers
has found that smoking did not
affect the overall success of implant surgery. However, smoking
did cause the bone around the
implants to heal more slowly;
thus, implants began to osseointegrate considerably later than in
the non-smoking group.
In the study, 45 ITI (Straumann)
implants were placed in the partially edentulous posterior mandibles of 32 male patients, of
whom 16 were heavy smokers and
16 did not smoke at all. Implant
stability and peri-implant tissue
response were assessed at three,
four, six, eight and 12 weeks
post-surgery.
Although implants in both
groups achieved osseointegration
by the end of the 12th week, the
healing process differed significantly between non-smokers and

Adapting treatment planning

As heavy smoking can cause peri-implant bone to heal more slowly, surgeons should consider adapting implant loading
planning to smokers, a new study has found.

heavy smokers. In non-smokers,
stability improved and implants
began to better integrate into the
bone after the second week. In
the smoking group, however, implants only began to osseointegrate and become more stable
after the third week. In light of
the findings, the researchers suggested that surgeons might need

to change their standard implant
loading schedule for patients who
smoke heavily. In addition, smokers should be aware that their
habit promotes the loss of marginal bone and the further development of dental pockets and
could thereby lead to complications even after osseointegration,
they concluded.

The study, titled “Effect of
heavy smoking on dental implants
placed in male patients posterior
mandibles: A prospective clinical
study”, was conducted by researchers at the First Affiliated Hospital of
Xi’an Jiaotong University in Xi’an
in China. The results were published in the December 2016 issue
of the Journal of Oral Implantology.

ORTHO TRIBUNE

Read the latest news about products and clinical developments
from the field of orthodontics in
our specialty section included in
this issue.

” Page 17

Love and
teeth
BRISBANE, Australia: Research from
the University of Queensland (UQ)
has suggested a link between a
healthy love life and good teeth.
The study built on previous research in adult attachment theory
and found that being in a trusting
and happy relationship is more
likely to encourage regular dental
check-ups. “We determined that
those who tended to avoid emotional intimacy, or worried their
partner would not be available to
them in times of need, were more
likely to have negative oral health
outcomes,” UQ researcher Grace
Branjerdporn said.
The study examined a group
of 265 people and found that
financial factors played a surprisingly small role in oral health behaviours. With many participants
covered by private health insurance (and thus able to access
dental care cheaply), motivation
primarily came from factors like
aesthetic appearance rather than
affordability.

IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1
© University of Western Australia

Australian researcher Marcus Pham demonstrates augmented reality glasses for
improved dental procedures.
” ASIA PACIFIC NEWS Page 2

Better
Gonorrhoea
primary care prevention
In an effort to enhance medical infrastructure in New Delhi,
the Aam Aadmi government has
announced to set up around one
hundred new dental clinics. They
will offer minor procedures and
consultation services for oral diseases and will be located near existing Mohalla clinics.

Gargling with an alcoholcontaining mouthwash could be
a cheap and effective means of
curbing the spread of gonorrhoea
among men, Australian researchers have found. In the study, daily
mouthwash use significantly inhibited the growth of the bacteria
responsible for the infection.

Powdered
gloves
banned
The US Food and Drug Administration (FDA) has issued a
final rule banning the use of
most powdered medical gloves in
the country. “While use of these
gloves is decreasing, they pose
an unreasonable and substantial
risk of illness or injury to health
care providers, patients and other
individuals who are exposed to
them, which cannot be corrected
through new or updated labeling,”
the agency said when proposing
the ban in March 2016.
According to the FDA, the
powder that is sometimes added
to natural rubber latex gloves to
make them easier to put on and
take off can carry proteins that
may cause respiratory allergic reactions.

Distinguished by innovation
Healthy teeth produce a radiant smile. We strive to achieve this goal on a daily basis. It inspires
us to search for innovative, economic and esthetic solutions for direct filling procedures and
the fabrication of indirect, fixed or removable restorations, so that you have quality products
at your disposal to help people regain a beautiful smile.

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

[2] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 1+2/2017

Augmented reality for dental use
By DTI
PERTH, Australia: An innovative
team of researchers at the Uni
versity of Western Australia (UWA)
has developed augmented reality
glasses that are designed to help
dental students learn more effi
ciently, improve their handling of
procedures and reduce teaching
costs. The technology used for the
glasses is in its final stage of devel
opment and is currently being tri
alled by students and professors at
the university.
The team responsible for devel
oping the device has already been
recognised for their potentially rev
olutionary approach with the Com
monwealth Scientific and Indus
trial Research Organisation (CSIRO)
selecting them for inclusion in their
prestigious ON Accelerate program.
ON Accelerate aims to reward inno
vation in research, science and busi
ness and will provide the research
ers with the necessary resources to
ideally make their invention availa
ble commercially.
Augmented reality (AR) is a
type of virtual reality that involves

semi-transparent, com
puter-generated imagery
that is superimposed on
the user’s view of the real
world. This allows them to
view both frames of refer
ence simultaneously. Cur
rently, dental students un
dergo training to acquire
manual skills with the
close supervision of their
educator, which can be
overly time-consuming.
The technology’s lead de
veloper, UWA student and
researcher Marcus Pham,
said that the glasses aim to
address this inefficiency.

The integration of digital
workflows into dental prac
tices has continued to increase
in frequency. AR technology
has only been used in dental
education since 2005, but it
is positioned to play an in
creasingly more prominent
role given how complex and
demanding dentistry training
can be. One of the main bene
fits of AR is that it allows for
dentists to have relevant infor
mation displayed right in front
of their eyes, instead of having
to continuously refer to a com
puter. This enables students to
apply their learned concepts to
practical situations more eas
ily and learn the appropriate
dental techniques faster.

“A big problem at the
moment is the amount of
interruptions dentists face
when performing proce Prof. Paul Ichim and Marcus Pham demonstrating the device.
The AR glasses will also
dures, with an estimated
allow the instructing dentists
20 per cent of their day spent car
dentists with all the information
to reduce the amount of time
rying out non-clinical tasks and a
they need without them having to
spent with each patient as they can
significant amount of time spent
interrupt a procedure, so they can
supervise multiple students at one
away from patients during a pro
focus entirely on the patient.”
time. Comparative clinical testing
cedure to review critical informa
was scheduled to begin in January
tion,” Pham said.
“This means the time taken to
2017 and the UWA’s dentistry school
carry out procedures will be drasti
is expected to officially incorpo
“The technology we are devel
cally reduced and the quality of the
rate the use of the glasses by the
oping will change this by providing
dental work will improve.”
middle of the year.

Apps for better oral hygiene habits
By Kristin Hübner, DTI
Developed for his daughter to help
her focus on her daily dental care regimen, Japanese dentist Dr Kiyoshi
Amano’s successful tooth-brushing
app Brush’n’Save was first launched
in Japan in 2014. The English version
of the app is now to be released in
about 130 countries. Dental Tribune
had the chance to speak to Amano
about how the app playfully helps
children, and adults alike, develop
a greater interest in oral hygiene
and improve their daily brushing
habits.
Dental Tribune: What gave you the
idea to develop the app?
Dr Kiyoshi Amano: My daughter
was in grade 9 at the time. She had
never had a cavity, partly because
I had always been after her to brush
her teeth from the time she was
a little girl, but as kids get older,
they no longer want to hear what
their parents have to say. She
would stay up late playing with her
smartphone and often she would
go to sleep without brushing,
which meant she was at a much
greater risk of developing cavities.
I knew I needed to come up with
something that would encourage
her to brush on her own. I had
the idea of combining brushing
teeth with things my daughter
would enjoy and I set out to create
Brush’n’Save, a tooth-brushing app
on your smartphone, where the
user can earn and save money by
brushing their teeth.
How did you get started with the
process?

First, I checked out some exist
ing tooth-brushing apps and what
I found was that there were many
apps available, but they were all
aimed at kids or were too game-like.

teenagers, so they could brush
along with the app and get their
teeth clean all over, thereby avoid
ing cavities and periodontal dis
ease their entire lives. I also wanted
it to be a full-featured app with
something for adults too. For ex
ample, I wanted to include infor
mation about optimal brushing
time and give a detailed look at
good brushing motion.
How long did the development take
and when was the app launched in
Japan?
It took six months to develop
and the app was released in Japan
in October 2014.

There were no apps available that
would likely be used by teens or
adults. For Brush’n’Save, I thought
about how to develop an app that
even adults could use and one that
would encourage my daughter to
keep brushing in the long run.

Once it was launched, how was it
received by users—and most importantly, did you daughter like it?
User response was very posi
tive and the app got many favoura
ble reviews. Many people with chil
dren expressed their appreciation.
The app also got many good re
views from other adult users who
said it helped them get their teeth
really clean and that they use the
app every day. Many dentists and
dental hygienists have also told
me that Brush’n’Save is the tooth-
brushing app that they recom
mend to their patients—adults and
children alike.

What were the most important features you wanted the app to have?
First of all, I thought it should
help people stay motivated to
brush their teeth. Next, it was im
portant to present simple, effec
tive tooth-brushing methods in
a way that would appeal even to

As for my daughter, when she
heard that the app was being devel
oped for her, she thought the idea
was kind of silly, but her attitude
changed when she learned that she
could earn money by brushing with
the app on a daily basis. (Editor’s
note: With the optional savings

Dr Kiyoshi Amano

function, parents can reward their
children for continuing to brush
with the app for a certain period of
time without skipping. The reward
can be set in the form of actual
money or other treats.) And then,
just as I’d hoped, she started using
the app every day, brushing toward
the target of that monetary reward.
By developing good daily brushing habits, I think she developed a
greater interest in oral hygiene.
The English version of the app will
now be available globally. Do you
think that applications such as
Brush’n’Save will become more important—or even routine—for people’s personal oral hygiene?
While tooth brushing is some
thing that most people around the
world do every day, many don’t
brush properly. Rather, they do it
their own way and do an imperfect
job. The result is that many people
still suffer from cavities and perio
dontal disease, so I hope that apps
like Brush’n’Save can help people
develop better, and the correct,
oral hygiene habits.
As a practicing dentist, what do you
think is key when it comes to edu
cation about the importance of oral
hygiene, and most importantly, motivating people to brush regularly?
I think it is critical that people
are motivated to brush at the same
time each day, using good brushing
techniques. I think this encourages
them to take an interest in main
taining their own oral hygiene.
Thank you very much for the interview.

IMPRINT
GROUP EDITOR:
Daniel ZIMMERMANN
newsroom@dental-tribune.com

MANAGING EDITOR AP:
Kristin HÜBNER

EDITOR:
Yvonne BACHMANN

ONLINE EDITOR/SOCIAL MEDIA MANAGER:
Claudia DUSCHEK

MANAGING EDITOR &
HEAD OF DTI COMMUNICATION SERVICES:
Marc CHALUPSKY

JUNIOR PR EDITOR:
Brendan DAY

COPY EDITORS:
Hans MOTSCHMANN
Sabrina RAAFF

CLINICAL EDITORS:
Magda WOJTKIEWICZ
Nathalie SCHÜLLER

PUBLISHER/PRESIDENT/CEO:
Torsten R. OEMUS

CHIEF FINANCIAL OFFICER:
Dan WUNDERLICH

BUSINESS DEVELOPMENT MANAGER:
Claudia SALWICZEK-MAJONEK

PROJECT MANAGER ONLINE:
Tom CARVALHO

JUNIOR PROJECT MANAGER ONLINE:
Hannes KUSCHICK

E-LEARNING MANAGER:
Lars HOFFMANN

MARKETING SERVICES:
Nadine DEHMEL

SALES SERVICES:
Nicole ANDRÄ

ACCOUNTING SERVICES:
Anja MAYWALD
Karen HAMATSCHEK
Manuela HUNGER

MEDIA SALES MANAGER:
Antje KAHNT (International)
Barbora SOLAROVA (Eastern Europe)
Hélène CARPENTIER (Western Europe)
Maria KAISER (North America)
Matthias DIESSNER (Key Accounts)
Melissa BROWN (International)
Peter WITTECZEK (Asia Pacific)
Weridiana MAGESWKI (Latin America)

EXECUTIVE PRODUCER:
Gernot MEYER

ADVERTISING DISPOSITION:
Marius MEZGER

DESIGNER:
Franziska SCHMID

INTERNATIONAL EDITORIAL BOARD:
Dr Nasser Barghi, Ceramics, USA
Dr Karl Behr, Endodontics, Germany
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 DT Asia Pacific Ltd.
DENTAL TRIBUNE INTERNATIONAL
Holbeinstr. 29, 04229, Leipzig, Germany
Tel.: +49 341 48474-302
Fax: +49 341 48474-173
info@dental-tribune.com
www.dental-tribune.com

Regional Offices:
DT ASIA PACIFIC LTD.
c/o Yonto Risio Communications Ltd,
Room 1406, Rightful Centre,
12 Tak Hing Street, Jordan,
Kowloon, Hong Kong
Tel.: +852 3113 6177
Fax: +852 3113 6199

UNITED KINGDOM
535, Stillwater Drive 5
Manchester M11 4TF
Tel.: +44 161 223 1830
www.dental-tribune.co.uk

DENTAL TRIBUNE AMERICA, LLC
116 West 23rd Street, Suite 500, New York,
NY 10011, USA
Tel.: +1 212 244 7181
Fax: +1 212 224 7185
© 2017, Dental Tribune International GmbH

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

[3] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 1+2/2017

KYOTO, Japan: Cerebral microbleeds
(CMBs) have attracted attention as
an important predictive marker of
stroke in several studies. Research
further suggests that cnm-positive
Streptococcus mutans, a type of
oral bacteria associated with dental caries, is involved in the development of CMBs.

fluence of the oral microbiota on
neurological disease, they further
called for improved collaboration
between dental and medical researchers.

The study, titled “Oral cnmpositive Streptococcus mutans expressing collagen binding activity
is a risk factor for cerebral microbleeds and cognitive impairment”,

was published online on in the
Scientific Reports journal.
CMBs have attracted attention as an
important predictive marker of stroke.
AD

Tetric N-Ceram Bulk Fill
®

Seeking to clarify the connection, a team of Japanese researchers has now found evidence that
cnm-positive S. mutans is a novel
factor of cognitive impairment associated with CMBs and therefore
may be linked to disorders such as
stroke and dementia.

The efficient posterior composite

Save

Aiming to understand the
clinical significance of CMBs and
the mechanisms of their production, researchers from Kyoto Prefectural University of Medicine
examined 279 patients (average
age of 70) for the presence or
absence of the collagen-binding
surface Cnm protein expressed
on cnm-positive S. mutans in the
saliva. In addition, cognitive function, dental health status and the
prevalence of CMB were assessed.
Oral examination included the
number of remaining teeth, presence or absence of dental caries,
and periodontal status of the participants.

55%
on time
*

In the study group, 94 per
cent tested positive for S. mutans
and 33 per cent for cnm-positive
S. mutans, and 25 per cent showed
collagen-binding activity associated with S. mutans. Magnetic
resonance imaging of the brain
detected CMBs in 73 participants
(26 per cent). As for the dental examination, 31 per cent of the participants had dental caries and
28 per cent scored a Code 3 or
higher on the Community Periodontal Index of Treatment Needs.
The mean number of remaining
teeth was 22.7 ± 7.5.

Data available on request.

E
AT

AS
W
O
!
N
W
O
L
F

NTED

ri
Ivoce
H T I NITI

* Compared with Tetric® N-Flow and Tetric® N-Ceram

According to the researchers,
the findings suggest a molecular
mechanism for the interaction
between chronic oral infections
and geriatric disorders, such as
stroke and cognitive impairment.
In order to clarify the causality,
an intervention study focused on
oral care and the microbiota in
CMB subjects would be of interest,
they emphasised. As the current
data supports the important in-

The analyses showed that
cnm-positive S. mutans was detected more often among participants with CMBs than those without. Furthermore, the percentage
of dental caries patients was significantly higher in the collagenbinding activity group, the study
found.

and achieve amazing results

By DTI

Oral bacteria, cerebral
microbleeds and stroke linked

Tetric® N-Ceram Bulk Fill

Tetric® N-Flow Bulk Fill

sculptable

flowable

www.ivoclarvivadent.com
Ivoclar Vivadent AG

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

[4] =>

INTERVIEW

Dental Tribune Asia Pacific Edition | 1+2/2017

“Essentially, we are not adapted to the
diets we eat today”
An interview with Prof. Debbie Guatelli-Steinberg, US
By Kristin Hübner, DTI
In her book What Teeth Reveal About Human Evolution
(Cambridge University Press,
2016), anthropologist Prof.
Debbie Guatelli-Steinberg
describes what fossilised
teeth reveal about history
and the living conditions of
our ancestors. One finding is
that the high proportion of
soft and sugary food people
consume in the Western
world these days is to blame
for the steady rise of dental
problems such as dental decay and malocclusion. Dental
Tribune had the opportunity
to speak to the Ohio State
University professor about
the causes of this development and the impact her research may have on modern
life.
Prof. Debbie Guatelli-Steinberg
Dental Tribune: Prof. Guatelli-Steinberg, you are studying fossilised
teeth in order to shed light on the
living conditions of our ancestors.
What can teeth reveal about earlier
life and human evolution?
Prof. Guatelli-Steinberg: Teeth
make up most of the mammalian
fossil record, and this is true for
human evolution as well. The reason: teeth are heavily mineralised,
so they resist destruction and decomposition. The fact that teeth
are likely to fossilise is extremely
convenient for physical anthropologists because teeth lock detailed information about diet and

dental development is linked to
the development of the organism
as a whole, it has been possible
to use the pace of dental growth
and development to gauge the
evolution of the protracted childhoods that are a unique feature
of humans among other primates.
It is even possible, and much of
my own research is about this,
to use growth lines in teeth to
assess the timing and duration
of enamel growth disruption, providing insight into periods of
physiological stress (malnutrition,
illness) in the individual lives of
our ancestors.

ment in teeth or about the
morphology of teeth, but
that information requires
a broader context for interpretation. For example,
human first molars erupt
at around six years of age,
but that fact does not tell
one much unless one compares it with other mammals, especially non-human primates. Dogs grow
up fast and their first
permanent teeth erupt
around six months of age.
They also mature and die
much earlier than we do
(which is sad for dog owners). Chimps erupt their
first molars more on the
order of four years of age
and do not appear to have
natural lifespans that are
as long as ours. In other
words, rates of dental development reflect the developmental
rates of species, but we would not
really know that unless we compared humans to other primates.
This applies to fossil teeth too:
we need a broader comparative
context to understand the indications they give us.
In your new book, you say that our
teeth were adapted for a very different diet than the one we eat in
Western societies today. Could you
explain that briefly? What are the
(negative) consequences of this
change in diet?

Would you say that today’s dental
problems, such as the high prevalence of dental caries and periodontal disease, are man-made
evolutional developments?
Well, it is possible to find dental pathologies in ancient hominin fossils, but only in a handful
of individuals. So, I would say that,
although dental pathologies did
occur early in human evolution,
they were nowhere nearly as frequent as they are today.
Why is that? When considering
that there were no dentists or even
oral hygiene products around, one
imagines our ancestors must have
been toothless by their mid-20s.
With the softer, more cariogenic foods eaten in an agricultural diet, the oral bacterial environment changed. One scientist,
Dr Christina Adler, from the University of Adelaide and her colleagues, sequenced bacterial DNA
obtained from dental calculus
adhering to the teeth of early
hunter-gatherer and early European agriculturalists. What they
found was that, with this change
in the oral environment, and later
with the production of processed
sugar during the Industrial Revolution, the diversity of oral
flora decreased, with
caries-causing strains
becoming predominant. Essentially, the
oral environment had
changed to provide

were introduced to processed foods
and sugary sodas, and then their
rates of caries increased dramatically.
I have read that breastfeeding
provides optimal oral mechanical
stimulation for the jaw’s normal
development. Given the decrease
in breastfeeding, could that mean
modern children are at a higher risk
of developing malocclusion and requiring orthodontic treatment?
That is a great question, but
as I am not a dental practitioner,
I do not have a great answer!
I can tell you that Prof. Robert
Corruccini’s pioneering experimental studies on baboons (which
rarely show malocclusions) showed
that soft diets led to dental crowding and rotations of teeth. Essentially, without foods that were
hard or tough, bone growth in the
baboon jaw was not great enough
to accommodate the animal’s
teeth.
What role does genetics play in influencing teeth, oral health and jaw
development? Since evolution is a
process of hundreds and thousands
of years, it is probably not possible
to turn back the wheel of time just
by sticking to a certain diet.

“The oral environment had changed
to provide an optimal environment for
caries-causing strains to flourish.”
growth into their physical and
chemical structure. The book is
meant to synthesise insights into
human evolution that researchers
have gleaned from teeth—those
insights include the recognition
that human diets began to diversify early in hominin evolution,
making it possible for our lineage
to ride out fluctuations in food
availability.
From daily growth lines in
teeth, researchers have been able
to calculate the length of time
teeth took to develop and erupt
into the oral cavity. And, since

What sparked your interest in this
field of research initially?
I have always had an interest in
human evolution and non-human
primates, and when I began my
doctoral program at the University of Oregon, I met Prof. John
Lukacs, who used teeth to answer
questions related to these topics.
This seemed like a really fascinating thing to me—that one could
find out so much from fossil teeth.
How does one decode the information garnered from fossilised teeth?
One can gain information
about growth rates and develop-

Yes. Over most of our evolutionary history (until the rise of
agriculture around 10,000 years
ago), we humans were foragers,
eating food that could be gathered
or hunted. Those kinds of foods
are the foods that our teeth are
adapted to eat. With the rise of
agriculture, and particularly with
the more recent introduction of
processed and sugary foods into
the diet, there was an enormous increase in dental malocclusion and
pathology. Essentially, we are not
adapted to the diets we eat today,
as these dietary changes are quite
recent in our evolutionary history.

an optimal environment for caries-causing strains to flourish.
How about primitive tribes that
are largely untouched by civilisation even today. Is their dental
status significantly better than
that of people living in industrial
regions?
When people who were not
eating a Western processed and
sugary diet are all of a sudden introduced to one, their rates of dental disease go up. So, for example,
native Eskimos had very little by
way of dental caries until they

Certainly, genetics plays a role.
Some individuals are more prone
to dental disease than others, but
what one eats also plays a role.
As far as that goes, there is no perfect diet, but diets that are low in
sugar and eating tough foods that
may stimulate jaw growth during
childhood might help to alleviate
our dental problems.
Thank you very much for the interview.

[5] =>

[6] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 1+2/2017

Measuring implant stability with
the W&H Osstell ISQ module
By DTI
BÜRMOOS, Austria: With the exclusive integration of the Osstell
ISQ (Implant Stability Quotient)
module, W&H is offering
users a unique system
for the measuring of
implant stability. In
combination with the
company’s improved
Implantmed functionalities, the Osstell ISQ
module ensures added
certainty and reliability
in the evaluation of the
treatment success by offering
the surgeon the ability to monitor
the status of osseointegration
continuously and document it,
along with the torque.
Determining the optimal time
to load an implant is complex,
since one must take into account
all key parameters and the pa-

tient’s risk factors. The retrofittable Osstell ISQ module allows the
surgeon to benefit from a unique
system for measuring implant
stability. While Implantmed’s integrated automatic threadcutter function and
the torque

Simply and
quickly retrofitted at
any time—the W&H Osstell ISQ module.

control help the dentist during
placement of implants, the ISQ
module makes it easier to determine the optimal loading time.

According to the company,
the stability value measured by
the device helps improve the
success rate
and is a form
of qu a l i t y
assurance.
With this
non-invasive
measuring
system, it is
not only pos
sible to determine the
primary stability of im
plants, but also
to mon
itor the osseointegration using
secondary measurements and determine
the optimal point in time for
loading the implant. The ISQ
value (scale of 1–100) is shown
on the display after the measurement has been taken and is
easy to interpret.
Implantmed’s documentation
function allows convenient saving
of all values of the implant placement to a USB stick. The W&H
Osstell ISQ module is optional and

can be retrofitted by simply connecting it to the new Implantmed
at a later point in time.
According to the Austrian
dental
manufacturer,
the unique fusion of state-ofthe-art technologies from
both

companies, W&H and
Osstell, has made it possible to set new benchmarks in the international dental market
and offer users a decisive
bonus in terms of functionalities and optimal
treatment efficiency.

The new Implantmed is characterised
by greater safety, ease of use, high
precision and flexibility in application.

Ivoclar introduces new dental platform
By DTI
SCHAAN, Liechtenstein: With the
launch of a new online platform,
dental manufacturer Ivoclar
Vivadent aims to provide dentists
and dental technicians with continually updated information and
news about industry trends and
the latest products. Through two
profession-specific blogs hosted
on the platform, the company
further seeks to answer specific
user questions and foster a lively
exchange within the dental community.

materials, and often provide additional content, including downloads of scientific publications and
explanatory videos.

“The main focus of the blog
is the readers’ benefit—both for
daily work as well as fundamental
questions, for example good laboratory or dental office strategies.
Fascinatingly presented and with
a wide variety of topics, the contributions are supplemented on
a weekly basis,” said Nicole van
Oers, Communications Director
at Ivoclar Vivadent.
The topics addressed in the
respective blogs cover different
areas of dentistry, such as aesthetics, digital development and

Aiming to establish a lively online community, Ivoclar Vivadent has launched
two new blogs—one for dental technicians and one for dentists.

In its present form, the platform has been online since September 2016. The blogs are published in five languages (English,
German, French, Italian and
Spanish) and can be assessed at
blog.ivoclarvivadent.com. Users who
subscribe to the free blog newsletter will be informed as soon
as new posts are available, the
company stated.

Dental South
2017
02. - 05. 03. 2017
Guangzhou/ China

Glass ionomer luting cement
• High level of adhesion
• Highly biocompatible, low acidity
• Continuous fluoride release
• Precision due to micro-fine film thickness
• Translucency for perfect aesthetic results
• High compressive strength and low solubility

Light-curing micro-hybrid composite
• Applicable for various indications
(Universal for all cavity classes)
• Attributes which ensure aesthetic results
• Excellent physical properties
• Perfect for durable and long-lasting fillings
• High filler content
• Packable consistency
(also available as Composan LCM flow)
Visit www.promedica.de to see all our products

Dental Material GmbH

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

[7] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 1+2/2017

MIS announces release
of B+ implant surface
By DTI
BAR-LEV, Israel: This March, MIS
Implants Technologies is officially
launching its latest in implant engineering, the B+ implant surface
treatment, at the International
Dental Show in Cologne. The B+
layer bonds chemically with the
surface of the titanium dioxide of
an implant and integrates perfectly with existing and newly
forming bone, achieving greater
initial osseointegration and
longer-term
stability.

directly into the surface of the
implant, which is unaffected by
the oral environment and has been
proved very stable in different
pH levels.

“With the initial results from
testing of the B+ surface, it was
discovered that, for the first time,
specific biochemical bonding can
be obtained already at the very

07
early healing phase after implantation,” Aronsson said.

a strong position in the market to
advance their product.

MIS was very excited to learn
about these discoveries and immediately saw the potential for
a major breakthrough. Having
been seeking a suitable company
to partner with, Aronsson and his
team were equally enthusiastic
about embarking on the commercialisation phase with a company
able to achieve rapid implementation in clinical practice and with

Most recently, MIS has launched
a user experience project involving
250 participants worldwide, who
will be placing ten implants each
with the B+ surface and reporting
their experiences. The results of
studies conducted by Aronsson
and his team are extremely promising and both partners are exploring future applications for
this advancement.
AD

VITA ENAMIC redefines load capacity.*
®

The first ceramic with dual network structure for unsurpassed absorption of masticatory forces

New:
VITA IMPLANT SOLUTIONS
VITA ENAMIC® IS

Aronsson explains: “Titanium
is used as implant material due to
its inertness and high acceptance
by the body. Over the years, however, a wish for faster and more
predictable integration with the
bone has been driving research
on the importance of the surface
structural and chemical properties.”
The surface consists of a
monolayer of multi-phosphonate
molecules. These have a very high
affinity to titanium dioxide, enabling a true covalent bond. The
unique properties of this layer
also make it extremely hydrophilic, which facilitates the colonisation of cells on the surface
naturally. Research has even
shown that blood vessels grow

3522E

Dr
Björn-Owe
Aronsson, who developed this
unique surface together with his
team at Nano Bridging Molecules,
has presented case studies in
which B+ proved very efficient in
maintaining the bone level over
time. This is particularly beneficial for patients with compromised bone healing and poor
blood supply. The specific bonebonding properties of the surface
have proved to produce greater
fixation of the implant in the
early stages post-placement, as
well as greater stability later on.

VITA ENAMIC
• enormous load capacity since masticatory forces are absorbed
• reduction of wall thickness possible to achieve restorations that require minimal preparation
• highly precise and particularly accurate results
• tooth-like material properties
• fast and easy to process with no furnace required
*) In addition to a high degree of elasticity, this innovative hybrid ceramic guarantees outstanding load capacity after adhesive bonding.

www.vita-enamic.com

facebook.com/vita.zahnfabrik

VITA shade, VITA made.

®

[8] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 1+2/2017

VITA Zahnfabrik to present innovative
clinical solutions at IDS 2017
At the 2017 International Dental
Show (IDS) in Cologne in Germany,
VITA Zahnfabrik will present new
process-safe solutions for highly
aesthetic results, as well as efficient and smooth clinical workflows.

High-end aesthetics:
VITA ENAMIC
multiColor and
Super Translucent
VITA ENAMIC has established
itself as a solution for functional
restorations since 2013. At this
year’s IDS, the reliable material will
attract attention with its integrated
natural colour gradient in six layers, from the cervical area to incisal area: VITA ENAMIC multiColor.
AD

“The work-flow for
monolithic ceramic
restorations remains
in the dentist’s hands.”
With its integrated natural colour
gradient in six layers, VITA ENAMIC
multiColor is suitable for aesthetic
single-tooth restorations in the anterior and molar regions.

The dual ceramic–polymer network makes aesthetic singletooth restorations in the anterior
and molar regions possible. VITA

ENAMIC ST (Super Translucent) is
ideally suited for veneers, inlays
and restorations in enamel. The
solid material can be milled as
usual and manufactured without
any firing. It offers all of the clinical advantages of VITA ENAMIC:
a pre-sintered, porous, fine-structure feldspathic ceramic block

(86 per cent by weight) is infiltrated with a polymer (14 per cent
by weight). Its thin layer thickness
allows for both minimally invasive and non-invasive rehabilitation. Masticatory forces are absorbed owing to the dentine-like
flexibility, while ceramic crack
growth is stopped at the interface
with the polymer network. In this
manner, durable restorations are
guaranteed.

VITA SMART.FIRE:
Small furnace,
large effect
VITA’s space-saving furnace for
the dental practice allows for more
efficient ceramic chairside restorations. The miniature vacuum furnace has been optimised for the
requirements of chairside applications and the particular needs
of dentists. Owing to its intuitive user interface, crystallisation

and glazing can be realised without any special background
knowledge. The intuitive “touch
& fire” application enables the
dentist to select the material
and navigate through the menu
easily. After try-in and grinding,
CAD/CAM-fabricated feldspathic
and glass ceramics can be finalised independently. Stressful polishing chairside can be avoided,
while the quality of the surface
is optimised. This furnace gives
the dentist greater independence
from the laboratory. The workflow for monolithic ceramic restorations remains in the dentist’s hands, from preparation,
including intra-oral scans, to final
insertion. The furnace makes
treatment procedures more economical and is time-saving for
patients.

Material-specific
cementation that is
easy, complete and
systematic
Different indirect restorative
materials follow various cementation protocols. The hydrofluoric
acid may come from one supplier,
the cementation composite from
another and silane from yet another. This leads to full drawers
and fridges resembling a rather
messy storeroom. With the VITA
ADIVA LUTING SOLUTIONS cementation system, reliable bond
strength is ensured and orderly
storage facilitated. The luting system is specifically matched to
all VITA materials and offers the
complete range of provisional,
self-adhesive and full-adhesive
cementation. Furthermore, the
systematic segmentation of the
tray into “practitioner” and “assistant” provides a clear overview,

Besides VITA ENAMIC multiColor, there
is VITA ENAMIC ST. Being highly translucent, it is the perfect material for
veneers, inlays and restorations in
enamel.

particularly helpful in stressful
situations. Its compact design
makes the VITA ADIVA set a perfect space-saving companion that
is always within reach. Moreover,
VITA ADIVA is compatible with
restorative materials from other
manufacturers too.
For more information, visit
VITA Zahnfabrik during IDS 2017
at Booth D 010 in Hall 10.1.

VITA and other VITA products mentioned are registered trademarks of
VITA Zahnfabrik H. Rauter GmbH
& Co. KG in Bad Säckingen in Germany.

[9] =>

TODAY EXHIBITION GUIDE APP

TODAY MESSEGUIDE
ONLINE

Make exhibitor search a walkover

© r.classen / Shutterstock.com

www.messeguide.today

today
Messeguide

The exhibition planner for dentistry
 exhibitor list
 latest news
 products
 quick search

OEMUS MEDIA AG

 companies
 hall plan
 favourites

Holbeinstraße 29 · 04229 Leipzig · Germany · Phone: +49 341 48474-0 · info@oemus-media.de

[10] =>

SCIENCE & PRACTICE

Dental Tribune Asia Pacific Edition | 1+2/2017

“We need to establish patient-centred
care in all practices”
An interview with Dr Kashif Hafeez, UK
As a practising dental implantologist in southern England, Dr Kashif
Hafeez regularly speaks on clinical
governance and the concept of
patient-centred care at congresses
and seminars worldwide. In anticipation of his lecture at this
year’s UAE International Dental
Conference & Arab Dental Exhibition in Dubai in February, Dental
Tribune had the opportunity to
speak with Hafeez about the various aspects of this approach and
why he believes patient-centred
care should be implemented in
every practice.
Dental Tribune: While “patientcentred care” is a widely used term
around the globe, there seems to
be little understanding of what it

actually entails. Could you explain
the fundamentals of this concept in
your opinion?
Dr Kashif Hafeez: There is indeed an international trend towards adopting a patient-centred
approach and modern health care
services are aiming to incorporate
it in their policies. This approach
refers to a system in which the
patient is the focal point of practice and all the services health
care professionals provide. I call
it the democracy of the health
care system, which translates to
a system by the patients for the
patients.
The basic principle behind patient-centred care is that patients
provide the maximum input to

improve their state of health. It is
a self-critical and self-correcting
mechanism that will allow patients to have their say in the system through feedback, including
surveys, questionnaires and complaints. The system analyses the
feedback data, learns from it, and
makes changes to the policies and
their everyday application. It is
cyclical and keeps evolving.
The system has to be open to
critical analysis and be prepared
to make the desired changes.
Audits are a fundamental part
of this system and these allow
an organisation to evaluate itself
against certain standards and set
goals to improve further towards
excellence.

Dr Kashif Hafeez

Education is a cornerstone
of this approach, which allows
health care professionals to learn
new skills and techniques to
improve patient treatment and
provide them with the best care
possible.
In our practice, where we focus
on implantology, we ensure that
patients are the focal point of our
services and pay special attention
to their concerns. We understand
that our primary aim is to address
those concerns and allow patients
to have the final say in our treatment plans. They are consulted
through several appointments
prior to treatment and given
ample time to digest and understand the proposed treatment
plan. With the help of mock-ups,
patients are briefed about the
final outcomes and assured that
they are an integral part of the
dental treatment.
What is the value of patient-centred
care, and why should patients be
generally more involved in their
treatment process?
The value is that patients are
an inherent part of their treatment. The journey of dental treatment with the patient sitting in
the dental chair for hours after
administration of dental anaesthetics and with the dentist holding a device in his or her hands to
perform surgeries in the patient’s
mouth is very daunting. Especially if patients feel that they are
not in control and in charge of
the whole process, it makes it even
more scary for them. Involving
patients in each aspect of treatment is very reassuring and comforting, giving them a measure of
World Oral
Health Day
20 March

control. As dentists, we are often
too occupied with clinical matters
—the right proportions, angles
and lines—sometimes forgetting
what our patients really want. Listening to them and their concerns
allows us to consider their wishes
and needs in each aspect of dental
treatment.
In our practice when the patient shows interest in dental implants, for example, our treatment
coordinator provides all the necessary information to help him
or her choose the most suitable
treatment options. The patient is
then consulted by our team and
taken through the whole journey
virtually. This helps us to explain
the proposed treatment in great
detail. With patient concerns at
the centre of our planning, dental
treatment is performed with the
patient involved in every step.
This allows our patients to enjoy
the overall dental experience they
have with us.
Are there lessons that can be drawn
from the practice of patient-centred
care in the UK, for example?
In the UK, we are very lucky to
have an open culture receptive to
criticism. We use criticism as an
opportunity to learn and improve
ourselves. I would like to mention
anaesthetist Prof. Stephen Bolsin,
who laid the foundation for the
openness in our health care system. With regard to the deaths
of 29 babies and children at the
Bristol Royal Infirmary in the late
1980s and early 1990s, he tried
first to raise this issue with colleagues, but when he was initially
ignored, he took his concerns to
the Department of Health.

[11] =>

SCIENCE & PRACTICE

Dental Tribune Asia Pacific Edition | 1+2/2017

Patient-centred practice breaks
the cavalier attitude some of us
may develop over the years. In
our practice, we consider patient
feedback as an important source
of suggestions and inspiration to
improve ourselves. We audit the
feedback received and make appropriate changes to our system
arising from this and follow this
cycle on regular basis to achieve
excellence.
How can this concept be applied in
other dental practices, and what are
the main components necessary to
achieve it?
We need to establish patientcentred care in all practices. It is
actually not that difficult even
though the whole atmosphere
and attitude of the practice has to
be changed. We need to regularly
identify shortcomings in our
practices and audit our policies
and methods. Lessons learnt from
our audits should be implemented
and regular re-audits should be
planned. We also need to identify
our educational needs, develop a
personal development plan based
on those needs and then plan
our learning accordingly. Targets
should be set realistically.

practices. Clinical governance
covers all the aspects of patientcentred practice and the various
components will become clear
with this policy in place. We offer
courses in clinical governance and
patient-centred practice policies
for individual practices and educational institutions and will be
happy to help any organisation
that wishes to implement it.
Thank you very much for the interview.

Respects your needs.
Today and tomorrow.

We have to develop a system of
openness in our practices, and we
need to encourage our colleagues
to raise concerns if they are not
happy with any methodology or
policies. An environment of research and development has to be
established, and we should keep
up to date with the latest developments in dentistry, such as implantology. The world is moving
at a very rapid pace, and with the
advent of new technologies in our
modern world, it is very easy to
fall behind the rest. We should
also move out of our comfort
zones to develop new skills and
methods.
It is a team effort after all, so
training our team and keeping
our team together in this effort is
equally important. In our practice, we ensure that our health
care professionals are well trained
and up to date with recent advancements.
For those interested in making their
practice patient-centred, what is a
good way to start?
I think the first step is to
develop a policy on clinical governance and implement it all

In the UK, we have learnt a
great deal over the last 20 years
and have moved forward in improving ourselves. Now, we have a
culture of transparency and placing patient concerns at the centre
of our daily practice. The General
Dental Council has made it mandatory for health care professionals to report any concerns about
patient safety and patients possibly being at risk. It is also mandatory for health care professionals
to receive continuing training
throughout their careers on the
issue of whistle-blowing and how
to raise their concerns to the
proper authorities.

NEW
The new W&H Implantmed
Needs and requirements can change. So can the W&H
Implantmed: The wireless foot control, LED+ motor and W&H
Osstell ISQ module are all available as optional accessories.
Upgrade at any time – for today and tomorrow!

Now available from your dental supplier or via wh.com

[12] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 1+2/2017

Hybrid ceramics in practice
A CAD/CAM material for patients with functional disorders
By Dr Sjoerd Smeekens, Netherlands
moulding was performed once
with and once without the splint.
The superimposed scans formed
the basis for the virtual design
of the monolithic restorations
made of VITA ENAMIC (Figs. 8 & 9).
After fabrication, these were
characterised and polished (Figs.
10 & 11).

When tried in, they exhibited
a high-precision fit, and the
patient was very satisfied with
the shade; therefore, the adhesive bonding was performed
immediately. In order to create
an invisible transition to the
tooth substance, pre-warmed
composite filling material was
used.

Summary
5

With the integration of the
VITA ENAMIC restorations (Figs.
12–14), the patient’s self-confidence increased and he took up
a new profession. This example
shows that the non-invasive treatment concept presented can
achieve outstanding results, leading to a significant increase in

Fig. 1: Initial situation.—Fig. 2: The extra-oral examination showed a reduced lower third of the face.—Fig. 3: Intra-oral examination: Situation at maximum intercuspation.—Fig. 4: Step-by-step determination
of the optimal vertical dimension.—Fig. 5: Frontal view of the therapeutic splint of PMMA on the model.—Fig. 6: Occlusal view of the therapeutic splint on the model.—Fig. 7: The splint in the patient’s mouth.—
Fig. 8: Superimposition of the data sets of digital moulding with and without the splint.—Fig. 9: Virtual design of the individual tooth restorations using superimposed scans.—Fig. 10: Occlusal view of the
restorations fabricated from VITA ENAMIC on the model.—Fig. 11: Frontal view of the restorations on the model.—Fig. 12: Situation immediately after integration.—Fig. 13: Occlusal view of the maxilla.—
Fig. 14: End result.

The treatment of patients with
functional disorders is a challenge
for dentists. The extent to which
the VITA ENAMIC hybrid ceramic
(VITA Zahnfabrik, Germany) with
its dentine-like elasticity may be
a suitable material for treating patients with bruxism is described in
this article. Although reconstructions with VITA ENAMIC are still
experimental for this indication,
I have already implemented them
with clinical success.

Initial situation
The 48-year-old patient had
suffered for ten years from severe
temporomandibular joint pain
and headaches, resulting in depression, which had led to his

inability to work. Numerous visits
to the dentist and treatment attempts (including occlusal splinting) had brought no relief. The
patient had rejected the corrective
jaw surgery recommended for the
existing Class III skeletal abnormality owing to the uncertain
therapy outcome. Figures 1 to 3
show the initial situation.

Preliminary treatment
After the patient’s referral to
our clinic, we first tried to stabilise
the occlusion via a reversible correction of tooth position. The optimal length of the incisal edges, the
occlusal plane, and the horizontal
and vertical dimensions were determined with a maxillary bite

registration in wax (Fig. 4). It was
shown that, through an elevation
of the vertical dimension by 8 mm,
a correction of the Angle Class III
relationship was possible.
For the long-term evaluation,
a PMMA splint for permanent
use was fabricated on the basis of
the bite registration (Figs. 5 & 6).
Ten hours after its insertion (Fig. 7),
the patient reported, with tears
of joy, that he was pain-free. This
situation has been maintained for
the wear time of two years.

Material selection
Only after successful elevation of the vertical dimension
were the permanent restorations

fabricated. The objective was to
preserve the healthy tooth substance through a non-invasive
procedure. In order to achieve an
exact fit, a restorative material
that could be milled very thinly at
the edges was required. Furthermore, a material with properties
as close as possible to those of the
natural teeth was needed. With its
high durability and elasticity, as
well as the possibility of adhesive
bonding, VITA ENAMIC met these
prerequisites.

Fabrication of the
definitive restorations
For the precise transfer of the
optimal tooth position, the digital

quality of life, even in patients
with extreme functional problems.
Editorial note: This article was first published in the 1/2016 issue of the Digital
Dentistry magazine (OEMUS MEDIA AG).

Dr Sjoerd
Smeekens
is a well-known
specialist in the
field of restorative dentistry.
He runs his
own practice in
Beuningen in the Netherlands and
can be contacted at administratie@
reconstructieve-tandheelkunde.nl.

[13] =>

Dental Tribune International

ESSENTIAL
DENTAL MEDIA
www.dental-tribune.com

[14] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 1+2/2017

Aesthetics and function
A systematic approach to full-mouth rehabilitation with all-ceramics
By Dr Anna Giorgadze & Ilias Psarris, Greece
This awarded entry in the Europe,
Middle East and Africa category
of the IPS e.max Smile Award 2016
describes the complex full-mouth
rehabilitation of a female patient
who consulted our practice because she was dissatisfied with the
appearance of her smile. A reliable
and efficient approach made the
most of the interplay of aesthetics
and function and all-ceramic materials.
Aesthetics and function—
these two requirements are inseparable in restorative dentistry.
The case outlined in this article highlights just how closely
these two aspects are connected.
The patient primarily wanted the
treatment to enhance her appearance. The dental team, however,
could not fulfil these aesthetic
demands without taking into account the functional considerations. Our aim from the time of
the treatment planning stage was
to achieve a harmonious result.
The extensive prosthetic work

required a systematic treatment
approach.

Case presentation
The young female patient consulted our dental practice about
a smile enhancement. Her maxillary and mandibular anterior
teeth were severely abraded and
stained (Fig. 1). Moreover, she had
received inadequate restorations
in the past. The metal-reinforced
bridges in the posterior region did
not provide suitable function and
aesthetics, and the patient was
dissatisfied with the entire situation (Fig. 2). The unattractive
appearance of her teeth was an
embarrassment to her, especially
when she smiled.

Diagnosis and
planning
The first general diagnosis was
based on the needs of the patient.
Furthermore, specific aspects of

the situation were assessed. A corresponding diagnosis was made
and the patient was presented
with a preliminary treatment
plan. In accordance with our protocol, the plan focused on attaining a satisfactory balance between
the functional and aesthetic requirements. Furthermore, mainly

defined wear facets. The vertical
dimension of occlusion was clearly
too low. The patient’s smile line
was not ideal and therefore negatively affected her facial expression. The patient was in good general health. She did not complain
of any temporomandibular joint
pain or of tense jaw muscles.

clusal scheme created. Therefore,
we proposed the following steps:
stabilise the situation with the
help of long-term temporaries before starting the prosthetic treatment; place two implants to close
the gaps left by the loss of teeth
#46 and #36; restore the dentition
with all-ceramic crowns, bridges

“The all-ceramic restorations looked
completely natural in the patient’s face.”
additive measures were planned,
which would make the treatment
minimally invasive. The clinical
diagnosis revealed the extent of
the damage. Severe abrasion had
considerably shortened the anterior teeth, which showed well-

In the development of the
final treatment plan, we first concentrated on the functional requirements. In the process, we
established that the vertical dimension of occlusion needed to
be raised by 1 mm and a new oc-

and veneers (IPS e.max Press,
Ivoclar Vivadent); and provide the
patient with a bite guard to protect the teeth after the treatment.
The patient agreed to this plan.

Prosthetic
pretreatment

Portrait photographs and video
clips showing the patient when
speaking and smiling constituted
important diagnostic tools in the
treatment process. They provided
us with valuable information
for the design of the diagnostic
wax-up. Impressions were taken
for the fabrication of the models.
A face-bow record was taken for
the skull-related transfer of the
situation to the articulator. Furthermore, the new vertical dimension was verified in the mouth
and it was raised by about 1 mm
compared with the original situation.

From wax-up
to mock-up

Figs. 1 & 2: Severely abraded maxillary anterior teeth and compromised aesthetics.—Fig. 3: The master cast clearly showed the functional and aesthetic shortcomings.—
Fig. 4: Additive build-up of the anterior teeth for the diagnostic wax-up.—Fig. 5: The wax-up with approximately 1 mm higher vertical occlusion.—Fig. 6: The mock-up
fabricated on the basis of the wax-up on the model.—Fig. 7: Try-in of the mock-up and validation of the functional and aesthetic parameters.—Fig. 8: Prepared teeth
ready for the permanent restorations.—Fig. 9: Grinding in of functional abrasion facets on the veneers in the lower jaw.—Fig. 10: The finished all-ceramic restorations
on the model of the lower jaw.—Fig. 11: Harmonious photograph of the all-ceramic restoration in situ.—Fig. 12: Examination of the functional parameters.

The models were articulated
and then a diagnostic wax-up
(Figs. 3–5) was created. The teeth
were built up according to the new
vertical dimension of occlusion.
The anterior teeth were designed
in such a way that their shape and
length would suit the face of the
patient. The aesthetic parameters,
such as the smile line, midline and
buccal corridor, were given as
much attention as the functional
requirements of the occlusion.
Since we wanted to check the
planned tooth length and shape in
the patient’s mouth, we fabricated
an acrylic mock-up on the basis
of the wax-up (Fig. 6). The try-in of
the mock-up allowed the dental
team to obtain indispensable insight into the aesthetics and function of the restoration. It also provided the patient with a preview
of the restoration and helped her
to become accustomed to her new

[15] =>

Dental Tribune Asia Pacific Edition | 1+2/2017

TRENDS & APPLICATIONS

Fig. 13: Harmonious appearance. The tooth shape and shade perfectly matched the face of the young woman.—Figs. 14 & 15:
The recall examination of the ceramic restorations showed that the soft tissue in the cervical region of the maxillary and
mandibular teeth was strong and healthy.

appearance. Actively involving patients in the planning process at
this stage has a highly motivating
effect and it positively influences
the treatment result. During the
try-in, the function of the restoration was tested in terms of the
static and dynamic occlusion.
Phonetic criteria were also checked
in the process. Finally, some aesthetic details were discussed (Fig. 7).
The patient requested light teeth
and bold tooth shapes.

Implant placement
and tooth preparation
The prosthetic restorations in
the lower jaw were removed and
implants were placed in the gaps
left by teeth #46 and #36. The
wounds took about three months
to heal. After the osseointegration
of the implants and conditioning
of the soft tissue, the teeth were
prepared for receiving the prosthetic restorations. The premolars
and molars required only light
preparation. The maxillary anterior teeth were prepared for 360°
veneers and the mandibular anterior teeth for ultrathin veneers
(Fig. 8).

a template. The restorations were
produced according to the established protocol. The requirements
of both function and aesthetics

were fulfilled. As requested by the
patient, the anterior teeth were
given a bold shape. The surface
of the ceramic was imparted with

a distinctive micro- and macrotexture, producing an interplay
of light similar to that of natural
teeth (Figs. 9 & 10).
AD

2017

HKIDEAS
Hong Kong International Dental Expo
And Symposium

4 – 6 AUGUST
Hong Kong Convention and Exhibition Centre

w w w. h k i d ea s . o rg

We pursued a minimally invasive strategy, which was quite
easy to implement owing to the
additive approach of the treatment plan. An impression of the
situation was taken. Based on
the mock-up, long-term composite resin temporaries (Telio Lab,
Ivoclar Vivadent) were fabricated.
During the next three months,
the patient was able to accustom
herself to the new situation. She
was given the opportunity to test
the new vertical dimension of occlusion and inform us about any
aesthetic or functional needs.

CALL FOR ABSTRACT

Deadline: 15 April 2017

E A R LY - B I R D R E G I S T R A T I O N
Deadline: 15 May 2017

P R E L I M I N A R Y F A C U LT Y
Professor Patrick Allen
(Singapore) – Geriatric
Dentistry

Permanent prosthetic
restorations

Dr. Yu-chih Chiang
(Taiwan) – Restorative
Dentistry

The patient had no trouble adjusting to the new situation and
eagerly anticipated the placement
of the permanent restorations. At
this stage, she emphasised her requirements again: beautiful and,
above all, light teeth. We decided
to create the veneers with the
press technique using a very light
material (IPS e.max Press, HT BL3).
The copings for the crowns in the
upper and lower jaws were fabricated with the press technique
(IPS e.max Press, LT BL3) and individually veneered (IPS e.max
Ceram, Ivoclar Vivadent). The
long-term temporaries served as

Dr. Jeanette Chua
(Malaysia) – Periodontics

Dr. Peter Pospiech
(Germany) – Prosthodontics
Professor Iain Pretty
(United Kingdom) –
Preventive Dentistry
Dr. Alan Reid
(Australia) – Medical
Emergency

NEW HORIZON IN DENTISTRY
Organizer

[16] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 1+2/2017

Placement of the
restorations

Fig. 16: Six months later, the patient
was highly satisfied with the result.
She was able to smile with confidence.

In preparation for the adhesive cementation of the restorations, the temporaries were
removed and the teeth cleaned.
The anterior restorations were
checked in the mouth using a
try-in paste and the aesthetic results were subsequently assessed.
The occlusion was checked in detail. Next, the ceramic restorations
were etched with 5 % hydrofluoric

acid for 20 seconds. They were
cleaned in an ultrasound bath and
dried. Their contact surfaces were
silanised (Monobond Plus, Ivoclar
Vivadent). Thereafter, a bonding
agent (Heliobond, Ivoclar Vivadent)
was applied. The individual ceramic components were temporarily stored in a container to
protect them against light and

contamination. The teeth were
then conditioned. A rubber dam
was placed and the teeth were
carefully air-abraded with aluminium oxide (0.5 µ). Subsequently, a 37 % phosphoric acid
gel was applied and thoroughly
rinsed off after a reaction time of
15 to 20 seconds. The preparations
were dried to the extent that a
slightly moist, shimmering dentine surface was visible. The application of the bonding agent
(Syntac, Ivoclar Vivadent) followed.
The restorations were placed with
the light-curing luting composite
Variolink Veneer (Ivoclar Vivadent).
First, the veneers of the two central incisors were seated and their
fit checked. Then one restoration
after the other was placed on both
sides. Before the restorations were
light-cured for the last time, the
margins were coated with glycerine gel to prevent the formation
of an oxygen inhibition layer. We
removed the excess with a fine
diamond paste and polishers and
then we polished and smoothed
the margins. After the final examination, we checked the aesthetic
and functional parameters in particular (Figs. 11 & 12). We provided
the patient with a protective bite
guard and then released her from
the practice.

Result
The all-ceramic restorations
looked completely natural in the
patient’s face and her facial expression had completely changed.
The young woman appeared to
be relaxed and enjoying her new
smile (Fig. 13). The first recall examination took place three days
after the restorations had been
placed. At that stage, the condition
of the soft tissue was excellent.
It had fully adapted to the ceramic surfaces (Figs. 14 & 15). The
success of the treatment was confirmed at the six- and 12-month
recalls (Fig. 16).

Conclusion
Sound functional principles,
excellent aesthetic design skills
and an outstanding materials
system combined to fulfil the
patient’s ardent wish for a smile
makeover. The restorations gave
her a new zest for life and improved her health at the same
time.

Dr Anna
Giorgadze
is a practising
dentist in Galatsi
in Greece. She can
be contacted at
annaesthdent@
yahoo.gr.

Ilias Psarris is a
dental technician
and runs his own
dental laboratory
in Athens in Greece.
He can be contacted at info@
psarris-ilias.gr.

[17] =>

ORTHOTRIBUNE
The World’s Orthodontic Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

Vol. 15, No. 1+2

“We have seen a tremendous growth
in the number of attendees”
An interview with Dr Mohanarajah s/o S. Senathirajah,
Chairperson of the Association of Orthodontists (Singapore) Congress 2017
By Kristin Hübner, DTI

Philippines and Vietnam and elsewhere, making AOSC 2017 a truly
regional event.

From 24 to 26 February, the orthodontic community will come
together at the Association of
Orthodontists (Singapore) Congress
(AOSC) at Marina Bay Sands in
Singapore. Dental Tribune had the
opportunity to speak with AOSC
Chairperson Dr Mohan about highlights of this year’s programme and
why he thinks it is important for
specialist congresses to both look
at successfully treated cases and
discuss and learn from cases that
have failed.
Dental Tribune: One objective of
the AOS is to provide a lively
platform for dental professionals
throughout the world and to foster
closer ties between them. How important is the congress in achieving
this aim?
Dr Mohan: In orthodontics
today, there are many new trends,
clinical developments and techniques to advance excellence
in orthodontic practices. AOS,
through our biennial conferences,
aims to bring together worldfamous researchers, academics
and clinicians to provide attendees with the most updated review
of the evidence base and clinical
areas related to the specialty of
orthodontics.

How many visitors do you expect to
attend the meeting?

“We can also learn from seeing
cases that have failed.”
We are expecting 550 attendees from across the region and
almost all of the workshops are
already sold out. Based on our
current registration numbers, we
have noticed an increase in the
number of visitors from neighbouring countries Malaysia, the

What are the key topics of the
scientific programme?
It is difficult to pick a key topic,
as all of our presenters are leaders
in their respective fields and will
be speaking on their specialty
topics. For example, Dr Richard
McLaughlin, the creator of the

evidence into the daily practice and
the biomechanical background of
Invisalign (Align Technology).
There will also be an industry exhibition alongside the congress. With
the event being held just before
the 2017 International Dental Show,

can visitors look forward to trying
out some exciting new orthodontic
products?
Yes, we are excited to have increased our number of exhibitors
by 15 per cent for this edition, bringing the total to 30 exhibitors representing 77 brands. Products on
display will cover both well-established brands, such as Invisalign
and CEREC (Dentsply Sirona), and
new brands and services, such as
Dental Monitoring and JoyAligner
(Bliva). There will also be a number
of live demonstrations of products
and software during the exhibition
that visitors can look forward to.
Aside from the exhibition and the
lectures, what networking events
have you planned this year?
Our networking events are
among the highlights of AOSC.
This edition’s fully booked welcome reception will be held at
Aura, which sits on top of Singapore’s newest museum, the National Gallery. The location offers
great views of Singapore’s skyline,
while reflecting Singapore’s history, as the building in which the
restaurant is housed is the former
Supreme Court of Singapore.
The Gardens by the Bay Run
will give participants another opportunity to meet with their peers.
I believe that the run is unique
to our conference and exhibition.
This edition’s two kilometres route
will take participants along both
the Marina Bay and the Gardens
by the Bay before the conference
begins on the second day.
Thank you very much for the interview.
© Koelnmesse marcom

What is the theme of this year’s
event and why was it chosen?
The theme “Achieving success:
Overcoming challenges in orthodontics” was chosen because, besides seeing successfully treated
cases, we feel we can also learn
from seeing cases that have failed.
Seeing such cases allows us to review our approach and adjust the
treatment plan as we go along.
Our speakers have been asked to
especially highlight cases with
poor outcomes for discussion.

What will be happening on the preand post-congress days?
The days before and after the
event have traditionally been
reserved for limited-attendance
workshops at AOSC. This edition
is no different. We have five halfday workshops, which will cover
topics such as how anchorage
concepts with mini-screws can be
implemented, how to incorporate

This is the fourth biennial meeting.
What has changed over the years?
In the last four editions, we
have seen a tremendous growth
in the number of attendees from
around the world, not just limited
to the Asia-Pacific region. We also
have an increased number of
international orthodontic companies exhibiting at AOSC, especially in the field of digital
imaging.

Dr Mohan, Vice President of the Association of Orthodontists (Singapore)
and chairperson of the 2017 congress
organising committee.

From your perspective, what have
been the most important developments in orthodontics in Singapore
and the Asia-Pacific region in recent years?
The most important developments in orthodontics in recent
years are the advancements in
digital imaging and 3-D printing.
Besides being crucial for orthodontic diagnosis and treatment
planning, digital imaging and
3-D printing are essential tools
that allow us to closely monitor
treatment progress and outcome.
With advancements in imaging
and 3-D printing, we are able to
improve the level of diagnosis,
vary the treatment options and
achieve more predictable treatment outcomes.

MBT system, will be giving an
overview on clinical orthodontics.
Prof. Ravindra Nanda will speak
on managing complex multidisciplinary patients, which is becoming more relevant these days as we
see more and more adult patients.
A range of topics, including retention, anterior open bite and clear
aligner treatment, will also be covered, providing all participants
with the opportunity to focus on
their chosen key topic.

[18] =>

18

ORTHO NEWS

Ortho Tribune Asia Pacific Edition | 1+2/2017

Orthodontic supplies market:
Report predicts highest growth rate in AP
By DTI

regional segments in the global orthodontic supplies market in 2016,
the Asia-Pacific market is projected
to register the highest growth rate
over the next five years, a new re-

PUNE, India: While North America
and Europe are expected to have accounted for the largest share of the

port by market specialist MarketsandMarkets has found.
According to the research
firm, the forces driving this de-

velopment are growing efforts to
increase awareness of advanced
orthodontic treatments in the region and a very large patient population with malocclusion and

AD

JADR 2017

© Toey Toey/Shutterstock.com

The 65th Annual Meeting of
Japanese Association for
Dental Research
The fixed braces segment is expected
to have gained the largest share in the
global orthodontic supplies market in
2016.

11 / 18 (Sat.) - 19 (Sun.) , 2017

[ Venue ]

SHOWA UNIVERSITY, Tokyo, Japan

jaw disorders. In addition, growth
is being stimulated through increasing disposable income, coupled with a growing middle class
and the stronger focus of global
orthodontic and dental companies on emerging Asia-Pacific
countries.

[ Theme
e]

Forefront of Dental Science

[U R L]

http://jadr65.umin.jp

Overall, the global orthodontic supplies market is expected to
grow further at a compound annual growth rate of 8 per cent over
the forecast period of 2016 to 2021
and is expected to reach US$4.71
billion by 2021.

[ Dates ]

- Toward the Global Standard in Medical Science

[ Congress President ]

Ryutaro Kamijo

Department of Biochemistry, School of Dentistry, Showa University

TOKYO

[ Congress Secretariat ]

Department of Biochemistry, School of Dentistry, Showa University
1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
TEL: +81-3-3784-8163 FAX: +81-3-3784-5555

[ Management Secretariat ]

Japanese Association for Dental Research
Academic Square Co., LTD. 2-348-302, Ryogae-machi, Fushimi-ku, Kyoto 612-8082, Japan
TEL: +81-75-468-8772 FAX: +81-75-468-8773 E-MAIL: jadr65@ac-square.co.jp

Among the three major product categories, fixed braces, removable braces and orthodontic
adhesives, the fixed braces segment is expected to have gained
the largest share in the global orthodontic supplies market in 2016.
According to the analysts, this is
primarily attributed to the greater
affordability (compared with removable braces) and increasing
adoption of fixed braces among
adolescents.
According to the market review,
the major competitors in the orthodontic supplies segment are 3M,
Align Technology, Danaher Corporation, Henry Schein, Dentsply
Sirona, American Orthodontics,
Rocky Mountain Orthodontics,
G&H Orthodontics, Dentaurum
and TP Orthodontics.
The full report, titled Orthodontic Supplies Market by Removable & Fixed Braces (Brackets
(Self Ligating, Lingual, Metal, Ceramic, Aesthetic), Archwire (Nickel
Titanium, Stainless Steel), Ligature (Elastomeric, Wire), Anchorage
Appliances, Adhesives), Patient—
Forecast to 2021, can be purchased
from the MarketsandMarkets website.

[19] =>

Ortho Tribune Asia Pacific Edition | 1+2/2017

ORTHO NEWS

“We need to update our knowledge on
the various aligner systems available”
An interview with Dr Graham Gardner, President of the European Aligner Society
© European Aligner Society

By Brendan Day, DTI
Since it was commercially introduced in 1999, aligner therapy has
grown and developed substantially
as an orthodontic treatment modality. Dr Graham Gardner is the first
President of the European Aligner
Society (EAS), an organisation dedicated to increasing education and
research in aligner therapy. The inaugural EAS AlignerLab workshop
will be held in Vienna in Austria on
18 February and aims to provide
a hands-on learning experience for
dental professionals interested in
updating their knowledge of aligner
treatment. Dental Tribune interviewed Gardner about the role of
aligners in orthodontics and what
the event organisers have in store.
Dental Tribune: What benefits do
aligners offer over fixed orthodontic appliances, and how have these
developed since aligners were first
introduced?
Dr Gardner: In my opinion, the
advantages of aligner therapy for
the patient are:
1) They are more comfortable than
fixed appliances.
2) They are more aesthetic, and
therefore less noticeable, compared with fixed appliances. This
is especially important for someone seeking orthodontic treatment because he or she is already concerned and self-conscious about his or her teeth, as
the last thing such a patient
would then want is to draw attention to his or her teeth with
fixed appliances.

This will allow attendees an
opportunity to listen to worldfamous clinicians on different
systems, to compare these different aligner systems and to gain
hands-on experience with the different equipment associated with
these systems.

Dr Graham Gardner at the first EAS congress last year.

3) Improved maintenance of oral
hygiene and no dietary restrictions, as the aligners are removed for eating.
The advantages of aligner therapy for the orthodontist are:
1) Improved treatment planning
capabilities owing to the 3-D
treatment software. Virtual
treatment planning allows one
to evaluate different treatment
options that, crucially, can be
more clearly discussed with the
patient owing to the virtual presentation process. In my opinion,
this allows the patient to make a
more informed decision on the
treatment.

2) Broken brackets and emergencies are things of the past.
Additionally, a benefit shared
by both patient and clinician is
that adjustment appointments are
often quicker and certainly more
comfortable for the patient compared with fixed appliances.
What have the main impediments
been to the adoption of aligners by
dental professionals?
I think that, initially, aligners
were basic and our knowledge on
how to move teeth with plastic was
limited. Hence, in the earlier years,
only minor tooth movement could
be predictably treated with aligners, and this limited their use

and then restricted the number
of practitioners prepared to use
aligners. Combined with the fact
that the practitioner now had to
learn new software programmes
and how to plan treatment on a
computer—a vastly different skill
to having the physical study model
in one’s hands and brackets on
teeth—one can see why the initial
take-up was perhaps less than
would have been expected.
The first EAS AlignerLab is set to
take place in Vienna in February.
What prompted the EAS to hold this
workshop, and what can participants expect to gain from it?
We are excited about the first
AlignerLab. With the explosion in

Organisers of ASOFRE 2017 invite
orthodontists to Brisbane
By DTI

The foundation is the primary
organisation for orthodontic research and education in Australia. It
aims to foster a collaborative and
sharing environment through its
biennial Foundation Meetings and
provides financial and educational
support to Australian universities,

BRISBANE, Australia: The Australian
Society of Orthodontists’ Foundation
for Research and Education (ASOFRE)
will play host to many of the specialty’s leading figures on 3 and 4 March
at its 2017 Foundation Meeting at
the Hilton hotel in Brisbane. The
organisers have warmly invited
dental practitioners to attend the
meeting, which has the theme of
“Aesthetics and evidence” this year.

the 3-D treatment planning and
manufacturing processes now
available, we at the EAS believe
that not only do we need to update
our knowledge on the various
aligner systems available, we also
need to understand the associated
hardware, such as scanners, computers and 3-D printers, and software that is necessary to optimise
the aligner system and improve
treatment results. It is therefore
our objective to bring these two
areas together at one event with
the AlignerLab.

Brisbane is set to host the Australian Society of Orthodontists’ Foundation for Research and Education’s 2017 Foundation Meeting.

We think it is a unique way to
update our knowledge on aligner
therapy, with a bonus opportunity
to forge links with our colleagues
across Europe.
Is the AlignerLab a one-off thing or
is it intended to become a regular
event?
We hope this will become a regular event because technological
developments and advances will
continue. Thus, an event at which
practitioners can both make direct
comparisons and trial new systems should become a popular and
regular occurrence.
Dental Tribune thanks Dr Gardner
for the interview.

students and researchers in the field
of orthodontics.
The event’s keynote speaker
will be Prof. Henry Fields, the Vig/
Williams Endowed Division Chair
of Orthodontics at the Ohio State
University’s College of Dentistry
in the US. Fields’s talk will cover
growth modification, smile aesthetics, and orthodontic surgical
treatments. In addition, a number
of Australian and international researchers will be conducting presentations throughout the two days
of the meeting. Those speaking include Dr Prashant Zaveri, Chairman
of the Asian Pacific Foundation for
Orthodontic Research and Education,
and recipient of the Medal of the
Order of Australia Dr John Fricker.
The Foundation Dinner on the
evening of 3 March is sure to be a
highlight, as it will take place in the
riverside restaurant of Brisbane’s
heritage-listed Customs House.

[20] =>

20

ORTHO BUSINESS

Ortho Tribune Asia Pacific Edition | 1+2/2017

3Shape and Ormco
expand collaboration
By DTI
COPENHAGEN, Denmark: Danish
dental manufacturer 3Shape has
announced that its indirect bondAD

ing solution, a function within the
company’s orthodontic software,
now integrates with the Damon
System bracket library by Ormco
Corporation. Consequently, users

are now able to digitally place the
Damon brackets based on a virtual model produced by 3Shape’s
TRIOS intra-oral scanner or conventional laboratory impressions.

Ormco’s Insignia Advanced Smile
Design already accepts TRIOS scans
for treatment. With the integration
of Ormco’s Damon System bracket
library, the companies are expanding
their collaboration.

“We are very excited to provide orthodontists and labs with
access to the Damon System
bracket libraries. The integration
gives professionals the advantage
of a fully digital workflow to reduce chair time and increase
treatment efficiency and patient
comfort,” said Allan Junge Hyldal,
Vice President of Orthodontics at
3Shape.
Owing to the simpler procedure, indirect bonding has proven
to have multiple benefits for the
patients compared with direct
bonding, including reduced treatment and chair time, as well as less
physical and mental stress.
The newly integrated Damon
System bracket library joins more
than 150 original bracket libraries
and orthodontic solution providers. “Ormco is pleased that doctors
now have access to our advanced
passive self-ligating metal and
aesthetic brackets, including the
improved Damon Clear2 bracket,”
commented Ormco President
Patrik Eriksson on the collaboration.
“With the increased demand
for aesthetic and effective treatment solutions, Damon Clear2
enables 3Shape customers to efficiently treat all of their patients
—including complex cases and
mixed dentition—to an exceptional result,” Eriksson said.

© YURALAITS ALBERT/Shutterstock.com

[21] =>

register for

FREE

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

www.OTStudyClub.com

Ortho Tribune Study Club

Join the largest
educational network
in orthodontics!
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.

[22] =>

ORTHO TRENDS

Ortho Tribune Asia Pacific Edition | 1+2/2017

Creative adjuncts for clear aligners
to improve predictability

Fig. 1: The Hu-Friedy Clear Collection consists of four instruments: the Tear Drop, Hole Punch, Vertical and Horizontal.—Figs. 2a–c: The Tear Drop is designed to cut a teardrop-shaped notch in the margin of clear
aligners to retain orthodontic elastics for various applications.—Fig. 3: Class II clear aligner treatment enhanced with Class II inter-maxillary elastics and Class I intra-maxillary elastics attached to mini-screw anchors
to produce the intended vectors of force.—Figs. 4a & b: The Hole Punch is used to cut a half-moon of plastic at the aligner margin to clear the way for bonded buttons or brackets in order to connect orthodontic elastics
or elastomeric chains.—Fig. 5: Seating elastics used to improve posterior intercuspation in finishing aligner treatment. The Hole Punch cleared plastic to permit bonding of buttons for the inter-maxillary box elastics.

By Dr S. Jay Bowman, US
The concept of clear aligners has
grown in leaps and bounds internationally since the introduction
of Invisalign (Align Technology)
in 1999. In the 1940s, Dr Harold
Kesling first proposed the original
theoretical basis for moving teeth
with a series of retainers, but it
took more than 50 years before
computer technology made the
idea workable.
Although some of the initial
excitement attending the idea
that all patients could be treated
without metal fixed orthodontic
appliances wore off quickly, early
adopters and innovators have

worked diligently to improve and
enhance clear aligner methods.
Limitations of clear aligner treatment simply required some time
and experience to discover, but
ultimately resulted in a series of
articles quantifying issues often
experienced clinically.1–16

endeavours, a series of articles were
published suggesting innovative
treatment options with various adjuncts to clear aligners,19–21 including Hu-Friedy’s Clear Collection
instruments (Fig. 1).22–24

As patients’ and practitioners’
desires for aesthetic alternatives
to fixed appliances continued to
coalesce in the past decade, there
have been a number of technological and biomechanical advancements that have led to an
ever-increasing number of treatment application possibilities for
aligners, including the expansion
to treating teenagers.17, 18 In those

As understanding of some of
the limitations of clear aligner
applications came to light, alterations to biomechanics, materials
and treatment planning were introduced. The primary aims were
to improve the predictability of
specific tooth movements and to
expand the scope of treatment
to a wider variety of presenting
malocclusions.

Clear Collection

A set of instruments were created specifically for clear aligners
in order to enhance, accent and
increase the spectrum of applicability and acceptability of this
form of aesthetic orthodontic treatment. The Clear Collection consists
of four instruments designed to
individualise aligners to address
specific treatment needs.23–24

The Tear Drop
The Tear Drop instrument is
used to add a notch or hook in the
gingival margin of aligner plastic
for the application of typical orthodontic elastics.19–21, 23 The design
of this cut-out is in the shape of
a teardrop with the intent that the
reservoir of the notch will keep an

elastic in place on the aligner (Figs.
2a–c). In this manner, the aligner
with elastics can be inserted into
the mouth, reducing the fumbling
and difficulty associated with attempting to put elastics into slits
or notches after the aligner tray is
already on the teeth. The Tear Drop
cuts can be made anywhere along
the aligner tray edges where elastics may be needed, such as intermaxillary Class II, Class III or delta,
or Class I intra-maxillary applications, even involving the use of
mini-screw anchors to support the
elastic forces (Fig. 3).19, 21, 23

The Hole Punch
The Hole Punch instrument is
used to create a half-moon cut-out

Figs. 6a & b: Areas of gingival impingement or irritation from clear aligners can be cleared using the Hole Punch to remove plastic.—Figs. 7a & b: The Vertical instrument produces a shallow indent in the plastic to
accent rotational couples on individual teeth.—Fig. 8: The indents from either the Vertical or the Horizontal pliers may be formed immediately adjacent to attachments to accent the contact point of plastic in the right
angle between composite and tooth, with the intention of increasing the effectiveness of the attachment.—Figs. 9a & b: Adding root torque to specific teeth is enhanced by creating indents with the Horizontal pliers.
The same tool may also be used to increase the retention of aligners or clear retainers.—Fig. 10: Aligner lag or loss of tracking is a common occurrence, especially for maxillary lateral incisors, the least predictable tooth
movement. The air gap is a symptom of ill-fitting aligners and may have a number of causes (e.g. poor compliance, insufficient space created for the tooth to follow and lack of surface area contact with plastic).

[23] =>

11a

12a

Figs. 11a & b: Chewies Aligner Tray Seaters were developed as a kind of mini-tooth
positioner for patients to clench in specific sites to encourage trays to seat and reduce
the development of aligner lag.—Figs. 12a–d: Bootstrap mechanics are designed to
extrude individual teeth into clear aligners with orthodontic elastics. (a & b) The Hole
Punch is used to cut out a half-moon clearance for a bonded button on the lingual
surface of a selected tooth. (c) The Tear Drop is used to place two elastic notches in
the facial margin of the aligner at both the mesial and distal gingival embrasures. An
elastic is then stretched from the dual notches, over the aligner, to the lingual button
to generate an extrusive force. (d) A second option is to cut a second half-moon in the
facial surface, bond a labial button and place the elastic from the labial to lingual
surfaces over the aligner.—Fig. 13: A Clear Collection prescription form is completed for
each patient to indicate the instruments that will be required to customise each aligner
in a series, along with the specific sites where they will be employed on each tooth.

11b

12b

at the gingival margin of aligner
plastic (Figs. 4a & b).19–21, 23 The intention is to relieve the plastic to
permit the application of bonded
buttons or brackets on specific
teeth to support orthodontic elastics or chains. These cuts can be
placed wherever needed along the
aligners on either buccal or lingual
surfaces. A common scenario would
be punching holes in the buccal
margin of plastic at the maxillary
and mandibular first molars and
canines to bond buttons to support seating or box elastics (Fig. 5)23
or cutting a half-moon on both the
lingual surface of the maxillary
first molar and buccal surface of
the mandibular first molar to facilitate the use of a through-the-bite
cross-bite elastic.
In addition, the Hole Punch
may be employed to simply clear
plastic away from impinging gingival tissue anywhere along the
aligners.23 The incisive papilla is
a common location for this type
of irritation that can be quickly
resolved by clipping the plastic in
that area for each tray in a series
(Figs. 6a & b).

Individualising aligners
with accent pliers
Two accent pliers round out
the Clear Collection. These unique
instruments were designed to
enhance specific types of tooth
movement by increasing plastic
contact points in precise locations
for individual teeth. The intent
is to increase the predictability
of tooth movements by creating
shallow indents in the plastic to
augment prescribed mechanical
couples. Most importantly, these
pliers are not heated. In addition,
these indents may be produced to
increase the retentiveness of aligners or clear retainers in undercuts
and at line angles.
The Vertical
Controlled rotations of teeth
are often difficult to achieve with
aligners,20, 25–27 as the computergenerated prescribed movement
may not be translated accurately
to the tooth. The first of the two accent pliers is called the Vertical20, 24
and it is used to gently impress a
vertical indent into the aligners in
a specific location in the lingual
and/or facial plastic for an individ-

ORTHO TRENDS

Ortho Tribune Asia Pacific Edition | 1+2/2017

12c

ual tooth (Figs. 7a & b). Rotating
maxillary lateral incisors and canines are often sites of these types
of problems.20, 25–27 As an example,
the rotated lateral incisors in Class
II Division 2 malocclusions are difficult to correct and typically
require that overcorrection be
designed into the aligners at the
outset. If additional rotation is
indicated, an indent can be placed
in the plastic at the mesial line
angle on the facial surface and the
distal line angle on the lingual
surface to create some extra force
in the form of a rotational couple
in a series of aligners.24 This may
preclude the necessity of another
round of refinement appliances
to achieve the intended goal. If a
composite attachment is in place
on a specific tooth, the Vertical can
be used at the right-angle contact
of the aligner and the composite
to sharpen the contact point in
that location for more efficient
transmission of force to the tooth
(Fig. 8).
The Horizontal
The second accent instrument
is the Horizontal19–21, 24 and it is primarily used to produce an indent
to affect a change in tooth root rotation or torque.18, 24, 28, 29 A horizontal impression into the plastic at
the gingival margin of the aligners
will emphasise the force applied
to torque the roots of individual
teeth (Fig. 9a). These horizontal
indents can also be placed at the
right-angle junction of a composite attachment and the tooth to
enhance the contact, thereby increasing the effectiveness of the
intended tooth movement and reducing the risk of lag as the plastic
may slip away. Another option is
to place horizontal indents at the
marginal undercuts of the crown
of the teeth to increase the retentiveness of aligners or retainers
(Fig. 9b).

Common applications:
Beating aligner lag and
bootstrap mechanics
Besides facilitating the typical
addition of inter-maxillary elastics for a variety of anchorage
supports for tooth movement or
intention to alter dentoalveolar
compensation (i.e. Class II, Class III,

12d

resolving deep and open bites, extraction space closure, etc.19–24, 30–34),
a common application for the Tear
Drop and the Hole Punch is establishing bootstrap mechanics.20, 23
For instance, a tooth or teeth may
be lagging behind the prescribed
movement, especially in terms of
extrusion—the tooth may not be
following along the projected path
(Fig. 10). This may be due to inadequate space created adjacent
to each side of the tooth or lack of
adequate contact on the tooth or
attachment.
Initially, Chewies Aligner Tray
Seaters20, 23, 35 (another of our creations from our private practice;
DENTSPLY Raintree Essix) are routinely used at each new aligner to
assist in seating them on to the
teeth (Fig. 11a), along with instructions to massage the trays into
place (use fingers to push the trays
on to the teeth as though attempting to stretch them over attachments and undercuts for the first
few days). Despite those efforts, an
air gap between the incisal edge
of the teeth and the plastic may
develop (Fig. 11b). It may be that
inadequate space has been created
prior to extrusion and the interproximal contacts thus cannot
pass by each other (consider the
widening taper towards the anterior incisal edges) and aligner lag
or lack of tracking is the result.
In these instances or in anticipation thereof, a bootstrap set-up
is prepared.20, 23 This consists of
placing bonded buttons on the
lingual surface of the offending
tooth near the gingival margin by
creating clearance for the button
in the aligner plastic with the Hole
Punch (Figs. 12a & b). On the facial
surface of the same tooth there are
two options: another button and
a hole punch (Fig. 12c). The Tear
Drop is used to create two elastic
notches at the mesial and distal
gingival embrasure spaces (Fig. 12d).
A small-diameter orthodontic elastic is then applied to either the
teardrop notches or the button on
the facial surface of the tooth and
stretched over the occlusal surface
of the aligner to the lingual button. In this scenario, the elastic is
intended to more predictably extrude the tooth into the aligner to
the prescribed position.

Future view on aligners
As demand by patients for
more comfortable, hygienic and
aesthetic treatments increases,
the clear aligner market will respond with more advances and alternatives. In addition, orthodontists will learn to better push the
envelope of applications by adding
adjuncts to improve the effectiveness and ultimately the predictability of treatments with aligners.
Much like fixed appliances, the
ability to individualise, accent and
enhance clear aligner biomechanics reduces the known limitations
of aligners and the associated clinical frustrations of the orthodontist. Managing alterations of series
of aligner trays in real time (including the use of a Clear Collection
prescription form;24 Fig. 13) provides increased flexibility in the
endeavour towards increased predictability of aligner orthodontic
outcomes.

More details on the Clear
Collection, treatment applications,
downloadable publications (including the Clear Collection prescription form) and a series of
instructional videos can be found
on the Hu-Friedy website.

Dr S. Jay Bowman
is a diplomate
of the American Board of
O r tho do ntics
and a member
of the Edward
H. Angle Society
of Orthodontists. At the Association of
Orthodontists (Singapore) Congress,
he will be presenting a lecture titled
“Creative adjuncts for clear aligners:
Improving the predictability of aligner
treatments”, among others. He maintains a private specialty orthodontic
practice in Portage in Michigan in
the US. He can be contacted at info@
kalamazooorthodontics.com.
AD

International Expo

Guangzhou

Top Dental inShow
China 行业盛事博览牙科

March 2 -5 ,2017
nd

www.dentalsouthchina.com
Area C of China Import and Export Fair Complex
Organizer: Guangdong Int’l Science & Technology Exhibition Company
Exhibitor Service

Tel: 0086-20-83549150

Email: dental@ste.cn

Visitor Service

Tel: 0086-20-83561589

Email: dentalvisit@ste.cn

Fax: 0086-20-83549078

[24] =>

ntries

© MIS Implants Technologies Ltd. All rights reserved.

u

co

EXPERIENCE THE GLOBAL SUCCESS
MAKE IT SIMPLE
MIS is a global leader in the development and production of advanced products
and innovative solutions aimed to simplify implant dentistry. Successfully sold and
distributed in over 65 countries worldwide, MIS provides unparalleled service to our
customers. To learn more, visit our website: www.mis-implants.com

®

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

[cover] => DT Asia Pacific No. 1+2, 2017

[toc] => Array ( [0] => Array ( [title] => Asia-Pacific News [page] => 01 ) [1] => Array ( [title] => Interview with Prof. Debbie Guatelli-Steinberg - US: “Essentially - we are not adapted to the diets we eat today” [page] => 04 ) [2] => Array ( [title] => Business [page] => 06 ) [3] => Array ( [title] => Interview with Dr Kashif Hafeez - UK: “We need to establish patient-centred care in all practices” [page] => 10 ) [4] => Array ( [title] => Hybrid ceramics in practice [page] => 12 ) [5] => Array ( [title] => Aesthetics and function [page] => 14 ) [6] => Array ( [title] => Ortho Tribune Asia Pacific Edition No. 1+2 - 2017 [page] => 17 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

[cached] => true )