DT Asia Pacific No. 5, 2017

Asia-Pacific News / “The Asian market is one of the most important growth markets for Adentatec” / Business / Acupuncture: Probing its way into dentistry—Part II / Trends & Applications / today 37th Australian Dental Congress - Melburne

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DENTALTRIBUNE
The World’s Dental Newspaper · Asia Pacific Edition

Published in Hong Kong

www.dental-tribune.asia

BLUE LASER SCANNER

Read about the new intra-oral
scanning technology soon to be
introduced by Taiwan’s Metal Industries Research and Development Centre.
” Page 3

Vol. 15, No. 5

INTERVIEW

INLAY RESTORATION

Staying ahead of the curve: iData
Strategic Analyst Manager Jeff
Wong about market potential
and how current trends are shaping the global dental industry.

In this case report, Dr Gerhard
Werling introduces the use of the
VITA ENAMIC hybrid ceramic for
aesthetically pleasing inlay restorations.

” Page 4

” Page 13

Cancer risk: Ill-fitting dentures
© TunedIn by Westend61/Shutterstock.com

By DTI
MUMBAI, India: Chronic mucosal
irritation resulting from ill-fitting
dentures may be a risk factor for
the development of oral cancer, researchers from the Department of
Head and Neck Oncology at Tata
Memorial Centre in Mumbai concluded after reviewing existing
literature on the relationship.
In addition to a variety of factors that are known to increase the
risk of oral cancer, including tobacco and alcohol use, poor diet and
neglected oral hygiene, chronic mucosal trauma has been associated
with the disease in the past. However, the connection between such
trauma, which can be caused by
sharp teeth, dentures or implants,
among others, and the occurrence
of oral cancer has not been scientifically established thus far.
In the current study, the researchers systematically reviewed
22 articles that described the role
of chronic irritation in causing
oral cancer. The results suggest

Chronic irritation caused by ill-fitting dentures may increase the risk of developing trauma-related cancer, a literature review in India has found.

that chronic mucosal irritation resulting from ill-fitting dentures
may be considered a risk factor for
carcinogenesis in the mouth. According to the researchers, trauma-related cancers might be seen
more often at the lateral border of
the tongue and at the alveolus.
However, no association was
found for the duration of denture
use and cancer formation.

Referring to mechanisms behind the relationship, research
has suggested different scenarios,
the researchers wrote. It has been
proposed that persistent mechanical irritation causes DNA damage
and may eventually result in cancer formation. Another possible
mechanism is that chronic mucosal trauma results in inflammation, thereby releasing chemical

mediators such as cytokines, prostaglandins and tumour necrosis
factor, which may result in carcinogenesis.
The study, titled “The role of
chronic mucosal trauma in oral
cancer: A review of literature”, was
published online on 30 March in
the Indian Journal of Medical and
Paediatric Oncology.

P. gingivalis
in focus
MELBOURNE, Australia: The latest
findings on the bacterium Porphyromonas gingivalis will be in focus
at PgMelbourne2017 from 14 to 16
May. The conference, hosted by the
Oral Health CRC (Cooperative Research Centre) at the University of
Melbourne, is the third in a series of
international conferences on P. gingivalis and related species in oral
and systemic diseases. P. gingivalis
is recognised as being a key factor
in the development and progression of periodontitis. It can also influence the host response and the
behaviour of other oral bacteria.
A definite point of discussion at
PgMelbourne2017 will be the recent development of a vaccine for
chronic periodontitis by researchers at the Oral Health CRC. This vaccine aims to reduce or even eliminate the need for antibiotics and
surgery for the condition and clinical trials are to commence in 2018.
More information about the conference is available at www.pgmelbourne2017.com.

IV_Image_Anz_102x128_Layout 1 01.12.11 17:10 Seite 1
AD

Early-life
stress
Yan Gao is the first Chinese master’s student to visit Plymouth University in the UK as part
of an agreement with Capital Medical University in Beijing. During her six-month stay, she
will be working on a research project focusing on the role of stem cells in craniofacial tissue
and bone regeneration.

Two new
Digital face
MALO CLINICs reconstruction
The MALO CLINIC group has
signed a partnership agreement
with Data Pacific Medical Group
that will result in the establishment of two new dental clinics in
Macao. According to Dr Paulo
Malo, founder and president of
the group, the first will open this
year at Centro Médico Pedder and
a larger one will follow in 2018 in
the islands.

In creating a digital reconstruction of the face of a woman who lived
13,640 years ago in what is today
Thailand, researchers used measurements of skulls, muscle, skin and
soft facial tissue derived from contemporary populations worldwide.
While the approximated face shows
characteristics of Late Pleistocene
skulls, it is surprisingly modernlooking, the researchers said.

While low birth weight, for
example, has been established as
a primary marker of early-life
stress, the fi ndings of a new study
have suggested that lower-face
asymmetries, assessed according
to the asymmetry of occlusion,
are a marker of environmental
stress and cerebral lateralisation
during early development too.
In the study, researchers at
the University of Washington assessed data on 6,654 US adolescents collected between 1966 and
1970. Retrognathic asymmetries
(17 per cent), the most common
lower-face asymmetry in the US
population, were found to fluctuate randomly between the left
and right sides of the face. Such
randomness indicates early-life
stress, said lead author Prof.
Philippe Hujoel, from the university’s School of Dentistry.

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[2] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

Drug-related oral health
problems investigated

IMPRINT
GROUP EDITOR:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
Tel.: +44 161 223 1830

MANAGING EDITOR AP:
Kristin HÜBNER

EDITOR:
Yvonne BACHMANN

with substance use disorders.
These include high-sugar diets,
malnutrition, poor oral hygiene
and lack of regular professional
dental care.
In order to lift the burden of
oral health-related problems, a
cautious dental approach is
needed when treating these patients. However, according to lead
researcher Dr Hooman Baghaie
from the University of Queensland, there are simple measures
that both dentists and doctors can
take to improve these patients’
oral health.

Lead researcher Dr Hooman Baghaie from the University of Queensland.

By DTI
BRISBANE, Australia: People with
substance use disorders are more
prone to dental caries and periodontal disease than the general
population, as well as less likely
to receive regular dental care.
Hence, the oral health of these patients is a particular challenge for
dentists. A new review study has
now aimed to examine drugassociated oral health problems

and ways for dental professionals
to improve these patients’ oral
health.
Drug use is associated with
problems such as xerostomia, an
increased urge to snack, clenching
and grinding of teeth, and chemical erosion due to applying cocaine to teeth and gingivae, research has shown. In addition,
lifestyle-associated factors can
worsen the oral health in patients

“Dentists should screen their
patients for substance use, notice
any advanced dental or periodontal disease inconsistent with a patient’s age and consider referral
to medical doctors for management,” Baghaie said. In addition,
dentists should be aware of issues
concerning treatment and consent when the patient is intoxicated and be alert to the possibility of resistance to painkillers, he
emphasised.
Generally, doctors and clinicians who care for people with

substance use disorders should
screen for oral disease and warn
patients of the oral health risks associated with xerostomia and
cravings for sweet foods, Baghaie
added.

ONLINE EDITOR/SOCIAL MEDIA MANAGER:

The review combined the results of 28 studies from around
the world, which collectively
provided data on 4,086 patients
with substance use disorders.
The fi ndings indicated that one
in 20 people between the ages of
15 and 64 use drugs each year,
with approximately 10 per cent
of this number having drug dependence or substance use disorders.

COPY EDITORS:

The findings mirror those of
increased dental caries and periodontal disease in people with severe mental illness, eating disorders and alcohol use disorders,
compared with the general population.
The study, titled “A systematic
review and meta-analysis of the
association between poor oral
health and substance abuse”, was
published in the May 2017 issue of
the Addiction journal.

Hong Kong: Access to dental
subsidy scheme to be widened
By DTI

Last year, the age requirement for the scheme
was already lowered from
80 to 75, giving an additional 24,600 senior citizens access to funding.
However, even with this
and the recently announced expansion of
those eligible for aid, the
sheer lack of public dental
services in Hong Kong is
still a limiting factor for
adequate treatment for
the elderly, according to
experts.
Although the lower
age limit will enable more

HONG KONG: The age limit for the
Community Care Fund scheme,
which subsidises dental care for
Hong Kong’s elderly population,
among other assistance programmes, is set to be lowered
from 75 to 70, fund task force
chairman Dr Law Chi-kwong has
announced. However, a general
lack of services for this
vulnerable group remains
a problem in the city.

people to obtain public dental
care, the general capacity to provide services will remain the
same. As reported by the South
China Morning Post, out of the 39
government dental clinics across
the city, only 11 offer emergency
services to the public. This imbalance is worsened by the fact that
most of the government clinics
provide only very basic services

free, such as pain relief and tooth
extraction, and are open to the
public only for limited sessions
per week, the paper wrote. As a result, elderly patients are often
forced to queue in the early morning hours to beat the crowds to see
a dentist.
“Dental care servicing in Hong
Kong has never been subject to

any serious review or any longterm planning,” Law said in this
regard. “This is something that
needs to be thought about.” However, the problem will probably
not be solved in a few years, he
stressed.
Just as in other Asian cities,
Hong Kong’s population is ageing
rapidly. However, while countries
such as Japan and South
Korea have three and four
dentists per 1,000 elderly
residents, respectively,
Hong Kong’s dentist–population ratio is only two to
1,000.
In the population eligible for funding, problems
such as tooth loss, untreated dental caries and
periodontal disease are
more prevalent than in
the general public.

While more people have been granted access to dental care, the continued shortage of dental service providers for the elderly in the public sector remains a challenge in Hong Kong.

Figures from a 2011 oral
health survey by the Department of Health indicate that
about 40 per cent of those
aged 65–74 have fewer than
20 teeth remaining and
about 5.5 per cent have none.

Claudia DUSCHEK

MANAGING EDITOR &
HEAD OF DTI COMMUNICATION SERVICES:
Marc CHALUPSKY

JUNIOR PR EDITORS:
Brendan DAY
Julia MACIEJEK
Sabrina RAAFF
Ann-Katrin PAULICK

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:
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Published by DT Asia Pacific Ltd.
DENTAL TRIBUNE INTERNATIONAL
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Fax: +49 341 48474-173
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© 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 | 5/2017

03

New cost-effective
blue laser intra-oral
scanning technology

Screenshot Youtube/solberg hu

© Tefi/Shutterstock.com

By DTI
AD

TAIPEI, Taiwan: Taiwan’s Metal Industries Research and Development Centre (MIRDC) has introduced a new blue laser line
intra-oral scanning technology.
According to the developers, the
device is built with mostly Taiwanese electronic components
and will be significantly cheaper
than similar scanning devices
from international competitors.

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Through software, the device
uses a triangular measuring
method to focus a high-coherence
laser light on to the object to be
scanned. In this manner, it is able
to accurately construct a dental
model, taking precise measurements within an area of 22 × 18 mm,
which reduces the margin of error,
the developers said.

Save

55%
on time

The blue laser line was introduced at a press conference held at
the Ministry of Economic Affairs in
the capital city of Taipei in April.
According to the ministry, the
technology has attracted nearly
NT$70.61 million (US$2.4 million)
in investments and generated
nearly NT$200 million (US$6.6 million) in market value so far.

*

and achieve amazing results

Data available on request.

Screenshot Youtube/solberg hu

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The scanner, which is currently being tested in clinical trials, is to be introduced to the market later this year. According to the
MIRDC, similar oral scanning devices made in Germany, Denmark
and the US, for example, cost
about NT$1.2 million–1.6 million
(US$39,900–53,200). The MIRDC’s
partners, however, hope that the
commercialised product will sell
for US$30,000 to hospitals and
dental clinics.

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

Developed by the MIRDC, a
non-profit organisation established in October 1963 to research
and develop leading technologies
for use in the metal and related industries in Taiwan, the blue laser
line was transferred to several
Taiwanese companies, including
EPED, ARIX CNC Machines, Gillion
Technology and Ain Tec Industrial, Taiwan News reported online.

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[4] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

Many Asian countries are experiencing
a great deal of growth
An interview with Jeff Wong, Strategic Analyst Manager at medical market research firm iData
dict that the trend will continue. Of
course, there will always be a couple of smaller companies that will
end up becoming fairly large themselves and remain independent.
However, we expect that many of
the successful emerging companies will be acquired at some point.
One advantage that the larger competitors have is the amount of resources they have. They can always
stay ahead of the curve. If they see
somebody come to the market
with something unique, they have

Jeff Wong in talks with Dental Tribune.

By DTI
The ever-progressing digitalisation,
changing regulations and a tendency
towards mergers are currently shaping
the dental industry. At the International Dental Show in Cologne, Dental
Tribune met with Jeff Wong, Strategic Analyst Manager at international
medical market research and consulting firm iData, to talk about how—
major and emerging—competitors
have reacted to these trends.
Digitalisation is one of the main
trends that is changing the industry.
Other than that, what developments are dominating the dental
market?
Yes, digitalisation is still the
up-and-coming trend and everybody is trying to get into that market now. On the product side, I
would say it is 3-D printing and intra-oral scanning. Three or four
years ago, there was only a handful of competitors in both of those
areas. This year at IDS, almost

every year, but many are also either
acquired or close down. There are
definitely certain regions that are
experiencing a great deal of growth,
for example many Asian countries.
At the same time, traditional markets such as Italy, Brazil and the US
are doing very well. These markets
are well penetrated at this point, so
in terms of market growth it will
definitely slow down. However,
there is still substantial growth opportunity for the lower-priced competitors, while the traditional pre-

So, you are saying that larger companies are looking for smaller businesses to acquire in order to bring
new technology to market?
Not only on the technology
side, but also to compete on the
pricing level as well.
In the current political climate, the
Chairman of the Association of the
German Dental Industry has issued
a warning about protectionism and
trade barriers. What are companies
doing in this regard?

“Digitalisation is still the up-and-coming trend.”
everybody is presenting some new
product in these fields—knowing
how fast these markets develop,
everybody wants to participate.
What consequences will this have
for the market in general?
Especially in these two areas,
where the level of imitation is high,
with so many competitors, it will
definitely start diluting the market
shares among the existing companies. However, if these participants
start focusing on specific regions
or niche audiences, I think there
will still be a great deal of benefit.
What about the recent merger
trend—is that something we will
see more of in the future?
From what we have seen in
other industries, we definitely pre-

the resources to quickly develop a
product of their own.

mium brands will see considerable
competition from other markets.

What role do the emerging markets
play? What regions will become
more significant in the future?
Regarding digital dentistry, I
would say much of the development is linked to implantology and
prosthodontics. The key countries
where those areas are big as well
are Brazil and Italy. Even though
the penetration of digital dentistry
might be relatively higher in those
areas compared with others, I
would say they have the greatest
opportunities for growth.

Do you think this will lead to those
companies buying local competitors? Or what will their strategy to
succeed be?
I think the strategy of most of
the larger key competitors will be
continuing acquisition. However,
the strategy of some of the larger
regional companies, for example
in Brazil, is to continue going and
to expand their global presence
instead of being acquired.
In addition, many of the current key participants—with the
regional regulations changing
from country to country—are
being forced to acquire new companies in order to be able to operate in the region.

What are the main trends in implantology?
In terms of implants, dozens of
new companies are popping up

At this stage, I think, companies
are mainly waiting to see what will
happen. Nevertheless, in light of what
is happening in other industries regarding the whole Brexit issue—for
example, European Union chiefs
have warned airlines, including easyJet and Ryanair, to relocate their headquarters to the EU if they wish to continue their routes within continental
Europe after the Brexit—if that can
happen in the airline industry, who is
to say it cannot happen in the dental
industry. Again, for example in Mexico, which has a major dental tourism industry, if that is going to be affected in terms of procedural volumes, it is definitely going to affect
the dental manufacturers as well.
Thank you very much for the interview.

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09.06 - 12.06.2017

Beijing / China

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[5] =>

ASIA PACIFIC NEWS

Dental Tribune Asia Pacific Edition | 5/2017

05

Osteoporosis: Resolvable magnesium
implants may promote bone formation
By DTI
MALMÖ, Sweden: According to new
research from Sweden, a groundbreaking method for stimulating
bone formation around implants
could soon be available. In testing
the cellular and molecular effects
of magnesium-based implants in
the early healing stages of implant
integration, the researchers found
that the release of magnesium promoted rapid bone formation and
the activation of osteogenic signals
near implants placed in osteoporotic bone.

Thus far, the method has only
been tested in animal models and
will need more research before
proceeding with clinical tests on

human patients, Prof. Lars Magnus Bjursten from Lund University emphasised in the radio interview. However, he said that it is

important to always look for alternatives, particularly in orthopaedics, and magnesium seems to be
a useful material.

Whether the method could potentially assist osseointegration around
dental implants was not addressed
in the current research project.
AD

I AM
DEMANDING

“We observed that the implant
material disappeared, having
formed calcium and phosphate,
which are similar to bone structure,” lead researcher and doctoral
student Silvia Galli from Malmö
University’s Faculty of Odontology told public broadcaster Sveriges Radio. By using magnesium-based implants that dissolve
completely over time instead of
titanium ones, osseointegration in
osteoporotic patients thus might
be enhanced.
The use of magnesium-based
implants could be a potential
method for restoring skulls after
facial fractures through promoting new bone tissue formation as
the implant dissolves over time.
According to Galli, the amount of
metal used in the implants is so
insignificant that it leaves the
body without a trace of the traumatic event having taken place
and without any side-effects for
the kidneys, or the need for a second surgical procedure to remove
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[6] =>

ADVERTORIAL

Dental Tribune Asia Pacific Edition | 5/2017

“The Asian market is one of the most
important growth markets for Adentatec”
Introducing German dental manufacturer Adentatec
given priority to patient health.
Its products thus undergo biocompatibility and corrosion resistance tests, among others, and

optimally cover traditional casting
technology and the new CAD/CAM
technologies, such as milling and
selective laser melting.”

tomers. “At this year’s Sino-Dental, we would like to introduce
the further developed cobalt–
chromium milling system SOFT-

“We are very well positioned with our
products and can optimally cover traditional
casting technology and the new CAD/CAM technologies.”
By DTI
Based in Cologne in Germany,
Adentatec is a global dental company specialised in the manufacture and distribution of non-precious dental alloys. Its medical
devices are exclusively produced
in Germany and certified to the
highest standards (CE marking, US
Food and Drug Administration,
and China Food and Drug Administration). Adentatec is committed to
the strict implementation of the
quality and process requirements
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of DIN EN ISO 13485 and DIN EN ISO
9001 in relation to the entire manufacturing chain.

are manufactured from highquality raw materials to ensure
consistent quality.

The company was established in 1997 and initially manufactured and distributed sandblasting material, dental plaster
and consumables to dental laboratories. In 2003, Adentatec
began production of dental alloys, for which it implemented a
quality management system. As
a manufacturer of medical products, the company has always

Over the last decade, the company’s export business has increased steadily. Consequently,
Adentatec now has more than 20
agents worldwide who represent its
product range. “The Asian market is
one of the most important growth
markets for Adentatec in the future,” Sales Director Julia Grabensee said. “We are very well positioned with our products and can

CAD/CAM discs on
cobalt–chromium
and titanium bases
The company’s brand-name
casting alloys, such as SYSTEM
KN, SYSTEM MG and SYSTEM NE,
have long been in use and been
proven over many years. In
2009, Adentatec expanded the
range to CAD/CAM discs on a
cobalt–chromium base (SYSTEM
NE-BLANK and SYSTEM SOFTBLANK). The high-quality discs
are available in many sizes and
compatible with all open milling
systems. Among the noteworthy
features of SYSTEM SOFT-BLANK
are its high corrosion resistance
and biocompatibility in accordance with DIN EN ISO 10271 and
10993-1. Owing to a special heat
treatment, it is especially soft
and homogeneous and has a
high strength. The system is
available in many diameters and
heights, for almost every type of
machine.

BLANK. Based on our experiences
at the recent International Dental Show in Cologne in March, we
expect a great deal of interest,
particularly because of the significant improvements regarding new milling properties and
more improved compatibility
with veneering ceramics,” she
said.

In addition, the CAD/CAM
product portfolio was extended
in 2012 with titanium milling
discs (SYSTEM TI 5-BLANK) especially for the production of implant-supported restorations.

Just last year, the company
expanded its product range
with a metal-free alternative,
the new ceramic-filled CAD/
CAM high-performance polymer SYSTEM PEEK-BLANK. Owing
to the material’s good physical
properties and low weight, the
patient will enjoy wearing comfort and be assured of a strong
material, the company said.
SYSTEM PEEK-BLANK meets all
of the biocompatibility requirements of DIN EN ISO 10993 and
is an ideal option for removable
dentures, particularly for allergic or sensitive patients. According to the company, it has been
particularly optimised for implant-supported restorations,
secondary structures on telescopic crowns, two-piece abutments, gingiva formers, denture bases and many other indications.

With the company’s planned
exhibitions at Asian dental
shows this year, Grabensee is
confident it will win over cus-

More information about
Adentatec and its product range
can be found at www.adentatec.
com.

[7] =>

Dental Tribune Asia Pacific Edition | 5/2017

BUSINESS

Change requires motivation
The iTOP approach to oral prophylaxis

By DTI
Despite advances in oral health
care, patients and dental professionals remain uncertain about
good oral hygiene, particularly regarding interdental cleaning. Prof.
Denis Bourgeois, Dean of the University of Lyon’s dental faculty in
France, has presented scientific evidence that interdental brushes are
efficient tools for interrupting the
biofilm between teeth. In order to
use these correctly, dental professionals need to offer a certain level
of individual instruction to their
patients. How can this be achieved
easily?
According to Bourgeois, the
majority of his studies have
found a positive significant difference in the plaque index when
using an interdental brush compared with floss. In general, interdental brushes were found to be
more effective in removing
plaque compared with brushing
alone or the combined use of
toothbrushing and dental floss.
Establishing the accessibility and
widths of the interdental spaces
should therefore be part of the
routine examination of all patients. An interdental brush that
is sized correctly for each space is
easy to handle and atraumatic,
yet effective. However, this routine examination needs to be
taught.
In fact, one major problem
with interdental cleaning has
always been patient ability and
motivation. “Interdental cleaning does not readily become an
established part of daily oral hygiene,” according to Bourgeois.
Damage to the interdental papillae and abrasive trauma to the
dental surface result from a lack
of motivation and instruction.
From a clinical perspective, it is
therefore necessary to emphasise
individual instruction and selection of high-quality oral hygiene
products. The ultimate goal
should be a high level of cleanliness with little or no harm to

The iTOP trainers use the
principle of “Touch to Teach” in
their seminars. “Only someone
who has experienced it in his or
her mouth knows the exact pressure of an interdental brush and
understands the importance of
oral hygiene and can thus teach
this to others,” said Dr Jiri Sedelmayer, founder of iTOP. Through
the iTOP approach, which combines efficient tools with a thorough knowledge of cleaning techniques, dental professionals and
patients can achieve optimum
and sustainable oral health. In
2016, 200 seminars were held in
44 countries.

After the iTOP seminar, you will
simply rediscover the meaning
of oral health,” said Dr Ana Stevanovi, Head of Education at

iTOP. Introductory and advanced
iTOP seminars in Ho Chi Minh
City are being offered on 30 and
31 May as well as 1 June.

Dental professionals interested in attending can obtain
more information at info@itopdental.com.
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presentations by several international iTOP lecturers covering the
main topics of this prophylaxis
approach in more detail.
In the practical part, certified
instructors will demonstrate the
requisite instruments and techniques using the “Touch to
Teach” principle. Around 22 participants from seven countries
are expected to attend. “Our
iTOP seminars will allow you to
experience motivation and education from the patient’s perspective and transmit this
knowledge to your patients in an
individual and tailored way.

3522E/1

Prof. Denis Bourgeois

Change through motivation: The
iTOP programme
The
iTOP
(individually
trained oral prophylaxis) programme covers the necessary
techniques, knowledge and instructions for dental professionals. This established educational
system provides simple and practical training for dental staff, who
can then apply this approach to
their dental hygiene delivery and
teach an effective prevention
technique to their patients. All
iTOP seminars are led by independent dentists and dental hygienists who have completed the
courses themselves. Only iTOP
facilitates individual training
with regular check-ups and corrections to the prophylaxis techniques learnt.

either soft- or hard-tissue. Oral
prophylaxis should therefore be
taught individually to dental professionals and not in lectures. By
correcting and repeating the
right cleaning technique, prevention of oral and systemic disease
can be achieved.

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3522E_1_162x227.indd 1

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03.04.17 16:06

[8] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 5/2017

Stronger together
An interview with Jean-François Tivoly, CEO of the TIVOLY group, and Christian Fontaine, CEO of FFDM Pneumat

Fig. 1: The Tivoly family: Jean-François Tivoly, Jamy Tivoly, Edouard Tivoly and Marc Tivoly (from left).

By DT France
In October 2016, the TIVOLY group
acquired the FFDM group. The two
companies specialise in the design
and production of cutting tools.
Both trace their origins to the
same familial and industrial culture dating back to the early twentieth century. The acquisition is
part of TIVOLY’s development
strategy, aimed at strengthening
its industrial base and consolidating its position in aeronautics and
its investments in expanding markets like medical devices. FFDM
will benefit by having a stronger
base for its investments, especially
in research and development. The
aim is to renew and strengthen
their respective offerings and to
put the THOMAS brand at the forefront of the dental market, in the
context of tightening regulation
and increased competition from
Asian products. Dental Tribune
France met with TIVOLY CEO JeanFrançois Tivoly and FFDM Pneumat
CEO Christian Fontaine.

What are the secret ingredients
that make a partnership successful?
Christian Fontaine: The founding of both of these family companies was based on a commitment
to the service of society. Lucien Tivoly, for example, built his first
factory to manufacture the cutting tools essential to the arms industry during the First World War,
and FFDM was established during
the Second World War. One war
may have separated us, but we
share common values. Throughout our history, we have always
striven for progress and concentrated our efforts on becoming a
centre of excellence regarding our
core business. Our teams have the
ability to listen and share a spirit
of open-mindedness that fuels intuition. We are, in fact, creating
added value, by using an approach
that focuses on adapting our products and services to the needs of
today’s consumers. Our aim is not
simply to anticipate their expectations, but to surpass them.

For example, in the era of
smartphones, no tool is available to
dismantle, clean and repair these
devices, so we created a toolkit to
address the problem. It is difficult
for dental surgeons to remove
posts of any kind from root canals,
so FFDM, along with Prof. Pierre
Machtou, improved an existing kit,
the Gonon kit, which is now used
in innumerable dental practices
around the world. Whatever the
problem, our expertise and knowledge of precision tools for the machining of materials can always
provide a concrete, tailor-made
solution. The exchanges that will
inevitably be created between the
teams in charge of research and
development will definitely enable
us to serve new markets linked to
our craftsman origins.
Mr Tivoly, could you briefly introduce us to your company?
Jean-François Tivoly: TIVOLY
is a family business that was established in 1917 and has its headquarters in Savoy. It is a highly

Fig. 2: Grinding and sharpening of an FFDM implant drill.—Fig. 3: Production of implant drills.

international industrial company
that designs and manufactures
cutting tools (drills, milling cutters, taps, etc.) and the related
accessories. TIVOLY is a publicly
traded company (Euronext) and
its annual turnover is € 85 million
(one full year with FFDM).
TIVOLY is structured around
two business units. The first, the
consumer unit, supplies tools for
the construction, DIY and industrial maintenance markets. The
second, the industrial unit, offers
machining solutions for industry, for example the aeronautic
and automobile industries. At
present, FFDM’s dental offering is
part of the industrial unit at group
level, but with a view to these activities being expanded, it seems
logical to create a medical unit at
group level, encompassing dental
products at first, but eventually
including all of the other areas
we have planned for the future.
TIVOLY is aiming for strong
growth, strengthened over the

next few years by its products
and international positioning. To
speed this growth up further,
TIVOLY making other acquisitions
is a possibility, on condition that
these are part of its strategy.
Which indicators make you believe
medicine is the field of the future?
Tivoly: Dentistry, which is an
FFDM specialty, is part of the
broader field of medicine. Globally, it is widely believed that this
area will continue growing. Indeed, populations always continue to increase in number and
age. In many areas, such as India,
Africa and China—where we have
a factory—living standards are
improving, and as the proportion
of income spent on necessities decreases, more income is left over
to invest in health.
However, there is strong competition in the medical equipment
field, with many companies of various sizes—some quite modest—in
France. The market and technolo-

[9] =>

BUSINESS

Dental Tribune Asia Pacific Edition | 5/2017

Fig. 4: The TIVOLY factory in China.—Fig. 5: TIVOLY’s ‘surgical’ smartphone kit.

gies are developing simultaneously.
Thus, it is evident that there are
many factors that may influence
the future. All of these can be viewed
as opportunities and that is why
medicine is the field of the future.
Mr Fontaine, could you tell us about
FFDM?
Fontaine: FFDM, with its
THOMAS brand, is a French company that has been active in the
dental field for over 70 years, along
with the companies NICHROMINOX, Anthogyr and MICRO-MEGA.
This seniority explains our strong
international presence. We are
present in over 65 countries with
our own brands and/or under the
trademarks of our distributors, and
more than 80 per cent of our annual turnover comes from exports.
The first dental products produced
by FFDM were milling cutters in
1946, sold under our THOMAS
brand or private labels (under our
clients’ brands). Our THOMAS
range was then expanded through
the manufacture and sale of con-

ventional endodontic files, marketing Gonon extraction kits, etc.
Parallel to developing in the
dental industry, FFDM has expanded its knowledge base into the
industrial area through the design,
production and sale of cutting tools
and assembly solutions, also under
the THOMAS trademark, and the
design, manufacture and sale of
machinery and assembly solutions
under the Pneumat trademark.
Today, we are recognised as a major
and essential partner.
Getting back to the dental field,
we have designed dental implant
drills for about 20 years. This activity has been a strong lever for our
company’s growth. We currently
work with some 50 implant companies across the world, many of
which are very well known, demonstrating our expertise and quality
products in this domain. We have
more than doubled our turnover in
the past decade, owing to a highly
sustainable investment and devel-

opment policy. More recently, we
have invested over 10 per cent of
our annual turnover. We now have
an assemblage of modern, highperformance machines at our
disposal. We will continue following this approach in the future, so
we can provide our clients with an
even better service.
Now, we have a stakeholder that
is a family-managed manufacturer
just like FFDM has been since it was
founded. It was surprising to discover the similarity of the industrial paths that the TIVOLY group
and FFDM have taken. We are now
part of a group that employs over
500 members of staff, with commercial and manufacturing plants
in many countries, spanning three
continents. Jamy Tivoly, the grandson of the founder, was recently
honoured with a distinguished national award in recognition of his
remarkable industrial career.
How do you see the future, and
what are your plans?

Fontaine: Currently, our implant
drills are sold exclusively to implantology companies. The drills are
made according to specifications
from these companies (we are subcontractors; our brand name never
appears on the instruments). We intend to offer a range of standard
drills to be sold under our THOMAS
trademark with our own CE marking. The aim is to sell these directly
to distributors and practitioners to
boost the THOMAS brand and give it
greater visibility. With standard
drills, another advantage for interested implantology companies
would be that they would not have
to take care of the CE marking themselves, as this would be an additional service we would offer them.
We plan to strengthen our technical and regulatory services to help
our clients with their new products
throughout all the stages of registration. We also intend extending
our product ranges (mainly the endodontic range) so we can provide
complete solutions to our clients.

Fig. 6: Plastic moulding of root canal instruments.—Fig. 7: Implant drills being cleaned.—Fig. 8: Drilling into metal with a TIVOLY drill.

We also have our sights set on
other markets, like cutting tools
for the ancillary orthopaedic segment. We have strengthened our
collaboration with well-known
dentists to gain greater visibility
on the market. We have achieved
this in the past with Prof. Machtou
with immense success.
Online sales is also an area we
are looking into. Through integration into TIVOLY, which guarantees
committed and transparent management, we now have the financial
capacity to implement all of our development projects, both industrial
and commercial. TIVOLY’s commercial and industrial sites in Europe,
Asia and North America will give us
access to facilities that are closer to
our clients and to our markets.
Thank you very much for the interview. Combining your respective
expertise should enable you to
achieve even greater things. We
hope you enjoy many successes
together.

[10] =>

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[11] =>

Dental Tribune Asia Pacific Edition | 5/2017

11

SCIENCE & PRACTICE

Acupuncture: Probing its way into
dentistry—Part II
Dental applications of acupuncture in managing xerostomia, dental anxiety and gag reflex
By Dr Wong Li Beng, Singapore
After a general introduction to acupuncture and its practical applications in contemporary dental practice, this second part of the article
will discuss the use of the method in
managing oral conditions such as
xerostomia and its effect in reducing dental phobia and the gag reflex
before illustrating the recent uptake
of acupuncture in the mainstream
health care sector in Singapore.
Management of xerostomia
Xerostomia may be medication-induced and other common
causes are autoimmune conditions like Sjögren’s syndrome and
irradiation of the head or neck region. Conventional management
of xerostomia includes palliative
treatment, such as a saliva substitute or chewing gum, and systemic
medication, like pilocarpine.
The use of acupuncture as an
alternative treatment modality for
xerostomia has been documented
in Western medicine since the
1980s. Observational studies have
demonstrated that acupuncture
treatment may increase salivary
flow in healthy volunteers, patients
with Sjögren’s syndrome and patients who have undergone radiotherapy of the head or neck region.
In a long-term retrospective study
involving 70 patients with xerostomia due to primary and secondary
Sjögren’s syndrome, irradiation
and other causes,1 the patients received a course of 24 acupuncture
treatment sessions over the first six
months. The salivary flow rate (SFR)
for stimulated and unstimulated
saliva was measured six months
after the baseline acupuncture
treatment and according to subjective changes observed by the patients. Data for up to three years
was also analysed, comparing
those who chose to receive additional acupuncture treatment with
those who did not. The results
showed that the SFR in both stimulated and unstimulated saliva was
significantly higher after six
months compared with the baseline and this was consistent with
the subjective improvement described by the patients. In addition,
patients who received additional
acupuncture treatment after six
months had a consistently higher
median SFR in both stimulated and
unstimulated saliva compared
with those who did not, suggesting
that supportive acupuncture treatment given over a long period may
help to maintain its therapeutic effect. This finding is in accordance
with the traditional Chinese medicine (TCM) concept that the treatment effect of acupuncture may be
accumulative after repeated sessions.

Acupuncture treatment may
provide relief for pilocarpine-resistant xerostomic patients after
radiotherapy for head or neck malignancies.2 However, the treatment outcome for the study cited
was only based on the Xerostomia
Inventory score, which is a self-report questionnaire. Acupuncture

seems to be able to increase the
SFR, provided that the salivary
glands are still functional. For
those patients whose salivary
glands have been structurally affected by radiotherapy and become resistant even to pilocarpine, acupuncture may provide
subjective relief to a limited ex-

tent, although the patients should
be advised on realistic expectations of acupuncture therapy.
The mechanism behind how
acupuncture can increase the SFR
is still not fully understood. It can
be a placebo effect as shown in Pavlovian conditioning, in which ex-

“...scientific evidence for [acupuncture's]
role in pain management is strong.”

pectation alone of those receiving
treatment can induce saliva production. Local acupoints in the
head and neck region may also directly stimulate the nerves innervating the salivary glands. Some
authors have suggested that acupuncture treatment triggers the
release of neuropeptides and this
can affect blood flow, have anti-inflammatory properties and exert a
trophic effect on the salivary
glands.3 Another possibility may
be related to neuronal activation.
In a descriptive study, cortical regions were evaluated using functional magnetic resonance imaging of volunteers undergoing acupuncture treatment. 4 It was observed that acupuncture treatment
activated the parietal, Rolandic
and frontal opercula, as well as the
insula, overlapping with the regions involved in gestation and salivation. The authors proposed that
acupuncture treatment may tap
into the neuronal circuit that activates the salivary nuclei in the
pons and subsequently the salivary glands via the cranial nerves.
More studies are needed to investigate how acupuncture therapy
may increase salivary flow.
Management of dental anxiety and
gag reflex
A recent Cochrane review
showed that 31 per cent of adults
are fearful of dental treatment.5 A
phobic patient may develop reluctance towards or avoidance of
dental treatment and thus not
seek dental care. During dental

[12] =>

12
procedures, an anxious patient
may hinder the operator from executing procedures properly.
Traditionally, medications like
benzodiazepines and midazolam
have been used to manage dental
anxiety. The use of acupuncture
may provide an alternative treatment modality without possible
adverse drug reactions. Several reports on the use of auricular acupuncture for treating chronic and
acute anxiety have shown promis-

SCIENCE & PRACTICE

ing results. A randomised controlled trial comparing auricular
acupuncture with intranasal midazolam for managing dental
anxiety suggested that both treatment methods were similarly effective.6 More large-scale studies
are needed to verify this finding.
The gag reflex is a normal protective, physiological mechanism
that occurs to prevent foreign objects or noxious material from entering the pharynx, larynx or tra-

chea. Its causes may be somatic,
that is brought about by stimulating certain trigger areas in the oral
cavity, or psychogenic, that is induced by thought stimulus modulated by the higher brain centres. A
hyperactive gag reflex can be a hindrance to dental procedures, such
as during taking of alginate impressions for denture fabrication.
The use of certain acupoints
like PC6 (neiguan) and CV24 (chengjiang) have been reported to reduce

Dental Tribune Asia Pacific Edition | 5/2017

the gag reflex significantly.7 Auricular acupuncture too has been suggested for treating a severe gag reflex.8 According to the TCM theory,
the acupoint PC6 (neiguan), located
on the palmar side of the forearm
2 in. (50.8 mm) above the transverse
crease of the wrist, falls on the pericardium meridian, which has the
effect of “calming the heart which
houses the spirit”. It is often used to
treat heart palpitation, nausea and
vomiting. In providing an explanation in the context of Western med-

icine, it has been proposed that acupuncture may trigger an increase
in circulating endorphin, which
binds to the opioid receptor, exerting an antiemetic effect.9 The anti-gagging point located on the ear
corresponds with the area of the
skin innervated by the auricular
branch of the vagus nerve and adjacent to the area innervated by the
auriculotemporal branch of the
mandibular division of the trigeminal nerve, both are responsible for
the sensory and motor function of
the larynx, pharynx and palatal region. It can be postulated that stimulation of the auricular acupoint
may inhibit the muscular function
in the gag reflex. More studies to
verify the effectiveness of acupuncture in controlling the gag reflex should be carried out.

Growing interest
among medical and
dental professionals
A recent press report in Singapore indicated that there are an
increasing number of medical and
dental professionals also trained
in providing acupuncture treatment.10 Based on the official figure
at the end of 2015, there were 249
registered acupuncturists in Singapore, of which 134 were medical
doctors and dentists, constituting
54 per cent of the group. In addition, acupuncture treatment for
pain management is currently
being offered in four major public
hospitals in the country, a major
step towards its recognition as a
treatment modality in the mainstream health care sector.

Conclusion
The use of acupuncture has a
long history and has been proven
to be an effective treatment modality in TCM. The scientific evidence for its role in pain management is strong, although more
large-scale studies with better experimental designs should be carried out to verify its application in
other areas. The use of acupuncture in dentistry may provide an
added dimension to the patientorientated holistic treatment approach that all health care providers should strive to achieve.
Editorial note: A list of references is
available from the publisher.

Dr Wong Li Beng
is a consultant
periodontist at
Ng Teng Fong
General Hospital and Jurong
Medical Centre
in Singapore
and Director of
Preventive Dentistry at the centre. In
2011, he obtained a graduate diploma
in acupuncture from the Singapore
College of Traditional Chinese Medicine and is now a registered acupuncturist with the Traditional Chinese
Medicine Practitioners Board. He can
be contacted at Li_Beng_Wong@
juronghealth.com.sg.

Hingis_DailyRitual_A4.indd 1

23.03.17 09:23

[13] =>

Dental Tribune Asia Pacific Edition | 5/2017

TRENDS & APPLICATIONS

Minimally invasive inlay restoration
using the VITA ENAMIC hybrid ceramic

By Dr Gerhard Werling,
Germany
Inlay restorations using CEREC procedures (Dentsply Sirona) have been
an established process in digital dentistry for decades. However, owing
to the required minimum wall thickness, a great deal of tooth substance
frequently had to be removed in reconstructions using conventional ceramics. Owing to reduced minimum
wall thickness, VITA ENAMIC (VITA
Zahnfabrik) allows for minimally invasive restorations and can be precisely ground to thinly tapering
edges. In this case report, I explain
the clinical procedures for an inlay
restoration using this hybrid ceramic
on teeth #24–26.

Initial situation
Figures 1 and 2 show the initial
situation of the 38-year-old male
patient. On the basis of his history
and in accordance with his request, he was not treated with
alternative methods (infi ltration
technique, fluoridation, regular
controls, etc.). Instead, a cavity was
carefully prepared on the teeth in
which caries was radiographically
shown to have already penetrated
the approximal enamel. Surprisingly, it was found clinically that
the caries had penetrated deep
into the dentine, such that after
extensive excavation, a considerable defect in the tooth substance
was present.

Material selection
As the patient wanted a permanent enamel-like and toothlike restoration, composite could
not be used as a restorative material. It was decided to proceed according to the extension for prevention rule, but as minimally invasively as possible. VITA ENAMIC
is very advantageous in such a
case. The unique network structure in which ceramic and acrylate
polymers interpenetrate provides
for enormous resilience and offers
more freedom than conventional
restorative materials do.

CAD/CAM workflow
Three VITA ENAMIC inlays
were fabricated using the CEREC

system (Sirona Dental Systems,
now Dentsply Sirona). The intraoral scan was performed using
the CEREC Omnicam. With the biogeneric software, the reconstruction was done corresponding to
the missing occlusal surfaces. In
the grinding preview, the inlays
were placed in the material blanks.
The EM-10 (8 × 10 × 15 mm) geometry was chosen according to the
shade determination with VITA
Easyshade (VITA Zahnfabrik) in
Shade 1M2-HT. The hybrid ceramic
can be processed very simply and
quickly by machine and manually. Owing to the high load-bearing capacity and edge stability,
constructions with comparatively
thin wall thicknesses and thin
edges are also feasible. Edge chipping, which can occur with conventional ceramics, is rare with
this material.

“Virtually no transition between the tooth
and the restoration remains visible.”

Processing and
integration
It is advantageous that there is
no firing process, and shade characterisation is possible if desired.
The available shade selection
(0M1–4M2) in two translucency
levels and the good light transmission of the material allow for
aesthetically pleasing results. The
inlays were polished to a high
gloss with the VITA ENAMIC Polishing Set in the clinic. The hybrid
ceramic can also be easily polished intra-orally. With VITA polishing instruments, the restoration edges can be finely polished
so that virtually no transition between the tooth and the restoration remains visible. Bonding is
performed adhesively.

Dr Gerhard
Werling is
a specialist
in aesthetic
dentistry and
implantology
and runs a
private practice in Bellheim in Germany. He can be contacted
at dr.werling@t-online.de.

Fig. 1: Initial situation.—Fig. 2: Radiographic situation: does the apparent caries have to be treated or can it be addressed
with alternative methods?—Fig. 3: Care was taken with the careful preparation of a cavity, but in the course of the excavation, there were clinically extensive undermining defects.—Fig. 4: Extension for prevention—but as minimally invasively
as possible.—Fig. 5: The digital impression was taken with an intraoral scanner.—Fig. 6: The occlusal surfaces were reconstructed using the software.—Fig. 7: By overlaying the opposing occlusal surfaces, the contact points could be checked.—
Fig. 8: In the grinding preview, the designs were placed optimally in the blank (the inlay for tooth #26 is shown).—Fig. 9: For
the adhesive bonding, absolute isolation was ensured with a rubber dam. Fig. 10: A defect-oriented restoration with composite
fillings was planned. The result was a minimally invasive restoration with VITA ENAMIC inlays.

[14] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 5/2017

Shade analysis: See, determine, realise

By Bastian Wagner,
Germany
The wide variety of ceramic materials available today allows the
dental technician to reproduce the
natural, dynamic light qualities of
natural dentition. Determining
and realising these visual characteristics, however, are challenges
that can only be mastered with a
great deal of patience and knowledge.
Each patient case requires the
full attention of all involved—
patient, dentist, dental technician—to the fi ner details in this
complex piece of work. It is the
dental technician’s job to produce a durable prosthetic restoration that, with its functional,
biological and aesthetic characteristics, is adapted to the individual requirements and specifications of the patient. The advancement in technologies and
materials within the last several
years has dramatically changed
the work of dental technicians.
We are, however, still often faced

with a significant challenge: to
recreate nature’s perfection in
harmony with the surrounding
dentition. In particular, consistency and discipline are needed to
fabricate anterior teeth.
In order to produce an aesthetic restoration, the dental
technician must determine the
correlation between the tooth
shape, surface structure and
function, and the effects of phonetics and colour. These factors
form the foundation. With a passion for the work involved and
the necessary sensitivity and
specialist knowledge, a lifelike
appearance can be successfully
imitated. At times, this can be a
laborious task and require a great
deal of patience; sometimes, it
takes quite a few attempts to
achieve the desired results. In
order to realise a harmonious
and aesthetic smile in the end,
good communication between
the patient and dental technician
is essential. The patient’s expectations must be clearly understood by all parties and his or her

1
2

The visual properties
of natural teeth
Three shade characteristics
must be taken into account when
determining the shade: the colour (hue), the brightness (value)
and the colour intensity (chroma).
The colour itself is the most obvious part of a shade. The brightness refers to how light or dark a
colour is. The colour intensity describes the purity of a colour. The
greatest attention should be paid
to the brightness. If the value of a
restoration is not ideally matched
to the rest of the dentition, even
the slightest deviation can be detected within normal speaking
distance by the person standing
opposite.1

wishes transposed as a team. This
article concentrates on shade selection and reproduction using
the veneering ceramic IPS e.max
Ceram (Ivoclar Vivadent). The
fabrication of an anterior tooth is
demonstrated based on a patient
case.

The principles of
shade selection
For shade selection, a shade
guide is used and it presents the
following colour tones:
A = orange
B = yellow/orange
C = grey/orange
D = brown/orange.
The shade should be selected
at the start of the restorative treatment so that it is not affected by a
dehydrated natural tooth structure. In order to select the hue,
value and chroma, individually
fabricated shade samples in the
relevant ceramic assortment are
useful (Fig. 1). The ceramic materials are designed in such a way that
the complex shades and characteristics of natural teeth can be
better distinguished.
The colour of the gingiva or
other surrounding influences can
affect the shade selection. For
example, the background colour
during shade selection can change
the perception of the colour inten-

sity and the colour tone. In order
to avoid any misinterpretation, it
is advisable to cover the dark oral
cavity with a grey card. Another
method is to use a gingivacoloured holder (Gumy, SHOFU)
for each individual shade sample
in order to provide simultaneous
and successive contrast effects.
The samples are surrounded by a
colour that imitates their natural
environment. The Gumy gingival
mask is available in four different
colours. When a shade is selected,
the sample is then placed into the
Gumy so that it can be checked
against the gingiva. For basic
shade determination, it is advisable to take a photograph of three
different shade samples on one
photograph. This provides a comparison. One sample should represent the brightness of the tooth to
be prepared, the second should
have a lower value and the third a
slightly higher value. Furthermore, during the pre-operative
shade determination, important
information on the selection of a
suitable material should be considered.

Fig. 1: Individual shade samples for the IPS e.max Ceram ceramic range.—Fig. 2: Reconstruction of tooth #11. Shade determination at the beginning.—
Fig. 3: Shade determination with a gingiva-coloured holder for the shade samples.—Fig. 4: Shade determination of the internal structures.—Fig 5: Selection
of the individual Opal Effect materials using self-fabricated shade samples.—Fig. 6: The crown framework IPS e.max Press (MO 1 ingot) before the wash
bake.—Fig. 7: The wash bake and characterisation with MM light before firing.—Fig 8: The crown framework was built up with Dentin B1 and MM light,
and Deep Dentin and MM light were built up towards the edges.

[15] =>

TRENDS & APPLICATIONS

Dental Tribune Asia Pacific Edition | 5/2017

Fig. 9: Completion of the internal structure with Dentin BL3.—Fig. 10: Creation of the mamelon structure with a mixture of MM light and Essence
materials.—Fig. 11: Completion of the incisal plate with Opal Effect materials.—Fig. 12: The results after the first bake.—Fig. 13: Checking the
15
surface structure.—Fig. 14: The finished piece of work after the glaze firing.—Fig. 15: The finished restoration of tooth #11 in situ.

Photographic documentation of the
shade selection
In an addition to the shade selection, photographic documentation is essential. A photographic
shade comparison of the natural
tooth colour and the corresponding shade tabs provides further
details. In general, digital photography is a unique communication tool for the entire treatment
team, and it should be firmly established within the treatment
process.2
When taking photographs, the
following procedure must be observed. The shade sample and the
natural tooth must both be parallel to the sensor level on the camera and receive the same amount
of light exposure from the camera
flash. The shade information in
the photograph and the anatomical and morphological characterisation can then be analysed on the
screen. In order to avoid falsified
information on the screen, it
should be calibrated perfectly. If a
grey card is used while photographing, differing camera values
can be corrected using white balance with an image-editing programme (e.g. Adobe Photoshop

Lightroom, Adobe Systems) so
that information is not lost or distorted. When the photographs are
converted in the image-editing
programme into black and white
images, the surface texture and
difference in brightness are
clearly visible. In order to better
identify internal characterisation,
the contrast control can be adjusted to “maximum” and the
highlight function to “minimum”.
This will show all of the details
clearly. The collected information
is converted into a shade diagram,
which is synchronised with the
ceramic material to be used, and a
layering concept is created. The
following case demonstrates one
possible procedure for realising
the determined tooth shade.

Patient case
This patient case with the reconstruction of tooth #11 illustrates clearly how the determined
shade can be reproduced. The
pre-operative shade analysis
showed that the adjacent tooth
#21 had a very high degree of
brightness in the cervical area
and in the body (Figs. 2 & 3). The
natural tooth exhibited opalescent/transparent areas on the
ridges and in the incisal region.
The mamelon structure had a

high value and a slightly yellowish chroma (Figs. 4 & 5). The basic
shade selected was BL3.
Various methods can be used
to increase the brightness of the
IPS e.max Ceram ceramic. In this
case, owing to the high degree of
value, the brightness of the Dentin B1 ceramic material was increased with the highly fluorescent MM light ceramic material
from the IPS e.max range. The
framework material used was an
MO 1 Press ingot (Fig. 6). The structure was lightly covered in a wash
bake with MM light and then fired
(Fig. 7).
During the fi rst dentine bake,
the framework was evenly covered with Dentin B1 and MM
light. The area towards the ridge
that had a high degree of value
was imitated using Deep Dentin
B1 and MM light in a ratio of 4:1
(Fig. 8). The tooth shape was then
completed using Dentin BL3
(Fig. 9). Cutting back the incisal
area and the edges made space for
the Effect materials. Before the
actual build-up, in order to create
the mamelon structure, the material MM light was mixed with
Essence lemon and white until
the ideal mixing ratio had been
found and then a fi ring sample

was fabricated. The exactly mixed
ratio was then applied to the incisal plate (Fig. 10) and the edges
were built up with OE1. The incisal plateau was completed by alternately layering OE2 and OE3
(Fig. 11). Finally, the halo effect
was imitated from the incisal
edge to the proximal area and the
crown was then fi red (Fig. 12). The
second bake included slight shape
corrections. In order to achieve a
natural appearance, the ceramic
surface was given structure and
then fi xed with a glaze bake
(Figs. 13–15).

In autumn 2015, Ivoclar
Vivadent introduced the IPS
e. max Ceram Power Dentin and
Incisal layering ceramics, which
feature a high brightness value.
These materials are ideal for use
on less-reflective translucent substructures. In cases such as the
one presented in this article, in
which a high degree of brightness
is required, the Power materials
can also be used on opaque frameworks to realise the desired results
with little effort.
Editorial note: A list of references is
available from the publisher.

Conclusion
The diverse spectrum of a
modern ceramic range gives the
technician the ability to reproduce a variety of dynamic light
properties. Determining and realising the tooth shade pose significant challenges. This is why the intensive study of chromatics and of
one’s own ceramic assortment is
essential. Even though the material prerequisites for reproducing
lifelike restorations are available,
each dental technician is responsible for developing his or her own
skills and capabilities. The challenge of recreating a shade will always be unique for each patient
case.

Bastian Wagner
Master dental
technician Bastian Wagner is
an expert in the
use of Ivoclar
Vivadent materials for dental restorations.
He works in a dental laboratory in
Munich in Germany and can be contacted at wagner.zahntechnik@
gmail.com.
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[16] =>

[17] =>

37th Australian Dental Congress • Melbourne, 17–21 May 2017
Interview

Networking

Practice Diary

ADC speaker Prof. Philip Marsh from the University of Leeds on the link between lifestyle,
the oral microbiome, health and well-being.

There is much to do and see at this year’s
ADC. Find an overview of the event’s social
programme in the “what’s on” section.

In this article, dentist Dr Diyari Abdah shares
a week of clinical cases utilising ACTEON’s
X-Mind trium CBCT imaging unit.

» page 2

» page 4

» page 6

ADC 2017: All about education
Melbourne welcomes dental community to biggest event to date
n From 17 to 21 May, the 37th Australian Dental Congress (ADC) 2017 is
bringing together over 4,000 dental
practitioners at the Melbourne Convention and Exhibition Centre. Established in 1907 and organised by
the Australian Dental Association
(ADA), the event is set to be the biggest ever this year. Held under the
theme “Educating for dental excellence”, ADC 2017 has attracted an
impressive line-up of four keynote
speakers: acclaimed UK prosthodontist Dr John Besford, UK periodontics
and prosthodontics specialist Dr Andrew Dawood, endodontist Prof. Anil
Kishen from the University of Toronto in Canada and prosthodontist
Dr Ken Malament from the US.
With an additional 100 speakers
from all over the world and a range of
topics in all fields of dentistry, including oral cancer screening, root canal
irrigation, ergonomics and infection
control, ADC 2017 is the largest continuing professional development
(CPD) event for dental practitioners

in Australia and an ideal way to fulfil
CPD requirements. According to the
ADA, the main scientific programme
and associated workshops, forums
and “lunch and learn” sessions offer
over 32 hours of CPD for dentists,
12 hours for dental hygienists, oral
health therapists and dental therapists, and 11.5 hours for dental prosthetists.
Another key part of the congress
programme is the ADA/PFA National
Emerging Young Lecturer Competi-

tion. Sponsored by the ADA and
Pierre Fauchard Academy (PFA), the
competition gives ADA branch-nominated young clinicians the opportunity to present their clinical, research
and lecture skills, providing insight
into the latest work being undertaken in dental schools across Australia. Candidates hold 15-minute presentations with a short Q & A session
and are judged by a panel of four experts from both sponsoring organisations.

The presentations will be held on
Friday from 10:30 to 14:30. The winners will be announced at 15:00. The
National Emerging Young Lecturer is
granted a sponsorship from the PFA
of A$ 5,000. A second prize, the Encouragement Award, is worth
A$ 1,000.

Free industry exhibition
For the first time, the accompanying industry exhibition—the largest of
its kind in Australia—is free, not just

for congress attendees, but also for all
those in dental practice. Hosting over
100 major companies, the exhibition
is showcasing a wide selection of
products and services available to
the dental profession. It runs from 18
to 20 May in a building adjacent to
the venues where the main congress
programme will be presented. The exhibition is also the location of the
morning and afternoon teas.
Graduate dentists should check
out the extensive range of work opportunities at the Employment Fair,
which has been brought back after its
successful premiere at the 2015
event. The fair features organisations
from across the dental industry, including private practices, public sector employers and companies, with
whom graduates will be able to book
appointments to discuss the opportunities available. 7
Read about the ADC’s numerous networking opportunities on pages 4 and 5.

“This year’s congress is not limited by a theme”
An interview with Dr Gordon Burt, Chairman of the Scientific Programme Division for the 37th Australian Dental Congress (ADC)
n Providing three and a half days of
presentations and over 100 speakers, this year’s edition of the ADC
will be the largest continuing professional development (CPD) event for
dental practitioners in Australia in
2017. today international spoke with
Dr Gordon Burt about highlights and
new additions to the Australian Dental Association’s (ADA) flagship
event, such as the “whole of practice”
sessions and the new congress app—
and coffee, which he believes is one
of the best things Melbourne has to
offer.
The congress has a very diverse
schedule of sessions. What did you
aim at when composing the scientific programme?
This year’s congress is not limited
by a theme. We have tried to organise
the concurrent sessions of the main
scientific programme into “procedural” (practical), “wholistic” (patient-centred) and “blue sky” (visionary and creative) streams. For
example, attendees have the opportu-

Canada, as well as other international
and local presenters. Including the
“lunch and learn” sessions, there are
more than 100 speakers. The congress also features programmes for
dental hygienists, oral health therapists and dental therapists.

nity to attend lectures that inform
them of techniques they could apply
in their practices on Monday morning, or confirm their contribution to
the health of a patient, or learn about
the future directions of the profession.
We have invited four keynote
speakers from the UK, the US and

What is the proportion of attendees
in these professions and have you
noticed an increase in participation
by these groups in recent years?
The ADA has selectively included
allied dental health professions as
part of the biennial congress since
2013. Two-day programmes are now
offered to dental hygienists and therapists, dental assistants, practice
managers and dental prosthetists.
While these attendees make up a
fraction of the total, they are none the
less important. Generally, the participation figures are continuing to increase.
You have introduced a new congress
app for recording of participants’
CPD hours. How does this work?

As well as providing general information about sessions and speakers, the congress app allows those attending the main scientific, dental
hygienist and therapist, or dental assistant programmes to accrue CPD
hours, by entering a unique code specific to the session they are attending
into the app. The code is only displayed in the session venue.
For ADA members, the recorded
CPD hours will flow back to the members’ CPD portal. For other participants, this information will form the
basis of a CPD certificate of attendance of the congress. The app is
available for smartphones and tablets.
Could you introduce the concept of
the “whole of practice” sessions?
The “whole of practice” sessions
are a first for the congress. The dental
profession has always relied on various clinicians and support from others
to provide the best care for an individual. To include those providers who
work closely with the dentist is logical.

The opportunity for the whole team to
attend lectures together is valuable in
reinforcing the bond between us all
and building mutual respect.
Melbourne is your home town. Could
you give attendees some tips on
making the most of their time in the
host city after hours?
Walk the streets and be spontaneous. Melbourne is one of those cities that really need to be explored.
Within a few metres from the congress site, there are arts venues, live
music, clubs, bars, restaurants, laneways and graffiti—and coffee. In my
opinion, it is the best in the world.
One of Melbourne’s most successful
international exports seems to be the
barista. There are plenty of online
publications that will tell attendees
what is on (apart from the ADA
events). Do not worry about the
weather; there will be some—a coat
and umbrella may be necessary.
Thank you very much for the interview. 7

[18] =>

news

The link between lifestyle, the oral microbiome, health and well-being
An interview with ADC speaker Prof. Philip Marsh, UK
n Philip Marsh is Professor of Oral
Microbiology at the University of
Leeds in the UK. He has received
national and international awards
for his research in the field and is a
regular conference speaker. In Melbourne, he will be addressing the
topics of dental biofilms and oral microbial ecology in three lectures.
Ahead of the event, today international had the opportunity to speak
with him about the relationship between lifestyle factors and the microbial composition and how to best
maintain a healthy bacterial balance in the mouth.
The microbial balance of the oral
cavity is essential for dental (and
overall) health. Could you briefly explain this relationship?
Humans and microorganisms
have evolved to have a close and important symbiotic relationship, to the
extent that we are 50 per cent microbial! These microorganisms [the

human microbiome] are natural and
deliver essential health benefits. In
the mouth, the normal oral microbiome prevents colonisation by external microbes—some of which would
be potentially pathogenic—and contributes to the development of our
host defences and cardiovascular
system. The natural oral microbiome
is closely linked to oral health and is
not associated with oral disease.

Prof. Philip Marsh

The 65th Annual Meeting of
Japanese Association for
Dental Research
JADR 2017
[ Dates ]

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

[ Venue ]

SHOWA UNIVERSITY, Tokyo, Japan

[ Theme
e]

Forefront of Dental Science

[U R L]

h ttp ://ja d r6 5 . u m i n . j p

- 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

Australian Dental Congress 2017

The oral microbiota is vulnerable to
disruption by lifestyle and environmental changes. What exactly can
cause a shift and what are potential
consequences?
The symbiotic relationship between the oral microbiota and the
host is dynamic and can alter if the
oral environment undergoes a substantial change, often as a consequence of an altered lifestyle. A
clear example is when salivary flow
is reduced or when an individual
more regularly consumes sugar-containing foods and beverages. In this
situation, the dental biofilm spends
more time at an acidic pH. This leads
to an enrichment of acid-producing
and -tolerating bacteria at the expense of beneficial organisms and increases the risk of dental caries.
Similarly, the host mounts an inflammatory response if biofilm accumulates around the gingival margin. If
this fails to reduce the microbial
load, then the protein-rich gingival
exudate that delivers the host defences inadvertently acts as a novel
supply of nutrients for the proteolytic and obligately anaerobic bacteria in subgingival biofilms. These
bacteria subvert the host response
and continue to drive inflammation;
this exaggerated response is responsible for host tissue damage.
Is the composition of the oral microbiota mainly based on heredity or
can it be managed through external
factors?
Some elements of the make-up of
the oral microbiota are linked to heredity, but the general composition
and activity of these microbes can be
managed by effective oral hygiene
and an appropriate lifestyle, for
example reducing the amount and
frequency of intake of fermentable
sugars in the diet, avoidance of tobacco-smoking, etc. An unintended
side-effect of some medications can
be a reduction of salivary flow; this
would disturb the natural balance of
the oral microbiota and increase the
risk of dental caries.
Dental care products aim to reduce
harmful bacteria while maintaining
the good ones. Is there a danger of
using too much product and thereby
destroying the oral flora?
The oral microbiota is natural
and beneficial and therefore needs
to be managed and maintained at
levels compatible with oral health.
Oral care products are designed and
evaluated to support the patient in
maintaining an appropriate level of
oral microorganisms, so if they are
used as intended, there is little danger of negatively disrupting the oral

At ADC 2017, Marsh will be
holding the following lectures:
· Friday, 19 May: “Are dental diseases examples of ecological catastrophes?” (14:35–15:20) and
“Oral biofilms in sickness and in
health” (16:00–16:45)
Saturday, 20 May: “The oral
·
microbiome: The good, the bad
and the ugly” (10:30–11:15).

microbiota. In contrast, the longterm use of broad-spectrum antibiotics can lead to the suppression of significant numbers and types of
beneficial oral bacteria, and this can
result in overgrowth by yeasts or environmental microbes.
Bacteria play an important role in
the development of diseases such
as periodontitis or caries. Are there
ways to manage harmful colonisation other than with dental hygiene
measures, for example with vaccines, or will there be in the future?
New strategies to promote beneficial oral bacteria and/or to suppress the likelihood of disease are
being developed. These strategies include the development of oral probiotic bacteria to prevent dental disease and the use of prebiotics, which
are supplements designed to boost
the growth of beneficial bacteria.
Novel anti-inflammatory agents are
being evaluated that would promote
wound healing and reduce the tissue
damage caused by a subverted host
response to subgingival dental biofilms. Molecules that reduce biofilm
formation or inhibit species implicated in dental disease are under active investigation. Some snack foods
and drinks contain sweeteners that
cannot be metabolised into acid by
oral bacteria.
Is dentistry experiencing greater
challenges with regard to biofilms
and bacterial shifts today than in
the past, and if so, why?
The main differences today compared with the past probably surround the increased amounts of
sugar in snack foods and drinks.
Also, people are living longer and are
retaining their teeth into later life, so
the dentition is vulnerable to dental
disease for longer, and this is coupled
with the fact that a side-effect of
many medications taken by the elderly is a reduction in salivary flow.
What strategies for keeping a
healthy balance in the mouth can
dentists teach patients?
The main strategies are for patients to practise effective oral hygiene and thereby reduce biofilm accumulation and to appreciate the
impact of sugar in their diet on their
risk of dental caries. It may be helpful if patients realise the relationship and direct link between their
lifestyle, their oral microbiome, and
their oral and general health and
well-being.
Thank you very much for the interview. 7

[19] =>

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[20] =>

what’s on

© Nils Versemann/Shutterstock.com

From welcome reception to Dia de los M

In addition to the vast number of educational and scientific opportunities on offer at the 37th Australian Dental Congress (ADC), attendees will be able to network with colleagu

AD

Welcome reception

Madrid, Spain
29 August - 1 September 2017

Giving the opportunity to reconnect with close friends
ipation of the event to come, the welcome reception kicks
20:30. The reception event is included in the registration
For those still looking to party after the official event h
enade offers many opportunities, including wonderful wat
most beautiful waterside views in Melbourne.
A ride along the Yarra River will add to the holiday
pick-up and drop-off service for passengers at the Melbourn
ing point. The water taxis operate day and night all week.
melbournewatertaxis.com.au.

Accompanying persons programme

Not to be forgotten at ADC 2017 are the partners of den
This year’s programme for accompanying persons has und
even more memorable. Instead of the traditional lunch, he

© ESB Professional/Shutterstock.com

© Olena Zaskochenko/Shutterstock.com

meet-and-greet event will give accompanying persons the
one another in a relaxed and convivial setting.
Another addition is a tourism desk operated by Best o
ration of the event, allowing visitors to plan their own exp
bourne.
One thing that remains unchanged is the Accompanyin
able to help themselves to a range of hot and cold beverage
leagues from Australia and around the world.

Congress Late Night

Bringing the World together
to improve oral health
THE BIGGEST INTERNATIONAL
DENTAL CONGRESS

What could be better than wrapping up a stimulating
tal minds with Congress Late Night on Saturday? Under th
Dead), attendees will witness calacas and calaveras—skele
point, and brightly decorated altars covered in candles, fru
to welcome the dead back into the land of the living with
Providing musical entertainment will be Los Romántico
embodies the essence of Mexico and who play a vibrant m
tendees can while away the evening strolling through the
ican dancers and food and drink stands serving tequila a
faces painted in the vividly coloured sugar skull tradition
ican festival.

More information on the social events is made available aft

Abstract submission deadline:
3 April 2017
Early-bird registration deadline:
31 May 2017

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Business Development Claudia Salwiczek-Majonek
Product Manager Antje Kahnt

2017_WDC-ad-A4.indd 1

4

Australian Dental Congress 2017

28/09/16 18:22

Productio

Productio

today will a
2017.

The magaz
right. Any u
admissible
information
nies and co
conditions

[21] =>

what’s on

e los Muertos: Social events at ADC 2017

k with colleagues and friends at a series of social events, commencing with a welcome reception on opening night and ending with Congress Late Night on the final evening.

with close friends and colleagues in celebration and antice reception kicks off at 18:30 on Wednesday and runs until
the registration fee regardless of the category you fall in.
he official event has ended, the nearby South Wharf Promng wonderful waterside dining options—likely boasting the
urne.
dd to the holiday feeling. Melbourne Water Taxis offer a
s at the Melbourne Convention and Exhibition Centre landnd night all week. More information can be found at www.

he partners of dental professionals attending the congress.
g persons has undergone some changes to make the event
ditional lunch, held on the Friday in the past, a Thursday

2017

HKIDEAS
Hong Kong International Dental Expo
And Symposium

4 – 6 AUGUST
Hong Kong Convention and Exhibition Centre

www.hkidea s . org

kochenko/Shutterstock.com

nying persons the opportunity to become acquainted with
etting.
perated by Best of Victoria, which will be open for the dulan their own experience of the beautiful host city of Mel-

the Accompanying Persons’ Lounge, where visitors will be
and cold beverages while catching up with friends and colworld.

CALL FOR ABSTRACT

up a stimulating three days of learning from the best denaturday? Under the theme “Dia de los Muertos” (Day of the
d calaveras—skeletons and skulls—adorning every vantage
ed in candles, fruit and toys, all of which are part of rituals
of the living with celebration and song.
be Los Románticos, a 22-piece Mariachi band whose music
play a vibrant mix of traditional folk and modern pop. Atling through the festively decorated space filled with Mexserving tequila and churros. Visitors can even have their
ar skull tradition that is the literal face of this iconic Mex-

P R E L I M I N A R Y F A C U LT Y

Deadline: 15 April 2017

Professor Patrick Allen
(Singapore) – Geriatric
Dentistry
Dr. Yu-chih Chiang
(Taiwan) – Restorative
Dentistry
Dr. Jeanette Chua
(Malaysia) – Periodontics

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

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

made available after registration.

about the publisher

Production Executive Gernot Meyer
Production Matthias Abicht
today will appear at Australian Dental Congress in Melbourne, 17–21 May,
2017.
The magazine and all articles and illustrations therein are protected by copyright. Any utilisation without prior consent from the editor or publisher is inadmissible and liable to prosecution. No responsibility shall be assumed for
information published about associations, companies and commercial markets. General terms and
conditions apply, legal venue is Leipzig, Germany.

NEW HORIZON IN DENTISTRY
Organizer

Australian Dental Congress 2017

[22] =>

trends & applications

One-week diary of the use of the X-Mind trium CBCT unit in practice
By Dr Diyari Abdah, UK
pared with a 2-D image that generally does not make sense to the untrained eye.
In order to show how a CBCT
unit can affect day-to-day dentistry
in a small family practice, it would
be beneficial to share a week’s diary of its use. This article provides
a small selection from a week’s diary regarding the use of the X-Mind
trium CBCT unit in the clinic. More
CBCT scans were often obtained on
any one day depending on the
cases on that day; however, owing
to space limitations in this article,
only one to two cases per day are
described. It must be borne in mind
that each practice’s needs are different, but one thing should be
common above all and that is to assess every case individually and
never take 3-D scans routinely, despite their clear diagnostic benefits.
n There is mounting evidence in
the literature of
the diagnostic superiority of 3-D
imaging versus
2-D. As a result,
many clinicians
today are using
3-D imaging either by referring
their patients to a
CBCT scanning
centre or having
mobile units visit
them—the only
benefit of this is that there is no initial capital outlay to buy the machine. In contrast, the benefits of an
in-house CBCT device are many, including the convenience of an
on-demand service at any time
(pre-, peri- or postoperatively if
needed), learning one software programme and utilising it fully, rather
than having to learn different ones
for different machines from various
manufacturers and thus not employing it to its full potential. Addi-

tionally, patients appreciate the
convenience of not having to travel
to another location.
Our X-Mind trium CBCT unit
from ACTEON is rather new to our

practice, and we have yet to fully
utilise it. Every day we find new
uses and ways to benefit our patients by using 3-D imaging where
applicable. Following the latest evidence from experts in the utilisation of 3-D imaging can help a great
deal in deciding where and when
to use it, consequently minimising
radiation dosage and improving diagnostics and planning.
We owe our patients the lowest
possible dose with the correspond-

that could affect our decision-making and treatment planning. Judging
every case individually is important
in order for the benefits of using a
CBCT scan to outweigh the potential
risks involved with the use of any
type of radiographic unit. A modern
CBCT machine should allow for different fields of view (FOV) to be utilised in order to minimise the dose
to the patient.
Despite the choice of four different FOV settings with the X-Mind

exposing the patient to extra radiation. In many cases, a small FOV
that is enough for one to several
teeth could be equal to the radiation dose of several periapical radiographs, but with a much higher
diagnostic value.
When a 3-D image is necessary,
patients appreciate the information and education they obtain by
the case being discussed with them
while pointing out vital structures
and proposed solutions in 3-D com-

and infections, and preferred to
have a fixed solution through implant therapy. At that point, the patient was wearing a well-fitted temporary mandibular denture. Initially, the idea was to take a scan of
the existing denture with radiopaque markers (gutta-percha in
six to eight holes made in the denture) to plan for the placement
stage. However, a decision was
made to duplicate the existing denture using a duplication flask (Lang

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

ing acceptable diagnostic value,
and sometimes, a 2-D image does
not provide satisfactory diagnostic
value. A great deal of guesswork is
often involved with 2-D imaging and

trium and other settings that reduce the radiation significantly, individual assessment of every case
is still very important to obtain the
most from the 3-D image without

Day 1
The patient had had all of his
mandibular teeth extracted many
months before, owing to mobility

“Assess every case individually and never take 3-D scans
routinely, despite their clear diagnostic benefits.”

Fig. 7

Australian Dental Congress 2017

Fig. 8

[23] =>

trends & applications

Fig. 9

Dental) in order to fabricate a
clear acrylic radiographic guide
(Figs. 1 & 2).
A 3-D scan was obtained using
the X-Mind trium CBCT scanner to
be utilised in the treatment planning of the case, and we found it to
be an invaluable resource. Through
the scan, the type and position of
the implants in relation to the density of the surrounding bone were
checked. The ACTEON Imaging
Suite software that comes with the
device includes a library of the
most current implants on the market, allowing placement of the right
implant with the right angulation,
plus abutments and crowns, in order to maximise the predictability
of positioning the implants, thus
improving the treatment success.
For clinicians who use more than
one implant system, in order to
change the implant model that was
inserted from the library, one simply clicks in the middle of the implant and the implant library is
opened again, allowing the selection of another implant model. The
software will retain the same insertion point and direction of the previous one.
In addition, the software evaluates the bone density around the
implant. The aim is to show, both
through colour maps and numerically (Figs. 3 & 4), the values before
commencing surgery (green if the

Fig. 10

Fig. 11

with an implant-supported crown.
In planning the case, a CBCT scan
was obtained to serve many purposes in assessing the positions, including the anatomy and bone surrounding these teeth. After this image was taken, both teeth were extracted and the socket was grafted
fully to prepare the site for a later
implant placement (Figs. 7 & 8).

Day 4
Case 1
A mandibular molar case was
in the planning stage, and the position of the mandibular canal was
located. At this stage, different implant sizes were tested to check for
best fit and the prognosis for maximum integration in the future. The
ACTEON Imaging Suite indicated
that the first implant considered
was too long and there was a risk
of nerve damage (Fig. 9); thus, another implant size was chosen to allow sufficient clearance above the
nerve, and the density of the bone
was checked at the same time, indicating good values in green, which
the patient too could understand
(Fig. 10). These tools, as mentioned
above, can be quite a revelation for
patients, and their use can affect
the outcome positively.
Case 2
A broken and loose bridge was
planned to be removed. The man-

ning, and it clearly showed that
this may have proved difficult. In
addition, on the 3-D image, we
noted that the tip of the implant on
the left side may have been colliding with the root of the adjacent
tooth, with long-term uncertainty
as a result (Fig. 15). In a scanning
slice (Fig. 16), we also noted the
challenge ahead for grafting this
implant successfully, indicating
that a great deal of consideration
would have to be given and careful
planning employed in order to obtain a successful outcome for this
case. However, and despite the outcome at that point with these two
implants, the patient appreciated
the high quality of the 3-D technology and being able to see the problem clearly and from different perspectives, eliminating any guesswork that might have affected the
final outcome and guiding the
treatment in the right direction.

Conclusion
These cases and many more every week pass through any dental
clinic, with patients hoping for the
best available treatment under the
circumstances (clinical, timescale,
financial, etc.). We know that 3-D
imaging is here to stay, and in order
to make treatments safer and more
predictable for our patients, we
have to engage these technologies
and involve patients more in show-

“We know that 3-D imaging is here to stay.”
Fig. 12

Fig. 13

values are acceptable or high and
red if the values are low; Fig. 5), allowing the clinician to make the
right decision. This can also be a
very good educational tool to show
the patient the bone density around
any potential implant. In our experience, patients like this feature
once shown what it means.

Day 2
Fig. 14

Fig. 15

Fig. 16

An implant was planned to replace a missing mandibular molar,
and the position of the mandibular
canal was not very clear on a 2-D
image; even on the 3-D image, the
position was still a little confusing.
For this case, we decided to use the
ACTEON Imaging Suite’s FlyMode
option, which is like a virtual endoscope that follows the mandibular
canal tract from within and clarifies the path to confirm that our
nerve tracking is correct (Fig. 6).
This is one of the unique features of
the software.

Day 3
Obtaining the correct position
and trajectory of a retained maxillary canine has conventionally
been dealt with by taking 2-D images (periapical radiographs) at different angles and possibly an occlusal film to determine the correct position in the buccopalatal aspect,
together with some guesswork. 3-D
imaging can be an invaluable tool
for this indication. The patient refused orthodontic extrusion of the
maxillary left canine and wanted
both the primary and permanent
canines extracted and replaced

dibular left second molar, which
served as the most posterior bridge
abutment tooth, was beyond saving
(visual inspection and probing). 3-D
imaging helped with planning the
case, including tracking the position of the mandibular canal in relation to the proposed positioning
of the implants (Figs. 11 & 12). In
addition, the density of the bone
was checked (Fig. 13), and the results indicated that a wider implant
would possibly be a better choice to
improve integration, rather than
the one chosen from the implant library. This would also allow us to
decide on perhaps performing an
under-preparation of the osteotomy
site in order for the implant to engage the bone better. This obviously
depends on the type of implant
used and other factors with which
the expert clinician will be familiar.

Day 5
This case was performed by another clinician, who was hoping to
achieve good integration after placing two anterior implants with
grafting material. According to the
clinician, primary stability was
good at the time of placement and
the implants were placed in bone
with some buccal fenestrations,
hence the grafting. It thus appeared that success was indicated.
After the patient complained about
some threads showing through the
soft tissue, the clinician suggested
further grafting to secure the implants. A CBCT scan was obtained
(Fig. 14) as part of the case plan-

ing them their clinical conditions
and perhaps the limitations (anatomical, structural, etc.), together
with other factors that may affect
treatment planning and outcome,
hopefully for the better. We hope
to be able to use our CBCT scanner
for more indications, especially in
endodontics, as we have seen amazingly positive results from using a
CBCT scan in some difficult endodontic cases since we acquired
this 3-D technology. It is the way
forward, and we wish we had had
the X-Mind trium sooner. 7
Editorial note: A list of references is
available from the publisher.

Dr
Diyari Abdah
is a cosmetic
and implant expert and runs a
private
dental
practice in Cambridge in the UK.
Passionate about research and innovations, especially in the fields of
implantology and 3-D imaging, he
deals with all aspects of implantology and grafting techniques and
has been actively promoting and
teaching implantology to general
dental practitioners worldwide for
over 15 years through lectures,
workshops, articles and mentoring
programmes. He can be reached at
drabdah@hotmail.com.

Australian Dental Congress 2017

[24] =>

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