photo: Dr David Alesna
A PRIL 2 0 1 6 • D E N TA L A CCE S S • 1
2 • D EN TAL AC C E S S • APR IL
Contents Page Page
15-16 Special Feature:
Batangas City Dental Chapter
Biomimicry using a Modifiable, Intelligent Shading System in the placement of Direct Layered Composite Resin Veneers in a post-trauma case
Give it or Keep it? Dental Records in Light of PD 1575
The Dentist as an Entrepreneur
Editorial Board Editor in Chief Dr Harris Co Publisher Dr Armi B. Cabero Managing Director Mr. Medardo Chua Business Development Manager Mr Roco Ibe Project Manager Mr Kojih Lanot Contributing Editor Dr Jhing Chua-Sy Contributors Dr Aaron B. Mayordomo Dr Brian Esporlas Dr Cherrylou Sison-Mendoza Dr Johanna Po Dr Joseph Lim Dr Juan Rafael Silva Dr Lloyd Tronco Dr Vincent Gabriel S. Caagbay Circulation Executive Dr Guenevere N. Uy - Tanchuanko Publication Manager Ms Michelle M. Chua
Dentsply Sirona: Merger Creates The Dental Solutions CompanyTM
Powerful new cells cloned
Advisory Board Members Dr Antoinette Veluz Prof Alexander Mersel Dr Claver O. Acero Jr. Dr Darwin Lim Dr Derek Mahony Dr How Kim Chuan Dr Maridin Munda-Lacson Dr Ramonito R. Lee Designers Mr Ace John Avila (Graphic Design) Mr Christian Nipa (Web Design) Published By: Dental Access is published 4 times in a year by ADJ Dental Access Publications. Its circulation reaches the three archipelagos of the Philippines mainly Luzon, Visayas and Mindanao. The collective efforts of our media and print platform will further extend in the Southeast Asia, Asia Pacific, and China. We are working close with other international organizations in order to build strong ties that will make Dental Access a resource of information and international talent with its pool of compotent an intelligent professionals.
The Philippine Cybercrime Prevention Act of 2012 (part 2)
All material received by ADJ Dental Access Publications are understood to have full copyrights from the advertiser / contributor / author and will have full rights to publish both on website and on print. The advertiser / contributor / author shall then indemnify all against the claims or suits for libel, violation of right of privacy and copyright infringements.
107 PDA Events
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Standing for a Cause by Dr Harris Co
lection Fever is as hot as the tem- perature today in Manila. We all have placed our bets and who to mark on that ballot. We are hearing and reading campaigns from each of the candidates in print, web and on social media. Publicity abounds the net causing web traffic. Concurrently, people are talking about their candidates and the contenders and some have taken sides to defend their aspirants - similar to the fans of celebrities. They will create banners, clips and post their testimonies to entice people to support their candidates. The Philippine politics is indeed as colorful as the Cirque De Soleil with the exception of the acrobatic stunts, so to speak. The downfall however is that once you engage in these activities, you are exposing yourself to potential bashing from netizens accompanied with character assassination if your comment contradicts their publicly announced propaganda. It is not uncommon these days that people engage in mindless throws of anger where later on they will realize the repercussion of their acts. But do you think its wise to be THAT vocal against a person, much so about his or her campaign that you are willing to sacrifice your credibility in exchange of favoring your candidate? In the likes of our upcoming PDA Elections, exchange of political arguments are always imminent. While there are personalities surfacing on certain group forums on the internet who contradict the belief and political platform of their antagonists, many are baffled if it’s still worth voting for their candidates because of the politicizing of others that overthrows the true essence of the election. What now is the basis of electing that person if he or she is smothered by insinuations, black propaganda and so forth?
2 • D EN TAL AC C E S S • April APR IL 2016 2016
Are we not professionals who are suppose to choose candidates based on their credentials, past and present achievements and cumulative platforms? And how can we discern a person of virtue who will serve the association with honesty and sincerity who will truly unite our general membership? Philippine politics has been ingrained in our country but I hope that it will not translate in our association further. We are dubbed as the Sick Man of Asia because progress seems to be a far cry up until now. Can we not, as dental professionals, make a significant change that will separate us from today’s politics?
I would like to call on our members to be OBJECTIVE NOT VINDICTIVE. RESPECTFUL NOT OPPRESSIVE. To be WISE NOT BASHFUL with their decisions.
Its already a burden that you do not know who to vote more so if you do not participate in the coming PDA elections. Not voting excludes you from your rights to be heard. Not voting makes you a careless individual because you submit to whoever is elected on that seat without expressing your rights. Voting for your candidates is your right to stand up for your future and the association. We all want to see the day where we stand united as an association despite parties and political beliefs. We are all blind-sided by this charade and frankly speaking, its not helping our association to move forward. In my personal opinion, I will vote for the candidate who will think of my welfare. Someone who will understand my needs as a professional in terms professional growth, continuing education, retirement, protection against crime and malicious intent from other agencies that will compromise my code of ethics as a dental professional. I will elect a person whose values and vision is parallel to the welfare of the general membership. Mark a distinct cornerstone and compare them side by side. This will validate your choice. Some will say my vote will not count, but I believe otherwise. One vote is all it takes to make a difference. So, who shall I vote for? My answer is simple, I will vote for the one who represents what I stand for as a professional. I will vote for that person who will carry on the good values that the past presidents possess. That is my candidate who will win my vote. As for the rest of the candidates, may the best man or woman win!
About the Author
Dr Harris Co is a graduate of Centro Escolar University in 1999 with an impressive number of achievements during his collegiate years. With his much promising career as a dentist, he became an Associate Member of the International Association for Orthodontics and is an active Member Tzu Chi International Medical Association, Philippine Prosthodontic Society, Philippine Academy of Esthetic Dentistry, and the Philippine Academy of Implant Dentistry. Currently he is the Editor in Chief of Dental Access Publications.
DENTAL LAW AND ETHICS
THE PHILIPPINE CYBERCRIME PREVENTION ACT OF 2012 (part 2) by Dr Jhing B. Chua-Sy
ibel is defined under the Philippines’ Revised Penal Code, as “a public and malicious imputatio n of a crime, or of a vice or defect, real or imaginary, or any act, omission, condition, status or cir cumstance tending to discredit or cause the dishonor or contempt of a natural or juridical person , or to blacken the memory of one who is dead.” (Article 353). Defamation is the action of damaging the good reputation of someone. Libel is defamation in the written word; slander is defamation that is verbally made. The elements of libel under the Cybercrime law is no different from that of our Revised Penal Code. First, there must be allegation of a discreditable act or condition concerning another; second, there must be publication of the i mputation; third, the person that is being defamed must be identifiable and lastly, there must be existence of malice. The science of law or jurisprudence goes on to quantify the determination of what defamatory words are considered to be as such: “Words calculated to induce suspicion are sometimes more effective to destroy reputation than false charges directly made. Ironical and metaphorical language is a favored vehicle for slander. A charge is sufficient if the words are calculated to induce the hearers to suppose and understand that the person or persons against whom they were uttered were guilty of certain offenses, or are sufficient to impeach their honesty, virtue, or reputation, or to hold the person or perso ns up to public ridicule. ” [Lacsa v. Intermediate Appellate Court, 161 SCRA 427 (1988) citing U.S. v. O’Connell, 37 Phil. 767 (1918)]” (http://www.abogadomo.com/law-professor/law-professor-archives/libel-laws-ofthe-philippines) To illustrate : Friend A writes on her facebook status an imputation of an alleged financial anomaly made by a well-known but unnamed official of her organization. Friend B, likes the post and makes a commentary questioning the integrity and character of the official. Friend C recognizes who that official is being alluded to; then Friends D and E and their common friends down the line catche s up on the conversations and continue the conversation thread by making their own sentiments known which starts to tarnish the integrity and malign the character of the said official.
Rules_and_Regulations_Implementing_Republic_Act_10175.pdf The penalty is one degree higher than that in the Revised Penal Code. The maximum period of prison correctional is from 5 years, 4 months and 21 days to 6 years; the minimum period of pris on mayor is 6 years and 1 day to 6 years and 8 months. (https://xa.yimg.com/kq/groups/88369806/.../Table+of+Penalties.pdf) With the many provisions contained in the Cybercrime Prevention Act of 2012, cyberlibel or online libel is the most profound and commonly made transgression by netizens who are not averse to making their views and opinions known to the world. The dental community, for which we belong, is no exception. Numerous dental forums abound over cyberspace. Mostly, they are of the educational type. There are, however, forums whose purpose to inform and reveal will tend to border dangerously into the gossipy side of the spectrum. While the Philippine Constitution upholds freedom of speech and expression, it does not carry w ith it the absolute freedom to abuse that fundamental right, as stipulated in the SC decision: “….indeed, the ICCPR (International Covenant of Civil and Political Rights) states that although everyone should enjoy freedom of expression, its exercise carries with it special duties and responsibilities. Free speech is not absolute. It is subject to certain restrictions, as may be necessar y and as may be provided by law.” “The Court agrees with the Solicitor General that libel is not a constitutionally protected speech and that the government has an obligation to protect private individuals from defamation. Indeed, cyberlibel is actually not a new crime since Article 353, in relation to Article 355 of the penal code, already punishes it. In effect, Section 4( c ) (4) above merely affirms that online defamation constitutes “similar means” for committing libel.” Cyberlibel in the Cybercrime Act of 2012 is more damaging than what is contained in the Revised Penal Code. One click of the mouse, one press of the “enter” button can spell the difference between what is a lie and what is the truth. Hence the reason why the penalties impotsed are higher compared to what is stipulated in our 80-year old penal code. Still, the Supreme Court decision has set parameters for which the IRR has been based on. Freedom of speech and expression carries with it certain responsibilities that allow us to move independently as well as collectively in a civilized society. It should never be done recklessly or falseheartedly to the point of casting aspersion on another person without so much as giving du e process to the individual being alluded to. The law is very deliberate on that matter. Prudence is the better part of valor. In this instance, it saves you a trip to a court of law.
Does this constitute cyberlibel? The need to specifically name the person referred to is not a prerequisite for libel. It is enough that there was a third party who recognized the official based on the commentaries made in the conversation thread. In effect, the official alluded to of the alleged misdeed has been identified by facebook friends who commented within the thread. The Implementing Rules and Regulations (IRR) of this law (released on August 12, 2015) cite s the corresponding penalties for cyberlibel, to wit:
About the Author
“….shall be punished with prison correctional in its maximum period and prison mayor in its minimum period or a fine ranging from Six Thousand Pesos (P6,000.00) up to the maximum amoun t determined by the Court, or both, in addition to the civil action which may be brought by the off ended party, Provided, That this provision applies only to the original author of the post or online libel and not to others who simply receive the post and react to it.” http:// doj.gov.ph/files/cybercrime_office/
Dr Jhing Chua - Sy is an alumna of Centro Escolar University, Manila, Batch ‘87. In her early days as a dental student, she was the News Editor for The Scholar - a CEU University Publication. After passing the board exam, she pursued her post-graduate training at the UP-PGH Department of Hospital Dentistry in 1991. In addition to her line of achievements, she is a Former Legal Affairs Committee Secretary for the Philippine Dental Association in 1995-1997, a Former Comelec Secretary PDA in 1997-1998, a Former Executive Secretary for the National Dental Health Week in 1996 and Founding President and co-founder of Novaliches Dental Professionals, Inc. Today she continues her passion in writing as one of the contributing editors of Dental Access with her column Dental Law and Ethics. A PRIL 2 0 1 6 • D E N TA L A CCE S S • 3
am humbled and at the same time grateful for the year that passed that gave me the blessed opportunity to have served our beloved Philippine Dental Association as its President for 2015-2016. Our administration’s theme, “Emerging Trends in Oral Health Care in Philippine Dentistry” saw the emergence of many firsts in terms of PDA projects and activities: • ECharting/Adopt A School Project • Persons With Disability (PWD) Project • Special Gift for Special Kids Project • Occupational Dental Health Course for PDA Members • PDA Wellness Program: Biggest Loser Challenge • Celebration of the World Oral Health Day (spearheaded by the FDI or World Dental Congress) Alongside these are the various yearly PDA projects and activities, like the month-long celebration of the National Dental Health Month (NDHM 12.0), Sports, Ngiti Mo Sagot Ko, PDA Visayas and PDA Mindanao Conventions all sponsored by Unique, Bright Smiles Bright Future, Kabaranggay Sa Oral Health Program, Environmental Project BINHI Tree Planting, Coastal Clean-Up as well as the 12 Regional PDA-Dolfenal Symposia and 6 Regional PDA Colgate Public Health Program held in various locations from Luzon, Visayas to Mindanao. The core of my administrative year, however, is the very first Electronic Data Collection or ECharting Project whose pilot launch was achieved this year wherein it will initially focus on the 15 million elementary pupils nationwide. The objective is to implement a digital record keeping of the status of oral health of these pupils since the target demographics is of a larger scale. It is hoped that this method will make a standardized and expedient way of keeping track of the pupils’ oral health development over the years. This project is concurrent with the Adopt-a-School Program that will make its initial run for the next 6 years. While I know that these may be not enough for some, to me, it has still been a fruitful year despite the many obstacles, conflicts and uncertainties of my tenure as President. For this, I sincerely thank each and everyone of my Committee Chairpersons and their respective committee members for their unselfish and dedicated volunteerism to their assigned tasks. The effort and time they spent to make a project or activity successful is something that I will always remember with deep appreciation. Undying gratitude to the generous partners who made the PDA’s projects and activities this year a reality that bore the sweetest fruits. I hope that PDA’s continued partnership with you will prosper for many more years to come. Of course, last but not the least, my sincere thanks to the Presidents of the Chapters and Affiliates alongside the general membership who made all the Scientific Seminars, Regional Conferences, Area Conventions, the National Dental Health Month Celebration and many other PDA activities highly successful with their overwhelming attendance and active participation. With the mission and vision of our beloved association, I am certain that Batch Tanglaw passed all of these with flying colors! All the sacrifices, all the hardships, all the persecution; I accept all these with a humble heart, all for God’s Glory! I am not perfect but I know in my heart that I had the best intentions for the association in the one year that I have served it as its President, the 13 years of service as elected and appointed officer and for the last 32 years as its member. Once again, my heartfelt congratulations to Batch Tanglaw 2015-2016 for a job well done! And thank you to all the members who showed their support in many, many ways. You have given me strength to pursue my mandate as embodied in our association’s Constitution and Bylaws. I close the pages of my PDA story with this: as your duly-elected PDA President, it has been my honor and privilege to have served all of you - such service is anchored on the principles of transparency and yes, accountability. And that goes for everyone who serve the association - past, present and future. Maraming Salamat po at Mabuhay ang Philippine Dental Association! Maria Lourdes M. Coronacion President 2015-2016 Philippine Dental Association 4 • D EN TAL AC C E S S • APR IL
The Dentist as an Entrepreneur “Set higher financial goals and back it up with hard work.” Whether we like it or not, when we put up our practice, we also put up a business enterprise. Unlike most medical doctors who don’t have to worry about overhead expenses as most of their income come from their Professional fees collected for them by the hospital, we have to contend with running our own ‘mini hospital’ clinics. With it comes overhead costs, material and supply inventory, equipment amortization, employee benefits (eg. SSS, Pag-big, Philhealth), tax payments and a host of other management related issues. Being on that subject matter, our lone college subject of ‘Practice Management’ would never have sufficed. Aside from, many of us, not taking the subject seriously, it was probably taught by professors who were not practicing or not running a practice of their own or by themselves. It is no wonder why a number of our colleagues would have problems managing clinic finances such as non-payment to laboratory fees and suppliers on time or if at all, and defaulting on equipment amortization. Yet these same colleagues may be driving luxurious cars and taking expensive vacations. Do I blame them? No, not entirely. We were never prepared to put up and run a business, more so a clinic practice, but even that is arguable. For those among us who did make it or are making it in the business learned a lot of hard lessons: an employee embezzling from clinic income, BIR penalties, over drafted accounts, unpaid bills and etc., it was a school of hard knocks, because we were never educated or trained to manage our finances and run a business as we should have been. From those points I raised, a clinic should be managed based on the 3 aspects of our dental practice.
3 Aspects of our Dental Practice Just like any business enterprise, our dental practice has at least, 3 aspects of management: finance, operations and marketing.
Finance We really have to be aware of the financial costs of running our practice. Knowing our costs would enable us to set realistic fees and give us financial goals to meet to be able to sustain our practices as well as our personal or family needs. Costs can be classified as fixed and variable. Fixed costs generally includes rental, utilities( electricity, water, telephone) and salaries, which we commonly consider as ‘overhead’. Variable costs ,which may be direct costs of the service, usually includes laboratory cost, supplies, materials, and equipment depreciation. The ideal formula to set your fees would be: overhead cost/hour + direct cost of service +value of time or professional fee. When starting a practice, knowing your overhead cost will allow you to estimate how much reserve fund you would need to cover the first few months of operation when your practice is still picking up. One common mistake in managing finances is when dentists treat their clinic income as their own personal fund. With this mindset, it would be easy to forget that we still have to pay bills, aside from the usual overhead expenses like laboratory and materials, and prioritize our personal ‘wants’. It would be a good idea then to separate your clinic income account from your personal account. That way, all your income gets to be accounted for. You can then issue yourself a ‘salary’ according to your needs and a ‘bonus’ when all the bills in the clinic has been paid for. If you have a lot of personal needs and wants, then set higher financial goals and back it up with hard work. Or else, live within your means.
Operations In a single or small practice, operations simply mean how we do things in the clinic: when do we open or close; how do we handle walk-ins/ appointments; how do we sterilize/prepare our instruments; how do order materials/ manage inventory; how do we bill our patients; how do we schedule/ remind/recall our patients; what tasks do we assign to our secretaries/ dental assistants. In other words, having a system in place, written or otherwise. In bigger practices, this system should be in a form of a written process, flow charts, work instructions and procedures to guide our associates, staff and ourselves, as well. This creates more accountability in our practice. Being mindful of how we do things or having a system, gives our practice a sense of consistency and predictability which can nspire and instill patient confidence within.
Marketing Aside from being considered unethical, it is not necessary to do external marketing (print and broadcast media) to promote our practices. As they say, the best advertising is by word of mouth. This can be enhanced by the ‘internal’ marketing that we can do inside our clinics. Facility. A clean, orderly and relaxing atmosphere in the reception and the whole clinic in general, creates a good first impression of our practice. Staff. The receptionist/ secretary is the first to come in contact with the patient. A friendly and attentive receptionist would make a lot of difference in convincing a potential patient, whether walk-in or phone inquiry, to make an appointment. It’s therefore important for us to choose our staff well and assign them tasks which would suit their personality and/or training. One of the ‘episodes’ that we should not take for granted is the first dental appointment. The challenge is convincing the first time patient to come back for their other dental needs. This is called ‘patient conversion’. Your patient conversion rate is the number of returning patients over the number of first-time patients with additional dental needs multiplied by 100. Ideally, it should be 70% and above. Recall. Having a recall system not only gives your practice a steady income in ‘lean months’, but also gives it a sense of reliability. So, even if they do not come after being reminded, it puts your practice on top of their mind whenever they would have dental needs or if asked for a referral by family or friends. After all, the best advertisement is a satisfied and happy patient.
About the Author Dr. David Alesna is the Past President of Cebu Dental Chapter in 2004. He pursued a specialization in Prosthodontics where he was among the participants of Ivoclar Vivadent’s workshop in the United States adding more skill to his clinical prowess. In addition to his accomplishments, He was a former instructor at the Centro Escolar University in the Prosthodontics Section and professor at the Cebu Doctors University. To date, he is the co-founder and owner of the Green Apple Dental Clinic located in Cebu City.
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Give it or Keep it? Dental Records in Light of PD 4. EO 292 Book VII, Sec 3.. Filing.—(1) Every agency shall file with the University of the Philippines Law Center three (3) certified copies of every rule adopted by it. Rules in force on the date of effectivity of this Code which are not filed within three (3) months from that date shall not thereafter be the basis of any sanction against any party or persons.
Dr Juan Rafael Silva
he recent call by National Bureau of Investigation (NBI) Chief Dentist Dr. Ann Manos1 caused an uproar in certain corners of social media. In her request, Dr. Manos asked all practicing dentists to submit their patient records through email, emphasizing that “THIS IS A CONTINOUS (sic) PROCESS!” This was to allegedly comply with the Presidential Decree 15752 (PD 1575), and the Memorandum of Agreement3 between the NBI and the Philippine Dental Association (PDA). PD 1575 is a 1978 Martial Law Presidential Decree, by then President Marcos, that requires practitioners of dentistry to keep records of their patients. I believe, however, that the community should ask for a stay in the implementation until concrete implementing rules and regulations have been presented, explained, and approved. To note: as of April 15, 2016, no implementing rules and regulations in relation to PD 1575 have been filed with the Office of the National Administrative Register in the University of the Philippines Law Center, required by Sec 3, Book VII of the Administrative code of 19874, nor annotations found at the Philippine Permanent and General Statutes of 2009 and CD Asia at the University of the Philippine College of Law Library. Section 1. It shall be obligatory upon all practitioners of dentistry to keep and maintain an accurate and complete record of the dentition of all their patients which shall include a history and description of the patient’s dentition and the treatments made thereon. Section 2. Upon the lapse of ten years from the last entry, dental practitioners shall turn over the dental records of their patients to the National Bureau of Investigation for record purposes: Provided, that the said practitioners may retain copies thereof for their own files. Section 3. Any violation of the provisions of this Decree shall be punishable by a fine of not less than one hundred pesos nor more than one thousand pesos. Section 4. This Decree shall take effect immediately. 3. Figure 2: National Bureau of Investigation and the Philippine Dental Association Memorandum of Agreement. Regarding the Creation of a Viable Information Management System to Facilitate Positive Identification of Individuals. February 1, 2013 6 • D EN TAL AC C E S S • APR IL
PD 1575 is short and direct: it requires dental practitioners to keep their records, and to turn them over to the NBI after 10 years. However, it glosses over certain procedural requirements which would have clarified its implementation, and would have given more “teeth” to the NBI Chief Dentist’s order. First, PD 1575 merely requires dental practitioners to “keep and maintain an accurate and complete record of the dentition of all their patients which shall include a history and description of the patient’s dentition and the treatments made thereon”. It does not accurately specify information to be sent, which may lead to the possibility of practitioners either disclosing too much, or too little information to the Bureau. Second, the law requires practitioners to “turn over” existing records – not to transfer said records from one form to another. Third, the manner of transfer has yet to be clarified: the command in Section 2 of PD 1575 is that dental practitioners shall “turn over the records”, contemplating the actual records to be submitted to the NBI and that practitioners may retain copies for their own files; however, the current order is for practitioners to fill-up the form, and submit the form through e-mail to the given address – presenting confusion between the order and the law. Fourth, only after a lapse of ten (10) years from the last entry are practitioners required to turn over the records. However, after a call to the NBI to clarify the procedure for the submission of records, the author was advised to send the records of recent patients, within the last 5 years, which does not harmonize with the directive of PD 1575. This has been later clarified to be merely a suggestion by the NBI to ask for submission. Despite my disagreement with the Facebook post urging submission of the dental records, I look forward to the full implementation of PD 1575. I believe that the law is essential to the proper practice of Dentistry. First, as explicitly stated in the whereas clauses of PD 1575, it greatly facilitates forensic identification of bodies5. This has proven to be crucial in calamities where access to dental records is preferred as opposed to more expensive DNA tests6. Second, this may then encourage patients and their families to drop by their dentist in hopes of having their records “kept” in case identification is needed. This could be an opportunity to both engage the community to improve their dental health, and encourage a preventive approach instead of interventional treatment approaches prevalent in the Philippine dental health system. The dental visit could be an occasion where high risk patients could be identified, incipient disease be detected and helpful oral health advice be given. Third, keeping
5. PD 1575: REQUIRING PRACTITIONERS OF DENTISTRY TO KEEP RECORDS OF THEIR PATIENTS WHEREAS, the identification of persons is a necessary factor in solving crimes and in settling certain disputes such as claims for damages, insurance, and inheritance; WHEREAS, in those cases where the identification of persons cannot be established through the regular means, identification through definition has been proven to be necessary and effective; WHEREAS, however, records of dentition of persons are often not available due to the lack of systematic recording by dental practitioners of the dental history of their patients. 6. https://www.doj.gov.ph/files/2013/speeches/0307Opening%20Ceremony%20of%20the%20Forensic%20 Ondotology %20Course.pdf good dental records, in whatever form in compliance with PD 1575 is part of providing efficient dental treatment and is one of the first clinical skills dental students learn. Its importance in patient care cannot be over emphasized. While the current NBI chart is a welcome step towards the implementation of the law, more is needed from our community to protect both our patients and our practice. Hopefully, the NBI, with the PDA, would be able to craft implementing rules and regulations to prevent the capricious and ambiguous enforcement of a straight forward, good intentioned law. Poorly implemented, it may be used as a tool for oppression through penal fines, or as a backdoor to intrude into the privilege communication between the patient and his/her doctor.
About the Author Dr Juan Rafael Sandico Silva is a practicing Periodontist in Ortigas, Pasig City, and Angeles City, Pampanga. He obtained his DDM from the University of the Philippines, and specialist training in Periodontology from the University of Hong Kong and Peking University, currently ranked #1 and # 16 respectively, as top universities for dentistry in the world. He ranked #2 in the Philippine Dental Board Licensure Examinations, qualified for the esteemed Membership in Periodontics to the Royal College of Surgeons of Edinburgh, Scotland, and Diplomate from our very own Philippine Board of Periodontology. He taught as a Clinical Associate Professor of Periodontology at the University of the Philippines in 2013, and a course instructor at the Philippine Society of Periodontology’s Basic Perio Workshop. Email: firstname.lastname@example.org
Localnews PRC APPOINTS CPD COUNCIL FOR DENTISTRY
he Philippine Regulation Commission appointed its new members of the CPD coun cil for Dentistry last February 2016 held at the PRC Building. Oversight for CPD Chairman is Honorable Ranier Reyes, Officer In Charge of the Board of Dentistry, Dr Arturo de Leon - Dean of Our Lady of Fatima University and Past PDA President as 2nd Member of the CPD Council and Dr. Ma. Lourdes M. Coronacion, 2015 PDA President, 1st Member. DA Photo credit to PRC Photographer
Dr Manuel V. Vallesteros awarded Most Outstanding Alumni during the UP Alumni Homecoming
ith several achievements to his name, Dr Manuel V. Vallesteros, Chairman of the Philippine Pediatric Dental Society, Inc (PP DSI) and Batang May K Project received the Most Outstanding Alumnus of the Century for Public Service by the UP Alumni Dental Association during its last Home Coming Ceremony held at the Sofitel Plaza Luzon and Visayas Ballroom. Hosted by the class of ’91, the UP Dental Alumni Association sponsored the GALA event entitled TIMELESS last February 8, 2016. Dr Manuel V. Vallesteros is among the many exceptional Key Opinion Leaders in the Philippine Dental Association and has recently partnered with the Philippine Pediatric Society (PPS) as an affiliate association with the Philippine Pediatric Dental Society Inc. (PPDSI) under his chairmanship. DA photo: Dr Vallesteros
NEW MEMBER FOR BOARD OF DENTISTRY
on. Maria Jona Develos - Godoy, who was recently appointed new member of the Board of Dentistry, formally took her oath before the Professional Regulation Commission last Tuesday, March 8 2016. Her oath was administered by PRC Chairman Teofilo S. Pilando Jr, Commissioner Angeline T. Chua Chiaco and Commissioner Yolanda D. Reyes. Dr. Maria Jona Develos – Godoy is a former Dean and assistant to the Dean for Academic Affairs of Dentistry at Centro Escolar University. She finished earned her BEED at Asuncion Lopez Lizares Elementary School in March 1976 and her BSED at West Negros College in March 1980. She earned her Doctorate of Dental Medicine, Master of Art, Major in Teaching, Master of Science in Dental Education and Doctor of Philosophy at Centro Escolar University in March 1986, 1994, 2003 and 2007 respectively. DA Story source: http://www.prc.gov.ph/news/?id=4137&page=1&maxrows=10 Credit to PRC photographer A PRIL 2 0 1 6 • D E N TA L A CCE S S • 7
Localnews Batangas City Dental Chapter unveils the opening of its Indigence Clinic.
Filipina dentist makes it to the British register of Dentists
hrough the collaborative efforts of Batangas City Dental Chapter or BCDC President Dr Josephine Mercado - Arago, its members, past presidents and the Rotary Club of Downtown Batangas City, a new indigence clinic made its pronouncement to the beneficiaries of Batangas City inaugurated last 16th of February 2016. Strategically located along one of the leading hospitals in town namely the Nazareth Hospital, the Indigence Clinic stands at a two story building donated by one of the generous benefactors Dr Vicente Acosta and was later inscribed as the Vicente Acosta BCDC Building in his honor. Rotary Club of Downtown Batangas City President Jolou Amorado and Rotary Club of Tong Yeong (South Korea District) Gyeong-Jo-Heo graced the inauguration where they witnessed a lively activity conducted by the chapter members. Included in their activities were oral prophylaxis and oral examination performed by volunteers from the BCDC to the indigents. Some of the donations provided by the Rotary Club of Downtown Batangas City and Rotary Club of Tong Yeong were the installation of the CLEVO UV Disinfectant System, auto clave sterilization equipment, and three units of needle incinerator and needle burner. DA
At the moment while waiting for her training post, she keeps herself busy revising for the MJDF (Member of the Joint Dental tFellowship) run by the Royal College of Surgeons in England. She envisions that once she has successfully finish her vocational training, she plans to pursue a specialization in Cosmetic Dentistry and open her own Dental Surgery. Marilou says, “It’s about time that community of Filipino dentists should be acknowledged the Philippines is amongst one of the best producers of dentists in the world and most of those who find themselves abroad are just settled doing assistant/ dental nurse jobs thinking that these qualifying exams are so impossible to pass. Actually, it is very doable!” Dr Denosta continues, “I wasn’t a practicing dentist for 10 years but I took the exam with no formal course in manikin (phantom head) and I passed it.” According to Dr Denosta, many nationalities including Indian, Pakistan, Nepali dentists pass because they help one another. On the other hand, there are a handful of Filipinos who take the exam and acknowledge their presence at the testing site. In the entire northwest of England Dr. Denosta seems to be the only Filipino dentist allowed to practice She adds, “Imagine how many Filipinos are here who have a dental degree but would rather work as in other medical disciplines just to get by. However, I am sure that they would rather work as a dentist if given the chance and Dr. Denosta says that basic dental education in the encouragement. I hope my story inspires other dentists Philippines is on a par with other dental profession- to take the exam too so that there would be more Filipino dentists practicing in the United Kingdom”. DA als abroad.
here are only a handful of Filipino Dentists in the United Kingdom who have graduated and partly practiced dentistry in the Philippines but are now included in the British Dentist Register. In the past, dentists who studied overseas and hoped to practice had to take the International Qualifying Examination (IQE). All that has been changed into the ORE (overseas registration examination). One of the few Filipinos who managed to pass the ORE in the UK and make it to the British Dentist Register is Dr Marilou Villaver-Denosta. Hailing from Cebu, Dr Marilou practiced her profession for four years as a dentist prior to migrating to the UK. In 2001, as a fresh board passer, Dr Marilou volunteered as a community dentist in Mandaue City Health Department. Afterwards she joined Macrohon Orthodontic Centre for 2 years, and moved to the Bernal Dental Clinic where she became the principal dentist. Simultaneously she was the reliever dentist for PAGCOR Mactan located in the Waterfront Hotel Mactan. When she moved to the UK, she wasn’t able to practice her profession immediately. After the long wait, she said she finally had the guts and money to take the exam to allow her to practice dentistry in the UK. In September 2015, she passed and was registered two months later. She is currently looking for a Dental Foundation Training Post for her to work in the NHS.
credit to Mr Lloyd Tronco 8 • D EN TAL AC C E S S • APR IL
NATURAL PLANT CHEMICALS COULD HELP FIGHT TOOTH DECAY, STUDY SHOWS
he plant natural product acts against harmful mouth bacteria and could improve oral health by helping to prevent the build-up of plaque, researchers say. The compound known as trans-chalcone is related to chemicals found in licorice root. The study shows that it blocks the action of a key enzyme that allows the bacteria to thrive in oral cavities. The bacteria Streptococcus mutans metabolize sugars from food and drink, which produces a mild acid and leads to the formation of plaque. Without good dental hygiene, the combination of plaque and mouth acid can lead to tooth decay. Researchers found that blocking the activity of the enzyme prevents bacteria forming a protective biological layer known as a biofilm around themselves. Plaque is formed when bacteria attach themselves to teeth and construct biofilms. Preventing the assembly of these protective layers would help stop bacteria forming plaque, the teams says. Oral care products that contain similar natural compounds could help people improve their dental hygiene, researchers say.
The study, led by scientists at the University of Edinburgh, is the first to show how transchalcone prevents bacteria forming biofilms. The team worked out the 3D structure of the enzyme called Sortase A which allows the bacteria to make biofilms. By doing this, researchers were able to identify how transchalcone prevents the enzyme from functioning. The study, published in the journal Chemical Communications, was supported by Wm. Wrigley Jr. Company and the University of Edinburgh. Dr Dominic Campopiano, of the University of Edinburgh’s School of Chemistry, who led the study, said: “We were delighted to observe that transchalcone inhibited Sortase A in a test tube and stopped Streptococcus mutans biofilm formation. We are expanding our study to include similar natural products and investigate if they can be incorporated into consumer products. This exciting discovery highlights the potential of this class of natural products in food and healthcare technologies.” DA Story Source: Provided by University of Edinburgh.
BACTERIUM THAT CAUSES GUM DISEASE PACKS A ONE-TWO PUNCH TO THE JAW
cientists and oral health care providers have known for decades that bacteria are responsible for periodontitis, or gum disease. Until now, however, they hadn’t identified the bacterium. “Identifying the mechanism that is responsible for periodontitis is a major discovery,” said Yizu Jiao, a postdoctoral fellow at the U-M Health System, and lead author of the study appearing in the recent issue of the journal Cell Host and Microbe. Jiao and Noahiro Inohara, research associate professor at the U-M Health System, worked with William Giannobile, professor of dentistry, and Julie Marchesan, formerly of Giannobile’s lab. The study yielded yet another significant finding: the bacterium that causes gum disease, called NI1060, also triggers a normally protective protein in the oral cavity, called Nod1, to turn traitorous and actually trigger bone-destroying cells. Under normal circumstances, Nod1 fights harmful bacterium in the body. “Nod1 is a part of our protective mechanisms against bacterial infection. It helps us to fight infection by recruiting neutrophils, blood cells that act as bacterial killers,” Inohara said. “It also removes harmful bacteria during infection. However, in the case of periodontitis, accumulation of NI1060 stimulates Nod1 to trigger neutrophils and osteoclasts, which are cells that destroy bone in the oral cavity.” Giannobile, who also chairs the Department of Periodontics and Oral Medicine at the U-M School of Dentistry, said understanding what causes gum disease at the molecular level could help develop personalized therapy for dental patients. “The findings from this study underscore the connection between beneficial and harmful bacteria that normally reside in the oral cavity, how a harmful bacterium causes the disease, and how an at-risk patient might respond to such bacteria,” Giannobile said. DA Story Source: Provided by University of Edinburgh.
POWERFUL NEW CELLS CLONED: KEY TO IMMUNE SYSTEM DISEASE COULD LIE INSIDE THE CHEEK
Photo credit by Stock images
team from the School of Dentistry led by Professor Phil Stephens, with col leagues from Stockholm’s Karolinska Institute, have found a new group of cells with a powerful ability to suppress the immune system’s action. The team took oral lining cells from the insides of patients’ cheeks and cloned them. Laboratory tests showed that even small doses of the cells could completely inhibit the lymphocytes. The breakthrough suggests that the cheek cells have wide-ranging potential for future therapies for immune system-related diseases. Existing immune system research has focused on adult stem cells, particularly those derived from bone marrow. The cheek tissue cells are much stronger in
Dr Lindsay Davies, a member of the Cardiff team, said: “At this stage, these are only laboratory results. We have yet to recreate the effect outside the laboratory and any treatments will be many years away. However, these cells are extremely powerful and offer promise for combating a number of diseases. They are also easy to collect — bone marrow stem cells require an invasive biopsy, whereas we just harvest a small biopsy from inside the mouth.” The findings have just been published online in Stem Cells and Development.The team has now been funded by the Medical Research Council to investigate the cloned cells further. DA Story Source: Provided by Cardiff University A PRIL 2 0 1 6 • D E N TA L A CCE S S • 9
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GUM DISEASE BACTERIA SELECTIVELY DISARM IMMUNE SYSTEM, STUDY FINDS
n a new study, University of Pennsylvania researchers show that bacteria re sponsible for many cases of periodontitis cause this imbalance, known as dysbiosis, with a sophisticated, two-prong manipulation of the human immune system. Their findings, reported in the journal Cell Host & Microbe, lay out the mechanism, revealing that the periodontal bacterium Porphyromonas gingivalis acts on two molecular pathways to simultaneously block immune cells’ killing ability while preserving the cells’ ability to cause inflammation. The selective strategy protects “bystander” gum bacteria from immune system clearance, promoting dysbiosis and leading to the bone loss and inflammation that characterizes periodontitis. At the same time, breakdown products produced by inflammation provide essential nutrients that “feed” the dysbiotic microbial community. The result is a vicious cycle in which inflammation and dysbiosis reinforce one another, exacerbating periodontitis. George Hajishengallis, a professor in the Penn School of Dental Medicine’s Department of Microbiology, was the senior author on the paper, collaborating with co-senior author John Lambris, the Dr. Ralph and Sallie Weaver Professor of Research Medicine in the Department of Pathology and Laboratory Medicine in Penn’s Perelman School of Medicine. Collaborators included Tomoki Maekawa and Toshiharu Abe of Penn Dental Medicine. Work by Hajishengallis’s group and collaborators had previously identified P. gingivalis as a “keystone pathogen.” Drawing an analogy from the field of ecology, in which a species such as a grizzly bear is thought of as a keystone species because of the influence it has over a number of other species in the community, the idea suggests that, although P. gingivalis may be relatively few in number in the mouth, their presence exerts an outsized pull on the overall microbial ecosystem. Indeed, the team has shown that, although P. gingivalis is responsible for instigating the process that leads to periodontitis, it can’t cause the disease by itself. “Scientists are beginning to suspect that keystone pathogens might be playing a role in irritable bowel disease, colon cancer and other inflammatory diseases,” Hajishengallis said. “They’re bugs that can’t mediate the disease on their own; they need other, normally nonpathogenic bacteria to cause the inflammation.” In this study, they wanted to more fully understand the molecules involved in the process by which P. gingivalis caused disease. “We asked the question, how could bacteria evade killing without shutting off inflammation, which they need to obtain their food,” Hajishengallis said. The researchers focused on neutrophils, which shoulder the bulk of responsibility of responding to periodontal insults. Based on the findings of previous studies, they examined the role of two protein receptors: C5aR and Toll-like receptor-2, or TLR2.
Photo credit to: maen_cg Inoculating mice with P. gingivalis, they found that animals that lacked either of these receptors as well as animals that were treated with drugs that blocked these receptors had lower levels of bacteria than untreated, normal mice. Blocking either of these receptors on human neutrophils in culture also significantly enhanced the cells’ ability to kill the bacteria. Microscopy revealed that P. gingivalis causes TLR2 and C5aR to physically come together. “These findings suggest that there is some crosstalk between TLR2 and C5aR,” Hajishengallis said. “Without either one, the bacteria weren’t as effective at colonizing the gums.” Further experiments in mice and in cultured human neutrophils helped the researchers identify additional elements of how P. gingivalis operates to subvert the immune system. They found that the TLR2-C5aR crosstalk leads to degradation of the protein MyD88, which normally helps clear infection. And in a separate pathway from MyD88, they discovered that P. gingivalisactivates the enzyme PI3K through C5aR-TLR2 crosstalk, promoting inflammation and inhibiting neutrophils’ ability to phagocytose, or “eat,” invading bacteria. Inhibiting the activity of either PI3K or a molecule that acted upstream of PI3K called Mal restored the neutrophils’ ability to clear P. gingivalis from the gums. “P. gingivalis uses this connection between C5aR and TLR2 to disarm and dissociate the MyD88 pathway, which normally protects the host from infection, from the proinflammatory and immune-evasive pathway mediated by Mal and PI3K,” Hajishengallis said. Not only does the team’s discovery open up new targets for periodontitis treatment, it also suggests a bacterial strategy that could be at play in other diseases involving dysbiosis. DA Story Source: Provided by University of Pennsylvania.
PREVIOUSLY ‘HIDDEN DIVERSITY’ OF MOUTH BACTERIA REVEALED IN STUDY
n important step in understanding the role of oral bacteria in health and disease is to discover how many different kinds live in the mouths of healthy people, and exactly where in the mouth they normally live. Using a novel computational method called oligotyping, developed by MBL Assistant Research Scientist A. Murat Eren, scientists analyzed gene sequence data from nine sites in the oral cavity. The data was provided by The Human Microbiome Project (HMP), an effort of the National Institutes of Health that produced a census of bacterial populations from 18 body sites in more than 200 healthy individuals.
DNA in these samples was sequenced from the gene in bacteria that encodes ribosomal RNA, called the 16S rRNA gene, or 16S. To this point, an understanding of the biomedical significance of HMP data has been hindered by limited taxonomic resolution. “Different species of bacteria can have very similar 16S gene sequences, sometimes differing by only a single DNA base in the region that was sequenced, and errors in DNA sequencing can also create differences of one or a few DNA bases,” says the study’s co-author Jessica Mark Welch, an Assistant Research Scientist at the MBL. While the HMP data set has been used to identify bacteria broadly, to genus-level groups, it has never been used to identify bacteria more precisely, to the species level. “This genus-level grouping meant that many bacteria with similar DNA, but very different roles in the human microbiome, were lumped together, limiting the usefulness of the data,” says Mark Welch. Using oligotyping, Eren, Mark Welch and their colleagues Gary Borisy of the Forsyth Institute and Susan Huse of Brown University re-analyzed the HMP 16S gene data from dental plaque, saliva, and the surfaces of the tongue, cheek, gums, hard palate, tonsils, and throat. They found closely related, but distinct, bacteria living on the tongue, on the gums, and in plaque. For example, bacteria in saliva and in hard palate, tonsils, and throat resembled the tongue bacteria, while bacteria on the cheek were similar to bacteria on the gums. Bacteria from plaque below the gum-line also were detected on the tonsils, suggesting that the tonsils provide an oxygen-free environment where these bacteria can grow and come into contact with the human immune system.
Oligotyping detected kinds of bacteria that differed by as little as a single DNA base in the sequence tag. These differences in the 16S gene did not change the properties of the bacteria, but acted as markers for larger changes elsewhere in the bacterial genome which, the researchers believe, lead to different bacterial properties that make the bacteria prefer one part of the mouth over another. “These distinct bacteria were present in the data all along, but were indistinguishable because they were so similar to each other — hidden in plain sight, and revealed by oligotyping,” says Mark Welch. “This method offers a better understanding of the distribution of precisely defined taxa within the mouth, and demonstrates a level of ecological and functional biodiversity not previously recognized. The ability to extract maximum information from sequencing data opens up new possibilities for the analysis of the dynamics of the human oral microbiome.” Eren has applied the oligotyping method to improve taxonomic resolution in other bacterial communities, including those from wastewater, from marine sponges, and from ocean water. The researchers say the technique has the capacity to analyze entire microbiomes, discriminate between closely related but distinct taxa and, in combination with habitat analysis, provide deeper insights into the microbial communities in health and disease. “The diversity of naturally occurring bacteria continues to impress us, and our study demonstrates that a comprehensive understanding in microbial ecology through marker genes requires our attention to subtle nucleotide variations,” says Eren. “I anticipate that the ecologically important information oligotyping helped us recover from the human oral microbiome will intrigue other investigators to take a second look from their microbiome data sets.” DA Story Source: Provided by Marine Biological Laboratory. The original item was written by Gina Hebert.
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WHAT WENT WRONG
What went wrong Dr How Kim Chuan Problem: Shade mismatch composite accompanied with sensitivity Help! I have a female foreign patient who just had composite veneers in my clinic. I did as instructed in the manual when I used a new composite material. I reduced the facial of the tooth (23-13) to 2 mm and etched it for 30 seconds, dried and bonded the tooth. Carved it with the composite and cured the material. As soon as she got off the chair, I realized that the two of the teeth I bonded were slightly yellowish namely tooth nos. 13 ad 23. It looked different and they matched when y patient was in the chair with the lights on. But it suddenly changed its color/hue when she checked her tooth in the mirror. To top it off, she felt a slight sensitivity on that area which deeply concerned me because from my standpoint, I followed the instruction manual in the box. I am bothered because I promised my patient that she would look good after the treatment. Where did I go wrong here?
Ideally, a veneer preparation should be kept at 0.7mm to 1.0mm. 2.0mm is stripping off too much of the enamel leaving behind only a minimal enamel thickness to only dentin. While sensitivity will usually reduce with long period of time, it is very uncomfortable for patients and also causes a change in the lifestyle when they have to avoid certain stimuli like cold and hot drinks. Hence we must always try to avoid that for our patients. Shade taking is an important step in veneers construction as you want the teeth to look as natural as possible without having a shout to the world that some work was done on the teeth. To make shade selection easier, it is always advisable to do whitening of teeth before the procedure to even out the difference in shades on all the teeth. Canines are generally more yellow in nature compared to the rest of the anterior teeth, hence it is a good reference point in selecting shade because they have the highest chroma (intensity) of the dominate hue (color) of the teeth.
Some of the tips that can be used in shade selection:
A veneer is a thin layer of restorative material placed over a tooth surface, either to protect a damaged tooth surface or to improve the aesthetics (shape and colour) of a tooth. It is sometimes being referred to as ‘instant orthodontics’. There are two types of veneers available; composite and porcelain. A composite veneer may be directly built up in the mouth, which was done in your case. In contrast, a porcelain veneer is indirectly fabricated and later bonded to the tooth using a resin cement. Depending on patient’s case and affordability, either composite or porcelain can be applied. Composite is generally cheaper compared to porcelain. Composite veneer is a conservative approach whereby minimal to none tooth structure is being removed as the material can be manipulated easily to carve and mimic a lively and natural tooth structure. Your patient is suffering from sensitivity as too much tooth structure is being stripped off for the veneer preparations. Dentinal exposure can cause sensitivity to patients. Not only that, if the teeth are being exposed for a long period of time during preparation, the dentinal tubules can be dehydrated which also causes sensitivity.
1) The patient should remove any lipstick or bright makeup. Drape the patient with a neutral (grey) bib. 2) Use natural daylight instead of chair light to give more accurate chroma and hue of the teeth 3) Make the shade selection at the beginning of the appointment before the tooth becomes dehydrated and your eyes become fatigue from the other procedures. Whenever possible, take the shade before tooth preparation 4) First impression is the most accurate shade selection 5) Take a digital photograph with the shade tab desired next to the teeth 6) Bleaching should be completed before veneers preparation 7) One shade higher chroma may be selected for the canines and the cervical areas of incisors for a more natural appearance Your smile is often the first thing about you that is noticed by others. In aesthetic dentistry, we must always strive for a dentition, natural or artificial, that recreates nature in a manner that pleases the patient. About the author: Dato’ Dr How received his dental degree in Singapore in 1991 and pursued his Masters in Orthodontics in London (1993). A well qualified clinician who possesses a number of postgraduate qualifications including Oral Surgery, Implantology, Laser and Aesthetic Dentistry. Dr How is both the Current Counsilor for FDI World Dental Federation and Chief Editor for Asia Pacific Dental Federation. Adding to his achievements, he is a Diplomate and Fellow of International Congress of Oral Implantologist (FICOI) and a Pioneer of Laser Dentistry in Malaysia, Dr How is among the International Advisor for the West African Journal of Orthodontics, and our new advisory board member of Dental Access.
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FDI calls for finacial support for amalgam phase down When and how the convention will come into force
epresenting FDI, Science Committee Chair Dr Harry-Sam Selikowitz spoke on day 2 of INC 7 where the focus was on preparatory work for the entry into force of the Minamata Convention on Mercury and the first meeting of the Conference of the Parties (COP). “The INC7 meeting impressed on me that countries are very serious about implementing the Convention,” said Dr Selikowitz. “NDAs would be well advised to find out where their government stands with regard to ratification and be proactive on the measures they can realistically put in place to phase-down dental amalgam.” Aligned with World Health Organization The FDI intervention was in relation Article 13 of the Convention, Financial resources and mechanism. Its position is fully aligned with the 2009 report of the World Health Organization expert consultation Future Use of Materials for Dental Restoration, which concluded that a global near-term ban on amalgam would be problematic for public health and the dental health sector. FDI’s official position is outlined in the Policy Statement Dental amalgam and the Minamata Convention on Mercury, adopted by the General Assembly in New Delhi in 2014. Role of the Intergovernmental Negotiating Committee
INC was set up to develop a global legally binding instrument on mercury. It undertook this work over a series of five sessions (INC1 to INC5) beginning in 2010 and ending in 2013, when negotiators reached agreement on the final text of the Convention. Subsequent INC meetings will take place “as may be necessary to facilitate the rapid entry into force of the Convention and its effective implementation upon its entry into force” up to opening of the first meeting of the COP. INC7 took place from 10–15 March 2016 in Jordan. Day-by-day coverage is reported in the Earth Negotiations Bulletin. This will be the last INC meeting before the COP. INC6 took place from 3–7 November 2014 in Bangkok where FDI was also invited to
According to Article 31, item 1, “The Convention shall enter into force on the ninetieth day after the date of the deposit of the fiftieth instrument of ratification, acceptance, approval or accession”. Currently, 128 countries have signed and 25 have ratified. Dental amalgam is covered in Annex A, Mercury-added products, Part 2, which provides a list of nine measures parties to the Convention have to take to phase down the use of dental amalgam, taking into account domestic circumstances and relevant international guidance.  The measures include two or more from the following list : • Setting national objectives aiming at dental caries prevention and health promotion, thereby minimizing the need for dental restoration; • Setting national objectives aiming at minimizing its use; • Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration; • Promoting research and development of quality mercury-free materials for dental restoration; • Encouraging representative professional organizations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices; • Discouraging insurance policies and programmes that favour dental amalgam use over mercury-free dental restoration; • Encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration; • Restricting the use of dental amalgam to its encapsulated form; • Promoting the use of best environmental practices in dental facilities to reduce releases of mercury and mercury compounds to water and land. DA See more at: http://www.fdiworldental.org/media/news/news/fdi-calls-for-financial-support-foramalgam-phase-down.aspx#sthash.PcNQiTHh.dpuf
Dentsply Sirona Merger Creates The Dental Solutions CompanyTM
enttsply Sirona Inc. (NASDAQ: XRAY) announced that it has success fully completed the merger of equals between DENTSPLY Internation- al Inc and Sirona Dental Systems, Inc. The merger of DENTSPLY, the market leader in dental consumables and Sirona, the market leader in dental technology and equipmentcreates the world’s largest and most diversified manufacturer of professional dental products and technologies. Dentsply Sirona will have leadin g positions and some of the most wellestablished brands across consumables, equipment, tech nology, and specialty products to address the needs of dental professionals, specialists and den tal labs. Each day, approximately 600,000 dental professionals will use a Dentsply Sirona product1 With the largest R&D platform in the industry, Dentsply Sirona will develop and support innovativ e end-to-end clinical solutions that advance patient care. Total Solution Provider By combining DENTSPLY’s consumables platform with Sirona’s technology and equipment, the new company offers more products and integrated solutions than any other dental organization. Dentsply Sirona’s wide array of products for dental professionals and labs enable the treatment of general and specialty procedures including implantology, endodontics, and orthodontics. With the broadest clinical education platform in the industry, the company is driving the adoption of new and approved technology and integrated solutions for more efficient workflows. Customer s ervice and satisfaction will remain a key value to the new company and will be supported by the industry largest sales and service infrastructure comprised of direct sales and leading distributors.
Two Innovation Drivers coming together The merger unites the two leading innovators in dental, each with over 100 years of experience. Combined, Dentsply Sirona will have largest and strongest R&D platform with over 600 experienced scientists and engineers to foster the development of better, safer and faster dental care. With its enhanced commitment to innovation, the company will advance patient care, impr ove the patient experience and reduce chair time for procedures. Jeffrey T. Slovin, Chief Executive Officer of Dentsply Sirona comments: “With our merger complete, Dentsply Sirona can now focus its efforts on empowering dental professionals to provide better, safer and faster dental care. As The Dental Solutions CompanyTM, we will drive l ong-term growth.” DA A PRIL 2 0 1 6 • D E N TA L A CCE S S • 13
STRAUMANN AND ANTHOGYR ANNOUNCE PARTNERSHIP
traumann, a global leader in tooth replacement solutions, and the French dental implant manufacturer Anthogyr have announced a partnership agreement that enables the Swiss company to invest in Anthogyr and to address a broader section of the fast-growing tooth replacement market in China. Anthogyr’s dental implant system is registered and established in China where it is positioned as a high-quality attractively-priced option. The agreement foresees the transfer of Anthogyr’s implantology business activities in China to Straumann by mid-year, giving the latter access to the fast-growing value segment there. The combination of the two companies’ sales capabilities is expected to provide the critical mass to compete and grow successfully in this segment. Straumann already leads the premium segment in China and has recently established a new country organization and distributor network covering all provinces.
Finalists confirmed for the IPS e.max Smile Award
he panel of experts has decided: for each of the three regions rep resented in the contest, they have selected three teams whose work they found particularly exciting. Hundreds of teams, each consisting of a dentist and dental technician, submitted their case presentations accompanied by written and photographic documentation. Now the panel only has to decide who will be awarded first, second and third place. The final results will be announced at the award ceremonies in Madrid/Spain. The ceremonies will take place on 10 June 2016, on the eve of the 3rd International Expert Symposium organized by Ivoclar Vivadent.
In addition, Straumann is to acquire a 30% stake in Anthogyr and offers potential leverage to the business in other markets through Instradent, the business platform that Straumann is building to address the global value segment with multiple brands. Financial details were not disclosed and the agreement is expected to become effective at the end of March, subject to the fulfilment of certain conditions. DA
Ultradent Products, Inc. Proudly Introduces MTA Flow ™ Repair Cement
Ultradent Products Inc. proudly introduces MTA Flow™ (Mineral Trioxide Aggregate), a repair cement made especially for pulpotomies, pulp capping, root-end filling, apexification, perforation repair, and root resorption. MTA Flow is a bioactive powder and liquid/gel system consisting of an extremely fine, radiopaque, inorganic powder of tricalcium and dicalcium silicate which sets with a water-based gel. When set, the repair cement forms a layer of hydroxyapatite, which induces a healing reaction. The powder/gel combination also gives the clinician a variety of mixing options needed for an effective, non-gritty, easy-to-deliver MTA. MTA Flow’s small particle size (less than 10 microns) allows for smooth and easy dispensation, and its proprietary gel formulation makes the product more washout-resistant than other MTAs mixed with water. MTA Flow’s mixing ratio is adaptable to every procedure, allowing the clinician the ability to achieve any desired consistency, from thin, to thick, to putty. Its quick setting time also makes it possible to rinse or air-dry without washing away the MTA within five minutes of application. MTA Flow is the only MTA that can be delivered in thin consistency through a 29 ga Navitip®tip for apexification and apical plug applications. To learn more about MTA Flow, please call 800.552.5512, or visit ultradent. com. DA
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Anticipation grows for announcement of the winner The following teams have been shortlisted for the IPS e.max Smile Award 2016: Asia - Pacific: Dr Jineel Ham and HaSeong Yoo (Korea), Dr Baijun Sun and Benhui Du (China), Dr Tetsuya Uchiyama and Michiro Manaka (Japan). Europe – Middle East – Africa: Anna Giorgadze and Ilias Psarris (Greece), Prof. Dr Petra Gierthmühlen and Udo Plaster (Germany), Dr Ferran Llansana and Juan Sampol Reus (Spain). North America and Latin America: Dr Gabriela Pappaterra and Libardo García Tolosa (Colombia), C.D. Lucio Armando Quevado Hernández und Ramon Sanchez Hernández (Mexiko) and Dr Luis Sanchez and Alic Alen (USA). Impressive standard of entries The members of the panel were genuinely impressed with the quality of the work they received. “To choose the winners was rather difficult as all the cases showed beautiful parts and details,” explains Gonzalo Zubiri (Argentina). Oliver Brix (Germany) confirms: “It was fun and very interesting to see the different workflows and concepts behind the cases.” Dr Jiang Shan (China) emphasizes the inspiration involved in many cases: “Because creation begins from perfect imitation, being a member of the panel for the IPS e.max Smile Award was a great opportunity for me to get inspired for my own work, too.” IPS e.max Smile Award The IPS e.max Smile Award is an international contest launched to find the best dental cases solved with the IPS e.max all-ceramic system. A panel of experts has been set up to evaluate all the projects submitted with regard to esthetics, complexity and harmony and select the winners. The winners will receive worldwide attention: their works will be presented at professional events and in the dental media. IPS e.max® is a registered trademark of Ivoclar Vivadent AG. DA
The Lion Hearts of Batangas City
atangas City. A quiet place in the South that has attracted local and foreign tourists all year round and a landmark for pilgrims, beaches and scuba diving. This place has appealed to me for its beautiful mountains and its sceneries that forever lingers in my thoughts. I vividly remember in my younger years as I was wading my feet along the shoreline of Anilao, Batangas. I could see the rare blue fishes circling around my feet. A few feet away from where I was standing is a long bamboo stick that stands from a 50 feet sea level below. It was among the amazing things I learned and up until now I am still awed by the greatness of mother nature. To my surprise, I am again inspired by the strength and energy of the Batangas City Dental Chapter (BCDC) who are constantly at large to promote humanitarian service to the people. Once again, my journey to meet a new league of doctors has begun.
Last February, I met with Dr Josephine Mercado-Arago President of the Batangas City Dental Chapter at a twinning seminar in Quezon City. This lady doctor had a way of persuading me to visit her place which is a two hour stretch from where I come from. But nonetheless, I was excited. Her way of inviting me already had me convinced. With a sheepish smile and warm hellos, I immediately said YES. Besides, I wanted to see the activities of their chapter especially after learning that they were hosting the PDA - Colgate Regional Conference in Batangas City. With all honesty, I do not know the way going there BUT I mustered my courage and relied on my WAZE app. As i drove off that morning, its interesting to know that the Batangas alone has three dental chapters namely Batangas City Dental Chapter, Lipa City Dental Chapter and Batangas Province Dental Chapter. With Batangas City alone, their membership reaches a total of 200 dentists - quite a big number to supervise and exercise authority. However, with a worthy leader who is consistent with her plans for the membership, no man can stand against a united front.
The Lion Hearts of Batangas City A president is a reflection of his or her constituents. When its members are committted to their president, you can expect greatness in that community. The projects, the systems employed, it all translates from its governance over its people. The same story I discovered here in Batangas City is realized with Dr Josephine Arago. A good natured person with a big heart for service. “All Batanguenos are hospitable, so it does not exclude me for that matter.
. But the Presidency was not among my ambition. Yes, I am an active member but I didn’t realize that I had what it takes to be a president until I became one.” Dr Arago modestly replies. As I met with the rest of the members, even the past presidents assimilated the same values she upholds. Its very easy to acknowledge the warm and calm demeanor that was present among the members. This proves my theory about my first impression with Dr Arago. Even BCDC Past President Dr. Elisa Baliwag were among the distinguished doctors I met during my visit to Batangas City. It was an ineffable moment for me to describe having met one of the pillars of the BCDC. “We all help our present leaders to become good and effective presidents during their term. We as their elders have a responsibility to provide support because their success translates as a fulfillment of our existence and leadership.” Dr Baliwag explains. Although a veteran in her turf, Dr Baliwag still proves to be one of the influential leaders ever elected in the chapter.
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Special Feature Opening its doors to charity Batangas City is among the progressive localities in the southern area of Luzon. It may be a quiet town it is but filled with activities including dental conventions and presidential campaigns. The locals are no foreign to these functions because it signifies growth in economy and sustainability. With this knowledge, its no wonder why the BCDC has been granted financial aid by the Rotary International adjutant to the first indigence clinic inaugurated last 16th of February 2016 in Batangas City.
“The series of meetings and dialogues I had with the President Mr. Jolou Amorado of RC Downtown Batangas City is to affirm our sincerity to the grant and I did it with much persistence and in accordance to its objective. We wanted to be transparent with the Rotary because this will greatly serve the community.” She disclosed. Although the challenges may be apparent, the BCDC actively consorted their activities with successive dental missions including oral examination, oral prophylaxis, dental extraction, dental fillings and dental consultation that occurred during the inauguration of the indigence clinic.
Dr Arago announced with pride during the interview. Its quite uncommon these days for this precedence to occur especially if the projects are focused on the indigents. But through the perseverance of Dr Arago and its members, the town has more reason to obtain good oral health. The indigence clinic is among the many testimonies that the BCDC has bestowed to its recipients. A good heart with a great leader will always prevail. “Where there is charity and wisdom, there is neither fear or ignorance” Saint Francis of Assisi. DA
“Our first encounter with the Rotary International is traced back during the term of then president Dr. Benilda Anastacia Ambida. Then superseded by the union and partnership of the Rotaract Club with the BCDC that captured the interest and recognition of the Rotary Club of Downtown, Batangas City. This all happened during the term of Immediate Past President Dr. Maria Jolet D. Berberabe. Our activities and support were abound with missions, donation of goods that made our outreach programs more meaningful to the Mangyan villages of Puerto Galera and the remote island of Isla Verde. This strong alliance was passed on to me when I became President in 2015.”Dr Arago narrates. Because of the constant symbiotic partnership between two alliances (Rotaract and BCDC), something unexpected was about to happen during the term of Dr Arago. With the participation and presence of Rotary Club of Tong Yeong (South Korea District 3590) and Rotary Club of Downtown Batangas City District 3820, a grant with a substantial amount materialized in Sept 23, 2015 at the Batangan Bayview Hotel in Batangas City. Indeed, this is the start for greater things for the BCDC members and its President Dr Josephine Arago as a worthy recipient for this great blessing. 16 • D E N NTT AL A L AC A CC E S S • APR A pril IL 2 2016 016
The building now stands at the Nazareth Compound named after one of its benefactors Dr Vicente Acosta which is called the BCDC Vicente Acosta Building. “So far we have received three units of needle incinerator, needle burner, a CLEVO UV Disinfectant System and an autoclave sterilization equipment, all donated by Rotary Club of Downtown Batangas City and Rotary Club of Tong Young. Soon we are short listing the procurement of another 18 portable dental chairs, 1 fixed dental chair, portable units, surgical instruments, needle incinerator, LCD projector and 1 second hand unit of service van.”
Special thanks to Rotary Club Downtown President Mr Jolou Amorado, Dr Elisa Baliwag, Dr. Mary Marjorie B. Montalbo Chairman, BCDC Board of Directors BCDC Past President and Mr. Nemesio Dan S. Montalbo Treasurer, Rotary Club of Downtown Batangas City.
Centro Escolar University’s College of Dentistry:
Forging ahead towards Global Excellence by Jhing B. Chua-Sy,
ne of the leading dental colleges in the country today, CEU’s College of Dentistry has continuously honed its dental students by providing quality dental education through its competent dental instructors and state-of-the-art dental equipment, x-ray and dental laboratories housed in their dental infirmary. Its dental education structure is centered on patient-clinical care which fosters compassion amidst quality care and productivity. It has consistently generated a considerable number of Dental Board Topnotchers with the latest January 2016 Dentists Licensure Examination of the Professional Regulation Commission producing four topnotchers (4th, 6th, 9th and 10th places). CEU Makati and Malolos had a 100% passing percentage while CEU Manila registered 92.66% passing percentage. One of the features of the CEU College of Dentistry are (http://www.ceu.edu.ph/ manila/ dentistry) • ISO 9001:2000 - certified by SGS • Granted Full Autonomy by the Commission on Higher education • Level IV Accredited by the PACUCOA as certified by FAAP • Recipient Philippine Quality Award for Quality Management • Member, South East Asia Association for Dental Education (SEAADE) • First Dental School in South East Asia to be Peer-Reviewed by the South East Asia Association for Dental Education • Professional Organization Affiliation ( School and Faculty Members) • Philippine Association of Dental Colleges • Philippine Dental Association • International Association for Dental Research (IADR-SEA) • South East Asia Association for Dental Education (SEAADE) • Pierre Fauchard Academy • Academy of Dentistry International • International College of Dentists • Philippine Prosthodontics Society • Endodontics Society of the Philippines • Philippine Society of Periodontics • Association of Philippine Orthodontists • School of Dentistry • Philippine Pediatric Dental Society, Inc.
CEU has always prided itself with the unceasing upgrade of its dental equipment to cater to the needs of the dental students so that they may put into practice the knowledge they acquire within the four walls of a classroom and translate the same in a manner that will be at par with global standards. CEU College of Dentistry: The first Dental School in South East Asia to be PeerReviewed by the South East Asia Association for Dental Education (SEEADE) The South East Asia Association for Dental Education (SEEADE) is an organization that promotes the advancement of Dental Education, Research and Cooperation among Dental Institutions in the SouthEast and East Asia Regions. The organization was formed in 1990 at the Singapore meeting of the Federation Internationale Dentaire (FDI) or World Dental Congress. The early proponents of this organization included Stephen H Y Wei, Eli Schwarz, Teo Choo Soo, Loh Hong Sai, Prathip Phantumvanit, Reuben C Navia, Keng Siong Beng, Esmonde Corbett, Aurelio B Ramos, Herwati Djoharnas and Shau Yuh Yuan. The first council was formed in Singapore in 1990 with Prof Loh Hong Sai as the first President and Keng Siong Beng as the Hon Secretary. The Constitution was then set up the following year and with it the preparation of the First Edition of the Directory of Dental Schools and Research. http://www.seaade.org/History/history.html In 2005 it embarked on its first SEAADE Peer Review and Visitation led by then President Toh Choo Gait to Centro Escolar University, Philippines. Subsequent visits were conducted in University of Indonesia, University Sains Malaysia (USM) and Mahidol University Thailand in 2007. http://www.seaade.org/reports/reports.html The Peer Review and Consultation Programme is composed of a Visitation Panel who are mostly professors coming from different dental institutions in SouthEast Asia. Their scope of work includes the inspection of facilities, meetings with staff and students, observation of clinical teaching sessions and reviewing a variety of supporting documents. From there, the Peer Review seeks to identify key issues that will enable the dental institution to progress further to attain full international status. Varying aspects of the CEU’s College of Dentistry were assessed and reviewed by the Visitation Panel. From its Educational Program, Management and Administrative Structure, Clinical Post Graduate Education and Continuing Professional Development. Human Resources including its auxiliary staff; the physical facilities including the dental laboratory and clinical facilities, Dental Library and Research facilities; Infection Control and Safety matters and Information Technology specifically its accessibility to wi-fi/internet. While the findings indicated certain areas of improvement (as is its primary purpose), the conclusion of the said Peer review, stated;
“There are many significant Best Practices recognised by the Visitors to the College of Dentistry, Centro Escolar University as highlighted in this report. The University in general and the College of Dentistry in particular are poised to realise the vision of being internationally recognised tertiary institutions if actions are taken to address the various areas of concern mentioned in this report.” Under the present leadership of Dean Pearlie P. Lim, the CEU College of Dentistry aims to do just that as it has taken its first step with the SEEADE Peer Review. It is a valuable advantage that will serve its purpose well as it pursues international recognition in light of the Asean Integration. CEU College of Dentistry has continuously lived up to its vision, “To be the leader in dental education nationally and internationally”. And it does so by espousing the fundamental foundation of every Escolarian - Ciencia y Virtud (Science and Virtue). DA
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ON THE COVER:
107 PDA Presidential Elections
n May 28, 2016 the PDA Elections will mark another history in the making where both the President and President - Elect will be lauded for the highest position in the Philippine Dental Association. Presidential standard bearers for 2016-2017 Dr Maridin Lacson and Dr Carlos Buendia, together with their Party List will set foot on the sacred ground of the SMX Convention Center to reveal their foremost platform to the general membership. Running for the PDA Presidential Elect are Drs Mark Villalobos (Independent), Balbino Villanueva (PDA White Team), and Flor Enriquez (Independent). The 107th PDA Annual Convention and Scientific Seminar is among the biggest dental exhibition in the Asia Pacific that is anticipated by delegates, exhibitors and visitors every year. In last year’s event, the PDA Elections was cancelled. This year, all presidential candidates including the electoral candidates will have a chance to showcase their political agenda that will include reforms and educational programs for the benefit of the general membership. DA
18 • D E N T AL AC C E S S • APR IL
CLINICAL ARTICLES Biomimicry using a Modifiable, Intelligent Shading System in the placement of Direct Layered Composite Resin Veneers in a post-trauma case Dr. Clarence Tam
Treatment List ( FDI classification ) • Tooth 11MIB: Direct acid-etched layered resin restoration (com plex veneer) • Tooth 21MIDBL: Direct acid-etched layered resin restoration (3/4 crown) Restorative Material • Lingual Shelf: Amaris TN: Translucent Neutral (VOCO) • Opaque layer: Amaris O3 (deep dentin and cervical locations) • Secondary Opaque layer: Amaris O2 (subsurface dentin and in cisal dentin characterization) • Incisal effects: Amaris HT (high translucency) flowable • Facial enamel layer: Amaris TL (Translucent Light) Adhesive System • Tooth 11MIB: acid-etched 4th generation (Kerr Optibond FL) preparation • Tooth 21MIDBL: acid-etched 4th generation (Kerr Optibond FL) preparation.
Introduction and Chief Complaint The male patient (16) presented to my service on referral from an endodontist in Auckland. His tooth 11 and 21 had been subjected to major trauma when he accidentally slipped off a cliff at the age of seven. He reported multiple past root canal attempts with functional failure attributed to coronal leakage and recontamination and esthetic failure associated with dark dental staining secondary to hemosiderin retention and bacterial mass ingress. Teeth 11 and 21 exhibit old composite restorations described as discolored, uneven and unacceptable, causing anxiety. Adding to this complexity, a repaired sub-gingival perforation was present in the immediate sub-gingival mid-buccal region causing gingival irregularity with a recently resolved periodontal pocket. The distal aspect of 21 had also been under contoured, leaving a sub-gingival shelf or under hang in this region with a deficient emergence profile. The patient desired more even, longer and attractive central incisors but had both financial and residual dento-structural limitations. Medical History Conditions: none reported Medications: none Allergies: none Diagnosis and Treatment Plan Diagnosis The specific examination began with an extra-oral examination of the patient’s lymph nodes, salivary glands, muscles of mastication and temporomandibular joints. His range of motion was 50mm and judged to be within normal limits. A specific review of his upper anterior dental sextant revealed deepest peri-tooth probing depths of this region to be 4mm in the 21DB region.
All other regions measured were recorded as a maximum of 3mm with bleeding on probing. Hard tissue examination revealed a shorter clinical crown on tooth 21 compared to 11. Tooth 21 was also in positioned in buccoversion or proclined compared to 11. The distal aspect of tooth 21 was where the “under hang” existed, and as such, there was a hard tissue deficiency present sub-gingivally affecting the emergence profile from distobuccal to distolingual aspects. Teeth 13 to 23 were not tender to percussion or palpation, and exhibited no significant clinical mobility. Radiographic examination involved a single peri-apical radiograph of the region. Large obturation spaces were noted with the absence of a post structure. This would require a preparation that was conservative of a maximal amount of the existing tooth structure as the lack of need for a post was again discussed with the endodontist and confirmed as not required before proceeding. Discussions with the patient revolved around the placement of two direct, layered complex composite veneer restorations to correct his esthetic concern, removing a minimum of tooth structure. Width:height ratios would be improved to better approximate an 0.8:1.0 width:height ratio as per ideal proportions. An option was also given to patient to have bonded porcelain restorations placed, as this would have a positive effect on coronal strengthening. Although the patient and his mother was interested in this option, the patient’s desire for reparability with potential future accidents and financial constraints were the limiting factors. The patient accepted my advice on the placement of direct, layered composite veneers on 11 and 21. Treatment Plan • Cursory examination (hard and soft tissue): extra-oral and intra- oral • Pre-operative peri-apical radiographs x 1 • Informed consent • 12 pre-operative American Academy of Cosmetic Dentistry (AACD) photo series taken • Color mapping • Anesthesia, split rubber dam isolation and preparation • Micro air abrasion (50 micron aluminum oxide) Etch, bond, direct, layered restoration with Amaris (VOCO) TN, O3, O2, HT and TL for teeth 11 and 21. • Rough primary and secondary anatomy finishing on first day • Confirm color integration, modification as necessary, final con touring and polishing 48 hours later (to wait for resin to set optimally before final polish ). • 12 post-operative AACD photo series taken along with post-op erative periapical radiograph. Description of Treatment Including Rationale for Choice of Restorative Material The patient was a 16 year old man referred to my service for cosmetic dental bonding by a local endodontist in Auckland. The endodontist had completed obturations of 11 and 21 using Gutta Percha and Roths sealer. The core had been restored using a liner of Cavit (3M Espe) in the deeper layer, non-descript B1 flowable and B2 composite. Following the specific examination, diagnosis, treatment plan and informed consent, the patient was recalled on a second day for preparation and completion of two direct, layered complex composite resin veneers on 11 and 21. The patient was anaesthetized ( 1.5 carpules of 4% Articaine (amide anaesthetic) with 1:105 epinephrine, fig. 1). Prior to split dam isolation (fig. 2), the colour map was immediately charted. It is noted that any given time, color assessment is a snapshot of the varying optical properties of the tooth in flux. This assessment is influenced by dehydration, time/aging, and is depending on 5 variables: hue, chroma, translucency, fluorescence and opalescence. Irfan Ahmad describes the color match at any given time is more ephemeral rather than eternal.1 A PRIL 2 0 1 6 • D E N TA L A CCE S S • 19
A diode laser gingivectomy (Ezelase 940nm, Biolase, 1.5W continuous) was completed to remove overgrown tissue in the underhang shelf region subgingivally on the distoaxial surface as described previously (fig. 3). The use of the laser facilitated simultaneous tissue removal and hemostasis, producing ideal conditions for bonding and was selected because the 940nm wavelength is optimally absorbed by hemoglobin and oxyhemoglobin. The subgingival perforation and repair can be visualised in this photograph, along with the translucent composite used by the dentist in the previous core. It was decided that complete removal of existing composite would result in possibly more damage to residual tooth structure so the preparation was stopped at this point. Caries detector dye (Caries Detector, Kuraray) was utilized at this point to visualize and remove residual bacterial mass, ensuring a hard, clean dentin base. Following dry #0 (Ultrapak, Ultradent) retraction cord placement via the continuous buccal sulcus packing technique, micro air abrasion was completed using 50 micron aluminum oxide for increased micromechanical retention (fig. 4). Etching with 33% orthophosphoric acid was completed, followed by application of a 4th generation, 3-step total etch adhesive system (Optibond FL, Kerr). The initial layer was the lingual shelf, created for both 11 and 21 freehand with the use of a Mylar matrix strip (fig. 5). The initial layer would have been more easily created with the use of a putty matrix fabricated from a diagnostic wax-up, however the patient chose to omit this step due to financial limitations. This initial layer is approximately 0.3mm thick, reestablishes the desired length and proportions of the tooth, and is fabricated from a milkywhite translucent enamel shade. Amaris TN (translucent neutral) was the shade used for this scaffold. The goal of the next layer was to start to mask out the translucent background as best as possible with opaque dentin shades. The opacity would be positioned in a way to block out the visibility of the join lines. Failure to do this would lead to a less-attractive final outcome. The limitation in this case was the thickness and translucency of the residual core due to past materials used. Amaris O3 (Opaque #3) was used in the distoaxial region in the deeper layers to visualize whether this shade was adequate to match the stump shade of the tooth (fig. 6). After curing, it was decided that a slightly lighter opaque shade (Opaque #2) would be utilized in the superficial layers to best match the target value of the tooth (fig. 7). This mathematical modifiability of Amaris makes direct esthetic dentistry a breeze and a pleasure to do. This layer is also important because dentin creates the basic hue of the tooth and complements the fluorescence and chromatic interpretation of the final restoration.4 The superficial dentin layer was sculpted and burnished cervically in the marginal areas to occlude the buccal subgingival perforation region. The incisal half was created from a second increment of Amaris O2 and burnished incisally. This layer is characterized by irregular fingers of dentin which will form the basis of the incisal effects seen in the final product. Lobe formation of the dentin layer is also built into this superficial dentinal layer before final curing. The next layer involves a highly-translucent shade used in the incisal fingerling and dentinal lobe areas as a space filler. The use of a clear translucent shade increases the light penetration, transmission, reflection and refraction of this area in the finished result (fig. 8). The shade is now assessed with the dehydrated shade of the adjacent teeth. It is an imperative that once the color map is decided on, that there is very little or no intra-operative modification. The lighter appearance of everdehydrating teeth is a great distractor, tricking many clinicians to create teeth that will stay too white after the adjacent dentition has rehydrated. In this case, the patient had requested slightly whiter teeth as he had wanted to complete vital tooth bleaching on the adjacent teeth sometime in the future. As central incisors are often a fraction lighter than the lateral incisors in nature, it was decided that we would place a lighter enamel shade (TL: translucent light) instead of our planned shade (TN: translucent neutral). Again, this mathematical modifiability of Amaris allows value control of the final product at different stages in the buildup. 20 • D E N T AL AC C E S S • APR IL
There are two balls of cured Amaris composite placed on tooth 11 as an intra-operative shade guide: the more incisally-placed ball is TN (translucent neutral), and the more cervical ball is TL (translucent light). TL applied by itself in a thick layer would increase the value of the tooth beyond our target shade (fig. 9), so it is important to always judge the thickness and morphology of your dentin layers from the incisal aspect.1 In this case, a very thin layer of final enamel-shaded composite was all that was required to build the tooth emergence profile and line angles to full profile, and thus it was decided to use TL to slightly lift the value of the dentin layer (fig. 10). Following final curing, contacts were opened using light interdental separating force (The “Mopper Pop”) and finished using moderate and fine abrasive metal strips (GC) as well as Epitex abrasive polymer strips (GC). Pencil markings were placed on the labial surface guiding preservation of line angles and emergence profile. Primary and secondary anatomy finishing was completed using coarse abrasive discs (Soflex, 3M ESPE) and fine needleshaped diamond grit burs (Mani Dia-Burs). Polishing was completed using the Double Diamond two-step (Clinician’s Choice) System at 5000 rpm to high shine, followed by final buffing using an aluminum oxide paste (Enamelize, Cosmedent) on a felt disc (Flexibuff, Cosmedent, fig. 11). The patient was sent away for gingival healing and final composite set before recall and final polishing (fig. 12). Rationale for Choice of Restorative Material For the patient, a 16 year old young male with multiple structural coronal compromises in his upper central incisors, it was important to select a composite system with both superior physical properties and an advanced shading system which would be critical in recreating the optical nuances of nature. The goal in this case is biomimicry through restoration of original tooth volume, maverick effects and anatomy. Tooth reduction required in this case was minimal, perhaps 15-20% of total tooth volume. Residual tooth volume in this case was comprised of a tight intermingling between core material and irregular tooth structure. It was thought best not to disturb this matrix as there was no evidence of deeper caries and the high risk of reducing yet even more precious dentin structure. Pascal Magne advocates bonded porcelain restorations in cases where structural coronal compromise is greater than 60% of the original tooth volume. This figure represents the critical threshold of minimal crown stiffness needed for long-term performance where increased loss will require a material with heightened physical properties. A composite material is more flexible than porcelain and when used to regain stiffness in a criticallyweakened tooth renders it still highly susceptible to fracture.3 Tooth 21 in this case exhibited less than 40% residual tooth structure, and would have been a good candidate for a bonded porcelain restoration, if financial constraints were a non-issue. Esthetic symmetry would have been most predictable by also placing a bonded porcelain restoration on tooth 11, but again was not possible in this case. It was realized before we started that the residual stump shade would be different from if the teeth exhibited intact dentin, and thus the flexibility of being able to modify shading intra-operatively became invaluable. The solution then, was to use a modern super composite that not only ranked highly in physical properties, but also exhibited an intelligent shading concept, that would allow value modification on the go. This case utilized the achromatic enamel technique according to Newton Fahl.2 The case utilized a non-Vita-shade enamel layer (Amaris TN: translucent neutral) with the chroma being composed of two dentin shades (Amaris O3 and O2). In this case, the value of O3 was judged to be too low relative to our target value, and hence utilizing the Intellligent Shade Concept coined by VOCO, was able to be modified using a dentin shade of brighter value, O2. The value was modified further by the use of a highervalue enamel layer than initially proposed (Amaris TL: translucent light). Precision of incremental layer thickness is crucial to the development of the shade match. Too thick an enamel layer will create a result with lower value than intended. Too thick a dentin layer will affect value, hue and chroma.1 This was judged frequently and systematically from the incisal edge as volume was rebuilt.
In this case, the preservation of residual intact dentin volume was key in our decision to leave the bulk of core structure intact. The use of an intelligent composite system that allows mathematical modifiability as core shade changes intra-operatively was crucial to the success of this case. The ability to recreate lost tooth volume, contours and optical nuances using a single system with the brains to help you through unexpected esthetic intra-operative hurdles really does make Amaris a modern super composite and a key instrument in the modern, conservative esthetic dentist’s arsenal. Featuring one of the most highly-polishable surfaces in combination with minimal surface roughness and 3-body abrasion features will provide this patient with a functional and ultra-esthetic result that lasts. Amaris is a formula: a formula for predictability in difficult anterior esthetics as well as the simple equation that will keep our patients smiling long into the future. DA
Fig. 9: Cured Amaris composite balls placed on tooth 11 to assess whether TN (lower value ball) or TL (higher value ball) would be most suited to the final situation.
Fig. 10: Amaris TL was used in a single increment to replace the facial enamel layer.
Fig. 11: Immediate post-operative result after contouring, finishing and polishing on Day 1
Fig. 12: 48 hour post-operative full frontal smile view 1:2 ratio unretracted
Fig. 13: 48 hour post-operative right lateral smile view 1:2 ratio unretracted. One can appreciate the development of incisal optical details and facial anatomy.
Fig. 14: 48 hour post-operative left lateral smile view 1:2 ratio unretracted. Indetectable restorations with good structural and color integration in the upper anterior sextant producing a very happy patient.
Fig. 1: Baseline full smile view: 1:2 ratio frontal aspect. The old composite bonding and asymmetry between 11 and 21 (FDI classification) is clearly visible, as is marked horizontal fluorotic streaking.
Fig. 2: Immediate Pre-operative situation: split dam isolation (Roeko, Coltene) with a nonlatex dam
Fig. 3: Laser gingivectomy on 21 distal axial and gingival aspects to expose marginal position. Preparations completed to full intended depth.
Fig. 4: Micro air abrasion used and dry, braided retraction cord (#0, Ultrapak, Ultradent) packed in sulcus via continuous buccal sulcus packing technique.
Fig. 5: Lingual shelf created (freehand) using Amaris TN (VOCO). Thickness is approximately 0.3mm.
Fig. 6: Initial deep layering in distobuccal aspect using Amaris O3.
Fig. 7: Secondary dentin body layering using Amaris O2. Internal dental lobes and incisal detail are sculpted in this layer.
1) Ahmad, I. Chromatically-Crafted Restorations: Shade Matching with Resin-Based Composites. J. Cosmetic Dent. 2013; 29(1): 43-50. 2) Fahl, N. Jr. Step-by-Step Approaches for Anterior Direct Restorative Challenges: Mastering Composite Artistry to Creat Anterior Masterpieces – Part 2. J. Cosmetic Dent. 2010; 26(4): 42-55. 3) Magne, P. and Belser, U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomimetic Approach. (2003) Quintessence Publishing Co, Inc. pp. 50-55. 4) Milnar, F.J. and Wohlberg, J. Direct Resin Veneers: Case Type V for AACD Accreditation. J. Cosmetic Dent. 2013; 29(1): 110-118. About the Author
Fig. 8: Incisal translucency of the final product is enhanced by applying Amaris HT flowable over the incisal 1/5th of the tooth and cured.
Dr Clarence Tam maintains a private practice in Newmarket, Auckland (New Zealand), with a special focus on cosmetic and restorative dentistry. Born and raised in Canada, she is a graduate of the University of Western Ontario also having completed a General Practice Residency at the University of Toronto/Hospital for Sick Children. She is the Director and Chairperson of the New Zealand Academy of Cosmetic Dentistry. Contact: Dr. Clarence Tam, HBSc, DDS Cosmetic and General Dentistry Morrow Street Dental 18 Morrow Street Newmarket, Auckland 1023 E-Mail: email@example.com www. clarencetam.co.nz A PRIL 2 0 1 6 • D E N TA L A CCE S S • 21
Hollywood Visual Effects in Dentistry Dr Kevin Ho
Imagine if you could practice procedures and truly learn complex clinical skills from the comfort of your own home.
raditionally dentists are used to attending expensive in-person seminars and confer ences to learn.
But the times are changing. With more dentists graduating every year, and more dentists appearing around every corner, it’s become more expensive to take time off. The need to learn skills efficiently and conveniently, without the exorbitant cost, has never been greater. This is where online education can revolutionize dental courses - but not the ones we’re used to. Online dental education has always been thought of as a static clinical video or lecture, and has always been perceived as inferior to in-person offering. But what if they were interactive? What if you could practice procedures virtually? What if these courses could be better than many in-person courses? By bringing technologies, once exclusive to the game and film industry, to dental education, this is now a possibility. Orosim, Inc. a Silicon Valley based company, has created the closest thing to treating a patient online – a virtual training platform for dentists. Accessing these 3D interactive courses is easy, all you need is access to the Internet and a web-browser – there are no downloads or plugins required. Interactive 3D courses marks the start of the next big thing in clinical education: Virtual and augmented reality. Apple has already filed several patents for virtual reality headsets. Healthcare training has been acknowledged as one of the fields that will be transformed by virtual reality, as reported in Forbes’ magazine.
About the Author Dr Kevin Ho is a Clinical Assistant Professor from the University of British Columbia, School of Dentistry. He’s board certified in both Australia and Canada. He is the Founder and CEO of Orosim – a VR Training Platform for Healthcare Professionals. E: firstname.lastname@example.org W:www.orosim.com 22 • D E N T AL AC C E S S • APR IL
What does this mean for dentistry? Imagine opening up a textbook or watching a video online, and then to have the procedure appear right on top of your desk in interactive 3D. Visualise how easy it would be to understand and learn complex clinical procedures. This is no longer science fiction – it’s real! Healthcare training will evolve radically in the coming months. Watch this space. DA
WHAT WENT WRONG SPECIAL FEATURE
IDEM Singapore 2016 Concludes on a Successful Note
his year’s IDEM Singapore closed on a high note, bringing together 8,173 visitors and conference delegates to witness sharing by world class speakers and exciting innovations being showcased. IDEM Singapore 2016 has successfully concluded its three days’ exhibition and conference, held from 8th-10th April 2016 at the Suntec Singapore Convention and Exhibition Centre. For the first time, the event saw a larger exhibition space of 18,000 sqm. The event was held over three levels; i.e. level 3, 4 & 6 with 8,173 visitors and conference delegates from 72 countries participating. Comprising of both the trade exhibition and scientific conference, visitors and delegates were updated on cutting-edge dental technology and practical clinical products and techniques based on findings in emerging research. 512 exhibitors from 38 countries were present to showcase their latest innovations in clinical dentistry, digital technology and patient care products.
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ADS SPECIAL FEATURE
More sophisticated innovations
he IDEM Singapore 2016 trade show once again proved to be the preferred platform for exhibitors who wish to enter into the Asian markets, with one-third of exhibitors exhibiting for the first time at the event. Laísa França, Trade Promotion Coordinator for ABIMO, the Brazilian Medical Devices Manufacturers Association, shared her opinion on the association’s IDEM Singapore 2016 experience: “Being geographically further away from the Asia-Pacific region, it is important for us to update our new technologies and the needs of the industry as we see Singapore as a key target for the dental industry. We hope to be able to participate in the next edition of IDEM Singapore in 2018”. Numerous new and returning exhibitors who presented their latest innovative products were met with excitement and warm welcome from dental professionals and visitors alike. Amir Cahaner, VicePresident for Adin Dental Implant Systems an Israeli company, shared his thoughts on the importance of Asia for the dental market. “The future of the dental market is here in Asia. Other markets are matured or saturated and Asia is the place where things happen fast and on a large scale. IDEM Singapore is the gateway into the Asian market, it is the best place to meet a full range of product manufacturers, and make an informed decision of how you’re going to proceed with your treatments.”
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Knowledge beyond the teeth
his year’s scientific conference was once again filled with enriching and informative sessions for dental practitioners and professionals. The theme this year was “Striving for Clinical Excellence”, with the programme focusing on technical, practical and molecular methods used to improve a patient’s oral health. The extensive scientific conference ran for three days, and featured 42 different conference sessions and 37 international speakers. Against the backdrop of the conference theme, visitors were presented with many thought-provoking discussions. One of the highlights of the event was the full-day symposium, “Towards the PostAmalgam Era” moderated by Dr. Hien Ngo. The symposium brought to light a highly topical issue facing the practice of dentistry and the delivery of dental care. Speakers shed light on the background and implications for the dental industry as a result of the Minamata Convention. The symposium rounded off with an insightful and lively panel discussion session. “Dental practitioners must be fully aware that dentistry is not merely about matters pertaining to the teeth, but it goes beyond. For instance, it has an impact on the environment, where biomaterials are concerned. As a result, dental schools need to educate and train dental professionals and students on the proper usage and disposal of dental materials,” said Professor Martin Tyas, World Dental Federation (FDI) speaker at the symposium. Prof. Loh Hong Sai, Former Dean, Faculty of Dentistry, National University of Singapore (NUS), who presented at the Dental Hygienist & Therapist Forum on the topic, ‘What you do not know about Dentistry’ is well-acquainted with the importance of inter-disciplinary management of oral health. “Dentistry is more than just the treatment of the tooth. The oral health being an essential part to a patient’s well-being, requires a thorough and holistic understanding of medicine from the members of the dental team. With dental technology advancing at a rapid pace, research, treatment and management will require very close collaboration.” AAPRIL pr il 2 0 1 6 • D E N TA L A CCE S S • 25
Anticipating the Future of Dentistry
s countries in the Asia-Pacific devel op economically, consumers will de mand better health and dental services. In return, this will boost the dental industry in the respective country and the region. “With an ongoing progressive dental industry in Asia, it will further underscore IDEM Singapore as a strategic event for industry players. The IDEM Singapore 2016 show statistics proved once again that we are Asia-Pacific’s most anticipated event on the dental calendar, providing all visitors the knowledge and insights in the industry. We will strive to continue to be the preferred platform for the dental industry to grow in this region,’ said Mr. Michael Dreyer, Vice President, Asia-Pacific, Koelnmesse Pte Ltd. Forging close partnerships with local and international organizations can also help to accelerate the development of the dental industry. As the industry grows globally, sharing knowledge and insights acrossboundaries will increase in importance for the progression of experts and professionals. “IDEM Singapore 2016 was a very successful event for the industry, as well for the Singapore Dental Association (SDA).
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We encourage professionalism and continuous learning through events such as IDEM Singapore. Through our partnership and efforts, we hope to ensure more participation from industry leaders in Asia and worldwide,” said Dr. Kuan Chee Keong, President of SDA. While IDEM Singapore 2016 comes to a close, planning for the next special milestone, the 10th edition of IDEM Singapore has already begun. Committed to advancing the dental industry, close cooperation with more specialist associations such as the International Academy of Periodontology (IAP) are in the pipeline. “Establishing a Symposium on Periodontology as part of IDEM Singapore 2018 is an exciting new prospect for us. IDEM Singapore seems like the natural partner for IAP to collaborate with in the Asia-Pacific region, as they already organize such a professional conference and international exhibition. We hope to help raise the clinical credibility of IDEM Singapore by bringing in a speaker of the highest caliber in the field of periodontology,” said Professor Ajay Kakar, President of IAP. The 10th edition of IDEM Singapore 2018 will be held from 13th – 15th April 2018. DA
IDEM SINGAPORE 2016
Dr. Loh Hong Sai
Dr. Loh Hong Sai is an Oral Surgeon who took up his basic dental degree from National University of Singapore in 1972. He obtained his Fellowship in Dental Surgery at the Royal College of Physicians and Surgeons of Glasgow in 1976, Fellowship of the Academy of Medicine, Singapore in 1981 and Fellowship in Dental Surgery of the Royal College of Surgeons of England in 1992. He has held various positions in the NUS from 1980 - 1995. Dr. Loh is also the President of the International Society for Lasers in Dentistry, the Chairman of the Medical Aumni Association and is former Secretary and Council Member of the Singapore Dental Association.
Conference Topic: “What You Do not Know about Dentistry”,
The International Dental Exhibition and Meeting, known as IDEM SINGAPORE 2016, is a leading dental event in the Asia Pacific Region. It is a specialized dental trade fair participated in by more than 550 trade exhibitors from all over the world. The event serves as a gateway of international dental manufacturers and distributors to penetrate the Asian market by introducing their company’s new innovations in dental products and technology. With a professional congress incorporated into the trade fair, it features a wide variety of lectures that cater to dentists, dental hygienists and dental therapists including a forum for new dentists. It is among one of the many dental trade fairs anticipated in the industry that Dental Access has witnessed and will share to its colleagues in the profession. IDEM Singapore 2016 was jointly organized by Koelnmesse Pte Ltd., and Singapore Dental Association.
Interview with the Stars (of Dentistry) Considered as dental luminaries in their respective fields, several lecturers lent their knowledge and expertise to the delegates who attended the event. The author considers herself lucky to have had the privilege to get up close and personal with the “brightest stars” in the world of dentistry.
(Dr.Loh): Dentistry is a branch of Medicine. Surprisingly, the mouth is strategically located in the face, so just as your eyes are windows to the world, the mouth is the pathway to your health. It is the entry of your food, beginning with the digestive system. We also talk about the face because now is the age of esthetics so dentistry provides a great deal of facial esthetics - the smile, your teeth, lip structure, facial structure, the soft tissues and so on. You know, in some countries, they call themselves stomatologists. Why? Because they’re doctors. They go for medicine first, then they do dentistry. In Asia, specifically, they do dentistry primarily as a separate entity. But in Russia or China, they call themselves stomatologists (science dealing with the mouth and its diseases-Ed) because they recognize that as medical health or medical oral health. In our undergraduate course, we spend about 60% of our initial years learning medicine including anatomy, biochemistry, physiology, medicine, surgery, the whole thing because when you’re dealing with a patient, you diagnose them holistically. For example, a diabetic patient comes to you, you must understand the disease and how it affects the oral environment before you treat him. On the contrary, in a medical college at least in Singapore, they are not given the opportunity to study dentistry. They cannot obtain a dental clinic nor a dental xray. But we spend the entire four years where 60% of that knowledge and application revolves around medicine then the final 2 years, we do dentistry. So, we know fairly (well), including the general dentists, they are able to attend to medically-compromised patients coming to you for dental needs. They can manage.
Dr. Serge DiBart
Dr. Serge DiBart is Professor and Chair of the Department of Periodontology and Oral Biology at the Boston University Henry M. Goldman School of Dental Medicine. He was also a research associate in Dr. Sigmund Socransky’s laboratory at the Forsythe Institute and senior periodontist at Boston’s Children’s Hospital before he was appointed to his latest position at Boston University. He has been working on periodontally accelerated orthodontics for the past 10 years. In 2009, he developed Piezocision© which is a minimally invasive alternative to existing surgical procedures. he is also an author of 4 books (Wiley-Blackwell editorship) and is a diplomate of the ABP. He maintains a private practicr limited to Periodontics and Implant Dentistry in Boston, Massachusetts.
Conference Topic: Piezocision ©For Rapid Orthodontic Therapy: A Multi-Disciplinary Team Approach
Dr DiBart): It’s a minimally invasive method that helps to achieve rapid tooth movement using microsurgery, micro incisions. Usually in the buccal gingiva where it allows transient demineralization so that treatment can be shortened from a span of two years to approximately 8 months-time. Why is it important? Because more adults are looking to get braces. And the last thing that the adult wants is to have braces that lasts up to 3 years. So they are able to shorten it by 60 to 70 percent and that’s better for everyone. It is a concept that is now developed as a technique in order to improve the treatment outcome of orthodontics. It makes use of a piezoelectric knife which is very specific. The vibration which aids in the response of the bone has developed new ways to increase orthodontic treatment time not only in terms of speed, but in terms of being able to correct malocclusions that normally should be treated with traumatic surgery. We are able now to treat them with less invasive surgery. The success rate is very high because the technique is minimally invasive. Furthermore there is no patient discomfort to speak of. With the piezocision©, we make small openings and make precise cuts that is well-managed. In return, dentists achieve better results in movement that were not possible before or were much difficult to do with conventional (sic). With Class 3 cases, you can now move the teeth and the jaw bone selectively with piezocision © without doing extensive surgery.
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Dr. Ian Meyers
Dr. Ian Meyers is a general dental practitioner at Indooroopilly in Brisbane, Australia and has honorary professional positions with The University of Queensland School of Dentistry and James Cook University of Medicine and Dentistry. He has been an academic staff member with The University of Queensland School of Dentistry since 1988. He is a member of the International Association for Dental Research, Immediate Past Chairman of the Australian Dental Research Foundation and Chair of the MRACDS Examinations Committee and member of the Continuing Professional Development Committee with the RACDS. His major clinical interest is in the field of restorative dentistry.
Conference Topic: The Broken Down Compromised Dentition - Risk Factors and Appropriate Interventions For Long-Term Outcomes
Dr Adrian Lussi Dr Adrian Lussi is Professor and Head of the Department of Operative, Preventive and Paediatric Dentistry University of Bern, Switzerland. In the same Department, he was head of the Pediatric Dentistry Division for eleven years. He holds a diploma in chemistry of the Swiss Federal University of Technology Zurich, Switzerland, a teaching licence at college level with chemistry as main subject as well as a diploma and a doctorate in dentistry of the University Berne, Switzerland. His research over the past 25 years has covered several aspects of erosion, caries diagnosis as well as minimally invasive preparation techniques in operative dentistry. He has published over 400 articles and edited four text books. He has received numerous National and International awards.
Conference Topic: Erosive Tooth Wear From Diagnosis to Therapy
(Dr. Lussi) In the older days, there are about 10 to 15 indeces to measure. There is a new method to measure with nowadays called BEWE, it’s a simple way to measure erosion. Before we can do therapy, we should know the cause. Then we should also introduce sporadic measures such as change of habits, such as probably instead of taking acidic drink, we take orange juice calcium. The therapy can also be simple. Only, sealing by composites then you can make complex restorations direct or crowns. In our department we employ gastroenterologists. They help in making the diagnosis. Other parts belong to operative dentistry. Other parts belong to constructive dentistry; we have access to psychologists in our department we have a lot of interdisciplinary. Not all dentists know how and what a tooth erosion really looks like so you have to be aware of the risk factors. Only knowing the risk factors, be it nutritional or behavioural risk factors, be it from intrinsic or extrinsic, from these you can start to recognize and know the facts and treat it. Actually there are 4 points: Diagnosis, Risk factors, Prevention, and Therapy and they are available in my published books.
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(Dr Meyers): As older people are able to retain their teeth, its suffice to say that their dentition had undergone a period of restoration overtime. And we went through a period instead of taking teeth out, teeth are restored. Still, several issues are being confronted by dentists such as caries, erosion, decreased vertical dimension due to wear and tear. These patients have complex problems that require tedious treatments overtime. We cannot discount the fact that dental work such as high level ceramic crowns or implants are far fetched in their budget so that can be hindrance to counter these dental problems. I treat patients with the philosophy of working on why they are where they are. And quite often they have a badly broken down dentition. Does it have to do something with their diet, or lifestyle or medications? Regardless of the kind of restoration you may use, you have to ensure that their own environment is stable and that you know the risks and by risks I mean, anything that results in more caries, more plaque, more periodontal disease, more tooth erosion. So risk management is all about controlling things before you restore; rather than simply saying that a teeth needs to be restored and fixing it. It has to be how it got to that stage, how to stabilize it and then choosing the appropriate restorative (material). From my perspective a lot of the composite resins and glass ionomers can work very efficiently on those cases. Maybe not as long as some of the strongest ceramic tools but they can certainly work efficiently in a cost-effective way in managing those patients, provided they can maintain their good oral hygiene and then you can structure more complex restorations over a period of time rather than doing them all at once. Compromised dentition are the ones that don’t have full function; have lost tooth structure that you get rapid breakdown of dentin because you’ve lost enamel protection. It can also be because of lost tooth structure from previous restorations. So once you get fractured restorations, you lose normal tooth structure that maintains balance so it goes out of balance. For my patients we go for direct composite resin-based restorations immediately because they are reasonably costeffective which can be done in short periods of time so patients can have a fairly very rapid resolution on some of their compromised dentitions and have a bit of function. And once we see the patient has the ability to look after that and maintain it, then I’ll know that its time for them to receive a more complex restoration such as bridgework and so forth.
Dr. Ray C. Williams, D.M.D. serves as the Straumann Distinguished Professor and Chairman of the Department of Periodontology at the University of North Carolina, School of Dentistry at Chapel Hill. From 1974 to 1994 Dr. Williams was a Member of the Faculty of the Harvard School of Dental Medicine where from 1981 to 1994, he was Graduate Program Director and from 1983 to 1994, he served as the Head of the Department of Periodontology. Dr. Williams received his DMD (with honors) from the University of Alabama, School of Dentistry and his certificate in Periodontology and Oral Medicine from the Harvard School of Dental Medicine. He was a postdoctoral felDr. Ray C. Williams low in microbiology at the Forsyth Institute in Boston. He is a member of the American and International Associations of Dental Research, the American Dental Education Association, the American and International College of Dentists, the American Academy of Periodontology and the American Dental Association where he serves on the Council on Scientific Affairs. He is the FDI World Dental Federation’s liaison to the United Nations. Dr. Williams has authored 140 papers. He is co-editor of the textbook Periodontal Disease and Overall Health: A Clinician’s Guide. In 2004, he received the American Academy of Periodontology’s Outstanding Educator Award. In 2008 he received the University of North Carolina’s Distinguished Teaching Award and the American Academy of Periodontology’s Gold Medal Award.
Conference Topic: The Importance of Oral Health in Overall Health: The Expanding Role of the Dental Professional
(Dr Williams): The more that evidence mounts that there is a true relationship between oral health and over-all health; that more and more of medicine and dentistry need to work together to talk about wellness, to talk about overall health, to talk about prevention, to talk about precision dentistry and it’s coming. Some of the medical specialties are particularly helpful such as cardiolog. They are really very anxious to work with dentistry to minimize the role of poor oral health in cardiovascular diseases. Since 1989, dentistry is holistic. Dentistry is its own profession but the relationship of oral health with overall health is critical. I personally would go carefully within the scope of the practice. I cannot diagnose diabetes but I can observe that the patient is probably suffering from diabetes and refer that patient to the physician. I cannot diagnose cardiovascular disease but I can observe that that person needs to see a cardiologist. So, more and more dentistry has got to be very observant of patients and pick up all the signs and symptoms of how is that person doing and get them to see the appropriate person. Dentistry has a responsibility of understanding signs and symptoms and referring them to physicians. Nothing makes physicians happier than have an educated dentist whom they can work with together, take care of the patient together. DA
BY MICROCOPY Gazelle Nano Composite Polishers
BY MAGPIE TECH CORP. Scooba Ultrasonic Cleaner
BY BIOLASE Epic X Diode Laser
Anti-crumble silicon ensures durability. Gazelle does not crumble. No paste needed. Individually packaged and sterile.
The Scooba is an ultrasonic cleaner that features a large corrosion resistant stainless steel tank that is also easy to drain. Abundant airflow around internal electronic modules prevents the unit from overheating when the tank is heated.
The Epic X diode laser features cutting edge software, and a cordless foot pedal. It is capable of a full range of soft tissue procedures as well as laser-assisted whitening and pain relief therapy.
BY SUNI MEDICAL IMAGING, INC. SuniRay 2 Digital Intraoral Sensor SuniRay 2 achieves maximal image quality with superior diagnostic capabilities while maintaining the lowest radiation levels among all digital sensors.
BY DENMAT Perfectemp10 Temporary Crown & Bridge Material Perfectemp10 is a highly esthetic, strong, multifunctional acrylic composite material. It uses a two component system based on a multi-functional acrylic composite that is produced using no Bisphenol-A or Bisphenol-A precursors in the manufacturing process.
BY SHOFU BeautiSealant Pit and Fissure Sealant
BY SHOFU Beautifil Flow Plus Flowable Composite
BeautiSealant Pit and Fissure Sealant is a tooth colored, fluoride recharging, pit and fissure sealant with a self-etching primer that speeds treatment time by eliminating the need for phosphoric acid etching.
BEAUTIFIL Flow Plus, is a radiopaque, base, liner, and final restorative in one. Amazing tooth-like light diffusion and chameleon properties provide intuitive and highly aesthetic outcomes.
BY KERR RESTORATIVES Herculite Ultra Nanohybrid Dental Composite
BY A-DEC INC. A-dec 300 Traditional Dental Delivery System
Herculite Ultra Universal Nanohybrid Dental Composite has herculite gold standard technology and Chameleon quality.
The A-dec 300 delivery System can integrate a quad-volt intraoral light source and two ancillaries.
BY PELTON & CRANE Helios 3000 LED Dental Operatory Light Helios 3000 LED Dental Operatory Light’s LED technology enables color mixing, A “No Cure” setting, and a crisp 3” x 6” light pattern that illuminates only where you need it to.
BY KERR RESTORATIVES SonicFill Sonic-Activated Bulk Fill Composite The SonicFill System comprises a handpiece that enables sonic activation of a specially formulated and conveniently delivered composite.
BY A-DEC INC. A-dec 511 Dental Chair Premium comfort for your patients with great ergonomic access that maintains great access and posture for you.
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BY ALIGN TECHNOLOGY, INC. iTero Element
BY SHOFU Artistic Composite Kit
A fast and versatile digital impression system with a small footprint, the iTero Element offers features well suited to both general dental practices and orthodontic specialists.
The Artistic Composite Kit includes high quality Shofu diamonds, carbides and stones suited for finishing anterior composite restorations.
BY ARMANN GIRRBACH Ceramill CAD/CAM materials Amann Girrbach enables the processing of CAD/CAM materials with absolutely unique precision using a new cutter and diamond trimmer for all Ceramill Motion generations and a special milling and grinding strategy, which was specially developed for these instruments. (Alphadent)
BY ARMANN GIRRBACH Ceramill Zolid
BY DENTSPLY ENDO BUR Dentsply Endo Access Bur
BY DMG Icon
With Ceramill Zolid the dental specialist Amann Girrbach succeeded in providing high-grade zirconia with aesthetically convincing translucency for non-veneered, fully anatomical restorations and veneerable frameworks as well as ensuring long-term stability.
The special diamond coating reduces gouging with its tip matching round bur sizes for initial penetration while its diamond shaft flares the pulp chamber. The cutting surface of the Endo Access Bur is 10mm. The total length is 21mm.
Icon is used for the micro-invasive treatment of smooth surface and proximal caries lesions. In one patient visit, and with no drilling, Icon can arrest the progression of early enamel lesions (caries) and white spot caries-like lesions. (Metro DNC)
BY DURR Tornado 2 - Super SIlent
BY IVOCLAR The New Bluephase N
BY IVOCLAR The New IPS Classic V Powder Opaquer
For decades the Tornado Compressor Programme has stood for quality at an attractive price. Efficiency was again boosted in the new model and energy consumption efficiently reduced by approx. 15 %. red dot design award winner 2011.
With the sales launch of the new Bluephase N product family, Ivoclar Vivadent sets again high standards in the field of LED polymerization devices. Users can choose between three curing lights tailored to individual customer needs.
IPS Classic V Powder Opaquer is developed using a new production method. Users benefit from its great flexibility in application techniques as well as from a fast and efficient veneering process.
BY IVOCLAR IPS e.max Press Multi
BY IVOCLAR Adhese Universal
BY IVOCLAR SR Nexco
An innovative, new ingot now allows highly esthetic restorations showing a lifelike shade progression to be fabricated in a single press sequence.
A new single-component, light-cured universal adhesive for direct and indirect bonding procedures. It features compatibility with all etching techniques: self-etch, selective-enamel-etch and total-etch.
SR Nexco Flask is a new type of flask with the help of which light-curing veneering composites can be pressed on dental frameworks.
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BY IVOCLAR Variolink Esthetic The new luting composite Variolink Esthetic is an esthetic light- and dual-curing composite material for the permanent cementation of demanding ceramic and composite restorations.
BY MAILLEFUR Endo Z Bur The Endo-Z’s long tapered configuration allows easy access to the canal orifices and funnel shaping of the chamber walls. Its’ six specially designed tungsten carbide spiral blade cuts but lifts debris coronally along its flutes. The non-cutting tip helps prevent damage to the chamber floor or walls. Available in one size, in FG and RA versions.
BY PLANMECA Planmeca Romexis® 4.0 a completely renewed all-in-one software
Unident delivers cutting edge technology in a range of hygiene and disinfection products, offering unprecedented performance whilst meeting and exceeding the needs of today’s modern dental practice.
Planmeca Romexis® is the first dental software in the world to combine 2D and 3D imaging and the complete CAD/CAM workflow, while also providing extended connectivity with Planmeca dental equipment.
BY RENFERT Renfert Layart The lay:art system from Renfert comprises 8 different, high quality mixing trays and 8 individual premium line brushes, which the porcelain artists can choose from to suit their own individual style.
BY SIRONA Orthopos XG 3D
BY SIRONA T2 Turbines
ORTHOPHOS XG 3D can capture the patient’s whole jaw in a single span. The field of view is large enough to avoid the stitching of several 3D x-ray images and thus multiple exposure to radiation. Yet it is also small enough to be a time-saver in diagnosis.
The T2 Comfort class provides you with top quality technology for relaxed work. The titanium coated turbines lie comfortably in your hand ensure that control, boost and mini satisfy every requirement.
The kit is composed of titanium scalpel handle for microblades; Molt periosteal elevator and periosteal HP3; Titanium Curved Micro tweezers; Titanium curved micro scissors; Titanium Micro needle holder.
BY UNIDENT Unident Group Selection
BY MEDESY New Periodontal Micro-Surgery Kit
BY TRIHAWK Trihawk Talon Burs The Trihawk Talon Bur cuts horizontally and vertically, cuts amalgam, crowns and bridges faster. An independent study supported the performance, economy, and value of Tri Hawk’s bur, and it was the only single-use bur that rated 100 percent performance in an ADA review.
BY VITA IN-CREAM The new VITA DISCs
BY VITA AKZENT VITA AKZENT® Plus
The DISC product line for the partially yttriumstabilized zirconium dioxide material VITA In-Ceram YZ will be extended to include additional variations for dental CAD/ CAM processing. The new VITA In-Ceram YZ DISC Color and VITA YZ DISC HT will be launched.
The new VITA AKZENT Plus stains provide a complete, integrated system that is both extremely user-friendly and offers exceptional application reliability. Thanks to a broader range of indications, these new stains provide users in practice and laboratory environments with freedom and versatility during processing.
BY VITA VM VITA VMK Master VITA VMK Master, a new ceramic belonging to the VMK (VITA MetallKeramik = VITA metal ceramics) generation for veneering metal frameworks in the conventional CTE range.
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316 Roosevelt Avenue San Francisco Del Monte, Quezon City, Philippines Tel No: (632)374-1111 Fax No: (632) 372-0893
A.V.M. Ortho Inc.
BY PAC-DENT INTERNATIONAL, INC. Rootpro Wireless Endo Motor And Apex Locator
BY DENTSPLY NUPRO White Gold Tooth Whitening System
The RootPro endodontic motor with Low-Speed Handpiece prepares root canals while displaying accurate measurements of the root canal. RootPro also accurately and precisely locates the position of the file inside a root canal, without requiring the user to set the machine to zero.
NUPRO White Gold is a dentist-prescribed, take-home system that has been designed to address your patient’s tooth whitening requirements. Dramatic tooth whitening results can be obtained in one-two weeks with the flexibility of either day or nighttime application.
Orthodontic and Dental Supplies, Recuerdo Townhouse Unite E 6623 E. Ramos Street Pio del Pilar, Makati City, Philippines Tel No: (632) 893-7696
Unit 717 Future Point Plaza 1 112 Panay Ave., Quezon City Philippines 1103 Tel No: (09228696657) ROCO IBE
Philippine College of Surgeons Bldg. Rm. 201 992 EDSA Quezon City, Philippines Tel No: (632) 926-4526 Fax No: (632) 927-1631
Metro DNC Inc.
3/F Chunics Bldg., 3368 Magsaysay Blvd. Sta. Mesa, Manila, Philippines 1016 Tel No: (02) 358-3257
BY HU-FRIEDY Abou-Rass Angled Apical Plugger
BY HU-FRIEDY Retro Filling Plugger
The Abou-Rass Angled Apical Plugger is designed for easy access and visability of the apical foramina.
The Retro Filling Plugger is used to compact filling material during vertical condensation.
Unit 1206 City and Land Mega Plaza ADB Avenue cor Garnet Road Ortigas Center, Pasig City Telephone: ++632.994.8306 Fax: +632.570.9840 Email: email@example.com
FILGEN Business Solutions, Inc.
59 Vista Verde Ave. Executive Village Cainta, Rizal, Philippines 1900 Tel No: (632) 645-7977 Fax No: (632) 646-4968
Suite 1001 Dasma Corporate Center 321 Dasmarinas St. Binondo Manila, Philippines Tel No: (632) 244-5634 Fax No: 244-5639
BY SHOFU Core Shade GlasIonomer Core Build-Up Base Cement CoreShade GlasIonomer is formulated to provide a dependable, easily detectable, metal-free core build-up.
BY ANTHOGYR Ergoject Intralig Syringe Ergonomically designed, these technical syringes allow every kind of anaesthesia, especially intraligamental and intraseptal. A Progressive mechanism which makes the injection very quiet and smooth.
2230 Jose Abad Santos Avenue Tondo, Manila, Philippines Tel No: (632) 252-6171 Fax No: (632) 253-0124
Jandra Global Traders Corp
494 Halcon St., Mandaluyong City Telephone: +632.570.7392 Fax: +632.533.4207 Email: firstname.lastname@example.org
New Citizens Dental Supply
655 Paterno St., Quiapo, Manila 1008 Tel. No.: (632) 733-2977; 733-2982; 733-3769; 733-9504; 733-9529 Cel. No.: 0927-2927696; 0917-8129958 Email: email@example.com
BY 3M Adper Easy Bond Self-Etch Adhesive
BY PHILIPS ORAL HEALTHCARE Zoom Whitening Pen
Eliminating post-operative sensitivity is high on every dentist’s list. With Adper Easy Bond Self-Etch Adhesive the etching and penetration of resin monomers into the demineralized dentin and enamel are carried out simultaneously in one step, thus preserving the collagen structure.
Zoom Whitening Pen as a convenient way for your patients to keep their white smiles on-the-go! The easy-to-use, stylish pen applicator brushes a 5.25% hydrogen peroxide formula directly onto the tooth to touch-up between whitening treatments.
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Suite 615 Don Santiago Building, 1344 Taft Avenue, Ermita, Manila, Philippines Tel No: (632) 5262911
R&R Newtech Dental Corp.
1207 Cityland Herrera Tower Rufino Street cor. Valero St., Salcedo Village, Makati City Tel No: (632) 753-2220 Fax No: (632) 753-2133
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Our April 2016 Issue features the presidential candidates Dr Maridin Lacson and Dr Carlos Buendia. Also featured in this issue is Batangas C...
Published on Apr 1, 2016
Our April 2016 Issue features the presidential candidates Dr Maridin Lacson and Dr Carlos Buendia. Also featured in this issue is Batangas C...