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photo: Dr David Alesna

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Editorial Board Editor in Chief Dr Harris Co Publisher Dr Armi B. Cabero Managing Director Mr. Medardo Chua 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 Vincent Gabriel S. Caagbay Circulation Executive Dr Guenevere N. Uy - Tanchuanko Publication Manager Ms Michelle M. Chua Advisory Board Members Dr Claver O. Acero Jr. Dr Maridin Munda-Lacson Dr Ramonito R. Lee Dr Darwin Lim Dr Derek Mahony Prof Alexander Mersel Dr Antoinette Veluz Designers Mr Christian Nipa (Web Design) Mr Ace John Avila (Graphic 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. 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. ADJ Dental Access Publications Rm 505 Admiralty Building 1101 Alabang - Zapote Road Muntinlupa City 1770 Tel: 02-8937837 2 • D EN TAL AC C E S S • M a r c h 2016

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EDITORIAL 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.



t has been claimed that Dentistry is a noble profession. With that respect, honor and popularity among your peers and patients. However, in my point of view, being a dentist is a calling, a pursuit for the good, a cause to make a significant change, and to be an inspiration to our future leaders.

In my youger years, I was eager to chase after my dreams to be ranked among my icons in the profession. For me, they were my symbol of inspiration that I too, can become one of the legends in Dentistry. On my road to having my name inscribed, it was tough, hence I had to invest heavily on my skill and knowledge knowing that all the pains I will bear will ferry the fruits of my labor. Now I am blessed with a thriving practice and a wonderful family who supports me on my every endeavor. But having my name up among the great influencers, I began to ask, how did they earn that merit to begin with? What service did they do that immortalized them as one of the great leaders in our profession? Looking at their achievements, they all served their constituents and loved their profession by heart. It was their heart for the service and for the craft that made them what they are. All the more I became inspired to follow their footsteps. Because now I realize there is so much I want to contribute to the society and to our profession that I decided to join Dental Access. Almost a year has passed and looking back, we have achieved in providing access to information about some of our dentists’ achievements in the country. We have made history when we first had our Dental Excellence Seminar in Cebu last January where one of the most distinguished speakers in the world stormed the city with his world class lecture namely Dr Markus Lenhard. Soon enough, we will be scoring another high in our record providing access to continuing education to our colleagues in far regions. By building a network that you can trust, we support the activities of our local chapters and affiliates through our media coverage. We understand that propagating your works will stand as witness for your heartfelt service to the community. I personally guarantee that each person you serve has been blessed by your generosity. Our publication may be setting a trend in this digital age but we are still at the beginning of our journey. Assuredly, I among others will continue this odyssey as I wait for the day when my efforts will be recognized. Until then, I encourage our readers and our partners to be daring in your field and make the best of what you have this day. Life is not about the glitz and glamour, but honor and humilty. We are neither defined by mediocrity nor by what society dictates rather we are characterized by our valiant efforts to make a positive change. DA

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Dr Jhing B. Chua-Sy

echnology doesn’t come without a price. So does one’s liberty to say what’s on his mind and post it reck lessly on social media. The Philippine Cybercrime Prevention Act of 2012 or Republic Act 10175 was signed into law by President Benigno Aquino III on September 12, 2012 ( adopted provisions of the first International Convention on Cybercrime also known as the Budapest Convention in November 2001. The first International Convention on Cybercrime is “the first international treaty that seeks to address internet and computer crimes by harmonizing national laws, improving investigative techniques and increasing cooperation among nations.” The said treaty was drawn up by the Council of Europe with 48 member-states as signatories with observer states (Canada, Japan, United States and South Africa) as active participants to the treaty. Republic Act 10175 went into effect on October 3, 2012. However, as early as September of the same year, at least fifteen petitions against the law were filed with the Supreme Court questioning its certain provisions; the most controversial of which was the provision on Online Libel or Cyber libel. The Supreme Court then issued a 120-day temporary restraining order (TRO) to give way to oral arguments which occurred on January of 2013. On February 18, 2013, the Supreme Court finally upheld the constitutionality of the Cybercrime Law, shooting down only 3 particular provisions of the law due to its unconstitutionality : Section 4 (c)(3) - penalizing posting of unsolicited commercial communications; Section 12 - authorizes the collection or recording of traffic data in realtime; Section 19 - authorizes the Department of Justice to restrict or block access to Computer Data.

The contentious provision of Online Libel or Cyber libel, was deemed by the Supreme Court “as VALID and CONSTITUTIONAL with respect to the original author of the post but void and unconstitutional with regards to the one who received it and reacted to it.” Analogous to and as controversial to the above-mentioned provision, is Section 5 of the same Act which states that aiding and abetting or attempting to aid and abet in the commission of online libel will also constitute as a criminal offense. The question as to whether the mere “like”, “comment” or “share”, in social media like Facebook, will constitute the criminal act as defined in Section 5 of the Cybercrime Law is thus explained in the said Supreme Court 50-page decision, to quote; “The question is: are online postings such as “Liking” an openly defamatory statement, “Commenting” on it, or “Sharing” it with others, to be regarded as “aiding or abetting?” In libel in the physical world, if Nestor places on the office bulletin board a small poster that says, “Armand is a thief!,” he could certainly be charged with libel. If Roger, seeing the poster, writes on it, “I like this!,” that could not be libel since he did not author the poster. If Arthur, passing by and noticing the poster, writes on it, “Correct!,” would that be libel? No, for he merely expresses agreement with the statement on the poster. He still is not its author. Besides, it is not clear if aiding or abetting libel in the physical world is a crime.

But suppose Nestor posts the blog, “Armand is a thief!” on a social networking site. Would a reader and his Friends or Followers, availing them selves of any of the “Like,” “Comment,” and “Share” reactions, be guilty of aiding or abetting libel? And, in the complex world of cyberspace expressions of thoughts, when will one be liable for aiding or abetting cybercrimes? Where is the venue of the crime? Except for the original author of the assailed statement, the rest (those who pressed Like, Comment and Share) are essentially knee-jerk sentiments of readers who may think little or haphazardly of their response to the original posting. Will they be liable for aiding or abetting? And, considering the inherent impossibility of joining hundreds or thousands of responding “Friends” or “Followers” in the criminal charge to be filed in court, who will make a choice as to who should go to jail for the outbreak of the challenged posting?” This is where the principal argument of unconstitutionality lies when it comes to the liability of acts such as liking, sharing or making comments on a post originally made by the author. There is, however, one part of the decision that quantifies what kind of comment can still be construed as online libel. If the comment made to an original post is a new comment altogether (example, when within the conversation thread, another comment made is defamatory and is no longer in reference to the original post), then the person who made the comment can also be deemed as the original author of the post. Again, as stated in the decision: “Of course, if the “Comment” does not merely react to the original posting but creates an altogether new defamatory story against Armand like “He beats his wife and children,” then that should be considered an original posting published on the internet. Both the penal code and the cybercrime law clearly punish authors of defamatory publications. Make no mistake, libel destroys reputations that society values. Allowed to cascade in the internet, it will destroy relationships and, under certain circumstances, will generate enmity and tension between social or economic groups, races, or religions, exacerbating existing tension in their relationships.”

(to be continued)

Under the Revised Penal Code (RPC), Libel is defined as “a public and malicious imputation of a crime, or of a vice or defect, real or imaginary, or any act, omission, condition, status, or circumstance tending to cause the dishonor, discredit, or contempt of a natural or juridical person, or to blacken the memory of one who is dead.” DA

About the Author 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 cofounder 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. M ar ch 2 0 1 6 • D E N TA L A CCE S S • 3

LOCAL NEWS by Dr Jhing Chua - Sy

GC Academy holds successful seminar


C Academy recently held the first of their scheduled seminars for the year 2016 at the Lung Center of the Philippines in Quezon City. Attended by 230 dental professionals, the auditorium was filled and packed with substantial topic that showcased 3 lectures by well-known speakers namely Dr. Delfin Abadco (Direct Labial Veneers Made Easy), Dr. Marilou Sembrano (Everything You Need to Know About Relining) and Dr. Noel Vallesteros (Updates on Management of Dental Pain in Children). A premier highlightof the activity was the introduction of GC’s new product line by none other than Dr. Lala Sanchez, GC’s Country Manager for the Philippines. EverX Posterior and G-ænial Universal Flo composites are made available by its Philippine Distributor Dental Domain since 2015. GC, a leading global innovator in dental products distributed in over 100 countries, has promised more of this kind of seminars that will make dentists well-informed of the latest innovations and technology in Philippine dentistry. The seminar was hosted by Dr. Boyet San Andres, Professional Relations Manager of GC Philippines. DA



rime Orthodontics Studies and Training (POST) held their com mencement exercise last September 17, 2015 at Rooms A and B of the Makati Shangri-la Hotel.

A total of 35 dentists (18 from Batch 35 and 17 from Batch 37) marched down the red-carpet laden aisle with the iconic graduation march played at the background as the ceremony signaled the conclusion of the once a week, year-long, tedious training program in the specialized field of orthodontics. Attended by the graduates’ family members, the glamorous event was headed by Prime’s founder, course director and trainer, Dr. Romeo N. Jacob, Jr. Also in attendance were the founding president of Prime, Dr. Tagumpay P. Tapawan and its President Dr. Mary Marjorie B. Montalbo. Lending glitter to the affair was the President of the Philippine Dental Association Dr. Ma. Lourdes M. Coronacion who served as their commencement speaker. POST’s graduation ceremony can be compared to a red carpet affair of an international awards night. The venue was beautifully set-up of pillars adorned with flowers. The lady graduates themselves were presented with their own mini-bouquet of flowers and the gentlemen with leis as they received their Certificates of Completion during the ceremony.

Batch 37, meanwhile, yielded 3 Academic Excellence awardees in the persons of Drs. Analyn B. Castillo, Fe Lourdes L. Santos and Shanna Marie G. Wong. The Clinical Excellence Award went to Dr. Allelie M. Mendoza while Dr. Raymonelle F. Mayor received the Most Distinguished Graduate Award. Two other awards were given out to Dr. Lee R. Siscar of Batch 35 and Dr. Jomariezen T. Amar of Batch 37. The successful graduation ceremony was also made possible through the combined efforts of Prime’s Executive Secretary Dr. Socorro D. Rahayel and Miss Maria Luisa Tandoc, Operations Manager of JacobOrtho Dental Clinic.

Special awards were given out to outstanding students of the training pro- Dr. Maria Remedios B. Chua-Sy served as the Master of Ceremony. DA gram. Drs. Corazon F. Basa, Melnita O. Bayot and Elsa V. Mendoza of Batch 35 photo credit: Dr. Zella Grace Biscocho of Smile Photography received the Clinical Excellence Award, Academic Excellence Award and (official photographer) Most Distinguished Graduate Award respectively. 4 • D EN TAL AC C E S S • M a r c h 2016




he Philippine Dental Association, with its 12,000-strong members nationwide, is set to hold its 107th Annual Convention and Scientific Sessions at the SMX Convention Center at the Mall of Asia Complex. With the theme, “Professional Excellence and Global Competitiveness”, the said confab will welcome its delegates with an Opening Ceremony scheduled on May 26, Thursday. The convention will run until May 30, 2016, Monday. The scientific sessions, chaired by Dr. Sonia I. Matic, promises to cater to a wider range of topics and table clinics. The lectures are “color-coded”, making it easier for the attendees to know in a glance the topics they would be interested to attend. Dr. Jesus Tumaneng, former PDA President, is this year’s General Chairman of the 107th Convention.DA


Philippine Pediatric Society Accredits PPDSI as Affiliate


hilippine Pediatric Dental Society, Inc. PPDSI recently announced its official status as a specialty affiliate of the Philippine Pediatric Society (PPS). General Chairman of the PPDSI Dr Noel Vallesteros claims this recent achievement the affiliate obtained early this year. “Today marks a milestone in the history of Pediatric Dentistry, or should I say Philippine Dentistry.” Dr Noel Vallesteros states. Present during the 2015 National Congress for the Oral Health of Filipino Children was Dr. Mila Bautista - President of the Philippine Pediatric Society (PPS) as guest panelists for the Early Childhood Caries Symposium. The two day affair covered topics that highlights the ongoing plight, policies and recommendations on how to combat dental disease including Dr Bautista’s views and dismay on the oral health situation among Filipino children. Her stern decision on PPDSI’s affiliation is a major step towards achieving its goal in reducing the caries rate while empowering parents with substantial knowledge in preventive oral health care. “This is a day of blessing for us. Dr Bautista announced that the PPS Board of Elders and the Board of Trustees unanimously approved PPDSI, the Philippine Pediatric Dental Society Inc., as a sub-specialty affiliate of the PPS. We all know the crucial role of pediatricians and physicians in preventive oral health care, because they are the very first health care professionals that parents consult once the baby is born. As a specialty affiliate of the PPS, PPDSI will formulate policies, recommendations and strategies in the prevention of oral disease, more specifically Early Childhood Caries.” Dr Vallesteros denotes. DA



he Philippine Dental Association led by its hard-working Presi dent, Dr. Ma. Lourdes M. Coronacion, trooped to the La Mesa Dam last October 18, 2015 in its annual environmental advocacy called “PDA Binhi Project”. The tree planting activity was participated in by 10 dental chapters, namely; Antipolo Dental Chapter, AFP, Cavite, Batangas, Kalookan City, Pasay, Pasig-Taguig-Pateros Dental chapter, Paranaque, Quezon City Dental Society and affiliate, Novaliches Dental Professionals, Inc. Chaired by Dr. Jean Bautista, the annual environmental project is the association’s modest but significant contribution to the challenges mankind is now facing with regards to the degradation of our forests and mountains. DA


he Asian Association of Oral and Max illofacial Surgeons (AAOMS) and the Philippine College of Oral and Maxillofacial Surgeons (PCOMS) brings to Manila the 12th Asian Congress on Oral and Maxillofacial Surgery on November 9-12, 2016 at the historic Manila Hotel. The 4-day congress will bring together a gathering of oral surgeons from all over the globe to listen to well-renowned speakers in a variety of topics which include Cleft Lip and Palate Surgery, Dentofacial Deformities, Orthognathic Surgery, Oral Pathology and Oncology, Oral and Maxillofacial Trauma and Sleep Apnea among others. Prof. Daniel Laskin, a famous oral surgeon and author of the popular Clinician’s Handbook of Oral and Maxillofacial Surgery, leads this year’s list of prestigious lecturers in Oral Surgery. Dr. Mario E. Esquillo, PCOM’s Past President and this year’s President of the AAOMS, is also the chairman of the international congress. DA

“Magtanim ay di biro….” PDA President Dr. Coronacion

The concerted effort of this year’s PDA, in as much as the years past, will make a huge difference in the lives of the next generation. 8 of the 11 participating chapters and affiliate take a moment for a snapshot with Dr. Coronacion M ar ch 2 0 1 6 • D E N TA L A CCE S S • 5


Philippine Dental Association launches eCharting by Dr Clarissa Jane F. Pe


It is the view of the Philippine Dental Association (PDA) that the absence of statistics on oral health in the Philippines is an unacceptable situation. As part of its 6-year Adopt a School Program, launched this Fiscal Year 2015-2016 up to the targeted FY of 2021-2022, the PDA has introduced digital charting at public elementary schools, referred to as eCharting.

Dental caries being rampant in the country is common knowledge. Yet, it is unknown to what extent, as data on oral health of the population is not available. Surveys on a meaningful scale were never undertaken.. For the longest time, the country’s Department of Education (DepEd) school dentists keep paper based dental records of each child from K - 6. They map the pupil’s dental health by manually marking yearly on the “Individual Oral Health Record” conditions and statuses such as caries, fillings, missing teeth and other conditions. Proposed dental treatment such as extractions, fillings, oral prophylaxis, fluoride treatment and application of sealant or varnish is also entered. This method of record keeping is not conducive to practical large scale data gathering, and next to impossible in generating oral health statistics. The absence of credible S M A R T oral health data prevents the country from understanding the true nature and extent of the true oral health situation of school children and prevents formulation of policies for countering caries. The introduction and practical use of digital record keeping is a necessary step towards long term policy formulation. Without it, generation of oral health statistics on a meaningful scale, so as to understand the extent of the caries problem in the country, is next to impossible. The most logical place to introduce digital record keeping is an obvious one: the youngest members of the population, i.e. the elementary school generation. It is the dream of the PDA that, over time, all Filipinos will have a digital dental chart. While reaching this ambition will be a daunting task, an achievable intermediate goal is to eChart all K - 6 pupils nationwide, some 15 million in 38,000 elementary schools. This intermediate goal is in itself challenging, yet realistic if indeed electronic means are used to map the children’s odontogram digitally. PDA Adopt A School Committee with the Board of Trustees under the leadership of 2015-2016 PDA President Dr. Maria Lourdes M. Coronacion, sought the approval of the House of Delegates, a Board Resolution Approving The Six Year eCharting Project, through the Adopt A School Program to pioneer digital dental data collection to generate initial digital oral health data in October 2015 when it undertook eCharting in 40 public elementary schools enrolled in the Adopt A School Program across the country. By February 2016, the Committee through volunteer Chapters and Affiliates in cooperation with DepEd school dentists, launched the project with a target of 150-200 dental charts per school. It is currently in progress using the online eCharting system, developed by DentalCharting ( The Association is anticipating the experience gained and lessons to be learned from digital data collection and what statistical report it can generate. This will be presented during the Public Health Forum at the PDA National Convention this May in Manila. We are excited with the conclusions that can be drawn and recommendations we hope to propose to the health and education authorities to scale- up eCharting at the thousands of schools or health centers across the country, beginning this third quarter of 2016. The Committee is composed of Dr. Analiza A. Lerio, Chairperson,-PDA Adopt-A-School Program and Dr. Clarissa Jane F. Pe, Chairperson of the PDA Adopt-A-School Echarting Project. DA

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reveals a new way to administer anesthetic in the mouth


study published in Colloids and Sur They tested the gel on the mouth lining of a faces B: Biointer faces reveals how the pig, applying a tiny electric current to see if it dentist could give you anesthetic using made the anesthetic more effective. a tiny electric current instead of a needle. The anesthesia was fast-acting and long-lastThe researchers behind the study, from the ing. The electric current made the prilocaine University of São Paulo, say their new find- hydrochloride enter the body more effectiveings could help improve dental procedures ly; the permeation of the anesthetic through and bring relief to millions of people who are the mouth lining increased 12-fold. scared of needles. It would also save money and avoid contamination and infection, they The researchers say the technology has applisay. cations not only in dentistry anesthesia, but also in other areas such as cancer treatment. “Needle-free administration could save costs, “Over the last few years, our research group improve patient compliance, facilitate appli- has been working on the development of cation and decrease the risks of intoxication novel drug delivery systems for the treatand contamination,” explained Professor Re- ment of several skin and eye diseases,” said nata Fonseca Vianna Lopez, one of the au- Prof. Lopez. “The skin and eyes pose chalthors of the study from the University of Sao lenges for drug delivery, so we have focused Paulo in Brazil. “This may facilitate access to on improving drug delivery in these organs more effective and safe dental treatments for using nanotechnology, iontophoresis and thousands of people around the world.” sonophoresis, which is permeation using sound waves.” Dentists often have to carry out invasive and painful procedures in the mouth. To mini- The researchers now plan to develop an ionmize patients’ discomfort, dentists use an- tophoretic device to use specifically in the esthetics that block the pain, which are ad- mouth and do some preclinical trials with ministered using needles. However, many the system.DA patients are extremely afraid of these injections, resulting in them postponing and even canceling visits to the dentist. For these patients, an additional step is needed: dentists first give them a topical painkiller to reduce the pain -- and associated fear -- caused by the needle. This can come in the form of a hydrogel, ointment or sprays; the Story Source: most common are hydrogels that can contain lidocaine and prilocaine. The above post is reprinted from materials provided by Elsevier. Note: Materials may be In the new study, the researchers investigated edited for content and length. a way of getting these topical anesthetics into the body more effectively, to see if they could Journal Reference: replace needles altogether. They found that applying a tiny electric current -- a process Camila Cubayachi, Renê Oliveira do Couto, called iontophoresis -- made the anesthetics Cristiane Masetto de Gaitani, Vinícius Pemore effective. drazzi, Osvaldo de Freitas, Renata Fonseca Vianna Lopez. Needle-free buccal anesthesia The researchers first prepared the anesthet- using iontophoresis and amino amide salts ic hydrogels with a polymer to help it stick combined in a mucoadhesive formulation. Colto the lining of the mouth. They added two loids and Surfaces B: Biointerfaces, 2015; 136: anesthetic drugs, prilocaine hydrochloride 1193 DOI: 10.1016/j.colsurfb.2015.11.005 (PCL) and lidocaine hydrochloride (LCL).

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percentage of patients prescribed opioids following tooth extraction


n a study published online by JAMA, Brian T. Bateman, M.D., M.Sc., of Brigham and Women’s Hospital, Boston, and colleagues examined nationwide patterns of opioid prescribing following surgical tooth extraction. Opioid abuse has reached epidemic proportions in the United States, and often begins with a prescription for a pain medication. Dentists are among the leading prescribers of opioid analgesics, and surgical tooth extraction is one of the most frequently performed dental procedures. Surveys suggest that dental practitioners commonly prescribe opioids following this procedure, despite evidence that a combination of nonsteroidal medications and acetaminophen may provide more effective treatment for postextraction pain. The researchers collected data from a national database of health claims drawn from Medicaid transactions for the years 2000-2010. All patients who underwent surgical dental extraction were included. The frequency of opioid prescriptions filled within 7 days of extraction was determined, as was the nature and amount of opioids dispensed. The analysis included 2,757,273 patients. Within 7 days of extraction, 42 percent of patients filled a prescription for an opioid medication. The most commonly dispensed opioid was hydrocodone (78 percent of all prescriptions), followed by oxycodone (15 percent), propoxyphene (3.5 percent), and codeine (1.6 percent). Patients age 14 to 17 years had the highest proportion who filled opioid prescriptions (61 percent), followed by patients age 18 to 24 years. There was great variability in the amount of opioids dispensed for a given procedure, with an approximately 3-fold difference between the 10th and 90th percentile in the oral morphine equivalents prescribed.

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“Although a limited supply of opioids may be required for some patients following tooth extraction, these data suggest that disproportionally large amounts of opioids are frequently prescribed given the expected intensity and duration of postextraction pain, particularly as nonopioid analgesics may be more effective in this setting,” the authors write. “This common dental procedure may represent an important area of excessive opioid prescribing in the United States. As the nation implements programs to reduce excessive prescribing of opioid medications, it will be important to include dental care in these approaches.” DA

References: Opioid Prescribing After Surgical Extraction of Teeth in Medicaid Patients, 20002010, James A. Baker, BS; Jerry Avorn, MD; Raisa Levin, MS; Brian T. Bateman, MD, MS. JAMA, doi:10.1001/jama.2015.19058, published online 15 March 2016. Research reported in this publication was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Dental Law and Ethics BUSINESS NEWS

New Managing Director at Ivoclar Vivadent KK Japan Koji Kezuka is Hideaki Kumazawa’s designated successor. Koji Kezuka will be taking over as the new Managing Director of Ivoclar Vivadent KK Japan based in Tokyo effective 1 April 2016. He succeeds Hideaki Kumazawa, who will be leaving the company. Koji Kezuka joined Ivoclar Vivadent KK Japan in April 2010 and took over the management of the sectors of Finance, Human Resources, IT, Logistics and Administration. Since 2014 he has additionally been responsible for successfully extending the agency business and stepping up the sales activities. “During the past six years, Koji Kezuka has had the opportunity to acquaint himself extensively with the Japanese dental market and our company. He is thus well prepared for his new position,“ said Christian Brutzer, Global Region Head Asia/Pacific, on the occasion of Koji Kezuka’s appointment as the new Managing Director. Kezuka succeeds Hideaki Kumazawa, who was in charge of Ivoclar Vivadent’s Japanese subsidiary during the past nine years. “We thank Mr Kumazawa for his outstanding commitment in establishing and building our Japanese subsidiary and we wish him well in his future professional career“, said Christian Brutzer. Hideaki Kumazawa will leave the company on 31 March 2016 to seek a new challenge and explore other professional opportunities.

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Planmeca ProModel™ part of first facial tissue transplant procedure in Nordics


he first facial tissue transplant procedure in the history of the Nordic countries was performed earlier this year in the Hospital District of Helsinki and Uusimaa (HUS) in Finland. Planmeca contributed to the demanding and rare operation, which was the 35th of its kind in the world to date. The facial tissue transplant surgery itself took 21 hours and was carried out by a group of 11 surgeons, as well as 20 nurses and other experts. The operation consisted of transplanting the patient’s upper and lower jaw, lips and nose, as well as segments of their skin, midfacial and tongue muscles, and the nerves of these muscles. The head the surgical team, Dr. Patrik Lassus, emphasised that the objective of the operation was to transplant facial functions, not external features.

“Based on literature, we know that it can take 3 to 4 hours to trim bones. In this particular operation, it took Patrik [Lassus] and myself under 10 minutes to place the transplant. This led to a drastic reduction in the duration of the surgery, while also significantly improving the accuracy of bone placement,” described Dr. Jyrki Törnwall, one of the operating surgeons, in the press conference on the operation. Planmeca participated in planning the facial tissue transplant right from the start, led by CAD/CAM Design Manager Jani Horelli. “We had the opportunity to join the surgeons in making medical history. In the end, we reduced the surgery time by 3 to 4 hours and successfully completed the operation with help of 3D planning for the first time in the world. It was a great job by all involved,” stated Horelli.

3D planning of the operation with the Planmeca ProModel™ service

At Planmeca, planning the operation began around three years ago. Careful steps were taken in preparing for the upcoming procedure.

The Planmeca ProModel™ service was part of the demanding procedure. It is a unique service for designing and creating patientspecific implants, surgical guides and skull models from CBCT/ CT images. 3D technology decreases surgical time and produces significantly more precise results when compared to traditional methods. This makes operations increasingly safer for patients.

“Planmeca’s part consisted of two phases. First, we designed the surgical guides together with Dr. Lassus and Dr. Törnwall, as well as determined the kinds of segments that would be surgically removed from the recipient and transplanted from the donor. At this point, we were anticipating a scenario, which would become concrete once a donor was found,” Horelli recounted.

The facial tissue transplant procedure was planned preoperatively utilising 3D technology. The planning consisted of modeling donor tissues and determining how they match the recipient. Surgeons Patrik Lassus and Jyrki Törnwall designed the 3D printed surgical guides together with Planmeca’s CAD/CAM designer.

“The second phase began immediately once we received word of a suitable donor. An X-ray image of the donor was taken at the hospital and the imaging data was utilised in 3D designing. We also simulated the operation together with the surgeons. Following this, the components were designed and manufactured at Planmeca headquarters and transported to the hospital, where they were taken directly to the operating room.”

Planmeca’s innovation substantially decreased the operating time – saving hours compared to similar procedures previously carried out elsewhere in the world. Conserving time is one of the key aspects of surgery, as longer operations increase the risk of complications. In transplant cases it is also of paramount importance to accelerate the restoration of blood flow.

“All 3D designing is carried out exactly according to the anatomy of the donor and the recipient. When time is limited and there are significant risk factors involved, there is no room for error,” Horelli concluded. DA

FDI Celebrates International Women’s Day

Clark County KY Receives Award for Dedication to Public Health


n 2013, Clark County Dental Health Initiative was honored for Excellence in Public Health. They were one of the commu nity programs to receive the “Model Practice Award” and they have now published a “how-to” guide on the Implementation of a Fluoride Varnish Application Program.


n International Women’s Day, FDI supports the United Na tions initiative on “Planet 50-50 by 2030: Step It Up for Geder Equality” asking governments to make national commitments to address the challenges holding women and girls back. As we reflect on what a gender-equal planet means, our focus is on the dental profession which has seen a drastic change over the past 30 years in terms of gender parity among dentists. A profession which had been predominantly male-dominated, has now become increasingly pursued by women. According to estimates, there are around 30% of women dentists in the world today. Europe and North America are regions with the largest number of collected data. In Europe, the percentage of women dentists exceeds 65%, while in Latvia and Estonia this is almost 90%. In contrast, the lowest percentage of women dentists is found in Switzerland, with only 22%. In the US, the percentage of women dentists has risen from 3% in 1980 to 25% today, and it is expected to reach 30% by 2020. Although available data in other regions is incomplete, there is evidence of increasing participation of women dentists from Arabic and Asian countries, and growing participation in the African region.

Women Dentists Worldwide operates through its members in six continents, and collects data on the number of women dentists and their roles in work and education. Continuous data publication and comparison not only reveal the obstacles and inequalities that remain, but also contribute to the networking of women dentists around the world. The current number of active dentists and women dentists holding positions of leadership is disproportionate to that of men. Therefore, the main task of Women Dentists Worldwide is to encourage and support women in their contending for leadership positions, which is essential to achieve full participation and introduce changes in the profession. DA

FDI recognizes the challenges brought about by changes in labour force composition. Thus, in 2001 it adopted the Kuala Lumpur Declaration, which established the FDI Section: Women Dentists Worldwide. The Section exists to coordinate the activities of national groups, promote the collection of information about women dentists and their work patterns, address inequalities where they exist, facilitate contacts - See more at: women worldwide, and enhance their full participation in all celebrates-international-womens-day.aspx#sthash.BRzjPsqW.dpuf branches of the profession. 10 • D E N T AL AC C E S S • M a r c h 2016

The Clark County Dental Health Initiative began in January 2008 and was designed to reduce tooth decay in the children of Clark County. Tooth decay is the most common disease during childhood and can affect overall health status: including quality of life, illness, chronic disease and nutrition. In 2008, 50% of the sixth graders in Clark County public schools had tooth decay. For five years, volunteer dentists, hygienists and community members have gone into the schools twice a year and applied dental fluoride varnish to children in preschool through fifth grade. After five years of applying Premier Enamel Pro Varnish, the decay rate for sixth graders is down 11%. That equals a 78% decrease in just five years! “The success of the Clark County Dental Health Initiative is due to the incredible cooperation between the community stakeholders in this project. The Clark County Health Department, the Clark County Community Foundation, Premier Dental Products Company, participating schools, dental teams from the Winchester/Clark County Dental Society and scores of community volunteers were in sync from the first moment. Dropping the decay rate in Clark County’s children was our common goal and I have never seen such commitment to reach that goal. Volunteerism is alive in Clark County and this truly is a Community Award,” said Rankin D. Skinner DMD, Project Director for the Clark County Dental Health Initiative. room for error,” Horelli concluded. DA

Hear the real life stories of dentists who are confronted by their every day bouts as a dental professional. Patients, colleagues and relevant topics that are similar to your experiences portray a moral lesson and a guide similar to a handbook that help us overcome these circumstances. We dedicate this to all dentists who are constantly searching for answers to their inquiries.

A difficult patient wants her money back. Dear Dr Jhing, Thank you for featuring my letter in this new column. I have been contemplating on this patient who has been giving me a headache for the past few weeks. A Senior citizen patient came to me to have a new complete upper denture but with two premolars (same quadrant) indicated for extraction. Upon examination and interview I found out that she is medically-compromised so I asked for a medical clearance. She returns after 3 days; physician OKs extractions. But she wants an immediate denture. So I explained the pros and cons then patient signs informed consent. After taking impressions I extracted and gave the necessary post-op instructions. Mrs A makes a 50% down payment which I acknowledged receipt thereof. Patient returns after 5 days and so I performed a trial denture. Of course, there is a re-trial so I took another impression. The patient is, well, impatient; complains about trial wax being lose and complains that extraction site hurts. So I explained again. I suggested another impression because the extracted sites are somewhat healed compared to the first impression. Patient throws a fit and says that her “technician only took one impression”. I was shocked and raised an eyebrow with a billowing thought, mama mia! Patient left the clinic and the next day, she sends her daughter to say, “I want my money back! I won’t continue anymore with the denture. I already talked to my technician!”So I refused to budge saying that the fabricated denture (porcelain) has already been purchased and in fact, a trial denture has already been made and the procedure already started. After a few days, the patient files a complaint against me in the barangay claiming I should return the money. Do you know what to do in this case?

Dear Wondering Dentist from Alabang, If you receive a barangay subpoena, attend the hearing. There are 3 hearings in the barangay level presided upon by the Lupon ng Tagapamayapa, composed of the Barangay Chairman (or his assign) and 2 of his kagawads. They will try to reconcile both parties in the hopes that it will not escalate to the point of bringing the case to court. Bring with you all the necessary documents to prove that the patient contracted your services: your dental record, the informed consent duly signed by the patient (or if patient is a minor, then an adult who is responsible for the minor), the official receipt, and if need be, the actual denture itself to show that the contracted professional service has been consummated (even if it is only partial like that of the trial denture because that would prove that the partial payment she gave you was actually used for its intended purpose). In this case, the dentist provided all the documents. But the one thing that the dentist did that turned the tables around against the patient was to file a countersuit for Breach of Contract. Why? Because the mere fact that Mrs. A sought the dentist out for a construction of a new denture by filling up a dental record and the exchange of monetary consideration to create the same, is already an Implied Contract, even in the absence of an Official Receipt since sometimes, we issue a Provisional one until they have rendered full payment. The Informed Consent form, which the patient knew and consented to sign, makes the Breach of Contract suit a tight case. Mrs. A backtracked when she was presented the Informed Consent which she signed. She even pretended not to remember having signed the same. The dentist offered to have Mrs. A’s signature tested by the NBI (at the dentist’s own expense) to prove that her (Mrs. A’s) signature is authentic. Mrs. A, still with her haughty attitude, gave up and says, “You can have my money! Who cares! I have many where that came from!” and continues with her ramblings. She was compelled by the Lupon to sign the Barangay certificate that she is no longer interested to pursue the case. After Mrs. A and her daughter has left the place (with angry frowns on their faces), the dentist, in all sobriety thanked the Lupon, bringing with her all the documentary evidences she brought with her.

Notice to the public

Wondering dentist from Alabang

Lesson of the story? Be diligent in record keeping. There are patients who can become unreasonable and incorrigible. Make sure that the patient signs an Informed Consent Form the first time out. During the next succeeding treatments, you can just write down in their records the treatment performed and make the patient sign the “Conforme” line opposite it. That way, it would not be too taxing for you or the patient to sign an Informed Consent every time she returns for a treatment, especially the ones that need a series of recalls (like RCT or prostho cases). For as long as you are astute enough to make a complete written record of each treatment plan, performed or cancelled, then you are well on your way to protecting yourself especially when it comes to legalities. Best, Dr Jhing Chua - Sy

M Mar arch ch 22001166 •• D DEEN NTA TALL A ACCE CCESSSS •• 11 11



About the Author Dr Cherrylou Sison Mendoza is an alumna of the University of the East College of Dentistry. She is an active member of the PDA Tarlac Dental Chapter and has been holding her dental practice in Tarlac City.

In addition, we can separate biodegradable items from nonA dentist’s perspective biodegradable items. We can use paper cups instead of plastic cups. Wet items are separated from dry items so that by Dr Cherrylou Sison - Mendoza the moisture will be limited within the clinic premises. This n dentistry, there is always a new trend or invention that will inhibit bacterial growth that can harm our staff and our we use in our practice. patients. A new material or equipment that play a significant role in our clinics that can affect our environment as well. But lately, have Second, when using amalgam as a filling material, we should we asked ourselves if we are doing our part in helping save our always place excess mercury in an air tight container filled world from further deteriorating? Are we following stricter with water. Never let mercury drain down in our pipes bemeasures and guidelines laid down to all medical and allied cause it will only go to places where a lot of harm can happen health professionals in the proper disposal of used items in to the sea. In a recent article about environmental issues by relation to our environment? Do we still have the compassion Dr Lilian Ebuen, it is stated that a....... and the right attitude to create and propagate this awareness in order to save our Mother Earth for generations to come? Third, when using disinfectants, we can consider the organic ones. Several manufacturers producing them have already I always thought that a dental clinic is like a small centre for considered using organic solutions that are readily available oral health care where we encounter different cases that need in the market. It’s not only good for the environment but to different treatment on a daily basis. With this, we also use dif- our skin as well since these organic solutions have lesser ferent items, instruments and everything just to meet our cli- chemicals incorporated within. ent’s needs. Sometimes, after treating a patient our work place is such a mess. But after all the mess, how do you personally Choosing to be responsible for our environment makes our dispose them? Why is it that we are able to follow stringent world a better place to live in. We are the stewards of Mother rules in handling clinical properties or materials and neglect Earth therefore we should protect it from being destroyed the simple practice of proper waste disposal? through our neglect. If we cannot impose these standards, then what kind of life will the next generation inherit from us? I have some ideas on how can we help save our Mother Earth If in our own small way. As I borrow the line from Ms. Universe 2015 Ms Pia Alonzo Wurtzbach, I would like to leave you this message by saying, First thing to do is segregate. We can segregate our wastes “We are confidently beautiful dental professionals with a by collecting all used needles, cartridges and place them in an heart for mankind and to Mother Earth”. DA empty water container. In turn, we can surrender these items to the nearest hospital from your clinics where they will be properly incinerated by the institution.


12 12 •• D DEENT N T AL A L AC A CC CEESSSS •• M Maar rc ch h 2016 2016

M ar ch 2 0 1 6 • D E N TA L A CCE S S • 13

This coming May 2016, as we celebrate the PDA Annual Convention, we are bringing you two of our aspiring presidential candidates for the year 20152016. Green team’s standard bearer Dr Carlos Buendia and White team’s presidential bet Dr Maridin Lacson will see eye to eye on this historical event. Know your candidates and be part of this history by casting your votes.

Dr Maridin Munda-Lacson LACSON-IN-ACTION! ‘IKAW AY KAISA – PAGKA’T TAYO AY IISA’ 1. DENTAL PRACTICE EMPOWERMENT (PAGPAPALAKAS) • To empower member dentists in the proper management and operation of their clinics with the end view of professionalizing their dental practice while increasing their income. STRATEGY: • PDA Members and their dental clinics must have an ALL OUT campaign drive to fully equip their practice with the management of their clinics, ethical & fair marketing obligations and responsible handling and management of the dental practice. • Practice Management thru inter-professional relationships (w/ the medical doctors [PMA], nurses, engineers, lawyers and entrepreneurs and business oriented individuals. Establish a cross section of professionals and meet to plan how we can integrate individual steps towards an effective planning system. • Increase Fee Proposal for HMO and Insurance Policy • SALARY INCREASE for Government Dentists and Public Health Dentists 2. MEMBERSHIP AWARENESS INFORMATION DRIVE (PAGPAPABATID) • To keep all member dentists constantly and regularly updated on the programs,projects and activities of the PDA to increase their level of awareness and motivate them to action. • Social Media Info (Updated Website) • Streamline current system on information details thru the data base gathered in the Membership Directory 3. DENTISTS’ PREPAREDNESS TO A GLOBALIZED COMPETITIVE PROFESSION (PAGHAHANDA) • To prepare dentists to be globally competitive in terms of thei clinical skills,state of the art instruments and equipment and prices of services offered. • Compete collectively and set standards individually • International relations with other dental associations in Asia and US

I am a woman of zeal. My plans translate into action that is why I was nicknamed, “Lacson in Action.” With me, I have included 8 core goals and action plans. These core goals and plans should resonate to all the members of the PDA- motivated by one direction and oneness to achieve our goals and put it in ACTION.

4. INCREASED ORAL REHABILITATION TARGETS (PAGPAPALAWAK) • To significantly reduce the incidence of dental caries and other periodontal diseases among Filipinos to a manageable level. • Active involvement of the dentist on ORAL REHAB Program, as a start‘SEAL THE 6’s’ project (Pits and Fissure Sealants on ALL first molars)

levels. How to particularly manage it, enhance and encourage dentists to be part of it

5. UNIFICATION AND HARMONIZATION PROGRAM FOR PDA AND TRADER PARTNERS (PAGKAKAISA) • Implementation of the MEMORANDUM OF AGREEMENT on strict compliance of ‘NO ID-NO ITEM’ policy to traders and licensed dentists only purchase of dental instruments and materials.

1.What do you think should a true leader of the PDA possess?

6. PURSUE GROWTH AND LEARNING ON ACHIEVEMENT OF HIGHER LEVEL OF DENTAL EDUCATION (PAGPAPATAAS) • Establish several broad strategies for growth in their professional status which include training and education resources • Minimize SOCIAL AFFAIRS, Maximize DENTAL ACTIVITIES • Continuing Dental Education Programs: Locate exceptional speakers, plan topics and lectures in a yearly program. FOCUS On: Clinical Case Presentations and Applications of topics discussed. 7. COORDINATE AND COOPERATE TO THE RIGHTFUL AUTHORITY TO ELIMINATE ILLEGAL PRACTITIONERS (PAKIKIPAG-UGNAYAN) • Observance of ethical principles and professional standards that establish the highest professional and individual behavior and integrity 8. NEW OPPORTUNITIES FOR DENTISTS AS ENTREPRENEURS AND BUSINESS ORIENTED INDIVIDUALS (PAGBABAGONG- BIHIS) • New horizons on growth and development not just on the dental profession but to venture on other opportunistic business • Highlight future programs that would collaboratively open doors on business opportunities • COOPERATIVES must be opened to all chapter and affiliate


• Servant leadership that puts action as their prime most goal, a person that is service-centered and believes that every member has it’s respective right and responsibility--- all of these make up a true leader suitable to be the PDA president. 2.What’s the first thing you intend to do as soon as you sit as PDA President? • To put back normalcy and unity to PDA, to take the challenges of everyday activities as president and positively put to action the 8 core goals and values for the entire membership. 3.What do you value most? Your loyalty to your party or your loyalty to the PDA? •Parallelism of values of both PDA and the TEAM PDA label the loyalty to the association we serve. It’s not a matter of choice of loyalty as it is of a similar loyalty we have for the only PDA we have.

Dr Carlos Buendia

Kay BUENDIA, Angat Pinoy Dentista!

Seeking for your trust, I lay down my mission to our members not only to court your votes but to provide you answers to your long drawn frustration in our association. As President Elect, I aim to be a beacon of commitment, honesty, integrity, perseverance and prudence and a conscientious servant of the association. My efforts will not be measured by who I exclude but rather by who I include in pursuing vital interests, related to improved oral healthcare that benefits the public. First, I speak among our doctors who have the same philantrophy as mine. The need for a Cleft lip and Oral Cancer Foundation has been my aspiration as your president - elect. Throughout my professional career, both as private and public servant of the association, I plan to establish a self sustaining foundation that will reserve and preserve the funds allocated and acquired mainly for its beneficiaries and the programs implemented dedicated to cancer striken patients and patients with cleft lip. This will allow the association to be independent from the strong arm of several private companies regaining the foothold of the PDA. Second, to improve and seek the welfare of our goverment dentists which include endowment benefits and retirement packages. Third, my hope is to provide additional benefits to our general members which include frequent dental education programs or seminars throughout the country. Choosing lecturers / speakers with good educational background and expertise in mentoring and public speaking, This will provide our doctors an effective medium for continuing dental education having the confidence that their acquired knowledge is from reputable resource speakers. Most importantly, I will include programs that will aid our members who are and will be inflicted by the cudgels of mother nature through our disaster assistance program. 14 • D E N T AL AC C E S S • M a r c h 2016

Platform My platform is clear and simple. Good Governance during my leadership that will be manifested to all members; Have a Research for evidenced based practice of dentistry in cooperation with various specialty groups for better continuing education; Efficient financial management that will deliver transparency among the members, Effective campaign against illegal practice of dentistry; Nurturing friendly relationships from the president down to the last member of the PDA for a more productive and better performing members; Truthful and ethical administration; Equal treat- ment regardless of party affiliation; Adherence and obedience to PDA Constitution and Bylaws, Membership empowerment.

2.What’s the first order of the day for you as soon as you sit as President of the PDA? Or to paraphrase : What’s the first thing you intend to do as soon as you sit as PDA President? As the new PDA President I will seek for unity of all members of the Board regardless of party or color affiliation. The problems of the PDA cannot be solved by a few people alone. We must be united in our vision for excellence to ensure a bright future for Philippine dentistry. That has been my aspiration from the beginning of my campaign. Equality will bear peace and unity.

1.What do you think should a true leader of the PDA possess? SINCERITY-Your willingness to serve the PDA constituents with humility. INTEGRITY- to maintain a high ethical standard in all aspects of life STRENGTH OF CHARACTER - To be firm with decisions that will uplift the image of PDA and that you will not be persuade by other people.

3.What do you value most? Your loyalty to your party or your loyalty to the PDA? Loyalty to PDA begins when Loyalty to the Party ends. We are all Dentists belonging to one national association which is the PDA. Regardless of party affiliation, we all must adhere to the fact that the our heart and mind should only be for the betterment of the PDA constituents. One Heart, One Mind, One Soul, One PDA


ebu, the Queen City of the South. A unique place that is enveloped by history, culture and adventure to its tourists has been the favorite city by local and foreign migrants due to its quaint charm and thriving local businesses. It is also home to one of our Advisory Board members, Dr David Alesna, past president of PDA Cebu Dental Chapter and a well - respected dentist in the field. In our newly opened section, Power Clinics, Dr Alesna will share his passion and vision to create a gateway for a world class dental facility with Green Apple Dental Group, Inc. as his flagship enterprise right in the heart of Cebu City.

photo: Dr David Alesna The Green Apple Dental Group, Inc. is among the many dental clinics Dr David Alesna owns and manages since it first started its operation in 2009. As one of the founders of the dental center, he and his partner / colleague, Dr Gamaliel Urbi took a shot and dreamed of making the Green Apple Dental Group, Inc. one of the crème de la crème dental centres in Cebu City. Although a plenitude of dental group practices are doing well, it takes an ingenious talent with a heart for practical and intelligent service to give you the leading advantage over your competitors. As such character manifests in Dr Alesna, through his years of experience he built a service oriented clinic that utilize cutting edge equipment to take advantage of today’s modern technology. “I want to cater to my patients with the service and technology that is available abroad. With that, not only did we upgrade our systems, we raised our standards in providing quality dental health care through optimized patient service and recall, efficient record facilitation, continuing professional development for our dentists and allied health workers, and more.” Dr Alesna relates as he shows us around his dental facility. Green Apple Dental is strategically stationed at the Ayala Center in Cebu City and has an area coverage of 170 square meters. It boasts of 5 completely advanced Operatory rooms, a state of the art Xray facility, complete sterilizing room managed by 3 fulltime dentists and 5 part-time dentists with 10 clinic staffs to help manage the dental center. To top it off, Green Apple Dental received its ISO certification in 2013 with Management Systems ISO 9001:2008. This certification help ensure that products and services offered by its staff and facility are safe, reliable and of good quality. “It was a strategic course of action that the founders of Green Apple Dental secured (including myself) because we want to be a full service dental facility with a reputation in providing high standard quality service. Patient experience and feedback is valuable to our practice because it reflects how serious and dedicated we are in keeping up with the standards of care.” Dr Alesna interjects in the interview.

Simplifying the work with good service according to Dr David Alesna Dental work can be tedious for our dental professionals especially if they are confronted by third parties such as dental lab works. Disputes between two parties

( dentist and technician ) can be a yo-yo bringing the case to and from the clinic thereby prolonging the treatment time. This is common among dentists who are constantly struggling with their cases due to faulty lab procedures and inefficient manpower. But instead of yielding, Dr Alesna sought a way to address this important issue so that he can live up to his barometer of excellence. “I had that same dilemma years ago and was frustrated with the outcome of the lab’s restorations. I wanted to understand the errors taken from the laboratory perspective to overcome the problems I normally encounter as a clinician. So from time to time I go abroad to attend seminars and dental congress but one of the most significant accomplishments in my career was when I enrolled at one of Ivoclar’s Work Shop and studied with other dental technicians and dentists. That experience gave me a whole new frame of reference where I was able to discern a good material from the subpar materials that proved vital to the success of my restorations today.” Dr Alesna recalls while affirming his sound judgement. Since then, he passed this knowledge on and mentored a few colleagues so that they too can emulate his sense of craftsmanship. Then in 2015, he decided to put up his own CADCAM Laboratory in focusing on Emax and Zirconia restorations. This he claims are some of the best decisions he made providing treatment to transients and short-staying tourists. “We could finish our lab work in an average of 2-3 days and were able to improve a lot on the quality of the lab work, as well. Also our decision to acquire a cone beam CT scan (CBCT) which made it easy for us to convince patients on the safety of the dental implant procedure.”

With all modesty, Dr Alesna adds “I am pointing this out not to brag, but because these were important milestones in the growth( both technically and financially) of Green Apple. This also sets the benchmark for other clinics to follow and proves that this can be done locally.” As some of you may know, Dr David Alesna was a former instructor of Centro Escolar University in the Prosthodontics Department and a professor at Cebu Doctor’s University. Later in his career, he formed a small group of dentists whom he taught in same field. Teaching, as he claims is his passion. “Were you not afraid of your sharing your knowledge to your colleagues?”I asked. “On the contrary, I believe that knowledge should be shared and passed on. There is enough market for everyone.“He denotes. Furthermore he added that by focusing on your talent and making your business strategy practical makes it easy for dental professionals to succeed in this industry. “Our profession is no longer based on the profession side. We are considered as business entrepreneurs and so we should be wise with our decisions in keeping our profit and gain intact over our expenses. That is one aspect I would like to tap among our dental professionals in the future. “ Suggests Dr Alesna. Gathering from all the life experience Dr Alesna obtained, there is no doubt that he knows how to use his business acumen for good. Green Apple Dental is a product of his vision and brilliance that he started 5 years ago. If only many of us can mirror his values especially on the professional side, our future dentists will have a public figure to emulate. DA

Dr David Alesna is the newest addition to Dental Access’ advisory board members. He is the past president of Cebu Dental Chapter in 2004 and is one of the founders and owners of Green Apple Dental Clinic. M Mar arch ch 22001166 •• D DEEN NTA TALL A ACCE CCESSSS •• 15 15



o fanfare. They practically slip into the coun try from time to time, armed with dental and medi cal supplies, trekking their way to rural areas and far-flung regions and quietly doing their share to alleviate whatever dire need their less fortunate countrymen can’t normally afford – dental and medical healthcare. The Philippine Medical Mission to the Kingdom of Saudi Arabia (PMMKSA) was originally a team of healthcare professionals who contributed and provided the needed healthcare to both the military and civilian personnel involved in the Gulf War’s Operation Desert Storm in 1990. The Philippines’ Department of National Defense was tasked to form the group when then Senator Santanina T. Rasul sponsored a bill that would form the contingent as part of the country’s humanitarian mission as a member of the United Nations. At the conclusion of the group’s mission (for which they helped save thousands of lives), the group members went on their separate ways and practically lost communication with each other. It was only in the advent of social media, specifically Facebook, where nearly all of them re-connected. A mini reunion then ensued on August 3, 2012. Then Defense Undersecretary Romeo T. Hernandez and his trusted aide, Dolores “Dolly” Cardinales, challenged the group to continue with their spirit of volunteerism. Their mission, after all, does not end even after the Gulf War has. So after 23 years, the group reorganized themselves. Relying on donations sourced from friends and colleagues alike in the States, they rose to the challenge with a medical-dental mission on June 19, 2013 in Camarines Sur and another on June 29, 2013 at Barangay Patadon, North Cotabato followed by a mission at Barangay Taluksanay in Zamboanga City on April 15, 2015. Back then, they decided to put order into their organization by electing among themselves the officers who will handle the affairs of the group. Founding member Amie Dizon Banawis, a dentist, was elected President. Priscila Cruz, a pharmacist, as Secretary and Registered nurse Ariel Filio as Treasurer. The consultant of the group was Francisco Altarejos, MD. Remedy Medina, a Medical Technologist is also a founding member.

16 • D E N T AL AC C E S S • M a r c h 2016

While the medical-dental mission of the group was revived, it nonetheless became a sporadic occurrence since most of its members who were scattered across the globe became busy with their individual lives. But because volunteerism is very hard to take out of one’s system, a handful of them were determined to pursue their mission relentlessly, motivated by the desire to continue what they have originally started.

Jhing B. Chua-Sy, DMD


It is that deep yearning that has given birth to the group, Providence Mabuhay Mission, Inc. (PMMI) An off-shoot of the PMMKSA, it is composed of some of the old members who are mostly based in the United States. The founding members Renato A. Reyes, M.D., MBA, FACP (CEO & Chairman), Maria T. Solis, D.M.D. (Board Treasurer) and Maria Elena Suarez-Perut, RMT (Board Secretary) were joined by volunteers Mufti G. Hassan Jr. MT (AMT) (Vice Chairman) and Remedy Medina, CLS (Board Member).


PMMI’s Mission statement is “to provide healthcare assistance to areas hit by natural calamities, civil unrest and devastations; to reach out to remote and far flung communities that need healthcare services.; to provide lasting impact by using healthcare and education to empower individuals and promote volunteerism to build stronger and better communities;” with the vision “that people who are isolated from the progressive communities will have the opportunity to enable themselves and help build their own communities into a stronger unit of society”.

photo: Sitting L-R Ms Elena Perrut, Dr Maria T. Solis, D r Renato Reyes Standing L-R Mr Mufti Hasan, Mr Remedy Medina


Their main source of support to fund their lined-up projects come from their numerous friends, colleagues, and acquaintances who have seen their group’s effort in bringing their professional expertise and committing their valuable time to their underprivileged countrymen who are the beneficiaries of their organization. As soon as the groundwork for a mission has been laid, they spend their own money to come back to the country and trek to the hills and mountains where most of the recipients have never seen a dentist or a doctor in their entire lives or even if they did, it would be the proverbial once-in-a-blue moon.

Some of the in-kind donations for their intended beneficiaries are also brought back to the Philippines. But mostly, they purchase the much needed materials and supplies for their dental and medical missions here in the country to minimize baggage costs. They make sure that the monetary contributions are spent wisely and fully accounted for with proper notifications to their donors and contributors. Theirs is an act that remains unnoticed. They silently do their share because their spirit of volunteerism far surpasses whatever personal convenience they may have. Silent. Quiet. No trumpets announcing their arrival. No fiesta banners greeting their presence. No mini Philippine flags to welcome them everytime they set foot on our soil. Only the smiles and whispers of gratitude from the recipients for their kindness and gracious hearts that has started to create a ripple effect in many of the barrios, sitios and obscure municipalities in our archipelago. When all is said and done, the Providence Mabuhay Mission, Inc. volunteers go back to their now declared homes abroad, spent and tired and sometimes heart-broken with the many woeful stories that are shared to them by the poor and downtrodden. But still, their hearts are not without gladness. They know that whatever aid they have provided, though miniscule by society’s standards, is something that has given hope to the people they served and will serve for many more years to come These silent Samaritans continue to live up to their organization’s tagline of

“pursuing happiness by helping others”. The rewarding feeling it creates is immeasurable as much as it is priceless. DA

M ar ch 2 0 1 6 • D E N TA L A CCE S S • 17






henever I hear a group of plebeians who conduct charitable functions in far flung areas, I always imagine a group of Non Government Organizations, physicians, dentists and barangay health workers who come to the aid of the indigents, all geared up with their scrub suits or white jackets while being couped up in the gym with electric fans and a long line of patients. Carrying with them are stethoscopes for physicians hung around their necks while dentists are lined up with their instruments on the side table ready to pull out teeth. But with the Tarlac Dental Chapter (TDC), together with DepEd Dentist II and PDA Regional Coordinator Dr Germilyn Guiao, and Dr Madeline F. Obiena Dentist in Charge of DepEd Tarlac Division and Chairman of Bright Smile Program, they roll a different beat.

Instead of the the usual companions, they are escorted by the Tactical Group 3 of the Philippine Air Force (PAF). Instead of having the missions in the city, they go to the mountains to reach out to these schools. Instead of having the common activity, (tooth brushing drill, oral health awareness and dental treatment) they developed programs that revolves around the needs of a child holistically. These activities include feeding programs, kit for kids, dedicated to school children combined with proper grooming all done during the culminating activity of the Indigenous Program. Witnessing this, the opportunity to visit Tarlac City in Capas and explore the day to day life of these doctors as they move from one school precint to another is an eye opener for our association. As I watch them in action under the heat of the sun, I told myself that I could not imagine doing this on a regular basis. This entailed a lot of hard work, dedication and sacrifice. Almost every week, these group of doctors brave the roads and embrace the dangers of travelling to and from these schools in the mountainous portion of Tarlac. Armed with nothing but their instruments and courage clutched underneath their skin, they readily reach out to these indigenous groups all in the name of charity. Through the support of the benefactors and partners of this program namely the Provincial Government of Tarlac, DepEd Schools Health Division of Tarlac Province, Air Force of the Philippines - Tactical Operations Group 3 and PDRRMC, these children are given a fighting chance to do better at school in preparation for the future. 18 • D E N T AL AC C E S S • M a r c h 2016

“These children have been receiving our program since it was implemented by the DOH and DEPED. It was concluded that these programs make a tremendous impact in their performance at school. If a child doesn’t eat, then what will the brain translate knowing there is no energy generated from the body.” Explains Dr Germilyn Guiao.

PROFILER “When your vision is of pure intention, everything will fall in the right places. Assistance will come knocking to your aid and the people around you will want to participate and join your cause.” Dr Carolina Pauco explains during the culminating activity. Today, joining their cause in promoting goodwill to humanity are the same group who escorted them during their activities which is the Tactical Group 3 of the Philippine Air Force. Inspired by the chapter’s initiative, they too conduct oral health and social related activities that is aligned with the TDC’s direction.

Going to Maribago School, it was half an hour to an hour drive from Tarlac City. Manning the wheels, Dr Germilyn Guiao drove easily across the mountains past the dirt road like a pro. It seemed like an everyday life for her to go from school to school but along the interview, she confessed how challenging it was especially when she was president of Tarlac Dental Chapter in 2014. “How were you able to outsource the Tactical Group of the PAF and be part of your missions?” “It was through my persistence. I just never gave up even when there were road blocks. I just never stopped asking for help even from my friends.” Dr Guiao smiled. “We have managed to hold successful programs in Tarlac including the Bright Smile Program which is a PDA initiated project. It is part of our advocacy to exercise and bring into play a zero cavity environment among the children at schools. The school mainly the teachers can greatly influence their attitude and behavior which is why we are active in claiming this project as our front - runner.” added by Dr Madeline F. Obiena Dentist in Charge of DepEd Tarlac Division and Chairman of Bright Smile Program.

Thanks to the efforts the Philippine Air Force namely LTC Joseph P. Archog PAF Tactical Operations Group 3, the TDC are able to extend its assistance to those communities that were difficult to reach. Their support has been a valuable contribution to the community of Tarlac and yet they remain unrecognized for their gallantry.

A New League of Heroes Charity is the heart of every successful program. Each successor of the Tarlac Dental Chapter possess a semblance of true leadership. Partnering with the DepEd dentists Dr Guaio and Dr Obenia, the Tarlac Dental Chapter are among the premier dentists who do not lead their members rather they mentor them as future leaders of the community. Furthermore, they engage their members into community service because they believe that social responsiblity is among the key factors that drives growth in our nation.

If two heads are better than one to lead a country, then this saying holds true to our new heroes of Tarlac. The joint efforts of these outstanding groups, the TDC, the PAF, DepEd and DOH is a victorious combination that fights for the future of these children. An educator, a leader and a warrior, all rolled into one fearless chapter found right in the heart of Tarlac. DA

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e attend the annual Dental Convention to hear lecturers here and in other countries. We also participate on various table clinics and most of us take a few hours purchasing dental materials at the trade exhibit. What must we install in our dental office to facilitate progress and effitciency for our practice? Significantly almost all additions will play a pivotal role in our office, hence there is technology and we must adapt to this innovation to uplift our effectivity of service. So how does a click sound that will show all the details of our patients medical and dental history? We joined the introduction of the latest dental innovation here in the Philippines, whereby answering the needs of our dentist from different sectors. Electronic Health records are widely used among hospitals and medical practices, to collaborate patient clinical information in a quick, accurate and most importantly secure manner. This also enables a practitioner to keep track of all information of the patient in his electronic device. No longer will there be a need to track down X-rays taken from a diagnostic center, or ask our secretary to search for files and record of patients from years back. Information of each person will be made available in a touch of a button, complete medical and dental history will pop out which will lead to a more substancial treatment decision. Radiographs, Photos, Cast records and analysis can be kept singularly along with the individual tooth record. Progress reports are cached and can only be accessible by the dentist.

The all-in-one application of Dental Electronic Charting arrived in the Philippines more than a decade ago and through its President Engineer Wouter Martin Put with the assistance of Dr. Clarissa Jane Pe as their Philippine consultant, the system provides a platform that is friendly to all dentist and dental service providers. This will enable a smooth transition from bulky records to paperless filing. In addition, it will create a concise yet solid data for our dentists, most especially from government health sectors to collect information about patients’ statistics that were flawed by their usual dental charting. From the perspective of the dentist and the dental team, the technological issues are easily addressed by selecting a software with the most relevant feature and oversimplification to bridge the gap of technology. While there are other instruments that were made available earlier, the dental charting provides upgrades periodically following the consumers demand making this the larger advantage of dental charting. A patient’s complete electronic medical and dental record captures image data such as panoramic xray, cephalometric xray, periapical xray and these images are appended to the clinical chart entries, periodontal chart, treatment recommendation and treatment done. Thereby, a properly configured program will be he hub for all the patients records. It will allow dentist to perform data entry and query from the same user interface in just a click. The Dental Electronic Charting provide dentist with everything they need to operate their offices functionally. From the baseline, it has preloaded 60 presets chart statuses, it can easily make a schedule of including what treatment that needs to be done, and alerts dental secretaries to notify them of the patients upcoming dental visit. It offers dashboard to instantly give a birds eye view of the scheduled appointments, it presents the clinic daily income for the past 30days and inform the top patient’s with outstanding balances. Dental eCharting has a function much like that of spell check however this is what they call fast intelligent search which has a almost 3000 pre-loaded dental procedures, dental materials, chief complains, sign and symptoms and diagnoses and prescription which can be printed. What tops this is it is customizable to fit the operator, and the presets are updated regularly.

The Link to the Future of Dentistry

With all the functionalities of Dental eCharting, this will in turn present compelling treatment plans which can boost the sale of the clinic. As this operates more effectively, extracting the use of papers significantly. Dental secretaries would have a manageable task as the patient record and finances can be viewed in an instant. Moreover it avoids hard copy document crowding and it is ISO 9000 certificated.

ernment and Private Dentists held last February 25. The event was made possible by the Overall Chairperson Dr. Germilyn A. Guiao, FPFA,RDH,RN from PDA-Region III, Regional Coordinator.

2015 PDA-President Dr. Malou Manalac Coronacion graced the monumental event along with Dr. Anna Liza Anoos Lerio, Chairperson of PDA- Adopt a School Program, and Dr. Clarissa Jane Pe, Chairperson for PDA-eCharting. The Zambales, Nueva Ecija, Tarlac Dental Chapters Presidents and representatives, Cabanatuan Health Office Dental representative were among those present to learn of these latest This innovative system and development paved the way dental innovation. for Dental Charting to tie up with the Department of Education Schools Division in Tarlac Province Adopt A To implement this new system can take years to grow in the region, however it is School Program Regional Electronic Charting for Gov- always said that new doors open new opportunities. The next step is up to you. DA

Dr Harris T. Co

20 • D E N T AL AC C E S S • M a r c h 2016

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A well-designed orthodontic recall system Dr Maridin M.Lacson,IBO,MSD Ed

In creating your orthodontic image, planning and implementation play key roles in achieving success. Prescheduling patients in their next appointment and communicating with them repeatedly increases the chance of their commitment to the next visit. Continuing care and preventive measures improve the dental practice and allows the patient to realize the importance of routine orthodontic scheduling. Looking inside the four walls of your dental clinic conveys an environment of your genuine desire to improve and positively create an image of pleasant personality and verbal skills. Ciardello and Janssen suggests that if patients aren`t being retained in your dental care, consider the causes. They often include: 1. The practice needs more patient education on the value of preventive care (short- and long-term benefits to patients). 2. The dental clinic constantly moves the appointments. 3. Staff or dentist need improved patient service skills and chairside manners. 4. Patients perceive the fees to be too high; fee rebuttals are weak. 5. The appointment is uncomfortable, clinically-speaking. 6. Patients constantly are reprimanded for poor home care. 7. There are frequent changes in staff. 8. The patients are kept waiting too long in the reception area or dental chair. 9. The clinic environment is stressful and disorganized. 10. The recare system isn`t supported by the doctor and entire team. 11. The practice needs verbal skills-training. 12. There`s no time to follow up on lost patients each week/month. Emphasis has been made that the clinic’s RECARE system must be considered ROCK SOLID! The best hours to make recalls are Monday-Friday between 4pm-7pm and Saturdays between 9am-12nn. Progress appointment system must be with right timing and consistent in their schedule system. Information includes: Clinic Name, Date, Time, Message and Confirmation. (DENTAL AVENUE: It’s time for your BRACE CHECK! We need to adjust your brackets and wires to make your teeth straight! Your sked is on {date, day ,hr. eg. Jan 18 Tues 10am.]Pls. text to confirm.) All dental practice needs sustainability to grow and receive new patients. Pre-appointing them is the initial and foremost rule to maintain your pools of patients and allow your orthodontic treatment to finish well. Your potential increase of investment lies on your consistent and persistent care to patients. Develop an image and improve communication schedule thru a monthly calendar set up. Compliance is 100% when patient already perceive that the next schedule is already in their cellphone alarm. Immediate impact is gained when after their orthodontic appointment you thank them for their presence in the dental office.(DENTAL AVENUE: Thanks for the privilege to treat you in your orthodontic care. We look forward for your staighter SMILE! Next sked is on _________(date,day,hr). See you then. Great day!) To start right and end well in orthodontics, an effective and positive recall system must be implemented in the dental office. Surely, taking care of minute details and concerns will potentially increase your dental offices’ revenue. Mark it! References: Denise Ciardello and Janice Janssen ‘Recall ... the heartbeat of the dental practice’ Miles,Linda L.CSP,CMC ‘The Lost Patient Syndrome’

About the Author Dr Maridin Munda-Lacson is a Diplomate of the International Board of Orthodontics in New York University and a Board Examiner for Orthodontics. She is an alumna of of the UE College of Dentistry graduated with honors including the Most Distinguished Dental Clinician in 1992. Currently she is a Faculty of both the Univeristy of the East College of Dentistry at the Post Graduate Orthodontic Department and NYU College of Dentistry at the Department of Biological Science. 22 • D E N T AL AC C E S S • M a r c h 2016


The Significance of Orthodontic Diagnostic Records Dr Brian E. Esporlas


There is an increasing number of patients who are seeking orthodontic care because of the orthodon- tic impact to the facial esthetics ( giving the patient a better facial profile), correcting malocclusion, treating temporo-mandibular disorders and sometimes for facilitating other dental procedures. Unfor tunately, many of these patients tend to transfer from one dentist to another because their dentist was not able to solve their problems. When these patients are asked how long did they stayed with their previous dentist, they would usually answers 2 to 5 years and that nothing has happened. Yes, they will tell you that their teeth are somehow aligned, yet, their profile has not improved. And when you will check their occlusion it will be revealed that it is not acceptable. So what goes wrong? Based on our experience from our practice, these patients, usually seek consultation with us on what should be done in order to correct their problem. It is in our practice not to accept orthodontic patients who are currently under any dentist care. So we usually ask them to seek a clearance or a release form from their previous dentist before we can accommodate them. Fortunately, some of them are released by their previous oral care provider. But unfortunately, there are no records to release. No pre-operative radiograph, no pre-operative study cast, no pre-operative intra and extra photograph and sometime (if not too often) even the history of the orthodontic treatment is also not available. Another problem that we have seen is that there are dentist who just send their patient’s cast to an orthodontic material supplier. And once the casts are sent back to them, a set of bracket with a series of arch wires are also sent with the instruction on when to use or change to the next arch wire. With this method, again, cast alone will not give us the overall information that we need in order to understand our patient’s condition. So this is what causing the failure of treatment in the first place. Many practitioner neglect the importance of diagnostic records and most frequently, the findings we can get once we do the analysis of records. Without acquiring a preoperative diagnostic record, one will not be able to identify the underlying problem/s that causes the deformity or deviation of the patient’s oro-facial parameters. If underlying problems will not be properly identified, a good diagnosis is not possible, and to top all these, a treatment plan specific for a patient cannot be formulated. Putting brackets on is not the first step in an orthodontic treatment scenario. Technically, the very first step in the patient’s orthodontic treatment is the record appointment. This is when the orthodontist will gather information to determine the patient’s orthodontic needs. It will all start with an interview so that the patient can provide crucial information regarding the history of the chief concern and information related to overall health issue of the patient. This will be followed by Clinical examination that will include assessment of the intra and extra oral condition of the patient which will eventually help determine what other diagnostic records are needed. Typically the basic orthodontic records include medical and dental history, clinical examination, diagnostic cast, intra and extra oral photograph, opg x-ray, lateral cephalogram and some other appropriate x-ray. All of these records will offer a wealth of very important information about the patient’s condition. Each of these records must be properly analyze to uncover the underlying orthodontic problems. Each problem must be put on a data base for further analysis in order to come up with a sound diagnosis. If a sound diagnosis has been made, it will be easier for the practitioner to formulate a quality treatment plan for the specific patient. With all these, I encourage all orthodontic practitioners to give ample time in doing record analysis. Through this method, we will be able to understand the needs of the patient and eventually provide them with a high quality of service which will end up in a successful treatment and a happy patient. About the Author Dr Brian Esporlas is an alumnus of Centro Escolar University College of Dentistry batch 2004 March. He pursued his post graduate education at his alma mater in 2009 where he graduated and took up a degree in Science of Dentistry, Major in Orthodontics. In 2014 he made his country proud when he was chosen to be among the Presenters for the Poster Board at the Hong Kong International Dental Exhibition and Symposium (HKIDEAS). In 2015 he present two more posters for the HKIDEAS that was followed by his induction as a Fellow member of the Pierre Fauchard Academy. Today he continues his doctorate degree in Philosophy in Development Administration at the Philippine Christian University and is an assistant professor and Chair for the Faculty Development at the University of Perpetual Help System Dalta in Las Pinas City.

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About the Author

LONG TERM STABILITY OF DISTRACTION OSTEGENESIS IN THE CONSTRICTED MAXILLA by Dr Derek Mahony I thought I would start my lecture by reviewing what I had learnt a number of years ago at a conference that was organized by the American Association of Orthodontists. The course that I attended had listed a number of conclusions about distraction osteogenesis. The first was that there should be a latency period of about 7 days after the initial surgical cut, and then the rate of turning (from a number of evidence-based research reports) should be 1mm a day with a rhythm of 0.25 mm. So, in other words, 4 turns x 0.25 mm. They felt that 20mm of distraction could be achieved and they had suggested a consolidation period of about 7 weeks. A number of researchers who presented at this conference felt that if those criteria were followed, it was certainly possible to move teeth into the new bone; which is great for me as an orthodontist; but also, the bone was of sufficient quality that it was possible to place implants in the newly formed bone. This would be very interesting for our referring general dentists, implantologists, periodontists, etc. One of the controversies that is often raised, is “when would be the best time to perform distraction osteogenesis for our patients?” and the answer very much depends on what effect it may or may not have on the growing craniofacial skeleton. The second controversy is stability, and long-term studies associated with that. We need to ask ourselves the question whether long-term stability of bone (that has been lengthened by osteo-distraction) is the same quality as bone from a conventional surgical procedure. Then we need to look at the limits of soft tissue stretching during distraction osteogenesis (DO). One of the reasons many surgeons are now looking at DO versus a conventional osteotomy is based on the ability for soft tissue to adapt. Many people feel that it is easier for the soft tissue to adapt during a prolonged DO than during a 4 hour operation for a normal osteotomy procedure. As an orthodontist, I have been looking at the effect of DO on the eruption of teeth; if we are performing DO in a mixed dentition, where tooth buds are still present, and where eventually teeth will have to erupt in the new bone that has been formed by the DO procedure. Also, in situations where we have new bone formed as a result of DO, is that bone of sufficient quality for us to move teeth into via normal orthodontic tooth movement. A number of papers have been presented on the effect of the periodontal ligament and the associated oral soft tissues following DO. Researchers have also reviewed the undesirable tooth movements when using an intra-oral tooth borne, or a hybrid device, versus a bone-bone (direct skeletal fixation) device. Many of the people I have spoken to, who I have spent time with at Baylor College in Texas, (which is one of the leading centres of distraction in the world) still debate as to whether an appliance should be used which is totally tooth borne or whether a hybrid type appliance should be used, i.e. one that is partly fixed to teeth and partly fixed to bone. Other proponents state we should have a direct bone-bone type distraction appliance. The main reason I became interested in distraction osteogenesis, is that I felt that one of the main limitations of conventional orthognathic surgery, is the inability of facial muscles to be acutely stretched without the inherent risk of relapse. In orthodontics that involves a combination of orthognathic surgery there is a war between tooth, bone and muscle; and in considering long term stability, muscle will always win the war. So, if we can perform our surgeries with a procedure that would allow facial muscles to re-adapt then maybe we can reduce some of the relapse that we have seen in previous osteotomy procedures. The other point to remember is that many of the congenital deformities require large musculoskeletal movements that soft tissues can not accommodate. This could lead to a compromise in function and aesthetics, unless we have additional soft tissue procedures performed at a later stage. One of the questions I raise with my surgeon, at our joint-surgical meetings, deals with patients who have a severe mid-face deficiency, but are only 11 years old. Do we have to wait until that patient is at the recommended age for an osteotomy (18 or 19 for a female, slightly older for a male)? By waiting this long, some patients go through a miserable social existence, as far as facial deformity, especially during the adolescent time frame. The whole concept of DO is that the traction generates tension within the callus and this stimulates new bone formation, which is parallel to the vector of distraction. The team at the University of Southern California has been using a combination of distraction with micro-implants. They use the micro-implants after the distraction (sometimes during) to change the vector (direction) of bone movement. The early work on DO, revealed that although new bone was formed, it was very hard for the oral surgeon and the orthodontist to control the vector of force, and many times we ended up with a distorted facial balance. I particularly remember a case where we tried DO in a short ramal height, long-faced individual; and although the ramal height increased, so did the direction (forward position) of the mandible. Distraction forces applied to bone, also create tension in the surrounding soft tissues. Some people use the 24 • D E N T AL AC C E S S • M a r c h 2016

term ‘distraction histogenesis’ saying that by using distraction osteogenesis vs. conventional osteotomies, we may have an improvement in the surrounding soft tissues and not just in the bone. Under the influence of these tensional stresses, which are produced by gradual distraction, active histogenesis occurs in different tissues. This includes the skin, fascia, blood vessels, nerves, muscle, ligament, cartilage, and the periosteum. These adaptive changes in the soft tissue may allow larger skeletal movements while minimizing the potential relapse seen in acute skeletal corrections. “The Long-Term Stability of Distraction Osteogenesis in the Constricted Maxilla” In the pursuit of optimum function and facial harmony, one of the biggest problems is the failure of general dentists to be educated on what can be achieved with conventional surgery, let alone DO. I still feel that the majority of general dentists talk their patients out of a combined orthodontic/orthognathic treatment plan as they feel that there is an inherently high risk; they find it is unstable; or many times they have heard that the desired results will not be achieved through surgery (perhaps due to their previous knowledge of out-dated surgical techniques). We all need to educate general dentists to recognise which underlying skeletal disproportions can be corrected with orthognathic surgery, rather than orthodontics alone. The indications that a patient requires a combined approach, is the patient whose orthodontic problems are so severe that neither growth modification nor camouflage offers a viable solution. For example, a patient who has a border-line Skeletal III problem and the orthodontist suggests the removal of upper and lower premolars to compensate and get the dentition into a Class I relationship. Although this may achieve a reasonable dental result, it may (on many occasions) worsen the facial balance. The same could be said for a Class II individual that has a retrognathic position of the mandible. Rather than extracting upper first premolars and retracting the upper incisors, to camouflage the underlying Skeletal II base, it may prove more successful to bring the mandible forward to balance the face. In cases such as the one described above, before you bring the mandible forward, you need to check the width of the maxilla. Many times, a patient who has a retrognathic mandible will also have a constricted maxilla. Hence, my surgeon and I will normally perform two surgeries, approximately 12 months apart. The first surgery will involve a lateral corticotomy (Surgically Assisted Expansion of the Maxilla); I will then place braces for 12 months to level and align the dentition and to de-compensate the arches in preparation for the second stage surgery which would normally be a one or two jaw procedure with or without a genioplasty.

Dr Derek Mahony is a specialist orthodontist who has spoken to thousand of practitioners about the benefits of interceptive orthodontic treatment. He is also a contributing editor to the Journal of Clinical Pediatric Dentistry and the Internatinal Jounal of Orthodontics. Dr Mahony is a Fellow of the International College of Dentists and is cinsidered a pioneer, throughout the world, in a raising dentist’s awareness of the need for early interceptive orthodontic treatment. He has presented over 400 lectures on orthodontics topics in more 30 countries.

two main cellular processes at action. The first is the formation of the callus, and subsequent to this, the generation of new bone via distraction. The latter is histologically similar to that seen in orthodontic tooth movement. Traditional orthodontics (often involving extractions) may achieve a satisfactory functional occlusion at the expense of facial aesthetics. This is now considered by most clinicians to be an unacceptable compromise and treatment should not be undertaken unless the patient is fully informed of the advantages and disadvantages of the surgical and non-surgical options. This discussion is limited to the non-growing individual. If you have a young child with a mid-face deficiency I would still develop the arch, and maybe use a reverse-pull facemask. If there is a young child with a retrognathic mandibular position, I would still try a functional appliance. However, in the non-growing individual, the above procedures are prone to relapse due to lack of facial growth. This is where the concept of the ‘osteotomy’ procedure is relevant. Most clinicians realise that in a severe skeletal discrepancy, dental camouflage is an unacceptable compromise. I offer my patients three possibilities; the first is not to do anything; the second is to dentally camouflage; and the third is to prepare the arches for surgery. I would personally prefer not to do anything rather than compromise the patient’s facial aesthetics for the sake of merely aligning teeth. Many times if a patient does not want to undertake orthognathic surgery I will accept the skeletal discrepancy and align the front anterior teeth (the ‘social six’) without worsening the profile. If we evaluate the advantages and disadvantages of surgery, with the patient, and he/she understand the limitations of surgery and what the possibilities are, the majority of people are quite happy to proceed. It also helps if the general dentist has already informed the patient that their problem is more severe than orthodontics alone can treat. That way, if the patient is aware of the possibility of joint orthodontics/orthognathics, they are not as reluctant to proceed. A patient who is dissatisfied with their facial proportions, patients with severe occlusal attrition (aggravated by skeletal discrepancies) and those with marked skeletal malocclusions experiencing severe TMD symptoms are suitable candidates for surgery. The same could be said for patients with sleep apnoea. My surgeon and I have had a number of successful cases where we have performed DO expansion in the upper and lower jaw as the first stage surgery, followed by a maxillary and mandibular advancement to improve the airway. The changes are quite astounding when reviewing the before and after sleep studies. We must then question, what is possible when it comes to changes in the width of the maxilla. We can certainly widen the maxilla and make it narrow, but narrowing is more difficult because bone must be removed. The amount of expansion that can be achieved is limited, with the major constraint being the soft tissue pull.

This diagram above also comes from the textbook by Bill Proffit. Surgeons that I have worked with favour a ‘cut’ in the midline, as well as a cut above the apices of the teeth in the buccal sulcus. Others seem to feel that the buccal sulcus cuts alone, with an anterior fracture is all that is required. We can expect about 10mm of expansion, and the stability could certainly be improved based on the rate of expansion and how long we can hold that expansion with a retainer. Research has shown that 40% relapse can be expected when you expand without rigid fixation; however RIF (rigid internal fixation) may improve the relapse tendency. The diagram above comes from one of the most popular text books in orthodontics and that is by Bill Proffit (Contemporary Orthodontics, 1986 first ed.). He calls this the ‘envelope of discrepancy’. This is a great way to educate the general dentist. You can see that the ‘black zone’ is our capabilities only with orthodontics; and in the ‘red zone’ is our capabilities in conjunction with surgery. In the far ‘outer’ circle, may be our capabilities with the refinement of distraction osteogenesis.

In our clinic, prior to surgery, we place a maxillary expander, and we show the patient how to turn that expander. Following the osteotomy cuts, the patient turns the expander on a daily basis and we leave the appliance in for 2-3 months to allow bone stabilization. During that 3 month period I commence my orthodontics, so that by the time I have removed the expander, there is a wire left in the mouth that is rigid enough to maintain the expansion. Using this technique, we have had much better stability of the expansion than in the past.

Distraction osteogenesis relies on prolonged, progressive and gradual distraction which does not disrupt the vascular supply. Some of the initial work done on this surgery was with the ‘Islasarov technique’, i.e. the ability not to perform a through and through cut of the bone, making a big difference in the callus formation. It is my understanding that there are

The relapse after orthodontic expansion is very similar to surgical expansion, therefore I recommend in younger patients the use of maxillary orthopaedics (expansion) which is effective until late teens, followed by a long term retainer. Using this method, I achieve good stability, and I believe that this may be due to the growth of the individual and the fact that


the mid-palatal suture is not totally fused. In a non-growing individual, however, we certainly need surgically assisted expansion. The surgically assisted expansion will rely on an osteotomy in the lateral buttress of the maxilla, in conjunction with expansion devices. In the mandible it is possible to narrow anteriorly, and to widen. However to significantly widen, we need to perform a distraction procedure. My surgeon and I have tried a number of different distraction procedures. One procedure, with a purely tooth borne appliance, involves me moving the mandibular central incisors apart so that he can do the surgical cut; another procedure is where he has done the surgical cut and fitted an expansion appliance directly to the bone.


AFTER (Showing excessive tipping of teeth) In terms of forward movement of the maxilla, my surgeon and I have not yet offered distraction osteogenesis, but this is something that hopefully we may recommend in the future. I find that a maxilla can be moved forward, up to 10-15 mm, with good stability. The major limitation to the forward movement is the resistance of soft tissue, particularly the upper lip, and the stretch of the palatine artery. You must also be aware of the effects that the advancement can have on speech and the velopharyngeal closure.

In this figure from Proffit, we can see the surgical movements that are possible in the transverse dimension. The solid red arrows indicate that the maxilla can be expanded laterally or constricted with reasonable stability. The smaller size of the arrows pointing to the midline represents the fact that the amount of constriction possible is somewhat less than the range of expansion. The only transverse movement easily achieved in the mandible is constriction, although limited expansion is possible. The problem with traditional orthodontic diagnosis is that most orthodontists are very familiar with the lateral cephalometric radiograph, but do not concentrate enough on the frontal PA skull radiograph. In our surgical work-ups we use a lateral cephalometric radiograph, and a frontal PA skull view. New and improved technology has also given us the opportunity to work with long-cone CT Xrays, where in 30 seconds we can have 230 sections of the upper and lower arches. We also use Spiral CT technology to perform a three-dimensional reconstruction. This has helped greatly when planning the treatment options of the transverse and AP discrepancies.

The patient below has had a first stage surgery involving a surgically assisted expansion of the maxilla, followed by a second stage procedure of a maxillary advancement. This patient has a Skeletal III malocclusion, with severe mid-face deficiency. Her chief complaint was that on smiling she didn’t show enough of her incisors. She was referred by her general dentist due to the excessive wear on the upper and lower incisor teeth- due to the edge to edge traumatic occlusion. The following diagrams show the patient 10 days post-operatively. It is very important that you monitor the surgical patients closely in the first week. On many occasions, the patient does not turn their expander properly; some patients turn it t he wrong way; some turn it more than the required amount. To avoid these situations, it is imperative to review the patient within the first week of surgery, check their expansion, then follow them on a regular two weekly basis for the initial 8 weeks following the distraction procedure.

(Surgery for the above patient is performed by Dr. Fued Samir Salmen, Brazil)

This patient above presents with a mild Class III dental problem, but a reasonable mid-face deficiency. The appliance of choice here is an expander with two bands on the premolars and two bands on the molars. The patient is sent to surgery with a rubber ‘O’ ring around the brackets on the bands so that there is less chance of soft tissue trauma. The reason for these ‘O’ rings, is that after expansion is complete, but before I remove the expander, I want to place an orthodontic archwire and having the tubes and the brackets in situ, within the appliance, makes this easier for me to place the archwire; such that I do not have to remove the expansion appliance to start fixed orthodontic treatment.

Below, we can see the osteotomy cut of the buttress and the mid-line fracture. This shows the older style expansion screw that we are no longer using, and we can see that this patient has a high palatal vault, and constricted maxillary archform. One of the problems with this style of expansion appliance is that it is very hard for the patient to locate the hole for the key. Many times the patient needs to turn the key themselves and this is an almost impossible task with this style of jackscrew. We now use a ‘super screw’ appliance which is easier to activate because it is a hexagon and the patient uses a small spanner to activate the device.

I warn the patients, prior to surgery, that they can expect a large diastema between their teeth because many of them are not prepared for this. The main problem that I encounter with patients, is that they try to convince me that the orthodontic treatment needs to be started straight away in order to close the diastema. When I attempted to try this early, many years ago, I found that I was moving the front teeth into ‘thin air’. This increases the chance of the incisors becoming non-vital. We now advise the patient that we will not commence orthodontics for at least 3-4 weeks after they have ceased their last expansion. Once orthodontics is commenced we use ultra-light forces. We employ the principles of the Damon system, which is a passive self-ligating bracket that drastically reduces the amount of force we place on the teeth. I have found that with this method, I am not seeing the same degree of root resorption and non-vitalities that I used to see 10 years ago when we did not use passive self-ligation. In terms of overexpansion, the first thing you will notice if a patient is expanding too quickly, is tipping teeth. Teeth will tip when you have reached the patients genetic potential for expansion. To avoid this, it is best to stay within the Schwartz Korkhaus measurements. The Schwartz Korkhaus measurements are calculated from the width of the four upper incisors. Below is a diagram of an adult patient’s narrow upper jaw. In the second diagram, you can see that this patient’s premolars have tilted outwards. In a good distraction procedure, one thing we should see (other than the midline diastema) is that the molars and the premolars are held upright in bone. The moment you see tipping, you are increasing the chance of orthodontic relapse.

The expansion appliance is fitted on the patient, however it is not cemented so that the surgeon can remove it to make the midline palatal cut. The surgeon will then cement the expander after the midline cut. The lateral wall surgical cuts are then made. M ar ch 2 0 1 6 • D E N TA L A CCE S S • 25


This patient was extremely happy, post-surgery, because we successfully addressed her chief complaint, i.e. she was concerned with the lack of incisal display. You can see that we have increased the patient’s incisal display by approximately 5 mm. In terms of her profile, there is better facial balance; the relationship of the maxilla to the chin and nose has improved, and if we show our intra-oral before and after photos, you can see the initial edge-to-edge occlusion, the decompensation prior to surgery, and then finally, the maxillary advancement procedure. The use of surgical hooks on the final archwire, has proven to be difficult in the past. Previously I crimped the hooks in place, or placed hooks on the orthodontic brackets.

The top left diagrams below, show the patient 14 days after the operation; then 45 days; 120 days; and 14 months. You can see from these images that once I am happy with the amount of expansion that I will start my orthodontics. The orthodontics is utilized to level and align the dentition, and close spaces by bringing the back teeth forward, so that the archform is maintained. This is generally called Type C anchorage (“burning anchorage”).



120 DAYS


The following pictures show the patient pre-treatment and pre-second stage surgery. The patient (particularly one with a Skeletal III malocclusion) is warned that the orthodontics will worsen their dental Class III prior to the surgery. For patients with an edge-edge bite, they are warned that they may end up with a 5-6mm negative overjet prior to the second surgery. Looking at this patient’s profile, you can see the Class III malocclusion is more evident on the right side.


Above: Surgical Hooks soldered on the archwire.

Why so many patients would benefit from Surgically Assisted Expansion of the Maxilla. The ‘perfect smile’ is indicative of what most patients would like to achieve; that is white teeth, and a wide smile. I can achieve straight teeth regardless of whether I choose to extract or not; however the question is whether I can achieve that wide smile without some form of maxillary expansion. Research published in the American Journal of Orthodontics, 2005, (Moore et al) attempted to determine the influence of the dark buccal corridors when it came to the attractiveness of the smile. The figure below shows the measurements used in the research article.

The researchers used a series of patients and showed lay judges their initial malocclusion (28% buccal corridor), then expanded their dentition (using photo manipulation), thereby reducing the percentage of buccal corridor. Using the opinion of the general public, the researchers gained insight into the most visually appealing smile. The majority of patients chose the broad smile with a minimal 2% buccal corridor.

In young children where the maxillary sutures are active, we can influence full growth of the mid-face based on the arch development. It is a far reaching effect from what we see dentally. I find that ‘A’ point comes forward in a growing individual when you expand, and many times in the borderline Class III patients, with a narrow arch, after the first stage expansion procedure we find that we don’t need to do the second stage maxillary advancement because the expansion opens up the palate like a ‘V’ and as a result the pre-maxilla tends to push forward. For young children the timing of treatment can be determined by the cervical vertebrae. This is based on the research by Franchi, Baccetti, Cameron and McNamara. They feel that between stage 3 and 4 of vertebral maturation is a good time for mandibular movement, i.e. where use of a functional appliance would be appropriate. For a maxillary expansion, however, compared to the control, the skeletal growth philosophy or period to commence expansion would be even earlier, i.e. between the stage of C2 and C3. From the diagram below you can see what we are trying to achieve via the pre-maxillary suture, the palatine suture, and cruciate suture, so that we are obtaining development of the archform. Growth of the maxilla, with normal airway and tongue position, results in good downward and forward movement. However, in a non-growing individual I cannot achieve these same results unless the sutures are opened for me by the surgeon. Of course, we cannot expect the natural forward movement of the maxilla in these individuals. That is normally the role of the Le Fort I advancement procedure. In a mixed dentition, we can achieve many of these skeletal changes non-surgically.

The patient below is an example of an individual with blocked out lateral incisors. By fitting an expansion appliance (without surgery) the clinician is able to create room for the eruption of the lateral incisors over a six month period, such that there is less need to extract premolar teeth at a later stage. Research has shown that the canine follows the root of the lateral, so that if you have an instanding lateral there is more chance of an impacted cuspid. If you have a peg lateral (or missing lateral) the same is true, but if you can align the four upper incisors at age 9 or 10, and have a well developed arch it really improves facial balance and minimizes the need for unnecessary premolar extractions.


If we look at this patient’s step-deformity, we have now created an increased negative overjet in preparation for the surgeon to perform the maxillary advancement procedure.



The benefit of working as a team is that we can perform plaster model surgery. We take a face-bow transfer, and mount the models on a semi-adjustable articulator, so we can look at the amount of movement that is required and where the surgical cuts need to be placed. We then construct a wafer-thin surgical splint, from these working models, which we use as a guide during surgery and also to maintain stability of the upper and lower jaw post-surgery.




26 • D E N T AL AC C E S S • M a r c h 2016

The ‘perfect smile’ can be defined using the following characteristics: 1) The amount of incisal display showing all upper teeth, minimal lower teeth, and showing no gingiva; 2) The upper teeth follow the line of the lower lip (smile arc); 3) The absence of dark buccal corridors. When it comes to expansion of the maxilla, we need to ask ourselves a number of questions. Firstly, does it work; secondly, is it stable; thirdly, when should we commence expansion; fourthly, once we start the expansion at what rate should we activate our device; lastly, which appliance is best to achieve the expansion. The orthodontic literature, and practical information provided by clinicians at meetings and in courses, regarding maxillary buccal segment expansion is variable and confusing. Therefore I will attempt to answer the above questions myself. In answer to the first question, in a growing individual (for a boy up to 14/15 years old and for a girl up to 12/13 years old) good expansion can be achieved, slowly, without the need for surgery. However, for the non-growing individual, I recommend a surgically assisted expansion to achieve stability, and the distraction approach to achieve stability from the soft tissue pull. In terms of rapid expansion versus slower techniques, in the non-growing individual, the best rate of expansion is about 1mm per week; whereas in a surgical case I would increase that to 2-3mm per week. Can we minimize the number of pre-molar extractions if we expand? Before we answer that question, we need to assess the patient’s smile line. If the patient already has a very broad smile and we remove teeth, but bring the back teeth forward in the same corridor width, you will find that the smile is not affected. Nevertheless, what sometimes happens in traditional orthodontics, teeth are removed and there is no pre-extraction arch development so the crowding is resolved by retraction of the incisors. This may narrow the archform and flatten the smile. So, although I wouldn’t say that all extraction cases end up with a narrow smile, certainly those patients who need arch development (surgically or not) should have that completed before a decision is made on the relief of crowding and the need to remove teeth. Regarding the elimination of buccal corridors, and achieving a fuller smile, a full smile can be achieved (with and without extractions) provided the archform is maintained, and provided that the extraction space is closed by bringing the back teeth forward rather than total retraction of the incisors.

(Pictures reproduced from Textbook on ‘Interceptive Orthodontics’ by Dr. Damaso Caprioglio, et al.)

WHICH APPLIANCE IS USED AND WHEN? Initially we used an expansion screw or jack screw that needed a key for the parent or patient to place in the hole in order to activate the device. This was a difficult procedure for parents, and many experienced problems with it. Also, we never put bands on the 1st bicuspids in the premolar region, instead we would use a heavybodied wire which resulted in tipping of the teeth. Now we always use bands on the 1st bicuspids and the first molars. For accuracy I fit the bands myself and I take an alginate over the bands. This way, when I send the case to my laboratory I know that it will fit. In the past, an alginate was taken and sent to the laboratory. They poured up the model and cut the teeth to fit the bands; this of course, would ensure that the bands fitted on the model, however it did not necessarily fit chair side. Dr. Lewis Klapper, Orthodontist, developed a ‘super screw’ expander design. The benefits of this design is that it is a rigid expander so there is less tipping of the teeth; secondly it has a screw that is easy for the parent or patient to turn; lastly it has a gauge built into the appliance, so as the patient is turning it you can measure the amount of expansion.

The “super screw”

The ‘super screw’ is the style of expander that I am now using in my surgical cases,, where bands are fitted on the fours and sixes. We extend a heavy bodied wire from the cuspids to the second molar so that when the expansion is activated, we have movement of the entire arch. Otherwise, in the past, we would have expansion of the buccal segment but narrowing of the anterior segment.

CONCLUSION Distraction Osteogenesis is a scientifically proven technique to expand the arches in non growing individuals. The clinician must pay close attention to what appliance they would use, when they should start turning, how many times the appliance should be turned per week, and how long they should retain the expansion to enhance stability. A patient should at least be offered the possibility of arch development as opposed to extraction based, dental compensation, before a final treatment plan is made. This is particularly relevant to relieve crowding in a constricted archform, for a non-growing individual.


Composite inlays as an alternative in the posterior region Dr Sanzio Marques and Dr Márcia Marcondes Guimarães


oday, composite restorations are regarded as a reliable alternative for the posterior region and combine both aesthetics and longevity. However, for the success of any restoration, it is fundamental that the dentist has a good command of the technique and materials. This article shows, step by step, the chairside fabrication of an indirect composite restoration on a molar. This is followed by a discussion of the indications, advantages and properties of this technique which not only cuts costs but which is also high in quality and simple to use.

Introduction The adhesion of restorations on the remaining dental hard tissue represented a major turning point for conservative treatment. The introduction of new materials not only helped to improve aesthetics, but also facilitated the restoration of the shape, strength and function of carious and traumatised teeth. And all this combined with the major advantage of the restorations being conservative and minimally invasive, without having to remove large amounts of tooth substance as was previously necessary with cavity preparations, e.g., for amalgam restorations. It is also general knowledge that the composites frequently used in the posterior region are subject to polymerisation shrinkage which, in the case of the incorrect use or disregard of this property common to all restorative composites, can lead to internal tension. If this tension exceeds the strength of the bond, this can result in marginal deficiencies or even cracks in the dental hard tissue and restoration. This occurs predominantly with larger cavities as a greater amount of composite materials increases the shrinkage tension (Davidson & DeGee, 1984; Lambrechts et al., 1977; Dietschi & Spreafico, 1997). Thus in the posterior region, particularly with larger cavities, the restoration result may be compromised. This is because this area is harder to access, which can cause problems when preparing the cavity margins and contouring the anatomy and also when creating physiological approximal contacts (Imparato et al., 1999). In light of these well-known factors, many dentists opt for indirect restorations produced in laboratories to treat larger cavities. This allows the restoration to be fabricated without having to deal with intraoral difficulties, thus offering improved contouring and the easier creation of correct approximal contacts with the optimal physical properties of the restoration material. However, there are a number of disadvantages associated with indirect methods, these include the need for a large number of sessions, the production of temporary restorations and higher costs due to the laboratory work (Bussadori et al., 1995). A very good alternative for the above-mentioned cases is the comparatively easy restoration technique using a chairside-produced inlay which combines the advantages of direct techniques with those of indirect techniques and is also associated with a reduction in costs and reduced time requirements. The clinical case below describes, step by step, the restoration of a posterior tooth using this technique.

Clinical case The female patient had an insufficient fractured amalgam restoration in tooth 16 (Fig. 1). She complained of discomfort in this tooth. The planned treatment comprised the replacement of the amalgam restoration with a chairside-produced indirect composite inlay, since this was a larger restoration. The GrandioSO Inlay System (VOCO) was selected for the creation of the inlay; this system includes all the necessary and coordinated material components. The amalgam restoration was firstly removed and a base layer was applied using the glass ionomer composite cement Ionoseal (VOCO) in order to smooth over the floor of the cavity and achieve an adapted cavity shape (Fig. 2). The cavity was prepared with special diamond burrs so that no undercut areas remaine Then an impression of the cavity and adjacent teeth was taken with alginate (Hydrogum, Zhermack) (Fig. 3). After the alginate had set, a silicone model was created using special A-silicone (die silicone, VOCO) (Figs. 4 and 5). The next step involved the application and modelling of the nanohybrid composite GrandioSO (VOCO, Fig. 6). Here every single layer, including the interior surface, was light-cured for 20 seconds. The pigments ochre and brown (Kolor+Plus, Kerr) were used for the surface characterisation of the fissures. The diamond-interspersed silicone polisher, Dimanto (VOCO, Fig. 8), a goat hair brush, Opal paste (Renfert) and a wool wheel were used one after the other for finishing and polishing. After the site had been dried completely, the steps for adhesive cementation of the restoration were performed. The prepared cavity was firstly cleaned with a Robson mini brush and a water-based pumice stone paste.

Fig. 4 – Filling of the alginate impression using the die silicone

Fig. 5 – Silicone model after curing (3 minutes) and demoulding.

Fig. 6 – Application in layers and modelling of the composite GrandioSO (VOCO) in shade A3

After the chemical curing of Bifix QM, the rubber dam was removed, the occlusion was ground and the restoration margins were polished using Dimanto (VOCO), brushes and felt polishers. The final inlay is characterised by its optimal aesthetics and shape which ensures ideal functionality (Fig. 12).

Discussion The composites which are available on the dental market are ideal for performing restorations given their aesthetic, adhesive and mechanical properties as well as their ease of handling. Since Buonocore developed the enamel etching technique in 1955 and Bowen introduced the composite based on BisGMA (Bisphenol A-glycidyl methacrylate) in 1963, composites have seen a continuous development not only in terms of their mechanical properties but also their aesthetic qualities, which is why they are now increasingly indicated as restoratives. The direct and indirect or direct-indirect restoration techniques with composites have both their indications and advantages and disadvantages, as is evident from the wealth of research work found in specialist dental literature. However, according to Porter (1990), the direct-indirect technique achieves a more resilient marginal seal as well as greater restoration strength and, in addition, facilitates the creation of the contact points and the correct shading which serves to ensure improved aesthetics. Another important perspective relates to the contraction forces which arise from the polymerisation of excessively large composite increments and can impair their adhesion to the tooth. Various authors consider this to be an important factor when selecting a restorative technique and point out that when treating larger defects, the direct-indirect technique enables greater control over polymerization shrinkage of the composite which, in turn, leads to a reduction in some of the problems which are seen after placement of a restoration, e.g., hypersensitivity, pain and masticatory problems (Davidson & DeGee, 1984; Lambrechts et al., 1977; Dietschi & Spreafico, 1997). Chaim & Baratieri (1998) described that the semi-direct restorative technique offers the advantages of the indirect technique and, at the same time, allows work to be concluded in a single session. The adhesive technique also enables a significant amount of healthy dental hard tissue to be preserved which probably delays the need for more complex, extended and expensive restorations (Chaim & Baratieri (1998), Dietschi & Spreafico, 1997).

Fig. 7 – Careful removal of the inlay from the Fig. 8 – Finishing and polishing with the silicone model diamond-interspersed polisher Dimanto (VOCO)

Fig. 9 – The adhesive Futurabond DC (VOCO) is applied in the cavity.

Figs. 10 and 11 – Direct application of the luting cement Bifix QM (VOCO) in the prepared cavity and careful placement of the composite inlay.

Literature 1. DAVIDSON, C.L. & DEGEE, A. J.: Realization of polymerization contraction stresses by flow in dental composites. J Dent Res, 1948, v.63, p.146-148. 2. LAMBRECHTS, M.; BRAEM, M; VANHERLE, G.: Evaluation of clinical performance for posterior composite resins and dentin adhesives. Oper Dent 1987; v.12, p.53-78. 3. DIETSCHI, D. & SPREAFICO, R.: Adhesive metal-free restorations: current concepts for the esthetic treatment of posterior teeth. 1a. Ed. German: Quintessence, 1997. 4. IMPARATO, J.C.P. et al.: Reconstrução de molares decíduos através da técnica restauradora indireta com resina composta – acompanhamento clínico e radiográfico de dois anos. RPG, 1998, v.5, n.2, p. 133-137. 5. BUSSADORI, S. C; IMPARATO, J.C.P.; GUEDES-PINTO, A, C.: Manual de materiais dentários e técnicas em dentística odontopediátrica. São Paulo: Banco de Boston, 1995. 6.BUONOCORE, M. G.: A simple method of increasing the adhesion of acrylic filling materials to enamel surface. J. Dent. Res., 1955, v. 34, p. 849. 7. BOWEN, R.L.: Properties of a sílica-reinforced polymer for dental restorations. J. Am Dent Assoc., 1963, v.66, p.57-64. 8. PORTER, K.H.: Posterior composite resin inlays and onlays: a comparison of avaible systems. Tex Dent J, 1990, v.107, n.5, p.9-11. 9. LAMBRECHTS, M.; BRAEM, M; VANHERLE, G.: Evaluation of clinical performance for posterior composite resins and dentin adhesives. Oper Dent 1987; v.12, p.53-78. 10. CHAIM, M.C. & BARATIERI, L.N.: Restaurações indiretas de resina composta em dentes posteriores, in: CHAIM, M.C. & BARATIERI, L.N.: Restaurações estéticas com resina composta em dentes posteriores. São Paulo: Artes Médicas, 1998, p.131-168. 11. MONELLI, R.F. et al.: Conservative approach to restore the first molar with extensive destruction: A 30-month follow-up. Quintessence Int, 2013, v.44, n.6, p.385-91.

The tooth was cleaned and then rinsed thoroughly with water and the cavity was gently dried with air. A not too thin layer of the self-conditioning adhesive Futurabond DC (VOCO) was applied inside the cavity and rubbed in for 20 seconds (Fig. 9). In order to accelerate evaporation of the solvent, the adhesive was gently dried with a stream of air. This was followed by light polymerisation for at least 10 seconds. The dual-curing composite cement Bifix QM (VOCO) was applied directly to the cavity surfaces (Fig. 10), the inlay was carefully put into place and held down by applying pressure (Fig. 11); the excess cement was removed with a brush and dental floss. Every tooth surface was then polymerised with light.

Fig. 2 – Cavity lined with Ionoseal (VOCO) for smoothing the cavity walls and postpreparation.

Fig. 1 – Initial situation with the fractured and insufficient amalgam restoration on tooth 16

Fig. 2 – Cavity lined with Ionoseal (VOCO) for smoothing the cavity walls and postpreparation.

Fig. 12 – The final result with the chairside-produced composite inlay

Information on the authors Dr Sanzio Marques is a practising dentist and specialises in conservative dentistry and prosthodontics in Belo Horizonte, Brazil. He also lectures at the Federal University of Minas Gerais and at the University of São Paulo. He is the author of various reference books and is a course instructor at several specialist institutions. Contact details: Márcia Marcondes Guimarães is a dentist at the School of Dentistry at the University of São Paulo and specialises in implantology, periodontology and prosthodontics. Grandio®SO Inlay System Set for chairside fabrication of indirect composite inlays VOO has extended its successful GrandioSO line by adding an innovative set for chairside fabrication of indirect composite inlays. The GrandioSO Inlay System makes VOCO the only manufacturer to offer such an all-in-one solution. The system set makes 15 indirect composite inlays, with chairside fabrication being equally simple and quick, making it unnecessary to involve a laboratory in the process. There is also no requirement for the use of expensive CAD/CAM equipment in order to create high-quality inlays. All components contained in the set are optimally matched and make it possible to extraorally fabricate, in just one sitting, composite inlays that are as stable as they are aesthetic. In addition to the tried and tested products GrandioSO, Futurabond DC, Bifix QM and Dimanto, the system set also contains a new, specially developed addition-curing silicone material for the fabrication of model teeth. This silicone is a high-definition material with high final hardness. Using conventional techniques, it produces realistic models that are ideal for use in the fabrication of inlays. The composite inlay is created extraorally, according to the principles applying to the placement of fillings, and the restoration is then inserted into the cavity lege artis. The patient is thus treated with a high-quality composite inlay in just one sitting. Manufacturer: VOCO GmbH, PO Box 767, 27457 Cuxhaven, Germany,,

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107 pda event

28 • D E N T AL AC C E S S • M a r c h 2016


IDEM Singapore 2016 is the Leading Showcase in Asia Pacific for Global Innovations in Dental Technology.

IDEM Singapore 2016 is the leading showcase in Asia Pacific for global innovations in dental technology. IDEM Singapore 2016 is a key driver for clinical excellence and adoption of innovation in oral health and dental care throughout Asia-Pacific. With technology developing at such a rapid rate, it is imperative that all dental professionals update their knowledge and skills in order to provide the safest and most effevctive care for the public. Modern dentistry is also undoubtedly dependent on advanced technologies in ensuring that dental care and oral health isv easily accessible to consumers. As a result, dental professionals need to constantly upgrade, update and familiarise themselves with the technological advances in dental care. In recent years, devntal professionals in the Asia-Pacific region have been early adopters of emerging technologies in their laboratories, dental practices and dental teaching. To enable dental professionals, take advantage of the critical benefits of new digital technologies, IDEM Singapore 2016 has expanded its broad offering of education to include The Digital Dentistry Forum. The theme for the new forum is ‘A Primer in Digital Dentistry – Practice and Laboratory Development for Clinical Excellence’. This introductory full day forum, to be held on the 10th of April, is open to dentists and dental technicians and its goal is to help dentists and dental technicians to navigate their way to the adoption of digital dentistry through understanding the process of change and the development of new skills necessary to harness the tremendous benefits of areas such as CAD/CAM, 3-D printing, and CAT scans. The forum will feature internationally-recognised experts in private practice and dental laboratories, who will be addressing, not just the benefits of digital technologies, but how to adopt them and transition to the delivery of dental care in the digital world. Dr. Jonathan Ferencz, world-leading prosthodontist from York University College of Dentistry, and Mr. Lee Culp, CDT, Chief Technology Officer for MicroDental, Inc., and other renowned experts and authors will lead the forum. To further cement its aim in striving for clinical excellence and highlighting the importance of innovative technologies, IDEM Singapore 2016 will also provide visitors with the opportunity to view the latest dental technologies and innovative products during the exhibition. Visitors can expect 550 exhibitors and, among them, more than 20% of current exhibitors are focused in the field of digital dentistry, including Creatz3D, 3Shape, Dentsply Implants, Planmeca, Sirona and many others. M ar ch 2 0 1 6 • D E N TA L A CCE S S • 29





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.


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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.



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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.

30 • D E N T AL AC C E S S • M a r c h 2016


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.


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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.

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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 DENTSPLY ENDO BUR Dentsply Endo Access Bur


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)




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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.

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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.




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SR Nexco Flask is a new type of flask with the help of which light-curing veneering composites can be pressed on dental frameworks.

M ar ch 2 0 1 6 • D E N TA L A CCE S S • 31




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 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 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 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.




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.

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BY RENFERT Renfert Layart


BY SIRONA Orthopos XG 3D


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 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.





BY AMD LASERS Picasso Lite

BY PERIOPTIX MicroLine Series TTL Loupes

BY VOCO Ionostar Molar

Indications of use include Soft Tissue Procedure; Gingival Troughing for Crown; Impressions; Gingivectomy & Gingivoplasty; Gingival Incision & Excision; Soft-Tissue Crown Lengthening

Weighing in from only 36 grams, these lighter, smaller optics can be worn all day with comfort and with less fatigue. Available in microTTLs on the Adidas Adivista frame or the classicallydesigned Ultralight titanium.

• Restorations of non occlusion-bearing class I cavities • Semi-permanent restorations of class I and II cavities • Restorations of cervical lesions, class V cavities, root caries • Restorations of class III cavities • Restoration of deciduous teeth • Base/liner •



BY DEXIS LLC DEXIS Platinum Digital Intraoral Sensor The DEXIS Platinum Sensor is a direct-USB digital X-ray solution with PureImage technology. Its sensor detects radiation where the image is automatically saved, dated, tooth numbered, and correctly oriented -no need to return to the keyboard. Its “One-Click Full-Mouth Series” reduces a FMX procedure to 5 minutes from start to finish.



BY SHOFU Veracia SA Denture Teeth


Veracia SA Denture Teeth is a new Semi-anatomical aesthetic denture tooth composed of homogenous MF-H (microfilled hybrid) composite reinforced with layered glass. Enhancing Shofu’s Veracia SA is a revolutionary Posterior tooth delivery system called the “Q3 Pack” allowing the simultaneous setup of 4 individual posterior teeth at once thereby saving production time

BISCO’s provisional materials are designed to address the differing requirements for creating and placing provisional restorations. The system comes with PRO-V COAT®, a hydrogel separating agent which prevents the dentin surfaces from bacterial or temporary cement contamination and PRO-V FILL® providing strength and durability while creating an optimal marginal seal.



BY LED DENTAL VELscope® Vx The VELscope® Vx, the latest model release of VELscope technology that uses natural tissue fluorescence to discover abnormalities in the oral mucosa improving the way practitioners examine and screen tissue abnormalities by enhancing the visualization of pre-cancers, cancer and other disease processes.


BY W&H Synea Vision Reliable, ergonomic and outstanding quality handpiece, the premium instrument line in the Synea series. Innovative and long service life guarantee excellent treatment results for restoration and prosthetics.


BY MOUTHWATCH, LLC MouthWatch ExamTab 8 inch The MouthWatch 8 inch ExamTab is the perfect chairside dental imaging tablet designed to help you boost case acceptance, patient education and begin conversations about cosmetic imaging. Powered with Windows 8.1, the tablet can accommodate many other functions including patient entertainment, practice management, email and more.



BY LED DENTAL EnvisionTEC 3D Printers


RAYSCAN Alpha - Expert is the world’s first imaging system to utilize a wireless remote control for patient positioning with unique benefits such as pulsed for reduced X-ray exposure, multiple panoramic scan modes, with scan time of a maximum of 14 seconds for panoramic, and minimum of 4.0 seconds for cephalometric.

EnvisionTEC printers integrate seamlessly with leading CAD software programs, allowing clinicians to go from design to a finished product in just a few clicks. With a smooth surface finish and Built-in ethernet interface, this innovation enables printing of orthodontic models, partials, surgical guides, & bite guards with complete efficiency.

TheraCal™ LC is a light-cured flowable resin that contains Calcium Silicates. A first of its class of internal flowable pulpal protectant materials known as Resin Modified Calcium Silicates (RMCS), TheraCal LC provides the sustained alkalinity

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BY VOCO Admira Fusion Flow

BY VOCO Provicol QM Plus

BY VOCO Remin Pro forte

Admira Fusion Flow is the world’s first purely ceramic-based universal restorative material.This unique “Pure Silicate Technology” brings a number of benefits including a high filler content, extremely low polymerisation shrinkage, low level of shrinkage stress with excellent biocompatibility and a very high colour stability.

Now with greater adhesion, the Provicol QM Plus is ideally suited to clinical situations requiring particularly high levels of adhesion. The eugenol-free material contains calcium hydroxide and is indicated for the temporary luting of provisional and definitive restorations (crowns, bridges, inlays and onlays), as well as for the temporary obturation of small, single-surface cavities.

Remin Pro forte is a protective dental care product with fluoride and hydroxy apatite that contains extracts of ginger (Zingiber officinale) and curcuma (Curcuma xanthorrhiza). Scientific studies have confirmed the antimicrobial potential of ginger particularly the curcuma extracts having an antibacterial effect against against streptococcus mutans and an anticariogenic effect.



BY BOTISS cerabone® cerabone® is derived from the mineral phase of bovine bone, which shows strong resemblance to the human bone with regard to chemical composition, porosity, and surface structure. The pronounced hydrophilicity of the cerabone® surface supports a fast uptake of blood or saline, thus improving handling.



BY BOTISS Jason® membrane Jason® membrane is a native collagen membrane obtained from porcine pericardium, developed and manufactured for dental tissue regeneration. The superior biomechanical and biologic properties of the natural pericardium are preserved during the patented production process that exhibits excellent handling characteristics like a remarkable tear resistance and very good surface adaptation.


BY BOTISS collacone® collacone® is a wet-stable and moldable cone made of natural collagen. As a completely resorbable and hemostatic wound coverage, it is intended for application in fresh extraction sockets in the daily clinical practice.


BY KERR ENDODONTICS Elements Diagnostic Unit Dental Pulp Tester Elements Diagnostic Unit Dental Pulp Tester provides the convenience and accuracy of a high quality pulp tester and apex locator in one system. The satellite display conveniently brings critical data into the field of vision for a faster more stable reading. 34 • D E N T AL AC C E S S • M a r c h 2016

BY BOTISS mucoderm® mucoderm® is a natural type I/III collagen matrix derived from porcine dermis that undergoes a multi-stage purification process, which removes all potential immunogens. mucoderm® promotes the revascularization and fast soft tissue integration and is a valid alternative to the patient’s own connective tissue.


BY BOTISS maxgraft®

maxgraft® is a sterile, high-safety allograft prouct, derived from human-donor bone, processed by Cells+Tissuebank Austria (C+TBA). C+TBA, a high-quality bone bank, is regulated, audited, and certified by the Austrian Ministry of Health and fulfills the highest EU safety standards.


BY STRAUMANN® Emdogain® Straumann® Emdogain® is a well-researched, easy-to-apply gel containing Enamel Matrix Derivative (30mg/ml) originating from unerupted porcine tooth buds. As a component of embryonic tissues it is designed to promote predictable regeneration of hard and soft tissues lost due to periodontal disease or trauma.


BY KERR ENDODONTICS Vitality Scanner 2006 Dental Pulp Tester

BY J. MORITA USA, INC Root ZX II Endodontic Apex Locator

Vitality Scanner 2006 Dental Pulp Tester ensures dependable and pain-free pulp testing. This outstanding diagnostic tool is automatically controlled and features large digital readouts. It’s the quick and easy solution for patientand practice-friendly pulp testing.

Root ZX II’s patented technology has been independently evaluated to be 96.2% accurate. The large color LCD display screen is easy to read and provides a clear, progressive display with high contrast and is lightweight with compact low speed handpiece option.


Distributors list:


Alphadent Corporation

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

Dental Domain

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

Ordent Trading

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:

FILGEN Business Solutions, Inc.



59 Vista Verde Ave. Executive Village Cainta, Rizal, Philippines 1900 Tel No: (632) 645-7977 Fax No: (632) 646-4968

Fortress Dental

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:

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:


BY 3M Adper Easy Bond Self-Etch Adhesive


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.

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 M ar ch 2 0 1 6 • D E N TA L A CCE S S • 35

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Discover our JAN-MAR issue. Doctors who made a significant change in dentistry featuring Dr David Alesna and the Tarlac City Dental Chapter...