Dental Asia July/August 2018

Photo Courtesy of Align Technology

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Dental Management

Dental Profile

Under the Spotlight

Behind the Scenes:

New Vision in Communication for the Development of a Dental Practice Dr. Andreas Kurbad: Paving the Way for Digital Dentistry

Mr. Joseph Hogan: Moving Teeth with Plastic 3D Printing in Dentistry

Contents

18. Dental Management New Vision in Communication for the Development of a Dental Practice

22. Under the Spotlight Dr. Andreas Kurbad: Paving the Way for Digital Dentistry

26. Up Close & Personal Ms. Jane Fonda: Keep Moving Forward

30. Dental Profile Mr. Joseph Hogan: Moving Teeth with Plastic

35. Clinical Feature Anti-Aging Medicine and Orthodontic Appliance Therapy Treatment: An Interdisciplinary Approach 38. Integrating Function with Conservative Aesthetic Approaches: The Restorative Sequence

44. User Report A New Concept in Posterior Denture Teeth Design 49. Reshaping Canines to Create Lateral Incisors

52. Behind the Scenes 3D Printing in Dentistry 56. Part I: Indispensable Guide for Implant-Supported Overdentures

62. Indepth With Nacera Blue X: Translucency-Enhancing Liquid for 3Y-TZP Zirconia 64. Asia Takes Notice of the Cattani Suction and Compressor Range

70. Show Review Technology Moves Us: 2018 Invisalign APAC Summit

72. Show Preview New Millennium of Oral Health: Hong Kong International Dental Expo and Symposium (HKIDEAS) 2018

Regulars 04. First Words 06. Dental Updates 65. Product Highlights 73. Events Calendar

74. Books for Sale 76. Advertiserâ&#x20AC;&#x2122;s Index 2

DENTAL ASIA JULY / AUGUST 2018

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First Words

Take the Leap, Adapt to Change

We all know that change is inevitable and I believe when there is change there is progress followed by development and growth.

Just as Socrates said, “The secret of change is to focus all your energy not on ̬ghting the old but on building a new.” This issue shows how the dental industry (manufacturers and dental professionals) has grown, adapted and improved in all ̬elds of dentistry.

Fondaco is a good example of a company who has made changes.

The company has been steadily enhancing its services for dental professionals since 1984, originally founded by Mr. Hendrik Fonda and currently taken over by his daughter, Ms. Jane Fonda. During this transition, Ms. Fonda decided to revise and develop the whole company pro̬le. Alongside this, she set up the FDC Academy, the education division of the company for continuing education wherein event organisers come together to provide a wider range or courses, workshops and services (pages 26–29).

Align Technology would not be in the industry for over 21 years if they have not adapted and made changes along the way. According to Mr. Joseph M. Hogan, president and CEO of Align Technology, the company has never stopped developing new innovations and technologies to bring

modern and better solutions in the market (pages 30-33). The company has always believed that technology is part of everything we do as seen in their theme of the 2018 Invisalign APAC Summit: Technology Moves Us. This summit demonstrated their commitment and dedication to the Asian region by adapting to the needs of Asian dentists, patients and diverse cultures (pages 70-71).

Aside from companies or manufacturers, dental professionals had to modify and adjust how to treat patients with all the latest ava i l a b l e a d va n c e m e n t s i n t h e industry today. Dr. Derek Mahony and Dr. Theodore Belfor demonstrated how dermal fillers can be used in conjunction with orthodontic appliance therapy to produce desirable facial soft tissue enhancement (pages 35-37).

Whilst, Dr. Andrew Dawood presented how we can utilise 3D printing for severe dental and facial reconstructions (pages 52-54).

Also, Dr. Andreas Kurbad an early user of CAD/CAM shares his fascination with modern technology.

According to him, there was no looking back and ever since he has been

promoting digital dentistry.

One lesson I learned from him is that ‘dentists have the right to say no’. He said that we should learn the art of case selection and patient selection in order to avoid di̮culties in the long run (pages 22-25).

Nevertheless, I believe that with all these new products, machines and technologies revolutionising dentistry, we must never forget connecting with our patients. Just as Dr. Jean Charles Rivoire discussed, being a good dentist is not just having the best hands and producing the best work. It is communicating, understanding, empathising, ethics and earning the trust of patients (pages 18-21).

Let us all take the leap, move forward in technology and keep in mind that we are dealing with people and can not neglect the human factors that are fundamental in making us better dentists! DA

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ADVISORY BOARD

Dr William Cheung

Dr Choo Teck Chuan

Dr Chung Kong Mun

Dr George Freedman

Dr Fay Goldstep

Prof Urban Hägg

Prof Nigel M. King

Dr Ramonito Rafols Lee

Dr Kevin Ng

Dr William O’Reilly

Dr Ryan Seto

Dr Adrian U J Yap

Dr Christopher Ho

Dr How Kim Chuan

Dr Derek Mahony

Prof Alex Mersel

Dental Updates

Tailor-Made Training to Exploit All the Opportunities of Digitisation Amann Girrbach oơers dental technicians various training courses tailored to their speciƤc requirements so that laboratories can benefit from all the opportunities oơered by increasingly digitised workƪows.

Individual online training is definitely a highlight.

The digitisation of workflows for the fabrication of dentures oơers laboratories enormous opportunities to increase efficiency. Currently, it is becoming increasingly important to extend digital workƪows to more complex restorations then and to acquire the corresponding know-how in this area. As a pioneer in the digital process chain, Amann Girrbach has been working for some time now on solutions for digitised prosthetics. The “Ceramill Advanced Prosthetics Program” is currently based on three indications, Ƥxed

dentures as well Amann Girrbach takes laboratories to the as full and partial state-of-the-art level in digital prosthetics dentures.

To ensure the optimal implementation of these digital processes in the laboratory, Amann Girrbach oơers an extensive course portfolio whereby dental technicians are provided with the necessary skills by selected speakers. Users seminars is that the time required is limited can choose between conventional courses to the actual duration of the course. A in an Amann Girrbach training centre, team further advantage: the trainer can adapt the training in their own laboratory or online content exactly to the level of knowledge training. The advantage of the online and needs of the participant. Ŷ

W&H Launches Own Instagram Account Instagram is all about capturing and sharing authentic, relevant and cutting-edge content. Today, the video and photo platform has more than 800 million users worldwide, including many dentists and dental assistants, which accounts for the surprising levels of interest in images from the dental industry. At W&H, they have therefore decided that now is the time to open up this communication channel with professional dental customers, by launching their very own innovative and modern Instagram account as of March 2018.

Young and mobile target audience More and more dentists and dental practices are using social media to help attract new customers and build trust in their services. In fact, there are now more than three million posts online with the hashtag #dentist. As a specialist in dental solutions, W&H is now looking to get involved in this conversation and reach out to dentists and dental practices with its Instagram account @whdentalwerk.

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The primary aim is to improve awareness of the brand among younger target groups.

The new Instagram account therefore forms part of a cross-media campaign, which also incorporates the company’s existing social media activities on Facebook, YouTube, LinkedIn and W&H’s very own Video Channel. Hashtags such as #whdentalwerk, #whdental and #patient2fan will be used to increase interaction and get users involved in W&H campaigns.

User-generated content “Our Instagram account will promote the unique corporate culture of our modern family company through our slogan ‘People have priority’. As well as sharing our own messages, we also want to encourage our customers to produce their own user-generated content,” explains Ms. Anita Thallinger, W&H Marketing Director. “Examples could include before-and-after photos or snapshots from their everyday work, which showcase close and trusting relationship between dentist and patient.”

Popularity of social media among dental community Social media inƪuencers have a key role to play in shaping user’s opinions. As with any industry, there are numerous experts and advisers from the dental community whose online contributions are very highly regarded. It is not rare to find dental practices and even dentists with more than 200,000 followers.

“Collaboration with these key opinion leaders is a key component of W&H’s digital strategy. This is the only way to develop a reputation as a genuine contributor, and ultimately generate popularity and trust among users,” explains Ms. Anita Thallinger. Ŷ

DENTAL ASIA JULY / AUGUST 2018

Dental Updates Nobel Biocare Invites to 2019 Global Symposium in Las Vegas : “Knowledge Changes Everything” Dental professionals should mark their calendars for the 2019 Nobel Biocare Global Symposium which will take place in Las Vegas under the theme “Knowledge Changes Everything”. The potent combination of expert knowledge alongside new innovations to be revealed will mark a true transformation in implant treatment care.

Groundbreaking solutions, ranging from smarter implant designs and the next evolution in site preparation to everything dental professionals need to further enhance the patient treatment journey with new digital solutions, will be available for them to discover and experience live.

Confirming the increased demand for more skill-enhancing training and education, the event has expanded in size and is planned to attract up to 3,500

participants from around the globe. Steered by a ScientiƤc Committee chaired

by Dr. Peter Wöhrle, USA, the program will feature some of the world’s most renowned experts in implant dentistry and oral rehabilitation.

Overall, it will bring together more than 100 speakers consisting of outstanding researchers, clinicians and laboratory technicians and oơer innovative podium lectures in addition to master classes and engaging hands-on courses.

Participants will have the opportunity to follow diơerent educational streams or to create their own learning program suited for their own individual treatment goals.

“Next year’s Nobel Biocare Global Symposium will mark a true transformation

in implant treatment care. This major event is fueled by the power of knowledge and the positive impact it can have on dentists’ skills, daily practice and their patients, through new solutions that will change the course of innovation forever,” said Mr. Hans Geiselhöringer, President, Nobel Biocare.

The 2019 Nobel Biocare Global Symposium will take place from 27th - 29th June at the Mandalay Bay hotel and convention centre in Las Vegas. Registration for the event is now open. Ŷ

Henry Schein Promotes Asia’s Growing Role in the International Dental Community, Praises Global Impact of ICD Member Volunteerism Mr. Stanley M. Bergman, Chairman of the Board and Chief Executive Oƥcer of Henry Schein, Inc., celebrated Asia’s increasing prominence in the global dental community in his keynote address at the International College of Dentists’ (ICD) International ScientiƤc Congress & Induction Ceremony in Macau.

Mr. Bergman delivered his remarks on 19th June to ICD’s Section XIII (China) and its newly established Section XV (which includes Macau and a number of nations throughout Asia). In his remarks, Mr. Bergman shared that Macau is an ideal location for the Congress, underscoring Asia’s increasingly important role in the global dental community.

“We recognise that Asia represents an important region of future growth, and we are committed to supporting dental practitioners in this region as well as expanding our presence in China, Hong Kong, Thailand, Japan, and Southeast Asia,” said Mr. Bergman. “We share ICD’s global perspective and values, and we

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applaud their effort to expand their important work throughout Asia.”

Mr. Bergman also praised the work of ICD members, who offer their time and talent to serve those who do not have access to oral health care.

“Through ICD’s Global Visionary Fund, we have successfully partnered with ICD embracing our common commitment to humanitarian service by advancing oral health care for underserved communities. We are appreciative of the tremendous volunteer work performed

by ICD Fellows and are excited by the new opportunities for collaboration between Sections XIII and Section XV,” he added.

Mr. Bergman concluded his remarks by stating, “We all know that addressing the complex issues of enhancing global oral health can be challenging, maybe even impossible at times. Of the many

wonderful leadership lessons to be learned from Nelson Mandela’s life, I believe that this is the most important – ‘It always seems impossible until it’s done.’ As you return to your respective countries and your individual practices and encounter new challenges, please remember that nothing is impossible.”

Presented in collaboration with the Macau Dental Association, the ICD Congress featured an educational program presented by a world-class line-up of international dental experts and a trade show focused on the latest advances in dental technology.

The International College of Dentists, which has been Honoring the World’s Leading Dentists Since 1920™, has over 12,000 members who have earned the title of FICD (Fellow International College of Dentists) in 122 countries throughout the world. Ŷ

DENTAL ASIA JULY / AUGUST 2018

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Dental Updates

Learn and Bond Together with Experts from GC Asia GC Asia recognises the voice of their customers, and has always believed in providing their very best in training and education to all dental professionals.

Hence, the company had rolled out a series of local lectures and workshop activities over the past few years in various South East Asia (SEA) countries.

GC – The Education Leader GC has been engaging world renowned speakers from diơerent parts of the world to uphold education in the industry. In recent years, they have conducted several SEA educational tours, from well-attended lectures to comprehensive workshops, making GC as a leader in providing quality training and educational programs.

The company secured the participation of Prof. Marleen Peumans (University of Belgium, KU Leuven), Prof. Hien Ngo (Dean, College of Dental Medicine, University of Sharjah, UAE), Dr. Javier Tapia, the expert in Bio-Emulation dentistry, Prof. Ian Meyers (University of Queensland School of Dentistry and James Cook University College of Medicine and Dentistry), and Prof. Eric Reynolds, (Laureate Professor from the University of Melbourne and the inventor of RECALDENT), just to name a few.

Prof. Ian Meyers (University of Queensland School of Dentistry and James Cook University College of Medicine and Dentistry), Prof. Finbarr Allen (Dean, NUS Faculty of Dentistry), A/Prof. Wong Mun Loke (Vice Dean, NUS Faculty of Dentistry), Prof. Hien Ngo (Dean, College of Dental Medicine, University of Sharjah, UAE) and Dr. Anthony Mak who gave a full day Silver Wave Symposium on managing the aging populations and patients.

The company understands the importance of providing dentists with the right knowledge and techniques to handle the demand from The Silver Wave phenomena – as older patients bring challenges such as severe root caries, erosion, xerostomia and advanced periodontal disease.

To keep up with the momentum, GC Asia brought Dr. Anthony Mak as well as Prof. Bart Van Meerbeek - two highly acclaimed dental experts to conduct their educational tour around SEA this year.

From dentists’ perspective

IDEM Symposium After the full day IDEM-GC Symposium – Towards the Post-Amalgam Era in 2016, where the company brought in Prof. Hien Ngo, Professor Martin Tyas, Prof. Adrian Yap, Dr. Anthony Mak, Prof. Ian Meyers and Dr. Yue Weng Cheu, GC quickly recognised the need to address the ageing population’s oral health concerns. Recently, GC decided to run another Symposium during IDEM 2018.

This time, the company gathered six experts across the region, n a m e l y A / P r o f . Te o h K h i m H e a n (Deputy Director, National Dental Centre),

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Dr. Mak shared his knowledge and clinical tips and tricks on achieving beautiful aesthetics, clinical applications of digital dentistry and shared the importance of embracing technology as the future of dentistry. Thereafter, he lectured on Silver Wave - a topic which involved management of the ageing patients.

Prof. Bartholomeus (Bart) Van Meerbeek, on the other hand comes with extensive knowledge and experience that he gained throughout his research career, he was published in more than 400 international peer-reviewed journals and has been highly acclaimed and honoured with prestigious awards.

In his tour across Singapore and Thailand, Prof. Bart shared optimal clinical bonding protocol for direct and indirect restorations.

Moreover, Prof. Bart presented numerous clinical studies to help clinicians to better understand the importance of having excellent bonding protocol and achieving clinical success in adhesion and cementation.

Meeting the experts During the May 2018 tour to Indonesia and Philippines, Dr. Anthony Mak, who has a thorough understanding of direct vs. indirect dental restorations, conducted a full day lecture in Jakarta, covering both anterior and posterior composite restorations, from simple aesthetic requirements to more complicated cases using digital dentistry.

In Manila, Dr. Mak further tackled two important topics in the industry during the 4th Asia PaciƤc Dental Conference (APDC) and 109th Philippine Dental Association (PDA) Annual Convention and ScientiƤc Meeting 2018.

“I’ve attended Prof. Bart’s lecture in Singapore, organised by GC Asia. The lecture was fantastic! It was well presented with excellent knowledge on key concepts that dentists utilise every day without necessarily knowing why. I would highly recommend attending his lecture to every dentist,” said Dr. Bryan Too, GPA Dental Group, Singapore.

“Dr. Anthony Mak is not your Restorative Dentistry teacher who breathes down your neck to point out your silliest mistakes. He’s a cool buddy who’ll humbly tell you his past and will cautiously advise you to thread the more appropriate path. He’s not a Professor who lulls you to sleep with his monotone lectures. He’s our favorite rock star idol whom you cheer for endless encores!” shared Dr. Marilou Sembrano, Philippines.

The lectures and workshops conducted over the years were well-received and this has encouraged GC to continue building the path towards excellence through quality education. Ŷ

DENTAL ASIA JULY / AUGUST 2018

Dental Updates Dentsply Sirona Implants World Summit Tour in Shanghai

Shanghai opens its doors to the World Summit Tour on 19th-20th May, when Dentsply Sirona Implants welcomes dental professionals from all over the world to this scientiƤc congress on implant dentistry.

A t t h e Wo r l d S u m m i t To u r , Dentsply Sirona Implants presents the next step in the continuous evolution of the Astra Tech Implant System. The Astra Tech Implant System EV is designed with a site-speciƤc, crown-down approach based on the natural dentition for increased surgical simplicity and flexibility and restorative ease — without compromising the unique Astra Tech Implant System BioManagement Complex.

The main objective of the new system is to further improve system logic, robustness and user friendliness—this has permeated the evolution of the Astra Tech Implant System EV. The new system is also the result of collaborative input and insights from dental professionals throughout the global dental industry.

“When we develop new implant therapy solutions, it is important that they meet actual clinical needs. With our solutions, clinicians are able to solve these various challenges and, as a result, they can deliver longterm function and aesthetics to their patients. Our focus is to deliver safe, well-documented solutions and the best service to our customers,” says Björn Delin, DDS, and Vice President Global Platform Implant Systems at Dentsply Sirona Implants.

Science and clinical experience The foundation of Dentsply Sirona Implants is innovation based on a thorough scientiƤc approach. In the comprehensive and diverse scientific program at the World Summit Tour, Dentsply Sirona Implants will dedicate a speciƤc session and posters to the clinical study program and research collaborations in China.

The session called “A clinical study program in China—science and clinical experience after 3 years” will feature three well-known researchers that will share experience and results from the study program between several Chinese universities and Dentsply Sirona Implants. The research collaboration has received worldwide recognition with several publications and presentations at international congresses.

This clinical research program was initiated in 2010, focusing on the Astra Tech Implant System. The program involves five prospective multicenter studies, 15 study centres across China, and more than 200 included patients.

World Summit Tour—the scientific congress on implant dentistry Dentsply Sirona Implants has welcomed dental professionals from all over the world to the World Summit Tour. This scientiƤc congress on implant dentistry has so far visited three cities around the world—Nice, San Diego and Tokyo—and more than 3,600 dental professionals have networked, discovered and learned more about the latest innovations and treatment solutions.

The theme of the World Summit Tour - Because inspiration and confidence matters - mirrors Dentsply Sirona Implants’ dedication to improved oral health and enhanced quality of life for implant patients worldwide. Each tour stop is designed to inspire clinicians and researchers to share scientiƤc knowledge and clinical experience and discover the latest developments in implant dentistry. By combining general sessions, hands-on workshops, and a choice of various parallel sessions, the program promises to deliver inspiration and education for all members of the treatment team. Ŷ For more information about the World Summit Tour, please visit worldsummittour.com

Cantel Expands its Dental Water Solutions Portfolio with Entry into Amalgam Separator Category Cantel Medical Corp. announced on 18 th June its entry into the dental wastewater management market through the recent launch of Syclone™ Amalgam Separator, previously marketed and sold under the brand name, Apavia™ Amalgam Separator. This new filtration technology and related assets were recently acquired from ENPRESS L.L.C. and its subsidiary Apavia LLC. Syclone™ Amalgam Separator captures mercury-containing amalgam particles from the wastewater of dental oƥces through a combination of mechanisms, including 12

Ƥltration and centrifugation. In addition, it features a high containment capacity for extended service and pump life, and cutting-edge cyclonic design with rapid velocity and waste capture.

“As a market leader, we are committed to staying at the forefront of the latest industry trends and to providing quality solutions that meet the compliance needs of dental practices. With the Syclone™ filtration technology, we can effectively support the hundreds of thousands of dental practices in meeting the requirement of removing mercury from wastewater and

improving the overall environment,” stated Mr. Gary Steinberg, President and CEO of Crosstex.

“We look forward to integrating the Syclone™ Amalgam Separator technology into our expanding portfolio of solutions for infection prevention,” stated Mr. Ken Plunkett, Senior Vice President Global Sales, Crosstex. “Given the EPA ruling on amalgam separators for wastewater management compliance by July 2020, the addition of this innovative technology further enhances our dental water compliance products, beyond our DentaPure™ Cartridge for dental water puriƤcation.” Ŷ DENTAL ASIA JULY / AUGUST 2018

Dental Updates

Ultradent Products, Inc., Australia Receives Dental Industry Leadership Award The Australia division of Ultradent Products, Inc., is honoured to have received the 2018 Dental Industry Leadership Award from the Australia Dental Industry Association. Of the award, ADIA says, “The award recognises leadership embodied in the form of corporate accomplishments that reflect well on the dental industry, and thus encourage other companies to strive for greater success. The activities that merit this award include innovative product development, domestic or overseas market development, pioneering marketing campaigns, commitment to the ADIA, and environmental sustainability.”

In choosing Ultradent Australia as this year’s winner, ADIA chief executive oƥcer, Mr. Troy Williams said, “There were a record number of entries from businesses that

Ultradent Receives ADIA Award

have set the standard that others strive to achieve. It’s in this context that the team of Ultradent Products Australia can be immensely proud of their achievement.”

He added, “We chose to recognise Ultradent Australia for its ability to grow from a little-known supplier locally, to an industry partner in just a few short years.

From a team of one person in 2012 to a team of four people who contribute to strengthening the reputation of Australia’s dental industry for providing dental professionals with quality treatment options.”

Accepting the award on behalf of Ultradent was Mr. Jim Wilson, Ultradent’s general manager overseeing the company’s Asia/Pacific/Sub-Saharan African regions. Mr. Wilson said, “I’m very proud of our team in Australia and the hard work and accomplishments they’ve achieved to merit receiving this award.”

Ultradent currently operates in and/ or markets its products to distributors in more than 100 countries around the world, including Australia, China, Japan, Indonesia, as well as countries throughout Europe, North America, and South America. Ŷ

US Patent & Trademark Oƥce Issues New Patent to DenMat for Removable Dental Appliances, Branded Snap-On Smile® DenMat Holdings, LLC (“DenMat”) a n n o u n c e d o n 2 5 th J u n e 2 0 1 8 t h e recent issuance of a new patent by the US Patent & Trademark Office for its line of Snap-On Smile removable dental appliances.

United States Patent No. 9,901,429 is for an appliance fabricated to enhance the appearance of a patient’s smile, including a plurality of simulated teeth, resulting in an improved smile without any need to alter the structure of a patient’s existing dentition.

“This latest patent broadens DenMat’s existing intellectual property assets covering Snap-On Smile,” said Mr. David Casper, CEO of DenMat. “The newly-issued patent recites, among other things, the use of acetyl resin,

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the ability for the appliance to be removed, and the tooth-borne retentive nature of the design,” he said.

The patent claims an invention in which an appliance is designed and fabricated to change the appearance of a patient’s smile without needing to alter the existing structure of the teeth. One embodiment of the invention may be fabricated from an acetyl resin material, has a continuous wall with an inner surface that adapts and conforms to the facial and lingual aspects of the existing teeth, an outer wall that has the desired visible appearance, and retentive points without utilising any dental adhesive or cement.

This latest patent strengthens DenMat’s patent portfolio for its Snap-On Smile product line, which includes U.S. Patent Nos. 8,449,296 and 7,357,637, as well as one or more pending patent applications.

“The DenMat laboratory has been a key area of focus for our Company,” said Mr. Casper. “That focus has included a strategic initiative aimed at strengthening our intellectual property assets covering the innovative technologies that we employ to deliver unique and aesthetic solutions for our customers,” he said.

DenMat operates one of dentistry’s most recognised dental laboratories, producing aesthetic solutions for dentists such as Lumineers® and Snap-On Smile appliances.

Recently, the Company expanded its laboratory product oơering to include its LumiZir® full contour zirconia restorations and its A.R.T (Additive Reductive Template) system for case design and presentation. DA

DENTAL ASIA JULY / AUGUST 2018

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Dental Updates

Registration Now Open For AO Mid-Atlantic Regional Meeting Heralding the home of the first modern root form dental implant placed and restored in the United States, the Academy of Osseointegration’s (AO) Mid-Atlantic Regional Meeting will be held in National Harbor, MD 14th – 15th September 2018.

“Advances in Clinical Implant Dentistry” will focus on various disciplines within implant dentistry, including the latest in surgical, restorative and laboratory techniques. The Gaylord National Resort, one of the most elegant convention centres along the Eastern seaboard of the United States, will provide the backdrop for this historic meeting with its picturesque views of Washington, DC and old-town Alexandria from the shores of the Potomac River.

The two-day program, featuring AO Member presenters from the US mid-Atlantic region, will include:

14th September 2018: Hands-on clinics Dr. Joseph P. Fiorellini, an AO director, who has served as Head of the Division of Periodontology and postgraduate program director of Periodontology at Harvard University, and is currently Chair of the Department of Periodontics at the University of Pennsylvania, will provide a hands-on course entitled “Socket Bone Grafting, with and without Biologic ModiƤers.”

Mr. Tony Prestipino, CDT, Alexandria, VA, a long-time, active AO member and master laboratory technician in the Washington, DC area, will provide a review and hands-on course entitled “Advanced Protocols for Converting Removable Dentures to Fixed Interim Prostheses: A review and hands-on course.”

Saturday, 15th March Main Program Dr. Eva Anadioti, Philadelphia, PA, director of the Post-Graduate Prosthodontics Specialty Program at the University of Pennsylvania, will provide a practical overview entitled “Implant Overdenture: The Past, the Present and the Future.”

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Dr. Edgard El Chaar, New York, NY, director of the Postgraduate Periodontics Specialty Program at New York University, will present “Innovative Strategies and Techniques in Ridge Augmentation.”

Dr. Thomas Taylor, West Hartford, CT, head of the Department of Prosthodontics and Reconstructive Sciences at the University of Connecticut, will address the topic, “Occlusion and Dental Implants: What Gives?”

Dr. Maria Troulis is chair of the Department of Oral and Maxillofacial Surgery at Harvard University School of Dental Medicine and Massachusetts General Hospital. Her presentation will be entitled “Bone Tissue Engineering.”

More than 30 poster presentations showcasing the latest cutting edge research in implant dentistry will also be on display at the meeting.

AO members are highly encouraged to invite their colleagues to this meeting, which carries historical significance in the field of osseointegration and AO’s history. In May 1982, following a three-day symposium hosted by Dr. George A. Zarb and conducted by Professor Per-Ingvar-Brånemark in Toronto, Canada, Dr. Paul H.J. Krogh, an oral and maxillofacial surgeon from Bethesda, MD, and his prosthodontic colleagues, Drs. Lloyd Vakay from Alexandria, VA, and his partner Dr. Daniel Y. Sullivan from Washington, DC, attended an intensive one-week training session in Sweden at

the University of Göteborg, hosted by Dr. Brånemark. Two months following this training in October 1982, the trio became the Ƥrst surgeons involved in the placement of titanium endosseous implants in four patients over two days, with Dr. Brånemark placing the implants.

This revolutionary time in the field of implant dentistry subsequently sparked four training centres across the United States and one in Canada, as well as the Osseointegration Study Group in New York in 1984, the organisation which then formed the Academy of Osseointegration in March 1985. Drs. Krogh and Sullivan would become two of the Academy’s early presidents in 1989 and 1993, respectively.

The mid-Atlantic Regional Meeting will also serve as the promotional launch of the much-anticipated AO annual global scientific Annual Meeting, to be held 13 th – 16 th March 2019 at the Walter E. Wa s h i n g t o n C o n v e n t i o n C e n t r e i n downtown Washington, DC. “With a focus on multidisciplinary evidence-based implant dentistry, and the latest surgical, prosthetic and laboratory technologies, the Academy’s Mid-Atlantic Regional Meeting in National Harbor, Maryland is an event you will not want to miss! I’ll look forward to seeing you there!” said AO President Dr. James C. Taylor, who will be there to open the meeting.

Space is limited, so be sure to register early to guarantee your seat at this special event! Ŷ

DENTAL ASIA JULY / AUGUST 2018

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Dental Management

New Vision in Communication for the Development of

A DENTAL PRACTICE

By Dr. Jean Charles Rivoire (France)

The challenges In the last 20 years, our profession has known several revolutions: dental implants, new techniques, new materials, and now we talk about ‘Digital dentistry’.

Some development laboratories are working on robots able to replace the dentists for speciƤc works. One has placed implants on a real patient, and these implants were Ƥtted within a margin of error of 0.2-0.3 mm, reaching the required standard for this kind of operation.

This operation was performed without any human intervention other than preparing and positioning the patient. It was developed in China, jointly by the Fourth Military Medical University’s aƥliated to the Stomatological Hospital, based in Xian, and the robot institute at Beihang University in Beijing. It took four years to develop the machine.

Clearly, we are at the dawn of a new era, these new technologies are going to make our work much safer and eƥcient, it is obviously the future.

Of course, it is crucial that all dentists follow that stream, get the proper training and make the right investments. The challenge is to make the right decision.

Questions we face In this very competitive world, will the new dentistry solely evolve through the technologies?

More or less, in a near future, most of the dentists in developed countries are going to have very similar training and in-house technologies. What next? Starting to escalate in buying more and more sophisticated equipments to compete with other dentists around?

What is going to make a patient choose your practice? Your equipment? Your ‘Robot’?

Actually, what motivates patients is rarely the real quality of your dentistry, but ‘only’ the idea they have of it, the way they perceive it.

Frustrating? Surely. Unfair? Probably.

We have to face the reality and accept to take this into account: People are not only driven by their rationality, the reptilian brain is in play. The way we communicate, the non-verbal, body language, the empathy, all these components are fundamental to attract, convince and motivate the patients.

This is a more diƥcult task, undoubtedly we can be trained on the new tech, but when it touches emotions, creating trust, how you express yourself… This is really more challenging.

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Like in every skill, we are all not equally gifted. In our studies or training, we have met in workshops some students with great adroitness: the best cavities, the best impressions, the best in various Ƥelds. Mr. or Mrs. ‘Perfect’. They are naturally gifted for working with their hands and others have to work hard to reach their level.

Are they better dentists than you? Not sure.

Are they attracting more patients? Maybe not!

Working on artiƤcial models, animal heads, cadaver, eggs is deƤnitely very diơerent in terms of interaction and working with real people!

It is clear now that being a perfect dentist is not only having a ‘good pair of hands’.

The patient’s perspective During our studies, we have been judged by other dentists on a technical basis and during our career, we still believe that it is the same. In fact, we have to face patients, their feelings or choices are based on totally diơerent standards.

We must look a step ahead and beyond the pure technical aspect of our job. Now, it is time to take into account the human aspect.

We need to think diơerently and take intelligence and experiences from other Ƥelds that can be comparable.

Think about marketing: ‘Basically, we might look at marketing as a wide range of activities involved in making sure that the needs of customers are continually met and they are getting value in return.’

It is crucial to understand what are the needs and expectations of our patients, but as professionals, it is our duty to help them make the right decision. At the end, we keep the entire responsibility of the treatment.

Some might think most patients are aware of how diƥcult and important some treatments are? Let’s take endoddontics as an example, perception of the patient when he leaves the clinic is like nothing really changed (except in case of an emergency treatment motivated by pain). Patients are not aware of the diƥculty, the expertise, the concentration involved in such treatment.

They only judge you on four main factors: 1. Painless treatments 2. How they feel with you 3. The cost of the treatment 4. The quality of the treatment I intentionally mentioned ‘quality of the treatment’ as last because, from the patient’s point of view, there is a big diơerence between the dentist and the patient.

The dentist thinks the ‘quality’ only in terms of technique: endodontic treatment is perfect, implant is exactly at the right position, or ceramic crown looks good.

But the patient has a diơerent perspective, combining the four points together as a unique sensation that he unconsciously names ‘quality of treatments’. We have, quite often, patients who are very happy with their dentist and we, as professionals, can see that the quality might not be good.

DENTAL ASIA JULY / AUGUST 2018

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Dental Management

If a dentist fails on any of these points, they are not sure to keep the patient connected and ready to follow through more important treatments. So once again, we must try to see the bigger picture!

Ethics in dentistry What is ethics?

“The rules or standards governing the conduct of a person or the members of a profession.”

Regarding our profession, as “Doctors”, representing knowledge and some kind of authority, we can easily manipulate our patients.

We can dramatise the situation, overtreat, using fear to persuade the patient to accept our treatments.

Using such methods is not an option, beyond the indignity, it is not productive in the long term. Your reputation is in play, the purpose of this article is not to create a better relationship with the patients to better manipulate them. The goal is to have a better understanding, beyond the obstacles, to be able to convince the patient and lead him to understand what is the best treatment for him (Fig. 1).

Fig. 1 Having ethics may not get more patients, but it’ll always get the dentists the right ones!

When a patient tells you “Doctor, I want to do that treatment” it implies that the dentist has the trust of the patient and succeeds in creating such a feeling. The question is “why” the patient got the trust. And like in many problems, if one understands the “why” you can deduct the “how”…

My experience, trying to codify the ingredients of the trust, led me to the concept of the 3C’s.

Three key components are required, if only one is missing, you cannot get the full trust from a patient.

• Credibility: One’s attitude, professional environment, reputation and the global atmosphere of a practice.

• Competencies: The logic and clarity of one’s explanations, organisation, behaviour during the treatments and leadership skills.

• Connection: “Make it personal.”

Communication Communication is a very vast topic with many aspects to address.

We can emphasize some particular points related to the dentistry.

The Ƥrst one is called the “communication gap” also known as “Curse of Knowledge” (Chip Heath Dec 2016).

It is very often we encounter an obstacle in the communication with our patients. When there is a high diơerential of expertise in a field, unknowingly we assume that the patients have the background to understand dentists. When we explain a situation using technical words and shortcuts, the patient cannot understand.

Once again, regarding their psychological and even physical situation (lying on the dental chair), most of the patients have a tendency to say “yes” to all the information we can provide, including those they do not really understand.

Several factors inƪuence the relationship with patients, most of them are non-verbal: • Eye contact • Posture • Tone of the voice • Pace of speech • Volume These factors are basically dependents of the personality, but we can be trained on these skills and improve a lot in this Ƥeld. The Ƥrst step would be the awareness of their importance, and accept our own weaknesses.

Trust: key in a relationship This is the key in a relationship. Trust is built in drops and lost in buckets and in a fraction of time one can lose all the trust one spend hours earning.

What is “Trust”?

“Trust is a psychological state comprising the intention to accept vulnerability based upon positive expectations of the intentions or behaviour of another.”

The word “vulnerability” is central, we just tend to forget because it is every day when patients open their mouth (drilling holes on teeth or bone) with scaring noisy tools and at the top they have to pay for that!

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Active listening Hearing is one thing, listening is another. You can hear the noise of the street, the TV in the background. You can even repeat what your interlocutor says, this is not listening. Listening is a totally diơerent process. Therefore, if hearing is passive, listening is an active thinking process that needs concentration.

Active listening is another step, one listens, and at the same time, one sends subtle signals to your interlocutor that he has your full attention. The most common is nodding, it can be a smile or a small change on your face reƪecting the words of your patient.

You encourage the patient to develop his own subject. You must DENTAL ASIA JULY / AUGUST 2018

Dental Management

the same treatment: The best, the one we would provide to our family members (Fig. 2). Stop the self-censorship!

Conclusion The years to come are going to be very exciting. All these new technologies are revolutionising the profession but we must remember that we are dealing with human people.

The technologies, as important as they are, are not going to replace the personal connection we must create with our patient. The world population is getting more educated. The internet and all the sources of media are making patients more demanding. If we do not adhere to these fundamentals, there is no reason for a patient to choose us over another dentist. Understanding patients, empathy and trust are not something we get in buying the most expensive robot!

We must be trained and have awareness on the importance of a good communication, not as a â&#x20AC;&#x2DC;salespersonâ&#x20AC;&#x2122; Fig. 2 but in regards to ethics and in providing the â&#x20AC;&#x2DC;state of the artâ&#x20AC;&#x2122; in dentistry. be in control to refocus the patient on the main purpose and stay A French philosopher said: â&#x20AC;&#x2DC;We do not treat pathologies, we treat in control of the time spend. people having pathologiesâ&#x20AC;&#x2122; (Georges Canguilhem). Being aware At the end, the person in front of us must feel we are with her, of the human factors is a major determinant in making us better we must listen. dentists, it is what we all want. DA Eye contact is also an excellent way to make the patient feel we are still connected, letting the other person know that we truly care Reference about them, that we understand where theyâ&#x20AC;&#x2122;re coming from, and Chip Heath, Dan Heath. Dec 2016. â&#x20AC;&#x2DC;The curse of Knowledge.â&#x20AC;&#x2122; Harvard we validate their perspective as part of the conversation.

Business review.

Empathy Most of the time, we use the word not knowing its real meaning.

Empathy n. â&#x20AC;&#x153;the power of entering into anotherâ&#x20AC;&#x2122;s personality and imaginatively experiencing his feelingsâ&#x20AC;?

In our professional life, we have to face diĆĽcult conversations and convey bad news. Most of the time we try to say something like:â&#x20AC;&#x2122; You will lose four incisors, at least you can have dental implants!â&#x20AC;&#x2122; or: â&#x20AC;&#x2DC;it could be worseâ&#x20AC;&#x2122;.

This is not empathy.We believe we bring support, but we are making our interlocutors feel alone and not totally received. We believe we are protecting them, but in fact, we are protecting ourselves in trying to lessen the situation. Empathy is an active process requiring energy. We have to accept and make the person/s feel we are with them. Empathy is innate, it can also be learned.

The â&#x20AC;&#x2DC;Princess of Walesâ&#x20AC;&#x2122; concept This is the idea that every patient deserves the best.

One of my patients, felt my discomfort when I told her the treatment needed. Understanding I was hesitant to make her spend such a large amount of money, the patient told me: â&#x20AC;&#x2DC;Please, just consider me like Iâ&#x20AC;&#x2122;m the Princess of Walesâ&#x20AC;&#x2122;.

I felt immediately relieved, having my vision greatly simpliƤed by this unknowingly self-censorship, leading to judge a patient on his appearance or his attitude. You must give everyone a chance to get

DENTAL ASIA JULY / AUGUST 2018

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21

Under the Spotlight

T

he use of digital technologies is vast a growing trend in most industries and dentistry is no exception. Statistics show that more dental clinics are now working with digital x-ray systems and it’s only a matter of time before all dental impressions are taken digitally using scanners. Digitising dentistry is upon us and it is up to us to decide to take the leap or be left behind.

Dental Asia shares this story of a cosmetic dentist who took the leap and believed in computer-assisted design (CAD) and computer-aided manufacturing (CAM) for more than 20 years and has been paving the way for digital dentistry.

Dr. Andreas Kurbad graduated from the University of Jena and Erfurt, Germany in 1983. He worked as a scientiƤc co-worker at the department of Restorative Dentistry at the University of Erfurt in the same year.

In 1987, he obtained his degree of dental medicine and has been in private practice in Viersen, Germany since 1990, specialising in cosmetic dentistry and implantology.

As an avid CEREC user since 1994, Dr. Kurbad is a founding member of the CEREC Masters Club. He has been actively participating in lectures and producing publications relating to restorative dentistry, adhesive technique, all-ceramics, computerised dentistry and implantology.

He has facilitated numerous clinics on all-ceramics and computerised dentistry since 1996 and is a returning lecturer at the

22

Dental Asia’s Publications Director, Ms. Jamie Tan and Dr. Andreas Kurbad.

Interviewed by Ms. Jamie Tan Written by Dr. Chala R. Platon Karl-Häupl-Institut in Düsseldorf, Germany for over a decade. He has produced over 100 publications and has co-published the Quintessence book ‘CAD/CAM and All-Cermics’. He is a respected member of several editorial boards such as the International Journal of Computerised Dentistry, theGerman Quintessence Journal of Dental Technology and the International Digital Dental News Journal.

Having a vision Dr. Kurbad started to explore implantology back in 1992. During this time, implantology was not that established and dentists were not sure if it was reliable.

“Sometimes you need to have a vision and an idea. Implants are fascinating and I am glad I started using it early on. I couldn’t imagine modern dentistry without it.

Nowadays, when someone has a missing tooth or teeth that need to be replaced, it is most commonly done with implants. It’s that simple,” he stated.

Aside from implants, Dr. Kurbad is highly trained in aesthetic dentistry. His interest in cosmetic dentistry slowly developed through the years. He said that the good thing about aesthetics is that people can immediately see the results. He believes that in this Ƥeld of dentistry it is crucial to have an excellent outcome and satisƤed patients because this serves as a personal marketing tool for the dentist and the clinic.

“Making a crown for the molar is diơerent as compared to an anterior crown.

Anterior restorations or prosthesis can be seen by everyone and must be appreciated DENTAL ASIA JULY / AUGUST 2018

Under the Spotlight

by the patient and other people. In every good case, you will get two more new cases.

This is one rule I’ve learned and adopted,” he added.

Digital photography Furthermore, Dr. Kurbad shared he is fond of taking photos of cases. This is brought about by his preparation for lectures and publications of articles. Photos are very important in showing the initial and Ƥnal outcomes of cases for his audience (in lectures) and also for the patient. He realised that in aesthetics, changing one’s smile also changes one’s personality and attitude. Often than not, this transformation is also seen in post images taken.

One memorable case that Dr. Kurbad mentioned was a patient asking for his help to fix her front teeth because nobody wanted to hire her based on her appearance. Though the patient couldn’t afford the treatment, Dr. Kurbad still proceeded with the case. He made a deal with the patient that in exchange he will use her photos as example/reference in lectures and in his clinic.

“For example, adding a 0.3mm veneers to anterior teeth may be a very small adjustment for a dentist. But for a patient, you have transformed their smile. And with this slight change, you have given back their conƤdence.

That patient, found a job and opened her own restaurant. She came from being unemployed to becoming her own boss. For me, that is something,” he fondly reminisced.

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Overcoming challenges with digital dentistry Meanwhile, when asked to share about challenging cases he has encountered and how he overcame them, Dr. Kurbad revealed that it is more difficult when a patient comes in with a good set of teeth and asks for improvement of aesthetics rather than a patient who has a broken or decayed tooth, which is more straightforward.

Dr. Kurbad immediately recalled his patient who happens to be a famous rock musician. The patient had ten good old crowns and wanted them replaced. After analysing the case, Dr. Kurbad agreed to proceed in changing the crowns because the shape of the patient’s teeth did not match his personality and profession; the crowns were too feminine and Dr. Kurbad planned to make it more masculine.

“Dentists have the right to say ‘No’. One must master the art of case selection and patient selection. This is really a diƥcult case. Whenever I have this kind of case, I usually take my time to think about it (accept or decline the case), treatment plan and I need an inspiration or idea before proceeding with a case. Looking at the patient’s photos, I decided to change

the shape of his crowns to give him more character/ personality,” he explained.

According to Dr. Kurbad, this is only the beginning. Even if dentists have done the treatment plan and the patient has agreed on it, the Ƥnal verdict still lies with the patient.

“I always say that ‘design is no democracy.’ Even if everyone likes the Ƥnish product, the deciding factor is always the patient. The patient must like it. This is the reason why we must show them how it’ll look like later on. Nowadays, we have software solutions that are capable of showing a mock-up which is an excellent tool in digital dentistry,” he made clear.

Thanks to CAD/CAM and all the new technologies, diƥcult cases are possible, developed and easily executed. Dr. Kurbad believes that one must use technology to its advantage to end up with a good result. He mentioned that with CAD/CAM, if changes (with colour/shape/Ƥt) needs to be done, it is so much faster because all the data are DENTAL ASIA JULY / AUGUST 2018

Under the Spotlight

stored in the software. There is no need to re-take tedious impressions, all you have to do is adjust the design and mill again.

“The results of digital dentistry still surprise me until now. When my musician patient came back for the Ƥnal check, he mentioned that even his speech and voice has improved because of the new crowns.

This was something nobody expected.

We must never forget that even in doing aesthetics, function is important. We not only changed his look but we also improved his voice.”

Advantages of digital dentistry Aside from digital photography and the latest innovations previously cited, Dr. Kurbad discussed other advantages of utilising digital dentistry, primarily, getting fast and immediate results. He said that with having a clinic for 27 years, being up-to-date is a must. Nowadays, patients have changed and evolved, too. Patients are now more resourceful, do researches online, and know exactly what they want most of the time even before stepping in the clinic. Dentists need to be alert and attentive.

“Patients know the latest trends in dentistry. They will ask for CAD/CAM (CEREC). They know about digital impressions and they expect everything to be done in one visit/appointment. They know what they want and they want things fast. I believe applying digital dentistry is a great marketing tool for a clinic and a practice,” he explained.

Secondly, he mentioned the precision/ accuracy of digital dentistry provides.

Others may consider that using digital may not yield good results as compared to

DENTAL ASIA JULY / AUGUST 2018

traditional methods. Dr. Kurbad strongly disagrees with this.

“I can tell you a lot of studies that show digital giving equal results when compared to traditional methods. But I believe digital gives improved results. Besides digital impression that I’ve earlier stated, another example is by using the prep check tool software from CEREC, one can immediately check the distance of the antagonist to the prepared tooth. This helps the dentist see if he has an ideal thickness for the future crown or not. With this software tool, using digital gives higher precision and control for the user. The dentist makes fewer mistakes and have few failures,” he added.

Moreover, Dr. Kurbad considers pursuing continuing education an excellent way of familiarising oneself with digital dentistry.

He is making use of social media in spreading continuing education through forming a study club for CEREC and also keeping his clinic’s website and Facebook page modern and relatable.

“I am still learning. I am learning from my daughter, who is also a dentist and practicing with me in the clinic, that more people are using their mobile phones than computers/laptops. From this realisation, we make sure that our website and media pages are also accessible using mobile phones. Presently, our website looks like an app and in the future work like an app. I think in the future, webinars will be a common thing. It’ll be more accessible,” he remarked.

Digital dentistry in Asia

Adapting to digital dentistry According to Dr. Kurbad, dental laboratories have adapted to digital dentistry, too. He said there are only a few labs that he knows of that still utilise traditional methods.

This is brought about by the majority of laboratories providing zirconia, which needs to be milled and not casted/pressed.

Generally, if most dentists are practicing digital dentistry, dental laboratories need to change their workƪow to accommodate the digital demand.

Dr. Kurbad leads by example and this is shown by his staff conforming to the digital trend as well. Today, all his dental assistants in his clinic can perform digital impressions on their own. Just like in the past, wherein dentists would ask assistants to prepare alginate for impression, now it is done by simply scanning the upper and lower arches with the use of CAD/CAM intraoral scanner.

Dr. Kurbad considers the region as limitless and full of potential. Due to diversity, there are highly developed areas as compared to others but majority embrace and have a huge interest in digital dentistry. Not only this, he said people are learning fast and may have a tendency of taking over the U.S. or Europe in the future.

With regards to technology, Japan and Korea, just to name a few, are meticulous and highly advanced. He sees Asia becoming a leading network for digital dentistry.

He predicts that in the next three to five years, digital instruments and digital workƪow will all be connected and organised – speciƤcally, digital endodontics, 3D printing and optical intraoral scanners.

“This is a very exciting time in the industry. I am glad I embraced digital dentistry from the start. The fascination about new things has always kept me going. At my age, I still don’t see myself slowing down any time soon. There’s always something new and we must never stop being fascinated,” revealed Dr. Kurbad. DA

25

Up Close & Personal

KEEP MOVING Interviewed by Ms. Jamie Tan Written by Dr. Chala R. Platon

F

DC Academy is the education division of Fondaco company. It was set up to provide a common place for continuing education to take place. It is also where event organisers come together to provide a wider range of specialised courses, workshops and services for professional

Commitment to education Founded in 1984 by Mr. Hendrik Fonda, Fondaco company has been steadily growing and enhancing its services for dental professionals through innovations and technology. The company has become the undisputed leading provider through constantly striving towards customer-driven services, focusing on enhancing a one-stop solution of top manufacturers (dental equipment, supplies and consumables), and service excellence in Singapore and the Indonesia region. With more than 40 years of highly skilled dedication to 24-hour service back-up, Fondaco company has earned the trust of its now extensive client base spread throughout the archipelago.

Through ongoing commitment to education and training by the company for both clients and staơ which established its

success and growth, the FDC Academy was founded. The regular professional seminars under FDC Academy utilises international experts (within the company) together with international event partners and has become a must-attend event in the industry.

With Singapore and Indonesia’s rapid growing economies and increasing uptake of private health insurance, employerprovided and individually funded, the prospects for new advancements into the future for the company is guaranteed.

Ms. Fonda shared that Fondaco has always had a division for education for product support and to upgrade the skills of dental practitioners. As the activities of education expanded, the company was advised to form their own company.

“When we started, we were working with societies and some event organisers.

aesthetic doctors and dentists to upgrade their skills and update themselves with the latest technology in the market.

FDC Academy welcomes doctors, dentists & societies to join the journey of learning and better patient care. Read on to further understand FDC Academy’s beginnings, educational portfolio and foresight in the future as our Publications Director, Jamie speaks to Ms. Jane Fonda, company executive oƥcer of Fondaco and controller of FDC Academy.

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DENTAL ASIA JULY / AUGUST 2018

Up Close & Personal

FORWARD

We were conducting educational events yearly, monthly, weekly and eventually bi-weekly. Finally, we decided that we should form a separate entity by itself,” reminisced Ms. Fonda.

According to Ms. Fonda, coming up with a suitable name took a while and she brieƪy explained how they came up with FDC. “FDC has always been our company name, FDC Pte Ltd to be exact. From there, we coined Fondaco to be shorter, memorable and easy to write. This came into mind when we were deciding on what to name our education division. Finally, we all agreed to use our old company name FDC,” she explained.

Evolution through change Ms. Fonda shared that when she took over from her father, she decided to change and develop the whole Fondaco company proƤle. It took them a number of years before actually learning and knowing how they wanted things to be.

Another change was with the company’s product range development. Presently, Fondaco’s product range is more focused and related to each other. They also decided to form an education division (FDC Academy) and expand it.

“In the past, our educational events (courses/workshops) were seldom. In a year we would only organise one to three

DENTAL ASIA JULY / AUGUST 2018

events. Nowadays, with FDC Academy, we learn a lot from our members. We are busier though we enjoy communicating and building relationships with dentists not only because of our products but through education,” she stated.

She believes that FDC Academy has deƤnitely beneƤted the company. Not only in terms of knowledge but also product know-how, the market development and fully understanding what the clients really need and want.

Concurrently, when asked if FDC Academy will expand in other countries, Ms. Fonda answered that in Indonesia they have formed their own Academy very similar to FDC Academy, not exactly the same but it has already started.

“We collaborate and work with many partners. FDC Academy will not be in other countries but we will help other groups/ organisations to get education across.

I believe it is faster this way,” she added.

Educational portfolio The FDC Academy gives short courses and provides products that support education and training. In addition, it also collaborates with societies and associations to have extra workshops and comprehensive courses that are distinctively diơerent from those provided by dental schools. Ms. Fonda added that they also work with event companies.

“Basically, FDC Academy is not only purely about product education but concentrates deeper on education even without the products we are selling. That’s why we called it an Academy. It’s not only about Fondaco products, it’s very generic,” she said.

Ms. Fonda mentioned that the Academy understands that each product has their pros and cons, and they take ideas contributed by members (dentist and doctors) and incorporate them in their portfolio. She thinks that having the FDC Academy under the education division of Fondaco gives them a lot of ƪexibility when organising events, whether they decide to display products or not during events rely solely on the company.

“So, having flexibility and freedom helped us to formulate two diơerent visions.

One is on product and equipment while the second is on academy and events. Our goal is to connect these two visions together in the lives of practicing professionals,” she explained.

Considering continuing education vital for every profession, Ms. Fonda believes that learning new skills, getting out of one’s comfort zone and continually upgrading equipment and knowledge is a must in the fast-paced industry. She believes that small details (product/technique/knowledge) can make a signiƤcant diơerence.

27

Up Close & Personal

Product portfolios Participants sometimes have different opinions and perspectives of product workshops. Several may think these are just marketing strategies by different companies. Thus, Ms. Fonda shared the company created two different product portfolios: product workshop and generic workshop. This is one thing that sets FDC Academy apart from the rest of the pack. Their product workshop focuses on products from Fondaco while the generic workshop makes use of varieties of product base on trainer request.

As long as one learns the basic knowledge from hands-on workshop/ courses, Ms. Fonda feels that this is more essential. She shared that she completely understands why some dentists may think that educational events are just marketing strategies by companies. However, plenty of products from different brands keep coming up with something new. For

28

example, nowadays composites come in different hues, values and chromas.

Ms. Fonda explains that educational events are beneficial to professionals as some techniques can only be applied for brand A and not brand B. “There will never be just one solution for everything,” she added.

the equipment, device or technology and provide it to their patients,” she said.

She reminisced that during those times, the company kept pushing hard for CEREC basic courses to be available to help the users. Hence, CEREC became the market leader in Singapore. Ms. Fonda did not stop there. She continued expanding and created a club. She has been organising it every year so participants who attended basic to advance workshops could also join the club. Members are invited and advised to submit problems they’ve encountered clinically and in terms of patient acceptance of the technology.

“A lot of factors affect clinical motivation in giving out and promoting this service (CEREC). We’ve foreseen this through being connected to our customers and their concerns.

Basically, we have workshops, follow-up with clubs and now with FDC Academy we

Facing problems head on Fondaco company has been the market leader for the provision of world-class products in dental and healthcare supplies and equipment throughout Singapore and Indonesia by meeting and exceeding customer needs and expectations. Through their dedication to customer concerns they have always been one step ahead and faced problems head on.

Just as when CEREC was still new in the market. Ms. Fonda remarked that selling equipment, especially clinical equipment, is not always simple. It is not about selling only, you need to be there with the customer.

“Selling CEREC is not like selling a laptop. There are other components like software and clinical materials needed in u t i l i s i n g C E R E C . Yo u need to guide the user because they are not yet familiar with the product and technology. If they are confident already, they will easily accept

DENTAL ASIA JULY / AUGUST 2018

can address all these issues. It may not be a big deal but every little activity/event we conduct that helps professionals is good enough for us,” commented Ms. Fonda.

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Small, compact and comprehensive Usually, lectures are attended by a large audience, unlike workshops. Ms. Fonda explained that having a large number of participants in a workshop is not that beneƤcial for the company and the attendees. She thinks that it is better to have workshops that are intimate, concise and comprehensive based on her personal experience attending big events.

“We love the words: small, compact and comprehensive.

Some people like to think big but I believe in keeping expectations small. For us, consistency is the key to everything. In whatever we do, whether it be a small number of participants, I believe in being consistent. We continue in moving forward in a steady pace,” she elaborated.

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Visualising the future Currently, Fondaco is working on lasers and anticipates that it would be the next thing in the years to come. Ms. Fonda excitedly mentioned that Botox (botulism toxin), other toxins and new treatment protocols that aid in easing patient’s frustrations with dentistry is another development we could expect to see in the market. She observed change is happening rapidly in the industry and there is so much more to come.

“Digital dentistry will be calming down in the next Ƥve years and presently it is happening now since many already adapting/know much about digital products available in the market comparing to once upon a time. How far will it go? I am not sure, until a brand new development arise. 3D printing is also going to be the next thing and denture making!” she added.

3D printing will be useful in fabricating aligners (maintenance and finishing) and even whitening trays without the need for taking impressions because of the presence of digital scanners. Ms. Fonda foresees that due to this the need for impression materials in the future will decrease even more.

“There is always a cause and effect, and pros and cons as a result of everything being digitalised. I think of it as a good thing. Being traders and educators, we just have to keep advancing forward. Faster than we have ever been,” concluded Ms. Fonda. DA DENTAL ASIA JULY / AUGUST 2018

120°

90 90°

P PERIO

→ easy switch from supra to subgingival air-polishing by a simple click → the best access thanks to 3 available nozzles → soft mode: maximum comfort for sensitive patients → more than 40 inserts for the widest range of ultrasound indications

Dental ProƤle

Moving Teeth With Plastic Interviewed by Ms. Jamie Tan Written by Dr. Chala R. Platon

F

or over 21 years, Align Technology has always set the bar for leadership and change in our industry by constantly innovating to bring new and better solutions to doctors and their patients.

Since 1999, when the company pioneered the invisible orthodontics market with the introduction of the Invisalign system they have consistently been combining digital treatment planning and mass-customisation, with shape-engineering based on biomechanical principles. As a result, Align Technology has certainly revolutionised the orthodontic industry.

With their continued dedication to transforming lives by improving the journey to a healthy, beautiful smile and by being an indispensable partner to dental professionals worldwide, Align Technology held the 2018 Invisalign APAC Summit on 31st May- 2nd June at Marina Bay Sands, Singapore. To Ƥnd out more about the company’s vision, how they overcome challenges and their plans in the Asia-Pacific region, Dental Asia spoke to Mr. Joseph M. Hogan, Director, President and Chief Executive Oƥcer of Align Technology.

Mr. Hogan earned his M.B.A. from Robert Morris University and a B.S. degree in Business and Economics from Geneva College, both in Pennsylvania. Before joining Align Technology, he served as CEO of ABB, a global power and automation technologies company in Zurich, Switzerland. Prior to ABB, Mr. Hogan spent 25 years at General Electric (GE) in a variety of executive and management roles, including eight years as CEO of GE Healthcare. He is an accomplished chief executive with extensive experience across multiple industries and plans to continue driving signiƤcant changes for Align Technology as well.

Determining where to focus Align Technology is known and synonymous for clear aligners, the Invisalign system, they are a global medical device company with other industry-leading innovative products such as the iTero intraoral scanners, which they acquired in 2011. They also have the OrthoCAD digital services that work with their scanners to help dental professionals achieve the clinical results they expect and deliver effective, cutting-edge dental options to their patients.

30

Mr. Joseph M. Hogan, Director, President and Chief Executive Oƥcer of Align Technology

Dental ProƤle

“Align Technology is not a holistic dental company. We don’t have 50 diơerent product lines. We do clear aligners and we frontend it with iTero. That’s what we do, that’s what we are good at, that’s what we’re known for and that’s what we’ll keep on doing. That’s what we want to bring to the market,” said Mr. Hogan.

According to him, Align Technology has a huge market and sometimes focusing on what/where to spend time and money on might be a challenge. Align Technology is a $1.5B company, and they value their resources and therefore the company has to Ƥgure out where to focus their investment and growth.

“Our biggest challenge is about being focused and making sure we pick the right things to apply our resources to. At the moment it is international expansion and ortho-utilisation (how do we get deeper in orthodontic practice),” he continued.

Adapting to the Asia Pacific market Mr. Hogan shared that the company is very excited about Asia and considers the region as their No. 1 market internationally. Asia is the company’s priority and strategically they are expanding in the region to show their support and dedication to the Asian market.

Align Technology will be manufacturing in China at the end of the year and they have moved case assessment/treatment planning into China (Chengdu) since last year. It was a challenge moving outside of the Americas for the Ƥrst time and Ƥnding resources to put everything in place.

“We are going to spend $140M moving our manufacturing in China. This is not a low cost manufacturing movement that most companies have done in the past. In fact, our cost will go up if we manufacture in China. We are moving here (Asia) for customer service and to be able to move into Asia’s speed,” he explained.

Mr. Hogan further shared that when the company went to China for customer relationship, they made sure that they were able to service customers in Mandarin. The company plans to show its commitment to Asia by respecting the diverse cultures, languages, time zones and being able to respond to whatever the region might DENTAL ASIA JULY / AUGUST 2018

need. He also mentioned that Asia has the highest quality of sensitivity of any culture compared to other parts of the world.

“I’ve been coming to Asia for 33 years regarding all kinds of businesses. What strikes me the most is the diversity in Asia.

We need to be able to understand that (culture) better and to move that back into our product line so we could be a better supplier to you in that way. We want to be an Asian business and that is why we are making these investments in the region,” he added.

On the 2018 Invisalign APAC Summit Mr. Hogan explained that Ƥrst and foremost, the 2018 Invisalign APAC Summit shows Align Technology’s commitment to the region. The company’s movement of treatment planning and manufacturing in China, as mentioned earlier, are for the beneƤt of consumers.

Secondly, the summit is about learning the latest and future innovations in Invisalign clear aligners, iTero scanner, increase knowledge on Invisalign clinical techniques, gaining valuable practice management and marketing through cases and ideas from fellow doctors.

“We’ve chosen Singapore because it is our headquarters in Asia. Logistically, it is a good central location for people coming from Australia, China, Japan and other countries. Singapore has great facilities for the number of participants, which is of 56-58% more compared to previous years. I think it is reƪective of the opportunity and how fast the business is growing here in the region,” said Mr. Hogan.

Lastly, another thing that the company wish to achieve through the summit is making Asian doctors feel more comfortable in using the Invisalign system.

Align Technology wants the region to be aware that the company is able to support their needs through peer-to-peer meetings and sharing experiences (good or bad) and working on how to manage things together.

“In the end, we just want doctors to walk out of here (summit) with more conƤdence in Invisalign treatment, more conƤdence with A l i g n Te c h n o l o g y a n d a s t r o n g understanding of the company. We are making significant investments to drive consumer demands to our doctors,” he explained.

Digitalisation in orthodontics Traditionally, in orthodontics wires and brackets are used to straighten teeth and impression materials such as alginate and putty (PVC or polyvinylsiloxane) are used to take records in order to make models of the upper and lower arches. Thanks to technology and digital advancements in dentistry brought by Align Technology, it has changed the analogue process or orthodontics to a digital process.

Mr. Hogan explained that today, rather than doing a physical impression, dental professionals can use intraoral scanners like the iTero which only takes one to two minutes in scanning images of the upper and lower arches. Then images are quickly submitted for digital planning, with ClinCheck, once approved by the doctor, fabrication of clear aligners are completed and the journey with Invisalign treatment begins.

Ms. Shirley Stacy, Vice President, Corporate Communications and Investor Relations with Mr. Joe Hogan, Director, President and CEO of Align Technology at the Invisalign APAC Summit 2018

31

Dental ProƤle

According to Mr. Hogan, in order to appreciate the eƥciency and beneƤt from digital orthodontics it is important to absolutely commit. One must incorporate at least 60-70% of the practice digitally to see, feel and get the efficiency of what digitalisation can fully provide.

“Digital is the undisputed champion of disrupted technology around the world.

We can all see the way digitalisation rips through industries. We have changed the analogue process and orthodontics’ future is digital.

So many things can happen. It is going to be fast.

We need to get there fast. And I think, Asia is the best region in the world to understand that,” he stated.

iTero Scanner: more than just a digital impression machine One very good example of digital orthodontics are the use of intraoral s c a n n e r s . i Te r o s c a n n e r s f r o m Align Technology may have started for the purpose of digital impression but it is so much more than that. iTero’s accuracy is based on its confocal imaging technology which uses both optical and laser scanning to achieve a high level of precision and accuracy without powder or complicated hovering.

Mr. Hogan also shared that aside from its speed and accuracy, the iTero Scanner is packed with powerful software capabilities and features such as simulation programs, colour scanning, continuous scanning and integration of OrthoCAD digital services. These allow the users to visualise immediately what the patient will look, how the teeth would look, it can superimpose a person’s face in real time and show how it works. Other than that, the OrthoCAD digital services allow iTero Scanners to be used in restorations by creating milling models and dies that can be used during treatment planning. Dentists 32

(orthodontists and general dentists) Ƥnd all these features very useful and convenient because it enables them to understand cases better. On the other hand, patients enjoy iTero scanning because they can really see how their teeth are going to move and how their smile is going to look. iTero is a frontend scanner that integrates with the digital aspect of orthodontics and Align Technology considers it a critical component to have in a digital workƪow system.

“The accuracy of iTero is unusual. We’ve perfected it over the years. There are other confocal imaging systems out in the market but we feel we are the pioneers and we have the lead in the technical standpoint. This is how we digitally continue to reposition and transform so quickly in this industry.

We couldn’t even attempt to think about doing all these in an analogue process,” he commented.

He also brieƪy mentioned about the two new additions to the iTero Element family: iTero Element 2 and the iTero Element Flex that was recently announced early this year. He said these new products are to give doctors options on what intraoral scanners Ƥt their practices the best. The iTero Element 2 boasts of 25% more speed as compared to its predecessor while the iTero Element Flex is a portable scanner that is ideal for those with multiple practices in diơerent locations because it can be used with compatible laptop.

Latest innovations and technologies in Invisalign Treatment Mr. Hogan remarked that besides improving on their iTero intraoral scanners, the company is

always looking to develop their materials, too.

This is where SmartTrack aligner material comes in. All aligners are not alike. Only Invisalign clear aligners are made from SmartTrack material which was patented by the company in 2013. It is a superior kind of plastic designed to move teeth versus any other clear aligners materials out in the market. It is specially engineered for Invisalign treatment that is gentle, comfortable, gives predictable results, improves control of teeth movement and enables shorter treatment time. The company was able to come up with new innovations like the Mandibular Advancement and the Invisalign First for teens and tweens (younger than teenagers) patients.

Mandibular Advancement, introduced only last year, is targeted for teens and tweens with Class II malocclusion wherein the mandible (lower jaw) is moved forward with aligners and teeth are straightened at the same time. It replaces the use of twin block appliances (cemented appliance) which makes it easier for patients to clean and maintain.

“Our initial trials on Mandibular Advancement, over 600 cases, have received so much enthusiasm. I have been with Align Technology for three years now and I haven’t seen this kind of response from doctors. Mandibular Advancement is truly a breakthrough. We are still waiting for approval in the U.S. but we think we’ll have it later this year. It has been readily adapted here in Asia and also in Europe. This clearly shows that our biggest market is in Asia,” remarked Mr. Hogan.

He excitedly talked about the company’s most recent announcement, on April 2018, about Invisalign First which will launch in Asia in 1st July. It targets younger patients between age six to ten with early mixed dentition. Invisalign First is designed speciƤcally to address a broad DENTAL ASIA JULY / AUGUST 2018

Dental ProƤle

range of younger patients’ malocclusions, including shorter clinical crowns, management of erupting dentition and palatal expansion (upper arch) during Phase 1 (initial/early interceptive orthodontic treatment for young children) orthodontic treatment.

“One of the challenges for us has been treating patients for Phase 1 which actually makes up 20% of orthodontic cases. What’s really interesting from the feedbacks on Invisalign First is how thrilled doctors are that they can use clear aligners on younger patients in way that is more comfortable for patients and convenient for doctors and parents.”

Staying on top of the game Mr. Hogan also opened up regarding present competitions in the market. He discussed that this part of the industry can’t be avoided and this only makes the company strive even harder in giving the best service and introducing latest innovations to the market.

“Honestly, when we look at our competition’s technology, they are ten years behind where we are. We have been in the business for 21 years, we had a few years of lead time, and we know this business at heart and what to do. They have a lot more way to go but we always believe in DENTAL ASIA JULY / AUGUST 2018

looking ahead and not behind. Consumers have to make a choice of who they want to work with and we’ll continue on convincing everyone that we are the right organisation to work with over time,” he elaborated.

He also added that Align Technology is also the partner in growing businesses to create demand. The company is dedicated in helping build practices and expanding businesses. The company has piloted a ‘concierge service’ in North America just last year to help doctors bring in more patients.

This service provides doctor and clinic locators for patients which can generate more patients for practices, another step in showing how to stay on top of the game.

“We are going to do all we can to put patients in front of you. We are committed to that. When you think of Align, we want you to think of technology and a partner in growing your businesses. We want to help you in the eƥciency of digital business and how to oơer it to all your clients.”

Predicting the future According to Mr. Hogan, the company will continue on investing in research and development to provide outstanding service and leading products and technologies in the digital orthodontics workƪow.

“Overall, we’ve spent over $1.3B in orthodontics over the years. No one has

done that in any history in the world. We’ll keep on doing that. We’re going to keep pursuing IT (Information Technology) in a big way,” he stated.

He shared that there are variables that the company is focusing on for the future.

First variable is demand. There are 12 million orthodontic cases that start around the globe every year: 4 million in Asia, 4 million in America and 4 million in Europe. 70% of people in the world have malocclusion and there are 300 million people that have malocclusion that belongs to the middle class with an income that can afford to address the problem. And those smiles have never been visible.

“We need to think of the 300 million people that want to Ƥx their smiles and how to reach them. Many adults want complete bite corrections. I think it is going to come out like a Tsunami, as consumers understand it more and as they become aware that digital plastic is the way to move teeth – more convenient, aesthetically pleasing and psychologically intrusive.”

T h e s e c o n d v a r i a b l e i s i Te r o scanners, there is going to be a big part of the business that will be driven by iTero intraoral scanners. Mr. Hogan revealed that visualisation and speed of visualisation is an important aspect in turning a consumer into a patient. This can presently be done through its real-time 3D visualisation capability.

“We are only at the tip of the iceberg in utilising iTero scanner’s capabilities. It has raw computer power and software that can be used in clinical assessment and so much more. We can see it in our technology road map and how things go forward,” he added.

With all that said, Mr. Hogan believes in falling in love with a business in order to have the passion to go the extra mile. He believes Invisalign treatment is changing one smile at a time. As this happens, people’s personality and how they view life also changes.

“Changing lives is great and together, there are so many lives we can change by going digital. We think digital makes us a new world. I hope you embrace it with the same enthusiasm and passion that we do,” he ended. DA 33

Organizer

Anti-Aging Medicine and Orthodontic Appliance Therapy Treatment: An Interdisciplinary Approach

By Dr. Derek Mahony and Dr. Theodore Belfor

Introduction

Abstract

Anti-aging is a branch of medicine focused on how to prevent, slow or reverse the eĆĄects of aging thus helping people to live longer and healthier lives. Recently, however, more evidence-based medicine has led to anti-aging becoming a multi-billion dollar industry with over 12 billion dollars spent in the US alone. The recent medical literature and evidenced-based medicine shows that as we age, there seems to be loss of fat volume in some areas of the face, as well as a change in the morphology of the facial skeleton. Facial soft-tissue augmentation, by injection, has become increasingly popular as a minimally invasive option for patients seeking cosmetic facial enhancement. Replacing depleted soft tissue has allowed for a more comprehensive approach to total facial rejuvenation. It has been demonstrated that orthodontic treatment, with an intra-oral orthopaedic dental appliance, (The Homeoblockâ&#x201E;˘) enhances facial symmetry producing soft tissue changes consistent with improved facial aesthetics.1 This appliance can be added to the treatment protocol of facial injection to create a relatively non-invasive interdisciplinary approach to mid-face enhancement.

It is the purpose of this article to demonstrate how the placement of dermal Ƥllers for the reduction of lines/wrinkles and depressions in the face, in conjunction with orthopaedic /orthodontic appliance therapy, can produce desirable facial soft tissue enhancement. Via a case study we can demonstrate that the volumetric changes, achieved by this combined treatment approach, can produce a desirable result, namely a more youthful appearance.

DENTAL ASIA JULY / AUGUST 2018

Case study A healthy woman, in her mid sixties, presented for treatment with a strong desire to improve her facial appearance. Her oral hygiene was good and there was no active periodontal disease. She exhibited headache symptoms and clinical examination showed a disc displacement, with reduction, on her right side with a maximum jaw opening of 38 mm. Her centreline was displaced two millimeters to the right and lined up when she opened less than 10 millimeters, indicating that she had a mandibular displacement to the same side (Fig. 1). A Homeoblock appliance, with a 5 mm bite block on the

35

Clinical Feature

right side, (to decompress her TMJ) was fabricated and delivered (Fig. 2). When she closed on the bite block, her occlusion freed up and the muscles realigned the mandible so that her centreline now lined up correctly. Her headache symptoms were relieved in three weeks and her maximum opening was improved to 42mm.

The patient continued Homoeoblock™ treatment for nine months.

Intra-oral and extra-oral photos were taken to monitor treatment, as well as 3D stereo photogrammetry. Extra oral 3D digital photos were taken with a 3dMD facial capture system. A 3dMD/Kodak facial capture system and stereo photogrammetry were used to generate a clinically accurate digital model of the patient’s facial surface.

It uses a technique of stereo-triangulation to identify external surface features viewed from at least two cameras. This approach incorporates projecting a unique, random light pattern that is used as the foundation for triangulating the geometry in 3D. The capture takes less than 2 milliseconds per frame. The data is processed creating a highly precise <0.5-mm RMS, root mean squared of the distance measured, creating a digital model of the patient that is ready for immediate clinical use. Stereo photogrammetry, for quantifying facial morphology, was introduced in the Journal of Dentistry in 1996.2 It was concluded that “stereo photogrammetry is a suitable 3D registration method for quantifying and detecting development changes in facial morphology.”

Fig. 1: Pre-treatment face and anterior, intra-oral photos (note deep dental overbite)

Fig. 2: The Homeoblock™ appliance

36

Fig. 3: The pre-treatment face, and at six months, at nine months and Ƥnally, a morphometric evaluation of the change.

Evaluating the patient’s face, over the nine months of Homeoblock™ treatment, for her tempero-mandibular dysfunction showed a change in the morphology of the face. Morphometric analysis was performed by superimposing before and after 3D images and using finite element modeling. Thousands of triangular reference points are used to establish the change. The blue area is no change and the red, to orange areas, show an increased dimension up to 2.9 mm. We see an increased volume above and under the eyes, the zygomatic region, the upper lip and the marionette (nasolabial folds or “laugh lines) and the pre jowl areas (fold/sulcus on either side of the chin). Viewing the facial photos we see a reduction in the lines, wrinkles and depressions (Fig. 3).

After nine months, the patient’s facial changes prompted her to go forward with injections of dermal Ƥllers. She was given 1ml of Restylane® for lip enhancement and two 1.3 cc corrections with Radiesse™ in the pre-jowl marionette area and along the inferior border the mandible, and the inferior and lateral borders of the zygoma.

Finite element analysis shows increased facial volume with a directional change of almost 4 mm indicated by the red to orange colour.

There is an increase in volume in the frontal, supra-orbital, inferior orbital, zygomatic, nasal base, upper lip, nasio-labial depression, marionette and pre jowl areas (Figs. 4-6).

Fig. 4: Shows the morphological facial changes in the lips, zygoma and jowl area after the placement of 1ml Restylane® and placement of 1.3 cc Radiesse™. Note the deeper red to orange colour in the areas where the injections were placed.

DENTAL ASIA JULY / AUGUST 2018

Clinical Feature

This paper documents the similar changes in a so called â&#x20AC;&#x153;non-growingâ&#x20AC;? adult. Combining the results of palatal expansion, and the placement of dermal Ƥllers, we can see very satisfactory improvements in facial aesthetics. DA

References: Fig. 5: Morphometric evaluation of the Ƥnal results. Superimposing the red after face over blue before face can graphically illustrate the volumetric changes that have occurred during treatment.

1.

2.

3.

Singh GD, Diaz J Busquettes-VaelloC et al. Facial changes following treatment with a removable orthodontic appliance in adults. Funct Orthod. 2004; 21:18-23 Ras F, Habets LL, van Ginkel FC, et al. Quantification of facial morphology using stereo photogrammetry: demonstration of a new concept, J Dent 1996; 24:369-374 Singh GD. On Growth and Treatment: The Spatial Matrix Hypotesis.

Growth and Treatment a Meeting of the Minds, JA MacNamara Jr. 2003; 41: 197-239

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Fig. 6: Before and after facial photos

Results After the treatment, face appears more youthful with better deƤned cheekbones and a Ƥrmer jaw line. The skin appears smoother with less lines, wrinkles and depressions.

Discussion Facial changes related to palatal expansion are clearly outlined in Growth and Treatment a Meeting of the Minds, J.A. McNamara Jr. 2003.3 â&#x20AC;&#x153;The maxillary complex shows a change in size (and/or mass) allied with an increase in structural complexity, in association with biological processes.â&#x20AC;? â&#x20AC;&#x153;Palatal expansion presumably, switches on osteoblastic genes associated with active boney deposition and concomitant remodeling of the spatial matrix ensues.â&#x20AC;? In relation to the changes around the eyes we must recall that the maxilla forms the ĆŞoor of the orbit and skeletal changes may become apparent post expansion. SpeciƤcally, changes in orbital morphology may be reĆŞected on the skin of the face as the lower eyelids become â&#x20AC;&#x153;fuller,â&#x20AC;? the lateral canthus becomes more â&#x20AC;&#x153;horizontal.â&#x20AC;?, facial width increases, particularly at the zygomatico-maxillary sutures and the craniofacial form, putatively, not only functions better but looks more attractive. These changes have been documented in children where palatal expansion is an everyday occurrence.

DENTAL ASIA JULY / AUGUST 2018

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37

Clinical Feature

Integrating Function with Conservative Aesthetic Approaches: The Restorative Sequence

By Dr. Ali Tunkiwala

N

ature, with its hidden intricacies, produces an enthralling symphony of elements that has left human beings enamoured for eons. In his quest to recreate nature, man has embraced art in various forms. The artists, the sculptors, the poets and the writers over the years have humbly surrendered to the magniƤcence of natures’ beauty. Dentists found their calling in the spectrum of art in which they created and designed the minute aspects of natural teeth in aesthetic restorations they have made for their patients. Emulating nature became the topmost goal for conscientious dentists. The exhaustive study of tooth morphology, the understanding of dental disease process and the gush of energy from the dental industry and material manufacturers have placed dentists today on the peak of an artistic revolution that infuses beauty in the things they create.

The case described here takes readers through a journey of understanding the principle and pathophysiology of an unpleasing smile that requires a methodical approach to restore its lost glory in the most suitable manner while conserving precious tooth structure.

Fig. 5: Analysing the problem list

The case analysis A patient, aged 30 years old, with a history of orthodontics in her adolescence reported to the dental oƥce with a complaint; that her smile does not do justice to the beauty of her face. On examination, the upper anterior teeth looked retroclined and over corrected as a result of orthodontics (Figs. 1-4). Detailed analysis1 was carried out using photographs and mounted study models; the relevant Ƥndings are tabulated in Table 1 (Fig. 5).

Fig. 1: Pre-operative smile

Fig. 2: Pre-operative retracted view

Fig. 1: Pre-operative smile

Fig. 2: Pre-operative retracted view

38

Table 1

DENTAL ASIA JULY / AUGUST 2018

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DENTAL ASIA JULY / AUGUST 2018 VOCO GmbH · Anton-Flettner-StraÃ&#x;e 1-3 · 27472 Cuxhaven · Germany · Tel. +49 4721 719-0 · www.voco.dental

39

Clinical Feature

Risk assessment The best way to understand the potential difficulties of the treatment and evaluating long term success of treatment outcome depends on thorough risk assessment strategies. A systematic approach to periodontal, biomechanical, functional and dentofacial risk are carried out2.

Periodontally the patient was ‘low risk’ as there was minimal or no bone loss and no bleeding on probing consistent with AAP (American Academy of Periodontology) classiƤcation.

Biomechanically the patient was at ‘low risk’, as there was mild wear with suƥcient enamel to bond to.

Functionally the patient was at ‘moderate risk’ although the patient had acceptable function, as the MIP (maximum intercuspation) was not coincident with CR (centric relation) and there was wear on all anterior teeth. Since the incisal edges of anterior teeth had to be reassigned their new positions, there is a need to alter the anterior guidance and thus CR would be the starting point for smile correction.

Dentofacially the patient had a ‘high risk’ rating as there was maximum tooth display and marginal gingival display due to the position of the lip line.

The treatment philosophy There are two main considerations in arriving at a treatment concept in such cases. The Ƥrst is the decision making regarding the joint position during treatment and the second is what treatment must be rendered on the anterior teeth to get the desired aesthetic result.

Considering the Ƥrst dilemma, as to whether to treat the patient in MIP or in CR3, the answer depends on several factors. In cases with no joint symptoms or pathology and no signs of occlusal disease, with the treatment being restricted to a few teeth in an arch (onlay, crown, bridge), the MIP position can be used as the joint position for treatment, especially if the anterior guidance is not being altered in anyway. In cases, where the signs of occlusal disease are present, the anterior guidance will be altered, the vertical dimension will be reassigned or the patient has clicking in the joints, the starting point of treatment has to be CR or an adapted centric posture. Needless to say, that a joint with a click (Pathology), needs a thorough analysis and treatment allowing the joint enough opportunity to heal and be in a stable, reproducible position without any symptoms lingering on during treatment.

The second consideration is more to do with the dental elements of the treatment. In cases such as these, the fact that there is anterior wear needs an investigation and in most cases, the cause of this anterior wear is either anterior friction or posterior interferences or a combination of both. As this patient had an overcorrected anterior retroclined dentition, anterior friction due to constricted chewing envelope is a distinct possibility4. Lack of equilibration of posterior teeth after orthodontics can lead to posterior interferences that can cause anterior wear. Thus the treatment approach must take both these into consideration.

The method of tooth preparation to create adequate room for the ceramic restoration has taken a huge reƤnement in the 40

past decades. Deciding the volume of the Ƥnal restoration with an intraoral mock-up not only allows the patient to test drive the smile but also acts as a great barometer for the clinician to judge the amount of tooth structure to be removed5. In most cases such a volume based tooth preparation shifts the entire treatment in the predictable mineralised enamel of the tooth thus allowing lesser sensitivity post operatively and better bonding capabilities.

The exceptional translucency of lithium disilicate allows life like aesthetics to be achieved in thinner sections when the underlying tooth has normal coloured dentin and hence is the material of choice in such cases, compared to zirconia that requires more room on the tooth to produce equivalent aesthetics and still fails to aesthetically satisfy, due to increased opacity, when judged by a trained eye of a keen observer. The fact that lithium disilicate can be bonded to the underlying enamel to produce a long term result tips the scales more in its favour.

The initiation process The Ƥrst step in such cases include the use of a deprogramming device such as a Kois Deprogrammer4 to allow the established memory patterns in muscles to be erased so that the unstressed muscles can guide the mandible and the joint to an optimum position of comfort that is not influenced by teeth. On the mounted study casts (Fig. 6) of this relationship of jaws, a wax-up is generated to emulate the tentative position of the anterior teeth in three dimensions (Fig. 7) based on the ideal proportions so well documented in literature6.

Fig. 6: Study casts mounted in centric relation

Fig. 7: Diagnostic wax-up

After two to three weeks of full time wear, the patient is scheduled for an equilibration of the posterior interferences that is carried out methodically using the Kois deprogrammer as a guiding tool (Fig. 8). As the anterior button of the deprogrammer is trimmed, the posterior teeth come in contact and using articulating papers of 200, followed by 40 microns the dentition is made to have simultaneous, uniform contacts of equal intensity on both sides. A shim stock conƤrms that each tooth backward of canines has a positive contact that aƥrms the establishment of good Fig. 8: Koi Deprogrammer occlusion in static CR position7.

DENTAL ASIA JULY / AUGUST 2018

Clinical Feature

Fig. 9: Putty indexes generated from wax-up

Fig. 10: Mock up bonded to teeth to test drive the smile and function

Using a putty silicone key, (Fig. 9) generated from the wax- up, a provisional restoration is made on unprepared teeth that have been totally etched and bonded to receive the putty indexes (Figs. 10-11). In this case, although, the patient had a very wide smile, we decided to treat #4 to #12 and #22 to #27 with ceramic veneers. #5 and #13 were extracted for orthodontic treatment at an earlier age.

pushed further and now it is possible to go to a depth that is as less as 0.3 mm. The incisal edge preparation may be around 1.5 mm in case an internal layering protocol for ceramics has to be followed. Using appropriate burs the incisal depth cuts are made and a depth cut of 0.3-0.5 mm made on cervical aspects of the provisionals (Fig. 12). Using a pencil to mark the depth grooves on teeth, the remainder of the material used for provisional is taken oơ. We realised in several cases that hardly any tooth preparation is required thereby helping us leave all the enamel intact on the labial surfaces of these teeth. The margins are left supragingival, too, in spite the fact that the patient has a very high lip line, as the current ingots for lithium disilicate allow translucency to be used in the cervical one thirds which provides a chameleon eơect and helps mask the crucial junction between the restoration and the uncut tooth. The added bonus of a supragingival margin being more conservative is an advantage in these cases.

Once the preparations are done, tissue management is carried out with a single cord (Figs. 13-14) dipped in buơered aluminium chloride and an impression made with addition silicone using a heavy and a light body consistency in two steps (Fig. 15). New Provisionals (Fig. 16) are made by spot bonding on the prepped teeth, using the previously made putty index.

Fig. 11: Smile view with mock-up

The pathway adjustments7 are then done on these provisionals with the patient in upright position using a 200 micron paper while the patient simulates the chewing cycle. In so doing all the surfaces on the lingual of upper incisors that are in the way of friction free anterior occlusion gets marked out. On removal of these anterior pathway interferences the patient will now have anterior guidance in harmony with the envelope of his chewing cycle. The canines (and sometimes the lateral incisors/premolars) are the only anterior teeth in this case that will bear the brunt of lateral excursive moments, touching Ƥrst and guiding the mandible safely into its home position at the end of the chewing cycle.

On aesthetically evaluating the provisionals, the entire team concurred with the patient that the upper centrals could be made longer to provide a more pleasing proportion. It was decided to make that change in the Ƥnal restorations.

Fig. 13: Tissue management with retraction cord in buơered Aluminium Chloride

Fig. 14: Preparation of lower anteriors

The finalisation The finalization of the restoration requires a methodical approach to tooth preparation and impression and transfer of data to the laboratory to aid the ceramist in fabricating life-like restorations8. The need for 0.5 mm depth in the cervical zone for lithium disilicate has been

42

Fig. 15: Final impressions

Fig. 12: Depth cuts on provisionals to initiate tooth preparations

Fig. 16: Smile with new provisionals

The models are mounted in the lab using a stick bite that allows aesthetically correct orientation of the upper plane. A full contour wax-up of the Ƥnal restorations (Fig. 17) is made and attached to a sprue to be invested. The pressed lithium disilicate is then cut DENTAL ASIA JULY / AUGUST 2018

Clinical Feature

back in the incisal aspects to get a good play of translucency and opacity in the restoration. The line angles are well deƤned to make a robust and dominant central incisor and a marginally subdued lateral. The surface texture was worked on to create natural light reƪections (Fig. 18).

Acknowledgements: The author acknowledges the crucial, inimitable role played by Mr. Danesh Vazifdar, of Adaro Dental Lab in Mumbai for the spectacular morphology and ceramic artistry on this case. DA

References: 1.

2.

3.

Fig. 17: Final Wax-ups duplicating the contours established from provisionals

4.

Fig. 18: Thin veneers with immaculate texture, layering and form to mimic nature

The veneers are then bonded altogether with strict isolation protocols taking care to prepare the tooth as well as the intaglio of the ceramic veneers diligently9. Pathway adjustments are again carried out on these bonded restorations to keep the anterior teeth contours well within the envelope of chewing cycle7.

The final result is a pleasing blend of health and beauty (Figs. 19-24), achieved with extreme minimalism, a perquisite while providing responsible aesthetics10 in the modern era.

5.

6.

7.

8.

9.

10.

Fig. 19: Post-operative 1:1

Fig. 21: Post-operative retracted view

Fig. 23: Image Photoshopped to highlight the textured areas

DENTAL ASIA JULY / AUGUST 2018

Fig. 20: Post-operative left lateral excursion showing anterior group function with posterior disocclusion

Fig. 22: Post-operative smile

Fig. 24: PostOperative view showing an ideal emergence and impeccable soft tissue health around veneers.

Fradeani M: Esthetic Analysis: A Systematic Approach to Prosthetic Treatment Vol.1. Chicago: Quintessence, 2004.

Kois JC. New challenges in treatment planning-Part 2. Incorporating the fundamentals of patient risk assessment. The Journal of Cosmetic Dentistry. Spring 2011.27 (1), 110-121 Dawson PE. Evaluation, Diagnosis and Treatment of occlusal problems.

Ed. 2, St. Louis. Mosby 1989.

Hartrick N, Kois J. Fuctional Occlusion: Science Driven Management.

J. Cosmetic Dentistry. Fall 2007. Number 3, Volume 23.

Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition-A Biomimetic Approach. 2002 Quintessence Publishing Co, Inc, Germany.

Hess L. Altering the Incisal Edge Position for Optimal Function and Esthetics. Vistas, Special Issues + Whitepapers, July - August 2010, Volume 31, Issue 4 Bakeman E, Kois J. Ten Steps for Designing Proper Clearance for Functional Pathways. J. Cosmetic Dentistry. Fall 2012. Number 28, Volume 3.

Tunkiwala AS. Controlling the Periodontal-Restorative Interface to Provide Esthetic Dentistry for an Esthetically High-Risk Patient.

February 2013, Volume 34, Issue 2, 120-129.

Barghi N, Fischer DE, Vatani L: Effects of porcelain leucite content, types of etchants, and etching time on porcelain â&#x20AC;&#x201C; composite bond. J Esthe Restr Dent 2006; 18:47-52 Bakeman EM, Goldstein RE, Sesemann MR. Question: Responsible esthetics-Is there a return to conservative esthetic dentistry? Inside Dentistry. June 2010, Vol.6, Issue 6. Aegis communications

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43

User Report

A New Concept in Posterior Denture Teeth Design

will provide guidance to the technician for ‘To o t h l o s s a n d the set up of anterior rehabilitation with teeth on the denture. dentures can have The posterior teeth are tremendous patient

By Dr. Roy Dixon, BDS MA MGDS RCSI then set up in occlusion impact and social in order to provide implications. In an Dr. Roy Dixon introduces Enigmalife dentures – the patient with an image-conscious society, a new concept in posterior denture teeth design acceptable appearance dentures restore a sense and adequate function of normalcy and allow the • Denture try-in – the artiƤcial teeth are patient the ability to interact with others’ are part of the denture bases, which rest on set up on wax by the technician and (Roumanas, 2009). The aims of denture moveable and displaceable tissues. Denture the clinician will try the dentures in the treatment are replacement of missing teeth tend to work as a functional group patient’s mouth to ensure to check the teeth to restore function, aesthetics and and there is no feedback mechanism. appearance, phonetics and function phonetics along with maintaining healthy Premature deƪective contacts between (Fig. 3) oral tissues (Figs. 1a-b). artificial teeth cause movement of the

Introduction

denture resulting in possible damage to the supporting tissues.

Fig 1a

Complete dentures The construction of complete dentures involves a number of clinical and laboratory stages that may include some or all of the following: • Primary impressions – these are the initial impressions of the patient’s edentulous arches recorded in the surgery. The dental technician would then cast stone models from these impressions and construct custom trays (Fig. 2).

Fig 1b

Figs. 1a-b: Edentulous ridges

The denture occlusal scheme plays an important role in achieving these aims by minimising trauma to the supporting structures, enhancing the stability of the dentures and facilitating function.

Natural teeth are suspended in the bone by the periodontal ligament, which acts as a shock absorber.

This means that natural teeth act individually, with the ligament providing a biofeedback mechanism. Denture teeth

44

Fig. 2: Primary impression – doric easy Ƥrst/Flo-light in Schottlander edentulous tray

• Secondary impressions – the custom trays are then used to record accurate and more detailed impressions • Jaw relation– the dental technician will construct wax rims on models produced from these initial impressions, which are representative of the position of the patient’s original teeth. The rims are modified in the surgery to reƪect the current clinical situation and

Fig. 3: Dentures set up for wax try-in

• Denture Ƥt – once the try-in has proved acceptable, the trial dentures are processed and Ƥnished and the dentist or the clinical dental technician Ƥnally Ƥts the dentures.

Occlusion can be defined as the relationship of the maxillary and mandibular teeth when they are in functional contact during mandibular activity. The challenge faced by the dental technician is to establish a functional occlusion for the patient using artiƤcial posterior teeth, as he may have little or no information about the patient’s natural teeth and their occlusal scheme.

Fig. 4: Digital dentures – planning the occlusion

DENTAL ASIA JULY / AUGUST 2018

User Report

Modern technology may allow some of these stages to become digitalised and a modiƤed workƪow is likely to evolve and will continue to be developed (Fig. 4): • Impressions – primary and secondary impressions would still be recorded and the laboratory would digitally scan the model and the adjusted wax rims. This would record the anatomical detail of the jaws and the desired occlusal plane.

At some point, it may be possible for this detail to be scanned directly at the chairside and transmitted to the dental laboratory • Reference points – within the denture design software reference points could be set to reƪect the anatomical landmarks, in order to guide the set-up of the denture teeth • Denture design – the software would allow the design of the denture base to ensure optimal coverage of the soft tissues • Selection of teeth – this could be done virtually and the teeth could be set up in the desired occlusal scheme within the denture design software. Where this takes place, the teeth need not be set-up in wax and any change from balanced to lingualised occlusion or vice versa may therefore be performed digitally • Digital manufacture of dentures – after the denture design has been finetuned and confirmed the dentures are constructed. A milling machine or 3D printing may do this.

for complete dentures has a direct inƪuence upon their stability and to a lesser extent retention and support, all consequently having an eơect upon their success.

According to Lang, three groups of occlusal forms are available: anatomic, non-anatomic and zero-degree teeth.

The Glossary of Prosthodontic Terms provides the following deƤnitions apply to each type: • Anatomic are teeth that have cuspal inclinations greater than zero degrees and tend to replicate occlusal anatomy.

Such teeth may have cuspal angles set to 20º, 30º, 33º or 45º • Non-anatomic teeth are designed in accordance with mechanical principles rather than from an anatomic standpoint • Zero-degree teeth are posterior teeth that have zero degree cuspal angles.

Traditionally the two most common types of posterior tooth set up are bilateral balanced occlusion and lingualised occlusion (Figs. 5-6).

Fig. 5: Denture teeth set up showing balanced occlusion

Occlusal schemes A key stage of conventional denture construction is the setting of the denture teeth on a wax base. The clinician will advise the dental technician on the selection of the appropriate mould and shade and would record the necessary anatomical detail such as the desired vertical dimension, the incisal relationship, the mid-line and the inter-alar distance (McCord and Grant, 2000). The technician is then able to set up the denture teeth with regard to this information to achieve a natural-looking appearance and a functional occlusal scheme.

Lang (1996), in a review of occlusal philosophies, stated that the occlusal scheme

DENTAL ASIA JULY / AUGUST 2018

Fig. 6: Denture teeth set up showing lingualised occlusion

‘Complete dentures were required to maintain their ability to function during mastication by means of stabilising contacts.

This led to the logical development of fullbalance occlusion concept’ (Slavicek, 2002).

In the scheme of balanced occlusion, the palatal cusps of the upper teeth are in contact with the fossa of the lower teeth and the buccal cusps of the lower teeth are in contact with the fossa of the upper teeth in centric occlusion. At rest, the buccal cusps of the upper teeth= and the lingual cusps of the lower teeth are not normally in contact with the opposing teeth but do come into contact during excursive movements.

The advantages of balanced occlusion are: distribution of load, stability, protection of the TMJ, reduced trauma on initial insertion, functional movement, masticatory eƥciency and comfort.

However, there are a number of concerns with this occlusal scheme: • It is a fabricated concept that does not exist in nature.

• Indeed, Dawson (2007) comments: ‘Many dentists have tried to apply the same concept of bilaterally balanced occlusion to the natural dentition but have abandoned the idea because of the disastrous clinical results.

Hypermobility, excessive wear and periodontal breakdown seem to be the rule rather than the exception, since the posterior teeth succumb to the eơects of the so-called balance.’

• The lingual cusps remain high ,to protect the tongue, giving a negative Curve of Wilson • However, the patient cannot bite as well and it encourages the patient to chew sideways, which is neither good for the joints nor the edentulous ridges • It is extremely difficult to set up and achieve, the cusps need to be shorter, the teeth ƪared and aesthetics is poor.

In their guide describing Enigma Tooth Set Up, Bourke and Besford from Schottlander state that balanced occlusion refers to ‘simultaneous sliding contact of posterior teeth on both sides of the jaw in small lateral and protrusive excursions (up to 2mm).’ They suggest that the upper posteriors are set with their palatal cusps centred bucco-lingually over the crest of the lower ridge, so that the central fossae of the lowers sit over the crest of the lower ridge. The buccal cusps of the molars are arranged to follow

45

User Report

the compensating curve starting with the palatal cusp of the Ƥrst premolar. The lower posterior teeth are set up to ensure that the upper and lower buccal cusps are in contact as well as the lingual cusps and that the balancing and working side teeth are in simultaneous contact over a small range of lateral excursions (Figs. 7-8).

Fig. 7: Denture teeth set up

Fig. 8: Enigmalife dentures

Gysi (1929) Ƥrst introduced a modiƤed version of balanced occlusion known as ‘lingualised occlusion’ in 1929. He almost eliminated the maxillary buccal cusp and the net result was a prominent palatal cusp that occluded into the lower anatomic teeth.

In lingualised occlusion, the palatal cusps of the upper teeth engage in the central fossa of the lower teeth with the buccal cusps of the upper teeth tilted at such an angle so that in normal function they never come into contact with the lower teeth. In this arrangement, any cusps of the lower teeth only come into contact with the upper teeth during excursive movements.

In previous examples of teeth designed for lingualised occlusion, the lower teeth frequently have cusps with a very low incisal angle or have fewer or smaller cusps or the occluding surfaces may have a saucer shape in which the upper palatal cusps move. The advantages of lingualised occlusion are:

46

• Reduced lateral stresses and dislodging forces • Stability • Ease of set-up as centric limited to the centric stop in the fossa • Excellent aesthetics with buccal cusp form retained • Enhanced functionality with good penetration of the food bolus • Vertical forces are more in line with the alveolar ridge.

In their guide on Tooth Set Up, Bourke and Besford state that ‘in the lingualised occlusion concept the lingual cusps of the upper posteriors bite into the central fossae of the lowers.’ However, the contacts are only on the upper palatal cusps and the upper buccal cusps do not contact the lower teeth in either balancing or working excursions.

It is clear from the literature that diơering views abound on whether a balanced occlusion or lingualised occlusion scheme is required, yet no randomised controlled trials have been identiƤed to date, which justify the validity of one philosophy over another. ‘A suitable occlusal scheme would be a critical factor for a successful complete denture.

However, there is no conclusive evidence to support which occlusal design is more appropriate for fabricating a successful complete denture. In occlusal design of conventional complete denture, lingualised occlusion can provide better clinical outcomes than other occlusal designs; meanwhile, canine-guided occlusion also can be used in clinic practice’ (Zhao et al, 2013).

‘Canine guided occlusion implies uniform contacts at maximum intercuspation position while during laterotrusive movement contact only occurs on the canine with every tooth movement, even non-working side, contact considered as an interference’ (Prasad et al, 2012).

Balanced occlusion attempts to enhance denture stability by maintaining contacts during lateral and protrusive movements.

However, the theoretical beneƤts of this concept have to be questioned as the introduction of a food bolus prevents the concept functioning as proposed.

In canine guidance, the only contact in eccentric movements is on the canines, which theoretically creates an oblique force capable of dislodging the denture.

Therefore, for many clinicians it seemed intuitive that canine guidance would result in an inherently unstable denture.

However, Farias et al (2010) report that ‘it did not happen. Thus, it is supposed that canine guidance does not decrease retention and stability.’ They also highlight the importance of training the patient to use complete dentures with a canine guided scheme, so as ‘to avoid these problems in denture retention, stability and bone resorption, it seems to be more reasonable to instruct the patient not to incise, but rather put small pieces of food in the mouth and masticate on both sides of the arch.’

Additionally, Peroz et al (2003) reported that ‘EMGbased studies suggest that the patients seem to avoid eccentric movements, as they did not notice the loss of retention of the maxillary dentures.

On the contrary, they noted a signiƤcant improvement in chewing ability with canine guided dentures.’

There are diơerent theories as to why one scheme is better or worse than the other and many previous designs of teeth can be set up by the technician, skilled in their art, to be used in either format.

However, in such teeth, the set up has to be made diơerently for each format and in order to change from a balanced occlusal concept to a lingualised occlusal concept or vice versa, the teeth have to be re-set up on the wax base or the occlusion/cusps reshaped by grinding to conform to the new scheme.

Setting up teeth for bilateral balanced occlusion is a complex and time-consuming process for the dental technician whereas the setting up for lingualised occlusion and canine guidance can be more straightforward, although changes between the occlusal schemes are not easy.

A new concept A new range of denture teeth, Enigmalife Posterior S Teeth, has been introduced to allow more ƪexibility in establishing the

DENTAL ASIA JULY / AUGUST 2018

User Report

palatal stamp cusps on the upper teeth and centric stops on the occluding surfaces of the lower teeth and is particularly of merit for complete dentures. A stamp cusp is a tooth cusp that, when the tooth is in occlusion, Ƥts in the fossa of the antagonist in a mortar and pestle fashion. Centric stops are the stable points of contact between occluded maxillary and mandibular teeth and are located in the central fossae of the antagonists. The denture tooth design enables the denture teeth to Fig. 9: Enigmalife Posterior S Teeth be easily set up in either a lingualised or a balanced occlusal scheme.

However, if the chosen scheme proves not to be acceptable in a particular clinical case, then the dental technician can readily change to the alternate occlusal scheme.

This is achieved by softening the wax under the upper posterior teeth Fig. 10 and rotating the teeth, the tooth shape allowing a simple rotation around one or more stamp cusps of the upper posterior teeth, which remain within their occlusal stops in the opposing lowers. Prof. Slavicek recommends that teeth be set up in lingualised occlusion because this occlusal scheme directs the Fig. 11 forces towards the remaining bone, avoiding any harmful forces.

Figs. 10-11: Dentures with Enigmalife Denture Teeth However, each individual clinical scenario may require a different approach and Enigmalife S posteriors have designed for implant-stabilised and partial been designed to set easily both in fully dentures, where the fuller form allows them balanced occlusion, lingualised occlusion to be readily adapted to the underlying and in cross bite. implant structures and to the remaining The Enigma System creates a denture natural dentition (Figs. 9-11). that is designed for the individual patient, Gnathological expert, Prof. Rudolf Slavicek, so the â&#x20AC;&#x2DC;occlusal planeâ&#x20AC;&#x2122; is called the aesthetic has developed the S Posteriors. They plane and reĆŞects what looks right for the have been designed to replicate the patientâ&#x20AC;&#x2122;s face. Average measurements, form and function of natural teeth with whilst helpful, often lead to a stereotype a cusp angle of 35o and provide a precise denture appearance that fails to live up to occlusal relationship and can be readily set the potential of a beautiful creation capable up in virtually any occlusal concept. The of changing a patientâ&#x20AC;&#x2122;s life. statement: â&#x20AC;&#x2DC;The quality of intercuspation is The well-defined stamp cusp and important for the physiology of chewingâ&#x20AC;&#x2122; fossae relationship will assist the patient refers to natural teeth, but is equally valid in adapting to complete dentures as they for denture teeth. become aware of the prosthetic seating.

This new design of artiƤcial posterior This process can be enhanced if the patient denture teeth presents clearly defined correct occlusal scheme for each individual patient. Posterior denture teeth require proper proportion and morphology in order to support the condyle when loaded axially and provide stability. These teeth have been

DENTAL ASIA JULY / AUGUST 2018

is encouraged to learn how to swallow liquids with the teeth together in order to keep the dentures stable. The patient should also be encouraged to undertake chewing exercises, creating a frontal loop instead of exaggerated lateral excursions.

The well-defined and stable cusp-fossae relationship, irrespective of the occlusal scheme, facilitates this training and enhances the outcome for the patient with complete dentures.

Conclusions â&#x20AC;˘ The requirement for dentures, both partial and complete, will remain an important aspect of modern dentistry for many years to come â&#x20AC;˘ The construction of dentures is complex, involving a number of clinical and laboratory stages â&#x20AC;˘ Complete dentures can be set up in a number of occlusal schemes including bilateral balanced occlusion, lingualised occlusion and canine guidance â&#x20AC;˘ There is no conclusive evidence suggesting that a particular occlusal scheme should always be used for complete dentures. However, setting up for bilateral balanced occlusion is complex and time-consuming, whereas lingualised occlusion and canine guidance are more straightforward â&#x20AC;˘ The new range of Engimalife Posterior S Teeth provides a precise occlusal relationship and can be readily set up in virtually any occlusal concept. DA

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47

6th Biennial Meeting of ADSS

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Giulio Pavolucci

Rita Singh

Kazunobu Yamada

South Korea

Italy

Nepal

Japan

Organiser

Co-host

www.dama.sg Event Manager

User Report

A

fter missing wisdom teeth, agenesis (lack of failure of development) of the upper lateral incisors 12 and 22 is the second most common cause of congenital hypodontia (developmentally missing teeth). For a young person in particular, such as the 18-year old patient shown here (Fig. 1), an anomaly of this kind is often associated with a psychological burden. The ‘Twilight’ look (fang-like) has an enormous impact on self conƤdence and reshaping the canines to create lateral incisors is an appropriate course of action.

RESHAPING CANINES TO CREATE LATERAL INCISORS

By Mr. Vanik Kaufman-Jinoian

Dental technology instructor Mr. Vanik Kaufmann- Jinoian demonstrates a solution to the ‘Twilight’ look (fang-like) with a Vita Enamic restoration.

Vita Enamic oơers stability and elasticity, enabling thinner walls for minimally-invasive restorations. The reliability of the material is also supported by integrated cracking prevention (Fig. 2). The material also oơers excellent edge stability after milling. This is generally a beneƤt in itself, but is also crucial in a case such as this in order to create thin restoration margins that taper oơ smoothly.

The tooth-coloured material facilitates light transmission with a natural appearance.

In this way, Vita Enamic restorations can be integrated perfectly into the remaining tooth substance, providing an attractive play of colours.

Vita Enamic is available in two levels of translucency, HT (HT= highly translucent) and T (T = translucent), as well as in the Ƥve Vita System 3D-Master shades 0M1, 1M1, 1M2, 2M2 and 3M2.

The product is available in packs of Ƥve in the geometry sizes EM-14 (12 x 14 x 18 mm) and EM- 10 (8 x 10 x 15 mm). The blocks can be processed using the Cerec/ inLab MC XL system from Sirona Dental with software versions > V4.0. This allows the blocks to also be milled with the small Cerec/inLab milling system, and using software versions earlier than 4.0, Vitablocs Mark II, I14 must be selected in the list of materials. Since September 2013, Vita Enamic blanks have also been available for processing using Ceramill Motion 2 (Amann Girrbach) and KaVo ARCTICA / KaVo Everest machines.

Fig. 1: An 18-year-old patient with agenesis of the upper lateral incisors

However, given that the tooth substance is healthy, an approach to restoration is required that is gentle as possible on the substance. Partial, non-prep veneers fabricated using the CAD/ CAM restoration material Vita Enamic proved to be particularly suitable in this case.

Decision-making process I met the patient during her visit to the dentist, where the suggested approach of treatment was initially met with scepticism.

The Vita Enamic composite material, for which I was one of the consultant testers, was still completely new at this time and the dentist had not heard of it. The following facts helped change his mind: the hybrid ceramic combines the beneƤts of dental ceramics with those of composite materials. By combining both materials,

DENTAL ASIA JULY / AUGUST 2018

Fig. 2: The Vita Enamic composite (a combination of ceramic and polymer material) offers integrated crack prevention (Source: VITA R&D, Vickers indentation)

Product information According to the manufacturer, Vita Enamic is the first hybrid dental ceramic in the world to oơer a dual-network structure: a dominant ceramic network reinforced by a polymer network, with both networks fully integrated with one another. The range of indications includes all conventional single-tooth restorations, from inlays and onlays, to veneers, through to full and partial crowns. The special material properties are beneficial particularly for restorations subject to high occlusal load, for example in the molar region, as well as for minimally-invasive restorations.

Fig. 3: Initial situation

CAD/CAM fabrication In the practice, conventional impressions were taken of the initial situation without preparation (Fig. 3), and gypsum models fabricated in the laboratory. These were digitised using the extra-oral scanner in Eos Blue from Sirona Dental. The inLab software (V4.2) was provided for virtual modelling; custom veneer restorations were created using biogeneric mode (Fig. 4). The model axis was adjusted Ƥrst (Fig. 5) following scanning and a preparation margin then

49

User Report

manually added for tooth 12 and 22 (Figs. 6-7). The following parameters were predeƤned for the design suggested by the software: spacer of 20Ɋm, veneer thickness 300Ɋm, occlusal milling offset of 0, no reinforcement at the margins, no milling tool radius correction, but with automatic removal of undercuts (Fig. 8). It was then possible to Ƥnalise the veneer models as usual by hand using free-forming tools (Fig. 9). Figure 10 shows the milling preview of one of the fully modelled partial veneers.

Fig. 12: …the block shade 2M2 was selected Fig. 8: DeƤnition of the modeling parameters

Fig. 13: Vita Enamic block with fully milled partial veneer Fig. 9: Processing of the veneer models

Fig. 4: Creating the task

Fig. 10: Milling preview of UL2 partial veneer

Fig. 5: Aligning the model

Using the inLab MC XL milling unit, the partial veneers were fabricated from Vita Enamic blocks in shade 2M2 (in accordance with prior shade determination) and HT translucency (Figs. 11-13). In this case, the T variant of the material would not have oơered suƥcient translucency, as in our experience, it is generally too opaque for reconstructions in the incisal area.

The T blocks were used primarily for the fabrication of custom implant abutments with adhesive bases.

Fig. 6: Jaw situation without preparation

Fig. 7: Addition of preparation margins

50

Fig. 11: Based on the result of shade determination

Cementation of restorations The Vita Enamic restorations are already virtually complete following milling. They should not be placed again in a furnace.

Instead, only chemical glazing or simple polishing remains to be carried out. In this case, the restorations were particularly small and delicate and so were not polished in the laboratory. The veneers were delivered to the practice unpolished and Ƥrst veriƤed in the patient’s mouth using try-in pastes.

It has been shown that the colour of Vita Enamic restorations can appear to be too bright until they come into contact with materials such as paste. Only at this point can the play of colours and the chameleon eơect of the material be evaluated.

Cementation into position was performed using Variolink Veneers from Ivoclar Vivadent. According to the manufacturer, the hybrid ceramic must be etched for 60 seconds in order to achieve a secure bond. When placing thin Vita Enamic veneers into position, the use of dual-curing composites should be avoided in accordance with the working instructions, as these can cause slight discolouration (yellowing) once curing has completed. Purely light-curing composites are preferable for this reason. A microbrush that is adhesively bonded to the veneer using light-curing bonding or a glue stick can be used as a holder. Fixing the veneer with a Ƥnger allows more uniform distribution of pressure during adhesive placement.

DENTAL ASIA JULY / AUGUST 2018

User Report

High-gloss polishing Polishing instruments were developed for reworking the hybrid ceramic that were specifically adapted to the properties of the material. Using these instruments are recommended in order to achieve superior surface finishing simply, reliably and efficiently. The Vita Enamic Polishing Set is available in a technical variant for laboratory use as well as a clinical variant for use in dental practices (Fig. 14).

As mentioned previously, only final polishing was carried out in this case by the dental surgeon. A transition area between the restoration material and the natural tooth substance is not discernible (Fig. 15).

In order to obtain a natural surface shine, two steps must be performed: Ƥrst, prepolishing must be done using the pink polishing instruments while cooling with water (7,000-10,000 rpm), followed by high-gloss polishing while cooling with water using the diamond coated, gray polishing instruments (5,000-8,000 rpm).

Excellent results are achieved when the lowest rpm rate is used to perform what amounts to Ƥnal high-gloss polishing without cooling with water. Generally, reduced contact pressure must be used.

that was achieved using comparatively simple methods: the former â&#x20AC;&#x2DC;Twilightâ&#x20AC;&#x2122; girl now sports a lovely smile, her appearance that of a completely normal teenager.

Summary Results A before-and-after comparison (Fig. 16a-16b) shows the considerable impact

Fig. 16b: Post treatment â&#x20AC;&#x201C; a natural, relaxed smile demonstrates her new- found conƤdence

Vita Enamic generally allows superior restorations to be fabricated very quickly and inexpensively. The dental surgeon who was initially sceptical has since become an enthusiastic fan of the hybrid ceramic.

Vita Enamic is distinguished by the fact that it oĆĄers both stability and elasticity, as well as other properties. This ensures unusually high edge stability. With a conventional CAD/CAM glass ceramic such as lithium disilicate ceramic, it would not be possible to create partial non-prep veneers in this way. Due to their brittle characteristics, it would have been expected that such materials would fracture when milling thin restoration margins of this kind.

Thanks to the intelligent combination of ceramic and polymer material, Vita Enamic is also the Ƥrst material to demonstrate properties incredibly similar to those of natural dentition. After all, the human tooth is not rigidly Ƥxed, but is always subject to a certain degree of movement. It can be assumed that a Vita Enamic restoration will bond reliably with the tooth substance when adhesively cemented in the mouth, and it will flexibly adapt thanks to its elasticity. These are excellent prerequisites for a lasting, durable restoration. DA

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Fig. 14: Vita Enamic polishing set clinical variant

Fig. 15: Based on shade determination

DENTAL ASIA JULY / AUGUST 2018

Fig. 16a: Patient prior to treatment â&#x20AC;&#x201C; the anomaly is immediately obvious

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51

Behind the Scenes

Dr. Andrew Dawood, co-founder of Dawood & Tanner, Digits2widgets and Cavendish Imaging, presents four extraordinary projects demonstrating the life-changing uses of 3D printing in dental and facial treatments.

By Dr. Andrew Dawood, BDS MRD RCS MSca

Case 1 Advanced implant reconstruction for a patient missing half of her upper jaw and all her teeth (Figs. 1-4).

A 3D-printed replica of the jaw gives the surgeon a feel for the surgical demands of the situation. In this case, the patient is missing one side of her upper jaw and all the teeth and supporting bone. A resin model has been used to rehearse innovative Fig. 2: Physical planning with 3D printed model surgery, and a white nylon model was On the left side of the jaw, two special sterilised and taken to surgery to help guide ‘zygomatic’ implants were placed into the the surgeon in the course of an innovative cheekbone. These are a type of dental implant procedure. implant used to anchor implant bridgework This patient lost half her upper jaw for people who have lost all their teeth and because of cancer. Because of the loss of have little remaining jawbone (Fig. 3). a great deal of bony structure, and the type and thickness of soft tissue that was grafted into place to Ƥll the resulting cavity, using ordinary dental implants to replace the missing teeth or support a prosthesis was possible. The patient was unable to open her mouth fully after surgery and radiation treatment complicated treatment still further.

The approach was to imagine the remaining structure with a CT scan and to Fig. 3: 3D-milled titanium bar Ƥtted to implant plan implant positions in implant planning software (Fig. 1). Although software For the right side, a new, specially simulation is useful, it does not offer designed custom 3D milled implant was the same tangible and intuitive feel as a fabricated, which could be inserted 3D printed model. backwards into The 3D printed model the rim of the eye allowed the left half socket, through a jaw, cheekbone, and small existing scar. both eye sockets to I believe this is the be ‘handled’, and for first ever use of a diơerent approaches ‘reverse’ implant, for surgery to be only conceived trialled and other and implemented novel options to be with the help considered (Fig. 2). of 3D printing Fig. 1: Planning in software

52

the procedure was tried out by actually ‘operating’ on a resin model before surgery.

Figures 4a and 4b show the result.

Fig. 4a: Final smile post-op

Fig. 4b: Prosthesis in place

• Implant design and surgery: Dr. Andrew Dawood • Prosthetic reconstruction: Dr. Susan Tanner • Facial surgery: Mr. Jonathan Collier and Mr. Simon Eccles, Chelsea and Westminster Hospital • 3D modelling: Dr. Veronique Sauret, Cavendish Imaging.

Case 2 Computer-guided replacement of upper teeth in 30 minutes with a 3D printed template (Figs. 5-7).

Implant planning software (Nobel Clinician) is used to plan the position of dental implants for a patient missing all his teeth. To transfer this virtual planning

DENTAL ASIA JULY / AUGUST 2018

Behind the Scenes

information to the patient, a drilling template is designed, and 3D printed (Fig. 5).

• Planning and dental implant surgery: Dr. Andrew Dawood and Dr. Susan Tanner.

Case 3

Fig. 5: 3D printed drill guide

This 3D-printed drilling template acts as an interface between the virtual and the physical, transferring the virtual plan to the patient’s mouth.

This planning also enables a physical model of the jaw to be made with implants in place before surgery actually takes place - and this means that the patient’s bridgework can be completed before surgery and fitted immediately upon completion (Fig. 6).

Treatment that used to take months can be completed in minutes (Fig. 7)!

A new jaw, dental implants and replacement teeth following a shotgun injury to the face (Figs. 8-10).

This patient received a dramatic shotgun injury to his jaw during a robbery in Nigeria, and was airlifted to London (Fig. 8).

Three-dimensional printing allowed a replica of his jaws to be produced before surgery. The position of a vascularised bone graft to be taken from his shoulder blade was planned using the 3D model.

The position of replacement teeth was also planned, and a Ƥxation plate prepared, all prior to surgery (Fig. 9).

the contour of the Ƥxation plate. Implants were placed into the new jaw, and a simple implants with supported prosthesis was Ƥtted, replacing the missing teeth, the gums and some of the supporting bone, providing suitable support for the lip, which was later further reconstructed using complex plastic surgery.

Three months later, the temporary prosthesis was replaced with definitive dental bridgework based upon 3D milled titanium frameworks, Ƥtted to the dental implants (Figs. 10a-b).

Fig. 10a

Fig. 8: At time of injury

Fig. 10a-b: 3D milled titanium prostheses in place Fig. 6: Pre-prepared 3D milled titanium/resin prosthesis

Fig. 9: 3D printing for planning

Fig. 7: Implants and prosthesis in place.

DENTAL ASIA JULY / AUGUST 2018

The patient received, to my knowledge the Ƥrst immediate jaw reconstruction with simultaneous dental implant placement and provision of implant-supported dental bridgework.

In the course of just one procedure, a vascularised bone graft was transferred from his shoulder to the jaw to Ƥt within

• • • •

Maxillofacial surgery: Prof. Iain Hutchison Implant surgery: Dr. Andrew Dawood Implant prosthetics: Dr. Susan Tanner Modelling: Dr. Veronique Sauret, Cavendish Imaging.

Case 4 A three-dimensional printing performed for the planning of complex facial/dental implant surgery and oral/facial prostheses (Figs. 11-14).

I was part of the team that developed the incredible facial prosthesis for cancer

53

Behind the Scenes

patient Mr. Eric Moger. My work as an early adopter of 3D scanning and 3D printing has made me an adviser for surgeons wishing to integrate these technologies into their surgical Ƥeld.

Three-dimensional printed models from a CT scan of jaw and skull were used to plan and rehearse implant surgery. It was printed in resin for simulation of surgery, and in sterile nylon for use during surgery.

Three-dimensional printed models from an optical scan of face, with â&#x20AC;&#x2DC;replacement partâ&#x20AC;&#x2122; modelled from right side and mirrored to left side, provided a template for the silicone prosthesis (Fig. 11).

Fig. 12a

Fig. 12b Fig. 12a-b: Digital modelling of the prostheses

Fig. 11: 3D printing to understand the defect

The patient had advanced cancer of the face/sinus, for which he was referred to University College London Hospital where he received life-saving surgery, having lost his left eye, cheek, jawbone and much of his skull.

He could not have a surgical reconstruction due to the extraordinary size of the defect, and the radical radiation treatment, which limited his capacity to heal.

For four years, he endured life with gauze dressing covering a defect that extends from the forehead down the left side of the face and into the mouth. He was not able to speak clearly, and had to be fed through a tube going into his stomach.

As reconstructive surgery was not an option, the approach was to use implants to anchor oral and facial prostheses.

Three-dimensional image, simulation and printing technologies were used to plan novel treatment.

54

Extra-long dental implants (â&#x20AC;&#x2DC;zygomaticâ&#x20AC;&#x2122; implants) extend across from the remaining right cheek bone, through the remaining part of the jaw, and these act together with dental implants placed into the rim of the eye socket to anchor a metal â&#x20AC;&#x2DC;scaĆĄoldâ&#x20AC;&#x2122; that extends through the face to provide retention for an oral plate, crucially sealing the defect, and a silicon prosthesis, which provides a much improved appearance (Fig. 12a-b).

Three-dimensional printing was a critical part of the treatment, allowing us to rehearse surgery on replica models of the small residual part of the jaw, plan and design the implants and components, predetermine the positions and orientation of the implants, and finally model the contour and shape of the prosthesis, which was made in silicone by clinical dental technician Mr. David Thatcher (Fig. 13).

This treatment is only the start of what is a lifelong process, as the prostheses will need regular, constant updating, with work already in progress on a more sophisticated internal structure and prosthesis.

Most importantly, Mr. Moger is able to eat and drink through his mouth, and speech and appearance has much improved - a huge boost to his self-conƤdence and quality of life (Fig. 14). DA

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Fig. 13: Oral prosthesis in place

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Fig. 14: Facial and oral prostheses in place

DENTAL ASIA JULY / AUGUST 2018

Behind the Scenes

Part I: Indispensable Guide for Implant-Supported Overdentures

By Dr. Alessio Casucci and Mr. Rodolfo Colognesi

T

he edentulous state affects many essential aspects of a patient’s life, their masticatory and phonetic functions, their appearance and even their social relationships. Although the edentulous patient’s rehabilitation can be successfully met thanks to a complete dental prosthesis, in some cases, however, problems of instability and poor retention can appear, primarily concerning the lower denture. The use of osseointegrated implants allows successfully managing all these inconveniences, even though implant rehabilitations may also present functional and aesthetic problems or requiring frequent maintenance interventions. It is therefore recommended to perform, right from the preliminary stages, an accurate surgical and prosthetic evaluation in order to intercept and reduce possible complications of the Ƥnal restorations. To this intent, the basic principles of the complete dental prosthesis can be a valuable support in planning future rehabilitations on implants.

The case reported in this paper describes the rehabilitation of an edentulous patient with a complete upper prosthesis and a lower implant-supported overdenture.

Introduction The functional and aesthetic restoration of edentulous patients is still nowadays a contemporary theme in prosthetics. In recent decades, the phenomenon of tooth loss has been greatly reduced thanks to the important achievements in the field of prevention of caries and periodontal disease. However, the marked tendency towards population ageing keeps the demand for this kind of rehabilitation constant in absolute terms1-2. For many years already, the complete prosthesis has allowed to successfully treat most edentulous patients 3-6 . However, the management of the lower denture is 56

often diƥcult due to lack of retention and poor stability7-8. The adaptation to this type of rehabilitation is a very complex process inƪuenced by various anatomical, functional and psychological aspects, and this is why it is not routine in all patients, as has been well-documented9. Therefore, the instability of the complete prosthesis aơects not only the chewing function but also the patient’s social life10; this greatly reduces the satisfaction of people more interested in their social life, and especially of women11. The advantages of mandibular implant-supported overdenture have been widely highlighted by many clinical studies 12-19. This type of prosthesis can be planned on a variable number of implant abutments (one to four) onto which can be positioned diơerent retentive components.

The overdenture on two intraforaminal implants with attachments is currently the most scientifically validated solution on an international level. The advantages of this type of rehabilitation are mainly linked to the improvement it determines in the quality of life of edentulous patients20, as well as the very favourable price-eƥciency ratio of the treatment.

Several authors at the Consensus Conference at McGill University21 in 2002 had already identiƤed this rehabilitation mode as a “potential treatment standard” for the edentulous mandible. However, the scientiƤc literature has often reported problems related to the maintenance of the retentive components and to the fracture of the prosthesis itself22-24. The attachments are exposed to stress, distortion and wear, which determine a premature loss of retention25-26; this is why a great number of solutions are offered on the market.

Furthermore, the fracture risk of the product increases when the prosthesis is thin; to overcome this drawback, in addition to the use of non-voluminous attachments and the insertion of reinforcing structures,

it may be necessary to schedule a resective plastic surgery of the alveolar ridge to be performed during implant surgery27-28. It has been reported that about 10-12 mm of space are required between the soft tissues and the occlusal table 29; in this evaluation it is necessary to not only consider the occlusal planes, but also to respect the neutral zone in order not to invade the necessary functional spaces of the tongue and cheeks30.

Some studies have also pointed out that in the case of rehabilitations with complete upper prostheses combined with lower implant overdenture or Ƥxed rehabilitations with reduced posterior occlusal support, one can recreate the underlying mechanisms of the combined syndrome31-32. This eơect seems to promote an excessive anterior occlusal contact that affects the pre-maxilla 33. It is not uncommon to Ƥnd some conditions wherein the anchorage structures impose an overexposure of the anterior teeth, which not only creates an aesthetic discomfort, but also a dramatic loss of functionality of the upper prosthesis34. The realisation of an implant-supported or implant-anchored prosthesis must therefore comply with the construction aspects of a full prosthesis in order to intercept and reduce the maintenance and functionality problems of future implant restorations. It is therefore essential to determine parameters such as the occlusal plane, the correct allocation of spaces between the upper and the lower jaw, the vertical dimension of occlusion (VDO), to establish a stable and repeatable centric relation (CR) and to properly set up the mounting of the teeth according to phonetic and aesthetic criteria. This preliminary analysis is ultimately functional to the correct setting of the treatment plan and to eƥcient communication with the patient. The aim of this paper is to describe the diagnostic and rehabilitation pathway of an edentulous patient treated with a complete upper prosthesis and an overdenture on two implants.

Case report A 68-year-old patient, edentulous upper and lower arches restored with prostheses for about three years, requested a new rehabilitation. The patient did not show any significant pathology (Figs. 1-3).

DENTAL ASIA JULY / AUGUST 2018

Behind the Scenes At the interview during her first visit, she complained having to stabilise the prostheses with large amounts of adhesive and in spite of this, the presence of an unreliable seal made her insecure while chewing and in her social life. The patient also reported often using anti-inƪammatory mouthwashes to cope with frequent irritations of the upper anterior area. She was generally satisƤed from an aesthetic point of view, but requested to be able to obtain a better support of the upper lip with the new rehabilitation.

Fig. 1

Clinical evaluations For the reasons of instability expressed already three months before the prosthetic visit, two implants had been placed in the intraforaminal area in position 33 and 43.

Considering the prostheses worn by the patient, it was noted that, even though the patient’s rehabilitations oơered a suƥcient coverage of the support areas, their adaptation to the tissues was insuƥcient.

From an occlusal point of view, both the lower prosthesis, which was derived from a partial skeletal prosthesis, and the upper one showed obvious signs of wear of the occlusal surfaces and there was also a strong anterior occlusal contact that caused a signiƤcant rotation of the upper prosthesis with resulting displacement (Fig. 4). Phonetic evaluation showed an excessive clearance between the arches probably due to wear and bone resorption35. The self-sustaining stability test of the masticatory units under load reported a noticeable displacement of the upper prosthetic body for the elements of the second quadrant. The clinical evaluation of the mucosa highlighted the presence of inƪamed mucosa in the area around the incisive papilla and a mobile crest (Figs. 5-6).

The evaluation of the OPG showed the presence of two implants in the front area in position 32-33 and 42-43.

stability and the seal of the upper prosthesis and to plan an eơective retention system on the lower implants. Variables to be deƤned by the diagnostic mounting: • Choice of the retention system.

• Assessing the need to place a metal reinforcement in the lower prosthesis.

Preliminary impression In the first session, two Neocolloid Normal Setting alginate impressions (Zhermack) were taken.

Schreinemakers impression trays were used and wax (Zeta blue extra soft wax) was placed to stabilise and support the impression material. On the surface of the tray, adhesive were applied for alginates.

The impressions were taken in two stages. First, a high-viscosity material was used, and the Ƥrst impression was dried for about 20 seconds with a gentle stream of compressed air. Then the undercuts were removed and the impression was relined with a low viscosity material (Figs. 7-10).

Fig. 7

Fig. 2

Fig. 5

Fig. 8

Fig. 6 Fig. 3 Figs. 1-3: Front, proƤle and relaxed smile

Figs. 5 - 6: Edentulous jaw

Fig. 9

Treatment Plan

Fig. 4: Prostheses inserted in occlusion. The contact points of the lower anterior teeth on the upper prosthesis are highlighted by the red lines, showing a remarkable shift of the lower dental midline DENTAL ASIA JULY / AUGUST 2018

The established treatment plan was built for a new complete upper prosthesis and a lower overdenture anchored on the two implants. The treatment goals were to restore the VDO and reduce excessive free space; furthermore, following the indications of the patient, to improve the

Fig. 10 Figs. 7-10: Phases of preliminary impressions

57

Behind the Scenes Realisation of the preliminary model and construction of the impression tray In the laboratory, the alginic acid residues were eliminated from the impressions by gently brushing on dental plaster and rinsing them thoroughly, and then they were casted using Elite Model type 3 plaster mixed with distilled water, according to the instructions of the manufacturer. The models obtained were squared and Ƥnished (Figs. 11-12).

dynamics, through functional movements of the lips, cheeks and the patient’s tongue, and then a light trimming was performed to activate the frenulum. Before recording the impressions, the rimming was moved into the external areas to avoid hyperextensions related to the overlap of impression material.

Fig. 15

Fig. 16

Fig. 19 Figs. 13-16: Alignment of the tray - Marking the lay out Fig. 11

Fig. 12 Figs. 11-12: Preliminary models and construction of the impression trays

At this point, the models were wet and insulated with Isolating fluid. The trays were made with Elite SC Tray EVO self-curing resin (Zhermack). The foundations were Ƥnished by giving the edge a thickness of about 2.0-2.5 mm, except for the lower one in the sublingual area and the upper one in the area of the retrozygomal fossa where we left a thickness of 3-4 mm (Figs. 17-18).

Fig. 20

Figs. 19-20: Length and thickness control of the impression trays Fig. 21

Fig. 17

After having analysed the support areas, we marked the layout of the future individual trays on the models. In this phase, anatomical knowledge as well as muscular dynamics of the person marking the layout is essential (Figs. 13 - 16). We then eliminated the undercuts with Tenatex Red wax (Kemdent), also being careful to place a layer of wax in the front to exclude any compression of the tray during the Ƥnal impression taking.

Fig. 22 Fig. 18

Fig. 13

Fig. 23 Figs. 17-18: Individual trays

Functional impressions

Fig. 14

58

The second session allowed for taking functional impressions. The trays were checked, as their stability and the absence of sharp areas are essential requirements.

The length limits were Ƥrst checked visually with the reference of the transition area between adherent mucosa and free mucosa, then by using a silicon-based paste (Figs. 19-20). The trays were lined with thermoplastic paste of diơerent texture in order to seek for a selective pressure in the internal seal areas. The peripheral edge was modelled first by using the muscle

Fig. 24

Figs. 21-24: Final stages, peripheral rimming and Ƥnal impressions DENTAL ASIA JULY / AUGUST 2018

Behind the Scenes These operations obviously did not aơect the inner seal areas. The upper tray was perforated in both the palatal and the anterior area to facilitate the leakage of the impression material, thus reducing the displacement of the tissues (Fig. 9). Once the adhesive had been applied on the surface of the tray the Ƥnal impressions were taken with a polysulƤde mixture (Fig. 21-24).

In the anterior region they were prepared with a thickness of about 2-4 mm; in the molar region the upper one was set with a thickness of 8-10 mm (Figs. 26-27).

Fig. 26

The CR was recorded after finding a stable and repeatable position. A face-bow transfer, with the reference of Camper’s plan to complete the information about the size and shape of the front teeth we used the Form Selector with which we chose the shape B62 Phonares II (Ivoclar Vivadent).

Creation of the master models and packaging of stabilised plates The fingerprints were carefully boxed in order to preserve the edges, then developed them using an Elite Stone type 4 plaster (Zhermack class), vacuum mixed with distilled water according to manufacturer’s directions (Fig. 25).

Fig. 27

Fig. 30: Articulator mounting with average values Fig. 31

Figs. 26-27: Plates stabilised with wax rims

Centric relation record

Fig. 25: Master models

The stabilised plates were made with Ivolen self-curing resin (Ivoclar Vivadent) after eliminating the undercuts from the models with wax and isolating them. The plate was then brushed with a thin layer of sticky wax in the ridge area where preformed wax rims were placed. For the upper one, the incisal margin of the rim was placed in front 22 mm from the upper labial groove and 8-10 mm from the incisive papilla with an angle of about 10° in the sagittal plane. The upper occlusal plane was set with the Rim Former by placing this instrument at the back at the level of the pterygomaxillary notches and in front in the position described above. The rear edge of the rim was set at the medial limit of the tuberosity. For the lower rim however, the distance between the lower labial groove and the incisal margin at the level of the incisors was set at 18 mm. This was placed on the centre of the alveolar ridge and was tilted forward by 8-10° in the sagittal plane; the width of this small phonetic rim was adjusted by simulating that of some of the lower incisors (about 15-20 mm)36. The rims were modelled by simulating an arch and following the shape of the residual ridge.

DENTAL ASIA JULY / AUGUST 2018

In this phase, the wax rims were adapted to the support needs of the lips. The upper rim was set parallel to Camper’s plane and to the bipupillary axis in the frontal plane using the Fox device. By using the phonetic tests, phonemes “f” and “v” for the upper range and “s” for the lower one, we determined the length and anteriorposterior position of the rims, which at the end of the recording will simulate the future assembling of the teeth. After distributing, the spaces between the upper and lower ƪoor we determined the VDO37 and marked both the median line and that of maximum reveal (Figs. 28-29).

Fig. 32

Fig. 33

Figs. 31-33: Anterior teeth mounting

Mounting on the articulator and anterior set up Fig. 28

Fig. 29 Figs. 28-29: Ratings of phonetic phonemes “f”, “v” and “s”

The models were positioned on a Stratos 200 average-value articulator (Ivoclar Vivadent) (Fig. 30). The mounting of the front teeth was set by using all the information recorded during the clinical stage: the occlusal plane, the median line, the position and the anterior-posterior tilt. This simpliƤed the positioning of the individual elements; in fact, it was suƥcient to create a breach in the upper rim starting from the median line to get the necessary 59

Behind the Scenes

space for the corresponding tooth. Then, while respecting the ratio with the occlusal plane and the tilt in mesiodistal direction, the front teeth were Ƥxed with modelling wax. A few abrasions, a few horizontal alignments of the incisal margins and slight rotations were set with the aim to adapt and harmonise the assembly of the teeth to the patientâ&#x20AC;&#x2122;s aesthetic needs (Figs. 31-33). The same approach was used for assembling the lower elements; setting the overjet and the overbite is extremely important as they tend to exclude any possibility of occlusal interference in the front area during the function, thus reducing traumatic forces in the premaxilla area. DA

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Who. International Classification of Functioning, Disability and Health Geneva, Switzerland, 2001 C. W. Douglass, A. Shih, and L. Ostry, â&#x20AC;&#x153;Will there be a need for complete dentures in the United States in 2020?â&#x20AC;? Journal of Prosthetic Dentistry, vol. 87, no. 1, pp. 5â&#x20AC;&#x201C;8, 2002 Winkler S, Protesi totale, Piccin Nuova Libraria Spa, Padova, 1988 Schreinemakers J. Le basi razionali della protesi totale, Piccin Editore, Padova Fuhr / Reiber, La protesi totale, Editrice Cides Odonto, Torino, 1996 Passamonti G. / Vergnano A. Atlante di protesi totale, Editrice Cides Odonto, Torino 1978 Brill N: Full denture retention: Factors in the mechanism of full denture retentionâ&#x20AC;&#x201D;A discussion of selected papers. Dent Pract Dent Rec 1967;18:9-19 Redford M, Drury TF, Kingman A, et al: Denture use and the technical quality of dental prostheses among persons 18-74 years of age: United States, 1988-1991. J Dent Res 1996; 75 (Spec Iss):714-725 Mericske-Stern R: Clinical evaluation of overdenture restorations supported by osseointegrated titanium implants: A retrospective study. Int J Oral Maxillofac Implants 1990; 5:375-383 Yoshida M, Sato Y, Akagawa Y, et al: Correlation between quality of life and denture satisfaction in elderly complete denture wearers. Int J Prosthodont 2001;14:77-80 Pan S, Awad M, Thomason JM, Dufresne E, Kobayashi T, Kimoto S, Wollin SD, Feine JS. Sex differences in denture satisfaction. Journal of Dentistry 2008 May; 36(5): 301-308 Attard NJ, Zarb GA. Long-term treatment outcomes in edentulous patients with implant overdentures: the Toronto study. Int J Prosthodont. 2004;17:425-433 van der Bilt A, van Kampen FM, Cune MS. Masticatory function with mandibular implant-supported overdentures fitted with different attachment types.

Eur J Oral Sci 2006;114:191-6 Thomason JM, Lund JP, Chehade A, Feine JS. Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery.Int J Prosthodont 2003;16:467-73 Awad MA, Lund JP, Shapiro SH, Locker D, Klemetti E, Chehade A, et al. Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: a randomized clinical trial in a senior population. Int J Prosthodont 2003;16:390-6 Bakke M, Holm B, Gotfredsen K. Masticatory function and patient satisfaction with implant-supported mandibular overdentures: a prospective 5-year study.

Int J Prosthodont 2002;15:575-81 Doundoulakis JH, Eckert SE, Lindquist CC, Jeffcoat MK. The implant-supported overdenture as an alternative to the complete mandibular denture. J Am Dent Assoc

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2003;134:1455-8 Heydecke G, Thomason JM, Awad MA, Lund JP, Feine JS. Do mandibular implant overdentures and conventional complete dentures meet the expectations of edentulous patients? Quintessence Int 2008;39:803-9 Burns Dr, Unger JW, Elswick RK Jr, Giglio JA. Prospective clinical evaluation of mandibular implant overdentures.

Part II: pa- tient satisfaction and preference. J Prosthet Dent 1995;73:364-9.

Naert I, Alsaadi G, Quirynen M. Prosthetic aspects and patient satisfaction with two-implant-retained mandibular overdentures: a 10-year randomized clinical study. Int J Prosthodont. 2004;17:401-410 Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, et al. The McGill consensus statement on overdentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients.

Montreal, Quebec, May 24-25, 2002. Int J Oral Maxillofac Implants 2002;17:601-2 Walton JN, MacEntee MI. A retrospective study on the maintenance and repair of implant-supported prostheses. Int J Prosthodont 1993;6:451-5 Bergendal T, Engquist B. Implant-supported overdentures: a longitudinal prospective study. Int J Oral Maxillofac Implants 1998;13:253-62 Naert I E,Gizani S,Vuylsteke M, VanSteenberghe D. A 5-yearprospective randomized clinical trial on the influence of splinted and unsplinted oral implants retaining a mandibular overdenture: prosthetic aspects and patient satisfaction. J Oral Rehabil 1999;26:195-202 Walton JN, MacEntee MI. Problems with prostheses on implants: A retrospective study. J Prosthet Dent 1994;71:283â&#x20AC;&#x201C;288.

Hemmings K, Schmitt A, Zarb G. Complications and maintenance requirements for fixed prostheses and overdentures in the eden tulous mandible: A 5-year report. Int J Oral Maxillofac Implants 1994;9:191-196

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Gotfredsen K, Holm B. Implant-supported mandibular overdentures retained with ball or bar attachments: a randomized prospective 5-year study. Int J Prosthodont 2000;13:125-30 Misch CE. Treatment options for mandibular implant overdenture: An organized approach. In: Contemporary implant dentistry, 2nd ed. St. Louis: Mosby; 1998. p.

175-92 Lee CK, Agar JR. Surgical and prosthetic planning for a two-implant-retained mandibular overdenture: a clinical report. J Prosthet Dent. 2006 Feb;95(2):102-5 Preiskel HW. Overdentures Made Easy: A guide to implant and root supported prostheses. Chicago: Quintessence Publishing; 2002. p. 24 Thiel CP, Evans DB, Burnett RR: Combination syndrome associated with a mandibular implant-supported overdenture: A clinical report. J Prosthet Dent 1996;75:107-113 Jacobs R, van Steenberghe D, Nys M, et al: Maxillary bone resorption in patients with mandibular implantsupported overdentures or fixed prostheses. J Prosthet Dent 1993;70:135- 140 Stafford D, Glantz PO, Lindqvist L, Strandman E. Influence of treatment with osseointegrated mandibular bridges on the clinical deformation of maxillary complete dentures. Swed Dent J Suppl 1985;28:117-35 Lechner SK, Mammen A. Combination syndrome in relation to osseointegrated implant-supported overdentures: a survey. Int J Prosthodont 1996;9:58-64 Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixedlongitudinal study covering 25 years. J. Prosthet. Dent.

1972; 27: 120-32 Pound, E. Let /S/ be your Guide. J Prosthet Dent 38:482489, 1977 Pound, E. Controlling Anomalies of Vertical Dimension and Speech. J Prosthet Dent 36:124-135, 1976

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DENTAL ASIA JULY / AUGUST 2018

In depth with -Nacera (DOCERAM Medical Ceramics GmbH)

Nacera Blue X: Translucency-Enhancing Liquid for 3Y-TZP Zirconia Market Overview The dental market is oơered a broad portfolio of zirconium oxide in terms of sizes, strengths, and aesthetics (colour). Additionally, a distinction is also made in the yttrium oxide content that leads to: Low Translucent Zirconia (LT), High Translucent Zirconia (HT) and Ultra High Translucent Zirconia (UHT, which is the highest concentration).

However, higher concentrations lead to changes in the crystal structure that reduce ƪexural strength.

Relation of stabilisation, translucency and ƪexural strength The zirconia (ZrO2) used for dental applications is a manufactured structure. Pure ZrO2 has an unusable monoclinic crystal structure at room temperature. The crystal structure refers to the physical orientation and distances between atoms. Diơerences in structure aơect density and other properties.

The monoclinic structure density is 5.56 g / cm3, cubic structure is approx. 5.68-5.91 g / cm3, while tetragonal ZrO 2 has Fig. 1: from left to righ: the highest density, at A= modiƤcations cubic, B= tetragonal, 6.1 g / cm³. These C= monoclinic crystal changes in structure lattice; bright spheres = Zr, are the results of dark spheres = O (Source: Brevier) small deviations in the orientation of the oxygen atoms (Fig. 1).

The most critical structural transformation is the phase shift from tetragonal to monoclinic that results in a volume expansion of 5-8%. Stretching the bonds between atoms weakens the material. For this reason, yttria oxide (Y2O3) is added to the ZrO2 in a process called, “doping,” to prevent the phase shift to monoclinic. The addition of yttria oxide stabilises the newly formed stronger structures of zirconium oxide, cubic and tetragonal.

As the yttrium content increases, the proportion of cubic phase in the material also increases. The greatest advantage for dental purposes is the stabilisation of the tetragonal phase that maximises ƪexural strength.

Flexural strength & microfractures 3Y-TZP stabilised ZrO2 is measured by its highest ƪexural strength.

However, in the presence of a microfracture, the tetragonal structure undergoes a transformation (phase shift) to the monoclinic structure that includes a 5-8% particle expansion. Tensile

62

stresses can induce cracks that propagate in the microstructure, depending on the rate of crack growth. As the crack travels through the structure, the adjacent tetragonal ZrO2 grains are converted to the monoclinic phase.

The resulting volume expansion compresses the crack, called “phase toughening,” and dissipates much of the crack energy to contain the fracture and increase ƪexural strength (Fig. 2).

This eơect also enhances 5 and 6 mol% stabilised ZrO2. However, in contrast to 3Y-TZP, there is a high proportion of cubic grains in the structure of the 5 & 6 Y-PSZ (partly stabilised zirconia). Because cubic grains are not converted into the monoclinic phase in the presence of a microfracture, much of the crack-inhibiting eơect is lost (Fig. 3). As a result, cubic microfractures extend deeper and decrease strength.

Fig. 2: 3Y-TZP Zirconia

Fig. 3: 5Y- and 6Y-PSZ Zirconia

Translucency Translucency is influenced by various aspects of the structure (grain sizes, pore distribution,etc.).

In addition to the absorption and the reƪection of the light beam by grain boundaries and porosity, light refraction’s dependence upon crystal boundary and structure also plays a major role.

Most systems show an anisotropic structure that splits the incident light beam and lowers translucency, a process called, birefringence.

Fig. 4: Phase transformation

DENTAL ASIA JULY / AUGUST 2018

Behind the Scenes

Fig. 5: Birefringence

Birefringence is a physical property of optical materials that have two refractive indices. In different polarisation levels, light is broken diơerently. In machinable polycrystalline zirconia, this leads to increased scattering and opacity.

In the 6Y-PSZ zirconia birefringence can be drastically reduced.

By locally increasing the yttrium content in the ZrO 2 ceramic, the cubic crystal system is also locally stabilised. For this reason, the disadvantageous effect of birefringence is avoided, and in these areas, translucency is increased.

More strength or more translucency, is a battle today’s dental laboratory owners often face.

The solution Nacera Blue X makes it possible to increase translucency of pre-shaded Nacera 3Y-TZP Zirconia, up to 8%, resulting in a cubic zirconia like appearance after sintering.

During use, it is important to follow simple guide-lines like the cubic structure, areas where Blue X is applied, undergo expansion. In case of a bridge, the underside of the pontic is subjected to tensile stress. Therefore, Nacera Blue X is limited to the occlusal portion of the restoration, Fig. 6: Nacera Blue X and should not be applied to connectors, gingival side of pontic or neck area of crown. Doing so also means that the gingival portion of the 3Y-TZP retains its tetragonal structure. Experiments have shown that treated restorations have a high ƪexural strength similar to untreated crowns.

Nacera Blue X, can be used for single tooth and three-unit bridges in the anterior and posterior region. It is applied with a brush individually, from the middle of the tooth to the incisal/occlusal edge, targeting an increasing translucency similar to a shade tab.

Due to the altered optical properties of the cubic phase, the chroma will be reduced on pre-coloured 3Y-TZP zirconium oxide where Nacera Blue X is applied, creating a natural colour gradient.

Nacera Blue X decreases the need to purchase additional ultra-high-translucency (UHT or 5Y-PSZ) zirconium oxide blanks, by providing natural aesthetics and translucency, without sacriƤcing maximum ƪexural strength.

DENTAL ASIA JULY / AUGUST 2018

Eơects of Nacera Blue X Patented Nacera Blue X is a complex solution with yttrium components. The low-viscosity liquid should only be applied with a brush to increase translucency on pre-sintered/ pre-shaded Nacera zirconia. Areas of application should be restricted to incisal or occlusal surfaces.

During sintering, the Nacera Blue X liquid and colour vaporises. The introduced Blue X yttrium atoms are included in the ZrO2 - Y2O3 lattice with an increased stabilisation of its new cubic phase. Nacera pre-shaded Pearl zirconia treated with Blue X maintains ƪexural strength of 1,200 MPa (DIN-EN ISO 6872-2016).

This is almost twice as high as cubic zirconia and up to three times as high as lithium disilicate. DA Fig. 7: 1 : Applying Nacera Blue X, 2: Sintering, 3: Finalising and 4: + 8% Translucency with Nacera Blue X

Fig. 8: Nacera Pearl with Nacera Blue X

Fig. 9: Modification structure of 3Y-TZP applied with Nacera Blue X

63

In depth with -Cattani Asia

Asia Takes Notice of the Cattani Suction and Compressor Range

C

attani has built an enviable reputation for over 50 years. Originating from Italy, the company practises a customer Ƥrst policy, producing robust and reliable equipment made for long hours of continuous, genuine energy savings and eƥcient use.

With headquarters in Singapore, Cattani Asia showcased for the Ƥrst time its industry-leading range of suction units and compression at IDEM 2018 to a receptive audience.

Cattani Asia’s entry into the Asian market along with a strong network of distributors behind them, makes it easier than ever to acquire their celebrated products in the region.

High quality, competitively priced Cattani Asia’s goals are clear, says Executive Director Mr. Barry Clark.

“With the help of our distribution partners we are bringing our high-quality, cutting edge technology products to the doorstep of every dentist and institution in the region – and at competitive prices.”

Mr. Clark said he was encouraged by the welcome the Cattani team received at events. “The response of our partners and the Asian dental community in general was heart-warming and productive in a business sense. It gives us real conƤdence.”

The appointment of Mr. Muhammad Nejim as Regional Director is essential in achieving Cattani Asia’s goal. Mr. Nejim has over 20 years of medical and dental business experience. Mr. Nejim together with the company’s distributors and end users are all supported by Cattani’s expert technicians in bringing vital technical support closer than ever before.

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Training: a key part for Asia Currently, Cattani Asia had established partnerships Mr. Muhammad Nejim, Regional Director with leading distributors in of Cattani Asia 11 countries namely Singapore, Malaysia, Indonesia, Thailand, Vietnam, India, Sri Lanka, Nepal, Taiwan, Pakistan, Bangladesh and Hong Kong. Additionally, training has been the priority for all countries.

“We aim to provide not just outstanding products but outstanding and comprehensive services as well. Training is an essential part of that service and we have already conducted the Ƥrst product and service training course for Asian distributors,” says Mr. Nejim.

Presently, Mr. Nejim is talking to other potential distributors in the region and training will be the continued focus especially as distribution network is growing. DA

DENTAL ASIA JULY / AUGUST 2018

Product Highlight

Reward Your Doctors with Unparalleled Restorations 3Shape, a global leader in 3D scanners and dental software solutions, releases Dental System™ 2018 – the newest version of its industry-leading CAD/CAM software for dental laboratories.

3Shape Dental System 2018 introduces new ƪexibility and functionality to make scanning, design and production workƪows more eƥcient and dependable for dental technicians.

Increased ƪexibility in 3Shape Dental System 2018 means professionals can now combine any types of scans, as well as save and access designs during any step in the workƪow. This makes the design of cases, especially complicated indications, simpler, more eƥcient and more predictable.

3Shape has worked extensively with consulting dental technicians to strengthen the latest version of its dental

laboratory CAD/CAM software. Feedback and best practices from CDTs have helped to significantly increase reliability and performance in the solution.

“Dental System 2018 is a great leap forward. It opens new possibilities and brings us the much-needed freedom to import, export and align scans freely. The solution’s stability has been improved and the workflows are optimised. I love it!” says Mr. Przemek Seweryniak, CEO Cosmodent Laboratory, Sweden.

3Shape Dental System 2018 highlights include: • Design more eƥciently with ƪexible scan handling that enables technicians to combine various types of scans (surface, pre-prep, bite and face scans) and save designs at any step in the workƪow • Create precision contacts with auto snap of the crown to the antagonist or neighbouring teeth • Double the speed of bridge and bar design with automatic creation and positioning of connectors • Make beautiful smiles in minutes with 3Shape Smile Design by simulating realistic smiles in 2D and linking design to 3D in 3Shape RealView to guide restorative steps

New CAD/CAM Materials from Anthogyr More zirconia choices for ALL implantand tooth-supported prostheses

Anthogyr, a people-oriented company dedicated to innovative implantology, is offering new materials for all implant- and tooth-supported restorations, cemented and screw retained restorations, and single and multiple-unit restorations. Now dental professionals can provide more solutions for each indication with: DENTAL ASIA JULY / AUGUST 2018

• Multi-layer Sina ML zirconia for anatomical restorations with no need for ceramisation. Sina ML also saves time and reduces maintenance.

• Translucent Sina T zirconia is now available for multiple-unit, implantsupported restorations.

The durability (over 1200 MPa) of all Sina Z, Sina T, and Sina ML zirconia is certiƤed for all indications, including multiple-unit, implant-supported restorations.

3Shape • Produce partial and full dentures more eơectively with signiƤcantly improved prosthetic workƪows • Deliver Clear Aligner* services with 3Shape driven workflows for either in-house design and production, or through partners

3Shape Dental System 2018 Open Ecosystem 3Shape’s open ecosystem offers an unrivalled range of treatment workƪows, integrated libraries, design service partnerships, and interfaces to virtually all manufacturing equipment and materials.

From over eighty sleeves and implant libraries, to integrated mills, 3D printers and materials, labs can take advantage of open digital dentistry to expertly serve the needs of their dentists and patients.

“This new 3Shape Dental System version received exceptionally positive feedback from the dental technicians taking part in the beta testing. Higher reliability and solid improvements have made Dental System 2018 a fantastic release! I really look forward to our users across the world beneƤtting from the new version,” says Mr. Rune Fisker, 3Shape vice president of Dental Lab. Ŷ

Anthogyr France More choice of materials for singleunit, tooth-supported and anatomical restorations.

• Glass ceramic VITA SUPRINITY® PC for its aesthetic qualities • Hybrid ceramic VITA ENAMIC® for its extremely simple Ƥnishing procedure and ability to absorb masticatory force. Ŷ

65

Product Highlight

Dentsply Sirona

CEREC Software 4.6: Five Clicks to a Restoration in Just One Visit

Dentsply Sirona now presents the new CEREC Software 4.6 that takes CAD/CAM technology in the practice to a new level of quality: It features wellstructured workƪows that make many tasks automatic and faster. The Ƥve-click concept enables users to produce restorations more easily, safely and quickly than ever before.

For dentists, this means they save time with even more comfortable handling.

CEREC has evolved from a technology that was once used mostly by ‘techies’ to a vehicle suitable for use in daily routine, and the CEREC Software 4.6 fulfils this promise more than ever before. The CEREC SW 4.6 reduces the process of creating a restoration to just one click per step: administration, acquisition, model, design, and manufacture. This means that with just five clicks, you can produce a crown, for example, that meets the highest standards. The software focuses on the restorations that can be produced in just one session in the daily practice routine.

Specific improvements for an optimal user experience The CEREC software has been simpliƤed once again to be even more intuitive, ensuring a fast yet precise workflow.

3M Over the years, dental zirconia has developed into one of the most popular aesthetic restorative solutions: highly translucent, pre-shaded and – in the case of 3M™ Lava™ Esthetic Fluorescent Full-Contour Zirconia – now available with built-in, toothlike ƪuorescence. In June 2018, the portfolio of this innovative material is expanding to include Lava Esthetic zirconia in all 17 shades – all 16 VITA® classical shades and one bleach shade.

Full-contour zirconia is trending in the aesthetic zone, making it essential for dental labs to offer highly aesth etic mon olith ic resto ratio n s.

66

The preparation margin is now automatically marked in a precise scanning process, but can be modiƤed manually at any time. This, in addition to functional adjustments within the software and a changed biogeneric algorithm with improved consideration of the minimum material thickness, leads to initial proposals requiring minimal-to-no modiƤcations. For easier use, the model axis is also set automatically ௅ for the first time using artificial intelligence. To further improve the aesthetic result for bridge designs, the anatomical connections between the elements can be adapted individually.

The approximately 20% reduction in the time needed for creating the margin and modification of the design is a decisive added value.

directly into the CEREC software. Or the scan data can be sent in the universal STL format to the lab of choice. In addition, there is a third option for sending the design and production of more complex restorations to a dental technician using the new wireless connection of CEREC SW and inLab.

Full flexibility with CEREC The CEREC SW 4.6 also gives dentists more flexibility by allowing them to produce the restoration in-house. This can be done easily with only Ƥve clicks in the software.

Dentists who choose to work with a dental technician now have three options. The scan or the model data can be uploaded in the Sirona Connect portal for production in the lab, a function that is now integrated

The CEREC SW 4.6 in combination with the CEREC Omnicam thus facilitates the easier, safer, and faster entry into CAD/CAM technology ௅ for production in the practice or lab. The data from the CEREC SW can be imported to the lab easily and reliably. The standardised workƪow optimised for the material used ensures the quality of the outcome. Ŷ

3M Expands Shade Portfolio Esthetic Fluorescent Zirconia Competitive-minded dental technicians can achieve this through use of a zirconia material with an extraordinarily high aesthetic potential. This is exactly what Lava Esthetic zirconia delivers with optimised translucency, a shade gradient designed for excellent match to VITA classical shades, and built-in ƪuorescence.

“With Lava Esthetic zirconia’s advanced optical features and the availability of 17 shades, a simple mill-sinter-glaze process is now generally suƥcient to produce a desirable monolithic restoration,” says Mr. Jim Buchanan,

National Accounts Manager, 3M Oral Care.

“Situations that require the use of a “close enough” shade followed by manual colour adjustments are a thing of the past. This beneƤt, combined with the fluorescent effect that comes from within the material, ensures that users of Lava Esthetic zirconia are taken to the next level of fullcontour aesthetics!”

For the placement of Lava Esthetic crowns and bridges, 3M recommends 3M™ RelyX™ Unicem 2 Self-Adhesive Universal Resin Cement. Ŷ

DENTAL ASIA JULY / AUGUST 2018

TeKne Dental

Sonosurgery®: Pneumatic Handpiece from TeKne Dental

Through TeKne Dental’s solid research and development, the company is proud to present the Sonosurgery ® . It is a pneumatic (powered by compressed air) handpiece that can be used in prophylaxis procedures and especially designed for

surgery procedures using the special KaVo/Komet® inserts.

The power of vibrations can be adjusted with a rotating ring, making the prophylaxis more ƪexible and accurate.

The handpiece connection is fully

compatible with the GYROFLEX/MULTIƪex rapid couplings (Multiƪex is a registered trade mark of Kaltenbach&Voigt & CO. GmbH, Germany).

The handpiece can also be used together with the new SONOSURGERY STERIL rapid coupling.

A special dynamometric wrench is available for the use and sterilisation of the inserts, making it versatile and easy to use. Ŷ

EyeSpecial C-III: A Smart Device for Daily Dental Photography New image sensor, exceptional focal length and aperture with its eight automated preset shooting modes, Shofu EyeSpecial C-III smart digital dental camera fulƤls a range of critical applications for your entire dental team from daily case documentation, treatment planning, patient communication

to medico-legal and insurance veriƤcation, and dental laboratory collaboration.

Special Benefits • New 1/1.7-inch CMOS Sensor, 12 Megapixel • Excellent 28 - 300mm focal length with maximum aperture • 8 Pre-set dental shooting modes without the need for extensive training on dental photography • Exclusive flashmatic system with combination of lateral ƪashes • Integrated smart focus and zoom

Shofu

features with built in anti-shake • Intuitive one-touch operation with 3.5-inch LCD touchscreen • Convenient and durable device with water, chemical and scratch resistance • Lightweight, single handed operation even with medical gloves • SureƤle Photo management software

Accessories The new Shofu EyeSpecial C-III camera has available accessories like the Shofu Gray Card, video cable and also a hand strap for easy handling. Ŷ

New Beautifil II LS, Beautifil II Enamel & Gingiva: Breaking New Grounds Growing Beautifil product line Shofu is continually expanding its BeautiƤl product line. The BeautiƤl II LS breaks new ground in direct resin technology with its extremely low polymerisation shrinkage and related stress. It exhibits superior aesthetics, optimal mechanical properties, ease of handling and polish, lasting natural lustre and remarkable abrasion resistance for universal application.

In addition, the BeautiƤl II LS has novel low shrinkage “SRS” monomer formulation and unique Ƥller technology that significantly

DENTAL ASIA JULY / AUGUST 2018

minimises polymerisation shrinkage stress while resulting in a more durable, robust and stable polymer complex that offers greater predictability to your restorations. Tooth-like optical characteristics enable an easy shade match for a wide spectrum of simple to complex, challenging cases.

BeautiƤl II LS exhibits additional anti-plaque beneƤts and sustained ƪuoride protection to all restorations. A rational selection of universal, opacious dentin, bleach white and enamel shades allow the users to explore a plethora

of possibilities ranging from simple to complex polychromatic restorations.

In conjunction, the Beautifil II LS is also compatible with the complimentary line-up of the value based BEAUTIFIL II ENAMEL an d natural gum-coloured BEAUTIFIL II GINGIVA shaded restoratives. BeautiƤl II Enamel and Gingiva are delivered in a special one-push syringe for controlled dispensing of the smooth and creamy material that is easy to sculpt into fine details and recreate the surface textures seen in natural enamel & gum. Ŷ

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Product Highlight

Canary System The Canary System Nominated for ‘2018 Manning Innovation Award’ On 31st May 2018, Dr. Stephen Abrams and Dr. Andreas Mandelis were nominated for the 2018 Manning Innovation Award in recognition for their work in creating The Canary System™. The Canary System is a laserbased device which finds small cavities and cracks in teeth before they are large enough to be seen on x-rays.

Additionally, The Canary System is also used in dental oƥces to Ƥnd decay under old Ƥllings, sealants, braces, crowns and it can examine the interior of root canals. Clinical trials have veriƤed that The Canary System is more accurate than x-rays for detecting decay between teeth.

“It has been a long journey from the Ƥrst discussion on how we could create a device that could accurately detect tooth decay without e x p o s i n g

patients to x-rays,” said Dr. Abrams. “The Canary System integrates technology developed by Dr. Mandelis into a clinical system that can diagnose, measure and record tooth decay at the earliest stages.

The Canary System has a camera, so patients can see the tooth surface, and a voice that reports on the findings of each examination. Canary examination results are easy to understand, unlike the small black patches on x-ray images, giving patients the conƤdence to accept treatment recommendations and the motivation to adhere to home management routines.”

“The core technology, PTRLUM, involves shining a low powered laser on a tooth and then measuring the heat and glow from the tooth. During a Ƥve

second scan over 520,000 measurements are taken and the Canary Number is calculated from these measurements.” said Dr. Koneswaran Sivagurunathan, who oversees research and product development for The Canary System.

“I am so pleased that our core technology is being used to improve oral health” says Dr. Mandelis, Professor at the Department of Mechanical and Industrial Engineering at the University of Toronto and director of the Center for Advanced Diơusion-Wave and Photoacoustic Technologies. “This is the Canadian solution to a very common oral disease and will improve the oral health of patients worldwide.”

Since 1982, the Ernest C. Manning Awards Foundation has been building a culture of innovation in Canada by discovering, honouring and rewarding Canadian innovators of all ages, and across all sectors. As a national charity, they take great pride in their ability to discover and support home-grown innovation heroes. Ŷ

R-dental Dentalerzeugnisse GmbH METAL-BITE®: An Award-Winning Universal Registration Material The universal registration material, METAL-BITE ® , received the “2018 Four Star Award” from REALITY Publishing in January. The dark grey A-silicone registration material was introduced more than 15 years ago. In recent years METAL-BITE ® has become an international standard for occlusal registrations. The product has received multiple awards in 2012 – 2018 from the Dental Advisor and REALITY and became known to a growing number of dentists worldwide. The product is recommended by several opinion leaders.

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In summary, METAL-BITE® oơers perfect physical properties such as extreme hardness, fast setting time, thixotropic and high durability. The product is also radiopaque for manufacturing surgical guides for implants. The well-balanced physical properties guarantee a precise registration in combination with a comfortable working time. It is tastless and cutting/countouring are easily done after it sets.

The METAL-BITE® product family includes also the CAD/CAM registration materials METAL-BITE® Blue, which is optimised for the Bluecam, and METAL-BITE® GOLD, which is recommended for CEREC 3D applications. Ŷ

DENTAL ASIA JULY / AUGUST 2018

Planmeca Orthodontics: Choose the Right Tool for You Planmeca likes to be at the forefront of new technologies. To make sure they serve all our users in the best possible way, they strive to provide several types of tools and services to add proven value to everyday dentistry. Their goal is always the same – to make clinical life more eƥcient and enjoyable.

Visual inspections of the extraoral and intraoral situation are typically performed during oral examination and a quick visual representation of the possibilities of the treatment can be done using 2D photographs and smile design software.

When a mutual decision on an orthodontic treatment is reached, further clinical records are taken which may include x-ray images: lateral cephalometric and panoramic images, as well as physical impressions. All these records can be obtained directly with Planmeca devices and visualised in their software.

When proceeding to treatment planning, a cephalometric analysis is usually performed. Making it easy as the software can perform a cephalometric analysis automatically in seconds. Stone model analyses can also be done digitally

using intraoral scans and model analyser software.

In deciding the treatment path best suited for the patient and the clinical indication, as well as where to get the needed appliances from. Planmeca collaborates with several third-party providers to make sure that you Ƥnd your favourite company from the growing list of supported partners. Planmeca’s cloud service allows sending digital impressions securely to a local lab or external solution provider with just a few clicks.

If customers prefer to do everything themselves, they can always design and fabricate clear aligners in-house using Planmeca’s software and 3D printer. The in-house workƪow is convenient, as you can optionally include roots from the

XP-endo® Shaper: The One to Shape your Success Through constant innovation and improvements, FKG has been working to ensure it can oơer practitioners instruments capable of meeting all these requirements.

With the creation of the exclusive MaxWire ® alloy, FKG is bringing two fundamental properties to the forefront: super elasticity and shape memory, with the aim of creating a completely new generation of instruments. Unlike other instruments, these are able to react to variations in temperature and to take on a predetermined shape inside the root canal, at body temperature.

The XP-endo Shaper is the latest addition to the XP-endo® range. It is a truly innovative broad spectrum shaping instrument which can be used to radically simplify endodontic sequences.

DENTAL ASIA JULY / AUGUST 2018

It results from the combination of two cutting-edge technologies: MaxWire® alloy and Booster Tip (BT).

The MaxWire® alloy, like the XP-endo Finisher, offers remarkable ƪexibility and fatigue resistance, and the ability to progress within the canals with ease and agility, expanding or contracting according to the canal morphology. With an initial taper of .01, the XP-endo Shaper expands once inside the canal, achieving a taper of at least .04.

Thanks to the Booster Tip (BT), the XP-endo Shaper benefits from a unique

Planmeca CBCT image to the plan and follow their position while simulating tooth movement.

Planmeca can help customers even more when treating early mixed dentition. The LM-Activator appliance is a cost-eƥcient alternative for both dentist and patient.

During the treatment, it is always important to keep track of the status and progress. The Planmeca Romexis® Model Analyser software is a marvellous tool for comparing scans captured at diơerent points in time.

Orthodontics is tightly connected to orthognathic surgery, another area they are making rapid advances in. For corrective jaw surgery, Planmeca’s powerful tools allow surgical planning to be done easily and eƥciently within the same software.

Planning is not just simulation with no connection to real life – instead, it allows producing surgical splints that can be printed on-site and are used to transfer the virtual operation to the actual operating room. The splints and, if needed, the entire surgical planning can also be ordered as a service from the Planmeca ProModel™ surgical planning team. Ŷ

FKG swiss endo geometry, having six cutting edges at the tip. The BT tip respects the trajectory of the canal, whilst removing more material with each pass. It enables the instrument to start shaping an ISO diameter smaller than the one of the instrument. In the case of the XP-endo Shaper, the BT enables it to start shaping after a glide path of at least ISO 15, and to gradually increase its working Ƥeld to achieve an ISO 30.

The MaxWire® and Booster Tip technologies combine to make the XP-endo Shaper a “One File Shaper” with remarkable benefits: provides simplified handling, minimal torque, minimal stress applied during treatment, excellent debris removal and improved disinfection. Ŷ

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Show Review

Technology Moves Us: 2018 Invisalign APAC Summit Technology is all around us, integrated into the most routine parts of our daily lives. It is a critical part of the work we all do. But it is not a static element.

Technology does not sit there – it moves us.

T

echnology moves us forward, moves us in new directions.

It moves us quite literally, physically – we see those movements and that progress in clinics and with patients every day. But technology also moves us together, creating connections, enabling communication, and facilitating relationships. And it moves us emotionally in the results we see and the quality of life it helps us achieve for patients.

With more than 1,200 doctors present at the 2018 Invisalign APAC Summit, Align Technology continues their dedication to transforming smiles and their goal of becoming an indispensable partner to dental professionals worldwide.

Held at Marina Bay Sands, Singapore on 31st May – 2nd June 2018 with the theme “Technology Moves Us”, the summit was an anticipated event within the region.

Impressive line-up The three-day summit included general sessions, breakout sessions, teen treatment session, aesthetic treatment session, treatment and clincheck roundtable session, clinic staơ workshop session and practice eƥciency Q&A sessions from 40 leading international speakers wherein headsets with 27 languages were provided to cater to all participants. Attendees learned about the latest and future innovations in Invisalign clear aligners, the iTero scanner and digitally driven treatment. Increased knowledge of Invisalign clinical techniques and the broad range of cases doctors

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are successfully treating were discussed.

Along with current and Ƥnished Invisalign treatments, valuable practice management and marketing insights were shared during sessions.

This year’s opening sessions features a focus on Invisalign treatment innovations and efficiency, treatment of teens and

DENTAL ASIA JULY / AUGUST 2018

Show Review

younger patients, and the future of digital treatment, as well as special recognition of top Invisalign practices.

Ms. Julie Tay, VP and Managing Director, APAC gave welcome and special recognitions, Mr. Joe Hogan, CEO talked about Align’s vision while Mr. Raph Pascaud, Chief Marketing Officer talked about aligning teen treatment, GP solutions and digital workƪow.

“We just want you to know that we’ll be spending $130M in engineering and that we’re in the lead on engineering, products, material science and software. We are dedicated to build practices and expand your businesses,” stated Mr. Joe Hogan.

“It is very important for us to provide

DENTAL ASIA JULY / AUGUST 2018

you with solutions that fit within the needs of the patients. The Asian protocol that is launching now in Asia is part of that promise that we’ve made over the years to adapt Invisalign to the needs of certain populations - Asian population

(protrusive proƤle). This is just an example of how we are expanding the applicability of Invisalign,” shared Mr. Raph Pascaud.

Moreover, during this year’s summit, Align technology also highlighted on the latest innovations in Invisalign such as Mandibular Advancement, Invisalign First – which will launch on 1st July in Asia, Invisalign Smile Concierge and two new iTero scanners.

Align Technology has always set the bar when it comes to standards and leadership.

This was definitely evident during the 2018 Invisalign APAC Summit which was a huge success. Attendees are already looking forward to the next event and what the company will bring next! DA

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New Millennium of Oral Health: Hong Kong International Dental Expo and Symposium (HKIDEAS) 2018 Follow the latest market trends and explore Dentistry’s advancements in HKIDEAS The Hong Kong International Dental Expo And Symposium (HKIDEAS) will take place on 24th – 26th August 2018 at the Hong Kong Convention and Exhibition Centre. The event has gathered over 7,000 dentistry professionals in the past and more will be joining this coming August!

Themed “New Millennium of Oral Health” HKIDEAS was envisioned as a platform for dental practitioners and researchers to exchange knowledge and skills in the field of dentistry. The event has an interdisciplinary manner with a multitude of tracks to choose from every segment and provides you with a unique opportunity to meet up with peers from both industries belonging to Dental Health, Oral Health Expertise and Academia.

Distinguished speakers sharing their expertise Alongside some major breakthroughs and developments in the field of dentistry, more than 20 sessions and three workshops will be presented by dentistry experts. Topics will cover the latest trends in the various specialties – from best clinical practices, to implantology as well as endodontics, periodontics and other areas of interest.

their latest and sophisticated products and devices which will provide an ideal platform for demonstration in advanced dental technology and innovation.

Latest dentistry equipments and technologies to be featured at the Trade Exhibition

The entire HKIDEAS 2018 is ready to fit in the palm of your hand! Create schedules and preview the list of speakers and much more with the mobile app for android and iPhone users (Search ‘HKIDEAS’).

Registration is now open! Don’t miss this golden opportunity for learning, collaborations, networking and relationship building among dental professionals.

The three-day exhibition will show continued expansion and will feature a record number of more than 55 exhibitors from various parts of the world to showcase their latest equipment, technologies and related services. Renowned brands such as Colgate-Palmolive and Johnson & Johnson are just a few of the countless brands who will participate and present their new products to the industry players. Other dental manufacturers and distributors will showcase

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Mark your calendars, set your mobile apps and register today!

For more information go to: www.hkideas.org DA

DENTAL ASIA JULY / AUGUST 2018

2018 Events Calendar JULY ϮϬͲϮϮ

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& ϮϬϭϴ Ͳ dŚĞ &ƌĞŶĐŚ ĞŶƚĂů ƐƐŽĐŝĂƟ ŽŶ ŶŶƵĂů DĞĞƟ ŶŐ WĂƌŝƐ͕ &ƌĂŶĐĞ tĞďƐŝƚĞ͗ ŚƩ Ɖ͗ͬ​ͬǁǁǁ͘ĂĚĨĐŽŶŐƌĞƐ͘ĐŽŵͬĞŶͬ

DECEMBER ϲͲϴ

sŝĞƚŶĂŵ DĞĚŝͲWŚĂƌŵ ϮϬϭϴ Ͳ ĞŶƚĂů sŝĞƚŶĂŵ ϮϬϭϴ

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DLJĂŶŵĂƌ >Ăď džƉŽ ϮϬϭϴ Ͳ DLJĂŶŵĂƌ ĞŶƚĂů džƉŽ ϮϬϭϴ

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DENTAL ASIA JULY / AUGUST 2018

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%22.6 IRU 6$/( AFG (Anatomic Functional Geometry) Modelling

Aesthetics and Techniques of New Material

by Alberto Battistelli Dario Severino Oto La Manna 314 pages • 865 photos

by MDT Paolo Smaniotto Dr. Alexander Beikircher

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Available in 12 languages: Italian, English, German, Portuguese, Spanish, French, Russian, Bulgarian, Arabic, Czech, Greek, Korean Though written as an operational handbook for those who are just starting out or want to begin again without the typical “scientific” books, this text has sunk its roots into the hard sciences (mathematics and geometry)

and the most ancient of artistic techniques, entrusting a system of innovative images not just with the technique but also the magic and excitement of expressiveness.

This book is crucial for every dental technician and dentist.

Users of this technique and geometric parameters will find plenty of improvements in their daily reconstructive practice. The AFG supplements all the known gnathological techniques.

The Terminal Dentition

by Dr. Leonello Biscaro 404 pages • 1,862 photos

216 pages • 1,000 photos

Available in 3 languages: Italian, English, German The authors show the way to a beautiful, aesthetic smile through a detailed description of their working methods. Their excellent works presented show how to solve every clinical case in a very aesthetic way, choosing the most

suitable techniques.

Why are these two dental professionals able to obtain such exemplary results? On one hand, it is due to their 30 years of experience, while on the other, it is because they are able to find a balance between theoretical concepts and practical applications that can lead to success.

Aesthetic & Function: Methodologies for Dental Clinics and Laboratories

by Claudio Nannini 336 pages • 827 photos

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6 Available in 3 languages: English, Italian and Spanish The real reason for the choice of the topic is make it understood how dentistry, which seems to be ever increasingly oriented towards cosmetics, remains a deeply medical discipline, making “ill” patients (a paradoxical tautology imposed by this historic time in which we often see “healthy” patients) the main players who can reacquire good health and joie de vivre thanks

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to our treatment. This book was written is merely quantitative but with significant professional repercussions. In contrast to patients with purely cosmetic needs, those with terminal or very much compromised dentition are much more numerous when one considers the rate at which the western world is ageing or if the horizons are widened to the millions of people in the world who are coming out of poverty and want to look after their oral health.

Available in 6 languages: Italian, English, German, Russian, Spanish, Portuguese

Fundamental principles of prosthetic reconstructions Chapter 5: Diagnostic aesthetic and functional wax-ups Chapter 1: The principles of with preview in the oral cavity Chapter 6: Temporary restorations: occlusion Immediate provisionals, Chapter 2: Face bows • Articulators on prepared teeth, on implants, • Accesories orthotics C h a p t e r 3 : R e c o r d i n g t h e C h a p t e r 7 : Te c h n i q u e s f o r relationships between the arches transferring temporary Methods for avoiding bite-raising restorations into the oral cavity Chapter 4: Aesthetic analysis Chapter 8: Clinical cases

DENTAL ASIA JULY / AUGUST 2018

Kindly contact Jamie Tan, jamietan@pabloasia.com with your personal data for a quotation (including shipping cost).

Veneers: Mini-Invasive Reconstructions

Zirconia: The Power of Light

by Aldo Zilio

by MDT Attilio Sommella Dr. Guerino Paolantoni

272 pages â&#x20AC;˘ 1,200 photos

240 pages â&#x20AC;˘ 1,336 photos

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achieving success in working with Zirconia. Thanks to his vast experience with zirconia, the This highly-requested international author describes his step-by-step speaker and author offers the approach to creating zirconia reader multiple solutions for solutions for several types of cases.

Available in 4 languages: Italian, English, German, Spanish

Available in 5 languages: English, Italian, German, Spanish, Portuguese.

Thanks to beautifully depicted techno-clinical cases, this book introduces restorations of a single tooth or more extensive rehabilitation cases. These show the placement of one or more veneers with a high level of predictability that give the ambitious dental technician the

ability to provide the aesthetic and functional needs that patients request. To achieve success when working with veneers, the technoclinical team requires an extremely accurate execution that can be obtained through a standardised system described in the book. By carefully following the procedural algorithm outlined, the dental team will be able to perform minimally invasive restorations easily and free from risk.

by Oliver Brix

Techno-Clinical Aspects of Fixed Removable Prosthesis

292 pages â&#x20AC;˘ 1,233 photos

by Various authors

6

616 pages â&#x20AC;˘ 1,550 photos

Fascinating All-Ceramics

6 Available in 8 languages: Italian, English, German, Portuguese, Spanish, Russian, Greek, Korean The author describes in detail how to use lithium disilicate by presenting clinical cases that he has worked on in cooperation with other world-renowned clinicians.

Chapter 1: Introduction Chapter 2: The correct procedures for aesthetics restorations â&#x20AC;&#x201C; treatment goals Chapter 3: e.max: The material from A to Z

Chapter 4: The layering technique with e.max Ceram Chapter 5: Colour examples, enamel blends and chroma control Chapter 6: Preparation instructions Chapter 7: Veneers Chapter 8: Crown restorations with the e.max system from A to Z Chapter 9: Crowns and veneers Chapter 10: Zirconium and bridges made of zirconium Chapter 11: Implants Chapter 12: Cross-mounting Chapter 13: Minimally invasive and no-prep method Chapter 14: Dental miracles Chapter 15: Instruments

Available in 3 languages: English, Italian, Spanish Today, the combined prosthesis offers the edentulous/partially edentulous patient comfort that was unthinkable a few decades ago. But combined prosthesis only represent an excellent solution if carried out by dental experts and dental technicians with cultural backgrounds and relevant experience in every branch of the sector â&#x20AC;&#x201C; clinical, anatomical, occlusion, gnathology, material

science, physics and chemistry.

In this book, 27 experts in combined prosthesis present clinical cases resolved using currently available materials and techniques. Due to the complexity of prosthetic manufacturing, strict cooperation between the dental practice and dental laboratory is necessary. Thanks to a team of experienced dentists and dental technicians, this book presents various polyhydric techniques and solutions rarely presented in one single book.

**Prices are before tax and shipping cost.

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DENTAL ASIA MARCH / APRIL 2018

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