Dental Asia Jul

www.dentalasia.net

JULY / AUGUST 2015

What’s inside: C lin linic ica al Feature

Periodontal Inflammation: Simplified User Report

Masking of Fluorosis by Resin Infiltration Behin hind d the the Sc Sc enes

There’s Sandblasting... And Then There’s Sandblasting!   r   e   z    l   u    K   s   u   e   a   r   e    H    f   o   y   s   e    t   r   u   o    C   o    t   o    h    P

Spe pec c ia iall Feature:

F o c u s  o n  n Italy  Italy 

CONTENTS Dental Management

Behind the Scenes

Show Preview 

21 C l e a n i n g o f T r a n s m i s s i o n Instruments: What do you Expect?

64 There’s Sandblasting... And Then There’s Sandblasting!

89 CDS 2015 Increases Exhibiti on Space due to Greater Demand

Under the Spotlight

Do You Know 

Regulars

24 Dr. In-Woong Um: Breaking New Ground in Alveolar Bone Repair through Tooth Recycling

Up Close & Personal

66 A Ceramic Furnace that Leaves Nothing to be Desired 67 SIROLaser Blue: Surgical Precision in Blue 68 Classic Surtex® Post

28 Kymata Dental Arts: Small in Size, Big on Quality 

Show Review 

Dental Profile

86 Sixth Annual Zimmer Dental/ NYU Global Implantology Week  88 Colgate at APDC: Prof. Seymour Talks about Periodontal Health

31 Morita: The Perfect Fusion of Ergonomics and Aesthetic Excellence 34 Continuously Making a Mark in Dentistry 

Clinical Feature

4 6 70 90 92

First Words Dental Updates Product Highlights Events Calendar Advertisers’ Index

Sp e c i a l F ea t u r e   80 Focus on Italy 

55

64

38 Modern Approach in Directly Placed Restorations for Endodontically Treated Teeth 40 Periodontal Inflammation: Simplified 48 Essential Factors to Achieving a High-Quality Cure 51 Smilefast: The Predictable ShortTerm Cosmetic Orthodontic Treatment

User Report 55 Masking of Fluoros is by Resin Infiltration 58 Digital Impression: The Final Frontier for Full Digital Integration in Restorative Dentistry? 62 Charisma® Classic Shows Excellent Colour olour Match due to its Microglass ® III Filler Technology 

 40

88 31  2

DENTAL ASIA  J ULY / AUGUST 2015

FIRST WORDS

The Dow nw ard

Spiral Rips are strong, localised currents that occur in shallow open  waters. It cuts through the lines of breaking waves that can eventually sweep swimmers into the deep. As it is not a common phenomenon, swimmers are unwary of the imminent danger lurking at the shoreline. This thought came about as I browsed through dental news. I noticed that there has been a wave of stories on DIY dentistry lately, and this might just be that rip tide prowling around the dental field – an undercurrent that can pull patients into the danger zone. Nowadays, simple DIY treatments that do not require strict medical attention have been deemed “acceptable”. Home tooth whitening kits are instant tickets to million-dollar smiles. Patients tend to favour DIY methods due to convenience and the promise of aesthetic improvement on the spot . However, what makes the situation alarming is the growing number of patients assuming the role at an advanced level: filling cavities, filing tooth edges, re-cementing crowns, or worse – performing surgical procedures like extraction – all on their own. Worse still, videos and tutorials on how to be a “street-smart and practical” patient have invaded the online platform, offering easy access and immediate dental solutions. There has to be limits to this DIY age, especially when health is involved. DIY dentistry re flects how much value patients put on their health – which is a critical matter that should only  be left to qualified hands. Nevertheless, patients who prefer DIY treatments would always have their own reason to validate their judgment. Imagine using superglue for wood to bond a crown, or a concrete filing tool to even out a chipped front tooth, or backyard tools to pu ll out an infected molar that has b een causing sleepless nights. These all sound absurd – but these are happening. A quite “reasonable” factor is its practicality. Failure is regarded as normal and acceptable as long as they can redo the procedure. However, complications could lead to a different story. The repercussions could be devastating, eventually translating to more costs, pain and, perhaps, irreversible results. These stories have significantly caught my attention, and I realised how DIY de ntistry has become one facet of the practice that has been left in the shade amidst the digital dentistry uproar. As the digital side continues to elevate the practice to a more ef ficient platform, DIY dentistry is somehow silently killing the practice and slowly pulling down the nobility of the profession. Money factors in as a primary reason why patients seek cheaper alternatives. However, it is a matter of priority. In spite of having insurance coverage or money, not everybody puts dental treatment on the top of their list. The one thing that truly compels patients to seek treatment is  when pain is present and when it has reached an unbearable state.  Although not directly stated in the Hippocratic Oath, “F i r s t d o n o h a r m  ” has been the classic medical creed. But when patients have assumed responsibility, how can dentists reverse the situation? These waves of thought incessantly ran through my mind as I reviewed my interview with Prof. Greg Seymour ( p. 88), an internationally acclaimed specialist in per iodontal disease. What struck me is his statement, “Education a l o n e  is n o t   a guarantee of behavioural change”. He stressed that patients have to be m o r e motivated than educated, as awareness without a strong drive can only go so far. In the case of DIY dentistry, patients are highly motivated because they have reason to be so. But it appears that they are not putting their know-how to good use or maybe there’s not enough of it. There should be a symbiosis between education and motivation to achieve positive results. A purpose-driven action must be accompanied by proper knowledge to help pull patients away from the DIY dentistry quicksand. Superglue can merit space in the dental clinic or laboratory for out-of-mouth procedures. But there is definitely no room for flat-nose or tongue-and-groove pliers in the dental clinic. Dental professionals and organisations need to mobilise efforts to continuously raise awareness about DIY dentistry and keep patients’ motivational juices flowing – in the right direction. Otherwise, the number of carpentry tool and superglue users in dentistry could gradually escalate in time. DA

Dr. Audrey Abe l a     Assistant Editor

   D    R    A    O    BDr Derek Mahony    Y    R    O    S    I    VDr Fay Goldstep    D    A

Prof Alex Mersel

Dr George Freedman

 Dr Christopher Ho

Dr Ramonito Lee

Dr Ryan Seto

Prof Nigel M. King

Dr Kevin Ng

Dr William Cheung

Dr Adrian U J Yap

Prof Urban Hägg

Dr William O’Reilly

Dr Chung Kong Mun

Dr Choo Teck Chuan

Dr How Kim Chuan

DENTAL UPDATES Markus Heinz is the new Chief Production Of ficer of Ivoclar Vivadent Group. He succeeds Wolfgang  Vogrin, Dipl. Ing., from July 1, 2015, who will retire.  Vogrin has headed up the production and logistics of the company since 2002.  With a co mpre he nsiv e man agem ent ex pe ri ence , Heinz has been working for Ivoclar Vivadent since 1985. He took over the responsibilities for the global tooth production in 2002. Since 2014, he has also  been responsible for the production site in Schaan/ Liechtenstein. “Markus Heinz is a proven production expert, manager and leader,” commented Robert Ganley, CEO Ivoclar Vivadent, upon the nomination of the new Chief Production Of ficer. Within the context of his function, Heinz will join the Corporate Management from July 1.

New Chief Production Of�cer at Ivoclar Vivadent Markus Heinz assumes position as head of the company’s worldwide production.

Significant contribution to growth Chairman of the Supervisory Board Christoph Zeller and CEO Robert Ganley have thanked Vogrin “for his contribution as manager to the rapid development of Ivoclar Vivadent on a global level”. Above all, the build-up of the ceramic production centre in USA, as well as the expansion of numerous other production sites, can be credited to Vogrin. DA

Faster and More Accurate CAD/CAM Solutions for Dental Laboratories 3Shape unveiled several new solutions for dental labs at the IDS 2015. These include upgraded versions of its desktop scanners, two new desktop scanners and the latest release of its industryleading CAD software solution, Dental System™ 2015 . “Our new CAD/CAM solutions demonstrate 3Shape’s commitment to providing dental labs with more opportunities to grow their product portfolios and serve more customers,” says Flemming Thorup, President & CEO at 3Shape.

Improved speed and performance The new versions of the D-series benchtop scanner (D750 and D850) are major upgrades of the former D700 and D800 models. The two, along with the presently available D900L, now feature a new technology platform combined with a larger interior space and blue LED for reduced scan noise.

Three years of LABcare™ The D750, D850 and D900L also include a three-year subscription  bundle to 3Shape LABcare™ , which features free yearly software updates, product training and service. The subscription offer is  valid up until September 30, 2015. The D-series also contains the D500 desktop scanner and includes a cost-effective option to extend the LABcare™ package to three years.

 by 40 per cent and includes several other new features like “All-in-One” scanning and a large interior with room for two models.

 All-in-One scanning  All-in-One scanning and the D2000’s large interior enable technicians to capture both upper and lower models, inserted dies, and occlusion information in a single scan. The technology also enables the D2000 scanner to “see” around dies in the model so that there is no need in most cases to remove dies during scanning.* This process can eliminate four out of the fi ve  work flow steps used to scan (i.e., a three-unit bridge), thereby saving up to 40 per cent of handling time for dental labs.  Additionally,  3Shape Auto-O cclusi on Technology   makes a separate bite scan unnecessary. Auto-Occlusion Technology merges the previously simultaneously scanned models within the software to create a correct bite. *An additional die scan may be required for cases with exceedingly limited interproximal space between dies and neighbouring teeth. All dies must be trimmed and models sectioned.

Two new D-series lab scanners Two new lab scanners (D2000 and D1000) were introduced at the Chicago Midwinter Meeting. Both are equipped with 4 x 5.0 MP cameras and high-quality mechanics to improve scanning accuracy and the aforementioned new multi-line technology for increased scanning speeds. The new D2000 benchtop scanner reduces handling time

6

Dental System™ 2015 3Shape Dental System™ 2015 introduces several new dental sculpting tools including full digital work flows for creating dentures, a simpli fied order form, boosted scanning speeds and more restorative component libraries and compatibility integrations with third party dental product makers. DA

DENTAL ASIA  J ULY / AUGUST 2015

DENTAL UPDATES

Roland DG’s New Wet Grinding Mill Steals Attention at the IDS The DWX-4W was developed for the production of crowns, bridges, inlays, onlays and veneers from popular glassceramic and composite resins with precision and reliability. Simultaneous 4-axis grinding of up to three standard pin-type blocks results in high ef ficiency.  Along with the DWX-4W, Roland DG exhibited its DWX series of affordable CAD/CAM milling devices for dental labs and clinics. The mills were demonstrated in conjunction with dental scanners, software and a wide range of milling materials to illustrate their versatility and compatibility.  According to Takuro Hosome, Manager of Dental Business Development at Roland DG, the user-friendliness, reliability, open architecture and compact size were the DWX-4W’s most-valued features as per visitors. “Like all our dental mills, it features open architecture,” he said. “This means that users can easily integrate the unit in their existing work flow, as the grinding unit works perfectly with all popular scanners and software. Rather than being locked into one source, users can also choose the material supplier they prefer.” Roland DG continues to promote the cost-saving and productivity advantages of operating separate wet and dry milling solutions. Their multiple device solution allows for the combination of dry and wet milling, but with the bene fit of being able to handle the simultaneous processing By decision dated May 13, 2015, the Commercial Court of the Canton of Zurich cancelled all registered shares of Nobel Biocare Holding AG  not directly or indirectly held by Danaher Corporation based on Article 33 of the Federal Act on Stock Exchanges and Securities Trading. Holders of cancelled shares were paid cash compensation in the amount of CHF 17.10 for each cancelled share, corresponding to the offer price paid by Danaher Corporation in its public tender offer for all publicly held shares of Nobel Biocare Holding AG. It was reported that

 8

of different materials without the inconvenience and delay of a changeover. “I very much like the concept of separate machines for wet and dry milling,” said Tomonari Okawa, Master Dental Technician at Organ Dental Technology in Hamburg. “This is highly efficient since you don’t need to clean the machine extensively between jobs and you can start your next task immediately.”  Visitors at the IDS were very positiv e about this new grinding machine, which  will be launched in the second half of 2015. “The success of the show underlines our growing success in the dental market and sets high expectations for the future,” Hosome said.

 Affordable 5- and 4-axis milling units The Roland 5-axis and 4-axis dry mills  wer e also prese nted at the IDS. The DWX-50 features 5-axis simultaneous machining capability, a five-station automatic tool changer with tool length sensor, and a diagnostic notification system that allows for minimal operator involvement. An integrated air blower system and advanced dust collection system contribute to the popularity of the DWX-50. Additionally, the mill offers multi-cast capability, making it possible to connect up to four machines to one computer. The DWX-4 is the world’s most compact

 yet professional dental mill. It combines simultaneous 4-axis milling with simple one-button operation. An included automated tool changer provides two tools for precision milling from start to finish. The DWX-4 can be enhanced with the addition of an optional four-position automatic tool changer (ATC), which supports up to four different tool sizes. Moreover, the DWX-4 can mill up to four different pin-type materials – including hybrid ceramics – simultaneously with an optional multi-pin clamp. As a result, prosthetics for up to four different patients can be produced in a single production run, thus saving time, labour and costs. Both milling units are compatible with a vast range of materials, including zirconia, PMMA, wax and composite resins. This allows dental labs (big or small) to produce all sorts of prosthetic components digitally. Examples include crowns, bridges, frames, inlays, onlays and veneers. DA

Cancellation of Publicly Held Nobel Biocare Shares and De-Listing from Six Swiss Exchange as of June 10, 2015 the compensation was paid on or around June 16, 2015. By decision dated (June 1, 2015), SIX Exchange Regulation de finitively approved the de-listing of the registered shares of Nobel Biocare Holding AG from SIX Swiss Exchange as of June 10, 2015. The last trading day of the registered shares of Nobel Biocare Holding AG was on June 9, 2015. DA

DENTAL ASIA  J ULY / AUGUST 2015

 www.dentalasia.net

Scientists Reveal Six Simple Tongue Exercises that can Stop Snoring  A Brazilian study found that oropharyngeal exercises significantly reduced the frequency of snoring by 36 per cent and total power of snoring  by 59 per cent in patients with primary snoring or mild obstructive sleep apnea (OSA). Snoring is one of the most common symptoms associated  with OSA and is caused by the vibration of the soft tissues obstructing the pharynx during sleep. However, most people  who snore do not have OSA. The prevalence of snoring in the general population varies widely (from 15 per cent to 54 per cent) mainly because most studies rely on patients’ self-reports. Despite evidence revealing snoring as a major burden to society, the management of patients with primary snoring or mild OSA has been poorly investigated. Treatment of primary snoring varies widely and includes avoiding alcohol and sedatives, avoiding lying flat on the back

DENTAL ASIA JULY / AUGUST 2015

to sleep, weight loss, treatment of nasal problems, palate and upper airway surgeries, and use of dental sleep devices. “Previous studies have focused on self-reporting questionnaires. New forms of treatment for snoring focusing on objective measures were needed. We tested the effectiveness of oropharyngeal exercises to reduce snoring,” said Geraldo Lorenzi-Filho, MD, PhD, study author. “The exercises significantly reduced snoring in our study group,” he revealed. The 39 patients in the study were randomised for three months of treatment with nasal dilator strips plus respiratory exercises (control) or daily exercises (therapy). The six exercises • Push the tip of the tongue against the roof of the mouth and slide the tongue backward. • Suck the tongue upward against the roof of the mouth and press the entire tongue against the roof of the mouth. • Force the back of the tongue against the floor of the mouth  while keeping the tip of the tongue in contact with the lower front teeth. • Elevate the back of the roof of the mouth and uvula while saying the vowel “A”. • Put a finger in your mouth on each side and press outward. • Alternate chewing on either side when you eat. DA

9

DENTAL UPDATES

Zimmer Will Sell US Assets to Complete Biomet Merger Zimmer Holdings, Inc.   recently announced that it will sell off some of its US-based business assets to comply with pre-conditions set by the Federal Trade Commission (FTC) as part of Zimmer’s proposed merger with fellow orthopaedic products manufacturer Biomet, Inc.  According to a press release, Zimmer has finalised deals with unspecified buyers to sell certain assets among its Zimmer Unicompartmental High-Flex Knee System, Biomet Discovery Elbow System, and Cobalt Bone Cement product lines. “Zimmer continues to work constructively  with the Bureau of Competition Staff of the US Federal Trade Commission and is highly confident that within the next few weeks, it can finalise the agreement in principle it reached previously with FTC Staff to resolve FTC Staff's competitive concerns regarding the proposed acquisition,” the company stated in the release. The deals are subject to further FTC review and approval by the FTC Commissioners

and will have to satisfy the usual closing conditions for divestiture agreements under federal law. Biomet’s proposed $13.4 billion merger  with Zimmer is believed to be the fifth largest medical device industry transaction over the past decade. The deal between the erstwhile cross-town rivals (both  based in Warsaw, Indiana) will create the second largest company in the $45 billion orthopaedic and dental product market, trailing Johnson & Johnson. Such a sizeable deal warranted antitrust concerns from the FTC, which, last year, requested additional information about the deal from both companies. Both manufacturers have since provided the FTC with the additional data. “Zimmer and Biomet will continue to  work closely with the FTC as it conducts its review of the proposed transaction. The proposed transaction remains subject to the expiration or termination of the  waiting period under the HSR Act (Hart-

Scott-Rodino Antitrust Improvements  Act of 1976), antitrust clearance in certain foreign jurisdictions, as well as other customary closing conditions,” stated a  joint news release from both companies. European regulators also requested more information about the transaction, and Zimmer provided a “revised remedy package” to facilitate the review. In  April, the European Commission (EC) granted conditional clearance to the pending merger, contingent upon Zimmer divesting two of its European knee implant businesses and one elbow implant  business in the near future. The Japan Fair Trade Commission also recently granted clearance to the proposed merger, leaving the FTC as the sole major regulator yet to approve the transaction. However, Zimmer stated in its press release that finalising the divestiture of its U.S. assets may be only weeks away, and the company expects its deal with Biomet to close as planned by mid-June. DA

American Dental Association Welcomes Ruth Lipman, Ph.D., as Director, Scienti�c Information Dr. Ruth Lipman has accepted the role of Director, Scientific Information for the  American Dental Association (ADA). Dr. Lipman will manage the development, review and publication of objective scientific information, providing the  ADA membership with clinically relevant dental research and information. “I’m thrilled to be part of the ADA,” said Dr. Lipman. “I look forward to serving ADA members and leading the development of scientific information that will help promote better oral health.” Prior to joining the ADA, Dr. Lipman  wa s th e Ch ie f Sc ie nc e an d Pr ac ti ce Officer for the American Association of Diabetes Educators (AADE) where she oversaw research efforts, reviewed evidence for practice documents and  wor ked to inc rease opp ortunities for diabetes educators. While at the AADE,

10

Dr. Lipman was the Principal Investigator on projects that received awards from the Agency for Healthcare Research and Quality (AHRQ), Bristol-Meyers Squibb Foundation’s Together on Diabetes programme and the Aetna Foundation. She was also the Principal Investigator on a cooperative agreement with the Centres for Disease Control that increased access to, participation in and sustainability of the National Diabetes Prevention Programme. Dr. Lipman has held various faculty appointments at Harvard University School of Medicine, Tufts University School of Nutrition and Worcester Polytechnic Institute. She received her Ph.D. in Biomedical Sciences and a Bachelor of Science in Life Sciences from  Worcester Polytechnic Institute. DA

DENTAL ASIA  J ULY / AUGUST 2015

 www.dentalasia.net

Experts Call for Consistent Digitisation in Healthcare Digital systems are essential for modern dentistry. However, they are not consistently applied in practices. Dr. Axel Wehmeier discusses the new trends in the industry and how dentists can take advantage of the digital world in the new edition of  VISION, Sirona’s innovation international customer magazine. Lef : Sirona informs dentists, practice teams and dental technicians about new trends in dentistry through VISION, which will come out twice a year in German and English.

Right : Illustrative infographics explain efficient work�ows with integrated digital technologies to users.

In the health sector, a lot of potential for digitisation is wasted, said Dr. Wehmeier, Managing Director of Deutsche Telekom Healthcare & Security Solutions GmbH. While Denmark has set up a patientcentred digital infrastructure and all patients in Singapore have an electronic medical record, digital networking in other areas and regions is progressing at a sluggish pace. “We take our digital x-ray images from one doctor to the next on DVDs,” said Dr. Wehmeier. This inconsistent handling of patient data is anachronistic. Only those who are willing to make their patient data digitally available  will be able to take part in the tremendous progress occurring in medicine and bene fit from innovative, life-saving measures in emergencies. Dr. Wehmeier is one of the experts who deals  with the key issue of “digitisation” in the customer magazine. The fact that digital systems are essential for modern dentistry is emphasised by Jeffrey T. Slovin, President & CEO of Sirona. In the magazine’s foreword, Slovin wrote: “Whether during diagnosis, planning or treatment – they make processes better, faster, safer and more ef ficient. We believe that by integrating and combining different technologies, digitisation can be the  basis for completely new treatments.”  VISION shows the advantages for dentistry and patients – i.e., in the treatment of craniomandibular dysfunction (CMD), obstructive sleep apnea or the production of transparent aligners to straighten teeth. In addition, users and testers describe their first experiences with the innovative ORTHOPHOS SL 3D x-ray system and the new CAD/CAM inLab MC X5 milling machine for dental laboratories. Participants from around the world report on the presentation of the new blue laser technology at the first “Sirona Laser Days”.  In addition to the print edition, VISION is available on Sirona’s website as an e-paper and as a free tablet magazine for the iPad. DA

DENTAL UPDATES

Ultradent Receives Prestigious Top National Honour for Ethics and Truth in Advertising

Dr. Amir Motamed and Dr. Dan Fischer (right), President & CEO of Ultradent Products, Inc.

Following a nationwide nomination and voting process, Ultradent Products, Inc. was selected out of over 3,000 other companies evaluated to receive the Golden Hands Award of Xcellence for Ethics and Truth in Advertising. This was held on April 30, 2015 at the California Dental Association meeting in Anaheim, California. Initial nominees for the prestigious award were selected by a respected group of clinicians and leaders in the dental industry, including numerous well-known key opinion leaders. Nominees  were selected based on criteria that include ethical conduct,

placement of public health before pro fits, dependable products, knowledgeable personnel, and excellent customer service. Nominees were then voted on by thousands of practicing dentists across the nation to select one winner. Dr. Dan Fischer, President & CEO of Ultradent Products, Inc., said, “We’re so honoured to have received this recognition.  Additionally, it must be said that the true honour for this award goes to the men and women at Ultradent who work tirelessly every day to uphold the values upon which Ultradent hangs its hat: integrity, care, quality, innovation and, lastly, hard work. They embody these values in the way they contribute to our  vision every day, regardless of their personal job description or the continent on which they serve. We are humbled to receive this recognition and will use it as a critical reminder of our duty to continue to be responsible and caring to those we serve, both inside and outside Ultradent. Indeed, we are truly fortunate humans. Onward and upward!” The Golden Hands Award of Xcellence has the distinction of  being the most elaborate award in Dentistry. Conceptualised by  Amir H. Motamed, DDS, the sculpture was designed and made by commissioned artist and master craftsman, Donjo. The sculpture is made of casted bronze over an Italian marble base. It stands 16 inches tall and weighs 18.4 pounds. The sculpted Golden Hands of Dentistry are shown upholding the four coloured triangles of the dental profession: Dental Education, Dental Professionals, Dental Organisations and the Dental Industry—all pointing to a common core. DA

Dental Calculus Analysis Reveals Mushrooms were Consumed as Early as the Upper Palaeolithic The human diet during the Magdalenian phase of Europe’s Upper individuals found at El Mirón Cave in Cantabria, Spain. Using Palaeolithic between 18,000 and 12,000 years ago is poorly optical and scanning electron microscopy with energy-dispersive known. This is particularly a problem regarding food resources x-ray spectroscopy, they detected a diverse assemblage of that leave little trace such as plant foods. An international micro-remains from the dental calculus. These micro-remains research team led by Robert Power of the Max Planck Institute from plant, fungal, animal and mineral sources provide some for Evolutionary Anthropology in Leipzig, Germany has now indication of the Magdalenian diet. “These types of microexplored diet in the period through dental calculus analysis on remains show that the individuals at El Mirón consumed a variety Magdalenian individuals found at El Mirón Cave in Cantabria, of plants from different environments, as well as other foods, Spain. The researchers found that Upper Palaeolithic individuals possibly including bolete mushrooms,” says Power. already used a variety of plant foods and mushrooms, in addition  Archaeologists know almost nothing about the early use of to other food sources. fungi. Although their use is poorly understood in pre-history,  Although the Magdalenian in much of northwest Europe is ethnographers have noted that recent hunter-gatherers have commonly characterised as the period of the “reindeer hunters”, often used fungi as food, flavouring and medicine. Mushroom this is unlikely to have been the case in Iberia. Other lines of use has firmly been identi fied from as early as the European evidence showed diet included substantial amounts of meat Chalcolithic. The Chalcolithic Tyrolean Iceman “Ötzi” carried supplied from red deer and Ibex, but until now, it was unclear if several types of fungi on his person. “This finding at El Mirón foods such as plants were a component of their diet. Cave could be the earliest indication of human mushroom use Robert Power, a PhD candidate in the Max Planck Research or consumption, which, until this point, has been unidenti fied Group on Plant Foods in Hominin Dietary Ecology, and his in the Palaeolithic,” says Power. DA colleagues took dental calculus samples from Magdalenian 12

DENTAL ASIA  J ULY / AUGUST 2015

DENTAL UPDATES

Natural Plant Chemical Could Help Fight Tooth Decay Primarily known as a sickly sweet candy that causes tooth decay, liquorice could actually be holding the key to conquering it, a new study suggests. University of Edinburgh researchers stated that a natural chemical extracted from plants acts against harmful mouth  bacteria and could improve oral health by helping to prevent plaque build-up. The biological compound known as trans-chalcone is related to chemicals found in liquorice root. The study shows that it  blocks the activity of a key enzyme that allows bacteria to thrive in oral cavities. The bacteria – Streptococcus mutans – metabolise sugars from food and drink, which produces a mild acid and leads to the formation of plaque. Without good dental hygiene, the combination of plaque and mouth acid can then lead to tooth decay. The researchers found that blocking the activity of the enzyme prevents bacteria from forming a protective biological layer (biofilm) around them. Plaque is formed once bacteria attach themselves to the teeth and construct bio films. Preventing the assembly of these protective layers would then help stop bacteria forming plaque, the team said.

Faecal Matter in Your Toothbrush?!

The toothbrush you keep in the communal washroom may be inviting the uninvited, serving as a vector for faecal bacteria, according to new research.

Recently presented at the annual meeting of the American Society for Microbiology, the study revealed that more than 60 per cent of toothbrushes stored in communal washrooms tested positive for faecal matter, which are potentially pathogenic organisms.  A more worrying finding is that there was an 80 per cent chance that the contamination came from other people using the same  bathroom. “The main concern is not the presence of your own faecal matter on your toothbrush but rather, being contaminated with faecal matter from someone else, which contains bacteria, viruses or parasites that are not part of your normal flora,” says Lauren  Aber, MHS, a graduate student at Quinnipiac University in Hamden, CT, USA. The researchers noted that Enterobacteriaceae and Pseudomonadaceae are some of the bacterial species that can potentially contaminate toothbrushes. Both can be found in normal gut flora, though some forms can be pathogenic. The data is based on an analysis of toothbrushes that came from participants (students) who use communal bathrooms at Quinnipiac University. Each bathroom had an average of 9.4 occupants. The researchers also found that there

14

Oral care products that contain similar natural compounds could also help improve dental hygiene, the researchers said. This study is the first to show how trans-chalcone prevents  bacteria-forming biofilms. The team worked out the 3D structure of the enzyme Sortase  A, which allows bacteria to make bio films. By doing so, the researchers were able to identify how trans-chalcone prevents the enzyme from functioning. The study, published in the journal Chemical Communications,  was supported by Wm. Wrigley Jr. Company and the University of Edinburgh. Dr. Dominic Campopiano of the University of Edinburgh's School of Chemistry led the study. He said: “We were delighted to observe that trans-chalcone inhibited Sortase A in a test tube and stopped Streptococcus mutans bio film formation. We are expanding our study to include similar natural products and investigate if they can be incorporated into consumer products. This exciting discovery highlights the potential of this class of natural products in food and health care technologies.” DA

 was no difference in the level of effectiveness for different decontamination methods including rinsing with cold or hot  water or mouthwash. Toothbrushes stored open in the bathroom are especially  vulnerable to contamination with material from the toilet or from other occupants. However, covering them is apparently not the best solution against bacterial growth either.  Aber said that using a cover does not protect a toothbrush from  bacteria – it actually creates a fertile environment, presenting a suitable breeding ground for bacteria as it keeps bristles moist and does not allow the toothbrush head to dry out between uses. She added that people who share bathrooms should use better hygiene practices to store their toothbrushes, including those recommended by the American Dental Association (ADA): • Avoid sharing toothbrushes; • Rinse toothbrush es thoroughl y with tap water after  brushing to remove remaining toothpaste and debris and allow them to air-dry; • Do not use toothbrush covers or store brushes in closed containers; • Replace toothbrush every three to four months or sooner once bristles become frayed. DA

DENTAL ASIA  J ULY / AUGUST 2015

DENTAL UPDATES

Larger Anaesthesia Needle Bore Fails to Reduce Pain  A local anaesthetic is often given during dental work to lessen pain, but for many patients, the injection is as bad or as scary as the experience of dental treatment itself. Dentists are constantly looking for ways to reduce the pain produced by injecting the numbing agent.  An art icl e in the jou rnal Ane sth esi a Progress describes a novel needle design that attempts to reduce pain. This new dental needle has the same outside diameter as a standard needle, but the opening inside the new needle is larger. The authors speculated that this larger opening inside the needle might decrease the pain of both inserting the needle, as  well as injecting the anaesthetic. Many patients avoid visits to the dentist  because they fear pain, which dentists have attempted to reduce – first with general anaesthesia and now mainly  with local anaesthesia. While generally effective, the injection can still be painful for patients. Many attempts

have been made to diminish injection pain, ranging from smaller needles and topical numbing agents to distracting the patient in various ways. In the current study, 20 dental patients  were given four anaesthesia injections on  both sides of the mouth using two types of needles from Septodont. The injection sites chosen are those commonly used for dental anaesthesia. The new larger inner bore needle was used on one side of each patient’s mouth, and a standard inner bore needle was used on the other. Patients then rated the amount of pain they felt. The authors found that the needle with the larger inner opening did not decrease

pain while the needle was inserted or the anaesthesia was injected. Compared to the standard bore needle of the same gauge, there was no signi ficant difference in the amount of pain reported by the patients. The same patient received injections using both inner bore sizes (the outer bore  being the same size) and rated the pain immediately after the anaesthesia was injected. The injection rate was carefully controlled so that it did not affect the level of pain experienced by the patients. Half of the patients received injections using the larger inner bore needle first and half had their first injections from the standard inner bore needle, so that the order of injection will not appear to  be a factor in the patients’ pain ratings. The authors noted that this is the first published study to assess the effect of inner needle bore size on pain with anaesthetic injections. Therefore, independent studies are needed to confirm their finding. Although this attempt to decrease pain was not effective, dentists continue to try to find ways to improve the experience of dental treatment that is still very disconcerting for many people. DA

3M Technologies Receive Top Honours at 2015 Edison Awards 3M True Definition Scanner recognised for innovative excellence 3M , a science-based company that inspires creative collaboration, announced recently that two of its powerful technologies have been selected to receive a 2015 Edison Award – a prestigious global honours programme highlighting excellence in creative innovation. The 3M™ True De finition Scanner from 3M ESPE Dental earned a silver Edison Award in the Science and Health category. More than 3,000 leading business executives comprised of previous  winners and academic leaders in the fields of product development, design, engineering, science and medicine made up this year’s panel of judges. Winners  were chosen based on concep t, value, delivery and impact.

16

Silver Award-Winning 3M True Definition Scanner R&D minds at 3M are constantly using new sciences to make a better world, and  with the 3M True De finition Scanner, they are revolutionising the consumer’s experience at the dental office. The scanner is an intraoral optical impression system that quickly captures a 3D video “impression” of teeth – eliminating the need for traditional dental impressions. This scanner, born of advanced optics and data analysis algorithms, is the most consistently accurate system and has the smallest handpiece on the market, resulting in ease of use for the dentist and comfort for the patient.  With secure cloud-based data storage and validated workflows, the system

integrates seamlessly to allow access to numerous treatment options. With this scanner, digital impressions are not only fast and easy; they are changing the way dentistry is practiced. “With new systems in use in more than a dozen countries, the 3M True De finition Scanner is bringing advanced digital oral care and truly accurate results to patients and dentists across the globe,” said David Frazee, Vice President of Digital at 3M ESPE Dental. “Recognition from the prestigious Edison Awards is an honour, and validates the commitment to research, development and innovation that is so important at 3M.” DA

DENTAL ASIA  J ULY / AUGUST 2015

We are making changes to improve your experience. “

Invisalign is not just a product but an experience for both the doctor and patient. Achieving a great smile is our mission and purpose. ”

Toshio Fukumura

Managing Director, Japan

>

invisalign-experience.com

Invisalign. Improving your experience.

New experiences. New possibilities.

DENTAL UPDATES

Joachim Weiss Celebrates his 90th Birthday Joachim Weiss, senior partner of dental specialist BEGO, invited guests from industry and politics to a reception to mark his 90th birthday on March 17. Staff and friends of BEGO also celebrated together with the jubilarian in the Bremen company headquarters. The celebrations were of ficially opened  by Christoph Weiss, Joachim Weiss’ son and Managing Partner of the BEGO Group. He is the fifth generation to stand at the helm of this medium-sized family company. The afternoon got underway  with a funny yet thoughtful poem written  by Weiss junior, which took a look back at his father’s life. Former mayor of Bremen Henning Scherf then listed  We is s’ s ac hi ev em en ts fo r th e ci ty of Bremen. Mr. Scherf was visibly impressed  by BEGO’s corporate principles, which  Weiss developed together with the staff at BEGO 25 years ago and still remains  valid even today. Here, the focus is very much on working in partnership. “You have provided the city with an example of partnership and are a role model for Bremen,” said Scherf.  Arend Vollers, former chairman of the East  Asian Association in Bremen (OAV) and long-standing friend of the Weiss family, described other stages in the life of his companion and friend Joachim Weiss. Over the course of six decades, the two

Steven W. Kess Receives the 2015 Harry Strusser Memorial Award

Christoph Weiss greets guests.

Carsten Vagt, Head of Technology at BEGO Medical, presenting the 3D Varseo printer, which was produced using the selective laser melting technique.

have shared many private and professional experiences. Master Dental Technician Henning Wulfes, Head of the BEGO Training Centre, recalled  Weiss’s years at the company in a picture presentation and showed that “he was able to make far-sighted decisions when it mattered, and set the course for the company’s further development in doing so.” Together, Wulfes and Weiss senior witnessed the  various phases of development in dental technology which – according to Wulfes –  Weiss senior played a key role in shaping.  A presentation of a sculpture produced using the selective laser melting technique concluded the affair. Presented by Carsten Vagt, Head of Technology at BEGO Medical, the sculpture represents the latest milestone in BEGO’s history – the Varseo 3D printer – and symbolises the progressiveness of the company which, without the solid foundations established by Joachim Weiss, would not be possible today. DA Henry Schein, Inc. recently announced that Steven W. Kess, the company’s Vice President of Global Professional Relations, received this year's Harry Strusser Memorial  Award. Presented annually by the New York University College of Dentistry (NYUCD), the award recognises outstanding contributions to public health. Dr. Charles N. Bertolami, Herman Robert Fox Dean and Professor of Oral and Maxillofacial Surgery at NYUCD, presented Mr. Kess with the award at NYUCD’s Graduation Ceremony, held on June 1 at Madison Square Garden in NYC. “Steve has been a leader in the field of public health for decades, during which he has  been instrumental in forging innovative public-private partnerships, which have helped advance the promotion of public health on a global scale,” said Dr. Bertolami. “From conceptualisation to implementation, Steve’s keen talent for spurring collaboration, his  wealth of knowledge, tireless service, and sustained leadership and vision have made him a touchstone for all of us who are committed to increasing awareness about and addressing public health issues.” Mr. Kess has a long history of supporting public health outreach programmes on behalf of Henry Schein, and is a co-founder of Henry Schein Cares, the company’s global corporate social responsibility programme. In recognition of his work, Mr. Kess was awarded a Presidential Citation by the American Dental Association (ADA). In 2013, the ADA created the Steven W. Kess Give Kids A Smile Corporate Volunteer Award to recognise outstanding achievement and commitment to the ADA Foundation’s “Give Kids A Smile ®” programme. DA From L to R: Dr. Michael P. O’Connor, Dr. Charles N. Bertolami, Mr. Steven W. Kess, Dr. Stuart M. Hirsch, Dr. Cosmo V. De Steno. (Photo: Henry Schein, Inc.)

18

DENTAL ASIA  J ULY / AUGUST 2015

DENTAL MANAGEMENT

Cleaning of Transmission Instruments: What do you Expect?

 by Mr. Christian Stempf 

The dental profession, treatments and related techniques have evolved over the years, as have hygiene procedures. Today, reprocessing instruments involves complex hygiene procedures and protocols that need to be regularly questioned, optimised and updated according to the latest developments in science and technology. Some products are more challenging to decontaminate than others such as transmission instruments, i.e., (high- and low-speed) turbines and straight and angled handpieces. They are complex to clean and sterilise without adequate equipment and specific processes, with greater requirement on validation to prove that the process is correct.

P

roper cleaning  is the foundation of the whole reprocessing cycle and is fundamental for safe sterilisation. During sterilisation, residues, debris,  blood proteins and lipids present an obstacle to steam. As most guidelines specify, “only clean instruments can be sterilised.” Instruments must be clean and visually free from organic residues (blood proteins, lipids, bio film), mineral deposits, debris and stains prior to steam sterilisation. Appropriate cleaning contributes to reducing the microbial population.  As illustrated by the Sinner Circle, cleaning combines  fou r factors interacting in variable proportions: • Chemical action • Mechanical action • Temperature • Contact time If one factor is reduced, the loss must be compensated by increasing one or more of the other factors. Chemicals represent the action of an acidic or alkaline detergent solution. Detergents contain surfactants with cleaning properties acting as wetting, foaming, emulsi fier and dispersant agents. Its ef ficiency is increased or decreased by its concentration. However, higher concentrations of detergent may lead to greater usage costs and additional rinsing, and may cause damage to instruments. The choice of detergent depends on the type of contamination (organic, mineral, microbial, etc.), type of surface, surface finish (smooth, rough, scratched) and shape of the instrument. The mechanical factor generates friction and pressure, i.e., the force needed to remove dirt, as well as renewing the cl eaning solution in contact with the instrument. Additionally, it helps disperse the dirt. If no equipment is used, the person doing the manual cleaning provides the mechanical action by scrubbing and brushing the instruments. Temperature reduces surface tensions of liquids, speeds up chemical reactions (wetting, foaming), softens soil and debris, and improves surfactant penetration. Temperature improves detergency but more importantly, it should not exceed 45°C to prevent fixing of blood proteins onto the surfaces. The contact time, which is strictly linked to the duration of the cleaning process, is the result of the other three factors. DENTAL ASIA  J ULY / AUGUST 2015

The challenge of manually processing transmission instruments

The internal parts of transmission instruments are constantly miniaturised and complex, resulting in rising challenges for cleaning processes. They mount components made of different materials (composite, rubber, steel alloys), as well as electronics. Unless the instruments can be disassembled, it is challenging to manually clean all internal parts, i.e., gears, chucking system, ball  bearings, tiny spray channels and nozzles. They cannot be soaked or cleaned in an ultrasonic bath – which does not help either. It is normally recommended to clean the external surfaces  with soft brushes under running water whilst avoiding too much tap water inside the instruments. After cleaning and drying, instruments must be lubricated prior to packaging and sterilisation. Completing this step manually with propellant lubricant may lead to over-lubrication if not done correctly, thus increasing the cost of handpiece maintenance whilst not being environmentally friendly.  With this in mind, anyone would agree that maintlaining and reprocessing transmission instruments is really challenging. If these operations are not performed properly, it will likely reduce the lifespan of instruments by up to 50 per cent. More importantly, it may lead to non-sterilised instruments with direct implications towards the safety of the team and patients. Transmission instruments go from one patient’s mouth into another, increasing the risk of transmitting blood-borne diseases such as Hepatitis B, C and D, as well as HIV.

 What about automated maintenance? The hygiene protocol for reprocessing transmission instruments starts with pre-disinfection immediately after use. Usually, the dental assistant will wipe the instruments with a disinfectant cloth whilst disconnecting them from the coupling or motor drive. The four essential steps  can be performed by specific processes/machines. However, it must be underlined

 21

DENTAL MANAGEMENT

  l  s that n o t e v er y m a c h i n e f u l fi a l l f o u r s t ep s .  Some machines exclusively clean the inside and lubricate; others simply lubricate. Thermal washer disinfectors clean inside and outside but do not lubricate. In these cases, one or more extra manual operations are still required. Prior to purchase, it is vital to understand the manufacturer’s claim, i.e., which pre-treatment steps does the machine ful fil?

How can machines correctly process transmission instruments? Clearly, we are talking about “all-in-one” devices that clean inside AND outside, rinse, dry and lubricate –  which is fulfilling the four essential steps. Thorough internal cleaning of instruments is c r u c i a l f o r a s e p s i s and the challenge for an automated process is to ensure that the spray channels, gear parts and ball bearings are thoroughly cleaned. Usually, internal cleaning is done via pressurised diluted detergent flushed through the internal components of the instrument. This satis fies the previously described cleaning principles (Sinner Circle), combining chemicals, mechanical forces and temperature for a de fined time. Some devices flush the instruments with steam. Ef ficient cleaning requires the four factors in the Sinner Circle to  be correctly balanced. There is no issue for applying chemicals at a defined temperature for a certain period to the outer parts of the instruments. However, the challenge lies in the missing main factor – how to generate the mechanical action. As mentioned earlier, if one factor is reduced, the loss must be compensated  by increasi ng one or more factors. Therefore, if little or no mechanical action (nebulisation) is applied, the concentration and/or harshness of the chemical must be intensi fied. Working temperature and/or contact time must also be augmented.  A very high concentration of chemicals may damage instruments and certainly requires additional rinsing. Over-application of chemicals on transmission instruments could also lead to drastic reduction of their lifespan and increased repair costs. High-end devices offer perfect lubrication. A tiny oil droplet is blown through the mechanical parts by pressurised air. The extra oil is removed in a second phase by a flow of compressed air that only leaves a thin layer of lubricant on the mechanical components. This system of lubrication is very ef ficient and more economical when compared to propellant cans.

Processing with Assistina 3x3 For over 125 years, W&H Dentalwerk has been one of the leading providers of dental instruments and devices in the world. The core business is the manufacturing of transmission instruments, maintenance and cleaning devices, as well as steam sterilisers.  W&H has gathered significant know-how and experience by being active in these fields for decades.

 22

 Whe n the y des igned the new  Assi stin a 3x3, the goal was to fulfil the four essential steps of the pre-treatment process by combining the relevant parameters, to provide the highest level of safety for users and patients, and to preserve the longterm integrity of the instruments. The engineers succeeded in designing an innovative reprocessing device that offers thorough cleaning of internal components and optimal external cleaning, thanks to the cleaning ring that travels along the instruments, spraying a cleaning solution at a very high pressure through six spray nozzles. Following the Sinner

Circle principles, the chemical action could be drastically reduced to a very mild concentration, thanks to the high mechanical action. This patented system avoided heating both the cleaning solution and the instruments. It also shortened the overall cycle time to 6:30 min and reduced the preparation cost per instrument to a few cents. This type of external cleaning cannot be reproduced manually. By eliminating brushing and scrubbing, we also avoid micro-scratches on the instruments,  which can harbour future debris. DA

 About the Author Mr. Christian Stempf , Hygiene adviser of the W&H Group, has  worked extensi vely within the European dental industry. He has been involved in infection prevention and sterilisation for over 20 years. He is a member of the European normalisation committee, which formulated the first norm on small steam sterilisers. He has gathered  valuable practical knowledge and experience through his daily activities and contacts with healthcare professionals and experts in the field of infection prevention throughout the world. He shares this experience offering vendor independent lectures in all objectivity on the topic of sterilisation and infection prevention to expert audiences.

DENTAL ASIA  J ULY / AUGUST 2015

UNDER THE SPOTLIGHT

Dr. In-Woong Um: Breaking New Ground in Alveolar Bone Repair through Tooth Recycling  It’s not about the environment,  but you’ve read it right: Tooth recycling might just be the missing link between flat or thin alveolar ridges and a highly successful implant outcome.  by Dr. Audrey Abella

 A 

utogenous Tooth Bone Graft Material (AutoBT) is a concept pioneered by Dr. In-Woong Um, an oral and maxillofacial surgeon in Korea. Read on as he  walks us through this revolutionary procedure that is gaining ground in the dental field. Dr. Um obtained his degree from Seoul National University (SNU).  After graduating, he completed his oral and maxillofacial surgery (OMS) training in 1987 and obtained his Ph.D. at SNU in 1992. He was a professor at the Department of Oral and Maxillofacial Surgery at WK University from 1990 to 1996, specialising in orthognathic surgery, as well as cancer and bone graft research. He is currently an af filiate professor in several university hospitals in Korea and running his own private practice. His interest mainly revolves around s u r g e r y  . He particularly chose bone reconstructive surgery (post jaw amputation) as his specialisation. His Ph.D. thesis on “ Allogenic Bone Graft ” fuelled his search for a suitable graft material; hence his devotion to this speciality, which eventually led him to founding the first Korea Bone Bank in 1993. He has also achieved a Certi fied Tissue Bank Specialist (CTBS) status, which was given by the American  Association of Tissue Banks (AATB). He related a particular experience that pushed him to investigate more about AutoBT. “I remember my first visit to the Bone Bank in the Philippines to learn how to develop a material under the guidance of the International Atomic Energy Agency (IAEA). The idea of repairing alveolar bone to achieve a successful, long-term clinical outcome became my strongest motivation. Since then, my interest shifted and I eventually specialised in  when I started my private practice as an i m p l a n t d en t i s t r y   OM surgeon.”  With his surgical expertise and training, Dr. Um has authored more than 100 papers and three textbooks based on research he conducted in 1993.

 24

Failure: A motivational springboard Dr. Um revealed his general thoughts on his role as a surgeon. “I always have several questions in my mind when treating patients: Would my treatment and materials be the right choice? Do I understand and did I study the material enough so that it would give highly successful, long-term results?” He constantly asks himself these questions as patients seek consult and treatment. He related that the impact only becomes greater  when he is met with failures or poor results. “I ask myself, ‘what do I know – and what do I n o t  know?’”  That window of failure gave him the idea to look further into a part of the surgical process that can signi ficantly change the procedure. He reiterated that dentists should not con fine their roles to  what was learned in the past. “Dentistry involves continuous learning. Along with the responsibility to provide treatment, we also have to constantly find suitable materials for our patients.” This mindset motivated him to conduct more studies to find a material solution. Eventually, he developed AutoBT and founded the Korea Tooth Bank (KTB) in 2009.

 AutoBT: The gold standard Dr. Um described the AutoBT procedure in detail. “The idea of utilising an autogenous tooth as a bone graft material was inspired by Dr. Urist, who discovered b o n e m o r p h o g e n et i c p r o t ei n ( B M P ) in bone and dentin in 1965. After ten years with the Bone Bank, I realised that a Demineralised Dentin Matrix (DDM) could be the gold standard in reconstructing alveolar  bone, most especially for implant dentistry cases.” He added, “AutoBT is not a discovery but an ultimate collection of scholars’ past discoveries and scienti fic research. Our mission  was to organise the data and facts and roll them into one, which  became the core of our system.”

DENTAL ASIA  J ULY / AUGUST 2015

UNDER THE SPOTLIGHT

T h e p r o c ed u r e  

Indications 

 AutoBT can be used to r e p a i r a l v e o l a r b o n e i n i m p l a n t d e n t i st r y  . Specific indications are socket preservation, guided bone regeneration (GBR), vertical and horizontal augmentation, sinus augmentation, and onlay grafting . It can also be used as an alternative to a mixture of conventional materials that can be used for the above-listed procedures. Furthermore, due to its osteoinductive, osteoconductive and remodelling capacities, it can act as a secondary or tertiary material in failed (alveolar bone) repair cases. Advantages 

1. 2. 3. 4. 5. Extracted teeth are collected from clinics and sent to the KTB. AutoBT is then manufactured in the processing facility and undergoes demineralisation, lyophilisation, sterilisation and other necessary procedures. After which, the processed AutoBT would be sent back to the clinics. The product 

Biocompatible: The components of AutoBT are identical to dentin (Type I co llagen, HA and non-collagenous protein). Dentin matrix macro-structures are very similar to cortical or cancellous bone. Abundant microporous dentinal tubular structures provide nanostructural micropores for movement of proteins. The geometric assembly of the root dentin block make a unique and ideal 3D scaffold for alveolar bone repair. Recycling of a patient’s own extracted tooth compensates for the limitations of other materials and eventually leads to positive results (with no pain, additional cost, genetic illness or need for a membrane).

S a m p l e c a se  

Restoration of an edentulous left mandibular first molar area. Extraction site  was treated with AutoBT block and powder. Procedure 

Fig. 1: Saucerisation of buccal wall on #36. Fig. 2: Repair of the buccal wall with block and powder without any membrane. Fig. 3: After fi ve months, the block and powder completely transformed into new bone. Fig. 4: Implant installation on the newly formed bone.

The influence of stem cell therapy  Dr. Um expressed his thoughts on stem cell therapy and how it has in fluenced  AutoBT. “Like stem cells, BMP has already been known for decades due to its ability to reconstruct bone. However, an appropriate carrie r had to be developed for the practical application of BMP. It has been discovered that dentin could act as an excellent carrier of BMP. Thus, I continued to probe f urther on this field and eventually came up with  AutoBT,” he stated. “I believe we could utilise pulp stem cells in the future,” he added, reflecting his endless quest for noteworthy surgical solutions. 1.

AutoBT (powder): Osteoinductive, osteoconductive and regenerative. 2. Root form (block type): Threedimensional scaffold for alveolar  bone repair and osteoconduction. 3. AutoBT (mouldable type): Powder is converted to an injectable and mouldable material for manipulability and fitting into the defect surrounding an implant. 4. AutoBT BMP: Growth factor (BMP) that is loaded on the powder, which enhances osteoinduction at an early stage.

 26

Special facility   AutoBT requires an exclusive facility for material processing and storage. Dr. Um disclosed that this is highly necessary, given the sensitive nature of the procedure. “AutoBT is being processed and stored in our special facility in the KTB. Processing should be done within a strictly controlled area and only by highly quali fied laboratory technicians.”

Sharing the knowledge Dr. Um’s active presence in several dental organisations in Korea has given him the leverage to propagate AutoBT. “We have established and researched on AutoBT at the Korea Auto Tooth & Bone Bank (KABB) since 2009. We have lectured extensively about it, and this is supported by the Korean Academy of Implant Dentistry (KAID), Korean  Academy of Oral and Maxillofacial Implantology (KAOMI) and Korean Academy of Dental Science (KADS). In fact, ten university hospitals and approximately 1,000 dental clinics are already using our product and system.” DENTAL ASIA  J ULY / AUGUST 2015

UNDER THE SPOTLIGHT

Despite this, he hopes that more dentists would embrace this concept in the future. He related that they are on a constant roll to spread the news about it. “We want our colleagues to learn about its exceptional results,” – noting that he does so by contributing to scienti fic publications and conducting lectures in different countries. “We also continuously upgrade AutoBT by adding several growth factors like  polydeoxyribonucleotide (PDRN) and BMPs. Mouldable AutoBT is already under clinical trial in Korea. I firmly believe that more dentists would be interested in our system and product in the near future. As mentioned earlier, a stem cell-loaded AutoBT scaffold might be available soon.” Korea Tooth Bank facility 

From textbook to chair-side application

These figures signify the growing interest in this new protocol. Additionally, with a reported figure of about 10,000 operative cases in a year, AutoBT has earned the new  Health Tec hno log y Ass ess ment (nHTA), which endows products with a safety and ef ficiency mark approved by the Korean government.

Dr. Um sends this message to practitioners who are aspiring to explore the surgical field. “We should always think as (and be on the side of ) patients when choosing the technology and materials for their treatments. Clinical applications must be “ e v i d e n c e - b a s e d  ”.  Although new products seem to be as innovative and promising – which compels us to conform to newer trends in the practical setting – we should still be able to con firm the procedures we do through textbooks to ensure patients that we are using safe and proven measures,” he indicated. These words highlight the importance of a solid theoretical foundation in formulating treatment plans and solutions.

International attention

Keeping it green

Research and clinical studies have proven the safety and clinical ef ficacy of AutoBT. Dr. Um revealed that three international patents have already been registered in Europe and China. He stated that more than 80 articles on AutoBT  were alre ady publishe d, including 12 SCI (e) journal articles. In addition, an English textbook, “ Adva nces in Oral Tissue Engineering”, which is a collective  writing of their rese arch results, has already been published by Quintessence USA in 2014. He named several renowned practitioners from several countries  who have been using AutoBT. “Dr. Mario Esquillo and Dr. Jonathan Acosta from the Philippines, Prof. Murata Mitsugi from Japan, and Prof. Zhang Yi and Prof. Zhang Shilei from China are already very familiar with our product and system.”

Spreading the word

The future of AutoBT However, Dr. Um pointed out that there are dentists who are still using ready-made or conventional materials. He shared with us his views on this. “Unlike conventional materials, AutoBT is manufactured and i n d i v i d u a l i s e d    to fit a specific patient’s need or a dentist’s diagnosis. But then again, accessibility  would be a dif ficulty: Not every country has the facility that AutoBT requires.” The lack of accessibility thus accounts for the fraction of practitioners who resort to readily available methods. DENTAL ASIA  J ULY / AUGUST 2015

The practice of recycling continues to go beyond the environmental line. Today, recycling has been introduced in dentistry through AutoBT, which would greatly contribute to structural preservation. What was once discarded immediately after extraction is now being recycled. “The next step after recycling would be the development of an effective allogenic graft material under our system, and then implement the “ tooth donation” culture. Once this becomes a regular process, we could con fidently say that this study has led us to the right path, which would eventually lead us to another goal: The development of a stem cell carrier at the end of the line, which we think would be a significant contribution to the dental society,” he explained.

Being well-recognised in the field, Dr. Um has been a globally sought-after lecturer. He regularly conducts lectures, hands-on trainings and workshops to keep colleagues in the loop. “Prior to AutoBT, I have regularly lectured about bone graft and implant for more than ten years. Since its development, I conducted lectures in Seoul on a monthly basis.” He added that the lectures reached an international level of acclaim as interest from professionals across the globe grew further, with the aid of professors from Japan, China and Vietnam. He has also held a Tooth Bank Specialised Training Course through KTB thrice in the Philippines.  At the moment, he is geared towards conducting lectures in the Asian Congress of Oral and Maxillofacial Surgery (ACOMS 2016) in the Philippines and the International Conference on Oral and Maxillofacial Surgery (ICOMS 2017). Dr. Um is constantly finding ways to innovate the procedure to present more satisfactory results. This groundbreaking concept is something that he would like to see in practices in the future. “I would say that we are still at the starting point and we still need more research and clinical trials. But before we can conduct further studies, I’d like to promote awareness about our tooth storage system to other countries as early as now so that they can also reap the bene fits of this promising material and procedure.”

Trash = Treasure  We have been witness to the wonders and bene fits of recycling: From practical home solutions and now to dental applications. As they say, “ One man’s trash is another man’s treasure,” and with this breakthrough, Dr. Um has allowed his colleagues to appreciate recycling from a dental perspective. This will de finitely be a signi ficant contribution to more ef ficient dental surgery procedures, which will be instrumental in changing the face of implant dentistry. DA

 27

UP CLOSE & PERSONAL

Mr. Mike Dominguez

Kymata Dental Arts: on Small in Size, Quality  by Dr. Audrey Abella

BIG

M

r. Mike Dominguez has already been in the dental laboratory industry since 1997. He progressed in this field and eventually decided to enter school and formalise his training. Now a Certi fied Dental Technician (CDT), he earned his B.S. in Dental Lab Sciences from the University of Texas Health Science Centre and graduated summa cum laude. He is one of the few technicians with the T.E. designation.  Armed with the experience and educational background, Mr. Dominguez established Kymata Dental Arts in 2009, a contemporary dental studio in Seattle, Washington, USA, which specialises in aesthetic, comprehensive and implant dentistry. He lectures across the US about various dental lab topics such as marketing, aesthetic ceramic techniques, and dental lab materials. He also sits on the  board of the Washington State Dental Laboratory Association and served as its Vice President (2013) and President (2014). He is also involved with the Dental Technicians’ Guild, as well as the Inside Dental Technology as one of its board of directors. Dental Asia had the chance to sit with Mr. Dominguez during the IDS 2015. He shared with us his insights on the digital dental laboratory scene, as well as his feedback on the Renfert equipment that he has acquired for his lab.

Commitment to education His strong sense of commitment to dental lab education has fuelled Mr. Dominguez’s enthusiasm even more. He immerses himself in the scene  by being actively involved in the state dental association. “I want to help local artists and small independent businesses. I want to see this industry progress. I’m passionate about what I do, as well as about the health of the industry and the success of small labs,” he started off.

 28

Mr. Dominguez with Ms. Jeannette Giesche, Renfert Area Sales Manager for Northern Europe and Asia-Paci�c, at the IDS 2015.

DENTAL ASIA  J ULY / AUGUST 2015

UP CLOSE & PERSONAL

The digital revolution

Te Kymata staff (from L to R): Ms. Jaime Miller, Mr. Dominguez, CD/E, DG, and Ms. Virginia Kim.

Comparing the technology they had  ba ck th en to wh at th e in du st ry ha s today, Mr. Dominguez indicated that there is a huge difference. “In 2009, I felt like it was going to be a very short time  before we can do away with casting. I didn’t want to buy a casting machine, nor did I want to have alloy inventory: I felt like we were going to be printing metal  within a few years. This didn’t happen for me until last year. Obviously, technology  was not as advanced as it is now.” He added, “Nowadays, it's easier for labs to afford technology, which is good. I think if we can automate the process, it is a good thing as long as the technician is skilled. In 2009, the technology was not  where I wanted it to be. But at this point, as far as how I imagined the work flow to go, I can say we’re getting pretty close. Modern lab equipment lessens the trial-and-error phase that usually happens  with the conventional way. Digital has trimmed down the process and time, leaving very minimal room for error.”

The critical role of manual skills Despite the advances in digital technology for dental labs today, dental technicians still agree on the importance of manual dexterity, and Mr. Dominguez couldn’t agree more: The skill of the technician still greatly accounts for a successfully fabricated prosthesis – in spite of the emergence of digital. He elaborated on this further. “Technical knowledge is still absolutely critical to the process. The old argument is – and has always been – that the machines can and will replace technicians. In my opinion, you need both. The technology is just a tool.” He also pointed out that there are still a lot of traditional materials being used today,  but they have somehow been modi fied to fit the digital picture. No matter how many tools you have, the background knowledge still accounts for about half of the equation. “As technicians, we still have to know morphology, occlusion, function and aesthetics. We cannot leave everything to the machines.” He also stated that he does not see how labs can get away with just machines. “What we don’t want to do is to allow technology to lead us down the road to DENTAL ASIA  J ULY / AUGUST 2015

Kymata’s Renfert line

mediocrity. We don’t want to sacri fice quality for ef ficiency. We want to demand the technology to produce aesthetic results. Thus, whenever I am talking about technology, or whenever I try to buy technology, in my mind, I want that technology to produce something pretty. We can’t settle for mediocrity just because it’s technology.”

The digital output He voiced out his insights as we talked about digital dentistry. “Almost everything is digital, yes, but the end result – what does it produce? Does it put out inferior material or aesthetics? So we de finitely need to get over the infatuation with technology and get back to traditional aesthetics, and tie this with the modern process for the bene fit of the patient,” he remarked.

The Renfert experience  Asked to describe the Renfert equipment that he has worked on, he went back to as far as his school days. “In lab school, I would use the Renfert wax and electric waxer. One of the first automatic mixers I used was a Renfert mixer. The Renfert vacuum mixer that I have now is a workhorse. We have their vacuum for sandblasting. We use their model preparation. We also have their dye material.”

Tying the traditional and modern knots together  As we went on, he took off from what he mentioned earlier pertaining to the marriage of the traditional concepts and digital philosophy, and integrating Renfert into the picture. “Dentistry is now a mix. And for our laboratory, this is where Renfert comes in.  29

UP CLOSE & PERSONAL

and buttons, thus adding up to its user-friendliness. I really recommend this brand to my colleagues all the time.”

One big leap “I think the biggest leap in dental technology at this point would be to re fine the printing process,” he commented, referring to 3D printing – as this has been the path that most labs have been walking on right now. Prostheses are being “printe d” digitally through the three-dimensional mechanism. Gone are the days when dentures are “processed” or “fabricated”. It’s still a long way up as he observed, but if the concepts that we have now have come into existence when nobody thought it to be possible, then high-definition printing is just looming in the horizon.

Small in size; great in value

Kymata workspace

They have a digital line and they still have a traditional one. They’re good at both.” He incorporated more input about Renfert and expressed his satisfaction about the equipment that he has obtained from them. “For me, Renfert has excelled in terms of the quality of their materials and equipment. With the cost of technology these days, we don’t want to spend tens of thousands of dollars on a piece of technology, only to be left with a broken trimmer or vacuum or a worn out brush in a month. That is too much. If you’re going to invest in technology, it has to last and produce quality output for you. Renfert is the perfect example of this. They guarantee their stuff and they make it well. Perhaps that is even an understatement – because they make it too well.” He also shared his thoughts on the notion of resorting to cheaper materials. “At times, it’s not even cheaper. You pay for  brand names but they lack the quality. If the quality does not live up to its exorbitant price, then it’s not worth it. But  with Renfert, it is nice and simple. They put their energy in quality. And this is the type of lab that I have as well – we’re not too flashy but we produce the best quality we can.”

Reliability and durability rolled into one Mr. Dominguez also noted that Renfert equipment are very easy to use. “Apart from their excellent performance, their tools are usually equipped with big dials  30

It’s not the size of the lab that matters; it’s the quality of the output. And Kymata Dental Arts is just the epitome of a small lab that offers valuable creations. Dentists seek their services because of the excellent results that they are capable of producing,  with technicians armed with the necessary skills and equipment to help them carry out their expertise. “We get calls almost on a weekly basis from dentists wanting to use our services – even from out-of-state. We’re very fortunate. We’ve been helped by a lot of good people,” he stated. He added, “Since we are a small lab, there is not a lot of time for us to maintain a  broken machine. We have checklists on how to maintain a working machine. That is part of our process. Because, for instance, we are in the middle of making a crown and the vacuum or trimmer suddenly goes out, it would be dif  ficult for us to stop our production. It does not happen now with the Renfert tools that we have. I know that it’s not going to fail me even in the worst possible moment. We get excellent after-sales support from Renfert, and if anything does go wrong, we get answers immediately. Renfert has offered us peace of mind.”  Although he kept emphasising that Kymata is a small lab, he welcomed the idea of  branching out in the future. He indicated that their size does not hamper their plans of spreading their wings. “Branching out would be good. As long as we stick to our guns and keep producing quality work, I think that would be feasible. I can see technology helping us communicate and accept cases from out-of-state.”

Not just a small voice Mr. Dominguez is passionate about what he does, and he has a fervent vision to see small labs succeeding. Whenever he comes across produc ts or manufacturers that help small labs, he spreads the word so everyone in the circle can go with the flow of today’s trend to create a homogenous environment amongst his peers. They are kept in the loop as to how they would be able to maximise their production despite being small labs.

“I believe it’s everyone’s responsibility to help each other. I believe in collaboration. And with regard to technology, I don’t want to push technology to push more mediocre units; I want them to push more q u a l i t y   in it. Big labs may beat us on price, but they can’t beat us on quality,” he concluded.

These statements clearly indicate that Mr. Dominguez serves as a voice for small labs.  With a goal to provide high-quality restorations and excellent customer service in every case, and a dash of his passion, it appears that he can get his message across all small labs – loud and clear. Kymata Dental Arts is indeed proof that success is not merely measured by size. Clear-cut goals, emphasis on quality and reliable equipment – they have just the perfect formula for success in the arena of small dental labs. DA DENTAL ASIA  J ULY / AUGUST 2015

DENTAL PROFILE

E Mr. Masanori Mori, Director, Morita Dental Asia Pte. Ltd., with the Soaric treatment unit (foreground) and Veraviewepocs imaging unit (behind).

stablished as a dental importer and retailer in Kyoto, Japan in 1916, J. Morita Corporation now stands as the J. Morita Group, which has grown to become one of the world’s largest distributors of high-quality dental equipment and supplies. With manufacturing facilities in Japan, Morita has dedicated its efforts to innovation in product design and development. Having the ability to adapt to the changing market conditions and a strong commitment to industry leadership, Morita helped redefine the direction of dentistry. In 1964, Morita introduced the S p a c e l i n e ,  a comprehensive dental treatment unit designed to accommodate patients in a supine position while the dentist sits comfortably in a 12-o-clock  position. This particular unit became the subject of our conversation as we sat down with Mr. Masanori Mori, Director of Morita Dental  Asia Pte. Ltd. According to Mr. Mori, this is what they would consider as the “ Morita edge”. Read on to know how Morita has positively transformed not just the conventional dental treatment unit, but the general dental practice as a whole.

Morita: The Perfect Fusion

Ergonomics and Aesthetic Excellence  by Dr. Audrey Abella

Traditional (stand-up) dentistry 

Back in the day, patients had to settle for non-reclining chairs while dentists performed procedures while standing. “The whole process  boils down to an unco mfor table experience that both patients and dentists had to endure,” Mr. Mori began. Today, although some dentists may still prefer to stand, sit-down dentistry has become the standard  treatment position.  And as for patients, they mostly assume the horizontal position, as treatment centres are typically designed to be in a reclining position to accommodate patients in the most comfortable  way.

DENTAL ASIA  J ULY / AUGUST 2015

 31

DENTAL PROFILE

The Spaceline: Not just another dental chair Mr. Mori revealed that the Spaceline holds a prime spot in their elite line of dental treatment units. An innovative patented concept from which others have taken off, and based on the principle of human-centred design, the Spaceline is the world’s fi r st  horizontally-positioned treatment unit. It combines aesthetic excellence, ergonomic re finement and comprehensive cross-contamination management to ensure a comfortable treatment – for both dentists and patients. He shared with us the story of the Spaceline evolution.

Patient AND dentist comfort: Spaceline offers both Dr. Daryl Beach was an endodontist who came up with the Spaceline concept in the 1960s. Being an endodontist, he normally performs lengthy procedures, which give him back pain and other musculoskeletal ailments at the end of the day. Every dentist could perhaps attest to the fact that this is the norm after a typical day in the clinic. Throughout the day, dentists are subjected to bodily contortions and repetitive unnecessary movements. Having this in mind, Dr. Beach came up with a concept that addresses one  thing: reduction of operator stress. The goal is to maintain a balanced posture that can be sustained throughout the daily treatment phase – without the back pains. The idea flowed through patient ergonomics as well,l, taking taking into into account the same amount of time thatt patients had to endure while undergoing treatment. t. “Dr. Beach was an American endodontist dontist who who made a genius out of himself. He went ent beyond beyond root canals and thought of a chair that at would would eventually revolutionise the dental treatment atment unit design not only in terms of aesthetics thetics  but with emphasis on the po stural health alth of o  both operator and patient. The solution n was a chair that would allow the operator or to to sit down while performing procedures res as the patient reclines comfortably,” Mr. Mori discussed.

position. It also helps in alleviating patient anxiety as instruments are not within their line of vision. Since most manufacturers have designs that are produced under the generic treatment centre concept, the Spaceline is indeed that one piece of equipment that has made Morita stand out. It has everything integrated and allows dentists to multi-task. It has also broken the traditional chain of chair designs that are present in most clinics today. It veered away from the ordinary and put in a little spice into the recipe as they tried to figure out  what would be best for both patients and dentists.

Making a difference The chair occupies the centre stage in the dental clinic. Mr. Mori stated that although there are numerous chair manufacturers in the dental field, the end product is mostly the same. “One manufacturer may be producing equipment that many other manufacturers are already capable of producing.” He also pointed out that, although the core is the same, some twitch their versions a little bit to serve as an attracting factor to customers. “They come up with small different details, but all are the same. With Morita equipment, we dared to be different by bringing in ‘ firsts’ that would eventually last and would make dentists say, ‘ I will never go back to my old treatment unit again ’,” Mr. Mori said.

 A brilliant fusion of accessibility and a time-saving concept This concept is not only ingenious  based on the points described earlier..  With bracket tables placed  behind thee unit, the Spaceline was also able to address ress the dentists’ concern of accessibility. ity. It It allowed exceptional, effortless accesss to to the the operating field and instruments, thus promoting romoting health and eventually increasing productivity. ctivity. The The counterproductive measure created by  y a typical typical  bracket table has been changed into a time-saving  work flow by the Spaceline. It is also comfortable for patients as it is tailored to the human anatomy to ensure a relaxed, stable

 32

 A crazy idea – that sold out Coming up with the world’s first horizontal dental chair has been Morita’s turning point,  which totally changed the concept of the practice. Mr. Mori went on further with this interesting story. “Dr. Beach approached several manufacturers, only to be turned down since they have been stuck with the idea that dental chairs must be designed the traditional way, and that the only  way dentists could treat thei r pati ents is while standing.” It appears that those manufacturers were not open to the idea that this whole ball of conventional dentistry can  be reshaped into something better that is more comfortable and favourable. “Nobody deemed it feasible. Everybody thought that it was a crazy idea,” he remarked.

Taking the risk  This might have been “crazy” enough of an idea indeed. But Morita was bold enough to take the risk. They took the chance and looked at it as an opportunity to strike a difference in the monotony of treatment centre units back then. Morita invested time and money to make the idea into a reality. “This investment was really worth it. Today, we are in constant production and upgrades, and Morita has never looked back since,” Mr. Mori indicated. Te Spaceline EMCIA

DENTAL ASIA  J ULY / AUGUST 2015

DENTAL PROFILE

Product lines and market shares Morita specialises in four main product lines: diagnostics and imaging equipment, endodontic systems, handpieces and instruments, and treatment units. According to Mr. Mori, although Spaceline is a highly competitive product, it is the imaging systems that account for a greater fraction of their market shares, constituting about 40 per cent in Japan. Their treatment chairs cover 30 per cent, while the rest of the line represents the remaining percentage. He also emphasised that Morita is not into mass product ion –  what they aim for is hitting the right targets with high-quality, top performance products – and not by the numbers. Mr. Mori said, “We want to be unique. We do not want to be followers. We want to be market leaders. Yes, we do produce equipment that may be similar to other manufacturers. However, Morita takes pride in producing high-quality equipment with precise function. Our aim is to provide dental chairs that will  bene fit both dentists and patients. It does not matter if we manufacture lesser chairs as long as we produce equipment of the highest quality for the most discerning practitioner.”

Product availability  Morita’s major markets are Japan, the US and Europe. However, regarding product availability, Mr. Mori disclosed that not every product is available in those markets. “For instance, the Spaceline is not available in Singapore unless there is a special request. Spaceline is tagged at a premium price. Hence, we are currently studying the market to see if it is feasible to bring it into this region.” He added that every part of their equipment is customised and made within Morita Japan. Unlike others that obtain spare parts from manufacturers or dealers and then assemble the pieces together, Morita makes every single component. As such, this is one reason why their products command a higher price: They have exclusive, patented designs – from the tiniest screw to the  biggest piece of metal in an equipment. They offer the quality that dentists would certainly want in their instruments.

 A century of success One hundred years in any business is an accomplishment that is hard to beat. And through the years, Morita has proven that this is attainable – with intense focus on product research and development. Having been present in the market for 100 years, their high-end product lines have created a strong magnetic pull that attract dental practitioners worldwide who gravitate towards quality equipment that stand true to their promise. The illustration of the Spaceline story given by Mr. Mori earlier reveals the reason why dentists favour Morita chairs over others. Dr. Beach’s idea coupled with Morita’s devotion to innovation may have compelled the company to step out of its comfort zone to make drastic moves, but this is one proof that there are indee d risks worth taking: Morita would not have lasted a century had it not been for a dentist who listened to his body and a pioneer in the dental manufacturing industry that was more than willing to embrace change – a change that has since revolutionised the practice, moulding the dental chair concept into one that stands out among the rest. DA

DENTAL PROFILE

Continuously Making a Mark in Dentistry  by Dr. Audrey Abella

H

aving been in the business for six decades, Bausch has earned the title as being the “ only  company in the world that s p e c i a l i s e s in occlusion test materials.” A testament that clearly reflects their focus on articulating products, Bausch has definitely made a mark  in the industry that their name has become THE yardstick when it comes to articulating materials. The company has manifested a strong sense of direction, having invested much of its attention to the “red and blue” staples on every dentist’s bracket table. Read on for more updates from Mr. Milan Rajek, Managing Director of Bausch Articulating Papers Australasia Pty Ltd.

History  Dr. Jean Bausch GmbH & Co. KG was founded in 1953 by Dr. Hans Bausch. Together with his wife Evelyn Bausch and his sons Peter and André Bausch, he has successfully expanded the company. Through his ideas and visions, Dr. Bausch has laid the foundation  for modern occlusion test materials. The tradition continued through further development, innovation and product management with investments in new, modern technologies, the construction of the new production facility in Rhineland-Palatinate with 2000 square meters of production area, and a robot-supported production. Consecutively, the areas of organisation and staff training were also developed. Likewise, product development is being pushed constantly,  which has been documented by their ISO 9001 and ISO 13485 MPG certification. Bausch products are used in more than 120 countries and sold by distributors and subsidiaries in USA, Australia, Japan and Brazil. All products are manufactured in strict compliance with the European Medical Products Decree and are constantly monitored by their Quality Assurance Department. The raw materials used are physiologically safe.

Bausch = Red and blue  When one thinks of Bausch, that light bulb in every dental practitioner’s head would immediately generate the “red and blue” articulating paper. This sense of immediate association mirrors the impact that they have made in the industry as the “only company in the world that s p e c i a l i s e s   in occlusion test materials.” Mr. Rajek shared the Bausch recipe for the success that they have achieved. “The development and production of special articulating materials designed to represent occlusal proportions as true to nature as possible – that is the main ingredient of Bausch’s success.” As one of the world’s leading manufacturers in this domain, Bausch has developed an extensive range of different articulating papers and films in different shapes, sizes and colours. “The permanent product development and investments in new, modern technologies, the construction of a new production facility, investments in new markets and quali fied staff are the qualities that have made Bausch stand out and make a mark over six decades,” he continued.

 34

DENTAL ASIA  J ULY / AUGUST 2015

  y   n   a   m   r   e    G  ,   e   n   g   o     l   o    C   n    i    5    1    0    2    S    D    I   e     h    t    t   a     h    t   o   o    B

DENTAL PROFILE

 A constant variable of the dental treatment equation  With the ir dedic ati on to art icula ting materials, it seems that Bausch will continue with what they have started. Mr. Rajek emphasised, “We concentrate exclusively on articulating materials.”  Additionally, he said that the ability to achieve markings on difficult surfaces – such as highly polished alloys and ceramics – is Bausch’s highest priority. It is interesting to note that, although digital dentistry has made a lot of traditional materials obsolete these days, articulating materials – no matter how traditional a material it is – have remained a necessity in this digital age. Occlusion test materials being a constant part of every   dental procedure – dentists can never do without Bausch products. And this is a primary reason why they continue to develop and produce high-quality occlusion test materials. “It is our task to adapt   our products to changing materials and the respective individual requirements,” he remarked.

Sustaining their position in the market  Asked how the company has managed to sustain their position in this competitive industry and outshine others, Mr. Rajek had this to say: “We have sustained our position through permanent development on the basis of proven values such as quality and service.”  With storage capacities in their subsidiaries in the United States, Japan, Brazil and  Australia, it has also propelled them into a better position, enabling them to serve different markets worldwide. “There are a lot of competitors or imitators out there, but most of them do not possess a high quality standard, and they try to

 36

 Milan Rajek, Managing Director of Bausch  Articulating Papers Australasia Pty Ltd (third from right, standing), with the Bausch team. (From L to R:) Kristian Buljat, Factory Manager of Dr. Jean Bausch GmbH & Co. KG; André Bausch, Managing Director of Dr. Jean Bausch GmbH & Co. KG; Cleiton Bauler, Director of Bausch Importação de Mats. Odontológicos Ltda, Brazil; Mr. Rajek; Andreas Kuhlemann, Operations Manager, Dr. Jean Bausch GmbH & Co. KG; Chris Gendron, Operations Manager, Bausch Articulating Papers, Inc., U.S.A.; and (sitting) Pablo Zulaika Elguezabal, Sales Manager for Spain, Italy and Hispanoamerica, Dr. Jean Bausch GmbH & Co. KG.

gain market shares by offering products at lower prices,” he added. He also indicated that Bausch’s annual sales have shown a consistent increase in 130 countries, even more so in the APAC market. “Our sales have grown about 10 to 15 per cent.”

The Dental Navigator Marketing in the digital age requires a responsibility to innovate. Thus, Bausch has implemented modern advertising technologiesthrough social media in order to improve their communication with customers worldwide. They capitalised on today’s internet trend by creating a foothold on the digital market. They have developed a speci fic interactive App that fits the practice of modern dentists. In their previous interview, Mr. Rajek mentioned about the Dental Navigator – an interactive application for the iPad. He shared with us updates on this. “The DentalNavigator serves as a medium of communication and exchange between dentists and patients. It allows dentists to inform their patients about various treatment methods.” The app is now used  by over 70,000 dentists worldwide. This is another highlight for Bausch as they initiated a campaign that would increase patient awareness and education, at the same time giving dentists another channel that would allow them to share  beneficial information with patients.

is still growing as has been proven by the huge number of visitors from Asia during the recent IDS. “We have received a lot of requests from Asia since,” said Mr. Rajek. Participating in the IDS for the 23 rd time, he also revealed that this was Bausch’s most successful IDS exhibition.

Dentistry’s paper fortress  Ac co rd in g to Mr . Ra je k, Ba us ch is currently investing in research and development of new technologies that have yet to be revealed. Bausch is indeed constantly motivated to keep up with the current stream of innovations in the dental industry especially in this digital age. Dentists will always need to have their articulating papers regardless of the robotics and automation that plagues the dental industry  today. When nobody ever thought that an empire can be built through the thinnest of papers, Bausch did. Dr. Jean Bausch’s vision has built a strong fortress in dentistry that would be hard to break. Bausch may just be making marks through their articulating papers, but that is exactly the reason why they’ve made such a significant mark in the dental industry. They have created deep-set footprints on the dental trail, and this will be Bausch’s continuing legacy: marking the industry  for several generations more. DA

Bausch exhibition booth at the World Dental Show 2014 in Yokohama, Japan. (From L to R:) Dagmar Lersch, Assistant Manager, Dr. Jean Bausch GmbH & Co. KG; C éline Bausch; André Bausch; Mr. Rajek; and Kai Ogawa, Director of Bausch Articulating Papers Japan K.K.

Bausch exhibition booth at the PDA Annual Convention 2015, Philippines.

IDS 2015: Bausch’s most successful IDS to date Mr. Rajek and Mr. Kai Ogawa, Director of Bausch Articulating Papers, Japan K.K., commented that the Asian market DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

Modern Approach

C

urrent innovations in adhesive systems and composite resins have improved the longevity of composite and amalgam restorations. However, a considerable amount of failure still occurs, and the replacement of a restoration often leads to further weakening of the tooth due to inevitable fractures or the additional loss of remaining tooth structure. Nowadays, dental materials play a large role in determining the quality of treatment rendered. Patients demand a fast, good and inexpensive restoration. It is a challenge to meet all the requirements,  but the available technology makes them more and more attainable. The following article presents a case showing a relatively strong, inexpensive and aesthetic restoration that can be done in a short time.

History and treatment planning

The patient presented with caries at the lower right second molar that has extended subgingivally. The diagnosis  was chronic apical periodontitis with deep caries resulting in irreversible  pulpitis.

 38

Non-surgical endodontic therapy was indicated. The distal part of the tooth was already mostly covered by the gingiva, and complicated crown lengthening surgery was required to expose the deep distal subgingival margin for crowning.  After discussing with the patient the different treatment options, we decided to adopt a more conservative approach. The decision was to restore the tooth after root canal treatment with a fib r e -r e i n f o r c ed c o m p o s i t e   as dentin replacement and conventional composite as enamel replacement. It was also explained to him that the placement of a strong substructure under a very large composite restoration will maintain the tooth’s integrity as it conserves the remaining tooth structure. This would also suit as an economical alternative given his financial situation. As this addressed his concerns, he finally opted for a directly placed restoration. The fi bre-reinforced composite material was placed to h e l p i n r ed u c i n g t h e r i sk o f cr a c k p r o p a g a t i o n  . All healthy tooth structure was maintained. Regular follow-up and occlusal management was advised for optimal outcome. The patient’s follow-up appointment was scheduled after finishing root canal treatment.

Procedure The tooth was isolated with rubber dam in preparation for the biomimetic  bui ld- up. The tem porary filling was removed and tooth preparation was done.  A conservative access was re-established to preserve the remaining tooth structure.

Before placement of the composite, G-aenial bond (GC), a self-etching seventh generation adhesive was used as  bonding agent. The self-etch technique  was used for both enamel and dentin.

 After light-curing, the cavity was initially lined with a layer of flowable composite to adequately seal the ori fices. GC’s everX Posterior was the material of choice for dentin replacement. Fibres in the composite prevent crack propagation and significantly reinforce composite restorations in endodontically treated teeth. The fi bres redirect fracture lines to a more reparable state, rendering ease in the restoration of fractures. It is clinically proven to have increased adhesion to overlying composite by providing added mechanical retention, thus serving as a reliable sandwich technique structure.

DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

in Directly Placed Restorations for Endodontically Treated Teeth  by Yue Weng Cheu, BDS, FRACDS, MJDF RCSEng, FICD

 A layer of everX Posterior (up to 4mm)  was init ially placed in the cavity and light-cured for 20 seconds, followed by a second increment of 2mm. A final 1mm to 2mm layer of Shade PA2 was then placed, contoured and cured.

Finishing and polishing The missing cavity wall has been built up during the previous visit with a conventional composite, G-aenial Posterior Shade PA2 (GC). The walls should be thick enough to  withstandthe application pressure of everX Posterior (GC).  An incremental layering technique was adopted in building up the dentin.

Finishing with a conventional composite like G-aenial Posterior (GC) is essential for good wear resistance and polishability. The restoration was finished with diamond drills in order to achieve the correct occlusal morphology. Polishing  was done with composite diamond points and polishing paste.

Discussion The modern advances of the different composites in the market such as everX Posterior makes it possible to extend the use of directly placed restorations in cases  where indirect restorations may have  been the next best option. The advantage of direct restorative procedures is that they are conservative and they reduce chair-side time and stress for both operator and patient. Indeed, innovations in composite restorative materials have  been succes sful in maki ng large and directly placed restorations feasible. DA

The strengthening effect of the fi bres is proven by increased fracture resistance. It can be concluded that the material withstands biting forces  well at the posterior area.

 About the Author Dr. Yue Weng Cheu  completed his BDS degree at the National University of Singapore and was awarded The Pierre Fauchard Academy Foundation Annual Scholarship Award. Dr. Yue was elected Fellow of the Royal Australasian College of Dental Surgeons, Fellow of the International College of Dentists, Fellow of the International Congress of Oral Implantologists, and Fellow of the World Clinical Laser Institute. He is a Member of the Joint Dental Faculties of the Royal College of Surgeons, England.  An ISCD-Certifie d International CEREC trainer (Paris, 2010; Istanbul, 2012; and Barcelona, 2014), Dr. Yue has also obtained his Certificate of Oral Implantology from Frankfurt University. He has also completed the full TMD continuum at Occlusion Connections under the tutelage of Dr. Clayton Chan. Dr. Yue has been lecturing and conducting hands-on courses on clinical digital photography, CAD/CAM, laser dentistry and TMD. He is the Clinical Director of DP Dental and his practice focuses on integrated utilisation of advanced dental technology such as laser, CAD/CAM and 3D jaw tracking and imaging to enhance diagnostic and therapeutic outcomes. DENTAL ASIA  J ULY / AUGUST 2015

 39

CLINICAL FEATURE

Periodontal In�ammation:

Simp li  fied  fi   

 by Dr. Fay Goldstep

I

nflammation has been studied since ancient times. It was observed that as a result of irritation, injury or infection, tissues in the body react by increased redness (rubor (rubor), ), swelling (tumor tumor), ), heat (calor (calor)) and pain (dolor (dolor). ).1 Today, we know that inflammation is a process driven by cells responding to signals from the body to fend off what it perceives as an intrusion intrusion.. This leads to the accumulation of fluid and leukocytes in the extravascular tissues. 2 The inflammatory response is a ben a bene eficial process. In the healthy periodontium,  bacteria  bacte ria in the crevicular fluid enter the  bloo  bl ood d st strea ream m an and d eli elicit cita pro protec tecti tive ve res respon ponse se during chewing, tooth brushing, etc. The in flammatory response occurs routinely to counteract microbial challenges and eliminate them –  without our awareness. We become en aware of inflammation o n l y w h en t h e r e sp sp o n s e i s p r o l o n g e d   and n o t s u c ce ce ss ss f u l i n r e so so l v i n g t h e m i c r o b i a l c h a l l e n g e. e.

Chronic inflammation is a destructive process that occurs when the response is not able to complete its normal cycle of removing bacteria and restoring the situation to health. The process continues for an extended period of time as the body tries to eliminate the bacteria. Tissue damage occurs due to the action of the cells involved in inflammation and their products. There is extensive research on periodontal inflammation. The following is the story so far: 1. Periodontal inflammation is initiated  by a bact bacteria eriall stim stimulu ulus. s. 2. A cascade of events occurs in response to the stimulus (innate and then adaptive). 3. The innate response must be actively resolved. This requires substances called lipoxins, resolvins and protectins. Resolution is an active process to restore healthy equilibrium.

 40

4.

Omega-3 fatty acids acids are precursors to resolvins. resolvins. Therefore, Therefore, diet can affect the resolution resolution of inflammation. 5. Inflammation is affected by many risk factors, including genetics. 6. Over-expression of inflammation is a key aspect of ageing that may in fluence and link diseases in the older individual. In flammatory mechanisms are critical in the development and progression of the diseases of ageing. 7. Treatment of periodontal disease should not only re flect the bacterial stimulus, but must take into account the in flammatory component of the disease as well. This article discusses these factors and will attempt to bring simplicity and clarity to a very complex topic.

The bacterial challenge The bacterial aetiology of periodontal disease has been established for over 100  years. Recent studies have also shown that it is not just the number of bacteria – b u t t h e sp s p e c i fi    c e r i a l t y p e s  – that are implicated in the pathogenesis of fi   b a c t er periodontal disease. By the 1980s, it was established that sites with periodontal disease predominantly contain Gram-negative organisms, while healthy sites are populated  with Gram-positive Gram-positive bacteria.3 In the 1990s, the particular in flammatory response of the affected individual (host) and the presence of certain speci fic bacteria were found to be associated with active periodontal disease progression. The four major species implicated were P. were  P. gingivalis, 4  A. actinomycetemcomitans, T. forsythensis and T. denticola. These pathogens are found in ecologic complexes (bio film). An ecologic shift in the bio film, like a change in available nutrients, can lead to the emergence of these speci fic microbial pathogens. 5 Periodontal inflammation is initiated by the products products   of biofilm bacteria such as lipopolysaccharide molecules (LPS – components of the cell wall of Gram-negative  bacte ria and are not not   found in Gram-positive bacteria). This creates a cascade 6 of reactions.   In the healthy periodontium, periodontium , the products are eliminated and the inflammation is resolved. In the compromised periodontium, periodontium , periopathogens like  P. gingivalis gingivalis suppress  suppress the innate host response by paralysing a key step in the host defence system. This permits  both P.  both  P. gingivalis and gingivalis and the commensal (benign or bene ficial) bacteria in the pocket to thrive and grow without any recognition or resistance by the host. 7  P. gingivalis may gingivalis may be present in low concentrations but it still has a profound effect on the amount and composition of the surrounding bacterial environment leading to periodontitis. For this reason, P. reason, P. gingival gingivalis is has  has been called a “keystone pathogen” – pathogen” – a species that supports and remodels a microbial community to promote pathogenesis. 8 Many of the bacterial model studies have focused on  P. gingival gingivalis is,, but the model applies to the other periopathogenic species as well. T h e sc sc en en a r i o i s a s f ol o l l o w s : In the deep, inaccessible, subgingival space of the

compromised compromise d periodontium, periodontium, P.  P. gingivalis gingivalis impedes  impedes the body’s defence system by  blocking  blocki ng protec protectiv tivee host host rece recepto ptors. rs.9 This creates a dysbiosis between host and plaque, interrupting the status quo and tipping the balance towards inflammatory disease. Just a very small level of P. of P. gingivalis leads gingivalis leads to increased numbers of normally benign  bacter  bac teria. ia. This enc encour ourages ages a grea greater ter inflammatory response and tissue breakdown. The  break  br eakdo down wn pro produ ducts cts (co (colla llagen gen fra fragme gments nts)) flood the crevicular fluid and are a great source of nutrition for P. for P. gingival gingivalis is and  and other periopathogens that require essential amino acids as a food source. (Caries pathogens thrive on sugars).9 This way, “keystone pathogens” manipulate their environment (periodontium) and their normally docile neighbours into creating a very comfortable environment and “food fest” for their own bene fit. Bacteria and the host bot host  both h  contribute to disease and the affected periodontal sites contain a unique microbial composition not seen in health.10 Changes in the composition of gut microbiota have also been implicated in the pathogenesis of other inflammatory diseases (i.e., inflammatory bowel disease, colon cancer, obesity, diabetes and coronary heart disease). Future Futu re treatment and prevention of these diseases may involve the identification and targeting of “keystone pathogens”.9

DENTAL ASIA  J ULY / AUGUST 201 2015 5

CLINICAL FEATURE

Resolution of the inflammatory response

(From lef to right)  Fig. 1. Te acute response Periodontal tissues : Bacteria initiate the immune response producing vascular dilation, increased permeability of capillaries and increased blood �ow. Cellular level : Te crevicular �uid contains neutrophils, macrophages and other in�ammatory cells. Macrophages eliminate bacteria by phagocytosis. Te in�ammatory cells secrete c ytokines that regulate the in� ammatory response. Biochemical Level : Arachidonic acid (released primarily by neutrophils) produces prostaglandin. Fig. 2. Te active resolution of the acute response Periodontal tissues : Te stimulus (bacteria) is removed. Cellular level : Te crevicular �uid contains fewer,, weakened neutrophils and remnants of bacteria. Biochemical level : Arachidonic acid produces fewer lipoxins. Dietary omega-3s produce resolvins. Lipoxins and resolvins actively stop in �ammation. Fig. 3. Return to health

The healthy beneficial inflammatory response The reaction to infection or any other noxious stimulus in the body precipitates two distinct and interconnected reactions: the innate innate and  and the adaptive adaptive.. sp o n s e is   an evolutionary defence mechanism that provides immediate The in n a t e r e sp protection. Phagocytic (ingesting) cells (neutrophils, monocytes, monocytes, macrophages) identify and eliminate foreign substances. These immune cells also release chemical mediators called cytokines (cyto = cell; kine = movers) move rs) that assist antibodies in clearing pathogens or marking them for destruction by other cells. The innate response is non-speci fic.1 The a d a p t i v e r e sp sp o n s e  is specific. Pathogens are recognised so that a stronger response will occur should these pathogens return in the future. The adaptive response is tailored to remove speci fic pathogens and to remember the pathogen’s antigen signature. T-cells recognise foreign antigens and speci fically target them. B-cells produce antibodies against the antigen. They assist the phagocytic cells in mounting a response to the noxious stimulus.1 In the healthy periodontium, the innate response eliminates or neutralises foreign bodies and is protective against injury or infection. 11 T h e s eq eq u e n c e i s a s f o l l o w s :11   

There is vascular dilation, enhanced permeability of capillaries, increased blood flow ow;; Neutrophils (polymorphonuclear leukocytes or PMNs) are dispatched to the site; Macrophages, etc. are recruited to the site; Cell mediators (cytokines) are produced by these recruited immune cells and by local cells in the area ( fi broblasts and osteoblasts). Cytokines are the mechanism by which the body facilitates cell communication. They are  biologically active proteins that alter the function of the cell that releases it or the function of adjacent cells. 12  They can act locally to regulate the inflammatory process or can be dispatched to distant sites; 6 5. Chemokines (cytokines with chemotactic properties) are released released and play an an 13 important role in further leukocyte recruitment; 6. Cytokines work work with the body body to defend it from attack. The immune immune cells and their their secreted chemicals attempt to destroy, dilute or wall off the injurious agent; 12 7. T- and B-cells mediate the adaptive response. 1. 2. 3. 4.

It is noteworthy that, while oral bacteria live close to a highly vascularised periodontium,  very few bacteria cause systemic systemic infections infections in the healthy healthy individual. individual. This is the result of the highly ef ficient innate host defence system that monitors bacterial growth and prevents bacterial intrusion into the local tissues. Dynamic equilibrium (homeostasis) exists between the dental plaque bacteria and the innate host defence system. 7 This is the situation as it occurs in health. When there is compromise in the health of the individual – systemically or locally – all bets are off and the process of in fl  in fl ammatory ammatory disease begins.  42

Complete resolution of an acute inflammatory response and the body’s return to homeostatis is necessary for health. The leukocytes and invading  ba ct er ia mu st be re mo ve d wi th ou t leaving remnants of the conflict. 14 Traditionally, it was thought that the innate response peters out passively as the pro-inflammatory signals decline. 15 However, evidence now suggests that the resolution of in fl  in fl ammation ammation and return to el y r e g u l a t e d homeostasis is an a c t i v el p r o c e ss ss  –   – not a passive one. 16 Lipoxins, resolvins and protectins are specialised pro-resolving lipid mediators in chemically distinct families that are involved in this process. These substances are actively biosynthesised during the resolution phase of acute in flammation and act to control the magnitude and duration of in flammation. 11 L i p o x i n s :  At the end of healthy

inflammation, neutrophils stop secreting pro-inflammatory cytokines and begin synthesising compounds that halt inflammation. Known as lipoxins, they are derived from lipids (arachido (arachidonic nic acid – a fatty acid found in cell membranes) released from neutrophils and other inflammatory cells.17 During acute inflammation, arachidonic acid is converted to pro-inflammatory mediators including prostaglandin. In the healthy individual, elevated prostaglandin level signals the need to resolve inflammation, triggering a switch in the action of arachidonic acid to produce lipoxins that actively halt inflammation.17 Lipoxins are essentially a “braking signal” for signal” for neutrophils.14  Aspirin trans transforms forms lipoxin into a more  bioactive  bioacti ve form with more powerf powerful ul 18 pro-resolving properties. R e s o l v i n s :  Substances that are derived from omega-3 dietary fatty acids (EPA and DHA). Several clinical studies have shown that diets rich in omega-3s are useful in the prevention and treatment of arthritis, cardiovascular disease (CVD) and other in flammatory conditions. Resolvins formed from omega-3s may be responsible for this. 17 Resolvins act locally to stop neutrophil recruitment and infiltration. Neutrophils are present in in flamed DENTAL ASIA  J ULY / AUGUST 201 2015 5

CLINICAL FEATURE

or injured tissue and their effective elimination is a pre-requisite for complete resolution of the inflammatory response and return to homeostasis. 19  Results from P. gingivalis-induced periodontitis animal studies showed topical resolvin treatment stopped the progression of periodontal disease: 20 Silk threads were tied around rabbit teeth to trap bacteria.  P. gingivalis was then added to induce periodontitis. One group received topical application of resolvin,  while the other group received a placebo. The rabbits receiving topical resolvin were healthy; the placebo group had periodontal disease. Topical resolvin treatment stopped the progression of disease and there was complete re solution of periodontal inflammation. Treatment resulted in bone re-growth to pre-disease leve ls. Histologic evidence showed both new collagen and new bone deposition. 20

The chronic maladaptive inflammatory response The primary etiologic basis for periodontal disease is bacterial. However, the excessive host inflammatory response and/or inadequate resolution of in flammation is critical to the pathogenesis of periodontitis.18 Periodontal disease results from the body’s failure to turn off its inflammatory response to infection. The result is chronic maladaptive in fl ammation.17  As discussed, “keystone pathogens” such as P. gingivalis create a dysbiosis between the host and dental plaque. An essential step in the innate mechanism is impaired, leading to growth in the number of commensal bacteria and increased in flammation. This produces an environment that exudes a rich source of nutrients such as degraded host proteins that are just what  P. gingivalis needs for survival and growth.  P. gingivalis continues to exploit the environmental change, leading to more bacteria, even higher inflammation and bone resorption, and a perfect niche space (deeper periodontal pockets) where everything can continue undisturbed.9 Chronic periodontitis has multiple etiologies. The persistent bacterial infection of  P. gingivalis  is just one of these. In flammatory disease represents a disruption of tissue homeostasis. Any factor (whether microbial- or host-based) that can destabilise the homeostatic equilibrium can tip the balance toward inflammatory disease. 8  Acute in flammation that is resolved within a reasonable time frame prevents tissue injury. Inadequate resolution and failure to return to homeostasis result in chronic inflammation and tissue destruction. 18 fl   mation:  I n c h r o n i c u n r eso l v ed i n   am

1. 2. 3.

4. 5. 6.

Cellular and molecular responses to bacterial challenges involve constant adjustment and regulatory feedback; 21 Neutrophils, macrophages and monocytes continue to secrete cytokines. This creates a complex chronic lesion that destroys the periodontium; Cytokines promote release of MMPs (matrix metalloproteinases – proteolytic enzymes implicated in normal bone re-modeling. They include collagenases.  Virtually, all collagenases found in periodontal disease are derived from host cells and not bacteria. 21 They are also the key mediators in irreversible tissue destruction in periodontitis and have been used as biomarkers of disease progression); 22 Tissue destruction is not uni-directional. It is constantly being adjusted by host-bacterial interactions; 21 Alveolar bone destruction is the result of the uncoupling of the normally tightly coupled processes of bone resorption and formation; 21 Prostaglandin production plays a role in alveolar bone resorption.

Cytokines are an intermediate mechanism between bacterial stimulation and tissue destruction. They were historically identi fied as leukocyte products, but many are also produced by other cell types such as fi broblasts and osteoblasts, etc. 23 The balance between stimulatory and inhibitory cytokines, and regulation and signaling of their receptors, may determine the level of periodontal tissue loss. 23 The host response is the major contributing factor for chronic maladaptive periodontal disease. A de ficient host response initiates the chronic condition and a too vigorous response leads to further tissue breakdown. 23

 44

Fig. 4 (Top). Early chronic lesion Periodontal tissues: Increased plaque, breakdown of periodontal ligament, ulcerations of epithelial lining, beginning of bone resorption. Cellular level : An increased number of neutrophils, macrophages, etc. Biochemical level : Increased pro-in�ammatory cytokine activity. Arachidonic acid continues to produce prostaglandin. Release of MMPs. Fig. 5 (Bottom). Late chronic lesion Periodontal tissues: Apical migration of pathogenic bacteria such as P. gingivalis, further breakdown of periodontal ligament, increased ulcerations of epithelial lining, severe bone resorption. Cellular level : Even more neutrophils, macrophages, etc. Biochemical level : Increased pro-in�ammatory cytokines regulate release of MMPs (involved in bone resorption and collagen degradation). Collagen fragments provide nutrition for pathogenic bacteria. Arachidonic acid continues to produce prostaglandin.

Risk factors for periodontal disease Clinical observation shows remarkable  variat ions in host res ponses betwee n individuals and in their presentation of periodontal disease. Though microbial challenge is a primary initiating factor, there are many other variables that modify disease expression. These risk factors interfere  with the way the body responds to bacterial invasion. Without the risk factors, the host may be capable of limiting periodontal tissue destruction. Disease modi fiers such as smoking in the presence of bacterial accumulation may shift the immune response beyond normal parameters. 24 DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

B a c t e r i a i n i t i a t e p er i o d o n t i t i s. They are essential but they

are insuf ficient. What is required is a susceptible host . Risk factors determine disease susceptibility, onset, progression, severity and outcome. 21 Through the 1990s, studies were undertaken to establish specific risk factors for periodontal disease. Clinical presentation, expected progression and responses to therapy  were found to be “a net integration of the host response modi fied  by patient genetics and environmental factors”. These factors may shift the balance to more severe periodontal destruction. 24 The various environmental, acquired and inherited risk factors  were found to be: diabetes, smoking, poor oral hygiene, speci fic microflora, stress, race and gender. 25 Diabetes increases risk through an amplified inflammatory response and depressed wound healing. 26   Diabetics have cytokines that respond to the bacterial challenge at a higher rate than normal. Gingival tissues and crevicular fluid contain elevated concentrations of these cytokines, producing high levels of MMPs that promote tissue destruction and disease severity. 21 E n v i r o n m en t   : Smoking, the identi fied environmental risk

most strongly associated with periodontal disease, contributes to increased severity by the release of toxins into the oral cavity. In some studies, the impact of smoking outweighs the effect of pathogenic bacteria as a determinant of outcome. 27 G e n e t i c s:    Twin studies of adult periodontitis show greater concordance for periodontitis susceptibility between monozygotic twins than between dizygotic twins. It has been estimated that heredity accounts for about 50 per cent of the enhanced risk for severe periodontitis. 21 Given the critical role of neutrophils in inflammation, genetic defects in neutrophil function would be expected to affect periodontal disease. Genetic abnormalities in neutrophil function have been demonstrated in 75 per cent of patients with juvenile periodontitis. 21 E p i g e n e t i c s :  This pertains to the control of how certain genes expressed in speci fic tissues can change throughout life by such factors as diet, stress, smoking and bacterial accumulation.28 Epigenetic alterations in DNA result in long-lasting changes in the expression of selected genes. 24 Rather than involving the  variability of the genetic sequence itself, epigenetic regulation is a reversible modi fication in gene expression determined by environmental exposures, and it may be inheritable. 29 The exposure actually changes the DNA through methylation of genetic sequences. The differential methylation of genes may contribute to the diseased state. The changes that persist in the tissue increase the susceptibility to re-infection. This  way, a previous bout of perio dontal inflammation may increase susceptibility to subsequent bouts of infection. 30 There are also anatomic changes that result from periodontal disease, like residual pockets and bony defects. These may also predispose the individual to further periodontal infection. 31

Inflammation as a factor in diseases of ageing: The local-systemic link  Chronic diseases such as rheumatoid arthritis, CVD, diabetes and periodontal disease may develop because of unrestrained inflammatory responses that have maladapted over decades. 1,12 In inflammatory diseases, the innate and adaptive responses  46

 be co me un re so lv ed and chronic. The tissues do not return to homeostasis. 1 Chronic inflammation is characterised by the continued production of cytokines, arachidonic aci d-d er ive d modulators (such as prostaglandin) and many other products. Periodontitis, located in the oral cavity and thus easily observable, has been used as a model for other Te local-systemic link  1. Local in�ammation produces ulcerations inflammatory diseases. in the pocket epithelium creating risks for It is also unique distant site infection or bacteraemia. among inflammatory 2. Systemic dissemination of locally produced diseases because the cytokines affects other organ systems. aetiology is well-known 3. Bacterial diffusion releases biologically active (bacterial plaque) and molecules that trigger host responses in distant areas, elevating serum cytokine level. the pathogenesis is so 4. The resulting cytokines affect arteries and organs.  well-characterised.20 The periodontitis- 5. CRP synthesised in the liver as a result of circulating cytokines, produces damage to systemic disease organ systems. relationship has been studied extensively. There is substantial epidemiological evidence to suggest that periodontal in flammation can influence the course of systemic disease, especially CVD, diabetes and low birth-weight infants. 20   Epidemiological studies (indirect evidence) have demonstrated statistical associations between poor oral health and several systemic diseases. 32 This epidemiological evidence continues to grow. More direct evidence through experimental studies suggests that the local in flammatory burden presented by periodontal infection causes an increased systemic in flammatory burden, i.e., local inflammation can be a modi fier of systemic in flammation. 20 Studies monitoring CRP (C-reactive protein) levels have shown this connection. CRP is: 1. One of the most reported bio-markers of systemic in flammation; 2. A protein whose production is triggered by infections, trauma, necrosis and malignancy, and also linked to heart disease and diabetes; 6 3. Synthesised in the liver in response to pro-in flammatory cytokines; 4. A component of normal serum, but an elevated serum CRP reflects an elevation in systemic in flammation. An elevated CRP level has been associated with an increased risk for CVD20 and is also seen in periodontal disease. 33 CRP produces biological actions that exacerbate the in flammatory response, and may also impact the initiation or progression of systemic diseases like atherosclerosis.34  A study on animals with induced periodontitis (ligature with  P. gingivalis for six weeks producing periodontitis) showed them to have elevated systemic CRP levels. After topical resolvin treatment, not only was the periodontal tissue returned to health  but the systemic level of CRP was returned to that associated with DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

health. The resolvin treatment lowers the in flammatory burden locally, which results in a lower systemic burden. 20  An ot he r st ud y us in g th e sa me mo de l of an im al s wi th periodontitis showed them to have more atherosclerosis (measured by fatty plaque deposits in their major blood vessels) than the control subjects.17 “ In fl ammation-resistant ” subjects (with high lipoxin levels in their blood) not only failed to develop periodontal disease, but their arteries were almost completely free of plaque compared to the control subjects. 17 Local inflammation from the periodontium may influence systemic inflammation through several distinct pathways: 35,36 1. Local inflammation produces micro-ulcerations through the pocket epithelium, promoting risks for distant site infections and transient bacteraemia; 2. There is systemic dissemination of locally produced inflammatory mediators (cytokines). These then begin to act systemically, affecting other organ systems; 3. Bacterial diffusion releases a variety of biologically active molecules such as lipopolysaccharides (from the bacterial cell membrane), endotoxins, chemotactic peptides, proteins and others that may enter the systemic circulation. These products trigger the host inflammatory response in areas far from the periodontium and elevate serum concentrations of cytokines; 4. The circulating cytokines produced by these responses affect arteries and organs; 5. CRP is synthesised in the liver in response to these circulating pro-inflammatory cytokines in the acute phase of inflammation. CRP can produce injurious effects on other organs, leading to vascular damage, CVD and strokes. The bottom line is that unresolved chronic local in flammation creates a toxic systemic situation. Bacteria, pro-in flammatory mediators, and CRP cause damage at the local level, and the dissemination of these noxious substances causes damage throughout the body. The “oral/systemic link” is an artificial construct. The periodontal/systemic link is simply a local/systemic inflammation link . The periodontium is an integral part of the body’s systemic ecosystem. It is obvious that the local effect on one part of this ecosystem will impact the entire organism.

The impact on patient care Understanding inflammatory response mechanisms is essential in developing innovative treatments for periodontal inflammation. While scaling and root planing is the gold standard in non-surgical therapy for chronic periodontitis, it only addresses its bacterial aetiology, not its in flammatory progression. Much of periodontal disease is the result of the host response breaking down the surrounding structures. The dynamic events of pathogenesis are determined primarily  by signalling and regulating molecules that direct cell function -- the cytokines.21 Chronic inflammation supports the growth of pathogenic bacteria through the production of tissue breakdown products. Resolution of in flammation effectively eliminates the pathogen from the lesion by removing its food source. 20  Advances in treatment must address the speci fic bacteriological factors, the host response and the systemic progression of disease.  When we are faced with new techniques and products designed to promote periodontal health, we should be open to innovation DENTAL ASIA  J ULY / AUGUST 2015

 but also judicious in our assessment. This is only possible if we are armed with a thorough knowledge of the mechanisms of periodontal inflammation and their sequelae. This knowledge supplies us with the tools to provide our patients with the best clinical outcome possible. DA

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36.

T VanDyke. Inflammation and factors thatmay regulate inflammatory response. J Periodontol (Suppl.) August 2008:1503-1507. R Cotran, et al. Inflammation: Basic principles and clinical correlates. Philadelphia: Lippincott Williams & Wilkins 1995:5-10. MG Newman, et al. Predominant cultivable microbiota of periodontitis and periodontosis. J Dent Res 1973;52:290. Proceedings of the 1996 World Workshop in Periodontics, Lansdowne,Virginia, July13-17, 1996, Ann Periodontol 1996;1:1-947. SS Socransky, et al. Microbialcomplexes in subgingival plaque. J Clin Periodontol 1998;25:134-144. A Gaffar, A Volpe.Inflammation, periodontal diseases and systemic health. Compendium July 2004;25:7:4-6. R Darveau, A Tanner, RPage. The microbial challenge in periodontitis. Periodontology 2000, 1997;14:12-32. R Darveau, G Hajishengallis, MA Curtis. Porphyromonas gingivalis as a potential community activist for disease, Journal of Dental Research July 2013. G Hajishengallis. Low-abundance biofilm species orchestrates inflammatory periodontal disease through the commensal microbiota and complement. Cell Host & Microbe10 Elsevier Inc November 2011:497-506. P Braham, C Herron, C Street, R Darveau. Anti-microbial photodynamic therapy may promote periodontal healing through multiple mechanisms. J Periodontol 2009;80:11, 1790-1798. M Shinohara, V Mirakaj, C Serhan. Functional metabolomics reveals novel active products in the DHA metabolome. Frontiers in Immunology April 2012;3:81:1-9. A Mariotti. A primer on inflammation, Compendium July 2004;25:7:7-11. D Graves. Cytokines that promote periodontal tissue destruction. J Periodotol August 2008 (Suppl.):1585-1591. C Serhan. Controlling the resolution of acute inflammation: A new genus of dual anti-inflammatory and pro-resolving mediators. J Periodontol 2008;79:8:1520-1526. RS Cotran, V Kumar, T Collins. Robbins pathologic basis of disease. Philadelphia: Saunders;1999. CN Serhan. Resolution phase of inflammation: Novel endogenous anti-inflammatory and pro-resolving lipid mediators and pathways. Annu Rev Immunol 2007;25:101-1137. T Van Dyke, C Serhan. A novel approach to resolving inflammation, oral and the whole body health 2006:42-45. T Van Dyke. The management of inflammation in periodontal disease. J Periodontol August 2008 (Suppl.):1601-1611. A Ariel, et al. Apoptotic neutrophils and T-cells sequester chemokines during immune response resolution through modulation of CCR5 expression. Nat Immunol 2006; 7:1209-1216. H Hasturk, et al. Resolvin E1 regulates inflammation at the cellular and tissue level and restores tissue homeostasis in vivo. J Immunol 2007;179:7021-7029. R Page, et al. Advances in the pathogenesis of periodontitis: Summary of developments, clinical implications and future directions. Periodontology 2000, 1997; 14:216-248. W Giannobile. Host-responses therapeutics for periodontal diseases. J Periodontol 2008;79:8:1592-1600. D Graves. Cytokines that promote periodontal tissue destruction. J Periodontol (Suppl.) 2008;1585-1591. K Kornman. Mapping the pathogenesis of periodontitis: A new look. J Periodontol 2008;79:8:1560-1568. R Williams. Understanding and managing periodontal diseases: A notable past, apromising future. J Periodontol 2008;79:8:1552-1559. HA Schenkein. Finding genetic risk factors for periodontal diseases: Is the climb worth the view?. Periodontol 2000, 2002;30:79-90. GE Salvi, et al. Influence of risk factors on the pathogenesis of periodontitis. Periodontol 2000, 1997;14:173-201. T Van Dyke. Inflammation and periodontal diseases: A re-appraisal. J Periodontol (Suppl.) 2008;1501-1502. G Egger, et al. Epigenetics in human disease and prospects for epigenetic therapy. Nature 2004;429:457-463. S Offenbacher, et al. Re-thinking periodontal inflammation. J Periodontol August 2008 (Suppl.);1577-1584. R Genco, Clinical innovations in managing inflammation and periodontal diseases: The workshop on inflammation and periodontal disease. J Periodontol August 2008 (Suppl.);1609-1611. KJ Mattila, etal. Association between dental health and acute myocardial infarction. BMJ 1989;298(6676):779-781. J Ebersole. Periodontitis in humans and non-human primates: Oral-systemic linkage inducing acute phase proteins. Periodontol 7 2002;102-111. J Danesh, et al. Association of fibrinogen, C-reactive protein, albumin or leukocyte count with coronary heart disease: Metaanalyses of prospective studies. J Am Med Assoc 1998;279:1477-1482. S Grossi, Oral inflammation and cardiovascular diseases. Colgate White Papers 2005. F Scannapieco. Periodontal Inflammation: From gingivitis to systemic disease?. Compendium July 2004;25;7 (Suppl 1);16-24.

 About the Author Dr. Fay Goldstep has been a featured speaker in the ADA Seminar Series and has lectured nationally and internationally on proactive/minimal intervention dentistry, soft tissue lasers, electronic caries detection, healing dentistry, and innovations in hygiene. She has served on the teaching faculties of the post-graduate programmes in aesthetic dentistry at SUNY Buffalo, University of Florida, University of Minnesota and University of Missouri-Kansas City. She has been a contributing author to four textbooks and has published more than 60 articles. She is a Fellow of the American College of Dentists, International Academy for Dental-Facial Aesthetics, American Society for Dental Aesthetics, and the Academy of Dentistry International. She sits on the editorial boards of the Oral Health  Journal , Dental Tribune US Edition and Dental Asia. She has been listed as one of the leaders in continuing education by Dentistry Today since 2002. She maintains a private practice in Markham, Canada.

 47

CLINICAL FEATURE

Essential Factors to Achieving a High-Quality Cure ure

T

here are numerous aspects and variables that affect the final outcome of a restoration. Some examples are dif ficulty in handling/manipulation of the restorative material, the quality of the preparation or the chosen composite resin used. However, the impact of the success and longevity of a restoration’s cure is too often ignored. Achieving a predictable, high-q uality cure every time is absolutely essential. Here are some factors that in fluence the quality of any cure, along with a few tips on how to successfully manoeuvre them for the bene fit of both the user and the patient.

Proximity to restoration

Type of light emitted

 VALO accessibility  Better access to the restoration with the curing light ensures the delivery of the maximum amount of power (emitted light) to the dental material. Therefore, a curing light that allows for perpendicular positioning to any curing site, including posterior teeth, is paramount to the quality of the procedure. While many of the curing lights available on the market feature a 60°-angle at the curing head at  best, VALO ®’s slim head and low-pro file design allow the clinician to easily access hard-to-reach areas, even in smaller mouths.

 VALO® LEDs Studies have repeatedly shown the importance of a curing light that features a wide spectrum of wavelengths, enabling it to polymerise all  dental materials. However, most existing devices on the market do not offer multiple LED  wa ve le ng ths no r ach ie ve un if orm irradiation with the LEDs offered.  VALO ®’s four highly efficient LEDs provide uniform dispersion of energy to the restoration, at three different  wavelengths of light to ensure complete polymerisation – every time.

 48

DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

Beam collimation co imation and an uniformity  Finding F n ng a high-energy g -energy light g t that reaches into all aspects of the restoration is critical to to predictably p produce high-quality results. resu ts. One o of the t e critical cr t aspects that in fluence this outcome includes n c u es the t e curing light’s beam collimation and nd uniformity.

Dr. r. Fischer says, “The quality of a restoration iss totally t ot a y dependent e pe n on how adequately that restoration restorat on and an its t bonding agent are polymerised. The power outp output and size of footprint varies immensely mmense y amo among the curing lights available on n the t e dental enta market today. VALO ®’s lens is designed es gne to create creat a beam that is close to parallel to the t e preparation, preparat while still emitting enough light g t to the t e curing cur n material on the axial walls of tthe e preparation.” preparat on.”

T s a This allows ows VALO VAL to deliver a complete and uniform u n o rm cure cu re to any a restoration. The power, concentration oncentrat on o of light, g and its collimated, uniform energy output also a so allow a it to cure dental materials completely mp ete y – even even at at a distance. Dr. r. John Jo n Kanca Kanca of o Middlebury, M Connecticut says, ® “VALO  VALO ’s ability a ty to produce pro the greatest amount of energy ergy at distances stances up to t 10mm from the tooth is just amazing. maz ng. I have ave been een using us n this light for some time and  would not want to be  wou e without wt it.” DA

50

DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

S

mileFast is a short-term cosmetic orthodontic solution suitable for the majority of adult patients with crowded or spaced anterior teeth. Traditionally, majority of adult patients refused conventional long-term or ideal orthodontic therapy for many reasons. The main barriers for acceptance are cost, appearance and time. In addition to this, many adults are reluctant to undergo dental extractions or orthognathic surgery, and most are only concerned about their anterior aesthetics. SmileFast involves the use of c l ea r b r a c es a n d t o o t h - co l o u r ed a r c h w i r e s  to   transform aesthetic smiles

usually within six to nine months. It is an innovative shift in orthodontic treatment philosophy, which can greatly benefit dentists and their adult patients as it offers enormous advantages over other systems. Figures 1 to 8 show examples of patients and treatment times treated with the SmileFast technique. In a study performed in our practice over a three-year period, we have been offering every adult patient (if eligible) t h r ee d i f f er e n t t r ea t m en t o p t i o n s.  • Firstly, we always offer the i d e a l treatment plan  , which usually involves upper and lower fixed  braces for 24 months in conjunction  with elastic wear and, if necessary, extractions and/or orthognathic surgery. • If they are a candidate for S m i l e F a s t ,   which comprises 80 per cent of our adult patients, SmileFast is offered as a second option, reiterating that this  will involve p u r e a l ig n m en t o f t h e t e et h t o i m p r o v e t h e co s m e t i c r es u l t w i t h o u t a f f ec t i n g t h e b i t e o r o c cl u s a l r e l a t i o n s h i p .  Patients

•

are informed about the treatment span and that it usually involves a n o n - e x t r a c t i o n treatment plan or, in the worst scenario, a l o w er i n c i so r   extraction. Finally, a l i g n e r t h er a p y   is offered to every eligible adult patient. The treatment modality is explained for them to be aware that aligner therapy will require attachments, IPR (interproximal reduction) and

DENTAL ASIA  J ULY / AUGUST 2015

SmileFast: The Predictable Short-Term Cosmetic Orthodontic Treatment Elite training, elite technology, elite support  by Geoffrey Hall, BDSc (Melb), Cert. Orth (Penn) and Derek Mahony, BDS (Syd), MDS (Lond)

usually elastics, requiring 18 months to two-and-a-half years of treatment.  We have conducted a survey and we found out that 90 per cent of our adult patients  who undergo any orthodontic therapy in our practice will choose the SmileFast approach over conventional/traditional comprehensive orthodontic care or aligner therapy, proving the main objection/  barrier to orthodontic treatment, apart from orthognathic surgery or extractions, is the t i m e i n b r a ces .   We beli eve ther e is a psycho logica l  barrier with patients. If we can finish the orthodontic treatment within 12 months – p r e f er a b l y si x t o n i n e m o n t h s –   adults feel very comfortable with proceeding  with orthodontic alignment. Most of our SmileFast cases take approximately six to nine months to obtain an excellent cosmetic orthodontic outcome. More patients are becoming frustrated  with the outcomes of aligner therapy, as there is a variety of difficult to achieve tooth movements, making treatment unpredictable – unless treated  by ex pe ri en ce d and kn ow le dg ea bl e clinicians. Patient cooperation is paramount to achieve a satisfactory result  with any type of aligner therapy. SmileFast allow dentists to take far better control of these cases and ultimately provide a more attractive and optimal aesthetic outcome within a very short period of time. The SmileFast aim: To dramatically improve the appearance of a patient’s smile – w i t h o u t a lt er i n g t h e i r o c c l u s a l s ch e m e.

Usually, the following items are NOT addressed when treating patients with any type of short-term orthodontics: • Class II or Class III malocclusions • Severe open bites

1a. Initial

1b. Nine months

2a. Initial

2b. Eight months

3a. Initial

3b. Nine months

4a. Initial

4b. Seven months

5a. Initial

5b. Ten months

6a. Initial

6b. Six months

7a. Initial

7b. Seven months

8a. Initial

8b. Eight months

Figures 1 to 8. Examples of patients who have been treated with the SmileFast approach with shortened treatment times.

• •

Midline discrepancies Bilateral posterior crossbites

Concerns addressed by SmileFast: • Levelli ng and alignment of the anterior teeth • Correcting anterior crossbites • Closing most spaces 51

CLINICAL FEATURE

Figure 10. Ideal alignment with ideal bracket placement in dig ital representation.

Figure 9. Malocclusion in a digital world.

• • • •

Rounding out upper and lower arches Treating minor dental open bites Improving deep dental bites Levelling the gingival margins The overall treatment goal is to transform a smile from asymmetrical to b a l a n c ed a n d h a r m o n i o u s.  Symmetry within the arch, gums and incisal edges is paramount in creating an attractive smile.

 What makes SmileFast unique? In Part 1 of this series, e i g h t   areas were identified as to how to assess each of the short-term orthodontic systems that are presently available. We would like to utilise these areas to discuss the unique quality of the SmileFast system.

1. Training SmileFast has been developed by a Specialist Orthodontist who has been involved in teaching general practitioners for over 20 years, ensuring sound orthodontic principles, CORRECT simple orthodontic diagnosis and the most efficient mechanics. It has been designed for the dentist to ONLY treat those patients from whom consistent quality outcomes will be achieved. The goal is minimal   treatment and chair time, maximum profitability and – most importantly – happy patients. SmileFast has now trained over 400 dentists and auxiliaries with the SmileFast Pro course and SmileFast Advanced course having received rave reviews. Over 95 per cent have rated the course nine out of ten or higher for quality and learning content. Also, the help desk on the unique portal has enormous amounts of clinical and practice materials, which are updated regularly. Dentists have commented that 52

Figure 11. Brackets transferred to maloccluded position showing position of brackets that will ultimately produce ideal alignment.

“the knowledge they have obtained from the SmileFast course gives them the con fidence to treat their own patients”.

2. Treatment support SmileFast has a unique web-based portal that allows easy case submission by the dentist and total control of production. The portal also provides a total support system for the dentist for each case,  with the ability to download progress photographs at each visit and ask questions about the case. Questions are answered by fully-trained practitioners and confirmed by a group of Specialist Orthodontists, ensuring that dentists  will learn very quickly as their skill level accelerates. In addition, the portal allows dentists to load cases purely for treatment assessment and identify whether a patient is suitable for SmileFast treatment. There is no software to be purchased as the online portal is accessible on any  Windows -based co mpute r or a Mac running in a Windows environment.

Figure 12. Indirect bonding trays with brackets using a digital computerised system – a key for dentists in easily mastering the orthodontic bracket placement approach.

understanding how the change will occur and to what extent it will occur is an incredibly powerful tool, as seeing how each new case will evolve builds and extends a dentist’s knowledge base. For example, patients can see if there will  be an overjet left in their particular case, as you may not be correcting a Class II  buccal relationship as one would do in a traditional comprehensive orthodontic treatment plan.

4. Ease of submitting cases The SmileFast unique online web-based portal allows easy case submission. The dentist initially loads all the patient details – including photographs and x-rays – thereby enabling the dentist to access interactive treatment plan comments and communicate quickly with the laboratory and the orthodontic mentor. The portal is so easy to use, staff can  be trained to upload all the necessary photographs and x-rays to save the dentist time in their busy practice.

3. Lab/Doctor/Patient communication

5. The learning experience

SmileFast utilises a 3D, web-based C a s e Viewer   to show the dentist and patient the anticipated orthodontic outcome and how this outcome can be technically achieved. Showing a “before and after”  view before treatment commences creates a clear, unequivocal and informed patient consent. This web-based viewer is also an excellent tool to communicate  with patients and ensure they know the anticipated orthodontic result. Being online, the dentist has instant access to the Case Viewer. Seeing the technical set-up in 3D and

Uploading progressive photos during treatment doubles as a learning and communication exercise with the SmileFast teacher/mentor. This allows the mentor to discuss with the dentist  wh er e an d ho w th e ca se co ul d be improved using sound orthodontic principles that underpin SmileFast’s treatment mechanics. The unique portal creates a comprehensive online record for you to refer to at any time, including billing and every comment or question/answer from the orthodontic mentor. In addition, the portal has a DENTAL ASIA  J ULY / AUGUST 2015

CLINICAL FEATURE

Figure 13. Indirect bonding trays inserted. Figure 14. Braces and wires placed within a total chair time of 45 minutes.

help desk with numerous videos and information to extend the dentist’s knowledge of orthodontic treatment.

6. Indirect bonding The k ey  to well-aligned orthodontic cases is the p o si t i o n o f o r t h o d o n t i c b r a c k et s . A good training programme will teach dentists the correct way to place orthodontic brackets, but even after 20 years of hands-on experience, this remains the most dif  ficult aspect of orthodontics. Incorrect bracket placement creates multiple problems. If left in the wrong place, treatment will not proceed to plan unless the bracket is removed and correctly placed. Accordingly, the patient will need to spend more time in the chair and longer time in braces to achieve the desired result. The dentist’s profitability on that case drops accordingly.  A d i g i t a l i n d i r ec t b o n d i n g s ol u t i o n    is, without a doubt, the most ef  ficient and accurate way to place orthodontic brackets in the correct position. SmileFast utilises a unique digital indirect bonding system where the digital set-up is performed via a computer. This digital set-up and bracket positioning in the virtual platform is the n sent to the dentist for approval or revision. Once the dentist approves the anticipated alignment of the teeth, the case is submitted and the indirect bonding trays – with brackets – are custom-fabricated for each case, guaranteeing ideal bracket placement. The big question is –  who  places the orthodontic brackets. Most systems utilise dental technicians to manually place orthodontic brackets. Dentists can choose to place these manually themselves, but it cannot be emphasised enough, as even experienced clinicians cannot place orthodontic brackets perfectly each and every time. It is impossible to train anyone to deliver perfection using manual bracket placement techniques. This digital set-up is a wonderful communication and marketing tool for patients. They can see the anticipated result of the treatment, similar to the Clincheck from Invisalign. This increases patient conversion rates and one of the reasons more and more patients are choosing SmileFast over alternative cosmetic orthodontic treatments. Now, if we suggested you could purchase a new aligner system for $500, but you have no access to see the visual final outcome or make any changes to the system, would you consider purchasing? The answer would almost certainly be a NO.  And if we suggested that you buy a new crown for $50, one that  was not fabricated on any model nor could you see it in a virtual aspect but would just arrive for you to fit – would you be willing to use this? The answer is still a NO.

CLINICAL FEATURE

The point we are trying to make with the cheap aligner system and crown as examples is that a manual indirect  bo nd ing sy st em ha s th e sa me principles: you receive brackets in a tray  without any idea of the final result and you have minimal control of the final outcome.  Any short-term cosme tic orth odontic system utilising braces that relies on a dental technician or the dentist placing the brackets is asking for trouble. It is the short cut to inaccurate bracket placement and signi ficant inconsistencies in treatment. Failure to precisely locate  brackets requires the dentist to undertake revisions to correct the earlier mistakes, and this, in turn, means more chair time, longer treatment time for the patient and, more often than not, patient outcomes that are less than ideal.

7. Cost  We are all aware that one of the barriers to conventional orthodontic treatment for patients is cost. SmileFast’s aim is to keep the cost at an affordable level but still maintain the highest quality. Many competing systems use cheap, poorquality composite/plastic brackets which discolour, break and are very ineffective in orthodontic movement. SmileFast uses high-quality, clear porcelain brackets and aesthetic toothcoloured orthodontic arch wires to provide a discreet aesthetic appearance.  With the digital technology of indirect  bonding and the systems taught in the SmileFast approach, total chair time for a case is approximately fi ve to six hours,  with most of this able to be delegated to dental hygienists/therapists. As such, many dentists are charging patients approximately $5,000 for SmileFast treatment and still maintaining an excellent rate of close to $1,000 per hour.  With regard to the over all cost , once  yo u co mp ar e th is to no rm al hi gh end dentistry, i.e., crown and bridge  work, most dentists would be charging approximately $1,500 to $2,000 for a crown. Typically, 25 per cent of the total fee charged to the patient is the laboratory fee (somewhere between $400 and $500). This provides a reasonable guideline for short-term orthodontics. 54

Therefore, assuming you will be charging a patient approximately $6,000 for a case, then a $1,500 lab fee (which would include the digital set-up, indirect bonding trays  with brackets, a selection of arch wires, elastics, ligatures and other miscellaneous products required for that particular case, as well as retainers) would be appropriate for the return that you would expect for this type of high-end treatment.

 Acknowledgment  In Part 2 of this series on the Inman aligner, Dr. Mahony would like to thank  Dr. Tif Qureshi for his contribution and case presentation within this article. Originally published in Australasian Dental  Practice, Vol 26 No 1, JanFeb 2015. Reprinted with permission. DA

 About the Authors 8. Scope and indications Many short-term orthodontic treatment systems only correct the alignment of anterior teeth, excluding rotation of premolars. With the SmileFast technique, the aim is to correct posterior rotations,  because this can create significant space to accommodate crowded anterior teeth. The SmileFast approach is proven to  be ver y eff ici ent and eff ective in the extrusion, intrusion and tipping of teeth, as well as some minor translatory movement. The key to efficient tooth movement is the use of light orthodontic forces, in conjunction with excellent  bracket placement, to achieve the desired tooth movement. SmileFast utilises light forces with exceptionally accurate bracket placement through the digital indirect  bonding approach.

The SmileFast future SmileFast is in the process of developing a programme for lingual orthodontics and  will be releasing several different aligner options in 2015 – including the Magic  Aligner (which combines aligners with  brack ets) and als o a uni que aligner finishing system that is incorporated with the initial digital set-up. It is believed that the aligner finishing system will reduce treatment time in fixed braces significantly and this will be an even more powerful tool for adults to undergo shortterm cosmetic alignment. In addition, 2015 will also see the  beginning of one-on-one, orthodontistsupervised patient treatments. Dentists  wi ll br in g th ei r Sm il eF as t pa ti en ts to a venue and have their treatment supervised by a Specialist Orthodontist to help develop their technique and clinical procedures. Dentists can learn the correct and most efficient way to treat their patients to achieve the highest quality results in the shortest period of time.

Dr. Geoffrey H a l l is a Spec iali st Orthodontist  b a s e d i n Melbourne,  Vi ct or ia and inventor of the SmileFast co sm et ic orthodontic system. Dr. Hall graduated from the University of Melbourne in 1983 and subsequently completed post-graduate studies in orthodontics at the University of Pennsylvania, and has been on the teaching staff of both universities. Dr. Hall lectures to dental professionals nationally and internationally and has  written numerous articles and, more recently, was a co-author for a book on lingual orthodontics. Dr. Derek Mahony i s a Diplomate o f t h e International Boa rd o f Orthodontics and Visiting Faculty at the City of London Dental School. Dr. Mahony is a Specialist Orthodontist  wh o ha s sp ok en to th ou sa nd s of practitioners about the benefits of interceptive orthodontic treatment. He has been actively involved in research that links to constricted maxillary arch forms to nasal breathing problems, adverse facial growth and systemic health problems such as nocturnal enuresis. As a practicing clinician, his research interests include the aetiology of malocclusion and the guidance of facial growth.

DENTAL ASIA  J ULY / AUGUST 2015

USER REPORT

 A

19-year-old female patient presented to the university outpatient clinic requesting treatment of the whitish spots on her teeth, which she found aesthetically disturbing. According to her, the spots had already been  visible since her adult teeth erupted. For this reason, composite fillings had already been placed alio loco on the anterior incisors (Figure 1).

Examination

 After a visual-tactile examination, the discolourations were diagnosed as dental  fluorosis. Whitish opaque discolourations of the tooth enamel, which could be  brownish opaque in severe forms, are characteristic of dental fluorosis cases. These discolourations are mostly located outside the traditional caries predilection sites. The whitish changes often affect several teeth and are poorly de fined. They are more clearly visible when the teeth are dried, and are accentuated on the perikymata. Also characteristic is the so-called “ sn o w c a p p i n g ” , a whitish discolouration of the incisal third of the teeth (Figure 2).

Fig. 1

Treatment planning  Various therapy options were discussed with the patient, including bleaching, resin infiltration, microabrasion, and composite restorations. The associated necessity for tooth structure removal, predictability of the aesthetic result, long-term prognosis, and costs were weighed against each other.  l t r a t i o n due to the relatively low tooth structure The patient opted for r esi n i n  fi  removal, good predictability and manageable costs. Fig. 2

 y  b s i s o r o u l F  f o g n i k s a M  n o   i  t a r   t  l  �   n I   n Re s i

 n Pa r is e bas t ia

 b y P ro f . S

Fig. 3

Fig. 4

Procedure For a better estimate of the aesthetic result, the most severely affected tooth (#13) was treated first. In the present case, there  was no isolati on with rubber dam because desiccation and protection of the soft tissue could be guaranteed by an adequate distance from the gingiva. After cleaning with prophylaxis paste, the affected vestibular area was initially conditioned for two minutes with 15 per cent hydrochloric acid gel (Icon-Etch, DMG) (Figure 3). DENTAL ASIA  J ULY / AUGUST 2015

 At this juncture, the more heavily mineralised surface layer was removed. This shows fewer pores as a result of the mineralisation process than the lesion underneath and would thus prevent the infiltrant from penetrating. After two minutes, the etching gel was sprayed off with water and the lesion was carefully dried (Figure 4). To achieve further deep drying and, at the same time, check  whether suf ficient abrasion of the surface layer was achieved, ethanol (Icon-Dry) was subsequently applied to the lesion. Due to penetration of the ethanol into the lesion’s porosities similar to the later infiltration with resin, light refraction within the caries  was reduced, making the lesion appear less whitish-opaque. Once this effect can be observed in the first two to fi ve seconds after ethanol application, the surface layer is suf ficiently abraded to guarantee quick and complete in filtration (Figures 5 to 7). If the colour change is slower, this most often indicates that the surface layer has not been eroded completely. In this case, the lesion should be etched again. In the present case, the lesion was etched again for two minutes. Subsequently, the etching gel was sprayed off, the lesion was dried  with compressed air, and ethanol was applied once again (Figure 8).  At this juncture, an instant (< two seconds) disappearance of the

55

USER REPORT

Fig. 5 to 9

lesion’s opacity could now be observed, which indicates adequate removal of the surface layer. In preparation for the subsequent infiltration, the ethanol was vapourised with compressed air and the lesion was consequently dried thoroughly (Figure 9). The infiltrant (Icon-In filtrant, DMG) was applied in the subsequent step (Figure 10). It could also be observed here how the resin penetrated the lesion and adapted its colour to the surrounding tooth enamel (Figures 11 and 12). Even though the lesion was fully masked after a few seconds (Figure 13), the excess resin was only removed from the lesion surface with a foam pellet after three

Fig. 10 to 14

Fig. 15

minutes (Figure 14). The resin then underwent light-curing for 40 seconds (Figure 15). To compensate for the in filtrant’s polymerisation shrinkage, the resin was re-applied and cured again after one minute. Thanks to the etching of the enamel and the oxygen inhibition of the polymerisation of the resin surface layers, a thin, raw and unpolymerised resin layer remains on the enamel surface. This should be removed by polishing.

Fig. 16 and 17

Final results In the current case, polishing was carried out with polishing disks (Sof-Lex, 3M Espe). The final result on tooth #13 was very satisfactory immediately after the treatment (Figure 16). The remaining teeth (#s 12 to 23) were subsequently treated as described above and showed complete masking of the fluorosis i m m ed i a t e l y a f t er    treatment was finished (Figure 17). DA

DENTAL ASIA  J ULY / AUGUST 2015

 About the Author Prof. Sebastian Paris

obtained his dentistry degree in 2003. He passed his doctorate thesis (Promotion) in 2005. From 2004 to 2008, he was a lecturer and instructor of undergraduate students at the Department of Operative Dentistry and Periodontology, Charité, Berlin. From 2008 to 2 013, he became a lecturer and associate professor at the Clinic for Operative Dentistry and Periodontology, University of Kiel, Germany, where he passed his Ph.D. thesis (Habilitation) in 2011. He has been the Head of the Department of Operative and Preventive Dentistry at Charité, Berlin since June 2013. Prof. Paris’ main scienti fic contributions have been  within the field of cariology. In particular, he worked on the infiltration of enamel caries lesions with lightcuring resins, a novel micro-invasive technique that might be an alternative way to arrest caries lesions. He has authored and co-authored more than 65 original papers, 20 review articles and 80 scienti fic abstracts. He has received the Oral-B Prophylaxis  Award, IADR-Wil liam Gies Award, IADR-Lion  Award and IADR-Basil Bibby Award for his works.

57

USER REPORT

Digital Impression: The Final Frontier for Full Digital Integration in Restorative Dentistry?  by Bruce Lee, BDS

R 

estorative cases with compromised aesthetics and function require the clinician to gather detailed data from clinical examination, digital radiography, clinical photography or  videography. Together with diagnostic  wax-ups on mount ed mod els, thes e are essential to fully diagnose and provide clarity on treatment needs and sequencing, as well as the expected treatment outcomes for the patient. There has been an increased level of interest from dentists about the use of digital smile analysis and design. However, the complete integration of the digital work flow in restorative dentistry – from diagnostic wax-up to fabrication of provisionals (prototypes), and digital impression taking to the fabrication of final restorations via CAD/CAM – may not be so easily and fully established. This is due to multiple cross-platform (both software and hardware) connections in the integration process. The following case report is presented to ‘connect the dots’ to achieve predictable and excellent aesthetic and functional outcomes for the patient.

restorative work done on her upper jaw more than eight years ago but has been unhappy  with the results. One of the reasons for her unhappiness is that she did not like the colour of her upper crowns, saying that they were too ‘yellow’ and ‘patchy’ with too much characterisation. She also claimed that she had a diastema between her central incisors, which she liked and wanted to maintain but her dentist then insisted that she looked better with the space closed. She reported that, recently, she has developed acute sensitivity in her lower front teeth, as well as ‘ fatigueness’ and ‘ache’ in her jaws,  which compelled her to wear a night guard (Figures 1A to 1D). Fig. 1B. Worn, aceted labial and incisal edges o the lower anterior teeth (lef). Occlusal views (right, top and bottom).

Fig. 1C. Lip positions at rest and ull smile.

Examination and data collection Fig. 1A. Retracted view revealing upper �xed restorations and a deep incisal relationship (overbite).

Patient presentation The patient is a 63-year-old female  who presented to our centre requesting for a solution to her aesthetic and jaw pain concerns. She has had extensive

58

Fig. 1D. Orthopantomogram.

 A de tailed ex ami nation re vealed an ‘over-closed ’ inter-arch situation. As a result of the deep overbite, the patient exhibited excessive wear on the labial and incisal edges of the lower incisors,  which was a result of her bruxism. This  was made worse as they grind against upper full porcelain restorations, hence the development of her jaw ‘aches’ or  ‘fatigue’, as she described. DENTAL ASIA  J ULY / AUGUST 2015

USER REPORT

 As the fixed restorations on her upper jaw were still in very good condition, we advised the patient against proceeding with any major treatment for now – and to just manage her lower jaw to relieve her excessive wear and aesthetic issues. Finally, the patient also requested that she be completely treated within two months – in time for her son’s wedding – which made the situation all the more challenging.

Diagnostics and treatment plan  With the study models mounted, it was transferred to the laboratory for scanning and mounting in a virtual articulator. In order to relieve the deep incisal relationship, the decision was to raise the bite by 3mm. With this increased occlusal vertical dimension, the diagnostic wax-up was digitally completed (Figure 2).

Fig. 2. Mounted models were sent to the laboratory or scanning. A virtual “wax-up” was done at the raised occlusal level. Milled PMMA provisionals on mounted models.

The prototype provisionals The digital diagnostic wax-up was assessed and approved. A set of prototype provisionals based on the digital wax-ups was fabricated, which were milled from a single PMMA (polymethyl methacrylate) block. For aesthetic and functional try-in, these were bonded directly on the patient’s dentition with no adjustments or tooth preparation. She was allowed to ‘road test’ these provisionals for two  weeks (Figures 2 and 3).

Fig. 3. Milled PMMA provisionals. Tese were milled as splinted units in three segments and bonded onto the teeth with no preparation.

 After two weeks, the patient revealed that she was happy with the increased height of her lower dentition. She also reported relief from her jaw discomfort. DENTAL ASIA  J ULY / AUGUST 2015

Thereafter, the plan was to convert to the final restorations in segments, to allow the patient more time to adjust in this new bite position with minimal changes and to shorten treatment times during each session.

Final treatment plan To achieve the plan from the diagnostics, a possible economically prudent solution was minimally invasive tooth preparations. We have decided to bond onlays over the existing implant crowns instead of redoing the entire implant abutments and crowns. Listed below are the materials selected for the final restorations. Treatment  was carried out in the sequence below: 1. Lower right side (Stage 1) Tooth #47 and implant #46 – ● Onlay preparations only. ● Teeth #45 and #44 – Onlay preparations with labial  veneer reduction. ● All restorations were milled from resin nano ceramic (hybrid resin/ceramic)  blocks. 2. Lower left side (Stage 2) Implants #37 and #36 – ● Splinted onlay preparations only. Teeth #35 and #34 – Onlay ● preparations with labial  veneer reduction. For splinted onlays to restore ● splinted implant crowns #37 and #36, zirconia onlay was the restorative material of choice; whereas for #35 and #34, resin nano ceramic (hybrid resin/ceramic)  blocks were used. 3. Lower anterior (Final stage) Lower anteriors #33 to #43 ●  were prepared minimally to receive porcelain laminate  veneers milled from lithium disilicate blocks.

Pre-preparation scanning and tooth preparation Prior to preparation, a pre-preparation   scan was made using the 3 Sh a p e T r i o s ®  intraoral scanner (Figure 4). The aim was

59

USER REPORT

to capture the provisionals that have been in function. This will greatly facilitate the design of the individual final restorations in terms of occlusal morphology and pattern. Tooth preparations were done using the bonded provisionals as reduction guides. Double cord technique was used to prepare for impression taking (Figure 5). Once each segment was prepared, a digital impression of the preparations was taken, as well as a digital bite registration. The case was then sent to the laboratory for design and fabrication.

Laboratory design and fabrication Upon receipt of the case, the technician used the 3 Sh a p e D en t a l Sy s t e m s ™ to design the individual prostheses. This was done by marking out the margins and virtually waxing up the morphology of the individual teeth, with reference to the pre-preparation scans and the teeth library in the software. 3D models were also printed to finalise the occlusion and fit (Figure 7A).

Fig. 4. Pre-preparation scan using the 3Shape Trios®  intraoral scanner was done to capture the bonded prototype provisionals, which has been in unction.

Fit and bond The individual prostheses were adhesively bonded in segments (Figure 7C). Even the zirconia splinted onlays were primed with zirconia primers before bonding to the implant crowns.  After completion of each segment, the patient was allowed to function on them for a week before returning to continue with the next segment.

Fig. 6C. Digital impression o the lower anterior segment. Note the minimal and conservative preparations. Fig. 5. Minimal preparations o the lower anterior teeth. reatment was carried out in segments.

Fig. 6D. Digital bite registration. Fig. 6A. Digital impression o the lower right side. Impressions are taken in ull colour but may be viewed in ‘ stone’ colour as an alternative way to view and clearly identiy the margins.

Fig. 6B. Digital impression o the lower lef side. Note the splinted implant crowns on ooth #36 and #37.

60

Fig. 7A. 3D printed models with individual dies that can be removed.

DENTAL ASIA  J ULY / AUGUST 2015

USER REPORT

Fig. 8A. Completed treatment afer seven weeks – afer �nal bonding o the anterior veneers.

Fig. 7B. Individual prostheses �tted on the 3D printed models to check �t and occlusion.

Fig. 7C. Individual prostheses were adhesively bonded in segments.

Conclusion  With the treatment carried out in stages, the entire treatment (including the prototype provisionals) was completed in seven weeks. The patient was happy with the aesthetic results. She has also settled comfortably into her new increased vertical dimension,  which provided relief from her jaw pains (Figure 8).  We have successfully applied a completely digital work flow to restore this complex case within a short period of time.  Digital intra-oral scanning (with the 3Shape Trios® intraoral scanner) proved to be the v i t a l fi n a l l i n k b e t w een t h e c l i n i c i a n a n d t h e la b o r a t o r y  . The digital process enabled us to reduce downtime, increase ef ficiency and, at the same time, maintain and improve precision in the prostheses  we deliver to our patients.

Fig. 8B. Completed treatment.

 Acknowledgments Special thanks to Mr. Yuki Fujimori and Mr. Nicholas Ng of Creative Dental  Studio* for the digital design and ceramic  work. DA

*Creative Dental Studio, with a team of international craftspeople, is a boutique provider of dental restorations and aesthetic prostheses.

 About the Author Dr. Bruce Lee completed his BDS degree at the National University of Singapore (NUS) in 1997,  where he was awarded the prestigious Drs. Tay & Partners Gold Medal for his outstanding academic and clinical performance. He also earned the “Best All-Round” Final Year Student in the Faculty of Dentistry. Dr. Lee is the Clinical Director and Course Director at the T32 Dental Centre and T32 Dental Academy in Singapore, respectively. He has conducted lectures and hands-on training courses locally and internationally. He also serves as Adjunct Lecturer at the NUS Department of Restorative Dentistry. Since 2008, Dr. Lee has been serving as Chairman of the Singapore Academy of Oral Rehabilitation and Implantology (SAORI) – a study club where local and international dentists come together to share and learn from each other. Dr. Lee has special interests in aesthetic, implant aesthetic, and digital dentistry. He is the Past President and Founding Member of the Aesthetic Dentistry Society of Singapore (ADSS). He is also an appointed key opinion leader for Singapore for Bisco, Kerr, Straumann and Dentsply.

DENTAL ASIA  J ULY / AUGUST 2015

61

USER REPORT

®

Charisma  Classic Shows Excellent Colour Match due to its Microglass® II Filler Technology Convincing results in a comparative study on composite materials for Heraeus Kulzer product

C

olour match is one of the main criteria to decide on a satisfying aesthetic appearance in dental restorations. In addition, it is one of the few parameters that patients are able to assess. As a result, the dentist’s  work has to meet a high demand. The colour of the restoration needs to match the surrounding teeth perfectly – a requirement that is still considered challenging by many dentists.

Charisma® Classic from Heraeus Kulzer, the very first composite to offer the second generation of Microglass ® II filler technology, facilitates this task. All refractive indices of the matrix and filler system have been optimally aligned, which ensures an excellent shade match with high reliability and little effort. In short, dentists find a universal composite that is ideal for easy singleshade layering techniques and provides restorations with an Source: Prof. Marcelo Giannini, Unicamp FOP, Priacicaba, Brazil. est report 2014. Unpublished data. Data on �le. Te study was abbreviated and summarised. All diagrams and titles have been established by Heraeus Kulzer.

62

DENTAL ASIA  J ULY / AUGUST 2015

USER REPORT

intrinsic shade brilliance and easy colour adaptation due to the Microglass® II effect. In a recently performed study, Charisma®  Classic restorations gave proof of excellent colour match compared to various competitor materials. 1 The comparative study, performed by Prof. Giannini and his team at the Unicamp FOP in Priacicaba, Brazil, aimed at evaluating the aesthetic perception, measured in mean colour match, of nine different composite materials in Class III cavities when using single-shade layering techniques. Denture teeth in shade A3 were used to simulate the tooth and a standardised Class III cavity was prepared into each specimen. Subsequently, the denture teeth were filled randomly with A3 shades of the reviewed composites in a single-shade layering technique. The 15 evaluating dental experts had to assess the colour match of the restorations under standard light conditions in a  blinded test. They rated zero for the best colour match and ten for the highest mismatch. For the statistical analysis of the colour match between the composites, the Kruksal  Wallis and Dunn test was used (p<0.05).

The study results report an excellent colour match of Charisma® Classic. This conclusion also con firms results from a field test performed among dentists from different European countries. The colour match then received good and very good ratings – nine out of ten participants would recommend the Charisma ® Classic composite to their colleagues.

The distinguished colour match is attributed to the Microglass® II effect. Composites with a conventional matrix and filler technology usually show less colour adaptation and a milky appearance due to different refractive indices. This makes good colour adaptation and a natural look that is often dif ficult to achieve. Charisma®  Classic contains approximately 61 per cent filler by volume with Barium Aluminium Fluoride glass and does not need any pyrogenic SiO2 anymore. Due to the Microglass® II filler technology, Charisma ®  Classic offers an intrinsic shade brilliance and increased colour adaptation of up to 56 per cent compared to its antecessor, Charisma.2 DA References 1.

Giannini M: Test report 2014, Unicamp FOP, Priacicaba, Brazil,

2.

2014. Unpublished data. Data on file. Giannini M: Test report 2013, Unicamp FOP, Priacicaba, Brazil, 2013. Unpublished data. Data on file.

BEHIND THE SCENES

T

he Basic quattro IS was designed for high precision microblasting. A professional and comfortable microblaster with two to four tanks, it delivers controlled and economical exact sandblasting of delicate objects, thanks to the integrated “ I S ” I m m e d i a t e St o p   technology,  which triggers/halts blasting within seconds. The blasting pressure can be adjusted individually to each tank via the internally mounted pressure regulators and metered via the gauges mounted on each tank lid. It provides for precise  working, process reliability and the most cost-ef ficient  blasting, thanks to the IS feature and the unique mixing chamber technology.

The Basic quattro IS experience

 o I S  a t t r  u  q   i c  B a s

There’s Sandblasting...

 And Then There’s Sandblasting!  by Mr. Rainer Semsch

Implant abutment  prior  to sandblasting treatment

Implant abutment afer  sandblasting treatment

A dental technician can recognise very well that only the retaining areas have been sandblasted while the areas that are relevant for accuracy of �t remained untouched and unaffected.

64

For 15 years, I worked with two ageing, 20-year-old sandblasters from a quality German manufacturer in my laboratory. Each of them had two tanks for the appropriate abrasive. We had to replace the tungsten carbide nozzles once in a while, renew the odd leaking pressure hose and the viewing panel again and again – and that’s all we ever did. There was no need to change anything.  At first, I was not enticed at all by Renfert’s offer to try out the Basic quattro IS. The time and effort required for installing it and what it should do other than sandblasting – if one were to try out everything, there would be no time for working. Nevertheless, I still had the Basic quattro IS installed. The initial reaction is that “ the glass pane was missing ”,  yet this is not true. The viewing panel is really fantastic: giant-sized and crystal clear. At second glance, I realised that it’s not the pane alone that is so great – after all, a brand new pane ought to be crystal clear – it is the pane together  with the illumination. To put it better, you can actually see things and it even stays that way after six months of use. The glass remains crystal clear and the excellent diode illumination has not faded. The blasting chamber side of the glass pane is coated with a thin layer of silicone, which is apparently not affected by the abrasive, and this is simply ingenious. Once in a while, you just need to carefully wipe the pane moist, dry it – that’s it. Many new features and canny solutions only became apparent one at a time. For instance, the working pressure for each of the large-sized abrasive tanks can be selected separately. Blasting is only triggered once the desired air pressure has built up in the tank, and it stops immediately  when the footswitch is released (IS = Immediate Stop). This saves time, abrasive and money, as well as promotes precise working. The dust extractor uses a wide diameter duct, which removes dust reliably yet without creating a powerful and disturbing jet of air. This “ fl ow effect ” is supported  by an air inlet membrane located opposite the extractor,  which ensures that the influx of air “carries off” the dust effectively – and this is another ingenious feature. “Odds and ends” such as the air blower in the blasting chamber go almost unnoticed.

DENTAL ASIA  J ULY / AUGUST 2015

BEHIND THE SCENES

 Actual sandblasting Renfert’s Basic quattro IS improved the actual sandblasting process. Even at a pressure of 0.5 bar (and lower), precise  blasting is possible. The abrasive strokes the object without choking up, spluttering or clogging to conjure up a uniform surface structure. At a blasting pressure of 6 bar, there’s no more stroking, the microblaster develops enormous power and, together with aggressive 250 μm “Cobra” aluminium oxide, things really get going. The “ edge de finition” of the sandblasted surface can be adjusted depending on the distance between the nozzle and object.

Conclusion  Without having to exaggerate, I can say that I am totally convinced of the Basic quattro IS sandblaster. I can now  work faster, more precisely and relaxed – stock-taking will tell how much less abrasive has passed thru the nozzles. And there is no way that my “old” sandblasters  will be put back on the bench.

Basic microblasters in general: Simplifying everyday routines P r e c i s i o n sandblasting is difficult where not all fine details can  b e r e c o g n i s e d easily. But with LED innovation , PerfectView stands for the perfect balance between diffused and focused light. There is homogeneous conditioning of surfaces, which is important for bonding porcelain and acrylic  veneers securely. This requires a uniform sandblasting jet and pressure to ensure that the restoration lasts longer. It allows for meeting your work plan through focused sandblasting with the special geometrical design of the nozzle that provides for accuracy. This ensures that only the required areas are sandblasted. The extensive field of view through the large glass panel guarantees that the entire interior of the blasting chamber can be used for sandblasting, allowing you to work safely.

 About the Author Mr. Rainer Semsch

is a Master D e n t a l Technician, laboratory owner and c o u r s e lecturer.  A f t e r graduating in high school in 1979, Mr. Semsch  became a dental technician apprentice in Heilbronn and eventually studied ceramic layering techniques in different laboratories in Freiburg. He took his Master’s exam in Stuttgart in 1985 and became an independent Master Dental Technician in Freiburg in 1992. In 2005, he moved his lab to Münstertal/Black Forest. He has been a DGÄZ member (German Society for  Aesthetic Dentistry) since 2007.

DENTAL ASIA  J ULY / AUGUST 2015

Mixing chamber technology  The unique mixing chamber provides an optimal air/abrasive mixture for the most ef ficient blasting process, assuring that very little blasting media goes to waste. This system is further enhanced when coupled with the “ immediate stop” or “ IS ” feature of the quattro IS, reducing sandblasting costs by up to 80 per cent.* *Proven at the Technical College, Osnabrück, Germany, Faculty of Engineering and  Informatics, Dental Centre

The silicone-coated pane in the Basic microblasters (except the Basic eco) ensures users a crystal clear view for an above-average period of time. The unique IT nozzles are more economical than conventional tips since they last four times longer. DA

65

DO YOU KNOW  IVOCLAR VIVADENT

 A Ceramic Furnace that Leaves Nothing to be Desired The new Programat P710 ceramic furnace incorporates a digital shade analyser and telephone functionality.

P

acked with innovative features, the new Programat P710 can do more than just fire. The innovations include a Digital Shade Assistant (DSA) for accurate shade selection, telephone capabilities and infrared technology for enhanced process reliability.

Digital Shade Assistant (DSA) The patented Digital Shade Assistant (DSA) enables users to determine the exact tooth shade in a snap. The user pre-selects the three closest shades and takes a photograph of the teeth and the selected shades. This information is transferred to the furnace via SD card,  WLAN or USB flash drive. On the furnace, the user selects the shade analysis mode to import the photographs and start digital shade selection. In addition to the shade, the brightness and saturation  val ues (L- , A- and B-v alu es) can be determined. The software compares the shade of the tooth to be analysed with the three pre-selected tooth samples from the shade guide. Special image processing software automatically recognises which tooth to analyse and displays the best shade match. The software also allows users to manually select speci fic aspects of the tooth for shade analysis. No further appliances are required.

Telephone functionality  The new ceramic furnace comes with integrated telephone capabilities. This allows users to discuss individual patient cases with the clinician directly at the furnace at any time, without having to change workstations. Both hands stay

66

P ro    g    ra    ma    t  P 71  0 

free to carry on working. The user’s mobile phone conne cts to the furnace via Bluetooth  wireless technology and transfers the user’s contact list to the furnace screen. A built-in hands-free system and a microphone ensure a high level of call quality.

Infrared technology  The integrated infrared technology represents another milestone achievement in the design of dental furnaces. The use of infrared technology heightens the process reliability and overall speed of the process. This increases the cost-effectiveness of the furnace and offers users a twofold advantage: The firing process can be completed up to 20 per cent quicker and the quality of the fired objects is superior compared to the results achieved with conventional ceramic furnaces. Cleverly devised software uses a thermographic camera to calculate the most suitable pre-drying and closing parameters for each firing cycle. Sensor controlled measurements ensure that the furnace recognises at which point the objects have been optimally pre-dried. Potential fluctuations in quality resulting from the individual adjustment of firing programmes are therefore eliminated.

Ease of operation In addition to several new features, the Programat P710 offers a high level of user-friendliness. The furnace is easy to operate by means of a large, swivelling, colour touch screen. The most important functions, however, are selected on the proven membrane-sealed keypad.

Proven portfolio The firing and press furnaces from Ivoclar Vivadent are based on long-standing success. The company has been designing high-quality dental furnaces for discerning customers for many decades. DA Programat® is a registered trademark of Ivoclar Vivadent AG.

DENTAL ASIA  J ULY / AUGUST 2015

DO YOU KNOW  SIRONA 

SIROLaser Surgical Precision in The light visible to humans comprises the seven colours of the rainbow. Starting with short-wavelength violet light, the spectrum ends in the long-wave red colour range. In dentistry,  blue laser light provides the greatest precision for surgery – as demonstrated by the new SIROLaser Blue.

Fig. 2

Fig. 1

T

he cutting and disinfecting power of a laser depends on the amount of energy absorbed by the tissue. The new SIROLaser Blue emits a blue light at a wavelength of 445 nanometers (nm). The light energy is absorbed particularly well by haemoglobin and melanin. Consequently, the blue laser beam achieves around 100 times better absorption than infrared light. This enables a very fast, precise and painless cutting. The results are impressive. Users of the conventional infrared diode lasers (810nm, 940nm and 970nm) have to move the optical fi ber slowly over the tissue several times, but the SIROLaser Blue enables immediate coupling with the tissue and considerably faster and cleaner cutting –  without even touching the tissue – making this laser the tool of choice whenever dentists want to make an incision without bleeding during treatment. The SIROLaser Blue is easy to operate and enables the dentist to treat patients  with very little pain, reducing the need for local anaesthetics or even dispensing  with them entirely. Gentle surgery, which often does not require post-operative stitches, reduces wound pain and scar formation. Post-operative bleeding and swelling are also avoided.

DENTAL ASIA  J ULY / AUGUST 2015

Fig. 1: Te excellent absorption in tissue pre-destines the SIROLaser Blue or sof tissue surgery. Equipped with two additional laser diodes, the laser is also well-suited or applications in endodontics and periodontics. Fig. 2: Te blue light o the SIROLaser Blue is readily absorbed by the tissue, thus enabling precise, painless cutting.

Three wavelengths make SIROLaser Blue the all-rounder Blue laser light is used particularly in soft tissue surgery because of its better absorption properties. Since the SIROLaser Blue can be operated at two additional wavelengths like the SIROLaser Advance and SIROLaser Xtend, it can also be used with infrared laser light at a wavelength of 970nm, not only for traditional indications in germ reduction (endodontics or periodontics),  but also for teeth whitening and in the treatment of canker sores and herpes.

The SIROLaser Blue is also equipped  with a visible red diode with a wavelength of 660nm, which enables soft laser applications (LLLT, biostimulation). “That’s an important advantage for me,” says Dr. Johannes Heimann, local dentist in Frankfurt/Main (Germany) and consultant for laser dentistry. “As a result, the SIROLaser Blue is universally applicable. All applications for laser dentistry in one unit – I call that an optimal solution.” DA Due to the different approval and registration times, not all  products are immediately available in all countries.

67

DO YOU KNOW  DENTATUS

Classic Surtex® Post Premium dental posts with proven reliability 

T

he Dentatus Classic Surtex®  Posts have been developed in line with the actual anatomy of the tooth, and the shapes of the posts are well accepted and recognised. This has been proven by its global following for over 80 years. Based on research and gathered experience, no other post can present a more thorough and fundamental documentation. The Surtex ®  post shape combines the advantages of both conical/tapered and parallel posts with a conical/tapered apical end and a parallel mid-section. The conical/tapered part follows the configuration of the apical part of the root to avoid dentinal micro-fractures apically, and the parallel part optimises the retention. Moreover, the thread is not intended for threading the post down the dentin wall but for increasing the surface against the surrounding cement. It is the cement that holds the post in the canal. All Dentatus posts are intended for passive use in order to minimise the risk of fractures. The most significant focus is at the surface of the post. Resin-based filling materials are the most common, and they require other retentive properties with the posts. At the same time, new materials have set new aesthetic demands on the posts. The ear li er sh in y metal

posts reflected light, sharply creating high contrast, which could expose a post through the composite. The Surtex® posts have therefore been given a matte surface obtained by sandblasting. A sandblasted post has an increased retentive area and creates a two-fold increase of the mechanical retention compared to a non-treated post. The matte surface also reduces light re flection, which is why the Surtex ® posts are more dif ficult to spot through a translucent resin filling material.

But why stick to a metal post when there are posts available in fi breglass and other aesthetic materials?  We need retention in the teeth for several reasons. Therefore, it is important that there are several methods available to create a functional post-retained restoration, all according to need.  A temporary restoration, which shall only last for a couple of days or weeks, does not require the same strength or aesthetics as an expensive post, which may be needed to carry extensive restorations for a lifetime. There are different reasons why it is not always necessary to use aesthetic tooth-coloured posts, especially in teeth that are not seen (posteriors). Therefore, titanium is a very good alternative in several aspects, i.e., strength and biological properties, not to mention the economical factor. The Surtex® posts are available in several sizes and in a range of materials to suit a wide array of indications and require ments. Since their launch in 1972, the p u r e t i t a n i u m  posts have  been delivering higher levels of strength, biocompatibility and cost-effectiveness. Since 1989, when dif ficult challenges required even greater strength, s t a i n l e s s s t e el   became the obvious alternative. The original g o l d - p l a t e d   posts have been delivering economic  benefits since their launch in 1932, and are also particularly suitable for temporary restorations. Together with Dentatus dedicated reamers, the Surtex ® posts form a state-of-the-art system for post retention in endodontically treated root canals. DA  With the Surtex surface treatment, Dentatus has created a retentive post that stands up very well to and ful fils the requirements set on a first-class modern post. Surtex ® posts retain both the original and reliable Classic shape, double the retention and create better aesthetics – all in one post.

68

DENTAL ASIA  J ULY / AUGUST 2015

PRODUCT HIGHLIGHTS  Amann Girrbach  Amann Girrbach introduces “Ceramill TI Forms” – titanium abutment blanks with pre-fabricated connection geometry for in-house processing. Ceramill TI Forms are available for a wide range of implant systems and can be used for fabricating customised, one-piece titanium abutments  with outstanding surface quality in-house using the Ceramill Motion 2 (5X).

Fabricate Customised Titanium Abutments In-House  An id ea l ap pr oa ch to pr ov id in g bo th high standards and reasonable costs is the fabrication of customised titanium abutments in-house in the laboratory. What  was previously only possible via industrial processing centres and large milling systems is now made possible by Amann Girrbach in the familiar high-quality using the Ceramill Motion 2 (5X) and “ rotational milling” technology.

In contrast to conventional milling in which the blank mainly remains in a static position during so-called “multipass milling” in the  wet mode, the blank rotates continuously around its own axis. This not only reduces the travel paths of the cutter but also provides for uniformly homogeneous material removal and surfaces with both a precise and smooth finish. The user bene fits  with full value creation from an increase in

precision and savings in time. Only a special adapter available from Amann Girrbach is required to upgrade already installed Ceramill Motion 2 (5X) machines.  Amann Girrbach has developed a hybrid dental CNC system with the Ceramill Motion 2, which combines milling and grinding technology in the wet and dry mode. This enables dental and practice laboratories to cover an extremely wide range of digital framework fabrication. The attractive price positioning coupled with the wide range of indications, including the dry millable sinter metal Ceramill Sintron, enables every laboratory, regardless of size and orientation, to amortise the system in minimum time. While the four-axis entry-level model of the Ceramill Motion 2 (4X) suits all users who do not require all the degrees of freedom of the tool, the additional axis of the 5X version creates additional mobility, which is particularly bene ficial with future or special ranges of indications (model milling, full-denture prosthetics, occlusally screw-retained bridges, splints etc.).

Coltene Practitioners the world over are sold on the innovative, ef ficient, new-generation  bulk composite. Conventional light-curing  bu lk -f il li ng ma te ri al s ar e li mi te d to 4mm to 5mm filling depth and often require a separate composite covering layer. Studies have also shown that many dentists are uncertain whether a conventional bulk-filling really cures through to the cavity floor. Now, Coltene is offering a reliable solution that avoids the disadvantages of light-curing treatment methods: the dual-cure bulk composite Fill-Up!

Fill-Up!™ – The New Dual Curing Bulk Composite  blends in very well with the existing colour environment. The Automix syringe enables easy and ef ficient application.

Two that work together perfectly 

Guaranteed curing – Even for the deepest cavities No matter what the filling depth is – thanks to the light and chemical polymerisation properties of Fill-Up! – the material cures reliably. In addition, the shrinkage stress during the chemical polymerisation is substantially milder, which improves the quality of the marginal seal.

Fast results that impress  Wit h Fil l-U p! sin gle lay er tec hno log y,

 70

even the largest cavities can be filled quickly and easily. This makes it a true bulk-fill material. The filling can be finished immediately after being applied, since it takes only fi ve seconds to cure  with light (1600 mW/cm3). Due to the solid mechanical properties, suf ficient colour, and good polishability of the material, no covering layer is necessary. The Fill-Up! Universal shade (Vita™ A2 to A3)

Fill-Up! and the multi-award-winning ParaBond adhesive system are perfectly matched. ParaBond accelerates polymerisationspecifically in the contact area  between the tooth and the filling material,  which significantly improves the marginal seal. Study results from the University of Geneva confirm the best marginal sealing  values. This avoids potential secondary cavities and lays the foundation for a reliable long-term restoration. F i l l - U p ! ™ i n a s i n g l e st e p t o g i v e a p e r f e c t r e su l t .

DENTAL ASIA  J ULY / AUGUST 2015

DenMat

Geristore®: The “Swiss Army Knife of Dentistry” Multi-use hybrid with unsurpassed biocompatibility,  bond strength, and versatility  The physical properties of this unique and extremely  bio com pat ibl e resto rat ive make it the ide al mat eri al for countless procedures that users will encounter in the practice. Geristore’s dual-cure, hydrophilic Bis-GMA formulation makes it the product of choice for subgingival lesions and restorations involving soft tissue due to its histological biocompatibility, adherence to dentin and cementum, release of fluoride, low coefficient of thermal expansion, and low polymerisation shrinkage. A clinical evaluation of Geristore as a restorative material for root caries and cervical erosions showed it to be an acceptable material with 100 per cent Alpha rating for retenti on, surface texture, and post-operative sensitivity. The auto-mix delivery system, with intra-oral tips, makes dispensing and placement fast and easy.

 Applications • • • • • • • • • • •

Class V restorations Cavity lining and base material Base material for cervical abrasion and erosion lesions Small Class I and Class II restorations Root caries lesions Cement for metal/PFM restorations Pulp capping for mechanical pulp exposure Restoring deciduous teeth Restoring and sealing overdenture abutments Subgingival restorative for fractured roots and resorption lesions Retrograde filling and root perforations

Fig. 1: Abfraction lesion. Fig. 2: Restoration successfully and aesthetically completed with Geristore and composite veneered with Virtuoso Flowable clear resin.

Fig. 3: Root resorption. Fig. 4: Root resorption restoration (90 days).

Product features and benefits • •

• • •

• • • •

Hybrid ionomer composite – combines the best properties of both types of materials Self-adhesive – no need for retentive cavity design; saves chair-time and tooth structure; speed can help ensure success with paediatric and geriatric patients Syringe delivery system – easy and simple to dispense Contains fluoride – reduces risk for secondary decay  Bonds to all surfaces including enamel, dentin, cementum, precious and non-precious metal, and old set amalgam – eliminates the need for multiple products Low polymerisation shrinkage and low coef ficient of thermal expansion - excellent marginal integrity  Resistant to marginal leakage and abrasion – longer lasting, durable restorations Biocompatible – years of clinically proven safety, especially subgingivally  Radiopaque – highly distinguishable from tooth structure in radiographs

 VOCO

Clip® Flow: The First Flowable Restorative Material for Temporary Treatments

DENTAL ASIA  J ULY / AUGUST 2015

Clip Flow is a flowable, light-curing material for all types of temporary fillings and treatments including onlay and inlay solutions. It is also suitable for: • relining temporary crowns and bridges; • blocking out before an impression is taken; • covering the gingival margin during in-of fice whitening; fixing resin matrices during placement of a filling; and • • temporary sealing of openings for implant screws, as well as root canal orifices during endodontic procedures. The material in the special NDT syringe can be positioned easily and accurately and flows smoothly into the cavity, achieving good marginal adaptation. Thanks to its rapid light-curing, Clip Flow is able to achieve a suf ficiently elastic consistency to enable particularly good removal of the temporary material in one piece before final placement of the filling, requiring no additional work on the cavity. Clip Flow has good load-bearing capacity and is saliva-proof with tight marginal seals, thus ensuring secure temporary restorations.

 71

Ivoclar Vivadent

Universal and Technique Tolerant  A new single-component, light-cured universal adhesive for direct and indirect restorations is ready to launch

Tetric N-Bond Universal adhesive is suitable for the total-etch technique, as self-etch adhesive and for selective enamel-etch procedures. It features high bonding capabilities to both dry and moist dentin substrates. The universally applicable adhesive establishes a strong bond to restorative and luting composites and is suitable for direct and indirect bonding procedures. As the adhesive is applied in a low film thickness, it does not impair the accuracy of fit of indirect restorations. No dual-cure activator is required for the cementation of indirect restorations.

Compatible with all etching techniques Tetric N-Bond Universal combines hydrophilic and hydrophobic properties. It is tolerant to moisture, penetrates open dentin tubules effectively and seals them reliably. Since Tetric N-Bond Universal is moderately acidic, it is compatible with any etching technique (self-etch, selective enamel-etch, or total-etch) and ensures an optimum bond between the tooth structure and the dental restorative.

Predictable results The new adhesive is technique tolerant and forgiving. It forms a stable and homogeneous layer that is not sensitive to any application technique. Consistently high bond strengths on enamel and dentin are achieved irrespective of the etching protocol employed, using only a single layer of adhesive. The

Te new single-component, light-cured universal adhesive etric N-Bond Universal from Ivoclar Vivadent

acetone-free, hydrophilic solvent contained in Tetric N-Bond Universal ensures optimum wetting of the dentin and enamel, reducing the risk for microleakage and post-operative sensitivi ty. Given the adhesive’s hydrophilic components, “wet-bonding” is no longer an absolute necessity. A high bond strength to the dentin can be achieved even if the dentin is etched with phosphoric acid and has become excessively dry.

Universal delivery form The simple “Click” activation of the VivaPen delivery form allows the exact amount of adhesive material to be dispensed for each procedure. Dispensing of adhesive material into a dish  before the application is not required. Thus, residual material  waste is considerably reduced. The VivaPen contains 2ml of adhesive, which is suf ficient for approximately 190 single-tooth applications. Compared to conventional bottle delivery forms, this amounts to almost three times more applications per millilitre.* VivaPen is also available in a conventional bottle delivery form. *Berndt & Partner, VivaPen Benchmarking Study, October 2014 Tetric® is a registered trademark of Ivoclar Vivadent AG.

Polishing and Crystallisation of Crowns IPS e.max CAD self-glaze offers alternative and efficient processing IPS e.max CAD is the clinically proven lithium disilicate glass-ceramic ideally suitable for manufacturing monolithic restorations featuring a new, alternative and ef ficient processing technique. The restorations are polished with silicone and diamond polishing systems (e.g. OptraFine) and then crystallised. Glazing  becomes unnecessary. IPS e.max CAD self-glaze for polishing and crystallisation of crowns

DENTAL ASIA  J ULY / AUGUST 2015

 IPS e.max ® is a registered trademark of Ivoclar Vivadent AG.

 73

Sirona

The TENEO Treatment Centre: A True Endodontics Expert TENEO, the premium treatment centre from Sirona, offers unrivaled comfort and optimal  workflow support for all treatment procedures. Its numerous integrated functions have now  been expanded to include innovative features – particularly for endodontics. Treatment centres by Sirona are renowned for optimum comfort and maximum treatment efficiency. To enhance treatment  work flows, the TENEO treatment centre includes numerous integrated functions, which normally require additional devices, a foot control or special treatment rooms. Equipped with an array of special features for endodontics and implantology to provide an optimised, ergonomic work flow, the endodontics function includes a comprehensive file library and can accept the addition of an ApexLocator. New options have made TENEO a real endodontic expert: Never before have the reciprocal file systems from VDW (RECIPROC®) and Dentsply Maillefer (WAVEONE ®) been integrated in a treatment centre’s file library. This new function is also displayed in its user interface and can be easily controlled  with the foot control. Another decisive advantage is that it is no longer necessary to spend valuable time setting up and cleaning another tabletop unit. This contributes to an ef ficient, smooth and optimised treatment work flow, which is further enhanced  with a handy, hygienic holder for the ApexLocator right at the dentist element. The new ENDO contra-angle handpiece with LED light can optionally be included, enabling improved visibility of the treatment area and further enhancing operator con fidence.

Fig. 1: Following the incorporation of extensive functions, the ENEO treatment centre has become a specialist centre for endodontics: E xtra devices are no longer necessary. Te �gure shows entry dialog with the integrated ApexLocator.

The classic chair positions can be stored f or individual patients and saved to the electronic patient index card. This means that patients can immediately assume the position optimised for their treatment, as the treatment positions are pre-programmed to suit their requirements precisely. The key to optimum patient positioning from the dentist’s point of view is the headrest. The TENEO headrest can be adjusted not only to the patient’s height – it can also be tilted effortlessly. Patients can relax even during prolonged treatment sessions,  while the headrest supports their head and holds it steadily in the optimum position for treatment access and good visibility.  Due to the different approval and registration times, not all products are immediately available in all countries.

 A highly integrated system The integrated USB interface enables technological innovations of the future to be retro fitted as well, such as additional file libraries and the installation of software updates. Remote diagnostics can also be run to carry out an error analysis should a fault arise. The new support arm system, presented for the first time, is incorporated seamlessly in its overall pro file and directly links several other systems, e.g., besides adapting a 22” HD-monitor SIVISION, it can be used to integrate the HELIODENTPLUS intraoral x-ray tube assembly on the light support column. Moreover, the new support arm system is easy to clean due to its closed, smooth surfaces and fully enclosed wiring.

Fig. 2: Te new support arm system blends in elegantly with the overall appearance of the treatment centre.

Increased comfort – for both patient and operator TENEO offers the best possible conditions for comfort. The chair itself already offers exceptional comfort when reclining, and with the optional lounge upholstery, patients could almost forget that they are in the dentist’s chair.

DENTAL ASIA  J ULY / AUGUST 2015

 75

PRODUCT HIGHLIGHTS

GC GC understands that continuous development of restorative materials is essential to give dental professionals and patients more options to achieve excellent quality fillings with the best aesthetic results while maintaining optimal physical performance. The search for an all-round restorative  wit h outstanding inv isi ble aes the tic s is over. G-ænial is GC’s answer to the increasing demands to highly aesthetic restorations and superior handling in the market today. G-ænial Anterior and Posterior were developed using GC’s extensive expertise and knowledge of dental materials. G-ænial is a user-friendly restorative that is indicated for highly aesthetic single-shade or multi-shade build-ups in all restorative classes. G-ænial’s forward thinking shading concept offers flexibility to help users achieve aesthetically  beautiful restorations. G-ænial contains different interfaces with different optical properties resulting in

The Art of Effortless Beauty

 varied reflection of light. The excellent light scattering ability of G-ænial is related to its extremely diverse structural composition, which results in it mimicking the reflectivity of a natural tooth. G-ænial captures the genius of nature and creates invisibility in restorations. G-ænial gives users the option to choose the best handling characteristics suitable to their needs. G-ænial Anterior allows users to shape, flow and sculpt, while G-ænial Posterior gives a more packable, firmer consistency. G-ænial does not stick

onto the spatula or matrices and provides more working time under ambient light extended to four minutes. G-ænial is a high-strength, low shrinkage stress composite. Both Anterior and Posterior shades can have universal applications (anterior shades can be used in posterior restorations and vice versa). G-ænial Anterior and Posterior deliver age-specific restorations. This restorative material is reliable and clinically proven to provide the best results for patients.

Renfert

die:master ivory and die:master aqua: Two New Die Spacers Perfect support with all-ceramic restorations

d ie  :   m a s  te   r a  qu  a   

The new spacers die:master ivory and die:master aqua, coming in a practical and smart organiser, enable perfect preparation of the stone dies for fabricating all-ceramic restorations. The optimum working underlay can be produced in three steps – hardening and sealing with the die:master duo, spacing with the die:master die spacers and separation with Picosep and the brush included in the set. The two new die spacers offer a coordinated layer thickness of just 10 μm for lithium disilicate, for example, and support the aesthetic colour effect with one of the most common shades (A2/B2 ivory and A1/B1 aqua).

 76

die:master ivory  offers consistent, extremely high steam-proof and scratch resistant surface thanks to a highly cross-linked spacer layer. The dies are permanently protected and the varnish produces the desired increase in size until the restoration is completed. Modern pressable ceramics also involve a change of dimension. die:master aqua, a die: master ivory   water-soluble die spacer, is able to compensate for precisely this effect. The die spacer remains stable during the wax-up but  before the restoration is fitted, it can very easily  b e wa s h e d o f f ag a i n using water and a brush if necessary. This makes it easy to fit the ceramic restoration.

DENTAL ASIA  J ULY / AUGUST 2015

Polydentia

The MyRing Ef�ciency: Save Money and Chair-Time, Keep the Ring and Just Replace the Rubber Ends Historically, dentistry moved from amalgam to composite and from simple matrices to sectional matrix systems – and many filling accessories followed – from matrix retainers to simple rings and finally, to very expensive, sophisticated matrix rings. Dentists usually throw away a whole sectional matrix ring  because of worn out rubber ends or bonding or composite residues sticking on it. This is a clear indication that there is a great need for exchangeable rubber ends that still keeps all the usual features of a sectional matrix ring. Polydentia developed MyRing, the answer and the solution to save money: Dentists can keep the ring and just exchange and re-order the rubber ends whenever needed. MyRing allows ideal adaptation of innovative sectional matrices, leading to tight contact points in Class II filling

procedures. It avoids poor anatomical contacts through its optimised anatomical form and grip mechanism, as even a small gap between neighbouring teeth means loss of chair-side time.  We dg es ca n be ea si ly inserted in the dedicated ring end slots. Innovative  wooden Hemo-Wedge contributes to an optimised filling procedure with gingival bleeding control by placing the ring over the previously positioned wedge.  Additionally, the light-weight and slim design of MyRing permits overlapping of two rings in MOD cavities. The special rubber composition makes the ring ends very soft, leading to an optimal adaptation to adjacent teeth, avoiding gingival trauma. The rings and rubber ends are resistant to ultrasonic bath, autoclave and thermodisinfector.

Busch

Rapid Working on Acrylics Acrylics and Plaster

 Working on acrylics and plaste r in dental laboratories can be a laborious and time-consuming task when using unsuitable instruments. For instance, the quality of the materials may suffer due to overheating of acrylics. This is effectively prevented with the diamond instruments in the DiaTWISTER range. Specially arranged aperture slits characterise the working part of Dia TWISTER  instruments. These slits ensure excellent air circulation while grinding and prevent the material from overheating. This reduction in the generation of heat also prevents the instrument from clogging. The instruments’ one-piece design guarantees precise concentric running and a long service life. The DiaTWISTER range with the tried and tested cylindrically rounded shape has been enlarged to include a conically rounded shape. This way, Busch can offer the most appropriate instrument for each user’s working technique. The conically rounded Dia TWISTER  instruments are also available in both mega-coarse and super-coarse diamond grit.

DENTAL ASIA JULY / AUGUST 2015

77

PRODUCT HIGHLIGHTS

 Acteon  A new way to perform air polishing has  been engineered by ACTEON®.  AIR-N-GO®  easy goes back to basic to focus on essential features to enhance day-to-day use. This convertible system offers freedom of movement and is an ef ficient weapon for pathogenic bacteria elimination. The quick maintenance of the device is child’s play – only items in contact with the patient need to be disconnected and sterilised.

Just change the nozzle – not the handpiece Depending on users’ clinical needs, switch from SUPRA to PERIO mode, thanks to four interchangeable AIR-N-GO ® nozzles. This comprehensive range of nozzles allows complete supra- and sub-gingival treatments, providing a targeted action against bio film.

easy not only user-friendly but increases patient comfort. The system provides gentle cleaning of the treated areas. “CLASSIC” powders ( ≈ 76 μ m) – sodium bicarbonate-based, contain natural components that come in five flavours. The fineness of the grain and softened geometry of the crystals allow patients to feel more secure during their treatment.   s   e     l    z    z   o   n   y   s   a   e    O    G      N      R    I    A

 AIR-N-GO® powders – customised solutions  AIR-N-GO®  powders make AIR-N-GO ®

AIR-N-GO easy 

Air Polishing: Becoming Even Simpler with AIR-N-GO® Easy

“PEARL” powder ( ≈ 55 μ m)  – natural calcium carbonate-based will please the most sensitive patients. This powder will facilitate the return to clinically healthy buccal flora and the cleaning of the composites in total safety. In addition to initial therapy, natural glycine-based “PERIO” powder (≈25μm), will help to fight against the advancement of periodontal and peri-implant diseases.

Dürr

A New Standard in Surgery Supply: Generation Tyscor For decades, robust suction units from Dürr Dental have been synonymous  with reliability and longevity. Thanks to innovative technology, the latest generation of these systems is also extremely thrifty and boasts excellent performance characteristics. The systems are ultra-compact and exceptionally quiet, governed with ease by Tyscor Pulse intelligent control software, which has raised the standards at networked surgeries. For the first time, the new Tyscor VS 2 suction units make use of extremely robust and powerful radial technology. Its high reliability and signi ficantly smaller footprint than conventional side channel  blowers set it apart. A generating set for two treatment stations is thus much more compact and weighs less than half of a comparable predecessor system. Yet it combines all necessary modules – suction motor, electronic control and separating functionality. At just 25lbs and the size of a conventional microwave oven, Generation Tyscor is very compact. This super compact construction also cuts a dashing figure. Thanks to a design that blends functionality,  78

comfort and appearance, it was awarded the renowned iF design Award 2015 . The Tyscor VS 2 is also highly ef ficient.  At the same performance, the systems make do with significantly less energy than their predecessors – the Tyscor VS 2 has been proven to use only about half as much electricity. Even at full capacity, a system for two treatment stations does not even draw 700 watts. Load-dependent automatic control also contributes to this extraordinarily economical operation. It keeps suction performance at optimum level, so systems always run in the most energy ef ficient mode. Tyscor Pulse software displays all relevant status data and service intervals of the

suction unit on a monitor, providing a complete overview at all times. Regular sight checks are thus unnecessary. If needed, the software even supports remote diagnosis by a service technician who can log directly into the system. This reduces the risk of downtimes to a minimum. Suction performance and rundown time can be adjusted via the surgery network from a PC.  With its super b performanc e and the consumption values of radial technology systems, the Tyscor VS 2 raises the bar for suction units. With Tyscor, market leader Dürr Dental bolsters its reputation as an innovative enterprise and proves yet again that the technology of even sophisticated products can still be further developed. DENTAL ASIA  J ULY / AUGUST 2015

BEGO

Varseo 3D Printing System

Simple and flexible printing is now a reality for dental laboratories with the  and f o r  dental multi-talented Varseo – a 3D printing system developed w i t h  and dental laboratories. Users can expect a harmonised portfolio comprising an in-house developed 3D printer, scientifically tested materials, software tools, and services. More printing technology  “With the Varseo, dental labs are now able to produce a diverse range of restorations using several resins quickly, simply and cost-effectively – and all that directly in the lab with maximum flexibility and a unique degree of precision,” explained Jürgen Schultze, Dental Technician and Head of International Sales at BEGO Bremer Goldschlägerei and BEGO Medical.  Varseo stands for  VAR iability, Speed, Ef ficiency and Openness. Along with a  wide and expanding range of materials and services, Varseo boasts an excellent  building speed and a user-friendly display. Thanks to the unique cartridge system, the material can be changed within a few seconds. Moreover, the low level of material consumption and minimal material ageing enable truly efficient  working. Furthermore, as an “open file” device, the Varseo is compatible with all dental software solutions.

 A variety of options Eight different special resins are available for producing different indications with

Lef : Customised restorations using specially developed resins. Right : Te BEGO Varseo – the latest milestone in dental history. (Images © BEGO)

the Varseo. During its launch in Germany in May, it was already possible to produce splints, drilling templates, CAD/cast partial denture frames and individual impression trays. In the fourth quarter of 2015, the system  will be expanded to include the option of producing bases, temporary crowns and  bridge restorations, models and crowns and bridges.

Support you can rely on In addition to the set-up and initial commissioning of the printer, as well as on-site training on the 3Shape CAMbridge software, the comprehensive 3D print service package that rounds off the Varseo system includes an extensive range of training courses, and a hotline

support offered by experts.

Enhanced safety  “Scientific testing of the Varseo special resins was performed by the Danube Private University under the supervision of Prof. Dr. Constantin von See. With him, we have gained an experienced practitioner who is also very active in research,” Schultze concluded. The excellent material properties of the Varseo resins have been con firmed in numerous scienti fic tests. The highperformance plastics are particularly characterised by their exceptional surface accuracy and residual monomer content,  which lies within the detection limit and high volume stability.

 VITA 

New Methods for Achieving Brilliant Aesthetics with VITA VM LC �ow  VI TA Zah nf ab rik is exp an di ng its  VITA VM LC li ne of ligh t- c ur ing micro-particle composites. In addition to the paste version, low-viscosity VITA  VM LC flow additional materials will also be introduced. Because of their excellent consistency, they are ideal for customising and intensifying the shade of the cervical area and for delicate, aesthetic modelling in the incisal area. Thus, the dental technician can decide  which processing method to use for each  veneer according to the specific situation and individual preference: p a s t e o n l y  or p a st e w i t h fl  o w . These options open up

DENTAL ASIA  J ULY / AUGUST 2015

new ways to achieve brilliant aesthetics that are very close to ceramic – and always systematically.  With high shade stabili ty, low plaque af finity and ideal processing properties,  VITA VM LC paste and flow meet all the challenges. The new flow materials can be applied either directly from a syringe or  with a brush. The optimal low-viscosity consistency always provides for excellent handling. And with the expansion of the shade spectrum, completely new design horizons are opened up for the dental technician. The functionality of the window material has been improved

Paste or �ow? VIA VM LC has the solution for every case!

 with an increase in the proportion of filler so that it can now be used on the surface as well. For a fast finish, the new VITA  VM LC gel is available, which is used to prevent an inhibition layer during final polymerisation.  With VITA VM LC, the dental technician not only has the choice between two consistencies for use within a broad spectrum of indications, it also has flexibility with regard to the shade system, the light-curing device and the  bonding system.

 79

 Italy has been known to stand out in different industries, and merchandise marked with the “Made in Italy” sign often signifies world-class quality and elegance. The country has had a reputation  for being a top player in industries such as  fashion and automobiles,

and even the dental industry has been  faring well in the game.  Dental equipment and instruments of Italian origin are often looked up to as tools of high quality and durability – with that element of style that perfectly represents the “Made in  Italy” mark.

UNIDI Introduces Expodental Meeting 2016 Expodental has been established as Italy’s most important international dental show. After their 2015 hiatus, they are gearing up for the trade show stage yet again. Now dubbed as the “ E x p o d en t a l M eet i n g ” , the fair will be held on May 19 to 21, 2016 in Rimini, Italy. The event will be a key platform for Italian brands in the dental manufacturing industry to showcase their products. Sponsored and organised by UNIDI (Italian Dental Industries Association), a large number of international companies are expected to grace the said exhibition. Previously held in Milan, the organisers have shifted to Rimini to accommodate the anticipated swell of delegates. There will be new pavilions, and the strategic location will also allow participants access to major cities for their side trips. Mr. Lorenzo Cagnoni, Rimini Fiera’s President, commented: “We are very happy that our fairgrounds will host the main event of the dental sector where the most excellent and innovative national dental companies will exhibit. We are very familiar with this sector because of the ultra-decennial presence of the national congress Amici di Brugg in Rimini Fiera. We make ourselves available to UNIDI to share development trajectories with the absolute certainty that, together, we will be able to plan a great future for the Expodental Meeting.” DA

LY

FOCUSONITALY TeKne Dental (TKD) TKD’s history dates back to more than 45 years ago when the TKD trademark  was created after successfully completing the design of their highly sophisticated product: the a i r - b ea r i n g t u r b i n e . This  was the only product manufactured and sold during their early years.  A hi gh ma rk et de ma nd fu el le d th e company to design and engineer numerous other products, remaining faithfully with the original idea of producing dynamic dental instruments. In the last ten years, TKD has also been specialising in the design and manufacture of high-performance electric micromotors and its accessories and control boards. TKD develops and manufacture all its products in-house, which they consider a primary advantage. The company’s R&D

department comprises highly-skilled people with the necessary pro ficiency to develop complex and high-precision parts.  Automated state-of-the-art machinery and continuous control tests, both intermediate and final, allow them to obtain an excellent quality standard and high reliability. Today, TKD has become one of the leading producers of handpieces and silicone hoses, becoming a reliable partner for several manufacturers of dental  un units. ts. TKD exports its products to over 50 countries and is a member of thee Italian UNIDI association. During the previous exhibitions this year, TKD has presented thee following products: • SONOSURGERY ® handpiece: Pneumatic handpiece especially ly designed for surgical procedures using the special Komet ® Intro set et of inserts. • DUOPAD® control panel: Compact unit board to control electric tric instruments (motors and scalers). • A wider range of ultrasonic high-precision EMS-compatible inserts.

Rhein83

OT Equator Abutment: Innovative Solution in Reduced Clinical Space Cases

 As the worldwide leader in sp h e r i c a l d e n t a l a t t a c h m en t s ,  Rhein83’s centreline philosophy has been to design and manufacture castable spherical attachments with a connecting nylon female component being processed into a removable prosthetic device. The new OT Equator 3-in-1 attachment system intro duced at the 2009 Rome Expo is an example of their engineering distinction. By vertically reducing the classic OT Cap 2.5mm sphere to its “equator”, the low-profile elastic caps use only the bottom half of the sphere, achieving equal functionality and retentive values as its predecessor. DENTAL ASIA  J ULY / AUGUST 2015

The OT Equator line offers the lowest pro file and has the least overall displacement of any attachment system on the market, giving both dentist and technician superior case design options for aesthetics and function, especially where space is limited. Rhein83 recently presented the new OT Equator abutment, the smallest dimensional attachment system in the market.  With a 2.1mm vertical pro file and 4.4mm diameter (including the metal housing), the Equator system is compatible with all implant brands and platforms requiring reduced dimensions. The innovative design offers an improved stability compared to traditional overdenture attachments, allowing the correction of implant divergence up to 30 degrees in all directions. A complete line of elastic caps used with the compatible metal housing will allow the dentist to choose from a minimum of 0.6kg retention to a maximum of 2.7kg. CAD/CAM solutions are available in the spherical version with the OT Cap normo (2.5mm diameter), the OT Cap micro (1.8mm diameter), and in the low pro file version with the Equator attachment – the smallest overdenture connection in the market. These threaded attachments are screwed directly inside the milled bar counting on the special 2mm thread. Rhein83 also offers another working protocol in cases wherein the final user utilises different CAD/CAM software: A special titanium sleeve to be glued into the bar, which will allow creati on of the bar directly in the laboratory using compatible Rhein83 attachments.

 81

FOCUSONITALY Medesy Medesy is a third-generation, family-run Italian company that manufactures high-quality dental, surgical and orthodontic instruments. Headquartered in Maniago – Italy’s globally renowned “ knives district ” due to its 600-year tradition and know-how in the manufacture of blades and cutting tools of the finest quality – Medesy is now present in more than 105 countries and appreciated for its excellent products with refined technical details and design. Medesy manufactures a wide range of instruments covering all dental specialities to

facilitate routine tasks. They also select the most suitable instruments for each discipline and present them in well   ,  x organised, ergonomic trays. G a m m a fi Medesy’s new range of sterilisation tray kits, ensures a perfectly safe cleaning and sterilisation process.

• Micro-Periodontal Surgery Kit Periodontology has now become extremely specialised, complex and advanced, thanks to the most recent developments in periodontal treatment techniques. It has created a demand for more sophisticated surgical instruments far more suitable for accurate intervention. Medesy has responded to this precise periodontal need with a new kit uniquely created for periodontal microsurgery: A mix of titanium instruments that is purer than steel  but extremely light. The kit has been speci fically designed for microsurgery and includes instruments that guarantee maximum precision and reliability.

• Micro-Surgical Tweezers This range presents fi ve different microsurgical tweezers, developed to fulfil the growing demand for more sensitive and finer instruments. Main technical features: • Tungsten carbide inserts • Diamond dusted tips • 0.7mm hole • 1x2 teeth • Standard serration The ultra-thin tips ensure a precise and firm grip on tissue fragments, as well as a  wider visual field.

• Peri-Implantitis Kit Bacterial aggression observed on the neck of implants is similar to that which forms at the muco-gingival junction of the tooth. Stainless steel instruments may contaminate titanium implants, while plastic instruments do not fully remove compromised tissues around the implant – hence, the need for titanium instruments. This is a unique solution for ef ficient and safe handling of implant sites. The tips are coloured blue for easy and fast identification.

 82

DENTAL ASIA  J ULY / AUGUST 2015

FOCUSONITALY

• Ortho  Advanced Kit Medesy produces a wide range of cutters and distal ends offering different cutting functions. They have now created a special orthodontic kit – the C e n t u r y L i n e   – which includes the most common and  basic orthodontic plie rs and instruments.  Main features: • Finely manufactured through a sophisticated handcrafted b o x - j o i n t s y s t em  , which provides higher stability of the pliers, ensures safer use and longer duration, and maintains perfect alignment of the tips. • New neat R h o m b u s d e si g n   for MEDESY’S distal ends:  A lighter and thinner shape for optimal performance. • T C i n s e r t s   on cutters and distal ends obtained by using the most advanced electro-welding technological processes. • A special g l a s s m i c r o s p h e r e su r f a c e t r ea t m e n t ,   which adds an anti-glare and elegant finishing to the instrument.

Excellent for orthodontic specialists Today, Medesy has more than 3.000 instruments, some of  which are covered by an international patent – which proves their success on the market. This is a testament to Medesy’s commitment to innovation: the right formula to better ful fil the needs of modern dentistry. The entire Medesy team takes pleasure in looking after all its customers with a personalised attention and punctual pre- and post sales-service.  Wi th th ei r kn ow -h ow , ex pe rt is e an d de ep pa ss io n in conceptualising instruments, Medesy offers their full service to provide users with the best – always, everywhere. Visit Medesy at FDI Bangkok, September 22 to 25, 2015, Italian  Pavilion.

DENTAL ASIA JULY / AUGUST 2015

83

FOCUSONITALY Mectron Mectron Medical Technologies has fully dedicated its focus on the development and production of technologically advanced dental products at a realistic price level. This concept seems to meet a real market need as the company has  been continuously growing over the years and is exporting to over 70 countries in the world today. In its Carasco headquarters, over 100 employees in R&D, manufacturing and administration are contributing to this success story. Mectron covers preventive and restorative dentistry and oral surgery with their Piezosurgery ® line, ultrasonic scalers, air polishers and curing lights.  As a te ch no log y- dr iv en co mp any , Mectron has tried not only to bring to the market a convenient alternative to other products but to convince users by offering clear practical and clinical advantages. 1980s: Mectron began manufacturing ultrasonic units (for supragingival scaling at that time). However, they never considered magnetostrictive technology,  which was then the g o l d st a n d a r d   (and still is) in several markets today. Instead, they chose the most modern technology available – piezoelectric – and worked on improvements to make it completely reliable. One of the critical points was the mechanical stress on the ultrasoundgenerating transducer in the handpiece. Mectron was the fi   r st m a n u f a ct u r e r t o i n t r o d u c e t r a n s d u c er s m a d e o f t i t a n i u m    and to solve this important

issue – all other companies later on decided to adapt this Mectron innovation to their products as well.

2001: The world’s first LED curing light. Mectron’s contribution to light-curing was even more decisive. The company had already been one of the leaders for conventional halogen lights, which were the preferred tools of operators everywhere – before it came out with the w o r l d ’ s fi r s t cu r i n g l i gh t b a s ed o n L E D t e ch n o l o g y  . Cordless, powerful and lightweight (roughly 100g) curing handpieces with a long lifespan had not existed before. This new invention revolutionised polymerisation and has  been imitated by numerous competitors that it can be considered a benchmark. Mectron thus remains one of the most important manufacturers of LED lights .

 84

2001: The first generation of Piezosurgery ®  – the latest and m o st i m p o r t a n t e x a m p l e o f M ec t r o n ’ s i n n o v a t i v e p o w e r  

– was introduced, representing the starting point of an important success story. For quite some time, Professor Tomaso Vercellotti, a dental specialist, researcher and  brothe r of Domeni co Ver cel lotti (one of Mectron’s founders), had  been unhap py with the level of precision and safety offered by intraoperative instruments available for dental bone surgery. Since 1997, he has worked together with Mectron on the idea of adapting piezoelectric technology to bone surgery applications. Initial results  were disappointing as conventional ultrasounds cannot cut bone without overheating the operation area and cannot cut deeper than a millimetre  because of lack of cutting power. The cooperation between clinician and engineers gave birth to the  winningconcept: modulating the basic ultrasonic vibration with a second, low-frequency vibration permits efficient cutting of bone without overheating. Clinical trials showed that the micrometric cut of Piezosurgery ® allows unrivalled precision in surgery, preserves surrounding soft tissues, and keeps the intra-operative field almost blood-free.  Years of work in Mectron’s research labs, in Prof. Vercellotti’s dental office, and in universities finally ended up with the development of an ef ficient and safe product.

IDS 2007: Launch of the fi   r st u l t r a so n i c i n s t r u m en t s f o r i m p l a n t s i t e p r e p a r a t i o n   – another result of the lucky

combination between Prof. Vercellotti’s clinical and Mectron’s technological know-how. 2009: Mectron re-de fined bone surgery  with the third  Piezosurgery ® generation  which had a completely digital power supply control, a wide range of ultrasonic frequency and a speci fic “implant” mode especially dedicated to implant site preparation inserts.

Mectron improved their technology in the following years with a strong focus on ergonomics. The outcome – two devices offering a perfect balance between cutting performance and safety. IDS 2011: Launch of thePiezosurgery ® touch ( fourth  generation), opening a new era in piezoelectric bone surgery. IDS 2015: Launch of the Piezosurgery ®  white ( fi fth generation). Today, thousands of specialists use this revolutionary surgical technique. Being the most innovative company in developing new indications and inserts for piezoelectric bone surgery, Mectron is still,  by far, the worldwide leader in ultrasonic  bone surgery. Day after day, Mectron continues to pursue the same philosophy of technical innovation and scientific research to which it owes its history.

Mectron is currently seeking a young, highly motivated candidate – preferably  with some experience in the dental and/ or medical field – to join their team as A R E A SA L E S M A N A G E R .   Territory  will be Asia-Far East. The candidate should be able to: follow and support all existing dealers and contacts within the territory; • establish and work with new partners; • understand the technical features of the products and train the sales force accordingly; • participate in main events and congresses within the territory; • report on a regular basis to the management. The candidate should present the following skills & qualifications: • permanent residence in the Far East territory; • ability to manage existing accounts  whilst developing new ones; • international or domestic sales experience in promoting dental and/ or medical devices; • willing to travel extensively; • language skills – excellent oral and  writte n Englis h and/or Italian are required; other languages reasonably required to cover the territory are preferred; • ability to self-motivate, multi-task and  work independently and within a team. • If interested, please e-mail your CV to: amministrazione@mectron. com.

DENTAL ASIA  J ULY / AUGUST 2015

SHOW REVIEW 

O

n March 9 to 12, 2015, 280 dental clinicians from 28 countries gathered in New York City to learn about the latest technical and clinical advances in implant therapy at the Sixth Annual Global Implantology  Week. It was the sixth si xth consecutive consecuti ve  yee ar th at Z i mm e r De nt a l h as  y collaborated with NYU’s College of Dentistry to organise this prestigious, CE-accredited global educational forum. This year’s programme featured six high-calibre clinicians from around the world, who provided valuable insights on a broad spectrum of topics including the latest advances in digital smile design, implant and facial aesthetics, hard and soft tissue surgery, immediate loading, and keys to prosthetic management and success. In addition to the peer-to-peer presentations, the programme included a variety of other activities, which took place throughout the week including a Product Fair, Scienti fic Poster Presentations and an optional tour of Zimmer’s Trabecular Metal™ manufacturing facility and state-of-the-art Zimmer Institute Training Centre located in Parsippany, New Jersey.

Event highlights One of the primary highlights of this year’s programme was the u n v e i l i n g o f E z t et e t i c ™  , Zimmer Dental’s new 3.1mmD narrow implant. It was the first time that Eztetic™ was shown to a global audience, and it generated a high level of interest among participants. Zimmer Dental’s Eztetic™ implant was of ficially launched in the second quarter of 2015.  Ano  A no t he r ne w ad di t i o n t o the 2015 NYU Programme  wa s a S c i e n t i f i c P o s t e r P r e s e n t a t i o n  , w h i c h featured 16 compelling cases submitted by the participating

 86

Sixth Annual Zimmer Dental/ NYU Global Implantology Implan tology Week Week Clinicians from around the world gathered in New York to learn about the latest advances in dental implantology.

clinicians. These poster presentations also generated a great deal of interest and provided an opportunity for attendees to exchange insights, ideas and techniques with each other in a collaborative setting. The t o u r   of Zimmer’s Trabecular Metal manufacturing facility and Zimmer Institute Training Centre provided participants insight into Zimmer’s proprietary process of making the Trabecular Metal material, which is used for both dental and orthopaedic applications. applications. They also toured Zimmer Institute’s Institute’s Simulated Patient Laboratory and Bio Skills Centre, which offers intermediate to advanced training courses on a variety of topics, including implantology, restorative procedures, and cadaveric courses. By all accounts, this year’s Global Implantology Week was a resounding success. Participants provided positive feedback on the quality and relevance of the presentations, as well as the ancillary activities. Mark your calendars for the Seventh Annual Zimmer Dental/ NYU Global Implantology Week, which is scheduled for  March 14 to 17, 2016 in New York City, USA. USA. DA DENTAL ASIA  J ULY / AUGUST 201 2015 5

SHOW REVIEW 

Colgate atAPDC: Prof. Seymour Talks about Periodontal Health

 by Dr. Audrey Abella

P

rof. Gregory Seymour, having an international reputation in Periodontology and Oral Immunology, sat down with Dental Asia during the Asia-Paci fic Dental Congress 2015 to discuss periodontal disease, its implications to society and why it is important to take action before it’s too late.

 A glob global al di disea sease se “Periodontal disease is a global disease. It is estimated that about 10 to 15 per cent of people are at risk ri sk of losing teeth as a result of untreated periodontal disease,” the professor prof essor began. “If one in ten people had a certain disease, society would, quite rightly, be very concerned about it. The same should go for periodontal disease: having one in ten people losing their teeth is high. Tooth loss and loss and the disability that it causes is something that is overlooked by the population,” he added.

The cause: Bacterial plaque Prof. Seymour emphasised that there is only one cause one cause of periodontal disease: ba disease: bact cter eria iall pl plaq aque ue.. “Other factors (such as smoking, stress, age, systemic conditions, etc.) modify modify the  the way in  whic  wh ich h pe peop ople lere resp spon ond d toth thei eirr pl plaq aque uebu butt do not causethe cause thediease.”

The signs “An early sign is bleeding from the gums, which indicates the presence of gingivitis. In many people, gingivitis may remain confined to the gums with only slow progression and so does not endanger not  endanger the life of teeth. In others, gingivitis may develop into periodontitis and lead to tooth loss. Even so, there will still be be periods of disease progression and stability throughout this whole process,” he explained. One thing to take note of is that periodontal disease is not not painful,  painful, so people are often unaware that they have it.

Systemic health and nutrition Several studies have linked periodontal disease to overall health. “Most studies reveal a statistical relationship between periodontal disease and systemic diseases such as cardiovascular disease and diabetes. In this context, medicine and dentistry should be  working  workin g more closely closely together. together. Different Different specialities specialities within within the health professions should be in synergy when treating patients,” he stated. Asked about how improving oral health contributes to the improvement of a speci fic medical condition, he indicated, “There is limited evidence showing this; however, oral health is an important component of overall health. Hence, oral disease, in its own right, should be treated.” He also discussed the role of nutrition and food choices in periodontal health. “Now, there is a greater realisation that diet may alter one’s immune responsiveness. If you lack micronutrients or antioxidants, then you may modify the type of response that  you have have to to dental dental plaq plaque, ue, and and that that may may manifes manifestt as period periodont ontal al  88

disease. As for diet per se, the link is developing but as yet it’s not firmly established.”

The social impact One problem associated with periodontitis is halitosis, an obvious social barrier. “It de finitely is a barrier. There's evidence supporting the fact that periodontal disease can – through halitosis and tooth loss – lead to a loss of self-esteem, which then leads to other social complications (e.g., dif ficulties in trying to find a job ). I think there is a role for dentists in terms of trying to improve one’s overall self-esteem,” he concluded. Given these concerns, he pointed out the signi ficance of including a periodontal assessment during routine dental procedures. “It is sses essm sm ent  imperative for dentists to always include a per iod on tal a ss in their routine. Periodontal treatment should be considered an important component of overall oral health care,” said the professor.

Educating patients  We asked the professor how he educates his patients about periodontal disease. “We want people to adopt a healthy lifestyle, and education alone alone   will not guarantee a change in patients’  behavi  beh aviour our.. For exa exampl mple, e, if you tel telll a you young ng pat patien ientt that that the they y might might lose their teeth in about 40 years’ time, they will not necessarily see that as a problem. So it will not not be  be an issue for them. If you talk to somebody in their 60s about losing their teeth in ten years, either they respond with “ I may not be aro around und in ten year yearss” or they might just brush it off, thinking people normally lose teeth as they age. What matters is the patient’s attitude attitude,, which varies across different age groups. If people expect expect that  that they will lose teeth in time, it won’t be a cause for alarm,” he shared. “I think education is not the only thing required, as what you’re looking for is a change in behaviour. behaviour. Therefore, ‘motivating ‘motivating’’ patients is more important than ‘educating ‘educating’’ patients.”

Choice of oral products Regarding the use of certain products for periodontal health, Prof. Seymour had this to say: “The anti-bacterial and anti-in flammatory properties of triclosan toothpaste attack two of the three components of periodontal disease (the bacteria and host response). Our studies over fi ve ye year arss (s (sup uppo port rted ed by Co Colg lgat atee Palmolive Company USA) have shown that if patients use this type of toothpaste, it can slow the progression of periodontal disease.” DA DENTAL ASIA  J ULY / AUGUST 201 2015 5

SHOW PREVIEW 

CDS 2015 Increases Exhibition Space due to Greater Demand Following the success of the China Dental Show (CDS) 2014, this year’s edition is all set to offer the latest innovations in dental technology within a dynamically growing Chinese market. With its impact on the growing middleclass in China, Digital Dentistry has been chosen as the new CDS 2015 theme.

T

he trends and techno logies making its way in the Chinese dental industry are indicative of the role that dentistry plays among consumers. Gone are the days  when dentists were perceived as specialists who could only cure a dental illness or injury. Today’s dentists are expected to provide a wide array of services for aesthetics, such as specialised orthodontics, implants and even dental cosmetology. Prof. Wang Xing, President of the Chinese Stomatological Association (CSA) says: “The demand for new technologies in China is unlimited and nowadays, dentists are more open to new techniques and fresh ideas. We are entering a new era where visual aesthetics is playing an important role in all stages of dental treatment.”

New Theme: Digital Dentistry  CDS brings together dental professionals from over 22 regions and countries. DENTAL ASIA  J ULY / AUGUST 2015

 A ma jo r pl at fo rm fo r th e latest ideas and innovations entering the dental market, CDS 2014 has attracted over 500 exhibitors and 44,000  vi s i to r s. C DS 2 0 15 wi ll provide special emphasis on Digital Dentistry, displaying the latest software and technologies from across the globe to empower domestic dentists in bringing worldclass services to Chinese consumers.  As in previous editions, CDS  will be hosted in collaboration  w i t h R e e d S i n o p h a r m Exhibitions (RSE) and the Chinese Stomatological  Association (CSA), the apex industry body that guides and enhances China’s market for dentistry and other allied services.

Latest developments It is no surprise that CDS 2015 is witnessing exponentially growing demands for exhibition space, as evidenced by the choice of the new and upgraded venue – the National Exhibition

& Convention Centre (NECC) Shanghai – equipped with the latest high-tech amenities to facilitate a global show such as CDS. The venue is also planned in the most ergonomic fashion, allowing exhibitors  w i t h i n t h e s a m e product category and  visitors to interact on the same floor, thus obtaining great results in a limited time. CDS 2015 has responded to the growing demand for space by acquiring one entire hall to provide comfortable exhibition spaces and meeting rooms. Mr. Wei Qinghua, Project Manager at RSE, explains, “We have seen exhibition space requests coming in, not only from individual companies but also from national pavilions – a clear indication that CDS is gaining international reputation.  With less than fi ve months to go for CDS 2015, the international section has

alr ea dy increased by over 30 per cent as compared to last year. We look forward to introducing new products and strengthening the product portfolio from each specific country at this edition. CDS 2015 will see another two to three country pavilions in addition to the ones who have  been participating regularly.” Currently, CDS 2015 is  wi tnessi ng a hi gh le ve l of interest not only from exhibitors but also from  visitors who are looking for quality products from China at competitive prices. DA

 89

Calendar 2015 Events Calendar 2015 Delhi Dental Show (DDS) 24th – 26th July 2015  New Delhi, India  Venue: Pragati Maidan Contact: Indian Dental Association Email: [email protected]  Website: www.ida.org.in /  www.delhidentalshow.org.in Tokyo Dental Show 2015 1st – 2nd August 2015  Ariake, Koto-ku, Tokyo, Japan  Venue: Tokyo Big Sight East 5-6 Hall Contact: Tokyo Dental Show Secretariat Email: [email protected]  Website: www.tokyo-dentalshow.com July/August issue

2015 Southwest Dental Conference 6th – 8th August 2015  Dallas, Texas, USA  Venue: Kay Bailey Hutchison Convention Centre Contact: Dallas County Dental Society  Email: [email protected]  Website: www.swdentalconf.org

DAC July-September issue

July/August issue

Hong Kong International Dental Expo & Symposium (HKIDEAS) 2015 7th - 9th August 2015 Wanchai, Hong Kong, China  Venue: HK Convention & Exhibition Centre Contact: Congress Secretariat Email: [email protected] / [email protected]  Website: www.hkideas.org GC Asia Dental – Modern Dentistry Lecture 13th August 2015  Singapore  Venue: National Dental Centre, L8 Auditorium Contact: Veron Koh / Eric Gan Email: [email protected] / [email protected]  Website: sea.gcasiadental.com The 8th Vietnam International Dental Exhibition & Congress (VIDEC) 19th – 21st August 2015  Hanoi, Vietnam  Venue: Cultural Palace Contact: Dr. Nguyen Manh Ha Email: [email protected] International Dental Scientific Exhibition – Vietnam 20th – 22nd August 2015  Ho Chi Minh City, Vietnam  Venue: Tan Binh Exhibition & Convention Centre (TBECC) Contact: Nguyen Minh Chau Email: [email protected]  Website: www.medipharmexpo.com

 90

2015 AesthetiCon – Dento-Facial  Aesthetics Conference & Exhibition 3rd – 5th September 2015  Sydney, Australia  Venue: The Star Sydney  Contact: Australasian Academy of  Dento-Facial Aesthetics (AADFA) Email: [email protected]  Website: www.aestheticon2015.com /  www.AADFA.net ITI Education Week Hong Kong 6th – 12th September 2015  Hong Kong, China  Venue: The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun Contact: ITI International Team for Implantology  Email: [email protected]  Website: www.iti.org The 8th Asia Conference of Oral Health Promotion for School Children 18th – 20th September 2015 Taiwan, R.O.C.  Venue: Taipei International Convention Centre Contact: Jessie Ou / Ta Yang Email: [email protected] / [email protected]   Website: www.acohpsc8.tw   WCLI 2015 Asia-Pacific Symposium 19th – 20th September 2015 Taipei, Taiwan, ROC   Venue: Le Meridien Taipei Hotel Contact: World Clinical Laser Institute Email: [email protected]  Website: www.wcli.org/2015taipei September/October issue

FDI Annual World Dental Congress 22nd – 25th September 2015  Bangkok, Thailand   Venue: Bangkok International Trade & Exhibition Centre (BITEC) Contact: Christopher M. Simpson / FDI Email: [email protected] / [email protected]  Website: www.fdiworldental.org /  www.fdi2015bangkok.org

DAC July-September issue

 Australasian Osseointegration Society (AOS) 2015 – 10th Biennial Conference & Exhibition 14th – 17th October 2015 Canberra, Australia  Venue: National Conventon Centre Canberra (NCCC) Contact: MCI Australia Email: info@ aosconference.com.au / [email protected]  Website: www.aosconference.com.au ITI Congress Middle East 15th – 16th October 2015  Dead Sea, Jordan  Venue: King Hussein Bin Talal Convention Centre (KHBTCC) Contact: ITI International Team for Implantology  Email: [email protected]  Website: www.iti.org 2015 World Dental Show  16th – 18th October 2015  Mumbai, India  Venue: MMRDA  Contact: Indian Dental Ass’n. / WDS Secretariat Email: [email protected]  Website: www.wds.org.in The 6th Indo Congress & Expo on Dental & Oral Health 19th – 21st October 2015  Bangalore, India  Venue: Crown Plaza Contact: OMICS International Conferences Email: indiandentalcongress@ conferenceseris.net / indiandentalcongress@ omicsgroup.com  Website: www.dentalcongress.com/india

DAC Oct-Dec issue

September/October issue

DenTech China 2015 21st – 24th October 2015  Shanghai, China  Venue: Shanghai World Expo Exhibition & Convention Centre Contact: Sandra Shen / Grif fin Ge / Vivian Zhou Email: [email protected] / grif fi[email protected] / [email protected]  Website: www.dentech.com.cn

September/October issue

The 17th CSA Annual Meeting & 2015 China Dental Show (CDS) 24th – 27th September 2015  Shanghai, China  Venue: National Exhibition & Convention Centre (NECC) Contact: Khamsay Luangpraseuth / Jenny Liu Email: [email protected] /  [email protected]  Website: www.reed-sinopharm.com /  www.chinadentalshow.com

2015 World Implant Orthodontic Conference (WIOC) 10th – 13th November 2015  Dubai, UAE   Venue: InterContinental Hotel, Festival City  Contact: Conference Secretariat, MCI Middle East / Divya Thapa Email: [email protected] / [email protected]  Website: www.wioc2015.com

DENTAL ASIA  J ULY / AUGUST 2015

The 10th Indonesian Association of Orthodontists (IAO) Annual Meeting 2015 12th – 15th November 2015  Bandung, West Java, Indonesia  Venue: Trans Luxury Hotel Contact: drg. Mariska Isfandiari, Sp. Ort. / drg. Agustina Suherman, Sp. Ort. Email: [email protected]  Website: ikorti-iaomeeting.com

2015 Expodent International India 25th – 27th December 2015  New Delhi, India  Venue: Pragati Maidan Contact: Expodent International India Email: [email protected] / [email protected]  Website: www.expodent-india.com

2016

th

The 7  Dental Facial Cosmetic International Conference 13th – 14th November 2015  Dubai, UAE   Venue: Jumeirah Beach Hotel Contact: CAPP FZ L.L.C. Email: [email protected]  Website: www.cappmea.com November/December issue

Greater New York Dental Meeting 2015 – 91st Annual Session 29th November – 2nd December 2015  New York City, USA  Venue: Jacob K. Javits Convention Centre Contact: Dr. Robert Edwab / Carla M. Borg Email: [email protected] / exhibits@ gnydm.com / [email protected]  Website: www.gnydm.com 2015 QMED – Qatar International Medical Devices & Healthcare Exhibition & Congress 2nd – 4th December 2015  Doha, Qatar  Venue: The New Doha Exhibition & Convention Centre (DECC) Contact: ExCo Media Ltd Email: [email protected] / [email protected]  Website: www.qmedexpo.com Dental Vietnam 2015 2nd – 4th December 2015  Hanoi City, Vietnam  Venue: Hanoi Int’l. Centre for Exhibition (ICE) Contact: Nguyen Minh Chau / Thai Tuyet Huong Email: [email protected] / [email protected]  Website: hn.medipharmexpo.com/eng/ index.php / www.vinexad.com.vn CAD/CAM & Digital Dentistry Int’l. Conference – 3rd Asia-Pacific Edition 4th – 5th December 2015  Singapore  Venue: Suntec Singapore Convention & Exhibition Centre Contact: Dr. Dobrina Mollova / Tzvetan Deyanov  Email: [email protected] / [email protected] / [email protected]  Website: www.cappmea.com / www.capp-asia.com

DENTAL ASIA  J ULY / AUGUST 2015

January/February issue

 AEEDC Dubai 2016 2nd – 4th February 2016  Dubai, UAE   Venue: Dubai International Convention & Exhibition Centre Contact: INDEX Conferences & Exhibitions / Dr. Matios Tcholakian / Vaneza Liaguno Email: [email protected] / [email protected] / [email protected]  Website: www.index.ae / www.aeedc.com ITI Education Week Melbourne 22nd – 26th February 2016  Melbourne, Australia  Venue: University of Melbourne Contact: ITI International Team for Implantology  Email: [email protected]  Website: www.iti.org/educationweek  DAC March/April issue

March/April issue

Dental South China 2016 2nd – 5th March 2016 Guangzhou, China  Venue: Area C, China Import & Export Fair Pazhou Complex Contact: Guangdong International Science & Technology Exhibition Company  Email: [email protected] / [email protected]  Website: www.dentalsouthchina.com

March/April issue

 ADX16 Sydney  18th – 20th March 2016  Sydney, Australia  Venue: Sydney Exhibition Centre @ Glebe Island Contact: Jan Van Dyk  Email: [email protected] / [email protected]  Website: www.adx.org.au IDEM (International Dental Exhibition & Meeting) Singapore 2016 8th – 10th April 2016  Singapore  Venue: Suntec Singapore Convention & Exhibition Centre Contact: Stephanie Sim / Corrine Zhang Email: [email protected] / [email protected]  Website: www.idem-singapore.com

May/June issue

The 38th Asia-Pacific Dental Congress 17th – 19th June 2016  Hong Kong, China  Venue: Hong Kong Convention & Exhibition Centre Contact: Erdem Koksaldi / Benan Eris / Selen Akun Email: [email protected] /  [email protected] / [email protected]  Website: www.apdc2016.org 2016 Int’l. Association for Dental Research 94th General Session & Exhibition (3rd Meeting – IADR APAC; 35th Annual Meeting – IADR Korean Division 22nd – 25th June 2016  Seoul, Republic of Korea Contact: IADR / Carman O’Quinn Email: [email protected] / [email protected]  Website: www.iadr.org 50th Australasian Begg Society of Orthodontists (ABSO) Meeting  August 2016  Singapore  Website: www.begg-society.org ITI Congress Australasia 2nd – 3rd September 2016  Melbourne, Australia Contact: ITI International Team for Implantology  Email: [email protected]  Website: www.iti.org/congress-australasia ITI Congress South East Asia 9th – 10th September 2016  Bali, Indonesia  Venue: The Stones Hotel Contact: ITI International Team for Implantology  Email: [email protected]  Website: www.iti.org/congress-southeastasia

November/December issue

The Greater New York Dental Meeting 2016 – 92nd Annual Session 27th November – 3rd December 2016  New York, USA  Venue: Jacob K. Javits Convention Centre Contact: Dr. Robert Edwab, Executive Director Email: [email protected] / [email protected]  Website: www.gnydm.com

 91

 ADVERTISERS’ INDEX  Advertisers

Page

3rd APAC CAD/CAM & Digital Dentistry Int’l. Conference 2015

20

3Shape A/S

03

 ADIA Australia 2016

74

 Amann Girrbach AG

19

 Anthogyr

43

Busch

33

Publisher | William Pang [email protected] Executive Director | Alistair Bryson  [email protected]  Associate Publisher | Pamela Buckley   [email protected] Publications Director | Jamie Tan  [email protected]  Assistant Editor | Audrey Abella [email protected]

Consulting Editor | Zoey Chong

Den-Mat Holdings, LLC

35

Dentech China 2015

56

DMG GmbH

11

GC Asia Dental

07

Greater New York Dental Meeting 2015

72

Heraeus Kulzer

41

IDEM Singapore 2016

53

Invisalign

15; 17

Ivoclar Vivadent AG

45;OBC

PABLO PUBLISHING PTE LTD

Mectron S.p.A.

85

Medesy srl

83

Dental Asia is a member of Pablo Publishing Pte Ltd Blk 988, Toa Payoh North #07-04, Singapore 319002 Tel: (65) 6369 9119 • Fax: (65) 6369 9919 E-mail: [email protected]

NSK Asia

IFC-01

Premier Dental Products Co

69

Promedica Dental Material GmbH

77

Renfert GmbH

63

Roland DG Australia

37

Shofu Dental Asia-Pacific Pte Ltd

23

Sirona Dental Systems Pte Ltd

05

SMACO

09

Ultradent Products Inc.

49

 VOCO GmbH

25

 W&H Dentalwerk

IBC

 WCLI 2015 Asia-Pacific Symposium

13

Zimmer Biomet

87

 [email protected]

Editor (Chinese Edition) | Consuela Tian  [email protected]  General Manager – Pablo Beijing | Ellen Gao  [email protected] Project Manager – Pablo Beijing | Vicky Wu  [email protected] Graphic Designer | Cecilia Foo [email protected]  Admin & Circulation Manager | Shu Ai Ling [email protected]

International Of fice: EUROPE Pablo Germany  Kilian-Spiegel-Strasse 6 D-64720 Michelstadt Germany  Tel: +49-6061-925100 Fax: +49-6061-925101 Email: [email protected] Contact: Mr Alistair Bryson

CHINA  Pablo Beijing Tel: +86-10-6509-7728 / 6509-7548 Fax: +86-10-6509-7719 Email: [email protected] Contact: Ms Ellen Gao Pablo Shanghai Tel: +86-21-5238-9737 Fax: +86-21-5238-9736 Email: [email protected] Contact: Ms Consuela Tian

Media Representatives: Italy, France, Spain Rancati Advertising Srl. Milano San Felice Torre 7 Tel: +39-02-703-00088 E-mail: csanfi[email protected]

20090 Segrate Italy  Fax: +39-02-703-00074 Contact: Mr Claudio San filippo

Company Registration No: 200001473N  All rights reserved. Views of writers do not necessarily reflect the views of the Publisher. No part of this publication may be reproduced in any form or by any means, without prior permission in writing from the Publisher and copyright owner. Whilst every care is taken to ensure accuracy of the information in this publication, the Publisher accepts no liability for damages caused by misinterpretation of information, expressed or implied, within the pages of the magazine. All advertisements are accepted on the understanding that the Advertiser is authorised to publish the contents of the advertisements, and in this respect, the Advertiser shall indemnify the Publisher against all claims or suits for libel, violation of right of privacy and copyright infringements. Dental Asia is a controlled-circulation bi-monthly magazine. It is mailed free-of-charge to readers who meet a set of criteria. Paid subscription is available to those who do not fit our terms of control. Please refer to subscription form provided in the publication for more details. Printed by Times Printers Pte Ltd