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DENTAL ASIA MARCH / APRIL 2018
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Embracing New Ideas 'U&KDOD53ODWRQ$VVLVWDQW(GLWRU
rowth and development depends upon oneâ€™s drive and willingness to learn new ideas. This is also the case in dentistry whether it is about accepting continuing education, new concepts or innovations in technology. One thing that all dental staĚŤ should learn and never overlook in a dental practice is instrument sterilisation. This is crucial so as not to spread any virus and sickness to and from the practice. Monitoring sterilisation and guidelines from Centres for Disease Control (CDC) should be applied to assure safety and proper patient care (page 18-20). At times, seeking answers brings enlightenment, purpose and even the birth of a new concept. For example, Dr. Yue Weng Cheuâ€™s journey in creating the concept of Linguadontics came from his personal search for an answer to his
own Temporomandibular (TMD) issues. This led him into opening The Linguadontics Clinic to help patients, together with other medical and allied healthcare practitioners, in addressing the root cause of various problems (page 26-30). Alternative approaches to dental treatments are always changing and developing. One of the innovations in digital dentistry is CEREC- the use of CAD/CAM technology in daily dental practice. Thanks to Dr. Michael Tsao, CEREC Asia was founded in Taiwan to further help fellow practitioners in Asia to expand their knowledge on how to utilise the technology to its full potential (page 32-34). Nowadays, the age of a patient inĚuences the dental procedure or treatment of the dentist. Dr. Tom Bereznicki and Ms. Lola Welch discuss a minimally invasive approach perfect for adolescent
patients (page 55-59). More often than not, dentists tend to steer older patients towards less costly alternatives but Dr. Raymond J. Voller explains why it should be the goal of the prudent practitioner to provide the very best that dentistry has to oĚŤer, irrespective of the patientâ€™s age (page 60-62). All these developments are possible through continuing education. There is no better platform to achieve this than IDEM 2018. With the eventâ€™s theme â€œStriving for Clinical Excellence in Dentistry in Singaporeâ€?, participants can look forward to attending comprehensive seminars and workshops, meeting key decision-makers, valuable contacts and exploring new innovative products (page 92-93). IDEM 2018 is expected to have approximately 9,000 attendees from over 83 and we at Dental Asia are hoping to meet you all there. DA
Dr William Cheung
Dr Choo Teck Chuan
Dr Chung Kong Mun
Dr George Freedman
Dr Fay Goldstep
Prof Urban HĂ¤gg
Prof Nigel M. King
Dr Ramonito Rafols Lee
Dr Kevin Ng
Dr William Oâ€™Reilly
Dr Ryan Seto
Dr Adrian U J Yap
Dr Christopher Ho
Dr How Kim Chuan
Dr Derek Mahony
Prof Alex Mersel
Dental Updates Successful launch of MyPlant II in Thailand Thailand ranks as one of the leading markets in implantology and training courses while playing a special role in Asia. It is a fastdeveloping country that has a strong presence in the dental tourism industry with a growing local dental market. As a result, the demand for high quality dental products is increasing signiƤcantly. Bur and Bone Management ® systems are in great demand in Thailand and in other South Asian countries. To help meet this demand, Fig. 1: The Thai dentists participating in the MyPlant II Hands-On workshop in Neuss, Germany. the MyPlant II was launched in the Thai market by Hager & Meisinger GmbH in December last year with positive feedback.
Further strengthening of market presence Hager & Meisinger GmbH, located in Neuss, Germany, manufactures a wide range of high quality dental products. Its new implant system, MyPlant II, was developed together with Prof. Dr. Georg-Hubertus Nentwig and Dr. Ing Walter Moser. Prof. Dr. Nentwig is a well-known developer in Thailand who created the popular Ankylos® system in Thailand. His development of MyPlant II is an advanced form of the 30-year-old concept of a twophase titanium implant with a special expansion thread and a self-locking cone as an abutment connection. The nonindexed cone connection allows free positioning and simple parallel alignment of angled abutments. MyPlant II also provides rotation stability, which creates a precise seal. This precise connection minimises micro-movement between the implant and the abutment, and its reinforced and extended inner cone allows for greater fatigue strength. “Thailand is an important and growing market for Hager & Meisinger. We want to be more present and gain a substantial market leader. The launch of Meisinger’s MyPlant II is a good opportunity for us in achieving our goal. One big advantage is
Fig. 2: Prof. Dr. Georg-Hubertus Nentwig and Dr. Koanantakool Thaweesak at the 4 th Thai-Germany International Congress in Chiang Mai.
we have many good trade relationships with long-standing and reliable local partners. Also, we were able to achieve approvals for MyPlant II quickly,” stated Ms. Christina Baumer, sales manager for Asia/Oceania at Hager & Meisinger GmbH.
featured the MyPlant II and current Bone Management® systems manufactured by Hager & Meisinger GmbH. The workshop received positive feedback and visitors were able to established solid networking with the Thai Association of Dental Implantology (TADI) at the Bangkok International Symposium of Implant Dentistry in December last year. With an audience of more than 900 guests, Hager & Meisinger presented MyPlant II in Thailand for the Ƥrst time and sold the Ƥrst MyPlant II kit. Additionally, Prof. Dr. Nentwig held an informative lecture giving the audience first-hand information about the implant system. Twenty-two implantologists from Thailand, Cambodia, and the Philippines also had the opportunity to train and experience MyPlant II in a Hands-On workshop with Dr. Boworn Klongnoi at the Chulalongkorn University. In January this year, the innovative MyPlant II implant system was promoted at the TDA show in Bangkok and the 4th Thai-Germany International Congress in Chiang Mai. The congress was organised by the PDAT and the German Association of Oral Implantology, which attracted approximately 600 participants.
Ongoing presence and support As Hager & Meisinger GmbH continues to strive in meeting the demands of the fast-growing dental field through its ongoing presence, MyPlant II is one of the many high-quality products manufactured by the company. Ŷ
First-time presentation in Bangkok Even before the launch of MyPlant II, Thai implantologists’ interest in the MyPlant II was huge. Twenty dentists travelled from Thailand to Hager & Meisinger GmbH in Germany during September 2017 to participate in the Thai-German Basic Implantology Course of the Private Dental Association Thailand (PDAT). The workshop was directed by Prof. Dr. Nentwig and
Fig. 3: MEISINGER’s precision quality products demonstrated at the TDA fair in Bangkok.
DENTAL ASIA MARCH / APRIL 2018
Crown Council Names Henry Schein Cares Its Humanitarian Partner of the Year at 2018 Annual Event
The Crown Council, an international association of independent dental practices committed to promoting oral health, fighting oral cancer, and serving communities, announced on 20 th February that it has named Henry Schein Cares as its Humanitarian Partner of the Year. Henry Schein Cares is the global corporate social responsibility program of Henry Schein, Inc. and was honoured in recognition of its long time support for the Smiles for Life Foundation, Crown Council’s children’s charity arm. Ms. Michele Penrose, Director of Global Professional Relations at Henry Schein, accepted the award on behalf of Henry Schein Cares at the 2018 Crown Council Annual Event held last month in San Antonio. Henry Schein has supported Smiles for Life for more than a decade, making annual donations of toothbrushes and other oral health supplies to the Foundation in support of its members’ humanitarian missions to underserved communities around the world. At each mission site, volunteer oral health professionals work with local dentists and hygienists to provide treatment—cleanings, root canals, implants, and more—and oral hygiene education to the local population. Volunteers also provide ongoing training to the local practitioners to ensure that community members are able to access care on a continuing basis. In 2018, Henry Schein is supporting four Foundation missions, two each to communities in Guatemala and the Dominican Republic. Volunteers also provide ongoing training to the local practitioners to ensure that community members are able to access care on a continuing basis. In 2018, Henry Schein is supporting four Foundation missions, two each to communities in Guatemala and the Dominican Republic. “We at Henry Schein are honoured to be named the Crown Council’s Humanitarian Partner of the Year, and we thank its members for sharing our commitment to expanding access to care to those who need it most,” said Mr. Stanley M. Bergman, Chairman of the Board and Chief Executive Oƥcer, Henry Schein. “By continuing to leverage our collective strengths in pursuit of a shared goal, we are able to make great strides in improving the oral health, and by extension overall health, of people in need. We thank the Crown Council for this award as we continue to ‘help health happen’ together.” Ŷ
DENTAL ASIA MARCH / APRIL 2018
Dental Updates Driving Change in Implant Dentistry The American Dental Association (ADA) announced on 21st February that Mr. Jim Goodman has been promoted to the position of senior vice president, business and conferences. Mr. Goodman will work closely with other ADA divisions and oversee the direction and leadership of ADA-wide revenue strategy. He most recently served as vice president, conferences and continuing education. “Working for the ADA since 2009 has been extremely rewarding,” Mr. Goodman said. “I am excited and humbled to have this opportunity to expand my role within this great association.”
“I’m pleased to congratulate Jim on his new role,” said Kathleen T. O’Loughlin,
D.M.D., M.P.H., ADA executive director. “His leadership of the division of conferences and continuing education has demonstrated his ability to move the ADA forward. I look forward to seeing him excel in his new position.” Mr. Goodman previously worked at the American Optometric Association in St. Louis as director of the meetings center. Prior to the AOA, he served as an account executive for Experient, Inc., formerly Conferon. Mr. Goodman earned his bachelor’s degree in restaurant, hotel, institutional and tourism management from Purdue University. Ŷ
Women in Dentistry Symposium Empowers, Educates and Encourages Dentistry started off as a maledominated profession. Presently, dentistry is witnessing a surge in women’s access during graduation in dental schools. Women are also opting to specialise and enter organised dentistry and private practices in larger numbers. Women in Dentistry: Work. Life. Balance. is dedicated in bringing together women in the dental Ƥeld to network, share and learn
from each other’s unique perspectives. Through regular events and initiatives, women strive to mentor and empower one another by sharing experiences, knowledge and expertise, limited not only to the clinical aspect of dentistry but also to the business management aspect while relating this to balance with a successful social and family life. The upcoming 8 th Annual Women in Dentistry Symposium held on 15th of May 2018,
will be presented by some of the brightest female specialists in dentistry on a variety of relevant topics. There is so much to know in dentistry and it is diƥcult to stay well informed on new developments. The goal of this symposium was to provide an update on current concepts in dentistry, network with other female dental professionals and exchange success stories. The speakers this year are Dr. Eƥe Habsha, Dr. Lesley David, Dr. Sally Safa and Ms. Elyte Barzilay. Ŷ
Tri Hawk Donates Over $250,000 for those in Need of Dental Care When we think of helping the needy, we usually start with feeding the hungry or donating clothing to some familiar charity. But what about deƤning the needy as people with little or no access to dental care? That’s what Tri Hawk has done. And in its generous attempt to serve these needy, the company has donated over a quarter of a million dollars in cash and product. There are millions of children and adults scattered throughout the world, millions with every kind of dental disease, millions who have never seen a dentist, never had
a screening, never had any preventive or restorative care. These are the needy that Tri Hawk notices and serves. By donating burs to charitable programs and dental clinics around the world, this manufacturer of high-performance burs enables frontline volunteer dental teams to treat more patients, relieve more pain, eliminate more infections and restore dignity to thousands of needy people. Donating burs – the bur, incidentally, preferred by dental connoisseurs – to volunteer and charitable clinics (in Canada, India, United States
and Africa, for example) enables those clinics to provide oral health education, screenings, normal care and emergency care to thousands of underserved and unserved people throughout the world. Ŷ Here is a sampling of those who beneƤt from Tri Hawk’s charitable giving: • America’s ToothFairy • The Smiles Foundation of Ontario • The Fountain of Life Foundation in Uganda • New York State Mission of Mercy • Maa Durga Dental Clinic in India • Evangel Hall Mission
DENTAL ASIA MARCH / APRIL 2018
Dentsply Sirona Welcomes New CEO “For me, Asia is one of the greatest places to grow the business. Whenever you think of Asia, all the other countries come in mind such as Japan, Korea, Hong Kong, Singapore, Philippines, Malaysia, Indonesia and many more. I strongly consider the Asian region as an opportunity to expand the company’s reach. For instance, China has a well-developed market that we want to participate in,” explained Mr. Casey.
A veteran in the industry
Dentsply Sirona, the world’s largest manufacturer of professional dental solutions, recently announced that its Board of Directors has appointed Mr. Donald M. Casey Jr. as chief executive officer (CEO) and a member of the company’s Board of Directors. Mr. Casey succeeds Mr. Mark A. Thierer, who served as interim chief executive oƥcer since 28th September 2017, and continued to work closely with Mr. Casey to ensure a seamless transition. “I am very new to the dental industry but I am excited on what I can bring to Dentsply Sirona. We have one of the biggest budgets for research and development, utilising this to bring transformative innovation is something to look forward to,” said Mr. Casey.
On the Asian market According to Mr. Casey, majority (about 70%) of Dentsply Sirona’s revenue comes from outside the U.S. and the management is focused in growing in these countries.
Mr. Casey has more than three decades of global health care experience with an outstanding track record in identifying and commercialising medical innovations. He most recently served as CEO at the Medical segment of Cardinal Health, a leading manufacturer and provider of medical products and supply chain services. Under his leadership, the Medical segment was positively repositioned to deliver consistent revenue and operating income. Prior to Cardinal Health, he was CEO of Gary and Mary West Wireless Health Institute, which focuses on studying, developing and advancing scalable, sustainable and more aơordable healthcare delivery models that enable seniors to successfully age in place. He started his career with Johnson & Johnson in 1985 where he grew to become the worldwide chairman for
Johnson & Johnson’s comprehensive care group as well as became a member of the company’s executive committee. In addition, Mr. Casey also serves on the boards of AdvaMed and the James Foundation. He has a bachelor’s degree in Ƥnance and a master’s degree in business administration from the University of Notre Dame. With his global health experience in many established companies, he shared a tip that one could tell a lot about a company through its employees. “I have the best job in the world. I never thought I would have this kind of opportunity working for a company like Dentsply Sirona, a completely global company in the dental market,” said Mr. Casey. “I’ve never met people who are so eager and excited about their products and services, and the diơerence it could bring to healthcare. When you go to a company, you want to see people who are Ƥred up and passionate enough everyday in helping patients. This is exactly what I have observed, in a short span of time, with all the staff and employees from Dentsply Sirona,” he added.
Under his leadership Despite being newly appointed, Mr. Casey already has a strategy in mind for his new role. “I am here not to change everything, but to continue what Mr. Mark Thierer has done. Now, my job is to continue the momentum. I want to focus on the customer and recognise their different needs. We’re going to take it one step at a time. I trust that Dentsply Sirona will transform lives by delivering the best solutions,” said Mr. Casey. Ŷ DENTAL ASIA MARCH / APRIL 2018
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Dental Updates W&H Dentalwerk Wins National Innovation Award
Award-winning innovation Dental turbines are among the dentist’s most important instruments. The noise of them alone is enough to fill many patients with dread and anxiety when they go into a dental practice. W&H Dentalwerk Bürmoos GmbH has managed to find a solution to this problem with the new Primea Advanced Air. The new Primea Advanced Air dental turbine generation has consistent rotation speeds, peak performance (approximately 50 per cent higher), shadow-free illumination of the treatment site and less noise when the turbine is running – are now achievable for the Ƥrst time. This innovation not only has a high level of economic potential, it also impressed the expert jury awarding the National State Prize.
The panel’s opinion – a lot of technical heart and a sensational team “W&H has developed an adjustable pneumatic drive system, which opens up the possibility for revolutionised dental treatment. Future trips to the dentist will no longer come with the high frequency noise that we’re all so familiar with – visits will be much quieter. Dentists can now adapt each procedure to the individual patient. A lot of technical heart, brain power, funding and time have been invested in this product, alongside a sensational team,
and the new system has been successfully patented. As a result, we believe that this will be something big – a product ‘Made in Austria’, that will take the world by storm, which we will hear a great deal about,” summarised panel judge and spokesperson Dr. Martha Mühlberger, Vice Rector of Montanuniversität Leoben.
National State Prize for Innovation – Austria’s highest national accolade for outstanding performance Most innovative companies in Austria competed for the National State Prize this year. The award was presented by the Federal Ministry for Digital and Economic Affairs and organised by Austria Wirtschaftsservice GmbH (aws). The aim is to acknowledge excellent innovation among Austrian companies and to highlight their individual economic, general economic and social policy aspirations in public. Out of the total of 438 submissions to the state innovation competitions, 25 were submitted for the National State Prize for Innovation. An expert jury nominated six companies as Ƥnalist and W&H was included.
The W&H innovation – Primea Advanced Air In the field of modern dentistry, W&H developed the Primea Advanced Air, an
innovative pneumatic drive system for dental turbines. “The global number of dentists is currently around 700,000. This shows that there is high potential for our technology,” explains W&H President Mr. Peter Malata. While in the past, the rotation speed and the power of the turbines could not be set. Now, the dentist can precisely adjust the new system for the speciƤc dental treatment. The rotation speed of the bur can now be set precisely and as a result of electronic regulation remains constant even when the contact pressure is increasing during the treatment. A better top performance shortens treatment time and sensitive Ƥne preparations can be carried out largely without thermal damage or soft tissue injuries. Lower levels of noise while the instrument is running thanks to a decrease in idle speed, improve the experience for patients. The ring-shaped LED lights in the small instrument head give dentists the beneƤt of 100% shadow-free illumination at the treatment site. “W&H has been a leader in the Ƥeld of LED technology for dental handpieces for decades. The ring LED has been welcomed by the market from the start. With our innovative drive and lighting technology, we have significant unique selling points and a competitive advantage of several years,” explains Dr. Wilhelm Brugger, member of the R&D Management Team. “We are really pleased with the National State Prize for Innovation and the associated recognition of what we have developed. With this innovation, we reached a milestone that opens up an entirely new dimension of minimally invasive, precise and atraumatic dental treatment,” said Mr. Peter Malata, W&H President. Ŷ
DENTAL ASIA MARCH / APRIL 2018
Dental Updates Velox Desktop 3D Printer Integration Into the glidewell.ioTM In-Oƥce Solution Glidewell Dental and Structo have enjoyed a strong working relationship over the years, with the California-based dental technology company being announced as the launch customer for Structo’s latest 3D printer designed for dental labs, the DentaForm, just last April. Since the emergence of 3D printing in the dental industry, adoption in the chairside segment has been hampered by time-consuming pre- and post- processes. “To take dental 3D printing to the next level, we believe the complexity of the technology must get out of the way so that clinicians can focus on delivering better patient outcomes,” said Mr. Huub van Esbroeck, founder at Structo. The Structo Velox is a desktop 3D printer that features a patented fully autonomous post-processing system to streamline the dental appliance manufacturing process. It is comprised of three stages – Print, Wash, and Cure – on a rotating carousel, Ƥtting all these functions into one low-footprint automated system. The Velox also features Structo’s new pre-processing service called AutoPrint, a cloud service to which users upload an STL Ƥle – after which the nesting, supporting, and slicing are taken care of, and the printer can start automatically without requiring any further intervention. Unveiled in November 2017, the glidewell.ioTM In-Oƥce Solution is described
as a chairside ecosystem designed to simplify the prescribing and delivering of laboratory-grade restorations. The workflow begins with an intraoral scan transferred to Glidewell’s fastdesign.ioTM Software, which serves to auto-design restorations. The software also serves as a communications platform to the lab, where users can prescribe cases or access digital optimisation and technical support. For cases in which chairside milling is indicated, the clinician submits the design to the fastmill.ioTM In-Oƥce Unit for immediate fabrication. Mr. Mike Selberis, Glidewell’s Chief Technology Oƥcer said: “With the addition of the Structo Velox, the glidewell.ioTM Solution will be able to oơer a complete suite of in-office applications covering intraoral scanning, desktop milling, and now desktop 3D printing, giving clinicians an all-inone solution for lab-grade appliance manufacturing in their own practice.” The Structo Velox will be an integral part of the
glidewell.ioTM ecosystem, adding direct printing capabilities for single and multi-unit restorations, drill guides, splints, models, and orthodontic appliances. “This partnership with Glidewell Dental and the development of a deep integration with their systems fully embodies our vision for the Velox – taking the work out of the workƪow – making this a perfect partnership to bring our dental-specific solutions to market,” adds Mr. Huub. Structo and Glidewell are both hopeful that through this collaboration, they can change the way clinicians approach appliance manufacturing and accelerate the progress of digital dentistry across the industry. Ŷ
Ultradent Announces Special Event, Icons of Dentistry – A Workshop for Women In-honour of International Women’s Day, Ultradent is pleased to announce an upcoming special two-day event, Icons of Dentistry: A Workshop for Women. It is a weekend of networking, socialising, rejuvenation, and education to celebrate women in dentistry. This year’s theme for the workshop will be Compassion. The Icons of Dentistry: A Workshop for Women event will take place 22nd–23rd June 2018 at Ultradent’s international
headquarters in South Jordan, UT. It will feature iconic women in the Ƥeld of dentistry teaching classes and workshops on everything from work/life balance, practice building and management, aesthetic dentistry, lasers and more. There will also be a special keynote speaker to be announced at the end of March. Attendees will be treated to a special dinner in an orchard at the home of Dr. Dan Fischer, founder and CEO of
Ultradent, as well as a cocktail social where attendees can mingle with each other and the event’s speakers. Additionally, attendees will be treated to an evening of dinner and drinks at one of Utah’s highestrated restaurants, Tuscany. By attending Icons of Dentistry: A Workshop for Women, clinicians will earn 16 continuing education credits. Registration begins 8th March 2018, with only 100 spots available. Ŷ
DENTAL ASIA MARCH / APRIL 2018
FDI Global Survey Shows Children Are Note Getting Check-Ups Early Enough A survey carried out in ten countries found that only 13% of parents with children aged 18 below took their child to the dentist before their Ƥrst birthday - the recommended age for a Ƥrst dental visit. Most parents Ƥrst took their child to the dentist when they were between one and three years old (24%) or between four and six years old (22%), while 20% of parents reported never having taken their child for a dental check-up. “It’s worrying to learn that most children are not getting a dental check-up at the recommended age,” said Dr. Kathryn Kell, FDI President. “Good oral health habits start early. Parents should visit the dentist after their child’s Ƥrst tooth starts erupting as a preventive measure to avoid risk of developing early childhood caries. Oral diseases can impact every aspect of life and are associated with many general health conditions. This World Oral Health Day, we want people to make the connection between their oral health and general health and understand the impact that one has on the other. Knowing how to protect your mouth and body at all ages contributes to a better quality of life,” she added. Half (50%) of the parents who had taken their child to the dentist identiƤed the reason as being a regular dental checkup. However, while this was the most frequent answer in the United Kingdom (82%), Sweden (77%), Argentina (65%), France (63%), the United States (63%), Australia (56%), and China (34%); the most reported response for going to the dentist in Egypt, the Philippines, and Morocco was pain or discomfort in their child’s mouth (56, 43 and 38% respectively). More than two-Ƥfths (43%) of parents with children aged 18 below said that they personally ensured their child’s teeth were brushed before bed time to avoid oral diseases - a key message promoted by FDI. The survey also showed that 40% of parents supervised their child’s toothbrushing twice a day, and 38%of them said they limited sugary foods and drinks in their child’s diet to avoid oral diseases. Only 26% reported to have personally cleaned their child’s teeth from as soon as the Ƥrst tooth pushed out, and merely 8% mentioned having encouraged their child to wearing a mouthguard when playing sports. FDI recommends practicing good oral care, avoiding risk factors such as an unhealthy diet - particularly one high in sugar, and having regular dental check-ups to protect oral health and general health at all ages. Parents should start cleaning their child’s teeth before bed time when the Ƥrst tooth starts pushing through, supervise children’s toothbrushing twice a day with a small amount of ƪuoride toothpaste, and schedule regular dental check-ups starting no later than the Ƥrst birthday. Ŷ
DENTAL ASIA MARCH / APRIL 2018
Dental Management by Score Dental
ased on our extensive practical insights and collaborations with ergonomic experts from a number of universities, these tips can help you to sit healthy and work comfortably. Try them out now!
Sitting properly means sitting actively and upright
Sit upright in an active posture: Push your chest out to minimise the static stress on your muscles (refer to the tip on tilting of pelvis). Adjust the treatment chair to the correct height and adopt a relaxed posture that allows a perpendicular gaze over your work field. If needed, tilt the patient’s head to get a direct view into the mouth.
Work dynamically Avoid working in a static tensed posture for too long. Try to move and relax as much as possible during and in between treatments.
Stand up! Refrain from sitting down for long periods. Get up and move about at regular intervals throughout the working day. A tip: Call the patients from the waiting room yourself and position the computer workstation desk at a standing height.
Stay fit Strengthen muscles through regular exercise. This will help to maintain a good posture for longer periods of time while accelerating the recovery of stressed muscles.
Tilt pelvis for optimal back posture The angle between your upper body and thigh (this is the hip angle) should be at least 110 degrees. This ensures that your pelvis is tilted forward to retain most of the natural S-shaped of your spine. The optimal hip angle is more open, at 135 degrees. This ‘neutral posture’ minimises strain on the muscles and spinal column.
Movements within limits Avoid adopting harmful postures. Try to alternate postures within the following limits: • Head: As the head is heavy (weighing an average 4.5kg), it puts great strain on the vertebrae and muscles whenever a person bends it. Refrain from bending your head forward of more than 20 degrees and always avoid tilting the head sideways. • Upper body: Bend the upper body forward from the hip joint to a maximum of 10 degrees. Avoid bending sideways (laterally) and twisting the upper body. • Upper arms: Whenever possible, rest the elbows and upper arms against the upper body to reduce static load on the upper arms and shoulders. 16
DENTAL ASIA MARCH / APRIL 2018
Dental Management • Forearms: According to a research, an angle of around 90 degrees between the lower and upper arms works best. To support the weight of the forearms, let the forearm rest on the fourth and Ƥfth Ƥnger — either inside or outside the mouth of the patient. In a healthy working posture, work at a distance of approximately 34 to 40 cm from the eyes. While these tips are helpful, having a proper chair like the Score Dental saddle stool while working will make a huge diơerence. Sitting actively and relaxed in an ergonomically favourable posture — a ‘seated stance’ — is the philosophy behind this innovative stool. Today, it is the seating solution for more than 35,000 dental professionals worldwide.
Advantages of the Score Dental saddle stool: Natural upright sitting posture prevents back and neck injuries Traditional dental stools limit the hip angle. This makes it very tiring to keep your spine, neck and head in a favourable vertical alignment. Staying seated upright requires a lot of muscle strength, which will automatically result in slouching and working in a bent-over position. The Score Dental saddle stools prevent this. The unique shape of the saddle and the elevated height open up the hip angle (up to 140 degrees). When your pelvis is tilted forward, it automatically places your spine, neck and head in a healthy vertical alignment (neutral posture). This provides a healthy standinglike posture while enjoying the stability and comfort of traditional sitting. Sit closer to the patient to avoid bending over With a hip angle of 90 to 110 degrees, your legs will get in the way of sitting close to the patient. You will bend over and put a strain on your back in order to get a DENTAL ASIA MARCH / APRIL 2018
good view into the mouth. Adjusting the treatment chair is also not a solution as the arms have to be lifted higher, which increases tension on your shoulders and neck. On a Score Dental saddle stool, an elevated position is achieved with your upper legs oriented in a more downward and sideways direction (instead of forwards). This places your legs under the treatment chair so as to sit closer to the patient. Moreover, moving the patient is easy as your legs are somewhat spread , allowing you to eơortlessly push oơ left and right. Open posture ensures better concentration and increased energy Prolonged static sitting on a traditional chair can lead to a dull or tingling feeling as blood vessels are pinched. In contrast to a hunched or cramped posture, an open posture does not obstruct the natural functioning of your breathing, digestion and blood circulation. On a Score Dental saddle stool, you are naturally able to sit with such a beneƤcial open posture, thanks to its ergonomically shaped seat. Advantages of such unobstructed bodily processes can include better concentration, greater oxygen intake, and feeling more energetic overall. The open posture provided by the ergonomic shape of the Score Dental saddle stool helps make breathing easier. In addition, digestion improves and blood circulation is optimised, which will lead to better concentration and a more active posture throughout the day while treating patients. Dynamic sitting with Score Balance The essence of healthy sitting is dynamic sitting. The unique adjustable balance mechanism from Score Dental ensures that the saddle subtly follows your movements. These ‘micro’ movements of the pelvis ensure that your muscle groups and intervertebral discs are not constantly under severe static strain. This prevents pain, helps maintain your working posture longer and exercises your core muscles. DA
Sterility Assurance begins with the end in mind by Ms. Leann Keefer, Director of Education, Crosstex International
hen the goal is sterility assurance, there are no short cuts and the process must start with a clear vision in direction and destination; the plan for success is to begin with the end in mind. Covey’s simple quote from his book, “The 7 Habits of Highly Eơective People” should be a guiding principle for sterilisation. Every step that happens from instrument cleaning, packaging, sterilisation, monitoring, storage and delivery must align with quality assurance. Sterilisation is a process that destroys or eliminates all forms of microbial life performed in health-care facilities by physical or chemical methods. Steam under pressure, dry heat, EtO gas, hydrogen peroxide gas plasma and liquid chemicals are the principal sterilising agents used in health-care facilities.1 The most predominant sterilisation method used in dentistry is the time honoured technique of steam sterilisation. This is due to the advantages of being non-toxic, rapid cycle time, highly eƥcacious, cost eơective, monitoring capability and strong penetrability.
What is monitoring? According to CDC guidelines, monitoring of sterilisation procedures should include a combination of process parameters, speciƤcally mechanical, chemical and biological. These parameters evaluate both the sterilising conditions and the procedure’s eơectiveness.2 The Ƥrst monitoring tool is mechanical which includes assessing cycle time, temperature and pressure by observing the gauge, digital displays or printout on the steriliser and noting the parameters for each load. Correct end point response does not ensure sterilisation but incorrect readings can be the Ƥrst indication of a gross equipment malfunction. Chemical indicators (CI’s) provide information about certain conditions within the sterilisation pouch or cassette, but do not provide sterility assurance of the load. The internal and external CI’s use reactive ink changes colour to assess one or more of the physical parameters (time, temperature and saturated steam), which the
instruments were exposed to during the cycle. Single-parameter indicators provide information on only one parameter while multiparameter indicators measure two to three parameters to provide a more complete evaluation of the sterilisation conditions. While these chemical indicators do not necessarily prove sterility, they provide an early warning system for processing errors and can help identify procedural errors. Every package should be examined by the clinician opening the package and an assessment should be made as to the acceptability of the end point response of the CI. Any package indicator not displaying the correct change and intensity of colour should not be used and must be reprocessed.
What is a biological indicator? Biological indicators (BI’s) commonly use highly resistant spores (spore test) to challenge the sterilisation process. Since they are more resistant and usually present in greater numbers than the common microbial contaminants found on instruments, destruction of these organisms will indicate destruction of other potential pathogens. While all three types of monitoring are important to the quality assurance process, biological monitoring is considered the gold standard for sterility assurance. The most commonly used forms of BI’s in dentistry are spore strips and self-contained spore vials. Spore strips are small pieces of Ƥlter paper impregnated with non-pathogenic bacterial spores (Geobacillus stearothermophilus and Bacillus atrophaeus) encased in a protective glassine envelope. After processing, the spore test envelope is sent to a laboratory where the paper strip is aseptically transferred to a test tube containing sterile culture media and then incubated. Self-contained vials have a glass ampoule of sterile media which is encased in a plastic vial with a spore strip inside. After sterilisation, the vial
DENTAL ASIA MARCH / APRIL 2018
is crushed allowing the media to come into contact with the spore strip and then incubated. With either the strips or vials, if the pH indicator in the growth media changes colour from purple to yellow after incubation, this is an indication of a positive culture (spore growth) - a failed test. It is recommended that a control be run with every BI test. There are three options available for monitoring sterility assurance in the dental office: mail-in sterilisation monitoring checked by a third-party testing laboratory (i.e. private laboratory facility or dental schools), in-oƥce 24-hour monitoring systems and a newly released in-oƥce 10-hour monitoring system. While some oƥces prefer the use of a professional lab for testing veriƤcation (gram staining) and third-party documentation of results, others appreciate the convenience provided by an in-oƥce monitoring system with a direct turnaround time and without the challenge of mailing and waiting for results. It should be noted that the majority of in-oƥce monitoring systems can only be used with steam (autoclave) sterilisers; the mail-in monitoring services can provide results for steam, dry heat, chemical vapor and EtO (ethylene oxide).
DENTAL ASIA MARCH / APRIL 2018
Guidelines for sterilisation The CDC guidelines state that correct functioning of sterilisation cycles should be verified for each steriliser by the periodic (at least weekly) use of biological indicators (BIs). Consideration should be given for more frequent testing if the steriliser is used multiple times each day or with use of a variation of sterilisation cycles. Users should follow the manufacturer’s directions concerning the appropriate placement of the biological indicators in the steriliser; the preferred area for the BI placement is in the least eơective zone of the steriliser, often near the door or in the middle of the load near the drain. In addition to conducting routine biological monitoring, equipment users should perform biological monitoring for the following occurrences: • Whenever a new type of packaging material or tray is used • After training new sterilisation personnel • After a steriliser process failure is indicated by a failed (positive) BI • After a steriliser has been repaired • After any change in the steriliser loading procedures
â€˘ During initial use of a new steriliser â€˘ After relocation of an existing steriliser â€˘ After electrical/power source failure
Steriliser documentation An accurate detailed and consistent documentation establish accountability for sterilisation. The information to be included with each steriliation cycle must include: â€˘ Steriliser identiĆ¤cation (serial) number â€˘ Full testing date â€˘ Operator identiĆ¤cation â€˘ Duration and temperature of the sterilisation cycle (if not provided by a machine printout) â€˘ Description of the general contents of the load â€˘ Test results of biological monitoring (pass or fail) â€˘ Repair and preventive maintenance procedures â€˘ Special notes citing conditions outside of normal procedures, i.e. diĆĄerent operators or load content Clinicians should refer to state or local regulation guidelines for retention times of documentation.
Sterilisation compliance Dental practices have demonstrated variability in sterilisation compliance as documented in several studies. For example, one study revealed 68% of respondents believed they were sterilising their instruments but did not use appropriate chemical sterilants or exposure times and 49% of respondents did not challenge autoclaves with biological indicator.3 Other investigators using biologic indicators have found a high proportion (15 â€“ 65%) of positive spore tests after assessing the eĆĽcacy of sterilisers used in dental oĆĽces.4 In a study of Minnesota dental oĆĽces, it was reported that operator error, rather than mechanical malfunction, caused 87% of sterilisation failures.5 Common factors leading to the improper use of sterilisers may include chamber overload, low temperature setting, inadequate exposure time, failure to preheat the steriliser and interruption of the cycle. Most recently, two sterility assurance compliance issues illustrate the importance of following the CDC recommendations for weekly testing. On 8th December 2011, the Supreme Judicial Court of Massachusetts aĆĽrmed the Ć¤nal decision and order the Board of Registration in Dentistry to suspend the license of a dentist who failed to conduct and record weekly spore testing. The dentistâ€™s failure constituted dental malpractice. For additional information, the entire summary of Stephen Chadwick vs. Board of Registration in Dentistry case # SJC-10831 is available online. In March 2012, a health center in Wisconsin contacted the families of eight school children who were treated in a mobile clinic with potential exposure to blood borne pathogens due to use of improper sterilised instruments. Some of the instrument packages used during treatment displayed failed chemical indicators which would have identiĆ¤ed either a procedural or processing sterilisation error.
EĆĄective sterilisation is critical towards safety and optimal patient care. Proper functioning of the sterilisation process should be routinely monitored and documented using mechanical, chemical, and biological methods. DA
Rutala WA, Weber, DJ et al.Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008; Available at: http://www.cdc.gov/hicpac/pdf/ guidelines/Disinfection_Nov_2008.pdf . Accessed March 1, 2012
KohnWG, Collins AS, Cleveland JL, et al. Guidelines for infectin ontrol in dental healthcare settings â€“ 2003. MMWR Recomm Rep. 2003. Available at http:// www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm. Accessed March 1, 2012
Gurevich I, Dubin R, Cunha BA. Dental instrument and device sterilization and disinfection practices. J. Hosp. Infect. 1996;32:295-304.
Smith A, Dickson M, Aitken J, Bagg J. Contaminated dental instruments. J. Hosp. Infect. 2002;51:233-5.
Hastreiter RJ, Molinari JA, Falken MC, Roesch MH, Gleason MJ, Merchant VA. Effectiveness of dental office instrument sterilization procedures. J. Am. Dent. Assoc. 1991;122:51-6.
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DENTAL ASIA MARCH / APRIL 2018
Under the Spotlight
The saying ‘let your work speaks for itself’ can be used to describe expert Dr. Ronnie Yap or who is more commonly known to the public as “Dentist to the Stars” with his countless celebrity clients. Dr. Yap is the principal dentist at Orchard Scotts Dental Clinic and focusses on aesthetic dentistry utilising mainly orthodontic clear aligner treatment and restorative dentistry – bonding, veneers and implants. At the beginning In his early days, Dr. Yap practiced general dentistry and performed mostly basic dental work. An opportunity with an implant dealership proved to be a valuable learning experience where it allowed him to travel to Europe on numerous occasions. He was an associate for six years before he bought into an excolleague’s practice, Dr. Jerry Lim and together they have steadily built it to what it is today. The current main practice located at Orchard Road is manned by 4 dentists and 3 hygienists and well-trained team. “I am practicing general dentistry but I choose to focus on the aesthetic aspect of dentistry. Most of my works are composed of smile makeovers and clear aligner orthodontic treatment,” shared Dr. Yap. He also has an interest in the area of Occlusion and TMJ (Temporo-Mandibular Joint) Disorders and how it relates to the head and neck muscles.
An impact of a smile Dr. Yap’s interest in aesthetic dentistry was motivated by seeing how the positive eơect of a healthy and beautiful smile can impact a patient’s life. In his practice, they are passionate about minimally invasive dentistry – a philosophy to give patients the best smile possible within the context of conserving as much tooth structure as possible. 22
DENTAL ASIA MARCH / APRIL 2018
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Under the Spotlight
Dr. Ronnie (second right) and his Orchard Scotts Dental (OSD) colleagues with Ms. Universe Singapore 2016 Cheryl Chou who is also the DAMA poster model and patient of Dr. Ronnie. OSD has been the oƥcial dental clinic of Ms. Universe Singapore pageant since 2009.
Though widely known as the “Dentist to the Stars”, Dr. Yap humbly admitted that he doesn’t let this get into his head. For him, celebrities have the same needs as the rest of us, though he mentions that whenever celebrities come for appointments, there is always a slight sense of anticipation at the clinic. “It’s fun for everyone in the office whenever a celebrity visits. In our experience, many of them are a delight to treat. It deƤnitely boosts excitement into our daily practice and becomes a talking point for some of our patients,” said Dr. Yap.
Giving and receiving education According to Dr. Yap, most dentists view CDE (Continuing Dental Education) as a personal responsibility, especially for the beneƤt of their patients and their practices.
Dentists also attend courses to enjoy the fellowship and camaraderie, in addition to the dental updates. Some even combine the pleasure of travelling with continued education by taking courses overseas. “I would not be where I am today without continuing education. It’s vital as dentistry is advancing at a breakneck speed. As professionals, it is our duty to provide patients the opportunity to consider better or more economical solutions with increased efficiency through technology and innovations,” emphasised Dr. Yap. Dr. Yap added that in private practice, having knowledge in patient communications and practice management is a must, stressing that these are the areas that dentists should receive more training to avoid simple and costly mistakes in their practice. As dental knowledge increases we become more comprehensive clinicians, we sometimes present elaborate treatment plans to patients without adequate training in proper case presentations. We may inadvertently appear as trying to ‘sell’ something that a patient actually needs but may not perceive the need. Sometimes there is a grey zone between elective and essential treatment options, and it is always a challenge getting patients to understand the benefits of an optimun treatment plan.
The basic challenges for professionals are in educating patients and emphasising preventive care to avoid costly treatment or reconstruction later on. “We can solve this problem mainly through dental education, showing patients through taking dental photographs and preventive treatments - oral health management, orthodontics and protective splints - that preventive is always better than curative,” added Dr. Yap.
Promoting dental awareness Being active in the dental scene as the current president of the Asian Academy of Aesthetic Dentistry (AAAD) and former President of the Aesthetic Dentistry Society of Singapore (ADSS), as well as being the Key Opinion Leader for several dental companies has granted Dr. Yap opportunities in promoting continuing education for dentists and he has lectured in many countries throughout Asia. He shared that in September this year, the above academies will jointly organise the Dental Aesthetic Meeting in Asia (DAMA 2018). Hosted by ADSS, this event will feature seven hands-on workshops and more than 10 international speakers. DAMA 2018 will focus exclusively on aesthetic dentistry and is an opportunity for dentists to be updated on the latest developments while showcasing aesthetic related products and services. In addition he is co-founder of the Aesthetic and Digital Dentistry Academy which provides conducts Live Patient Courses
DENTAL ASIA MARCH / APRIL 2018
Under the Spotlight and hands-on training in the areas of aesthetics and digital dentistry.
Advancements in dentistry The turn of the millennium has ushered in signiƤcant advancements in dentistry, particularly the digitalisation of the practice. Dr. Yap recalls starting with digital photography more than 15 years ago- and he never looked back. As early as 2005, he successfully performed his Ƥrst 3D implant guided surgery and since, has embraced other innovations- such as digital 3D radiography, digital smile design, the use of intra oral scanners and an in-house lab that utilises CAD/CAM (computer-aided design and computer-aided manufacturing) technology in producing restorations. “For instance, the use of scanners in clear aligner orthodontics allows for quicker case submission using Cloud technology. Interaction with lab technicians through the internet increases eƥciency
of communication (between dentist and technicians). Digital dentistry makes it easier in explaining concepts to patients while providing shorter waiting time for treatment,” said Dr. Yap. With the fast pace technological advancement in dentistry, Dr. Yap finds himself indulging in purchasing the latest devices for the beneƤts of his patients and to increase work efficiency. He believes that there deƤnitely remains a place for traditional methods. “Like any other field, new changes take time to be accepted. As health professionals, dentists have a responsibility to their patients and many prefer to continue with tried and proven processes unless newer methods have thoroughly proven otherwise,” stated Dr. Yap.
Principle and balance in life Balancing work and personal time is always challenging, if not impossible. Rather the
concept of CounterBalancing® is important especially for someone who has so much on his plate. Dr. Yap shared that with his busy schedule, taking additional eơort to create signiƤcant or memorable magical moments for family and friends, is important and meaningful for him. In the end, family and friends are what really matters most. Another principle he lives by is inspiring and empowering others to live a healthy, passionate and productive life full of meaning and joy. “I think anyone can achieve almost what they really want in their lives with dedication, hard work and passion. As cliché as it may sound, it is starts with a Vision and Plan,” said Dr. Yap. “I am very passionate with what I do and often involve our staff and dentists through our teaching academy. This allows them to grow as we grow. The secret is continuously improving oneself through learning and inspiring others through giving and teaching.” DA
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Under the Spotlight
by Dr. Chala R. Platon photo credit: Parable Studios and Benny Ang
ituated at Scotts Medical Centre is a newly opened, sleek and modern practice, The Linguadontics Clinic. Founder and clinical director, Dr. Yue Weng Cheu, runs it together with his wife and managing director, Ms. Louisa Lee. The husband-and-wife tandem is not exactly new in establishing practices and may even be considered veterans. In fact, alongside the Linguadontics Clinic, they also run DP Dental, The Light Spa and Progressive Practice – an education and consultancy company.
As a general dentist with extensive years in treating TMD issues, Dr. Yue uses natural habit-changing methods, photobiomodultion, GNM (Gneuromuscular) orthotic with myofunctional therapy and Invisalign to help his patients. Always in search for answers throughout his practice, Dr. Yue eventually realised that the root cause of his patients’ problems does not occur in adulthood but originates as early as birth. At The Linguadontics Clinic, they leverage on the latest research, minimally invasive treatment and advanced technologies to
enhance wellness through the power of the tongue. This led to Dr. Yue coining the term, Linguadontics - lingua (tongue) and dontics (dentistry).
Focusing on the tongue Stepping inside The Linguadontics Clinic, one immediately notices that the practice revolves around the tongue. The clinic’s logo — Chinese character for tongue — and most of the treatment rooms are named after it in different languages. For instance, the four treatment rooms are named Lingua (tongue in Latin),
DENTAL ASIA MARCH / APRIL 2018
Under the Spotlight
Glossa (tongue in Greek), Myo (muscle in Latin) and Core (heart in Latin). Perhaps a first of its kind, The Linguadontics Clinic helps patients to understand and manage a diverse range of health conditions; from infant breastfeeding, speech development, mouth breathing tendency with nasal congestion, paediatric to adult obstructive sleep apnea, TMD, malocclusion and misalignment. These are uncovered and enhanced through the tongue strength and functions. “What we’re trying to do is return the focus to the tongue in the healthy situation. The tongue is a very important aspect that tends to be forgotten, overlooked and neglected by everyone, even by dentists,” explained Dr. Yue.
Essential functions of the tongue It is essential to comprehend that the functions of the tongue are for suckling, swallowing and breathing, which are originated from birth. These reflexes require a tongue-up position to perform the functions suƥciently. But a low tongue position due to habitual conditioning or physical restrictions — for example, tongue tie — will lead to a cascade of health issues. The Linguadontics Clinic is unique as they have been treating babies as young as a four-day-old for tongue tie release. The clinic caters to all age groups from infants, growing children, young adults,
adults and up to the elderly. With the tongue being able to aơect us in any stage of our lives, The Linguadontics Clinic is always prepared to guide and help in all aspects.
Symbiotic relationship The Linguadontics Clinic works closely with other medical and allied healthcare practitioners to bring about patientcentric and integrated care solutions that address the root cause of various problems. Dr. Yue currently partners with IBCLCs (International Board Certified Lactation Consultants), breastfeeding counsellors, midwives, doulas, osteopaths, chiropractors, paediatric doctors, speech language pathologists, nutritionists, ENTs (Ear, nose and throat) specialists, neurologists and many more. He believes that collaborations with experts and specialists in the Ƥeld will bring about the best results for his patients. In fact, this collaborative eơort allows him and his team to be one of the Ƥrst dental practices to use laser for infant lip and tongue tie releases in Singapore and Southeast Asia. “It is time healthcare be more fully integrated with different practitioners working closely together. While referrals from other dentists are important, we also work together with a bigger community of health care providers,” Dr. Yue shared. For instance, mothers would see paediatricians or lactation consultants when they encounter difficulty in breastfeeding their babies. After the practitioner assessed the situation, the dyad is referred to a dentist who further diagnoses and carries out any lip or tongue tie release. Some general dentists do perform lip or tongue tie releases but Dr. Yue is one of the few who provides it for infants. Harnessing the beneƤts or Erbium lasers, Dr. Yue manages cases from infants to geriatrics. “Children between the age of one to Ƥve are the most challenging to handle. Some come for consultation due to trouble in swallowing food, difficulty in speech and breathing
issues. Due to toddlers’ unmanageable behaviour, we cannot fully optimise their myofunctional training therefore we opt to not perform lip or tongue tie releases straight away. We want them to see a speech language pathologist and undergo as much training as possible before we do the tongue tie release. Older children, six to nine years of age, are the ones we work with. Our in-house Myofunctional Educators are able to do the Myofunctional training before and after I do the release,” said Dr. Yue. According to him, later stages of mixed dentition to full adult dentition would require orthodontics using Invisalign with Myofunctional training. Patients who still display a physical restriction would then have their tongue tie released. The Linguadontics Clinic does the tongue tie release only after all the minimally invasive procedures have been explored. They believe that with proper Myofunctional training, surgery may not be needed.
Birth of a new concept Dr. Yue’s journey in creating the concept of Linguadontics stems from his own personal search for an answer for his own Temporomandibular (TMD) issues. His search resulted in his tutelage under Dr. Clayton Chan, pioneer of Gneuromuscular (GNM) Dentistry, which teaches Occlusion by looking for a Physiologic Rest position that is neutral for the muscles. This started opening up Dr. Yue’s perspective that to treat dentally-related problems, one cannot ignore the systemic link of the bite to muscles. Dr. Yue has also been a long-term trainer in the application of Lasers in dentistry, but it was when he started also working with lactation consultants and bodyworkers to help babies with laser lip and tongue tie releases that he started to explore the neurology of humans and that was how he started tracing the importance of the tongue and the role that it plays for a person from birth. To Dr. Yue, the tongue is a highly underrated organ that has an important role in helping an infant from birth to be able to feed and swallow and hence grow. DENTAL ASIA MARCH / APRIL 2018
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Under the Spotlight The tongue, when displaying the proper myofunctional habits then in turn serves as the architect of the mouth and promotes a good airway that in turn ensures that there is no disruption of one’s sleep at night. This discovery of the link of the tongue to airway and then to sleep has now resulted in the birth of the term “Linguadontics”, a term Dr. Yue has trademarked. Dr. Yue now attends to patients who hail from as far as Indonesia, Malaysia, Thailand, India, the Philippines and all over the world, and he continues to spread his Linguadontics concept to his colleagues — by teaching all that he knows via his School of Linguadontics masterclasses – both locally and internationally. “What I have done is put together various concepts that have been out there for many years, under the common denominator that I have observed – the tongue. By unifying all these under the concept of Linguadontics, we are making the first move towards making an integration of the tongue back into the mouth and the mouth back into the body. Patients deserve to be treated as a whole and The Linguadontics Clinic serve to consciously work together with other healthcare practitioners to help them get to the root cause of their problems and solving them. I believe everybody has a piece of the puzzle and it is time to put all the pieces together. By doing so, I think we can open up a lot of possibilities,” remarked Dr. Yue.
Always searching for answers Aside from being the founder and clinical director of The Linguadontics Clinic, Dr. Yue also calls himself a ‘dental gym instructor.’ Other titles he goes by are: Cranio-Facial Pain Manager Healthcare (R)Evolution Activist, tongue trainer, laser healer, dental sleep advisor and TEDx speaker. Not surprisingly, his TEDxSingapore talk is also about the tongue – and his public health message – that everyone just needs to abide by three simple steps of “Tongue Up, Lips Closed, Breathe Through Nose” for a healthy life. Currently, he is taking the Dental Sleep Residency at Tufts University, School of Dental Medicine in Boston, America as continuing education is vital for him and 30
his entire team. This is also proven by him having half his team trained in Orofacial Myology. He is also generous in sharing his knowledge and experience, and conducts seminars on the applications of Myofunctional therapy in dentistry so as to educate the next generation and to give back to the industry. And success comes to those who persevere. For Dr. Yue, his tenacity in pushing forth the Linguadontics concept sees him invited back by to Taiwan to conduct a workshop in June. In fact, this year, he will also be travelling to Egypt, Canada and the U.S. to give his lectures as well. “I enjoy sharing, teaching and pitching my concept to my colleagues from all over the world. Getting invited back is such a great opportunity and privilege. We like to go places we haven’t been to (to educate) and conquer one continent at a time,” said Dr. Yue.
This is just the beginning After years of hard work and perseverance in the dental industry, it is no surprise that the couple were one of the recipients of the prestigious Entrepreneurship Award (EYA) in 2017 — the oldest award in Singapore that honours local entrepreneurs who have shown outstanding performance as business owners. Dr. Yue and Ms. Lee accepted the award on behalf of the DP Dental clinic which was established since 2006. DP Dental is a progressive dental practice committed to fulfilling minimally invasive dentistry. Although they have succeeded amongst bigger and well-established companies/ entrepreneurs, Dr. Yue and Ms. Lee have no plans of slowing down. The couple explained that even though they were overjoyed about receiving the award, being recognised by peers is just the beginning. “Our journey does not end here, it is just the beginning for us. We did not win by producing the most revenue, but because of our concept - progressiveness and innovation. We are going to use this honour to develop our network to the next level. We are looking forward to how they (EYA)
can protect and market our brand to the dental community,” said Dr. Yue.
Sound advice and future plans Nowadays, technology is constantly progressing, developing and disrupting the diơerent industries. In order to keep abreast with the latest trends and innovations, professionals must invest time and eơort in continuing education like seminars, lectures, conventions and workshops. “Keep educating yourself and never stop learning. You must change with time otherwise you will fall behind and become obsolete. This is why I like to network with other people from industries that are propelling steadily. I believe I can learn from them and then adopt it into our industry,” said Ms. Lee. She also emphasised that their accomplishments do not solely happen because of Dr. Yue and her, but because of their reliable and exceptional team. She reiterated that everyone in the team plays an important role that brought forth the clinic’s outstanding performance. In addition, Ms. Lee also has countless plans for The Linguadontics Clinic and disclosed that this first clinic is only a starting point. For instance, one of her plans is to focus on building and developing the clinic’s growth worldwide, in the form of licensing and accreditation of other doctors. It is their dream to have a Linguadontics Clinic in every major city in the world. “Our dream is also to have a whole building where we can practice Linguadontics on a greater scale, one level for each of the diơerent age groups that we are currently catering to – from infants to geriatrics - an entire building where all referring health care specialists are working side by side to provide a one-stop service. This would make it even more accessible and convenient for the patients, who now have to travel from one healthcare provider to another. The body operates as a systemic whole, and the treatment centre should likewise have all the experts under one roof and truly provide integrated service,” said Ms. Lee, glancing far ahead into the future. DA DENTAL ASIA MARCH / APRIL 2018
Interviewed by Ms. Jamie Tan
Dr. Michael Tsao, Founder of CEREC Asia and owner of Sweet Space Dental Clinic
ne of the more renowned developments in digital dentistry that is used prevalently today in practices is CEREC. This is a method wherein CAD/CAM is applied by digital impression taking, using one or more scans, designing the restoration using software and manufacturing the restoration by milling or 3D printing. For practitioners in Asia who wish to further expand their knowledge on how to utilise this technology to the fullest, they have an option of seeking a Dental Continuing Education Centre that specialises in this: CEREC Asia. Read on to Ƥnd out more about how they started out, their motivations as well as how they are helping dental professionals acquire the knowledge they seek.
Dr. Tsao and his team’s dedication had Ƥnally paid oơ. Soon, Sweet Space Dental Clinic had become the forerunner for digital dentistry in Taiwan. With the increasing popularity of intraoral scanners and CAD/CAM, it soon became apparent that new users were facing the exact same problem as Dr. Tsao had before: there was a need for reliable source of information without an excessive commitment of time, eơort, and money. Witnessing this demand in a rapidly growing market, Dr. Tsao and his team began an ambitious project: an independently-funded training facility for CEREC users capable of hands-on capabilities for over a dozen participants at a time. Most importantly, the goal was to provide access to high quality education in digital dentistry right here in Asia. Thus, CEREC Asia was born, and the rest, as they say, is history.
Recognising the potential CEREC Asia was oƥcially founded in mid-2016 by Dr. Michael Tsao, owner of Sweet Space Dental Clinic. Situated in Taipei City, CEREC Asia operates with 15 CEREC Omnicams, a dozen phantom heads, and complete workstations for hands-on ceramic work. In addition to its lecture room, meeting rooms and common halls, two dental chairs from Dentsply Sirona were also installed for live demonstrations. Over the last year, signiƤcant growth was witnessed in both its training facility and digital dentistry as a whole in Taiwan. Having taught over 633 participants from seven countries, CEREC Asia is the single most comprehensive education centre for the CEREC system. It all started back in 2012, when Dr. Tsao saw the untapped potential of digital dentistry and began searching for a CAD/CAM system suitable for transforming his clinic. After months of deliberation, CEREC was chosen over other many other systems, but then a problem arose: there was no place for Dr. Tsao to get answers to his questions in Taiwan, or Asia for that matter. After spending countless trips and hours travelling abroad to North America and Europe for his education, as well as endless trials and errors, 32
DENTAL D DE EN E ENTAL NTAL TA AL A AL AS ASIA SIA IA MAR M MA AR A RCH CH / APRIL AP PR PRI RIL 2018 R 2018 018 01 18 MARCH
Up Close & Personal Primary goal is to learn CEREC Asia is supported by a team of dedicated full-time clinicians. ProƤciency in dental work comes not only from just technical mastery or knowledge collection, but a combination of both, laid upon a foundation of clinical experience. The success enjoyed by CEREC Asia comes from the fact that it strives to provide its participants with all three elements. Too often the team sees instances where trivial amounts of new information are stretched into a full-day of lectures or workshops. Whatever the motivation, this sort of pervasive course layout is incompatible with the participant’s primary goal to learn. At CEREC Asia, high importance is placed on their participants’ time, thus the schedule is packed with as much relevant and useful content as humanly possible. Through numerous iterations, feedback
and improvements, its programs are perfectly calibrated for the serious learners.
No boundaries – Open to all The Taiwan-based CEREC Asia Dental Continuing Education Centre is an ideally located for international community as it is a short hop away from most of the East Asian countries. In Asia, training facilities for digital dentistry are few and far between when compared with other regions. For most dentists, the beneƤt of these institutions is not limited to the moment when the lectures take place. Rather, the true value lies in the resulting community of dental professionals who aggregate in pursuit of the same knowledge. The team already had a close-knit group of passionate clinicians doing and sharing research into digital dentistry, so it was a relatively easy transition to open up and include dental professionals from the global community. Education knows no boundaries, so at its core, CEREC Asia is open to every dentist in the world. With the courses predominantly taught in Mandarin and English, it is also possible for the team to communicate with most of the fellow dentists from overseas. For participants who are more comfortable in their own languages, professional interpreters will be brought in to assist with the translation.
Careful methodical investment For a majority of dentists in Asia, lectures are mostly taught by foreign dentists over a course of a couple of days. Workshops, on the other hand, are heavily sponsored by dental equipment manufacturers and retailers, who bring their devices for temporary use at the designated location. While this format has been successfully copied over the years, it is not without drawbacks; the reliance on outside support often creates an asymmetrical relationship where business agendas are inevitably pushed. This doesn’t always end in the best interest of the course participants. For this reason, CEREC Asia can and does receive hardware support from dental-related companies, but the team ensures it remains completely self-suƥcient nonetheless. The cost of this independence, however, is the scale of careful and methodical investments needed. Apart from Taiwan, there are currently no other CEREC training institutes in East Asia. Given Taiwan’s geographical proximity to every major country in East Asia, expansion to other regions would only distract from its commitment to the highest level of quality for education.
Independently operated Although the company’s name implies aƥliation with CEREC and Dentsply Sirona, CEREC Asia operates independently and is not beholden to any Ƥnancial sponsors. Being a centre for education Ƥrst and foremost, it is important that facts that are presented are not Ƥltered or misrepresented. That being said, CEREC Asia does partner up with numerous international companies to promote useful and relevant courses.
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Dentsply Sirona is a special case, however, because what CEREC Asia does directly impacts their customers. As a corporation, it takes an active interest in the well-being of their end-users. CEREC Asia is open to working with them toward common goals as no other education centres in the region can provide a more comprehensive training program.
When dentists participate in CEREC Asia’s programs, they are taking advantage of years of CEREC experience condensed into coursework. As they fast-track through our successes, trials, and errors, they get to save a large amount of time while avoiding all the costly mistakes that could be made. These insights are invaluable to many of the participants, who have later gone out and successfully opened their own digital clinics.
Develop a passion for learning Dentists and dental technicians accumulate their skills over a life-long learning process. For the consummate professional, complacency in his or her current level of expertise is to ignore the ƪood of developments occurring all around the dental Ƥeld. In digital dentistry, where changes and revisions occur over months instead of years, continuing education is even more vital to provide the optimal care for patients.
Fulfilling demands A proƤt-driven marketing agenda is ultimately no good for a training facility in the long run because its business and education goals will inevitably end in conƪict. On the other hand, a purely-educational facility is beneficial to no one if nobody knows about it. At CEREC Asia, a middle ground is achieved by being transparent about their partnerships, so the information is clearly laid out to participants. Ultimately, CEREC Asia wants to hold discussions with the largest audience possible without compromising facts or information. This is possible because it operates independently without sponsors.
Obstacles ahead For many dentists, CAD/CAM dentistry is a completely new Ƥeld. They not only have to pick up new skills with the same proƤciency as before but also make hefty investments on new machinery. The biggest concerns are oftentimes the costs: cost to time, cost to reputation, and, of course, cost to Ƥnances.
A growing community For the next five years, CEREC Asia aims to continue expanding its community to other Asian countries, both online and offline. Its goal is simply to get dental professionals involved in p r o d u c t i v e discussion about digital dentistry, because only then further development can come into fruition. Digital dentistry is still in its infancy, despite recent trends of its results slowly overtaking those from traditional protocols. While the team at CEREC Asia often shares and discusses what digital technology can already achieve in its programs; however, what it can’t do is oftentimes a more interesting question. CEREC Asia is already actively engaged in basic and clinical studies, but one of its top priorities is to work with universities and push its research potential toward the upper spectrum of the public domain. In the next half-decade, CEREC Asia sees itself at the top of the digital dentistry realm in Asia. DA
DENTAL ASIA MARCH / APRIL 2018
Mr. Vyomeshi Joshi, President and CEO, together with Mr. Rik Jacobs, VP, General Manager, Dental, 3D Systems.
DENTAL ASIA MARCH / APRIL 2018
Interviewed by Jamie Tan
nnovation, camaraderie and diversity in the dental space were qualities the Chicago Midwinter Meeting set out to celebrate early this year in February. As it turned out, this theme ran true to what 3D Systems has achieved to date with the recent launch of its fully integrated solution at the show. Its latest innovation was largely made possible with the company’s strategic acquisition of Vertex Global Holding, a leading provider for innovative dental materials worldwide, over a year ago. The expertise and unrivalled materials oơered by dental prosthetics manufacturer Vertex Dental and dental 3D printing materials developer NextDent – previously subsidiary companies under Vertex Global Holding – enabled 3D Systems to boost its capabilities and solidify its foothold in the industry. To Ƥnd out more about what the pioneer and manufacturer of 3D printing has been up to in the lead-up to its recent product launch, Ms. Jamie Tan, Dental Asia’s Publications Director sat down with Mr. Vyomeshi Joshi (VJ), President and CEO, together with Mr. Rik Jacobs, VP, General Manager, Dental, 3D Systems for a chat.
DENTAL ASIA MARCH / APRIL 2018
The right partnership The merger between 3D Systems and Vertex Global Holding Ƥrst began with a shared vision to bring 3D dental production to the next level. One and a half years ago, Mr. Jacobs, founder and former CEO of NextDent and Mr. Joshi sat down together to discuss the possibilities of realising their
goal of manufacturing 3D dental production solutions. “Having been in the industry for 10 years, I had acquired extensive knowledge on printing technologies and developing dental materials. 3D systems was also an expert in 3D printing, with over 30 years of experience in the business. At that time,
3D Systems’ President & CEO Mr. Vyomesh Joshi at Lab Day Chicago 2018 emphasizing the importance of starting with the customer.
The 3D Systems team at Lab Day Chicago 2018.
we knew exactly what our customers were looking for: a trusted, accurate and productive solution that would allow them to easily incorporate 3D dental printing into their daily workƪow,” shared Mr. Jacobs, 3D Systems. Akin to two puzzle pieces that Ƥt together perfectly, NextDent’s portfolio of dental 3D printing materials complemented that of 3D Systems’ disruptive 3D production systems to a tee. NextDent’s products, for one, had been approved for use in more than 70 countries worldwide. This would grant 3D Systems immediate access to several markets, helping to propel the company to the global stage. Embracing this synergy, the two proceeded with the merger – which saw Mr. Jacobs being appointed VP and General Manager of 3D Systems’ Dental business. Since then, the team had been busy working on developing a fully integrated 3D dental printing solution that would meet the needs of customers – both today and in the future.
Starting with the customer “I believe that you can only develop a great
solution if you start with the customer. As Vertex Global Holding has been around for the past 80 years, we have the advantage of being able to leverage their insights as well as our engineering talent to Ƥgure out which direction to take. From there, we can formulate incredible solutions. This also applies to any other kind of manufacturing;
you have to start with the customer, followed by the use case, then materials and hardware,” opined Mr. Joshi. He then proceeded to list four top needs that customers require solutions to fulƤl: predictability, accuracy, productivity and cost structure. By anticipating and meeting these needs through its novel solutions,
3D Systems’ Mr. Rik Jacobs and Mrs. Connie Peterse with the NextDent 5100 - enables improvements in patient care while revolutionizing the dental workƪow.
Dental ProƤle Everyone stands to gain with the right outcome, savings and fewer trips to the dentist,” added Mr. Joshi. With the recent unveiling of NextDent 5100 and FabPro 1000 in Chicago, the company plans to launch the solutions in Asia, country by country, starting from Australia, Korea and Japan. Mr. Jacobs continued to share that they are now in the process of registration in China, which is expected to be completed by September this year. Following that, there are plans in place to carry on expanding in more countries in the region. This is how 3D Systems aims to transform businesses for the better, bringing smiles to patients, dentists, technicians, resellers and the society. Considering the massive beneƤts that come with 3D printing, it is certain that this trend will continue to grow in importance around the world – but only time will tell how fast it will take place. DA
3D Systems’ Mr. Rik Jacobs at Lab Day Chicago 2018 addressing how the NextDent 5100 delivers more accurate results than conventional manual production techniques.
3D Systems is already on its way to carving out its own market share on a new plane altogether. Its newly launched 3D printing solution NextDentTM 5100, for one, easily delivers unparalleled predictability and accuracy with its revolutionary high-speed Figure 4™ 3D printing technology combined with the industry’s broadest portfolio of dental materials. As for productivity, the groundbreaking industrial-grade desktop 3D printer FabPro TM 1000 offered by 3D Systems delivers exceptional quality and speed with lower total cost of operation. Lastly, 3D Systems’ solutions are currently available at a price point that is accessible to virtually all labs and clinics. In addition to simply oơering a solution, 3D systems also believes in providing customers with proper training, service and support. According to Mr. Jacobs, this means the team will be consistently applying dedicated research in the manufacturing of their products and also relying on a network of dedicated resellers in different parts of the world who will be equipped with the necessary knowledge in regulations, CAD/CAM usage and professionalism to provide customers with the right kind of guidance, support and assistance.
Future plans Within the next five years, Mr. Joshi is confident that 3D Systems will be at the forefront of the industry with its revolutionary solutions – with every country eventually adopting this technology. At present, the company is already a heavyweight in the industry, printing hundreds of thousands of aligners every year. The range of 3D printed dental devices manufactured by the business also remains unrivalled. There are a number of reasons why he believes 3D printing will be the way to go in the near future. Mr. Jacobs explained, “Milling is an outdated solution as the machine cycle times are long and it is also expensive. There are also manual errors that can surface, incurring unnecessary costs. Printing will likely be the only technology used in the dental industry after a period of time as dental professionals witness the unmatched beneƤts it can bring to businesses.” “For example, with 3D printing, we can shorten the 14 hours usually required to produce a full denture into 30 minutes. This can not only help the business but also the patients beneƤt from savings in time and costs as well.
DENTAL ASIA MARCH / APRIL 2018
Clinical Feature Introduction
Table 1 lists some examples of bioactive restorative materials by their mechanism of action. /EZ^/E'/Kd/s/dzzD,E/^D
The word “bioactivity” is one of the latest buzz words in the dentistry. It is highlighted as a feature in many restorative products with diơerent and conƪicting claims. This has stirred up confusion and controversy surrounding the concept. This article will attempt to provide clarity for the practicing restorative dentist: What is bioactivity? What are bioactive products? How can they be used to provide the best dental care? The term “bioactive material” originated with Dr. Larry Hench in 1969. He was looking for an improved graft material for bone reconstruction needed by injured returning soldiers of the Vietnam war. Hench was searching for a material that could form a living bond with tissues in the body. All the available materials at the time were rejected by the body. He developed bioglass (calcium silicophosphate glass), a completely synthetic material that chemically bonds to bone.1
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Some examples of bioactive restorative materials by their mechanism of action, bioactivity increasing with each mechanism as you go down. Materials that remineralise, only remineralise. Materials that deposit hydroxyapatite also remineralise. Materials that stimulate pulpal regeneration also remineralise and deposit hydroxyapatite.
Materials that mineralise
By Dr. Fay Goldstep Hench deƤned a bioactive material as “one that elicits a speciƤc biological response at the interface of a material which results in the formation of a bond between the tissues and the material”.2 Today there are many diơerent deƤnitions of bioactivity found in the dental literature, dependant on the research and on the researcher. The deƤnition Ƥts the research, whereas it should Ƥt the concept. To achieve clarity of meaning, it is best to go with what can be most easily understood by clinicians and patients alike - the deƤnition found in the dictionary.
Dental decay is the cumulative result of consecutive cycles of demineralisation and remineralisation at the interface between bioƤlm and the tooth surface. Oral bacteria excrete acid after consuming sugar, leading to demineralisation. Hydroxyapatite crystals are dissolved from the subsurface. Remineralisation is the natural repair process for non-cavitated lesions. It relies on calcium and phosphate ions, assisted by ƪuoride, to rebuild a new surface on the existing crystal remnants in the subsurface.5 Under normal physiological conditions at pH 7, saliva is supersaturated with calcium and phosphate ions, making caries progress slow. As the pH is lowered, higher concentrations of calcium and phosphate are required to reach saturation with respect to hydroxyapatite.5 This is called the “critical pH”, the point where equilibrium exists and there is no mineral dissolution and no mineral precipitation. The critical pH of hydroxyapatite is around 5.5 and that of ƪuorapatite is around 4.5. This varies with individual patients. Below critical pH, demineralisation occurs while above critical pH, remineralisation occurs (Figs. 1-2)43.
Bioactivity: noun - any effect on, interaction with, or response from living tissue Historically dental materials were designed to have a “neutral” eơect on the tooth.3 Many current dental materials are not neutral. They are “active”, not “passive”, participants in the restorative process. New materials are being developed to harness this potential behavior. These are “bioactive” materials. For simpliƤcation and clarity in discussing bioactive restorative materials it is best to separate them according to their mechanism of action. There are three separate mechanisms that are demonstrated by bioactive restorative materials. A bioactive restorative material can display one or more of the following actions: 1. Remineralises and strengthens tooth structure through ƪuoride release and/or the release of other minerals 2. Forms an apatite-like material on its surface when immersed in body ƪuid or simulated body ƪuid (SBF) over time4 3. Regenerates live tissue to promote vitality in the tooth
Cycling of oral pH during cariogenic challenges in naturally occurring hydroxyapatite
DENTAL ASIA MARCH / APRIL 2018
Clinical Feature When the enamel and dentin no longer have adequate structure to maintain their mineral framework, cavitation takes place and simple remineralisation is an insuƥcient treatment. Tooth preparation and restoration are now required. Bioactive restorative materials replace dental hard tissues and help to remineralise the remaining dental structures. Glass ionomer cements and their derivatives, such as resin modiƤed glass ionomers, compomers and giomers, fall into this category.
Glass ionomer cements encourage remineralisation
Cycling of oral pH during cariogenic challenges in ƪuoridated hydroxyapatite
If ƪuoride is present in the plaque ƪuid, it will penetrate the enamel, along with the acids at the subsurface, adsorb to the apatite crystal surface and protect the crystals from dissolution.6 This coating makes the crystals similar to ƪuorapatite (critical pH of 4.5), ensuring that no demineralisation takes place until the pH reaches this point. Fluoride present in solution at low levels among the enamel crystals can markedly decrease demineralisation.7,8 When the pH returns to 5.5 or above, the saliva which is supersaturated with calcium and phosphate, forces minerals back into the tooth.8 Fluoride increases remineralisation by bringing calcium and phosphate ions together and is also preferentially incorporated into the remineralised surface, which is now more acid resistant. The beneƤts of ƪuoride are maintained long-term through the mechanism of fluoride reservoirs. Fluoride is retained intraorally after ƪuoride treatments such as ƪuoridated toothpaste and ƪuoride varnish application and is then released into the saliva over time.9,10 Fluoride can remain on teeth, mucosa, dental plaque or within bioactive restorative materials. Fluoride retention is clinically beneƤcial since it can be released during cariogenic challenges to decrease demineralisation and enhance remineralisation.5 Fig. 3 & 3B Examples of glass ionomers, Riva Self Cure (SDI) and Equia Forte (GC). These are bioactive materials that remineralise.
Glass ionomer cements were developed in the early 1970s. They are particularly valuable for caries control in high caries risk patients and in areas where location or isolation create restorative challenges (Fig. 3). Glass ionomers have a true chemical bond with dental tissue. They encourage remineralisation of the surrounding tooth structure and prevent bacterial microleakage through ion-exchange adhesion with both enamel and dentin.11 A new, ion-enriched layer is created at the tooth-glass ionomer interface. This layer contains phosphate and calcium ions from the dental tissues, and calcium (or strontium), phosphate and aluminum from the glass ionomer c e m e n t . 11 T h e remineralisation process creates Fig. 4 Glass ionomers create an ion enriched harder a h a r d e r d e n t i n dentin surface adjacent to the glass ionomer surface. surface (Fig. 4). 12,43 Restoration fracture is usually cohesive, leaving the ion exchange layer Ƥrmly attached to the cavity wall. The dentinal tubules are sealed and protected from bacterial penetration.13 To eliminate the physical property disadvantages of glass ionomers and harness their remineralising benefits, dental researchers have produced an assortment of glass ionomers derivatives: resin modiƤed glass ionomers, compomers and giomers. Two product lines in this category are: Activa BioACTIVE Restorative (Pulpdent, Watertown, MA) (Fig. 5) and the BeautiƤl giomer family of restorative materials including Beautifil II and BeautiƤl Flo Plus (Shofu Dental, San Marcos, CA) (Fig. 6). Studies have shown ACTIVA’s remineralisation potential through ƪuoride release and recharge and calcium release.14,15 Giomers are used in restorative dentistry as equivalent to composite resin, in all their applications.
Fig. 5 Activa BioACTIVE Restorative (Pulpdent) is a bioactive restorative material that remineralises.
DENTAL ASIA MARCH / APRIL 2018
Fig. 6 The Beautifil giomer family of restorative materials including Beautifil II and Beautifil Flow Plus (Shofu Dental) are bioactive restorative materials that remineralise.
vitro study found that this apatite-forming bioactive cement can occlude artiƤcial marginal gaps. This is beneƤcial clinically at the margin of the prepared tooth and cemented restoration. It suggests that bioactive dental materials may signiƤcantly improve clinical outcomes and longevity of dental restorations.23 Calcium silicates have also been shown to deposit hydroxyapatite.23 Even more importantly, they can stimulate the regeneration of live tissue—dentin, pulp, blood vessels and bone.24,25,26
Giomers concept based on PRG
Materials that can regenerate live tissue
Giomers represent the hybridisation of glass ionomer and composite resin properties: the ƪuoride release and recharge of glass ionomers and the aesthetics, physical properties, and handling of composite resins.16 The giomer concept is based on PRG (Pre-Reacted Glass) technology: a glass core, surrounded by a glass ionomer phase enclosed within a polyacid matrix. Studies show dentin remineralisation occurs at the preparation surface adjacent to the giomer. 17 Giomers, through the creation of ƪuoride reservoirs, release and recharge ƪuoride eƥciently, signiƤcantly better than compomers18 and composite resins, although not as well as glass ionomers.19 The clinical performance of giomers has been tested against those of hybrid resin composites. Giomers have been found to compare positively for all criteria.20
Some bioactive materials not only remineralise and form hydroxyapatite but also regenerate live tissue. This is crucial in many restorative as well as pulp related treatments. One major example is vital pulp therapy. The goal of vital pulp therapy (direct pulp capping and pulpotomy) is to treat reversible pulpal injury arising from trauma, caries or restorative dentistry. These injuries destroy the normal tissue architecture at the pulp-dentin interface but can be healed if the wound is properly protected.27 Treatment must maintain pulp vitality and function and restore dentin continuity below the injury through hard tissue bridge formation.28 Optimal quality of this hard tissue bridge is essential to the long-term success of vital pulp therapy.29,30 There is a pulp tissue speciƤc response to the capping material and this determines the quality of the dentin bridge.28 Calcium hydroxide products have been used in vital pulp therapy for many years. The ability of calcium hydroxide to promote dentin bridge formation and enhance wound healing is well established.31 However, calcium hydroxide has inadequate physical properties and produces poorly formed dentinal bridges containing tunnels.32 This has directed research to seek out new materials for this therapy. The Ƥrst of these materials created for practical clinical use was mineral trioxide aggregate (MTA).33 MTA was originally developed as a root end Ƥlling material for apicoectomy procedures and to repair root perforations.34 Indications for use have expanded broadly within restorative dentistry and pedodontics.21
Materials that deposit Hydroxyapatite Some bioactive materials not only remineralise by adding minerals to tooth structure but also create an apatite-like material on their surfaces when immersed in body ƪuid or simulated body ƪuid (SBF) over time.4 There are two chemical classes of these bioactive restorative materials: calcium silicates and calcium aluminates.21,22 These materials are non-resin based. Both materials set with an acid-base reaction, and produce an alkaline pH after setting. High pH levels (7.5 or higher) appear to stimulate more active and complete bioactivity.4 Ceramir (Doxa Dental, Uppsala, Sweden) (Fig. 7) is a calcium aluminate material developed for cementation. An in
Fig. 7 Ceramir (Doxa Dental) is a bioactive cement that remineralises and deposits hydroxyapatite.
Limitations of MTA-based materials MTA is a calcium silicate based material (derived from Portland cement) with high sealing ability and excellent biocompatibility. MTA-based materials stimulate faster formation of dentinal bridges that are of better quality than those of calcium hydroxide.35,36 Since the mid-1990s, MTA has been recognised as the standard in conservative pulp vitality treatments.37 MTA-based materials have limitations however: • long setting time, weak mechanical properties and diƥcult handling38 • may produce tooth discolouration39 • may contain heavy metals40 Much research has followed to build on the advantages of MTA while eliminating most of the disadvantages. One such material is Biodentine (Septodont, Lancaster, PA) (Fig. 8). It was formulated
DENTAL ASIA MARCH / APRIL 2018
by taking MTA-based endodontic repair cement technology, improving its physical and handling properties, and creating a dentin replacement material with signiƤcant reparative qualities.
Advantages of Biodentine Biodentine can be used as a complete dentin replacement material to treat damaged dentin both in the crown and Fig. 8 Biodentine (Septodont) is a bioactive the root with clinical restorative material that remineralises, deposits indications that exceed hydroxyapatite and regenerates live tissue. those of MTA and other related Portland cement calcium silicate products.21 Biodentine can be used as a: • cavity base/liner in deep carious lesions • pulp capping agent in vital pulp therapy (both direct pulp capping and pulpotomy) • root repair material for perforations, resorptions, apexiƤcation and root end Ƥlling material in endodontic surgery • A restorative material to replace missing or defective dentin. It cannot be used to replace enamel. The advantages of Biodentine over MTA and modified MTA materials include: • ease of handling, high viscosity, shorter setting time (12 minutes) • better physical properties41 • composition containing raw materials with known degree of purity42 • good colour stability so there is no discolouration43 Biodentine is a tricalcium silicate based material. Its mechanical properties compare to those of dentin and it can be used as a dentin substitute in both the crown and root.44,45,46 It stimulates deposition of hydroxyapatite when exposed to tissue ƪuids.47 It is nontoxic as tested on human pulp cells.48 Studies have shown complete dentinal bridge formation after six weeks in human teeth.49 Biodentine provides a hermetic seal that protects the dental pulp by preventing bacterial inƤltration. This creates a protected environment where healing can take place. The seal is created through micromechanical retention by inƤltrating the dentin tubules as well as by stimulating odontoblasts to deposit dentin.25 It is the calcium releasing ability of pulp-capping materials that induces pulp tissue regeneration. Tricalcium silicate based materials like Biodentine produce calcium hydroxide as a product of hydration.50 The calcium silicate setting reaction is as follows: 2(3CaO.SiO2) + 6H2Oĺ 3CaO.2SiO2.3H2O + 3Ca(OH)2 calcium trisilicate hydrated calcium calcium silicate gel hydroxide Calcium silicate in the powder interacts with water, leading to the setting and hardening of the cement. This produces hydrated calcium silicate gel and calcium hydroxide. Calcium hydroxide can now stimulate pulp regeneration within a gel-like material that is
DENTAL ASIA MARCH / APRIL 2018
strong and not porous; this harnesses the regenerative powers of calcium hydroxide without its physical disadvantages. Biodentine in vital pulp therapy, through the action of calcium hydroxide in this enhanced physical state, boosts the deposition of reparatory dentin by odontoblasts. This creates a dense dentin barrier51,52 as well as healing damaged pulp Ƥbroblasts.53 Clinical results conƤrm Biodentine’s ability to preserve pulp vitality even in very diƥcult cases. It has the potential to heal pulps, avoiding what may have been inevitable endodontic involvement in the past.
Results with resin and non-resin modified Calcium Silicates Studies have shown that the presence of a resin matrix modiƤes the setting mechanism and calcium leaching of calcium silicates.54 A partial pulpotomy clinical study compared TheraCal (Bisco,Schaumburg, IL), a light-cured, resin modified calcium silicate base/liner designed for direct and indirect pulp capping, with non-resin containing materials, Biodentine and ProRoot MTA (Dentsply Sirona, York, PA). Results showed Biodentine with complete dentinal bridge formation in all teeth. The rates for bridge formation were 56% for ProRoot MTA and 11% for TheraCal.55 Normal pulp organisation was seen in 66.6% of the teeth in the Biodentine group, 33.3 % of the ProRoot MTA group and 11.1% of the TheraCal group. The study concluded that the non-resin based partial pulpotomy materials perform better than the resin based materials and present potential for the best clinical outcomes.55 Another recent study compared Biodentine with TheraCal with respect to how they each aơect inƪammation and regeneration of the pulp in a direct pulp capping in vitro model. TheraCal was shown to increase inflammatory cells and decrease the regenerative processes of the pulp whereas Biodentine did not increase inƪammation and supported the regenerative processes of the pulp.56 These two studies seem to suggest caution in using resin based materials for vital pulp therapy. Biodentine has good biocompatibility and bioactivity for use in vital pulp therapy.
Calcium Silicates as Endodontic Sealers The ability to deposit hydroxyapatite and regenerate live tissue has brought calcium silicate technology into the scope of endodontic sealers. After obturation there is generally contact between the obturating materials and the periapical tissues. The success of treatment greatly depends on the integrity of the obturated seal to prevent recurrent infection of the periapical space. The introduction of bioactive endodontic sealers has changed the concept of obturated seal from hermetic sealing with inert materials to biological bonding with bioactivity.57 The sealer becomes a Ƥller, not only a sealer. Calcium silicates are well suited to endodontic obturation due to the following properties:58 • High pH (anti-bacterial) • Hydrophilic (use moisture present in dentinal tubules to initiate set) • Biocompatible
Clinical Feature • Do not shrink or resorb 8. Ten Cate JM, Feathersone JDB. Mechanistic aspects of the interactions between fluoride and dental enamel. Crit Rev Oral Biol. 1991; • Excellent seal (bond chemically 2:283-96. and mechanically to dentin) 9. Whitford GM, Wadison JL, Schafer TE, Adair SM. • Ease of use (can be used with many Plaque fluoride concentrations are dependent on plaque methods of condensation) calcium concentrations, Caries Res.2002; 36:256-265. • And they are bioactive: 10. Pessan JP, Alves KM, Ramires I, et al. Effects of regular • Remineralise hard tissue and low-fluoride. J Dent Res. 2010; 89:1106-1110. • Deposit HA to improve the seal 11. Mount GJ. Adhesion of glass-ionomer cement in the Fig. 9 BioRoot (Septodont) is a bioactive over time endodontic sealer that remineralises, deposits clinical environment. Oper Dent. 1991; 16:141-148. • Regenerate and heal surrounding hydroxyapatite and regenerates live tissue. 12. McIntyre JM, Cheetham J, Dalidjan M. Ionic Exchange periapical tissue Between Riva Self Cure GIC and Demineralized Dentine; BioRoot (Septodont, Lancaster, PA) (Fig. 9) has been developed Brisbane 2006 IADR Abstract #2078, University of Adelaide, Australia. 13. Mount, G. Advances in Glass Ionomer Cements – Chapter 14, Glass to incorporate these bioactive traits.
Research has shown Hydroxyapatite formation upon setting reaction - Bioceramic sealers bond to dentin through the process of alkaline etching. This is due to the alkalinity of the sealer. A mineral inƤltration zone develops between the dentin and the sealer.59 Tissue healing - A study that compared the eơects of BioRoot RCS on human PDL (periodontal ligament) cells with the standard zinc oxide eugenol based root canal sealer, Pulp Canal Sealer (Kerr Dental, Orange, CA) showed BioRoot to have fewer toxic eơects on PDL cells and it induced greater secretion of angiogenic and osteogenic growth factors. These properties are essential in periapical tissue regeneration.60,61 BioRoot also showed excellent biocompatibility when compared with many other contemporary endodontic sealers.62
Conclusion With a bit of simplicity and focus on the essentials of bioactivity in dentistry it becomes clear that bioactivity is now an essential part of the practice of clinical dentistry. Dentists can now harness the potential to remineralise, generate tooth material and heal biological structures for their ultimate objective which is attaining the best possible clinical outcomes for their patients. DA
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Jones JR. Review of bioactive glass: from Hench to hybrids. Acta Biomater. 2013;9(1):4457-4486. Kugel G, Eisen S. Contemporary Use of Bioactive Materials in Restorative Dentistry. Compendium of CE in Dentistry. 2016;37(5). McCabe JF, Yan Z, Al Naimi OT, Mahmoud G, Rolland SL. Smart Materials in Dentistry. Australian Dental Journal. 2011;56(1):3-10. Jefferies SR. Bioactive Dental Materials: composition, properties, and indications for a new class of restorative materials. Inside Dentistry. 2016: 58-64. Buzalaf MAR. Fluoride and the Oral Environment. Monogr Oral Sci, Basel, Karger. 2011; 22: 97-114. Featherstone JDB. Prevention and reversal of dental caries: role of low level fluoride, community. Dent Oral Epidemiol. 1999; 27: 31-40. Featherstone JDB, Glena r, Shariati M, Shields CP. Dependence of invitro demineralization and remineralization of dental enamel on fluoride concentration. J Dent Res. 1990; 69:620-5.
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Ionomers: Advantages, Disadvantages, and Future Implications. Quintessence Publishing. 1999; 269-293.Slow Slowikowski L, et al. Fluoride ion release and recharge over time in three restoratives. J Dent Res 93 (Spec Iss A). 2014; 268. Morrow BR, Brown J, Stewart C W, Garcia-Godoy F. Evaluation of pH, Fluoride and Calcium Release for Dental Materials. UTHSC, Memphis TN. IADR San Francisco 2017. Koirala S, Yap A. A Clinical Guide to Direct Cosmetic Restorations with Giomer. Dental Tribune International, 2008. Miyauchi T et al. The effect of Giomer restorative materials on demineralized dentin. IADR Abstract 135006, 2010. Dhull KS, Nandlal B. Comparative evaluation of fluoride release from PRG-composites and compomer on application of topical fluoride. Journal of Indian Society of Periodontics and Preventive Dentistry. 2009:27:1:27-32. Okuyama K, et al. Fluoride release and uptake by various dental materials after fluoride application. Am J Dent. 2006:19:123-127. Tian FC. Clinical performance of Giomer restorative system, 2010 IADR Abstract. Jefferies SR. Bioactive and biomimetic restorative materials: a comprehensive review. Part I. J Esthet Restor Dent. 2014;26(1):14-26. Jefferies SR. Bioactive and biomimetic restorative materials: a comprehensive review. Part II. J Esthet Restor Dent. 2014;26(1):27-39. Jefferies SR, Fuller AE, Boston DW. Preliminary Evidence That Bioactive Cements Occlude Artificial Marginal Gaps. Journal of Esthetic and Restorative Dentistry. 2015;1-10. Corral Nunez CM, et al. Biodentine and Mineral Trioxide Aggregate Induce Similar Cellular Responses in a Fibroblast Cell Line. JOE. 2014;40(3): 406-411. About I. Biodentine: from biochemical and bioactive properties to clinical applications. Giornale Italiano di Endodonzia. 2016;30: 81-88. Camps J, Jeanneau C, El Ayachi I, et al. Bioactivity of a Calcium Silicatebased Endodontic Cement (BioRoot RCS): Interactions with Human Periodontal Ligament Cells in Vitro. J Endod. 2015;41(9):1469-73. Schroder U. Effects of calcium hydroxide-containing pulp-capping agents on pulp cell migration, proliferation, and differentiation. J Dent Res.1985;64(Spec No.):541-8. Tziafa C, Tziafas D, et al. Dentinogenic Responses after Direct Pulp Capping of Miniature Swine Teeth with Biodentine. JOE. 2014;40(12):1967-71. Stanley HR. Pulp capping: conserving the dental pulp-can it be done? Is it worth it? Oral Surg Oral Med Oral Pathol. 1989;68: 628-39. Bergenholtz G. Advances since the paper by Zander and Glass (1949)
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on the pursuit of healing methods for pulpal exposures: historical perspectives. Oral Surg Oral Med Oral Pahtol Oral Radiol Endod. 2005;100 (suppl 2): 102-8. Horsted P, Sandergaard B, Thylstrup A, et al. A retrospective study of direct pulp capping with calcium hydroxide compounds. Endod Dent Traumatol. 1985;1: 29-34. Cox CF, Subay RK, Ostro e, et al. Tunnel defects in dentin bridges: their formation following direct pulp capping. Oper Dent. 1996;21: 4-11. Abedi HR, Ingle JI. Mineral trioxide aggregate: a review of a new cement. J Calif Dent Assoc. 1995;23(12): 36-9. Parirokh M, Torabinejab M. Mineral trioxide aggregate: a comprehensive literature review â€“ part III: clinical applications, drawbacks, and mechanism of action. J Endod. 2010;36(3): 400-13. Qudeimat MA, Barrieshi-Nusair KM, Owais AI. Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Eur Arch Paediatr Dent. 2007;8: 99-104. Tuna D, Olmez A. Clinical long-term evaluation of MTA as a direct pulp capping material in primary teeth. Int Endod J. 2008;41: 273-8. De Rossi A, Bezerra Silva LA, Gaton-Hernandez P, et al. Comparison of Pulpal Responses to Pulpotomy and Pulp Capping with Biodentine and Mineral Trioxide Aggregate in Dogs. JOE. 2014;40(9): 1362-69. Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford DR. Bacterial leakage of mineral trioxide aggregate as root-end filling material. J Endod. 1995;21: 109-12. Valles M, Mercade M, Duran-Sindreu F, et al. Influence of light and oxygen on the color stability of five calcium silicate-based materials. J Endod. 2013;39(4): 525-8. Camilleri J, Montesin FE, Brady K, et al. The constitution of mineral trioxide aggregate. Dent Mater. 2005;21: 297-303. Nowicka A, Lipski M, Parafiniuk M, et al. Response of human dental pulp capped with Biodentine and mineral trioxide aggregate. J Endod. 2013;39: 743-7. Pradelle-Plasse N, Tran Xuan-Vin C. Physico-chemical properties of Biodentine. In: Goldberg M, ed. Biocompatibility or Cytotoxic Effects of Dental Composites, 1st ed. Oxford: Coxmoor Publishing. 2009. Goldstep F, Proactive Intervention Dentistry: A Model for Oral Care through Life. Compendium 2012;33(6):394-404 Tuna D, Olmez A. Clinical long-term evaluation of MTA as a direct pulp capping material in primary teeth. Int Endod J. 2008;41: 273-8. Koubi G, Colon P, Franquin J-C, et al. Clinical evaluation of the performance and safety of a new dentin substitute, Biodentine, in the restoration of posterior teeth: a prospective study. Clin Oral Investig. 2013;17: 243-9. Tran XV, Gorin C, Willig C, et al. Effect of calcium-silicate-based restorative cement on pulp repair. J Dent Res. 2012;91: 1166-71. Camilleri J, Sorrentino F, Damidot D. Investigation of the hydration and bioactivity of radiopacified tricalcium silicate cement, Biodentine and MTA Angelus. Dent Mater. 2013;29: 580-93. Laurent P, Camps J, About I. Biodentineâ„¢ induces TGF-È¾1 release from human pulp cells and early dental pulp mineralization. Int Endod J. 2012;45: 439-48. Nowicka A, Lipski M, Parafiniuk M, et al. Response of human dental pulp capped with Biodentine and mineral trioxide aggregate. J Endod. 2013;39: 743-7. Camilleri J, Laurent P, About I. Hydration of Biodentine, Theracal LC, and a Prototype Tricalcium Silicate-based Dentin Replacement Material after Pulp Capping in Entire Tooth Cultures. JOE. 2014; 1-9.
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57. 58. 59.
About I, Coiffage pulpaire direct de RD94 a lâ€™aide du modele de culture de dent entiere, Report RD EN RA EXT-RD94/096, 2007 Shayegan A, RD 94 Etude #PC08-001, Etude de RD 94 comme agent pulpaire dans le cadre de pulpotomie et coiffage direct sur les dents lacteales de cochon, Report RD RA DEV 94-006, 2009 About I, Effects des materiaux bioactifs Biodentine â„¢ et CalcipulpeÂ® sure les etapes preoces de la regeneration dentaire, Report RD RA DEV 94-013, 2009 Camilleri J. Hydration characteristics of Biodentine and Theracal used as pulp capping materials. Dent Mater. 2014. Bakhtiar H, Nekoofar MH, Aminishakib P, et al. Human Pulp Responses to Partial Pulpotomy Treatment with TheraCal as Compared with Biodentine and ProRoot MTA: A Clinical Trial. JOE. 2017; 1-6. Giraud T, Rufas P, Chmilewsky F, et al. Complement Activation by Pulp Capping Materials Plays a Significant Role in Both Inflammatory and Pulp Stem Cellsâ€™ Recruitment. JOE. 2017;43(7): 1104-1110. Camilleri J. Will Bioceramics be the Future Root Canal Filling Materials? Curr Oral Health Rep.2017. Koch K, Brave D, Ali Nasseh A. A review of bioceramic technology in endodontics. Roots. 2012;4: 6-12. Viapiana R, Moinzadeh AT, Camilleri L, et al. Porosity and sealing ability of root fillings with gutta percha and Bioroot RCS or AH Plus sealers. Evaluation by three ex vivo methods. Int Endod J. 2016;49(8):774-82. Camps J, Jeanneau C, El Ayachi I, et al. Bioactivity of a Calcium Silicatebased Endodontic Cement (BioRoot RCS): Interactions with Human Periodontal Ligament Cells in Vitro. J Endod. 2015;41(9):1469-73. Dimitrova-Nakov S, Uzunoglu E, Ardila-Osorio H, et al. In vitro bioactivity of Biorootâ„¢ RCS, via A4 mouse pulpal stem cells. Dent Mater. 2015;31(11): 1290-7. Reichl FX, Rothmund L, Shehata M, Hogg C. DNA double-strand breaks caused by new and contemporary endodontic sealers. Int Endod J. 2015;17(11).
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by Dr. Wong Li Beng
ccording to the 7th EuroPerio Consensus in 2012, it was established that diseases in the oral cavity like caries, gingivitis and periodontitis are bioƤlm induced, and the mechanical removal of this bacterial bioƤlm is key to the prevention and control of these diseases. Air polishing devices have been shown to be eƥcacious in removing supraand sub-gingival bioƤlm. The EMS AIRFLOW® Master Piezon has been my daily workhorse in my clinic for both the removal of plaque bioƤlm and calculus in active periodontal patients as well as patient with controlled periodontal diseases undergoing maintenance. The machine has fulƤlled its primary role in providing quality prophylaxis care for my patients with high degree of comfort, in alignment with the Guided Biofilm Therapy philosophy. (The science behind air polishing technology and details on Guided BioƤlm Therapy has been covered in my earlier articles). I was privileged to try out the newly launched AIRFLOW® Prophylaxis Master (AFPM) last year and was pleasantly surprised by the enhancement in features over the AIRFLOW® Master Piezon, which by itself is a state-ofthe-art equipment. This article will cover some of the main characteristics of AFPM from a user perspective.
Fig. 1: AIRFLOW® Prophylaxis Master
Closer look at AIRFLOW® Prophylaxis Master The AFPM is smaller compared to the AIRFLOW ® Master Piezon, measuring 260mm by 290cm by 245mm, with an approximate weight of 5kg (Fig. 1).
Fig. 2: Temperature and operation sound notiƤcation volume control
The machine can be easily held with one hand at the pressurisation tower. With a smaller size compared to the AIRFLOW® Master Piezon and its trendy design, one would have easily mistaken an AFPM as a coơee machine in the oƥce pantry. Most of my patients who saw the AFPM for the Ƥrst time were all intrigued by its appearance, and it definitely had helped to break the ice for some of my most apprehensive, dental-phobic patients. To make the dental appointment even more interesting for my patients, I would usually demonstrate to them how the powder capsule can connect to the pressurisation tower within seconds using its integrated magnetic connection.
The interactive touch panel regulates and adjusts the AIRFLOW® and PIEZON ® power level, just like in the AIRFLOW ® Master Piezon. To enhance the patient comfort during treatment, especially for those with teeth having exposed cementum and dentine, the AFPM also comes with an adjustable temperature control for the irrigant, which can be set as unheated, 25, 30, 35 or 40 degree Celsius (Figure 2). The operation sound notification volume can also be adjusted. The bottle which is used to contain the irrigant during scaling has been upsized to 800ml (Fig. 3). To me, this is definitely Fig. 3: AFPM using the 800ml an added incentive PIEZON® bottle compared to the smaller bottle volume of 500ml used in the AIRFLOW® Master Piezon as this minimises the inconvenience for my dental assistant to constantly top up the bottle, especially in patients who require longer treatment time. The AFPM also comes with another blue bottle called the Night Cleaner bottle which provides the necessary waterline cleaning and disinfection at the end of the day (Fig. 4). Fig. 4: The Night Cleaner bottle used in AFPM
DENTAL ASIA MARCH / APRIL 2018
User Report Perhaps one of the most interesting, or rather, enticing feature I Æ¤nd in the AFPM is the wireless foot-pedal (Fig. 5). Being a lefthanded as well as a left-footed dentist myself,
I am no longer restricted by the operatory room conÆ¤guration in terms of which side of the operator the machine has to be placed. The wireless design also cuts down any risk of wire tripping by the patients when they step out of the dental chair. The foot-pedal also comes with a boost mode at the centre of the pedal.
Fig. 5: Wireless foot-pedal used in AFPM
DENTAL ASIA MARCH / APRIL 2018
The AIRFLOWÂ® Prophylaxis Master builds on all the unique characteristics of the AIRFLOWÂ® Master Piezon, with additional features which are both patient-centric and operator-centric. Its role as the bridge between dentists and patients to re-ignite their common passion in preventive dentistry seems rather promising. DA
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User Report covering sufficient support (Fig. 1a). This may be due to suƥcient structure is required in software default to fabricate the guide (Fig. 1b). Thus, to avoid a bulky guide but still provide sufficient hard tissue support, the modification can be processed in advance at the step of “image acquiring,” by trimming away the unnecessary supporting ridge portion of the image. Third, the digital proposal/ wax-up should be the expected as close as possible to the Ƥnal restoration. Therefore, when drawing the margin on the digital model, the outline should be as ideal as possible to provide suƥcient information for the implant planning (Fig. 2). Finally all these information can be exported as *.SSI Ƥle, and further transferred to compatible Galileo Implant software.
By Dr. T. James Lee DMD, PhD
he prerequisites for CEREC Guide 2 are well described in the CEREC guide manual. Depends on the amount of tubes required, three to four steps of processing are required for the fabrication of a CEREC surgical guide: 1. Creating of optical impression 2. Creating of 3D X-ray volume 3. Implant planning and develop of the guide
bulky to aơect the surgical instrumentation. This can be defined by “seating space” function in the CEREC software during the development stage. Narrowing the margin at “drawing the margin” function, however, may constantly generate proposals without Fig. 1a Fig. 2: Outline of the digital wax-up margin signiƤcantly inƪuences the Ƥnal restoration and position of implant. It also determines whether a graft is required for the Ƥxture placement.
Creating of 3D X-ray volume
Creating of the optical impression Intra-oral or model images can be acquired via Omni-cam or Blue-Cam. Sufficient large area is required to provide a good Ƥtting of Ƥnal design. All remaining teeth considered being the support of the guide should be obtained in the image. Two problems however, can occur during this step. First, the computation of the CEREC from scanning to image forming is achieved by linear mathematical calculation. Any dramatic turning during the scanning can induce errors on the Ƥnal image. This can result in jiggling of the developed guide on the supporting teeth. To reduce the errors during the scanning, a segment and suture-back technique used by CEREC Ortho software is preferred. This method can cover most of the span that a guide needs. Second, a guide is expected not to be too
Fig. 1c F i g s . 1 a - c : D e f e c t e d proposal (a) due to insufficient amount of area was chosen during “draw the margin” step (b). New proposal after adjustment of margin (c).
Due to CEREC Guide is a closed/complete planning system design, 3-D X-ray volume can only be obtained by DentplySirona CBCT devices such as Galileos, Orthophos XG 3D, Orthophos SL 3D, and software such as Sidexis XG, Sidexis 4 and Galaxis 1.9.2 or a higher version. Only these devices are compatible with Galileo Implant software V 1.9.2 or higher ones, which can recognise the *.SSI Ƥle generated by CEREC and being superimposed together with the DVT scan.
Implant planning The placement can be well determined by the depth, distance to adjacent structure together with angle to the margin of restoration (emergence proƤle). For Ankylos implant system, the system is designed to be placed sub-crestally,
DENTAL ASIA MARCH / APRIL 2018
User Report which allows the bone structure follow the contour of the shape of the abutment and in turn facilitates the forming of soft tissue chamber. For Astra E.V. system, although equi-crestal placement is recommended, in the situation of restoration with wider contour, implant fixture may be required to be placed more apically to allow a better emergence proƤle (Fig. 3). Research has suggested that restoration beyond 30 degrees angle has higher rate of periodontitis. A conƪuent emergence proƤle with lower angles directly improves the soft tissue response and long-term maintenance. From the digital wax-up to the Ƥnal implant placement and fabrication of restoration, the CEREC coupled with Galileo Implant system provides a logical and systematic ƪow for prosthodonticsdriven implant therapy. It supports not only single-unit individual restorations. Multiimplant work possible in Galileos Implant, easy to align them in parallel, also cross arch. Bridges need to be exported from CEREC. CG2 allows for multiple implants in one guide if milled on MC X5. For case like edentulou full arch multiple units, Galileo Implant may not be as powerful as Dentsply Sirona’s another product: Simplant to provide a bone or tissue support guide.
Develop of the Guide Once the planning is finalised, it can be saved as a *.CMG.DXD file format and exported to CEREC or inLab. All the default parameters are set to avoid fracture of template made of PMMA material. As mentioned before, any excessive change of drawn margin may generate an improper proposal. Additionally, planning involved with more than one implants placement in the same segment would require the guide milled by inLab. Currently, CEREC still does not allow the milling of more than one tube per template.
Fig. 4: Drill keys for CEREC guide.
Fig. 5: Astra EV guided surgery kit with built-in sleeves.
Fig. 3: Implant may require to be placed more apically instead of equi-crestal to allow a better emergence proƤle.
DENTAL ASIA MARCH / APRIL 2018
At surgery stage, the template can be fit into patient’s mouth supported by the remaining teeth. Additional window placement option allows to check the Ƥt of the CEREC guide in patients mouth. Diơerent from using drilling keys for CEREC guide (Fig. 4), with reducing bushes for respective drilling diameters, Astra EV guided surgery kit (EV-GS) comes with built-in sleeves on individual drills (Fig. 5). The measurements of outer dimension of the sleeves are 4.5mm (ND) and 5.13mm(WD). If we look at the sleeves option for Cerec guide itself, the dimensions of inner side of sleeves are 4.5(S), 5.3(M) and 6.0(L) mm. Two options can be applied, Ƥrst is by trimming the S-size PMMA
Figs. 6a-e: #44 and #45 outings were widen to Ƥt the sleeves of Astra EV guided drill. #46; third party sleeve inserted into the template allowing the Ƥtting of the guide drill. The surgey was done with Cerec guide 2 for osseotomy followed by autogenous bone graft.
sleeves into slighter wider to accommodate 4.5mm metal sleeves for EV-GS ND drills. Another option is by selecting the L-size sleeves on guide template and insert a thirdparty metal sleeves into the guide to have a close Ƥt of the EV-GS WD drills (Fig. 6). For Ankylos system, which the CEREC drill keys so far are also not supporting, comes with default metal sleeves for its guided surgery kit. The measurement of the Ankylos sleeves is 4.45mm in average. It may loosely Ƥt into the small sleeves of the template.
Calculation of D1 and D2 value
using D2 value. The logic is as following: the tubes on CEREC guide template has a default design with 5mm by height, which is longer than the sleeve length 4mm in Astra EV guided Surgery manual. Therefore, provided a 8mm length implant is to be placed, adding the drill tip 1mm and tube as 5 mm, by using a 20mm drill with a builtin drill sleeve collar 1mm and extra metal sleeve 1mm, D1: 20-8-1-5-1-1=4mm (Fig. 7a). With this calculation in mind, provided a 8mm implant is to be place with internal sinus lift required and 5.5mm bone height to the sinus ƪoor. It is expected to drill up to 5mm depth, the calculation of D1=205-5-1-1=8mm. It will turn out D2 value as 21mm, while a 20mm drill is still to be used (Fig. 7b). Therefore, a calculation of D1 instead of D2 provides the clinicians a clearer concept and better control on how deep the drill should stop.
The D1 and D2 value determine the depth of osseotomy. D1 and D2 distance is locked, changing D1 will change D2 equally as vice versa. According to the guideline in the Astra EV Guided Surgery manual, it is suggested to have D2 value as 1mm subtracted from the drill length. This is co-respondent to Astra EV guided Surgery kit, which has 3 diơerent lengths of drills: 20, 23 and 27mm (Fig. 5). For each drill length, it includes the lengths of implant (6-15mm), prolongation (6 or 8mm), drill tip (1mm), sleeve (4mm) and sleeve collar (1mm). First the 1mm collar height needs to be reduced from the total calculation. Then if we use extra 1-mm-height internal sleeves, Fig. 7a then extra height needs to take into consideration, which will require minus 2mm in this case. This 2mm calculation comes from 1mm extra height on the guided built-in sleeves and 1mm from the extra height of the metal sleeves attached to the PMMA guide. For placement requires sinus lift, the drill protocol needs to be modiƤed to drill to the level 0.5-1mm shy of sinus ƪoor. The calculation of general protocol Fig. 7b applying D2 by minus 1 mm (or 2mm with extra sleeve) from Figs. 7a-b: (a) Calculation of D1 by subtracting the heights of drilling length was found not implant (8mm) sleeve on drill (1mm), PMMA tube (6mm), applicable with these situations. and drill tip (1mm) and third-party metal extra sleeve (1mm): 20(total drill length)-8-1-5-1-1=4(mm). (b) Calculation of D1 This problem can be easily solved instead of D2 helps for the surgery involving in the internal by recalculation of D1 instead of sinus lift bone augmentation. 52
Fig. 8c Figs. 8a-c: Case 1 pre-op planning after merging the digital wax-up (a) with CT-Scan images on Galileo software (b). Sinus ƪoor perforation or internal sinus lift augmentation was technically avoided while maintaining a wellcontoured emergence proƤle. (c) Case 1 post-op image on radiograph traced the pre-op planning.
Case 1: Patient with chief complain of one-unit edentulous space affecting chewing efficiency. First diagnosis with CT-scan detected the bone height 8mm with initial treatment plan of internal sinus lift during placement. ModiƤed treatment plan was proposed after digital wax up with CEREC, followed by changing the contour and angulation to allow a preferred emergence proƤle (Fig. 8a). D1 value was proposed as 4mm. Astra EV implant 8mm length with diameter 4.2mm was placed and tracing the exact position as pre-op planning (Fig 8b). DENTAL ASIA MARCH / APRIL 2018
signiĆ¤cant anatomical structure. Astra EV 8mm implant with diameter 3.6mm was planned at site of #24. A 4.5 mm drilling length was planned for #25 and internal sinus lift was expected (Fig.9). At surgery stage, #24 was placed as exact the position as planning. At #25 site, osseotomy was performed with template followed by internal sinus lift. Final Ć¤xtures placement at the same position as the planning was conĆ¤rmed (Fig. 9c).
Fig. 9c Figs. 9a-c: (a) Digital wax up with ideal contour of the restoration. (b) Planning with Galileo software and internal sinus lift is expected for site #25. Further adjustment of D1 in the Ć¤nal planning to allow osseotomy up to 0.5mm away from the sinus ĆŞoor. (C) Post-op radiograph conĆ¤rming the placement as planed.
Case 2: Patient had existing failed bridge with extraction of #24, and would like to restore the space with individual units. CT-Scan detected a very curved root of #23 and insuĆĽcient bone height at the edentulous site #25. Planning stage focused on creating screw-retained restorations with conĆŞuent under 30-degree-angle emergence proĆ¤les while avoiding fixture colliding with
DENTAL ASIA MARCH / APRIL 2018
CEREC Guided 2, unlike Guide 1, has moved to the direction similar to other surgical guide system. The major limitation is that the CEREC chair side milling/fabrication is limited to single unit. Even though multiple units with parallelism in planning can be achieved, cross arch scanning distortion may still occur to aĆĄect the guideâ€™s Ć¤tting. This problem can be solved by inLab system and MC X5. When facing a full edentulous case or insuĆĽcient remaining teeth present, CEREC guide may not be the choice. Simplant or other guide built for bone or tissue support may be the choice. Also, currently the keys are not supporting most implant systems, including Astra EV and Ankylos. This can be Ć¤xed, as mentioned before, by adjustment of PMMA tube size or applying third-party sleeves. Both options are criticised that this may reduce the accuracy. However, it should be bear in mind that EV system is designed with underprep protocol. In other words, each Ć¤nal drill except V and X drills actually provides osseotomy dimension of 0.5mm narrower than that of the co-respondent implant fixture. The trimming of PMMA, if was done minimally and properly, should aĆĄect less than +/- .02mm in the tubeâ€™s internal dimension. This is still far less than that of the under-prep itself. Another important point is Astra EV system is designed as selfguided. Once the osseotomy is done by #1 drill, the oĆĄsets of following drills are quite reduced. Additionally, while most guidelines focus on the D2 value, D1 value is actually a more logical concept for the clinicians to calculate. It allows the clinician to take control on chair side to apply different
available tools, and determine the depth of osseotomy based on the need of each individual case.
Conclusion: Although CEREC Guide 2, unlike other central-based manufactured guide, requires understanding of flow thinking and familiarity of the relations between the guided surgery kits and software, it provides a ĆŞexible, time and cost eĆĽcient option for a prosthodontics-driven implant therapy. DA
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Southeast Implants (S) Pte Ltd places great emphasis on providing training and education to dental practitioners as it believes in continued learning and at the same time enhancing user experience in this ever-green industry. Furthermore, its close working relationship with Dentsply Sirona enables Southeast Implants to present an all dental solutions and integrate digital implantology in its procedures. With this integration and sales support services via various platforms for our esteemed practitioners, it elevates the overall experience they have with Southeast Implants. Equipped with relevant technical knowledge, our sales staĆĄs render chair-side assistance to dental practitioners and assist to overcome complications when required. Contact Mr Vern Lee at firstname.lastname@example.org for more details.
Behind the Scenes
high lip line case. Consequently, simple To m B e r e z n i c k i a n d direct composite placement techniques Ms. Lola Welch present a have evolved to provide this medium-term minimally invasive approach aesthetic solution. perfect for adolescent patients Nowadays, a great premium is placed on aesthetics with cosmetic Limitations of solutions being sought by direct placement the parents of adolescent composites patients at very early ages. Direct placement of Conventional orthodontics composites as a filling plays a huge part in and cosmetic bonding satisfying this demand in material has been adolescents, but cannot available for many years always provide all the Fig. 1: An example of poor aesthetics and it is not within the with direct composite bonding. answers. In cases such scope of this article to as partial anodontia, peg lateral incisors, review the chemistry and clinical techniques misshapen and malformed teeth, additional associated with these materials. As a aesthetic improvements have to be provided general rule, indirect bonding, when used by a variety of restorative procedures. to close diastemas, can provide an excellent Whenever possible in adolescents, these and predictable aesthetic result. The techniques should be minimally, if at all, case (Fig. 1) shows how more advanced invasive. Gingival tissues continue to mature and extensive space closure cases can and change shape during this period, as do prove too complex when using the direct skeletal changes through skull growth, and technique â€“ poor slanted midline closure, therefore, as a general rule, any restorations disproportionately shaped teeth, and placed should be viewed as providing a a particularly disappointing emergence solution in the medium term until early profile. Although various techniques have adulthood. been advocated, including the use of various Restorations placed subgingivally for space closure celluloid formers to overcome aesthetics at an early age are soon likely these problems, the final results in the to appear supragingivally and require authorsâ€™ hands can still be unpredictable. probable replacement especially in the It is the opinion of the authors that these
DENTAL ASIA MARCH / APRIL 2018
Fig. 2: A pre-treatment aesthetic dilemma presented by the excessively large diastemas.
Fig. 3: The case following Invisalign orthodontic tooth movement (Courtesy of Dr. R. Edwards)
Fig. 4: The case upon completion of indirect composite.
Behind the Scenes complex cases are more easily, cheaply, and predictably restored with indirectly custom-fabricated composite mesial/distal space closure veneers (or chips, as they are sometimes called) (Figs. 2-4). Although this technique can also be carried out using porcelain chips, the degree of tooth preparation required to achieve an imperceptible join between the tooth and porcelain, along with associated problems of colour matching and cost preclude their use in the medium-term in teenagers and are ideally provided in the early adolescent age group upward.
Figs. 5a-c: Pre-operative photos
Diagnosis and treatment planning A 16-year-old patient presented with a cosmetic opinion toward the completion of his orthodontic treatment. In the lower arch, both central incisors were congenitally absent, and orthodontic tooth movement had provided a one-tooth space for restoration. His age precluded implant placement and the interim proposed solution of the provision of a conventional Maryland bridge was accepted by the patient and his mother. The aesthetic problems in the maxillary arch were more complex. Both lateral incisors were malformed as well as misshapen (Figs. 5a-c). All four incisors were wider at the necks than at the incisal edge, with both canines relatively pointed. As tooth positioning following orthodontics was excellent for aesthetics and lip support, further treatment to bring the teeth together would have been counterproductive. Finally, the patient and his mother were adamant that whichever technique 56
was chosen to improve aesthetics, it has to be minimally if at all invasive. The patient additionally requested that tooth whitening be carried out prior to the restorative phase of treatment, and his existing Raintree Essix Orthodontic Retainers (Dentsply International) were used as trays for home whitening applying 15% carbamide peroxide gel (Ultradent Products). Study casts were taken and mounted with a face-bow on a semiadjustable articulator (Dentatus). The case was studied with particular respect to the proposed space closure and the maintenance of the correct crown
ensuring that the theoretical demands of the golden proportion were met. The following treatment plan was proposed: two composite veneers to address the issue of tooth width and the malformed buccal surfaces of the lateral incisors, as well as the provision of indirect interproximal composite veneers on the central incisors to close the remaining diastemas and mesially on both canines to improve their aesthetic appearance. The existing large overjet following orthodontic treatment would ensure that occlusal stresses on the composite restorations were minimal and chipping were unlikely due to everyday usage. The patient was informed that minimal preparation of the lateral incisors would be necessary to improve their surface morphology and provide Ƥnishing lines. In addition, the provision of minimal depth grooves within enamel on the central incisor and canine teeth was required to provide location and seamless transition between the composite chips and enamel on the buccal surfaces of the teeth. Similar cases were demonstrated to the patient and the treatment plan was accepted.
width to length ratio of 75% and Clinical technique corresponding Following teeth whitening, g o l d e n colour swatches similar in shape proportion ratios to the Ƥnal restorations were for remaining made in a variety of composite teeth. Although combinations on the upper minimal/no study model to trial Ƥt on one preparation Fig. 6: The original study model of the central incisors. veneers (eg, These swatches were Lumineers) located in turn and, without were an option enamel etching, bonded if crown length sequentially in place with the was to be chosen translucent composite increased, this luting cement (Choice 2 Cement approach was [BIS CO Dental Products]) to not the preferred be used in Ƥnal bonding, until choice of the Fig. 7: The diagnostic wax-up completed such time as the correct colour patient. by the dental laboratory team. match had been achieved. The To o t h s i z e colour combination was noted was analysed for future use during fabrication of the Ƥnal by my technician with Digital Callipers restorations. (Har bor Freight Tools) and a diagnostic While reƤning this technique in previous wax up carried out with IQ Compact cases, it became apparent that the issue Opaque Wax (Yeti Dental) without of the emergence proƤle and the creation increasing tooth length (Figs. 6-7), while DENTAL ASIA MARCH / APRIL 2018
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*Depending on clinician preference and close cooperation with the laboratory. GMT 53206. Disclaimer of liability: This product is part of an overall concept and may only be used in conjunction with the associated original products according to the instructions and recommendation of Nobel Biocare. Non-recommended use of products made by third parties in conjunction with Nobel Biocare products will void any warranty or other obligation, express or implied, of Nobel Biocare. The user of Nobel Biocare products has the duty to determine whether or not any product is suitable for the particular patient and circumstances. Nobel Biocare disclaims any liability, express or implied, and shall have no responsibility for any direct, indirect, punitive or other damages, arising out of or in connection with any errors in professional judgment or practice in the use of Nobel Biocare products. The user is also obliged to study the latest developments in regard to this Nobel Biocare product and its applications regularly. In cases of doubt, the user has to contact Nobel Biocare. Since the utilization of this product is under the control of the user, it is his/her responsibility. Nobel Biocare does not assume any liability whatsoever for damage arising thereof. Please note that some products detailed in this Instructions for Use may not be regulatory cleared, released QTNKEGPUGFHQTUCNGKPCNNOCTMGVU#UUWEJRTQXKFGFRCVKGPVETKVGTKCCTGOGVCPFCFGSWCVGRTKOCT[UVCDKNKV[KUCEJKGXGF0QDGN$KQECTGKORNCPVUCNNQYCÆ‚ZGFRTQXKUKQPCNTGUVQTCVKQPVQDGNQCFGFQPVJGFC[QHUWTIGT[
Behind the Scenes surfaces of the other teeth and extending along the gingival margin just into the palatal surface in order to provide a positive finishing lines (Figs. 8a & b). The final impression Figs. 8a Figs. 8b was taken with Polyether R u b b e r (Impregum 6 Minute Hard, 3M Espe) in a custom tray. Te m p o r a r y Figs. 8a-b: Minimal tooth preparation restorations were not required in this case. Then, the Ƥnal impression was poured in stone (Fuji Rock, GC America) to fabricate the working model (Fig. 9). For the laboratory stage of fabrication, an indirect composite system was chosen (Gradia, GC America). A separator (Gradia Separator, GC America) was applied to the working Fig. 9: The Ƥnal working model model and the chips fabricated to the previously chosen had combination: A1 dentine combined with a superficial The design of the chips also required layer of enamel E2 and Intensive enamel positive location to ensure correct EI1. Translucent enamel was used only on placement and positioning on the teeth the locating handle. during bonding. To satisfy this requirement, To ensure that the aesthetic appearance the shape of each chip was extended over was achieved and the trial wax-up the incisal edge to provide a location handle duplicated, the dental technician started and can be cut away once bonding was by creating the ideal shape and width of completed. the full veneers on both lateral incisors. Following placement of gingival Followed by the space closure veneers on retraction cord (Racestyptine Cord, the mesial surfaces of the canines (Fig. 10) Septodont), the necessary minimal tooth and Ƥ nally on the distal then mesial surfaces reduction was carried out conventionally for of the central incisors (Fig. 11). the full veneers, and vertically on the buccal The authors’ preferred composite bonding system in cases such as these comprises of Uni-etch, One step Plus, Composite Activator, and Choice 2 Cement (Translucent) (Bisco Dental Products). Translucent cement was used to ensure that the transition between the enamel and Fig. 10: The i n d i r e c t composite chip would be imperceptible, composite commonly known as the contact lens eơect. mesial space The use of shaded cement can often result Fig. 11: A closein the transition line being visible. of papillae could only be addressed by extending the veneer chips subgingivally to a featheredge margin necessitating use of retraction cord prior to tooth preparation.
up view of the indirect composite space closure veneers on the working model.
and removal of the rubber dam to give a clearer picture of the results achieved with each clinical step. Prior to etching, the teeth involved were thoroughly cleaned by spraying 50Ɋm oxide powder using the Etch Master (Groman Dental) and all the powder thoroughly washed oơ. Prior to bonding each full veneer and individual chip, the tooth was isolated from adjacent teeth with a celluloid matrix strip.
Fig. 12: The Ƥrst space closure veneer following bonding.
Fig. 13: Bonded indirect veneers following initial trimming.
Fig. 14: Bonding of the full veneer on the lateral incisor.
Final placement Isolation was achieved with the placement of rubber dam, but the clinical photographs shown are following sequential cementation
Fig. 15: Final bonding of space closure veneers on the canine and central incisor.
DENTAL ASIA MARCH / APRIL 2018
Behind the Scenes
Each surface was treated sequentially with the manufacturerâ€™s recommended technique, which is common for all composite bonding systems, namely etching the enamel, thorough washing of the etchant gel, drying, then application of the bonding agent and subsequent light curing. The Æ¤t surface of each chip was treated with composite activator prior to the application of One Step Plus but not light cured. A thin layer of cement was applied to the Æ¤t surface and the veneer gently eased onto place and excess luting cement removed with a sable brush prior to light curing. In the case of each chip, the handle was removed Æ¤rst and, along with the cemented veneers, polished with composite Æ¤nishing discs and rubber cups (Shofu Dental) prior to Æ¤tting the next one in the cementing sequence.
The Æ¤nal clinical results achieved are shown in Figures 20 and 21.
Fig. 18: The case pre-placement â€“ lateral view
Fig. 19: The completed case â€“ lateral view
Fig. 16: The case on presentation and following orthodontic band removal. Fig. 20: Pre-operative smile
Fig. 17: The completed case, Æ¤nal polishing, and a Maryland bridge to replace the missing lower incisor.
Each subsequent chip was trial Æ¤tted to ensure correct location and passive Æ¤t prior to further bonding. The cementation sequence is shown in Figures 12 to 15. The case pre- and post-bonding is shown in Figures 16 and 17, and after Æ¤tting the lower Maryland bridge in Figures 18 and 19.
DENTAL ASIA MARCH / APRIL 2018
veneers and chips. The technique has the added benefit of being simple and cost-eÆ¡ective as skilled dental technicians versed in the art of indirect composites can easily carry it out. Composites have shown excellent and predictable longevity, especially when bonded to enamel. If necessary, following the arrival of full dental maturity, the composite can easily be stripped off and replaced using an appropriate pressed ceramic material. The clinical technique presented in this article oÆ¡ers clinicians a simple and eÆ¡ective method of fulÆ¤lling a patientâ€™s requirement for a cost-effective, predictable, noninvasive solution to a complex aesthetic challenge in adolescents. DA
Fig. 21: Post-operative aesthetics
Conclusion The suggested technique as outlined is very predictable and it demonstrates both excellent aesthetics and colour matching. Natural-looking gingival papillae, resulting from proper emergence profile, were created by the fabricated shape of the
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Behind the Scenes
s is the case with many of our patients, besides taking years for them to trust our treatment recommendations at face value, they must also be able to afford our best treatment recommendations. People born before 1946, which predates the ‘baby boomers’, are living long, productive and healthy lives. The practitioner who can eƥciently handle the mature patient, frequently with contributing medical problems and/or potential medication complications, is often challenged by the patient’s restorative and or prosthetic needs. Numerous patients have certain financial parameters that necessitate segmented treatment; nonetheless, it should always be the goal of the prudent practitioner to provide the very best that dentistry has to oơer, within the guidelines of the patient’s desires and needs.
Implant therapy and the older patient An example of this is making use of implant therapy with elderly patients. A lot of these patients have long-standing yet failing restorations and they would be better suited with implant-supported replacement restorations than trying to salvage a dentition with a questionable prognosis. Often, however, due to circumstance such as ridge resorption and/or sinus proximity, our abilities to use implants are restricted.
Case study In this case, a patient in her late 70s, who has been in our practice for over 20 years, had recurrent decay around a bridge abutment. Once the abutments were sectioned, it was discovered that the remaining structure would be unlikely to support another bridge (Fig. 1). The patient was presented with various treatment options, including a removable partial denture or a Ƥxed implant-supported bridge. Surprisingly, she chose the implant option.
Fig. 1: Close-up occlusal view of partially sectioned bridge illustrating ‘wash-out’ of anterior bridge abutment (UL4).
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DENTAL ASIA MARCH / APRIL 2018
Behind the Scenes Often we practitioners tend to ‘steer’ the elderly patients towards less costly alternatives, because we sometimes practise with the ‘noose’ of the familiar scene – an elderly patient on a fixed income, with not a lot of time left to enjoy the beneƤts of long-term dental solutions. As such, we tend to think that what most mature, older patients want is the least expensive option. However, many of our senior patients have experienced the occasional shortcomings of removable prosthetics, or can relate to other family members who never wore their dentures. These patients want the Ƥxed implant beneƤts. They do not want to put up with the ‘sore spots’ or the inconvenience of the non-Ƥxed prosthetics. More than likely, many patients are never given the options that we tend to reserve for our younger patient population.
After the placement of the fixtures, the implant surgeon sent a radiograph conƤrming ideal positioning and parallelism (Fig. 2). The clinical exam revealed exquisitely placed fixtures in the centre of the alveolar space (Fig. 3). There was no real necessity to create more natural emergence profiles, so the healing caps were removed revealing beautifully healed tissue interfaces on all three implants (Figs. 4-5). The appropriately sized implant impression posts were carefully threaded into position (Figs. 6-7) and the feeling of ‘seating’ them into one of the six possible positions via the Zimmer internal hex design was confirmed with tactile sense and a radiograph (Fig. 8).
Fig. 6: Occlusal view of the impression posts placed.
Fig. 7: Occlusal/buccal view of the impression posts placed.
Fig. 3: Occlusal view of the patient’s upper left quadrant with healing caps in after four months to allow for osseous integration.
Fig. 8: Radiograph conƤrming proper seating of the impression posts.
Fig. 2: Radiograph illustrating correct and ideal placement of three Zimmer 4.7 implant Ƥxtures. The Ƥxtures are in ideal positions because of the use of a surgical stent provided by the author to the implant surgeon.
Treatment The patient chose three endosseous implants and a treatment plan was put together in accordance with her wishes. Impressions were taken for upper and lower mounted models using a Kois facebow transfer. Bite registration was sent to the laboratory for fabrication of the surgical stent. This would facilitate the strategic placement of the implant Ƥxtures by the surgeon; the surgical guide was designed to take advantage of the best locations with regard to the occlusion and the alveolar ridge.
DENTAL ASIA MARCH / APRIL 2018
Fig. 4: Occlusal/lingual view of the implant Ƥxtures with healing caps removed.
Fig. 9: Taking the shade for construction of the Ƥnal restorations.
Fig. 5: Occlusal/ buccal view of the implant Ƥxtures without healing caps.
The shade of the corresponding adjacent teeth was taken and then photographed to enhance the communication with the dental laboratory (Fig. 9). The opposing model and a bite registration was also sent
Behind the Scenes
to the laboratory to complete the final customised abutments (UCLA cast to/wax to type Zimmer abutments).
Fig. 13: Buccal view immediately after cementation of final crown restorations over customised implants replacing teeth UL4, UL5 and UL6.
The crowns were cemented in with Variolink (Ivoclar) opaque (oĆĄ label) to allow us to see the excess and to help with removal of excess cement. The Ć¤nal restoration met with the satisfaction of the author and, more importantly, the patient. She mentioned that it felt much more natural than the previous bridge (Figs. 13-15). The Ć¤nal radiograph of the restorations in place illustrates ideal contours and contacts (Fig. 16).
Conclusion Fig. 10: Occlusal view of customised lab-processed abutments in place.
Fig. 14: Occlusal/lingual view following cementation.
Fig. 11: Buccal view of customised lab-processed abutments in place.
In a perfect world, we would only have ideal patients in great medical health, and they would allow us to perform all necessary procedures, resulting in optimal dental health. Unfortunately, we donâ€™t practise in a Utopia and, often, our bias with our senior patients is to provide dentistry that will just â€˜get them byâ€™. This is wrong. It is only right that we practitioners present our patients with the very best options available, rather than dictating what we think they need or want. The treatment presented in this article on this patient in her late 70â€™s illustrates that ideal dental treatment is for anyone, and no one is too old for implant dentistry. DA
Fig. 15: Occlusal view after cementation.
Fig. 12: Occlusal view of Ć¤nal abutments with cotton and red wax over the access opening to preclude cement in this area for possible future access.
Abutments When the patient returned, the customised abutments were checked on the model and in the patientâ€™s mouth to conĆ¤rm ideal Ć¤t and contours (Figs. 10-11). After conĆ¤rming the Ć¤t of the abutments with a radiograph, they were torque down to 35Ncm twice to verify full torquing. Cotton pledgets and red
Fig. 16: Periapical radiograph illustrating final marginal fit of implant-retained crown restorations of the upper left quadrant.
wax were placed over the abutment access holes to ensure re-access to the screw after cementation, should the need arise (Fig. 12).
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In depth with - Amann Girrbach
s a pioneer in dental CAD/CAM technology, Amann Girrbach is one of the leading innovators and preferred fullservice providers in digital dental prosthetics. With its high degree of expertise in development and commitment to customer orientation, the company creates sophisticated system solutions for tomorrow’s practice routine. Two of Amann Girrbach sophisticated system solutions just got another update and once more set new standards.
Setting New Standards in Digital Dental Technology
Ceramill Sintron® sintering metal (CoCr) The Ceramill Sintron ® allows the in-house laboratory fabrication of CNC-based nonprecious metal restorations. Due to the wax-like texture of the Ceramill Sintron ® blanks, they can easily be dry milled on desktop machines. Since the market launch in 2012, more than three million units have been manufactured in over 2,000 laboratories worldwide. According to the data available from over Ƥve years of market surveillance, Ceramill Sintron® has proven itself to be an established and extremely safe material. Developed together with the Fraunhofer IFAM Dresden and validated by independent universities and accredited test laboratories, the material and the matched workƪow assure maximum safety for the user and the patient. The Ceramill Argotherm high-temperature furnace, which was speciƤcally designed for this material, has been meticulously matched to the material properties and ensures unprecedented quality, accuracy of fit, homogeneity and reproducibility. The continuous further development of the software and hardware components guarantees an efficient workflow and enables a virtually unlimited variety of indications. Recently, the removable Ceramill Argovent 2 sintering compartment was further optimised and now oơers space for approximately 40 units with its 25% increase in capacity. Even large-span bridges can now be sintered without any problems. Owing to improved thermal conductivity, the heat
required now penetrates faster to the sintering material and results in a shortened sintering process.
Ceramill Suite 3.8 updated software
With the most comprehensive software update in the company’s history, Amann Girrbach catapults digital workƪow in the dental laboratory to a new level. Version 3.8 of the Ceramill Suite comprehensively optimises numerous features and adds new, innovative functions. As a pioneer of fully integrated digital workƪows, Amann Girrbach also expands its application options in the Ƥeld of complex restorations. Even implant-supported, long-span bridges or full dentures can now be created in simple, reliable CAD/CAM workƪows. In concrete terms, the Ceramill Suite 3.8 offers the following improvements, among others: the Ceramill Full Denture System FDS has been supplemented with dental libraries from VITA and Merz. With the full workƪow integration of the Vita Vionic* and Baltic Denture System (BDS)*, laboratories now have the most comprehensive range for digital prostheses and can thus cover all requirements from maximum individuality to maximum eƥciency. New scanning features raise the performance of all existing type Map 400 and Map 200 scanners to a new level at no extra cost. Numerous improvements in the handling of the software suite ensure greater convenience and more eƥcient working. The laboratories also gain additional options by integrating all materials of the Zolid DNA generation including the groundbreaking Zolid HT+. This new generation of materials guarantees m a x i m u m aesthetics with the customary strength of 1100 MPa and is now also available in the form of prestained blanks in 16 Vita shades. Registered customers can download the update from March 2018 via the customer portal Ceramill Customer Center (C3). *D e p e n d i n g on regional availability DA
DENTAL ASIA ASIA DENTAL MARCH / APRIL 2018 2018 MARCH / APRIL
In depth with - 3Shape
e live in a connected world. The faster and simpler the connection to your customer, the better for your business. To make it easier for dental laboratories to connect, get found, and work with doctors, 3Shape created the 3Shape TRIOS Ready program. The 3Shape TRIOS Ready program cloud-connects dental practices and labs. For dentists using the 3Shape TRIOS intraoral scanner, it means that they can search on the 3Shape website to Ƥnd a local dental lab that works digitally and freely connect with them using the 3Shape Communicate app. 3Shape Communicate is 3Shape’s Ƥle sharing app that enables doctors to send with just a click, TRIOS intraoral scans, cases information and comments to labs and partners. In turn, labs can use the app to make annotations on images and designs, add comments and facilitate overall case communications. Once connected to a TRIOS Ready Lab, doctors can simply share their scans, discuss cases and much more. For labs participating in the free program, it means that they are digitally-ready and advertised on the 3Shape website. 3Shape recently had a chance to speak with a dental lab and doctor about the TRIOS Ready program and what being digital connected means for their business.
Mr. Willis Woon, Master Dental Technician and Owner, Dental World Laboratory & Supplies Pte Ltd, says, “Being a TRIOS Ready Lab has made it so easy for us to communicate in 3D with our dentists. We can identify areas very quickly on the images and highlight them for our doctors. The 3Shape Communicate app makes this very simple.” Dr. Darren Lee from the LQ Dental clinic in Singapore agrees, saying, “Being connected through the program and 3Shape Communicate, makes it much simpler for labs to ask for advice, or highlight areas of concern and vice versa. The clinician can detail what is required. So far, in all my cases that have required advanced detailing, there have not been any misunderstandings. I am able to draw, point out, circle, and even highlight areas that need to be brought to their attention. This has greatly enhanced the experience both for myself, my lab technician and the patient. The ease of use of 3Shape Communicate makes this possible.” Longtime 3Shape user, CDA, Mr. Lee Culp, owner of Sculpture Studios in the states, says that for him, the beneƤts of the digital workƪow are that “designing and working in the laboratory with a 3Shape TRIOS scan, is like actually working in the patient’s mouth.”
THRIVING IN A CONNECTED WORLD
DENTAL DEN TAL T TA A AS ASIA IA MA CH / APRI MAR A PRI RILL 2018 RI 2 MARCH APRIL
Moving forward digitally In a recent 3Shape marketing survey, 56% of dental practices polled planned to buy an intraoral scanner within the next three years. Dental laboratories must be ready to accept and work with digital Ƥles. The free 3Shape TRIOS Ready program helps make this possible. Dr. Lee shared, “We discovered on the 3Shape website that regionally, there are numerous TRIOS Ready labs. I believe that once other labs realise what an extensive and feature-rich software 3Shape Dental System is, (CAD/CAM design software) more labs will want to use their solutions and join the program.” Mr. Woon remarked, “Because we are a TRIOS Ready Lab and listed on the 3Shape website, we have had doctors contact us and try our lab. I would recommend that our fellow lab-friends consider joining the program, so we can all learn together.” Dr. Lee agrees, “Labs should deƤnitely get onboard. The program is a very detailed system. When coupled with good Millers and 3D Printers, 3Shape solutions can virtually be endless.”
Joining the 3Shape TRIOS Ready Program To be a TRIOS Ready Lab, labs must Ƥrst complete a TRIOS workƪow trial case. The TRIOS Ready program will help you setup your system and complete a TRIOS workƪow trial case. The program will assist you in creating your 3Shape Communicate account, prepare connectivity, and ensure your Dental System is completely up-to-date. The trial and your listing, as a TRIOS Ready lab, is all free. 3Shape is happy to congratulate the labs in Southeast Asia who joined 3Shape TRIOS Ready program: Lab Name
Dental World Laboratory & Supplies Pte Ltd
Q&M Dental Centre Orchard (Lab)
Creative Dental Studio (International) Pte Ltd
Advance Dental Lab Pte Ltd
Orient Dental Laboratories & Suppliers Pte Ltd
Patrick Dental Ceramic Arts
Orthodontic Master lab
PC Dental Lab
Sainamtip Dental Laboratory Co., Ltd.
Crown Dental Laboratory
To learn more about the 3Shape TRIOS Ready Program, please go to: https://www.3shape.com/en/customer-programs/3shape-ready-programs/trios-ready DA
DENTAL ASIA MARCH / APRIL 2018
In depth with - Roland
The Dental Mills that Meet the Increasing Demand for Lab-friendly Automation and Management Tools
G S H A P E Corporation, a wholly-owned subsidiary of Roland DG Corporation and a leading provider of dental milling solutions, has recently announced the launch of two new 5-axis dental mills: the DWX-52DCi automatic disc changer model, with new DWINDEX software for clarifying return-on-investment and productivity at a glance, and the DWX-52D with value-added upgrades to the industry-standard DWX-51D. Since their introduction in 2010, DWX series dental mills have gained widespread recognition and industry awards for their desktop size, user-friendliness, robust reliability and open architecture, which contributed to the digitalisation of dental restorations worldwide. With the DWX-52DCi and DWX-52D, it adds exciting new features and capabilities to further automate and expand the formerly labourintensive workƪow. The DWX-52DCi features an Automatic Disc Changer (ADC) capable of storing up to six discs of diơerent materials and enabling discs to be replaced automatically during milling to maximise lab productivity. In addition, the DWX-52DCi supports new DWINDEX management software for monitoring key productivity indexes including operation time, materials used and deliverables. According to Mr. Kohei Tanabe, president of DGSHAPE Corporation, the company developed DWINDEX to simplify information gathering and decision making for busy lab managers. “Now, you can see at a glance when to order materials, replace tools or determine your return-on-investment. These features will also become key elements when digital dentistry enters the era of IoT and AI,” explained Mr. Tanabe. The DWX-52D is now equipped with a new snap-on clamp system, which offers a faster and more secure set-up of various materials, making lab operation easier than ever. Both mills represent the latest dental technologies available, including an Automatic Tool Changer (ATC) for fully automated 5-axis milling of a wide range of materials, including Zirconia,
DENTAL ASIA MARCH / APRIL 2018
wax, PMMA, gypsum, PEEK, glass fiber-reinforced resin, composite resin and CoCr sinter metal. Typical applications include crowns, copings, bridges, inlays and onlays, veneers, abutments, implant bars, screw-retained crowns, dentures, models, surgical guides and bite splints. The ATC is capable of holding 15 tools for uninterrupted milling overnight with an additional slot dedicated to a cleaning tool for maintaining a clean milling operation. Continuing DGSHAPE’s reputation for high-quality precision milling, both mills include a rigid frame with ball screw axis control, automatic calibration of all five axes and an ioniser for reducing static electricity when milling PMMA. Air pressure is adjusted automatically, depending on the type of material being milled, for continuous, reliable production. Other advanced features include a Virtual Machine Panel (VPanel) which allows users to quickly conƤgure settings for up to four machines from a single computer for high-volume production. To help minimise downtime, the VPanel monitors operational status and sends email notiƤcations at the end of milling, maintenance completion or if errors should occur. “The DWX-52DCi and DWX-52D are the latest in a long line of DGSHAPE products designed to satisfy our customers’ demands for easy-touse, plug-and-play devices that can be operational and out of the box within minutes. The open architecture means they can be used with the CAD/CAM software that dental technicians are already familiar with to cut learning time and create the optimum workƪow for every production environment,” said Mr. Tanabe. DGSHAPE Corporation was developed from Roland DG Corporation in April 2017. “The mission of DGSHAPE is to harness the 3D digital fabrication technologies and expertise, that Roland DG has developed for more than three decades, together with its proprietary digital cell production system, global customer service and support in order to provide advanced digital solutions that shape the future,” ended Mr. Tanabe. DA 69
In depth with - Structo
tructo Velox is the Ƥrst desktop 3D printer that features a patented fully autonomous post processing system to streamline the appliance manufacturing process in dental practices. Unveiled recently at the Chicago Dental Society‘s 153rd Midwinter Meeting 2018, this revolutionary desktop 3D printer will forever change the landscape of dental 3D printing. The Velox will allow dental professionals to go from designed appliance to Ƥnal printed part at just the push of a button. Since the emergence of 3D printing in the dental industry, adoption in the chairside segment has been hampered by time-consuming pre- and post-processes. Traditionally, automation of these processes were only accessible to the largest of dental laboratories with heavy capital expenditure. While Structo does provide custom automated manufacturing solutions to labs that operate at large scales, the company saw a clear need to develop a solution that brings that level of automation into dental practices. “To take dental 3D printing to the next level, we believe the complexity of the technology must not get in the way of clinicians but instead help them focus on delivering better patient outcomes,” said Mr. Huub van Esbroeck, founder of Structo.
A revolutionary new 3D printer The Velox system comprises of three stages – Print, Wash and Cure – on a rotating carousel, Ƥtting all these functions into one single low-footprint desktop automated system. The Velox also features Structo’s new pre-processing service called AutoPrint, a cloud service that allows the user to simply upload an STL Ƥle, after which the nesting, supporting and slicing are taken care of automatically – and the printer can start automatically without requiring any further user intervention. “This revolutionary new 3D printer will allow dental professionals to seamlessly go from intra oral scan to Ƥnal printed part, making this a true industry game changer,” explained Mr. Dhruv Sahgal, head of Business Development at Structo. In terms of materials management, Velox employs a single-use cartridge-based system that allows easy material management and storage. With its wide range of materials available, Velox is capable of printing everything from models, surgical guides, denture bases
DENTAL ASIA MARCH / APRIL 2018
to temporary restorations, allowing it to be used for almost all dental applications — from orthodontics, prosthetics, restorations to fully guided implant cases. With Velox and Structo’s existing range of dental 3D printing solutions, it completes their portfolio — covering both dental laboratories and practices, which further solidify Structo‘s position as a true dental 3D printing solutions provider in the industry.
The perfect partnership The Structo Velox will be an integral part of the glidewell.ioTM In-Oƥce ecosystem by Glidewell Dental as it adds seamless direct printing capabilities for single and multi-unit restorations, drill guides, splints, models and orthodontic appliances. This partnership with Glidewell Dental and the development of a deep integration with their systems fully embodies Structo’s vision for Velox — taking the work out of the workƪow — making this a perfect partnership to bring dental-speciƤc solutions to market. Mr. Mike Selberis, Glidewell’s chief technology oƥcer said, “With the addition of the Structo Velox, the glidewell.ioTM Solution will be able to oơer a complete suite of in-oƥce applications covering intraoral scanning, desktop milling and now desktop 3D printing, giving clinicians an all-in-one solution for lab-grade appliance manufacturing in their own practice.” The Structo Velox 3D printer will make its debut in Asia at IDEM 2018 (Booth 6K-10, Level 6) at Suntec Singapore Convention & Exhibition Centre from 13th - 15th April 2018. DA
In depth with - 3D Systems
n 22 nd February at LMT Lab Day Chicago 2018: 3D Systems, whose technology enables production of the largest number of orthodontic aligners in the world, unveiled the NextDentTM 5100 and 18 new NextDent resins -- bringing the entire NextDent portfolio to 30 materials. These latest additions to the company’s renowned 3D digital dentistry portfolio, which includes solutions for dental laboratories and clinics of all sizes, enable improvements in patient care while once again revolutionising the dental workƪow. By incorporating the NextDent 5100 into their workflow, dental laboratories and clinics are able to address – for the Ƥrst time - more indications with one solution. With 3D Systems’ NextDent solution, dental laboratories and clinics are able to produce dental devices at dramatically increased speed - up to 4x faster than other available solutions - while reducing material waste and capital equipment expenditure as well as reliance upon milling centres. BeneƤts also extend to the patient by reducing the time it takes to produce prosthodontics and orthodontics, as well as the number of required oƥce visits. For example, by using the NextDent 5100 solution, dental labs can achieve a 70- 80% decrease in the amount of time needed to produce dentures. Additionally, patients are expected to need to visit the dentist only twice, versus the four to Ƥve visits currently needed.
Traditional dental device production – Labor intensive and susceptible to errors Production of prosthodontic and orthodontic devices via traditional manual methods is labour intensive, and vulnerable to potential human error. Referencing denture production as an example, there are roughly 14 hours of work in the lab required from casting of the Ƥrst impression of a patient’s mouth to delivery of the Ƥnal denture. Additionally, models need to be shipped back and forth between the lab and the dentist’s oƥce where the patient will make an average of Ƥve visits to be Ƥtted for the device. The process also results in signiƤcant material waste in the form of plaster and wax that is used in all iterations of the models working toward creation of the Ƥnal product.
DENTAL ASIA MARCH / APRIL 2018
Precise, high-speed 3D printer, compatible with 30 diơerent resins The NextDent 5100 is powered by 3D Systems’ proprietary Figure 4™ technology, which facilitates high-speed 3D printing of dental devices and fixtures. The printer is compatible with industry-standard state-of-the-art intra-oral scanning and software solutions, delivering more precise results than conventional manual production techniques. The trusted end-to-end digital workƪow also provides higher and more predictable uptime, with a signiƤcant reduction in risk for the operator. The NextDent 5100 is complemented by a portfolio of 30 unique NextDent resins – the largest number available from any dental material supplier. Oơered in a variety of aesthetic colours, these materials enable dental labs and clinics to provide Ƥnished products that closely match the patient’s own teeth and gums. All NextDent dental 3D printing materials are biocompatible and CE-certiƤed, making them suitable for a wide range of applications. The materials are certified in accordance with medical device directive 93/42/EEC, listed at the FDA and also registered in various other countries. “We’re bringing a complete digital dentistry solution to the market – combining an unmatched materials portfolio with leading 3D printing technology, software and services,” said Mr. Vyomesh Joshi, president and chief executive officer, 3D Systems. “We oơer the industry’s widest range of regulatoryapproved 3D printing materials and technologies that allow dental labs and clinics of every size to drive precision, productivity, and eƥciency at a reduced cost for a wide range of dental applications.” The NextDent 5100 solution is currently in beta testing with select customers and will be priced below $10,000 (US)/€10.000 (EU Countries). The company plans to take pre-orders in the second quarter and general availability is planned for Summer of 2018. Feedback from customers testing the NextDent 5100 highlight the product’s precision, ease of use, speed, eƥciency and cost eơectiveness. Rely on 3D Systems’ team of experts, materials scientists, application engineers and experienced resellers for training and support to empower innovation and deliver streamlined digital workƪows. DA
In depth with - Formlabs
or the Ƥrst time, Formlabs, the designer and manufacturer of powerful and accessible 3D printing systems, showcased the Form Cell, a fully automated 3D printing platform, to the dental world at the LMT Lab Day, as well as a range of dental workƪows during the Chicago Midwinter Meeting. Form Cell, the Ƥrst commercially available automated 3D printing system, will be shipped to initial customers in the Ƥrst half of 2018. New England Orthodontic Lab and Recigno Lab will be taking advantage of automation with Form Cell as a cost-eơective way to scale up production, reduce labour costs and enable 24/7 lights-out manufacturing. “Digital is my future. That is why I am constantly looking at what my business is going to need in the next Ƥve years and staying ahead of those trends. 3D printing with the Form 2 and automating this process with the Form Cell will play a huge role in helping my lab remain competitive,” said Mr. Christian Saurman from New England Orthodontic Lab. Form Cell is built on a strong foundation laid by Formlabs, whose Form 2 3D printers have already been adopted by thousands of dental users. By delivering a reliable and costeffective platform
DENTAL ASIA MARCH / APRIL 2018
for a traditionally expensive technology, Formlabs Form 2 printers have a 95 per cent print success rate, building conƤdence in the adoption of 3D printing for a wide range of dental applications, including thermoformed aligners, models, surgical guides, and splints. “Formlabs has done an amazing job with all of the automated systems under the hood, they’ve made reliable 3D printing something that I can now take for granted,” said Mr. David Recigno from Recigno Labs. “We’re already scaling up production with the Form 2, and are looking towards further streamlining production costs with the Form Cell. Recigno Labs has for over 60 years utilised advanced technology to advance the practices of dentists throughout the U.S.” “To date, Form 2 users have completed more than 100,000 surgeries with Dental SG, made more than 20,000 splints and printed more than 1 million 3D printed dental parts. The Form 2 is powerful for dental businesses of any size, and the Form Cell is a strong next step for labs to consider as they look to scale. Our customers have seen a huge improvement in printing with Form 2 for high-quality, reliable, cost-effective and diverse material option prints,” said Mr. Gideon Balloch from Dental Product Lead at Formlabs. DA
In depth with - exocad
• Advanced Articulation: Free selection of guidance surface in articulator movement • New HD Tooth Library: Natural and aesthetically pleasing tooth set • Model Creator: Implant models with gingival mask and individual insertion direction for dies • Improved Rendering: More realistic 3D rendering and greatly improved colour texturing of intraoral scans • Cut View: Additional optional display for interactive cut views All users who already have an update contract will be able to use the new release.
exocad GmbH is a dynamic and innovative software company committed to expanding the possibilities of digital dentistry and providing OEMs (Original Equipment Manufacturers) with flexible, reliable and easy-to-use CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) software for dental labs and dental practices. exocad GmbH recently announced three new software releases: ChairsideCAD, PartialCAD Framework Design and a new release of DentalCAD, called DentalCAD 2.2 Valletta.
New DentalCAD 2.2 Valletta With more than 30 new enhancements added to over 130 existing functions, the Valletta release stands as the largest expansion to the DentalCAD product in the company’s history. It also marks the introduction of exocad’s new naming scheme, where the company names each major software release after a major cultural city. For this year’s release, it is named after the 2018 European Capital of Culture, Valletta. “We are delighted to announce the new possibilities of Valletta for dental professionals. This release is a collaborative effort between exocad and customers. The product evolves as a result of invaluable feedback and feature requests from users, enabling us to drive innovation and continuously set the industry standard in digital dentistry excellence,” said Tillmann Steinbrecher, CEO of exocad. Major highlights of DentalCAD Valletta include: • dentalshare webview: True 3D preview links that can be viewed in a web browser and on mobile devices • New hotkeys: Faster interaction thanks to multiple usability and performance improvements • Free forming: Allows adding embossed text to any design • New Contact Point Tools: Smarter approximal adaptation, easy editing with Disc Cutter
ChairsideCAD ChairsideCAD is the Ƥrst complete open-architecture CAD/CAM software platform for single-visit dentistry. The chairside workƪow is streamlined, easy to learn, and optimised for usage in the practice, including a step-by-step guide through the design process. It’s based on the same proven technology as exocad’s ‘best-of-breed’ lab software, renowned for its reliability and robust features. “What makes ChairsideCAD unique is its seamless integration with open-architecture scanners, milling machines, and printers“, says Maik Gerth, CTO of exocad. It can be also used together with the integrated communication system dentalshare to easily collaborate with the lab of your choice.
PartialCAD for partial framework design This module boasts unparalleled ƪexibility and provides design freedom thanks to its special voxel-based technology. The PartialCAD software for partial frameworks can now be combined with other indications in the DentalCAD platform – telescopic crowns, attachments, advanced implant cases and many more – making anything possible. “The traditional process of creating partial frameworks is fully analog and both resource intensive and time consuming. PartialCAD enables for eƥcient production with 3D printers or milling machines thus saving time and increasing productivity,” Tillman Steinbrecher stated. DA
In depth with - Nacera
Nacera Hybrid Pearl Q3
Nacera Pearl Q³ Multi-Shade rede̬nes the accuracy of colour and ̬t of CAD/CAM restoration materials. The new high-yttrium-stabilised zirconium dioxide series, which Doceram Medical Ceramics is adding to its proven Nacera Pearl Multi-Shade system at IDS, not only o̫ers increased ultra-high translucency but also extremely natural light dynamics and colour reproduction that precisely matches the Vita colour system. The photo-optical properties of the new high-performance ceramic are achieved through a range of factors including a special chemical composition that results in a tetragonal-cubic phase. The optimised light refraction greatly increases dispersion and radiance, hence, helping ceramists to easily fabricate aesthetic masterpieces in zirconia.
uilt on more than 20 years of industrial ceramic expertise, Doceram Medical Ceramics in Dortmund conducts researches, engineers and produces innovative zirconium dioxide milling blanks — with increasing success and an expanding portfolio. Consequently, the globally established Nacera brand has introduced a semitranslucent, highly translucent, pre-coloured and multilayer variants along with the recently added easy-to-mill Nacera hybrid ceramics for chair-side and lab-side manufacturing.
Easy, exact and eƥcient: Colour accuracy redeƤned! The new Nacera Pearl Q³ Multi-Shade provides technicians with another premium material for aesthetic and CAD/CAM-based dental prostheses – with ultra-high translucence and precisely deƤned colour accuracy. The new cubic 6Y-PS2 high-performance ceramic from Nacera’s Multi-Shade family relies on a new proprietary colour blending and calibration method to precisely measure and adjust colour-dependent value and chroma. At the same time, the Ƥnely ƪowing colour gradations from the cervical to the incisal edge gives the dental prostheses – either fully anatomical or anatomically reduced – a natural colour character. These improvements make it easier for ceramists to predictably produce highly aesthetic zirconium dioxide restorations.
highly aesthetic and durable monolithic single tooth restorations as well as three-segment bridges. The new polychrome UHT zirconium blanks are available in 98mm with 16 or 20mm thicknesses. Additionally, all popular shades for posterior, anterior and bridges up to three units are also oơered: A-Light, A-Dark, B-Light, B-Dark and C. Relying on the best-in-class technology, dental technicians can now count on Nacera Pearl Q³ Multi-Shade for modern CAD/CAM restoration material whenever highly aesthetic restorations are desired. Its natural colour and translucency progression easily, reliably and eƥciently – makes it a perfect addition to the Nacera system family. For Asia/PaciƤc inquiries and special packages, kindly contact Carsten Siemers at email@example.com. DA Pearl Q3
Beautiful like LiDi Due to selective control of grain size and density, the light transmission and translucency have further increased and are now comparable to that of a lithium silicate ceramic. With a bending strength of 700 +/- 120 MPa, Nacera Pearl Q³ Multi-Shade can be used to produce Nacera Hybrid DENTAL ASIA MARCH / APRIL 2018
An Eye on the Object and a Focus on Quality
Devoted to their mission of “making work easy”, Renfert has developed the new EASY View 3D Dental Viewer as the ̬rst video microscope with a large 3D monitor to provide improved working perspective – visual, virtual and functional - in the market. The new EASY view 3D Dental Viewer allows you to achieve work precision, safe upright sitting position, and quick communication with customers and colleagues – directly or via virtual network. P r o v i d i n g a 2D/3D screen on a 21.5-inch display with 15x or 20x magniƤcation, the EASY 3D Dental Viewer is ideal for examining, checking and assessing the quality of dental objects. The device has the ability to create digital photographs and video sequences, making it suitable for presentations, clinic-lab communications,
trainings as well as documentations. Users are also provided with quality, precision and control while working in a relaxed posture through its design.
Total overview – total control In 3D mode, the new EASY view 3D Dental Viewer provides high resolution with an optimal depth focus. Technicians can now view the entire screen content or magnified excerpt directly on a full HD screen without moving their heads or bodies. The projected images allow for perfect hand-eye
coordination to work seamlessly. With just a click of the mouse, the operator can toggle through four diơerent object modes, hence, making changes fast and eƥcient. The dental viewer is also equipped with a daylight LED lamp (5,000 kelvin) and an integrated USB stick for various presentation options. Its footswitch can be used to take a screenshot of the image onscreen to be saved or sent directly via LAN connection for faster communication and documentation. In addition, the device’s ƪexible camera arm can be adapted to the working environment and object for testing. With the new EASY view 3D Dental Viewer, work is made easy, precise and safe. Live Demonstration at Renfert Booth in the Singapore Pavillon during IDEM 2018. Ŷ
Nobel Biocare Trefoil™ – A DeƤnitive Fixed Solution to Treat Patients Better The launch of the new Trefoil system has made the passive ̬t of a pre-manufactured bar possible for the very ̬rst time, using a revolutionary, self-adjusting ̬xation mechanism and just three implants. a pre-manufactured bar and wraparound acrylic technique for the prosthesis, saves substantial time.
Straightforward prosthetic workƪow The Trefoil system, combining a premanufactured titanium bar, three implants, a simpliƤed restorative workƪow, acrylic prosthesis and minimised restorative component, enables shorter time-toteeth and reduced chair time compared to conventional treatments that use provisional restorations. With no need for temporary prosthetics, the ability to place definitive teeth on the day of surgery using
Nobel Biocare’s development of the Ƥrst pre-manufactured bar with a passive Ƥt, enabled by a unique Ƥxation mechanism with self-adjusting joints. This mechanism provides passive Ƥt by compensating for horizontal, vertical and angular deviations from the ideal placement of the three implants. Accurate drilling with standardised drill guides enables precise parallel implant positioning and placement for passive Ƥt. Additionally, the TiUnite surface has is
able to maintain implant stability during the critical healing phase through fast bone formation and it promotes long-term success. The pre-manufactured framework, anatomically designed for the natural arch of the mandible, contains adaptive joints that adjust to compensate for horizontal, vertical and angular deviations from the ideal implant position and enable the passive Ƥt of the deƤnitive prosthesis. Ŷ
DENTAL ASIA MARCH / APRIL 2018
Shofu Shofu Breaking New Grounds with the New BeautiƤl II LS Shofu, a world renowned dental materials and equipment manufacturer, has added another product to their Beauti̬l Composite range: Beauti̬l II LS A Great Addition to the BeautiƤl Family The BeautiƤl II LS (Low Shrinkage) breaks new ground in direct resin technology with its extremely low polymerisation shrinkage and related stress. BeautiƤl II LS exhibits superior aesthetics, optimal mechanical properties, ease of handling and polishing while ensuring lasting natural lustre and remarkable abrasion resistance for universal application. In addition, the BeautiƤl has novel low shrinkage “SRS” monomer formulation and unique Ƥller technology that signiƤcantly
DENTAL ASIA MARCH / APRIL 2018
minimises polymerisation shrinkage stress while resulting in a more durable, robust
and stable polymer complex. This provides greater predictability of restorations. Toothlike optical characteristics enable an easy shade match for a wide spectrum of simple to complex, challenging cases. Additionally, the Beautifil II LS exhibits additional anti-plaque benefits and sustained fluoride protection to all your restorations. A rational selection of universal, opaceous dentin, bleach white and enamel shades allow you to explore a plethora of possibilities for predictable lifelike direct resin restorations. Ŷ
GC Asia Dental
GC: Striving to Support Vitality and Well-being in Oral Health
Established since 1921, GC Asia is one of the world’s largest and most successful manufacturer for dental products today. The company is steadfast in setting benchmarks in dentistry; focusing not only on the latest scienti̬c knowledge, but also on safety and quality. GC is constantly keeping their products’ portfolio up-to-date in order to continuously meet consumers’ demands. And to do so, the company is introducing their GC Initial™ Lisi Press, GC Lisi PressVest and GC Initial IQ Lustre Pastes NF at IDEM this year.
To ensure quick and easy processing in daily laboratory procedures, GC is oơering LiSi PressVest, a carbon-free phosphatebonded speed investment for pressable ceramics. Its high flowability and extended processing time permits more processing ƪexibility before Ƥring. It has been optimised for speed-heating and is suitable for a variety of pressing techniques. When used in combination with GC Initial™ LiSi Press, it removes the resulting reaction layer by sandblasting with glass beads — saving valuable time compared to the usual method.
GC Initial™ Lisi Press for appealing aesthetics and ease of processing GC Initial™ LiSi Press is a pressable lithium disilicate ceramic that combines the advantages of modern ceramics with the exceptional ease of handling. Its unique High Density Micronisation technology (HDM) allows stability even after several firing cycles with high flexural strength of 500 MPa. The Initial™ LiSi Press makes restoration highly antagonist-friendly and abrasion resistant. Its high colour stability and ƪuorescence also ensure the natural aesthetics of the pressable ceramic material.
GC Initial IQ Lustre Pastes NF brings aesthetics to work by just painting GC Initial IQ Lustre Pastes NF is a complete kit with 3-dimensional ceramic pastes developed to create colour depth and life-like translucency with a single paint on application. Its “new formula” can bring crowns and bridges to life with an optimal match to both low and high CTE (Coefficient of Thermal Expansion) ceramics. Available in ready to use consistency, the GC Lustre Pastes NF are based on fine ceramic particles and can be applied in a thicker layer for unsurpassed vitality and natural glaze restorations.
More innovative quality materials to satisfy customer needs In addition to the GC Initial line, the company is also introducing the TEMPSMART™ and GC Fuji® BULK to recognise the need for better oral health. TEMPSMART™ is an innovative, dualcured, bis-acrylic composite temporary crown and bridge material using microƤlled resin (MFR) and nano-Ƥller technologies. It maintains a smooth surface after polishing and its high-density polymer network is a strong material for any sized provisional, hence, making TEMPSMART™ an ideal for temporary crowns, bridges, inlays, onlays and veneers, as well as long-term restorations. The GC Fuji ® BULK is the most acidresistant conventional GIC (Glass Ionomer Cement) available in the market. GC Fuji® BULK is a robust, rapid-setting, multipurpose autocure GIC designed to meet the challenge of bulk placed restorations in more acidic oral environments. By providing a unique balance between restoring function and protecting tooth surfaces from acid challenges, it is the perfect choice for restorations where speed, acid resistance and bulk cure are priorities over aesthetics. Ŷ For more information, please visit http://sea.gcasiadental.com DENTAL ASIA MARCH / APRIL 2018
DENTAL ASIA MARCH / APRIL 2018
Coltene Whaledent With PRESIDENT the first A-silicone on the market the Swiss dental specialist COLTENE created a milestone in 1975 in the development of high precision dental impression materials. Through the Ƥrst use of polyvinyl siloxane (PVS) elastomers, the users of PRESIDENT achieved unsurpassed dimensional stability and precision which are still typical today for an A-silicone. This famous brand has been relaunched under the name PRESIDENT The Original and now oơers further optimised consistencies as well as fresh, highly contrasting colours.
A Small Step for Dentists, A Great Step for Dentistry Careful matching of the two new consistencies is also demonstrated by a perfect contrast between the intense violet of Xtra light body and the creamy orange of putty super soft.
Additional viscosities In addition to the familiar heavy body, putty and putty soft tray materials,
Enhanced readability of details The new, fresh colours of the upgraded PRESIDENT line give even greater contrast between the wash and tray materials. This allows better readability of the details.
the high precision A-silicone line oơers two additional viscosities: putty super soft and MonoBody. Putty super soft is extremely smooth and very easy to mix. This makes it the perfect tray material for double-mix impression techniques. By extending the range with PRESIDENT MonoBody, there is now an ideal alternative for implant impression taking. In addition to light body and regular body, the range of wash materials now includes the new Xtra light body. As the name implies, Xtra light body is a very thin-flowing material which captures even the smallest details and images them clearly. Ŷ
Ultradent Ultradent Products, Inc. Proudly Introduces Jiơy® Natural Universal System Ultradent Products, Inc., proudly introduces the Jiơy® Natural Universal Finishing System—a complement to Ultradent’s renowned Jiơy® Universal Finishing System. The polishers in the Jiơy® Natural Universal Finishing System are designed to eƥciently and easily reach all tooth surface areas to give a natural Ƥnish on all ceramic materials, including zirconia. They can also be used to temper super high-gloss Ƥnishes to create the look of natural enamel. The Jiffy ® Natural Universal System consists of malleable spiral-shaped wheels that are designed to easily conform to tooth anatomy.Their pliable, finger-like extensions easily reach where cups and points can’t, including occlusal anatomy.
The system is designed to be used in conjunction with the Jiffy® Universal Finishing System to give clinicians options and versatility to achieve the right aesthetic look for their patient. The efficient two-step process allows clinicians to easily get the most natural finish they desire on any ceramic material, including zirconia, lithium disilicate, and porcelain. To learn more about the Jiơy® Natural Universal System, please visit ultradent.com. Ŷ
DENTAL ASIA MARCH / APRIL 2018
CALL FOR ABSTRACT Deadline
30 April 2018 EARLY-BIRD REGISTRATION
HKIDEAS Hong Kong International Dental Expo And Symposium
24â€“26 A U G U S T
D eadlin e
31 May 2018
Hong Kong Convention and Exhibition Centre
NEW MILLENNIUM OF ORAALL HEALLTTH PRELIMINARY FACULTY Dr. David Craig (UK) Dr. Jerry Hu (USA) Dr. Terence Jee (Singapore) Dr. Alfred Lau (Hong Kong) Dr. Donald Li (Hong Kong) Dr. Edmond Pow (Hong Kong) Dr. Alan Reid (Australia) Dr. Mario Roccuzzo (Italy) Dr. Frankie So (Hong Kong) Dr. Chong-meng Tay (Singapore) Professor Wim Teughels (Belgium) Professor Maurizio Tonetti (Hong Kong) Dr. Victoria Yu (Singapore)
Submit your abstracts online to win awards! BEST POSTER
1 S T RUNNER-UP
2 ND RUNNER-UP
DENTAL ASIA MARCH / APRIL 2018
Ceramill Advanced Prosthetics Program
comprehensive online and oƫine training and courses to ensure the successful implementation of business boosting opportunities. Thanks to the implemented dental libraries from VITA and Merz and the full workƪow integration of Vita Vionic* and Baltic Denture System (BDS)* into the Ceramill Full Denture System FDS, laboratories now have the most comprehensive range for digital prostheses and can thus cover all requirements from maximum individuality to maximum eƥciency. *Depending on regional availability Ŷ
Since the beginning, Amann Girrbach has been a pioneer of the digital in-house movement and with the “Ceramill Advanced Prostethics Program” AG rockets digital dental workƪows to the next level. At present, the Ceramill Advanced Prosthetics Program is based on the three super-indications of fixed dentures, full dentures and partial dentures. They are fully integrated into the Amann Girrbach CAD/CAM-System as “D-Flow” and provide fully supported and comprehensive digital work¬ƪows from A (Scanning) to Z (Material). Besides that, AG supports laboratories and technicians with
Ceramill DNA Generation - Still Challenging the Status Quo Due to continuous development, AG has redeƤned the benchmark once more. Two new processing modes for Ceramill Motion 2 and Ceramill Mikro IC increase
processing speeds with consistently high precision. The new processing strategy, called “Carving Mode”, reduces the grinding times of diƥcult to process materials such as glass-ceramics and hybridceramics by up to 60%. The “Carving Mode“ cuts oơ excess material as a whole, thus avoiding grinding down the blank to the actual geometry. And with the latest implemented processing strategy “Thrilling Mode”, it is now also possible to “thrill” block
abutments including connectors made of standard CAD blocks. The newly developed “DNA Speed Scanning” strategy reduces scan times by up to 50% with constantly high precision. A full arch scan with unlimited usable results is possible in only 18 seconds. Furthermore, the scanner with Splitex integration, Ceramill Map400+, offers a number of valuable scanning options such as the digitisation of Triple Tray impressions and textures in colour, recording correct positioning of up to 12 stumps (M-Die). Ŷ
Zolid DNA Generation - Expansion of the Zirconium Oxide Portfolio The new integrated material, Zolid HT+ is a highly translucent zirconia, which combines high mechanical parameters with excellent aesthetics. With its high strength of over 1000 MPa, there are hardly any restrictions on indications. Thanks to its high translucency, even solid structures such as large, implant-supported structures with gingiva sections radiate the vitality of natural tooth structure. An optimised manufacturing process also positively influences the milling of the
DENTAL ASIA MARCH / APRIL 2018
blank and results in even finer marginal contouring with outstanding edge stability. The white Zolid HT+ portfolio is completed by pre-stained Preshade blanks in 16 VITA tooth shades. They provide labs with a high degree of shade stability, eƥciency and reproducibility. Early in 2018, the Zolid DNA portfolio will be rounded oơ with Zolid FX Multilayer blocks for crowns and bridges. Two block sizes will be available, one for single restorations and one for restorations for up to 3-pontic bridges. Ŷ
TeKne Dental (TKD)
TKD Presents its New Innovative Brushless lectric micromotor
TeKne Dental is highly recognised in the dental manufacturing industry for the production of dynamic instruments, especially high-level micro mechanics. Under its solid research & development, the company is proud to present the NUCLEUS®LED. NUCLEUS®LED is the new innovative brushless electric micromotor, speciƤcally developed for endodontic procedures. The NUCLEUS ® LED is designed for dental professionals who seek excellent performance. The micromotor features extremely high power, reliability and eƥciency as well as reduced noise. Its speed ranged between 100 to 40000 RPM and is LED illuminated with standard ISO coupling to allow connection to any handpiece with fibre-optics and internal spray. The electric micromotor does not require any maintenance and is equipped with a blue non-return O-ring for spray water. In addition, it can be sterilised in autoclave up to 134 °C / 2 bar. High flexibility and high precision movement are the key features of the
Colgate Colgate Introduces Its First App-Enabled Electronic Toothbrush with Artificial Intelligence exclusively on Apple.com and select Apple Stores Colgate, a global leader in oral care, is committed to improving the way people brush their teeth. The new Colgate® Smart Electronic Toothbrush E1 with Artificial Intelligence, Colgate ® is taking a leap forward by providing users with real-time feedback about their brushing so they can take better care of their oral health. Building on its rich history of understanding and anticipating the future of oral care and consumer needs, Colgate® and the new Colgate Smart Electronic Toothbrush use Apple ResearchKit - with the user’s permission - to crowdsource toothbrushing data to get even smarter about oral care for better and faster future innovation.
NUCLEUS ®LED. Precise torque control, auto-reverse and rocking/reciprocating functions are also special features available due to the new BMC60 electronic board. During reciprocation, the connected endodontic Ƥle is Ƥrst driven in a cutting direction and then reversed during release. As the angle in the cutting direction is greater than the angle in the reverse direction, one complete rotation is completed in several reciprocating movements and therefore, the instrument progresses towards the apex. Additionally, with the aid of the CONV24 converter and PPOT pneumatic potentiometer, the NUCLEUS®LED micromotor can be used on any pneumatic unit. Ŷ For more information, please visit www.teknedental.com.
Colgate Advances the Future of Oral Care The new Colgate ® Smart Electronic Toothbrush provides real-time feedback to improve brushing habits and help prevent problems before they start. Designed with the help of dentists, the brush features real-time sensors and artiƤcial intelligence algorithms to detect brushing eơectiveness in 16 zones of the mouth. The toothbrush uses Bluetooth ® connectivity and sonic vibrating technology and is powered by Kolibree – the smart device company that is a pioneer in embedding c o n n e c t e d toothbrushes with artiƤcial intelligence and 3D motion
sensors. The Colgate Connect app is integrated with Apple ResearchKit and features a 3D brushing coach to create an enjoyable oral care routine while encouraging better brushing habits. The Bluetooth® word mark and logos are registered trademarks owned by the Bluetooth SIG, Inc., and any use of such marks by Colgate is under license. Other trademarks and trade names are those of their respective owners. The new Colgate ® Smart Electronic Toothbrush E1 with ArtiƤcial Intelligence is already available in the U.S. and soon will be arriving in Asia. Ŷ
DENTAL ASIA MARCH / APRIL 2018
Dentatus Dentatus ProƤn Directional System - The Ultimate Finishing and Polishing System The Pro̬n /EVA System from Dentatus are products made in Sweden maintaining high quality control by using quality components and ISO Certi̬ed. Profin PDH
The ProƤn system is the professional’s choice for finishing, polishing and contouring dental surfaces both for natural and restored teeth. It has been in the market since 1990 and continuously expanding until today. Presently, the Dentatus ProƤn range of products includes a handpiece, manual instrument, Lamineer tips and IPR (Interproximal Reduction) tips. The updated version of ProƤn PDX, the motor-driven handpiece for Dentatus Lamineer tips, was introduced in 2012. The ProƤn PDX is a handpiece with a wide assortment of abrasive Lamineer/EVA® tips that allow re-shaping of enamel and
restorations made of porcelain, metal, composite and amalgam. The advantages of using the ProƤn PDX is that it provides tactile ergonomics, more accessibility to diƥcult-to-reach areas (with its miniature head) and a smooth glarefree polished surface. Profin PDH is also based on the established ProƤn/ EVA system and only added to the range in 2015. ProƤn PDH is a high quality manual instrument that can be used with a variety of interchangeable diamond tips for safe and precise Ƥnishing details. The Profin PDH is ideal for interproximal and marginal adjustments as well as overhang reductions. Dentatus recently added a new range of Lamineer tips for Profin/EVA system,
the Profin IPR™ - for interproximal reduction. Profin IPR diminishes the risk of excessive stripping thereby ensuring a more conservative enamel reduction for orthodontics. ProƤn IPR and Lamineer Tips are safe to use, easy to control and performs eƥciently by giving aesthetically natural result. Ŷ Profin IPR
OccluSense® an Innovative System for Digital Occlusion Test
Established since 1953 as one of the world’s leading manufacturers in dentistry, Bausch has continued to o̫er an extensive range of di̫erent articulating papers and test-̬lms in di̫erent shapes, sizes and colours. A new system, developed by Bausch, combines the traditional and digital registration of the pressure distribution of occlusal surfaces. The new device is used in combination with a 60 microns thin single-use pressure sensor coated in red colour. This disposable pressure sensor is applied exactly like a conventional occlusion test foil. In addition, the patient’s masticatory pressure distribution is recorded digitally in 256 pressure levels. The data of the occlusal masticatory distribution are displayed with the OccluSense® iPad App. The traditional colour
DENTAL ASIA MARCH / APRIL 2018
transfer on the occlusal surfaces facilitates the assignment of th e re co rde d data. The data gathered can be displayed as 2D and 3D graphics, including the masticatory distribution, with up to 150 images per second and can be stored in the patient management system of the iPad app and reviewed or exported any time. Ŷ
Three New Ways to Move Forward with 3Shape!
The 3Shape TRIOS intraoral scanner gets a brand-new hardware setup along with updated patient-engagement apps and new 3Shape online community for dental professionals. 3Shape has launched a new hardware setup for its award-winning 3Shape TRIOS intraoral scanner: The 3Shape TRIOS MOVE.
3Shape TRIOS® MOVE The brand-new hardware setup places the 3Shape TRIOS scanner, monitor and PC on the lightweight, fully-adjustable and ergonomic 3Shape TRIOS MOVE.
3Shape TRIOS MOVE is perfectlybalanced and can be rolled effortlessly from operatory to operatory. Its mobility also enables doctors to always position the screen in the right place. Doctors who already own a 3Shape TRIOS 3 intraoral scanner can purchase the 3Shape TRIOS MOVE setup separately, which includes the PC and monitor, and plug their own TRIOS scanner into the unit. The portfolio of 3Shape TRIOS intraoral scanner hardware-setups will now include: the 3Shape TRIOS Pod, TRIOS Cart and TRIOS MOVE.
Excite patients with 3Shape TRIOS apps Professionals can take advantage of a fast-growing portfolio of 3Shape apps - Patient monitoring, Smile Design, Treatment Simulator and My3Shape — to get their patients excited and engaged while providing insight into their dental health and proposed treatment plans.
3Shape Online Community 3Shape launched a brand-new professional online community for 3Shape TRIOS dentists and labs. The 3Shape Community works as a platform for professionals to expand their knowledge and network around the globe. In addition, community membership is free as part of 3Shape owners’ CliniCare and LabCare packages. The 3Shape Community offers four focused forums geared specifically to 3Shape solution owners: Discussions – about CAD/CAM dentistry; Training – featuring training materials and case studies; Showcasing – for sharing work and feedback, and Inspiration – aimed at industry trends and opinion leader pieces. 3Shape solution-owners are encouraged to join the community at www.community.3shape.com. Please contact your local 3Shape distribution partner to ask about TRIOS MOVE availability in your country. Ŷ
Newly Improved Implant Motors from Mariotti
Founded in 1973, Mariotti&C is an Italian company specialising in manufacturing reliable and high quality micromotors in the dental industry. Through its continual research and development, Mariotti has now introduced its new line: “MiniUko” motors for implantology. The MiniUniko line combines the ease of use and practicality with second-to-none torque value performance. It is endowed with full safety and operating precision that is compatible with various implant system, handpieces and contra-angles (with or without optic Ƥbre). The device set also includes a control-unit that is user-friendly with immediate and intuitive use by touch keyboard and wide display.
Improved versions to select from From the new MiniUniko line, the three improved versions are the MUN.CL (LED Light), MUN.C (Classic) and MUN.F (Easy).
With the MUN.CL (LED Light), the latest generation brushless motor with high luminosity LED light and multifunctional pedal are added. The classic version (MUN.C) sees the latest generation brushless motor with multifunctional pedal while the MUN.F (Easy) consists of the latest generation brushless motor and a simple switch pedal on/oơ. The use of the newest generation brushless motor ensures the accurate adjustment of speed and torque of up to 40,000 rpm and 80 Ncm, respectively.
Additionally, the new practical peristaltic pump provides fast and efficient tube replacement. An extended life service is also given for parts that are autoclaved or sterilised, particularly the motor, cable and connector. And with the optic contra-angle, it works as the ideal accessory for LED motors (C20L or the classic contra-angle C20), which allows for reduction 20:1 with irrigation (external and internal) to provide solid reliability and high torque capability. Ŷ
DENTAL ASIA MARCH / APRIL 2018
Best Hands-Free Suction Solution in Dentistry
Ivory ReLeaf from Kulzer is an innovative, handsfree HVE (High Volume Evacuation) suction device that can conveniently connect to existing dental vacuum systems. ReLeaf ensures that practitioners are always able to provide comfort and e̮ciency to their dental appointment. With 280 degrees of suction, they never have to worry about suction location again. Hands-free comfort and control ReLeaf assists with evacuation, retraction and maintaining a dry field during various dental and hygiene procedures. Be it patient or dental professional, the goal during a dental procedure is either to receive or provide comfort. ReLeaf is made with a custom blend FDA approved polymer that is BPA free and enables ReLeaf to be soft. With this engineering upgrade, it sets the foundation for several other comfortable attributes ReLeaf provides to the patient.
Ergonomic eƥciency for a wide range of procedures When a practitioner is provided with a variety of proper tools, it empowers them to work eơectively and eƥciently. The tolerance of dental treatment varies from patient to patient and the diơerences in tolerance can result in procedures taking longer than expected. ReLeaf empowers staff by allowing them to have another option at their reach to assist during a tricky situation, in turn preventing the schedule from getting behind.
Time saving and productivity During a procedure, there are many things that need to be simultaneously maintained in order to provide a positive dental experience. By implementing ReLeaf, it allows practitioners to turn their attention onto other important aspects of the treatment. It also saves time of up to 15 minutes for each patient, which translates into hundreds of dollars in production throughout the day. Hence, ReLeaf is the cost-effective solution in the market. Ŷ
DENTAL ASIA MARCH / APRIL 2018
6th Biennial Meeting of ADSS
15th Biennial Meeting of AAAD
Pre-Congress Day: 27 September 2018 Main Congress: 28-29 September 2018 Post-Congress Day: 30 September 2018 Level 3, Marina Bay Sands, Singapore
LEARNING | COLLABORATION | INSPIRATION
ONLINE REGISTRATION OPENS IN MAY 2018! 2018 SPEAKERS
Cheung Lai Chu
Ho Feng Chuan
Joan Lim Zhi Yin
MIDS 2018: Technological Advancement Towards Excellence in Dentistry The Malaysia International Dental Show (MIDS) is the country’s ﬁrst dental exhibition and conference that is jointly organised by MDDA - Malaysian Dental Dealers Association for the Trade Exhibition and MAHSA University for the Scientiﬁc Conference.
eaturing over 15 renowned international and local speakers from the dental industry, the MIDS is a show not to be missed. With the theme “Technological Advancement Towards Excellence in Dentistry” at the MIDS 2018, the show is expected to draw over 1,500 delegates from both the private and government sectors including local and international exhibitors and industry leaders. Participants at the show will have the privilege to: • Learn from top-notch speakers and improve their knowledge about modern dentistry; • Network with dentists, practice
DENTAL ASIA MARCH / APRIL 2018
managers, hygienists, dental nurses, technicians and laboratory owners; • Witness the latest display of dental technologies and most innovative dental products in the market today; • Enjoy special offers & promotions by traders during the exhibition. The first MIDS show was founded in 2016 with over 80 exhibitors and saw about 1,000 delegates and visitors. And in 2017, it attracted back many participants and saw a line-up of distinguished local and international speakers in its plenary sessions, conferences, workshops and symposiums. After two successful years, MIDS is gaining more recognition and traction
in the ASEAN region and is a step closer to realising the vision of becoming ‘The Upcoming Dental Exhibition & Conference in the ASEAN Economic Community’. This year, MIDS 2018 will be even more exciting as it incorporates the Dental Technologist Symposium again to cater for dental technologists. Registration fee is inclusive of meals and early birds will receive complimentary vouchers that are redeemable for workshops and purchases at the exhibition hall. MIDS 2018 will take place from 4th - 6th May in Selangor, Malaysia. For registration and more details on MIDS 2018, please visit www.mids.com.my or email firstname.lastname@example.org. DA
Show Preview Dental Innovation Takes Centre Stage at the Singapore Pavilion at IDEM 2018 IDEM Singapore, a specialised dental trade fair accompanied by a professional congress, has developed into one of the leading dental events in the Asia-Pacific region. At IDEM 2018, participants will meet key decision-makers, strengthen valuable contacts with customers and partners, and explore the potential of an exciting growth market.
he 10th edition of the International Dental Exhibition and Meeting (IDEM) will take place from 13th-15th of April 2018 at Suntec Singapore Convention and Exhibition Centre. With the theme, “Striving for Clinical Excellence in Dentistry in Singapore”, it focuses on key trends such as Teeth and Implants for Life; Oral health in the Growing Elderly Population in Asia; Digital Workflows within the Team; and The Caries Prevention Plan. Co-organised by Koelnmesse and the Singapore Dental Association, the Asia Pacific’s cornerstone event in dentistry is expected to attract approximately 9,000 attendees from over 83 countries. In addition, the exhibition floor will see 13 national pavilions and 500 exhibitors from across 38 countries. “Singapore companies make ideal business partners because they’re renowned for their dedication to quality and innovation. We work closely with our partners at IDEM to identify the latest products and trends which will enhance the knowledge of dental practitioners to drive the industry forward,” shared Mr. Mathias Kuepper, managing director of Koelnmesse Pte Ltd. According to a report by Business Monitor International, the Singapore market for dental products is expected to grow to US$38.7 million by 2020. The growing demand is reflected in this edition of IDEM which hosts the largest Singapore Pavilion to-date; featuring a total of 44 exhibitors occupying 666 sq m of the exhibition floor.
SHOW ShowPREVIEW Preview
Participants to the full IDEM exhibition can look forward to high quality and innovative new products such as intra-oral scanners, anti-bacterial gels, bone surgery tools and will be able to see live demonstrations and hands-on testing of solutions at exhibitor booths. The Singapore Pavilion, a mainstay of IDEM since 2006 and supported by Enterprise Singapore, is located in the exhibition halls on level six of the Suntec Singapore Convention and Exhibition Centre. DA 2018 Exhibiting Companies ADM Asia-Pacific Pte Ltd
Calgin Enterprises Pte Ltd
Carl Zeiss Pte Ltd
Chee Sang Dental Supply Pte Ltd
Chemtron Pte Ltd
Comax Technology Pte Ltd
Core3dCentres (S) Pte Ltd
Dentalthon Medtech Pte Ltd
Eastland Dental Supplies Pte Ltd
Eye-2-Eye Communications Pte Ltd
FDC Academy Pte Ltd
Fondaco Pte Ltd
HealthBiz Resource Pte Ltd
Jacks BS Singapore Pte Ltd
Junnimed Services Pte Ltd
Mandarin Opto-Medic Co Pte Ltd
Maxillofacial Solutions & Services Pte Ltd
Medical & Dental Supplies Pte. Ltd.
Medisys Innovation Pte Ltd
Modern Dental Laboratory (Singapore) Pte Ltd
N.K. Luck (S) Pte Ltd
email@example.com / firstname.lastname@example.org
Neuva Era Pte Ltd
Nu-Hup Teck Pte Ltd
Pearlie White Pte Ltd
Pharmaforte Singapore Pte Ltd
QST Dental Pte Ltd
QST Technologies Pte Ltd
QuantumLeap Healthcare Pte Ltd
Raydent Supplies (S) Pte Ltd
Singapore Dental CADCAM Laboratory Pte Ltd
Singapore Smart Tech Pte Ltd
Smilesmith Dental Services Pte. Ltd.
Standard Dental Co. Pte. Ltd.
Sunny Dental Medical Supply Pte Ltd
For more information on IDEM Singapore, visit http://www.idem-singapore.com DENTAL ASIA MARCH / APRIL 2018
ino-Dental 2018 will be held at China National Convention Centre, Beijing, China on 9 th -12 th June this year with a total exhibition area of 50,000 square meters and 2,000 booths from 800 exhibitors from 26 countries and regions. Over 100,000 visitors from 90 countries around the world are expected to attend the one and only dental exhibition in China oƥcially recommended by the Department of Commerce of P.R. China. Sino-Dental will be having the most ideal business platform with developing business cooperation, exploring the potential market and partner hunting. The latest dental technology and scientiƤc advances will be on display alongside all the excellent Chinese products having competitive price and service at the Innovation exhibition zone. Top-level academic seminars and workshops will also be held for the attendees. Sino-Dental is a one-stop solution for product purchasing and continued learning.
Benchmark in dental exhibition Sino-Dental ® is a benchmarking dental exhibition in China, which has always been regarded as the most influential dental exhibition in Asian-PaciƤc region. Till 2017, it has been successfully held for 22 years. Over the past two decades, Sino-Dental has strived to introduce and promote advanced technologies and products; to provide a platform for national and international dental companies to demonstrate images, be informed of market information, learn the advanced technologies and develop new products; to provide opportunities for the exhibitors and professionals to communicate and exchange experiences.
First choice in product launches ®
Sino-Dental has always been the most ideal business platform for business cooperation and potential market exploring. Many of the exhibitors all over the world now regard Sino-Dental® as their Ƥrst choice in China for new products launching. In 2018, the total exhibition area will be 50,000 square meters and over 2,000 booths in all. More than 800 exhibitors from nearly 30 countries and regions (such as China, Germany, Japan, Korea, USA, Singapore, Brazil, Italy, France, UK, Switzerland, Sweden, Hong Kong, Taiwan and etc.) will be presenting their products and service. Companies from Germany, Japan, Korea, USA, Israel and Switzerland will be attending as National Pavilions. The state-of-the-art technologies and products, as well as excellent Chinese products with competitive price and service, will all be showcased on this platform.
Exhibitors Statistics In 2017, 800 exhibitors from 26 countries and regions participated in Sino-Dental® and we are expecting that this year more will join.
Congress & Seminar Besides the splendid showcase of products and technology presented by the exhibitors, over 200 top-level academic seminars and workshops will also be held during the exhibition period to introduce the most updated academic and technology development in dental Ƥled.
Visitors As one of the most popular dental exhibitions in Asian-PaciƤc, Sino-Dental is looking forward to more than 100,000 visitors from 90 countries and regions in 2018. Statistics show that majority of attendees and participants are dentists and dealers from around the Asia-PaciƤc and the world whose main purposes are to get to know new products/ technology and also to purchase products.
DENTAL ASIA MARCH / APRIL 2018
invite more international dealers and traders to Sino-Dental® by providing free local accommodations during 8th-12th June for the one who could invite a group of 20.
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Online pre-registration are now ongoing with no registration fee. There will be an on-site quick pass counter for badge claim, free catalogue, drinking water and a gift. Sino-Dental is providing Visa assistance for participants coming overseas by providing an invitation letter service. For hotel accommodations, hotels are located near exhibition site and visitors can get Sino-Dental® special hotel discount. Aside from the great exhibition, we are sure you will enjoy the city a lot, too. Guided tour on discounts by partner travel agencies with multiple choices of routes to explore the ancient & modern city of Beijing. Beijing, the capital of China, is no doubt one of the most popular tourist destinations
in the world. As a historic city with glorious culture, and a perfect blend of ancient and modern, with a wide variety of famous tourist spots, Beijing’s attractions are second to none in China. The organising committee provides various services to our exhibitors and visitors. For all the information and services, please visit our website www.sinodent.com.cn/en or contact us: email@example.com. We are looking forward to seeing you in Beijing this June at Sino-Dental®! DA
International Dealers Sino-Dental ® has become a one-stop solution for dealers on product purchasing. International Dealer’s Lounge with free interpretation service will provide you with a private space for business conversation. We encourage visitors to
DENTAL ASIA MARCH / APRIL 2018
AFG (Anatomic Functional Geometry) Modelling
Aesthetics and Techniques of New Material
by Alberto Battistelli Dario Severino Oto La Manna 314 pages • 865 photos
by MDT Paolo Smaniotto Dr. Alexander Beikircher
Available in 12 languages: Italian, English, German, Portuguese, Spanish, French, Russian, Bulgarian, Arabic, Czech, Greek, Korean Though written as an operational handbook for those who are just starting out or want to begin again without the typical “scientific” books, this text has sunk its roots into the hard sciences (mathematics and geometry)
and the most ancient of artistic techniques, entrusting a system of innovative images not just with the technique but also the magic and excitement of expressiveness. This book is crucial for every dental technician and dentist. Users of this technique and geometric parameters will find plenty of improvements in their daily reconstructive practice. The AFG supplements all the known gnathological techniques.
The Terminal Dentition by Dr. Leonello Biscaro 404 pages • 1,862 photos
216 pages • 1,000 photos
Available in 3 languages: Italian, English, German The authors show the way to a beautiful, aesthetic smile through a detailed description of their working methods. Their excellent works presented show how to solve every clinical case in a very aesthetic way, choosing the most
suitable techniques. Why are these two dental professionals able to obtain such exemplary results? On one hand, it is due to their 30 years of experience, while on the other, it is because they are able to find a balance between theoretical concepts and practical applications that can lead to success.
Aesthetic & Function: Methodologies for Dental Clinics and Laboratories by Claudio Nannini
336 pages • 827 photos
¼ Available in 3 languages: English, Italian and Spanish The real reason for the choice of the topic is make it understood how dentistry, which seems to be ever increasingly oriented towards cosmetics, remains a deeply medical discipline, making “ill” patients (a paradoxical tautology imposed by this historic time in which we often see “healthy” patients) the main players who can reacquire good health and joie de vivre thanks
to our treatment. This book was written is merely quantitative but with significant professional repercussions. In contrast to patients with purely cosmetic needs, those with terminal or very much compromised dentition are much more numerous when one considers the rate at which the western world is ageing or if the horizons are widened to the millions of people in the world who are coming out of poverty and want to look after their oral health.
Available in 6 languages: Italian, English, German, Russian, Spanish, Portuguese
Fundamental principles of prosthetic reconstructions Chapter 5: Diagnostic aesthetic and functional wax-ups Chapter 1: The principles of with preview in the oral cavity Chapter 6: Temporary restorations: occlusion Immediate provisionals, Chapter 2: Face bows • Articulators on prepared teeth, on implants, • Accesories orthotics C h a p t e r 3 : R e c o r d i n g t h e C h a p t e r 7 : Te c h n i q u e s f o r relationships between the arches transferring temporary Methods for avoiding bite-raising restorations into the oral cavity Chapter 4: Aesthetic analysis Chapter 8: Clinical cases
DENTAL ASIA MARCH / APRIL 2018
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Veneers: Mini-Invasive Reconstructions
Zirconia: The Power of Light by Aldo Zilio
by MDT Attilio Sommella Dr. Guerino Paolantoni
272 pages â€˘ 1,200 photos
240 pages â€˘ 1,336 photos
achieving success in working with Zirconia. Thanks to his vast experience with zirconia, the This highly-requested international author describes his step-by-step speaker and author offers the approach to creating zirconia reader multiple solutions for solutions for several types of cases. Available in 4 languages: Italian, English, German, Spanish
Available in 5 languages: English, Italian, German, Spanish, Portuguese. Thanks to beautifully depicted techno-clinical cases, this book introduces restorations of a single tooth or more extensive rehabilitation cases. These show the placement of one or more veneers with a high level of predictability that give the ambitious dental technician the
ability to provide the aesthetic and functional needs that patients request. To achieve success when working with veneers, the technoclinical team requires an extremely accurate execution that can be obtained through a standardised system described in the book. By carefully following the procedural algorithm outlined, the dental team will be able to perform minimally invasive restorations easily and free from risk.
by Oliver Brix
Techno-Clinical Aspects of Fixed Removable Prosthesis
292 pages â€˘ 1,233 photos
by Various authors
616 pages â€˘ 1,550 photos
Âź Available in 8 languages: Italian, English, German, Portuguese, Spanish, Russian, Greek, Korean The author describes in detail how to use lithium disilicate by presenting clinical cases that he has worked on in cooperation with other world-renowned clinicians. Chapter 1: Introduction Chapter 2: The correct procedures for aesthetics restorations â€“ treatment goals Chapter 3: e.max: The material from A to Z
Chapter 4: The layering technique with e.max Ceram Chapter 5: Colour examples, enamel blends and chroma control Chapter 6: Preparation instructions Chapter 7: Veneers Chapter 8: Crown restorations with the e.max system from A to Z Chapter 9: Crowns and veneers Chapter 10: Zirconium and bridges made of zirconium Chapter 11: Implants Chapter 12: Cross-mounting Chapter 13: Minimally invasive and no-prep method Chapter 14: Dental miracles Chapter 15: Instruments
Available in 3 languages: English, Italian, Spanish Today, the combined prosthesis offers the edentulous/partially edentulous patient comfort that was unthinkable a few decades ago. But combined prosthesis only represent an excellent solution if carried out by dental experts and dental technicians with cultural backgrounds and relevant experience in every branch of the sector â€“ clinical, anatomical, occlusion, gnathology, material
science, physics and chemistry. In this book, 27 experts in combined prosthesis present clinical cases resolved using currently available materials and techniques. Due to the complexity of prosthetic manufacturing, strict cooperation between the dental practice and dental laboratory is necessary. Thanks to a team of experienced dentists and dental technicians, this book presents various polyhydric techniques and solutions rarely presented in one single book.
**Prices are before tax and shipping cost. DENTAL ASIA MARCH / APRIL 2018
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