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JULY / AUGUST 2015

Whats inside:
Clinical Feature

Periodontal Inflammation:
Simplified
User Report

Masking of Fluorosis
by Resin Infiltration
Behind the Scenes

Photo Courtesy of Heraeus Kulzer

Theres
Sandblasting...
And Then Theres
Sandblasting!
Special Feature:

Focus on Italy

CONTENTS
Dental Management
21

Cleaning of Transmission
Instruments: What do you Expect?

Under the Spotlight

24 Dr. In-Woong Um: Breaking New


Ground in Alveolar Bone Repair
through Tooth Recycling

Up Close & Personal

28 Kymata Dental Arts: Small in Size,


Big on Quality

Dental Profile
31

Morita: The Perfect Fusion of


Ergonomics and Aesthetic
Excellence
34 Continuously Making a Mark in
Dentistry

Clinical Feature

Behind the Scenes

Show Preview

Do You Know

Regulars

64 Theres Sandblasting... And Then


Theres Sandblasting!

66 A Ceramic Furnace that Leaves


Nothing to be Desired
67 SIROLaser Blue: Surgical Precision in
Blue
68 Classic Surtex Post

Show Review

86 Sixth Annual Zimmer Dental/


NYU Global Implantology Week
88 Colgate at APDC: Prof. Seymour
Talks about Periodontal Health

89 CDS 2015 Increases Exhibition


Space due to Greater Demand

4
6
70
90
92

First Words
Dental Updates
Product Highlights
Events Calendar
Advertisers Index

Special Feature
80 Focus on Italy

55

64

38 Modern Approach in Directly Placed


Restorations for Endodontically
Treated Teeth
40 P e r i o d o n t a l I n f l a m m a t i o n :
Simplified
48 Essential Factors to Achieving a
High-Quality Cure
51 Smilefast: The Predictable ShortTerm Cosmetic Orthodontic
Treatment

User Report

55 Masking of Fluorosis by Resin


Infiltration
58 Digital Impression: The Final
Frontier for Full Digital Integration
in Restorative Dentistry?
62 Charisma Classic Shows Excellent
Colour Match due to its Microglass
II Filler Technology

40

88
2

31

DENTAL ASIA
JULY / AUGUST 2015

The Downward

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 reflects
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 pull out an infected molar that has been 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 dentistry 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 efficient 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, First do no harm 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 periodontal disease. What
struck me is his statement, Education alone is not a guarantee of behavioural change. He
stressed that patients have to be more 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 theres 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 Abella


Assistant Editor

ADVISORY BOARD

FIRST WORDS

Dr Derek Mahony

Prof Alex Mersel

Dr Fay Goldstep

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 Hgg

Dr William OReilly

Dr Chung Kong Mun

Dr Choo Teck Chuan

Dr How Kim Chuan

DENTAL UPDATES
Markus Heinz is the new Chief Production Officer 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 comprehensive management experience,
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 Officer. Within the context of
his function, Heinz will join the Corporate Management
from July 1.

New Chief
Production
Officer
at Ivoclar
Vivadent
Markus Heinz assumes
position as head of the
companys 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 3Shapes
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.

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

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 D2000s 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 five
workflow 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-Occlusion 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.

Dental System 2015

3Shape Dental System 2015 introduces several new dental


sculpting tools including full digital workflows for creating
dentures, a simplified order form, boosted scanning speeds
and more restorative component libraries and compatibility
integrations with third party dental product makers. DA
DENTAL ASIA
JULY / AUGUST 2015

DENTAL UPDATES

Roland DGs 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 efficiency.
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-4Ws 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 workflow, 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 benefit of being able
to handle the simultaneous processing

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 dont need to clean the machine
extensively between jobs and you can
start your next task immediately.
Visitors at the IDS were very positive
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.

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

Cancellation of Publicly Held


Nobel Biocare Shares and
De-Listing from Six Swiss
Exchange as of June 10, 2015

Affordable 5- and 4-axis


milling units
The Roland 5-axis and 4-axis dry mills
were also presented 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 worlds 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

the compensation was paid on or around June 16, 2015.


By decision dated (June 1, 2015), SIX Exchange Regulation definitively 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
JULY / 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

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 Zimmers
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.
Biomets 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, Scientific 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.
Im 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
was the Chief Science and Practice
Officer for the American Association
of Diabetes Educators (AADE) where
she oversaw research efforts, reviewed
evidence for practice documents and
worked to increase opportunities 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
Foundations 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
JULY / 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, Sironas innovation international customer
magazine.
Left: 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 workflows
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 benefit 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 magazines foreword, Slovin wrote: Whether during
diagnosis, planning or treatment they make processes better,
faster, safer and more efficient. 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 Sironas 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 profits, 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, Were 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 Industryall 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 Europes Upper
Palaeolithic between 18,000 and 12,000 years ago is poorly
known. This is particularly a problem regarding food resources
that leave little trace such as plant foods. An international
research team led by Robert Power of the Max Planck Institute
for Evolutionary Anthropology in Leipzig, Germany has now
explored diet in the period through dental calculus analysis on
Magdalenian individuals found at El Mirn Cave in Cantabria,
Spain. The researchers found that Upper Palaeolithic individuals
already used a variety of plant foods and mushrooms, in addition
to other food sources.
Although the Magdalenian in much of northwest Europe is
commonly characterised as the period of the reindeer hunters,
this is unlikely to have been the case in Iberia. Other lines of
evidence showed diet included substantial amounts of meat
supplied from red deer and Ibex, but until now, it was unclear if
foods such as plants were a component of their diet.
Robert Power, a PhD candidate in the Max Planck Research
Group on Plant Foods in Hominin Dietary Ecology, and his
colleagues took dental calculus samples from Magdalenian
12

individuals found at El Mirn Cave in Cantabria, Spain. Using


optical and scanning electron microscopy with energy-dispersive
x-ray spectroscopy, they detected a diverse assemblage of
micro-remains from the dental calculus. These micro-remains
from plant, fungal, animal and mineral sources provide some
indication of the Magdalenian diet. These types of microremains show that the individuals at El Mirn consumed a variety
of plants from different environments, as well as other foods,
possibly including bolete mushrooms, says Power.
Archaeologists know almost nothing about the early use of
fungi. Although their use is poorly understood in pre-history,
ethnographers have noted that recent hunter-gatherers have
often used fungi as food, flavouring and medicine. Mushroom
use has firmly been identified from as early as the European
Chalcolithic. The Chalcolithic Tyrolean Iceman tzi carried
several types of fungi on his person. This finding at El Mirn
Cave could be the earliest indication of human mushroom use
or consumption, which, until this point, has been unidentified
in the Palaeolithic, says Power. DA

DENTAL ASIA
JULY / 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 biofilms. 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 biofilms. 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 biofilm 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 toothbrushes thoroughly 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
JULY / 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 article in the journal Anesthesia
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 patients 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 significant 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 Definition
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 years panel of judges. Winners
were chosen based on concept, 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 Definition Scanner,
they are revolutionising the consumers
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 Definition
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
JULY / 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 officially 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 fathers life. Former mayor of
Bremen Henning Scherf then listed
Weisss achievements for the city of
Bremen. Mr. Scherf was visibly impressed
by BEGOs 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
Weisss 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 companys
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 BEGOs 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 companys 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 NYUCDs
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, Steves 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 companys 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 Foundations Give
Kids A Smile programme. DA
From L to R: Dr. Michael P. OConnor, Dr. Charles N. Bertolami, Mr. Steven W. Kess, Dr. Stuart M. Hirsch,
Dr. Cosmo V. De Steno. (Photo: Henry Schein, Inc.)

18

DENTAL ASIA
JULY / 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.

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, biofilm), 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 four factors
interacting in variable proportions:

Chemical action

Mechanical action

Temperature

Contact time
If one factor is reduced, the loss mustt
be compensated by increasing one orr
more of the other factors.
Chemicals represent the action off
an acidic or alkaline detergent solution. Detergents contain
surfactants with cleaning properties acting as wetting, foaming,
emulsifier and dispersant agents. Its efficiency 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 cleaning
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 45C 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
JULY / 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 patients 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

that not every machine fulfils


all four steps. 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 manufacturers
claim, i.e., which pre-treatment steps
does the machine fulfil?

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 crucial for
asepsis 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 satisfies the previously
described cleaning principles (Sinner Circle), combining
chemicals, mechanical forces and temperature for a defined time.
Some devices flush the instruments with steam.
Efficient 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 increasing one or more factors. Therefore, if little or no
mechanical action (nebulisation) is applied, the concentration
and/or harshness of the chemical must be intensified. 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 efficient 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

When they designed the new


Assistina 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 extensively 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
JULY / AUGUST 2015

UNDER THE SPOTLIGHT

Dr. In-Woong Um:

Breaking New
Ground in Alveolar
Bone Repair through
Tooth Recycling
Its not about the environment,
but youve 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

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 affiliate professor in several university hospitals
in Korea and running his own private practice.
His interest mainly revolves around surgery. 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 Certified 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
implant dentistry when I started my private practice as an
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 not know?
That window of failure gave him the idea to look further into a part
of the surgical process that can significantly change the procedure.
He reiterated that dentists should not confine 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 bone morphogenetic
protein (BMP) 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 scientific research. Our mission
was to organise the data and facts and roll them into one, which
became the core of our system.

DENTAL ASIA
JULY / AUGUST 2015

UNDER THE SPOTLIGHT

The procedure

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

Indications
AutoBT can be used to repair alveolar bone in implant dentistry. 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. Biocompatible: The components of AutoBT are identical to dentin (Type I collagen,
HA and non-collagenous protein).
2. Dentin matrix macro-structures are very similar to cortical or cancellous bone.
3. Abundant microporous dentinal tubular structures provide nanostructural
micropores for movement of proteins.
4. The geometric assembly of the root dentin block make a unique and ideal 3D
scaffold for alveolar bone repair.
5. Recycling of a patients 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).
Sample case
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 five 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 influenced
AutoBT. Like stem cells, BMP has already been known for decades due to its ability to
reconstruct bone. However, an appropriate carrier 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 further 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.
2.

3.

4.

26

AutoBT (powder): Osteoinductive,


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

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 qualified laboratory technicians.

Sharing the knowledge


Dr. Ums 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
JULY / 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 scientific 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 Technology Assessment
(nHTA), which endows products with a
safety and efficiency 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 evidence-based.
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 confirm
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 efficacy
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 already published, including 12
SCI (e) journal articles. In addition, an
English textbook, Advances in Oral
Tissue Engineering, which is a collective
writing of their research 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 individualised to
fit a specific patients need or a dentists
diagnosis. But then again, accessibility
would be a difficulty: 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
JULY / 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 confidently 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, Id like to promote
awareness about our tooth storage system to other countries as early as now so that
they can also reap the benefits of this promising material and procedure.

Trash = Treasure
We have been witness to the wonders and benefits of recycling: From practical home
solutions and now to dental applications. As they say, One mans trash is another
mans treasure, and with this breakthrough, Dr. Um has allowed his colleagues to
appreciate recycling from a dental perspective. This will definitely be a significant
contribution to more efficient 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:


Small in Size,
on
Quality
by Dr. Audrey Abella
a

BIG

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 Certified 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. Dominguezs 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. Im 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-Pacific, at the IDS 2015.

DENTAL ASIA
JULY / AUGUST 2015

UP CLOSE & PERSONAL

The digital revolution

The Kymata staff (from L to R):


Ms. Jaime Miller, Mr. Dominguez,
CDT/TE, DTG, and Ms. Virginia Kim.

Comparing the technology they had


back then to what the industry has
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
didnt 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 didnt 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 workflow to
go, I can say were 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 couldnt
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 modified
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 dont want to do is to allow
technology to lead us down the road to
DENTAL ASIA
JULY / AUGUST 2015

Kymatas Renfert line

mediocrity. We dont want to sacrifice quality for efficiency. 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 cant settle for mediocrity just because its 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 definitely need to get over the infatuation with technology and
get back to traditional aesthetics, and tie this with the modern process for the benefit
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 refine 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 printed digitally
through the three-dimensional mechanism. Gone are the days when dentures are
processed or fabricated. Its 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. Theyre 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 dont 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 youre 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, its 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 its 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 were
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

Its not the size of the lab that matters; its 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. Were very fortunate. Weve 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 difficult for us to stop our
production. It does not happen now with the Renfert tools that we have. I know that
its 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 products or manufacturers that help
small labs, he spreads the word so everyone in the circle can go with the flow of todays
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 its everyones responsibility to help each other. I believe in


collaboration. And with regard to technology, I dont want to push technology
to push more mediocre units; I want them to push more quality in it. Big
labs may beat us on price, but they cant 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
JULY / 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 worlds
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 Spaceline, 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 uncomfortable 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
JULY / 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 worlds
first horizontally-positioned treatment unit. It combines
aesthetic excellence, ergonomic refinement 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 into
account the same amount of time thatt patients had
to endure while undergoing treatment.
nt.
Dr. Beach was an American endodontist
odontist who
made a genius out of himself. He went beyond
root canals and thought of a chair that
hat would
eventually revolutionise the dental treatment
eatment
unit design not only in terms of aesthetics
sthetics
but with emphasis on the postural health
ealth of
both operator and patient. The solution
on was
a chair that would allow the operator
or to
sit down while performing procedures
ures
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.
r.
With bracket tables placed behind the
unit, the Spaceline was also able to address
dress
the dentists concern of accessibility.
lity. It
allowed exceptional, effortless access
ss to the
operating field and instruments, thus promoting
health and eventually increasing productivity.
uctivity. The
counterproductive measure created by a typical
bracket table has been changed into a time-saving
workflow by the Spaceline.
It is also comfortable for patients ass it is tailored
to the human anatomy to ensure a relaxed, stable

32

A crazy idea that sold out


Coming up with the worlds first horizontal
dental chair has been Moritas 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 their patients
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.
The Spaceline EMCIA
DENTAL ASIA
JULY / 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 production
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
benefit 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
Moritas 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. Beachs idea coupled with Moritas 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 indeed
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

aving been in the business for six decades, Bausch has


earned the title as being the only company in the world that
specialises 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 dentists 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 Andr 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.

When one thinks of Bausch, that light bulb in every dental practitioners
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 specialises
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 Bauschs success. As one of the worlds 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 qualified staff are the qualities that have made Bausch
stand out and make a mark over six decades, he continued.

34

DENTAL ASIA
JULY / AUGUST 2015

Booth at the IDS 2015 in Cologne, Germany

Bausch = Red and blue

DENTAL PROFILE

A constant variable of the


dental treatment equation
With their dedication to articulating
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 Bauschs 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; Andr Bausch, Managing Director of
Dr. Jean Bausch GmbH & Co. KG; Cleiton Bauler,
Director of Bausch Importao de Mats.
Odontolgicos 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 Bauschs 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
technologies through social media in order
to improve their communication with
customers worldwide. They capitalised
on todays internet trend by creating a
foothold on the digital market. They have
developed a specific 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 23rd time,
he also revealed that this was Bauschs
most successful IDS exhibition.

Dentistrys paper fortress


According to Mr. Rajek, Bausch 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 Bauschs 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 theyve made such
a significant mark in the dental industry.
They have created deep-set footprints on
the dental trail, and this will be Bauschs
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; Cline Bausch;
Andr 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: Bauschs 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
JULY / AUGUST 2015

CLINICAL FEATURE

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

Modern
Approach
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 fibre-reinforced composite 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 tooths 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 fibre-reinforced composite material was placed to help in reducing the
risk of crack propagation. All healthy tooth structure was maintained. Regular
follow-up and occlusal management was advised for optimal outcome. The patients
follow-up appointment was scheduled after finishing root canal treatment.

Procedure
The tooth was isolated with rubber
dam in preparation for the biomimetic
build-up. The temporary 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 orifices.
GCs 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 fibres 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
JULY / 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 initially 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
withstand the 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 successful in making large and
directly placed restorations feasible. DA

The strengthening effect of the fibres 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-Certified 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
JULY / AUGUST 2015

39

CLINICAL FEATURE

Periodontal
Inflammation:

Simplified

by Dr. Fay Goldstep

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), swelling
(tumor), heat (calor) and pain (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. This leads to
the accumulation of fluid and leukocytes
in the extravascular tissues.2
The inflammatory response is a beneficial
process. In the healthy periodontium,
bacteria in the crevicular fluid enter the
blood stream and elicit a protective response
during chewing, tooth brushing, etc.
The inflammatory response occurs
routinely to counteract microbial
challenges and eliminate them
without our awareness. We become
aware of inflammation only when
the response is prolonged and
not successful in resolving the
microbial challenge.

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 bacterial stimulus.
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 are precursors to resolvins. Therefore, diet can affect the 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 influence and
link diseases in the older individual. Inflammatory mechanisms are critical in the
development and progression of the diseases of ageing.
7. Treatment of periodontal disease should not only reflect the bacterial stimulus, but
must take into account the inflammatory 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
but the specific bacterial types that are implicated in the pathogenesis of
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 bacteria.3
In the 1990s, the particular inflammatory response of the affected individual (host)
and the presence of certain specific bacteria were found to be associated with active
periodontal disease progression. The four major species implicated were P. gingivalis,
A. actinomycetemcomitans, T. forsythensis and T. denticola.4 These pathogens are
found in ecologic complexes (biofilm). An ecologic shift in the biofilm, like a change in
available nutrients, can lead to the emergence of these specific microbial pathogens.5
Periodontal inflammation is initiated by the products of biofilm bacteria such as
lipopolysaccharide molecules (LPS components of the cell wall of Gram-negative
bacteria and are not found in Gram-positive bacteria). This creates a cascade
of reactions.6 In the healthy periodontium, the products are eliminated and the
inflammation is resolved.
In the compromised periodontium, periopathogens like P. gingivalis suppress the
innate host response by paralysing a key step in the host defence system. This permits
both P. gingivalis and the commensal (benign or beneficial) bacteria in the pocket to
thrive and grow without any recognition or resistance by the host.7
P. 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. gingivalis has been called a keystone pathogen
a species that supports and remodels a microbial community to promote pathogenesis.8
Many of the bacterial model studies have focused on P. gingivalis, but the model applies
to the other periopathogenic species as well.
The scenario is as follows: In the deep, inaccessible, subgingival space of the
compromised periodontium, P. gingivalis impedes the bodys defence system by
blocking protective host receptors.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. gingivalis leads to increased numbers of normally benign
bacteria. This encourages a greater inflammatory response and tissue breakdown. The
breakdown products (collagen fragments) flood the crevicular fluid and are a great source
of nutrition for P. gingivalis 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 benefit.
Bacteria and the host both 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 treatment and prevention
of these diseases may involve the identification and targeting of keystone pathogens.9

DENTAL ASIA
JULY / AUGUST 2015

CLINICAL FEATURE

Resolution of the
inflammatory response

(From left to right) Fig. 1. The acute response


Periodontal tissues: Bacteria initiate the immune response producing vascular dilation, increased
permeability of capillaries and increased blood flow. Cellular level: The crevicular fluid contains
neutrophils, macrophages and other inflammatory cells. Macrophages eliminate bacteria by
phagocytosis. The inflammatory cells secrete cytokines that regulate the inflammatory response.
Biochemical Level: Arachidonic acid (released primarily by neutrophils) produces prostaglandin.
Fig. 2. The active resolution of the acute response
Periodontal tissues: The stimulus (bacteria) is removed. Cellular level: The crevicular fluid contains
fewer, weakened neutrophils and remnants of bacteria. Biochemical level: Arachidonic acid produces
lipoxins. Dietary omega-3s produce resolvins. Lipoxins and resolvins actively stop inflammation.
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 and the adaptive.
The innate response is an evolutionary defence mechanism that provides immediate
protection. Phagocytic (ingesting) cells (neutrophils, monocytes, macrophages) identify
and eliminate foreign substances. These immune cells also release chemical mediators
called cytokines (cyto = cell; kine = movers) that assist antibodies in clearing pathogens
or marking them for destruction by other cells. The innate response is non-specific.1
The adaptive response 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 specific pathogens and to remember the pathogens antigen
signature. T-cells recognise foreign antigens and specifically 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
The sequence is as follows:11
1. There is vascular dilation, enhanced permeability of capillaries, increased blood flow;
2. Neutrophils (polymorphonuclear leukocytes or PMNs) are dispatched to the site;
3. Macrophages, etc. are recruited to the site;
4. Cell mediators (cytokines) are produced by these recruited immune cells
and by local cells in the area (fibroblasts 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 and play an
important role in further leukocyte recruitment;13
6. Cytokines work with the body to defend it from attack. The immune cells and their
secreted chemicals attempt to destroy, dilute or wall off the injurious agent;12
7. T- and B-cells mediate the adaptive response.
It is noteworthy that, while oral bacteria live close to a highly vascularised periodontium,
very few bacteria cause systemic infections in the healthy individual. This is the result
of the highly efficient 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 inflammatory disease begins.
42

Complete resolution of an acute


inflammatory response and the bodys
return to homeostatis is necessary for
health. The leukocytes and invading
bacteria must be removed without
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 inflammation and return to
homeostasis is an actively regulated
process 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 inflammation
and act to control the magnitude and
duration of inflammation.11
Lipoxins: 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 (arachidonic 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 neutrophils.14
Aspirin transforms lipoxin into a more
bioactive form with more powerful
pro-resolving properties.18
Resolvins: Substances that are
derived from omega-3 dietary fatty
acids (EPA and DHA). Several clinical
studies have shown that diets rich in
omega-3sare useful in the prevention and
treatment of arthritis, cardiovascular
disease (CVD) and other inflammatory
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 inflamed
DENTAL ASIA
JULY / AUGUST 2015

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 resolution of periodontal
inflammation. Treatment resulted in bone re-growth to pre-disease levels. 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 inflammation is critical to the
pathogenesis of periodontitis.18 Periodontal disease results from the bodys failure to turn off
its inflammatory response to infection. The result is chronic maladaptive inflammation.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 inflammation. 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. Inflammatory 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 inflammation 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
In chronic unresolved inflammation:
1. Cellular and molecular responses to bacterial challenges involve constant
adjustment and regulatory feedback;21
2. Neutrophils, macrophages and monocytes continue to secrete cytokines. This
creates a complex chronic lesion that destroys the periodontium;
3. 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
4. Tissue destruction is not uni-directional. It is constantly being adjusted by
host-bacterial interactions;21
5. Alveolar bone destruction is the result of the uncoupling of the normally tightly
coupled processes of bone resorption and formation;21
6. Prostaglandin production plays a role in alveolar bone resorption.
Cytokines are an intermediate mechanism between bacterial stimulation and tissue
destruction. They were historically identified as leukocyte products, but many are also
produced by other cell types such as fibroblasts 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 deficient 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-inflammatory
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-inflammatory
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
variations in host responses between
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 modifiers such
as smoking in the presence of bacterial
accumulation may shift the immune
response beyond normal parameters.24
DENTAL ASIA
JULY / AUGUST 2015

CLINICAL FEATURE

Bacteria initiate periodontitis. They are essential but they


are insufficient. 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 modified
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, specific
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
Environment: Smoking, the identified 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
Genetics: 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
Epigenetics: This pertains to the control of how certain
genes expressed in specific 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 modification 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 periodontal 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

become unresolved
and chronic. The
tissues do not return
to homeostasis.1
Chronic inflammation
is characterised by the
continued production of
cytokines, arachidonic
acid-derived
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 The local-systemic link
1.
Local inflammation 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 inflammation 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 inflammatory burden presented by periodontal
infection causes an increased systemic inflammatory burden, i.e.,
local inflammation can be a modifier of systemic inflammation.20
Studies monitoring CRP (C-reactive protein) levels have shown
this connection. CRP is:
1. One of the most reported bio-markers of systemic inflammation;
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-inflammatory cytokines;
4. A component of normal serum, but an elevated serum
CRP reflects an elevation in systemic inflammation. 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 inflammatory
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
JULY / AUGUST 2015

CLINICAL FEATURE

health. The resolvin treatment lowers the inflammatory burden


locally, which results in a lower systemic burden.20
Another study using the same model of animals with
periodontitis showed them to have more atherosclerosis
(measured by fatty plaque deposits in their major blood vessels)
than the control subjects.17 Inflammation-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 inflammation
creates a toxic systemic situation. Bacteria, pro-inflammatory
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 bodys 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 inflammatory
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 inflammation effectively eliminates the
pathogen from the lesion by removing its food source.20
Advances in treatment must address the specific 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
JULY / 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

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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, a promising 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, et al. 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

here are numerous aspects and variables that affect the final outcome
of a restoration. Some examples are difficulty 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
restorations cure is too often ignored. Achieving a predictable, high-quality
cure every time is absolutely essential.
Here are some factors that influence the quality of any cure, along with a few tips on
how to successfully manoeuvre them for the benefit 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, VALOs slim head and low-profile
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
wavelengths nor achieve uniform
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
JULY / AUGUST 2015

CLINICAL FEATURE

Beam collimation an
and uniformity
Finding a high-energy light that
t
reaches into all aspects of the
produce high-quality
restoration is critical to predictably
p
critical aspects that influence this
results. One of the crit
outcome includes the curing lights beam collimation
and uniformity.

Dr. Fischer says, The quality of a restoration


on how adequately that
is totally dependent
depend
restoration and its bonding agent are polymerised.
The power outp
output and size of footprint varies
immensely amo
among the curing lights available
on the dental market
today. VALOs lens is
m
designed to create
creat a beam that is close to parallel
to the preparation,
preparatio while still emitting enough
light to the curing material on the axial walls of
the preparation.

This allows VALO to deliver a complete and


uniform cure to any
an restoration. The power,
concentration of light,
ligh and its collimated, uniform
it to cure dental materials
energy output also allow
all
completely even at a distance.
Connecticut says,
Dr. John Kanca of Middlebury,
Mi
VALOs ability to pro
produce the greatest amount of
energy at distances up to 10mm from the tooth is just
using this light for some time and
amazing. I have been usin
without it. DA
would not want to be with

50

DENTAL ASIA
JULY / AUGUST 2015

CLINICAL FEATURE

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 clear
braces and tooth-coloured arch
wires 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)
three different treatment options.

Firstly, we always offer the ideal


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 SmileFast,


which comprises 80 per cent of our
adult patients, SmileFast is offered as
a second option, reiterating that this
will involve pure alignment of the
teeth to improve the cosmetic
result without affecting the bite
or occlusal relationship. Patients
are informed about the treatment
span and that it usually involves a
non-extraction treatment plan or,
in the worst scenario, a lower incisor
extraction.

Finally, aligner therapy 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
JULY / 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 time in braces.
We believe there is a psychological
barrier with patients. If we can finish the
orthodontic treatment within 12 months
preferably six to nine months 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 experienced and knowledgeable
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
patients smile without altering
their occlusal scheme.
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:

Levelling and alignment of the


anterior teeth

Correcting anterior crossbites

Closing most spaces


51

CLINICAL FEATURE

Figure 10. Ideal alignment with ideal bracket


placement in digital 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 balanced and harmonious.
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, eight 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
confidence 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 computer or a Mac
running in a Windows environment.

3. Lab/Doctor/Patient
communication
SmileFast utilises a 3D, web-based Case
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

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 dentists 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.

5. The learning experience


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
where and how the case could be
improved using sound orthodontic
principles that underpin SmileFasts
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
JULY / 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


dentists knowledge of orthodontic treatment.

6. Indirect bonding
The key to well-aligned orthodontic cases is the position of
orthodontic brackets. 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
difficult 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 dentists
profitability on that case drops accordingly.
A digital indirect bonding solution is, without
a doubt, the most efficient 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 then 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
bonding system has the same
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 cosmetic orthodontic
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 significant 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. SmileFasts 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 five 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 overall cost, once
you compare this to normal highend 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.

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 very efficient and effective 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
brackets) and also a unique 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
will bring their SmileFast patients
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.

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


Dr. Geoffrey
Hall is a
Specialist
Orthodontist
based in
Melbourne,
Victoria and
inventor of
the SmileFast
cosmetic
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 is
a Diplomate
o f
t h e
International
Board of
Orthodontics
and Visiting
Faculty at the
City of London
Dental School.
Dr. Mahony is a Specialist Orthodontist
who has spoken to thousands 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
JULY / AUGUST 2015

USER REPORT

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 defined. They are more
clearly visible when the teeth are dried, and are accentuated on the perikymata. Also
characteristic is the so-called snow capping, 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.
The patient opted for resin infiltration due to the relatively low tooth structure
removal, good predictability and manageable costs.
Fig. 2

y
b
s
i
s
o
r
o
lu
F
f
o
g
n
i
k
Mas
ation

r
t
l
fi
n
I
n
Resi

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 isolation 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
JULY / AUGUST 2015

ebastian

by Prof. S

Paris

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 sufficient abrasion of the surface layer was achieved,
ethanol (Icon-Dry) was subsequently applied to the lesion. Due
to penetration of the ethanol into the lesions 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 five seconds
after ethanol application, the surface layer is sufficiently abraded
to guarantee quick and complete infiltration (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

lesions 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-Infiltrant, 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

Final results

minutes (Figure 14). The resin then underwent


light-curing for 40 seconds (Figure 15).
To compensate for the infiltrants 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

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
immediately after treatment was finished (Figure 17). DA

DENTAL ASIA
JULY / 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, Charit, Berlin. From 2008 to 2013,
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 Charit, Berlin since June 2013.
Prof. Paris main scientific 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 scientific
abstracts. He has received the Oral-B Prophylaxis
Award, IADR-William 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?

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 mounted models, these
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 workflow 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.

by Bruce Lee, BDS

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,
faceted labial and
incisal edges of the
lower anterior teeth
(left).
Occlusal views
(right, top and
bottom).

Fig. 1C. Lip positions at rest and full smile.

Examination and data


collection
Fig. 1A. Retracted view revealing upper fixed
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 detailed examination revealed 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
JULY / 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 sons 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 for 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 patients dentition with no adjustments
or tooth preparation. She was allowed to road test these provisionals for two
weeks (Figures 2 and 3).

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.

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

Pre-preparation scanning
and tooth 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.

Prior to preparation, a pre-preparation


scan was made using the 3Shape Trios
intraoral scanner (Figure 4). The aim was

DENTAL ASIA
JULY / AUGUST 2015

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 3Shape Dental
Systems 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 function.

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 of the lower anterior segment. Note the minimal
and conservative preparations.
Fig. 5. Minimal preparations of the lower anterior teeth. Treatment was
carried out in segments.

Fig. 6D. Digital bite registration.


Fig. 6A. Digital impression of the lower right side. Impressions are taken in
full colour but may be viewed in stone colour as an alternative way to view
and clearly identify the margins.

Fig. 6B. Digital impression of the lower left side. Note the splinted implant
crowns on Tooth #36 and #37.

60

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

DENTAL ASIA
JULY / AUGUST 2015

USER REPORT

Fig. 8A. Completed treatment after seven weeks


after final bonding of the anterior veneers.

Fig. 7B. Individual prostheses fitted on the 3D printed models to check fit 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 workflow 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 vital final link between the clinician
and the laboratory. The digital process enabled us to reduce downtime, increase
efficiency 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
JULY / 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

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 dentists
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. Test
report 2014. Unpublished data. Data on file. The study was abbreviated and
summarised. All diagrams and titles have been established by Heraeus Kulzer.

62

DENTAL ASIA
JULY / 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 confirms 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 difficult 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.
2.

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


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

BEHIND THE SCENES

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 IS Immediate Stop 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-efficient
blasting, thanks to the IS feature and the unique mixing
chamber technology.

The Basic quattro IS experience

ro
uatt
ic q
Bas

IS

Theres Sandblasting...

And Then Theres


Sandblasting!
by Mr. Rainer Semsch

Implant
abutment prior
to sandblasting
treatment

Implant
abutment after
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 fit 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 thats all we ever
did. There was no need to change anything.
At first, I was not enticed at all by Renferts 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 its 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 thats 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 flow 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
JULY / AUGUST 2015

BEHIND THE SCENES

Actual sandblasting
Renferts 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, theres no more stroking, the
microblaster develops enormous power
and, together with aggressive 250m
Cobra aluminium oxide, things really
get going. The edge definition 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
be recognised
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 Masters exam in Stuttgart
in 1985 and became an independent
Master Dental Technician in Freiburg
in 1992. In 2005, he moved his lab to
Mnstertal/Black Forest. He has been
a DGZ member (German Society for
Aesthetic Dentistry) since 2007.

DENTAL ASIA
JULY / AUGUST 2015

Mixing chamber technology


The unique mixing chamber provides an optimal air/abrasive mixture for the most
efficient 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, Osnabrck, 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.

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
values (L-, A- and B-values) 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 specific 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

Prog
rama
t P71
0

free to carry on working. The users mobile phone connects to the furnace via Bluetooth
wireless technology and transfers the users 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
JULY / 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

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 fiber 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
JULY / AUGUST 2015

Fig. 1: The excellent absorption in tissue


pre-destines the SIROLaser Blue for soft
tissue surgery. Equipped with two additional
laser diodes, the laser is also well-suited for
applications in endodontics and periodontics.
Fig. 2: The blue light of 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).
Thats 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

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
earlier
shiny
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 reflection, which is why the Surtex posts are
more difficult to spot through a translucent resin filling material.

But why stick to a metal post when there


are posts available in fibreglass 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 requirements.
Since their launch in 1972, the pure titanium posts have
been delivering higher levels of strength, biocompatibility and
cost-effectiveness.
Since 1989, when difficult challenges required even greater
strength, stainless steel became the obvious alternative.
The original gold-plated 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 fulfils 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
JULY / 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 ideal approach to providing both
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 benefits
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 beneficial 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, efficient, new-generation
bulk composite. Conventional light-curing
bulk-filling materials are limited 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 efficient 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


With Fill-Up! single layer technology,

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 five seconds to cure
with light (1600 mW/cm3). Due to the
solid mechanical properties, sufficient
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
polymerisation specifically 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.
Fill-Up! in a single step to give a
perfect result.

DENTAL ASIA
JULY / 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
biocompatible restorative make it the ideal material for
countless procedures that users will encounter in the practice.
Geristores 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 retention,
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 coefficient 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
JULY / 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-office 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 sufficiently 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

The new single-component, light-cured universal adhesive


Tetric 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 sensitivity.
Given the adhesives 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 sufficient 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 efficient 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
JULY / 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
workflows, 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 workflow, 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 centres 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 efficient, smooth
and optimised treatment workflow, 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 confidence.

Fig. 1: Following the incorporation of extensive functions, the TENEO


treatment centre has become a specialist centre for endodontics: Extra
devices are no longer necessary. The figure shows entry dialog with the
integrated ApexLocator.

The classic chair positions can be stored for 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 dentists point
of view is the headrest. The TENEO headrest can be adjusted
not only to the patients 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 retrofitted 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 profile 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: The 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 dentists chair.

DENTAL ASIA
JULY / 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
with outstanding invisible aesthetics
is over. G-nial is GCs answer to the
increasing demands to highly aesthetic
restorations and superior handling in the
market today.
G-nial Anterior and Posterior were
developed using GCs extensive expertise
and knowledge of dental materials.
G-nial is a user-friendly restorative
that is indicated for highly aesthetic
single-shade or multi-shade build-ups in
all restorative classes. G-nials forward
thinking shading concept offers flexibility
to help users achieve aesthetically
beautiful restorations.
G-nial 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-nial is
related to its extremely diverse structural
composition, which results in it mimicking
the reflectivity of a natural tooth. G-nial
captures the genius of nature and creates
invisibility in restorations.
G-nial gives users the option to choose
the best handling characteristics suitable
to their needs. G-nial Anterior allows
users to shape, flow and sculpt, while
G-nial Posterior gives a more packable,
firmer consistency. G-nial does not stick

onto the spatula or matrices and provides


more working time under ambient light
extended to four minutes. G-nial 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-nial 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

die:
mas
ter a
qua

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 10m 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
be washed off again
using water and a brush
if necessary. This makes
it easy to fit the ceramic
restoration.

DENTAL ASIA
JULY / AUGUST 2015

Polydentia

The MyRing Efficiency:


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.
Wedges can be easily
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 and
Plaster

Working on acrylics and plaster 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 DiaTWISTER 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 users working technique.
The conically rounded DiaTWISTER instruments are also
available in both mega-coarse and super-coarse diamond grit.

DENTAL ASIA
JULY / AUGUST 2015

77

PRODUCT HIGHLIGHTS

Acteon

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 biofilm.

easy not only user-friendly but increases


patient comfort. The system provides
gentle cleaning of the treated areas.
CLASSIC powders (76m)
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.

AIR-N-GO easy nozzles

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
efficient weapon for pathogenic bacteria
elimination. The quick maintenance of
the device is childs play only items
in contact with the patient need to be
disconnected and sterilised.

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 (55m) 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 (25m), will help to
fight against the advancement of periodontal
and peri-implant diseases.

Drr

A New Standard in Surgery Supply:


Generation Tyscor

For decades, robust suction units from Drr 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 significantly 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 efficient.
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 efficient 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 superb performance and the
consumption values of radial technology
systems, the Tyscor VS 2 raises the bar for
suction units. With Tyscor, market leader
Drr 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
JULY / AUGUST 2015

BEGO

Varseo 3D Printing System

Simple and flexible printing is now a reality for dental laboratories with the
multi-talented Varseo a 3D printing system developed with and for 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 Jrgen
Schultze, Dental Technician and Head
of International Sales at BEGO Bremer
Goldschlgerei and BEGO Medical.
Varseo stands for VARiability, Speed,
Efficiency 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

Left: Customised
restorations using
specially developed
resins.
Right: The 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 confirmed
in numerous scientific 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 flow
VITA Zahnfabrik is expanding its
VITA VM LC line of light-curing
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: paste only or
paste with flow. These options open up
DENTAL ASIA
JULY / AUGUST 2015

new ways to achieve brilliant aesthetics


that are very close to ceramic and
always systematically.
With high shade stability, low plaque
affinity 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 flow? VITA 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 Italys most important international dental
show. After their 2015 hiatus, they are gearing up for the trade show stage yet
again. Now dubbed as the Expodental Meeting, 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 Fieras 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

FOCUS
FOC
ON
ITALY

FOCUSONITALY
TeKne Dental (TKD)
TKDs 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 air-bearing turbine. This
was the only product manufactured and
sold during their early years.
A high market demand fuelled the
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 companys R&D

department comprises highly-skilled people with the necessary proficiency


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 dentall units.
TKD exports its products to over 50 countries and is a member of the
he
Italian UNIDI association.
During the previous exhibitions this year, TKD has presented the
he
following products:

SONOSURGERY handpiece: Pneumatic handpiece especially


lly
designed for surgical procedures using the special Komet Intro set
of inserts.

DUOPAD control panel: Compact unit board to control electric


ctric
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 spherical dental attachments,


Rhein83s 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 introduced 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
JULY / AUGUST 2015

The OT Equator line offers the lowest profile 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 profile 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 profile 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 creation
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
Italys 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 wellorganised, ergonomic trays. Gammafix,
Medesys 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 specifically designed for microsurgery and includes instruments that
guarantee maximum precision and reliability.

Micro-Surgical Tweezers
This range presents five 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 efficient
and safe handling of implant sites. The tips are coloured blue for easy and fast
identification.

82

DENTAL ASIA
JULY / 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 Century
Line which includes
the most common and
basic orthodontic pliers and
instruments.
Main features:

Finely manufactured through a sophisticated handcrafted


box-joint system, which provides higher stability of
the pliers, ensures safer use and longer duration, and
maintains perfect alignment of the tips.

New neat Rhombus design for MEDESYS distal ends:


A lighter and thinner shape for optimal performance.

TC inserts on cutters and distal ends obtained by


using the most advanced electro-welding technological
processes.

A special glass microsphere surface treatment,


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 Medesys
commitment to innovation: the right formula to better fulfil
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.
With their know-how, expertise and deep passion 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 technology-driven company,
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 gold standard (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 first manufacturer
to introduce transducers made of
titanium and to solve this important
issue all other companies later on
decided to adapt this Mectron innovation
to their products as well.

2001: The worlds first LED


curing light. Mectrons 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 worlds first curing light
based on LED technology. 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
most important example of
Mectrons innovative power
was introduced, representing
the starting point of an important
success story. For quite some time,
Professor Tomaso Vercellotti, a
dental specialist, researcher and
brother of Domenico Vercellotti
(one of Mectrons founders), had
been unhappy 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
winning concept: 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 Mectrons research
labs, in Prof. Vercellottis dental
office, and in universities finally
ended up with the development of
an efficient and safe product.

IDS 2007: Launch of the first ultrasonic


instruments for implant site
preparation another result of the lucky
combination between Prof. Vercellottis clinical
and Mectrons technological know-how.
2009: Mectron re-defined bone surgery
with the third Piezosurgery generation
which had a completely digital power
supply control, a wide range of ultrasonic
frequency and a specific 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 the Piezosurgery
touch (fourth generation), opening a
new era in piezoelectric bone surgery.
IDS 2015: Launch of the Piezosurgery
white (fifth 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
AREA SALES MANAGER. 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


written English 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
JULY / AUGUST 2015

SHOW REVIEW

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 consecutive
year that Zimmer Dental has
collaborated with NYUs College
of Dentistry to organise this
prestigious, CE-accredited global
educational forum.
This years 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, Scientific Poster
Presentations and an optional
tour of Zimmers 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 years programme was
the unveiling of Eztetic,
Zimmer Dentals 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 Dentals Eztetic
implant was officially launched
in the second quarter of 2015.
Another new addition to
the 2015 NYU Programme
was a Scientific Poster
Presentation, which
featured 16 compelling cases
submitted by the participating
86

Sixth Annual
Zimmer Dental/
NYU Global
Implantology 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 tour of Zimmers Trabecular Metal manufacturing facility
and Zimmer Institute Training Centre provided participants
insight into Zimmers proprietary process of making the
Trabecular Metal material, which is used for both dental and
orthopaedic applications. They also toured Zimmer Institutes
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 years 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. DA
DENTAL ASIA
JULY / AUGUST 2015

SHOW REVIEW

Colgate
atAPDC:
Prof. Seymour Talks about
Periodontal Health

by Dr. Audrey Abella

rof. Gregory Seymour, having an international reputation


in Periodontology and Oral Immunology, sat down with
Dental Asia during the Asia-Pacific Dental Congress 2015
to discuss periodontal disease, its implications to society
and why it is important to take action before its too late.

A global disease
Periodontal disease is a global disease. It is estimated that about 10 to
15 per cent of people are at risk of losing teeth as a result of untreated
periodontal disease, the professor 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 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 of
periodontal disease: bacterial plaque. Other factors (such as
smoking, stress, age, systemic conditions, etc.) modify the way in
which people respond to their plaque but do not cause the diease.

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 the life of teeth. In others, gingivitis may develop
into periodontitis and lead to tooth loss. Even so, there will still 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 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 more closely together. Different specialities 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 specific 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 ones immune responsiveness. If you lack micronutrients
or antioxidants, then you may modify the type of response that
you have to dental plaque, and that may manifest as periodontal
88

disease. As for diet per se, the link is developing but as yet its not
firmly established.

The social impact


One problem associated with periodontitis is halitosis, an obvious
social barrier. It definitely 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., difficulties in trying to find a job ). I think there
is a role for dentists in terms of trying to improve ones overall
self-esteem, he concluded.
Given these concerns, he pointed out the significance of including
a periodontal assessment during routine dental procedures. It is
imperative for dentists to always include a periodontal assessment
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 will not guarantee a change in patients
behaviour. For example, if you tell a young patient that they might
lose their teeth in about 40 years time, they will not necessarily
see that as a problem. So it will not 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 around in ten years or they
might just brush it off, thinking people normally lose teeth as they
age. What matters is the patients attitude, which varies across
different age groups. If people expect that they will lose teeth in
time, it wont be a cause for alarm, he shared. I think education is
not the only thing required, as what youre looking for is a change
in behaviour. Therefore, motivating patients is more important
than 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-inflammatory properties of triclosan toothpaste attack
two of the three components of periodontal disease (the bacteria
and host response). Our studies over five years (supported by Colgate
Palmolive Company USA) have shown that if patients use this type
of toothpaste, it can slow the progression of periodontal disease. DA
DENTAL ASIA
JULY / AUGUST 2015

SHOW PREVIEW

CDS 2015 Increases


Exhibition Space due to
Greater Demand
Following the success of the China Dental Show (CDS) 2014, this years
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.

he trends and
technologies
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.
Todays 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
JULY / AUGUST 2015

A major platform for the


latest ideas and innovations
entering the dental market,
CDS 2014 has attracted over
500 exhibitors and 44,000
visitors. CDS 2015 will
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
with Reed Sinopharm
Exhibitions (RSE) and the
Chinese Stomatological
Association (CSA), the apex
industry body that guides
and enhances Chinas 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 mostt
ergonomic fashion,
allowing exhibitors
within the same
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 five months
to go for CDS 2015, the
international section has

already
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
witnessing a high level
of interest not only from
exhibitors but also from
visitors who are looking for
quality products from China
at competitive prices. DA
89

2015 Events Calendar


2015 Delhi Dental Show (DDS)
24th 26th July 2015
New Delhi, India
Venue: Pragati Maidan
Contact: Indian Dental Association
Email: info@delhidentalshow.org.in
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: tds@fujiya-net.co.jp
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: bonnie@dcds.org
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: hkideas@hkda.org / info@hkideas.org
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: veron.koh@gcasiadental.com /
eric.gan@gcasiadental.com
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: dr.ha.vosa@gmail.com
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: minhchauvinexad@gmail.com
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: aestheticon@AADFA.net
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: headquarters@iti.org
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: acohpsc8@gmail.com /
tata50101987@cda.org.tw
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: info@wcli.org
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: csimpson@fdiworldental.org /
info@fdiworldental.org
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 /
sponex@aosconference.com.au
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: headquarters@iti.org
Website: www.iti.org
2015 World Dental Show
16th 18th October 2015
Mumbai, India
Venue: MMRDA
Contact: Indian Dental Assn. / WDS Secretariat
Email: info@wds.org.in
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 / Griffin Ge / Vivian Zhou
Email: sandra.shen@ubm.com /
griffin.ge@ubm.com / jc.zhou@ubm.com
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: khamsay.l@reedsinopharm.com /
jenny.liu@reedexpo.com.cn
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: wioc2015@mci-group.com /
Divya.Thapa@mci-group.com
Website: www.wioc2015.com

DENTAL ASIA
JULY / 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: iaobandung2015@yahoo.com
Website: ikorti-iaomeeting.com
The 7th Dental Facial Cosmetic
International Conference
13th 14th November 2015
Dubai, UAE
Venue: Jumeirah Beach Hotel
Contact: CAPP FZ L.L.C.
Email: events@cappmea.com
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: execdirector@gnydm.com / exhibits@
gnydm.com / info@gnydm.com
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: international@qmedexpo.com /
national@qmedexpo.com
Website: www.qmedexpo.com
Dental Vietnam 2015
2nd 4th December 2015
Hanoi City, Vietnam
Venue: Hanoi Intl. Centre for Exhibition (ICE)
Contact: Nguyen Minh Chau / Thai Tuyet Huong
Email: minhchauvinexad@gmail.com /
chaunguyen.vinexad@gmail.com
Website: hn.medipharmexpo.com/eng/
index.php / www.vinexad.com.vn
CAD/CAM & Digital Dentistry Intl.
Conference 3rd Asia-Pacific Edition
4th 5th December 2015
Singapore
Venue: Suntec Singapore Convention &
Exhibition Centre
Contact: Dr. Dobrina Mollova / Tzvetan Deyanov
Email: info@cappmea.com /
mollova@capp-asia.com / deyanov@capp-asia.com
Website: www.cappmea.com / www.capp-asia.com

DENTAL ASIA
JULY / AUGUST 2015

2015 Expodent International India


25th 27th December 2015
New Delhi, India
Venue: Pragati Maidan
Contact: Expodent International India
Email: info@expodent-india.com /
expodent_india@yahoo.com
Website: www.expodent-india.com

2016
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: index@emirates.net.ae /
matios.tcholakian@index.ae / info@aeedc.com
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: education@iti.org
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: dental@ste.cn / dentalvisit@ste.cn
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: sydney@adx.org.au /
exhibitions@adia.org.au
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: s.sim@koelnmesse.com.sg /
c.zhang@koelnmesse.com.sg
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: ekoksaldi@kenes.com /
beris@kenes.com / sakun@kenes.com
Website: www.apdc2016.org
2016 Intl. 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 OQuinn
Email: coquinn@iadr.org / meetings@aadr.org
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: events@iti.org
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: events@iti.org
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: exhibits@gnydm.com /
info@gnydm.com
Website: www.gnydm.com

91

ADVERTISERS INDEX
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Page

3rd APAC CAD/CAM & Digital Dentistry Intl. Conference 2015

20

3Shape A/S

03

ADIA Australia 2016

74

Amann Girrbach AG

19

Anthogyr

43

Busch

33

Den-Mat Holdings, LLC

35

Dentech China 2015

56

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