Dental Tribune ASEAN Oct - Dec 2021

Vol. 1. No. 1, Oct-Dec 2021

Poor oral hygiene could affect accuracy of SARS-CoV-2 test

Artificial intelligence may help predict implant treatment outcomes

COVID-19 and the dental market: the pandemic continues to bite

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4Dental Tribune ASEAN

EDITOR’S MESSAGE

W

Publisher

FBI Publications (M) Sdn. Bhd.

e are proud to present to you the inaugural Dental Tribune ASEAN Edition!

Marketing Communication Nur Izyan binti Dzulkifli izyandzul@fireworksbi.com

The world’s dental newspaper is now in Malaysia, sharing with you the latest news on dentistry which covers various topics from region to world news, event updates, innovations, research, and clinical section.

Publication Manager

Dental Tribune International (DTI), based in Leipzig, Germany, has been in the dental publishing business since 2003 and has grown substantially over the last ten years. Today, the DTI publishing group is composed of the world’s leading dental trade publishers and this partnership with FBI Publications (M) Sdn Bhd is expected to flourish!

Creative Designer

Our international team of journalists and writers will bring you the latest news in the industry to deliver you worthwhile and compelling articles and interviews to ensure you are always up to date.

Vanny Lim

vanny@fireworksbi.com

Assistant Editor

Atthira Zawana atthirah@fireworksbi.com

Susan Tricia Editor DT ASEAN will also be circulated in dental exhibitions, seminars and even webinars in Malaysia providing additional mileage for advertisers of the magazine and reaching out to new subscribers.

So go ahead and indulge in this edition and keep the feedback coming in to ensure our writers are providing you with a quality read always!

Making its debut in Malaysia, our news will provide you exclusive insights and content into the dentistry world.

Malaysia Publishing Partner FBI Publications (M) Sdn Bhd 9-3, Jalan PJU 5/6, Dataran Sunway, 47810, Petaling Jaya, Selangor Tel: +603-6151 9178 Email: my@fireworksbi.com International Headquarters Publisher and Chief Executive Officer Torsten R. Oemus Chief Content Officer Claudia Duschek Dental Tribune International GmbHHolbeinstr. 29, 04229 Leipzig, Germany Tel.: +49 341 4847 4302 | Fax: +49 341 4847 4173 General requests info@dental-tribune.com Sales requests ASEAN region: vanny@fireworksbi.com asean.dental-tribune.com Europe region: mediasales@dental-tribune.com www.dental-tribune.com

Dental Tribune ASEAN | Oct-Dec 2021

Muhammad Fadzil design@fireworksbi.com

Board of Directors Kenny Yong Susan Tricia

Official Magazine of

Disclaimer Material from Dental Tribune International GmbH that has been reprinted or translated and reprinted in this issue is copyrighted by Dental Tribune International GmbH. Such material must be published with the permission of Dental Tribune International GmbH. Dental Tribune is a trademark of Dental Tribune International GmbH.All rights reserved. © 2021 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written permission of Dental Tribune International GmbH is expressly prohibited. Dental Tribune International GmbH makes every effort to report clinical information and manufacturers’ product news accurately but cannot assume responsibility for the validity of product claims or for typographical errors. The publisher also does not assume responsibility for product names, claims or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune International GmbH. Dental Tribune International GmbH, FBI Publications (M) Sdn Bhd nor its affiliated entities make any promises, implied or otherwise, about the fitness of any technique, piece of equipment, or material for a particular purpose.

Dental Tribune International GmbH, FBI Publications (M) Sdn Bhd, or its affiliated entities will not be liable for any damages of any kind or loss of profits that might arise from information found in this magazine regardless of whether Dental Tribune International GmbH has been advised of the possibility of such damages.

The material contained in this magazine is offered as information only and should not be used to replace any practice, financial, accounting, legal, or other professional advice that users might obtain from their own professional advisors.

Information in this magazine should not be substituted for the individual judgment brought to each clinical situation by a patient’s dental practitioner. The techniques and opinions presented on this site reflect the science of dentistry at a particular point in time, and users should be aware that continued research on these topics may provide new knowledge or recommendations.

Dental Tribune International GmbH and FBI Publications (M) Sdn Bhd does not necessarily endorse the non-Dental Tribune International resources that may appear or be referenced in this magazine and offer no guarantee about the products or services they may provide.

Some sections in this magazine are published by separate organizations or entities, which are solely responsible for their content. Statements appearing in those portions are not necessarily endorsed by Dental Tribune International GmbH, FBI Publications (M) Sdn Bhd, or any of its subsidiaries. Also, Dental Tribune International GmbH and FBI Publications (M) Sdn Bhd does not offer any guarantee with respect to the accuracy of any items or claims contained therein.

Dental Tribune International GmbH and FBI Publications (M) Sdn Bhd does not, via this magazine or any of its affiliated media, encourage dentists to make any particular business decision based on issues addressed herein. Business decisions and decisions about individual patients and methods of practice are personal decisions, and the responsibility for these decisions rests upon the shoulders of the attending dental practitioner.

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6Dental Tribune ASEAN

CONTENTS Clinical news

08

The use of new technologies and digital implant solutions in a one-stage surgical procedure

18

16 World news

20

Tobacco smoking associated with periodontal pocket development

Innovations

12

Artificial intelligence may help predict implant treatment outcome

14

DentalCAD 3.0 Galway: exocad announces roll-out

16

I built Pearlii to improve access to dental care and oral health education

21 Transmission of SARS-CoV-2 in dental offices very unlikely, study says

22

Back pain—a clinician’s nightmare

25

The importance of pain management for young dental patients

26

Dental biofilm of symptomatic COVID-19 patients harbours SARS-CoV-2

28

Europe’s clear aligner market heats up as Impress opens new production facility

In the hot seat

27

30

How can dentists and pharmacists collaborate and improve patients’ health?

Business

32 Regional news

COVID-19 and the dental market: the pandemic continues to bite

18

Dental researcher is developing more aesthetic crowns for children

19

Poor oral hygiene could affect accuracy of SARSCoV-2 tests

Dental Tribune ASEAN | Oct-Dec 2021

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8 CLINICAL NEWS

The use of new technologies and digital implant solutions in a one-stage surgical procedure

By Dr Michał Nawrocki, Poland The aim of this article is to present a case of single-tooth prosthetic restoration in the aesthetic zone step by step.

The patient was referred to our clinic with a fractured root of tooth #11 (Fig. 1). The cone beam computed tomography (CBCT) analysis confirmed the fracture and revealed external resorption of the root from the vestibular side (Fig. 2). The tooth had to be extracted, and it was decided to follow immediate implant placement with a temporary aesthetic implant restoration. The immediate implant placement was planned with short-term non-occlusal loading.

Fig. 2: CBCT scan: the root of the tooth was visibly fractured, and Fig. 1: Situation before treatment, which led to the decision to extract tooth #11

there was clear external resorption of the root from the vestibular side.

With the use of the CEREC Omnicam scanner (Dentsply Sirona), scans were taken of both the maxillary and the mandibular full arches along with a buccal scan (Fig. 3). The scans, together with the DICOM files, were uploaded to the Simplant software (Dentsply Sirona; Figs. 4 & 5).

The optimal position was planned for an Ankylos C/X B 14 implant (Dentsply Sirona) in line with the 3A–2B rule.1 Using the Simplant software, a Simplant Guide, along with a patientspecific Atlantis CustomBase Solution (with a titanium nitride abutment surface; Dentsply Sirona) and digital files, were ordered using Atlantis Core File (Dentsply Sirona).

Dental Tribune ASEAN | Oct-Dec 2021

Fig. 3: Buccal scan: information on the positioning of the maxilla relative to the mandible. This is absolutely necessary for designing a crown.

9

After precise planning, the tooth was extracted. At the resorption and fracture area of tooth #11, granulation tissue was clearly visible (Fig. 9). The granulation tissue was removed with an Er:YAG laser (H14 handpiece, Fotona; Fig. 10). The extraction was atraumatic and the socket clean and ready for implant placement (Fig. 11).

Fig. 4: Designing thee guide in the Simplant software based on the planned implant position.

Fig. 7: Full ceramic crown milled in the CEREC CAD/CAM system before sintering. As can be seen in the images, the Atlantis Abutment and the crown would fit perfectly together.

Fig. 5: Overlaying the CBCT and CEREC intra-oral scans, as well as the planned implant position, in the Simplant software.

The digital files were used to design and manufacture a screwretained Atlantis crown for implant #11 in the CEREC CAD/ CAM system (Dentsply Sirona). All the components, the Simplant Guide, the Atlantis abutment and the temporary crown, using CEREC, were manufactured and delivered prior to the surgical procedure (Figs. 6–8).

Fig. 8: The completed screw-retainbed IPS e.max crown ready to be cemented extra-orally with the Atlantis abutment (titanium nitride abutment surface).

Fig. 6: Planning the shape and size of the future CAD/CAM full ceramic crown in cut-back technique in the inLab software (Dentsply

Fig. 9: Visible granulation tissues at the resorption and fracture

Sirona) based on the Atlantis Core Fire received.

area of tooth #11.

Dental Tribune ASEAN | Oct-Dec 2021

10 CLINICAL NEWS The treatment was successful, and the final outcome was very satisfying. After three years, the soft tissue around the implant was well adapted and healthy (Fig. 18). In addition, a ceramic crown was placed on tooth #12 (after root canal therapy) and ceramic veneers on teeth #21 and 22.

Fig. 10: Removal of the granulation tissue with an Er:YAG laser.

Fig. 13: The Guide fitted flawlessly on the patient’s teeth.

Fig. 11: Clean socket after atraumatic extraction of tooth #11.

Fig. 14: A sequence of implant drills with specific guide sleeves were used.

Fig. 12: Tooth-supported Simplant Guide.

The implant was placed sub-crestally using the Simplant Guide (Figs. 12–15), which assures precision and safety. The screw-retained full ceramic crown on the Atlantis abutment (non-functional restoration) was placed immediately after implantation (Fig. 16). A follow-up CBCT scan demonstrated the perfectly executed positioning of the implant as it had been planned in the Simplant software (Fig. 17).

Dental Tribune ASEAN | Oct-Dec 2021

Fig. 15: Placement of the Ankylos implant using the Simplant Guide.

11

Fig. 16: Sub-crestal placement of the Ankylos implant. Attachment of the screw-retained IPS e.max crown on to the Atlantis abutment (nonfunctional restoration)

Fig. 17: A follow-up CBCT scan demonstrated the perfectly

Fig. 18:There was perfect adaption of the soft tissues around the

executed positioning of the impant as it had been planned.

implant restoration. In addition, a ceramic crown was placed on

Reference 1. Rojas-Vizcaya F. Biological aspects as a rule for single implant placement. The 3A-2B rule: a clinical report. J Prosthodont 2013;22(7):575-80

tooth #12 (after root canal therapy) and ceramic veneers on teeth #21 and 22. Three years follow up shows stability of soft and hard tissue.

Editorial note: This article was published in digital international magazine of digital dentistry Vol. 2, Issue 1/2021.

Dental Tribune ASEAN | Oct-Dec 2021

12 INNOVATIONS

Artificial intelligence may help predict implant treatment outcomes

By Brendan Day, Dental Tribune International As dental implants become an increasingly common treatment modality for edentulous patients, understanding their potential side effects grows ever more important. An American research team has thus developed a novel machine learning algorithm that could help dental practitioners better predict the risk of their implant patients developing periimplantitis.

The study was conducted by an interdisciplinary team spread across the University of Michigan, Michigan State University and the Harvard School of Dental Medicine. According to the researchers, periimplantitis affects the long-term success rates of at least 25% of dental implants, as the inflammation leads to the loss of supporting bone. Further complicating the treatment of periimplantitis is the fact that there is currently no reliable method for accurately predicting how an individual might respond to treatment.

In an attempt to untangle this issue, the research team developed a machine learning algorithm that they titled Fast and Robust Deconvolution of Expression Profiles—FARDEEP, in short.

FARDEEP was then used to investigate the clinical, microbial and immune profiles of a group of implant patients undergoing regenerative therapy to help correct advanced periimplant defects. In doing so, the team was able to measure the relative levels of certain deleterious bacteria and helpful immune cells in each tissue sample collected from the patients.

Dental Tribune ASEAN | Oct-Dec 2021

An interdisciplinary team of researchers has developed a machine learning algorithm that they hope will be able to predict the outcome of surgical treatment for patients with periimplantitis. (Image: Panchenko Vladimir/Shutterstock)

Overall, higher amounts of immune cell types associated with microbial control were found to be strongly correlated to better clinical outcomes. According to Dr. Jeff Wang, lead author of the study and clinical assistant professor at the University of Michigan School of Dentistry, the results greatly improved the research team’s understanding of the nature of periimplantitis and could help them “further understand how to provide precision care.”

“The most direct clinical application of this study will be to help predict the outcome of surgical regenerative therapy for periimplantitis,” Wang told Dental Tribune International.

“When a patient has severe periimplantitis, it is difficult to make a decision about whether to treat or remove the implant.

Regenerative therapy is expensive yet unpredictable; rebuilding the bone and replacing the implant is also a challenge,” he added.

“Therefore, prognostic information can be very helpful in determining what the best course of treatment for each individual patient is.”

Though FARDEEP’s potential is promising, Wang acknowledged that further clinical trials would be needed before it could be used by dental professionals to help predict periimplantitis risk in patients.

“This was a pilot study, as we plan to conduct larger clinical trials for validation,” he noted.

The study, titled “Machine learning-assisted immune profiling stratifies peri-implantitis patients with unique microbial colonization and clinical outcomes,” was published on 3 May 2021 in Theranostics.

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14 INNOVATIONS

DentalCAD 3.0 Galway: exocad announces roll-out

With the new DentalCAD 3.0 Galway release, exocad introduces AI technology for its Smile Creator. Facial features like the lip line or the eye position are automatically detected to assist the smile design. This helps the user reach an aesthetic proposal faster and saves valuable time when designing cases. (Image: exocad)

Software company exocad announced that DentalCAD 3.0 Galway, with new additional improvements to reduce design time, is currently being rolled out to end users by exocad distributors. With this new release, initially made available to distributors in December 2020, the company introduced the new Instant Anatomic Morphing, offering automatic adaptation of teeth in real time, with improved speed and precision for anatomic tooth placement.

“We have systematically analysed which steps dental technicians around the world spend the most time on during restorative design,” said Tillmann Steinbrecher, exocad CEO. “Based on the extensive analysis, we developed technologies such as the new Instant Anatomic Morphing, which enables users to reduce design time by as much as 20–30%, on average*.”

“Thanks to the advanced process automation, dental technicians will get from the automatic proposal to their individual design goal faster, as the anatomy of teeth is adjusted in real time with each movement, resulting in a major increase in productivity,” added Steinbrecher.

Dental Tribune ASEAN | Oct-Dec 2021

With the new Galway release, exocad additionally introduced artificial intelligence (AI) technology for its Smile Creator.

Facial features are automatically detected to achieve an aesthetic proposal faster to save valuable time when designing cases. Another new feature offers printable clip-on mockups of the planned anatomic result. Instead of a purely visual representation of the smile makeover on screen, patients can physically experience their new smile with try-ins, resulting in higher patient engagement and opening up new possibilities in consultation.

Inspired by Google Material Design, DentalCAD 3.0 Galway comes with a new, modern user interface and improved integration with exoplan, exocad’s implant planning software.

All features of the new release are built to improve ease of use in CAD design and to expand the possibilities of digital dentistry.

With this new release, exocad introduces 90 new and 80 optimised features. Key highlights of DentalCAD 3.0 Galway include:

15

Improved bridge connector editing for a faster workflow in every situation and three additional cut views can be optionally activated in the bridge connector step, providing the user with a faster workflow. (Image: exocad)

·

New Instant Anatomic Morphing for reduced design time and increased productivity;

·

AI-assisted technology for Smile Creator: facial features are automatically detected for faster smile design;

·

Parametric shape adjustment: all tooth libraries are continuously adjustable from a newer to an older anatomy, seamlessly applying natural abrasion to all selected teeth;

·

New and modern exocad user interface, offering a usercentred design to make digital interaction as fluid, intuitive and efficient as possible;

·

New tools for easy and intuitive controlling of the individual path of insertion;

·

Improved bridge connector editing with split screen view and tools to change several connectors at once for a faster workflow in every anatomic situation;

·

Mock-up tooth set-ups for improved patient communication. Clip-on try-ins, wax-up models, virtually prepared models and virtual tooth extractions are now supported;

·

Model Creator now supports conical stump dies for easier fitting even with lower accuracy printers; and

·

Bite Splint Module can now add anatomic shapes directly to the designed bite splints.

DentalCAD 3.0 Galway is available immediately worldwide and can be accessed by all users with a valid upgrade contract. exocad names its releases after current EU European Capitals of Culture and selected the Irish city of Galway for the name of this release.

Dental Tribune ASEAN | Oct-Dec 2021

16 INNOVATIONS

I built Pearlii to improve access to dental care and oral health education

Dr Kyle Turner created Pearlii, a free application that uses artificial intelligence technology to provide dental check-ups, in order to make it easier, quicker and cheaper for people to detect and

By Iveta Ramonaite, Dental Tribune International Health inequalities are avoidable and can be reduced by improving access to healthcare. In the hope of making dental care and oral health education accessible to those who need it the most, Dr Kyle Turner created a free artificial intelligence (AI)-based application for dental check-ups. In this interview, he talks about what prompted him to launch Pearlii and shares his experience of growing up in a vast remote area in Australia where access to oral healthcare was, and still is, restricted.

Dr Turner, what is Pearlii, and what inspired you to create the application?

I created Pearlii because, when I was growing up, I didn’t have any access to dental check-ups or oral health education. And now, as an adult, I’m paying thousands in treatment costs. My family was poor, and we lived in the Outback. I remember first learning to brush my teeth twice daily during a sleepover when I was a teenager. While getting ready for bed, I made fun of my friend for brushing his teeth at night. No one had ever told me before that I was supposed to be brushing my teeth twice daily, let alone after every meal.

Dental Tribune ASEAN | Oct-Dec 2021

prevent potential oral health issues. (Image: Kyle Turner)

Inequalities in health are never more pronounced than in a person’s oral health, be it between rural and urban people, indigenous and non-indigenous people, and certainly between rich and poor. Your smile is an immediate indicator of your socio-economic status, your employability and your self-esteem, and a major predictor of your overall health. Thankfully, my dad’s friend was kind enough to give me the 101 on oral hygiene, and I’ve been scrupulous about my oral hygiene ever since. However, many children are not as fortunate and haven’t encountered such an important intervention point. I built Pearlii to improve access to dental care and oral health education for those who have previously lacked this access.

How does Pearlii work, and how accurately does it detect oral health problems in patients?

Pearlii users upload five photos of their teeth and gingivae using a smartphone. We’ve developed a technology to control the camera’s lighting and focus. The images must be clear, so we instruct users to ask someone else to take their photos if they’re unable to do so themselves.

We’ve worked the longest on developing our machine learning algorithm to detect potential dental caries.

It’s important to highlight that I built Pearlii to give something to people who have limited access to the dentist for reasons such as high treatment cost, limited time or poor access to dental care.

It is intended to be a free selfhelp tool to improve your oral health. One of the key ways that Pearlii makes money is through our users booking dentist appointments. We’ve onboarded more than 3,000 dentists around Australia, and we incentivise our users to see the dentist. We desperately want our users to get the treatment they need earlier than they would normally have done.

Finally, I’m an epidemiologist by trade. I’ve been dying to run larger trials! Sadly, owing to strict COVID-19 restrictions in Melbourne in Australia, we haven’t been able to run formal research studies, but these are in the pipeline at the Royal Dental Hospital of Melbourne. Before then, we’ve been running small internal trials with our partner dentists. We plan to scale up these trials later this year, going through the standard research processes.

17 enable a computer to find patterns in data; and predictive analytics, where we use statistical modelling to better predict an outcome, such as weather forecasts. As you can imagine, the list of potential applications is almost endless.

In dentistry, computer vision is being used to scan dental radiographs and to identify dozens of pathologies, such as dental caries and bone loss, in just seconds and with remarkable accuracy. Predictive analytics are being used to scan dental patient records to find hidden patterns and instantly chart treatment plans. The dental market is being transformed by AI before our very eyes. We will continue to see improved diagnostics, enhanced communication, reduced healing times, better triage of patients, reduced infection and readmission rates, as well as significant cost-savings for patients and dentists.

Do you think that dental technology that uses AI could one day replace a dentist?

No, I don’t think so. There will always be a need for in-person dental care, especially when it comes to taking radiographs and performing dental surgery, for example.

AI continues to influence healthcare. What potential does it have to advance dentistry?

Thanks to advancements in computer vision software and camera technology in smartphones, we have reached the point where we can teach a computer to scan photos of teeth in order to check for dental problems such as dental caries and periodontal disease and to provide oral health education tailored to the results in just seconds. It might sound like something from the future, but it is here today.

What is your personal experience of dental care access in Australia, and how can Pearlii help remove some of the barriers to accessing dental services in the country?

I strongly believe that the costs of dental care should be covered by the Australian Government. We’re a wealthy country. Sadly, the average waiting time in Australia for a general dentist appointment in the public system is two years—three years if you live outside of the city. This is appalling. A staggering 90% of dentists in Australia work in private practice, and most are charging through the roof. On average, a dental check-up costs around $231. I’ve heard all types of excuses from dentists for why they charge so much, but it is inexcusable. These people are running a business; they want to maximise their earnings. And what is the result? More than half of Australians, or 65%, have not been to the dentist in the last two years. The industry reeks of privilege, and it is overdue for a shake-up.

We’re now entering an era of DIY healthcare, and telehealth, big data analytics and cloud-based care are rapidly on the rise.

Patients are increasingly taking matters into their own hands, choosing to jump online, download an application or join a local network to find the health information and support

What is the next step for Pearlii?

We’re extremely lucky to have some well-known impact investors backing Pearlii. We’ve raised $1.25 million in seed capital to date. We have a great ambition to improve oral health globally.

Australia has been an ideal pilot site to develop our technology

they need. AI is only accelerating this transition towards more personalised, more accessible healthcare.

and brand, but we’ll be ready to expand by the end of 2021.

More about Pearlii can be found at www.pearlii.com.

AI may seem too technical, but it is mostly a combination of computer vision, where we teach a computer to identify imagery; machine learning, where we write an algorithm to Dental Tribune ASEAN | Oct-Dec 2021

18 REGIONAL NEWS

Dental researcher is developing more aesthetic crowns for children More aesthetically pleasing and more cost-effective alternatives to metal crowns.

By Brendan Day, Dental Tribune International In New Zealand, one of most common methods for treating dental caries in primary teeth is the Hall technique. The noninvasive method involves placing metal crowns over teeth that are only moderately decayed, and is relatively quick and inexpensive to perform. Numerous issues have been reported with the type of crown used in Kiwi dental practices, however, leading a local dental researcher to begin developing her own restorative technology.

Dr Joanne Choi, a lecturer at the University of Otago’s Faculty of Dentistry and a dental technology and materials researcher, told Dental Tribune International (DTI) that her research into the topic “began almost by chance” in 2017, when her colleague Dr Lyndie Foster Page conducted a presentation on the implementation of the Hall technique in New Zealand.

Dr Joanne Choi, a dental technology and materials researcher, is currently developing a tooth-coloured crown to be used with the

“She mentioned how parents had said that the metal Hall crowns don’t look nice,” Choi said. “If the kids have one or two metal crowns, it’s not such a problem, but if they have three or four, it becomes noticeable. This got me interested in starting a project to develop tooth-coloured crowns for New Zealand children.”

These metal crowns may draw unwanted attention to a child’s caries and add to any pre-existing dental anxiety, Choi said to DTI. Furthermore, she said that, although the crowns come in a number of different sizes, Maori and Pacific Islander children often have teeth that are larger than any of the available crowns.

In a press release from the University of Otago, Choi mentioned that the crowns she and her team are currently developing would be both more aesthetically pleasing and more cost-effective than the metal crowns currently used in local public dental health services.

Dental Tribune ASEAN | Oct-Dec 2021

Hall technique. (Image: University of Otago)

Choi told DTI that the COVID-19 pandemic had briefly delayed aspects of the project and had made securing funding more difficult. However, New Zealand’s relatively good ability to control the spread of SARS-CoV-2 has allowed her team to get back on schedule since, and a recent grant from the Cure Kids foundation—a charity that invests in medical research aimed at improving the lives of children—has ensured that they have sufficient funding.

According to Choi, a prototype of the tooth-coloured crown should be available and ready for clinical testing by the end of 2021.

REGIONAL NEWS 19

Poor oral hygiene could affect accuracy of SARSCoV-2 tests

By Jeremy Booth, Dental Tribune International

A study conducted at a hospital in Tokyo has found that poor oral hygiene could lead to prolonged viral shedding in patients with COVID-19. In the study, it was observed that patients with inadequate oral health regimes returned positive results in polymerase chain reaction (PCR) tests for the virus long after their clinical recovery, leading the researchers to believe that oral hygiene could affect the accuracy of testing for the virus.

The researchers evaluated the course of treatment of eight COVID-19 patients who were admitted to the Department of Neurology at Tokyo Metropolitan Neurological Hospital between 30 April and 14 May 2020. The patients had passed the acute phase of the disease, but were admitted to the dedicated medical facility for infectious diseases owing to persistent positive PCR test results for SARS-CoV-2.

The study found that, among the patients, the viral shedding period—the period during which the virus was still detectable after clinical recovery—ranged from one to 40 days. The average viral shedding period was found to be 15.1 days, but for two patients, Patient 1 and Patient 2, it continued for 53.0 days and 44.0 days, respectively. For Patients 3–8, two consecutive negative PCR test results were confirmed within 18 days of clinical recovery.

The researchers sought to establish why Patients 1 and 2 continued to test positive for the extended period. They noted that Patients 3–8 had kept up their personal hygiene routines, which included regular toothbrushing, while hospitalised in isolation in private rooms in the hospital. Patients 1 and 2, however, who had mental and/or psychiatric disorders, had not voluntarily brushed their teeth while hospitalised. After being instructed by the researchers to practise regular toothbrushing and gargling, the PCR tests of Patients 1 and 2 returned a negative result within four to nine days.

hospitalisation, but after that, she did not brush her teeth at all.

Her virus shedding period reached 46 days, with consistently positive PCR test results. We speculated that her inappropriate oral care might have caused the persistence of PCR test positivity.

In collaboration with the nurse, we repeatedly encouraged Patient 1 to brush her teeth and gargle. Two days after the start of this instruction, on the 49th day after the patient’s onset of symptoms, the patient’s PCR test result was negative for the first time.”

Patient 2, who had the underlying diseases of dissociative disorder and mild mental retardation, returned a negative PCR test result 26 days after being admitted to the medical facility; however, the viral shedding period reached 43 days before two consecutive negative PCR test results could be obtained. “At that time, we found that Patient 2 rarely brushed her teeth. Since then, we repeatedly instructed her to brush her teeth. With four days of intensive toothbrushing with only water, Patient 2 had two consecutive negative PCR test results on Days 44 and 47, so she was discharged,” the researchers wrote. They acknowledged that the low number of patients who were followed in the study made it difficult to draw statistical conclusions from the research, but noted that it was significant that the two patients with poor oral health regimes had displayed significantly longer than average viral shedding periods. “In such prolonged viral shedding cases, non-infectious viral nucleic acid may accumulate in an uncleaned oral cavity and may continue to be detected by PCR. We propose toothbrushing and gargling to remove accumulated non-infectious viral nucleic acid, leading to consistently negative PCR test results and thus avoiding unnecessarily long hospital stays,” the researchers concluded.

The study, titled “Effects of oral care on prolonged viral shedding in coronavirus disease 2019 (COVID-19)”, was published online on 24 July 2020 in Special Care in Dentistry, ahead of inclusion in an issue.

“Patient 1 had schizophrenia and was unable to voluntarily keep herself clean during isolated hospitalised life,” the study reads. “She brushed her teeth for the first time on the 18th day of Dental Tribune ASEAN | Oct-Dec 2021

20 WORLD NEWS

Tobacco smoking associated with periodontal pocket development

By Jeremy Booth, Dental Tribune International

A study by researchers in Finland and the UK has found that self-reported daily smokers had a higher incidence of deepened periodontal pockets than those who had never smoked. The study also investigated the accuracy of self-reported smoking by assessing serum cotinine levels and found a positive association between these levels and the development of periodontal pockets.

Tobacco smoking is known to have a causal effect on the progression of periodontal disease. According to the study by researchers at the University of Eastern Finland in Kuopio, Oulu University Hospital in Finland and King’s College London in the UK, self-reports are the most common method of assessing an individual’s tobacco use; however, incorrect disclosure of smoking status and the level of tobacco consumption can lead to invalid data in studies that examine the effects of tobacco use.

Together with the incidence of deepened periodontal pockets, the researchers therefore assessed study participants’ serum cotinine levels. Serum cotinine is the primary metabolite in nicotine and measuring it is a reliable quantitative biomarker for exposure to nicotine-containing tobacco products.

A total of 294 participants were included in the analysis, and smoking status was assessed through home interviews, resulting in study participants being categorised into the following groups: daily smokers, occasional smokers, quitters and never-smokers.

Serum cotinine levels were measured using liquid-phase radioimmunoassay methodology, and a follow-up clinical oral examination was performed, where the depth of periodontal pockets was assessed using the World Health Organization periodontal probe.

found. After adjusting for confounding factors, an incidence rate ratio (IRR) of 1.59 was observed for daily smokers in comparison with never-smokers. Close to no elevated risk for periodontal pocket development was found for occasional smokers and quitters.

A study by researchers in Finland and the UK found that the development of periodontal pockets was more likely in males who were less educated and who smoked cigarettes daily. (Image: Nopphon_1987/Shutterstock)

The amount of smoking was found to be associated with the development of deepened periodontal pockets in an exposuredependent manner.

“The IRRs for the highest category (20+cig/day) varied from 2.03 to 2.41. In a fully adjusted model, 1–9 cigarettes/day was not associated with periodontal pocket development,” the study read.

Covariates were assessed, including participants’ sociodemographic factors—such as education—and dental behaviour and oral hygiene.

In assessing the accuracy of self-reported smoking status, the researchers found a strong correlation in daily smokers between serum cotinine levels and the reported number of cigarettes smoked. “This study reveals that smoking is related to deterioration of periodontal health irrespective of whether the measurement of smoking is based on self-reports or serum cotinine level,” the researchers wrote, noting that the selfreported smoking was consistent with the serum cotinine levels found in study participants.

“The participants who developed periodontal pockets after four years were more likely to be males, less educated, daily smokers and had serum cotinine levels ≥ 42.0 µg/L than those with no periodontal pocket after four years,” the researchers

The study, titled “Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels”, was published online on 8 May 2021 in Acta Odontologica Scandinavica, ahead of inclusion in an issue.

Dental Tribune ASEAN | Oct-Dec 2021

WORLD NEWS 21

Understanding the transmission of SARS-CoV-2 will help dental office owners make appropriate decisions about the protection of staff and patients. (Image: peterschreiber.media/Shutterstock)

Transmission of SARS-CoV-2 in dental offices very unlikely, study says

By Dental Tribune International Researchers worldwide investigate COVID-19, and every week, new information about the illness is discovered or confirmed. A recent study from the Ohio State University has shown yet again that a SARS-CoV-2 infection risk at the dentist’s office is low, despite the tenacious misconception that patients and treatment providers are at high risk of catching COVID-19 at the dentist’s office.

Dental procedures are known to produce a considerable amount of aerosol, and this leads to fears that saliva in the aerosols generated during dental treatments could make the dentist’s chair a high-transmission location since SARS-CoV-2 spreads mainly through respiratory droplets. In order to investigate whether saliva is the main source of the spray, the researchers collected samples from personnel, equipment and other surfaces reached by aerosols during a range of dental procedures.

of asymptomatic patients, the aerosols generated during their procedures showed no signs of SARS-CoV-2.

“Getting your teeth cleaned does not increase your risk for COVID-19 infection any more than drinking a glass of water from the dentist’s office does,” said lead author Dr. Purnima Kumar, professor of periodontics at Ohio State. “These findings should help us open up our practices, make ourselves feel safe about our environment and, for patients, get their oral and dental problems treated—there is so much evidence emerging that if you have poor oral health, you are more susceptible to COVID,” Kumar added.

The study, titled “Sources of SARS-CoV-2 and other microorganisms in dental aerosols,” was published online on 12 May 2021, in the Journal of Dental Research, ahead of inclusion in an issue.

By analyzing the genetic makeup of the organisms detected in those samples, the researchers determined that dental irrigant, not saliva, was the main source of any bacteria or viruses present in the spatter and spurts from patients’ mouths. Even when low levels of SARS-CoV-2 were detected in the saliva Dental Tribune ASEAN | Oct-Dec 2021

22 WORLD NEWS

Back pain—a clinician’s nightmare Back pain is one of the most common complications of an incorrect sitting or standing posture. It may appear gradually or suddenly. Many dental practitioners only realise how much of an impact back pain can have on their practice once they experience it. Luckily, although some people suffer from long-term shoulder or back pain, this pain can be reduced within a few weeks or months of treatment.

Dr Ali Nankali, UK Back pain is one of the main disadvantages of a dentist’s profession. Some studies show that over 70% of dental practitioners suffer from chronic back pain. In one study on back pain prevalence and intensity in French dentists, female

For the last seven years, I have paid special attention to the topic and discovered some interesting facts. For example, I now know that the wearing of glasses is one of the main factors affecting posture. Regular reading glasses, provided by an

clinicians reported more frequent and intense pain than men, especially in the neck and upper back areas. In the same study, age and years of practice had a direct relationship to the intensity of pain and discomfort.

ophthalmologist, have a 22−25 cm focus point. Therefore, the student or practitioner maintains the recommended distance in order to see clearly. Asking for new glasses with a focus point of about 40−45 cm is an easy solution that could help tremendously.

Dental students are starting to experience musculoskeletal pain as well—an alarming observation that should be taken seriously.

I am a clinician myself and have taught both postgraduate and undergraduate dental students for many years. I have also been involved in various research projects and studies. In my experience, it is clear that incorrect posture and positioning is what causes back pain among clinicians.

Another interesting fact is that practitioners know better than anyone that they have incorrect posture and positioning, yet they do not know how to correct it. The lack of confidence does not allow them to challenge their habits on their own, and so they often seek help.

The problem usually begins when a dental student starts to work with a phantom head at an early stage of his or her studies. A student who is just starting practical exercises is often too eager to absorb all the information and to complete the programmed tasks. Tutors might talk in-depth about the required posture and positioning, yet young practitioners often think that by minimising the working distance and getting closer to the treatment area, they will be able to get a better look at what they are doing and, consequently, achieve a better outcome. This is a false assumption.

After a while, many tutors, myself included, get tired of repeatedly talking about the importance of correct posture.

Unfortunately, the students in question do not realise that the problem is only getting worse, and they become aware of it only when they start treating their first patients. Since they have a gap in their learning, they do not have enough confidence to correct their posture and positioning, and therefore the incorrect posture and positioning will remain.

Dental Tribune ASEAN | Oct-Dec 2021

Choosing the right dental care unit Being a member of the dental community, I realised that the first step for many professionals who suffer from back pain is getting a new patient chair. I contacted Planmeca, a well-known dental unit manufacturer based in Helsinki in Finland, to explore its opinion on the topic. Planmeca offers a selection of dental care units with many different configurations. Discussing the issue, Planmeca Senior Vice President Jukka Kanerva explained that the company’s product philosophy has always been that its equipment needs to adapt to the user’s ways of working, not the other way around.

Planmeca is a global company, and its products are distributed in over 120 countries. In order to successfully function in all these markets, the company’s dental units have to adapt to different market requirements. “For example, the preferences of Japanese dentists differ greatly from those of their French colleagues. People come in different shapes and sizes, and dentists like different types of instrument delivery systems,” Kanerva explained.

23

Besides causing discomfort, back pain caused by incorrect posture and positioning may also undermine clinicians’ confidence and affect treatment outcomes. (Image: Ali Nankali)

“Also, some like to treat their patients while sitting down, some while standing. This means that the design of the dental unit needs to adapt to several different variables. For this reason alone, our Planmeca Compact i5 dental unit has an almost unlimited number of different customer configurations available. All our units can also be customised for left-handed users,” he continued.

As we can see from Planmeca’s response, manufacturers are happy to provide practitioners with what is needed. Kanerva assured me that Planmeca follows ergonomic guidelines and studies closely since these are the backbone of its product development process. He commented: “We (Planmeca) also gather feedback from our customers by using many different methods, such as clinic visits by our usability specialists and trade show visits by our sales staff.”

“Of course, anyone can submit their ideas through our website, and these submissions are saved in our database and analysed.

The most common requests are those pertaining to a particular way of working, and these vary from country to country. Ease of use and ergonomics are the key attributes that dentists around the world are looking for. We are constantly following trends and developments in the industry.” He also added that Planmeca has several qualified in-house dental professionals who help improve the daily dental workflow from a clinician’s point of view. Additionally, the company says that it tests its products in cooperation with dental clinics. So what, then, are the main factors that a dental unit manufacturer has to consider?

“There are several key requirements regarding the design and manufacturing of dental units. First of all, wide and smooth movements of instrument delivery are crucial because the unit needs to adapt to different working positions. Wide movement range of the patient chair as well as the shape of the chair’s backrest are also important since they help to ensure that the clinician can get as close to the patient as possible and find and maintain the best working position,” Kanerva explained.

“In order to maintain an ergonomic way of working while treating a patient, all necessary equipment and instruments need to be close by, with the instruments always in the peripheral vision of the practitioner. In this way, hand and arm movements can be limited to the fingers, wrist and elbow, and larger shoulder and torso movements can be avoided. We have also designed special mid-bending instrument arms that further contribute to an ergonomic workflow since they make instruments especially light to use.”

As we can see from the manufacturer’s explanations, it is in its interest to listen to practitioners’ requirements. However, statistics demonstrate that many clinicians are still suffering from back pain. Many dentists who do not know how to manage back pain try to work in a standing or a different sitting position, which, unfortunately, is reported to lead to more intense pain, especially in the upper and lower back areas. Having said that, there are some situations where practitioners should stand to perform the required tasks. These include when extracting a tooth and when taking impressions.

Dental Tribune ASEAN | Oct-Dec 2021

24 WORLD NEWS the treatment outcome too. To give practitioners guidance on the topic, I started to run courses on posture and positioning on UKDentalCourses.

Studies demonstrate that about 85.5% of clinicians have a forward head posture, whereas 68.8% have a round shoulder posture. For this reason, 36.1% of practitioners suffer from scoliosis and hyperlordosis. Most studies on working posture demonstrate a high risk to the lower back and neck. However, appropriate posture muscle strengthening exercises for the neck area can play an important role in minimising this risk.

Although it is clear that a dentist’s back pain is mainly caused by an incorrect posture, alternative diagnoses should be ruled out by examining or reviewing the signs and symptoms. If a serious underlying pathology is suspected, the dentist should be referred to the right specialist for relevant guidance. Medication, exercises, surgery and cold or warm therapies are the most Dr Ali Nankali is a clinical senior lecturer at Barts and the London School of Medicine and Dentistry at Queen Mary University of London in the UK and the president of UKDentalCourses. (Image:

common methods of treatment depending on the definitive diagnosis. However, the pain will return if the practitioner does not improve his or her posture and positioning.

Ali Nankali)

Maintaining the correct posture Maintaining a good posture helps practitioners achieve superior outcomes and protects them from future problems such as back pain. It allows the practitioner to see the working area properly, which optimises performance and minimises the risk of iatrogenic damage. Contrary to popular belief, keeping the eyes closer to the working area does not help the clinician to have better control of a handpiece. In fact, being too close to the target area, less than 25 cm away, will not only decrease the level of accuracy but will also create discomfort for the patient.

When talking to practitioners, I realised that many of them are turning to self-help sources. I found out that these sources are relatively expensive and written in a very general manner. To help clinicians, I spent nearly three years with both right- and left-handed students and practitioners to create and publish a textbook named Posturedontics. This textbook aims to show the best position and posture for treating each tooth surface area. The book was published a few years ago and has received excellent feedback. Some practitioners mentioned that it is difficult to use the book at first, but as soon as you understand it, you benefit from it.

In most cases, if a practitioner needs to move his or her head or change posture, he or she has not been able to see the working surface area correctly during the procedure. Not maintaining the most suitable posture for each task will most likely affect Dental Tribune ASEAN | Oct-Dec 2021

To remain active in their daily activities, practitioners are advised to take over-the-counter painkillers such as paracetamol or ibuprofen. In my opinion, this depends on the severity of the pathology, as taking medicine might temporarily make you feel better, but it will not solve the problem permanently. Exercises such as lower back pain exercises, bottom to heels stretches, knee rolls and pelvic tilts could be of help.

In conclusion, a young learner needs to understand the importance of his or her posture and positioning from day one and follow the instructor’s recommendations. Incorrect posture and positioning not only cause discomfort such as back pain but also undermine a clinician’s confidence and affect treatment outcomes. Existing self-help sources are highly limited, and practitioners need more help on the topic. Dealing with back pain is crucial, and postponing the treatment may result in more complications.

WORLD NEWS 25

The importance of pain management for young dental patients

By Brendan Day, Dental Tribune International In Sweden, free dental check-ups are provided for children and adolescents until they reach the age of 20. Whereas this means that much is known about their oral health status, there have been relatively few studies measuring consideration for the oral pain that young Swedish dental patients undergo and its treatment. A new study has shed light on this topic, suggesting that dental professionals with more experience tend to be more alert to the needs of young patients.

The study was conducted by a research team from Sahlgrenska Academy at the University of Gothenburg and focused on the attitudes of general dental professionals (GDPs) working for the public dental service in the Västra Götaland region. In all, 387 GDPs were surveyed for the study, 71% of whom were female.

According to the study’s authors, previous analysis of dentists in the US and Finland conducted by Murtomaa et al. found that nearly 50% of GDPs fail to routinely ask young patients about pain. A study of Swedish dentists from 2005, meanwhile, revealed that around “one-third of the GDPs [surveyed] were to some extent indifferent to young patients’ experience of pain and psychological management”.

“In the literature up until now, there are no studies offering multidimensional data on GDPs’ knowledge and attitudes,” the study’s authors added.

They stated: “Thus, the aim was to study general dental practitioners’ knowledge and attitudes on pain and pain management in children and adolescents, using a multidimensional questionnaire.”

The results of the survey showed that the age and numbers of years of professional experience of GDPs influenced how they interpreted and responded to children’s pain in a clinical setting.

GDPs with more than 17 years of experience were found to be more responsive to a young patient’s particular needs—a trend that has been similarly reported across other medical professions, the authors noted.

A recent study out of Sweden found that more experienced general dental professionals tended to be more responsive than their younger colleagues to child patients’ specific needs. (Image: Kateryna Omelianchenko/Shutterstock)

Furthermore, it was observed that among the survey respondents, “female dentists displayed significantly more care regarding pain management” than their male colleagues, whereas the parental status of GDPs was not noted to be an influencing factor.

In their discussion, the study authors suggested that future research on this topic could “apply the questionnaire to other large GDP cohorts”. They also advised, however, that any further research should “revise, shorten and refine the questionnaire”.

The study, titled “General dental practitioners’ knowledge and attitudes on children’s pain and pain management—a questionnaire survey”, was published online on 10 May 2021 in Paediatric and Neonatal Pain.

Dental Tribune ASEAN | Oct-Dec 2021

26 WORLD NEWS

Dental biofilm of symptomatic COVID-19 patients harbours SARS-CoV-2

By Iveta Ramonaite, Dental Tribune International meaning that it is composed of bacteria, fungi and viruses— Gomes hypothesised that it may also harbour SARS-CoV-2, and her team felt obliged to investigate this, thereby joining other healthcare workers in the fight against COVID-19.

Study co-author Dr Sabrina Carvalho Gomes. (Image: Sabrina Carvalho Gomes)

Since SARS-CoV-2 has been found in different sites in the human body, researchers have recently sought to examine the presence of the virus in the dental biofilm of symptomatic patients who had tested positive for COVID-19. They reported that some patients who had tested positive in nasopharyngeal and oropharyngeal samples also presented SARS-CoV-2 in the supragingival biofilm sample. The findings suggest that dental biofilm may play an important role in COVID-19 transmission as it may harbour SARS-CoV-2 in symptomatic patients.

“Measuring human health in parts is not possible anymore,” said co-author Dr Sabrina Carvalho Gomes, professor of periodontics in the Department of Conservative Dentistry at the Federal University of Rio Grande do Sul in Porto Alegre. Gomes believes that the oral cavity plays an essential role in human health. This has become even more evident during the pandemic since the oral cavity is one of the key entry and identification points for SARS-CoV-2, she noted. Since dental biofilm is polymicrobial—

Dental Tribune ASEAN | Oct-Dec 2021

Talking about the motivation for conducting the study, Gomes told Dental Tribune International: “This study was designed and approved in March/June 2020, right at the beginning of the pandemic in Brazil. At the same time, I experienced flulike symptoms. As a result, I was examined by the hospital’s occupational medical department, which had recommended that all staff members with symptoms show up for medical examination and laboratory analysis. Once there, I realised that it would be a great place to do the investigation.”

Aiming to better understand the link between SARS-CoV-2 and oral health, the researchers collected biofilm samples from individuals with flu-like symptoms between July and September 2020. In total, 70 participants tested positive for SARS-CoV-2 and were included in the study. Subsequently, the researchers analysed the dental biofilm samples of those who had tested positive in nasopharyngeal and oropharyngeal samples.

The findings showed that 18.6% of the patients who had had a positive polymerase chain reaction test result also presented SARS-CoV-2 in the supragingival biofilm sample. In addition, the viral load observed in the medical samples of those who tested positivett in the dental biofilm was higher than that observed in the participants who tested negative. According to Gomes, these findings suggest that systemic viral load influences the presence of the virus in dental biofilm.

27

In a recent study, researchers investigated whether patients who presented flu-like symptoms and were consequently diagnosed with COVID-19 by means of nasopharyngeal and oropharyngeal swabs could also be positive in dental biofilm samples. (Image: LightField Studios/Shutterstock)

“Dentistry, again, is being called upon to reinforce its role in human health,” Gomes commented. “The current results put us on the alert and stimulate good oral health habits, especially the mechanical removal of the biofilm. Once inside a biofilm, no microorganism is susceptible to systemic or local drugs and host response. Therefore, mechanical disruption remains the only way to access the virus properly. So my recommendation is that we continue fighting to improve oral health by encouraging the daily mechanical removal of dental biofilm,” she concluded.

The study, titled “Dental biofilm of symptomatic COVID-19 patients harbours SARS-CoV-2,” was published online on 25 April 2021 in the Journal of Clinical Periodontology, ahead of inclusion in an issue.

The researchers will continue to work on the topic and already have two studies underway at the hospital’s intensive care unit. Additionally, Gomes noted that there is a strong need to study the human microbiome closely in order to evaluate the relationship of the viruses inside the biofilm, a task Gomes is keen to undertake in the near future.

Dental Tribune ASEAN | Oct-Dec 2021

28 WORLD NEWS

Europe’s clear aligner market heats up as Impress opens new production facility Orthodontics company Impress has opened an automated clear aligner production facility that uses HP industrial 3D-printing technology. The company raised more than €40 million in funding earlier this year and has made no secret of the fact that it aims to disrupt the orthodontic market.

Since 2019, the company has provided clear aligner therapy to tens of thousands of patients in Spain, the UK, Italy and France.

Impress has been steadily scaling up its business operations, and it now has a presence in nearly 100 cities. It was named one of the fastest-growing direct-to-consumer health technology startups by business news website Sifted in 2020, and the company says that its new production facility will further strengthen its upward trajectory.

Vladimir Lupenko, CEO and co-founder of Impress, told Dental Tribune International (DTI) that the new facility spans 1,500 m2 and is located in Barcelona’s important Zona Franca industrial area. Impress says that it is the largest technology-driven clear aligner treatment and planning facility in Europe. The company has partnered with 3D-printing specialists Carbon and HP on the facility, and HP Jet Fusion 5200 3D-printing technology will be used to tailor clear aligner trays to the treatment plans of Impress patients. The company will create around 1,000 jobs in the next few years not only in clear aligner production but also at forthcoming flagship stores in the UK. Dental Tribune ASEAN | Oct-Dec 2021

“We are proud to say that after these last few years we are the first company to create a fully digital orthodontic chain of a new generation” – Vladimir Lupenko, CEO, Impress Lupenko explained to DTI: “The creation of the new factory in Barcelona and new flagship stores in Manchester and London will create jobs in the UK, although an exact number cannot be specified just yet. Our aim is to continue to expand our offering to UK residents, so watch this space!”

He added: “Impress currently has two clinics in the UK, one in London and one in Manchester. More importantly, in a matter of weeks, we will be announcing the opening of our flagship stores in London and Manchester.”

Clear aligner manufacturer Impress has opened a new, high-tech production facility in Barcelona’s Zona Franca industrial area, which is strategically connected to European shipping routes.

(Image: James Heming/Shutterstock)

Lupenko said in a press release that the company was conceived as a disruptive player in the orthodontics market. He explained: “We are proud to say that after these last few years we are the first company to create a fully digital orthodontic chain of a new generation with our IT technology, professional medical team, and our own clinics.”

“Now, we have made the next very important strategic step with vertical integration,” he continued. “In-house treatment planning and our production facility will allow us to reduce turnaround and our patients will be able to start the treatment within just 5–7 days after the first visit.”

Impress’s clear aligner treatment model for mild to severe malocclusion will be familiar to most orthodontists. Patients receive a clinical check, which includes radiographs and a 3D intra-oral scan. A personalised treatment plan is created, aligner trays are shipped, and patients can monitor their treatment using a dental mobile application.

WORLD NEWS 29

Formnext prepared for successful return as in-person event industry professionals. It is the perfect springboard for getting future-oriented, sustainable technological developments off the ground,” he explained.

Formnext 2021 will take place on 16–19 November in Frankfurt and will feature industry talks, engaging presentations and the latest innovations in 3D printing. (Image: Mesago Messe Frankfurt/Mathias Kutt)

Formnext is a leading international exhibition for additive manufacturing and industrial 3D printing. This year, the event will take place on 16–19 November in Frankfurt and return to its in-person format. According to the organisers, Formnext 2021 will feature more than 600 exhibitors, 55% of which are from abroad, and offer an extensive and diverse supporting programme, including talks by industry experts.

3D printing is a valuable asset to both dental clinics and laboratories, and its benefits in dentistry are plentiful. It offers wide-ranging applications and is reinventing the dental industry by continuously providing new solutions and systems that will improve the practice workflow and offer increased efficiency and cost-effectiveness. This is achieved through constant innovations across the process chain, from materials to post-processing, and Formnext 2021 will provide the perfect platform for showcasing the latest technological advancements in the field.

“The amazing response we have seen from exhibitors and the [additive manufacturing] industry as a whole, including those based outside of Germany, underscores the importance of Formnext as the leading international event in this sector and the strong appetite for coming together and interacting in person once again,” said Sascha F. Wenzler, vice president of Formnext at organiser Mesago Messe Frankfurt, in a press release.

“It also demonstrates that this vibrant, in-person exhibition is crucial to a highly innovative industry like ours as a platform for showcasing innovations and discussing them with international

The event will showcase the global market leaders of additive manufacturing and exhibitors from 35 nations, including 3D Systems, Additive Industries, Formlabs, Materialise and TRUMPF, to mention just a few. Exhibitors will also include innovative start-ups, material manufacturers and companies operating in the areas of measuring technology, machining and surface finishing, such as BASF 3D Printing Solutions, Covestro, Hexagon, Höganäs and Sandvik. Also presenting their expertise at Formnext 2021 will be an increasing number of larger corporate groups and additive manufacturing users with significant experience in the industry, such as Rosswag and the SMS group.

Supporting events Formnext 2021 will additionally offer an attractive programme of supporting events, including talks by industry experts and innovations from the purmundus challenge and the Formnext Start-up Challenge. Attendees will also have the opportunity to join free seminars on 3D printing that are tailored for newcomers in small and medium-sized enterprises and aim to demonstrate the potential offered by 3D printing and how it can profit production facilities.

For the first time, Formnext will have a European partner country, Italy. Italian exhibitors such as Lincotek, Mimete and Prima Industrie will be representing Italy’s position as an important innovator for the entire industry.

Finally, the four-day TCT Conference will discuss current and future applications and technologies of additive manufacturing, and there will be high-profile presentations by Boeing, Deutsche Bahn and GE Healthcare, among others.

This year, Formnext will be held as a “2G” event, which means that it will only admit people who have been vaccinated or who have recovered from COVID-19. Those unable to attend Formnext 2021 in person are invited to join the Formnext Digital Days on 30 November and 1 December.

Dental Tribune ASEAN | Oct-Dec 2021

30 IN THE HOT SEAT

How can dentists and pharmacists collaborate and improve patients’ health?

An Interview with Dr Meng-Wong Taing, University of Queensland

By Brendan Day, Dental Tribune International

A lecturer at the University of Queensland’s School of Pharmacy, Dr Meng-Wong Taing is passionate about expanding the role pharmacists play in improving their patients’ health through a collaborative approach.

Naturally, this approach includes giving advice regarding appropriate oral healthcare. In this interview, Taing discusses why oral health promotion means so much to him and shows how dentists and pharmacists can work together in order to optimise patient health outcomes.

Dr Meng-Wong Taing

Dental Tribune ASEAN | Oct-Dec 2021

31 Dr Taing, as someone with a background in pharmacy, what first made you interested in maintaining oral health?

Since my youth, I have had a predisposition for cavities. My parents made us brush our teeth, so I was surprised that I constantly needed fillings at my annual school dental check-ups and also later in life. Growing up, I developed poor oral hygiene habits and, in hindsight, didn’t brush my teeth properly. It wasn’t until I found a proactive dentist who educated me on identifying plaque that I developed a greater self-interest and increased confidence about the better management of my oral health. By following simple oral hygiene recommendations, I have been filling-free for over six years— that’s a record for me! What I realised was how simple it is to prevent cavities and promote good oral health. All I needed to do was make subtle changes in how I looked after my teeth—something I wish I’d known much earlier in life. Being better educated in oral healthcare, I now feel empowered and confident about maintaining my oral health and would like to promote better oral hygiene practices for everyone, particularly for the disadvantaged, who are at a much greater risk of having poor oral health.

What are the benefits of getting pharmacists more involved in providing advice and services regarding oral healthcare?

Pharmacists have great access to patients within the community, which provides them with ample opportunity to promote oral healthcare and offer advice. The average Australian visits his or her community pharmacy approximately 14 times a year, and we also know from various studies that pharmacy staff express a strong interest in promoting better oral healthcare within their communities.

Specifically, pharmacists may be more involved in: identifying patients at risk of poor oral health implementing oral health prevention initiatives and providing advice on good oral hygiene and minor oral health problems supplying oral health products and providing evidencebased advice informing patients about medications which may affect oral health, including medicines that increase the risk of dental implementing assessment and referral pathways

What can dental professionals do to make this collaborative approach a reality?

I believe that the principles underpinning good collaborative working relationships are trust, open communication pathways and professionalism. The advice I give to my pharmacist colleagues that can be reciprocated by dentists for promoting good collaborative working relationships includes: Get to know your local pharmacist if you’re a dentist, and vice versa. Reach out to each other, share ideas and support each other in your clinical practices so that you aren’t isolated and feeling alone.

Make yourselves available for each other whenever there is need. In your busy schedules, please make sure to provide a timely response if a call is missed or a message is left.

Find ways in which you can assist each other. By talking openly about your respective needs, try to identify where you can best support each other’s practices and work hard towards achieving these goals with the aim of improving patient outcomes.

To make this collaborative approach a reality, there is also a need for growing partnerships and collaborations between national professional dental and pharmacy organisations.

These partnerships could support the development and implementation of mutually appropriate pharmacy practice guidelines, decision support pathways and interprofessional education resources.

Is your model specific to Australia and its approach to oral health? Is it influenced, for example, by the fact that only 53% of Australians possess dental coverage?

Currently, there are no established oral healthcare models within Australian community pharmacies.

What is needed is the development and evaluation of innovative and collaborative pharmacybased models to address poor oral health in rural and metropolitan regions. We need to show evidence that implementation of any proposed model is feasible, effective and mutually acceptable by both professions. I am working with Australian dentists, university dental schools and government health departments in order to obtain funding for the development and testing of collaborative oral healthcare models.

addressing common risk factors in chronic diseases Dental Tribune ASEAN | Oct-Dec 2021

32 BUSINESS

COVID-19 and the dental market: the pandemic continues to bite

By Jeremy Booth, Dental Tribune International The latest earnings reports from major dental companies show that dental offices around the world are open and doing business, but that the market has not yet returned to 2019 levels. (Image: Mirror-Images/Shutterstock)

Sales at major dental companies climbed in the second quarter of this year compared with the same period in 2020, during which the pandemic brought dentistry to a grinding halt. In the latest series of earnings reports, some dental company chiefs praised the recovery of the market, whereas others outlined falling discretionary spending, concerns about SARS-CoV-2 variants and sluggish vaccine rollouts in some geographic areas.

David Katzman, CEO of tele-orthodontics company SmileDirectClub (SDC), was candid when he spoke with analysts in August. SDC missed its earnings expectations for the quarter. Katzman pointed to SDC’s newest international markets, Spain and Germany, where he said “lingering effects” of the COVID-19 pandemic had hampered earnings. He said that, at home in the US, the company’s target demographic had been hit hard in the pocket by the health crisis.

He explained: “[Our] core demographic, which has a median household income of $68,000 (€58,000), likely experienced outsized pressures in their capacity to spend on discretionary items given the significant inflationary headwinds facing the non-discretionary categories like transportation, utilities and food.”

SDC’s target consumers, Katzman said, appeared to be favouring products over services owing to pent-up demand for apparel, automobiles and home-related goods. Joblessness was also having an impact. He explained: “Further contributing to the unfavourable condition of constrained capacity on spend on discretionary items and a general consumer preference for products over services, joblessness remains pervasive in four of our larger states, California, New York, Texas and Florida.

Through 10 July 2021, these four states represent 40% of the nation’s continuing jobless claims.”

Total sales revenue at SDC for the quarter was $174.2 million, an increase of 62.7% year over year, and the company completed just over 90,000 unique aligner shipments, compared with 57,136 in the second quarter of last year.

Dental Tribune ASEAN | Oct-Dec 2021

Align Technology posts $1 billion in sales Staying with orthodontics, leading clear aligner maker Align Technology fared better than SDC during the quarter, as it continued to break its own earnings records. The company sold $841 million worth of clear aligner trays during the period—a year-over-year increase of 181.9%—and its imaging systems and CAD/CAM services revenue was $169.8 million, a 214.7% yearover-year increase. Total sales therefore topped $1 billion for the first time. Compared with the first quarter of this year, the company’s clear aligner and imaging services revenue streams were up 11.6% and 20.0%, respectively. Clear aligner volume for the second quarter increased by 200.0% year over year to reach 665,600 cases, and clear aligner volume for teenagers increased by 156.3% to reach 181,000 cases.

A look at the company’s regional figures shows that dentists in most regions provided Invisalign treatment to more patients in the second quarter of this year than they did in the quarterly periods before the pandemic. In the Americas region, case volume was up 260.7% year over year. International shipments were up 149.2%, and those in the Europe, Middle East and Africa region (EMEA) were up 265%, led by Iberia, the UK and Italy. In the Asia Pacific region, clear aligner volume increased by 50%, led by Japan, China, Australia and New Zealand.

Straumann remarks on improved patient volumes in 2021 The results of another international player, Straumann Group, will give readers an impression of the state of global dental markets. In the EMEA region, total sales of CHF 230 million (€212.7 million) represented a 102% year-over-year increase, which Straumann credited to sales of premium and challenger implant brands, its orthodontics business, and strong sales in Germany, Iberia, France, the UK and Turkey. Straumann’s organic sales growth in North America decreased by 42% during the second quarter of 2020; this year, it increased by 135% to reach CHF 152 million. Sales in the Asia Pacific region rebounded by 63% in the period to reach CHF 103 million. In

33 Latin America, where Brazil is the largest contributor to regional revenue, CHF 31 million in sales represented a year-over-year increase of 174.4%.

Straumann’s total revenue for the second quarter was CHF 516 million. This represented a year-over-year increase of around 92%—in the comparable period last year, Straumann’s total revenue of CHF 248 million was down nearly 40%.

The company published a half-yearly report at the close of the second quarter, and in the report, the company said that dental practices had been operating with “healthy patient flows throughout the first half of 2021”.

“With the exception of Latin America, which is still in the eye of the storm, all of our regions report that more than 85% of dental practices are open” – Guillaume Daniellot, CEO Straumann Group Guillaume Daniellot, Straumann CEO, reminded analysts in a conference call: “When we held our last media conference three months ago, our industry was in lockdown. COVID-19 had cut our monthly revenue by 70%, and we were initiating measures to reduce our headcount and cost base in preparation for the economic recession that the pandemic is expected to trigger.” He added that the situation on the day of the latest media conference (12 August 2021) was more positive. “With the exception of Latin America, which is still in the eye of the storm, all of our regions report that more than 85% of dental practices are open. Correspondingly, between 85% and 100% of our facilities are open and our sales team are operating at similar levels. In short, both we and our customers are back to business.”

Envista optimistic about continued recovery Sales at Envista Holdings in the second quarter were $740.1 million, an increase of 104.4% year over year. The close of the period marked four consecutive quarters of growth for Envista’s premium implant business—which achieved 90% core sales growth in the three-month period ended 30 June.

Envista CEO Amir Aghdaei said during the company’s earnings call that Envista had seen solid demand for its infection prevention business, owing to the fact that enhanced disinfection protocols are now the new normal. Aghdaei said: “We’re excited about the opportunities for a new CaviWipes 2.0 product. It features a two-minute universal contact time, shows efficacy against a broad range of pathogens, including the COVID-19 virus, and increases our opportunity to penetrate the medical market further while enhancing our dental position.”

Howard Yu, senior vice president and chief financial officer at the company, said: “While patient volumes have improved to pre-pandemic levels in our major markets, we continue to see inconsistent roll-outs of vaccines and spikes in COVID-19 variant infections in several geographic areas, including Western Europe and parts of the United States. Overall, we are mindful of the pandemic-related risks but remain optimistic for a continued recovery throughout the balance of 2021.”

Aghdaei added: “While vaccination rates are increasing every day, we are mindful of the risk related to COVID-19 variance, continue to monitor reopening of economies and acknowledge that vaccination rollout worldwide [is] at different stages.

However, we believe that patient demand will sustain at prepandemic levels, due to the industry’s enhanced sanitation measures.”

Envista owns more than 30 dental brands, including major names like KaVo Kerr, Nobel Biocare and Ormco.

Dentsply Sirona cautions over “ongoing impact” Net sales at Dentsply Sirona for the second quarter were $1.067 billion, a 117.3% year-over-year increase. In the dental consumables segment, net sales of $445 million for the period represented a 138.0% increase. Sales of dental technology and equipment reached $622 million, a year-over-year gain of 104.6%.

US sales were $366 million, up 179.4% year over year, European sales of $431 million were up 99.5%, and sales in all other markets reached $270 million, an increase of 87.5%.

In a call with analysts, Jorge M. Gomez, executive vice president and chief financial officer at the company, commented: “Growth was strong across all regions and in all categories, most notably within the endo and [restorative] parts of our portfolio, which represent strategic priorities for our business.”

CEO Donald M. Casey said that the dental market continues to recover and to demonstrate its underlying resilience, but that dentistry is not yet out of the woods. “The pandemic remains a key consideration for us as we evaluate our performance for the quarter and plan for the remainder of the year,” he explained. “At this point, we feel the market is operating slightly below 2019 levels with a continued recovery expected for the remainder of the year. As we navigate through the newest phase of the pandemic, we are mindful that there [continues] to be some ongoing impact in certain regions and some stresses to the supply chain.”

Dental Tribune ASEAN | Oct-Dec 2021

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Dental Tribune ASEAN | Oct-Dec 2021

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